Designing for Movement Quality in Exergames: Lessons Learned from Observing Senior Citizens Playing Stepping Games

Abstract

Background: Exergames are increasingly used as an exercise intervention to reduce fall risk in elderly. However, few exergames have been designed specifically for elderly, and we lack knowledge about the characteristics of the movements elicited by exergames and thereby about their potential to train functions important for fall risk reduction. Objective: This study investigates game elements and older players' movement characteristics during stepping exergames in order to inform exergame design for movement quality in the context of fall preventive exercise. Methods: Fourteen senior citizens (mean age 73 years ± 5.7, range 65 - 85) played 3 stepping exergames in a laboratory. Each of the exergames was described with respect to 7 game elements (physical space, sensing hardware technology, game graphics and sound, model of user, avatar/mapping of movements, game mechanism and game narrative). Five movement characteristics (weight shift; variation in step length, speed, and movement direction; visual independency) were scored on a 5-point Likert scale based on video observations of each player and each game. Disagreement between raters was resolved by agreement. Differences in scores for the 3 exergames were analyzed with a multivariate one-way ANOVA. Results: The Mole received the highest sum score and the best score on each of the 5 movement characteristics (all p values <0.0005). LightRace scored the lowest of the 3 exergames on weight shift and variation in movement direction (both p values <0.0005), while DanceDanceRevolution scored lowest on step length variation and visual independency (p < 0.03 and p < 0.0005, respectively), and lower than The Mole on speed variation (p < 0.05). The physical space players used when exergaming and the on-screen representation of the player, affected movement quality positively as indexed by multiple weight shifts and variation in stepping size, direction, and speed. Furthermore, players' movements improved when playing speed-affected game progression and when the game narrative was related to a natural context. Conclusion: Comparing differences in game elements with associated differences in game movement requirements provides valuable insights about how to design for movement quality in exergames. This provided important lessons for the design of exergames for fall-preventive exercise in senior citizens and illustrates the value of including analyses of movement characteristics when designing such exergames.

Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy

“…However, how progression was attained differed between studies, ranging from increasing the difficulty of the game to adding additional cognitive challenges or based on their current performance (23). The use of implemented standardized tests that have to be performed in regular intervals may also provide individual adjustments in loading and difficulty level.…”

Correlação entre os resultados obtidos em testes motores e o desempenho em exergames em idosos

“…Segundo Sato et al, 33 a utilização dos exergames podem melhorar e manter as variáveis físicas de sujeitos idosos. Pesquisadores como Agmon et al 34 e Skjaeret et al, 14 tem utilizado os exergames na elaboração de treinos físicos para idosos e montagem de protocolos de atividades físicas para esta população, além de trabalharem com possibilidades de remontagem de software dos exergames para adaptação à laboratórios e clínicas específicas relacionadas à área da saúde.…”

“…[6][7][12][13][14][15] A prática do exergame como promoção de exercício para idosos parece já ser uma realidade, além de mostrar-se efetiva na melhoria da condição física dos idosos. Sendo assim, considerando tais achados acredita-se que o seu uso também possa servir como avaliação da capacidade motora do idoso, já que o jogo apresenta escores de desempenho durante a execução do jogo.…”

Assessing seniors' user experience (UX) of exergames for balance training

“…In another recent study [28], we have described in detail that we lack knowledge about the characteristics of the movements elicited by exergames and thereby about their potential to train functions which are important for fall risk reduction. In order for exergames to be usable for elderly people, the game should elicit different movement characteristics such as weight shift, variation in step length, step speed and movement direction, and visual independency [28].…”

“…In order for exergames to be usable for elderly people, the game should elicit different movement characteristics such as weight shift, variation in step length, step speed and movement direction, and visual independency [28].…”