A review of Literature: Exergaming Approach to Engage Elderly into Physical Exercise
Computer Science Studio 1 41078
Jaime A. Garcia
In the last several years’ video gaming has rapidly gained a lot of attention not only amongst children and parents but also amongst grandparents. It has evolved from being merely kids entertainment to a source of family entertainment. Many grandparents these days are seen playing video games and often competing against players half their age. In fact, a survey conducted by PopCap Games found that 71% of its players were older than 40 among them 47% were older than 50. (Jennifer Soong, 2009)
The public health industry is also taking advantage, of the rise in the use of gaming technologies amongst the elderly, to help them increase their independence and mobility. Consequently, many new pieces of research have been conducted on seniors to demonstrate, positive correlation between the use of video games and its effect on improving brain and physical functions. Supporting these result of the researches, Neuropsychologist Glenn Smith of the Mayo Clinic in Rochester, MN says that the brain appears to be able to modify its structure and develop new skills over the course of a lifetime. (Jennifer Soong, 2009) This review will analyse the current literature consisting of studies that have made use of gaming technology to improve the quality of life of the elderly. Furthermore, it also highlights how combining physical exercise and gameplay will increase their motivation to engage with physical exercise and the nature of game one should consider while developing games for the seniors in order to increase their motivation and support long term adherence for exercising balance.
To investigate the benefits and outcome of gaming systems, research was conducted on 86-year-old woman, by Heidi Sugarman, Aviva Weisel-Eichler, Riki Brown and Arie Burstin in 2009. The patient had recently suffered from a stroke so was unable to walk without close supervision, due to poor balance and a tendency to fall. Beside standard physical therapy, the patient participated in four training sessions with the Wii Fit system; each training session included four different games for the treatment of her balance disorder. These training sessions were assessed using Berg Balance Scale (BBS), the Functional Reach and Lateral Reach tests, Timed Up & Go test (TUG), computerized post-urography, and the Short Feedback Questionnaire (SFQ). At the end of the intervention, the result of these tests showed improved balance and self-confidence, this was also indicated by her ability to perform the various tasks without external support. However, concluding that gaming technology was purely the cause of the improvement is a biased approach in this study as there is no way know how much of this improvement was due to the intervention and how much to conventional therapy and natural recovery. Moreover, since it was a pilot study, only one subject was studied, the result of this study cannot be generalized to all the elderly population as individual difference exists amongst them. Subsequently, to combat these limitations a large scale full clinical trial should be conducted with a larger number of participant and a control group should be made so that we could study the contribution of gaming technology in the improvement.
Taking advantage of the many studies show similar results to the one earlier by Heidi et al., many rehabilitation institutes have also introduced interactive games to help people with stroke in recovering their motor function. Similarly, many retirement homes are taking advantage of Nintendo Wii to encourage the elderly to stay active, socialize and have fun by introducing Wii nights with tennis, bowling, and other sports.
Cornelius Neufeldt from the University of Siegen in 2009 examined the effect of introducing Wii in the retirement house setting. He conducted an experiment with a limited number of participants where Wii and Wiimote were introduced to the older generation over a period of six months. As it was harder for the seniors to play the game a few modifications throughout the trial had to be made to the settings and device used, so that the games could become more suitable for the elders. For example, chairs without armrest were used to allow free movement, unneeded buttons of controllers were covered so they could not be pressed accidentally, to moderate the level of confusion the volume of the television device was turned down, to increase their level of attention. Though, it took the seniors a long time to handle the game and have fun. But when they got used to handling the game and could not stop themselves from talking about it even over the lunch. Semi-structured interviews were randomly conducted with the participates along with evaluation meetings with the leading caregiver to study the difference caused by Wii before and after the intervention. The result from these qualitative sources indicated that Wii could help improve coordination capabilities and encourage people to move their arms. However, the result of the study cannot be generalized as the group selected was small and not randomly selected rather it was selected by the management of the retirement house from the group of people who were interested in playing Wii. Another limitation can be that the study lacks validity as the conclusion was reached purely based on qualitative data.
Apart from improving balance and coordination as highlighted in the studies above, doctors say physical activities can also prevent, delay or slow down chronic illness like arthritis, heart disease, blood pressure, high cholesterol, diabetes and dementia which is particularly important at an advanced age. Therefore, experts have introduced a new trend in the games called exergaming which links physical exercise and gameplay. In simple words you can get power-ups or unlock levels in the game by simply going for a morning walk. (Project Elaine, 2019) Moreover, many studies have also shown interactive games which involves exercise like Wii exercise has a similar effect to real exercise. Both can boost the level of a chemical named Dopamine. (Jenny Hope 2014)
A literature search was conducted by Leonie Verheijden Klompstra, Tiny Jaarsma, and Anna Str?mberg in the year 2014 with the aim to study feasibility and influence of exergames on physical activity in older adults, especially in patients diagnosed with heart failure. A total of 11 studies were reviewed in term of characteristics like safety, balance, cognition, and experiences from different databases including sychINFO, PubMed, Scopus, Web of Science and CINAHL varying from the year 2006 to 2012. The review also highlighted that exergames increase physical activity in the elderly was safe and feasible for stroke and cardiac patients. Furthermore, the result of this research showed positive outcomes in relation to balance and cognitive performance thus validating the result from the earlier studies conducted by Cornelius Neufeldt and Heidi et al. Participants also reported enjoyment in being active thus promising long-term adherence to exercising. Moreover, they also described a decrease in depressive symptoms, hence improved quality of life and empowerment and felt closer to their family specifically grandchildren. The review, however, has some limitation mainly small number of studies were studied with a small sample size and most studies did not include a control group to make a comparison to. However, to fully benefit from exergaming seniors should be properly familiarized and guided about how to approach this game.
Although the previous investigations showed that digital games have the potential for the seniors by improving their cognitive and physical wellbeing, enhancing their social connectedness and offering an entertaining hobby. Despite this potential, the game developers are only targeting adolescent user, therefore, there are not enough games available in the market to accommodate the interests, needs, abilities, and limitations of elderly users.
An article by Wijnand IJsselsteijn, Henk Herman Nap, Yvonne de Kort, and Karolien Poels in the year 2007 aimed to assess and explain the factors that should be considered when designing games for the elderly users. The article further highlights as many of the game developers are still quite inexperienced regarding the basic game accessibility guidelines which could be beneficial for seniors. Many games fail to consider both age-related functional limitations, for example, sensory-perceptual processes, response speed, cognitive processes and motor abilities combined with the lack of technological experience, thus causing usability issue for the seniors. Moreover, the paper also stated along with taking care of seniors usability and designing requirement there is a need to make sure that there are substantial perceived benefits for elderly users so that they are willing to invest their valuable time and energy in what could potentially be a rich and rewarding experience. However, to explore and understand the needs and motivations of elderly gamers, there is a great need for a large research effort, which includes focus group studies, interviews, surveys, and general market segmentation research. Furthermore, studies are required to determine the effects of different genres of digital games on elderly gamers while putting various hypothesized benefits to a much more detailed test.
The results of these studies clearly indicate that the enjoyable nature of exergaming increases motivation and supports long term adherence for exercising balance. Thus, public health sector will continue to take advantage of it to increase seniors independence and mobility. However, to fully reap the benefits, games should be developed to be elder friendly which means it should along with fulfilling age-related useability and designing requirement, provide some sort of benefit to the elderly user. These benefits can be in a form of improving physical and cognitive wellbeing, increasing social life and providing relaxation and entertainment.
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