5th Fit-In Conference: Play + Game + Tech = Health

 I had the distinct honor of speaking at the 5th Annual Fit-In Conference at SUNY Cortland's Sensory Integration Motor Sensory (SIMS) Lab run out of the Physical Education Department and Dr. Tim Davis.  I was given a small window of time to provide a glimpse of where technology might be a benefit to Special Ed or Adapted PE students, assistive learning and fitness facilities, and even in the home and communities. It was a pleasure to meet so many dedicated practitioners, educators, and researcher shaping programs and improving health of people with a varied abilities.

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Ping Ping Pong Pong Kinect Exergaming

A research arm from Singapore is showcasing some work done to encourage physical activity in older adults (seniors).

Using a Kinect sensor to interact with a simple ping-pong game interface, seniors can game their way to better health.

For the task of selective attention, two balls will fly out simultaneously, where only the ball of a specific colour is the target.
For the inhibition task, the ball in some rounds will be of a different colour, and players are required to ignore balls of a given colour while hitting balls of other colours. The innovative data analysis tools at the back end enable healthcare professionals to easily track the health conditions of each individual elderly user under their care, and assist in crafting personalized training programs.

Ping Ping Pong Pong (A Motion-based Physio-cognitive Sport Game)

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Meta-Analysis of Exergaming on Physical Activity

Although not surprising, a meta-analysis of 11 RCT studies found that  playing exergames was one way to accumulate more physical activity for overweight individuals. Due to the differences in methodologies and inconsistent findings, no relationships were able to be established for patients with Type II diabetes. It does stand to reason that if you want more physical activity that can be done at home, exergaming might be one way to engage the target population and maybe others at home. What interventions need to focus on is the implementation at schools and community to be truly effective for long-lasting results or gateway to other physical activities.

ResultsOf 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.

Abstract
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/m2) 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.

Effects of Exergaming on Physical Activity in Overweight Individuals


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Active gaming benefits brain health #exergaming

There have been some mixed results about the effectiveness of basic brain training games and their impact on cognitive function. In general, we tend to see some low to moderate gains in certain brain processes, but they tend to be short lived and typically specific to the type of testing or assessment used.

In this meta-analysis of RCT, the authors found that across the 17 included studies, exergames were found to improve executive function, attentional processing and visuospatial skills in older people and people with neurocognitive deficits.

Let's get playing!

Abstract
Physically-active video games (‘exergames’) have recently gained popularity for leisure and entertainment purposes. Using exergames to combine physical activity and cognitively-demanding tasks may offer a novel strategy to improve cognitive functioning. Therefore, this systematic review and meta-analysis was performed to establish effects of exergames on overall cognition and specific cognitive domains in clinical and non-clinical populations. We identified 17 eligible RCTs with cognitive outcome data for 926 participants. Random-effects meta-analyses found exergames significantly improved global cognition (g = 0.436, 95% CI = 0.18–0.69, p = 0.001). Significant effects still existed when excluding waitlist-only controlled studies, and when comparing to physical activity interventions. Furthermore, benefits of exergames where observed for both healthy older adults and clinical populations with conditions associated with neurocognitive impairments (all p < 0.05). Domain-specific analyses found exergames improved executive functions, attentional processing and visuospatial skills. The findings present the first meta-analytic evidence for effects of exergames on cognition. Future research must establish which patient/treatment factors influence efficacy of exergames, and explore neurobiological mechanisms of action.

Link:  Study suggests active gaming benefits brain health | Alzheimer's Research UK:

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4Active Exergaming at 2017 FIBO

Finnish company CSE has released their multiplatform exergame system 4Active and it was nominated at 2017 FIBO in the Fitness, Wellness & Health category.

I haven't seen much from this company but it looks like one of their systems uses an XBox Kinect to play some customized games while the other system is a multi-player dance game that doesn't have near the development or player status and feedback like iDance by Postive Gaming.

4Active Exergaming: Trendsport virtual fitness games - FIT FOR FUN:

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Zwift exergaming bike

Get cycling at home but with your Zwift bike you can compete with people from all over the world.

Much like the other exergaming bikes reviewed here and here, Zwift allows for multiple platforms, group based rides, virtual simulator, all while connected to your indoor cycle trainer setup such as Wahoo, Tacx, and Kinetic.

A similar setup from Peleton was spotted at CES 2017.

Zwift translates your real world effort into speed in the digital one. Your power, measured by the watts you produce, propels you through the digital landscape.
Just like the real world, your speed is adjusted for your height, weight and the road gradient. We even give you credit for drafting.

Zwift review: the return of the home exercise bike:

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Gaming Fitness podcast interview on Exergaming

I know this is really old but I forgot to post an older podcast I did back in 2013 with Ben Tyrer for his blog Gaming Fitness. Enjoy!

You wouldn’t expect to hear a fitness game researcher tell you that fitness games might not be for everyone. But Stephen Yang, an adjunct faculty at State University New York Cortland, believes that to be the case.
In this exclusive interview with Ben Tyrer, Stephen explains how the most important aspect when it comes to health is identifying the needs of the individual.
Of course, Stephen is a firm advocate for fitness games, but he says that the focus should be on building a plan that suits the individual’s needs, not just expecting a fitness game to work because you brought it. - Gaming Fitness

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Exergaming podcast with Global PhysEd @PhysedNow

I had a great time with @physedNow doing their Global PhysEd podcast using Voxcast on exergaming but it was great to be able to talk about where technology can fit in, compliment, and accelerate learning, engagement, and social growth in the K12 setting. For the past 23 years, I've worked with, researched, and taught about infants, toddlers, children, teens, and now college students, and it was great to be able to draw on my vast experiences and recall some stories and stumbles along the way. We are all learners on this journey of life, discovery, and growth and I was humbled to be interviewed and encouraged them to continue their mission to support other teachers, students, parents, administrators, and the public on the critical importance of creating healthier environments and people.



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Can Cycle Exergaming increase Brain Function in Seniors? (Study)

Can cycle exergaming increase brain function in seniors with diabetes? German researchers wanted to know if exergaming was as effective at increasing BDNF levels as a regular cycle ergometer.

Findings

• Similar heart rates but lactate threshold levels were higher in the cycle group.
• BDNF and VEGF were increased to similar levels post-exercise.

Exergaming Points to Ponder - ExP2P

• Which gaming platform did they use?
• Was it one of the cycle exergames or exergame bikes?
• Did they have social connections to others including in other locations?
• Were there gamification features like leaderboards, and points and challenges across the individuals?

Effects of Cycling and Exergaming on Neurotrophic Factors in Elderly Type 2 DM

Patients with type 2 diabetes mellitus (T2DM) are at increased risk of developing neurodegenerative diseases. There is growing evidence that repeated exercise-induced transient increases in neurotrophic factors can augment neurogenesis and neuroplasticity. This pilot study compares the effects of 30-min submaximal cycling with those of exergaming (combining exercise and video gaming) at the same duration and same rating of perceived exertion (BORG RPE: 14-15) on serum neurotrophic factors in 8 elderly non-insulin-dependent T2DM patients (71±4 years) (2×2 crossover design). Brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF) and insulin-like growth factor (IGF)-1 levels were quantified using enzyme-linked immunosorbent assay (ELISA) kits. Heart rates were almost equal during cycling and exergaming, while lactate values were significantly higher during cycling (cycling versus exergaming: 3.7±1.1 versus 2.5±1.2 mmol/l, p<0.05). BDNF and VEGF levels were increased significantly post-cycling (+20%,+14%, p<0.05). No other significant pre-post changes were evident. This study demonstrates that acute exercise can increase neurotrophic factors (BDNF, VEGF) in elderly T2DM patients, depending on exercise mode.

Journal link

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Pavlok Shocking for Health or Harm?

Would a slight jolt of electricity help you stick to your good behaviors and avoid poor choices?
Pavlok is positioning itself to be the master trainer and tamer of all unhealthy habits and behaviors. Similar to Pavlov's experiments, you will be zapped with a small current if you commit a bad habit. Friends can even Zap you if they catch you cheating or you can reward yourself if you accomplish your goals.

Will this be the device to get you to a healthier version of you?

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Will Teens Get Fitter with Wearabletech? @SmartLife_eu

Can teens get fitter by wearing a smart shirt? The EU Foundation Horizon 2020 is supporting SmartLife to test this hypothesis using a mobile app, exergame, and gamification features.

Exergaming Points to Ponder (ExP2P)

• How many shirts will teens have?
• Do the shirts have attachments to a detachable pod like (Sensoria)?
• Does the shirt have to be synced to a mobile device at all times?
• Will this be a RCT across multiple countries and age groups?
• Will schools/classes be stratified according to socioeconomic status?
• I think it would be great to have some North American comparison groups.

BTW - This sentence is music to my ears!

SmartLife project aims to create a mobile game that requires lower body movement, and is personalized by physiological feedback measured by smart textiles. To date, no serious games exist that personalize the game play by real-time feedback on achievement of the target behaviour. Personalization via smart textiles can present a game challenge achievable for the current fitness level of the player and can adjust this based on activity levels during game play. This approach can improve current exergames to achieve a higher level of intensity in physical activity, needed to create a health impact, and can do so taking into account what is achievable for the person and hence reduce drop-out and injury risks. 

Energy-related behaviours (physical activity, sedentary behaviour) are main modifiable determinants of several non-communicable health conditions, e.g. diabetes type 2, overweight and obesity, and track into adulthood. Promoting these behaviours among youngsters can have great health and societal gains. Meeting recommended levels for these behaviours is especially low among adolescents, girls and those of lower socio-economic status. An intervention to promote energy related behaviours among adolescents is thus indicated, and may also address social inclusion. Exergames, which require movement to be played, have great yet underused potential to promote these behaviours. To fully utilise this potential, exergames need to promote moderate-to-vigorous physical activity; need to be tailored to the individual user; and need to be more engaging.
The SmartLife project aims to create such an exergame. The SmartLife exergame will be:
 

• A mobile game requiring lower body movements;

• Combined with a smart textile that provides immediate physiological feedback (e.g. heartrate, respiration) and ensures exercises are performed at a moderate-to-vigorous intensity level;

• Tailored to individual user’s needs, using the smart textile data, and based on available evidence and big data analysis;

• Highly engaging, e.g. by adding a narrative and context information, and using user input throughout the design (‘participatory development’).

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Can Akili Health App Get FDA Approval for Autism?

Playing a mobile app Playing Project EVO might improve mental health levels and cognitive function, but most companies don't apply to the FDA for approval as a medical intervention. One company that is the rare exception is Akili.

In a series of registered clinical trials, they are attempting to prove their technology helps improve cognitive function and executive control in populations such as ADHD, autism, depression, and traumatic brain injury.

This is the true definition of a Serious game and Game for Health (GFH) and we wish them all the best.

Akili functions on the premise that advances in neuroscience research and consumer-facing technology are enabling a new way to sensitively measure neural function, and intervene in any measured deficits, wherever the patient may be.  Akili's products address both quantitative measurement of and intensive intervention in cognitive functions in a variety of patient populations. 

The science behind our proprietary technology platform was developed at the University of California, San Francisco by Dr. Adam Gazzaley, Founding Director of the UCSF Neuroscape and Akili's Chief Science Advisor. Dr. Gazzaley's research has led to a patent-pending new software-based method to measure and improve a key system of executive function known as interference processing™. We've deployed these mechanics from the ground up in a consumer video game interface that runs on mobile phones and tablets, and meets all requirements for rigorous clinical studies. The Project: EVO™platform is currently being tested in a variety of clinical studies in multiple patient populations around the globe, including ADHD, autism, depression, and traumatic brain injury.

Akili Video Game Aims To Get FDA Approval Despite Concerns Over Legitimacy

Twitter Link


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Does VR Kettler cycling + Oculus Rift Get Your Sweat On? VRexergaming at home

Connecting VR and fitness at home is exergaming customized to a user's preferences in physical activities. Kettler bikes have been moving this way previously with their cycling KETT app that has gamification features like social networks, leaderboards, and ride sharing features.  

In this French news piece on VRexergaming combination, being immersed in your cycling environment could be a great way to feel more like you're actually there. The cycle when connected to your mobile device actually adjusts when going up and down hills so it feels more realistic.

Exergaming Points to Ponder (ExP2P)

• Sweating with a head piece on would be fine for a few minutes, but I wonder how comfortable it'd be for more than 10 minutes or a really sweaty workout? 
• Can the straps be easily washed?
• All we need is a fan to simulate some wind and we'd be in a near complete immersive environment.

Kettler App

Via Apsia & KinoMap

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LEGOLAND: A GPS Adventure Game Exergaming

40 games
1000s of landmarks
One Great Big World.

So goes the tagline for Legoland the GPS Adventure game. If you're headed to LegoLand i in Florida, you and your kids can get a jump on the action of building by experiencing augmented-reality features as you drive.

I have not heard a lot of feedback from this mobile exergame yet, but I imagine as the summer heats up and Pokemon Go starts its second summer of fantastic folly - we'll hear more.

LEGOLAND: A GPS Adventure Game | Digital Buzz Blog:

Calling all backseat drivers! Join Captain Brickbeard, Surfer Girl, the World’s Greatest Adventurer, and the Good Knight for a road trip of epic proportions with Quest to LEGOLAND®, the all new GPS adventure game built for kids. 

Kids can follow a LEGO® Minifigure on a route to LEGOLAND Florida that’s mapped in real-time using GPS. Along the way, they’ll unlock themed missions, answer trivia, and learn about the world around them as landmarks they pass pop up on-screen right before their eyes. With 40 total games and more than 1,000 pieces of contextual trivia, what you see in the app depends on the route you take so every trip is a unique adventure for the entire family.

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Can Playing Xbox Kinect Exergame Improve Mood States? RCT (Study)

I spotted this RCT trial from Taiwan that studied how much enjoyment university students had while playing the exergame Your Shape: Fitness Evolved for Xbox 360.

Sample: 337 participants (168 intervention group, 167 control group)

Population: Mean age 20 years

Methods: RCT, 2 sessions over 2 weeks, 30 minutes per session

Measurements: vigor, happiness, and stress

Results:
Intervention group had higher levels of vigor from the start to the end of the study.

Exergaming Points 2 Ponder (ExP2P)

• After playing YourShape: Fitness Evolved I still hold PS2 EyeToy Kinectic as the top of the whole body exergaming genre. Although it is a step up from the YourSelf Fitness (Wii), it still doesn't compare to actually seeing you actually moving and interacting with virtual objects (and without VR headsets). 
• I wonder if they (Sony) own the actual patent for that feature?
• I wonder if we will ever see ourselves instead of an avatar?

To examine how playing exergames impacts the mood states of university students and staff, and whether such an impact depends on gender and players' previous exercise time. This study was designed as a randomized controlled trial. It enrolled 337 participants and randomly assigned them to an intervention group (n = 168) or a control group (n = 167). A 2-week exergame program was designed for the participants in the intervention group. They were required to play exergames for 30 consecutive minutes each week for 2 weeks and respond to the items measuring vigor, happiness, and perceived stress. All measures were administered before and after the study. Repeated measures analysis of variances were conducted. Playing exergames enhanced vigor and happiness for participants in the intervention group. This group exhibited more positive change in vigor and happiness than the control group. This effect of playing exergames was not moderated by gender, age, occupation (student or staff), or previous exercise time. Playing exergames may induce positive mood states among university students and staff.

Impact of Playing Exergames on Mood States: A Randomized Controlled Trial

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5 VR Games To Keep You Fit - Exergaming

Doing whole body exercises is clearly one of the best forms of exercises you can do, and boxing is right up there with the best of them.  Using your own VR headset you can get pretty active, although I'm not sure how much you'll want to sweat with a headset on. Seems to me to be a good way to get more activity in, or therapy, but not necessarily vigorous exercise. Time will tell! Either way I'd like to challenge an octopus to fight!

via 5 VR Games To Keep You Fit On World Physical Activity Day:

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