@Article{info:doi/10.2196/10679,
author="Militello, K. Lisa
and Hanna, Nathan
and Nigg, R. Claudio",
title="Pok{\'e}mon GO Within the Context of Family Health: Retrospective Study",
journal="JMIR Pediatr Parent",
year="2018",
month="Oct",
day="03",
volume="1",
number="2",
pages="e10679",
keywords="family",
keywords="pediatrics",
keywords="mHealth",
keywords="exercise",
keywords="mobile health, public health",
abstract="Background: Pok{\'e}mon GO illuminated the potential for mobile phone gaming apps to engage users and promote health. However, much work is needed to fully understand the mechanisms through which digitally supported behavior change interventions operate, particularly for children and families. Objective: The aims of this study were (1) to explore the Pok{\'e}mon GO user experience from a family perspective and (2) to investigate Pok{\'e}mon GO within the context of family health. Methods: Between January and February 2017, congruent with one of the largest anticipated Pok{\'e}mon GO updates Gen 2, participants were recruited from parks, word of mouth, and social media to complete a Web-based survey. Participants were surveyed about family characteristics, interest, and experiences playing Pok{\'e}mon GO and healthy lifestyle beliefs. Using a revised Godin Leisure-Time Exercise Questionnaire, a retrospective pre-post design assessed changes in parent physical activity (PA) before and after playing Pok{\'e}mon GO. Results: Self-reported data from 160 parents and 31 children were included in the final analyses (representing 129 parents and 31 parent-child dyads). Gameplay most often occurred between sons aged 10 years or younger and mothers. ``Spending time together'' was the most cited reason for gameplay by both parents (122/160, 76.3\%) and children (24/31, 77\%), followed by ``it helped me go outdoors'' for parents (113/160, 70.1\%) and ``I am a Pok{\'e}mon fan'' by children (21/31, 68\%). Interestingly, open-ended responses indicated that gameplay could trigger both positive and negative emotional parent response. The most cited reason for app disengagement was boredom; conversely, the most cited reason for app re-engagement was in-app events. For parents, there were significant increases in minutes spent in mild (mean 23.36 [SD 66.02]; t97=3.50, P<.001) and moderate (mean 21.76 [SD 53.04]; t130=4.70, P<.001) PA per week after playing Pok{\'e}mon GO. However, child perceptions of parental influence on PA most significantly associated with parents who reported weekly strenuous PA both before (rs=.514, P=.003) and after (rs=.536, P=.003) Pok{\'e}mon GO uptake. Conclusions: Pok{\'e}mon GO transcended traditional understanding of digital health and uniquely reached across generations to engage users. Findings from this study highlight that, for a period of time, Pok{\'e}mon GO fostered social and physical well-being for children and families through a multifaceted approach. ",
doi="10.2196/10679",
url="http://pediatrics.jmir.org/2018/2/e10679/"
}


@Article{info:doi/10.2196/10486,
author="Li, Jinhui
and Erdt, Mojisola
and Chen, Luxi
and Cao, Yuanyuan
and Lee, Shan-Qi
and Theng, Yin-Leng",
title="The Social Effects of Exergames on Older Adults: Systematic Review and Metric Analysis",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="28",
volume="20",
number="6",
pages="e10486",
keywords="active video games",
keywords="psychosocial well-being",
keywords="ageing",
keywords="literature review",
keywords="citation analysis",
abstract="Background: Recently, many studies have been conducted to investigate the effects of exergames on the social well-being of older adults. Objective: The aim of this paper is to synthesize existing studies and provide an overall picture on the social effects of exergames on older adults. Methods: A comprehensive literature search with inclusive criteria was conducted in major social science bibliographic databases. The characteristics of exergames, participants, methodology, as well as outcome measurements were extracted from the relevant studies included in the review. The bibliometric and altmetric outreach of the included studies were also investigated. Results: A total of 10 studies were included in the review, with 8 studies having used the Nintendo Wii platform. Most of the studies recruited healthy older adults from local communities or senior activity centers. Three groups of social-related outcomes have been identified, including emotion-related, behavior-related, and attitude-related outcomes. A metric analysis has shown that the emotion-related and behavior-related outcomes received high attention from both the academic community and social media platforms. Conclusions: Overall, the majority of exergame studies demonstrated promising results for enhanced social well-being, such as reduction of loneliness, increased social connection, and positive attitudes towards others. The paper also provided implications for health care researchers and exergame designers. ",
doi="10.2196/10486",
url="http://www.jmir.org/2018/6/e10486/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29954727"
}


@Article{info:doi/10.2196/jmir.9670,
author="Ma, D. Ben
and Ng, Leung Sai
and Schwanen, Tim
and Zacharias, John
and Zhou, Mudi
and Kawachi, Ichiro
and Sun, Guibo",
title="Pok{\'e}mon GO and Physical Activity in Asia: Multilevel Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="15",
volume="20",
number="6",
pages="e217",
keywords="physical activity",
keywords="Pok{\'e}mon Go",
keywords="public health intervention",
keywords="exergame",
keywords="weather",
abstract="Background: Physical activity has long been considered as an important component of a healthy lifestyle. Although many efforts have been made to promote physical activity, there is no effective global intervention for physical activity promotion. Some researchers have suggested that Pok{\'e}mon GO, a location-based augmented reality game, was associated with a short-term increase in players' physical activity on a global scale, but the details are far from clear. Objective: The objective of our study was to study the relationship between Pok{\'e}mon GO use and players' physical activity and how the relationship varies across players with different physical activity levels. Methods: We conducted a field study in Hong Kong to investigate if Pok{\'e}mon GO use was associated with physical activity. Pok{\'e}mon GO players were asked to report their demographics through a survey; data on their Pok{\'e}mon GO behaviors and daily walking and running distances were collected from their mobile phones. Participants (n=210) were Hong Kong residents, aged 13 to 65 years, who played Pok{\'e}mon GO using iPhone 5 or 6 series in 5 selected types of built environment. We measured the participants' average daily walking and running distances over a period of 35 days, from 14 days before to 21 days after game installation. Multilevel modeling was used to identify and examine the predictors (including Pok{\'e}mon GO behaviors, weather, demographics, and built environment) of the relationship between Pok{\'e}mon GO use and daily walking and running distances. Results: The average daily walking and running distances increased by 18.1\% (0.96 km, approximately 1200 steps) in the 21 days after the participants installed Pok{\'e}mon GO compared with the average distances over the 14 days before installation (P<.001). However, this association attenuated over time and was estimated to disappear 24 days after game installation. Multilevel models indicated that Pok{\'e}mon GO had a stronger and more lasting association among the less physically active players compared with the physically active ones (P<.001). Playing Pok{\'e}mon GO in green space had a significant positive relationship with daily walking and running distances (P=.03). Moreover, our results showed that whether Pok{\'e}mon GO was played, the number of days played, weather (total rainfall, bright sunshine, mean air temperature, and mean wind speed), and demographics (age, gender, income, education, and body mass index) were associated with daily walking and running distances. Conclusions: Pok{\'e}mon GO was associated with a short-term increase in the players' daily walking and running distances; this association was especially strong among less physically active participants. Pok{\'e}mon GO can build new links between humans and green space and encourage people to engage in physical activity. Our results show that location-based augmented reality games, such as Pok{\'e}mon GO, have the potential to be a global public health intervention tool. ",
doi="10.2196/jmir.9670",
url="http://www.jmir.org/2018/6/e217/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29907559"
}


@Article{info:doi/10.2196/games.9571,
author="Arnaez, James
and Frey, Georgia
and Cothran, Donetta
and Lion, Margaret
and Chomistek, Andrea",
title="Physical Wellness Among Gaming Adults: Cross-Sectional Study",
journal="JMIR Serious Games",
year="2018",
month="Jun",
day="12",
volume="6",
number="2",
pages="e12",
keywords="video games",
keywords="electronic gaming",
keywords="traditional gaming",
keywords="obesity",
keywords="physical activity",
keywords="sedentary behavior",
abstract="Background: Video and hobby gaming are immensely popular among adults; however, associations between gaming and health have primarily been investigated in children and adolescents. Furthermore, most research has focused on electronic gaming, despite traditional hobby gaming gaining prominence. Objective: To determine whether the number of platforms used, platform preference, and gaming time are associated with obesity, physical activity, sedentary behavior, and cardiovascular risk factors in an adult gaming population. Methods: We conducted a cross-sectional analysis using data obtained from 292 participants who attended a large Midwestern gaming convention. We collected data using a computer-based questionnaire that comprised questions on gaming behavior, demographics, physical activity (using the International Physical Activity Questionnaire), and health characteristics. In addition, we used multivariable-adjusted linear and logistic regression to model health outcomes as a function of the number of platforms used, platform preference, and weekday and weekend gaming time quartile. Results: After adjusting for covariates, we observed a significant linear trend for increasing odds of being obese and higher weekend sitting time by the number of platforms used (P=.03 for both). The platform preference and weekend gaming time quartile exhibited significant associations with odds of meeting physical activity recommendations (P=.047 and P=.03, respectively). In addition, we observed higher odds of being obese among those reporting that they sat most or all of the time while gaming [odds ratio (OR) 2.69 (95\% CI 1.14-6.31) and OR 2.71 (95\% CI 1.06-6.93), respectively]. Conclusions: In adult gamers, the number of platforms used, which platforms they prefer to play on, and the amount of time spent gaming on weekends could have significant implications for their odds of being obese and meeting physical activity recommendations. ",
doi="10.2196/games.9571",
url="http://games.jmir.org/2018/2/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29895516"
}


@Article{info:doi/10.2196/rehab.9123,
author="Dimaguila, Luis Gerardo
and Gray, Kathleen
and Merolli, Mark",
title="Person-Generated Health Data in Simulated Rehabilitation Using Kinect for Stroke: Literature Review",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="May",
day="08",
volume="5",
number="1",
pages="e11",
keywords="health care information systems",
keywords="Kinect",
keywords="patient-generated health data",
keywords="person-generated health data",
keywords="review",
keywords="simulated rehabilitation",
keywords="stroke",
keywords="stroke rehabilitation",
keywords="video games",
keywords="virtual rehabilitation",
abstract="Background: Person- or patient-generated health data (PGHD) are health, wellness, and clinical data that people generate, record, and analyze for themselves. There is potential for PGHD to improve the efficiency and effectiveness of simulated rehabilitation technologies for stroke. Simulated rehabilitation is a type of telerehabilitation that uses computer technologies and interfaces to allow the real-time simulation of rehabilitation activities or a rehabilitation environment. A leading technology for simulated rehabilitation is Microsoft's Kinect, a video-based technology that uses infrared to track a user's body movements. Objective: This review attempts to understand to what extent Kinect-based stroke rehabilitation systems (K-SRS) have used PGHD and to what benefit. Methods: The review is conducted in two parts. In part 1, aspects of relevance for PGHD were searched for in existing systematic reviews on K-SRS. The following databases were searched: IEEE Xplore, Association of Computing Machinery Digital Library, PubMed, Biomed Central, Cochrane Library, and Campbell Collaboration. In part 2, original research papers that presented or used K-SRS were reviewed in terms of (1) types of PGHD, (2) patient access to PGHD, (3) PGHD use, and (4) effects of PGHD use. The search was conducted in the same databases as part 1 except Cochrane and Campbell Collaboration. Reference lists on K-SRS of the reviews found in part 1 were also included in the search for part 2. There was no date restriction. The search was closed in June 2017. The quality of the papers was not assessed, as it was not deemed critical to understanding PGHD access and use in studies that used K-SRS. Results: In part 1, 192 papers were identified, and after assessment only 3 papers were included. Part 1 showed that previous reviews focused on technical effectiveness of K-SRS with some attention on clinical effectiveness. None of those reviews reported on home-based implementation or PGHD use. In part 2, 163 papers were identified and after assessment, 41 papers were included. Part 2 showed that there is a gap in understanding how PGHD use may affect patients using K-SRS and a lack of patient participation in the design of such systems. Conclusions: This paper calls specifically for further studies of K-SRS---and for studies of technologies that allow patients to generate their own health data in general---to pay more attention to how patients' own use of their data may influence their care processes and outcomes. Future studies that trial the effectiveness of K-SRS outside the clinic should also explore how patients and carers use PGHD in home rehabilitation programs. ",
doi="10.2196/rehab.9123",
url="http://rehab.jmir.org/2018/1/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29739739"
}


@Article{info:doi/10.2196/games.7758,
author="McBain, Thomas
and Weston, Matthew
and Crawshaw, Paul
and Haighton, Catherine
and Spears, Iain",
title="Development of an Exergame to Deliver a Sustained Dose of High-Intensity Training: Formative Pilot Randomized Trial",
journal="JMIR Serious Games",
year="2018",
month="Mar",
day="27",
volume="6",
number="1",
pages="e4",
keywords="high-intensity interval training",
keywords="video games",
keywords="heart rate",
keywords="boxing",
keywords="metabolic syndrome",
abstract="Background: Sport science can play a critical role in reducing health inequalities. The inverse relationship between life expectancy, cardiorespiratory fitness, and socioeconomic status could be addressed by performing high-intensity training (HIT), delivered in a class salient and accessible approach. Commercially available exergames have shown encouraging compliance rates but are primarily designed for entertainment purposes rather than focusing on health-related outcomes. A serious game tailored toward delivering an exercise stimulus, while reducing the aversive protocols associated with HIT, could be beneficial to engage and improve health outcomes in socially deprived males. Objective: The aims of this study were to develop an exergame capable of delivering HIT and evaluate the effect on selected health outcomes in men recruited in regions of socioeconomic deprivation. Methods: We conducted an exploratory trial in our target population, and participants were allocated to intervention (n=14) or control groups (n=10) by third-party minimization. The intervention was a 6-week training program consisting of three sessions of exergaming per week. The sessions involved a structured warm-up, then brief intermittent repetitions in the form of boxing rounds (10 s, 20 s, and 30 s) against their peers with a work/rest ratio of 0.25. Results: Retention to the intervention was 87.5\% (21/24). Over the duration of the intervention, session attendance was 67.5\% (170/252); repetition mean and peak heart rates (\% of maximal) and session ratings of perceived exertion (AU, arbitrary units) were 86.3 (5.4\%), 89.9 (6.1\%), and 7.5 (2.2 AU), respectively. The effect of the intervention, when compared with the control, was a likely small beneficial improvement in predicted maximum oxygen consumption (VO2 max, 3.0; 90\% confidence limits {\textpm}2.6\%). Effects on body mass, waist circumference, and blood pressure were either trivial or unclear. Conclusions: Over the 6-week intervention, the exergame delivered a consistent and sustained dose of HIT, with some beneficial effects on aerobic fitness in the target population. Trial Registration: ClinicalTrials.gov NCT03477773; https://clinicaltrials.gov/ct2/show/NCT03477773 (Archived by WebCite at http://www.webcitation.org/6yDLgVs35) ",
doi="10.2196/games.7758",
url="http://games.jmir.org/2018/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29588271"
}


@Article{info:doi/10.2196/rehab.8003,
author="Thirumalai, Mohanraj
and Kirkland, B. William
and Misko, R. Samuel
and Padalabalanarayanan, Sangeetha
and Malone, A. Laurie",
title="Adapting the Wii Fit Balance Board to Enable Active Video Game Play by Wheelchair Users: User-Centered Design and Usability Evaluation",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Mar",
day="06",
volume="5",
number="1",
pages="e2",
keywords="sedentary lifestyle",
keywords="video games",
keywords="active video gaming",
keywords="Wii Fit",
keywords="equipment design",
keywords="physical activity",
keywords="exercise",
keywords="wheelchairs",
keywords="physical disability",
keywords="rehabilitation",
keywords="usability",
abstract="Background: Active video game (AVG) playing, also known as ``exergaming,'' is increasingly employed to promote physical activity across all age groups. The Wii Fit Balance Board is a popular gaming controller for AVGs and is used in a variety of settings. However, the commercial off-the-shelf (OTS) design poses several limitations. It is inaccessible to wheelchair users, does not support the use of stabilization assistive devices, and requires the ability to shift the center of balance (COB) in all directions to fully engage in game play. Objective: The aim of this study was to design an adapted version of the Wii Fit Balance Board to overcome the identified limitations and to evaluate the usability of the newly designed adapted Wii Fit Balance Board in persons with mobility impairments. Methods: In a previous study, 16 participants tried the OTS version of the Wii Fit Balance Board. On the basis of observed limitations, a team of engineers developed and adapted the design of the Wii Fit Balance Board, which was then subjected to multiple iterations of user feedback and design tweaks. On design completion, we recruited a new pool of participants with mobility impairments for a larger study. During their first visit, we assessed lower-extremity function using selected mobility tasks from the International Classification of Functioning, Disability and Health. During a subsequent session, participants played 2 sets of games on both the OTS and adapted versions of the Wii Fit Balance Board. Order of controller version played first was randomized. After participants played each version, we administered the System Usability Scale (SUS) to examine the participants' perceived usability. Results: The adapted version of the Wii Fit Balance Board resulting from the user-centered design approach met the needs of a variety of users. The adapted controller (1) allowed manual wheelchair users to engage in game play, which was previously not possible; (2) included Americans with Disabilities Act-compliant handrails as part of the controller, enabling stable and safe game play; and (3) included a sensitivity control feature, allowing users to fine-tune the controller to match the users' range of COB motion. More than half the sample could not use the OTS version of the Wii Fit Balance Board, while all participants were able to use the adapted version. All participants rated the adapted Wii Fit Balance Board at a minimum as ``good,'' while those who could not use the OTS Wii Fit Balance Board rated the adapted Wii Fit Balance Board as ``excellent.'' We found a significant negative correlation between lower-extremity function and differences between OTS and adapted SUS scores, indicating that as lower-extremity function decreased, participants perceived the adapted Wii Fit Balance Board as more usable. Conclusions: This study demonstrated a successful adaptation of a widely used AVG controller. The adapted controller's potential to increase physical activity levels among people with mobility impairments will be evaluated in a subsequent trial. Trial Registration: ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by WebCite at http://www.webcitation.org/6xWTyiJWf) ",
doi="10.2196/rehab.8003",
url="http://rehab.jmir.org/2018/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29510972"
}


@Article{info:doi/10.2196/games.8979,
author="Lindqvist, Anna-Karin
and Castelli, Darla
and Hallberg, Josef
and Rutberg, Stina",
title="The Praise and Price of Pok{\'e}mon GO: A Qualitative Study of Children's and Parents' Experiences",
journal="JMIR Serious Games",
year="2018",
month="Jan",
day="03",
volume="6",
number="1",
pages="e1",
keywords="child",
keywords="cell phone",
keywords="parents",
keywords="exercise",
keywords="mobile apps",
abstract="Background: Physical activity has multiple health benefits; however, the majority of children around the world do not attain the recommended levels of daily physical activity. Research has shown that the game Pok{\'e}mon GO has increased the amount of physical activity of players and that the game has the potential to reach populations that traditionally have low levels of physical activity. Therefore, there is a need to understand which game components can promote initial and sustained physical activity. By using a qualitative research approach, it is possible to achieve rich descriptions and enhance a deep understanding of the components promoting physical activity among children in a game such as Pok{\'e}mon GO. Objective: The objective of this study was to explore children's and parents' experiences playing Pok{\'e}mon GO. Methods: Eight families comprising 13 children (aged 7-12 years) and 9 parents were selected using purposeful sampling. Data collected using focus groups were analyzed using qualitative latent content analysis. Results: The following three themes were revealed: (1) exciting and enjoyable exploration; (2) dangers and disadvantages; and (3) cooperation conquers competition. The first centers around the present and possible future aspects of Pok{\'e}mon GO that promote physical activity. The second focuses on unwanted aspects and specific threats to safety when playing the game. The third shows that cooperation and togetherness are highly valued by the participants and that competition is fun but less important. Conclusions: Components from Pok{\'e}mon GO could enhance the efficacy of physical activity interventions. Cooperation and exploration are aspects of the game that preferably could be transferred into interventions aimed at promoting children's physical activity. ",
doi="10.2196/games.8979",
url="http://games.jmir.org/2018/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29298750"
}


@Article{info:doi/10.2196/mhealth.8470,
author="Koh, Elizabeth Hyeseung
and Oh, Jeeyun
and Mackert, Michael",
title="Predictors of Playing Augmented Reality Mobile Games While Walking Based on the Theory of Planned Behavior: Web-Based Survey",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Dec",
day="11",
volume="5",
number="12",
pages="e191",
keywords="mobile phone",
keywords="pedestrians",
keywords="safety on the street",
keywords="psychological models",
keywords="predictive value of tests",
keywords="intention",
keywords="age factors",
keywords="attitude",
keywords="social norms",
keywords="self-efficacy",
keywords="habits",
keywords="immersion",
keywords="self-report",
abstract="Background: There has been a sharp increase in the number of pedestrians injured while using a mobile phone, but little research has been conducted to explain how and why people use mobile devices while walking. Therefore, we conducted a survey study to explicate the motivations of mobile phone use while walking Objective: The purpose of this study was to identify the critical predictors of behavioral intention to play a popular mobile game, Pokemon Go, while walking, based on the theory of planned behavior (TPB). In addition to the three components of TPB, automaticity, immersion, and enjoyment were added to the model. This study is a theory-based investigation that explores the underlying mechanisms of mobile phone use while walking focusing on a mobile game behavior. Methods: Participants were recruited from a university (study 1; N=262) and Amazon Mechanical Turk (MTurk) (study 2; N=197) in the United States. Participants completed a Web-based questionnaire, which included measures of attitude, subjective norms, perceived behavioral control (PBC), automaticity, immersion, and enjoyment. Participants also answered questions regarding demographic items. Results: Hierarchical regression analyses were conducted to examine hypotheses. The model we tested explained about 41\% (study 1) and 63\% (study 2) of people's intention to play Pokemon Go while walking. The following 3 TPB variables were significant predictors of intention to play Pokemon Go while walking in study 1 and study 2: attitude (P<.001), subjective norms (P<.001), and PBC (P=.007 in study 1; P<.001 in study 2). Automaticity tendency (P<.001), immersion (P=.02), and enjoyment (P=.04) were significant predictors in study 1, whereas enjoyment was the only significant predictor in study 2 (P=.01). Conclusions: Findings from this study demonstrated the utility of TPB in predicting a new behavioral domain---mobile use while walking. To sum up, younger users who are habitual, impulsive, and less immersed players are more likely to intend to play a mobile game while walking. ",
doi="10.2196/mhealth.8470",
url="http://mhealth.jmir.org/2017/12/e191/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29229586"
}


@Article{info:doi/10.2196/games.8048,
author="Marquet, Oriol
and Alberico, Claudia
and Adlakha, Deepti
and Hipp, Aaron J.",
title="Examining Motivations to Play Pok{\'e}mon GO and Their Influence on Perceived Outcomes and Physical Activity",
journal="JMIR Serious Games",
year="2017",
month="Oct",
day="24",
volume="5",
number="4",
pages="e21",
keywords="Pok{\'e}mon GO",
keywords="physical activity",
keywords="excercise",
keywords="exergames",
keywords="gaming outcomes",
keywords="games, recreational",
keywords="motivation",
abstract="Background: Pok{\'e}mon GO is the most played augmented reality game in history. With more than 44 million players at the peak of its popularity, the game has sparked interest on its effects on the young population's health. Objective: This pilot study examined motivations to start playing Pok{\'e}mon GO among a sample of US college students, and how motivations were associated with perceived outcomes of the playing experience and physical activity derived while playing. Methods: In November 2016, we asked a sample of 47 US college students (all Pok{\'e}mon GO players) to complete online surveys and install an ecological momentary assessment (EMA) tool and step counter on their smartphones. The EMA tool prompted a set of questions on playing behavior and physical activity, 3 times per day (12:00 PM, 7:00 PM, and 10:00 PM), for 7 days. We used a factorial analysis to identify 3 distinctive groups of players based on their motivations to start playing Pok{\'e}mon GO. We tested differences across motivation groups related to 5 unique outcomes using 1-way analysis of variance. Results: We extracted 3 interpretable factors from the clustering of motivations to start playing Pok{\'e}mon GO: Pok{\'e}mon and video game fans (n=26, 55\% of the sample), physical activity seekers (n=8, 17\%), and curious \& social (n=13, 28\%). The clusters differed significantly on the enjoyment of different aspects of the game, particularly battling, discovering new places, and meeting new people, as well as differences in agreement that playing improved mood and made them more social. Days when playing Pok{\'e}mon GO were associated with higher number of steps reported at the end of the day, especially among physical activity seekers, but also for Pok{\'e}mon and video game fans. All groups perceived traffic as a major threat to playing. Conclusions: Days during which Pok{\'e}mon GO was played were positively associated with a set of beneficial health behaviors, including higher physical activity levels, more socialization, and better mood. Results, however, depended on personal motivations and expectations when joining the game. These results highlight the importance of taking motivation into account when attempting to extract conclusions from the Pok{\'e}mon GO phenomenon to enhance future exergames' designs or health interventions. ",
doi="10.2196/games.8048",
url="http://games.jmir.org/2017/4/e21/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29066423"
}


@Article{info:doi/10.2196/mhealth.6675,
author="Leinonen, Anna-Maiju
and Pyky, Riitta
and Ahola, Riikka
and Kangas, Maarit
and Siirtola, Pekka
and Luoto, Tim
and Enwald, Heidi
and Ik{\"a}heimo, M. Tiina
and R{\"o}ning, Juha
and Kein{\"a}nen-Kiukaanniemi, Sirkka
and M{\"a}ntysaari, Matti
and Korpelainen, Raija
and J{\"a}ms{\"a}, Timo",
title="Feasibility of Gamified Mobile Service Aimed at Physical Activation in Young Men: Population-Based Randomized Controlled Study (MOPO)",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Oct",
day="10",
volume="5",
number="10",
pages="e146",
keywords="accelerometry",
keywords="adolescent",
keywords="behavior change",
keywords="health",
keywords="Internet",
keywords="self-monitoring",
keywords="wearable",
abstract="Background: The majority of young people do not meet the recommendations on physical activity for health. New innovative ways to motivate young people to adopt a physically active lifestyle are needed. Objective: The study aimed to study the feasibility of an automated, gamified, tailored Web-based mobile service aimed at physical and social activation among young men. Methods: A population-based sample of 496 young men (mean age 17.8 years [standard deviation 0.6]) participated in a 6-month randomized controlled trial (MOPO study). Participants were randomized to an intervention (n=250) and a control group (n=246). The intervention group was given a wrist-worn physical activity monitor (Polar Active) with physical activity feedback and access to a gamified Web-based mobile service, providing fitness guidelines, tailored health information, advice of youth services, social networking, and feedback on physical activity. Through the trial, the physical activity of the men in the control group was measured continuously with an otherwise similar monitor but providing only the time of day and no feedback. The primary outcome was the feasibility of the service based on log data and questionnaires. Among completers, we also analyzed the change in anthropometry and fitness between baseline and 6 months and the change over time in weekly time spent in moderate to vigorous physical activity. Results: Mobile service users considered the various functionalities related to physical activity important. However, compliance of the service was limited, with 161 (64.4\%, 161/250) participants visiting the service, 118 (47.2\%, 118/250) logging in more than once, and 41 (16.4\%, 41/250) more than 5 times. Baseline sedentary time was higher in those who uploaded physical activity data until the end of the trial (P=.02). A total of 187 (74.8\%, 187/250) participants in the intervention and 167 (67.9\%, 167/246) in the control group participated in the final measurements. There were no differences in the change in anthropometry and fitness from baseline between the groups, whereas waist circumference was reduced in the most inactive men within the intervention group (P=.01). Among completers with valid physical activity data (n=167), there was a borderline difference in the change in mean daily time spent in moderate to vigorous physical activity between the groups (11.9 min vs ?9.1 min, P=.055, linear mixed model). Within the intervention group (n=87), baseline vigorous physical activity was inversely associated with change in moderate to vigorous physical activity during the trial (R=?.382, P=.01). Conclusions: The various functionalities related to physical activity of the gamified tailored mobile service were considered important. However, the compliance was limited. Within the current setup, the mobile service had no effect on anthropometry or fitness, except reduced waist circumference in the most inactive men. Among completers with valid physical activity data, the trial had a borderline positive effect on moderate to vigorous physical activity. Further development is needed to improve the feasibility and adherence of an integrated multifunctional service. Trial registration: Clinicaltrials.gov NCT01376986; http://clinicaltrials.gov/ct2/show/NCT01376986 (Archived by WebCite at http://www.webcitation.org/6tjdmIroA) ",
doi="10.2196/mhealth.6675",
url="https://mhealth.jmir.org/2017/10/e146/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29017991"
}


@Article{info:doi/10.2196/games.8013,
author="Tobler-Ammann, C. Bernadette
and Surer, Elif
and Knols, H. Ruud
and Borghese, Alberto N.
and de Bruin, D. Eling",
title="User Perspectives on Exergames Designed to Explore the Hemineglected Space for Stroke Patients With Visuospatial Neglect: Usability Study",
journal="JMIR Serious Games",
year="2017",
month="Aug",
day="25",
volume="5",
number="3",
pages="e18",
keywords="usability",
keywords="user perspective",
keywords="mixed-methods",
keywords="exergames",
keywords="visuo-spatial neglect",
keywords="stroke",
abstract="Background: Visuospatial neglect due to stroke is characterized by the inability to perceive stimuli emerging in the area opposite to the side of brain damage. Besides adopting conventional rehabilitation methods to treat neglect symptoms, the use of virtual reality (VR) is becoming increasingly popular. We designed a series of 9 exergames aimed to improve exploration of the neglected side of space. When new VR interventions are designed, it is important to assess the usability aspects of such management strategies within the target population. To date, most studies used questionnaires to assess user satisfaction with the intervention or product being tested. However, only a combination of both quantitative and qualitative data allows a full picture of user perspective. Objective: The purpose of this study was to quantitatively and qualitatively assess patient and therapist perspectives of a VR intervention based on the series of 9 exergames designed to explore hemineglected space. Specifically, we wanted to evaluate (1) perceived-user friendliness of the exergames, (2) attitude towards using the exergames, and (3) intention to use the exergames in the future. Methods: A total of 19 participants (7 patients, 12 therapists) evaluated the exergames they had used 5 times a week during 3 weeks. The Technology Acceptance Model (TAM) questionnaire was filled out after the intervention. Based on those responses, we conducted focus group interviews (with therapists) and individual interviews (with patients). To analyze the TAM questionnaires, we used descriptive statistics. We adopted content and comparative analysis to analyze the interviews and drew illustration maps to analyze the focus group interviews. Results: The therapists took a more critical stance with a mean TAM questionnaire total score of 48.6 (SD 4.5) compared to the patients who had a mean total score of 56.1 (SD 12.3). The perceived user-friendliness score was 5.6 (SD 1.4) for patients and 4.9 (SD 1.4) for therapists. The attitude towards using the exergames was rated 4.8 (SD 1.9) by patients and 3.6 (SD 1.4) by therapists, respectively. The intention to use the exergames in the future was rated 3.9 (SD 2.1) by patients and 3.7 (SD 1.8) by therapists. We gained information on how to improve the exergames in the interviews. Conclusions: Patients and therapists perceived the exergames as user-friendly; however, using the games further with the actual test version was not perceived as conceivable. The therapists were generally more critical towards future use than the patients. Therefore, involving both users to achieve acceptable and user-friendly versions of game-based rehabilitation for the future is deemed crucial and warranted. Trial Registration: Clinicaltrials.gov NCT02353962; https://clinicaltrials.gov/ct2/show/NCT02353962 (Archived by WebCite at http://www.webcitation.org/6soxIJlAZ) ",
doi="10.2196/games.8013",
url="http://games.jmir.org/2017/3/e18/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28842390"
}


@Article{info:doi/10.2196/games.7923,
author="Tobler-Ammann, C. Bernadette
and Surer, Elif
and de Bruin, D. Eling
and Rabuffetti, Marco
and Borghese, Alberto N.
and Mainetti, Renato
and Pirovano, Michele
and Wittwer, Lia
and Knols, H. Ruud",
title="Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect: A Feasibility Study",
journal="JMIR Serious Games",
year="2017",
month="Aug",
day="25",
volume="5",
number="3",
pages="e17",
keywords="exergames",
keywords="eye tracking",
keywords="virtual reality",
keywords="visuospatial neglect",
keywords="feasibility",
abstract="Background: Use of exergames can complement conventional therapy and increase the amount and intensity of visuospatial neglect (VSN) training. A series of 9 exergames---games based on therapeutic principles---aimed at improving exploration of the neglected space for patients with VSN symptoms poststroke was developed and tested for its feasibility. Objectives: The goal was to determine the feasibility of the exergames with minimal supervision in terms of (1) implementation of the intervention, including adherence, attrition and safety, and (2) limited efficacy testing, aiming to document possible effects on VSN symptoms in a case series of patients early poststroke. Methods: A total of 7 patients attended the 3-week exergames training program on a daily basis. Adherence of the patients was documented in a training diary. For attrition, the number of participants lost during the intervention was registered. Any adverse events related to the exergames intervention were noted to document safety. Changes in cognitive and spatial exploration skills were measured with the Z{\"u}rich Maxi Mental Status Inventory and the Neglect Test. Additionally, we developed an Eye Tracker Neglect Test (ETNT) using an infrared camera to detect and measure neglect symptoms pre- and postintervention. Results: The median was 14 out of 15 (93\%) attended sessions, indicating that the adherence to the exergames training sessions was high. There were no adverse events and no drop-outs during the exergame intervention. The individual cognitive and spatial exploration skills slightly improved postintervention (P=.06 to P=.98) and continued improving at follow-up (P=.04 to P=.92) in 5 out of 7 (71\%) patients. Calibration of the ETNT was rather error prone. The ETNT showed a trend for a slight median group improvement from 15 to 16 total located targets (+6\%). Conclusions: The high adherence rate and absence of adverse events showed that these exergames were feasible and safe for the participants. The results of the amount of exergames use is promising for future applications and warrants further investigations---for example, in the home setting of patients to augment training frequency and intensity. The preliminary results indicate the potential of these exergames to cause improvements in cognitive and spatial exploration skills over the course of training for stroke patients with VSN symptoms. Thus, these exergames are proposed as a motivating training tool to complement usual care. The ETNT showed to be a promising assessment for quantifying spatial exploration skills. However, further adaptations are needed, especially regarding calibration issues, before its use can be justified in a larger study sample. ",
doi="10.2196/games.7923",
url="http://games.jmir.org/2017/3/e17/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28842388"
}


@Article{info:doi/10.2196/jmir.6841,
author="Meekes, Wytske
and Stanmore, Kate Emma",
title="Motivational Determinants of Exergame Participation for Older People in Assisted Living Facilities: Mixed-Methods Study",
journal="J Med Internet Res",
year="2017",
month="Jul",
day="06",
volume="19",
number="7",
pages="e238",
keywords="technology",
keywords="aged",
keywords="accidental falls",
keywords="rehabilitation",
keywords="motivation",
abstract="Background: Exergames (exercise-based videogames) for delivering strength and balance exercise for older people are growing in popularity with the emergence of new Kinect-based technologies; however, little is known about the factors affecting their uptake and usage by older people. Objective: The aim of this study was to determine the factors that may influence the motivation of older people to use exergames to improve their physical function and reduce fall risk. Methods: Mixed methods were employed in which 14 semistructured interviews were conducted with older people (n=12, aged 59-91 years) from 2 assisted living facilities in the North West of the United Kingdom. The older people participated in a 6-week trial of exergames along with one manager and one physiotherapist; 81 h of observation and Technology Acceptance Model questionnaires were conducted. Results: The findings suggest that the participants were intrinsically motivated to participate in the exergames because of the enjoyment experienced when playing the exergames and perceived improvements in their physical and mental health and social confidence. The social interaction provided in this study was an important extrinsic motivator that increased the intrinsic motivation to adhere to the exergame program. Conclusions: The findings of this study suggest that exergames may be a promising tool for delivering falls prevention exercises and increasing adherence to exercise in older people. Understanding the motivation of older people to use exergames may assist in the process of implementation. ",
doi="10.2196/jmir.6841",
url="http://www.jmir.org/2017/7/e238/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28684385"
}


@Article{info:doi/10.2196/mhealth.6233,
author="Liao, Gen-Yih
and Chien, Yu-Tai
and Chen, Yu-Jen
and Hsiung, Hsiao-Fang
and Chen, Hsiao-Jung
and Hsieh, Meng-Hua
and Wu, Wen-Jie",
title="What to Build for Middle-Agers to Come? Attractive and Necessary Functions of Exercise-Promotion Mobile Phone Apps: A Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="May",
day="25",
volume="5",
number="5",
pages="e65",
keywords="physical exercise",
keywords="middle aged",
keywords="mobile application",
keywords="self efficacy",
keywords="consumer preference",
abstract="Background: Physical activity is important for middle-agers to maintain health both in middle age and in old age. Although thousands of exercise-promotion mobile phone apps are available for download, current literature offers little understanding regarding which design features can enhance middle-aged adults' quality perception toward exercise-promotion apps and which factor may influence such perception. Objectives: The aims of this study were to understand (1) which design features of exercise-promotion apps can enhance quality perception of middle-agers, (2) whether their needs are matched by current functions offered in app stores, and (3) whether physical activity (PA) and mobile phone self-efficacy (MPSE) influence quality perception. Methods: A total of 105 middle-agers participated and filled out three scales: the International Physical Activity Questionnaire (IPAQ), the MPSE scale, and the need for design features questionnaire. The design features were developed based on the Coventry, Aberdeen, and London---Refined (CALO-RE) taxonomy. Following the Kano quality model, the need for design features questionnaire asked participants to classify design features into five categories: attractive, one-dimensional, must-be, indifferent, and reverse. The quality categorization was conducted based on a voting approach and the categorization results were compared with the findings of a prevalence study to realize whether needs match current availability. In total, 52 multinomial logistic regression models were analyzed to evaluate the effects of PA level and MPSE on quality perception of design features. Results: The Kano analysis on the total sample revealed that visual demonstration of exercise instructions is the only attractive design feature, whereas the other 51 design features were perceived with indifference. Although examining quality perception by PA level, 21 features are recommended to low level, 6 features to medium level, but none to high-level PA. In contrast, high-level MPSE is recommended with 14 design features, medium level with 6 features, whereas low-level participants are recommended with 1 feature. The analysis suggests that the implementation of demanded features could be low, as the average prevalence of demanded design features is 20\% (4.3/21). Surprisingly, social comparison and social support, most implemented features in current apps, were categorized into the indifferent category. The magnitude of effect is larger for MPSE because it effects quality perception of more design features than PA. Delving into the 52 regression models revealed that high MPSE more likely induces attractive or one- dimensional categorization, suggesting the importance of technological self-efficacy on eHealth care promotion. Conclusions: This study is the first to propose middle-agers' needs in relation to mobile phone exercise-promotion. In addition to the tailor-made recommendations, suggestions are offered to app designers to enhance the performance of persuasive features. An interesting finding on change of quality perception attributed to MPSE is proposed as future research. ",
doi="10.2196/mhealth.6233",
url="http://mhealth.jmir.org/2017/5/e65/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28546140"
}


@Article{info:doi/10.2196/jmir.6616,
author="Bartlett, Kiera Yvonne
and Webb, L. Thomas
and Hawley, S. Mark",
title="Using Persuasive Technology to Increase Physical Activity in People With Chronic Obstructive Pulmonary Disease by Encouraging Regular Walking: A Mixed-Methods Study Exploring Opinions and Preferences",
journal="J Med Internet Res",
year="2017",
month="Apr",
day="20",
volume="19",
number="4",
pages="e124",
keywords="persuasive technology",
keywords="chronic obstructive pulmonary disease",
keywords="physical activity",
keywords="walking",
keywords="mHealth",
keywords="mobile apps",
abstract="Background: People with chronic obstructive pulmonary disease (PwCOPD) often experience breathlessness and fatigue, making physical activity challenging. Although many persuasive technologies (such as mobile phone apps) have been designed to support physical activity among members of the general population, current technologies aimed at PwCOPD are underdeveloped and only use a limited range of persuasive technology design principles. Objective: The aim of this study was to explore how acceptable different persuasive technology design principles were considered to be in supporting and encouraging physical activity among PwCOPD. Methods: Three prototypes for mobile apps using different persuasive technology design principles as defined by the persuasive systems design (PSD) model---namely, dialogue support, primary task support, and social support---were developed. Opinions of these prototypes were explored through 28 interviews with PwCOPD, carers, and the health care professionals (HCPs) involved in their care and questionnaires completed by 87 PwCOPD. Participants also ranked how likely individual techniques (eg, competition) would be to convince them to use a technology designed to support physical activity. Data were analyzed using framework analysis, Friedman tests, and Wilcoxon signed rank tests and a convergent mixed methods design was used to integrate findings. Results: The prototypes for mobile apps were received positively by participants. The prototype that used a dialogue support approach was identified as the most likely to be used or recommended by those interviewed, and was perceived as more persuasive than both of the other prototypes (Z=?3.06, P=.002; Z=?5.50, P<.001) by those who completed the questionnaire. PwCOPD identified dialogue support and primary task support techniques as more likely to convince them to use a technology than social support techniques (Z=?5.00, P<.001; Z=?4.92, P<.001, respectively). Opinions of social support techniques such as competition and collaboration were divided. Conclusions: Dialogue support and primary task support approaches are considered to be both acceptable and likely to be persuasive by PwCOPD, carers, and HCPs. In the future, these approaches should be considered when designing apps to encourage physical activity by PwCOPD. ",
doi="10.2196/jmir.6616",
url="http://www.jmir.org/2017/4/e124/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28428155"
}


@Article{info:doi/10.2196/games.7197,
author="Rasche, Peter
and Schlomann, Anna
and Mertens, Alexander",
title="Who Is Still Playing Pok{\'e}mon Go? A Web-Based Survey",
journal="JMIR Serious Games",
year="2017",
month="Apr",
day="05",
volume="5",
number="2",
pages="e7",
keywords="games",
keywords="recreational",
keywords="mobile apps",
keywords="cell phones",
keywords="Pok{\'e}mon Go",
abstract="Background: Poor physical activity is one of the major health care problems in Western civilizations. Various digital gadgets aiming to increase physical activity, such as activity trackers or fitness apps, have been introduced over recent years. The newest products are serious games that incorporate real-life physical activity into their game concept. Recent studies have shown that such games increase the physical activity of their users over the short term. Objective: In this study, we investigated the motivational effects of the digital game ``Pok{\'e}mon Go'' leading to continued use or abandonment of the game. The aim of the study was to determine aspects that motivate individuals to play augmented reality exergames and how this motivation can be used to strengthen the initial interest in physical activity. Methods: A total of 199 participants completed an open self-selected Web-based survey. On the basis of their self-indicated assignment to one of three predefined user groups (active, former, and nonuser of Pok{\'e}mon Go), participants answered various questions regarding game experience, physical activity, motivation, and personality as measured by the Big Five Inventory. Results: In total, 81 active, 56 former, and 62 nonusers of Pok{\'e}mon Go were recruited. When asked about the times they perform physical activity, active users stated that they were less physically active in general than former and nonusers. However, based on a subjective rating, active users were more motivated to be physically active due to playing Pok{\'e}mon Go. Motivational aspects differed for active and former users, whereas fan status was the same within both groups. Active users are more motivated by features directly related to Pok{\'e}mon, such as catching all possible Pok{\'e}mon and reaching higher levels, whereas former users stress the importance of general game quality, such as better augmented reality and more challenges in the game. Personality did not affect whether a person started to play Pok{\'e}mon Go nor their abandonment of the game. Conclusions: The results show various motivating elements that should be incorporated into augmented reality exergames based on the game Pok{\'e}mon Go. We identified different user types for whom different features of the game contribute to maintained motivation or abandonment. Our results show aspects that augmented reality exergame designers should keep in mind to encourage individuals to start playing their game and facilitate long-term user engagement, resulting in a greater interest in physical activity. ",
doi="10.2196/games.7197",
url="http://games.jmir.org/2017/2/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28381393"
}


@Article{info:doi/10.2196/games.6421,
author="Kouwenhoven-Pasmooij, A. Tessa
and Robroek, JW Suzan
and Ling, Wai Sui
and van Rosmalen, Joost
and van Rossum, FC Elisabeth
and Burdorf, Alex
and Hunink, Myriam M. G.",
title="A Blended Web-Based Gaming Intervention on Changes in Physical Activity for Overweight and Obese Employees: Influence and Usage in an Experimental Pilot Study",
journal="JMIR Serious Games",
year="2017",
month="Apr",
day="03",
volume="5",
number="2",
pages="e6",
keywords="eHealth",
keywords="gamification",
keywords="physical activity",
keywords="fitness tracker",
keywords="body mass index",
keywords="engagement",
keywords="social support",
keywords="blended care",
abstract="Background: Addressing the obesity epidemic requires the development of effective interventions aimed at increasing physical activity (PA). eHealth interventions with the use of accelerometers and gaming elements, such as rewarding or social bonding, seem promising. These eHealth elements, blended with face-to-face contacts, have the potential to help people adopt and maintain a physically active lifestyle. Objective: The aim of this study was to assess the influence and usage of a blended Web-based gaming intervention on PA, body mass index (BMI), and waist circumference among overweight and obese employees. Methods: In an uncontrolled before-after study, we observed 52 health care employees with BMI more than 25 kg/m2, who were recruited via the company's intranet and who voluntarily participated in a 23-week Web-based gaming intervention, supplemented (blended) with non-eHealth components. These non-eHealth components were an individual session with an occupational health physician involving motivational interviewing and 5 multidisciplinary group sessions. The game was played by teams in 5 time periods, aiming to gain points by being physically active, as measured by an accelerometer. Data were collected in 2014 and 2015. Primary outcome was PA, defined as length of time at MET (metabolic equivalent task) ?3, as measured by the accelerometer during the game. Secondary outcomes were reductions in BMI and waist circumference, measured at baseline and 10 and 23 weeks after the start of the program. Gaming elements such as ``compliance'' with the game (ie, days of accelerometer wear), ``engagement'' with the game (ie, frequency of reaching a personal monthly target), and ``eHealth teams'' (ie, social influence of eHealth teams) were measured as potential determinants of the outcomes. Linear mixed models were used to evaluate the effects on all outcome measures. Results: The mean age of participants was 48.1 years; most participants were female (42/51, 82\%). The mean PA was 86 minutes per day, ranging from 6.5 to 223 minutes, which was on average 26.2 minutes per day more than self-reported PA at baseline and remained fairly constant during the game. Mean BMI was reduced by 1.87 kg/m2 (5.6\%) and waist circumference by 5.6 cm (4.8\%). The univariable model showed that compliance, engagement, and eHealth team were significantly associated with more PA, which remained significant for eHealth team in the multivariable model. Conclusions: This blended Web-based gaming intervention was beneficial for overweight workers in becoming physically active above the recommended activity levels during the entire intervention period, and a favorable influence on BMI and waist circumference was observed. Promising components in the intervention, and thus targets for upscaling, are eHealth teams and engagement with the game. Broader implementation and long-term follow-up can provide insights into the sustainable effects on PA and weight loss and into who benefits the most from this approach. ",
doi="10.2196/games.6421",
url="http://games.jmir.org/2017/2/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28373157"
}


@Article{info:doi/10.2196/games.6254,
author="Brox, Ellen
and Konstantinidis, Th Stathis
and Evertsen, Gunn",
title="User-Centered Design of Serious Games for Older Adults Following 3 Years of Experience With Exergames for Seniors: A Study Design",
journal="JMIR Serious Games",
year="2017",
month="Jan",
day="11",
volume="5",
number="1",
pages="e2",
keywords="user studies",
keywords="usability testing",
keywords="gestural input",
keywords="user-centred design",
keywords="accessibility",
keywords="consumer health",
keywords="exergames",
keywords="participatory design",
keywords="lessons learned",
abstract="Background: Seniors need sufficient balance and strength to manage in daily life, and sufficient physical activity is required to achieve and maintain these abilities. This can be a challenge, but fun and motivational exergames can be of help. However, most commercial games are not suited for this age group for several reasons. Many usability studies and user-centered design (UCD) protocols have been developed and applied, but to the best of our knowledge none of them are focusing on seniors' use of games for physical activity. In GameUp, a European cofunded project, some prototype Kinect exergames to enhance the mobility of seniors were developed in a user-centered approach. Objective: In this paper we aim to record lessons learned in 3 years of experience with exergames for seniors, considering both the needs of older adults regarding user-centered development of exergames and participation in UCD. We also provide a UCD protocol for exergames tailored to senior needs. Methods: An initial UCD protocol was formed based on literature of previous research outcomes. Senior users participated in UCD following the initial protocol. The users formed a steady group that met every second week for 3 years to play exergames and participate in the UCD during the 4 phases of the protocol. Several methods were applied in the 4 different phases of the UCD protocol; the most important methods were structured and semistructured interviews, observations, and group discussions. Results: A total of 16 seniors with an average age above 80 years participated for 3 years in UCD in order to develop the GameUp exergames. As a result of the lessons learned by applying the different methodologies of the UCD protocol, we propose an adjusted UCD protocol providing explanations on how it should be applied for seniors as users. Questionnaires should be turned into semistructured and structured interviews while user consultation sessions should be repeated with the same theme to ensure that the UCD methods produce a valid outcome. By first following the initial and gradually the adjusted UCD protocol, the project resulted in exergame functionalities and interface features for seniors. Conclusions: The main lessons learned during 3 years of experience with exergames for seniors applying UCD are that devoting time to seniors is a key element of success so that trust can be gained, communication can be established, and users' opinions can be recorded. All different game elements should be taken into consideration during the design of exergames for seniors even if they seem obvious. Despite the limitations of this study, one might argue that it provides a best practice guide to the development of serious games for physical activity targeting seniors. ",
doi="10.2196/games.6254",
url="http://games.jmir.org/2017/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28077348"
}


@Article{info:doi/10.2196/jmir.6759,
author="Althoff, Tim
and White, W. Ryen
and Horvitz, Eric",
title="Influence of Pok{\'e}mon Go on Physical Activity: Study and Implications",
journal="J Med Internet Res",
year="2016",
month="Dec",
day="06",
volume="18",
number="12",
pages="e315",
keywords="physical activity",
keywords="Pok{\'e}mon Go",
keywords="mobile health",
keywords="mHealth",
keywords="wearable devices",
keywords="mobile applications",
keywords="games",
keywords="exergames",
keywords="public health",
abstract="Background: Physical activity helps people maintain a healthy weight and reduces the risk for several chronic diseases. Although this knowledge is widely recognized, adults and children in many countries around the world do not get recommended amounts of physical activity. Although many interventions are found to be ineffective at increasing physical activity or reaching inactive populations, there have been anecdotal reports of increased physical activity due to novel mobile games that embed game play in the physical world. The most recent and salient example of such a game is Pok{\'e}mon Go, which has reportedly reached tens of millions of users in the United States and worldwide. Objective: The objective of this study was to quantify the impact of Pok{\'e}mon Go on physical activity. Methods: We study the effect of Pok{\'e}mon Go on physical activity through a combination of signals from large-scale corpora of wearable sensor data and search engine logs for 32,000 Microsoft Band users over a period of 3 months. Pok{\'e}mon Go players are identified through search engine queries and physical activity is measured through accelerometers. Results: We find that Pok{\'e}mon Go?leads to significant increases in physical activity over a period of 30 days, with particularly engaged users (ie, those making multiple search queries for details about game usage) increasing their activity by 1473 steps a day on average, a more than 25\% increase compared with their prior activity level (P<.001). In the short time span of the study, we estimate that Pok{\'e}mon Go?has added a total of 144 billion steps to US physical activity. Furthermore, Pok{\'e}mon Go?has been able to increase physical activity across men and women of all ages, weight status, and prior activity levels showing this form of game leads to increases in physical activity with significant implications for public health. In particular, we find that Pok{\'e}mon Go?is able to reach low activity populations, whereas all 4 leading mobile health apps studied in this work largely draw from an already very active population. Conclusions: Mobile apps combining game play with physical activity lead to substantial short-term activity increases and, in contrast to many existing interventions and mobile health apps, have the potential to reach activity-poor populations. Future studies are needed to investigate potential long-term effects of these applications. ",
doi="10.2196/jmir.6759",
url="http://www.jmir.org/2016/12/e315/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27923778"
}


@Article{info:doi/10.2196/jmir.4964,
author="Spook, Jorinde
and Paulussen, Theo
and Kok, Gerjo
and van Empelen, Pepijn",
title="Evaluation of a Serious Self-Regulation Game Intervention for Overweight-Related Behaviors (``Balance It''): A Pilot Study",
journal="J Med Internet Res",
year="2016",
month="Sep",
day="26",
volume="18",
number="9",
pages="e225",
keywords="Balance It",
keywords="effect evaluation",
keywords="serious game",
keywords="self-regulation",
keywords="prevention and control",
keywords="health promotion",
keywords="dietary intake",
keywords="physical activity",
abstract="Background: Serious games have the potential to promote health behavior. Because overweight is still a major issue among secondary vocational education students in the Netherlands, this study piloted the effects of ``Balance It,'' a serious self-regulation game intervention targeting students' overweight-related behaviors: dietary intake and physical activity (PA). Objective: We aimed to pilot the effects of Balance It on secondary vocational education students' dietary intake and PA. Methods: In total, 501 secondary vocational education students participated at baseline (intervention: n=250; control: n=251) in this pre-post cluster randomized trial. After 4 weeks, at immediate posttest, 231 students filled in the posttest questionnaire (intervention: n=105; control: n=126). The sample had a mean age of 17.28 (SD 1.26, range 15-21) years, 62.8\% (145/231) were female, and 26.8\% (62/231) had a non-Dutch background. Body mass index (BMI kg/m2) ranged from 14.4 to 31.1 (mean 21.1, SD 3.3). The intervention and control groups were compared on the primary (behavioral) outcomes of dietary intake (fruit and vegetable consumption, snack consumption, and soft drink consumption) and PA (moderate and vigorous). Additionally, we explored (1) differences between the intervention and control groups in determinants of dietary intake and PA, including attitude, self-efficacy, intention, barrier identification, action planning, and action control, and (2) differences between active (intervention) users and the control group in dietary intake, PA, and associated determinants. Results: After corrections for multiple testing, we did not find significant differences between the intervention group and control group in terms of dietary intake, PA, and determinants of dietary intake and PA. Exploratory research indicated that only 27.6\% (29/105) of the intervention group reported actual intervention use (ie, active users). For exploratory reasons, we compared the active users (n=29) with the control group (n=124) and corrected for multiple testing. Results showed that active users' snack consumption decreased more strongly (active users: mean change=--0.20; control group: mean change=--0.08; beta=--0.36, P=.01, R2 change=.05), and their use of active transport had a stronger increase (active users: mean change=0.92; control group=--0.12; beta=1.58, P=.02, R2 change=.03) than the control group. Results also revealed significant differences in action planning (active users: mean change=0.42; control group: mean change=0.07; beta=0.91, P=.01, R2 change=.04) and action control (active users: mean change=0.63; control group: mean change=--0.05; beta=1.25, P=.001, R2 change=.08) in terms of unhealthy eating. Conclusions: The Balance It intervention did not show favorable effects on dietary intake and PA compared to the control condition. However, only a small number of people in the intervention condition actually used Balance It (27.6\%). Exploratory analyses did suggest that, if used as planned, Balance It could contribute to changing dietary intake and PA behaviors, albeit it remains debatable whether this would be sufficient to prevent overweight. ",
doi="10.2196/jmir.4964",
url="http://www.jmir.org/2016/9/e225/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27670222"
}


@Article{info:doi/10.2196/games.5528,
author="Levac, Danielle
and Nawrotek, Joanna
and Deschenes, Emilie
and Giguere, Tia
and Serafin, Julie
and Bilodeau, Martin
and Sveistrup, Heidi",
title="Development and Reliability Evaluation of the Movement Rating Instrument for Virtual Reality Video Game Play",
journal="JMIR Serious Games",
year="2016",
month="Jun",
day="01",
volume="4",
number="1",
pages="e9",
keywords="active video games, virtual reality, physical therapy, movement, reliability",
abstract="Background: Virtual reality active video games are increasingly popular physical therapy interventions for children with cerebral palsy. However, physical therapists require educational resources to support decision making about game selection to match individual patient goals. Quantifying the movements elicited during virtual reality active video game play can inform individualized game selection in pediatric rehabilitation. Objective: The objectives of this study were to develop and evaluate the feasibility and reliability of the Movement Rating Instrument for Virtual Reality Game Play (MRI-VRGP). Methods: Item generation occurred through an iterative process of literature review and sample videotape viewing. The MRI-VRGP includes 25 items quantifying upper extremity, lower extremity, and total body movements. A total of 176 videotaped 90-second game play sessions involving 7 typically developing children and 4 children with cerebral palsy were rated by 3 raters trained in MRI-VRGP use. Children played 8 games on 2 virtual reality and active video game systems. Intraclass correlation coefficients (ICCs) determined intra-rater and interrater reliability. Results: Excellent intrarater reliability was evidenced by ICCs of >0.75 for 17 of the 25 items across the 3 raters. Interrater reliability estimates were less precise. Excellent interrater reliability was achieved for far reach upper extremity movements (ICC=0.92 [for right and ICC=0.90 for left) and for squat (ICC=0.80) and jump items (ICC=0.99), with 9 items achieving ICCs of >0.70, 12 items achieving ICCs of between 0.40 and 0.70, and 4 items achieving poor reliability (close-reach upper extremity-ICC=0.14 for right and ICC=0.07 for left) and single-leg stance (ICC=0.55 for right and ICC=0.27 for left). Conclusions: Poor video quality, differing item interpretations between raters, and difficulty quantifying the high-speed movements involved in game play affected reliability. With item definition clarification and further psychometric property evaluation, the MRI-VRGP could inform the content of educational resources for therapists by ranking games according to frequency and type of elicited body movements. ",
doi="10.2196/games.5528",
url="http://games.jmir.org/2016/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27251029"
}


@Article{info:doi/10.2196/games.4561,
author="de Vette, Frederiek
and Tabak, Monique
and Dekker - van Weering, Marit
and Vollenbroek-Hutten, Miriam",
title="Engaging Elderly People in Telemedicine Through Gamification",
journal="JMIR Serious Games",
year="2015",
month="Dec",
day="18",
volume="3",
number="2",
pages="e9",
keywords="gamification",
keywords="framework",
keywords="elderly",
keywords="older adults",
keywords="eHealth",
keywords="telemedicine",
keywords="adherence",
keywords="engagement",
keywords="classification",
keywords="player type",
keywords="personality",
abstract="Background: Telemedicine can alleviate the increasing demand for elderly care caused by the rapidly aging population. However, user adherence to technology in telemedicine interventions is low and decreases over time. Therefore, there is a need for methods to increase adherence, specifically of the elderly user. A strategy that has recently emerged to address this problem is gamification. It is the application of game elements to nongame fields to motivate and increase user activity and retention. Objective: This research aims to (1) provide an overview of existing theoretical frameworks for gamification and explore methods that specifically target the elderly user and (2) explore user classification theories for tailoring game content to the elderly user. This knowledge will provide a foundation for creating a new framework for applying gamification in telemedicine applications to effectively engage the elderly user by increasing and maintaining adherence. Methods: We performed a broad Internet search using scientific and nonscientific search engines and included information that described either of the following subjects: the conceptualization of gamification, methods to engage elderly users through gamification, or user classification theories for tailored game content. Results: Our search showed two main approaches concerning frameworks for gamification: from business practices, which mostly aim for more revenue, emerge an applied approach, while academia frameworks are developed incorporating theories on motivation while often aiming for lasting engagement. The search provided limited information regarding the application of gamification to engage elderly users, and a significant gap in knowledge on the effectiveness of a gamified application in practice. Several approaches for classifying users in general were found, based on archetypes and reasons to play, and we present them along with their corresponding taxonomies. The overview we created indicates great connectivity between these taxonomies. Conclusions: Gamification frameworks have been developed from different backgrounds---business and academia---but rarely target the elderly user. The effectiveness of user classifications for tailored game content in this context is not yet known. As a next step, we propose the development of a framework based on the hypothesized existence of a relation between preference for game content and personality. ",
doi="10.2196/games.4561",
url="http://games.jmir.org/2015/2/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26685287"
}


@Article{info:doi/10.2196/games.4275,
author="Bird, Marie-Louise
and Clark, Brodie
and Millar, Johanna
and Whetton, Sue
and Smith, Stuart",
title="Exposure to ``Exergames'' Increases Older Adults' Perception of the Usefulness of Technology for Improving Health and Physical Activity: A Pilot Study",
journal="JMIR Serious Games",
year="2015",
month="Nov",
day="27",
volume="3",
number="2",
pages="e8",
keywords="health care reform",
keywords="postural balance",
keywords="pleasure",
keywords="exercise",
keywords="perception",
abstract="Background: High rates of sedentary behaviors in older adults can lead to poor health outcomes. However, new technologies, namely exercise-based videogames (``exergames''), may provide ways of stimulating uptake and ongoing participation in physical activities. Older adults' perceptions of the use of technology to improve health are not known. Objective: The study aimed to determine use and perceptions of technology before and after using a 5-week exergame. Methods: Focus groups determined habitual use of technology and the participant's perceptions of technology to assist with health and physical activity. Surveys were developed to quantitatively measure these perceptions and were administered before and after a 5-week intervention. The intervention was an exergame that focused on postural balance (``Your Shape Fitness Evolved 2012''). Games scores, rates of game participation, and enjoyment were also recorded. Results: A total of 24 healthy participants aged between 55 and 82 years (mean 70, SD 6 years) indicated that after the intervention there was an increased awareness that technology (in the form of exergames) can assist with maintaining physical activity (P<.001). High levels of enjoyment (Physical Activity Enjoyment Scale [PACES-8] score mean 53.0, SE 0.7) and participation rates over the whole study (83\%-100\%) were recorded. Conclusions: Older adults' have low perception of the use of technology for improving health outcomes until after exposure to exergames. Technology, in the form of enjoyable exergames, may be useful for improving participation in physical activity that is relevant for older adults. ",
doi="10.2196/games.4275",
url="http://games.jmir.org/2015/2/e8/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26614263"
}


@Article{info:doi/10.2196/jmir.4568,
author="Direito, Artur
and Jiang, Yannan
and Whittaker, Robyn
and Maddison, Ralph",
title="Apps for IMproving FITness and Increasing Physical Activity Among Young People: The AIMFIT Pragmatic Randomized Controlled Trial",
journal="J Med Internet Res",
year="2015",
month="Aug",
day="27",
volume="17",
number="8",
pages="e210",
keywords="physical fitness",
keywords="motor activity",
keywords="exercise",
keywords="physical activity",
keywords="adolescent",
keywords="health promotion",
keywords="telemedicine",
keywords="mHealth",
keywords="mobile applications",
keywords="smartphone",
abstract="Background: Given the global prevalence of insufficient physical activity (PA), effective interventions that attenuate age-related decline in PA levels are needed. Mobile phone interventions that positively affect health (mHealth) show promise; however, their impact on PA levels and fitness in young people is unclear and little is known about what makes a good mHealth app. Objective: The aim was to determine the effects of two commercially available smartphone apps (Zombies, Run and Get Running) on cardiorespiratory fitness and PA levels in insufficiently active healthy young people. A second aim was to identify the features of the app design that may contribute to improved fitness and PA levels. Methods: Apps for IMproving FITness (AIMFIT) was a 3-arm, parallel, randomized controlled trial conducted in Auckland, New Zealand. Participants were recruited through advertisements in electronic mailing lists, local newspapers, flyers posted in community locations, and presentations at schools. Eligible young people aged 14-17 years were allocated at random to 1 of 3 conditions: (1) use of an immersive app (Zombies, Run), (2) use of a nonimmersive app (Get Running), or (3) usual behavior (control). Both smartphone apps consisted of a fully automated 8-week training program designed to improve fitness and ability to run 5 km; however, the immersive app featured a game-themed design and narrative. Intention-to-treat analysis was performed using data collected face-to-face at baseline and 8 weeks, and all regression models were adjusted for baseline outcome value and gender. The primary outcome was cardiorespiratory fitness, objectively assessed as time to complete the 1-mile run/walk test at 8 weeks. Secondary outcomes were PA levels (accelerometry and self-reported), enjoyment, psychological need satisfaction, self-efficacy, and acceptability and usability of the apps. Results: A total of 51 participants were randomized to the immersive app intervention (n=17), nonimmersive app intervention (n=16), or the control group (n=18). The mean age of participants was 15.7 (SD 1.2) years; participants were mostly NZ Europeans (61\%, 31/51) and 57\% (29/51) were female. Overall retention rate was 96\% (49/51). There was no significant intervention effect on the primary outcome using either of the apps. Compared to the control, time to complete the fitness test was --28.4 seconds shorter (95\% CI --66.5 to 9.82, P=.20) for the immersive app group and --24.7 seconds (95\% CI --63.5 to 14.2, P=.32) for the nonimmersive app group. No significant intervention effects were found for secondary outcomes. Conclusions: Although apps have the ability to increase reach at a low cost, our pragmatic approach using readily available commercial apps as a stand-alone instrument did not have a significant effect on fitness. However, interest in future use of PA apps is promising and highlights a potentially important role of these tools in a multifaceted approach to increase fitness, promote PA, and consequently reduce the adverse health outcomes associated with insufficient activity. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12613001030763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12613001030763 (Archived by WebCite at http://www.webcitation.org/6aasfJVTJ). ",
doi="10.2196/jmir.4568",
url="http://www.jmir.org/2015/8/e210/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26316499"
}


@Article{info:doi/10.2196/resprot.4031,
author="Imam, Bita
and Miller, C. William
and Finlayson, C. Heather
and Eng, J. Janice
and Payne, WC Michael
and Jarus, Tal
and Goldsmith, H. Charles
and Mitchell, M. Ian",
title="A Telehealth Intervention Using Nintendo Wii Fit Balance Boards and iPads to Improve Walking in Older Adults With Lower Limb Amputation (Wii.n.Walk): Study Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2014",
month="Dec",
day="22",
volume="3",
number="4",
pages="e80",
keywords="amputation",
keywords="adult",
keywords="aged",
keywords="randomized controlled trial",
keywords="telemedicine",
keywords="walking",
abstract="Background: The number of older adults living with lower limb amputation (LLA) who require rehabilitation for improving their walking capacity and mobility is growing. Existing rehabilitation practices frequently fail to meet this demand. Nintendo Wii Fit may be a valuable tool to enable rehabilitation interventions. Based on pilot studies, we have developed ``Wii.n.Walk'', an in-home telehealth Wii Fit intervention targeted to improve walking capacity in older adults with LLA. Objective: The objective of this study is to determine whether the Wii.n.Walk intervention enhances walking capacity compared to an attention control group. Methods: This project is a multi-site (Vancouver BC, London ON), parallel, evaluator-blind randomized controlled trial. Participants include community-dwelling older adults over the age of 50 years with unilateral transtibial or transfemoral amputation. Participants will be stratified by site and block randomized in triplets to either the Wii.n.Walk intervention or an attention control group employing the Wii Big Brain cognitive software. This trial will include both supervised and unsupervised phases. During the supervised phase, both groups will receive 40-minute sessions of supervised group training three times per week for a duration of 4 weeks. Participants will complete the first week of the intervention in groups of three at their local rehabilitation center with a trainer. The remaining 3 weeks will take place at participants' homes using remote supervision by the trainer using Apple iPad technology. At the end of 4 weeks, the supervised period will end and the unsupervised period will begin. Participants will retain the Wii console and be encouraged to continue using the program for an additional 4 weeks' duration. The primary outcome measure will be the ``Two-Minute Walk Test'' to measure walking capacity. Outcome measures will be evaluated for all participants at baseline, after the end of both the supervised and unsupervised phases, and after 1-year follow up. Results: Study staff have been hired and trained at both sites and recruitment is currently underway. No participants have been enrolled yet. Conclusions: Wii.n.Walk is a promising in-home telehealth intervention that may have useful applications for older adults with LLA who are discharged from rehabilitation or live in remote areas having limited or no access to existing rehabilitation programs. Trial Registration: Clinicaltrial.gov NCT01942798; http://clinicaltrials.gov/ct2/show/NCT01942798 (Archived by WebCite at http://www.webcitation.org/6V0w8baKP). ",
doi="10.2196/resprot.4031",
url="http://www.researchprotocols.org/2014/4/e80/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25533902"
}


@Article{info:doi/10.2196/jmir.3154,
author="Garrido Navarro, Enrique Juan
and Ruiz Penichet, Manuel Victor
and Lozano P{\'e}rez, Dolores Mar{\'i}a",
title="Movement-Based Interaction Applied to Physical Rehabilitation Therapies",
journal="J Med Internet Res",
year="2014",
month="Dec",
day="09",
volume="16",
number="12",
pages="e281",
keywords="exercise movement techniques",
keywords="human--computer interaction",
keywords="interaction devices",
keywords="movement-based interaction",
keywords="rehabilitation therapies",
abstract="Background: Health care environments are continuously improving conditions, especially regarding the use of current technology. In the field of rehabilitation, the use of video games and related technology has helped to develop new rehabilitation procedures. Patients are able to work on their disabilities through new processes that are more motivating and entertaining. However, these patients are required to leave their home environment to complete their rehabilitation programs. Objective: The focus of our research interests is on finding a solution to eliminate the need for patients to interrupt their daily routines to attend rehabilitation therapy. We have developed an innovative  system that allows patients with a balance disorder to perform a specific rehabilitation exercise at home. Additionally, the system features an assistive tool to complement the work of physiotherapists. Medical staff are thus provided with a system that avoids the need for them to be present during the exercise in specific cases in which patients are under suitable supervision. Methods: A movement-based interaction device was used to achieve a reliable system for monitoring rehabilitation exercises performed at home. The system accurately utilizes parameters previously defined by the specialist for correct performance of the exercise. Accordingly, the system gives instructions and corrects the patient's actions. The data generated during the session are collected for assessment by the specialist to adapt the difficulty of the exercise to the patient's progress. Results: The evaluation of the system was conducted by two experts in balance disorder rehabilitation.  They were required to verify the effectiveness of the system, and they also facilitated the simulation of real patient behavior. They used the system freely for a period of time and provided interesting and optimistic feedback. First, they evaluated the system as a tool for real-life rehabilitation therapy. Second, their interaction with the system allowed us to obtain important feedback needed to improve the system. Conclusions: The system improves the rehabilitation conditions of people with balance disorder. The main contribution comes from the fact that it allows patients to carry out the rehabilitation process at home under the supervision of physiotherapists. As a result, patients avoid having to attend medical centers. Additionally, medical staff have access to an assistant, which means their presence is not required in many exercises that involve constant repetition. ",
doi="10.2196/jmir.3154",
url="http://www.jmir.org/2014/12/e281/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25491148"
}


@Article{info:doi/10.2196/games.3691,
author="Moller, C. Arlen
and Majewski, Sara
and Standish, Melanie
and Agarwal, Pooja
and Podowski, Aleksandra
and Carson, Rebecca
and Eyesus, Biruk
and Shah, Aakash
and Schneider, L. Kristin",
title="Active Fantasy Sports: Rationale and Feasibility of Leveraging Online Fantasy Sports to Promote Physical Activity",
journal="JMIR Serious Games",
year="2014",
month="Nov",
day="25",
volume="2",
number="2",
pages="e13",
keywords="physical activity",
keywords="games for health",
keywords="active video game",
keywords="exergame",
keywords="asynchronous",
keywords="social support",
keywords="multiplayer",
keywords="enjoyment",
keywords="intrinsic motivation",
keywords="sports",
abstract="Background: The popularity of active video games (AVGs) has skyrocketed over the last decade. However, research suggests that the most popular AVGs, which rely on synchronous integration between players' activity and game features, fail to promote physical activity outside of the game or for extended periods of engagement. This limitation has led researchers to consider AVGs that involve asynchronous integration of players' ongoing physical activity with game features. Rather than build an AVG de novo, we selected an established sedentary video game uniquely well suited for the incorporation of asynchronous activity: online fantasy sports. Objective: The primary aim of this study was to explore the feasibility of a new asynchronous AVG---active fantasy sports---designed to promote physical activity. Methods: We conducted two pilot studies of an active fantasy sports game designed to promote physical activity. Participants wore a low cost triaxial accelerometer and participated in an online fantasy baseball (Study 1, n=9, 13-weeks) or fantasy basketball (Study 2, n=10, 17-weeks) league. Privileges within the game were made contingent on meeting weekly physical activity goals (eg, averaging 10,000 steps/day). Results: Across the two studies, the feasibility of integrating physical activity contingent features and privileges into online fantasy sports games was supported. Participants found the active fantasy sports game enjoyable, as or more enjoyable than traditional (sedentary) online fantasy sports (Study 1: t8=4.43, P<.01; Study 2: t9=2.09, P=.07). Participants in Study 1 increased their average steps/day, t8=2.63, P<.05, while participants in Study 2 maintained (ie, did not change) their activity, t9=1.57, P=.15). In postassessment interviews, social support within the game was cited as a key motivating factor for increasing physical activity. Conclusions: Preliminary evidence supports potential for the active fantasy sports system as a sustainable and scalable intervention for promoting adult physical activity. ",
doi="10.2196/games.3691",
url="http://games.jmir.org/2014/2/e13/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25654304"
}


@Article{info:doi/10.2196/games.2933,
author="Lozano-Quilis, Jose-Antonio
and Gil-G{\'o}mez, Hermenegildo
and Gil-G{\'o}mez, Jose-Antonio
and Albiol-P{\'e}rez, Sergio
and Palacios-Navarro, Guillermo
and Fardoun, M. Habib
and Mashat, S. Abdulfattah",
title="Virtual Rehabilitation for Multiple Sclerosis Using a Kinect-Based System: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2014",
month="Nov",
day="12",
volume="2",
number="2",
pages="e12",
keywords="multiple sclerosis",
keywords="motor rehabilitation",
keywords="virtual reality",
keywords="natural interfaces",
keywords="augmented reality",
abstract="Background: The methods used for the motor rehabilitation of patients with neurological disorders include a number of different rehabilitation exercises. For patients who have been diagnosed with multiple sclerosis (MS), the performance of motor rehabilitation exercises is essential. Nevertheless, this rehabilitation may be tedious, negatively influencing patients' motivation and adherence to treatment. Objective: We present RemoviEM, a system based on Kinect that uses virtual reality (VR) and natural user interfaces (NUI) to offer patients with MS an intuitive and motivating way to perform several motor rehabilitation exercises. It offers therapists a new motor rehabilitation tool for the rehabilitation process, providing feedback on the patient's progress. Moreover, it is a low-cost system, a feature that can facilitate its integration in clinical rehabilitation centers. Methods: A randomized and controlled single blinded study was carried out to assess the influence of a Kinect-based virtual rehabilitation system on the balance rehabilitation of patients with MS. This study describes RemoviEM and evaluates its effectiveness compared to standard rehabilitation. To achieve this objective, a clinical trial was carried out. Eleven patients from a MS association participated in the clinical trial. The mean age was 44.82 (SD 10.44) and the mean time from diagnosis (years) was 9.77 (SD 10.40). Clinical effectiveness was evaluated using clinical balance scales. Results: Significant group-by-time interaction was detected in the scores of the Berg Balance Scale (P=.011) and the Anterior Reach Test in standing position (P=.011). Post-hoc analysis showed greater improvement in the experimental group for these variables than in the control group for these variables. The Suitability Evaluation Questionnaire (SEQ) showed good results in usability, acceptance, security, and safety for the evaluated system. Conclusions: The results obtained suggest that RemoviEM represents a motivational and effective alternative to traditional motor rehabilitation for MS patients. These results have encouraged us to improve the system with new exercises, which are currently being developed. ",
doi="10.2196/games.2933",
url="http://games.jmir.org/2014/2/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25654242"
}


@Article{info:doi/10.2196/games.3413,
author="Lister, Cameron
and West, H. Joshua
and Cannon, Ben
and Sax, Tyler
and Brodegard, David",
title="Just a Fad? Gamification in Health and Fitness Apps",
journal="JMIR Serious Games",
year="2014",
month="Aug",
day="04",
volume="2",
number="2",
pages="e9",
keywords="gamification",
keywords="mobile phone",
keywords="behavioral health",
keywords="health and fitness apps",
abstract="Background: Gamification has been a predominant focus of the health app industry in recent years. However, to our knowledge, there has yet to be a review of gamification elements in relation to health behavior constructs, or insight into the true proliferation of gamification in health apps. Objective: The objective of this study was to identify the extent to which gamification is used in health apps, and analyze gamification of health and fitness apps as a potential component of influence on a consumer's health behavior. Methods: An analysis of health and fitness apps related to physical activity and diet was conducted among apps in the Apple App Store in the winter of 2014. This analysis reviewed a sample of 132 apps for the 10 effective game elements, the 6 core components of health gamification, and 13 core health behavior constructs. A regression analysis was conducted in order to measure the correlation between health behavior constructs, gamification components, and effective game elements. Results: This review of the most popular apps showed widespread use of gamification principles, but low adherence to any professional guidelines or industry standard. Regression analysis showed that game elements were associated with gamification (P<.001). Behavioral theory was associated with gamification (P<.05), but not game elements, and upon further analysis gamification was only associated with composite motivational behavior scores (P<.001), and not capacity or opportunity/trigger. Conclusions: This research, to our knowledge, represents the first comprehensive review of gamification use in health and fitness apps, and the potential to impact health behavior. The results show that use of gamification in health and fitness apps has become immensely popular, as evidenced by the number of apps found in the Apple App Store containing at least some components of gamification. This shows a lack of integrating important elements of behavioral theory from the app industry, which can potentially impact the efficacy of gamification apps to change behavior. Apps represent a very promising, burgeoning market and landscape in which to disseminate health behavior change interventions. Initial results show an abundant use of gamification in health and fitness apps, which necessitates the in-depth study and evaluation of the potential of gamification to change health behaviors. ",
doi="10.2196/games.3413",
url="http://games.jmir.org/2014/2/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25654660"
}


@Article{info:doi/10.2196/games.3092,
author="Simons, Monique
and de Vet, Emely
and Chinapaw, JM Mai
and de Boer, Michiel
and Seidell, C. Jacob
and Brug, Johannes",
title="Personal, Social, and Game-Related Correlates of Active and Non-Active Gaming Among Dutch Gaming Adolescents: Survey-Based Multivariable, Multilevel Logistic Regression Analyses",
journal="JMIR Serious Games",
year="2014",
month="Apr",
day="04",
volume="2",
number="1",
pages="e4",
keywords="video games",
keywords="interactive games",
keywords="active games",
keywords="adolescent",
keywords="sedentary lifestyle",
keywords="physical activity",
keywords="determinants",
abstract="Background: Playing video games contributes substantially to sedentary behavior in youth. A new generation of video games---active games---seems to be a promising alternative to sedentary games to promote physical activity and reduce sedentary behavior. At this time, little is known about correlates of active and non-active gaming among adolescents. Objective: The objective of this study was to examine potential personal, social, and game-related correlates of both active and non-active gaming in adolescents. Methods: A survey assessing game behavior and potential personal, social, and game-related correlates was conducted among adolescents (12-16 years, N=353) recruited via schools. Multivariable, multilevel logistic regression analyses, adjusted for demographics (age, sex and educational level of adolescents), were conducted to examine personal, social, and game-related correlates of active gaming ?1 hour per week (h/wk) and non-active gaming >7 h/wk. Results: Active gaming ?1 h/wk was significantly associated with a more positive attitude toward active gaming (OR 5.3, CI 2.4-11.8; P<.001), a less positive attitude toward non-active games (OR 0.30, CI 0.1-0.6; P=.002), a higher score on habit strength regarding gaming (OR 1.9, CI 1.2-3.2; P=.008) and having brothers/sisters (OR 6.7, CI 2.6-17.1; P<.001) and friends (OR 3.4, CI 1.4-8.4; P=.009) who spend more time on active gaming and a little bit lower score on game engagement (OR 0.95, CI 0.91-0.997; P=.04). Non-active gaming >7 h/wk was significantly associated with a more positive attitude toward non-active gaming (OR 2.6, CI 1.1-6.3; P=.035), a stronger habit regarding gaming (OR 3.0, CI 1.7-5.3; P<.001), having friends who spend more time on non-active gaming (OR 3.3, CI 1.46-7.53; P=.004), and a more positive image of a non-active gamer (OR 2, CI 1.07--3.75; P=.03). Conclusions: Various factors were significantly associated with active gaming ?1 h/wk and non-active gaming >7 h/wk. Active gaming is most strongly (negatively) associated with attitude with respect to non-active games, followed by observed active game behavior of brothers and sisters and attitude with respect to active gaming (positive associations). On the other hand, non-active gaming is most strongly associated with observed non-active game behavior of friends, habit strength regarding gaming and attitude toward non-active gaming (positive associations). Habit strength was a correlate of both active and non-active gaming, indicating that both types of gaming are habitual behaviors. Although these results should be interpreted with caution because of the limitations of the study, they do provide preliminary insights into potential correlates of active and non-active gaming that can be used for further research as well as preliminary direction for the development of effective intervention strategies for replacing non-active gaming by active gaming among adolescents. ",
doi="10.2196/games.3092",
url="http://games.jmir.org/2014/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25654657"
}


@Article{info:doi/10.2196/jmir.2403,
author="Lyons, Jane Elizabeth
and Hatkevich, Claire",
title="Prevalence of Behavior Changing Strategies in Fitness Video Games: Theory-Based Content Analysis",
journal="J Med Internet Res",
year="2013",
month="May",
day="07",
volume="15",
number="5",
pages="e81",
keywords="video game",
keywords="theory",
keywords="content analysis",
keywords="fitness",
keywords="physical activity",
keywords="exergame",
abstract="Background: Fitness video games are popular, but little is known about their content. Because many contain interactive tools that mimic behavioral strategies from weight loss intervention programs, it is possible that differences in content could affect player physical activity and/or weight outcomes. There is a need for a better understanding of what behavioral strategies are currently available in fitness games and how they are implemented. Objective: The purpose of this study was to investigate the prevalence of evidence-based behavioral strategies across fitness video games available for home use. Games available for consoles that used camera-based controllers were also contrasted with games available for a console that used handheld motion controllers. Methods: Fitness games (N=18) available for three home consoles were systematically identified and play-tested by 2 trained coders for at least 3 hours each. In cases of multiple games from one series, only the most recently released game was included. The Sony PlayStation 3 and Microsoft Xbox360 were the two camera-based consoles, and the Nintendo Wii was the handheld motion controller console. A coding list based on a taxonomy of behavioral strategies was used to begin coding. Codes were refined in an iterative process based on data found during play-testing. Results: The most prevalent behavioral strategies were modeling (17/18), specific performance feedback (17/18), reinforcement (16/18), caloric expenditure feedback (15/18), and guided practice (15/18). All games included some kind of feedback on performance accuracy, exercise frequency, and/or fitness progress. Action planning (scheduling future workouts) was the least prevalent of the included strategies (4/18). Twelve games included some kind of social integration, with nine of them providing options for real-time multiplayer sessions. Only two games did not feature any kind of reward. Games for the camera-based consoles (mean 12.89, SD 2.71) included a greater number of strategies than those for the handheld motion controller console (mean 10.00, SD 2.74, P=.04). Conclusions: Behavioral strategies for increasing self-efficacy and self-regulation are common in home console fitness video games. Social support and reinforcement occurred in approximately half of the studied games. Strategy prevalence varies by console type, partially due to greater feedback afforded by camera-based controllers. Experimental studies are required to test the effects of these strategies when delivered as interactive tools, as this medium may represent an innovative platform for disseminating evidence-based behavioral weight loss intervention components. ",
doi="10.2196/jmir.2403",
url="http://www.jmir.org/2013/5/e81/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23651701"
}