Virtual-reality exergaming improves performance during high-intensity interval training

Perceptions of Immersive Virtual Reality for Physical Activity Among Individuals with Hypertension at Risk of Cardiovascular Disease: A Qualitative Study

Background: Hypertension, obesity, and a sedentary lifestyle are interrelated, forming a vicious cycle that deteriorates cardiovascular health. In addition to being a pathology, hypertension is a risk factor for cardiovascular diseases, one of the leading causes of mortality worldwide. Interventions that combine weight loss and physical activity (PA) reduce cardiovascular risk, but many people face barriers in adhering to regular PA regimens such as a lack of time or motivation. Immersive virtual reality (IVR) has emerged as an innovative alternative to promote PA. This study explored the perceptions of individuals with hypertension and cardiovascular risk regarding the use of IVR as a tool for PA. Methods: Fifteen hypertensive adults with cardiovascular risk completed twelve IVR exercise sessions over thirty days. Semi-structured interviews were conducted. Results: The thematic analysis identified three main themes: (1) PA, sedentary lifestyle, and health; (2) experiences and perceptions of IVR and PA; and (3) IVR as a useful and safe tool. The participants found IVR engaging, motivating, and effective in overcoming barriers such as a lack of time and social anxiety. Gamification and immersion facilitated greater adherence and enjoyment. Conclusions: The participants of this study perceived IVR as an innovative, engaging, and motivating tool for promoting PA. The participants positively valued IVR's ability to overcome common barriers such as lack of time, adverse weather conditions, and lack of motivation, as well as its immersive and gamified features, which enhanced the adherence to and enjoyment of PA. These results suggest that IVR could complement traditional exercise programs by facilitating the initiation of active routines in sedentary individuals.

Virtual Reality High-Intensity Interval Training Exergaming Compared to Traditional High-Intensity Circuit Training Among Medical Students: Pilot Crossover Study

Background

This study evaluated the effectiveness of a virtual reality (VR) high-intensity interval training (HIIT) boxing protocol compared to traditional high-intensity circuit training (HICT) in improving exercise motivation, engagement, and physiological responses among 30 healthy medical students.

Objective

The purpose was to compare the VR HIIT protocol, which involved using an Oculus Quest 2 for a futuristic exoskeleton game experience, with a traditional 12-exercise HICT.

Methods

In total, 30 medical students engaged in both VR HIIT, using an Oculus Quest 2 for a futuristic exoskeleton game experience, and a traditional 12-exercise HICT. Metrics included heart rate (HR) and blood lactate levels before and after exercise alongside ratings of perceived exertion and the Situational Motivation Scale.

Results

VR HIIT showed significantly higher mean HR (mean 161, SD 15 vs mean 144, SD 11 bpm; d=1.5; P<.001), peak HR (mean 182, SD 15 vs mean 176, SD 11 bpm; d=0.8; P=.001), and ratings of perceived exertion (mean 16, SD 2 vs mean 15, SD 2; d=0.4; P=.03). Postexercise lactate levels were higher in HICT (mean 8.8, SD 4.5 vs mean 10.6, SD 3.0 mmol/L; d=0.6; P=.006). Intrinsic motivation and other psychological measures showed no significant differences, except for lower fatigue in HICT (d=0.5; P=.02).

Conclusions

VR HIIT significantly enhances physiological parameters while maintaining intrinsic motivation, making it a viable alternative to traditional HICT. However, the short-term nature of this study is a limitation, and future research should explore the long-term engagement and therapeutic impacts of VR exercise in diverse and clinical populations.

Acute psychological and physiological benefits of exercising with virtual reality

Exercise is a powerful tool for disease prevention and rehabilitation. Commercially available virtual reality (VR) devices and apps offer an immersive platform to gamify exercise and potentially enhance physiological and psychological benefits. However, no work has compared immersive exercise to closely matched 2D screen-based equivalents with the same visual and auditory stimuli. This study aims to compare the acute effects of an exercise session using a commercial immersive VR workout to the same stimuli and workout presented on a screen. 17 healthy participants (male = 7, female = 10; aged 24.18±4.56 years), completed a 12-minute guided VR boxing exercise session in FitXR™ and a screen-based equivalent. Physiological responses were recorded continuously using a heart rate monitor and telemetricmetabolic cart system. Psychological and perceptual responses were measured using their ratings of perceived exertion, the physical activity enjoyment scale, and the physical activity affect scale. In the immersive VR participants chose to engage in more intense exercise (%VO2max; p = 0.044), showed higher levels of all enjoyment subscales (p<0.05) and reported higher positive affect (p = 0.003) and lower negative affect (p = 0.045) following exercise compared to the screen-based equivalent. However, the design here could not determine which elements of immersive VR contributed to the positive effects. Immersive VR may offer a more efficient alternative to other forms of screen based and exergaming workouts and could be offered as a gateway into exercise.

Immersive Virtual Reality Decreases Work Rate and Manipulates Attentional Focus During Self-Regulated Vigorous Exercise

To determine the effect of immersive virtual reality use on finishing time of a vigorous-intensity self-regulated exercise task, and on relevant psychological variables. Healthy untrained adults (N = 21; 10 men/11 women; age = 22.9 ± 7.2 years; BMI = 24.0 ± 4.5 kg/m2) completed 1500-m exercise bouts on a rowing ergometer in a counterbalanced and randomized order, with and without use of a headset-delivered virtual reality fitness program. Heart rate, rating of perceived exertion, affective valence, and attentional focus were collected every 300 m, in addition to finishing time. Data were analyzed with repeated measures as appropriate. Intensity of both exercise bouts was considered vigorous according to heart rate results (>77% maximal heart rate). Finishing time was faster in the control condition (449.57 ± 82.39 s) than in the virtual reality condition (463.00 ± 91.78 s), p = .007. Compared to the control condition, the virtual reality condition was characterized by a more external attentional focus (52.38 ± 18.22 vs. 38.76 ± 17.81, p < .001). No differences were observed for remaining variables as a result of condition (p > .05 for all). When a headset-delivered VR program was used during a self-regulated vigorous-intensity exercise task, participants were 13.6 seconds (~3%) slower than in a control condition. Attentional focus was manipulated to be more external with VR use, which may have ultimately distracted from the exercise objective. Recommendations for selecting an appropriate virtual reality experience for a given exercise task are discussed.

Sensing In Exergames for Efficacy and Motion Quality: Scoping Review of Recent Publications

BACKGROUND

Many studies have shown a direct relationship between physical activity and health. It has also been shown that the average fitness level in Western societies is lower than recommended by the World Health Organization. One tool that can be used to increase physical activity for individual people is exergaming, that is, serious games that motivate players to do physical exercises.

OBJECTIVE

This scoping review of recent studies regarding exergame efficacy aims to evaluate which sensing modalities are used to assess exergame efficacy as well as motion quality. We also analyze how the collected motion sensing data is being leveraged with respect to exergame efficacy and motion quality assessment.

METHODS

We conducted 2 extensive and systematic searches of the ACM Digital Library and the PubMed database, as well as a single search of the IEEE Xplore database, all according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Overall, 343 studies were assessed for eligibility by the following criteria: The study should be peer-reviewed; the year of publication should be between 2015 and 2023; the study should be available in English or German; the study evaluates the efficacy of at least 1 exergame; sensor data is recorded during the study and is used for evaluation; and the study is sufficiently described to extract information on the exergames, sensors, metrics, and results.

RESULTS

We found 67 eligible studies, which we analyzed with regard to sensor usage for both efficacy evaluation and motion analysis. Overall, heart rate (HR) was the most commonly used vital sign to evaluate efficacy (n=52), while the Microsoft Kinect was the most commonly used exergame sensor (n=26). The results of the analysis show that the sensors used in the exergames and the sensors used in the evaluation are, in most cases, mutually exclusive, with motion quality rarely being considered as a metric.

CONCLUSIONS

The lack of motion quality assessment is identified as a problem both for the studies and the exergames themselves since incorrectly executed motions can reduce an exergame's effectiveness and increase the risk of injury. Here we propose how to use the same sensors both as input for the exergame and to assess motion quality by presenting recent developments in motion recognition and sensing.

Digital motor intervention effects on physical activity performance of individuals with developmental disabilities: a systematic review

PURPOSE

Post-pandemic, use of digital technologies (e.g., mobile app, Zoom, virtual reality, and videogaming) to promote physical activity (PA) in populations with intellectual and developmental disabilities (IDD) has increased. The efficacy of various digital technologies in promoting PA in individuals with IDD varies. We conducted a systematic review to examine current literature findings on the efficacy of digital PA interventions on PA outcomes in individuals with IDD.

METHODS

Articles published between 1900 and 2024 that examined effects of technology-based PA interventions on PA levels/fitness of individuals with IDD using experimental or quasi-experimental study designs were included. Sixteen articles were retrieved from four health databases PubMed (914), PsycInfo (1201), SCOPUS (1910), and CINAHL (948).

RESULTS

Findings based on 604 participants (Autism: 383; Down Syndrome: 106; Developmental Disability: 83, Developmental Coordination Disorder: 37) provide the most support for exergaming/digital PA intervention benefits for populations with ID, Down Syndrome, and Autism; however, there was limited support for its use in those without ID (e.g., DCD).

CONCLUSION

Digital technology is an effective tool to promote improvements in PA/fitness, motor, cardiovascular performance in individuals with ID. Future studies need to build on this evidence to support the use of PA outcomes in individuals with different IDD diagnoses.

Assessment of the intensity and attractiveness of physical exercise while playing table tennis in an immersive virtual environment depending on the game mode

BACKGROUND

It appears that active video games (AVGs) and training apps that allow for physical activity (PA) in immersive virtual reality (VR) may be useful for sports, health-enhancing PA, and physical education (PE). Therefore, research is needed to identify their potential.

OBJECTIVE

The study aimed to evaluate the intensity and attractiveness of exercise during table tennis (TT) training in VR in arcade and simulation modes and to assess the potential for using such exercises in health-enhancing PA, sport, and PE.

METHODS

The research used the Racket Fury: Table Tennis VR. Exercise intensity during TT training in VR was evaluated by heart rate (HR) monitoring and rating of perceived exertion (RPE 6-20). The effectiveness of short-term TT training in VR was estimated based on the user's performance in playing against an opponent with artificial intelligence (AI), satisfaction with playing TT was measured using the Physical Activity Enjoyment Scale (PACES), and the potential usefulness of the tested app in PA, sport, and PE was assessed based on a questionnaire for participating PE teachers (30 participants).

RESULTS

PA intensity during TT training in VR expressed as a percentage of maximum heart rate (HRmax) was moderate but was significantly (p < 0.001; d=-0.830) higher in the easier arcade mode (69.50 ± 12.58%HRmax) than in the simulation mode (64.10 ± 9.67%HRmax). Despite the greater fatigue of respondents, user satisfaction was significantly higher in arcade mode. Users' performance when playing with AI was significantly better after 20 min of training in VR than before training. PE teachers recognize the great potential of the app.

CONCLUSIONS

The application tested is characterized by a beneficial PA intensity, with its level depending on the game mode. Facilitating strokes during a game of virtual TT promotes increased intensity of exercise and increased enjoyment of the PA. Short-term TT training in VR improves playing skills in a virtual environment. PE teachers spoke highly of the app and recognized the potential for using VR technology in PA, sports, and school PE.

Examining and Comparing the Energy Expenditure of Two Modes of a Virtual Reality Fitness Game (Supernatural): Indirect Calorimetry Study

BACKGROUND

The effectiveness of virtual reality (VR) fitness games as a form of moderate to vigorous physical activity has yet to be thoroughly quantified through gold standard energy expenditure measures.

OBJECTIVE

The purpose of this study was to examine the energy expenditure of 2 medium-intensity modes ("Flow and "Boxing") of a VR fitness game, Supernatural, using indirect calorimetry.

METHODS

Indirect calorimetry was used to examine relative and objective maximal oxygen consumption (VO2 max), metabolic equivalents of task (METs), and calories burned during medium-intensity bouts of both Flow and Boxing gameplay modes in young (mean age 25.42, SD 3.25 years), active individuals (n=12 female and n=11 male). METs and calories were also compared using a triaxial waist-worn accelerometer, an Apple smartwatch, and a VR headset. Mood states were assessed pre- and postbout using the shortened Profile of Mood States Questionnaire. Paired 2-tailed t tests were used to examine differences in game modes, between sexes, and pre-post exercise sessions.

RESULTS

Objective and relative VO2 max averaged 1.93 (SD 0.44) L/min and 27.61 (SD 5.60) mL/kg/min, respectively, between modes. Flow (mean 8.2, SD 1.54 METs) and Boxing (mean 7.6, SD 1.66 METs) are both classified as high energy expenditure, vigorous activities. Calorie expenditure data of the accelerometer and VR headset differed significantly from the metabolic cart. Mood changes pre- to post exercise were consistent with expected values for moderate- to vigorous-intensity physical activity, with participants reporting that they felt more "active," "full of pep," "vigorous," and "lively" (P<.05) following bouts. Male individuals reported higher objective oxygen consumption (VO2) for both Flow and Boxing modes; no other sex-specific differences were observed.

CONCLUSIONS

Both Flow and Boxing gameplay modes of Supernatural classify as vigorous physical activity and demonstrate the potential to promote mental and physical health benefits. Supernatural may be an effective exercise modality in a VO2 training program.

Effects of 6-Week Motor-Cognitive Agility Training on Football Test Performance in Adult Amateur Players - A Three-Armed Randomized Controlled Trial

Agility, defined as the ability to rapidly respond to unforeseen events, constitutes a central performance component in football. Existing agility training approaches often focus on change of direction that does not reflect the complex motor-cognitive demands on the pitch. The objective of this study is to examine the effects of a novel motor-cognitive dual-task agility training (Multiple-object tracking integrated into agility training) on agility and football-specific test performance parameters, compared to agility and a change of direction (COD) training. Adult male amateur football players (n = 42; age: 27±6; height: 181±7cm; weight: 80±12kg) were randomly allocated to one of the three intervention groups (COD, agility, agility + multiple object tracking). The Loughborough Soccer Passing Test (LSPT), a dribbling test with/without cognitive task as well as the Random Star Run (with/without ball) and the modified T-Test were assessed before and after a 6-week training period. Time effects within the T-Test (F = 83.9; p < 0.001; η2 = 0.68) and dribbling test without cognitive task (F = 23.9; p < 0.001; η2 = 0.38) with improvements of all intervention groups (p < 0.05) were found. Dribbling with cognitive task revealed a time effect (F = 7.8; p = 0.008; η2 = 0.17), with improvements exclusively in the agility and dual-task agility groups (p < 0.05). Random Star Run with and without ball exhibited a time (F = 38.8; p < 0.001; η2 = 0.5; F = 82.7; p < 0.001; η2 = 0.68) and interaction effect (F = 14.14; p < 0.001; η2 = 0.42; F = 27.8; p < 0.001; η2 = 0.59), with improvements for the agility and dual-task agility groups. LSPT showed no time, group or interaction effect. The effects of change of direction training are limited to change of direction and dribbling test performance within preplanned scenarios. In contrast, motor-cognitive agility interventions result in notable enhancements in football-specific and agility tests, incorporating decision-making and multitasking components. No differences were observed between agility and agility + multiple object tracking. To achieve a transfer to game-relevant performance, coaches should focus on integrating cognitive challenges into motor training.

Enhancing Physical Activity with Immersive Virtual Reality: A Systematic Review

The aim of this article is to review how immersive virtual reality-enhanced physical activity (IVR-PA) can be used to improve psychological, physiological, and performance outcomes linked to exercising and to compare it with non-immersive virtual reality-enhanced physical activity (nIVR-PA) and with traditional physical activity (TR-PA). We also aimed to explore the effectiveness of IVR-PA in promoting psychological well-being and engagement in physical activity. A systematic literature review (Prospero CRD42022330572) was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. OVID (including Medline, Embase, GlobalHealth, and APA PsychInfo), Web of Science, and Sport Discuss were searched. The quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment. The search identified 26,548 titles. After screening, 20 studies (the total number of participants was 798) published between 2009 and 2023 were included in this systematic review. The quality of the studies was rated as weak (n = 9), moderate (n = 10), or strong (n = 1). Overall, the reviewed studies indicated that, compared with TR-PA and nIVR-PA, IVR-PA was associated with an increase in enjoyment of physical activity, a reduction in perceived exertion, and increased rates of self-efficacy, intrinsic motivation, and exercise intention. Furthermore, some studies showed higher muscular strength and aerobic increase after an IVR-PA intervention compared with TR-PA. The findings suggest that IVR-PA can improve psychological, physiological, and performance outcomes linked to exercising, as well as improving psychological well-being and engagement in physical activity. However, owing to the methodological limitations of the reviewed studies, further research is encouraged.

A virtual reality-based endurance training program for COPD patients: acceptability and user experience

PURPOSE

To investigate the acceptability and user experience of an in-hospital endurance training program based on the Virtual Park, a semi-immersive Virtual Reality (VR) system for patients with Chronic Obstructive Pulmonary Disease (COPD).Materials and methodsPatients performed 20 min of cycling two times/day for around ten days. The evaluation included adherence, exercise capacity, physical performance, and user experience.

RESULTS

Fourteen patients (6 F/8 M; age = 71.29 ± 6.93 years) with mild/moderate COPD participated. The adherence rate was satisfying: 85.71% of patients attended the program without adverse events; the individual attendance rate (86.85% ± 27.43) was also high. The exercise capacity assessed before and after the training significantly improved in our group (6MWT pre-post: t(11)= -5.040, p < 0.05), as happens in standard PR programs. The physical performance metrics of each session indicate that all participants could sustain the proposed training protocol over the whole period. Patients judged the VR experience positively (User Experience Questionnaire = 1.84 ± 0.22) and were highly engaged in the activity for the whole period (Short Flow State Scale pre-post: 4.61 ± 0.27/4.40 ± 0.36).

CONCLUSIONS

Our preliminary results open the possibility for further investigations on long-term motivation and clinical effectiveness of more immersive VR interventions for COPD.

Exergaming in augmented reality is tailor-made for aerobic training and enjoyment among healthy young adults

In recent years, the use of exergaming for physical activity practice has gain in popularity but few is known about the use of augmented reality for physical activity, particularly at moderate to vigorous intensities. The present study examined the use of an exergame in augmented reality for aerobic training in healthy young adults. In a within-subject design, 18 participants (19.8 ± 1.4 years of age) have performed two physical activity sessions playing dodgeball. Indeed, they realized a classical dodgeball session and an exergaming session with an augmented reality version of dodgeball game. Physical loads and intensities were measured with accelerometers, RPE and heart sensors. Enjoyment experienced during the sessions was measured with the short version of the physical activity enjoyment scale questionnaire. Results revealed that both physical load and intensity were appropriate for aerobic training in the two conditions (i.e., classical and exergame in augmented reality) although values were significantly higher in the classical condition. Enjoyment was high in the two conditions with a higher significant value in the classical condition compared to the exergame in augmented reality condition. Put together, these results indicate that an aerobic state can be attained through both physical gameplay and its augmented reality equivalent and was associated to a high level of enjoyment among healthy young adults.

Training effects of set- and repetition-interval rest time on recumbent-boxing exercise: Could virtual reality improve further?

This study examined the influence of set-interval and repetition-interval rest time of virtual reality (VR) boxing game in supine-lying posture. Fifty healthy middle-aged adults were randomly assigned into VR and non-VR groups to perform six different exercise protocols with varying set-interval and repetition-interval rest times (S0R0, S0R1/3, S0R2/3, S40R0, S40R1/3, and S40R2/3). Analysis on the non-VR group showed significant differences between exercise protocols for average heart rate (p < 0.001), maximum ventilation volume (p < 0.001), respiratory quotient (p < 0.001), oxygen pulse (p < 0.001), and excess post-exercise oxygen consumption (EPOC) (p = 0.003). VR appeared to have no further improvement on physical training effects in middle-aged adults, while the participants reported negative experience that might be associated with the over-exertion. Future study might need to explore game design elements that can accommodate high-exertion exercises.

Physical activity for cognitive health promotion: An overview of the underlying neurobiological mechanisms

Physical activity is one of the modifiable factors of cognitive decline and dementia with the strongest evidence. Although many influential reviews have illustrated the neurobiological mechanisms of the cognitive benefits of physical activity, none of them have linked the neurobiological mechanisms to normal exercise physiology to help the readers gain a more advanced, comprehensive understanding of the phenomenon. In this review, we address this issue and provide a synthesis of the literature by focusing on five most studied neurobiological mechanisms. We show that the body's adaptations to enhance exercise performance also benefit the brain and contribute to improved cognition. Specifically, these adaptations include, 1), the release of growth factors that are essential for the development and growth of neurons and for neurogenesis and angiogenesis, 2), the production of lactate that provides energy to the brain and is involved in the synthesis of glutamate and the maintenance of long-term potentiation, 3), the release of anti-inflammatory cytokines that reduce neuroinflammation, 4), the increase in mitochondrial biogenesis and antioxidant enzyme activity that reduce oxidative stress, and 5), the release of neurotransmitters such as dopamine and 5-HT that regulate neurogenesis and modulate cognition. We also discussed several issues relevant for prescribing physical activity, including what intensity and mode of physical activity brings the most cognitive benefits, based on their influence on the above five neurobiological mechanisms. We hope this review helps readers gain a general understanding of the state-of-the-art knowledge on the neurobiological mechanisms of the cognitive benefits of physical activity and guide them in designing new studies to further advance the field.

Task-Oriented and Imitation-Oriented Movements in Virtual Reality Exercise Performance and Design

OBJECTIVE

This study investigated the influence of game features and practice type on human kinematic and muscular performance in a virtual reality exercise (VRE). Participants demonstrated changes in shoulder flexion angle and muscle activation under different virtual scenarios.

BACKGROUND

Conventional VRE studies often compared the outcomes between an experimental group that underwent exercise in VR and a real-world exercise control group, whereas comparisons between VRE programs are lacking. Besides, the attributes of VREs received little attention.

METHOD

Thirteen able-bodied participants performed upper extremity exercise movements in immersive VR using a head-mounted display. Participants performed task-oriented and imitation-oriented movements with different game features. Shoulder muscle activity (the deltoid, supraspinatus, and infraspinatus) and shoulder motion were collected.

RESULTS

Practice type (task-oriented, imitation-oriented) significantly influenced the flexion angle of the shoulder complex (F(1,11) = 9.53, p = .01), and the muscle activity of the supraspinatus (F(1,9) = 12.61, p = .006) and the infraspinatus (F(1,9) = 12.71, p = .006). Game features did not have a statistically significant effect on shoulder flexion angle or shoulder muscles' activations.

CONCLUSIONS

Compared to imitation-oriented practice, task-oriented practice elicited more intensive shoulder movements and muscular efforts but also induced greater movement variations. Substantial differences across game features levels should be further investigated to have significant effects.

APPLICATIONS

This research may help guide the design of future VREs. For strength training or rehabilitation where intensive practice is required, task-oriented practice should be considered; for movement learning where movement consistency is required, imitation oriented practice should be adopted.

Feasibility of Internet-Based Physical-Cognitive Exercise for Health Benefits of Middle-Aged Obese Women

INTRODUCTION

Obesity in middle-aged women markedly increases the risk for non-communicable diseases, neurodegenerative diseases, and physical and cognitive problems. Exercise, particularly combined physical-cognitive exercise, has been demonstrated to have beneficial effects on both physical and cognitive health. However, middle-aged women often face barriers to engaging in exercise, which include time constraints, lack of motivation, and enjoyment. Incorporating an exercise program into a technology-based intervention in the home environment may help overcome these barriers and promote health benefits. Therefore, this study aimed to assess the feasibility of home-based, physical-cognitive internet-based exercise for middle-aged obese women.

METHODS

A total of 33 middle-aged obese women were enrolled in the study. Participants performed an intervention for 60 min/day, 3 days/week for 3 months. Feasibility outcomes (adherence, adverse events, physical performances, obesity parameters, and enjoyment of the program) were measured.

RESULTS

Average exercise adherence was 91.67%, and no adverse events were reported in this feasibility study. At the end of the training period, body weight and BMI were significantly decreased compared to baseline. As for physical performances, both cardiorespiratory fitness and lower limb muscle power were significantly improved at post-training when compared to baseline. Furthermore, the participants experienced a high level of exercise enjoyment, and it was maintained over the 3-month training period.

CONCLUSION

These findings suggest that home-based, internet-based physical-cognitive exercise was safe and feasible for reducing obesity parameters, improving physical function, maintaining enjoyment over the course of training, and facilitating adherence to exercise in middle-aged obese women.

Handheld Weights as an Effective and Comfortable Way To Increase Exercise Intensity of Physical Activity in Virtual Reality: Empirical Study

BACKGROUND

In recent years, there has been a growing interest in active virtual reality games (AVRGs) that provide entertainment and encourage more physical activity (PA). Since playing AVRGs involves primarily arm movements, the intensity of this form of PA may not be sufficient for health benefits. Therefore, it is worth looking for virtual entertainment solutions that are comfortable for users and at the same time increase physical exercise.

OBJECTIVE

The main objective of this study was to evaluate the effect of external loading of the arms in the form of handheld weights (HHWs) on exercise intensity in users playing a popular AVRG. The results obtained in the study were compared with the PA recommendations for health. The study also assessed the perceptions of the users about the attractiveness and usefulness of this type of exercise and discomfort caused by additional load on the arms.

METHODS

The study covered 17 young adults aged 18 to 25 years playing an AVRG (Beat Saber) with no arm load and with HHWs (0.5 kg). A PlayStation 4 PRO console (Sony) with accessories including a head-mounted display and controllers was used in the study. PA intensity was evaluated using a heart rate monitor based on the percentage of maximal heart rate (% HRmax). The usability, attractiveness, and comfort perceived during exercise by users were evaluated using a survey questionnaire.

RESULTS

The measurements showed that the mean % HRmax in participants playing Beat Saber without HHWs was significantly lower (P<.001; Cohen d=1.07) than that observed when playing with HHWs. It should be emphasized that with no additional load, the intensity of PA was low (mean 63.7% HRmax, SD 9.3% HRmax), while with the upper limb load, it increased to a moderate level (mean 67.1% HRmax, SD 10.3% HRmax), which is recommended for health benefits. The survey conducted in the study showed that HHWs (0.5 kg) attached to the wrists did not disturb Beat Saber players.

CONCLUSIONS

Since PA in most of the modern AVRGs primarily involves upper limb movements, the use of HHW seems to be a simple and effective way to increase exercise intensity, especially because, as reported by the study participants, such a procedure does not cause discomfort while using the application.

The size and behavior of virtual objects have influence on functional exercise and motivation of persons with multiple sclerosis: a randomized study

The consequences of multiple sclerosis are problems with limb movement, coordination, and vision. Heretofore a combination of therapy and additional medications can alter the course of the disease and reduce upper extremity disability. We developed a virtual environment for pick-and-place tasks as a supportive tool to address the problem of challenging task in occupational therapy. The primary objective of the study was to investigate the influence of size and bounce on proximal and fine motor performance and intrinsic motivation. The secondary objective was to examine how the absence of challenge may decrease intrinsic motivation and heart rate. The randomized trial involved 84/107 eligible inpatients with multiple sclerosis. They were divided into 4 groups by computer randomization: Group 1 small and bouncing, Group 2 small and non-bouncing, Group 3 large and bouncing, and Group 4 large and non-bouncing virtual cubes. Each participant completed 50 sessions of up to 2 min each in approximately 14 days. Before commencement of the study the participants completed visuospatial and cognitive tests. Participants' subjective experiences were assessed daily using the intrinsic motivation inventory. Before and after the study, the box and block test and the 9-hole peg test were administered. Kinematic analysis showed significant differences between groups (average manipulation time p = 0.008, inserted cubes p = 0.004). Group 4 was the most successful (inserted cubes > 9) and the fastest (63.4 SD 25.8 s), but had low pressure/tension and heart rate. Group 1 was the slowest (88.9 SD 28.2 s) but had increased interest/enjoyment in the task under higher pressure/tension. There were substantial differences in intrinsic motivation between the 1st and last sessions within groups (Cohen's U3 < 0.3 or > 0.8). The size and behavior of virtual objects may be important for training proximal movements and fine motor skills in people with multiple sclerosis. Furthermore, the demonstrated approach proved to be effective and may reduce upper extremity disability in the long term if intrinsic motivation can be sustained longer with a challenging task.Trial registration The small scale randomized pilot trial has been registered at ClinicalTrials.gov Identifier: NCT04266444, 12/02/2020, https://clinicaltrials.gov/ct2/show/NCT04266444 .

Exercise Task Characteristics Influence Time Perception During Vigorous Exercise

The passage of time is observed subjectively, and changes rate based on attentional or physiological stimuli. Self-adjusted exercise typically leads to the experience that time is progressing more slowly than it really is, but only when intensity is sufficiently high. This study was designed to determine if high exercise intensity at a fixed work rate would lead to differences in subjective timing. Subjects (26 total; 17 men/ 9 women) completed a maximal exercise test on a Velotron cycle ergometer until volitional exhaustion. A time production task was completed at baseline prior to exercise, and during each 3-min stage. Heart rate (HR) was assessed continuously. Time perception ratio (actual time divided by perceived time) was compared at baseline, during light exercise (40 W), and during the first stage at which age-predicted HRmax was considered vigorous (76–90% HRmax), using a repeated-measures analysis of variance (ANOVA). The result of the ANOVA was significant, F1.63,39 = 6.19, p = 0.007, η2 = 0.21. Bonferroni-adjusted post-hoc comparisons showed that the time perception ratio was higher during vigorous exercise (1.21 ± 0.34) compared to baseline (1.06 ± 0.19; p = 0.028) and light (1.09 ± 0.27; p = 0.048) exercise. Unlike several similar studies finding that subjective time increases at higher exercise intensities, the results of this study indicate the opposite effect at a fixed vigorous-intensity work rate. The motivational nature of the task and unique attentional factors associated with it are likely explanations for the deviation from earlier reports.

Virtual Reality "exergames": A promising countermeasure to improve motivation and restorative effects during long duration spaceflight missions

Long duration spaceflight missions will require novel exercise systems to protect astronaut crew from the detrimental effects of microgravity exposure. The SPRINT protocol is a novel and promising exercise prescription that combines aerobic and resistive training using a flywheel device, and it was successfully employed in a 70-day bed-rest study as well as onboard the International Space Station. Our team created a VR simulation to further augment the SPRINT protocol when using a flywheel ergometer training device (the Multi-Mode Exercise Device or M-MED). The simulation aspired to maximal realism in a virtual river setting while providing real-time biometric feedback on heart rate performance to subjects. In this pilot study, five healthy, male, physically-active subjects aged 35 ± 9.0 years old underwent 2 weeks of SPRINT protocol, either with or without the VR simulation. After a 1-month washout period, subjects returned for a subsequent 2 weeks in the opposite VR condition. We measured physiological and cognitive variables of stress, performance, and well-being. While physiological effects did not suggest much difference with the VR condition over 2 weeks, metrics of motivation, affect, and mood restoration showed detectable differences, or trended toward more positive outcomes than exercise without VR. These results provide evidence that a well-designed VR "exergaming" simulation with biometric feedback could be a beneficial addition to exercise prescriptions, especially if users are exposed to isolation and confinement.

Actual vs. perceived exertion during active virtual reality game exercise

Background

Virtual exercise has become more common as emerging and converging technologies make active virtual reality games (AVRGs) a viable mode of exercise for health and fitness. Our lab has previously shown that AVRGs can elicit moderate to vigorous exercise intensities that meet recommended health benefit guidelines. Dissociative attentional focuses during AVRG gameplay have the potential to widen the gap between participants' perception of exertion and actual exertion.

Objective

The aim of this study was to determine actual exertion (AEx) vs. perceived exertion (PEx) levels during AVRGs by measuring heart rate (HR) and ratings of perceived exertion (RPE) in two different settings.

Materials and methods

HR and RPE were collected on participants (N = 32; age 22.6 ± 2.6) during 10 min of gameplay in LabS and GymS using the HTC VIVE with the following games played: Fruit Ninja VR (FNVR), Beat Saber (BS), and Holopoint (HP).

Results

Participants exhibited significantly higher levels of AEx compared to reported PEx for all three AVRGs (Intensity): FNVR [AEx = 11.6 ± 1.8 (Light), PEx = 9.0 ± 2.0 (Very Light)], BS [AEx = 11.3 ± 1.7 (Light), PEx = 10.3 ± 2.1 (Very Light)], HP [AEx = 13.1 ± 2.3 (Somewhat Hard), PEx = 12.3 ± 2.4 (Light–Somewhat Hard)]. Additionally, participants playing in the GymS experienced significantly higher levels of AEx [12.4 ± 2.3 (Light–Somewhat Hard)] and PEx [10.8 ± 2.5 (Very Light–Light)] compared to the LabS [AEx = 11.6 ± 1.8 (Light), PEx = 10.3 ± 2.6 (Very Light–Light)].

Conclusion

Perceptions of exertion may be lower than actual exertion during AVRG gameplay, and exertion levels can be influenced by the setting in which AVRGs are played. This may inform VR developers and health clinicians who aim to incorporate exercise/fitness regimens into upcoming ‘virtual worlds' currently being developed at large scales (i.e., the “metaverse”).

Virtual reality exergaming improves affect during physical activity and reduces subsequent food consumption in inactive adults

An individual's affective (i.e. emotional) response to exercise may play an important role in post-exercise eating behaviour for some individuals. Taking advantage of advances in fully immersive virtual reality (VR) technology, this study aimed to: a) examine whether VR exergaming can improve the psychological response to exercise in inactive adults, and b) assess the extent to which this improvement reduces post-exercise appetite and eating behaviour. In a cross-over study, 34 adults not meeting the World Health Organisation's physical activity recommendations completed two exercise sessions on a stationary bike; one while engaging in a VR exergame and one without VR. Monitoring enabled heart rate, energy expenditure, and duration across conditions to be closely matched. The Physical Activity Enjoyment Scale, Feeling Scale, Felt Arousal Scale and Borg's Ratings of Perceived Exertion were measured to capture the affective responses to exercise. Appetite and eating behaviour were evaluated using visual-analogue scales, a computerised food preference task, and intake at a post-exercise buffet meal. Cycling in VR elicited greater exercise enjoyment (p < 0.001, η2p = 0.62), pleasure (p < 0.001, η2p = 0.47), and activation (p < 0.001, η2p = 0.55). VR exergaming did not alter perceived physical exertion (p = 0.64), perceived appetite (p = 0.68), and preference for energy dense (p = 0.78) or sweet/savoury foods (p = 0.90) compared to standard exercise. However, it did result in a mean 12% reduction in post-exercise food intake (mean difference: 105.9 kcal; p < 0.01; η2p = 0.20) and a decrease in relative food intake (p < 0.01; η2p = 0.20), although inter-individual differences in response to VR exergaming were observed. The integration of VR in a cycling workout improves the affective experience of physical activity for inactive adults and reduces subsequent food intake. Virtual reality technology shows potential as an adjunct tool to support adults in weight management programmes become more active, especially for those individuals who are prone to eat in excess after physical activity.

The Impact of Implementing an Exergame Program on the Level of Reaction Time Optimization in Handball, Volleyball, and Basketball Players

The main aim of the present study was to implement an exergame program that uses Fitlight technology to identify the impact on motor, recognition, and cognitive reaction times in junior athletes practicing team sports: basketball, handball, and volleyball. The second aim was to identifying differences in progress of the three types of reaction time between female and male players through computerized tests. The study included 360 subjects for basketball, 130 athletes of which were 68 male subjects and 62 female subjects; for handball, 124 athletes of which 64 were male subjects and 60 female athletes; for volleyball, 106 athletes of which 48 male were subjects and 48 female athletes. Characteristics of the experimental players: average age ± SD 13.60 ± 1.07; average sports experience ± SD 6.24 ± 0.92. The research included an initial and a final test between which a program of exergames was implemented over a period of 3 months focused on optimizing human reaction times. The evaluation of the reaction times was carried out through three computer games, the results being processed in SPSS 22. The relevant results of the research: for the simple motor reaction time (MSRT), the greatest progress between tests was the volleyball group, and for women, it was the basketball group; for the recognition reaction time (RRT), the male handball group and the female basketball group recorded the greatest progress; for the cognitive reactive time (CRT), the greatest progress was achieved by the male and female volleyball players. In all tests, the progress of the female basketball, handball, and volleyball players showed superior progress to similar male players. The results of the research highlighted the effectiveness of the experimental exergame program by using Fitlight technology in optimizing human reaction times in junior team-game athletes. Using computer games to evaluate reaction times allowed us to differentiate the evaluation on the types of human reactions under both standardized conditions but also under conditions of efficiency and attractiveness.

Gamification in a Physical Activity App: What Gamification Features Are Being Used, by Whom, and Does It Make a Difference?

Background: Gamification is purported to enhance engagement with health behavior apps, ultimately improving their effectiveness. This study aimed to examine (1) whether the inclusion of gamification features in a physical activity smartphone app was associated with improved app usage and goal adherence, describe (2) use of the gamification features, and (3) by whom, and determine (4) whether engagement was associated with increased physical activity. Methods: Data from community-dwelling adult participants (mean age 42.1 years, standard deviation [SD 11.9], 74% female) in the gamified (n = 134) and nongamified (n = 155) conditions from a three-group randomized controlled trial were analyzed. Physical activity was assessed at baseline and 9 months using a survey and accelerometers. App usage (number of days steps were logged), goal adherence (number of days step count was ≥10,000), and behavioral engagement with gamification features were obtained from server logs. Multilevel modeling was used to examine the study aims. Results: Participants who received the gamified app showed more days of usage than those who received the nongamified app (M = 113 days [SD 88] vs. M = 81 days [SD 54], P = 0.006), whereas goal adherence did not differ between groups. The leaderboard and "status" gamification features were the most frequently used gamification features (M = 83 [SD 114] and M = 50 [SD 67] views, respectively). Older age (P = 0.008) and lower body mass index (P = 0.004) were associated with more status views. Participants who reported higher stress symptoms sent more gifts (P = 0.04). The use of gamification features was associated with increased physical activity (P = 0.04). Conclusion: The gamified app was used substantially longer than the nongamified app. Use of gamification features was positively associated with change in physical activity. Leaderboards promoting social comparison may be a promising form of gamification. Research on different forms of gamification is warranted.

Gaming Instead of Training? Exergaming Induces High-Intensity Exercise Stimulus and Reduces Cardiovascular Reactivity to Cold Pressor Test

Introduction

The present study assessed if an exercise session in an innovative exergame can modulate hemodynamic reactivity to a cold pressor test (CPT) to a similar extent as a typical moderate endurance training (ET). Furthermore, cardiorespiratory, and affective responses of an exergame session and an ET were compared.

Methods

Twenty-seven healthy participants aged 25 ± 4 years (48% female; BMI 23.0 ± 2.1 kg/m2) participated in this cross-sectional study. All participants completed both an ET on a treadmill and training in the ExerCube (ECT). HR and oxygen consumption were recorded during both training sessions. Before and after both exercise sessions, the hemodynamic reactivity to a CPT was determined.

Results

During ECT, HR, oxygen consumption, energy expenditure, and the metabolic equivalent of the task were significantly higher than those obtained during ET (p &lt; 0.001). With regard to the CPT, the participants showed significantly lower responses in peripheral systolic (p = 0.004) and diastolic blood pressure (p = 0.009) as well as central systolic (p = 0.002) and diastolic BP (P = 0.01) after ECT compared to ET. The same was true for pulse wave velocity (p = 0.039).

Conclusion

The ECT induced a significantly higher exercise stimulus compared to the ET. At the same time, it attenuated hemodynamic stress reactivity. The ECT presents a relevant training stimulus that modulates cardiovascular reactivity to stress, which has been proven as a predictor for the development of hypertension.

Trial Registration

ISRCTN registry, ISRCTN43067716, 14 April 2020, Trial number: 38154.

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

Background

In 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.

Objective

This 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.

Methods

A 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.

Results

A 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.

Conclusions

The 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.

Physical Activity and Health Promotion in Esports and Gaming-Discussing Unique Opportunities for an Unprecedented Cultural Phenomenon

Due to long periods of sedentary behavior, and unhealthy diets gamers and esports players are at risk for numerous chronic diseases and all-cause mortality. Health research has started addressing the public health implications of the esports phenomenon, drawing a bleak picture of this megatrend. However, instead of just highlighting adverse public health implications of this trend, it is recommended to become involved in this phenomenon and positively influence it. Esports has an enormous potential for physical activity and health-promoting efforts, provides a context for broadly disseminating interventions, and offers new ways of gaining access to an often-neglected population. This paper presents: the potential of the esports phenomenon to promote physical activity, health, and well-being in gamers and esports players; the strategic and preventive solutions to ameliorate esports possible adverse health impacts; and the utilization of esports technology (streams, media platforms, exergames, etc.) as an innovative health promotion tool, especially reaching gamers and esports players with attractive and interactive interventions. This is to encourage systematic scientific research so that evidence-based guidelines and intervention strategies involving regular physical activity, healthy diet, and sleep hygiene for esports will be developed. The goal is to promote public health approaches that move toward a better integration of esports and gaming.

Physical Activity Intensity, Perceived Exertion, and Enjoyment During Head-Mounted Display Virtual Reality Games

Objectives: The purpose of this study was to determine the following: (1) the level of physical activity (PA) achieved during commercial active virtual reality (VR) games, and (2) which active VR games elicit higher enjoyment levels in young, healthy adults. Materials and Methods: Thirty-six participants completed four study sessions, each devoted to playing one of the following head-mounted display VR games for 15 minutes: Beat Saber (BS), Holopoint (HP), Hot Squat (HS), and Relax Walk VR. PA intensity measures included percentage of heart rate reserve (%HRR), ratings of perceived exertion (RPE), and accelerometry. Enjoyment was measured with the Physical Activity Enjoyment Scale (PACES) following each gaming session. Mixed-model analysis of variances were used to analyze the outcome measures. Results: The analyses showed that HS elicited significantly higher %HRR and RPE than BS, HP, and Relax Walk. HS was the only game to reach moderate intensity via %HRR. Accelerometer data showed that time in whole-body moderate-to-vigorous physical activity (MVPA) for HS was significantly greater than HP, which was greater than BS and Relax Walk. Also, males exhibited significantly more whole-body and upper limb MVPA compared with females during gameplay. BS and HP were rated significantly more enjoyable than HS and Relax Walk. Conclusions: Results from this study suggest that active VR games can elicit varying degrees of PA intensity levels in young healthy adults, with HS eliciting moderate intensity activity. The games rated highest in enjoyment required mostly arm movement and a perceived light exertion. ClinicalTrials: NCT04221139.

Comparing the Impact of Heart Rate-Based In-Game Adaptations in an Exergame-Based Functional High-Intensity Interval Training on Training Intensity and Experience in Healthy Young Adults

Physical inactivity remains one of the biggest societal challenges of the 21st century. The gaming industry and the fitness sector have responded to this alarming fact with game-based or gamified training scenarios and thus established the promising trend of exergaming. Exergames—games played with the (whole) body as physical input—have been extolled as potential attractive and effective training tools. Simultaneously, researchers and designers are still exploring new approaches to exploit the full potential of this innovative and enjoyable training method. One way to boost the attractiveness and effectiveness of an exergame is to individualize it with game adaptations. A physiological parameter that is often used to balance the physical challenge and intensity of exergames to the player’s fitness skills is the heart rate (HR). Therefore, researchers and designers often rely on age-based, maximum HR (HR_max) formulas originating from performance diagnostics. In combination with the player’s assessed real-time HR during an exergame session, the pre-determined HR_max is used to adapt the game’s challenge to reach a pre-defined HR and physical intensity level (in-exergame adaptations), respectively. Although the validity and reliability of these age-based HR_max formulas were proven in heterogeneous target populations, their use is still often criticized as HR is an individual parameter that is affected by various internal and external factors. So far, no study has investigated whether the formula-based pre-calculated HR_max compared to a standardized individually pre-assessed HR_max elicits different training intensities, training experiences, and flow feelings in an exergame. Therefore, we compared both variants for in-exergame adaptation with the ExerCube – a functional high-intensity interval training exergame – in healthy young adults. Comparing the results of the two conditions, no significant differences were found for HR parameters and perceived physical and cognitive exertion, nor for overall flow feelings and physical activity enjoyment. Thus, the formula-based in-exergame adaptation approach was suitable in the presented study population, and the ExerCube provided an equally reliable in-exergame adaptation and comparable exergame play experiences. We discuss our findings in the context of related work on exergame adaptation approaches and draw out some implications for future adaptive exergame design and research topics.

Virtual Training of Endurance Cycling - A Summary of Strengths, Weaknesses, Opportunities and Threats

Virtual online training has emerged as one of the top 20 worldwide fitness trends for 2021 and continues to develop rapidly. Although this allows the cycling community to engage in virtual training and competition, critical evaluation of virtual training platforms is limited. Here, we discuss the strengths, weaknesses, opportunities and threats associated with virtual training technology and cycling in an attempt to enhance awareness of such aspects. Strengths include immersive worlds, innovative drafting mechanics, and versatility. Weaknesses include questionable data accuracy, inadequate strength and reliability of power-speed algorithms. Opportunities exist for expanding strategic partnerships with major cycling races, brands, and sponsors and improving user experience with the addition of video capture and "e-coaching." Threats are present in the form of cheating during competition, and a lack of uptake and acceptance by a broader community.

Immersive virtual reality health games: a narrative review of game design

BACKGROUND

High quality head-mounted display based virtual reality (HMD-VR) has become widely available, spurring greater development of HMD-VR health games. As a behavior change approach, these applications use HMD-VR and game-based formats to support long-term engagement with therapeutic interventions. While the bulk of research to date has primarily focused on the therapeutic efficacy of particular HMD-VR health games, how developers and researchers incorporate best-practices in game design to achieve engaging experiences remains underexplored. This paper presents the findings of a narrative review exploring the trends and future directions of game design for HMD-VR health games.

METHODS

We searched the literature on the intersection between HMD-VR, games, and health in databases including MEDLINE, Embase, CINAHL, PsycINFO, and Compendex. We identified articles describing HMD-VR games designed specifically as health applications from 2015 onwards in English. HMD-VR health games were charted and tabulated according to technology, health context, outcomes, and user engagement in game design.

FINDINGS

We identified 29 HMD-VR health games from 2015 to 2020, with the majority addressing health contexts related to physical exercise, motor rehabilitation, and pain. These games typically involved obstacle-based challenges and extrinsic reward systems to engage clients in interventions related to physical functioning and pain. Less common were games emphasizing narrative experiences and non-physical exercise interventions. However, discourse regarding game design was diverse and often lacked sufficient detail. Game experience was evaluated using primarily ad-hoc questionnaires. User engagement in the development of HMD-VR health games primarily manifested as user studies.

CONCLUSION

HMD-VR health games are promising tools for engaging clients in highly immersive experiences designed to address diverse health contexts. However, more in-depth and structured attention to how HMD-VR health games are designed as game experiences is needed. Future development of HMD-VR health games may also benefit from greater involvement of end-users in participatory approaches.

Can Physical Activity in Immersive Virtual Reality Be Attractive and Have Sufficient Intensity to Meet Health Recommendations for Obese Children? A Pilot Study

Immersive virtual reality (IVR) is a technology that blurs the line between the physical world and a digital environment. Using appropriate pointing devices, it is possible to engage in physical activity (PA). The main aim of the study was to assess the attractiveness and intensity of physical exercise while playing active video games (AVGs) in IVR on an omnidirectional treadmill by obese children and to present the results compared to health recommendations (PA). It was also assessed whether the AVGs storyline can effectively motivate the participants to undertake locomotor activity by increasing the intensity of their effort (moving in a limited space vs. having to follow a set route). Eleven children aged 8 to 12 years with diagnosed obesity participated in the experiment. The attractiveness of PA was assessed with a questionnaire, while the intensity of exercise was estimated on the basis of heart rate. The answers show that AVGs are attractive and more enjoyable for the respondents than conventional video games. All participants declared their willingness to practice this form of PA. The intensity of PA of obese children during two games was high but during the game where the player was supposed to follow a set route, it was significantly higher (83.3 ± 9.2% HRmax) than during the game whose storyline assumed moving in a limited space (77.4 ± 9.8% HRmax). Due to the high intensity of PA while playing the AVGs studied, it can be assumed that obese children can benefit for their health if the games are used on a regular basis. However, further research is needed to verify this thesis.

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

BACKGROUND

Although 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.

OBJECTIVE

This 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.

METHODS

A 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.

RESULTS

Players 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).

CONCLUSIONS

Seated 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.

Ready Exerciser One: Effects of music and virtual reality on cycle ergometer exercise

OBJECTIVES

Physical inactivity remains a major global health concern, and researchers have been encouraged to explore the role of technology in the promotion of physical activity. Technologies that deliver audio-visual stimuli are frequently applied in the exercise domain. However, there is a paucity of research that examines the efficacy of modern virtual reality (VR) technology in this context. We investigated the effects of VR and music on affective, perceptual, enjoyment, and cardiac responses to aerobic-type exercise.

DESIGN

A fully counterbalanced, within-subjects design was employed.

METHODS

A convenience sample of recreationally active adult volunteers (N = 24) completed a 12-min protocol during which they exercised under music, VR, VR-with-music, and control conditions.

RESULTS

Analyses indicated a Condition × Time interaction for affective valence and perceived activation. Moreover, a main effect of condition emerged for state attention and perceived enjoyment. The VR and VR-with-music conditions elicited the most positive affective valence, highest levels of perceived activation, greatest number of dissociative thoughts, and most exercise enjoyment. Differences between these two conditions were negligible across the breadth of dependent variables.

CONCLUSIONS

The present findings illustrate the efficacy of modern VR technology in the exercise context, applied both with and without musical accompaniment. Additional research is required to assess the degree to which the findings are replicable among sedentary or ageing segments of the population. Given the emerging support pertaining to a positive relationship between affective responses and exercise adherence, VR technology should be considered as a means by which to promote an enjoyable exercise experience.

Game on: a cycling exergame can elicit moderate-to-vigorous intensity. A pilot study

Objectives

The aims of this pilot study were to investigate oxygen uptake (V̇O₂) while playing a cycling exergame to assess exercise intensity to determine its potential as a feasible exercise alternative to improve aerobic fitness, and to assess the validity of using heart rate (HR) to estimate V̇O₂ in exergaming.

Methods

Five males (age: 32±8; peak oxygen uptake (V̇O_2peak): 47.9±7.8 mL·kg⁻¹·min⁻¹) and five females (age: 27±3; V̇O_2peak: 33.9±4.6 mL·kg⁻¹·min⁻¹) played the cycling exergame ‘Pedal Tanks’ for 45 min, with measurements of HR and V̇O₂.

Results

Average and peak V̇O₂ during exergaming were 61.7±10.1% and 78.3±11.7% of V̇O_2peak, respectively, whereas average and peak HR were 80.0±9.4% and 91.5%±6.7% of HR_peak. There was a strong positive correlation between V̇O₂ and HR for all participants (p<0.05) although estimated V̇O₂ from HR was 9% higher than that measured during exergaming.

Conclusion

Our preliminary data suggest that the cycling exergame we investigated can elicit moderate-to-vigorous intensities and may therefore be a viable alternative to conventional aerobic exercise. The exercise intensity during exergaming was overestimated when using HR alone.

Does exergaming drive future physical activity and sport intentions?

We studied how usability and playability of sport exergames affect future intentions of participation in physical activity or actual sport. We employed questionnaires to measure participants' enjoyment, usability, game-experience, and future intentions of physical activity and real sport. We compared the outcomes based on players' gender, previous real-swimming, and exergame experience. Psychological parameters were not different between groups but players without exergame experience enjoyed the game more. Physical activity intentions increased for all participants but not swimming intentions. The limitations of current gaming systems and their effects on players' gaming experience and intentions are discussed.

Let the Body'n'Brain Games Begin: Toward Innovative Training Approaches in eSports Athletes

The phenomenon of eSports is omnipresent today. International championships and their competitive athletes thrill millions of spectators who watch as eSports athletes and their teams try to improve and outperform each other. In order to achieve the necessary cognitive and physical top form and to counteract general health problems caused by several hours of training in front of the PC or console, eSports athletes need optimal cognitive, physical and mental training. However, a gap exists in eSports specific health management, including prevention of health issues and training of these functions. To contribute to this topic, we present in this mini review possible avenues for holistic training approaches for cognitively, physically and mentally fitter and more powerful eSports athletes based on interdisciplinary findings. We discuss exergames as a motivating and promising complementary training approach for eSports athletes, which simultaneously combines physical and cognitive stimulation and challenges in an attractive gaming environment. Furthermore, we propose exergames as innovative full-body eSports-tournament revolution. To conclude, exergames bring new approaches to (physical) eSports, which in turn raise new topics in the growing eSports research and development community.

Virtual Reality Gaming Elevates Heart Rate but Not Energy Expenditure Compared to Conventional Exercise in Adult Males

Virtual reality using head-mounted displays (HMD) could provide enhanced physical load during active gaming (AG) compared to traditional displays. We aimed to compare the physical load elicited by conventional exercise and AG with an HMD. We measured energy expenditure (EE) and heart rate (HR) in nine healthy men (age: 27 ± 5 years) performing three testing components in a randomised order: walking at 6 km/h (W6), AG, and AG with an additional constraint (AG^W; wrist-worn weights). Although we found that HR was not significantly different between W6 and the two modes of AG, actual energy expenditure was consistently lower in AG and AG^W compared to W6. We observed that playing AG with wrist-worn weights could be used as a means of increasing energy expenditure only at maximum game level, but ineffective otherwise. Our findings indicate that AG in an HMD may not provide a sufficient stimulus to meet recommended physical activity levels despite increased psychophysiological load. The differential outcomes of measures of HR and EE indicates that HR should not be used as an indicator of EE in AG. Yet, adding a simple constraint (wrist-worn weights) proved to be a simple and effective measure to increase EE during AG.