A Bowling Exergame to Improve Functional Capacity in Older Adults: Co-Design, Development, and Testing to Compare the Progress of Playing Alone Versus Playing With Peers

Abstract

Background Older people often do not meet the recommended levels of exercise required to reduce functional decline. Social interaction is mentioned by this cohort as a reason for joining group-based exercises, which does not occur when exercising alone. This perspective shows that exergames can be used as motivational resources. However, most available exergames are generic, obtained from commercial sources, and usually not specifically designed or adapted for older people. Objective In this study, we aim to co-design and develop a new exergame alongside older participants to (1) tailor the game mechanics and optimize participants’ adherence to and enjoyment of exercise; (2) test the participants’ functional capacity, motivation, and adherence to the exergaming program; and (3) compare these scores between those who played alone and those who played with peers. Methods We conducted a co-design process to develop a new exergame adapted to older people. For user testing, 23 participants were divided into 2 groups to play individually (alone group) or to compete in pairs (with peers group). They played the game twice a week, resulting in 21 exergaming sessions. We assessed the participants’ General Physical Fitness Index (GPFI) before and after the user testing. We also administered questionnaires about the gaming experience and exercise adherence with its motivators and barriers. Results We introduced a new bowling exergame for Xbox with a Kinect motion sensor that can be played in single or multiplayer mode. For the GPFI measurements, the sample was homogeneous in the pretest (with peers group: mean 40.5 [SD 9.6], alone group: mean 33.9 [SD 7.8]; P=.11). After the exergame testing sessions, both groups had significant gains (with peers group: mean 57.5 [SD 8.7], P=.005; alone group: mean 44.7 [SD 10.6]; P=.02). Comparing the posttest between groups, it was found that the group in which participants played with peers had better outcomes than the group in which participants played alone (P=.02). Regarding the gaming experience and exercise adherence, both groups recognized the benefits and expressed enthusiasm toward the exergame. Conclusions The findings suggest that the developed exergame helps in improving the functional capacity and adherence to physical exercise among older people, with even better results for those who played with peers. In addition to leading to more appropriate products, a co-design approach may positively influence the motivation and adherence of participants.

An Interactive Physical-Cognitive Game-Based Training System Using Kinect for Older Adults: Development and Usability Study

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The use of co-design in developing physical activity interventions for older adults: a scoping review

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Using a mobile health app to improve patients’ adherence to hypertension treatment: a non-randomized clinical trial

“…However, over time, most users realized that through the support provided by the app they could solve problems, reduce insecurities, and improve their self-monitoring, thus making the time spent with the app pleasant and enjoyable, partly due to the intrinsic rewards provided by the gamification system included in the app (Cechetti et al, 2019). These results show that game elements complement the user experience, improving engagement, motivating patients, caregivers, and family members in the quest to acquire more knowledge and use technology to improve health condition (Da Silva Júnior et al, 2021). Hence, as long as the quality of health services can meet the expectations of patients, they will continue to use the services (Guo et al, 2020 The results of the UEQ questionnaire summarized participants' impressions regarding the influence of experience on the use of the health app.…”