@Article{info:doi/10.2196/50992,
author="Rico-Olarte, Carolina
and Lopez, M. Diego
and Eskofier, M. Bjoern
and Becker, Linda",
title="Electrophysiological Insights in Exergaming---Electroencephalography Data Recording and Movement Artifact Detection: Systematic Review",
journal="JMIR Serious Games",
year="2025",
month="Apr",
day="7",
volume="13",
pages="e50992",
keywords="exergaming",
keywords="EEG",
keywords="brain activity",
keywords="motion artifact",
keywords="artifact removal",
abstract="Background: Exergames are interactive solutions that require physical activity and are commonly used in learning or rehabilitation settings. For cognitive rehabilitation with exergames, the assessment of the intervention progress can be conducted by verifying the changes in brain activity. Electroencephalography (EEG) is a well-known method for this evaluation. However, motion artifacts due to large body movements can impede signal quality. No comprehensive guide on the artifact removal methods in the context of exergaming has been found. Objective: This paper aimed to identify studies that have assessed EEG signals while a user interacts with an exergame and the applied methods for data handling and analysis with a focus on dealing with movement artifacts. Methods: This review included studies on human participants while engaging in exergames, where the primary outcome was brain activity measured by EEG. A total of 5 databases were searched at 3 time points: March 2021, October 2022, and February 2024. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies assessed methodological quality, rating studies as ``good,'' ``fair,'' or ``poor.'' Data were synthesized quantitatively to identify characteristics across studies, including sample demographics and intervention details, and basic statistics (mean [SD]) were calculated. Results: A total of 494 papers were screened, resulting in 17 studies having been included. All studies carried out EEG recordings during exergame interactions, primarily assessing attention and concentration, with the alpha wave being the most analyzed EEG band. Common motion artifact removal methods included visual inspection and independent component analysis. The review identified significant risks of bias, with 2 studies rated as ``good,'' 7 as ``fair,'' and 8 as ``poor.'' Due to the small number of studies and their heterogeneity, a meta-analysis was not feasible. Conclusions: The study successfully identifies the feasibility of recording electrophysiological brain activity during exergaming and provides insights into EEG devices, analysis methods, and exergaming systems used in previous studies. However, limitations, such as the lack of sufficient detail on motion artifact removal and a focus on short-term effects, underscore the need for improved methodologies and reporting standards, with recommendations for enhancing reliability in cognitive rehabilitation with exergames. ",
doi="10.2196/50992",
url="https://games.jmir.org/2025/1/e50992"
}


@Article{info:doi/10.2196/64742,
author="Chen, Yuyin
and Zhang, Yuanyuan
and Long, Xiuhong
and Tu, Huiqiong
and Chen, Jibing",
title="Effectiveness of Virtual Reality--Complemented Pulmonary Rehabilitation on Lung Function, Exercise Capacity, Dyspnea, and Health Status in Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="7",
volume="27",
pages="e64742",
keywords="virtual reality",
keywords="video games",
keywords="exergaming",
keywords="pulmonary rehabilitation",
keywords="chronic obstructive pulmonary disease",
keywords="lung function",
keywords="exercise capacity",
keywords="dyspnea",
keywords="health status",
keywords="randomized controlled trial",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition characterized by persistent airflow obstruction. Pulmonary rehabilitation (PR) is a cornerstone of COPD management but remains underutilized due to barriers such as low motivation and accessibility issues. Virtual reality (VR)--complemented PR offers a novel approach to overcoming these barriers by enhancing patient engagement and rehabilitation outcomes. Objective: This review aims to evaluate the effect of VR-complemented PR compared with comparators on lung function, exercise capacity, dyspnea, health status, and oxygenation in patients with COPD. Additionally, the study aimed to identify which comparator type (active exercise vs nonactive exercise control group) and intervention duration would result in the greatest improvements in rehabilitation outcomes. The study also assessed patient-reported experience measures, including acceptability and engagement. Methods: A comprehensive search of 11 international and Chinese databases identified randomized controlled trials (RCTs) published up to November 2024. Data were analyzed using RevMan 5.4, with pooled effect sizes reported as mean differences (MDs) and 95\% CIs. Results: A total of 16 RCTs involving 1052 participants were included. VR-complemented PR significantly improved lung function (forced expiratory volume in 1 second [FEV1] [L], MD 0.25, P<.001; FEV1/forced vital capacity [FVC], MD 6.12, P<.001; FVC, MD 0.28, P<.001) compared with comparators. Exercise capacity, assessed by the 6MWD, significantly improved (MD 23.49, P<.001) compared with comparators; however, it did not reach the minimally clinically important difference of 26 m, indicating limited clinical significance despite statistical significance. VR-complemented PR also significantly reduced dyspnea measured by the modified British Medical Research Council scale (MD --0.28, P<.001), improved health status measured by the COPD Assessment Test (MD --2.95, P<.001), and enhanced oxygenation status measured by SpO2 (MD 1.35, P=.04) compared with comparators. Subgroup analyses revealed that VR-complemented PR had a significantly greater effect on FEV1 (L) (MD 0.32, P=.005) and 6MWD (MD 40.93, P<.001) compared with the nonactive exercise control group. Additionally, VR-complemented PR showed a greater improvement in FEV1/FVC (MD 6.15, P<.001) compared with the active exercise control group. Intervention duration influenced outcomes, with 5-12-week programs showing the greatest improvement in 6MWD (MD 38.96, P<.001). VR-complemented PR was well-accepted, with higher adherence and engagement rates than comparators. Conclusions: VR-complemented PR significantly improves lung function, exercise capacity, dyspnea, health status, and oxygenation in patients with COPD compared with comparators, while enhancing adherence and engagement. Subgroup analyses showed greater effects on FEV1 (L) and 6MWD compared with the nonactive exercise control group, and a larger improvement in FEV1/FVC compared with the active exercise control group. Interventions (5-12 weeks) yielded the most significant benefits in exercise capacity. These findings highlight VR as a promising adjunct to traditional PR, with future research focusing on long-term outcomes and standardized protocols. ",
doi="10.2196/64742",
url="https://www.jmir.org/2025/1/e64742"
}


@Article{info:doi/10.2196/66593,
author="Boots, Brenden
and Berg, Daniel
and Hewitt, Easton
and Naugle, Keith
and Naugle, Kelly",
title="Physical Activity and Enjoyment in Active Virtual Reality Games in Youth: Comparative Analysis of Gorilla Tag and Beat Saber",
journal="JMIR Serious Games",
year="2025",
month="Apr",
day="1",
volume="13",
pages="e66593",
keywords="active gaming",
keywords="movement",
keywords="Gorilla Tag",
keywords="Beat Saber",
keywords="virtual reality",
keywords="VR",
keywords="physical activity",
keywords="youth",
keywords="early adolescents",
keywords="young adults",
keywords="gaming",
keywords="heart rate",
keywords="exergame",
keywords="enjoyment",
abstract="Background: Virtual reality (VR) active gaming is growing in popularity, but little is known about physical activity during gameplay. Two popular VR games are Gorilla Tag (Another Axiom Inc) and Beat Saber (Beat Games). Little is known about physical activity during these games in youth. Objective: The purpose of this study was to investigate the enjoyment, intensity, and amount of physical activity while playing Gorilla Tag and Beat Saber in early adolescent youth. Methods: Sixteen participants, 13 males and 3 females with an average age of 10.7 (SD 0.34) years, played 2 VR games (Gorilla Tag and Beat Saber) in a single session. Both games followed the same procedure: a maximum of 10-minute familiarization period, 5 minutes of rest, 15 minutes of gameplay, and 10 minutes of rest. Participants wore a heart rate monitor to track heart rate reserve (\%HRR) and accelerometers on the wrist and waist to monitor time in sedentary activity, light physical activity, and moderate to vigorous physical activity of the arm and whole body. The Physical Activity Enjoyment Scale--Child Version (PACES) and ratings of perceived exertion (RPE) were completed after each game. Dependent t tests compared measures between games. Results: The results revealed that average and maximum \%HRR were significantly higher during Gorilla Tag than during Beat Saber, with heart rate--based physical activity intensity reaching light for Beat Saber and moderate for Gorilla Tag. Arm moderate to vigorous physical activity and whole-body moderate to vigorous physical activity and light physical activity were greater during Gorilla Tag than during Beat Saber. Arm and whole-body sedentary time were significantly lower during Gorilla Tag than during Beat Saber. Gorilla Tag and Beat Saber were rated as highly enjoyable. There were no differences between games for maximum (P=.352) or average (P=.362) RPE. Both games were rated as light intensity for average RPE (Gorilla Tag: mean 4.3, SD 1.9; Beat Saber: mean 4.7, SD 2.3) and moderate intensity for maximum RPE (Gorilla Tag: mean 5.4, SD 1.9; Beat Saber: mean 5.8, SD 2.4). Conclusions: These results suggest that Beat Saber produced light-intensity physical activity and Gorilla Tag produced light- to moderate-intensity physical activity in early adolescent youth, with both games rated as highly enjoyable. ",
doi="10.2196/66593",
url="https://games.jmir.org/2025/1/e66593"
}


@Article{info:doi/10.2196/72565,
author="Kannan, Lakshmi
and Bhatt, Tanvi",
title="Authors' Reply: Addressing the Digital Divide Among the Older Population Presents a Substantial Challenge",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="28",
volume="27",
pages="e72565",
keywords="exergame training",
keywords="Matter of Balance",
keywords="MOB",
keywords="pre-frail",
keywords="tele-exergame",
keywords="tele-rehabilitation",
keywords="gaming-based",
keywords="tele-exercise",
keywords="physical function",
keywords="frailty",
keywords="older adults",
keywords="aging",
keywords="physical activity",
keywords="dementia",
keywords="CogXergaming",
keywords="telehealth",
keywords="dynamic balance",
doi="10.2196/72565",
url="https://www.jmir.org/2025/1/e72565"
}


@Article{info:doi/10.2196/69482,
author="Xie, Su-hang",
title="Addressing the Digital Divide Among the Older Population Presents a Substantial Challenge",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="28",
volume="27",
pages="e69482",
keywords="exergame training",
keywords="Matter of Balance",
keywords="MOB",
keywords="pre-frail",
keywords="tele-exergame",
keywords="tele-rehabilitation",
keywords="gaming-based",
keywords="tele-exercise",
keywords="physical function",
keywords="frailty",
keywords="older adults",
keywords="aging",
keywords="physical activity",
keywords="dementia",
keywords="CogXergaming",
keywords="telehealth",
keywords="dynamic balance",
doi="10.2196/69482",
url="https://www.jmir.org/2025/1/e69482"
}


@Article{info:doi/10.2196/65562,
author="Miranda, Macedo Juliana
and Browne, Vieira Rodrigo Alberto
and da Silva, Alves Weslley Quirino
and Rodrigues dos Santos, Paulo Jo{\~a}o
and Campbell, Grubert Carmen Silvia
and Ramos, Almeida Isabela",
title="Effects of a Session of Exergames and Traditional Games on Inhibitory Control in Children With Autism Spectrum Disorder: Randomized Controlled Crossover Trial",
journal="JMIR Serious Games",
year="2025",
month="Mar",
day="5",
volume="13",
pages="e65562",
keywords="children",
keywords="pediatric",
keywords="autism",
keywords="ASD, autistic",
keywords="behavior",
keywords="exergame",
keywords="physical education",
keywords="exercise",
keywords="physical activity",
keywords="cognition",
keywords="anthropometric",
keywords="Flanker test",
keywords="inhibitory control",
keywords="randomized control trial",
keywords="crossover",
abstract="Background: Autism spectrum disorder (ASD) is characterized by deficits in executive functions, such as inhibitory control, which affect behavior and social adaptation. Although physical activity--based interventions, such as exergames, have shown potential to improve these functions, their comparative effects with active traditional games remain underexplored, particularly regarding inhibitory control in children with ASD. Objective: We aim to analyze the effects of a session of exergames and active traditional games on inhibitory control in children with ASD. Methods: This randomized controlled crossover trial included 9 male children with ASD (mean age 8.6, SD 1.4 y). Participants completed three 20-minute experimental sessions in random order, with a minimum interval of 48 hours: (1) active traditional games, (2) exergames using Just Dance 2022, and (3) a control session with manual painting activities. Inhibitory control was assessed 5 minutes postsession using a modified flanker task in the E-Prime (version 3.0; Psychological Software Tools Inc) program, recording reaction time (RT) and accuracy in congruent and incongruent phases. Repeated measures ANOVA was used to compare RT and accuracy between experimental and control conditions. Data are presented as means and 95\% CIs. Results: There was a statistically significant effect of condition on RT in the incongruent phase (P=.02). RT in the exergame session (849 ms, 95\% CI 642 to 1057) was lower compared to the traditional games (938 ms, 95\% CI 684 to 1191; P=.02) and control (969 ms, 95\% CI 742, 1196 to P=.01) sessions. No significant differences were observed in RT during the congruent phase or in accuracy across either phase. Conclusions: A 20-minute session of exergame improved inhibitory control performance in children with ASD compared to active traditional games and painting activities. Trial Registration: Brazilian Registry of Clinical Trials (ReBEC) RBR-5r9xzbq, Universal Trial Number U1111-1302-3490; https://ensaiosclinicos.gov.br/rg/RBR-5r9xzbq ",
doi="10.2196/65562",
url="https://games.jmir.org/2025/1/e65562"
}


@Article{info:doi/10.2196/60185,
author="Legarra-Gorgo{\~n}on, Gaizka
and Garc{\'i}a-Alonso, Yesenia
and Ram{\'i}rez-V{\'e}lez, Robinson
and Alonso-Mart{\'i}nez, Loreto
and Izquierdo, Mikel
and Alonso-Mart{\'i}nez, M. Alicia",
title="Effect of a Gamified Family-Based Exercise Intervention on Adherence to 24-Hour Movement Behavior Recommendations in Preschool Children: Single-Center Pragmatic Trial",
journal="JMIR Serious Games",
year="2025",
month="Mar",
day="4",
volume="13",
pages="e60185",
keywords="children",
keywords="gamification",
keywords="exercise",
keywords="physical fitness",
keywords="domains of physical activity",
keywords="game",
keywords="fitness",
keywords="child",
keywords="family-based",
keywords="exercise program",
keywords="randomized controlled trial",
keywords="strength",
abstract="Background: Adherence to 24-hour movement behavior recommendations, including physical activity (PA), sedentary time, and sleep, is essential for the healthy development of preschool children. Gamified family-based interventions have shown the potential to improve adherence to these guidelines, but evidence of their effectiveness among children is limited. Objective: This study aimed to evaluate the effectiveness of a gamified family-based exercise intervention in promoting adherence to 24-hour movement behavior recommendations among preschool-aged children. Methods: This 12-week study is a single-center, pragmatic randomized controlled trial that included 80 preschool children (56\% boys) and their families, who were randomly assigned to either the gamification group (n=40) or the control group (n=40). The ``3, 2, 1 Move on Study'' incorporates family-oriented physical activities and gamification techniques to increase PA domains, reduce sedentary behavior, and improve sleep patterns. The primary outcome was to increase\thinspacemoderate to vigorous PA (MVPA) by 5 minutes/day, as measured by accelerometer at follow-up. Accelerometer-determined daily time spent (PA domains, sedentary behavior, and sleep), physical fitness (cardiorespiratory, speed-agility, muscular, physical fitness z-score), basic motor competencies (self-movement and object movement), and executive function (memory, cognitive flexibility, and inhibitory control) were also included as secondary outcomes. Results: The 71 participants included in the per-protocol analyses (32 girls, 45\%; 39 boys, 55\%) had a mean (SD) age of 5.0 (0.5) years. Change in MVPA per day after the intervention (12 weeks) increased in both groups by +25.3 (SD 24.6) minutes/day in the gamification group and +10.0 (SD 31.4) minutes/day in the routine care group, but no significant between-group differences were observed (8.62, 95\% CI --5.72 to 22.95 minutes/day, $\eta$p2=.025; P=.23). The analysis of secondary outcomes showed significant between-group mean differences in the change in physical behaviors derived from the accelerometers from baseline to follow-up of 26.44 (95\% CI 8.93 to 43.94) minutes/day in favor of light PA ($\eta$p2=.138; P=.01) and 30.88 (95\% CI 4.36 to 57.41) minutes/day in favor of total PA, which corresponds to a large effect size ($\eta$p2=.087; P=.02). Likewise, the gamification group substantially increased their score in standing long jump and physical fitness z-score from baseline (P<.05). Conclusions: In the ``3, 2, 1 Move on Study,'' a gamified intervention showed a modest but relevant increase in MVPA and other domains of 24-hour movement behavior among preschool-aged children. Therefore, gamified family-based interventions may provide a viable alternative to improve adherence to 24-hour movement behavior recommendations. Trial Registration: ClinicalTrials.gov NCT05741879; https://clinicaltrials.gov/study/NCT05741879?tab=history ",
doi="10.2196/60185",
url="https://games.jmir.org/2025/1/e60185"
}


@Article{info:doi/10.2196/57802,
author="Mia, Raihan Md
and Ahamed, Iqbal Sheikh
and Nemanich, Samuel",
title="Gamified mHealth System for Evaluating Upper Limb Motor Performance in Children: Cross-Sectional Feasibility Study",
journal="JMIR Serious Games",
year="2025",
month="Feb",
day="28",
volume="13",
pages="e57802",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="mobile apps",
keywords="smartphones",
keywords="iPad",
keywords="gamification",
keywords="serious games",
keywords="digital interventions",
keywords="digital technology",
keywords="spatiotemporal",
keywords="upper limb movement",
keywords="motor performance",
keywords="motor skills",
keywords="pediatrics",
keywords="toddler",
keywords="children",
keywords="youth",
abstract="Background: Approximately 17\% of children in the United States have been diagnosed with a developmental or neurological disorder that affects upper limb (UL) movements needed for completing activities of daily living. Gold-standard laboratory assessments of the UL are objective and precise but may not be portable, while clinical assessments can be time-intensive. We developed MoEvGame, a mobile health (mHealth) gamification software system for the iPad, as a potential advanced technology to assess UL motor functions. Objective: This feasibility study examines whether MoEvGame can assess children's whole-limb movement, fine motor skills, manual dexterity, and bimanual coordination. The specific aims were to (1) design and develop novel mHealth gamified software tools to examine theory-driven features of UL movement, (2) analyze spatiotemporal game data with new algorithms and statistical techniques to quantify movement performance as a parameter of speed, accuracy, and precision, and (3) validate assessment methods with healthy participants from schools. Methods: Elementary school children (N=31, median 9.0, IQR 4.0-14.0 years old) participated by playing 5 games. The game tasks were focused on key features of skilled motor control: (1) whole limb reaching, (2) fine motor control and manual dexterity, and (3) bilateral coordination. Spatiotemporal game data were transferred and stored in a cloud-based data management server for further processing and analysis. We applied change point detection (ie, the pruned exact linear time method), signal processing techniques, and other algorithms to calculate movement speed and accuracy from spatiotemporal parameters. Different statistical methods (ie, Pearson correlation, mean, standard deviation, P value, 95\% confidence interval) were used to compare speed-accuracy tradeoffs and evaluate the relationship between age and motor performance. Results: A negative correlation was identified between speed and accuracy in the whole limb movement (r=--0.30 to --0.42). Significant relationships between age and upper limb performance were found: older participants exhibited lower errors with faster completion times compared to younger participants. Significant differences in bimanual coordination were found related to phase synchronization (in-phase congruent [mean 28.85, SD 18.97] vs antiphase congruent [mean 112.64, SD 25.82] and in-phase mirrored [mean 23.78, SD 16.07] vs antiphase mirrored [mean 121.39, SD 28.19]). Moreover, the average speed (revolutions per second) and travel distance (m) of the in-phase mode were significantly higher than those of the antiphase coordination. Conclusions: Results of this feasibility study show that spatiotemporal data captured from the mHealth app can quantify motor performance. Moving beyond traditional assessments, MoEvGame incorporates gamification into ubiquitous and accessible technology as a fast, flexible, and objective tool for UL motor assessment. ",
doi="10.2196/57802",
url="https://games.jmir.org/2025/1/e57802",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053722"
}


@Article{info:doi/10.2196/69205,
author="Balloufaud, Maxime
and Boujut, Arnaud
and Marie, Romain
and Guinaldo, Aur{\'e}lie
and Fourcade, Laurent
and Hamonet-Torny, Julia
and Perrochon, Anaick",
title="Augmented Reality Exergames for Upcoming Cognitive-Motor Rehabilitation: User-Centered Design Approach and User Experience of Healthy Children",
journal="JMIR Rehabil Assist Technol",
year="2025",
month="Feb",
day="19",
volume="12",
pages="e69205",
keywords="augmented reality",
keywords="exergames",
keywords="user experience",
keywords="healthy children",
keywords="cognitive-motor intervention",
abstract="Background: Traditional rehabilitation programs for children with cerebral palsy and acquired brain injuries aim to enhance motor and cognitive abilities through repetitive exercises, which are often perceived as tedious and demotivating. Extended reality technologies, including augmented reality (AR) and virtual reality, offer more engaging methods through exergames. However, to date, no AR exergames simultaneously integrate cognitive and motor aspects within navigational tasks. Developing these exergames necessitates rigorous methodological steps, especially when using emerging technologies such as AR. The MIDE (Multidisciplinary Iterative Design of Exergames) framework advocates a participatory design approach, involving users from the outset, the objective being to optimize the interface and validate game mechanics through user experience (UX) assessment. Some researchers initially test these mechanisms on healthy children before applying them to clinical populations. Objective: This study aims to evaluate the UX of our AR exergames, consisting of two games (AR Corsi and AR Zoo), in typically developing children. Methods: Typically developing children participated in two 1.5-hour sessions. During each session, they played one of two AR games using the Microsoft HoloLens 2 headset: AR Corsi and AR Zoo, both of which are designed to engage executive functions and motor skills through navigational capabilities. UX was assessed after each session using the following measures: System Usability Scale scores for usability, AttrakDiff for attractiveness and game quality, MeCue for emotional experience, and Rating scale of Perceived Exertion for Children for pre- and postsession mental and physical fatigue. Results: A total of 27 participants (mean age 11.9, SD 1.2 years) were included in the study. Mean System Usability Scale scores were 79.9 (SD 11.4) for AR Corsi and 76.3 (SD 12.1) for AR Zoo, indicating good usability. The AttrakDiff questionnaire yielded favorable results, with scores between 1 and 3 for overall attractiveness, pragmatic quality, and stimulation for both AR games. However, the hedonic quality ``identity'' received neutral scores (mean 0.6, SD 0.5 for AR Corsi and mean 0.7, SD 0.8 for AR Zoo). The MeCue emotions module yielded average scores of 5.2 (SD 0.7) for AR Corsi and 5.3 (SD 0.8) for AR Zoo, significantly exceeding the theoretical mean of 4 (P<.001). We observed a significant effect of physical fatigue (P=.02) and mental fatigue (P=.002) after exposure to both games. A comparative analysis of UX between the two games showed no significant differences. Conclusions: This study demonstrates that our exergame, comprising two AR games, is user-friendly and well-received by typically developing children, eliciting positive emotions and overall appeal. Although some children reported fatigue, favorable UX evaluation confirms the validity of the game's content and mechanisms, suggesting its suitability for use among children with cerebral palsy and acquired brain injuries. ",
doi="10.2196/69205",
url="https://rehab.jmir.org/2025/1/e69205",
url="http://www.ncbi.nlm.nih.gov/pubmed/39970421"
}


@Article{info:doi/10.2196/69109,
author="Li, Aoyu
and Qiang, Wei
and Li, Jingwen
and Geng, Yan
and Qiang, Yan
and Zhao, Juanjuan",
title="Evaluating the Clinical Efficacy of an Exergame-Based Training Program for Enhancing Physical and Cognitive Functions in Older Adults With Mild Cognitive Impairment and Dementia Residing in Rural Long-Term Care Facilities: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="19",
volume="27",
pages="e69109",
keywords="exergame",
keywords="mild cognitive impairment",
keywords="dementia",
keywords="long-term care facilities",
keywords="multicomponent training",
abstract="Background: Cognitive impairment is an important public health challenge among older adults, particularly in long-term care facilities (LTCFs), where prevalence is higher due to staffing shortages, limited resources, and difficulty maintaining structured exercise programs. Furthermore, older adults often lose interest in repetitive interventions. The exergame ``WarioWare: Move It!'' (Nintendo) offers a novel solution by combining aerobic exercise, motor coordination, balance training, and cognitive engagement into an immersive experience. Objective: This study aimed to assess the clinical efficacy of an exergame-based training program delivered via ``WarioWare: Move It!'' in improving physical flexibility, joint range of motion, motor coordination, hand dexterity, and cognitive function in older adults living in LTCFs. Methods: The training program was conducted across multiple rural LTCFs in Shanxi Province, China. Participants were randomly assigned to the intervention or control group. The intervention protocol encompassed two 60-minute sessions per week over 12 weeks, using motion-sensing exercises such as waving, jumping, arm swinging, rotational movements, and object-mimicking postures with Joy-Con controllers. Primary outcome measures were derived through clinical tests, including the sit and reach test, shoulder flexibility test, trunk rotation flexibility test, shoulder and elbow range of motion, figure-of-8 walk test, standing balance test, hand dexterity test, and cognitive function tests. Statistical analysis was performed using mixed ANOVA, with time as the within-participant factor and intervention group as the between-participant factor, to assess the training effects on the various outcome measures. Results: A total of 232 participants were recruited, including 32 (13.8\%) patients with mild dementia, 18 (7.8\%) with moderate dementia, and 182 (78.4\%) with mild cognitive impairment, all of whom completed the study. The mixed ANOVA revealed significant group {\texttimes} time interactions across multiple physical flexibility assessments, including the remaining distance between the hands and toes during the forward bend (F2,156=8.484; P<.001; $\eta${\texttwosuperior}=0.098), the distance between the hands clasped behind the back (F2,156=3.666; P=.04; $\eta${\texttwosuperior}=0.045), and the angle formed by trunk rotation to the left and right (F2,156=17.353; P<.001; $\eta${\texttwosuperior}=0.182). Significant group {\texttimes} time interactions also emerged for shoulder joint forward flexion (F2,156=17.655; P<.001; $\eta${\texttwosuperior}=0.185), abduction (F2,156=6.281; P=.004; $\eta${\texttwosuperior}=0.075), and elbow flexion (F2,156=3.298; P=.049; $\eta${\texttwosuperior}=0.041). In addition, the time to complete the figure-of-8 walk test (F2,156=11.846; P<.001; $\eta${\texttwosuperior}=0.132) and the number of blocks moved within 1 minute (F2,156=4.016; P=.02; $\eta${\texttwosuperior}=0.049) showed significant interactions. Finally, all scale-based measures exhibited statistically significant group {\texttimes} time interactions (all P values <.001). Conclusions: The ``WarioWare: Move It!'' intervention significantly improved physical flexibility, joint range of motion, motor coordination, hand dexterity, and cognitive function among older adults with mild cognitive impairment or dementia residing in rural LTCFs. The intervention offers an innovative and feasible approach for promoting the health of older adults in resource-limited settings, demonstrating its potential for widespread application in diverse low-resource environments. Trial Registration: ClinicalTrials.gov NCT06717971; https://clinicaltrials.gov/study/NCT06717971 ",
doi="10.2196/69109",
url="https://www.jmir.org/2025/1/e69109",
url="http://www.ncbi.nlm.nih.gov/pubmed/39969990"
}


@Article{info:doi/10.2196/68251,
author="Kimhy, David
and Ospina, H. Luz
and Wall, Melanie
and Alschuler, M. Daniel
and Jarskog, F. Lars
and Ballon, S. Jacob
and McEvoy, Joseph
and Bartels, N. Matthew
and Buchsbaum, Richard
and Goodman, Marianne
and Miller, A. Sloane
and Stroup, Scott T.",
title="Telehealth-Based vs In-Person Aerobic Exercise in Individuals With Schizophrenia: Comparative Analysis of Feasibility, Safety, and Efficacy",
journal="JMIR Ment Health",
year="2025",
month="Feb",
day="14",
volume="12",
pages="e68251",
keywords="schizophrenia",
keywords="psychosis",
keywords="exercise",
keywords="aerobic fitness",
keywords="VO2max",
keywords="telehealth",
keywords="telemedicine",
keywords="COVID-19",
keywords="clinical trial",
keywords="safety",
keywords="maximum oxygen consumption",
abstract="Background: Aerobic exercise (AE) training has been shown to enhance aerobic fitness in people with schizophrenia. Traditionally, such training has been administered in person at gyms or other communal exercise spaces. However, following the advent of the COVID-19 pandemic, many clinics transitioned their services to telehealth-based delivery. Yet, at present, there is scarce information about the feasibility, safety, and efficacy of telehealth-based AE in this population. Objective: To examine the feasibility, safety, and efficacy of trainer-led, at-home, telehealth-based AE in individuals with schizophrenia. Methods: We analyzed data from the AE arm (n=37) of a single-blind, randomized clinical trial examining the impact of a 12-week AE intervention in people with schizophrenia. Following the onset of the COVID-19 pandemic, the AE trial intervention transitioned from in-person to at-home, telehealth-based delivery of AE, with the training frequency and duration remaining identical. We compared the feasibility, safety, and efficacy of the delivery of trainer-led AE training among participants undergoing in-person (pre--COVID-19; n=23) versus at-home telehealth AE (post--COVID-19; n=14). Results: The telehealth and in-person participants attended a similar number of exercise sessions across the 12-week interventions (26.8, SD 10.2 vs 26.1, SD 9.7, respectively; P=.84) and had similar number of weeks with at least 1 exercise session (10.4, SD 3.4 vs 10.6, SD 3.1, respectively; P=.79). The telehealth-based AE was associated with a significantly lower drop-out rate (telehealth: 0/14, 0\%; in-person: 7/23, 30.4\%; P=.04). There were no significant group differences in total time spent exercising (telehealth: 1246, SD 686 min; in-person: 1494, SD 580 min; P=.28); however, over the 12-week intervention, the telehealth group had a significantly lower proportion of session-time exercising at or above target intensity (telehealth: 33.3\%, SD 21.4\%; in-person: 63.5\%, SD 16.3\%; P<.001). There were no AE-related serious adverse events associated with either AE delivery format. Similarly, there were no significant differences in the percentage of participants experiencing minor or moderate adverse events, such as muscle soreness, joint pain, blisters, or dyspnea (telehealth: 3/14, 21\%; in-person: 5/19, 26\%; P>.99) or in the percentage of weeks per participant with at least 1 exercise-related adverse event (telehealth: 31\%, SD 33\%; in-person: 40\%, SD 33\%; P=.44). There were no significant differences between the telehealth versus in-person groups regarding changes in aerobic fitness as indexed by maximum oxygen consumption (VO2max; P=.27). Conclusions: Our findings provide preliminary support for the delivery of telehealth-based AE for individuals with schizophrenia. Our results indicate that in-home telehealth-based AE is feasible and safe in this population, although when available, in-person AE appears preferable given the opportunity for social interactions and the higher intensity of exercises. We discuss the findings' clinical implications, specifically within the context of the COVID-19 pandemic, as well as review potential challenges for the implementation of telehealth-based AE among people with schizophrenia. ",
doi="10.2196/68251",
url="https://mental.jmir.org/2025/1/e68251"
}


@Article{info:doi/10.2196/66979,
author="Anguera, A. Joaquin
and Choudhry, Aleem
and Seaman, Michael
and Fedele, Dominick",
title="Assessing the Impact of a Virtual Reality Cognitive Intervention on Tennis Performance in Junior Tennis Players: Pilot Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="7",
volume="9",
pages="e66979",
keywords="executive function",
keywords="serious games",
keywords="cognitive training",
keywords="performance enhancement",
keywords="athletes",
keywords="sport",
keywords="pilot study",
keywords="VR",
keywords="virtual reality",
keywords="serious game",
keywords="tennis",
keywords="adolescents",
keywords="teenagers",
keywords="youth",
keywords="randomized controlled trial",
keywords="players",
abstract="Background: There is evidence that cognitive training interventions can positively impact executive functions, and that some studies have demonstrated that athletes typically exhibit greater accuracy and faster response times on select cognitive tasks. While the engagement of executive functions is suggested to be part of high-level sporting activities, it is unclear whether such training approaches could directly benefit athletic performance. Objective: The objective of this study was to evaluate the impact of a combined virtual reality (VR)-- and tablet-based cognitive training intervention on adolescent tennis players' performance. Here, we examined differences in Universal Tennis Rating (UTR) between players who supplemented their regular tennis training with a cognitive training intervention and a group that continued regular tennis training alone. This custom cognitive training program targeted specific cognitive control abilities including attention, working memory, and goal management. Methods: Data were collected from a cohort of tennis players in a randomized controlled trial design led by the dedicated research team. Participants (N=23, age: mean 14.8, SD 2.4 years) from the Czech Lawn Tenis Klub (Prague, Czech Republic) were invited to participate in this study. These individuals were randomized into an intervention + training-as-usual group (n=13) or training-as-usual group (control group; n=10), with the change in UTR score being the primary metric of interest. Results: There was no difference in UTR between the 2 groups at baseline (intervention: mean 8.32, SD 2.7; control: mean 7.60, SD 2.3). Following the treatment period, individuals in the intervention group showed a significant improvement in their UTR (an increase of 0.5; t12=4.88, P<.001) unlike the control group (an increase of 0.02; t9=1.77, P=.12). On comparing the change in UTR (posttraining UTR minus pretraining UTR) attained by each group, we found that the intervention group had a 38\% greater improvement in UTR than the control group. An analysis of covariance revealed a significantly greater improvement in UTR for the intervention group than for the control group (F1,20=8.82, P=.008). Conclusions: The present findings suggest that training cognitive abilities through an immersive visual platform may benefit athletic performance, including tennis. Such a result warrants careful consideration, given the known difficulties in evidencing far transfer not only in cognitive studies but also in athletic activities. These preliminary pilot findings suggest that the Mastermind Cognitive Training program may be a viable tool for supplementing athletic training practices, although this result warrants further investigation and replication. However, many questions remain unanswered, and further work is needed to better understand the potential utility and mechanisms underlying potential effects of such a platform. ",
doi="10.2196/66979",
url="https://formative.jmir.org/2025/1/e66979",
url="http://www.ncbi.nlm.nih.gov/pubmed/39918854"
}


@Article{info:doi/10.2196/57443,
author="Wu, Richard
and Chakka, Keerthana
and Belko, Sara
and Khargonkar, Ninad
and Desai, Kevin
and Prabhakaran, Balakrishnan
and Annaswamy, Thiru",
title="Comparing In-Person, Standard Telehealth, and Remote Musculoskeletal Examination With a Novel Augmented Reality Exercise Game System: Pilot Cross-Sectional Comparison Study",
journal="JMIR Serious Games",
year="2025",
month="Feb",
day="5",
volume="13",
pages="e57443",
keywords="physical examination",
keywords="telemedicine",
keywords="tele-health",
keywords="virtual care",
keywords="virtual health",
keywords="telerehabilitation",
keywords="augmented reality",
keywords="AR",
keywords="game",
keywords="simulation",
keywords="digital world",
keywords="virtual environment",
keywords="motion",
keywords="strength",
keywords="force",
keywords="musculoskeletal",
keywords="remote examination",
keywords="exercise",
keywords="physical examinations",
keywords="telehealth",
keywords="cross-sectional",
keywords="VIRTEPEX",
keywords="patient",
keywords="exergame",
abstract="Background: Current telemedicine technologies are not fully optimized for conducting physical examinations. The Virtual Remote Tele-Physical Examination (VIRTEPEX) system, a novel proprietary technology platform using a Microsoft Kinect-based augmented reality game system to track motion and estimate force, has the potential to assist with conducting asynchronous, remote musculoskeletal examinations. Objective: This pilot study evaluated the feasibility of the VIRTEPEX system as a supplement to telehealth musculoskeletal strength assessments. Methods: In this cross-sectional pilot study, 12 study participants with upper extremity pain and/or weakness underwent strength evaluations for four upper extremity movements using in-person, telehealth, VIRTEPEX, and composite (telehealth plus VIRTEPEX) assessments. The evaluators were blinded to each other's assessments. The primary outcome was feasibility, as determined by participant recruitment, study completion, and safety. The secondary outcome was preliminary evaluation of inter-rater agreement between in-person, telehealth, and VIRTEPEX strength assessments, including $\kappa$ statistics. Results: This pilot study had an 80\% recruitment rate, a 100\% completion rate, and reported no adverse events. In-person and telehealth evaluations achieved highest overall agreement (85.71\%), followed by agreements between in-person and composite (75\%), in-person and VIRTEPEX (62.5\%), and telehealth and VIRTEPEX (62.5\%) evaluations. However, for shoulder flexion, agreement between in-person and VIRTEPEX evaluations (78.57\%; $\kappa$=0.571, 95\% CI 0.183 to 0.960) and in-person and composite evaluations (78.57\%; $\kappa$=0.571, 95\% CI 0.183 to 0.960) was higher than that between in-person and telehealth evaluations (71.43\%; $\kappa$=0.429, 95\% CI ?0.025 to 0.882). Conclusions: This study demonstrates the feasibility of asynchronous VIRTEPEX examinations and supports the potential for VIRTEPEX to supplement and add value to standard telehealth platforms. Further studies with an additional development of VIRTEPEX and larger sample sizes for adequate power are warranted. ",
doi="10.2196/57443",
url="https://games.jmir.org/2025/1/e57443"
}


@Article{info:doi/10.2196/57297,
author="Sarai, Gurdeep
and Jayaraman, Prakash Prem
and Tirosh, Oren
and Wickramasinghe, Nilmini",
title="Exploring Virtual Reality and Exercise Simulator Interventions in Patients With Attention Deficit Hyperactivity Disorder: Comprehensive Literature Review",
journal="JMIR Serious Games",
year="2025",
month="Jan",
day="29",
volume="13",
pages="e57297",
keywords="exercise-based simulator",
keywords="exergame",
keywords="virtual reality",
keywords="physical activity",
keywords="attention-deficit/hyperactivity disorder",
abstract="Background: This review explores virtual reality (VR) and exercise simulator--based interventions for individuals with attention-deficit/hyperactivity disorder (ADHD). Past research indicates that both VR and simulator-based interventions enhance cognitive functions, such as executive function and memory, though their impacts on attention vary. Objective: This study aimed to contribute to the ongoing scientific discourse on integrating technology-driven interventions into the management and evaluation of ADHD. It specifically seeks to consolidate findings on how VR and exercise simulators may support individuals with ADHD, acknowledging associated challenges and implications inherent in both technological approaches. Methods: This research looks at existing literature to examine the potential efficacy of VR and exercise simulator--based interventions for individuals with ADHD. It evaluates the capacity of these interventions to address specific challenges along with an emphasis on the adjustments for accommodating unique user behaviors. Additionally, it underscores the limited exploration of user perceptions of exercise simulator--based interventions and the undervalued role of motor function in both ADHD assessment and symptom management. Results: The findings of this scoping review reveal that, while these interventions enhance user motivation and enjoyment, certain challenges resist modification through technology. Furthermore, this study explores the intricate complexities involved in customizing these technologies to accommodate the diverse aspects of user behavior and highlights the potential limitations in the use of VR. Conclusions: This scoping review contributes to the ongoing research on enhancing interventions to support individuals with ADHD. It advocates for participant-centric approaches that aim to optimize both cognitive and motor outcomes while prioritizing the enhancement of user experiences. This study emphasizes the need for a comprehensive approach to interventions, recognizing the relationship between cognitive and motor abilities, and calls for improving technological interventions to address the varied needs of individuals with ADHD. ",
doi="10.2196/57297",
url="https://games.jmir.org/2025/1/e57297",
url="http://www.ncbi.nlm.nih.gov/pubmed/39879092"
}


@Article{info:doi/10.2196/69080,
author="Nakagomi, Atsushi
and Ide, Kazushige
and Kondo, Katsunori
and Shiba, Koichiro",
title="Digital Gaming and Subsequent Health and Well-Being Among Older Adults: Longitudinal Outcome-Wide Analysis",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="27",
volume="27",
pages="e69080",
keywords="digital gaming",
keywords="older adults",
keywords="flourishing",
keywords="well-being",
keywords="physical activity",
keywords="social engagement",
keywords="mobile phone",
abstract="Background: Digital gaming has become increasingly popular among older adults, potentially offering cognitive, social, and physical benefits. However, its broader impact on health and well-being, particularly in real-world settings, remains unclear. Objective: This study aimed to evaluate the multidimensional effects of digital gaming on health and well-being among older adults, using data from the Japan Gerontological Evaluation Study conducted in Matsudo City, Chiba, Japan. Methods: Data were drawn from 3 survey waves (2020 prebaseline, 2021 baseline, and 2022 follow-up) of the Japan Gerontological Evaluation Study, which targets functionally independent older adults. The exposure variable, digital gaming, was defined as regular video game play and was assessed in 2021. In total, 18 outcomes across 6 domains were evaluated in 2022; domain 1---happiness and life satisfaction, domain 2---physical and mental health, domain 3---meaning and purpose, domain 4---character and virtue, domain 5---close social relationships, and domain 6---health behavior. Furthermore, 10 items from the Human Flourishing Index were included in domains 1-5, with 2 items for each domain. Overall flourishing was defined as the average of the means across these 5 domains. In addition, 7 items related to domains 2, 5, and 6 were assessed. The final sample consisted of 2504 participants aged 65 years or older, with questionnaires containing the Human Flourishing Index randomly distributed to approximately half of the respondents (submodule: n=1243). Consequently, we used 2 datasets for analysis. We applied targeted maximum likelihood estimation to estimate the population average treatment effects, with Bonferroni correction used to adjust for multiple testing. Results: Digital gaming was not significantly associated with overall flourishing or with any of the 5 domains from the Human Flourishing Index. Although initial analyses indicated associations between digital gaming and participation in hobby groups (mean difference=0.12, P=.005) as well as meeting with friends (mean difference=0.076, P=.02), these associations did not remain significant after applying the Bonferroni correction for multiple testing. In addition, digital gaming was not associated with increased sedentary behavior or reduced outdoor activities. Conclusions: This study provides valuable insights into the impact of digital gaming on the health and well-being of older adults in a real-world context. Although digital gaming did not show a significant association with improvements in flourishing or in the individual items across the 5 domains, it was also not associated with increased sedentary behavior or reduced outdoor activities. These findings suggest that digital gaming can be part of a balanced lifestyle for older adults, offering opportunities for social engagement, particularly through hobby groups. Considering the solitary nature of gaming, promoting social gaming opportunities may be a promising approach to enhance the positive effects of digital gaming on well-being. ",
doi="10.2196/69080",
url="https://www.jmir.org/2025/1/e69080"
}


@Article{info:doi/10.2196/64410,
author="Yu, Tianzhuo
and Parry, Monica
and Yu, Tianyue
and Xu, Linqi
and Wu, Yuejin
and Zeng, Ting
and Leng, Xin
and Tong, Qian
and Li, Feng",
title="Effectiveness of Mobile Health--Based Gamification Interventions for Improving Physical Activity in Individuals With Cardiovascular Diseases: Systematic Review and Meta-Analysis of Randomized Controlled Trials",
journal="JMIR Serious Games",
year="2025",
month="Jan",
day="24",
volume="13",
pages="e64410",
keywords="cardiovascular diseases",
keywords="digital health",
keywords="mobile health",
keywords="gamification",
keywords="exercise",
keywords="physical activity",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Gamification refers to using game design elements in nongame contexts. Promoting physical activity (PA) through gamification is a novel and promising avenue for improving lifestyles and mitigating the advancement of cardiovascular diseases (CVDs). However, evidence of its effectiveness remains mixed. Objective: This systematic review and meta-analysis aimed to evaluate the efficacy of gamification interventions in promoting PA during short-term and follow-up periods in individuals with CVDs and to explore the most effective game design elements. Methods: A comprehensive search of 7 electronic databases was conducted for randomized controlled trials published in English from January 1, 2010, to February 3, 2024. Eligible studies used mobile health--based gamification interventions to promote PA or reduce sedentary behavior in individuals with CVDs. In total, 2 independent reviewers screened the retrieved records, extracted data, and evaluated the risk of bias using the RoB 2 tool. Discrepancies were resolved by a third reviewer. Meta-analyses were performed using a random-effects model with the Sidik-Jonkman method adjusted by the Knapp-Hartung method. Sensitivity analysis and influence analysis examined the robustness of results, while prediction intervals indicated heterogeneity. A meta-regression using a multimodel inference approach explored the most important game design elements. Statistical analyses were conducted using R (version 4.3.2; R Foundation for Statistical Computing). Results: In total, 6 randomized controlled trials were included. Meta-analysis of 5 studies revealed a small effect of gamification interventions on short-term PA (after sensitivity analysis: Hedges g=0.32, 95\% CI 0.19-0.45, 95\% prediction interval [PI] 0.02-0.62). Meta-analysis of 3 studies found the maintenance effect (measured with follow-up averaging 2.5 months after the end of the intervention) was small (Hedges g=0.20, 95\% CI 0.12-0.29, 95\% PI --0.01 to 0.41). A meta-analysis of 3 studies found participants taking 696.96 more steps per day than the control group (95\% CI 327.80 to 1066.12, 95\% PI --121.39 to 1515.31). ``Feedback'' was the most important game design element, followed by ``Avatar.'' Conclusions: This meta-analysis demonstrates that gamification interventions effectively promote PA in individuals with CVD, with effects persisting beyond the intervention period, indicating they are not merely novel effects caused by the game nature of gamification. The 95\% PI suggests that implementing gamification interventions in similar populations in the future will lead to actual effects in promoting PA in the vast majority of cases. However, the limited number of included studies underscores the urgent need for more high-quality research in this emerging field. Trial Registration: PROSPERO CRD42024518795; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=518795 ",
doi="10.2196/64410",
url="https://games.jmir.org/2025/1/e64410"
}


@Article{info:doi/10.2196/50669,
author="Chang, Chien-Hsiang
and Wei, Chun-Chun
and Lien, Wei-Chih
and Yang, Tai-Hua
and Liu, Bo
and Lin, Yimo
and Tan, Thong Poh
and Lin, Yang-Cheng",
title="The Usability and Effect of a Novel Intelligent Rehabilitation Exergame System on Quality of Life in Frail Older Adults: Prospective Cohort Study",
journal="JMIR Serious Games",
year="2025",
month="Jan",
day="21",
volume="13",
pages="e50669",
keywords="frailty",
keywords="exergame",
keywords="older adults",
keywords="intelligent rehabilitation",
keywords="reminiscence therapy",
keywords="eHealth care",
abstract="Background: Aging in older adults results in a decline in physical function and quality of daily life. Due to the COVID-19 pandemic, the exercise frequency among older adults decreased, further contributing to frailty. Traditional rehabilitation using repetitive movements tends not to attract older adults to perform independently. Objective: Intelligent Rehabilitation Exergame System (IRES), a novel retro interactive exergame that incorporates real-time surface electromyography, was developed and evaluated. Methods: Frail older adults were invited to use the IRES for rehabilitation using lower limb training twice per week for 4 weeks. Participants were required to have no mobility or communication difficulties and be willing to complete the 4-week study. The enrolled cohort had baseline scores ranging from 1 to 5 on the Clinical Frailty Scale, as described by Rockwood et al. Three major lower limb movements (knee extension, plantar flexion, and dorsiflexion) were performed 20 times for each leg within 30 minutes. The surface electromyography collected and analyzed muscle potential signals for review by health care professionals to customize the protocol for the next training. The System Usability Scale (SUS) and Taiwanese version of the EuroQol-5 Dimensions (EQ-5D) were administered after completing the first (week 1, baseline) and last training (week 4, one-month follow-up) to evaluate the usability of the IRES and its effects on the quality of life of participants. Results: A total of 49 frail older adults (mean age 74.6 years) were included in the analysis. The usability of the IRES improved according to the mean SUS score, from 82.09 (good) at baseline to 87.14 (good+) at 1-month follow-up. The willingness to use (t96=?4.51; P<.001), learnability (t96=?4.83; P<.001), and confidence (t96=?2.27; P=.02) in working with the IRES increased. After using the IRES for 1 month, significant improvements were observed in the ease of use (t47=2.05; P=.04) and confidence (t47=2.68; P<.001) among participants without previous rehabilitation experience. No sex-based differences in the SUS scores were found at baseline or 1-month follow-up. The quality of life, as assessed by the EQ-5D, improved significantly after 1 month of IRES training compared to that at baseline (t96=6.03; P<.001). Conclusions: The novel IRES proposed in this study received positive feedback from frail older adults. Integrating retro-style exergame training into rehabilitation not only improved their rehabilitation motivation but also increased their learning, system operability, and willingness to continue rehabilitation. The IRES provides an essential tool for the new eHealth care service in the post--COVID-19 era. ",
doi="10.2196/50669",
url="https://games.jmir.org/2025/1/e50669"
}


@Article{info:doi/10.2196/64560,
author="Zhao, Jing
and Yasunaga, Akitomo
and Kaczynski, T. Andrew
and Park, Hyuntae
and Luo, Yufeng
and Li, Jiuling
and Shibata, Ai
and Ishii, Kaori
and Yano, Shohei
and Oka, Koichiro
and Koohsari, Javad Mohammad",
title="At-Home Immersive Virtual Reality Exergames to Reduce Cardiometabolic Risk Among Office Workers: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="20",
volume="14",
pages="e64560",
keywords="metabolic syndrome",
keywords="noncommunicable diseases",
keywords="active video game",
keywords="interactive virtual reality environment",
keywords="physical activity",
keywords="workplace health",
keywords="at-home intervention",
abstract="Background: The worldwide rise in the prevalence of noncommunicable diseases has increased the recognition of the need to identify modifiable risk factors for preventing and managing these diseases. The office worker, as a representative group of physically inactive workers, is exposed to risk factors for metabolic syndrome, which is a primary driver of noncommunicable diseases. The use of virtual reality (VR) exergames may offer a potential solution to the problem of increasing noncommunicable disease prevalence, as it can help individuals increase their physical activity levels while providing a more immersive experience. Objective: This exploratory study aims to examine the interventional efficacy of at-home immersive VR exergames on metabolic syndrome biomarkers among office workers. Additionally, it seeks to investigate the impacts of at-home immersive VR exergames on the active and sedentary behaviors of office workers. Methods: A 3-arm, single-blinded pilot randomized controlled trial will be conducted to examine the therapeutic effects of at-home immersive VR exergames. A total of 120 Chinese office workers, engaging in less than 150 minutes per week of moderate to vigorous intensity physical activity, will be recruited via a convenience sampling method. The participants, who will be tested over a 12-week period, will be randomly assigned to one of three groups: (1) the VR exergame intervention group, (2) the regular physical activity control group, and (3) the nonexercise control group. Throughout the 12-week trial, three categories of variables will be collected across the three groups: clinical risk factors associated with metabolic syndrome, active and sedentary behaviors, and demographics. To analyze variance among the groups, a mixed linear model will be applied to assess the efficacy of each group. Differences in metabolic syndrome clinical risk factors among all groups will be used to evaluate the effects of at-home immersive VR exergames. Changes in active and sedentary behaviors will also be used to determine the impacts of VR exergames on metabolic syndrome. Results: The ethics committee of Guangzhou University, China, approved this study on September 25, 2024. Participant recruitment will begin in early 2025 and continue for approximately 3 months. Data will be analyzed after the 12-week trial is completed, with full results expected to be presented in early 2026. Conclusions: This study explores an emerging topic by applying an at-home immersive VR exergame intervention, potentially contributing to understanding the effects of an exergame program on metabolic syndrome risk among office workers. Trial Registration: ClinicalTrials.gov NCT06556784; https://clinicaltrials.gov/study/NCT06556784 International Registered Report Identifier (IRRID): PRR1-10.2196/64560 ",
doi="10.2196/64560",
url="https://www.researchprotocols.org/2025/1/e64560"
}


@Article{info:doi/10.2196/53045,
author="Su, Kuan-Chu
and Wu, Ko-Chiu
and Chou, Kuei-Ru
and Huang, Chia-Hsu",
title="Tongue Muscle Training App for Middle-Aged and Older Adults Incorporating Flow-Based Gameplay: Design and Feasibility Pilot Study",
journal="JMIR Serious Games",
year="2025",
month="Jan",
day="9",
volume="13",
pages="e53045",
keywords="exergame",
keywords="mobile app",
keywords="flow",
keywords="self-care",
keywords="feasibility",
keywords="older adults",
keywords="dysphagia",
keywords="tongue exercises",
abstract="Background: Complications due to dysphagia are increasingly prevalent among older adults; however, the tediousness and complexity of conventional tongue rehabilitation treatments affect their willingness to rehabilitate. It is unclear whether integrating gameplay into a tongue training app is a feasible approach to rehabilitation. Objective: Tongue training has been proven helpful for dysphagia treatment. Following the development of a tongue training app, a feasibility trial aimed to identify physiological and psychological factors that affect user and flow experience and explored whether training specialized muscles could produce a flow experience for optimal immersion. We aimed to provide a useful tool for medical rehabilitation so that older adults could retain tongue muscle flexibility. Methods: After consulting professional nurses, we developed a mobile gaming app for middle-aged and older adults to train their tongue muscles. This pilot study used an image recognition system to detect the tongue movements of 32 healthy middle-aged and older adults (7 males, 21.9\%; 25 females, 78.1\%) during 3 game training tasks, each requiring different reaction speeds. Their physiological and psychological signals, as well as the results of the Flow State Scale 2 (FSS2) questionnaire, were used for correlation analysis regarding relevant flow experiences to establish and evaluate the feasibility of our method. Results: Through exploratory factor analyses, a 2-factor (operation and immersion) structure was confirmed to have an adequate model fit ($\chi${\texttwosuperior}36=448.478; P<.001; Kaiser-Meyer-Olkin=0.757) and internal consistency reliability (Cronbach $\alpha$=0.802). The slow, medium, and fast levels all significantly affected the FSS2 score for operation (P=.001), the National Aeronautics and Space Administration Task Load Index (P<.001), and flow distance (P<.001). K-means clustering revealed that participants could be further categorized into 3 groups. Through the analysis of changes in the participants' physiological and psychological signals for each given task, Pearson correlation indicated that changes were primarily related to flow distance. For the 12 indicators measured in this study, the low, medium, and high operation groups showed significance in 58\% (7/12), 50\% (6/12), and 25\% (3/12) of the indicators, respectively. Similarly, the low, medium, and high immersion groups had changes in 50\% (6/12), 33\% (4/12), and 17\% (2/12) of indicators, respectively. Conclusions: Our research supports the further development of a gaming app to aid older adults with tongue muscle training and measure flow using physiological and psychological signals to enhance training accuracy and feasibility. Next, we aim to conduct a randomized pilot trial, improve app functions, offer alternative rehabilitation options, and encourage long-term participation. Future goals include enhancing long-term efficacy, diversifying training modes, and adding a multiuser interactive option for an added challenge. ",
doi="10.2196/53045",
url="https://games.jmir.org/2025/1/e53045"
}


@Article{info:doi/10.2196/63461,
author="Merola, Pietro
and Cardoso, Barros Marcos
and Barreto, Gabriel
and Chagas, Carvalho Matheus
and Farias Oliveira Saunders, Luana
and Saunders, Bryan
and Cortozi Berton, Danilo",
title="Virtual Reality High-Intensity Interval Training Exergaming Compared to Traditional High-Intensity Circuit Training Among Medical Students: Pilot Crossover Study",
journal="JMIR Serious Games",
year="2025",
month="Jan",
day="7",
volume="13",
pages="e63461",
keywords="virtual reality",
keywords="VR",
keywords="high-intensity interval training",
keywords="exercise motivation",
keywords="exergame",
keywords="physical activity",
keywords="exercise",
keywords="heart rate",
abstract="Background: This study evaluated the effectiveness of a virtual reality (VR) high-intensity interval training (HIIT) boxing protocol compared to traditional high-intensity circuit training (HICT) in improving exercise motivation, engagement, and physiological responses among 30 healthy medical students. Objective: The purpose was to compare the VR HIIT protocol, which involved using an Oculus Quest 2 for a futuristic exoskeleton game experience, with a traditional 12-exercise HICT. Methods: In total, 30 medical students engaged in both VR HIIT, using an Oculus Quest 2 for a futuristic exoskeleton game experience, and a traditional 12-exercise HICT. Metrics included heart rate (HR) and blood lactate levels before and after exercise alongside ratings of perceived exertion and the Situational Motivation Scale. Results: VR HIIT showed significantly higher mean HR (mean 161, SD 15 vs mean 144, SD 11 bpm; d=1.5; P<.001), peak HR (mean 182, SD 15 vs mean 176, SD 11 bpm; d=0.8; P=.001), and ratings of perceived exertion (mean 16, SD 2 vs mean 15, SD 2; d=0.4; P=.03). Postexercise lactate levels were higher in HICT (mean 8.8, SD 4.5 vs mean 10.6, SD 3.0 mmol/L; d=0.6; P=.006). Intrinsic motivation and other psychological measures showed no significant differences, except for lower fatigue in HICT (d=0.5; P=.02). Conclusions: VR HIIT significantly enhances physiological parameters while maintaining intrinsic motivation, making it a viable alternative to traditional HICT. However, the short-term nature of this study is a limitation, and future research should explore the long-term engagement and therapeutic impacts of VR exercise in diverse and clinical populations. ",
doi="10.2196/63461",
url="https://games.jmir.org/2025/1/e63461"
}


@Article{info:doi/10.2196/58422,
author="Chen, Yanya
and Guan, Lina
and Wu, Weixin
and Ye, Liang
and He, Yan
and Zheng, Xiaofen
and Li, Sicun
and Guan, Bingsheng
and Ming, Wai-kit",
title="Factors That Influence Young Adults' Preferences for Virtual Reality Exergames in a Weight Control Setting: Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="30",
volume="26",
pages="e58422",
keywords="virtual reality",
keywords="games",
keywords="weight control",
keywords="preferences",
keywords="young adults",
keywords="qualitative research",
abstract="Background: Obesity could compromise people's health and elevate the risk of numerous severe chronic conditions and premature mortality. Young adults are at high risk of adopting unhealthy lifestyles related to overweight and obesity, as they are at a phase marked by several significant life milestones that have been linked to weight gain. They gain weight rapidly and excess adiposity mostly accrues, compared with middle-aged and older adults when weight stabilizes or even decreases. Virtual reality exergames have the potential to increase physical activity in people's daily lives. However, the factors that influence young adults' preference for using virtual reality exergames for weight control remain unclear. Objective: The objective of this study is to identify, characterize, and explain the factors influencing young adults' preference for weight control using virtual reality exergames. Methods: This qualitative study used semistructured interviews. In total, 4 focus group interviews were conducted with 23 young adults aged between 18 and 25 years. The qualitative data were analyzed using the Colaizzi phenomenological methodology. Results: In total, 3 major factors were found to influence young adults' preference for virtual reality exergames in weight control settings: individual factors, social or environmental factors, and expectations of virtual reality exergames. Individual factors included experience with previous weight control methods, previous experience with virtual reality, psychological status, attitudes toward personal BMI, preference for exercise type, and acceptance of virtual reality exergames. Social or environmental factors included social definitions of beauty, weather or public health events, and knowledge of virtual reality provided. Expectations of virtual reality exergames included cost of the device, the fun of virtual reality exergames, supervision, modality of virtual reality exergames, feedback after exercise, convenience to use, and weight loss effect. Conclusions: Young adults take various factors into account when deciding whether to use virtual reality exergames for weight control. These factors can inform the development and further refinement of devices, guides, and policies related to virtual reality exergames for controlling weight. ",
doi="10.2196/58422",
url="https://www.jmir.org/2024/1/e58422"
}


@Article{info:doi/10.2196/64879,
author="Lai, Byron
and Chaviano, Kelli
and Richman, S. Joshua
and Ahmad, Mahmoud
and Wright, Ashley
and Young, Raven
and Davis, Drew
and Rimmer, H. James
and Madan-Swain, Avi
and Chewning, H. Joseph",
title="Extended Reality Gaming for Exercise and Mindfulness Throughout Pediatric Cancer Rehabilitation: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Dec",
day="23",
volume="13",
pages="e64879",
keywords="oncology",
keywords="rehabilitation",
keywords="bone marrow transplant",
keywords="virtual reality",
keywords="VR",
keywords="physical activity",
keywords="exercise",
keywords="extended reality",
keywords="XR",
keywords="pediatric cancer",
abstract="Background: Pediatric patients with cancer have limited options to self-manage their health while they are undergoing treatments in the hospital and after they are discharged to their homes. Extended reality (ER) using head-mounted displays has emerged as an immersive method of improving pain and mental health and promoting health-enhancing physical activity among a variety of clinical groups, but there is currently no established protocol for improving both physical and mental health in pediatric cancer rehabilitation. Objective: This phase I, pilot, feasibility randomized controlled trial aims to investigate the potential effects of a 14-week ER program on physical activity participation and indicators of health among pediatric patients with cancer who undergo bone marrow transplantation. An ancillary aim is to evaluate the feasibility of the program through participant engagement. Methods: This study includes a 2-arm parallel group design with a 1-group crossover (the control group will start the intervention after a waiting period). Overall, 16 pediatric patients with cancer undergoing rehabilitation (aged ?8 years) at a children's hospital will be randomly allocated into one of two groups: (1) an immediate start group that undergoes an ER program in the hospital until discharge and then for 8 weeks at home (total duration of approximately 14 weeks), and (2) a waitlist control group that undergoes usual care in the hospital and for 8 weeks at home, before receiving the 8-week home ER program. The program will include active video gaming with rhythmic music exercises as well as mindfulness-based practices using a high-quality app. Home-based programming will include behavioral coaching calls. Physical activity will be measured daily through step counts using a tri-axial accelerometer. Health outcomes will be measured across time and include global health, measured by the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health Scale Short Form 7+2, and lung function, measured by a forced expiratory volume using a peak flow meter. Feasibility will be evaluated through participant engagement metrics, such as enrollment, dropout, adverse events, and attendance rates. Descriptive statistics will be obtained for all study variables. Outcomes will be modeled using mixed modeling procedures, and changes in means will be estimated with CIs. Results: The study was funded in February 2024. Recruitment procedures started on June 27, 2024. All data are anticipated to be collected by February 2026. Full trial results are anticipated to be analyzed and submitted for publication by March 2026. The study's anticipated end date is March 31, 2026. Conclusions: This trial tests an accessible remote program for improving both physical and mental health among pediatric patients with cancer. The knowledge obtained from this study will inform the development of a larger trial. Trial Registration: ClinicalTrials.gov NCT06298357; https://clinicaltrials.gov/study/NCT06298357 International Registered Report Identifier (IRRID): DERR1-10.2196/64879 ",
doi="10.2196/64879",
url="https://www.researchprotocols.org/2024/1/e64879"
}


@Article{info:doi/10.2196/60155,
author="Kwan, Cho Rick Yiu
and Law, Sze Queenie Pui
and Tsang, Yee Jenny Tsun
and Lam, Hin Siu
and Wang, To Kam
and Sin, Kan Olive Shuk
and Cheung, Ki Daphne Sze",
title="The Effect of the Mediterranean Diet--Integrated Gamified Home-Based Cognitive-Nutritional (GAHOCON) Training Programme for Older People With Cognitive Frailty: Pilot Randomized Controlled Trial",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Dec",
day="13",
volume="11",
pages="e60155",
keywords="cognitive frailty",
keywords="gamification",
keywords="health education",
keywords="Mediterranean diet",
keywords="home based",
keywords="cognitive training",
keywords="older adults",
keywords="geriatric",
keywords="elderly",
keywords="cognitive function",
keywords="intervention",
keywords="nutritional education",
keywords="cognitive impairment",
keywords="dementia",
abstract="Background: Cognitive frailty is known to be associated with both nutrition and cognitive training. However, effective treatments that engage older adults with cognitive frailty in both the Mediterranean diet and cognitive training are lacking. Objective: This study aims to examine the feasibility and preliminary effects of Gamified Home-Based Cognitive-Nutritional (GAHOCON) on older adults with cognitive frailty, focusing on Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Methods: This study applied a 2-center, assessor-blinded, 2-parallel-group, noninferiority, randomized controlled trial design. Eligible participants were community-dwelling adults aged 60 years or older, living with cognitive frailty, and exhibiting poor adherence to the Mediterranean diet. Participants were randomly assigned to the intervention or control group in a 1:1 ratio. In the intervention group, participants received 4 weeks of center-based training (health education) followed by 8 weeks of home-based training (GAHOCON). In the control group, participants received only the 4 weeks of center-based training and 8 weeks of self-revision of health educational materials at home. During the intervention period, time spent by the participants and the levels of difficulty completed by them weekly on GAHOCON were measured as markers of feasibility. The outcomes included Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Data were collected at baseline (T0) and 1 week postintervention (T1). The Wilcoxon signed rank test was used to examine within-group effects for the outcome variables in each group separately. Results: A total of 25 participants were recruited, with 13 allocated to the intervention group and 12 to the control group. The median cumulative minutes spent on GAHOCON training increased from 117 to 926 minutes. The median level of difficulty completed for game 1 increased from level 14 to level 20, while for game 2, it increased from level 2 to level 24. After the completion of the interventions, Mediterranean diet knowledge was retained in the intervention group but significantly decreased in the control group (r=--0.606, P=.04). Significant improvements were observed in the intervention group in Mediterranean diet adherence (r=--0.728, P=.009), cognitive function (r=--0.752, P=.007), physical frailty (r=--0.668, P=.02), and walking speed (r=--0.587, P=.03), but no such improvements were seen in the control group. Conclusions: GAHOCON is feasible in engaging older adults with cognitive frailty to regularly participate in the intervention. Preliminary evidence suggests that it can retain Mediterranean diet knowledge following nutritional education, improve adherence to the Mediterranean diet, and enhance global cognitive function, physical frailty, and walking speed. However, the difficulty of the later levels of game 1 may be too high. Future studies should adjust the difficulty level of game 1. Additionally, trials with larger sample sizes and longer follow-up periods are needed to confirm its effects. Trial Registration: ClinicalTrials.gov NCT05207930; https://clinicaltrials.gov/ct2/show/NCT05207930 ",
doi="10.2196/60155",
url="https://rehab.jmir.org/2024/1/e60155"
}


@Article{info:doi/10.2196/56810,
author="Kannan, Lakshmi
and Sahu, Upasana
and Subramaniam, Savitha
and Mehta, Neha
and Kaur, Tanjeev
and Hughes, Susan
and Bhatt, Tanvi",
title="Gaming-Based Tele-Exercise Program to Improve Physical Function in Frail Older Adults: Feasibility Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="27",
volume="26",
pages="e56810",
keywords="exergame training",
keywords="Matter of Balance",
keywords="MOB",
keywords="pre-frail",
keywords="tele-exergame",
keywords="tele-rehabilitation",
keywords="gaming-based",
keywords="tele-exercise",
keywords="physical function",
keywords="frailty",
keywords="older adults",
keywords="aging",
keywords="physical activity",
keywords="dementia",
keywords="CogXergaming",
keywords="telehealth",
keywords="dynamic balance",
abstract="Background: Frailty leads to reduced physical activity can cause increased fall risk. This contributes to accelerated aging processes, leading to adverse health outcomes and reduced quality of life. We have developed and piloted the design, usability, safety, and feasibility of a gaming-based cognitive-motor (CogXergaming) tele-exercise protocol in prefrail older adults. Objective: This pilot randomized control trial tested preliminary feasibility and effectiveness of the CogXergaming telehealth protocol for improving physical function. Methods: Community-dwelling, prefrail older adults were randomly assigned to CogXergaming (n=13) or a control group (n=14). The CogXergaming group received supervised tele-exercises in a gaming format for 6 weeks (3 sessions per week) comprising 18 sessions lasting 90 minutes each. Control group participants participated in a Matter of Balance (MOB), an 8-week, once-a-week structured 90-minute tele-session that has been shown to reduce the fear of falling and increase physical activity. Feasibility of training was obtained by computing the median duration of training sessions for the CogXergaming group. Effectiveness was assessed using dynamic balance control (Four Square Step Test), subjective self-efficacy (Activities-Specific Balance Confidence scale), gait function (Tinetti Performance Oriented Mobility Assessment), muscle strength (30-second chair stand test), and endurance (2-minute step in-place test). Results: Of the 45 participants enrolled in the study, 4 participants from CogXergaming group and 5 from MOB group lost contact after signing the consent form and did not receive their respective intervention. Eighteen participants were randomized to each group. In the CogXergaming group, 15 (83\%) completed the intervention, with 3 (16\%) dropping out in the first week. In the MOB group, 16 (88\%) completed the program, with 2 (11\%) withdrawing during the first week. In addition, there was a significant time group interaction for Four Square Step Test (F1,21=5.55, P=.03), Tinetti Performance Oriented Mobility Assessment (F1,25=4.16, P=.05), and 30-second chair stand test (F1,21=5.06, P=.03), with a significant improvement in these measures for the CogXergaming group post training, compared with no change observed in the MOB group. Conclusions: These pilot findings indicate that CogXergaming is feasible and applicable in prefrail older adults. Such game-based protocols can be beneficial in improving physical function among community-dwelling, prefrail older adults, however, the efficacy of such training requires further investigation. Trial Registration: ClinicalTrials.gov NCT04534686; https://clinicaltrials.gov/study/NCT04534686 ",
doi="10.2196/56810",
url="https://www.jmir.org/2024/1/e56810"
}


@Article{info:doi/10.2196/51714,
author="Bi, Siyuan
and Yuan, Junfeng
and Wang, Yanling
and Zhang, Wenxin
and Zhang, Luqin
and Zhang, Yongjuan
and Zhu, Rui
and Luo, Lin",
title="Effectiveness of Digital Health Interventions in Promoting Physical Activity Among College Students: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="20",
volume="26",
pages="e51714",
keywords="digital health intervention",
keywords="college students",
keywords="physical activity behavior",
keywords="steps",
keywords="light intensity physical activity",
keywords="moderate to vigorous physical activity",
keywords="sedentary behavior",
keywords="knowledge synthesis",
keywords="systematic review",
keywords="meta-analysis",
keywords="physical activity",
keywords="eHealth",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Recent studies offer conflicting conclusions about the effectiveness of digital health interventions in changing physical activity behaviors. In addition, research focusing on digital health interventions for college students remains relatively scarce. Objective: This study aims to examine the impact of digital health interventions on physical activity behaviors among college students, using objective measures as outcome indicators. Methods: In accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted across several databases, including MEDLINE (PubMed), Web of Science, Cochrane Library, and EBSCO (CINAHL Plus with full text), to identify relevant intervention studies published up to June 6, 2023. The inclusion criteria specified studies that examined the quantitative relationships between digital health interventions and physical activity among adults aged 18 years to 29 years, focusing on light physical activity (LPA), moderate to vigorous physical activity (MVPA), sedentary time (ST), or steps. Non--randomized controlled trials were excluded. The quality of the studies was assessed using the Cochrane Risk of Bias tool. Results were synthesized both narratively and quantitatively, where applicable. When sufficient homogeneity was found among studies, a random-effects model was used for meta-analysis to account for variability. Results: In total, 8 studies, encompassing 569 participants, were included in the analysis. The primary outcomes measured were LPA, MVPA, ST, and steps. Among these studies, 3 reported on LPA, 5 on MVPA, 5 on ST, and 3 on steps. The meta-analysis revealed a significant increase in steps for the intervention group compared with the control group (standardized mean difference [SMD] 0.64, 95\% CI 0.37-0.92; P<.001). However, no significant differences were observed between the intervention and control groups regarding LPA (SMD --0.08, 95\% CI --0.32 to 0.16; P=.51), MVPA (SMD 0.02, 95\% CI --0.19 to 0.22; P=.88), and ST (SMD 0.03, 95\% CI --0.18 to 0.24; P=.78). Conclusions: Digital health interventions are effective in increasing steps among college students; however, their effects on LPA, MVPA, and sedentary behavior are limited. Trial Registration: PROSPERO CRD42024533180; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=533180 ",
doi="10.2196/51714",
url="https://www.jmir.org/2024/1/e51714"
}


@Article{info:doi/10.2196/57352,
author="Wong, Ching Arkers Kwan
and Zhang, Qian Melissa
and Bayuo, Jonathan
and Chow, Sum Karen Kit
and Wong, Man Siu
and Wong, Po Bonnie
and Liu, Man Bob Chung
and Lau, Ho David Chi
and Kowatsch, Tobias",
title="The Effect of Young People--Assisted, Individualized, Motion-Based Video Games on Physical, Cognitive, and Social Frailty Among Community-Dwelling Older Adults With Frailty: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2024",
month="Nov",
day="20",
volume="12",
pages="e57352",
keywords="frailty",
keywords="gaming intervention",
keywords="motion-based",
keywords="video games",
keywords="older adults",
keywords="gerontology",
keywords="geriatrics",
keywords="randomized controlled trial",
keywords="RCT",
keywords="physical fitness",
keywords="adolescents",
keywords="young people--assisted",
keywords="eHealth literacy",
keywords="well-being",
keywords="therapists",
keywords="youth volunteers",
keywords="social support",
keywords="exergames",
keywords="gamification",
keywords="active games",
keywords="physical activity",
abstract="Background: The aging population highlights the need to maintain both physical and psychological well-being. Frailty, a multidimensional syndrome, increases vulnerability to adverse outcomes. Although physical exercise is effective, adherence among older adults with frailty is often low due to barriers. Motion-based video games (MBVGs) may enhance motivation and engagement. Objective: This study aims to evaluate the effect of individualized exercise programs that combine MBVGs, intergenerational support, and therapeutic frameworks on physical, cognitive, and social frailty outcomes in community-dwelling older adults. Methods: This randomized controlled trial was conducted from March 2022 to October 2023 across 6 community centers in Hong Kong. Participants aged 60 years and above with mild neurocognitive disorder were recruited, screened, and randomly assigned to either an intervention (n=101) or control group (n=101). The intervention included an 18-week program with 12 supervised exercise sessions utilizing motion-based technology, led by occupational therapists and assisted by youth volunteers. Data were collected at baseline (T1) and postintervention (T2), focusing on physical, cognitive, and social frailty outcomes, as well as client-related metrics. Statistical analyses were performed using SPSS, with significance set at P<.05. Results: A total of 202 participants were recruited, with a mean age of 78.8 years (SD 7.8). Both groups showed improvements in balance from T1 to T2, with a significant time effect ($\beta$=?0.63, P=.03). The intervention group demonstrated enhancements in hand strength and BMI, but no statistically significant between-group differences were observed. The intervention group also exhibited significant improvements in cognitive function ($\beta$=2.43, P<.001), while the control group's scores declined. Short-term memory improved for both groups, with no significant differences noted. Both groups experienced a reduction in depression levels, with a significant within-group effect at T2 ($\beta$=?1.16, P=.001). Improvements in social connectedness and eHealth literacy were observed in both groups, with the latter showing a significant within-group effect at T2 ($\beta$=3.56, P=.002). No significant effects were found for social isolation, physical activities, or quality of life. Conclusions: The growing aging population necessitates innovative strategies to support aging in place. Results indicated statistically significant improvements only in BMI and cognition, while other outcomes such as loneliness, balance, and eHealth literacy showed positive trends but lacked significance. Despite the limitations observed, particularly regarding the role of volunteer support and the diverse needs of community-dwelling older adults, the findings contribute to the foundation for future research aimed at enhancing biopsychosocial outcomes. Future studies should explore tailored interventions that consider individual preferences and abilities, as well as evaluate specific components of motion-based video games to optimize their effectiveness. Trial Registration: ClinicalTrials.gov NCT05267444; https://clinicaltrials.gov/study/NCT05267444 ",
doi="10.2196/57352",
url="https://games.jmir.org/2024/1/e57352"
}


@Article{info:doi/10.2196/53156,
author="Kershner, Kyle
and Morton, David
and Robison, Justin
and N'dah, Williams Kindia
and Fanning, Jason",
title="Assessing the Feasibility and Acceptability of Virtual Reality for Remote Group-Mediated Physical Activity in Older Adults: Pilot Randomized Controlled Trial",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="8",
volume="8",
pages="e53156",
keywords="virtual reality",
keywords="physical activity",
keywords="videoconference",
keywords="social connection",
keywords="remote meeting",
keywords="gerontology",
keywords="physical inactivity",
keywords="at-home intervention",
keywords="descriptive statistics",
keywords="eHealth",
keywords="comorbidity",
keywords="cybersickness",
abstract="Background: Physical inactivity represents a major health concern for older adults. Most social, at-home physical activity (PA) interventions use videoconference, email, or telephone communication for program delivery. However, evidence suggests that these platforms may hinder the social connection experienced by users. Recent advancements in virtual reality (VR) suggest that it may be a rich platform for social, at-home interventions because it offers legitimate options for intervention delivery and PA. Objective: This pilot study aims to determine the feasibility and acceptability of VR compared to videoconference as a medium for remote group-mediated behavioral intervention for older adults. The information generated from this investigation will inform the use of VR as a medium for intervention delivery. Methods: Nine low-active older adults (mean age 66.8, SD 4.8 y) were randomized to a 4-week home-based, group-mediated PA intervention delivered via VR or videoconference. Feasibility (ie, the total number of sessions attended and the number of VR accesses outside of scheduled meetings) and acceptability (ie, the number of participants reporting high levels of nausea, program evaluations using Likert-style prompts with responses ranging from --5=very difficult or disconnected to 5=very easy or connected, and participant feedback on immersion and social connection) are illustrated via descriptive statistics and quotes from open-ended responses. Results: None of the participants experienced severe VR-related sickness before randomization, with a low average sickness rating of 1.6 (SD 1.6) out of 27 points. Attendance rates for group meetings were 98\% (59/60) and 96\% (46/48) for the VR and videoconference groups, respectively. Outside of scheduled meeting times, participants reported a median of 5.5 (IQR 5.3-5.8, range 0-27) VR accesses throughout the entire intervention. Program evaluations suggested that participants felt personally connected to their peers (VR group: median 3.0, IQR 2.5-3.5; videoconference group: median 3.0, IQR 2.7-3.3), found that goals were easy to accomplish (VR group: median 3.0, IQR 2.8-3.3; videoconference group: median 3.0, IQR 2.6-3.4), and had ease in finding PA options (VR group: median 4.0, IQR 3.5-4.3; videoconference group: median 2.0, IQR 1.6-2.4) and engaging in meaningful dialogue with peers (VR group: median 4.0, IQR 4.0-4.0; videoconference group: median 3.5, IQR 3.3-3.8). Open-ended responses regarding VR use indicated increased immersion experiences and intrinsic motivation for PA. Conclusions: These findings suggest that VR may be a useful medium for social PA programming in older adults, given it was found to be feasible and acceptable in this sample. Importantly, all participants indicated low levels of VR-related sickness before randomization, and both groups demonstrated very high attendance at meetings with their groups and behavioral coaches, which is promising for using VR and videoconference in future interventions. Modifications for future iterations of similar interventions are provided. Further work using larger samples and longer follow-up durations is needed. Trial Registration: ClinicalTrials.gov NCT04756245; https://www.clinicaltrials.gov/study/NCT04756245 ",
doi="10.2196/53156",
url="https://formative.jmir.org/2024/1/e53156"
}


@Article{info:doi/10.2196/52153,
author="Dill, Sebastian
and M{\"u}ller, Niklas Philipp
and Caserman, Polona
and G{\"o}bel, Stefan
and Hoog Antink, Christoph
and Tregel, Thomas",
title="Sensing In Exergames for Efficacy and Motion Quality: Scoping Review of Recent Publications",
journal="JMIR Serious Games",
year="2024",
month="Nov",
day="5",
volume="12",
pages="e52153",
keywords="exergame efficacy",
keywords="motion quality assessment",
keywords="vital signs",
keywords="body sensors",
keywords="camera",
keywords="virtual reality",
abstract="Background: Many studies have shown a direct relationship between physical activity and health. It has also been shown that the average fitness level in Western societies is lower than recommended by the World Health Organization. One tool that can be used to increase physical activity for individual people is exergaming, that is, serious games that motivate players to do physical exercises. Objective: This scoping review of recent studies regarding exergame efficacy aims to evaluate which sensing modalities are used to assess exergame efficacy as well as motion quality. We also analyze how the collected motion sensing data is being leveraged with respect to exergame efficacy and motion quality assessment. Methods: We conducted 2 extensive and systematic searches of the ACM Digital Library and the PubMed database, as well as a single search of the IEEE Xplore database, all according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Overall, 343 studies were assessed for eligibility by the following criteria: The study should be peer-reviewed; the year of publication should be between 2015 and 2023; the study should be available in English or German; the study evaluates the efficacy of at least 1 exergame; sensor data is recorded during the study and is used for evaluation; and the study is sufficiently described to extract information on the exergames, sensors, metrics, and results. Results: We found 67 eligible studies, which we analyzed with regard to sensor usage for both efficacy evaluation and motion analysis. Overall, heart rate (HR) was the most commonly used vital sign to evaluate efficacy (n=52), while the Microsoft Kinect was the most commonly used exergame sensor (n=26). The results of the analysis show that the sensors used in the exergames and the sensors used in the evaluation are, in most cases, mutually exclusive, with motion quality rarely being considered as a metric. Conclusions: The lack of motion quality assessment is identified as a problem both for the studies and the exergames themselves since incorrectly executed motions can reduce an exergame's effectiveness and increase the risk of injury. Here we propose how to use the same sensors both as input for the exergame and to assess motion quality by presenting recent developments in motion recognition and sensing. ",
doi="10.2196/52153",
url="https://games.jmir.org/2024/1/e52153"
}


@Article{info:doi/10.2196/52991,
author="Schwarz, Ayla
and Verkooijen, Kirsten
and de Vet, Emely
and Simons, Monique",
title="Perceived Barriers and Facilitators Regarding the Implementation of Gamification to Promote Physical Activity in the Neighborhood: Interview Study Among Intermediaries",
journal="JMIR Serious Games",
year="2024",
month="Aug",
day="28",
volume="12",
pages="e52991",
keywords="gamification",
keywords="gamified apps",
keywords="physical activity",
keywords="implementation",
keywords="intermediaries",
keywords="interview",
abstract="Background: In the Netherlands, neighborhood sport coaches (NSCs) play an important role as intermediaries in promoting physical activity (PA) in the neighborhood. Gamification is the use of game elements in nongame contexts; it can be implemented with or without technology and holds promise for promoting PA. NSCs infrequently make use of this option. Objective: This study aims to understand barriers to, and facilitators of, using gamification to promote PA, as perceived by NSCs. Methods: A total of 25 semistructured interviews were conducted with NSCs in the Netherlands. The interviews were audiotaped, transcribed, and analyzed by means of thematic analysis using ATLAS.ti (version 22; ATLAS.ti Scientific Software Development GmbH) software. The deductive coding was informed by the capability, opportunity, motivation, behavior model and the theoretical domains framework, complemented by inductive coding. Results: Barriers and facilitators identified as factors influencing the implementation of gamification were related to 7 themes. NSCs required technical, creative, and promotion skills; knowledge about existing gamification tools; and social support from their employer and professional network. Financial costs were identified as a barrier to the successful implementation of gamification. Lack of clarity regarding stakeholders' responsibility to implement gamification could further hamper implementation. In general, NSCs were positive about investing time in implementing gamification and expected positive effects from implementing it. Conclusions: To overcome identified barriers, a clear overview of tools, best practices, and available subsidies must be created, a gamification network must be established, the responsibility of NSCs must be clarified, and guidance must be offered on the promotion of gamification. ",
doi="10.2196/52991",
url="https://games.jmir.org/2024/1/e52991",
url="http://www.ncbi.nlm.nih.gov/pubmed/39196618"
}


@Article{info:doi/10.2196/55905,
author="Berglund, Aseel
and Or{\"a}dd, Helena",
title="Exploring the Psychological Effects and Physical Exertion of Using Different Movement Interactions in Casual Exergames That Promote Active Microbreaks: Quasi-Experimental Study",
journal="JMIR Serious Games",
year="2024",
month="Aug",
day="26",
volume="12",
pages="e55905",
keywords="physical activity",
keywords="exergames",
keywords="casual exergames",
keywords="enjoyment",
keywords="exertion",
keywords="motion-based games",
abstract="Background: Prolonged sedentary behavior, such as sitting or reclining, has consistently been identified as a stand-alone risk factor for heightened cardiometabolic risk and overall mortality. Conversely, interrupting sedentary periods by incorporating short, active microbreaks has been shown to mitigate the negative effects of sedentary behavior. Casual exergames, which mix elements of casual gaming with physical activity, are one prospective intervention to reduce sedentary behavior because they require physical exertion. Casual exergames have shown promise in fostering emotional and physical advantages when played in specific circumstances. However, little research exists on how different types of movement interactions impact the psychological effects as well as the physical exertion of playing casual exergames. Objective: The primary aim of this work was to explore the psychological effects and physical exertion of playing casual exergames lasting 2 minutes. More precisely, the investigation focused on comparing upper body and full body movement interactions. In addition, the work examined variations in body positions, considering both standing and seated positions during upper body movement interactions. Methods: Two casual exergames were developed and investigated through 2 quasi-experimental studies. In study 1, we investigated how players' perceptions of control, exertion, and immersion were affected by using upper body as opposed to full body exergame controllers when playing casual exergames. In study 2, we investigated differences in positive affect, performance, enjoyment, and exertion when playing casual exergames with upper body movement interactions in seated and standing positions. Results: Study 1 showed that perceived control was significantly higher for upper body movement interactions than for full body movement interactions (P=.04), but there were no significant differences regarding perceived exertion (P=.15) or immersion (P=.66). Study 2 showed that positive affect increased significantly for both standing (P=.003) and seated (P=.001) gameplay. The participants in the standing gameplay group showed slightly higher actual exertion; however, there were no differences between the groups in terms of positive affect, perceived exertion, enjoyment, or performance. Conclusions: Casual exergames controlled by upper body movement interactions in seated gameplay can produce similar psychological effects and physical exertion as upper body movement interactions in standing gameplay and full body movement interactions. Therefore, upper body and seated casual exergames should not be overlooked as a suitable microbreak activity. ",
doi="10.2196/55905",
url="https://games.jmir.org/2024/1/e55905"
}


@Article{info:doi/10.2196/50066,
author="Berglund, Aseel
and Klompstra, Leonie
and Or{\"a}dd, Helena
and Fallstr{\"o}m, Johan
and Str{\"o}mberg, Anna
and Jaarsma, Tiny
and Berglund, Erik",
title="The Rationale Behind the Design Decisions in an Augmented Reality Mobile eHealth Exergame to Increase Physical Activity for Inactive Older People With Heart Failure",
journal="JMIR Serious Games",
year="2024",
month="Aug",
day="21",
volume="12",
pages="e50066",
keywords="sedentary",
keywords="exercise",
keywords="exertion",
keywords="exergames",
keywords="technology",
keywords="training",
keywords="inactivity",
keywords="eHealth application",
keywords="heart disease",
keywords="physical activity",
doi="10.2196/50066",
url="https://games.jmir.org/2024/1/e50066"
}


@Article{info:doi/10.2196/48787,
author="Lo, Man Hermione Hin
and Zhu, Mengting
and Zou, Zihui
and Wong, Lee Cho
and Lo, Shan Suzanne Hoi
and Chung, Chi-Ho Vincent
and Wong, Yeung-Shan Samuel
and Sit, Shan Regina Wing",
title="Immersive and Nonimmersive Virtual Reality--Assisted Active Training in Chronic Musculoskeletal Pain: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="19",
volume="26",
pages="e48787",
keywords="virtual reality",
keywords="VR",
keywords="physical therapy",
keywords="musculoskeletal",
keywords="pain",
keywords="physiotherapy",
keywords="chronic pain",
keywords="musculoskeletal pain",
keywords="low back pain",
keywords="neck pain",
keywords="osteoarthritis",
keywords="knee pain",
keywords="shoulder pain",
keywords="disability",
keywords="kinesiophobia",
keywords="arthritis",
keywords="systematic",
keywords="review methods",
keywords="review methodology",
keywords="immersive",
keywords="simulation",
keywords="simulations",
abstract="Background: Virtual reality (VR) in different immersive conditions has been increasingly used as a nonpharmacological method for managing chronic musculoskeletal pain. Objective: We aimed to assess the effectiveness of VR-assisted active training versus conventional exercise or physiotherapy in chronic musculoskeletal pain and to analyze the effects of immersive versus nonimmersive VR on pain outcomes. Methods: This systematic review of randomized control trials (RCTs) searched PubMed, Scopus, and Web of Science databases from inception to June 9, 2024. RCTs comparing adults with chronic musculoskeletal pain receiving VR-assisted training were included. The primary outcome was pain intensity; secondary outcomes included functional disability and kinesiophobia. Available data were pooled in a meta-analysis. Studies were graded using the Cochrane Risk-of-Bias Tool version 2. Results: In total, 28 RCTs including 1114 participants with some concerns for a high risk of bias were identified, and 25 RCTs were included in the meta-analysis. In low back pain, short-term outcomes measured post intervention showed that nonimmersive VR is effective in reducing pain (standardized mean difference [SMD] --1.79, 95\% CI --2.72 to --0.87; P<.001), improving disability (SMD --0.44, 95\% CI --0.72 to --0.16; P=.002), and kinesiophobia (SMD --2.94, 95\% CI --5.20 to --0.68; P=.01). Intermediate-term outcomes measured at 6 months also showed that nonimmersive VR is effective in reducing pain (SMD --8.15, 95\% CI --15.29 to --1.01; P=.03), and kinesiophobia (SMD --4.28, 95\% CI --8.12 to --0.44; P=.03) compared to conventional active training. For neck pain, immersive VR reduced pain intensity (SMD --0.55, 95\% CI --1.02 to --0.08; P=.02) but not disability and kinesiophobia in the short term. No statistical significances were detected for knee pain or other pain regions at all time points. In addition, 2 (8\%) studies had a high risk of bias. Conclusions: Both nonimmersive and immersive VR--assisted active training is effective in reducing back and neck pain symptoms. Our study findings suggest that VR is effective in alleviating chronic musculoskeletal pain. Trial Registration: PROSPERO CRD42022302912; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=302912 ",
doi="10.2196/48787",
url="https://www.jmir.org/2024/1/e48787"
}


@Article{info:doi/10.2196/47116,
author="Maz{\'e}as, Alexandre
and Forestier, Cyril
and Harel, Guillaume
and Duclos, Martine
and Chalabaev, A{\"i}na",
title="The Impact of a Gamified Intervention on Daily Steps in Real-Life Conditions: Retrospective Analysis of 4800 Individuals",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="12",
volume="26",
pages="e47116",
keywords="behavior change",
keywords="daily steps",
keywords="exercise",
keywords="gamification",
keywords="intervention",
keywords="mHealth",
keywords="mobile health",
keywords="mobile phone",
keywords="physical activity",
keywords="real world data",
keywords="retrospective",
keywords="self-determination theory",
keywords="step",
keywords="steps",
abstract="Background: Digital interventions integrating gamification features hold promise to promote daily steps. However, results regarding the effectiveness of this type of intervention are heterogeneous and not yet confirmed in real-life contexts. Objective: This study aims to examine the effectiveness of a gamified intervention and its potential moderators in a large sample using real-world data. Specifically, we tested (1) whether a gamified intervention enhanced daily steps during the intervention and follow-up periods compared to baseline, (2) whether this enhancement was higher in participants in the intervention than in nonparticipants, and (3) what participant characteristics or intervention parameters moderated the effect of the program. Methods: Data from 4819 individuals who registered for a mobile health Kiplin program between 2019 and 2022 were retrospectively analyzed. In this intervention, participants could take part in one or several games in which their daily step count was tracked, allowing individuals to play with their overall activity. Nonparticipants were people who registered for the program but did not take part in the intervention and were considered as a control group. Daily step counts were measured via accelerometers embedded in either commercial wearables or smartphones of the participants. Exposure to the intervention, the intervention content, and participants' characteristics were included in multilevel models to test the study objectives. Results: Participants in the intervention group demonstrated a significantly greater increase in mean daily steps from baseline than nonparticipants (P<.001). However, intervention effectiveness depended on participants' initial physical activity. The daily steps of participants with <7500 baseline daily steps significantly improved from baseline both during the Kiplin intervention (+3291 daily steps) and the follow-up period (+945 daily steps), whereas participants with a higher baseline had no improvement or significant decreases in daily steps after the intervention. Age (P<.001) and exposure (P<.001) positively moderated the intervention effect. Conclusions: In real-world settings and among a large sample, the Kiplin intervention was significantly effective in increasing the daily steps of participants from baseline during intervention and follow-up periods compared to nonparticipants. Interestingly, responses to the intervention differed based on participants' initial steps, with the existence of a plateau effect. Drawing on the insights of self-determination theory, we can assume that the effect of gamification could depend of the initial motivation and activity of participants. ",
doi="10.2196/47116",
url="https://www.jmir.org/2024/1/e47116",
url="http://www.ncbi.nlm.nih.gov/pubmed/39133533"
}


@Article{info:doi/10.2196/50063,
author="Berglund, Aseel
and Jaarsma, Tiny
and Or{\"a}dd, Helena
and Fallstr{\"o}m, Johan
and Str{\"o}mberg, Anna
and Klompstra, Leonie
and Berglund, Erik",
title="The Application of a Serious Game Framework to Design and Develop an Exergame for Patients With Heart Failure",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="7",
volume="8",
pages="e50063",
keywords="mobile health apps",
keywords="physical activity",
keywords="exergames",
keywords="player-centered design",
keywords="heart failure",
keywords="human-computer interaction",
keywords="mobile phone",
doi="10.2196/50063",
url="https://formative.jmir.org/2024/1/e50063"
}


@Article{info:doi/10.2196/51206,
author="Mateo-Orcajada, Adri{\'a}n
and Vaquero-Crist{\'o}bal, Raquel
and Mota, Jorge
and Abenza-Cano, Luc{\'i}a",
title="Physical Activity, Body Composition, and Fitness Variables in Adolescents After Periods of Mandatory, Promoted or Nonmandatory, Nonpromoted Use of Step Tracker Mobile Apps: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="30",
volume="12",
pages="e51206",
keywords="body composition",
keywords="detraining",
keywords="new technologies",
keywords="physical education subject",
keywords="physical fitness",
keywords="youth",
abstract="Background: It is not known whether an intervention made mandatory as a physical education (PE) class assignment and aimed at promoting physical activity (PA) in adolescents can create a healthy walking habit, which would allow further improvements to be achieved after the mandatory and promoted intervention has been completed. Objective: The aims of this study were to (1) investigate whether, after a period of using a step tracker mobile app made mandatory and promoted as a PE class assignment, adolescents continue to use it when its use is no longer mandatory and promoted; (2) determine whether there are changes in the PA level, body composition, and fitness of adolescents when the use of the app is mandatory and promoted and when it is neither mandatory nor promoted; and (3) analyze whether the covariates maturity status, gender, and specific app used can have an influence. Methods: A total of 357 students in compulsory secondary education (age: mean 13.92, SD 1.91 y) participated in the study. A randomized controlled trial was conducted consisting of 2 consecutive 10-week interventions. Participants' PA level, body composition, and fitness were measured at baseline (T1), after 10 weeks of mandatory and promoted app use (T2), and after 10 weeks of nonmandatory and nonpromoted app use (T3). Each participant in the experimental group (EG) used 1 of 4 selected step tracker mobile apps after school hours. Results: The results showed that when the use of the apps was neither mandatory nor promoted as a PE class assignment, only a few adolescents (18/216, 8.3\%) continued the walking practice. After the mandatory and promoted intervention period (T1 vs T2), a decrease in the sum of 3 skinfolds (mean difference [MD] 1.679; P=.02) as well as improvements in the PA level (MD --0.170; P<.001), maximal oxygen uptake (MD --1.006; P<.001), countermovement jump test (MD --1.337; P=.04), curl-up test (MD --3.791; P<.001), and push-up test (MD --1.920; P<.001) in the EG were recorded. However, the changes between T1 and T2 were significantly greater in the EG than in the control group only in the PA level and curl-up test. Thus, when comparing the measurements taken between T1 and T3, no significant changes in body composition (P=.07) or fitness (P=.84) were observed between the EG and the control group. The covariates maturity status, gender, and specific app used showed a significant effect in most of the analyses performed. Conclusions: A period of mandatory and promoted use of step tracker mobile apps benefited the variables of body composition and fitness in adolescents but did not create a healthy walking habit in this population; therefore, when the use of these apps ceased to be mandatory and promoted, the effects obtained disappeared. Trial Registration: ClinicalTrials.gov NCT06164041; https://clinicaltrials.gov/study/NCT06164041 ",
doi="10.2196/51206",
url="https://mhealth.jmir.org/2024/1/e51206"
}


@Article{info:doi/10.2196/58411,
author="Polecho?ski, Jacek
and Przepi{\'o}rzy?ski, Alan
and Polecho?ski, Piotr
and Tomik, Rajmund",
title="Effect of Elastic Resistance on Exercise Intensity and User Satisfaction While Playing the Active Video Game BoxVR in Immersive Virtual Reality: Empirical Study",
journal="JMIR Serious Games",
year="2024",
month="Jul",
day="16",
volume="12",
pages="e58411",
keywords="virtual reality",
keywords="VR",
keywords="game",
keywords="gaming",
keywords="immersive",
keywords="immersion",
keywords="health-related physical activity",
keywords="physical activity",
keywords="exercise",
keywords="active video games",
keywords="attractiveness",
keywords="enjoyment scale",
keywords="enjoyment",
keywords="serious games",
keywords="elastic resistance",
keywords="resistance",
abstract="Background: One of the main contemporary forms of physical activity (PA) involves exercises and games in an immersive virtual reality (VR) environment, which allows the user to practice various forms of PA in a small space. Unfortunately, most of the currently available VR games and workout applications are mostly based on upper body movements, especially the arms, which do not guarantee sufficiently high exercise intensity and health benefits. Therefore, it is worth seeking solutions to help increase the exercise load during PA in VR. Objective: The main aim of this study was to evaluate the effect of elastic arm resistance in the form of latex resistance bands of different elasticity levels on the intensity of students' PA while playing the BoxVR game. We further assessed the satisfaction of this form of exercise and its associations with PA intensity. Methods: A total of 21 healthy and physically fit men (mean age 22.5, SD 2.0 years) were included in the study. The tests consisted of 3 10-minute games. One game was run with no load and the other two were run with 1.5-meter latex resistance bands (low and high resistance). The order of the tests was randomized and the participants rested for 20 minutes after each exercise. Exercise intensity was estimated using objective (heart rate monitoring) and subjective (Borg scale) methods. The Physical Activity Enjoyment Scale was used to assess satisfaction with the PA. The effect of elastic resistance on exercise intensity and user enjoyment was estimated using ANOVA for repeated measures. Results: The ANOVA results indicated that incorporation of elastic resistance caused a significant change (F2,40=20.235, P<.001; $\eta${\texttwosuperior}p=0.503) in the intensity of PA in VR, which was low while playing without resistance and then increased to a moderate level with additional resistance. The use of elastic bands also changed participants' perceptions of the enjoyment of exercise in VR (F2,40=9.259, P<.001; $\eta${\texttwosuperior}p=0.316). The students rated their satisfaction with PA in VR on a 7-point scale highly and similarly when exercising without an upper limb load (mean 6.19, SD 0.61) and with slight elastic resistance (mean 6.17, SD 0.66), whereas their satisfaction declined significantly (mean 5.66, SD 0.94) when incorporating a higher load. Conclusions: The intensity of PA among students playing the BoxVR game is at a relatively low level. With the added resistance of elastic bands attached to the upper limbs, the intensity of the exercise increased to a moderate level, as recommended for obtaining health benefits. Participants rated the enjoyment of PA in VR highly. The use of slight elastic resistance did not negatively affect satisfaction with the BoxVR game, although user satisfaction declined with a higher load. Further research should be undertaken to increase the effectiveness of exercise in VR so that regular users can enjoy the health benefits. ",
doi="10.2196/58411",
url="https://games.jmir.org/2024/1/e58411"
}


@Article{info:doi/10.2196/46570,
author="Krarup, Bygum Kasper
and Riis, Johannes
and M{\o}rk, Morten
and Nguyen, Thu Hien Thi
and S{\o}kilde Pedersen, Inge
and Risom Kristensen, S{\o}ren
and Handberg, Aase
and Krarup, Bygum Henrik",
title="Biochemical Changes in Adult Male Gamers During Prolonged Gaming: Pilot Study",
journal="Interact J Med Res",
year="2024",
month="Jul",
day="8",
volume="13",
pages="e46570",
keywords="long gaming sessions",
keywords="local area network party",
keywords="biochemistry",
keywords="cortisol",
keywords="glucose",
keywords="gaming",
keywords="biochemical",
keywords="blood sample",
keywords="hematology",
keywords="hematological",
keywords="games",
keywords="gamers",
keywords="hemoglobin",
keywords="adults",
keywords="males",
keywords="men",
keywords="blood",
abstract="Background: Gaming has become an integrated part of life for children and adults worldwide. Previous studies on the impact of gaming on biochemical parameters have primarily addressed the acute effects of gaming. The literature is limited, and the study designs are very diverse. The parameters that have been investigated most thoroughly are blood glucose and cortisol. Objective: This exploratory study is the first to investigate the effects of long gaming sessions on the biochemical parameters of healthy male adults. The extensive testing allowed us to observe short-term changes (within 6 hours), long-term changes during the duration of the gaming sessions, and follow-up after 1 week to determine whether any changes were longer lasting. Methods: In total, 9 experienced gamers completed 2 back-to-back 18-hour gaming sessions interspersed with a 6-hour rest period. All participants adhered to a structured sleep pattern due to daytime employment or attending university. Blood, saliva, and urine samples were collected from the participants every 6 hours. Linear mixed-effect models were used to analyze the repeated-measures data accumulated during the study. A total of 51 biochemical parameters were investigated. Results: In total, 12 of the 51 biochemical parameters significantly changed during the study: alkaline phosphatase, aspartate aminotransferase, bilirubin, chloride, creatinine, glucose, hemoglobin, immature reticulocyte fraction, lactate, methemoglobin, sodium, and thrombocytes. All changes were within the normal range. The mean glucose level of the participants was 4.39 (SD 0.07) mmol/L at baseline, which increased significantly by 0.24 (SD 0.07) mmol/L per 6 hours during the first period and by 0.38 (SD 0.07) mmol/L per 6 hours in the second period (P<.001). The glucose levels during the second session increased even though the participants had little energy intake. Cortisol levels did not change significantly, although the cortisol pattern deviated from the typical circadian rhythm. During both gaming sessions, we observed increasing cortisol levels from 6 AM until noon. The participants were relatively dehydrated at the start of the study. The patients were asked to fast before the first blood sampling. Within the first 6 hours of the study, the participants rehydrated, followed by relative dehydration during the remainder of the study. This pattern was identified using the following parameters: albumin, creatinine, hemoglobin, erythrocytes, potassium, and platelets. Conclusions: This study is the first of its kind, and many of the analyses in the study yielded novel results. The study was designed to emulate the behavior of gamers during the weekend and other long gaming sessions. At this point, we are not able to determine the difference between the effects of gaming and behavior during gaming. Regardless, the results of this study suggest that healthy gamers can partake in long gaming sessions, with ample amounts of unhealthy foods and little rest, without acute impacts on health. ",
doi="10.2196/46570",
url="https://www.i-jmr.org/2024/1/e46570",
url="http://www.ncbi.nlm.nih.gov/pubmed/38976326"
}


@Article{info:doi/10.2196/52231,
author="Lin, Shu-Cheng
and Wang, Chien-Yen
and Hou, Tien-Hung
and Chen, Hong-Ching
and Wang, Chia-Chi",
title="Impact of Fruit and Vegetable Enzyme Supplementation on Aerobic Performance and Lactate Response in Older Adults Following High-Intensity Interval Exercise Through Exergaming: Randomized Experimental Matched-Pair Study",
journal="JMIR Serious Games",
year="2024",
month="Jun",
day="25",
volume="12",
pages="e52231",
keywords="Ring Fit Adventure",
keywords="training load",
keywords="older adult training",
keywords="training impulse",
keywords="food supplement",
keywords="older adults",
keywords="exergames",
keywords="exergame",
keywords="Taiwan",
keywords="female",
keywords="fruits",
keywords="vegetables",
keywords="blood lactate",
keywords="exercise",
keywords="feasibility",
keywords="aerobic",
keywords="enzymes",
keywords="enzyme",
keywords="female older adults",
keywords="fitness",
keywords="food intake",
keywords="diet",
keywords="exergaming",
keywords="enzyme supplements",
keywords="older adults training",
keywords="female older adult",
keywords="older adult",
abstract="Background: Exercise offers substantial health benefits but can induce oxidative stress and inflammation, especially in high-intensity formats such as high-intensity interval exercise (HIIE). Exergaming has become an effective, enjoyable fitness tool for all ages, particularly older adults. Enzyme supplements may enhance exercise performance by improving lactate metabolism and reducing oxidative stress. Objective: This study investigates the efficacy of fruit and vegetable enzyme supplementation in modulating fatigue and enhancing aerobic capacity in older adults following HIIE through exergaming. Methods: The study recruited 16 older adult female participants and allocated them into 2 distinct groups (enzyme and placebo) based on their pretest lactate levels. This division used pairwise grouping to guarantee comparability between the groups, ensuring the integrity of the results. They engaged in HIIE using Nintendo Switch Ring Fit Adventure, performing 8 sets of 20 seconds of maximum effort exercise interspersed with 30 seconds of rest, totaling 370 seconds of exercise. Key metrics assessed included blood lactate levels, heart rate, rating of perceived exertion, and training impulse. Participants in the enzyme group were administered a fruit and vegetable enzyme supplement at a dosage of 30 mL twice daily over a period of 14 days. Results: The enzyme group showed significantly lower blood lactate levels compared to the placebo group, notably after the fourth (mean 4.29, SD 0.67 vs mean 6.34, SD 1.17 mmol/L; P=.001) and eighth (mean 5.84, SD 0.63 vs mean 8.20, SD 1.15 mmol/L; P<.001) exercise sessions. This trend continued at 5 minutes (mean 6.85, SD 0.82 vs mean 8.60, SD 1.13 mmol/L; P=.003) and 10 minutes (mean 5.91, SD 1.16 vs mean 8.21, SD 1.27 mmol/L; P=.002) after exercise. Although both groups exceeded 85\% of their estimated maximum heart rate during the exercise, enzyme supplementation did not markedly affect the perceived intensity or effort. Conclusions: The study indicates that fruit and vegetable enzyme supplementation can significantly reduce blood lactate levels in older adults following HIIE through exergaming. This suggests a potential role for these enzymes in modulating lactate production or clearance during and after high-intensity exercise. These findings have implications for developing targeted interventions to enhance exercise tolerance and recovery in older adults. Trial Registration: ClinicalTrials.gov NCT06466408; https://clinicaltrials.gov/study/NCT06466408 ",
doi="10.2196/52231",
url="https://games.jmir.org/2024/1/e52231"
}


@Article{info:doi/10.2196/56357,
author="Chien, Shih-Ying
and Wong, MK Alice
and Wu, Ching-Yi
and Beckman, L. Sara",
title="Interactive Electronic Pegboard for Enhancing Manual Dexterity and Cognitive Abilities: Instrument Usability Study",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="21",
volume="11",
pages="e56357",
keywords="interactive electronic pegboard",
keywords="stroke",
keywords="hand dexterity",
keywords="cognitive rehabilitation",
keywords="system",
abstract="Background: Strokes pose a substantial health burden, impacting 1 in 6 people globally. One-tenth of patients will endure a second, often more severe, stroke within a year. Alarmingly, a younger demographic is being affected due to recent lifestyle changes. As fine motor and cognitive issues arise, patient disability as well as the strain on caregivers and health care resources is exacerbated. Contemporary occupational therapy assesses manual dexterity and cognitive functions through object manipulation and pen-and-paper recordings. However, these assessments are typically isolated, which makes it challenging for therapists to comprehensively evaluate specific patient conditions. Furthermore, the reliance on one-on-one training and assessment approaches on manual documentation is inefficient and prone to transcription errors. Objective: This study examines the feasibility of using an interactive electronic pegboard for stroke rehabilitation in clinical settings. Methods: A total of 10 patients with a history of stroke and 10 healthy older individuals were recruited. With a limit of 10 minutes, both groups of participants underwent a series of challenges involving tasks related to manual operation, shape recognition, and color discrimination. All participants underwent the Box and Block Test and the Purdue Pegboard Test to assess manual dexterity, as well as an array of cognitive assessments, including the Trail Making Test and the Mini-Mental Status Examination, which served as a basis to quantify participants' attention, executive functioning, and cognitive abilities. Results: The findings validate the potential application of an interactive electronic pegboard for stroke rehabilitation in clinical contexts. Significant statistical differences (P<.01) were observed across all assessed variables, including age, Box and Block Test results, Purdue Pegboard Test outcomes, Trail Making Test-A scores, and Mini-Mental Status Examination performance, between patients with a history of stroke and their healthy older counterparts. Functional and task testing, along with questionnaire interviews, revealed that patients with a history of stroke demonstrated prolonged completion times and slightly inferior performance. Nonetheless, most patients perceived the prototype as user-friendly and engaging. Thus, in the context of patient rehabilitation interventions or the evaluation of patient cognition, physical functioning, or manual dexterity assessments, the developed pegboard could potentially serve as a valuable tool for hand function, attention, and cognitive rehabilitation, thereby mitigating the burden on health care professionals. Conclusions: Health care professionals can use digital electronic pegboards not only as a precise one-on-one training tool but also as a flexible system that can be configured for online or offline, single-player or multiplayer use. Through data analysis, a more informed examination of patients' cognitive and functional issues can be conducted. Importantly, patient records will be fully retained throughout practices, exercises, or tests, and by leveraging the characteristics of big data, patients can receive the most accurate rehabilitation prescriptions, thereby assisting them in obtaining optimal care. ",
doi="10.2196/56357",
url="https://humanfactors.jmir.org/2024/1/e56357",
url="http://www.ncbi.nlm.nih.gov/pubmed/38904991"
}


@Article{info:doi/10.2196/57198,
author="Patton, R. Susana
and Gal, L. Robin
and Bergford, Simon
and Calhoun, Peter
and Clements, A. Mark
and Sherr, L. Jennifer
and Riddell, C. Michael",
title="Digital Gaming and Exercise Among Youth With Type 1 Diabetes: Cross-Sectional Analysis of Data From the Type 1 Diabetes Exercise Initiative Pediatric Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Jun",
day="13",
volume="7",
pages="e57198",
keywords="exercise",
keywords="exercises",
keywords="exercising",
keywords="physical activity",
keywords="physical activities",
keywords="digital game",
keywords="digital games",
keywords="gaming",
keywords="electronic game",
keywords="electronic games",
keywords="computerized game",
keywords="computerized games",
keywords="pediatric",
keywords="pediatrics",
keywords="child",
keywords="children",
keywords="youth",
keywords="adolescent",
keywords="adolescents",
keywords="teen",
keywords="teens",
keywords="teenager",
keywords="teenagers",
keywords="diabetes",
keywords="diabetic",
keywords="DM",
keywords="diabetes mellitus",
keywords="type 2 diabetes",
keywords="type 1 diabetes",
keywords="TD1",
keywords="TD2",
keywords="mobile phone",
abstract="Background: Regular physical activity and exercise are fundamental components of a healthy lifestyle for youth living with type 1 diabetes (T1D). Yet, few youth living with T1D achieve the daily minimum recommended levels of physical activity. For all youth, regardless of their disease status, minutes of physical activity compete with other daily activities, including digital gaming. There is an emerging area of research exploring whether digital games could be displacing other physical activities and exercise among youth, though, to date, no studies have examined this question in the context of youth living with T1D. Objective: We examined characteristics of digital gaming versus nondigital gaming (other exercise) sessions and whether youth with T1D who play digital games (gamers) engaged in less other exercise than youth who do not (nongamers), using data from the Type 1 Diabetes Exercise Initiative Pediatric study. Methods: During a 10-day observation period, youth self-reported exercise sessions, digital gaming sessions, and insulin use. We also collected data from activity wearables, continuous glucose monitors, and insulin pumps (if available). Results: The sample included 251 youths with T1D (age: mean 14, SD 2 y; self-reported glycated hemoglobin A1c level: mean 7.1\%, SD 1.3\%), of whom 105 (41.8\%) were female. Youth logged 123 digital gaming sessions and 3658 other exercise (nondigital gaming) sessions during the 10-day observation period. Digital gaming sessions lasted longer, and youth had less changes in glucose and lower mean heart rates during these sessions than during other exercise sessions. Youth described a greater percentage of digital gaming sessions as low intensity (82/123, 66.7\%) when compared to other exercise sessions (1104/3658, 30.2\%). We had 31 youths with T1D who reported at least 1 digital gaming session (gamers) and 220 youths who reported no digital gaming (nongamers). Notably, gamers engaged in a mean of 86 (SD 43) minutes of other exercise per day, which was similar to the minutes of other exercise per day reported by nongamers (mean 80, SD 47 min). Conclusions: Digital gaming sessions were longer in duration, and youth had less changes in glucose and lower mean heart rates during these sessions when compared to other exercise sessions. Nevertheless, gamers reported similar levels of other exercise per day as nongamers, suggesting that digital gaming may not fully displace other exercise among youth with T1D. ",
doi="10.2196/57198",
url="https://pediatrics.jmir.org/2024/1/e57198"
}


@Article{info:doi/10.2196/53999,
author="Craig, V. Tabitha
and Rhodes, E. Ryan
and Sui, Wuyou",
title="Examining and Comparing the Energy Expenditure of Two Modes of a Virtual Reality Fitness Game (Supernatural): Indirect Calorimetry Study",
journal="JMIR Serious Games",
year="2024",
month="Jun",
day="4",
volume="12",
pages="e53999",
keywords="energy expenditure",
keywords="exergaming",
keywords="indirect calorimetry",
keywords="virtual reality",
keywords="VR",
keywords="VR fitness",
keywords="VR gaming",
abstract="Background: The effectiveness of virtual reality (VR) fitness games as a form of moderate to vigorous physical activity has yet to be thoroughly quantified through gold standard energy expenditure measures. Objective: The purpose of this study was to examine the energy expenditure of 2 medium-intensity modes (``Flow and ``Boxing'') of a VR fitness game, Supernatural, using indirect calorimetry. Methods: Indirect calorimetry was used to examine relative and objective maximal oxygen consumption (VO2 max), metabolic equivalents of task (METs), and calories burned during medium-intensity bouts of both Flow and Boxing gameplay modes in young (mean age 25.42, SD 3.25 years), active individuals (n=12 female and n=11 male). METs and calories were also compared using a triaxial waist-worn accelerometer, an Apple smartwatch, and a VR headset. Mood states were assessed pre- and postbout using the shortened Profile of Mood States Questionnaire. Paired 2-tailed t tests were used to examine differences in game modes, between sexes, and pre-post exercise sessions. Results: Objective and relative VO2 max averaged 1.93 (SD 0.44) L/min and 27.61 (SD 5.60) mL/kg/min, respectively, between modes. Flow (mean 8.2, SD 1.54 METs) and Boxing (mean 7.6, SD 1.66 METs) are both classified as high energy expenditure, vigorous activities. Calorie expenditure data of the accelerometer and VR headset differed significantly from the metabolic cart. Mood changes pre- to post exercise were consistent with expected values for moderate- to vigorous-intensity physical activity, with participants reporting that they felt more ``active,'' ``full of pep,'' ``vigorous,'' and ``lively'' (P<.05) following bouts. Male individuals reported higher objective oxygen consumption (VO2) for both Flow and Boxing modes; no other sex-specific differences were observed. Conclusions: Both Flow and Boxing gameplay modes of Supernatural classify as vigorous physical activity and demonstrate the potential to promote mental and physical health benefits. Supernatural may be an effective exercise modality in a VO2 training program. ",
doi="10.2196/53999",
url="https://games.jmir.org/2024/1/e53999",
url="http://www.ncbi.nlm.nih.gov/pubmed/38833285"
}


@Article{info:doi/10.2196/52275,
author="Feria-Madue{\~n}o, Adrian
and Monterrubio-Fern{\'a}ndez, Germ{\'a}n
and Mateo Cortes, Jesus
and Carnero-Diaz, Angel",
title="The Effect of a Novel Video Game on Young Soccer Players' Sports Performance and Attention: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2024",
month="May",
day="27",
volume="12",
pages="e52275",
keywords="reaction time",
keywords="serious games",
keywords="executive function",
keywords="decision making",
keywords="game",
keywords="games",
keywords="gaming",
keywords="sport",
keywords="sports",
keywords="soccer",
keywords="football",
keywords="athlete",
keywords="athletes",
keywords="athletic",
keywords="training",
keywords="performance",
keywords="physiological",
keywords="muscle",
keywords="muscular",
keywords="sweat",
keywords="sweating",
keywords="attention training",
keywords="attentional",
keywords="ball",
keywords="exercise",
keywords="physical activity",
keywords="exergame",
keywords="exergames",
keywords="interview",
keywords="interviews",
abstract="Background: Currently, the fusion of technology and sports is inevitable. The integration of various systems and devices has brought about significant transformations in established sports practices, impacting not only the rules but also physiological, biomechanical, and even psychological aspects. Objective: The purpose of this study was to analyze the effect of an attention intervention through a video game on young soccer players. Methods: Twelve young male soccer players (age: mean 8.5, SD 1 years) were divided into 2 groups: a control group (CG; n=10) and an experimental group (EG; n=10). During the 6-week training program, the EG received attention training through a video game twice a week for 15 minutes per session. Pre- and postintervention measurements included a specific decision-making soccer test and interviews with coaching staff. Additionally, success in the video game, muscular activity, and sweat levels were monitored. Results: The EG demonstrated a significant improvement in video game success following the intervention program, as indicated by the achieved level (P<.001). However, no significant differences were found between groups regarding electromyographic (EMG) activity (P=.21) and sweating (P=.20). Prior to implementing the attention training program, both groups exhibited similar data for variables related to decision-making and execution mechanisms (?10\%). Only 2 decision-making variables exceeded 10\% but remained below 15\% (Shot\_D=13.35\%; Marking\_with\_Ball\_D=?12.64\%). Furthermore, changes in attacking action variables were more pronounced in execution-related variables, except for dribbling and fixing. Conversely, in defensive action variables, changes were greater in decision-related variables, except for marking with the ball and marking without the ball. Conclusions: Our findings reveal that incorporating a specific attentional video game into a soccer training program enhances decision-making compared to a program without the video game. Therefore, it is advisable for practitioners to consider using this tool due to its high efficiency in terms of economic and temporal costs, particularly in improving a key psychological variable. Trial Registration: ISRCTN Registry ISRCTN12742775; https://www.isrctn.com/ISRCTN12742775 ",
doi="10.2196/52275",
url="https://games.jmir.org/2024/1/e52275"
}


@Article{info:doi/10.2196/47600,
author="Lee, J. Edmund W.
and Tan, W. Warrick
and Pham, Phat Ben Tan
and Kawaja, Ariffin
and Theng, Yin-Leng",
title="Addressing Data Absenteeism and Technology Chauvinism in the Use of Gamified Wearable Gloves Among Older Adults: Moderated Usability Study",
journal="JMIR Serious Games",
year="2024",
month="Apr",
day="24",
volume="12",
pages="e47600",
keywords="wearables",
keywords="exergames",
keywords="older adults",
keywords="active aging",
keywords="rehabilitation",
keywords="stroke",
abstract="Background: Digital health technologies have the potential to improve health outcomes for older adults, especially for those recovering from stroke. However, there are challenges to developing these technologies, such as data absenteeism (where older adults' views are often underrepresented in research and development) and technology chauvinism (the belief that sophisticated technology alone is the panacea to addressing health problems), which hinder their effectiveness. Objective: In this study, we aimed to address these challenges by developing a wearable glove integrated with culturally relevant exergames to motivate older adults to exercise and, for those recovering from stroke, to adhere to rehabilitation. Methods: We conducted a moderated usability study with 19 older adults, of which 11 (58\%) had a history of stroke. Our participants engaged in a 30-minute gameplay session with the wearable glove integrated with exergames, followed by a quantitative survey and an in-depth interview. We used descriptive analysis to compare responses to the System Usability Scale between those who had a history of stroke and those who did not. In addition, we analyzed the qualitative interviews using a bottom-up thematic analysis to identify key themes related to the motivations and barriers regarding the use of wearable gloves for rehabilitation and exercise. Results: Our study generated several key insights. First, making the exergames exciting and challenging could improve exercise and rehabilitation motivation, but it could also have a boomerang effect, where participants may become demotivated if the games were very challenging. Second, the comfort and ease of use of the wearable gloves were important for older adults, regardless of their stroke history. Third, for older adults with a history of stroke, the functionality and purpose of the wearable glove were important in helping them with specific exercise movements. Conclusions: Our findings highlight the importance of providing contextual support for the effective use of digital technologies, particularly for older adults recovering from stroke. In addition to technology and usability factors, other contextual factors such as gamification and social support (from occupational therapists or caregivers) should be considered to provide a comprehensive approach to addressing health problems. To overcome data absenteeism and technology chauvinism, it is important to develop digital health technologies that are tailored to the needs of underserved communities. Our study provides valuable insights for the development of digital health technologies that can motivate older adults recovering from stroke to exercise and adhere to rehabilitation. ",
doi="10.2196/47600",
url="https://games.jmir.org/2024/1/e47600",
url="http://www.ncbi.nlm.nih.gov/pubmed/38656778"
}


@Article{info:doi/10.2196/51730,
author="Lin, Shu-Cheng
and Lee, Jing-Yu
and Yang, Yong
and Fang, Chu-Chun
and Fang, Hsiao-Lin
and Hou, Tien-Hung",
title="Exploring the Design of Upper Limb Strength Training Through High-Intensity Interval Training Combined With Exergaming: Usability Study",
journal="JMIR Serious Games",
year="2024",
month="Apr",
day="17",
volume="12",
pages="e51730",
keywords="muscle",
keywords="electromyography",
keywords="healthy",
keywords="home training",
keywords="exercise",
abstract="Background: High-intensity interval training (HIIT) has become a popular exercise strategy in modern society, with the Tabata training method being the most popular. In the past, these training methods were mostly done without equipment, but incorporating exergaming into the training may provide a new option for muscle training. Objectives: The aim of this study was to explore the differences in upper limb muscle activation using an HIIT program combined with exergaming. Methods: A total of 15 healthy male participants were recruited for the study, and the differences in muscle activation were compared between push-ups and exergaming (Nintendo Switch Ring Fit Adventure with the Ring-Con accessory) during HIIT. Prior to the tests, participants underwent pretests, including maximal voluntary contractions of various muscle groups, maximal push-up tests, and maximal movement tests using the exergaming device. The push-up and exergaming tests were conducted on separate days to avoid interference, with a warm-up period of 5 minutes on a treadmill before testing. Muscle activation in the lateral and anterior portions of the deltoid muscle, the sternal and clavicular heads of the pectoralis major muscle, and the latissimus dorsi muscle were measured during the maximal voluntary contractions and single-round tests for each exercise mode. A repeated measures ANOVA was used to assess the variations in muscle activation observed across the 2 distinct modes of exercise, specifically push-ups and exergaming. Results: In exergaming, the number of repetitions for push-ups was significantly fewer than for single-site exercises across both exhaustive (mean 23.13, SD 6.36 vs mean 55.67, SD 17.83; P=.001; effect size [ES]: 2.43) and single-round (mean 21.93, SD 7.67 vs mean 92.40, SD 20.47; P=.001; ES: 4.56) training. Heart rate differences were not significant (all P>.05), yet exergaming led to better muscle activation in specific muscle groups, particularly the right anterior deltoid (mean 48.00\%, SD 7.66\% vs mean 32.84\%, SD 10.27\%; P=.001; ES: 1.67) and right pectoralis major (sternal head: mean 38.99\%, SD 9.98\% vs mean 26.90\%, SD 12.97\%; P=.001; ES: 1.04; clavicular head: mean 43.54\%, SD 9.59\% vs mean 30.09\%, SD 11.59\%; P=.002; ES: 1.26) during exhaustive training. In single-round training, similar patterns were observed with the anterior deltoid (mean 51.37\%, SD 11.76\% vs mean 35.47\%, SD 12.72\%; P=.002; ES: 1.30) and pectoralis major (sternal head: mean 53.27\%, SD 10.79\% vs mean 31.56\%, SD 16.92\%; P=.001; ES: 1.53; clavicular head: mean 53.75\%, SD 13.01\% vs mean 37.95\%, SD 14.67\%; P=.006; ES: 1.14). These results suggest that exergaming may be more effective for targeted muscle activation. Conclusions: In conclusion, HIIT can increase muscle activation in the upper extremities and can be incorporated into exergaming strategies to provide a fun and engaging way to exercise. ",
doi="10.2196/51730",
url="https://games.jmir.org/2024/1/e51730"
}


@Article{info:doi/10.2196/36154,
author="Wang, Yu-Han",
title="Understanding Senior Adults' Needs, Preferences, and Experiences of Commercial Exergames for Health: Usability Study",
journal="JMIR Serious Games",
year="2024",
month="Apr",
day="5",
volume="12",
pages="e36154",
keywords="exergame",
keywords="senior user experience",
keywords="senior technology acceptance",
keywords="game technology",
keywords="psychological perception",
keywords="serious games",
keywords="exercise",
keywords="aging",
keywords="older adults",
keywords="physical activity",
abstract="Background: Many senior adults are at risk of mental and physical disorders due to a lack of sufficient exercise. Therefore, adherent exercise should be urgently promoted to improve senior adults' muscle strength, preventing falls and conditions caused by physical and cognitive decline. However, off-the-shelf exercise games, so-called exergames, are mainly targeted at the younger generation or children, while senior adults are neglected, when this age group strongly needs exercise. Exergames could serve as a health intervention for promoting exercise. Objective: This study aimed to investigate senior adults' experience, perceptions, and acceptance of game technology to promote exercise in order to suggest game design guidelines. Methods: In this usability study, participants engaged in playing Nintendo Switch and Xbox Kinect games, after which semistructured interviews were conducted. Before the gameplay, the participants provided their background information, exercise habits, and use of technology products. Next, all participants completed a workshop including 3 activities (brief instructions on how to play the games: 20 minutes; playing the selected exergames: 80 minutes; semistructured interviews: 20 minutes) for 2 hours a day for 3 days each. The participants played the latest Nintendo Switch games (eg, Just Dance, Boxing, Ring Fit Adventure) and Xbox Kinect games (eg, Kinect Adventures!, Mini Games). Just Dance, Zumba, and Boxing were played in activity 1; Ring Fit Adventure and Mini Games in activity 2; and Kinect Adventures! in activity 3. Reflexive thematic analysis was applied to identify the relative themes generated from the interviews. Results: In total, 22 participants (mean age 70.4, SD 6.1 years) were enrolled in the workshop in May 2021. The results of the generated themes included incomprehension of game instructions, psychological perception of game technology, and game art preferences. The subthemes generated from game art preferences included favorite game genres, characters, and scenes. Conclusions: There is a significant need for customized game tutorials considering senior adults' cognitive and physical aging. Furthermore, the adventure game genre is preferable to other games. Humanlike game characters are preferable, especially those with a fit and healthy body shape. Nature scenes are more enjoyable than indoor stages or rooms. Furthermore, the game intensity design and playing time should be carefully planned to meet the World Health Organization's criteria for physical activity in older adults. Intelligent recommendation systems might be helpful to support older adults with various health conditions. The guidelines suggested in this study might be beneficial for game design, exercise training, and game technology adoption of exergames for older adults to improve health. ",
doi="10.2196/36154",
url="https://games.jmir.org/2024/1/e36154",
url="http://www.ncbi.nlm.nih.gov/pubmed/38578674"
}


@Article{info:doi/10.2196/50796,
author="Li, Yijun
and Wilke, Carlotta
and Shiyanov, Irina
and Muschalla, Beate",
title="Impact of Virtual Reality--Based Group Activities on Activity Level and Well-Being Among Older Adults in Nursing Homes: Longitudinal Exploratory Study",
journal="JMIR Serious Games",
year="2024",
month="Mar",
day="29",
volume="12",
pages="e50796",
keywords="virtual reality",
keywords="group activity",
keywords="aging care",
keywords="older adults",
keywords="meaningful activity",
keywords="mental health",
keywords="well-being",
keywords="social interaction",
keywords="psychosocial capacities",
keywords="activity of daily living",
abstract="Background: In addition to illness, inactivity is a risk factor for high mortality in nursing homes. Using innovative technology, such as virtual reality (VR), for meaningful group activities could provide new opportunities for solving this problem. VR interventions have already been approved as a promising method for enhancing the health of older adults. Objective: In this study, we examined whether VR-based group activities can have a positive impact on activity level and group interaction among older adults living in nursing homes. Methods: We conducted a longitudinal study and provided VR interventions as a group activity once a week for 4 consecutive weeks in nursing homes. Participants were recruited based on the experience of the nursing staff members and the natural decisions of the older adults. Within a virtual cottage, designed according to the needs of the target group, older adults were able to perform daily tasks that they were no longer able to do in real life, such as gardening and making pizza. Overall, 2 psychologists measured the psychosocial capacities, activities of daily life, and well-being before and after the interventions using standardized instruments. Results: The results focus on a total of 84 older adults from 14 nursing homes who completed at least 3 VR interventions. The results indicate that several psychosocial capacities among the older adults improved, including adherence to regulations (P<.001; $\eta${\texttwosuperior}=0.122), flexibility (P<.001; $\eta${\texttwosuperior}=0.109), and group integration (P<.001; $\eta${\texttwosuperior}=0.141). Problems related to competence also showed a slight decrease (P=.04; $\eta${\texttwosuperior}=0.039). In addition, the VR intervention promoted their proactivity (P<.001; $\eta${\texttwosuperior}=0.104) and mobility (P=.04; $\eta${\texttwosuperior}=0.039). During the VR group intervention, older adults' well-being could be maintained at a high level. The results highlight the beneficial effects of VR intervention as a meaningful activity in nursing homes, showcasing the potential of VR applications in this setting. Conclusions: This study provides a novel and naturalistic perspective, offering new insights into the use of VR in nursing homes. The VR intervention was well accepted and fulfilled the aim of enhancing capacity and well-being. It could be a meaningful group activity in nursing homes to improve social group interaction. To provide stronger evidence, randomized controlled trials are necessary. ",
doi="10.2196/50796",
url="https://games.jmir.org/2024/1/e50796",
url="http://www.ncbi.nlm.nih.gov/pubmed/38551635"
}


@Article{info:doi/10.2196/49312,
author="Su, Zhenzhen
and Zhang, Liyan
and Lian, Xuemin
and Guan, Miaomiao",
title="Virtual Reality--Based Exercise Rehabilitation in Cancer-Related Dysfunctions: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="26",
volume="26",
pages="e49312",
keywords="virtual reality",
keywords="cancer",
keywords="virtual reality--based exercise rehabilitation",
keywords="cancer-related dysfunction",
keywords="rehabilitation",
keywords="scoping review",
abstract="Background: Virtual reality--based exercise rehabilitation (VRER) is a promising intervention for patients with cancer-related dysfunctions (CRDs). However, studies focusing on VRER for CRDs are lacking, and the results are inconsistent. Objective: We aimed to review the application of VRER in patients with CRDs. Methods: This scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist framework. Publications were included from the time of database establishment to October 14, 2023. The databases were PubMed, Embase, Scopus, Cochrane, Web of Science, ProQuest, arXiv, IEEE Xplore, MedRxiv, CNKI, Wanfang Data, VIP, and SinoMed. The population included patients with cancer. A virtual reality (VR) system or device was required to be provided in exercise rehabilitation as an intervention. Eligible studies focused on VRER used for CRDs. Study selection and data extraction were performed by 2 reviewers independently. Extracted data included authors, year, country, study type, groups, sample size, participant age, cancer type, existing or potential CRDs, VR models and devices, intervention programs and durations, effectiveness, compliance, satisfaction, and safety. Results: We identified 25 articles, and among these, 12 (48\%) were randomized clinical trials, 11 (44\%) were other experimental studies, and 2 (8\%) were observational studies. The total sample size was 1174 (range 6-136). Among the 25 studies, 22 (88\%), 2 (8\%), and 1 (4\%) included nonimmersive VR, immersive VR, and augmented reality, respectively, which are models of VRER. Commercial game programs (17/25, 68\%) were the most popular interventions of VRER, and their duration ranged from 3 to 12 weeks. Using these models and devices, VRER was mostly applied in patients with breast cancer (14/25, 56\%), leukemia (8/25, 32\%), and lung cancer (3/25, 12\%). Furthermore, 6 CRDs were intervened by VRER, and among these, postmastectomy syndromes were the most common (10/25, 40\%). Overall, 74\% (17/23) of studies reported positive results, including significant improvements in limb function, joint range of motion, edema rates, cognition, respiratory disturbance index, apnea, activities of daily living, and quality of life. The compliance rate ranged from 56\% to 100\%. Overall, 32\% (8/25) of studies reported on patient satisfaction, and of these, 88\% (7/8) reported satisfaction with VRER. Moreover, 13\% (1/8) reported mild sickness as an adverse event. Conclusions: We found that around half of the studies reported using VRER in patients with breast cancer and postmastectomy dysfunctions through nonimmersive models and commercial game programs having durations of 3-12 weeks. In addition, most studies showed that VRER was effective owing to virtualization and interaction. Therefore, VRER may be an alternate intervention for patients with CRDs. However, as the conclusions were drawn from data with acknowledged inconsistencies and limited satisfaction reports, studies with larger sample sizes and more outcome indictors are required. ",
doi="10.2196/49312",
url="https://www.jmir.org/2024/1/e49312",
url="http://www.ncbi.nlm.nih.gov/pubmed/38407951"
}


@Article{info:doi/10.2196/53072,
author="Goncalves, Aurelie
and Lespiau, Florence
and Briet, Ga{\"e}tan
and Vaillant-Coindard, Eug{\'e}nie
and Palermo, Ang{\`e}le
and Decobert, Elsa
and Allegret-Bourdon, Nathan
and Charbonnier, Elodie",
title="Exploring the Use of a Learning-Based Exergame to Enhance Physical Literacy, Soft Skills, and Academic Learning in School-Age Children: Pilot Interventional Study",
journal="JMIR Serious Games",
year="2024",
month="Feb",
day="23",
volume="12",
pages="e53072",
keywords="learning support",
keywords="exergaming",
keywords="physics playground",
keywords="educational games",
keywords="primary school",
keywords="children",
abstract="Background: There is ample evidence that most children do not perform enough physical activity (PA). To address this major public health problem, the French government implemented 30 minutes of daily PA (DPA) at schools but did not provide any supplemental resources or concrete guidance. Considering both children's interest in video games and the need for teachers to complete their curriculum, the use of a learning-based exergame that combines PA and learning appears particularly relevant. Objective: The first objective of this study was to evaluate the feasibility of implementing 30 minutes of DPA through exergaming among school-age children. The second objective was to examine the effects of an exergaming program on physical literacy, academic learning, and soft skills (motivation, self-efficacy, and concentration). Methods: This interventional study had a pre-post design and used the Play L{\"U} exergame platform. The study included 79 children with a mean age of 8.9 (SD 1.2) years from grade 2 (7 years old) to grade 5 (11 years old). Play L{\"U} requires players to throw balls against a wall to reach a target or to activate an object and provides an interactive game area for educational activities linked to specific learning themes. After a 4-session familiarization phase during which the teachers chose to prioritize mathematics learning in 30-minute DPA sessions, students took part in DPA sessions over a period of 3 weeks with Play L{\"U} and a motor skills circuit behind the L{\"U} setup to keep them continuously active. All sessions were carried out by PA specialists. Each session started with a warm-up using the Gr{\"o}{\"o}ve application, continued with main activities promoting mathematics learning adapted to each grade level, and ended with a 3-minute meditation for returning to a calm and serene state using the Ga{\"i}a application. Before (T0) and after (T1) the program, students completed a self-evaluation booklet to assess their levels of physical literacy, academic performance, and soft skills. Results: The implementation of this exergaming program was welcomed by the school's administration, teaching staff, and parents. After the program, we observed increased scores for physical literacy (difference +2.6, percentage change +3.6\%; W=933.0; P=.002; rrb=?0.39, 95\% CI ?0.58 to ?0.16) and motivation in mathematics (+0.7, +9.8\%; W=381.5; P=.005; rrb=?0.44, 95\% CI ?0.66 to ?0.16). In addition, it is important to note that some measures progressed differently across learning levels and age groups. Conclusions: The study results indicate positive impacts of learning-based exergaming on physical literacy and motivation in mathematics among school-age children. ",
doi="10.2196/53072",
url="https://games.jmir.org/2024/1/e53072",
url="http://www.ncbi.nlm.nih.gov/pubmed/38393767"
}


@Article{info:doi/10.2196/46397,
author="Mizuta, Rami
and Maeda, Noriaki
and Tashiro, Tsubasa
and Suzuki, Yuta
and Kuroda, Sayo
and Ishida, Ayano
and Oda, Sakura
and Watanabe, Tomoya
and Tamura, Yuki
and Komiya, Makoto
and Urabe, Yukio",
title="Effectiveness of Metaverse Space--Based Exercise Video Distribution in Young Adults: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="16",
volume="12",
pages="e46397",
keywords="exercise video distribution",
keywords="exercise",
keywords="metaverse",
keywords="physical activity",
keywords="web-based intervention",
abstract="Background: In response to the serious lack of physical activity among young adults, recent attempts have been made to encourage young people to exercise through exercise video distribution. However, merely distributing videos does not lead to improved physical activity levels. Metaverse space, which enables web-based interaction through avatars, allows users to watch exercise videos in the same space as other avatars. Objective: This study explored whether exercise video distribution using metaverse space is effective in improving physical activity levels, along with mental health and locomotive function, among young people. Methods: In this parallel-group randomized controlled trial participants were recruited using printed poster displays. A total of 48 young adults aged between 18 and 30 years were assigned to 3 groups of 16 each: the metaverse, YouTube, and control group. To encourage exercise, the metaverse group was given an exercise video each week with a load of around 4-8 metabolic equivalents of tasks (METs) for 8 videos delivered in the metaverse space. The YouTube group was sent a URL on YouTube every week to view exercise videos with the same content as the metaverse group. The control group was given no special instructions. The intervention period was 8 weeks. Pre- and postintervention physical activity, well-being, locomotive syndrome risk tests, and social capital were measured. Although this study was not blinded to the participants, the measurers did not know to which group the participants belonged. Mixed model repeated-measures analyses and a post hoc Wilcoxon signed rank sum test were performed to detect the effects of the intervention in all groups. Results: The results of the mixed model repeated-measures analyses showed a significant interaction between groups and before and after the intervention for total physical activity (metaverse group: pre 737.1, SD 609.5 METs/week, post 1575.4, SD 1071.8 METs/week; YouTube group: pre 661.7, SD 710.7 METs/week, post 911.9, SD 1103.3 METs/week; and control group: pre 930.6, SD 665.1 METs/week, post 844.7, SD 701.8 METs/week; P=.04) but none for the indicators of well-being (P=.40), locomotive function scale (P=.17), and social capital (P=.23). A post hoc test showed a significant increase in physical activity in the metaverse group before and after the intervention (P=.006). Conclusions: This study is the first to show that delivering exercise videos through metaverse space can increase physical activity in young adults by providing a gathering space for individuals similarly motivated for exercise practice. This way, the sense of isolation during exercise is reduced compared with merely distributing videos on YouTube. The use of metaverse space in health promotion is likely to spread, and this study provides a useful reference for its exploration. Trial Registration: ClinicalTrials.gov NCT06019156; https://ichgcp.net/clinical-trials-registry/NCT06019156 ",
doi="10.2196/46397",
url="https://mhealth.jmir.org/2024/1/e46397",
url="http://www.ncbi.nlm.nih.gov/pubmed/38227355"
}


@Article{info:doi/10.2196/48900,
author="Villada Castillo, Felipe Julian
and Montoya Vega, Fernanda Maria
and Mu{\~n}oz Cardona, Edison John
and Lopez, David
and Qui{\~n}ones, Leonardo
and Henao Gallo, Alberto Oscar
and Lopez, Fernando Jose",
title="Design of Virtual Reality Exergames for Upper Limb Stroke Rehabilitation Following Iterative Design Methods: Usability Study",
journal="JMIR Serious Games",
year="2024",
month="Jan",
day="11",
volume="12",
pages="e48900",
keywords="stroke",
keywords="user-centered design",
keywords="exergame",
keywords="design",
keywords="virtual reality",
keywords="playtest",
keywords="upper limb rehabilitation",
abstract="Background: Since the early 2000s, there has been a growing interest in using exercise video games (exergames) and virtual reality (VR)--based interventions as innovative methods to enhance physical rehabilitation for individuals with multiple disabilities. Over the past decade, researchers and exercise professionals have focused on developing specialized immersive exercise video games for various populations, including those who have experienced a stroke, revealing tangible benefits for upper limb rehabilitation. However, it is necessary to develop highly engaging, personalized games that can facilitate the creation of experiences aligned with the preferences, motivations, and challenges communicated by people who have had an episode of stroke. Objective: This study seeks to explore the customization potential of an exergame for individuals who have undergone a stroke, concurrently evaluating its usability as a technological tool in the realm of physical therapy and rehabilitation. Methods: We introduce a playtest methodology to enhance the design of a VR exergame developed using a user-centered approach for upper limb rehabilitation in stroke survivors. Over 4 playtesting sessions, stroke survivors interacted with initial game versions using VR headsets, providing essential feedback for refining game content and mechanics. Additionally, a pilot study involving 10 stroke survivors collected data through VR-related questionnaires to assess game design aspects such as mechanics, assistance, experience, motion sickness, and immersion. Results: The playtest methodology was beneficial for improving the exergame to align with user needs, consistently incorporating their perspectives and achieving noteworthy results. The pilot study revealed that users had a positive response. In the first scenario, a carpenter presents a game based on the flexion-extension movement of the elbow; the second scenario includes a tejo game (a traditional Colombian throwing game) designed around game mechanics related to the flexion-extension movement of the shoulder; and in the third scenario, a farmer challenges the player to perform a movement combining elbow flexion and extension with internal and external rotation of the shoulder. These findings suggest the potential of the studied exergame as a tool for the upper limb rehabilitation of individuals who have experienced a stroke. Conclusions: The inclusion of exergames in rehabilitation for stroke-induced hemiparesis has significantly benefited the recovery process by focusing on essential shoulder and elbow movements. These interactive games play a crucial role in helping users regain mobility and restore practical use of affected limbs. They also serve as valuable data sources for researchers, improving the system's responsiveness. This iterative approach enhances game design and markedly boosts user satisfaction, suggesting exergames have promising potential as adjunctive elements in traditional therapeutic approaches. ",
doi="10.2196/48900",
url="https://games.jmir.org/2024/1/e48900",
url="http://www.ncbi.nlm.nih.gov/pubmed/38206670"
}


@Article{info:doi/10.2196/39286,
author="Rojo, Ana
and Castrillo Calvillo, Arantxa
and L{\'o}pez, Cristina
and Raya, Rafael
and Moreno, C. Juan",
title="Effects of a Virtual Reality Cycling Platform on Lower Limb Rehabilitation in Patients With Ataxia and Hemiparesis: Pilot Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2024",
month="Jan",
day="4",
volume="12",
pages="e39286",
keywords="ataxia",
keywords="cycling",
keywords="hemiparesis",
keywords="lower limb",
keywords="neuropathology",
keywords="rehabilitation",
keywords="virtual reality",
keywords="limb",
keywords="intervention",
keywords="neural",
keywords="neural plasticity",
keywords="therapy",
keywords="muscle",
keywords="strength",
keywords="balance",
keywords="tool",
keywords="exercise",
keywords="physical activity",
keywords="neuroplasticity",
abstract="Background: New interventions based on motor learning principles and neural plasticity have been tested among patients with ataxia and hemiparesis. Therapies of pedaling exercises have also shown their potential to induce improvements in muscle activity, strength, and balance. Virtual reality (VR) has been demonstrated as an effective tool for improving the adherence to physical therapy, but it is still undetermined if it promotes greater improvements than conventional therapy. Objective: Our objective was to compare the effect on lower limb range of motion (ROM) when using VR technology for cycling exercise versus not using VR technology. Methods: A randomized controlled trial with 20 patients with ataxia and hemiparesis was carried out. The participants were divided into 2 groups: the experimental group (n=10, 50\%) performed pedaling exercises using the VR system and the control group (n=10, 50\%) performed pedaling exercises without using VR. Measurements of the active and passive ROM of the hip and knee joint were taken before and after a cycling intervention, which consisted of 3 sessions of the same duration but with progressively increasing speeds (4, 5, and 6 km/h). Repeated measures ANOVAs were conducted to compare the preintervention (Ti) and postintervention (Te) assessments within each group. Additionally, the improvement effect of using the VR system was analyzed by comparing the variation coefficient ($\Delta$ = 1 -- [Te / Ti]) between the preintervention and postintervention assessments for each group. Group comparisons were made using independent 1-tailed t tests. Results: Significant improvements were shown in active left hip flexion (P=.03) over time, but there was no group-time interaction effect (P=.67). Passive left hip flexion (P=.93) did not show significant improvements, and similar results were observed for active and passive right hip flexion (P=.39 and P=.83, respectively). Neither assessments of knee flexion (active left: P=.06; passive left: P=.76; active right: P=.34; passive right: P=.06) nor knee extension showed significant changes (active left: P=.66; passive left: P=.92; active right: P=.12; passive right: P=.38). However, passive right knee extension (P=.04) showed a significant improvement over time. Overall, although active and passive ROM of the knee and hip joints showed a general improvement, no statistically significant differences were found between the groups. Conclusions: In this study, participants who underwent the cycling intervention using the VR system showed similar improvement in lower limb ROM to the participants who underwent conventional training. Ultimately, the VR system can be used to engage participants in physical activity. Trial Registration: ClinicalTrials.gov NCT05162040; https://www.clinicaltrials.gov/study/NCT05162040 ",
doi="10.2196/39286",
url="https://games.jmir.org/2023/1/e39286"
}


@Article{info:doi/10.2196/41371,
author="Tacchino, Andrea
and Ponzio, Michela
and Confalonieri, Paolo
and Leocani, Letizia
and Inglese, Matilde
and Centonze, Diego
and Cocco, Eleonora
and Gallo, Paolo
and Paolicelli, Damiano
and Rovaris, Marco
and Sabattini, Loredana
and Tedeschi, Gioacchino
and Prosperini, Luca
and Patti, Francesco
and Bramanti, Placido
and Pedrazzoli, Elisabetta
and Battaglia, Alberto Mario
and Brichetto, Giampaolo",
title="An Internet- and Kinect-Based Multiple Sclerosis Fitness Intervention Training With Pilates Exercises: Development and Usability Study",
journal="JMIR Serious Games",
year="2023",
month="Nov",
day="8",
volume="11",
pages="e41371",
keywords="exergame",
keywords="Multiple Sclerosis Fitness Intervention Training",
keywords="MS-FIT",
keywords="Pilates",
keywords="Kinect",
keywords="multiple sclerosis",
keywords="exercise",
keywords="serious games",
keywords="balance",
keywords="mobile phone",
abstract="Background: Balance impairments are common in people with multiple sclerosis (MS), with reduced ability to maintain position and delayed responses to postural adjustments. Pilates is a popular alternative method for balance training that may reduce the rapid worsening of symptoms and the increased risk of secondary conditions (eg, depression) that are frequently associated with physical inactivity. Objective: In this paper, we aimed to describe the design, development, and usability testing of MS Fitness Intervention Training (MS-FIT), a Kinect-based tool implementing Pilates exercises customized for MS. Methods: MS-FIT has been developed using a user-centered design approach (design, prototype, user feedback, and analysis) to gain the target user's perspective. A team composed of 1 physical therapist, 2 game programmers, and 1 game designer developed the first version of MS-FIT that integrated the knowledge and experience of the team with MS literature findings related to Pilates exercises and balance interventions based on exergames. MS-FIT, developed by using the Unity 3D (Unity Technologies) game engine software with Kinect Sensor V2 for Windows, implements exercises for breathing, posture, and balance. Feedback from an Italian panel of experts in MS rehabilitation (neurologists, physiatrists, physical therapists, 1 statistician, and 1 bioengineer) and people with MS was collected to customize the tool for use in MS. The context of MS-FIT is traveling around the world to visit some of the most important cities to learn the aspects of their culture through pictures and stories. At each stay of the travel, the avatar of a Pilates teacher shows the user the exercises to be performed. Overall, 9 people with MS (n=4, 44\% women; mean age 42.89, SD 11.97 years; mean disease duration 10.19, SD 9.18 years; Expanded Disability Status Scale score 3.17, SD 0.75) were involved in 3 outpatient user test sessions of 30 minutes; MS-FIT's usability was assessed through an ad hoc questionnaire (maximum value=5; higher the score, higher the usability) evaluating easiness to use, playability, enjoyment, satisfaction, and acceptance. Results: A user-centered design approach was used to develop an accessible and challenging tool for balance training. All people with MS (9/9, 100\%) completed the user test sessions and answered the ad hoc questionnaire. The average score on each item ranged from 3.78 (SD 0.67) to 4.33 (SD 1.00), which indicated a high usability level. The feedback and suggestions provided by 64\% (9/14) of people with MS and 36\% (5/14) of therapists involved in the user test were implemented to refine the first prototype to release MS-FIT 2.0. Conclusions: The participants reported that MS-FIT was a usable tool. It is a promising system for enhancing the motivation and engagement of people with MS in performing exercise with the aim of improving their physical status. ",
doi="10.2196/41371",
url="https://games.jmir.org/2023/1/e41371",
url="http://www.ncbi.nlm.nih.gov/pubmed/37938895"
}


@Article{info:doi/10.2196/49080,
author="Park, Je Sung
and Lee, Woog Jea",
title="Effects of Virtual Reality Pilates Training on Duration of Posture Maintenance and Flow in Young, Healthy Individuals: Randomized Crossover Trial",
journal="JMIR Serious Games",
year="2023",
month="Oct",
day="19",
volume="11",
pages="e49080",
keywords="virtual reality",
keywords="Pilates",
keywords="exercise program",
keywords="flow",
keywords="duration of posture maintenance",
keywords="sport video data analytics",
keywords="video",
keywords="data analytics",
keywords="sport",
keywords="sports",
keywords="exercise",
keywords="physical activity",
keywords="posture",
keywords="VR",
keywords="balance",
keywords="movement",
keywords="self-reported",
keywords="patient reported",
abstract="Background: This study explored the use of virtual reality (VR) technology to enhance the effectiveness and duration of low-intensity movements and postures in Pilates-derived exercises. We postulate that by leveraging the flow state in VR, individuals can engage in these exercises for longer periods while maintaining a high level of flow. Objective: The purpose of this study was to compare differences in posture maintenance and flow between VR Pilates training and conventional Pilates training, and the correlation between the 2 factors. Methods: The 18 participants in each group received either VR training or conventional training and were switched to the other training type after a 2-day wash-out period. Each group performed Pilates movements in a VR environment and a conventional environment, divided into 4 types. After training sessions, participants were evaluated for flow using a self-report questionnaire. In addition, a sports video analysis program was used to measure the duration of posture maintenance in 2 video-recorded sessions. Repeated-measures ANOVA and correlation analysis were performed on the measured duration of posture maintenance and flow scores. In all cases, the statistical significance level was set at P<.05. Results: Results for the duration of posture maintenance verification by type showed that simple behavior (F1,16=17.631; P<.001), upper body--arm coordination behavior (F1,16=6.083; P=.04), upper body--leg coordination behavior (F1,16=8.359; P<.001), and whole-body coordination behavior (F1,16=8.426; P<.001) all showed an interaction effect at P<.05. Flow (F1,16=15.250; P<.001) also showed an interaction effect. In addition, significant correlations were determined between duration of all types of posture maintenance and flow in the VR training group at P<.05. Conclusions: Our results indicate that VR Pilates training may be more useful than conventional Pilates training in improving the duration of posture maintenance and that it promotes a significantly higher degree of flow when compared with conventional Pilates training. ",
doi="10.2196/49080",
url="https://games.jmir.org/2023/1/e49080",
url="http://www.ncbi.nlm.nih.gov/pubmed/37856178"
}


@Article{info:doi/10.2196/42697,
author="Wu, Jinlong
and Xu, Zhuang
and Liu, Haowei
and Chen, Xiaoke
and Huang, Li
and Shi, Qiuqiong
and Weng, Linman
and Ji, Yemeng
and Zeng, Hao
and Peng, Li",
title="Effects of Commercial Exergames and Conventional Exercises on Improving Executive Functions in Children and Adolescents: Meta-Analysis of Randomized Controlled Trials",
journal="JMIR Serious Games",
year="2023",
month="Oct",
day="19",
volume="11",
pages="e42697",
keywords="commercial exergames",
keywords="exergame",
keywords="randomized controlled trial",
keywords="RCT",
keywords="conventional exercises",
keywords="executive function",
keywords="children",
keywords="adolescent",
keywords="pediatric",
keywords="youth",
keywords="exergaming",
keywords="randomized",
keywords="meta-analysis",
keywords="meta analyses",
keywords="review method",
keywords="systematic review",
abstract="Background: Exergames are promising exercise tools for improving health. To the best of our knowledge, no systematic review has compared the effects of commercial exergames and conventional exercises on improving executive functions (EFs) in children and adolescents. Objective: This study aimed to investigate the effects of commercial exergames and conventional exercises on improving EFs in children and adolescents. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 5 randomized controlled trial (RCT) databases (PubMed, Web of Science, Scopus, PsycINFO, and SPORTDiscus) were searched from their inception to July 7, 2022, to identify relevant RCTs. The Cochrane Collaboration tool was used to evaluate the risk of bias for each study. GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) was used to evaluate the overall quality of evidence. Results: In total, 8 RCTs including 435 children and adolescents were included in the analysis. Commercial exergames had no significant benefit on overall EFs compared to conventional exercises (Hedges g=1.464, 95\% CI --0.352 to 3.280; P=.06). For core EFs, there was no evidence to suggest that commercial exergames are more beneficial for improving cognitive flexibility (g=0.906, 95\% CI --0.274 to 2.086; P=.13), inhibitory control (g=1.323, 95\% CI --0.398 to 3.044; P=.13), or working memory (g=2.420, 95\% CI --1.199 to 6.038; P=.19) than conventional exercises. We rated the evidence for overall EFs, cognitive flexibility, inhibitory control, and working memory as being of very low quality due to inconsistency (large heterogeneity) and imprecision (low number of people). Additionally, no effects of the intervention were observed in the acute and chronic groups. Conclusions: We do not have strong evidence to support the benefit of commercial exergaming on EFs because we did not observe a Hedges g close to 0 with tight CIs. Further research is needed to confirm this hypothesis. Trial Registration: PROSPERO CRD42022324111; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=324111 ",
doi="10.2196/42697",
url="https://games.jmir.org/2023/1/e42697",
url="http://www.ncbi.nlm.nih.gov/pubmed/37856191"
}


@Article{info:doi/10.2196/43985,
author="Afzal, Waqar M.
and Ahmad, Ashfaq
and Hanif, Bilal Hafiz Muhammad
and Chaudhary, Nauman
and Gilani, Amir Syed",
title="Effects of Virtual Reality Exercises on Chronic Low Back Pain: Quasi-Experimental Study",
journal="JMIR Rehabil Assist Technol",
year="2023",
month="Sep",
day="15",
volume="10",
pages="e43985",
keywords="low back pain, lumbar range of motion",
keywords="pain",
keywords="Oswestry disability index",
keywords="virtual reality",
keywords="exercise",
keywords="back pain",
keywords="lumbar",
keywords="range of motion",
keywords="VR",
keywords="rehabilitation",
keywords="gaming",
keywords="serious game",
abstract="Background: Low back pain is a common health problem globally. Based on the duration of pain, it is classified as acute, subacute, or chronic low back pain. Different treatment strategies are available to reduce chronic low back pain. Virtual reality (VR) is a novel approach in back pain rehabilitation. Objective: This study aimed to compare the effects of VR games on chronic low back pain. Methods: This quasi-experimental study was conducted among 40 patients with chronic low back pain. The data were collected using a nonprobability, convenient sampling technique. Patients visiting the Department of Physiotherapy, Government Services Hospital, Lahore, Pakistan, were recruited and equally divided into 4 groups. Group A received the Reflex Ridge game; group B received the Body Ball game; group C combined the 2 games without back-strengthening exercises; and group D combined the 2 games with back-strengthening exercises. The participants received 8 treatment sessions, with 3 sessions/wk. The outcomes were pre- and posttest measurements of pain intensity, low back disability, and lumbar range of motion. The repeated measurement ANOVA was used for inter- and intragroup comparison, with significance at P?.05. Results: The study comprised a sample of 40 patients with low back pain; 12 (40\%) were female and 28 (60\%) were male, with a mean age of 37.85 (SD 12.15) years. The pre- and posttest mean pain scores were 7.60 (SD 1.84) and 4.20 (SD 1.62) in group A, 6.60 (SD 1.776) and 5.90 (SD 1.73) in group B, 6.90 (SD 1.73) and 5.40 (SD 1.07) in group C, and 7.10 (SD 1.53) and 3.60 (SD 0.97) in group D, respectively. The mean pain score differences of group D (combining the Reflex Ridge and Body Ball games with back-strengthening exercises) compared to groups A, B, and C were --.60 (P=.76), --2.30 (P<.001), and --1.80 (P=.03), respectively. Regarding the range of motion, the forward lumbar flexion mean differences of group D compared to groups A, B, and C were 3.80 (P=.21), 4.80 (P=.07), and 7.40 (P<.001), respectively. Similarly, the right lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P=.04), 5.20 (P<.001), and 4.80 (P<.001), respectively. The left lateral lumbar flexion mean differences of group D compared to groups A, B, and C were 2.80 (P<.001), 4.80 (P=.02), and 2.20 (P<.001). respectively, showing significant pre- and posttreatment effects. Conclusions: VR exercises had statistically significant effects on improving pain, low back disability, and range of motion in all groups, but the combination of Reflex Ridge and Body Ball games with back-strengthening exercises had dominant effects compared to the other groups. Trial Registration: Iranian Registry of Clinical Trial IRCT20200330046895N1; https://en.irct.ir/trial/46916 ",
doi="10.2196/43985",
url="https://rehab.jmir.org/2023/1/e43985",
url="http://www.ncbi.nlm.nih.gov/pubmed/37713252"
}


@Article{info:doi/10.2196/51772,
author="Erten, B{\"u}?ra Ay?e
and Tarak{\c{c}}?, Devrim
and {\c{C}}a{\c{c}}an, Akif Mehmet",
title="The Effectiveness of Video-Based Game Exercise Therapy Applications in Pes Planus Rehabilitation: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="11",
volume="12",
pages="e51772",
keywords="exergame",
keywords="pes planus",
keywords="rehabilitation",
keywords="serious game",
keywords="video-based game therapy",
abstract="Background: Pes planus is one of the most common foot deformities. Although there are many studies on the effectiveness of various exercise methods in pes planus rehabilitation, the number of studies on video-based game exercise therapy applications is very limited. Objective: This study aims to evaluate the effectiveness of 2 video-based game exercise therapies and structured exercise practices in pes planus rehabilitation. Methods: This study is a 3-arm, parallel-group, single-blinded randomized controlled trial. The study will include 69 patients with flexible pes planus aged between 18 and 25 years who attend the orthopedics and traumatology clinic and meet the inclusion criteria. The primary outcomes are measures of navicular drop and pedobarographic analysis before and after the intervention, and the secondary outcomes include balance, femoral anteversion, and lower extremity muscle strength. Participants will be evaluated with a navicular drop test for medial longitudinal arch height, a pedobarographic analysis system for plantar pressure analysis, a Craig test for femoral anteversion, the Becure Balance System for balance measurement, and a myometer device for lower extremity muscle strength measurement. Participants will be randomly assigned to a structured exercise group, an exergame group, or a serious game group according to their order of arrival. The structured exercise group will use a short foot exercise, a towel-picking exercise, and various walking and balance exercises. Patients in the serious play group will play the lower extremity games in the Becure Balance System. Patients in the exergame group will play balance games on the Nintendo Wii game console. All participants will participate in 18 exercise sessions (3 days a week for 6 weeks). After the treatment, the initial measurements will be repeated. Results: The study started in January 2023. It is expected to be completed in June 2024. Conclusions: This study will be the first randomized controlled study to evaluate the effectiveness of 2 different video-based game exercise therapy applications in pes planus rehabilitation. Through this study, the use of video-based game exercise therapy in pes planus rehabilitation, together with the developing technology, will be a guide. In addition, a new exercise protocol, including serious game exercises, will be added to the literature. In the future, it is expected that our study on the development of different game systems, especially for the ankle, will provide pioneering feedback. Trial Registration: ClinicalTrials.gov NCT05679219; https://clinicaltrials.gov/study/NCT05679219 International Registered Report Identifier (IRRID): DERR1-10.2196/51772 ",
doi="10.2196/51772",
url="https://www.researchprotocols.org/2023/1/e51772",
url="http://www.ncbi.nlm.nih.gov/pubmed/37695657"
}


@Article{info:doi/10.2196/42878,
author="Kai, Liu
and Tan, Hoe Wee
and Saari, Marlina Erni",
title="Dimensions of Interactive Pervasive Game Design: Systematic Review",
journal="JMIR Serious Games",
year="2023",
month="Aug",
day="22",
volume="11",
pages="e42878",
keywords="interactive",
keywords="pervasive game",
keywords="systematic review",
keywords="design",
keywords="mobile phone",
abstract="Background: As the gaming industry grows around the world, playing pervasive games is becoming an important mode of entertainment. A pervasive game is one in which the game experience extends into the actual world or where the fictive world of the game merges with the physical world. How pervasive games can adapt to the ever-changing nature of technology and design in current society requires a comprehensive review. Objective: In this systematic review, we aimed to measure and analyze 4 dimensions of pervasive games through development, technology, experience, and evaluation. Moreover, we also aimed to discover and interpret their relationship with game, interaction, experience, and service design. Methods: We first chose 3 well-known databases, Web of Science, Scopus, and EBSCO, and searched from 2013 to April 2022. A strictly thorough Boolean search for research keywords such as ``pervasive game,'' ``design,'' and ``interactive'' resulted in 394 relevant articles. These articles were identified, screened, and checked for eligibility to find valid and useful articles, which were then categorized and analyzed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method. Results: The systematic selection was finally left with 40 valid and valuable articles. After categorization and analysis, all articles were classified according to 4 main themes, which were design and development (11/40, 28\%), interaction and technology (15/40, 38\%), users and experience (9/40, 23\%), and evaluation and service (5/40, 13\%). These 4 main areas can be subdivided into several smaller areas. Conclusions: In the 4 areas of game design, interaction design, experience design, and service design, many scholars have studied pervasive games and made contributions. Although the development and technology of pervasive games have evolved with the times, there is still a need to strengthen emerging design concepts within pervasive games. ",
doi="10.2196/42878",
url="https://games.jmir.org/2023/1/e42878",
url="http://www.ncbi.nlm.nih.gov/pubmed/37463860"
}


@Article{info:doi/10.2196/42374,
author="Chen, Xi
and Wu, Lina
and Feng, Hui
and Ning, Hongting
and Wu, Shuang
and Hu, Mingyue
and Jiang, Dian
and Chen, Yifei
and Jiang, Yu
and Liu, Xin",
title="Comparison of Exergames Versus Conventional Exercises on the Health Benefits of Older Adults: Systematic Review With Meta-Analysis of Randomized Controlled Trials",
journal="JMIR Serious Games",
year="2023",
month="Jun",
day="22",
volume="11",
pages="e42374",
keywords="exergame",
keywords="exergaming",
keywords="older adult",
keywords="elder",
keywords="geriatric",
keywords="gerontology",
keywords="physical function",
keywords="mental health",
keywords="systematic review",
keywords="meta-analysis",
keywords="meta-analyses",
keywords="review methodology",
keywords="RCT",
keywords="randomized",
keywords="cognitive function",
keywords="depression",
keywords="QOL",
keywords="quality of life",
abstract="Background: Conventional exercises (CEs) can provide health benefits for older adults, but the long-term exercise adherence rate is low. As an emerging, stimulating, and self-motivating strategy, exergames (EGs) are defined as combinations of exercises and games that users carry out through physical actions. They can promote exercise, but the health effects of EGs versus CEs on the physical function and mental health (cognitive function, depression, and quality of life) of older adults remain controversial. Objective: The aim of the study is to compare the health benefits of EGs versus those of CEs for the physical function and mental health of older adults. Methods: A comprehensive search was conducted from the earliest available date to February 2023 in the following 6 databases: PubMed, Web of Science, Embase, Cochrane, CINAHL, and PsycINFO. All English-language randomized controlled trials comparing the effects of EGs versus those of CEs on the physical function and mental health of older adults, with nearly same physical activity between the 2 interventions, were included. Risk of bias was independently evaluated by 2 authors using the Cochrane risk of bias in randomized trials tool. Two authors independently extracted data. We followed the Cochrane Handbook of Systematic Reviews of Interventions to process and analyze the data for meta-analysis. Standardized mean differences (SMDs) and 95\% CIs were used for continuous data, and random models were used for analyses. Results: We included 12 studies consisting of 919 participants in total. Of these, 10 studies were eventually included in the meta-analysis. The results showed that EGs versus CEs exhibited no significant differences in physical (P=.13; $\tau$2=0.31; $\chi$26=26.6; I2=77\%; SMD=0.37; 95\% CI --0.11 to 0.86) or cognitive function (P=.63; $\tau$2=0.01; $\chi$23=3.1; I2=4\%; SMD=0.09; 95\% CI --0.27 to 0.44) effects. Conclusions: Our findings indicate no significant difference between EGs and CEs in improving the physical function and cognitive function of older adults. Future studies are required to compare the effects of EGs versus those of CEs on cognitive function according to cognitive status, quantify the ``dose-effect'' relationship between EGs and health benefits, and evaluate the effects of different types and devices of EGs with regard to the health benefits of older adults. Trial Registration: PROSPERO CRD42022322734; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=322734 ",
doi="10.2196/42374",
url="https://games.jmir.org/2023/1/e42374",
url="http://www.ncbi.nlm.nih.gov/pubmed/37347534"
}


@Article{info:doi/10.2196/41553,
author="O'Loughlin, K. Erin
and Sabiston, M. Catherine
and O'Rourke, H. Roxy
and B{\'e}langer, Mathieu
and Sylvestre, Marie-Pierre
and O'Loughlin, L. Jennifer",
title="The Change in Exergaming From Before to During the COVID-19 Pandemic Among Young Adults: Longitudinal Study",
journal="JMIR Serious Games",
year="2023",
month="May",
day="22",
volume="11",
pages="e41553",
keywords="exergaming",
keywords="active video games",
keywords="longitudinal study",
keywords="COVID-19 pandemic",
keywords="physical activity",
keywords="serious game",
keywords="youth",
keywords="young adult",
keywords="health promotion",
keywords="digital health intervention",
keywords="exergame",
abstract="Background: Exergaming may be an important option to support an active lifestyle, especially during pandemics. Objective: Our objectives were (1) to explore whether change in exergaming status (stopped, started or sustained exergaming, or never exergamed) from before to during the COVID-19 pandemic was related to changes in walking, moderate-to-vigorous physical activity (MVPA) or meeting MVPA guidelines and (2) to describe changes among past-year exergamers in minutes per week exergaming from before to during the pandemic. Methods: A total of 681 participants (mean age 33.6; SD 0.5 years; n=280, 41\% male) from the 22-year Nicotine Dependence in Teens (NDIT) study provided data on walking, MVPA, and exergaming before (2017 to 2020) and during (2021) the COVID-19 pandemic. Physical activity (PA) change scores were described by change in exergaming status. Results: We found that 62.4\% (n=425) of the 681 participants never exergamed, 8.2\% (n=56) started exergaming during the pandemic, 19.7\% (n=134) stopped exergaming, and 9.7\% (n=66) sustained exergaming. Declines were observed in all 3 PA indicators in all 4 exergaming groups. The more salient findings were that (1) participants who started exergaming during COVID-19 reported the highest MVPA levels before and during the pandemic and declined the least (mean --35 minutes/week), (2) sustained exergamers reported the lowest MVPA levels during the pandemic (median 66 minutes/week) and declined the most in MVPA (mean change of --92 minutes/week) and in meeting MVPA guidelines (--23.6\%). During the pandemic, starting exergamers reported 85 minutes of exergaming per week and sustained exergamers increased exergaming by a median 60 minutes per week. Conclusions: Although starting and sustaining exergaming did not appear to help exergamers maintain prepandemic PA levels, exergaming can contribute a substantial proportion of total PA in young adults and may still represent a useful option to promote PA during pandemics. ",
doi="10.2196/41553",
url="https://games.jmir.org/2023/1/e41553",
url="http://www.ncbi.nlm.nih.gov/pubmed/36952329"
}


@Article{info:doi/10.2196/45243,
author="Moller, C. Arlen
and Sousa, Victor Caio
and Lee, Jihyeon Kelly
and Alon, Dar
and Lu, Shirong Amy",
title="Active Video Game Interventions Targeting Physical Activity Behaviors: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2023",
month="May",
day="16",
volume="25",
pages="e45243",
keywords="active video game",
keywords="exergame",
keywords="games for health",
keywords="digital health",
keywords="physical activity",
keywords="systematic review",
keywords="meta-analysis",
keywords="digital game",
keywords="digital health intervention",
keywords="health promotion",
abstract="Background: Research on digital games designed to increase physical activity (PA), also known as exergames or active video games (AVGs), has proliferated over the past 2 decades. As a result, reviews of literature in this field can become outdated, revealing the need for updated high-quality reviews that identify overarching insights. Furthermore, given the significant heterogeneity in AVG research, study inclusion criteria may significantly influence conclusions. To the best of our knowledge, no prior systematic review or meta-analysis has specifically focused on studies of longitudinal AVG interventions targeting increases in PA behaviors. Objective: The aim of this study was to obtain insights into when and why longitudinal AVG interventions are more or less successful for sustained increases in PA, especially for public health. Methods: Six databases (PubMed, PsycINFO, SPORTDiscus, MEDLINE, Web of Science, and Google Scholar) were reviewed until December 31, 2020. This protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020204191). For inclusion, randomized controlled trials had to prominently (>50\% of intervention) feature AVG technology, involve repeated AVG exposure, and target changes in PA behavior. Experimental designs had to include ?2 within- or between-participant conditions with ?10 participants per condition. Results: A total of 25 studies published in English between 1996 and 2020 were identified, with 19 studies providing sufficient data for inclusion in the meta-analysis. Our findings indicated that AVG interventions had a moderately positive effect, thereby increasing overall PA (Hedges g=0.525, 95\% CI 0.322-0.728). Our analysis showed substantial heterogeneity (I2=87.7\%; Q=154.1). The main findings were consistent across all subgroup analyses. The comparison between PA assessment type groups showed a moderate effect for objective measures (Hedges g=0.586, 95\% CI 0.321-0.852) and a small effect for subjective measures (Hedges g=0.301, 95\% CI 0.049-0.554) but no significant difference between the groups (P=.13). The platform subgroup analysis indicated a moderate effect for stepping devices (Hedges g=0.303, 95\% CI 0.110-0.496), combination of handheld and body-sensing devices (Hedges g=0.512, 95\% CI 0.288-0.736), and other devices (Hedges g=0.694, 95\% CI 0.350-1.039). The type of control group showed a wide range of effects sizes, ranging from a small effect size (Hedges g=0.370, 95\% CI 0.212-0.527) for the passive control group (nothing) to a moderate effect size for the conventional PA intervention group (Hedges g=0.693, 95\% CI 0.107-1.279) and ultimately to a large effect size for sedentary game as control groups (Hedges g=0.932, 95\% CI 0.043-1.821). There was no significant difference among the groups (P=.29). Conclusions: AVGs represent a promising tool for PA promotion among the general population and clinical subpopulations. However, significant variabilities in AVG quality, study design, and impact were also detected. Suggestions for improving AVG interventions and related research will be discussed. Trial Registration: PROSPERO CRD42020204191; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=204191 ",
doi="10.2196/45243",
url="https://www.jmir.org/2023/1/e45243",
url="http://www.ncbi.nlm.nih.gov/pubmed/37191992"
}


@Article{info:doi/10.2196/40438,
author="Ji, HongQing
and Wu, Shanshan
and Won, Junyeon
and Weng, Shiyang
and Lee, Sujin
and Seo, Sangmin
and Park, Jung-Jun",
title="The Effects of Exergaming on Attention in Children With Attention Deficit/Hyperactivity Disorder: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2023",
month="May",
day="9",
volume="11",
pages="e40438",
keywords="exergame",
keywords="N2 amplitude",
keywords="attention function",
keywords="response time",
keywords="attention deficit/hyperactivity disorder",
keywords="ADHD",
abstract="Background: Despite growing evidence showing the effects of exercise and cognitive trainings on enhancing attention, little is known about the combined effects of exergame on attention in children with attention deficit/hyperactivity disorder (ADHD). Exergame, a form of exercise using a video game, has both cognitive stimulation and physical activity components and has been shown to improve cognitive function in children. Objective: The purpose of this study was to investigate the effect of exergaming on attention and to compare the effect induced by exergaming with the effect of aerobic exercise on attention in children with ADHD. Methods: In all, 30 children with ADHD, aged 8-12 years, were randomly divided into an exergaming group (EXG; n=16) or a bicycle exercise group (BEG; n=14). Before and after the 4-week intervention, the Frankfurter Aufmerksamkeits-Inventar (FAIR; Frankfurt Attention Inventory) test was administrated, and event-related potentials during the Go/No-go task was measured to assess attention. Results: After intervention, both the EXG and BEG had significantly increased selective attention and continuous attention (all P<.001), as well as self-control on the FAIR test (EXG: P=.02 and BEG: P=.005). Similarly, both the EXG and BEG had significantly reduced response time on the Go/No-go test (all P<.001). For the Go response, the N2 amplitude (frontocentral maximal negativity) was significantly increased in Fz (midfrontal line) in the EXG (P=.003) but was not changed in the BEG (P=.97). Importantly, the N2 amplitude in Fz was significantly greater in the EXG compared to the BEG (Go: P=.001 and No-go: P=.008). Conclusions: Exergaming has the comparable effects to bicycle exercise to enhance attention in children with ADHD, suggesting that exergaming can be used as an alternative treatment for children with ADHD. Trial Registration: Clinical Research Information Service KCT0008239; https://tinyurl.com/57e4jtnb ",
doi="10.2196/40438",
url="https://games.jmir.org/2023/1/e40438",
url="http://www.ncbi.nlm.nih.gov/pubmed/37159253"
}


@Article{info:doi/10.2196/42944,
author="Mo, Nan
and Feng, yu Jin
and Liu, xia Hai
and Chen, yu Xiao
and Zhang, Hui
and Zeng, Hui",
title="Effects of Exergaming on Musculoskeletal Pain in Older Adults: Systematic Review and Meta-analysis",
journal="JMIR Serious Games",
year="2023",
month="Apr",
day="25",
volume="11",
pages="e42944",
keywords="aged",
keywords="exergaming",
keywords="pain",
keywords="review",
keywords="video game",
keywords="virtual reality",
abstract="Background: Exercise is effective for musculoskeletal pain. However, physical, social, and environmental factors make it difficult for older adults to persist in exercising. Exergaming is a new pathway that combines exercise with gameplay and may be helpful for older adults to overcome these difficulties and engage in regular exercise. Objective: This systematic review aimed to determine the efficacy of exergaming to improve musculoskeletal pain in older adults. Methods: The search was performed in 5 databases (PubMed, Embase, CINAHL, Web of Science, and Cochrane Library). The risk of bias for randomized controlled studies was assessed using the revised Cochrane Risk of Bias tool in randomized trials (RoB 2), and the methodological quality was assessed using the Physiotherapy Evidence-Based Database scale. Standardized mean difference and 95\% CI were calculated using fixed-effects model meta-analyses in the Review Manager version 5.3 (RevMan 5.3). Results: Seven randomized controlled studies were included, which contained 264 older adults. Three of the 7 studies reported significant improvements in pain after the exergaming intervention, but only 1 reported a significant difference between groups after adjustment for baseline (P<.05), and another reported a significant improvement in thermal pain between the 2 groups (P<.001). The results of the meta-analysis of the 7 studies showed no statistically significant improvement in pain compared to the control group (standardized mean difference --0.22; 95\% CI --0.47 to 0.02; P=.07). Conclusions: Although the effects of exergames on musculoskeletal pain in older adults are unknown, exergame training is generally safe, fun, and appealing to older adults. Unsupervised exercise at home is feasible and cost-effective. However, most of the current studies have used commercial exergames, and it is recommended that there should be more cooperation between industries in the future to develop professional rehabilitation exergames that are more suitable for older adults. The sample sizes of the studies included are small, the risk of bias is high, and the results should be interpreted with caution. Further randomized controlled studies with large sample sizes, high quality, and rigor are needed in the future. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022342325; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=342325 ",
doi="10.2196/42944",
url="https://games.jmir.org/2023/1/e42944",
url="http://www.ncbi.nlm.nih.gov/pubmed/37097717"
}


@Article{info:doi/10.2196/44135,
author="Lopez-Barreiro, Juan
and Alvarez-Sabucedo, Luis
and Garcia-Soidan, Jose-Luis
and Santos-Gago, M. Juan",
title="Creation of a Holistic Platform for Health Boosting Using a Blockchain-Based Approach: Development Study",
journal="Interact J Med Res",
year="2023",
month="Apr",
day="19",
volume="12",
pages="e44135",
keywords="blockchain",
keywords="exercise",
keywords="gamification",
keywords="habits",
keywords="healthy lifestyle",
keywords="physical fitness",
abstract="Background: Low adherence to healthy habits, which is associated with a higher risk of disease and death, among citizens of Organization for Economic Co-operation and Development countries is a serious concern. The World Health Organization (WHO) and the physical activity (PA) guidelines for Americans provide recommendations on PA and healthy diets. To promote these habits, we suggest using a blockchain-based platform, using the PA Messaging Framework to deliver messages and rewards to users. Blockchain is a decentralized secure platform for data management, which can be used for value-added controls and services such as smart contracts (SCs), oracles, and decentralized applications (dApps). Of note, there is a substantial penetration of blockchain technologies in the field of PA, but there is a need for more implementations of dApps to take advantage of features such as nonfungible tokens. Objective: This study aimed to create a comprehensive platform for promoting healthy habits, using scientific evidence and blockchain technology. The platform will use gamification to encourage healthy PA and eating habits; in addition, it will monitor the activities through noninvasive means, evaluate them using open-source software, and follow up through blockchain messages. Methods: A literature search was conducted on the use of blockchain technology in the field of PA and healthy eating. On the basis of the results of this search, it is possible to define an innovative platform for promoting and monitoring healthy habits through health-related challenges on a dApp. Contact with the user will be maintained through messages following a proposed model in the literature to improve adherence to the challenges. Results: The proposed strategy is based on a dApp that relies on blockchain technology. The challenges include PA and healthy eating habits based on the recommendations of the WHO and the Food and Agriculture Organization. The system is constituted of a blockchain network where challenge-related achievements are stored and verified using SCs. The user interacts with the system through a dApp that runs on their local device, monitors the challenge, and self-authenticates by providing their public and private keys. The SC verifies challenge fulfillment and generates messages, and the information stored in the network can be used to encourage competition among participants. The ultimate goal is to create a habit of healthy activities through rewards and peer competition. Conclusions: The use of blockchain technology has the potential to improve people's quality of life through the development of relevant services. In this work, strategies using gamification and blockchain are proposed for monitoring healthy activities, with a focus on transparency and reward allocation. The results are promising, but compliance with the General Data Protection Regulation is still a concern. Personal data are stored on personal devices, whereas challenge data are recorded on the blockchain. ",
doi="10.2196/44135",
url="https://www.i-jmr.org/2023/1/e44135",
url="http://www.ncbi.nlm.nih.gov/pubmed/37074766"
}


@Article{info:doi/10.2196/39993,
author="Wu, Shanshan
and Ji, Hongqing
and Won, Junyeon
and Jo, Eun-Ah
and Kim, Yun-Sik
and Park, Jung-Jun",
title="The Effects of Exergaming on Executive and Physical Functions in Older Adults With Dementia: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="7",
volume="25",
pages="e39993",
keywords="exergame",
keywords="exergaming",
keywords="executive function",
keywords="physical function",
keywords="reaction time",
keywords="N2",
keywords="P3b",
keywords="physical",
keywords="function",
keywords="game",
keywords="dementia",
keywords="RCT",
keywords="cognitive function",
keywords="older adults",
keywords="aerobic exercise",
keywords="exercise",
keywords="neuronal",
keywords="activity",
keywords="task",
keywords="stimulation",
keywords="intervention",
abstract="Background: Despite increasing interest in the effects of exergaming on cognitive function, little is known about its effects on older adults with dementia. Objective: The purpose of this is to investigate the effects of exergaming on executive and physical functions in older adults with dementia compared to regular aerobic exercise. Methods: In total, 24 older adults with moderate dementia participated in the study. Participants were randomized into either the exergame group (EXG, n=13, 54\%) or the aerobic exercise group (AEG, n=11, 46\%). For 12 weeks, EXG engaged in a running-based exergame and AEG performed a cycling exercise. At baseline and postintervention, participants underwent the Ericksen flanker test (accuracy \% and response time [RT]) while recording event-related potentials (ERPs) that included the N2 and P3b potentials. Participants also underwent the senior fitness test (SFT) and the body composition test pre- and postintervention. Repeated-measures ANOVA was performed to assess the effects of time (pre- vs postintervention), group (EXG vs AEG), and group{\texttimes}time interactions. Results: Compared to AEG, EXG demonstrated greater improvements in the SFT (F1.22=7.434, P=.01), reduction in body fat (F1.22=6.476, P=.02), and increase in skeletal mass (F1.22=4.525, P=.05), fat-free mass (F1.22=6.103, P=.02), and muscle mass (F1.22=6.636, P=.02). Although there was a significantly shorter RT in EXG postintervention (congruent P=.03, 95\% CI 13.581-260.419, incongruent P=.04, 95\% CI 14.621-408.917), no changes occurred in AEG. EXG also yielded a shorter N2 latency for central (Cz) cortices during both congruent conditions compared to AEG (F1.22=4.281, P=.05). Lastly, EXG presented a significantly increased P3b amplitude compared to AEG during the Ericksen flanker test (congruent: frontal [Fz] F1.22=6.546, P=.02; Cz F1.22=5.963, P=.23; parietal [Pz] F1.22=4.302, P=.05; incongruent: Fz F1.22=8.302, P=.01; Cz F1.22=15.199, P=.001; Pz F1.22=13.774, P=.001). Conclusions: Our results suggest that exergaming may be associated with greater improvements in brain neuronal activity and enhanced executive function task performance than regular aerobic exercise. Exergaming characterized by both aerobic exercise and cognitive stimulation can be used as an effective intervention to improve cognitive and physical functions in older adults with dementia. Trial Registration: Clinical Research Information Service KCT0008238; https://cris.nih.go.kr/cris/search/detailSearch.do/24170 ",
doi="10.2196/39993",
url="https://www.jmir.org/2023/1/e39993",
url="http://www.ncbi.nlm.nih.gov/pubmed/36881445"
}


@Article{info:doi/10.2196/41091,
author="Fan, Ting
and Wang, Xiaobei
and Song, Xiaoxi
and Zhao, Gang
and Zhang, Zhichang",
title="Research Status and Emerging Trends in Virtual Reality Rehabilitation: Bibliometric and Knowledge Graph Study",
journal="JMIR Serious Games",
year="2023",
month="Mar",
day="6",
volume="11",
pages="e41091",
keywords="mobility",
keywords="rehabilitation",
keywords="virtual reality",
keywords="bibliometric",
keywords="technology",
keywords="training",
keywords="interactive",
keywords="research",
keywords="exercise",
keywords="resources",
keywords="cerebral palsy",
keywords="adult",
keywords="video games",
abstract="Background: Virtual reality (VR) technology has been widely used in rehabilitation training because of its immersive, interactive, and imaginative features. A comprehensive bibliometric review is required to help researchers focus on future directions based on the new de?nitions of VR technologies in rehabilitation, which reveal new situations and requirements. Objective: Herein, we aimed to summarize effective research methods for and potential innovative approaches to VR rehabilitation by evaluating publications from various countries to encourage research on efficient strategies to improve VR rehabilitation. Methods: The SCIE (Science Citation Index Expanded) database was searched on January 20, 2022, for publications related to the application of VR technology in rehabilitation research. We found 1617 papers, and we created a clustered network, using the 46,116 references cited in the papers. CiteSpace V (Drexel University) and VOSviewer (Leiden University) were used to identify countries, institutions, journals, keywords, cocited references, and research hot spots. Results: A total of 63 countries and 1921 institutes have contributed publications. The United States of America has taken the leading position in this field; it has the highest number of publications; the highest h-index; and the largest collaborative network, which includes other countries. The reference clusters of SCIE papers were divided into the following nine categories: kinematics, neurorehabilitation, brain injury, exergames, aging, motor rehabilitation, mobility, cerebral palsy, and exercise intensity. The research frontiers were represented by the following keywords: video games (2017-2021), and young adults (2018-2021). Conclusions: Our study comprehensively assesses the current research state of VR rehabilitation and analyzes the current research hot spots and future trends in the field, with the aims of providing resources for more intensive investigation and encouraging more researchers to further develop VR rehabilitation. ",
doi="10.2196/41091",
url="https://games.jmir.org/2023/1/e41091",
url="http://www.ncbi.nlm.nih.gov/pubmed/36877556"
}


@Article{info:doi/10.2196/36126,
author="Gallou-Guyot, Matthieu
and Perrochon, Anaick
and Marie, Romain
and Bourgeois, Maxence
and Mandigout, Stephane",
title="Measured and Perceived Exercise Intensity During the Performance of Single-Task, Cognitive-Motor Dual-Task, and Exergame Training: Transversal Study",
journal="JMIR Serious Games",
year="2023",
month="Feb",
day="2",
volume="11",
pages="e36126",
keywords="exergame",
keywords="dual-task",
keywords="exercise intensity",
keywords="heart rate",
keywords="cognitive load",
keywords="active video game",
keywords="physical activity",
abstract="Background: The physical and cognitive loads borne during exergaming may differ from more conventional cognitive-motor dual-task trainings. Objective: The aim of this pilot transversal study was to compare objectively measured and perceived exercise intensity during exergame, cognitive-motor dual-task, and single-task training sessions. Methods: We recruited apparently healthy young adults who carried out one session of each type of training: exergaming, cognitive-motor dual-tasking, and single-tasking. We used a custom-made exergame as support. The sessions lasted 30 minutes, were spaced at least 24 hours apart, and took place in random order for each group of 4 participants. We used heart rates to assess exercise intensity and the modified Borg scale to assess perception of intensity. In all, 16 apparently healthy young participants carried out all sessions. Results: There was no difference between the different types of training in mean heart rates (P=.27), peak heart rates (P=.50), or Borg scale scores (P=.40). Our custom-made exergame's objectively measured and perceived physical load did not differ between cognitive-motor dual-task and single-task training. Conclusions: As a result, our exergame can be considered to be as challenging as more traditional physical training. Future studies should be conducted in older adults with or without cognitive impairments and incorporate an assessment of cognitive performance. ",
doi="10.2196/36126",
url="https://games.jmir.org/2023/1/e36126",
url="http://www.ncbi.nlm.nih.gov/pubmed/36729572"
}


@Article{info:doi/10.2196/42178,
author="Th{\'e}rouanne, Pierre
and Hayotte, Meggy
and Halgand, Florent
and d'Arripe-Longueville, Fabienne",
title="The Acceptability of Technology-Based Physical Activity Interventions in Postbariatric Surgery Women: Insights From Qualitative Analysis Using the Unified Theory of Acceptance and Use of Technology 2 Model",
journal="JMIR Hum Factors",
year="2023",
month="Jan",
day="23",
volume="10",
pages="e42178",
keywords="acceptability",
keywords="health technology",
keywords="physical activity",
keywords="obesity",
keywords="UTAUT2",
abstract="Background: Bariatric surgery offers an opportunity for physical activity (PA) promotion due to patients' increased ability to engage in PA. Technology-based PA interventions are promising tools for promoting PA to support patients in this key period. The Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model is a recognized theoretical model for examining technology acceptability. Although a previous study reported that 92\% of women with obesity have high acceptability of at least one technology-based PA intervention, little is known about the factors that lead to different levels of acceptability between technologies and therefore the reasons for choosing a preferred intervention. Objective: The purpose of this study was to (1) characterize the acceptability of 3 technology-based PA interventions (ie, telehealth, active video game, mobile app) in the context of bariatric surgery, and (2) explore patients' preference motives. This study, using a qualitative design, examined the suitability of the UTAUT2 model in this specific context. Methods: Participants (n=26) read written French descriptions of the technology-based PA interventions with illustrations and chose their preferred intervention. Semidirective interviews were conducted to explore the reasons for their choice of the preferred intervention, notably using the UTAUT2 framework. Data were analyzed based on inductive and deductive approaches. Results: All participants who preferred a technology-based PA intervention (ie, active video game, n=10; mobile app, n=10; telehealth, n=6) expressed a behavioral intention to use it. In addition, some of them expressed a high behavioral intention to use another technology (ie, active video game, n=4; mobile app, n=1; telehealth, n=7). All the constructs of the UTAUT2 emerged during the qualitative interviews and were specified through subcategories. Additional constructs also emerged, especially other motivational factors. Conclusions: This study showed that, in the context of technology-based PA interventions for postbariatric patients, the UTAUT2 is suitable, although additional motivational factors (which were not considered by the UTAUT2 model) should be considered. ",
doi="10.2196/42178",
url="https://humanfactors.jmir.org/2023/1/e42178",
url="http://www.ncbi.nlm.nih.gov/pubmed/36689255"
}


@Article{info:doi/10.2196/36110,
author="Eckert, Martina
and Domingo Soria, Beatriz
and Terroso Gil, Noelia",
title="Finding Effective Adjustment Levels for Upper Limb Exergames: Focus Group Study With Children With Physical Disabilities",
journal="JMIR Serious Games",
year="2023",
month="Jan",
day="13",
volume="11",
pages="e36110",
keywords="rehabilitation",
keywords="physical therapy",
keywords="cerebral palsy",
keywords="obstetric brachial plexus palsy",
keywords="serious games",
keywords="exergames",
keywords="Kinect",
abstract="Background: We developed the Blexer system consisting of a database and a web interface for therapists that can host different types of adaptive and personally configurable virtual reality exergames based on Kinect (Microsoft Corp) motion capture to provide entertaining exercises for children with motor disabilities. It allows for parameter adjustment and the monitoring of results remotely, thereby providing a useful tool to complement traditional physical therapy sessions with home exercises. Objective: The aim of this study was to observe the motor benefits achieved through the use of a video exergame and the importance and implications of correctly setting the game's difficulty parameters. Methods: This was an observational case study of 6 children with different physical disabilities receiving physical therapy at school combined with the use of a fully configurable exergame under research that forms a part of the Blexer environment. The game integrates 4 repeatedly appearing upper limb exercises with individually adjustable difficulties (intermittent arm rising, arm forward and backward movement, rising and holding of one arm, and trunk control in all directions). The outcomes were 3 assessments of 2 efficacy measures: Box and Block Test and Jebsen Taylor Hand Function Test. Results: A total of 5 children with cerebral palsy (mean 8.4, SD 2.7 years; Gross Motor Function Classification II---2/5, 40\%; III---2/5, 40\%; and IV---1/5, 20\%) and 1 child with obstetric brachial plexus palsy (aged 8 years; Mallet Classification III) received between 8 and 11 sessions of training (10-20 minutes per session), depending on age, motivation, and fatigue. Significant associations were observed between game parameter settings and improvements in motor function, on the one hand, and between the type of improvement and disability severity, on the other: with adjusted game parameters goal and time in the range of 70\% to 100\%, only less affected children improved in the Box and Block Test (+11 blocks vs ?1 block), and more affected children improved more in the Jebsen Taylor Hand Function Test (+90 seconds vs +27 seconds). Conclusions: When defining the difficulty parameters for an exergame, we suggest a classification in levels ranging from very easy to very hard. For practical use, we suggest setting the difficulty for the player to an easy or medium level rather than high-commitment goals, as this leads to a longer playtime with more fun and, therefore, seems to improve the results of the game and, consequently, mobility. ",
doi="10.2196/36110",
url="https://games.jmir.org/2023/1/e36110",
url="http://www.ncbi.nlm.nih.gov/pubmed/36637882"
}


@Article{info:doi/10.2196/36325,
author="Raffegeau, E. Tiphanie
and Young, R. William
and Fino, C. Peter
and Williams, Mark A.",
title="A Perspective on Using Virtual Reality to Incorporate the Affective Context of Everyday Falls Into Fall Prevention",
journal="JMIR Aging",
year="2023",
month="Jan",
day="11",
volume="6",
pages="e36325",
keywords="aging",
keywords="balance",
keywords="perturbation",
keywords="locomotion",
keywords="cognition",
keywords="exergame",
keywords="anxiety",
doi="10.2196/36325",
url="https://aging.jmir.org/2023/1/e36325",
url="http://www.ncbi.nlm.nih.gov/pubmed/36630173"
}


@Article{info:doi/10.2196/38484,
author="Malone, A. Laurie
and Mendonca, J. Christen
and Mohanraj, Sangeetha
and Misko, R. Samuel
and Moore, Joseph
and Brascome, Michael James
and Thirumalai, Mohanraj",
title="Usability of the GAIMplank Video Game Controller for People With Mobility Impairments: Observational Study",
journal="JMIR Serious Games",
year="2023",
month="Jan",
day="10",
volume="11",
pages="e38484",
keywords="exergaming",
keywords="physical disability",
keywords="equipment design",
keywords="video gaming",
keywords="physical activity",
keywords="exercise",
keywords="wheelchair",
abstract="Background: Replacing sedentary behaviors during leisure time with active video gaming has been shown to be an enjoyable option for increasing physical activity. However, most off-the-shelf active video gaming controllers are not accessible or usable for individuals with mobility impairments. To address this requirement, a universal video game controller (called the GAIMplank) was designed and developed. Objective: This study aimed to assess the usability of the GAIMplank video game controller for playing PC video games among individuals with mobility impairments. Measures of enjoyment, perceived exertion, and qualitative data on the user experience were also examined. Methods: Adults (aged 18-75 years) with a mobility impairment were recruited to participate in a single testing session in the laboratory. Before testing began, basic demographic information, along with minutes of weekday and weekend physical activity, minutes of weekday and weekend video game play, and video game play experience were collected. The GAIMplank was mapped to operate as a typical joystick controller. Depending on their comfort and functional ability, participants chose to play seated in a chair, standing, or in their own manual wheelchair. Leaning movements of the trunk created corresponding action in the game (ie, lean right to move right). The participants played a total of 5 preselected video games for approximately 5 minutes each. Data were collected to assess the usability of the GAIMplank, along with self-efficacy regarding execution of game play actions, rating of perceived exertion and enjoyment for each game, and overall qualitative feedback. Results: A total of 21 adults (n=15, 71\% men; n=6, 29\% women) completed the usability testing, with a mean age of 48.8 (SD 13.8; range 21-73) years. Overall, 38\% (8/21) of adults played while standing, 33\% (7/21) of adults played while seated in a chair, and 29\% (6/21) played in their own manual wheelchair. Scores from the System Usability Scale indicated above average (74.8, SD 14.5) usability, with scores best for those who played seated in a chair, followed by those standing, and then individuals who played seated in their own wheelchairs. Inconsistencies in the responsiveness of the controller and general feedback for minor improvements were documented. Rating of perceived exertion scores ranged from light to moderate intensity, with the highest scores for those who played seated in a chair. Participants rated their experience with playing each game from above average to very enjoyable. Conclusions: The GAIMplank video game controller was found to be usable and accessible, providing an enjoyable option for light-to-moderate intensity exercise among adults with mobility impairments. Minor issues with inconsistencies in controller responsiveness were also recorded. Following further development and refinement, the next phase will include a pilot exercise intervention using the GAIMplank system. ",
doi="10.2196/38484",
url="https://games.jmir.org/2023/1/e38484",
url="http://www.ncbi.nlm.nih.gov/pubmed/36626195"
}


@Article{info:doi/10.2196/40421,
author="Kim, Jin Hee
and Lee, Woog Jea
and Choi, Gangta
and Huh, Junghoon
and Han, Hyun Doug",
title="Differences in Brain Activity and Body Movements Between Virtual Reality and Offline Exercise: Randomized Crossover Trial",
journal="JMIR Serious Games",
year="2023",
month="Jan",
day="5",
volume="11",
pages="e40421",
keywords="virtual reality exercise",
keywords="near-infrared spectroscopy",
keywords="spectroscopy",
keywords="hemodynamic",
keywords="blood flow",
keywords="hemoglobin",
keywords="brain",
keywords="prefrontal cortex",
keywords="orbitofrontal cortex",
keywords="immersion",
keywords="virtual reality",
keywords="VR",
keywords="exercise",
keywords="range of motion",
keywords="physical activity",
keywords="fitness",
keywords="motion",
keywords="movement",
keywords="randomized",
keywords="calorie",
abstract="Background: Virtual reality (VR) has been suggested to be effective at enhancing physical exercises because of its immersive characteristics. However, few studies have quantitatively assessed the range of motion and brain activity during VR exercises. Objective: We hypothesized that 3D immersive VR could stimulate body movement and brain activity more effectively than standard exercises and that the increased range of motions during 3D immersive VR exercises would be associated with orbitofrontal activation. Methods: A randomized crossover trial was conducted to compare exercises with and without VR. A total of 24 healthy males performed the same motions when exercising with and without 3D immersive VR, and the recorded videos were used for motion analysis. Hemodynamic changes in the prefrontal cortex were assessed using functional near-infrared spectroscopy. Results: There were significant differences in the total angle (z=?2.31; P=.02), length (z=?2.78; P=.005), calorie consumption (z=?3.04; P=.002), and change in accumulated oxygenated hemoglobin within the right orbitofrontal cortex (F1,94=9.36; P=.003) between the VR and offline trials. Hemodynamic changes in the right orbitofrontal cortex were positively correlated with the total angle (r=0.45; P=.001) and length (r=0.38; P=.007) in the VR exercise; however, there was no significant correlation in the offline trial. Conclusions: The results of this study suggest that 3D immersive VR exercise effectively increases the range of motion in healthy individuals in relation to orbitofrontal activation. Trial Registration: Clinical Research Information Service KCT0008021; https://cris.nih.go.kr/cris/search/detailSearch.do/23671 ",
doi="10.2196/40421",
url="https://games.jmir.org/2023/1/e40421",
url="http://www.ncbi.nlm.nih.gov/pubmed/36602842"
}


@Article{info:doi/10.2196/37616,
author="Manser, Patrick
and Adcock-Omlin, Manuela
and de Bruin, D. Eling",
title="Design Considerations for an Exergame-Based Training Intervention for Older Adults With Mild Neurocognitive Disorder: Qualitative Study Including Focus Groups With Experts and Health Care Professionals and Individual Semistructured In-depth Patient Interviews",
journal="JMIR Serious Games",
year="2023",
month="Jan",
day="5",
volume="11",
pages="e37616",
keywords="cognition",
keywords="exercise",
keywords="exergame",
keywords="design",
keywords="development",
keywords="neurosciences",
keywords="technology",
keywords="training",
abstract="Background: Exergames have attracted growing interest in the prevention and treatment of neurocognitive disorders. The most effective exergame and training components (ie, exercise and training variables such as frequency, intensity, duration, or volume of training and type and content of specific exergame scenarios) however remain to be established for older adults with mild neurocognitive disorders (mNCDs). Regarding the design and development of novel exergame-based training concepts, it seems of crucial importance to explicitly include the intended users' perspective by adopting an interactive and participatory design that includes end users throughout different iterative cycles of development. Objective: This study aimed to determine the capabilities, treatment preferences, and motivators for the training of older adults with mNCD and the perspectives of individuals on training goals and settings and requirements for exergame and training components. Methods: A qualitative study including expert focus groups and individual semistructured in-depth patient interviews was conducted. Data were transcribed to a written format to perform qualitative content analysis using QCAmap software. Results: In total, 10 experts and health care professionals (80\% females) and 8 older adults with mNCD (38\% females; mean age 82.4, SD 6.2 years) were recruited until data saturation was observed. Conclusions: The psychosocial consequences of patients' self-perceived cognitive deterioration might be more burdensome than the cognitive changes themselves. Older adults with mNCD prefer integrative forms of training (such as exergaming) and are primarily motivated by enjoyment or fun in exercising and the effectiveness of the training. Putting the synthesized perspectives of training goals, settings, and requirements for exergames and training components into context, our considerations point to opportunities for improvement in research and rehabilitation, either by adapting existing exergames to patients with mNCDs or by developing novel exergames and exergame-based training concepts specifically tailored to meet patient requirements and needs. ",
doi="10.2196/37616",
url="https://games.jmir.org/2023/1/e37616",
url="http://www.ncbi.nlm.nih.gov/pubmed/36602851"
}


@Article{info:doi/10.2196/38133,
author="Kim, Hyungsook
and O'Sullivan, Michael David
and Chung, Hee Seong",
title="Applying Gamification Principles and Therapeutic Movement Sequences to Design an Interactive Physical Activity Game: Development Study",
journal="JMIR Serious Games",
year="2022",
month="Dec",
day="16",
volume="10",
number="4",
pages="e38133",
keywords="home workout",
keywords="mobile assistant",
keywords="movement",
keywords="physical activity",
keywords="depression",
abstract="Background: Depression is a severe illness that has accelerated with the spread of COVID-19 and associated lockdowns. As a result, reported physical activity has substantially decreased, further increasing depressive symptoms. Objective: This study aims to explain the use of gamification principles to develop content for an interactive physical activity game for depression based on clinically proven depression diagnostic criteria. Methods: We discuss related work in this field, the game design framework, the users' depression severity, how we customize the contents accordingly, the gradual progression of the game to match exercise principles, and user flow optimization. Results: We provide a brief description of each of the games developed, including instructions on how to play and design aspects for flow, audio, and visual feedback methods. Exergames (interactive physical activity--based games) stimulate certain physical fitness factors such as improving reaction time, endurance, cardiovascular fitness, and flexibility. In addition, the game difficulty progresses based on various factors, such as the user's performance for successful completion, reaction time, movement speed, and stimulated larger joint range of motions. Cognitive aspects are included, as the user has to memorize particular movement sequences. Conclusions: Mental health issues are linked to behavior and movement; therefore, future physical activity--based interactive games may provide excellent stimulation for inducing user flow, while physical activity can help train various physical fitness factors linked to depression. ",
doi="10.2196/38133",
url="https://games.jmir.org/2022/4/e38133",
url="http://www.ncbi.nlm.nih.gov/pubmed/36525298"
}


@Article{info:doi/10.2196/38703,
author="Sch{\"a}ttin, Alexandra
and Pickles, Jordan
and Flagmeier, David
and Sch{\"a}rer, Benjamin
and Riederer, Yanick
and Niedecken, Stephan
and Villiger, Stefan
and Jurt, Roman
and Kind, Nicole
and Scott, N. Sam
and Stettler, Christoph
and Martin-Niedecken, Lisa Anna",
title="Development of a Novel Home-Based Exergame With On-Body Feedback: Usability Study",
journal="JMIR Serious Games",
year="2022",
month="Dec",
day="6",
volume="10",
number="4",
pages="e38703",
keywords="exergame",
keywords="iterative design",
keywords="home-based exergame",
keywords="on-body feedback",
keywords="usability",
keywords="training experience",
keywords="gameplay experience",
keywords="home-based exercise",
keywords="serious games",
keywords="physical activity",
abstract="Background: With more than 1.4 billion adults worldwide classified as physically inactive, physical inactivity is a public health crisis leading to an increased risk of cardiometabolic diseases. Motivating and engaging training strategies are needed to tackle this public health crisis. Studies have shown that exergames, games controlled by active body movements, are potentially usable, attractive, and effective tools for home-based training. The ExerCube (by Sphery Ltd) has been developed as a physically immersive and adaptive functional fitness game. The development of a home-based version of the ExerCube could increase accessibility, reduce barriers to exercise, and provide an attractive solution to improve physical and cognitive health. Objective: The aim was threefold: (1) to develop a usable home-based exergame system, (2) to evaluate the usability and training experience of the home-based exergame and its early-stage on-body feedback system, and (3) to identify avenues for further user-centered design iterations of the system. Methods: A total of 15 healthy participants (mean age 25, SD 3 years) completed 2 laboratory visits consisting of four 5-minute exergame sessions. In each session, the on-body feedback system provided a different feedback modality (auditory, haptic, and visual feedback) to the participant. Following the second visit, participants completed a range of assessments, including the System Usability Scale (SUS), the Physical Activity Enjoyment Scale (PACES), the Flow Short Scale (FSS), the Immersive Experience Questionnaire (IEQ), and a rating of perceived exertions (RPEs) both physically and cognitively. Participants answered questions regarding the on-body feedback system and completed a semistructured interview. Results: Usability was rated as acceptable, with a SUS score of 70.5 (SD 12). The questionnaires revealed medium-to-high values for the training experience (FSS: 5.3, SD 1; PACES: 5.3, SD 1.1; IEQ: 4.7, SD 0.9. Physical (mean 4.8, SD 1.6) and cognitive (mean 3.9, SD 1.4) RPEs were moderate. Interviews about the on-body feedback system revealed that the majority of participants liked the haptic feedback and the combination of haptic and auditory feedback the best. Participants enjoyed the distinct perceptibility, processing, and integration of the exergame and its supportive and motivating effect. The visual feedback was perceived less positively by participants but was still classified as ``potentially'' helpful. The auditory feedback was rated well but highlighted an area for further improvement. Participants enjoyed the training experience and described it as motivating, interactive, immersive, something new, interesting, self-explanatory, as well as physically and cognitively challenging. Moreover, 67\% (n=10) of the participants could imagine exercising at home and continuing to play the exergame in the future. Conclusions: The home-based exergame and its early-stage on-body feedback system were rated as usable and an enjoyable training experience by a young healthy population. Promising avenues emerged for future design iterations. ",
doi="10.2196/38703",
url="https://games.jmir.org/2022/4/e38703",
url="http://www.ncbi.nlm.nih.gov/pubmed/36472900"
}


@Article{info:doi/10.2196/41234,
author="Ci??y?ska, Julia
and Janowski, Micha?
and Maciaszek, Janusz",
title="Effects of a Modern Virtual Reality 3D Head-Mounted Display Exergame on Simulator Sickness and Immersion Under Specific Conditions in Young Women and Men: Experimental Study",
journal="JMIR Serious Games",
year="2022",
month="Nov",
day="29",
volume="10",
number="4",
pages="e41234",
keywords="virtual reality",
keywords="HMD",
keywords="simulator sickness",
keywords="immersion",
keywords="physical activity",
keywords="exergame",
keywords="Zephyr",
keywords="gender differences",
keywords="WHO recommendation",
keywords="young adult",
keywords="digital health",
keywords="energy expenditure",
keywords="exercise game",
abstract="Background: Many young adults do not reach the World Health Organization's minimum recommendations for the amount of weekly physical activity. The virtual reality 3D head-mounted display (VR 3D HMD) exergame is a technology that is more immersive than a typical exercise session. Our study considers gender differences in the experience of using VR games for increasing physical activity. Objective: The aim of this study was to examine the differences in the effects of VR 3D HMD gaming in terms of immersion, simulator sickness, heart rate, breathing rate, and energy expenditure during two 30-minute sessions of playing an exergame of increasing intensity on males and females. Methods: To examine the effects of the VR 3D HMD exergame, we experimented with 45 participants (23 males and 22 females) exercising with VR 3D HMD Oculus Quest 1, hand controllers, and Zephyr BioHarness 3.0. Players exercised according to the Audio Trip exergame. We evaluated the immersion levels and monitored the average heart rate, maximum heart rate, average breathing rate, maximum breathing rate, and energy expenditure in addition to simulator sickness during two 30-minute exergame sessions of increasing intensity. Results: Audio Trip was well-tolerated, as there were no dropouts due to simulator sickness. Significant differences between genders were observed in the simulator sickness questionnaire for nausea (F2,86=0.80; P=.046), oculomotor disorders (F2,86=2.37; P=.010), disorientation (F2,86=0.92; P=.040), and total of all these symptoms (F2,86=3.33; P=.04). The measurements after the first 30-minute VR 3D HMD exergame session for all the participants showed no significant change compared to the measurements before the first 30-minute exergame session according to the total score. There were no gender differences in the immersion (F1,43=0.02; P=.90), but the measurements after the second 30-minute exergame session showed an increase in the average points for immersion in women and men. The increase in the level of immersion in the female group was higher than that in the male group. A significant difference between genders was observed in the average breathing rate (F2,86=1.44; P=.04), maximum breathing rate (F2,86=1.15; P=.047), and energy expenditure (F2,86=10.51; P=.001) measurements. No gender differences were observed in the average heart rate and maximum heart rate measurements in the two 30-minute sessions. Conclusions: Our 30-minute VR 3D HMD exergame session does not cause simulator sickness and is a very immersive type of exercise for men and women users. This exergame allows reaching the minimum recommendations for the amount of weekly physical activity for adults. The second exergame session resulted in simulator sickness in both groups, more noticeably in women, as reflected in the responses in the simulator sickness questionnaire. The gender differences observed in the breathing rates and energy expenditure measurements can be helpful when programming VR exergame intensity in future research. ",
doi="10.2196/41234",
url="https://games.jmir.org/2022/4/e41234",
url="http://www.ncbi.nlm.nih.gov/pubmed/36445744"
}


@Article{info:doi/10.2196/38434,
author="Aartolahti, Eeva
and Janhunen, Maarit
and Katajapuu, Niina
and Paloneva, Juha
and Pamilo, Konsta
and Oksanen, Airi
and Keemu, Hannes
and Karvonen, Mikko
and Luimula, Mika
and Korpelainen, Raija
and J{\"a}ms{\"a}, Timo
and M{\"a}kel{\"a}, Keijo
and Heinonen, Ari",
title="Effectiveness of Gamification in Knee Replacement Rehabilitation: Protocol for a Randomized Controlled Trial With a Qualitative Approach",
journal="JMIR Res Protoc",
year="2022",
month="Nov",
day="28",
volume="11",
number="11",
pages="e38434",
keywords="knee arthroplasty",
keywords="serious game",
keywords="gamification",
keywords="therapeutic exercise",
keywords="rehabilitation",
keywords="physical therapy",
keywords="Kinect",
keywords="mixed methods",
keywords="randomized controlled trial",
abstract="Background: Exergames can provide encouraging exercise options. Currently, there is limited evidence regarding home-based exergaming in the postoperative phase of total knee replacement (TKR). Objective: This study aimed to investigate the effects of a 4-month postoperative home-based exergame intervention with an 8-month follow-up on physical function and symptoms among older persons undergoing TKR compared with home exercise using a standard protocol. In addition, a concurrent embedded design of a mixed methods study was used by including a qualitative component within a quantitative study of exergame effects. Methods: This was a dual-center, nonblinded, two-arm, parallel group randomized controlled trial with an embedded qualitative approach. This study aimed to recruit 100 patients who underwent their first unilateral TKR (aged 60-75 years). Participants were randomized to the exergame or standard home exercise arms. Participants followed a custom-made exergame program independently at their homes daily for 4 months. The primary outcomes at 4 months were function and pain related to the knee using the Oxford Knee Score questionnaire and mobility using the Timed Up and Go test. Other outcomes, in addition to physical function, symptoms, and disability, were game user experience, exercise adherence, physical activity, and satisfaction with the operated knee. Assessments were performed at the preoperative baseline and at 2, 4, and 12 months postoperatively. Exergame adherence was followed from game computers and using a structured diary. Self-reported standard exercise was followed for 4 months of intervention and physical activity was followed for 12 months using a structured diary. Qualitative data on patients' perspectives on rehabilitation and exergames were collected through laddering interviews at 4 and 12 months. Results: This study was funded in 2018. Data collection began in 2019 and was completed in January 2022. The COVID-19 pandemic caused an unavoidable situation in the study for recruitment, data collection, and statistical analysis. As of November 2020, a total of 52 participants had been enrolled in the study. Primary results are expected to be published by the end of 2022. Conclusions: Our study provides new knowledge on the effects of postoperative exergame intervention among older patients with TKR. In addition, this study provides a new understanding of gamified postoperative rehabilitation, home exercise adherence, physical function, and physical activity among older adults undergoing TKR. Trial Registration: ClinicalTrials.gov NCT03717727; https://clinicaltrials.gov/ct2/show/NCT03717727 International Registered Report Identifier (IRRID): RR1-10.2196/38434 ",
doi="10.2196/38434",
url="https://www.researchprotocols.org/2022/11/e38434",
url="http://www.ncbi.nlm.nih.gov/pubmed/36441574"
}


@Article{info:doi/10.2196/39932,
author="Polecho?ski, Jacek
and Zwierzchowska, Anna
and Makio?a, ?ukasz
and Groffik, Dorota
and Kostorz, Karolina",
title="Handheld Weights as an Effective and Comfortable Way To Increase Exercise Intensity of Physical Activity in Virtual Reality: Empirical Study",
journal="JMIR Serious Games",
year="2022",
month="Nov",
day="23",
volume="10",
number="4",
pages="e39932",
keywords="immersive virtual reality",
keywords="virtual reality",
keywords="health-related physical activity",
keywords="intensity of physical activity",
keywords="active video games",
keywords="serious games",
abstract="Background: In recent years, there has been a growing interest in active virtual reality games (AVRGs) that provide entertainment and encourage more physical activity (PA). Since playing AVRGs involves primarily arm movements, the intensity of this form of PA may not be sufficient for health benefits. Therefore, it is worth looking for virtual entertainment solutions that are comfortable for users and at the same time increase physical exercise. Objective: The main objective of this study was to evaluate the effect of external loading of the arms in the form of handheld weights (HHWs) on exercise intensity in users playing a popular AVRG. The results obtained in the study were compared with the PA recommendations for health. The study also assessed the perceptions of the users about the attractiveness and usefulness of this type of exercise and discomfort caused by additional load on the arms. Methods: The study covered 17 young adults aged 18 to 25 years playing an AVRG (Beat Saber) with no arm load and with HHWs (0.5 kg). A PlayStation 4 PRO console (Sony) with accessories including a head-mounted display and controllers was used in the study. PA intensity was evaluated using a heart rate monitor based on the percentage of maximal heart rate (\% HRmax). The usability, attractiveness, and comfort perceived during exercise by users were evaluated using a survey questionnaire. Results: The measurements showed that the mean \% HRmax in participants playing Beat Saber without HHWs was significantly lower (P<.001; Cohen d=1.07) than that observed when playing with HHWs. It should be emphasized that with no additional load, the intensity of PA was low (mean 63.7\% HRmax, SD 9.3\% HRmax), while with the upper limb load, it increased to a moderate level (mean 67.1\% HRmax, SD 10.3\% HRmax), which is recommended for health benefits. The survey conducted in the study showed that HHWs (0.5 kg) attached to the wrists did not disturb Beat Saber players. Conclusions: Since PA in most of the modern AVRGs primarily involves upper limb movements, the use of HHW seems to be a simple and effective way to increase exercise intensity, especially because, as reported by the study participants, such a procedure does not cause discomfort while using the application. ",
doi="10.2196/39932",
url="https://games.jmir.org/2022/4/e39932",
url="http://www.ncbi.nlm.nih.gov/pubmed/36416873"
}


@Article{info:doi/10.2196/38972,
author="Liu, Cong
and Wang, Xing
and Chen, Rao
and Zhang, Jie",
title="The Effects of Virtual Reality Training on Balance, Gross Motor Function, and Daily Living Ability in Children With Cerebral Palsy: Systematic Review and Meta-analysis",
journal="JMIR Serious Games",
year="2022",
month="Nov",
day="9",
volume="10",
number="4",
pages="e38972",
keywords="virtual reality",
keywords="cerebral palsy",
keywords="balance",
keywords="gross motor activities",
keywords="activities of daily living",
keywords="meta",
keywords="motor",
keywords="children",
keywords="pediatrics",
abstract="Background: The increasing number of children with cerebral palsy (CP) has a serious impact on individuals, families, and society. As a new technology, virtual reality (VR) has been used in the rehabilitation of children with CP. Objective: This study aimed to systematically evaluate the effect of VR training on balance, gross motor function, and daily living ability in children with CP. Methods: PubMed, Embase, The Cochrane Library, Web of Science, and China National Knowledge Infrastructure databases were searched by computer, with the search period being from the establishment of each database to December 25, 2021, to collect randomized controlled trials (RCTs) on the effects of VR training on balance, gross motor function, and daily living ability in children with CP. The Cochrane risk of bias assessment tool was used to conduct quality assessment on the included literature, and RevMan software (version 5.3) was used to analyze data. Results: A total of 16 articles were included, involving 513 children with CP. VR training can improve the balance function (Pediatric Balance Scale: mean difference 2.06, 95\% CI 1.15-2.97; P<.001; Berg Balance Scale: mean difference 3.66, 95\% CI 0.29-7.02; P=.03) and gross motor function (standardized mean difference [SMD] 0.60, 95\% CI 0.34-0.87; P<.001) of children with CP. However, there is still certain disagreement on the impact on daily living ability (SMD 0.37, 95\% CI --0.04 to 0.78; P=.08); after removing the source literature with heterogeneity, VR training can improve the daily living ability of children with CP (SMD 0.55, 95\% CI 0.30-0.81; P<.001). Conclusions: VR training can significantly improve the balance function and gross motor function of children with CP, but the effect on the daily living ability of children with CP remains controversial. ",
doi="10.2196/38972",
url="https://games.jmir.org/2022/4/e38972",
url="http://www.ncbi.nlm.nih.gov/pubmed/36350683"
}


@Article{info:doi/10.2196/40119,
author="Jung, Myeongul
and Sim, Sangyong
and Kim, Jejoong
and Kim, Kwanguk",
title="Impact of Personalized Avatars and Motion Synchrony on Embodiment and Users' Subjective Experience: Empirical Study",
journal="JMIR Serious Games",
year="2022",
month="Nov",
day="8",
volume="10",
number="4",
pages="e40119",
keywords="embodiment",
keywords="virtual reality",
keywords="virtual avatar",
keywords="personalization",
keywords="personalized",
keywords="body motion",
keywords="presence",
keywords="simulator sickness",
keywords="simulator",
keywords="simulation",
keywords="avatar",
keywords="motion",
keywords="body ownership",
keywords="self location",
keywords="agency",
keywords="experience",
keywords="virtual world",
keywords="immersive",
abstract="Background: Embodiment through a virtual avatar is a key element for people to feel that they are in the virtual world. Objective: This study aimed to elucidate the interaction between 2 methods of eliciting embodiment through a virtual avatar: motion synchronization and appearance similarity between a human and avatar, to understand embodiment (agency, body ownership, and self-location) and subjective experience (presence, simulator sickness, and emotion) in virtual reality. Methods: Using a full-body motion capture system, 24 participants experienced their virtual avatars with a 3D-scanned face and size-matched body from a first-person perspective. This study used a 2 (motion; sync and async) {\texttimes} 2 (appearance; personalized and generic) within-subject design. Results: The results indicated that agency and body ownership increased when motion and appearance were matched, whereas self-location, presence, and emotion were affected by motion only. Interestingly, if the avatar's appearance was similar to the participants (personalized avatar), they formed an agency toward the avatar's motion that was not performed by themselves. Conclusions: Our findings would be applicable in the field of behavioral therapy, rehabilitation, and entertainment applications, by eliciting higher agency with a personalized avatar. ",
doi="10.2196/40119",
url="https://games.jmir.org/2022/4/e40119",
url="http://www.ncbi.nlm.nih.gov/pubmed/36346658"
}


@Article{info:doi/10.2196/38192,
author="Temprado, Jean-Jacques
and Torre, Maria Marta",
title="Are Conventional Combined Training Interventions and Exergames Two Facets of the Same Coin to Improve Brain and Cognition in Healthy Older Adults? Data-Based Viewpoint",
journal="JMIR Serious Games",
year="2022",
month="Oct",
day="3",
volume="10",
number="4",
pages="e38192",
keywords="aging",
keywords="older",
keywords="gerontology",
keywords="exergame",
keywords="physical activity",
keywords="cognition",
keywords="training",
keywords="intervention",
keywords="cognitive",
keywords="brain",
keywords="older adult",
keywords="motor skills",
keywords="exercise",
keywords="physical",
keywords="motor",
keywords="combined training",
doi="10.2196/38192",
url="https://games.jmir.org/2022/4/e38192",
url="http://www.ncbi.nlm.nih.gov/pubmed/36190757"
}


@Article{info:doi/10.2196/38200,
author="Ochi, Genta
and Kuwamizu, Ryuta
and Fujimoto, Tomomi
and Ikarashi, Koyuki
and Yamashiro, Koya
and Sato, Daisuke",
title="The Effects of Acute Virtual Reality Exergaming on Mood and Executive Function: Exploratory Crossover Trial",
journal="JMIR Serious Games",
year="2022",
month="Sep",
day="28",
volume="10",
number="3",
pages="e38200",
keywords="virtual reality",
keywords="exergaming",
keywords="exercise",
keywords="executive function",
keywords="physical activity",
keywords="mental health",
abstract="Background: Virtual reality (VR) exergaming is a new intervention strategy to help humans engage in physical activity to enhance mood. VR exergaming may improve both mood and executive function by acting on the prefrontal cortex, expanding the potential benefits. However, the impact of VR exergaming on executive function has not been fully investigated, and associated intervention strategies have not yet been established. Objective: This study aims to investigate the effects of 10 minutes of VR exergaming on mood and executive function. Methods: A total of 12 participants played the exergame ``FitXR'' under 3 conditions: (1) a VR exergame condition (ie, exercise with a head-mounted display condition [VR-EX]) in which they played using a head-mounted display, (2) playing the exergame in front of a flat display (2D-EX), and (3) a resting condition in which they sat in a chair. The color-word Stroop task (CWST), which assesses executive function; the short form of the Profile of Mood States second edition (POMS2); and the short form of the Two-Dimensional Mood Scale (TDMS), which assess mood, were administered before and after the exercise or rest conditions. Results: The VR-EX condition increased the POMS2 vigor activity score (rest and VR-EX: t11=3.69, P=.003) as well as the TDMS arousal (rest vs 2D-EX: t11=5.34, P<.001; rest vs VR-EX: t11=5.99, P<.001; 2D-EX vs VR-EX: t11=3.02, P=.01) and vitality scores (rest vs 2D-EX: t11=3.74, P=.007; rest vs VR-EX: t11=4.84, P=.002; 2D-EX vs VR-EX: t11=3.53, P=.006), suggesting that VR exergaming enhanced mood. Conversely, there was no effect on CWST performance in either the 2D-EX or VR-EX conditions. Interestingly, the VR-EX condition showed a significant positive correlation between changes in CWST arousal and reaction time (r=0.58, P=.046). This suggests that the effect of exergaming on improving executive function may disappear under an excessively increased arousal level in VR exergaming. Conclusions: Our findings showed that 10 minutes of VR exergaming enhanced mood but did not affect executive function. This suggests that some VR content may increase cognitive demands, leading to psychological fatigue and cognitive decline as an individual approaches the limits of available attentional capacity. Future research must examine the combination of exercise and VR that enhances both brain function and mood. ",
doi="10.2196/38200",
url="https://games.jmir.org/2022/3/e38200",
url="http://www.ncbi.nlm.nih.gov/pubmed/36169992"
}


@Article{info:doi/10.2196/34768,
author="Petsani, Despoina
and Konstantinidis, Evdokimos
and Katsouli, Aikaterini-Marina
and Zilidou, Vasiliki
and Dias, B. Sofia
and Hadjileontiadis, Leontios
and Bamidis, Panagiotis",
title="Digital Biomarkers for Well-being Through Exergame Interactions: Exploratory Study",
journal="JMIR Serious Games",
year="2022",
month="Sep",
day="13",
volume="10",
number="3",
pages="e34768",
keywords="serious games",
keywords="machine learning",
keywords="physical well-being",
keywords="cognitive well-being",
abstract="Background: Ecologically valid evaluations of patient states or well-being by means of new technologies is a key issue in contemporary research in health and well-being of the aging population. The in-game metrics generated from the interaction of users with serious games (SG) can potentially be used to predict or characterize a user's state of health and well-being. There is currently an increasing body of research that investigates the use of measures of interaction with games as digital biomarkers for health and well-being. Objective: The aim of this paper is to predict well-being digital biomarkers from data collected during interactions with SG, using the values of standard clinical assessment tests as ground truth. Methods: The data set was gathered during the interaction with patients with Parkinson disease with the webFitForAll exergame platform, an SG engine designed to promote physical activity among older adults, patients, and vulnerable populations. The collected data, referred to as in-game metrics, represent the body movements captured by a 3D sensor camera and translated into game analytics. Standard clinical tests gathered before and after the long-term interaction with exergames (preintervention test vs postintervention test) were used to provide user baselines. Results: Our results showed that in-game metrics can effectively categorize participants into groups of different cognitive and physical states. Different in-game metrics have higher descriptive values for specific tests and can be used to predict the value range for these tests. Conclusions: Our results provide encouraging evidence for the value of in-game metrics as digital biomarkers and can boost the analysis of improving in-game metrics to obtain more detailed results. ",
doi="10.2196/34768",
url="https://games.jmir.org/2022/3/e34768",
url="http://www.ncbi.nlm.nih.gov/pubmed/36099000"
}


@Article{info:doi/10.2196/33089,
author="Maddison, Ralph
and Baghaei, Nilufar
and Calder, Amanda
and Murphy, Rinki
and Parag, Varsha
and Heke, Ihirangi
and Dobson, Rosie
and Marsh, Samantha",
title="Feasibility of Using Games to Improve Healthy Lifestyle Knowledge in Youth Aged 9-16 Years at Risk for Type 2 Diabetes: Pilot Randomized Controlled Trial",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="17",
volume="6",
number="6",
pages="e33089",
keywords="children's health",
keywords="diabetes mellitus",
keywords="type 2 diabetes",
keywords="experimental games",
keywords="recruitment",
abstract="Background: Mobile games can be effective and motivating tools for promoting children's health. Objective: We aimed to determine the comparative use of 2 prototype serious games for health and assess their effects on healthy lifestyle knowledge in youth aged 9-16 years at risk for type 2 diabetes (T2D). Methods: A 3-arm parallel pilot randomized controlled trial was undertaken to determine the feasibility and preliminary effectiveness of 2 serious games. Feasibility aspects included recruitment, participant attitudes toward the games, the amount of time the participants played each game at home, and the effects of the games on healthy lifestyle and T2D knowledge. Participants were allocated to play Diabetic Jumper (n=7), Ari and Friends (n=8), or a control game (n=8). All participants completed healthy lifestyle and T2D knowledge questionnaires at baseline, immediately after game play, and 4 weeks after game play. Game attitudes and preferences were also assessed. The primary outcome was the use of the game (specifically, the number of minutes played over 4 weeks). Results: In terms of feasibility, we were unable to recruit our target of 60 participants. In total, 23 participants were recruited. Participants generally viewed the games positively. There were no statistical differences in healthy lifestyle knowledge or diabetes knowledge over time or across games. Only 1 participant accessed the game for an extended period, playing the game for a total of 33 min over 4 weeks. Conclusions: It was not feasible to recruit the target sample for this trial. The 2 prototype serious games were unsuccessful at sustaining long-term game play outside a clinic environment. Based on positive participant attitudes toward the games, it is possible to use these games or similar games as short-term stimuli to engage young people with healthy lifestyle and diabetes knowledge in a clinic setting; however, future research is required to explore this area. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12619000380190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377123 ",
doi="10.2196/33089",
url="https://formative.jmir.org/2022/6/e33089",
url="http://www.ncbi.nlm.nih.gov/pubmed/35713955"
}


@Article{info:doi/10.2196/32955,
author="Mehrabi, Samira
and Mu{\~n}oz, E. John
and Basharat, Aysha
and Boger, Jennifer
and Cao, Shi
and Barnett-Cowan, Michael
and Middleton, E. Laura",
title="Immersive Virtual Reality Exergames to Promote the Well-being of Community-Dwelling Older Adults: Protocol for a Mixed Methods Pilot Study",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="13",
volume="11",
number="6",
pages="e32955",
keywords="virtual reality",
keywords="exergames",
keywords="community-dwelling older adults",
keywords="pilot protocol",
keywords="feasibility",
keywords="well-being",
keywords="physical activity",
keywords="cognition",
keywords="perception",
keywords="mood",
keywords="COVID-19",
abstract="Background: Despite the proven benefits of exercise in older adults, challenges such as access and motivation can deter their engagement. Interactive virtual reality (VR) games combined with exercise (exergames) are a plausible strategy to encourage physical activity among this population. However, there has been little research on the feasibility, acceptability, and potential benefits of deploying at-home VR exergames among community-dwelling older adults. Objective: The objectives of this study are to estimate the feasibility, usability, and acceptability of a co-designed VR exergame in community-dwelling older adults; examine intervention feasibility and assessment protocols for a future large-scale trial; and provide pilot data on outcomes of interest (physical activity, exercise self-efficacy, mood, cognition, perception, and gameplay metrics). Methods: The study will be a remote, 6-week intervention comprising an experimental and a control group. A sample of at least 12 community-dwelling older adults (with no or mild cognitive impairment) will be recruited for each group. Both groups will follow the same study procedures and assessment methods. However, the experimental group will engage with a co-designed VR exergame (Seas The Day) thrice weekly for approximately 20 minutes using the Oculus Quest 2 (Facebook Reality Labs) VR headset. The control group will read (instead of playing Seas The Day) thrice weekly for approximately 20 minutes over the 6-week period. A mixed methods evaluation will be used. Changes in physical activity, exercise self-efficacy, mood, cognition, and perception will be compared before and after acute data as well as before and after the 6 weeks between the experimental (exergaming) and control (reading) groups. Qualitative data from postintervention focus groups or interviews and informal notes and reports from all participants will be analyzed to assess the feasibility of the study protocol. Qualitative data from the experimental group will also be analyzed to assess the feasibility, usability, and acceptability of at-home VR exergames and explore perceived facilitators of and barriers to uptaking VR systems among community-dwelling older adults. Results: The screening and recruitment process for the experimental group started in May 2021, and the data collection process will be completed by September 2021. The timeline of the recruitment process for the control group is September 2021 to December 2021. We anticipate an estimated adherence rate of ?80\%. Challenges associated with VR technology and the complexity of remote assessments are expected. Conclusions: This pilot study will provide important information on the feasibility, acceptability, and usability of a custom-made VR exergaming intervention to promote older adults' well-being. Findings from this study will be useful to inform the methodology, design, study procedures, and assessment protocol for future large-scale trials of VR exergames with older adults as well as deepen the understanding of remote deployment and at-home use of VR for exercise in older adults. International Registered Report Identifier (IRRID): DERR1-10.2196/32955 ",
doi="10.2196/32955",
url="https://www.researchprotocols.org/2022/6/e32955",
url="http://www.ncbi.nlm.nih.gov/pubmed/35700014"
}


@Article{info:doi/10.2196/31685,
author="Meinke, Anita
and Peters, Rick
and Knols, H. Ruud
and Swanenburg, Jaap
and Karlen, Walter",
title="Feedback on Trunk Movements From an Electronic Game to Improve Postural Balance in People With Nonspecific Low Back Pain: Pilot Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2022",
month="Jun",
day="10",
volume="10",
number="2",
pages="e31685",
keywords="low back pain",
keywords="postural balance",
keywords="exergame",
keywords="postural feedback",
keywords="motor control",
keywords="kinesiophobia",
keywords="inertial measurement unit",
keywords="randomized controlled trial",
abstract="Background: Postural balance is compromised in people with low back pain, possibly by changes in motor control of the trunk. Augmenting exercising interventions with sensor-based feedback on trunk posture and movements might improve postural balance in people with low back pain. Objective: We hypothesized that exercising with feedback on trunk movements reduces sway in anterior-posterior direction during quiet standing in people with low back pain. Secondary outcomes were lumbar spine and hip movement assessed during box lift and waiter bow tasks, as well as participant-reported outcomes. Adherence to the exercising intervention was also examined. Methods: A randomized controlled trial was conducted with the intervention group receiving unsupervised home exercises with visual feedback using the Valedo Home, an exergame based on 2 inertial measurement units. The control group received no intervention. Outcomes were recorded by blinded staff during 4 visits (T1-T4) at University Hospital Zurich. The intervention group performed 9 sessions of 20 minutes in the 3 weeks between T2 and T3 and were instructed to exercise at their own convenience between T3 and T4. Postural balance was assessed on a force platform. Lumbar spine and hip angles were obtained from 3 inertial measurement units. The assessments included pain intensity, disability, quality of life, and fear of movement questionnaires. Results: A total of 32 participants with nonspecific low back pain completed the first assessment T1, and 27 (84\%) participants were randomized at T2 (n=14, 52\% control and n=13, 48\% intervention). Intention-to-treat analysis revealed no significant difference in change in anterior-posterior sway direction during the intervention period with a specified schedule (T2-T3) between the groups (W=99; P=.36; r=0.07). None of the outcomes showed significant change in accordance with our hypotheses. The intervention group completed a median of 61\% (55/90; range 2\%-99\%) of the exercises in the predefined training program. Adherence was higher in the first intervention period with a specified schedule. Conclusions: The intervention had no significant effect on postural balance or other outcomes, but the wide range of adherence and a limited sample size challenged the robustness of these conclusions. Future work should increase focus on improving adherence to digital interventions. Trial Registration: ClinicalTrials.gov NCT04364243; https://clinicaltrials.gov/ct2/show/NCT04364243 International Registered Report Identifier (IRRID): RR2-10.2196/26982 ",
doi="10.2196/31685",
url="https://games.jmir.org/2022/2/e31685",
url="http://www.ncbi.nlm.nih.gov/pubmed/35687390"
}


@Article{info:doi/10.2196/33782,
author="Comeras-Chueca, Cristina
and Villalba-Heredia, Lorena
and Perez-Lasierra, Luis Jose
and Lozano-Berges, Gabriel
and Matute-Llorente, Angel
and Vicente-Rodriguez, German
and Casajus, Antonio Jose
and Gonzalez-Aguero, Alex",
title="Effect of an Active Video Game Intervention Combined With Multicomponent Exercise for Cardiorespiratory Fitness in Children With Overweight and Obesity: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2022",
month="May",
day="24",
volume="10",
number="2",
pages="e33782",
keywords="active videogames",
keywords="VO2peak",
keywords="obesity",
keywords="prepuberty",
keywords="cardiorespiratory",
keywords="fitness",
keywords="gaming",
keywords="childhood",
keywords="intervention",
abstract="Background: Childhood overweight and obesity have become major global health problems and are negatively related with the cardiorespiratory fitness (CRF) level in school children and adolescents. Exercise, specifically multicomponent training, is effective for CRF improvement, but the main challenge is to ensure adherence to exercise in children with overweight and obesity. Therefore, new ways of exercising that are more attractive and motivational for this population are needed and playing or training with active video games (AVGs) has been proposed as an effective alternative because they require full-body movement and therefore increase energy expenditure. Objective: The main aim of this study was to investigate the effects of an AVG intervention combined with multicomponent training on CRF at maximal and submaximal intensities in children with overweight or obesity. Methods: We recruited 28 children (13 girls and 15 boys) aged 9 to 11 years with overweight or obesity from medical centers and divided them into 2 groups, an intervention group (n=20) that participated in a 5-month supervised AVG exercise program combined with multicomponent exercise, and a control group (n=8) that continued daily activities without modification. A maximal stress test to measure CRF using a walking-graded protocol with respiratory gas exchange was performed by the participants. Results: The AVG group showed a significant decrease in heart rate and oxygen uptake for the same intensities in the submaximal stages of the maximal treadmill test, as well as a lower oxygen uptake percentage according to the individual maximal oxygen uptake, whereas the control group did not show overall changes. No change in the peak oxygen uptake (VO2peak) was found. Conclusions: A 5-month AVG intervention combined with multicomponent exercise had positive effects on CRF at submaximal intensity, showing a lower heart rate and oxygen uptake at the same intensities and displaying a lower oxygen uptake percentage according to the individual (VO2peak). Greater benefits were found in children with the highest fat percentage. Trial Registration: ClinicalTrials.gov NCT04418713; https://clinicaltrials.gov/show/NCT04418713 ",
doi="10.2196/33782",
url="https://games.jmir.org/2022/2/e33782",
url="http://www.ncbi.nlm.nih.gov/pubmed/35471240"
}


@Article{info:doi/10.2196/34402,
author="Goudman, Lisa
and Jansen, Julie
and Billot, Maxime
and Vets, Nieke
and De Smedt, Ann
and Roulaud, Manuel
and Rigoard, Philippe
and Moens, Maarten",
title="Virtual Reality Applications in Chronic Pain Management: Systematic Review and Meta-analysis",
journal="JMIR Serious Games",
year="2022",
month="May",
day="10",
volume="10",
number="2",
pages="e34402",
keywords="virtual reality",
keywords="chronic pain",
keywords="systematic review",
keywords="multilevel meta-analysis",
keywords="immersive technologies",
keywords="clinical outcomes",
keywords="mobile phone",
abstract="Background: Virtual reality (VR) is a computer technology that immerses a user in a completely different reality. The application of VR in acute pain settings is well established. However, in chronic pain, the applications and outcome parameters influenced by VR are less clear. Objective: This review aimed to systematically identify all outcome parameters that are reported in relation to VR in patients with chronic pain. Methods: A total of 4 electronic databases (PubMed, Scopus, Web of Science, and Embase) were searched for relevant studies. Multilevel random-effect meta-analyses were performed, whereby the standardized mean difference was chosen as the effect size to denote the difference between measurements before and after a VR intervention. Results: The initial database search identified 1430 studies, of which 41 (2.87\%) were eventually included in the systematic review. Evidence has been found for the effects of VR on pain, functioning, mobility, functional capacity, psychological outcomes, quality of life, neuropsychological outcomes, and physical sensations. The overall effect size (a total of 194 effect sizes from 25 studies) based on a three level meta-analysis was estimated at 1.22 (95\% CI 0.55-1.89; z=3.56; P<.001), in favor of improvements after a VR intervention. When categorizing effect sizes, the overall effect sizes were reported as follows: 1.60 (95\% CI 0.83-2.36; z=4.09; P<.001) for the effect of VR on pain (n=31), 1.40 (95\% CI 0.13-2.67; z=2.17; P=.03) for functioning (n=60), 0.49 (95\% CI ?0.71 to 1.68; z=0.80; P=.42) for mobility (n=24), and 0.34 (95\% CI ?1.52 to 2.20; z=0.36; P=.72) for functional capacity (n=21). Conclusions: This systematic review revealed a broad range of outcome variables influenced by an intervention of VR technology, with statistically significant pain relief and improvements in functioning. These findings indicate that VR not only has applications in acute pain management but also in chronic pain settings, whereby VR might be able to become a promising first-line intervention as complementary therapy for patients with chronic pain. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021227016; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=227016 ",
doi="10.2196/34402",
url="https://games.jmir.org/2022/2/e34402",
url="http://www.ncbi.nlm.nih.gov/pubmed/35536641"
}


@Article{info:doi/10.2196/36768,
author="Kleschnitzki, Marina Jana
and Grossmann, Inga
and Beyer, Reinhard
and Beyer, Luzi",
title="Modification in the Motor Skills of Seniors in Care Homes Using Serious Games and the Impact of COVID-19: Field Study",
journal="JMIR Serious Games",
year="2022",
month="May",
day="10",
volume="10",
number="2",
pages="e36768",
keywords="serious games",
keywords="motor skills",
keywords="motor",
keywords="long-term care",
keywords="exercise",
keywords="movement",
keywords="coronavirus effects",
keywords="eHealth",
keywords="seniors",
keywords="older adult",
keywords="elder",
keywords="senior population",
keywords="aged",
keywords="care home",
keywords="intervention effects analysis",
keywords="COVID-19",
keywords="pandemic",
keywords="digital game",
keywords="digital health",
keywords="physical activity",
abstract="Background: The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. At the beginning of 2020, the COVID-19 pandemic led to many restrictions, which affected seniors in care facilities in the form of severe isolation. The isolation led, among other things, to a lack of exercise, which has led to a multitude of negative effects for this target group. Serious games can potentially help by being used anywhere at any time to strengthen skills with few resources. Objective: The aim of this study is to evaluate the effectiveness of a serious game to strengthen motor skills (study 1) and the influence of pandemic restrictions (study 2) on seniors in care facilities. Methods: The data on motor skills (measured by the Tinetti test) originated from an intervention study with repeated measurements that was interrupted by the pandemic conditions. Data were collected 4 times every 3 months with an intervention group (IG, training 3 times for 1 hour per week) and a control group (CG, no intervention). There were 2 substudies. The first considered the first 6 months until the pandemic restrictions, while the second considered the influence of the restrictions on motor skills. Results: The sample size was 70. The IG comprised 31 (44\%) participants, with 22 (71\%) female and 9 (29\%) male seniors with an average age of 85 years. The CG comprised 39 (56\%) participants, with 31 (79\%) female and 8 (21\%) male seniors with an average age of 87 years. In study 1, mixed-design ANOVA showed no significant interaction between measurement times and group membership for the first measurements (F2.136=1.414, P<.25, partial $\eta$2=.044), but there was a significant difference between the CG (mean 16.23, SD 1.1) and the IG (mean 19.81, SD 1.2) at the third time of measurement (P=.02). In study 2 the mixed-design ANOVA (used to investigate motor skills before and after the pandemic conditions between the 2 groups) couldn't reveal any significant interaction between measurement times and group membership: F1.67=2.997, P<.09, partial $\eta$2=.043. However, there was a significant main effect of the time of measurement: F1.67=5.44, P<.02, partial $\eta${\texttwosuperior}=.075. Conclusions: During the first 6 months, the IG showed increased motor skills, whereas the motor skills of the CG slightly deteriorated and showed a statistically significant difference after 6 months. The pandemic restrictions leveled the difference and showed a significant negative effect on motor skills over 3 months. As our results show, digital games have the potential to break down access barriers and promote necessary maintenance for important skills. The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. This potentially great benefit for the challenges of tomorrow shows the relevance of the topic and demonstrates the urgent need for action and research. Trial Registration: Deutsches Register klinischer Studien DRKS00016633; https://tinyurl.com/yckmj4px ",
doi="10.2196/36768",
url="https://games.jmir.org/2022/2/e36768",
url="http://www.ncbi.nlm.nih.gov/pubmed/35536610"
}


@Article{info:doi/10.2196/38212,
author="Mazeas, Alexandre
and Duclos, Martine
and Pereira, Bruno
and Chalabaev, A{\"i}na",
title="Authors' Reply to: Learning More About the Effects of Gamification on Physical Activity. Comment on ``Evaluating the Effectiveness of Gamification on Physical Activity: Systematic Review and Meta-analysis of Randomized Controlled Trials''",
journal="J Med Internet Res",
year="2022",
month="May",
day="3",
volume="24",
number="5",
pages="e38212",
keywords="behavior change",
keywords="eHealth",
keywords="gamification",
keywords="health behavior",
keywords="intervention",
keywords="meta-analysis",
keywords="mobile phone",
keywords="physical activity",
keywords="systematic review",
keywords="elderly",
keywords="old adults",
doi="10.2196/38212",
url="https://www.jmir.org/2022/5/e38212",
url="http://www.ncbi.nlm.nih.gov/pubmed/35503414"
}


@Article{info:doi/10.2196/36396,
author="Hung, Cheng-Hsien
and Kao, Yung-Shuo",
title="Learning More About the Effects of Gamification on Physical Activity. Comment on ``Evaluating the Effectiveness of Gamification on Physical Activity: Systematic Review and Meta-analysis of Randomized Controlled Trials''",
journal="J Med Internet Res",
year="2022",
month="May",
day="3",
volume="24",
number="5",
pages="e36396",
keywords="behavior change",
keywords="eHealth",
keywords="gamification",
keywords="health behavior",
keywords="intervention",
keywords="meta-analysis",
keywords="mobile phone",
keywords="physical activity",
keywords="systematic review",
keywords="elderly",
keywords="old adults",
doi="10.2196/36396",
url="https://www.jmir.org/2022/5/e36396",
url="http://www.ncbi.nlm.nih.gov/pubmed/35503654"
}


@Article{info:doi/10.2196/35511,
author="Robertson, C. Michael
and Swartz, Chang Maria
and Christopherson, Ursela
and Bentley, R. Jason
and Basen-Engquist, M. Karen
and Thompson, Debbe
and Volpi, Elena
and Lyons, J. Elizabeth",
title="A Photography-based, Social Media Walking Intervention Targeting Autonomous Motivations for Physical Activity: Semistructured Interviews With Older Women",
journal="JMIR Serious Games",
year="2022",
month="Apr",
day="14",
volume="10",
number="2",
pages="e35511",
keywords="physical activity",
keywords="walking",
keywords="exercise",
keywords="fitness",
keywords="social media",
keywords="health",
keywords="intervention",
keywords="behavior",
keywords="behavior mechanism",
keywords="psychological theory",
keywords="serious games",
keywords="gamification",
keywords="older women",
keywords="older adults",
keywords="behavior change",
keywords="behavioral interventions",
keywords="mobile phone",
keywords="photography",
keywords="patient perspective",
keywords="patient attitude",
abstract="Background: Older adult women are at risk for negative health outcomes that engaging in sustained physical activity can help prevent. However, promoting long-term maintenance of physical activity in this population has proven to be a challenge. Increasing autonomous motivations (ie, intrinsic, integrated, and identified regulations) for physical activity may facilitate enduring behavior change. Digitally delivered games for health that take a celebratory technology approach, that is, using technology to create new ways to experience valued behaviors and express valued beliefs, may be a useful way to target autonomous motivations for physical activity. Formative research with the target population is needed to design compelling intervention content. Objective: The objective of this study is to investigate older adult women's reactions to and thoughts about a photography-based, social media walking game targeting autonomous motivations for physical activity. Methods: During an individual semistructured interview, a moderator solicited feedback from 20 older adult women (age range 65-74 years) as part of formative research to develop a social media game featuring weekly walking challenges. The challenges were designed to target autonomous motivations for physical activity. Interviews were audio-recorded and transcribed verbatim. Two reviewers conducted thematic content analysis on interview transcripts. Results: We identified 3 overarching themes in qualitative data analysis. These reflected the playful experiences, value, and acceptability associated with the intervention challenges. Generally, participants understood what the challenges were asking them to do, proffered appropriate example responses, and indicated that the challenges would be enjoyable. Participants reported that the intervention content afforded many and varied playful experiences (eg, competition, discovery, exploration, expression, fellowship, humor, nurture, sensation). Further, participants indicated that the intervention increased their motivation for physical activity, occasioned meaningful shifts in perspective, increased their knowledge of various topics of interest, provided an opportunity to create valued connection with others, and provided health-related benefits. Participants suggested the intervention emphasize local history, nature, and cultural events. Conclusions: The photography-based, social media walking game with relatively simple game mechanics was well received and judged to be apt to bring about a wide variety of emotive experiences. A clear, geographically specific identity emerged as a key driver of interest for intervention content. Taking a celebratory technology approach holds promise for targeting autonomous motivations for physical activity in older adult women. ",
doi="10.2196/35511",
url="https://games.jmir.org/2022/2/e35511",
url="http://www.ncbi.nlm.nih.gov/pubmed/35436205"
}


@Article{info:doi/10.2196/32027,
author="Peebles, T. Alexander
and van der Veen, Susanne
and Stamenkovic, Alexander
and France, R. Christopher
and Pidcoe, E. Peter
and Thomas, S. James",
title="A Virtual Reality Game Suite for Graded Rehabilitation in Patients With Low Back Pain and a High Fear of Movement: Within-Subject Comparative Study",
journal="JMIR Serious Games",
year="2022",
month="Mar",
day="23",
volume="10",
number="1",
pages="e32027",
keywords="virtual reality",
keywords="reaching",
keywords="intervention",
keywords="rehabilitation",
keywords="exergaming",
keywords="biomechanics",
keywords="serious games",
keywords="gamification",
keywords="movement",
keywords="physiotherapy",
keywords="lumbar",
abstract="Background: Complex movement pathologies that are biopsychosocial in nature (eg, back pain) require a multidimensional approach for effective treatment. Virtual reality is a promising tool for rehabilitation, where therapeutic interventions can be gamified to promote and train specific movement behaviors while increasing enjoyment, engagement, and retention. We have previously created virtual reality--based tools to assess and promote lumbar excursion during reaching and functional gameplay tasks by manipulating the position of static and dynamic contact targets. Based on the framework of graded exposure rehabilitation, we have created a new virtual reality therapy aimed to alter movement speed while retaining the movement-promoting features of our other developments. Objective: This study aims to compare lumbar flexion excursion and velocity across our previous and newly developed virtual reality tools in a healthy control cohort. Methods: A total of 31 healthy participants (16 males, 15 females) took part in 3 gamified virtual reality therapies (ie, Reachality, Fishality, and Dodgeality), while whole-body 3D kinematics were collected at 100 Hz using a 14-camera motion capture system. Lumbar excursion, lumbar flexion velocity, and actual target impact location in the anterior and vertical direction were compared across each virtual reality task and between the 4 anthropometrically defined intended target impact locations using separate 2-way repeated measures analysis of variance models. Results: There was an interaction between game and impact height for each outcome (all P<.001). Post-hoc simple effects models revealed that lumbar excursion was reduced during Reachality and Fishality relative to that during Dodgeality for the 2 higher impact heights but was greater during Reachality than during Fishality and Dodgeality for the lowest impact height. Peak lumbar flexion velocity was greater during Dodgeality than during Fishality and Reachality across heights. Actual target impact locations during Dodgeality and Fishality were lower relative to those during Reachality at higher intended impact locations but higher at lower intended impact locations. Finally, actual target impact location was further in the anterior direction for Reachality compared to that for Fishality and for Fishality relative to that for Dodgeality. Conclusions: Lumbar flexion velocity was reduced during Fishality relative to that during Dodgeality and resembled velocity demands more similar to those for a self-paced reaching task (ie, Reachality). Additionally, lumbar motion and target impact location during Fishality were more similar to those during Reachality than to those during Dodgeality, which suggests that this new virtual reality game is an effective tool for shaping movement. These findings are encouraging for future research aimed at developing an individualized and graded virtual reality intervention for patients with low back pain and a high fear of movement. ",
doi="10.2196/32027",
url="https://games.jmir.org/2022/1/e32027",
url="http://www.ncbi.nlm.nih.gov/pubmed/35319471"
}


@Article{info:doi/10.2196/30366,
author="Wiskerke, Evelyne
and Kool, Jan
and Hilfiker, Roger
and Sattelmayer, Martin Karl
and Verheyden, Geert",
title="Determining the Optimal Virtual Reality Exergame Approach for Balance Therapy in Persons With Neurological Disorders Using a Rasch Analysis: Longitudinal Observational Study",
journal="JMIR Serious Games",
year="2022",
month="Mar",
day="22",
volume="10",
number="1",
pages="e30366",
keywords="digital therapeutics",
keywords="virtual reality",
keywords="exergaming",
keywords="balance",
keywords="stroke",
keywords="multiple sclerosis",
keywords="neurorehabilitation",
keywords="Rasch analysis",
abstract="Background: Virtual reality (VR) exergames have gained popularity in the rehabilitation of persons with neurological disorders as an add-on therapy to increase intensity of training. Intensity is strongly dependent on the motivation of the patient. Motivation can be increased by delivering variation within training and challenging exercises. However, patients are often underchallenged, as exergame difficulty often does not match the patient's ability. A Rasch analysis can establish hierarchy of exergame items in order to assist the delivery of patient-centered therapy. Objective: The aim of this study was to apply the Rasch model to create a hierarchical order of existing VR balance exergames and to relate these exergames to the abilities of persons with neurological disorders, in order to deliver challenge and variation. Methods: A total of 30 persons with stroke and 51 persons with multiple sclerosis (MS) were included in the study. All participants performed a training program, lasting 3 weeks for persons with MS and 4 weeks for persons with stroke, in which they performed VR balance exergames with a movement recognition--based system (MindMotion GO; MindMaze SA). VR exercise scores, Berg Balance Scale scores, and clinical descriptive data were collected. Berg Balance Scale and device scores were analyzed with the Rasch model using a repeated-measures approach to examine whether the distribution of exercise scores fitted the Rasch model. Secondly, a person-item map was created to show the hierarchy of exercise difficulty and person ability. Results: Participants completed a selection of 56 balance exercises (ie, items), which consisted of a combination of various balance tasks and levels (ie, exercises). Using repeated measures, this resulted in a count of 785 observations. Analysis showed strong evidence for unidimensionality of the data. A total of 47 exercises (ie, items) had a sufficiently good fit to the Rasch model. Six items showed underfit, with outfit mean square values above 1.5. One item showed underfit but was kept in the analysis. Three items had negative point-biserial correlations. The final model consisted of 47 exercises, which were provided for persons with low to moderate balance ability. Conclusions: The VR exercises sufficiently fitted the Rasch model and resulted in a hierarchical order of VR balance exercises for persons with stroke and MS with low to moderate balance ability. In combination with the Berg Balance Scale, the results can guide clinical decision-making in the selection of patient-focused VR balance exercises. Trial Registration: ClinicalTrials.gov NCT03993275; https://clinicaltrials.gov/ct2/show/NCT03993275 ",
doi="10.2196/30366",
url="https://games.jmir.org/2022/1/e30366",
url="http://www.ncbi.nlm.nih.gov/pubmed/35315785"
}


@Article{info:doi/10.2196/35040,
author="Wu, Yi-Syuan
and Wang, Wei-Yun
and Chan, Ta-Chien
and Chiu, Yu-Lung
and Lin, Hung-Che
and Chang, Yu-Tien
and Wu, Hao-Yi
and Liu, Tzu-Chi
and Chuang, Yu-Cheng
and Wu, Jonan
and Chang, Wen-Yen
and Sun, Chien-An
and Lin, Meng-Chiung
and Tseng, S. Vincent
and Hu, Je-Ming
and Li, Yuan-Kuei
and Hsiao, Po-Jen
and Chen, Chao-Wen
and Kao, Hao-Yun
and Lee, Chia-Cheng
and Hsieh, Chung-Bao
and Wang, Chih-Hung
and Chu, Chi-Ming",
title="Effect of the Nintendo Ring Fit Adventure Exergame on Running Completion Time and Psychological Factors Among University Students Engaging in Distance Learning During the COVID-19 Pandemic: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2022",
month="Mar",
day="22",
volume="10",
number="1",
pages="e35040",
keywords="exergaming",
keywords="cardiac force index",
keywords="running",
keywords="physical activity",
keywords="sleep quality",
keywords="mood disorders",
keywords="digital health",
keywords="physical fitness",
keywords="Nintendo Ring Fit Adventure",
keywords="COVID-19 pandemic",
abstract="Background: The COVID-19 outbreak has not only changed the lifestyles of people globally but has also resulted in other challenges, such as the requirement of self-isolation and distance learning. Moreover, people are unable to venture out to exercise, leading to reduced movement, and therefore, the demand for exercise at home has increased. Objective: We intended to investigate the relationships between a Nintendo Ring Fit Adventure (RFA) intervention and improvements in running time, cardiac force index (CFI), sleep quality (Chinese version of the Pittsburgh Sleep Quality Index score), and mood disorders (5-item Brief Symptom Rating Scale score). Methods: This was a randomized prospective study and included 80 students who were required to complete a 1600-meter outdoor run before and after the intervention, the completion times of which were recorded in seconds. They were also required to fill out a lifestyle questionnaire. During the study, 40 participants (16 males and 24 females, with an average age of 23.75 years) were assigned to the RFA group and were required to exercise for 30 minutes 3 times per week (in the adventure mode) over 4 weeks. The exercise intensity was set according to the instructions given by the virtual coach during the first game. The remaining 40 participants (30 males and 10 females, with an average age of 22.65 years) were assigned to the control group and maintained their regular habits during the study period. Results: The study was completed by 80 participants aged 20 to 36 years (mean 23.20, SD 2.96 years). The results showed that the running time in the RFA group was significantly reduced. After 4 weeks of physical training, it took females in the RFA group 19.79 seconds (P=.03) and males 22.56 seconds (P=.03) less than the baseline to complete the 1600-meter run. In contrast, there were no significant differences in the performance of the control group in the run before and after the fourth week of intervention. In terms of mood disorders, the average score of the RFA group increased from 1.81 to 3.31 for males (difference=1.50, P=.04) and from 3.17 to 4.54 for females (difference=1.38, P=.06). In addition, no significant differences between the RFA and control groups were observed for the CFI peak acceleration (CFIPA)\_walk, CFIPA\_run, or sleep quality. Conclusions: RFA could either maintain or improve an individual's physical fitness, thereby providing a good solution for people involved in distance learning or those who have not exercised for an extended period. Trial Registration: ClinicalTrials.gov NCT05227040; https://clinicaltrials.gov/ct2/show/NCT05227040 ",
doi="10.2196/35040",
url="https://games.jmir.org/2022/1/e35040",
url="http://www.ncbi.nlm.nih.gov/pubmed/35315780"
}


@Article{info:doi/10.2196/31974,
author="Sawa, Ryuichi
and Saitoh, Masakazu
and Morisawa, Tomoyuki
and Takahashi, Tetsuya
and Morimoto, Yuh
and Kagiyama, Nobuyuki
and Kasai, Takatoshi
and Dinesen, Birthe
and Daida, Hiroyuki",
title="The Potential Application of Commercially Available Active Video Games to Cardiac Rehabilitation: Scoping Review",
journal="JMIR Serious Games",
year="2022",
month="Mar",
day="18",
volume="10",
number="1",
pages="e31974",
keywords="active video game",
keywords="cardiac rehabilitation",
keywords="physical exercise",
keywords="rehabilitation",
keywords="serious games",
keywords="CVD",
keywords="AVG",
keywords="cardiovascular disease",
keywords="exercise",
keywords="safety",
keywords="adherence",
abstract="Background: Commercially available active video games (AVGs) have recently been used for rehabilitation in some specific patient populations but rarely in those with cardiovascular disease (CVD). Commercially available AVGs are designed to increase motivation for continuous play, which could be applicable to the long-term cardiac rehabilitation process. Objective: The objective of this scoping review was to assess the effectiveness of AVG-induced physical exercise, safety management, and patient adherence by applying commercially available AVGs to cardiac rehabilitation. Methods: Four databases (CINAHL, MEDLINE, PubMed, and SPORTDiscus) were searched for all years up to August 12, 2020. Articles were retained if they were written in English, included patients with CVD who were aged 18 years or older, and used AVGs as part of a physical exercise program. The included studies were then evaluated from the viewpoints of effectiveness as physical exercise, safety, and adherence management. Results: Among 120 nonduplicate articles reviewed, 5 (4.2\%) were eligible for inclusion, of which 3 (2.5\%) were reported by the same research group. The AVG consoles used were Xbox Kinect and Nintendo Wii, and sports-related programs were adopted for the intervention. No adverse cardiac events occurred in the identified studies, and dropout rates tended to be low. Conclusions: AVGs appear to be safe and feasible for promoting an active lifestyle in patients with CVD. However, the effectiveness of AVGs alone as a therapeutic exercise to improve physical function may be limited. ",
doi="10.2196/31974",
url="https://games.jmir.org/2022/1/e31974",
url="http://www.ncbi.nlm.nih.gov/pubmed/35302503"
}


@Article{info:doi/10.2196/31638,
author="Laine, H. Teemu
and Duong, Nhi
and Lindvall, Helena
and Oyelere, Sunday Solomon
and Rutberg, Stina
and Lindqvist, Anna-Karin",
title="A Reusable Multiplayer Game for Promoting Active School Transport: Development Study",
journal="JMIR Serious Games",
year="2022",
month="Mar",
day="14",
volume="10",
number="1",
pages="e31638",
keywords="gamification",
keywords="active school transport",
keywords="physical activity",
keywords="formative evaluation",
keywords="architecture",
keywords="mobile phone",
keywords="web browser",
abstract="Background: Most children and adolescents in Sweden do not meet the recommended daily physical activity levels of the World Health Organization. Active school transport (AST) and gamification are potential methods for increasing children's daily physical activity. We previously developed a game named Tic-Tac-Training for promoting active transport at workplaces; however, the game has not been applied to AST. Objective: The objectives of this study are to investigate how Tic-Tac-Training functions to promote AST among schoolchildren in northern Sweden, improve the game to be more suitable for schoolchildren, and construct a road map for future development based on children's ideas. Methods: First, we developed Tic-Tac-Training using the Scrum agile software development method. Second, we conducted a questionnaire-based formative evaluation of the game with schoolchildren (n=16; 9/16, 56\% male; 6/16, 38\% female; and 1/16, 6\% other aged 11-12 years) in Lule{\aa}, Sweden. Third, we conducted focus group interviews with 33 children (13/33, 39\% male and 20/33, 61\% female aged 12-13 years) to gather ideas for gamifying AST. We mapped the interview results to the Octalysis gamification framework and established a road map for future development. Results: The formative evaluation revealed several issues, including a lack of interesting game features, lack of support for continuous engagement, disliked competitive features, and lack of incentives for discourse and participation. New features such as rewards, collectibles, and levels were implemented based on the results. The focus group interviews revealed additional ideas for gamifying AST, such as using avatars, in-game currency and trading, and context-sensitive tasks. Conclusions: The results have several potential impacts on how reusable, gamified AST interventions can be developed and what kind of gamification elements schoolchildren in northern Sweden wish to see. These results can interest game researchers and teachers who wish to apply gamification in school contexts. Finally, we aim to continue developing the game based on the road map. ",
doi="10.2196/31638",
url="https://games.jmir.org/2022/1/e31638",
url="http://www.ncbi.nlm.nih.gov/pubmed/35285815"
}


@Article{info:doi/10.2196/34592,
author="Abd-alrazaq, Alaa
and Alajlani, Mohannad
and Alhuwail, Dari
and Toro, T. Carla
and Giannicchi, Anna
and Ahmed, Arfan
and Makhlouf, Ahmed
and Househ, Mowafa",
title="The Effectiveness and Safety of Serious Games for Improving Cognitive Abilities Among Elderly People With Cognitive Impairment: Systematic Review and Meta-Analysis",
journal="JMIR Serious Games",
year="2022",
month="Mar",
day="10",
volume="10",
number="1",
pages="e34592",
keywords="serious games",
keywords="cognitive training",
keywords="exergames",
keywords="mild cognitive impairment",
keywords="Alzheimer disease",
keywords="dementia",
keywords="global cognition",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Cognitive impairment is a mental disorder that commonly affects elderly people. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological intervention for improving cognitive abilities. The effectiveness and safety of serious games for improving cognitive abilities have been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses. Objective: This study aims to assess the effectiveness and safety of serious games for improving cognitive abilities among elderly people with cognitive impairment. Methods: A systematic review of randomized controlled trials (RCTs) was conducted. The following 8 electronic databases were searched: MEDLINE, Embase, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also screened reference lists of the included studies and relevant reviews, as well as checked studies citing our included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies. Results: Fifteen studies met the eligibility criteria among 466 citations retrieved. Of those, 14 RCTs were eventually included in the meta-analysis. We found that, regardless of their type, serious games were more effective than no intervention (P=.04) and conventional exercises (P=.002) for improving global cognition among elderly people with cognitive impairment. Further, a subgroup analysis showed that cognitive training games were more effective than no intervention (P=.05) and conventional exercises (P<.001) for improving global cognition among elderly people with cognitive impairment. Another subgroup analysis demonstrated that exergames (a category of serious games that includes physical exercises) are as effective as no intervention and conventional exercises (P=.38) for improving global cognition among elderly people with cognitive impairment. Although some studies found adverse events from using serious games, the number of adverse events (ie, falls and exacerbations of pre-existing arthritis symptoms) was comparable between the serious game and control groups. Conclusions: Serious games and specifically cognitive training games have the potential to improve global cognition among elderly people with cognitive impairment. However, our findings remain inconclusive because the quality of evidence in all meta-analyses was very low, mainly due to the risk of bias raised in the majority of the included studies, high heterogeneity of the evidence, and imprecision of total effect sizes. Therefore, psychologists, psychiatrists, and patients should consider offering serious games as a complement and not a substitute to existing interventions until further more robust evidence is available. Further studies are needed to assess the effect of exergames, the safety of serious games, and their long-term effects. ",
doi="10.2196/34592",
url="https://games.jmir.org/2022/1/e34592",
url="http://www.ncbi.nlm.nih.gov/pubmed/35266877"
}


@Article{info:doi/10.2196/31020,
author="Garc{\'i}a-Mu{\~n}oz, Cristina
and Cort{\'e}s-Vega, Mar{\'i}a-Dolores
and Hern{\'a}ndez-Rodr{\'i}guez, Juan-Carlos
and Fern{\'a}ndez-Segu{\'i}n, M. Lourdes
and Escobio-Prieto, Isabel
and Casuso-Holgado, Jes{\'u}s Mar{\'i}a",
title="Immersive Virtual Reality and Vestibular Rehabilitation in Multiple Sclerosis: Case Report",
journal="JMIR Serious Games",
year="2022",
month="Feb",
day="16",
volume="10",
number="1",
pages="e31020",
keywords="immersive virtual reality",
keywords="vestibular rehabilitation",
keywords="multiple sclerosis",
keywords="exergames",
abstract="Background: Dizziness and imbalance are common and disabling symptoms in patients with multiple sclerosis (MS) and are caused by a central, peripheral, or mixed vestibulopathy. Central vestibular disorder is the most frequently reported vestibular problem in the MS population due to demyelination. Vestibular rehabilitation ameliorates these symptoms and their repercussions and improves quality of life. Immersive virtual reality (VRi) is an emerging tool in this field; however, no previous research has been performed studying its effects in MS. Objective: The aim of this study was to apply a VRi vestibular training protocol to a patient with MS and assess the effects induced by the experimental intervention. Methods: This case study included a 54-year-old woman with relapsing-remitting MS. We developed a standardized VRi exercise protocol for vestibular rehabilitation based on the gold-standard Cawthorne-Cooksey vestibular training protocol. The 20-session intervention was made up of 10 initial sessions and 10 advanced sessions. Each 50-minute session was performed two to three times per week for 7 weeks. Four evaluations were carried out over the study period: at baseline (T0), between initial and advances phases (T1), postintervention (T2), and 1 month after the experimental procedure (T3). The research outcomes were dizziness, balance, gait, impact of fatigue, quality of life, repercussions in muscular tone, and usability of the head-mounted display device. Results: After implementing the VRi vestibular protocol, improvements were seen in the following patient parameters: Dizziness Handicap Inventory score (62 points at T0; 4 points at T2); Berg Balance Scale score (47 points at T0; 54 points at T2); instrumented Timed Up and Go time (8.35 seconds at T0; 5.57 seconds at T2); muscular tone of the erector spinae, rectus femoris, and soleus; Modified Fatigue Impact Scale score (61 points at T0; 37 points at T2); and Multiple Sclerosis Quality of Life-54 values (67.16\% in the physical health area at T2; 33.56\% in the mental health area at T2). The patient rated the usability of the system as 90\%, based on the System Usability Scale, and gave the system a grade of A. Conclusions: Although further research is needed, this study provided initial evidence that the first VRi vestibular protocol for the MS population can improve dizziness, balance, gait, impact of fatigue, quality of life, and muscular tone through an exergame intervention. This study may help establish a standardized VRi protocol for vestibular rehabilitation. ",
doi="10.2196/31020",
url="https://games.jmir.org/2022/1/e31020",
url="http://www.ncbi.nlm.nih.gov/pubmed/34766551"
}


@Article{info:doi/10.2196/24946,
author="Blanc, Margaux
and Roy, Anne-Laure
and Fraudet, Bastien
and Piette, Patrice
and Le Toullec, Elodie
and Nicolas, Benoit
and Gallien, Philippe
and Leblong, Emilie",
title="Evaluation of a Digitally Guided Self-Rehabilitation Device Coupled With Telerehabilitation Monitoring in Patients With Parkinson Disease (TELEP@RK): Open, Prospective Observational Study",
journal="JMIR Serious Games",
year="2022",
month="Feb",
day="7",
volume="10",
number="1",
pages="e24946",
keywords="Parkinson's disease",
keywords="telerehabilitation",
keywords="serious games",
keywords="UTAUT",
keywords="physiotherapist",
keywords="acceptability",
keywords="acceptance",
abstract="Background: Parkinson disease is a neurodegenerative disease causing a progressive loss of autonomy. This requires long-term rehabilitation care. Currently, new technologies are being developed for use in daily life, and there is a progressive implementation of telerehabilitation. Objective: The aim of this study (the TELEP@RK study) is to evaluate the uses of a digital self-rehabilitation device in patients with Parkinson disease and their independent physiotherapists on the scale of a health territory. Methods: A total of 10 independent physiotherapists and 31 patients with Parkinson disease were followed for 1 year to evaluate the use of a telerehabilitation tool (digital tablet and inertial sensor) via questionnaires of the Unified Theory of Acceptance and Use of Technology (UTAUT). The questionnaires were submitted to participants at 0, 2, and 12 months from the start of follow-up. The averages of the scores of the different determinants and constructs of the UTAUT questionnaires were compared at the different follow-up times. Results: Among professionals, the averages of the various determinants were generally high at the beginning of the study with an average (out of 5) performance expectancy of 4.19, effort expectancy of 3.88, social influence of 3.95, facilitating conditions of 4, and intention to use of 3.97. These averages decreased over time. Conclusions: Acceptability, acceptance, and appropriation of the tool were very high among the physiotherapists as well as the patients, despite the tool's lack of evolution during the study. In the current health care context, these results allow us to envision a new organization of the care pathway for patients with chronic diseases, with the increased use of new technologies associated with telecare. ",
doi="10.2196/24946",
url="https://games.jmir.org/2022/1/e24946",
url="http://www.ncbi.nlm.nih.gov/pubmed/35129449"
}


@Article{info:doi/10.2196/27794,
author="Xu, Linqi
and Shi, Hongyu
and Shen, Meidi
and Ni, Yuanyuan
and Zhang, Xin
and Pang, Yue
and Yu, Tianzhuo
and Lian, Xiaoqian
and Yu, Tianyue
and Yang, Xige
and Li, Feng",
title="The Effects of mHealth-Based Gamification Interventions on Participation in Physical Activity: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="3",
volume="10",
number="2",
pages="e27794",
keywords="mobile health",
keywords="gamification",
keywords="physical activity",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: It is well known that regular physical exercise has associated benefits; yet, participation remains suboptimal. Mobile health (mHealth) has become an indispensable medium to deliver behavior change interventions, and there is a growing interest in the gamification apps in mHealth to promote physical activity (PA) participation. Gamification could use game design elements (such as points, leaderboards, and progress bars), and it has the potential to increase motivation for PA and engagement. However, mHealth-based gamification interventions are still emerging, and little is known about the application status and efficacy of such interventions. Objective: This systematic review aims to investigate gamification apps in mHealth for improving PA levels and simultaneously summarize the impact of gamification interventions on PA participation. Methods: We searched PubMed, Scopus, Web of Science, Embase, CINAHL (EBSCO host), and IEEE Xplore from inception to December 20, 2020. Original empirical research exploring the effects of gamification interventions on PA participation was included. The papers described at least one outcome regarding exercise or PA participation, which could be subjective self-report or objective indicator measurement. Of note, we excluded studies about serious games or full-fledged games. Results: Of 2944 studies identified from the database search, 50 (1.69\%) were included, and the information was synthesized. The review revealed that gamification of PA had been applied to various population groups and broadly distributed among young people but less distributed among older adults and patients with a disease. Most of the studies (30/50, 60\%) combined gamification with wearable devices to improve PA behavior change, and 50\% (25/50) of the studies used theories or principles for designing gamified PA interventions. The most frequently used game elements were goal-setting, followed by progress bars, rewards, points, and feedback. This review demonstrated that gamification interventions could increase PA participation; however, the results were mixed, and modest changes were attained, which could be attributed to the heterogeneity across studies. Conclusions: Overall, this study provides an overview of the existing empirical research in PA gamification interventions and provides evidence for the efficacy of gamification in enhancing PA participation. High-quality empirical studies are needed in the future to assess the efficacy of a combination of gamification and wearable activity devices to promote PA, and further exploration is needed to investigate the optimal implementation of these features of game elements and theories to enhance PA participation. ",
doi="10.2196/27794",
url="https://mhealth.jmir.org/2022/2/e27794",
url="http://www.ncbi.nlm.nih.gov/pubmed/35113034"
}


@Article{info:doi/10.2196/31404,
author="Beltran-Alacreu, Hector
and Navarro-Fern{\'a}ndez, Gonzalo
and Godia-Lled{\'o}, Daniela
and Graell-Pasar{\'o}n, Lucas
and Ramos-Gonz{\'a}lez, {\'A}lvaro
and Raya, Rafael
and Martin-Pintado Zugasti, Aitor
and Fernandez-Carnero, Josue",
title="A Serious Game for Performing Task-Oriented Cervical Exercises Among Older Adult Patients With Chronic Neck Pain: Development, Suitability, and Crossover Pilot Study",
journal="JMIR Serious Games",
year="2022",
month="Feb",
day="1",
volume="10",
number="1",
pages="e31404",
keywords="video games",
keywords="neck pain",
keywords="aged",
keywords="virtual reality",
keywords="exercise therapy",
keywords="physical therapy modalities",
keywords="technology",
abstract="Background: There is sparse research on the effectiveness of therapeutic exercise for the treatment of neck pain in older adult populations. Moreover, there is a lack of research on the use of serious games or virtual reality for the treatment of neck pain in this population. Objective: The primary aim of this study was to develop and assess the suitability of a serious game for performing task-oriented cervical exercises in patients with neck pain. Methods: A serious game was designed based on the key features identified by previous studies that designed serious video games for physical and cognitive rehabilitation or exercise. The game in this study was designed to provide an interactive scenario, with the main functionality of the software solution to control a virtual airplane to reach targets using head motions. At the end of the exercise, the application stores the targets reached and missed and the airplane's trajectory. A crossover pilot study was carried out for preliminary evaluation of the suitability of the technology in the older adult population. Men and women over 65 years of age with chronic neck pain were included. Subjects were randomly assigned to two study arms; each arm consisted of a sequence of two 4-week treatments with an intermediate washout period of 4 weeks. The total study duration was 16 weeks due to a final follow-up measure 4 weeks after the end of all treatments. Treatment A consisted of the use of the serious game developed in this study, and treatment B consisted of conventional exercises. Subjects allocated to the A-B study arm received treatment A first, followed by treatment B, and vice versa in the B-A arm. The following variables were assessed: Suitability Evaluation Questionnaire (SEQ) scores, Visual Analog Scale scores, and the number of targets reached in the serious game. Results: A total of 18 subjects were assessed for eligibility. A total of 13 subjects, aged between 71 and 92 years (mean 81.85, SD 6.82), were finally included and completed the study protocol. The global mean SEQ score was 50.38 (SD 5.35) out of 65 points, showing good suitability of the serious game. Most patients considered the experience very enjoyable and ``real'' in terms of the virtual environment and found the information provided to be clear. Also, they believed that the game could be very helpful for their rehabilitation. None of the patients felt any neck pain or discomfort when playing the game, and only 2 patients out of 13 (15\%) reported some degree of dizziness, eye discomfort, or disorientation, which did not limit their capacity to finish the session. Conclusions: The serious game developed in this study showed good suitability for use in adults over 70 years of age with chronic neck pain. The game was a safe method for performing task-oriented cervical exercises, and patients reported very high levels of satisfaction and acceptance after the use of this technology. ",
doi="10.2196/31404",
url="https://games.jmir.org/2022/1/e31404",
url="http://www.ncbi.nlm.nih.gov/pubmed/35103608"
}


@Article{info:doi/10.2196/29987,
author="Mu{\~n}oz, John
and Mehrabi, Samira
and Li, Yirou
and Basharat, Aysha
and Middleton, E. Laura
and Cao, Shi
and Barnett-Cowan, Michael
and Boger, Jennifer",
title="Immersive Virtual Reality Exergames for Persons Living With Dementia: User-Centered Design Study as a Multistakeholder Team During the COVID-19 Pandemic",
journal="JMIR Serious Games",
year="2022",
month="Jan",
day="19",
volume="10",
number="1",
pages="e29987",
keywords="virtual reality",
keywords="exergames",
keywords="persons living with dementia",
keywords="physical activity",
keywords="head mounted displays",
keywords="participatory design",
keywords="co-development",
keywords="gaming",
keywords="older adults",
keywords="elderly",
keywords="design",
keywords="dementia",
keywords="VR",
keywords="user-centered",
keywords="exercise",
keywords="COVID-19",
abstract="Background: Advancements in supporting personalized health care and well-being using virtual reality (VR) have created opportunities to use immersive games to support a healthy lifestyle for persons living with dementia and mild cognitive impairment (MCI). Collaboratively designing exercise video games (exergames) as a multistakeholder team is fundamental to creating games that are attractive, effective, and accessible. Objective: This research extensively explores the use of human-centered design methods that involve persons living with dementia in long-term care facilitates, exercise professionals, content developers, game designers, and researchers in the creation of VR exergames targeting physical activity promotion for persons living with dementia/MCI. Methods: Conceptualization, collaborative design, and playtesting activities were carried out to design VR exergames to engage persons living with dementia in exercises to promote upper limb flexibility, strength, and aerobic endurance. We involved a total of 7 persons living with dementia/MCI, 5 exercise professionals, 5 community-dwelling older adults, a VR company for content creation, and a multidisciplinary research team with game designers, engineers, and kinesiology experts. Results: An immersive VR exergame called Seas the Day was jointly designed and developed and it is freely available to be played in state-of-the-art VR headsets (Oculus Quest 1, 2). A model for the triadic interaction (health care institution, industry partner, academia) is also presented to illustrate how different stakeholders contribute to the design of VR exergames that consider/complement complex needs, preferences, and motivators of an underrepresented group of end users. Conclusions: This study provides evidence that a collaborative multistakeholder design results in more tailored and context-aware VR games for persons living with dementia. The insights and lessons learned from this research can be used by others to co-design games, including remote engagement techniques that were used during the COVID-19 pandemic. ",
doi="10.2196/29987",
url="https://games.jmir.org/2022/1/e29987",
url="http://www.ncbi.nlm.nih.gov/pubmed/35044320"
}


@Article{info:doi/10.2196/26779,
author="Mazeas, Alexandre
and Duclos, Martine
and Pereira, Bruno
and Chalabaev, A{\"i}na",
title="Evaluating the Effectiveness of Gamification on Physical Activity: Systematic Review and Meta-analysis of Randomized Controlled
Trials",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="4",
volume="24",
number="1",
pages="e26779",
keywords="behavior change",
keywords="eHealth",
keywords="gamification",
keywords="health behavior",
keywords="intervention",
keywords="meta-analysis",
keywords="mobile phone",
keywords="physical activity",
keywords="systematic review",
abstract="Background: Gamification refers to the use of game elements in nongame contexts. The use of gamification to change behaviors and promote physical activity (PA) is a promising avenue for tackling the global physical inactivity pandemic and the current prevalence of chronic diseases. However, there is no evidence of the effectiveness of gamified interventions with the existence of mixed results in the literature. Objective: The aim of this systematic review and meta-analysis is to evaluate the effectiveness of gamified interventions and their health care potential by testing the generalizability and sustainability of their influence on PA and sedentary behavior. Methods: A total of 5 electronic databases (PubMed, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials) were searched for randomized controlled trials published in English from 2010 to 2020. Eligibility criteria were based on the components of the participants, interventions, comparators, and outcomes framework. Studies were included when they used gamified interventions in daily life with an active or inactive control group and when they assessed a PA or sedentary behavior outcome. We conducted meta-analyses using a random-effects model approach. Sensitivity analyses, influence analyses, and publication bias analyses were performed to examine the robustness of our results. Results: The main meta-analysis performed on 16 studies and 2407 participants revealed a small to medium summary effect of gamified interventions on PA behavior (Hedges g=0.42, 95\% CI 0.14-0.69). No statistical difference among different subgroups (adults vs adolescents and healthy participants vs adults with chronic diseases) and no interaction effects with moderators such as age, gender, or BMI were found, suggesting good generalizability of gamified interventions to different user populations. The effect was statistically significant when gamified interventions were compared with inactive control groups, such as waiting lists (Hedges g=0.58, 95\% CI 0.08-1.07), and active control groups that included a nongamified PA intervention (Hedges g=0.23, 95\% CI 0.05-0.41). This suggests that gamified interventions are not only efficient in changing behavior but also more effective compared with other behavioral interventions. The long-term effect (measured with follow-up averaging 14 weeks after the end of the intervention) was weaker, with a very small to small effect (Hedges g=0.15, 95\% CI 0.07-0.23). Conclusions: This meta-analysis confirms that gamified interventions are promising for promoting PA in various populations. Additional analyses revealed that this effect persists after the follow-up period, suggesting that it is not just a novelty effect caused by the playful nature of gamification, and that gamified products appear effective compared with equivalent nongamified PA interventions. Future rigorous trials are required to confirm these findings. ",
doi="10.2196/26779",
url="https://www.jmir.org/2022/1/e26779",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982715"
}


@Article{info:doi/10.2196/27058,
author="Yang, Chao
and Han, Xiaolei
and Jin, Mingxue
and Xu, Jianhui
and Wang, Yiren
and Zhang, Yajun
and Xu, Chonglong
and Zhang, Yingshi
and Jin, Enshi
and Piao, Chengzhe",
title="The Effect of Video Game--Based Interventions on Performance and Cognitive Function in Older Adults: Bayesian Network Meta-analysis",
journal="JMIR Serious Games",
year="2021",
month="Dec",
day="30",
volume="9",
number="4",
pages="e27058",
keywords="video game",
keywords="performance",
keywords="cognitive function",
keywords="older",
keywords="Bayesian network meta-analysis",
abstract="Background: The decline in performance of older people includes balance function, physical function, and fear of falling and depression. General cognitive function decline is described in terms of processing speed, working memory, attention, and executive functioning, and video game interventions may be effective. Objective: This study evaluates the effect of video game interventions on performance and cognitive function in older participants in terms of 6 indicators: balance function, executive function, general cognitive function, physical function, processing speed, and fear of falling and depression. Methods: Electronic databases were searched for studies from inception to June 30, 2020. Randomized controlled trials and case-controlled trials comparing video game interventions versus nonvideo game control in terms of performance and cognitive function outcomes were incorporated into a Bayesian network meta-analysis. All data were continuous variables. Results: In total, 47 studies (3244 participants) were included. In pairwise meta-analysis, compared with nonvideo game control, video game interventions improved processing speed, general cognitive function, and depression scores. In the Bayesian network meta-analysis, interventions with video games improved balance function time (standardized mean difference [SMD] --3.34, 95\% credible interval [CrI] --5.54 to --2.56), the cognitive function score (SMD 1.23, 95\% CrI 0.82-1.86), processing speed time (SMD --0.29, 95\% CrI --0.49 to --0.08), and processing speed number (SMD 0.72, 95\% CrI 0.36-1.09), similar to the pairwise meta-analysis. Interventions with video games with strong visual senses and good interactivity ranked first, and these might be more beneficial for the elderly. Conclusions: Our comprehensive Bayesian network meta-analysis provides evidence that video game interventions could be considered for the elderly for improving performance and cognitive function, especially general cognitive scores and processing speed. Games with better interactivity and visual stimulation have better curative effects. Based on the available evidence, we recommend video game interventions for the elderly. Trial Registration: PROSPERO CRD42020197158; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=197158 ",
doi="10.2196/27058",
url="https://games.jmir.org/2021/4/e27058",
url="http://www.ncbi.nlm.nih.gov/pubmed/34967759"
}


@Article{info:doi/10.2196/29964,
author="Robertson, C. Michael
and Baranowski, Tom
and Thompson, Debbe
and Basen-Engquist, M. Karen
and Swartz, Chang Maria
and Lyons, J. Elizabeth",
title="Using the Behaviour Change Wheel Program Planning Model to Design Games for Health: Development Study",
journal="JMIR Serious Games",
year="2021",
month="Dec",
day="3",
volume="9",
number="4",
pages="e29964",
keywords="physical activity",
keywords="video games",
keywords="eHealth",
keywords="intervention",
keywords="behavior and behavior mechanisms",
keywords="psychological theory",
keywords="serious games",
keywords="gamification",
keywords="older women",
keywords="older adults",
keywords="behavior change",
keywords="behavioral interventions",
keywords="mobile phone",
abstract="Background: Games for health are a promising approach to health promotion. Their success depends on achieving both experiential (game) and instrumental (health) objectives. There is little to guide game for health (G4H) designers in integrating the science of behavior change with the art of game design. Objective: The aim of this study is to extend the Behaviour Change Wheel program planning model to develop Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-Based Exercise (CHALLENGE), a G4H centered on increasing physical activity in insufficiently active older women. Methods: We present and apply the G4H Mechanics, Experiences, and Change (MECHA) process, which supplements the Behaviour Change Wheel program planning model. The additional steps are centered on identifying target G4H player experiences and corresponding game mechanics to help game designers integrate design elements and G4H objectives into behavioral interventions. Results: We identified a target behavior of increasing moderate-intensity walking among insufficiently active older women and key psychosocial determinants of this behavior from self-determination theory (eg, autonomy). We used MECHA to map these constructs to intervention functions (eg, persuasion) and G4H target player experiences (eg, captivation). Next, we identified behavior change techniques (eg, framing or reframing) and specific game mechanics (eg, transforming) to help realize intervention functions and elicit targeted player experiences. Conclusions: MECHA can help researchers map specific linkages between distal intervention objectives and more proximal game design mechanics in games for health. This can facilitate G4H program planning, evaluation, and clearer scientific communication. ",
doi="10.2196/29964",
url="https://games.jmir.org/2021/4/e29964",
url="http://www.ncbi.nlm.nih.gov/pubmed/34870604"
}


@Article{info:doi/10.2196/29330,
author="Xu, Wenge
and Liang, Hai-Ning
and Baghaei, Nilufar
and Ma, Xiaoyue
and Yu, Kangyou
and Meng, Xuanru
and Wen, Shaoyue",
title="Effects of an Immersive Virtual Reality Exergame on University Students' Anxiety, Depression, and Perceived Stress: Pilot Feasibility and Usability Study",
journal="JMIR Serious Games",
year="2021",
month="Nov",
day="22",
volume="9",
number="4",
pages="e29330",
keywords="university students",
keywords="depression",
keywords="anxiety",
keywords="stress",
keywords="immersive virtual reality",
keywords="exergame",
abstract="Background: In recent years, there has been an increase in the number of students with depression, anxiety, and perceived stress. A solution that has been increasingly used for improving health and well-being is exergaming. The effects and acceptability of exergames have been studied widely but mostly with older adults. The feasibility and usability of exergames among university students, especially those of immersive virtual reality (iVR) exergames, remain unexplored. Objective: This study aimed to explore the feasibility of a 6-week iVR exergame--based intervention in reducing anxiety, depression, and perceived stress among university students and to examine the usability and acceptability of such games. Methods: A total of 31 university students were recruited to participate in a 6-week study in which they needed to play a boxing-style iVR exergame called FitXR (FitXR Limited) twice per week (30 minutes per session). Their anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory-II), and perceived stress (Perceived Stress Scale) levels were measured before and after intervention. Results: A total of 15 participants completed the 6-week study. Our results suggested that participants' mean depression scores decreased significantly from 8.33 (SD 5.98) to 5.40 (SD 5.14) after the intervention (P=.01). In addition, most participants (14/15, 93\%) believed that the iVR exergame has good usability. Furthermore, most participants (14/15, 93\%) were satisfied with the iVR gameplay experience and would play the iVR exergame again in the future. Of the 15 participants, 11 (73\%) would recommend the iVR exergame to their friends. Conclusions: The results gained from this study show that the iVR exergame has good usability, is highly acceptable, and has the potential to reduce depression levels among university students. ",
doi="10.2196/29330",
url="https://games.jmir.org/2021/4/e29330",
url="http://www.ncbi.nlm.nih.gov/pubmed/34813487"
}


@Article{info:doi/10.2196/27848,
author="Kamnardsiri, Teerawat
and Phirom, Kochaphan
and Boripuntakul, Sirinun
and Sungkarat, Somporn",
title="An Interactive Physical-Cognitive Game-Based Training System Using Kinect for Older Adults: Development and Usability Study",
journal="JMIR Serious Games",
year="2021",
month="Oct",
day="27",
volume="9",
number="4",
pages="e27848",
keywords="digital game",
keywords="interactive game-based training",
keywords="physical-cognitive training",
keywords="exergaming",
keywords="Kinect sensors",
keywords="older adults",
keywords="falls",
keywords="PACES",
keywords="user-centered design",
keywords="game-based exercise",
abstract="Background: Declines in physical and cognitive functions are recognized as important risk factors for falls in older adults. Promising evidence suggests that interactive game-based systems that allow simultaneous physical and cognitive exercise are a potential approach to enhance exercise adherence and reduce fall risk in older adults. However, a limited number of studies have reported the development of a combined physical-cognitive game-based training system for fall risk reduction in older adults. Objective: The aim of this study is to develop and evaluate the usability of an interactive physical-cognitive game-based training system (game-based exercise) for older adults. Methods: In the development phase (Part I), a game-based exercise prototype was created by integrating knowledge and a literature review as well as brainstorming with experts on effective fall prevention exercise for older adults. The output was a game-based exercise prototype that covers crucial physical and cognitive components related to falls. In the usability testing (Part II), 5 games (ie, Fruits Hunter, Where Am I?, Whack a Mole, Sky Falls, and Crossing Poison River) with three difficulty levels (ie, beginner, intermediate, and advanced levels) were tested in 5 older adults (mean age 70.40 years, SD 5.41 years). After completing the games, participants rated their enjoyment level while engaging with the games using the Physical Activity Enjoyment Scale (PACES) and commented on the games. Descriptive statistics were used to describe the participants' characteristics and PACES scores. Results: The results showed that the average PACES score was 123 out of 126 points overall and between 6.66 and 7.00 for each item, indicating a high level of enjoyment. Positive feedback, such as praise for the well-designed interactions and user-friendly interfaces, was also provided. Conclusions: These findings suggest that it is promising to implement an interactive, physical-cognitive game-based exercise in older adults. The effectiveness of a game-based exercise program for fall risk reduction has yet to be determined. ",
doi="10.2196/27848",
url="https://games.jmir.org/2021/4/e27848",
url="http://www.ncbi.nlm.nih.gov/pubmed/34704953"
}


@Article{info:doi/10.2196/29981,
author="Comeras-Chueca, Cristina
and Marin-Puyalto, Jorge
and Matute-Llorente, Angel
and Vicente-Rodriguez, German
and Casajus, Antonio Jose
and Gonzalez-Aguero, Alex",
title="Effects of Active Video Games on Health-Related Physical Fitness and Motor Competence in Children and Adolescents With Overweight or Obesity: Systematic Review and Meta-Analysis",
journal="JMIR Serious Games",
year="2021",
month="Oct",
day="18",
volume="9",
number="4",
pages="e29981",
keywords="active videogames",
keywords="exergaming",
keywords="BMI",
keywords="body fat",
keywords="motor skills",
keywords="cardiorespiratory fitness",
keywords="muscle",
abstract="Background: Childhood obesity is one of the most important public health problems. Active video games (AVGs) have been proposed as an attractive alternative to increase energy expenditure and are being investigated to determine their effectiveness against childhood obesity. Objective: The aim of this study is to summarize the existing research and draw conclusions about the effects of AVGs on health-related physical fitness and motor competence in children and adolescents with overweight and obesity. Methods: The search strategy was applied to PubMed, MEDLINE, Web of Science, and SPORTDiscus, including randomized and nonrandomized controlled trials investigating the effects of AVG programs on health-related physical fitness and motor competence in children and adolescents with overweight and obesity. To measure the risk of bias in randomized and nonrandomized controlled trials, 2 different quality assessment tools were used. In total, 15 articles met the inclusion criteria, and the variables of interest were BMI, body fat percentage, cardiorespiratory fitness (CRF), waist circumference, fat-free mass, muscular fitness, and motor competence. A meta-analysis was performed. Results: Positive effects were found for BMI and body fat percentage, favoring the AVG group compared with a control group with no intervention (mean difference ?0.209; 95\% CI ?0.388 to ?0.031 vs mean difference ?0.879; 95\% CI ?1.138 to ?0.602). Positive effects seem to be observed for CRF. The effects of AVG interventions on muscular fitness, fat-free mass, waist circumference, and motor competence are unclear. Conclusions: AVG programs showed positive effects on BMI, body fat percentage, and CRF. AVG could be a good strategy to combat childhood obesity. ",
doi="10.2196/29981",
url="https://games.jmir.org/2021/4/e29981",
url="http://www.ncbi.nlm.nih.gov/pubmed/34661549"
}


@Article{info:doi/10.2196/32729,
author="Henrique, Bazzanello Patr{\'i}cia Paula
and Perez, Pelle Fabr{\'i}zzio Martin
and Becker, Cemin Osvaldo Henrique
and Bellei, Andrei Ericles
and Biduski, Daiana
and Korb, Arthiese
and Pochmann, Daniela
and Dani, Caroline
and Elsner, Rostirola Viviane
and De Marchi, Bertoletti Ana Carolina",
title="Kinesiotherapy With Exergaming as a Potential Modulator of Epigenetic Marks and Clinical Functional Variables of Older Women: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="13",
volume="10",
number="10",
pages="e32729",
keywords="elderly women",
keywords="exergame",
keywords="epigenome",
keywords="cognition",
keywords="kinesiotherapy",
abstract="Background: Kinesiotherapy is an option to mitigate worsening neuropsychomotor function due to human aging. Moreover, exergames are beneficial for the practice of physical therapy by older patients. Physical exercise interventions are known to alter the epigenome, but little is known about their association with exergames. Objective: We aim to evaluate the effects of kinesiotherapy with exergaming on older women's epigenetic marks and cognitive ability, as well as on their clinical functional variables. Our hypothesis states that this kind of therapy can elicit equal or even better outcomes than conventional therapy. Methods: We will develop a virtual clinic exergame with 8 types of kinesiotherapy exercises. Afterward, we will conduct a 1:1 randomized clinical trial to compare the practice of kinesiotherapy with exergames (intervention group) against conventional kinesiotherapy (control group). A total of 24 older women will be enrolled for 1-hour sessions performed twice a week, for 6 weeks, totaling 12 sessions. We will assess outcomes using epigenetic blood tests, the Montreal Cognitive Assessment test, the Timed Up and Go test, muscle strength grading in a hydraulic dynamometer, and the Game Experience Questionnaire at various stages. Results: The project was funded in October 2019. Game development took place in 2020. Patient recruitment and a clinical trial are planned for 2021. Conclusions: Research on this topic is likely to significantly expand the understanding of kinesiotherapy and the impact of exergames. To the best of our knowledge, this may be one of the first studies exploring epigenetic outcomes of exergaming interventions. Trial Registration: Brazilian Clinical Trials Registry/Registro Brasileiro de Ensaios Cl{\'i}nicos (ReBEC) RBR-9tdrmw; https://ensaiosclinicos.gov.br/rg/RBR-9tdrmw. International Registered Report Identifier (IRRID): DERR1-10.2196/32729 ",
doi="10.2196/32729",
url="https://www.researchprotocols.org/2021/10/e32729",
url="http://www.ncbi.nlm.nih.gov/pubmed/34643543"
}


@Article{info:doi/10.2196/20066,
author="Vieira, Catarina
and Ferreira da Silva Pais-Vieira, Carla
and Novais, Jo{\~a}o
and Perrotta, Andr{\'e}",
title="Serious Game Design and Clinical Improvement in Physical Rehabilitation: Systematic Review",
journal="JMIR Serious Games",
year="2021",
month="Sep",
day="23",
volume="9",
number="3",
pages="e20066",
keywords="serious games",
keywords="physical rehabilitation",
keywords="systematic review",
keywords="physical impairment",
keywords="game design",
keywords="game characteristics",
keywords="stroke",
keywords="multiple sclerosis",
keywords="cerebral palsy",
abstract="Background: Serious video games have now been used and assessed in clinical protocols, with several studies reporting patient improvement and engagement with this type of therapy. Even though some literature reviews have approached this topic from a game perspective and presented a broad overview of the types of video games that have been used in this context, there is still a need to better understand how different game characteristics and development strategies might impact and relate to clinical outcomes. Objective: This review assessed the relationship between the characteristics of serious games (SGs) and their relationship with the clinical outcomes of studies that use this type of therapy in motor impairment rehabilitation of patients with stroke, multiple sclerosis, or cerebral palsy. The purpose was to take a closer look at video game design features described in the literature (game genre [GG], game nature [GN], and game development strategy [GDS]) and assess how they may contribute toward improving health outcomes. Additionally, this review attempted to bring together medical and game development perspectives to facilitate communication between clinicians and game developers, therefore easing the process of choosing the video games to be used for physical rehabilitation. Methods: We analyzed the main features of SG design to obtain significant clinical outcomes when applied to physical rehabilitation of patients recovering from motor impairments resulting from stroke, multiple sclerosis, and cerebral palsy. We implemented a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) database-adjusted electronic search strategy for the PubMed, IEEE Xplore, and Cochrane databases. Results: We screened 623 related papers from 2010-2021 and identified 12 that presented results compatible with our inclusion criteria. A total of 512 participants with stroke (8 studies, 417 participants), cerebral palsy (1 study, 8 participants), and multiple sclerosis (2 studies, 46 participants) were included; 1 study targeting the elderly (41 participants) was also included. All studies assessed motor, sensory, and functional functions, while some also measured general health outcomes. Interventions with games were used for upper-limb motor rehabilitation. Of the 12 studies, 8 presented significant improvements in at least one clinical measurement, of which 6 presented games from the casual GG, 1 combined the casual, simulation, and exergaming GGs, and 2 combined the sports and simulation GGs. Conclusions: Of the possible combinations of game design features (GG, GN, and GDS) described, custom-made casual games that resort to the first-person perspective, do not feature a visible player character, are played in single-player mode, and use nonimmersive virtual reality attain the best results in terms of positive clinical outcomes. In addition, the use of custom-made games versus commercial off-the-shelf games tends to give better clinical results, although the latter are perceived as more motivating and engaging. ",
doi="10.2196/20066",
url="https://games.jmir.org/2021/3/e20066",
url="http://www.ncbi.nlm.nih.gov/pubmed/34554102"
}


@Article{info:doi/10.2196/26153,
author="Allegue, Rakia Dorra
and Kairy, Dahlia
and Higgins, Johanne
and Archambault, S. Philippe
and Michaud, Francois
and Miller, C. William
and Sweet, N. Shane
and Tousignant, Michel",
title="A Personalized Home-Based Rehabilitation Program Using Exergames Combined With a Telerehabilitation App in a Chronic Stroke Survivor: Mixed Methods Case Study",
journal="JMIR Serious Games",
year="2021",
month="Aug",
day="31",
volume="9",
number="3",
pages="e26153",
keywords="stroke",
keywords="rehabilitation",
keywords="virtual reality",
keywords="video games",
keywords="telerehabilitation",
keywords="upper extremity",
keywords="motivation",
abstract="Background: In Canada, only 11\% of stroke survivors have access to outpatient and community-based rehabilitation after discharge from inpatient rehabilitation. Hence, innovative community-based strategies are needed to provide adequate postrehabilitation services. The VirTele program, which combines virtual reality exergames and a telerehabilitation app, was developed to provide stroke survivors with residual upper extremity deficits, the opportunity to participate in a personalized home rehabilitation program. Objective: This study aims to determine the feasibility of VirTele for remote upper extremity rehabilitation in a chronic stroke survivor; explore the preliminary efficacy of VirTele on upper extremity motor function, the amount and quality of upper extremity use, and impact on quality of life and motivation; and explore the determinants of behavioral intention and use behavior of VirTele along with indicators of empowerment. Methods: A 63-year-old male stroke survivor (3 years) with moderate upper extremity impairment participated in a 2-month VirTele intervention. He was instructed to use exergames (5 games for upper extremity) for 30 minutes, 5 times per week, and conduct videoconference sessions with a clinician at least once per week. Motivational interviewing was incorporated into VirTele to empower the participant to continue exercising and use his upper extremities in everyday activities. Upper extremity motor function (Fugl-Meyer Assessment--upper extremity), amount and quality of upper extremity use (Motor Activity Log-30), and impact on quality of life (Stroke Impact Scale-16) and motivation (Treatment Self-Regulation Questionnaire-15) were measured before (T1), after (T2) VirTele intervention, and during a 1- (T3) and 2-month (T4) follow-up period. Qualitative data were collected through logs and semistructured interviews. Feasibility data (eg, number and duration of videoconference sessions and adherence) were documented at the end of each week. Results: The participant completed 48 exergame sessions (33 hours) and 8 videoconference sessions. Results suggest that the VirTele intervention and the study protocol could be feasible for stroke survivors. The participant exhibited clinically meaningful improvements at T2 on the Fugl-Meyer and Stroke Impact Scale-16 and maintained these gains at T3 and T4. During the follow-up periods, the amount and quality of upper extremity use showed meaningful changes, suggesting more involvement of the affected upper extremity in daily activities. The participant demonstrated a high level of autonomous motivation, which may explain his adherence. Performance, effort, and social influence have meaningful weights in the behavioral intention of using VirTele. However, the lack of control of technical and organizational infrastructures may influence the long-term use of technology. At the end of the intervention, the participant demonstrated considerable empowerment at both the behavioral and capacity levels. Conclusions: VirTele was shown to be feasible for use in chronic stroke survivors for remote upper extremity rehabilitation. Meaningful determinants of behavioral intention and use behavior of VirTele were identified, and preliminary efficacy results are promising.  International Registered Report Identifier (IRRID): RR2-10.2196/14629 ",
doi="10.2196/26153",
url="https://games.jmir.org/2021/3/e26153",
url="http://www.ncbi.nlm.nih.gov/pubmed/34132649"
}


@Article{info:doi/10.2196/27195,
author="McClincy, Michael
and Seabol, G. Liliana
and Riffitts, Michelle
and Ruh, Ethan
and Novak, E. Natalie
and Wasilko, Rachel
and Hamm, E. Megan
and Bell, M. Kevin",
title="Perspectives on the Gamification of an Interactive Health Technology for Postoperative Rehabilitation of Pediatric Anterior Cruciate Ligament Reconstruction: User-Centered Design Approach",
journal="JMIR Serious Games",
year="2021",
month="Aug",
day="27",
volume="9",
number="3",
pages="e27195",
keywords="IHT",
keywords="pediatric",
keywords="sports medicine",
keywords="ACL",
keywords="orthopaedics",
keywords="rehabilitation",
keywords="health technology",
keywords="gamification",
abstract="Background: Pediatric and adolescent athletes are a large demographic undergoing anterior cruciate ligament reconstruction (ACL-R). Postoperative rehabilitation is critical, requiring patients to complete home exercise programs (HEPs). To address obstacles to HEP adherence, we developed an interactive health technology, interACTION (iA), to monitor knee-specific rehabilitation. iA is a web-based platform that incorporates wearable motion sensors and a mobile app that provides feedback and allows remote monitoring. The Wheel of Sukr is a gamification mechanism that includes numerous behavioral elements.  Objective: This study aims to use a user-centered design process to incorporate behavioral change strategies derived from self-management theory into iA using the Wheel of Sukr, with the aim of influencing patient behavior. Methods: In total, 10 athletes aged 10-18 years with a history of ACL-R were included in this study. Patients were between 4 weeks and 1 year post--ACL-R. Participants underwent a 60-minute triphasic interview. Phase 1 focused on elements of gaming that led to high participation and information regarding surgery and recovery. In phase 2, participants were asked to think aloud and rank cards representing the components of the Wheel of Sukr in order of interest. In phase 3, the patients reviewed the current version of iA. Interviews were recorded, transcribed, and checked for accuracy. Qualitative content analysis segmented the data and tagged meaningful codes until descriptive redundancy was achieved; next, 2 coders independently coded the data set. These elements were categorized according to the Wheel of Sukr framework. The mean age of participants was 12.8 (SD 1.32) years, and 70\% (7/10) were female. Most participants (7/10, 70\%) reported attending sessions twice weekly. All patients were prescribed home exercises. Self-reported HEP compliance was 75\%-100\% in 40\% (4/10), 50\%-75\% in 40\% (4/10), and 25\%-50\% of prescribed exercises in 20\% (2/10) of the participants. Results: The participants responded positively to an app that could track home exercises. Desirable features included exercise demonstrations, motivational components, and convenience. The participants listed sports specificity, competition, notifications, reminders, rewards, and social aspects of gameplay as features to incorporate. In the Wheel of Sukr card sort exercise, motivation was ranked first; self-management, second; and growth, esteem, and fun tied for the third position. The recommended gameplay components closely followed the themes from the Wheel of Sukr card sort activity. Conclusions: The participants believe iA is a helpful addition to recovery and want the app to include exercise movement tracking and encouragement. Despite the small number of participants, thematic saturation was reached, suggesting the sample was sufficient to obtain a representative range of perspectives. Future work will implement motivation; self-management; and growth, confidence, and fun in the iA user experience. Young athlete ACL-R patients will complete typical clinical scenarios using increasingly developed prototypes of the gamified iA in a controlled setting. ",
doi="10.2196/27195",
url="https://games.jmir.org/2021/3/e27195",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448715"
}


@Article{info:doi/10.2196/30672,
author="Malone, A. Laurie
and Davlyatov, K. Ganisher
and Padalabalanarayanan, Sangeetha
and Thirumalai, Mohanraj",
title="Active Video Gaming Using an Adapted Gaming Mat in Youth and Adults With Physical Disabilities: Observational Study",
journal="JMIR Serious Games",
year="2021",
month="Aug",
day="26",
volume="9",
number="3",
pages="e30672",
keywords="exergaming",
keywords="video games",
keywords="disability",
keywords="exercise",
keywords="physical activity",
keywords="enjoyment",
keywords="dance mat",
keywords="serious games",
keywords="gaming mat",
keywords="mobility impairment",
keywords="physical impairment",
abstract="Background: A common leisure-time activity amongst youth and adults in the United States is video gameplay. Playing video games is typically a sedentary endeavor; however, to encourage an increased level of physical activity in an engaging and enjoyable way, active video gaming has become popular. Unfortunately, the accessibility of gaming controllers is often an issue for persons with disabilities. A commercial off-the-shelf (OTS) gaming mat was adapted to facilitate use by individuals with mobility impairments to address this issue. Objective: Our study aimed to examine energy expenditure, enjoyment, and gameplay experience in youth and adults with mobility impairment during active video gaming using an OTS and adapted versions of a gaming mat. Methods: The study used an observational design. During visit 1, physical function was assessed, and participants were given a familiarization period with the gaming system. For visit 2, based on observation during the physical function tests and discussion with the participant, it was decided whether the participant would play in a standing or seated position. For standing gameplay, the mat was placed on the floor, and for seated play, the mat was placed on a height-adjustable and tilt-adjustable tabletop. Metabolic data were collected during a 20-minute baseline and four 10-minute bouts of Wii Fit Plus gameplay, with 2 bouts on each of the mats (adapted and OTS). During gameplay, the research staff observed and rated participants' ability to use the game controller (mat) and the quality of gameplay. At the end of each game set, participants reported their rating of perceived exertion on a scale from 0 to 10. During rest, participants completed the physical activity enjoyment scale. Participants also answered additional questions regarding the system's usability with each controller (adapted mat and OTS mat). Statistical analyses were computed using Stata 16 (version 16.1; StataCorp). Linear mixed-effects maximum likelihood regression was performed separately for individuals who could play standing and for those who played seated. Results: A convenience sample of 78 individuals with mobility impairments between the ages of 12 and 60 years (mean 39.6, SD 15.8) participated in the study. Of the sample, 48 participants played the video games in a seated position, while 30 played the games standing. Energy expenditure and heart rate tended to be higher in the OTS mat condition for seated players, while values were similar for both conditions among standing players. However, seated participants reported greater gameplay experience, and both groups exhibited a higher quality of gameplay during the adapted mat condition. Conclusions: Active video gaming using an adapted gaming mat provided an enjoyable exercise activity for individuals with mobility impairments. The use of the adapted controller provides a means by which this population can engage in light to moderate intensity active video gaming, thereby reducing sedentary leisure time. Trial Registration: ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 ",
doi="10.2196/30672",
url="https://games.jmir.org/2021/3/e30672",
url="http://www.ncbi.nlm.nih.gov/pubmed/34435962"
}


@Article{info:doi/10.2196/26982,
author="Meinke, Anita
and Peters, Rick
and Knols, Ruud
and Karlen, Walter
and Swanenburg, Jaap",
title="Exergaming Using Postural Feedback From Wearable Sensors and Exercise Therapy to Improve Postural Balance in People With Nonspecific Low Back Pain: Protocol for a Factorial Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="26",
volume="10",
number="8",
pages="e26982",
keywords="low back pain",
keywords="exercise therapy",
keywords="postural balance",
keywords="postural feedback",
keywords="motor control",
keywords="fear of movement",
keywords="exergame",
keywords="randomized controlled trial",
keywords="physical activity",
keywords="smartphone",
keywords="sensors",
keywords="activity tracker",
keywords="mobile phone",
abstract="Background: Physical exercise is a common treatment for people with low back pain (LBP). Wearable sensors that provide feedback on body movements and posture during exercise may enhance postural balance and motor control in people with LBP. Objective: This study aims to investigate whether physical exercising with postural feedback (EPF) improves postural balance, motor control, and patient-reported outcomes in people with LBP. Methods: The study was an assessor-blinded 2{\texttimes}2 factorial trial. We planned to recruit 80 participants with nonspecific LBP who did not receive treatment for LBP. In addition, we aimed to recruit 40 patients with chronic, nonspecific LBP who were receiving exercise therapy (ET) at the University Hospital Zurich. Both ET patients and participants without treatment were randomized to receive either an additional EPF intervention or no additional intervention. This resulted in four different combinations of interventions: ET+EPF, ET, EPF, and no intervention. The participants underwent outcome assessments at inclusion (T1); 3 weeks later, at randomization (T2); after an intervention period of 3 weeks with a predefined exercise schedule for participants receiving EPF (T3); and after an additional 6 weeks, during which participants assigned to the EPF groups could exercise as much as they wished (T4). Patients receiving ET completed their regularly prescribed therapies during the study period. Balance was assessed during quiet standing on a force platform, and motor control was assessed during a lifting task and a waiter's bow task. Physical activity was recorded using an activity tracker and the participants' mobile phones during the study. The predefined EPF schedule consisted of nine sessions of 20 minutes of exercise with a tablet and inertial measurement unit sensors at home. Participants performed a series of trunk and hip movements and received feedback on their movements in a gamified environment displayed on the tablet. Results: The first participant was recruited in May 2019. Data collection was completed in October 2020, with 3 patients and 32 eligible people without therapy who passed the eligibility check. Conclusions: Although it will not be possible to investigate differences in patients and people without other therapies, we expect this pilot study to provide insights into the potential of EPF to improve balance in people with LBP and adherence to such interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/26982 ",
doi="10.2196/26982",
url="https://www.researchprotocols.org/2021/8/e26982",
url="http://www.ncbi.nlm.nih.gov/pubmed/34435954"
}


@Article{info:doi/10.2196/24665,
author="Lapierre, Nolwenn
and Um Din, Nathavy
and Igout, Manuella
and Chevrier, Jo{\"e}l
and Belmin, Jo{\"e}l",
title="Effects of a Rehabilitation Program Using a Patient-Personalized Exergame on Fear of Falling and Risk of Falls in Vulnerable Older Adults: Protocol for a Randomized Controlled Group Study",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="26",
volume="10",
number="8",
pages="e24665",
keywords="older adult",
keywords="fall",
keywords="fear of falling",
keywords="exergame",
keywords="randomized controlled trial",
keywords="psychomotor therapy",
keywords="rehabilitation",
keywords="fear",
keywords="risk",
keywords="elderly",
keywords="protocol",
keywords="therapy",
abstract="Background: Older adults often experience physical, sensory, and cognitive decline. Therefore, they have a high risk of falls, which leads to severe health and psychological consequences and can induce fear of falling. Rehabilitation programs using exergames to prevent falls are being increasingly studied. Medimoov is a movement-based patient-personalized exergame for rehabilitation in older adults. A preliminary study showed that its use may influence functional ability and motivation. Most existing studies that evaluate the use of exergames do not involve an appropriate control group and do not focus on patient-personalized exergames. Objective: This study aims to evaluate the effects of Medimoov on risk of falls and fear of falling in older adults compared with standard psychomotor rehabilitation. Methods: This is a serial, comparative, randomized controlled group study. Both groups (n=25 in each) will receive psychomotor rehabilitation care. However, the methods of delivery will be different; one group will be exposed to the Medimoov exergame platform, and the other only to traditional means of psychomotor rehabilitation. The selection criteria will be (1) age of 65 years or older, (2) ability to answer a questionnaire, (3) ability to stand in a bipedal position for at least 1 minute, (4) score of 13 or greater on the Short Fall Efficacy Scale, and (5) stable medical condition. An evaluation will be made prior to starting the intervention, after 4 weeks of intervention, and at the end of the intervention (after 8 weeks), and it will focus on (1) risk of falls, (2) fear of falling, and (3) cognitive evaluations. Physical activity outside the session will also be assessed by actimetry. The outcome assessment will be performed according to intention-to-treat analysis. Results: The protocol (2019-11-22) has been approved by the Comit{\'e} de Protection des Personnes Nord-Ouest I--Universit{\'e} de Rouen (2019-A00395-52), which is part of the French national ethical committee. The study received funding in February 2020. As of October 2020 (submission date), and due to the context of the COVID-19 pandemic, a total of 10 participants out of 50 had been enrolled in the study. The projected date for the end of the data collection is December 2021. Data analyses have not been started yet, and publication of the results is expected for Spring 2022. Conclusions: The effects of psychomotor rehabilitation using the Medimoov exergame platform on the risk and fear of falls will be evaluated. This pilot study will be the basis for larger trials. Trial Registration: ClinicalTrials.gov NCT04134988; https://clinicaltrials.gov/ct2/show/NCT04134988 International Registered Report Identifier (IRRID): DERR1-10.2196/24665 ",
doi="10.2196/24665",
url="https://www.researchprotocols.org/2021/8/e24665",
url="http://www.ncbi.nlm.nih.gov/pubmed/34435968"
}


@Article{info:doi/10.2196/28150,
author="Pallavicini, Federica
and Pepe, Alessandro
and Mantovani, Fabrizia",
title="Commercial Off-The-Shelf Video Games for Reducing Stress and Anxiety: Systematic Review",
journal="JMIR Ment Health",
year="2021",
month="Aug",
day="16",
volume="8",
number="8",
pages="e28150",
keywords="commercial off-the-shelf video games",
keywords="video games",
keywords="stress",
keywords="anxiety",
keywords="relaxation",
abstract="Background: Using commercial off-the-shelf video games rather than custom-made computer games could have several advantages for reducing stress and anxiety, including their low cost, advanced graphics, and the possibility to reach millions of individuals worldwide. However, it is important to emphasize that not all commercial video games are equal, and their effects strongly depend on specific characteristics of the games. Objective: The aim of this systematic review was to describe the literature on the use of commercial off-the-shelf video games for diminishing stress and anxiety, examining the research outcomes along with critical variables related to computer game characteristics (ie, genre, platform, time of play). Methods: A systematic search of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The search databases were PsycINFO, Web of Science, Medline, IEEExplore, and the Cochrane Library. The search string was: [(``video game*'') OR (``computer game*'')] AND [(``stress'') OR (``anxiety'') OR (``relaxation'')] AND [(``study'') OR (``trial'') OR (``training'')]. Results: A total of 28 studies met the inclusion criteria for the publication period 2006-2021. The findings demonstrate the benefit of commercial off-the-shelf video games for reducing stress in children, adults, and older adults. The majority of the retrieved studies recruited young adults, and fewer studies have involved children, middle-aged adults, and older adults. In addition to exergames and casual video games, other genres of commercial off-the-shelf games helped to reduce stress and anxiety. Conclusions: Efficacy in reducing stress  and anxiety has been demonstrated not only for exergames and casual video games but also for other genres such as action games, action-adventure games, and augmented reality games. Various gaming platforms, including consoles, PCs, smartphones, mobile consoles, and virtual reality systems, have been used with positive results. Finally, even single and short sessions of play had benefits in reducing stress and anxiety. Trial Registration: International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY202130081; https://inplasy.com/?s=INPLASY202130081 ",
doi="10.2196/28150",
url="https://mental.jmir.org/2021/8/e28150",
url="http://www.ncbi.nlm.nih.gov/pubmed/34398795"
}


@Article{info:doi/10.2196/28400,
author="Kwan, Cho Rick Yiu
and Liu, Wa Justina Yat
and Fong, Kuen Kenneth Nai
and Qin, Jing
and Leung, Kwok-Yuen Philip
and Sin, Kan Olive Suk
and Hon, Yuen Pik
and Suen, W. Lydia
and Tse, Man-Kei
and Lai, KY Claudia",
title="Feasibility and Effects of Virtual Reality Motor-Cognitive Training in Community-Dwelling Older People With Cognitive Frailty: Pilot Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2021",
month="Aug",
day="6",
volume="9",
number="3",
pages="e28400",
keywords="virtual reality",
keywords="motor-cognitive training",
keywords="cognitive frailty",
keywords="game",
keywords="feasibility",
keywords="VR",
keywords="training",
keywords="older adults",
keywords="frail",
keywords="pilot study",
keywords="randomized controlled trial",
abstract="Background: Cognitive frailty refers to the coexistence of physical frailty and cognitive impairment, and is associated with many adverse health outcomes. Although cognitive frailty is prevalent in older people, motor-cognitive training is effective at enhancing cognitive and physical function. We proposed a virtual reality (VR) simultaneous motor-cognitive training program, which allowed older people to perform daily activities in a virtual space mimicking real environments. Objective: We aimed to (1) explore the feasibility of offering VR simultaneous motor-cognitive training to older people with cognitive frailty and (2) compare its effects with an existing motor-cognitive training program in the community on the cognitive function and physical function of older people with cognitive frailty. Methods: A two-arm (1:1), assessor-blinded, parallel design, randomized controlled trial was employed. The eligibility criteria for participants were: (1) aged ?60 years, (2) community dwelling, and (3) with cognitive frailty. Those in the intervention group received cognitive training (ie, cognitive games) and motor training (ie, cycling on an ergometer) simultaneously on a VR platform, mimicking the daily living activities of older people. Those in the control group received cognitive training (ie, cognitive games) on tablet computers and motor training (ie, cycling on the ergometer) sequentially on a non-VR platform. Both groups received a 30-minute session twice a week for 8 weeks. Feasibility was measured by adherence, adverse outcomes, and successful learning. The outcomes were cognitive function, physical frailty level, and walking speed. Results: Seventeen participants were recruited and randomized to either the control group (n=8) or intervention group (n=9). At baseline, the median age was 74.0 years (IQR 9.5) and the median Montreal Cognitive Assessment score was 20.0 (IQR 4.0). No significant between-group differences were found in baseline characteristics except in the number of chronic illnesses (P=.04). At postintervention, the intervention group (Z=--2.67, P=.01) showed a significantly larger improvement in cognitive function than the control group (Z=--1.19, P=.24). The reduction in physical frailty in the intervention group (Z=--1.73, P=.08) was similar to that in the control group (Z=--1.89, P=.06). Improvement in walking speed based on the Timed Up-and-Go test was moderate in the intervention group (Z=--0.16, P=.11) and greater in the control group (Z=--2.52, P=.01). The recruitment rate was acceptable (17/33, 52\%). Both groups had a 100\% attendance rate. The intervention group had a higher completion rate than the control group. Training was terminated for one participant (1/9, 11\%) due to minimal VR sickness (Virtual Reality Sickness Questionnaire score=18.3/100). Two participants (2/8, 25\%) in the control group withdrew due to moderate leg pain. No injuries were observed in either group. Conclusions: This study provides preliminary evidence that the VR simultaneous motor-cognitive training is effective at enhancing the cognitive function of older people with cognitive frailty. The effect size on frailty was close to reaching a level of significance and was similar to that observed in the control group. VR training is feasible and safe for older people with cognitive frailty. Trial Registration: ClinicalTrials.gov NCT04467216; https://clinicaltrials.gov/ct2/show/NCT04467216 ",
doi="10.2196/28400",
url="https://games.jmir.org/2021/3/e28400",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383662"
}


@Article{info:doi/10.2196/27884,
author="S{\'a}pi, Mariann
and Feh{\'e}r-Kiss, Anna
and Csern{\'a}k, Krisztina
and Domj{\'a}n, Andrea
and Pint{\'e}r, S{\'a}ndor",
title="The Effects of Exergaming on Sensory Reweighting and Mediolateral Stability of Women Aged Over 60: Usability Study",
journal="JMIR Serious Games",
year="2021",
month="Jul",
day="21",
volume="9",
number="3",
pages="e27884",
keywords="exergaming",
keywords="sensory reweighting",
keywords="older women",
keywords="mediolateral sway",
keywords="vestibular",
abstract="Background: Older adults tend to experience difficulties in switching quickly between various reliable sensory inputs, which ultimately may contribute to an increased risk of falls and injuries. Sideward falls are the most frequent cause of hip fractures among older adults. Recently, exergame programs have been confirmed as beneficial tools for enhancing postural control, which can reduce the risk of falls. However, studies to explore more precisely which mechanism of exergaming directly influences older women's ability to balance are still needed. Objective: Our aim was to evaluate, in a single-group pretest/posttest/follow-up usability study, whether Kinect exergame balance training might have a beneficial impact on the sensory reweighting in women aged over 60. Methods: A total of 14 healthy women (mean age 69.57 [SD 4.66] years, mean body mass index 26.21 [SD 2.6] kg/m2) participated in the study. The volunteers trained with the commercially available games of Kinect for Xbox?360 console 3 times (30 minutes/session) a week over a 6-week period (total of 18 visits). Participants' postural sway in both the anteroposterior (AP) and mediolateral (ML) directions was recorded with NeuroCom Balance Master 6.0. To assess and measure postural sensory reweighting, the Modified Clinical Test of Sensory Interaction in Balance was used, where volunteers were exposed to various changes in visual (eyes open or eyes closed) and surface conditions (firm or foam surface). Results: In the ML direction, the Kinect exergame training caused a significant decrease in the sway path on the firm surface with the eyes open (P<.001) and eyes closed (P=.001), and on the foam surface with the eyes open (P=.001) and eyes closed (P<.001) conditions compared with baseline data. The follow-up measurements when compared with the baseline data showed a significant change in the sway path on the firm surface with the eyes open (P<.001) and eyes closed (P<.001) conditions, as well as on the foam surface with the eyes open (P=.003) and eyes closed (P<.001) conditions. Besides, on the firm surface, there were no significant differences in sway path values in the AP direction between the baseline and the posttraining measurements (eyes open: P=.49; eyes closed: P=.18). Likewise, on the foam surface, there were no significant differences in sway path values in the AP direction under both eyes open (P=.24) and eyes closed (P=.84) conditions. Conclusions: The improved posturography measurements of the sway path in the ML direction might suggest that the Kinect exergame balance training may have effects on sensory reweighting, and thus on the balance of women aged over 60. Based on these results, Kinect exergaming may provide a safe and potentially useful tool for improving postural stability in the crucial ML direction, and thus it may help reduce the risk of falling. ",
doi="10.2196/27884",
url="https://games.jmir.org/2021/3/e27884",
url="http://www.ncbi.nlm.nih.gov/pubmed/34287215"
}


@Article{info:doi/10.2196/28282,
author="Esmaeilzadeh, Pouyan",
title="The Influence of Gamification and Information Technology Identity on Postadoption Behaviors of Health and Fitness App Users: Empirical Study in the United States",
journal="JMIR Serious Games",
year="2021",
month="Jul",
day="5",
volume="9",
number="3",
pages="e28282",
keywords="gamification",
keywords="health and fitness apps",
keywords="IT identity",
keywords="continued intention to use",
keywords="information-sharing tendency",
keywords="mHealth",
keywords="app design",
keywords="user interaction",
abstract="Background: The use of health and fitness apps has been on the rise to monitor personal fitness and health parameters. However, recent research discovered that many users discontinue using these apps after only a few months. Gamification has been suggested as a technique to increase users' interactions with apps. Nevertheless, it is still not clear how gamification mechanisms encourage continued use and inspire user self-management. Objective: The main objective of this study was to articulate how gamification mechanisms in studies of designing and using health and fitness apps can contribute to the realization of information technology (IT) identity and positive behavioral outcomes. The broader goal was to shed light on how gamification mechanisms will translate into positive use behaviors in the context of mobile health apps. Methods: Data were collected from 364 users of health and fitness apps through an online survey to empirically examine the proposed model. Results: Based on identity theories, this study suggests the fully mediating role of IT identity to describe how gamification elements can lead to continued intention to use health and fitness apps, and increase users' tendency for information sharing through the apps. The findings indicate that perceived gamification can increase users' IT identity. In turn, a higher IT identity would encourage users to continue using the apps and share more personal health information with others through the apps. Conclusions: The results of this study can have practical implications for app designers to use gamification elements to increase users' dependency, relatedness, and emotional energy associated with health apps. Moreover, the findings can have theoretical contributions for researchers to help better articulate the process in which gamification can be translated into positive use behaviors. ",
doi="10.2196/28282",
url="https://games.jmir.org/2021/3/e28282/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34812736"
}


@Article{info:doi/10.2196/25854,
author="Beristain-Colorado, Pilar Mar{\'i}a Del
and Ambros-Antemate, Fernando Jorge
and Vargas-Trevi{\~n}o, Marciano
and Guti{\'e}rrez-Guti{\'e}rrez, Jaime
and Moreno-Rodriguez, Adriana
and Hern{\'a}ndez-Cruz, Antonio Pedro
and Gallegos-Velasco, Belem Itandehui
and Torres-Rosas, Rafael",
title="Standardizing the Development of Serious Games for Physical Rehabilitation: Conceptual Framework Proposal",
journal="JMIR Serious Games",
year="2021",
month="Jun",
day="24",
volume="9",
number="2",
pages="e25854",
keywords="serious game",
keywords="physical rehabilitation",
keywords="framework",
keywords="software engineering",
keywords="gamification",
abstract="Background: Serious games have been used as supportive therapy for traditional rehabilitation. However, most are designed without a systematic process to guide their development from the phases of requirement identification, planning, design, construction, and evaluation, which reflect the lack of adaptation of rehabilitation requirements and thus the patient's needs. Objective: The aim of this study was to propose a conceptual framework with standardized elements for the development of information systems by using a flexible and an adaptable process centered on the patient's needs and focused on the creation of serious games for physical rehabilitation. Methods: The conceptual framework is based on 3 fundamental concepts: (1) user-centered design, which is an iterative design process focused on users and their needs at each phase of the process, (2) generic structural activities of software engineering, which guides the independent development process regardless of the complexity or size of the problem, and (3) gamification elements, which allow the transformation of obstacles into positive and fun reinforcements, thereby encouraging patients in their rehabilitation process. Results: We propose a conceptual framework to guide the development of serious games through a systematic process by using an iterative and incremental process applying the phases of context identification, user requirements, planning, design, construction of the interaction devices and video game, and evaluation. Conclusions: This proposed framework will provide developers of serious games a systematic process with standardized elements for the development of flexible and adaptable software with a high level of patient commitment, which will effectively contribute to their rehabilitation process. ",
doi="10.2196/25854",
url="https://games.jmir.org/2021/2/e25854/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34185003"
}


@Article{info:doi/10.2196/25771,
author="Darzi, Ali
and McCrea, M. Sean
and Novak, Domen",
title="User Experience With Dynamic Difficulty Adjustment Methods for an Affective Exergame: Comparative Laboratory-Based Study",
journal="JMIR Serious Games",
year="2021",
month="May",
day="31",
volume="9",
number="2",
pages="e25771",
keywords="affective computing",
keywords="dynamic difficulty adaptation",
keywords="exergames",
keywords="physiological measurements",
keywords="task performance",
keywords="personality characteristics",
keywords="psychophysiology",
abstract="Background: In affective exergames, game difficulty is dynamically adjusted to match the user's physical and psychological state. Such an adjustment is commonly made based on a combination of performance measures (eg, in-game scores) and physiological measurements, which provide insight into the player's psychological state. However, although many prototypes of affective games have been presented and many studies have shown that physiological measurements allow more accurate classification of the player's psychological state than performance measures, few studies have examined whether dynamic difficulty adjustment (DDA) based on physiological measurements (which requires additional sensors) results in a better user experience than performance-based DDA or manual difficulty adjustment. Objective: This study aims to compare five DDA methods in an affective exergame: manual (player-controlled), random, performance-based, personality-performance--based, and physiology-personality-performance--based (all-data). Methods: A total of 50 participants (N=50) were divided into five groups, corresponding to the five DDA methods. They played an exergame version of Pong for 18 minutes, starting at a medium difficulty; every 2 minutes, two game difficulty parameters (ball speed and paddle size) were adjusted using the participant's assigned DDA method. The DDA rules for the performance-based, personality-performance--based, and all-data groups were developed based on data from a previous open-loop study. Seven physiological responses were recorded throughout the sessions, and participants self-reported their preferred changes to difficulty every 2 minutes. After playing the game, participants reported their in-game experience using two questionnaires: the Intrinsic Motivation Inventory and the Flow Experience Measure. Results: Although the all-data method resulted in the most accurate changes to ball speed and paddle size (defined as the percentage match between DDA choice and participants' preference), no significant differences between DDA methods were found on the Intrinsic Motivation Inventory and Flow Experience Measure. When the data from all four automated DDA methods were pooled together, the accuracy of changes in ball speed was significantly correlated with players' enjoyment (r=0.38) and pressure (r=0.43). Conclusions: Although our study is limited by the use of a between-subjects design and may not generalize to other exergame designs, the results do not currently support the inclusion of physiological measurements in affective exergames, as they did not result in an improved user experience. As the accuracy of difficulty changes is correlated with user experience, the results support the development of more effective DDA methods. However, they show that the inclusion of physiological measurements does not guarantee a better user experience even if it yields promising results in offline cross-validation. ",
doi="10.2196/25771",
url="https://games.jmir.org/2021/2/e25771",
url="http://www.ncbi.nlm.nih.gov/pubmed/34057423"
}


@Article{info:doi/10.2196/28210,
author="Lai, Byron
and Powell, Maegen
and Clement, Grace Anne
and Davis, Drew
and Swanson-Kimani, Erin
and Hayes, Leslie",
title="Examining the Feasibility of Early Mobilization With Virtual Reality Gaming Using Head-Mounted Display and Adaptive Software With Adolescents in the Pediatric Intensive Care Unit: Case Report",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="May",
day="27",
volume="8",
number="2",
pages="e28210",
keywords="physical activity",
keywords="active video gaming",
keywords="exergaming",
keywords="early mobility",
keywords="rehabilitation",
abstract="Background: Early rehabilitative mobilization for adolescents is safe and feasible. However, there is a lack of published rehabilitation strategies and treatments that can maximize engagement and outcomes among adolescents in the pediatric intensive care unit (PICU). Virtual reality (VR) gaming using a head-mounted display (HMD) and adaptive software can allow active and nonactive gameplay at the bedside for people with limited arm mobility, making it a potentially inclusive and enjoyable treatment modality for adolescents in the PICU. Objective: The purpose of this brief case study is to report on the preliminary feasibility of incorporating adaptive VR gaming using an HMD with 2 adolescents who received early mobility treatment within the PICU. Methods: This study was a mini-ethnographic investigation of 2 adolescents (a 15-year-old male and a 13-year old male) in the PICU who underwent VR gaming sessions as part of their early mobilization care, using an Oculus Rift HMD and adaptive software (WalkinVR) that promoted full gameplay in bed. The Rift was plugged into a gaming laptop that was set up on a table within the patient's room before each session. The intervention was delivered by an adapted exercise professional and supervised by a physical therapist. Patients had access to a variety of active games (eg, boxing, rhythmic movement to music, and exploratory adventure) and nonactive games (eg, racing and narrative adventure). Gaming sessions were scheduled between usual care, when tolerable and requested by the participant. The interventionist and therapists took audio-recorded and written notes after completing each gaming session. These data were analyzed and presented in a narrative format from the perspective of the research team. Results: Case 1 participated in 4 gaming sessions, with an average of 18 minutes (SD 11) per session. Case 2 participated in 2 sessions, with an average of 35 minutes (SD 7) per session. Both cases were capable of performing active gaming at a moderate level of exercise intensity, as indicated by their heart rate. However, their health and symptoms fluctuated on a daily basis, which prompted the gameplay of adventure or nonactive games. Gameplay appeared to improve participants' affect and alertness and motivate them to be more engaged in early mobilization therapy. Gameplay without the WalkinVR software caused several usability issues. There were no serious adverse events, but both cases experienced symptoms based on their condition. Conclusions: The findings of this study suggest that VR gaming with HMDs and adaptive software is likely a feasible supplement to usual care for adolescents within the PICU, and these findings warrant further investigation. Recommendations for future studies aimed at incorporating VR gaming during early mobilization are presented herein. ",
doi="10.2196/28210",
url="https://rehab.jmir.org/2021/2/e28210",
url="http://www.ncbi.nlm.nih.gov/pubmed/34042602"
}


@Article{info:doi/10.2196/22826,
author="Sch{\"a}ttin, Alexandra
and H{\"a}fliger, Stephan
and Meyer, Alain
and Fr{\"u}h, Barbara
and B{\"o}ckler, Sonja
and Hungerb{\"u}hler, Yannic
and de Bruin, D. Eling
and Frese, Sebastian
and Steinlin Egli, Regula
and G{\"o}tz, Ulrich
and Bauer, Ren{\'e}
and Martin-Niedecken, Lisa Anna",
title="Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies",
journal="JMIR Serious Games",
year="2021",
month="May",
day="7",
volume="9",
number="2",
pages="e22826",
keywords="multiple sclerosis",
keywords="exergame",
keywords="motor",
keywords="physical",
keywords="cognition",
keywords="usability",
keywords="feasibility",
abstract="Background: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Patients with MS experience a wide range of physical and cognitive dysfunctions that affect their quality of life. A promising training approach that concurrently trains physical and cognitive functions is video game--based physical exercising (ie, exergaming). Previous studies have indicated that exergames have positive effects on balance and cognitive functions in patients with MS. However, there is still a need for specific, user-centered exergames that function as a motivating and effective therapy tool for patients with MS and studies investigating their usability and feasibility. Objective: The aim of this interdisciplinary research project is to develop usable and feasible user-centered exergames for the pressure-sensitive plate Dividat Senso by incorporating theoretical backgrounds from movement sciences, neuropsychology, and game research as well as participatory design processes. Methods: Focus groups (patients and therapists) were set up to define the user-centered design process. This was followed by the field testing of newly developed exergame concepts. Two sequential usability and feasibility studies were conducted on patients with MS. The first study included a single exergaming session followed by measurements. Between the first and second studies, prototypes were iterated based on the findings. The second study ran for 4 weeks (1-2 trainings per week), and measurements were taken before and after the intervention. For each study, participants answered the System Usability Scale (SUS; 10 items; 5-point Likert Scale; score range 0-100) and interview questions. In the second study, participants answered game experience--related questionnaires (Flow Short Scale [FSS]: 13 items; 7-point Likert Scale; score range 1-7; Game Flow questionnaire: 17 items; 6-point Likert Scale; score range 1-6). Mixed methods were used to analyze the quantitative and qualitative data. Results: In the first study (N=16), usability was acceptable, with a median SUS score of 71.3 (IQR 58.8-80.0). In the second study (N=25), the median SUS scores were 89.7 (IQR 78.8-95.0; before) and 82.5 (IQR 77.5-90.0; after), and thus, a significant decrease was observed after training (z=?2.077; P=.04; r=0.42). Moreover, high values were observed for the overall FSS (pre: median 5.9, IQR 4.6-6.4; post: median 5.8, IQR 5.4-6.2) and overall Game Flow Questionnaire (pre: median 5.0, IQR 4.7-5.3; post: median 5.1, IQR 4.9-5.3). A significant decrease was observed in the item perceived importance (FSS: z=?2.118; P=.03; r=0.42). Interviews revealed that user-centered exergames were usable, well accepted, and enjoyable. Points of reference were identified for future research and development. Conclusions: The project revealed that the newly developed, user-centered exergames were usable and feasible for patients with MS. Furthermore, exergame elements should be considered in the development phase of user-centered exergames (for patients with MS). Future studies are needed to provide indications about the efficacy of user-centered exergames for patients with MS. ",
doi="10.2196/22826",
url="https://games.jmir.org/2021/2/e22826",
url="http://www.ncbi.nlm.nih.gov/pubmed/33960956"
}


@Article{info:doi/10.2196/21924,
author="Hendrickx, Roel
and van der Avoird, Tim
and Pilot, Peter
and Kerkhoffs, Gino
and Schotanus, Martijn",
title="Exergaming as a Functional Test Battery in Patients Who Received Arthroscopic Ankle Arthrodesis: Cross-sectional Pilot Study",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="May",
day="5",
volume="8",
number="2",
pages="e21924",
keywords="arthroscopic ankle arthrodesis",
keywords="exergaming",
keywords="functional test battery",
keywords="exergames",
keywords="serious games",
keywords="ankle",
keywords="function",
keywords="game",
keywords="exercise",
keywords="physical activity",
keywords="rehabilitation",
keywords="gait",
keywords="quality of care",
abstract="Background: Recently, movement-based videogames (exergames) have gained popularity in improving the rehabilitation process after surgery. During exergaming, participants are physically challenged as the game component stimulates adherence to the training program. There is no literature on the effect of exergame training interventions in patients who received arthroscopic ankle arthrodesis. Objective: This pilot study assessed the potency of an existing exergaming tool for the rehabilitation program of patients who received arthroscopic ankle arthrodesis. Methods: A cross-sectional pilot study was performed, in which patients who received arthroscopic ankle arthrodesis (n=8) were subjected to an exergaming protocol. Gait analysis was performed with a treadmill system. A healthy age-matched control group (n=10) was used as the control group. Results: The patient group was capable of performing exergaming exercises and they showed no floor or ceiling effect. Only in case of the overall stability, the patient group performed significantly less better than the control group (P=.03). Gait analysis showed equal step length with increased external rotation of the affected limb. Conclusions: Exergaming seems to be a valuable tool for measuring the ability of patients who received AAA to perform activities of daily living and it has the potential to individualize rehabilitation programs. When exergaming is systematically integrated with patient-reported outcome measures and activity tracking, it has the potential to improve the quality of care. ",
doi="10.2196/21924",
url="https://rehab.jmir.org/2021/2/e21924",
url="http://www.ncbi.nlm.nih.gov/pubmed/33949311"
}


@Article{info:doi/10.2196/18161,
author="Fari{\v c}, Nu{\vs}a
and Smith, Lee
and Hon, Adrian
and Potts, W. Henry W.
and Newby, Katie
and Steptoe, Andrew
and Fisher, Abi",
title="A Virtual Reality Exergame to Engage Adolescents in Physical Activity: Mixed Methods Study Describing the Formative Intervention Development Process",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="4",
volume="23",
number="2",
pages="e18161",
keywords="adolescent",
keywords="adult",
keywords="exercise",
keywords="leisure activities",
keywords="obesity",
keywords="sports",
keywords="video games",
keywords="mobile phone",
keywords="virtual reality",
keywords="motivation",
abstract="Background: Early adolescence (13-17 years) is a critical developmental stage for physical activity promotion. Virtual reality (VR) exergaming is a promising intervention strategy to engage adolescents in physical activity. Objective: The vEngage project aims to develop a physical activity intervention for adolescents using VR exergaming. Here, we describe the formative intervention development work and process of academic-industry collaboration. Methods: The formative development was guided by the Medical Research Council framework and included recruiting an adolescent user group to provide iterative feedback, a literature review, a quantitative survey of adolescents, qualitative interviews with adolescents and parents, inductive thematic analysis of public reviews of VR exergames, a quantitative survey and qualitative interviews with users of the augmented reality running app Zombies, Run!, and building and testing a prototype with our adolescent user group. Results: VR exergaming was appealing to adolescents and acceptable to parents. We identified behavior change techniques that users would engage with and features that should be incorporated into a VR exergame, including realistic body movements, accurate graphics, stepped levels of gameplay difficulty, new challenges, in-game rewards, multiplayer options, and the potential to link with real-world aspects such as physical activity trackers. We also identified some potential barriers to use, such as cost, perceived discomfort of VR headsets, and motion sickness concerns. A prototype game was developed and user-tested with generally positive feedback. Conclusions: This is the first attempt to develop a VR exergame designed to engage adolescents in physical activity that has been developed within a public health intervention development framework. Our formative work suggests that this is a very promising avenue. The benefit of the design process was the collaborative parallel work between academics and game designers and the involvement of the target population in the game (intervention) design from the outset. Developing the game within an intervention framework allowed us to consider factors, such as parental support, that would be important for future implementation. This study also serves as a call to action for potential collaborators who may wish to join this endeavor for future phases and an example of how academic-industry collaboration can be successful and beneficial. ",
doi="10.2196/18161",
url="http://www.jmir.org/2021/2/e18161/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33538697"
}


@Article{info:doi/10.2196/23389,
author="Parker, Kate
and Uddin, Riaz
and Ridgers, D. Nicola
and Brown, Helen
and Veitch, Jenny
and Salmon, Jo
and Timperio, Anna
and Sahlqvist, Shannon
and Cassar, Samuel
and Toffoletti, Kim
and Maddison, Ralph
and Arundell, Lauren",
title="The Use of Digital Platforms for Adults' and Adolescents' Physical Activity During the COVID-19 Pandemic (Our Life at Home): Survey Study",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="1",
volume="23",
number="2",
pages="e23389",
keywords="digital health",
keywords="moderate- to vigorous-intensity physical activity",
keywords="muscle-strengthening exercise",
keywords="online platforms",
keywords="COVID-19",
abstract="Background: Government responses to managing the COVID-19 pandemic may have impacted the way individuals were able to engage in physical activity. Digital platforms are a promising way to support physical activity levels and may have provided an alternative for people to maintain their activity while at home.  Objective: This study aimed to examine associations between the use of digital platforms and adherence to the physical activity guidelines among Australian adults and adolescents during the COVID-19 stay-at-home restrictions in April and May 2020. Methods: A national online survey was distributed in May 2020. Participants included 1188 adults (mean age 37.4 years, SD 15.1; 980/1188, 82.5\% female) and 963 adolescents (mean age 16.2 years, SD 1.2; 685/963, 71.1\% female). Participants reported demographic characteristics, use of digital platforms for physical activity over the previous month, and adherence to moderate- to vigorous-intensity physical activity (MVPA) and muscle-strengthening exercise (MSE) guidelines. Multilevel logistic regression models examined differences in guideline adherence between those who used digital platforms (ie, users) to support their physical activity compared to those who did not (ie, nonusers). Results: Digital platforms include streaming services for exercise (eg, YouTube, Instagram, and Facebook); subscriber fitness programs, via an app or online (eg, Centr and MyFitnessPal); facilitated online live or recorded classes, via platforms such as Zoom (eg, dance, sport training, and fitness class); sport- or activity-specific apps designed by sporting organizations for participants to keep up their skills (eg, TeamBuildr); active electronic games (eg, Xbox Kinect); and/or online or digital training or racing platforms (eg, Zwift, FullGaz, and Rouvy). Overall, 39.5\% (469/1188) of adults and 26.5\% (255/963) of adolescents reported using digital platforms for physical activity. Among adults, MVPA (odds ratio [OR] 2.0, 95\% CI 1.5-2.7), MSE (OR 3.3, 95\% CI 2.5-4.5), and combined (OR 2.7, 95\% CI 2.0-3.8) guideline adherence were higher among digital platform users relative to nonusers. Adolescents' MVPA (OR 2.4, 95\% CI 1.3-4.3), MSE (OR 3.1, 95\% CI 2.1-4.4), and combined (OR 4.3, 95\% CI 2.1-9.0) guideline adherence were also higher among users of digital platforms relative to nonusers. Conclusions: Digital platform users were more likely than nonusers to meet MVPA and MSE guidelines during the COVID-19 stay-at-home restrictions in April and May 2020. Digital platforms may play a critical role in helping to support physical activity engagement when access to facilities or opportunities for physical activity outside the home are restricted. ",
doi="10.2196/23389",
url="https://www.jmir.org/2021/2/e23389",
url="http://www.ncbi.nlm.nih.gov/pubmed/33481759"
}


@Article{info:doi/10.2196/23423,
author="Da Silva J{\'u}nior, Andrade Jorge Luiz
and Biduski, Daiana
and Bellei, Andrei Ericles
and Becker, Cemin Osvaldo Henrique
and Daroit, Luciane
and Pasqualotti, Adriano
and Tourinho Filho, Hugo
and De Marchi, Bertoletti Ana Carolina",
title="A Bowling Exergame to Improve Functional Capacity in Older Adults: Co-Design, Development, and Testing to Compare the Progress of Playing Alone Versus Playing With Peers",
journal="JMIR Serious Games",
year="2021",
month="Jan",
day="29",
volume="9",
number="1",
pages="e23423",
keywords="functional status",
keywords="elderly",
keywords="virtual reality therapy",
keywords="user-centered design",
keywords="software design",
keywords="video games",
abstract="Background: Older people often do not meet the recommended levels of exercise required to reduce functional decline. Social interaction is mentioned by this cohort as a reason for joining group-based exercises, which does not occur when exercising alone. This perspective shows that exergames can be used as motivational resources. However, most available exergames are generic, obtained from commercial sources, and usually not specifically designed or adapted for older people. Objective: In this study, we aim to co-design and develop a new exergame alongside older participants to (1) tailor the game mechanics and optimize participants' adherence to and enjoyment of exercise; (2) test the participants' functional capacity, motivation, and adherence to the exergaming program; and (3) compare these scores between those who played alone and those who played with peers. Methods: We conducted a co-design process to develop a new exergame adapted to older people. For user testing, 23 participants were divided into 2 groups to play individually (alone group) or to compete in pairs (with peers group). They played the game twice a week, resulting in 21 exergaming sessions. We assessed the participants' General Physical Fitness Index (GPFI) before and after the user testing. We also administered questionnaires about the gaming experience and exercise adherence with its motivators and barriers. Results: We introduced a new bowling exergame for Xbox with a Kinect motion sensor that can be played in single or multiplayer mode. For the GPFI measurements, the sample was homogeneous in the pretest (with peers group: mean 40.5 [SD 9.6], alone group: mean 33.9 [SD 7.8]; P=.11). After the exergame testing sessions, both groups had significant gains (with peers group: mean 57.5 [SD 8.7], P=.005; alone group: mean 44.7 [SD 10.6]; P=.02). Comparing the posttest between groups, it was found that the group in which participants played with peers had better outcomes than the group in which participants played alone (P=.02). Regarding the gaming experience and exercise adherence, both groups recognized the benefits and expressed enthusiasm toward the exergame. Conclusions: The findings suggest that the developed exergame helps in improving the functional capacity and adherence to physical exercise among older people, with even better results for those who played with peers. In addition to leading to more appropriate products, a co-design approach may positively influence the motivation and adherence of participants. ",
doi="10.2196/23423",
url="http://games.jmir.org/2021/1/e23423/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33512319"
}


@Article{info:doi/10.2196/23069,
author="Simmich, Joshua
and Mandrusiak, Allison
and Smith, Trevor Stuart
and Hartley, Nicole
and Russell, Glen Trevor",
title="A Co-Designed Active Video Game for Physical Activity Promotion in People With Chronic Obstructive Pulmonary Disease: Pilot Trial",
journal="JMIR Serious Games",
year="2021",
month="Jan",
day="27",
volume="9",
number="1",
pages="e23069",
keywords="fitness trackers",
keywords="chronic obstructive pulmonary disease",
keywords="physical activity",
keywords="video games",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: People with chronic obstructive pulmonary disease (COPD) who are less active have lower quality of life, greater risk of exacerbations, and greater mortality than those who are more active. The effectiveness of physical activity interventions may facilitate the addition of game elements to improve engagement. The use of a co-design approach with people with COPD and clinicians as co-designers may also improve the effectiveness of the intervention. Objective: The primary aim of this study is to evaluate the feasibility of a co-designed mobile game by examining the usage of the game, subjective measures of game engagement, and adherence to wearing activity trackers. The secondary aim of this study is to estimate the effect of the game on daily steps and daily moderate-to-vigorous physical activity (MVPA). Methods: Participants with COPD who were taking part in the co-design of the active video game (n=9) acted as the experiment group, spending 3 weeks testing the game they helped to develop. Daily steps and MVPA were compared with a control group (n=9) of participants who did not co-design or test the game. Results: Most participants (8/9, 89\%) engaged with the game after downloading it. Participants used the game to record physical activity on 58.6\% (82/141) of the days the game was available. The highest scores on the Intrinsic Motivation Inventory were seen for the value and usefulness subscale, with a mean of 6.38 (SD 0.6). Adherence to wearing Fitbit was high, with participants in both groups recording steps on >80\% of days. Usage of the game was positively correlated with changes in daily steps but not with MVPA. Conclusions: The co-designed mobile app shows promise as an intervention and should be evaluated in a larger-scale trial in this population. ",
doi="10.2196/23069",
url="http://games.jmir.org/2021/1/e23069/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33502321"
}


@Article{info:doi/10.2196/16054,
author="Enciso, James
and Variya, Dhruval
and Sunthonlap, James
and Sarmiento, Terrence
and Lee, Mun Ka
and Velasco, James
and Pebdani, N. Roxanna
and de Leon, D. Ray
and Dy, Christine
and Keslacy, Stefan
and Won, Soonmee Deborah",
title="Electromyography-Driven Exergaming in Wheelchairs on a Mobile Platform: Bench and Pilot Testing of the WOW-Mobile Fitness System",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Jan",
day="19",
volume="8",
number="1",
pages="e16054",
keywords="exergaming",
keywords="gamercising",
keywords="mobile health",
keywords="wheelchair exercises",
keywords="wireless electromyography",
keywords="mobile phone",
abstract="Background: Implementing exercises in the form of video games, otherwise known as exergaming, has gained recent attention as a way to combat health issues resulting from sedentary lifestyles. However, these exergaming apps have not been developed for exercises that can be performed in wheelchairs, and they tend to rely on whole-body movements. Objective: This study aims to develop a mobile phone app that implements electromyography (EMG)-driven exergaming, to test the feasibility of using this app to enable people in wheelchairs to perform exergames independently and flexibly in their own home, and to assess the perceived usefulness and usability of this mobile health system. Methods: We developed an Android mobile phone app (Workout on Wheels, WOW-Mobile) that senses upper limb muscle activity (EMG) from wireless body-worn sensors to drive 3 different video games that implement upper limb exercises designed for people in wheelchairs. Cloud server recordings of EMG enabled long-term monitoring and feedback as well as multiplayer gaming. Bench testing of data transmission and power consumption were tested. Pilot testing was conducted on 4 individuals with spinal cord injury. Each had a WOW-Mobile system at home for 8 weeks. We measured the minutes for which the app was used and the exergames were played, and we integrated EMG as a measure of energy expended. We also conducted a perceived usefulness and usability questionnaire. Results: Bench test results revealed that the app meets performance specifications to enable real-time gaming, cloud storage of data, and live cloud server transmission for multiplayer gaming. The EMG sampling rate of 64 samples per second, in combination with zero-loss data communication with the cloud server within a 10-m range, provided seamless control over the app exergames and allowed for offline data analysis. Each participant successfully used the WOW-Mobile system at home for 8 weeks, using the app for an average of 146 (range 89-267) minutes per week with the system, actively exergaming for an average of 53\% of that time (39\%-59\%). Energy expenditure, as measured by integrated EMG, was found to be directly proportional to the time spent on the app (Pearson correlation coefficient, r=0.57-0.86, depending on the game). Of the 4 participants, 2 did not exercise regularly before the study; these 2 participants increased from reportedly exercising close to 0 minutes per week to exergaming 58 and 158 minutes on average using the WOW-Mobile fitness system. The perceived usefulness of WOW-Mobile in motivating participants to exercise averaged 4.5 on a 5-point Likert scale and averaged 5 for the 3 participants with thoracic level injuries. The mean overall ease of use score was 4.25 out of 5. Conclusions: Mobile app exergames driven by EMG have promising potential for encouraging and facilitating fitness for individuals in wheelchairs who have maintained arm and hand mobility. ",
doi="10.2196/16054",
url="http://rehab.jmir.org/2021/1/e16054/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33464221"
}


@Article{info:doi/10.2196/16458,
author="Santos, Oliveira Luciano Henrique De
and Okamoto, Kazuya
and Otsuki, Ryo
and Hiragi, Shusuke
and Yamamoto, Goshiro
and Sugiyama, Osamu
and Aoyama, Tomoki
and Kuroda, Tomohiro",
title="Promoting Physical Activity in Japanese Older Adults Using a Social Pervasive Game: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2021",
month="Jan",
day="6",
volume="9",
number="1",
pages="e16458",
keywords="aged",
keywords="physical activity",
keywords="pervasive games",
keywords="social interaction",
abstract="Background: Pervasive games aim to create more fun and engaging experiences by mixing elements from the real world into the game world. Because they intermingle with players' lives and naturally promote more casual gameplay, they could be a powerful strategy to stimulate physical activity among older adults. However, to use these games more effectively, it is necessary to understand how design elements of the game affect player behavior. Objective: The aim of this study was to evaluate how the presence of a specific design element, namely social interaction, would affect levels of physical activity. Methods: Participants were recruited offline and randomly assigned to control and intervention groups in a single-blind design. Over 4 weeks, two variations of the same pervasive game were compared: with social interaction (intervention group) and with no social interaction (control group). In both versions, players had to walk to physical locations and collect virtual cards, but the social interaction version allowed people to collaborate to obtain more cards. Changes in the weekly step counts were used to evaluate the effect on each group, and the number of places visited was used as an indicator of play activity. Results: A total of 20 participants were recruited (no social interaction group, n=10; social interaction group, n=10); 18 participants remained active until the end of the study (no social interaction group, n=9; social interaction group, n=9). Step counts during the first week were used as the baseline level of physical activity (no social interaction group: mean 46,697.2, SE 7905.4; social interaction group: mean 45,967.3, SE 8260.7). For the subsequent weeks, changes to individual baseline values (absolute/proportional) for the no social interaction group were as follows: 1583.3 (SE 3108.3)/4.6\% (SE 7.2\%) (week 2), 591.5 (SE 2414.5)/2.4\% (SE 4.7\%) (week 3), and ?1041.8 (SE 1992.7)/0.6\% (SE 4.4\%) (week 4). For the social interaction group, changes to individual baseline values were as follows: 11520.0 (SE 3941.5)/28.0\% (SE 8.7\%) (week 2), 9567.3 (SE 2631.5)/23.0\% (SE 5.1\%) (week 3), and 7648.7 (SE 3900.9)/13.9\% (SE 8.0\%) (week 4). The result of the analysis of the group effect was significant (absolute change: $\eta$2=0.31, P=.04; proportional change: $\eta$2=0.30, P=.03). Correlations between both absolute and proportional change and the play activity were significant (absolute change: r=0.59, 95\% CI 0.32 to 0.77; proportional change: r=0.39, 95\% CI 0.08 to 0.64). Conclusions: The presence of social interaction design elements in pervasive games appears to have a positive effect on levels of physical activity. Trial Registration: Japan Medical Association Clinical Trial Registration Number JMA-IIA00314; https://tinyurl.com/y5nh6ylr (Archived by WebCite at http://www.webcitation.org/761a6MVAy) ",
doi="10.2196/16458",
url="https://games.jmir.org/2021/1/e16458",
url="http://www.ncbi.nlm.nih.gov/pubmed/33404507"
}


@Article{info:doi/10.2196/24035,
author="ten Velde, Gabrielle
and Plasqui, Guy
and Willeboordse, Maartje
and Winkens, Bjorn
and Vreugdenhil, Anita",
title="Feasibility and Effect of the Exergame BOOSTH Introduced to Improve Physical Activity and Health in Children: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Dec",
day="11",
volume="9",
number="12",
pages="e24035",
keywords="exercise",
keywords="sedentary lifestyle",
keywords="mHealth",
keywords="mobile health",
keywords="serious game",
keywords="exergame",
keywords="prevention",
keywords="pupil",
keywords="randomized controlled trial",
abstract="Background: Despite the well-known beneficial health effects of physical activity (PA), the majority of Dutch primary school children do not meet the recommended PA guidelines. Although there is growing evidence on the effectiveness of exergames for PA in children, there is limited evidence on their effect on health outcomes, such as cardiovascular health and health-related quality of life (HRQOL), and on factors influencing their effectiveness and feasibility. The exergame BOOSTH uses a wrist-worn activity tracker to measure steps per day. As a reward for the performed PA, children can unlock levels in the online BOOSTH game. In addition, ``BOOSTH battle'' enables competition between groups. Objective: This protocol describes a cluster randomized controlled trial in 16 primary schools in the Netherlands investigating the effect of BOOSTH on moderate-to-vigorous PA (MVPA) using accelerometry. Secondary aims are to investigate the feasibility of BOOSTH (mixed methods: questionnaires and focus group interviews) and its effect on cardiovascular risk factors (anthropometrics, blood pressure, and retinal microvasculature) and HRQOL. Methods: Stratification variables and relevant variables related to outcomes (such as BMI [z-score], sex, age, and parenting style) and/or missingness will be taken into account. Measurements will be performed at baseline and after 3, 6, and 12 months. Results: The study has received funding from Province Limburg (SAS-2015-04956) and received ethical approval from the Medical Ethics Committee of Maastricht University Medical Centre (METC172043/NL64324.068.17). The results of the analyses are expected to be published in 2021. Conclusions: With this study, the ability of the exergame BOOSTH to increase PA and improve health in children of primary school age will be investigated. The insights into effectiveness and feasibility will result in scientific and societal recommendations, which could potentially contribute to widespread implementation of exergames for children. Trial Registration: ClinicalTrials.gov NCT03440580; https://clinicaltrials.gov/ct2/show/NCT03440580. International Registered Report Identifier (IRRID): DERR1-10.2196/24035 ",
doi="10.2196/24035",
url="http://www.researchprotocols.org/2020/12/e24035/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33306031"
}


@Article{info:doi/10.2196/19968,
author="Zhao, Zhao
and Arya, Ali
and Orji, Rita
and Chan, Gerry",
title="Effects of a Personalized Fitness Recommender System Using Gamification and Continuous Player Modeling: System Design and Long-Term Validation Study",
journal="JMIR Serious Games",
year="2020",
month="Nov",
day="17",
volume="8",
number="4",
pages="e19968",
keywords="persuasive communication",
keywords="video games",
keywords="mobile apps",
keywords="wearable electronic devices",
keywords="motivation",
keywords="mobile phone",
abstract="Background: Gamification and persuasive games are effective tools to motivate behavior change, particularly to promote daily physical activities. On the one hand, studies have suggested that a one-size-fits-all approach does not work well for persuasive game design. On the other hand, player modeling and recommender systems are increasingly used for personalizing content. However, there are few existing studies on how to build comprehensive player models for personalizing gamified systems, recommending daily physical activities, or the long-term effectiveness of such gamified exercise-promoting systems. Objective: This paper aims to introduce a gamified, 24/7 fitness assistant system that provides personalized recommendations and generates gamified content targeted at individual users to bridge the aforementioned gaps. This research aims to investigate how to design gamified physical activity interventions to achieve long-term engagement. Methods: We proposed a comprehensive model for gamified fitness recommender systems that uses detailed and dynamic player modeling and wearable-based tracking to provide personalized game features and activity recommendations. Data were collected from 40 participants (23 men and 17 women) who participated in a long-term investigation on the effectiveness of our recommender system that gradually establishes and updates an individual player model (for each unique user) over a period of 60 days. Results: Our results showed the feasibility and effectiveness of the proposed system, particularly for generating personalized exercise recommendations using player modeling. There was a statistically significant difference among the 3 groups (full, personalized, and gamified) for overall motivation (F3,36=22.49; P<.001), satisfaction (F3,36=22.12; P<.001), and preference (F3,36=15.0; P<.001), suggesting that both gamification and personalization have positive effects on the levels of motivation, satisfaction, and preference. Furthermore, qualitative results revealed that a customized storyline was the most requested feature, followed by a multiplayer mode, more quality recommendations, a feature for setting and tracking fitness goals, and more location-based features. Conclusions: On the basis of these results and drawing from the gamer modeling literature, we conclude that personalizing recommendations using player modeling and gamification can improve participants' engagement and motivation toward fitness activities over time. ",
doi="10.2196/19968",
url="http://games.jmir.org/2020/4/e19968/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33200994"
}


@Article{info:doi/10.2196/16693,
author="Ko, Junho
and Jang, Seong-Wook
and Lee, Taek Hyo
and Yun, Han-Kyung
and Kim, Sang Yoon",
title="Effects of Virtual Reality and Non--Virtual Reality Exercises on the Exercise Capacity and Concentration of Users in a Ski Exergame: Comparative Study",
journal="JMIR Serious Games",
year="2020",
month="Oct",
day="28",
volume="8",
number="4",
pages="e16693",
keywords="exergame",
keywords="virtual reality",
keywords="VR content",
keywords="ski simulation",
abstract="Background: Recently, ski exergames have been gaining popularity due to the growing interest in health improvement. Conventional studies evaluating the effects of ski exergames only considered exercise capacity and overlooked concentration. Ski exergames consist of a motion platform for exercise and virtual reality (VR) content in the game. The VR content enhances the exercise capacity and concentration of the user by providing a challenging goal. Objective: The aim of this study is to evaluate the effects of VR and non-VR exercises on the exercise capacity and concentration of users in a ski exergame. Methods: To examine the effects of the VR content in ski exergames, we performed 2 experiments, non-VR exercise and VR exercise, where participants exercised on the motion platform. If a user performs an exercise without using any VR content, it is a non-VR exercise. Contrastingly, in the case of VR exercise, a user exercises according to the VR content (a downhill scenario). In addition to the range of motion (ROM) of the ankle and rated perceived exertion (RPE) to assess exercise capacity, we used electroencephalography (EEG) to assess users' concentration. Results: We evaluated the effects of the VR content by comparing the results obtained from VR and non-VR exercises. The ROM of the ankle with VR exercise was wider than that with non-VR exercise. Specifically, ROM of the ankle was 115.71{\textdegree} (SD 17.71{\textdegree}) and 78.50{\textdegree} (SD 20.43{\textdegree}) in VR exercise and non-VR exercise, respectively. The RPE difference between the 2 exercises was not statistically significant. The result of the sensorimotor rhythm waves (which are concentration-related EEG signals) was more favorable for VR exercise than non-VR exercise. The ratios of sensorimotor rhythm wave in EEG were 3.08\% and 2.70\% in the VR exercise and non-VR exercise, respectively. Conclusions: According to the results of this experiment, higher exercise capability and concentration were achieved with the VR exercise compared with non-VR exercise. The observations confirm that VR content can enhance both exercise capability and concentration of the user. Thus, the ski exergames can be used effectively by those who, in general, do not like exercise but enjoy games. ",
doi="10.2196/16693",
url="https://games.jmir.org/2020/4/e16693",
url="http://www.ncbi.nlm.nih.gov/pubmed/33112240"
}


@Article{info:doi/10.2196/19840,
author="Szpak, Ancret
and Michalski, Carlo Stefan
and Loetscher, Tobias",
title="Exergaming With Beat Saber: An Investigation of Virtual Reality Aftereffects",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="23",
volume="22",
number="10",
pages="e19840",
keywords="virtual reality",
keywords="motion sickness",
keywords="exercise",
keywords="sedentary behavior",
keywords="depth perception",
abstract="Background: Virtual reality (VR) exergaming has the potential to target sedentary behavior. Immersive environments can distract users from the physical exertion of exercise and can motivate them to continue exergaming. Despite the recent surge in VR popularity, numerous users still experience VR sickness from using head-mounted displays (HMDs). Apart from the commonly assessed self-reported symptoms, depth perception and cognition may also be affected. Considering the potential benefits of VR exergaming, it is crucial to identify the adverse effects limiting its potential and continued uptake. Objective: This study aims to investigate the consequences of playing one of the most popular VR exergames for 10 and 50 min on aspects of vision, cognition, and self-reported VR sickness. Methods: A total of 36 participants played an exergame, called Beat Saber, using an HMD. A repeated measures within-subject design was conducted to assess changes in vision, cognition, and well-being after short (10 min) and long (50 min) durations of VR exposure. We measured accommodation, convergence, decision speed, movement speed, and self-reported sickness at 3 test periods---before VR, immediately after VR, and 40 min after VR (late). Results: Beat Saber was well tolerated, as there were no dropouts due to sickness. For most participants, any immediate aftereffects were short-lived and returned to baseline levels after 40 min of exiting VR. For both short and long exposures, there were changes in accommodation (F1,35=8.424; P=.006) and convergence (F1,35=7.826; P=.008); however, in the late test period, participants returned to baseline levels. Measures on cognition revealed no concern. The total simulator sickness questionnaire (SSQ) scores increased immediately after VR (F1,35=26.515; P<.001) and were significantly higher for long compared with short exposures (t35=2.807; P=.03), but there were no differences in exposure duration in the late test period, with scores returning to baseline levels. Although at a group level, participants' sickness levels returned to baseline 40 min after VR exposure, approximately 14\% of the participants still reported high levels of sickness in the late test period after playing 50 min of Beat Saber. We also showed that the participants who experienced a high level of sickness after a short exposure were almost certain to experience a high level of symptoms after a longer exposure. Conclusions: Irrespective of the duration of exposure, this study found no strong evidence for adverse symptoms 40 min after exiting VR; however, some individuals still reported high levels of VR sickness at this stage. We recommend that users commit to a waiting period after exiting VR to ensure that any aftereffects have deteriorated. Exergames in HMDs have the potential to encourage people to exercise but are understudied, and the aftereffects of exergaming need to be closely monitored to ensure that VR exergames can reach their full potential. ",
doi="10.2196/19840",
url="http://www.jmir.org/2020/10/e19840/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33095182"
}


@Article{info:doi/10.2196/19280,
author="Schmidt-Kraepelin, Manuel
and Toussaint, A. Philipp
and Thiebes, Scott
and Hamari, Juho
and Sunyaev, Ali",
title="Archetypes of Gamification: Analysis of mHealth Apps",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="19",
volume="8",
number="10",
pages="e19280",
keywords="mHealth",
keywords="smartphones",
keywords="mobile phones",
keywords="gamification",
keywords="quantified-self",
keywords="exergames, persuasive technology",
abstract="Background: Nowadays, numerous health-related mobile apps implement gamification in an attempt to draw on the motivational potential of video games and thereby increase user engagement or foster certain health behaviors. However, research on effective gamification is still in its infancy and researchers increasingly recognize methodological shortcomings of existing studies. What we actually know about the phenomenon today stems from fragmented pieces of knowledge, and a variety of different perspectives. Existing research primarily draws on conceptual knowledge that is gained from research prototypes, and isolated from industry best practices. We still lack knowledge on how gamification has been successfully designed and implemented within the industry and whether certain gamification approaches have shown to be particularly suitable for certain health behaviors. Objective: We address this lack of knowledge concerning best practices in the design and implementation of gamification for health-related mobile apps by identifying archetypes of gamification approaches that have emerged in pertinent health-related mobile apps and analyzing to what extent those gamification approaches are influenced by the underlying desired health-related outcomes. Methods: A 3-step research approach is employed. As a first step, a database of 143 pertinent gamified health-related mobile apps from the Apple App Store and Google Play Store is set up. Second, the gamification approach of each app within the database is classified based on an established taxonomy for gamification in health-related apps. Finally, a 2-step cluster analysis is conducted in order to identify archetypes of the most dominant gamification approaches in pertinent gamified health-related mobile apps. Results: Eight archetypes of gamification emerged from the analysis of health-related mobile apps: (1) competition and collaboration, (2) pursuing self-set goals without rewards, (3) episodical compliance tracking, (4) inherent gamification for external goals, (5) internal rewards for self-set goals, (6) continuous assistance through positive reinforcement, (7) positive and negative reinforcement without rewards, and (8) progressive gamification for health professionals. The results indicate a close relationship between the identified archetypes and the actual health behavior that is being targeted. Conclusions: By unveiling salient best practices and discussing their relationship to targeted health behaviors, this study contributes to a more profound understanding of gamification in mobile health. The results can serve as a foundation for future research that advances the knowledge on how gamification may positively influence health behavior change and guide practitioners in the design and development of highly motivating and effective health-related mobile health apps. ",
doi="10.2196/19280",
url="https://mhealth.jmir.org/2020/10/e19280",
url="http://www.ncbi.nlm.nih.gov/pubmed/33074155"
}


@Article{info:doi/10.2196/20667,
author="Lai, Byron
and Davis, Drew
and Narasaki-Jara, Mai
and Hopson, Betsy
and Powell, Danielle
and Gowey, Marissa
and Rocque, G. Brandon
and Rimmer, H. James",
title="Feasibility of a Commercially Available Virtual Reality System to Achieve Exercise Guidelines in Youth With Spina Bifida: Mixed Methods Case Study",
journal="JMIR Serious Games",
year="2020",
month="Sep",
day="3",
volume="8",
number="3",
pages="e20667",
keywords="physical activity",
keywords="active video gaming",
keywords="exergaming",
keywords="disability",
keywords="Oculus Quest",
abstract="Background: Access to physical activity among youth with spina bifida (SB) is much lower than it is for children without disability. Enjoyable home-based exercise programs are greatly needed. Objective: Our objective is to examine the feasibility of a virtual reality (VR) active video gaming system (ie, bundle of consumer-available equipment) to meet US physical activity guidelines in two youth with SB. Methods: Two youth with SB---a 12-year-old female and a 13-year-old male; both full-time wheelchair users---participated in a brief, 4-week exercise program using a popular VR head-mounted display: Oculus Quest (Facebook Technologies). The system included a Polar H10 (Polar Canada) Bluetooth heart rate monitor, a no-cost mobile phone app (VR Health Exercise Tracker [Virtual Reality Institute of Health and Exercise]), and 13 games. The intervention protocol was conducted entirely in the homes of the participants due to the coronavirus disease 2019 (COVID-19) pandemic. The VR system was shipped to participants and they were instructed to do their best to complete 60 minutes of moderate-intensity VR exercise per day. Exercise duration, intensity, and calories expended were objectively monitored and recorded during exercise using the heart rate monitor and a mobile app. Fatigue and depression were measured via self-report questionnaires at pre- and postintervention. Participants underwent a semistructured interview with research staff at postintervention. Results: Across the intervention period, the total average minutes of all exercise performed each week for participants 1 and 2 were 281 (SD 93) and 262 (SD 55) minutes, respectively. The total average minutes of moderate-intensity exercise performed per week for participants 1 and 2 were 184 (SD 103) (184/281, 65.4\%) and 215 (SD 90) (215/262, 82.1\%) minutes, respectively. One participant had a reduction in their depression score, using the Quality of Life in Neurological Disorders (Neuro-QoL) test, from baseline to postintervention, but no other changes were observed for fatigue and depression scores. Participants reported that the amount of exercise they completed was far higher than what was objectively recorded, due to usability issues with the chest-worn heart rate monitor. Participants noted that they were motivated to exercise due to the enjoyment of the games and VR headset as well as support from a caregiver. Conclusions: This study demonstrated that two youth with SB who used wheelchairs could use a VR system to independently and safely achieve exercise guidelines at home. Study findings identified a promising protocol for promoting exercise in this population and this warrants further examination in future studies with larger samples. ",
doi="10.2196/20667",
url="http://games.jmir.org/2020/3/e20667/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32880577"
}


@Article{info:doi/10.2196/19495,
author="Petersen, Ding Jindong
and Larsen, Ladekj{\ae}r Eva
and la Cour, Karen
and von B{\"u}low, Cecilie
and Skouboe, Malene
and Christensen, Reffstrup Jeanette
and Waldorff, Boch Frans",
title="Motion-Based Technology for People With Dementia Training at Home: Three-Phase Pilot Study Assessing Feasibility and Efficacy",
journal="JMIR Ment Health",
year="2020",
month="Aug",
day="26",
volume="7",
number="8",
pages="e19495",
keywords="dementia",
keywords="motion-based technology",
keywords="virtual reality",
keywords="telerehabilitation",
keywords="physical training",
keywords="physical and mental function",
abstract="Background: Persons with dementia tend to be vulnerable to mobility challenges and hence face a greater risk of fall and subsequent fractures, morbidity, and mortality. Motion-based technologies (MBTs), also called sensor-based technologies or virtual reality, have the potential for assisting physical exercise and training as a part of a disease management and rehabilitation program, but little is known about its' use for people with dementia.  Objective: The purpose of this pilot study was to investigate the feasibility and efficacy of MBT physical training at home for people with dementia. Methods: A 3-phase pilot study: (1) baseline start-up, (2) 15 weeks of group training at a local care center twice a week, and (3) 12 weeks of group training reduced to once a week, supplemented with individual MBT training twice a week at home. A total of 26 people with dementia from a municipality in Southern Denmark were eligible and agreed to participate in this study. Three withdrew from the study, leaving 23 participants for the final analysis. Feasibility was measured by the percentage of participants who trained with MBT at home, and their completion rate of total scheduled MBT sessions. Efficacy was evaluated by physical function, measured by Sit-to-Stand (STS), Timed-Up-and-Go (TUG), 6-minute Walk Test (6MW), and 10-meter Dual-task Walking Test (10MDW); cognitive function was measured by Mini-Mental State Examination (MMSE) and Neuropsychiatric Inventory-Questionnaire (NPI-Q); and European Quality of Life 5 dimensions questionnaire (EQOL5) was used for measuring quality of life. Descriptive statistics were applied accordingly. Wilcoxon signed-rank and rank-sum tests were applied to explore significant differences within and between the groups. Results: As much as 12 of 23 participants (52\%) used the supplemental MBT training at home. Among them, 6 (50\%) completed 75\% or more scheduled sessions, 3 completed 25\% or less, and 3 completed between 25\% and 75\% of scheduled sessions. For physical and cognitive function tests, supplementing with MBT training at home showed a tendency of overall stabilization of scores among the group of participants who actively trained with MBT; especially, the 10MDW test even showed a significant improvement from 9.2 to 7.1 seconds (P=.03). We found no positive effect on EQOL5 tests. Conclusions: More than half of the study population with dementia used MBT training at home, and among them, half had an overall high adherence to the home training activity. Physical function tended to remain stable or even improved among high-adherence MBT individuals. We conclude that MBT training at home may be feasible for some individuals with dementia. Further research is warranted. ",
doi="10.2196/19495",
url="http://mental.jmir.org/2020/8/e19495/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32845243"
}


@Article{info:doi/10.2196/19914,
author="Steiner, Bianca
and Elgert, Lena
and Saalfeld, Birgit
and Wolf, Klaus-Hendrik",
title="Gamification in Rehabilitation of Patients With Musculoskeletal Diseases of the Shoulder: Scoping Review",
journal="JMIR Serious Games",
year="2020",
month="Aug",
day="25",
volume="8",
number="3",
pages="e19914",
keywords="shoulder",
keywords="upper extremity",
keywords="musculoskeletal diseases",
keywords="rehabilitation",
keywords="gamification",
keywords="serious games",
keywords="exergames",
keywords="scoping review",
abstract="Background: Gamification has become increasingly important both in research and in practice. Particularly in long-term care processes, such as rehabilitation, playful concepts are gaining in importance to increase motivation and adherence. In addition to neurological diseases, this also affects the treatment of patients with musculoskeletal diseases such as shoulder disorders. Although it would be important to assist patients during more than one rehabilitation phase, it is hypothesized that existing systems only support a single phase. It is also unclear which game design elements are currently used in this context and how they are combined to achieve optimal positive effects on motivation. Objective: This scoping review aims to identify and analyze information and communication technologies that use game design elements to support the rehabilitation processes of patients with musculoskeletal diseases of the shoulder. The state of the art with regard to fields of application, game design elements, and motivation concepts will be determined. Methods: We conducted a scoping review to identify relevant application systems. The search was performed in 3 literature databases: PubMed, IEEE Xplore, and Scopus. Following the PICO (population, intervention, comparison, outcome) framework, keywords and Medical Subject Headings for shoulder, rehabilitation, and gamification were derived to define a suitable search term. Two independent reviewers, a physical therapist and a medical informatician, completed the search as specified by the search strategy. There was no restriction on year of publication. Data synthesis was done by deductive-inductive coding based on qualitative content analysis. Results: A total of 1994 articles were screened; 31 articles in English, published between 2006 and 2019, were included. Within, 27 application systems that support patients with musculoskeletal diseases of the shoulder in exercising, usually at home but also in inpatient or outpatient rehabilitation clinics, were described. Only 2 application systems carried out monitoring of adherence. Almost all were based on in-house developed software. The most frequently used game components were points, tasks, and avatars. More complex game components, such as collections and teams, were rarely used. When selecting game components, patient-specific characteristics, such as age and gender, were only considered in 2 application systems. Most were described as motivating, though an evaluation of motivational effects was usually not conducted. Conclusions: There are only a few application systems supporting patients with musculoskeletal diseases of the shoulder in rehabilitation by using game design elements. Almost all application systems are exergames for supporting self-exercising. Application systems for multiple rehabilitation phases seem to be nonexistent. It is also evident that only a few complex game design elements are used. Patient-specific characteristic are generally neglected when selecting and implementing game components. Consequently, a holistic approach to enhance adherence to rehabilitation is required supporting patients during the entire rehabilitation process by providing motivational game design elements based on patient-specific characteristics. ",
doi="10.2196/19914",
url="http://games.jmir.org/2020/3/e19914/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32840488"
}


@Article{info:doi/10.2196/14920,
author="McMichael, Lucy
and Fari{\v c}, Nu{\vs}a
and Newby, Katie
and Potts, W. Henry W.
and Hon, Adrian
and Smith, Lee
and Steptoe, Andrew
and Fisher, Abi",
title="Parents of Adolescents Perspectives of Physical Activity, Gaming and Virtual Reality: Qualitative Study",
journal="JMIR Serious Games",
year="2020",
month="Aug",
day="25",
volume="8",
number="3",
pages="e14920",
keywords="exercise",
keywords="obesity",
keywords="video games",
keywords="adolescent",
keywords="adolescence",
keywords="sports",
keywords="health",
keywords="leisure activities",
keywords="virtual reality",
abstract="Background: Virtual reality (VR) exergaming may be a promising avenue to engage adolescents with physical activity. Since parental support is a consistent determinant of physical activity in adolescents, it is crucial to gather the views of parents of adolescents about this type of intervention. Objective: This study aimed to interview parents of younger adolescents (13-17 years old) about physical activity, gaming, and VR as part of the larger vEngage study. Methods: Semistructured interviews were conducted with 18 parents of adolescents. Data were synthesized using framework analysis. Results: Parents believed that encouraging physical activity in adolescents was important, particularly for mental health. Most parents felt that their children were not active enough. Parents reported their adolescents regularly gamed, with mostly negative perceptions of gaming due to violent content and becoming addicted. Parents discussed an inability to relate to gaming due to ``generational differences,'' but an exception was exergaming, which they had played with their children in the past (eg, Wii Fit). Specific recommendations for promoting a VR exergaming intervention were provided, but ultimately parents strongly supported harnessing gaming for any positive purpose. Conclusions: The current study suggests promise for a VR exergaming intervention, but this must be framed in a way that addresses parental concerns, particularly around addiction, violence, and safety, without actively involving their participation. While parents would rather their children performed ``real-world'' physical activity, they believed the key to engagement was through technology. Overall, there was the perception that harnessing gaming and sedentary screen time for a positive purpose would be strongly supported. ",
doi="10.2196/14920",
url="http://games.jmir.org/2020/3/e14920/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32840487"
}


@Article{info:doi/10.2196/18888,
author="van der Veen, M. Susanne
and Stamenkovic, Alexander
and Applegate, E. Megan
and Leitkam, T. Samuel
and France, R. Christopher
and Thomas, S. James",
title="Effects of Avatar Perspective on Joint Excursions Used to Play Virtual Dodgeball: Within-Subject Comparative Study",
journal="JMIR Serious Games",
year="2020",
month="Aug",
day="19",
volume="8",
number="3",
pages="e18888",
keywords="virtual reality",
keywords="avatar perspective",
keywords="reaching",
keywords="joint excursion",
keywords="exergaming",
keywords="exercise rehabilitation",
keywords="head mounted display",
abstract="Background: Visual representation of oneself is likely to affect movement patterns. Prior work in virtual dodgeball showed greater excursion of the ankles, knees, hips, spine, and shoulder occurs when presented in the first-person perspective compared to the third-person perspective. However, the mode of presentation differed between the two conditions such that a head-mounted display was used to present the avatar in the first-person perspective, but a 3D television (3DTV) display was used to present the avatar in the third-person. Thus, it is unknown whether changes in joint excursions are driven by the visual display (head-mounted display versus 3DTV) or avatar perspective during virtual gameplay. Objective: This study aimed to determine the influence of avatar perspective on joint excursion in healthy individuals playing virtual dodgeball using a head-mounted display. Methods: Participants (n=29, 15 male, 14 female) performed full-body movements to intercept launched virtual targets presented in a game of virtual dodgeball using a head-mounted display. Two avatar perspectives were compared during each session of gameplay. A first-person perspective was created by placing the center of the displayed content at the bridge of the participant's nose, while a third-person perspective was created by placing the camera view at the participant's eye level but set 1 m behind the participant avatar. During gameplay, virtual dodgeballs were launched at a consistent velocity of 30 m/s to one of nine locations determined by a combination of three different intended impact heights and three different directions (left, center, or right) based on subject anthropometrics. Joint kinematics and angular excursions of the ankles, knees, hips, lumbar spine, elbows, and shoulders were assessed. Results: The change in joint excursions from initial posture to the interception of the virtual dodgeball were averaged across trials. Separate repeated-measures ANOVAs revealed greater excursions of the ankle (P=.010), knee (P=.001), hip (P=.0014), spine (P=.001), and shoulder (P=.001) joints while playing virtual dodgeball in the first versus third-person perspective. Aligning with the expectations, there was a significant effect of impact height on joint excursions. Conclusions: As clinicians develop treatment strategies in virtual reality to shape motion in orthopedic populations, it is important to be aware that changes in avatar perspective can significantly influence motor behavior. These data are important for the development of virtual reality assessment and treatment tools that are becoming increasingly practical for home and clinic-based rehabilitation. ",
doi="10.2196/18888",
url="http://games.jmir.org/2020/3/e18888/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32812885"
}


@Article{info:doi/10.2196/17289,
author="Haghighi Osgouei, Reza
and Soulsby, David
and Bello, Fernando",
title="Rehabilitation Exergames: Use of Motion Sensing and Machine Learning to Quantify Exercise Performance in Healthy Volunteers",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Aug",
day="18",
volume="7",
number="2",
pages="e17289",
keywords="rehabilitation exergames",
keywords="performance assessment",
keywords="similarity score",
keywords="motion sensing",
keywords="machine learning",
keywords="dynamic time warping",
keywords="hidden Markov model",
abstract="Background: Performing physiotherapy exercises in front of a physiotherapist yields qualitative assessment notes and immediate feedback. However, practicing the exercises at home lacks feedback on how well patients are performing the prescribed tasks. The absence of proper feedback might result in patients performing the exercises incorrectly, which could worsen their condition. We present an approach to generate performance scores to enable tracking the progress by both the patient at home and the physiotherapist in the clinic. Objective: This study aims to propose the use of 2 machine learning algorithms, dynamic time warping (DTW) and hidden Markov model (HMM), to quantitatively assess the patient's performance with respect to a reference. Methods: Movement data were recorded using a motion sensor (Kinect V2), capable of detecting 25 joints in the human skeleton model, and were compared with those of a reference. A total of 16 participants were recruited to perform 4 different exercises: shoulder abduction, hip abduction, lunge, and sit-to-stand exercises. Their performance was compared with that of a physiotherapist as a reference. Results: Both algorithms showed a similar trend in assessing participant performance. However, their sensitivity levels were different. Although DTW was more sensitive to small changes, HMM captured a general view of the performance, being less sensitive to the details. Conclusions: The chosen algorithms demonstrated their capacity to objectively assess the performance of physical therapy. HMM may be more suitable in the early stages of a physiotherapy program to capture and report general performance, whereas DTW could be used later to focus on the details. The scores enable the patient to monitor their daily performance. They can also be reported back to the physiotherapist to track and assess patient progress, provide feedback, and adjust the exercise program if needed. ",
doi="10.2196/17289",
url="http://rehab.jmir.org/2020/2/e17289/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32808932"
}


@Article{info:doi/10.2196/17799,
author="Hennessy, White Rebecca
and Rumble, Deanna
and Christian, Mike
and Brown, A. David
and Trost, Zina",
title="A Graded Exposure, Locomotion-Enabled Virtual Reality App During Walking and Reaching for Individuals With Chronic Low Back Pain: Cohort Gaming Design",
journal="JMIR Serious Games",
year="2020",
month="Aug",
day="10",
volume="8",
number="3",
pages="e17799",
keywords="virtual reality",
keywords="chronic low back pain",
keywords="walking",
keywords="rehabilitation",
keywords="virtual reality exposure therapy",
abstract="Background: Chronic low back pain (cLBP) can interfere with daily activities, and individuals with elevated pain-related fear (also known as kinesiophobia or the fear of injury due to movement) can develop worse long-term disability. Graded exposure (GEXP) protocols use successive participation in avoided activities to help individuals overcome fearful movement appraisals and encourage activity. We sought to develop a series of GEXP virtual reality (VR) walking and reaching scenarios to increase the exposure and engagement of people with high kinesiophobia and cLBP. Objective: This study aims to (1) determine GEXP content validity of the VR application and (2) determine the feasibility of individuals with cLBP performing locomotion-enabled physical activities. Methods: We recruited 13 individuals with cLBP and high pain-related fear to experience six VR modules, which provide progressive movement exposure over three sessions in a 1 week period. At session 1, participants ranked each module by likelihood to avoid and assigned an expected pain and concern for harming their back rating to each module. Participants provided a rating of perceived exertion (RPE) after experiencing each module. To test feasibility, we administered the system usability scale (SUS) and treatment evaluation inventory (TEI) following the final session. In addition, we measured pain and pain-related fear at baseline and follow-up. Results: The 12 participants who completed the study period assigned higher avoidance (P=.002), expected pain (P=.002), and expected concern (P=.002) for session 3 modules compared with session 1 modules. RPE significantly increased from session 1 (mean 14.8, SD 2.3) to session 3 (mean 16.8, SD 2.2; P=.009). The VR application showed positive feasibility for individuals with cLBP through acceptable SUS (mean 76.7, SD 13.0) and TEI (mean 32.5, SD 4.9) scores. Neither pain (P=.20) nor pain-related fear (P=.58) changed significantly across sessions. Conclusions: The GEXP VR modules provided progressive exposure to physical challenges, and participants found the VR application acceptable and usable as a potential treatment option. Furthermore, the lack of significant change for pain and pain-related fear reflects that participants were able to complete the modules safely. ",
doi="10.2196/17799",
url="http://games.jmir.org/2020/3/e17799/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32773381"
}


@Article{info:doi/10.2196/17972,
author="Xu, Wenge
and Liang, Hai-Ning
and He, Qiuyu
and Li, Xiang
and Yu, Kangyou
and Chen, Yuzheng",
title="Results and Guidelines From a Repeated-Measures Design Experiment Comparing Standing and Seated Full-Body Gesture-Based Immersive Virtual Reality Exergames: Within-Subjects Evaluation",
journal="JMIR Serious Games",
year="2020",
month="Jul",
day="27",
volume="8",
number="3",
pages="e17972",
keywords="exergames",
keywords="immersive virtual reality",
keywords="standing exergame",
keywords="seated exergame",
keywords="exercising",
abstract="Background: Although full-body seated exercises have been studied in a wide range of settings (ie, homes, hospitals, and daycare centers), they have rarely been converted to seated exergames. In addition, there is an increasing number of studies on immersive virtual reality (iVR) full-body gesture-based standing exergames, but the suitability and usefulness of seated exergames remain largely unexplored. Objective: This study aimed to evaluate the difference between playing a full-body gesture-based iVR standing exergame and seated exergame in terms of gameplay performance, intrinsic motivation, and motion sickness. Methods: A total of 52 participants completed the experiment. The order of the game mode (standing and sitting) was counterbalanced. Gameplay performance was evaluated by action or gesture completion time and the number of missed gestures. Exertion was measured by the average heart rate (HR) percentage (AvgHR\%), increased HR\%, calories burned, and the Borg 6-20 questionnaire. Intrinsic motivation was assessed with the Intrinsic Motivation Inventory (IMI), whereas motion sickness was assessed via the Motion Sickness Assessment Questionnaire (MSAQ). In addition, we measured the fear of falling using a 10-point Likert scale questionnaire. Results: Players missed more gestures in the seated exergame than in the standing exergame, but the overall miss rate was low (2.3/120, 1.9\%). The analysis yielded significantly higher AvgHR\%, increased HR\%, calories burned, and Borg 6-20 rating of perceived exertion values for the seated exergame (all P<.001). The seated exergame was rated significantly higher on peripheral sickness (P=.02) and sopite-related sickness (MSAQ) (P=.004) than the standing exergame. The score of the subscale ``value/usefulness'' from IMI was reported to be higher for the seated exergame than the standing exergame. There was no significant difference between the seated exergame and standing exergame in terms of intrinsic motivation (interest/enjoyment, P=.96; perceived competence, P=.26; pressure/tension, P=.42) and the fear of falling (P=.25). Conclusions: Seated iVR full-body gesture-based exergames can be valuable complements to standing exergames. Seated exergames have the potential to lead to higher exertion, provide higher value to players, and be more applicable in small spaces compared with standing exergames. However, gestures for seated exergames need to be designed carefully to minimize motion sickness, and more time should be given to users to perform gestures in seated exergames compared with standing exergames. ",
doi="10.2196/17972",
url="http://games.jmir.org/2020/3/e17972/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32716004"
}


@Article{info:doi/10.2196/19037,
author="Caserman, Polona
and Hoffmann, Katrin
and M{\"u}ller, Philipp
and Schaub, Marcel
and Stra{\ss}burg, Katharina
and Wiemeyer, Josef
and Bruder, Regina
and G{\"o}bel, Stefan",
title="Quality Criteria for Serious Games: Serious Part, Game Part, and Balance",
journal="JMIR Serious Games",
year="2020",
month="Jul",
day="24",
volume="8",
number="3",
pages="e19037",
keywords="serious games",
keywords="educational games",
keywords="games for health",
keywords="exergames",
keywords="quality criteria",
keywords="video games",
doi="10.2196/19037",
url="http://games.jmir.org/2020/3/e19037/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706669"
}


@Article{info:doi/10.2196/16841,
author="Zhao, Yinan
and Feng, Hui
and Wu, Xinyin
and Du, Yan
and Yang, Xiufen
and Hu, Mingyue
and Ning, Hongting
and Liao, Lulu
and Chen, Huijing
and Zhao, Yishan",
title="Effectiveness of Exergaming in Improving Cognitive and Physical Function in People With Mild Cognitive Impairment or Dementia: Systematic Review",
journal="JMIR Serious Games",
year="2020",
month="Jun",
day="30",
volume="8",
number="2",
pages="e16841",
keywords="mild cognitive impairment",
keywords="dementia",
keywords="exergaming",
keywords="physical",
keywords="cognitive",
abstract="Background: Individuals with mild cognitive impairment and dementia have impaired physical and cognitive functions, leading to a reduced quality of life compared with those without such impairment. Exergaming, which is defined as a combination of exercise and gaming, is an innovative, fun, and relatively safe way to exercise in a virtual reality or gaming environment. Therefore, exergaming may help people living with mild cognitive impairment or dementia to overcome obstacles that they may experience regarding regular exercise and activities. Objective: The aim of this systematic review was to review studies on exergaming interventions administered to elderly individuals with mild cognitive impairment and dementia, and to summarize the results related to physical and cognitive functions such as balance, gait, executive function, and episodic memory. Methods: We searched Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, PsycINFO, Amed, and Nursing Database for articles published from the inception of the respective databases to January 2019. We included all clinical trials of exergaming interventions in individuals with mild cognitive impairment and dementia for review. The risk of bias was independently evaluated by two reviewers using the Cochrane Collaboration and Risk of Bias in Non-randomized Studies of Interventions tools. Results: Ten studies involving 702 participants were included for review. There was consistent evidence from 7 studies with a low risk of bias showing statistically significant effects of exergaming on cognitive functioning in people with mild cognitive impairment and dementia. With respect to physical function, 3 of 5 full-scale studies found positive results, and the intensity of most games was classified as moderate. Conclusions: Overall, exergaming is an innovative tool for improving physical and cognitive function in people with mild cognitive impairment or dementia, although there is high heterogeneity among studies in terms of the duration, frequency, and gaming platform used. The quality of the included articles was moderate to high. More high-quality studies with more accurate outcome indicators are needed for further exploration and validation of the benefits of exergaming for this population. ",
doi="10.2196/16841",
url="http://games.jmir.org/2020/2/e16841/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32602841"
}


@Article{info:doi/10.2196/16354,
author="Radha, Mustafa
and den Boer, Niels
and Willemsen, C. Martijn
and Paardekooper, Thom
and IJsselsteijn, A. Wijnand
and Sartor, Francesco",
title="Assisting Home-Based Resistance Training for Normotensive and Prehypertensive Individuals Using Ambient Lighting and Sonification Feedback: Sensor-Based System Evaluation",
journal="JMIR Cardio",
year="2020",
month="Jun",
day="29",
volume="4",
number="1",
pages="e16354",
keywords="hypertension",
keywords="sonification",
keywords="respiratory guidance",
keywords="intrinsic motivation",
keywords="physical exertion",
abstract="Background: Physical exercise is an effective lifestyle intervention to improve blood pressure. Although aerobic sports can be performed anywhere, resistance exercises are traditionally performed at the gym; extending the latter to the home setting may promote an increase in the number of practitioners. Objective: This study aims to evaluate a sensor-based system that guides resistance exercises through ambient lighting and sonification (A/S) feedback in a home setting in 34 study participants who were normotensive and prehypertensive. Methods: Participants took part in a 1.5-hour exercise session in which they experienced the A/S feedback (ie, experimental condition) as well as a control condition (ie, no feedback) and a reference condition (ie, verbal feedback through a human remote coach). The system was evaluated for improving exercise form (range of motion, timing, and breathing patterns) as well as psychophysiological experience (perceived exertion, attentional focus, competence, and motivation). Results: A/S feedback was significantly better than the control for concentric (mean 2.48, SD 0.75 seconds; P<.001) and eccentric (mean 2.92, SD 1.05 seconds; P<.001) contraction times, concentric range of motion consistency (mean 15.64, SD 8.31 cm vs mean 17.94, SD 9.75 cm; P<.001), and perceived exertion (mean 3.37, SD 0.78 vs mean 3.64, SD 0.76; P<.001). However, A/S feedback did not outperform verbal feedback on any of these measures. The breathing technique was best in the control condition (ie, without any feedback). Participants did not show more positive changes in perceived competence with A/S feedback or verbal feedback. Conclusions: The system seemed to improve resistance exercise execution and perception in comparison with the control, but did not outperform a human tele-coach. Further research is warranted to improve the breathing technique. ",
doi="10.2196/16354",
url="https://cardio.jmir.org/2020/1/e16354",
url="http://www.ncbi.nlm.nih.gov/pubmed/32597789"
}


@Article{info:doi/10.2196/15635,
author="Pallavicini, Federica
and Pepe, Alessandro",
title="Virtual Reality Games and the Role of Body Involvement in Enhancing Positive Emotions and Decreasing Anxiety: Within-Subjects Pilot Study",
journal="JMIR Serious Games",
year="2020",
month="Jun",
day="17",
volume="8",
number="2",
pages="e15635",
keywords="virtual reality",
keywords="virtual reality gaming",
keywords="video games",
keywords="emotions",
keywords="positive emotions",
keywords="anxiety",
keywords="state anxiety",
abstract="Background: In the last few years, the introduction of immersive technologies, especially virtual reality, into the gaming market has dramatically altered the traditional concept of video games. Given the unique features of virtual reality in terms of interaction and its ability to completely immerse the individual into the game, this technology should increase the propensity for video games to effectively elicit positive emotions and decrease negative emotions and anxiety in the players. However, to date, few studies have investigated the ability of virtual reality games to induce positive emotions, and the possible effect of this new type of video game in diminishing negative emotions and anxiety has not yet been tested. Furthermore, given the critical role of body movement in individuals' well-being and in emotional responses to video games, it seems critical to investigate how body involvement can be exploited to modulate the psychological benefits of virtual reality games in terms of enhancing players' positive emotions and decreasing negative emotions and anxiety. Objective: This within-subjects study aimed to explore the ability of commercial virtual reality games to induce positive emotions and diminish negative emotions and state anxiety of the players, investigating the effects of the level of body involvement requested by the game (ie, high vs low). Methods: A total of 36 young adults played a low body-involvement (ie, Fruit Ninja VR) and a high body-involvement (ie, Audioshield) video game in virtual reality. The Visual Analogue Scale (VAS) and the State-Trait Anxiety Inventory, Form-Y1 (STAI-Y1) were used to assess positive and negative emotions and state anxiety. Results: Results of the generalized linear model (GLM) for repeated-measures multivariate analysis of variance (MANOVA) revealed a statistically significant increase in the intensity of happiness (P<.001) and surprise (P=.003) and, in parallel, a significant decrease in fear (P=.01) and sadness (P<.001) reported by the users. Regarding the ability to improve anxiety in the players, the results showed a significant decrease in perceived state anxiety after game play, assessed with both the STAI-Y1 (P=.003) and the VAS-anxiety (P=.002).  Finally, the results of the GLM MANOVA showed a greater efficacy of the high body-involvement game (ie, Audioshield) compared to the low body-involvement game (ie, Fruit Ninja VR), both for eliciting positive emotions (happiness, P<.001; and surprise, P=.01) and in reducing negative emotions (fear, P=.05; and sadness, P=.05) and state anxiety, as measured by the STAI-Y1 (P=.05). Conclusions: The two main principal findings of this study are as follows: (1) virtual reality video games appear to be effective tools to elicit positive emotions and to decrease negative emotions and state anxiety in individuals and (2) the level of body involvement of the virtual video game has an important effect in determining the ability of the game to improve positive emotions and decrease negative emotions and state anxiety of the players. ",
doi="10.2196/15635",
url="http://games.jmir.org/2020/2/e15635/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32554371"
}


@Article{info:doi/10.2196/16261,
author="O'Loughlin, Erin
and Sabiston, M. Catherine
and Kakinami, Lisa
and McGrath, J. Jennifer
and Consalvo, Mia
and O'Loughlin, L. Jennifer
and Barnett, A. Tracie",
title="Development and Validation of the Reasons to Exergame (RTEX) Scale in Young Adults: Exploratory Factors Analysis",
journal="JMIR Serious Games",
year="2020",
month="Jun",
day="15",
volume="8",
number="2",
pages="e16261",
keywords="exergaming",
keywords="youth",
keywords="young adults",
keywords="motivation",
keywords="scale",
abstract="Background: Exergaming is associated with positive health benefits; however, little is known about what motivates young people to exergame. Objective: This study aimed to develop a new Reasons to Exergame (RTEX) scale and describe its psychometric properties (Study 1) including test-retest reliability (Study 2). We also examined the test-retest reliability of self-report exergaming behavior measures (Study 2). Methods: We identified scale items in consultation with experts. In Study 1, we conducted an Exploratory Factor Analysis of RTEX and examined how the factors identified relate to exergaming frequency and intensity in a population-based sample of 272 young adults. In Study 2, we examined the test-retest reliability of RTEX factors and self-report measures of past-week exergaming frequency and intensity among 147 college students. Results: We identified four factors in RTEX: exergaming for fitness, exergaming for enjoyment, preferring exergaming over other gaming options, and choosing exergaming over competing interests (eg, sports). Test-retest reliability of RTEX factors (ICC 0.7-0.8) and self-report exergaming frequency (ICC 0.4-0.9) was adequate. Exergaming for fitness and enjoyment were positively associated with the frequency of exergaming with friends and family, and with exergaming intensity. Preferring exergaming over other gaming options and choosing exergaming over competing interests (eg, sports) were not related to exergaming behavior. Conclusions: RTEX is a psychometrically sound scale with four factors that measure reasons to exergame. Replication of these findings is needed in larger, more diverse samples. ",
doi="10.2196/16261",
url="http://games.jmir.org/2020/2/e16261/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32538792"
}


@Article{info:doi/10.2196/17112,
author="Wong, Man Rosa Sze
and Ho, Wing Frederick Ka
and Tung, Suen Keith Tsz
and Fu, King-Wa
and Ip, Patrick",
title="Effect of Pok{\'e}mon Go on Self-Harm Using Population-Based Interrupted Time-Series Analysis: Quasi-Experimental Study",
journal="JMIR Serious Games",
year="2020",
month="Jun",
day="12",
volume="8",
number="2",
pages="e17112",
keywords="Pok{\'e}mon Go",
keywords="self-harm",
keywords="mobile game",
keywords="injury",
keywords="mHealth interventions",
keywords="interrupted time-series analysis",
abstract="Background: Pok{\'e}mon Go is a very popular location-based augmented reality game with widespread influences over the world. An emerging body of research demonstrates that playing Pok{\'e}mon Go can lead to improvements in physical activity and psychosocial well-being; however, whether Pok{\'e}mon Go reduces self-harm incidence at the population-level is still questionable. Objective: This study aimed to quantify how the launch of Pok{\'e}mon Go in Hong Kong affected the incidence of self-harm using a quasi-experimental design. Methods: An interrupted time-series design with Poisson segmented regression adjusted for time and seasonality trends was used on data from 2012 to 2018 to detect any changes in the number of accident and emergency attendances due to self-harm, after Pok{\'e}mon Go was launched. The findings were validated using a baseline control period and using other intentional injuries and minor noninjuries as control outcomes. We also assessed intervention effects by age group. Results: From January 1, 2012 to July 31, 2018, there were 13,463 accident and emergency attendances due to self-harm in Hong Kong. During the period after launching Pok{\'e}mon Go, self-harm attendances dropped by 34\% (adjusted incidence rate ratio: 0.66, 95\% CI 0.61-0.73). When analyzed by age group, a reduction in self-harm incidence was only apparent in adults (18 to 24 years of age: adjusted incidence rate ratio: 0.78, P=.02; 25 to 39 years of age: adjusted incidence rate ratio: 0.75, P<.001; 40 years of age and older: adjusted incidence rate ratio: 0.57, P<.001). Conclusions: Self-harm incidence in the population, particularly in adults, showed a significant decline in the period after Pok{\'e}mon Go was launched. Augmented reality games such as Pok{\'e}mon Go show great promise as a tool to enhance psychosocial well-being and improve mental health. ",
doi="10.2196/17112",
url="http://games.jmir.org/2020/2/e17112/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32530429"
}


@Article{info:doi/10.2196/15339,
author="Fornasini, Silvia
and Dianti, Marco
and Bacchiega, Alessandro
and Forti, Stefano
and Conforti, Diego",
title="Using Geocaching to Promote Active Aging: Qualitative Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="11",
volume="22",
number="6",
pages="e15339",
keywords="geocaching",
keywords="active ageing",
keywords="elderly empowerment",
keywords="qualitative methods",
abstract="Background: Over the past few years, the development of technologies supporting active aging has been increasing. Among the activities that promote physical exercise by using technologies is geocaching---a treasure hunt of sorts in which participants use a receiver GPS to hide or find real or virtual objects. Although this activity is particularly suited to the promotion of healthy lifestyles in older people, geocaching remains to be unexplored in this area. Objective: This study aimed to investigate the effectiveness of activities combining geocaching and self-tracking technologies to promote active aging, evaluate the usability of technologies, and explore the ways in which technologies have been integrated in the organizational context under examination to determine the user experience of participants. Methods: A group of individuals aged 65 years and older (N=14) attending a senior center managed by a social cooperative was involved in the study. Some of them created the geocaching contents, and others, split into 2 teams, participated in the game. Each participant was given a pedometer bracelet and the geocaching app. The steps taken by individual participants along with the number of caches found by each group translated into team scores. Results: The main results of the study were as follows: (1) activities in favor of active aging that involve the use of new technologies can foster the participation of elderly people; in particular, adding gamification to self-tracking can be a valid strategy to promote physical exercise among the elderly; (2) for this to happen, involvement of older people firsthand is crucial, and there must be a focus on their active involvement and empowerment in every phase of the project; and (3) the mediation of conflicts and competition that arise from the gamification could only take place because of the strong support of the organization in the form of social workers. Conclusions: The results show that promoting active aging through technologies requires more effort than simply using these tools; it requires a wider process that involves an articulated organizational network with heterogeneous actors, technologies, and relations. ",
doi="10.2196/15339",
url="http://www.jmir.org/2020/6/e15339/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32525486"
}


@Article{info:doi/10.2196/17884,
author="Poli, Arianna
and Kelfve, Susanne
and Klompstra, Leonie
and Str{\"o}mberg, Anna
and Jaarsma, Tiny
and Motel-Klingebiel, Andreas",
title="Prediction of (Non)Participation of Older People in Digital Health Research: Exergame Intervention Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="5",
volume="22",
number="6",
pages="e17884",
keywords="technology",
keywords="exclusion",
keywords="recruitment",
keywords="self-selection",
keywords="nonparticipation",
abstract="Background: The use of digital technologies is increasing in health care. However, studies evaluating digital health technologies can be characterized by selective nonparticipation of older people, although older people represent one of the main user groups of health care. Objective: We examined whether and how participation in an exergame intervention study was associated with age, gender, and heart failure (HF) symptom severity. Methods: A subset of data from the HF-Wii study was used. The data came from patients with HF in institutional settings in Germany, Italy, the Netherlands, and Sweden. Selective nonparticipation was examined as resulting from two processes: (non)recruitment and self-selection. Baseline information on age, gender, and New York Heart Association Functional Classification of 1632 patients with HF were the predictor variables. These patients were screened for HF-Wii study participation. Reasons for nonparticipation were evaluated. Results: Of the 1632 screened patients, 71\% did not participate. The nonrecruitment rate was 21\%, and based on the eligible sample, the refusal rate was 61\%. Higher age was associated with lower probability of participation; it increased both the probabilities of not being recruited and declining to participate. More severe symptoms increased the likelihood of nonrecruitment. Gender had no effect. The most common reasons for nonrecruitment and self-selection were related to physical limitations and lack of time, respectively. Conclusions: Results indicate that selective nonparticipation takes place in digital health research and that it is associated with age and symptom severity. Gender effects cannot be proven. Such systematic selection can lead to biased research results that inappropriately inform research, policy, and practice. Trial Registration: ClinicalTrial.gov NCT01785121, https://clinicaltrials.gov/ct2/show/NCT01785121 ",
doi="10.2196/17884",
url="http://www.jmir.org/2020/6/e17884/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32501275"
}


@Article{info:doi/10.2196/16000,
author="Yu, Chin-Wen
and Rau, Patrick Pei-Luen
and Liu, Xueqian",
title="Development and Preliminary Usability Evaluation of a Somatosensory Square Dance System for Older Chinese Persons: Mixed Methods Study",
journal="JMIR Serious Games",
year="2020",
month="May",
day="28",
volume="8",
number="2",
pages="e16000",
keywords="older persons",
keywords="chinese square dance",
keywords="somatosensory games",
keywords="somatosensory square dance system",
keywords="physical exercise",
abstract="Background: Chinese square dancing, known as guangchang wu in Chinese, is a well-known public fitness activity that provides an entertaining way for older Chinese women to improve their flexibility, lower extremity strength, overall coordination, and balance. However, injuries, noise conflicts, and lack of space are challenging aspects of this activity. Somatosensory games (SG) are an increasingly popular physical fitness approach to enhance the selective attention of older persons with indoor engagement and exercises. Objective: The objectives of this study were to develop a newly designed somatosensory square dance system for older Chinese people and to evaluate its usability. Methods: This is a mixed methods study. The newly designed somatosensory square dance system is a somatic training tool that provides adequate Chinese square dance fitness training based on Laban Movement Analysis (LMA) and design guidelines established in a previous stage. The usability evaluation involved a questionnaire and interviews. Twelve participants were interviewed before and after experiencing the 15-minute dancing and learning process within the program. In addition, participants scored their experience satisfaction in psychological, physiological, and relaxation sections on a scale of 1 to 5 using a questionnaire. Qualitative content analysis and quantitative analysis of the satisfaction scores supported understanding of usability problems. Results: Based on the interview results, 6/12 (50\%) of the participants thought the system could help them correct their dancing movements indoors without being affected by poor outdoor weather. Among the participants, 3/12 (25\%) indicated that this indoor system could enable them to enjoy fitness activities in a private space. Moreover, 3/12 participants (25\%) stated that this system could promote family relationships by providing easy dancing movements. All participants were highly satisfied with the relaxation aspect of the system (4.45/5). The participants were all psychologically satisfied and interested in the novel features of the system, with an average score of 4.16/5. Physiologically, participants affirmed that the system could help them maintain good health (4.91/5). Conclusions: The results of this study suggest that the somatosensory square dance system can be used as an indoor fitness tool to improve older Chinese square dancers' health conditions with reasonable dance training. Noise and space conflicts can be addressed. The Laban Elated Square Dance system, which was modified by therapists based on LMA and square dance design guidelines, was highly approved by dancers because it decreased the possibility of injuries, falls, and joint damage by considering the physical and psychological difficulties of older persons. Different features will be considered in the next stage, such as greater selection of exercises and difficulty level settings. Users' social needs will also be explored in subsequent stages. ",
doi="10.2196/16000",
url="http://games.jmir.org/2020/2/e16000/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32463376"
}


@Article{info:doi/10.2196/13190,
author="Flogie, Andrej
and Aber{\vs}ek, Boris
and Kordigel Aber{\vs}ek, Metka
and Sik Lanyi, Cecilia
and Pesek, Igor",
title="Development and Evaluation of Intelligent Serious Games for Children With Learning Difficulties: Observational Study",
journal="JMIR Serious Games",
year="2020",
month="Apr",
day="16",
volume="8",
number="2",
pages="e13190",
keywords="serious games, experimental",
keywords="social skills",
keywords="cognitive competence",
keywords="intellectual disability",
keywords="learning disabilities",
abstract="Background: Positive results can be obtained through game-based learning, but children with physical disabilities have fewer opportunities to participate in enjoyable physical activity. Because intelligent serious games can provide personalized learning opportunities, motivate the learner, teach 21st-century skills, and provide an environment for authentic and relevant assessment, they may be used to help children and adolescents with different kinds of learning disabilities to develop social and cognitive competences. Objective: The aim of the study was to produce and evaluate a suite of intelligent serious games based on accessible learning objectives for improving key skills, personal development, and work sustainability among children with learning difficulties. Methods: We conducted this research between 2016 and 2018, with pupils aged 11 to 12 years with learning disabilities who were integrated into the mainstream educational system. We used a 4-step methodology to develop learner creativity and social competences: (1) needs analysis, (2) development of learning content, (3) development of intelligent serious games, and (4) a usability evaluation focusing on the research questions and hypothesis. This was based on an initial teachers' evaluation, using a survey, of students using 2 of the games, where the main goal was to determine user motivation and initiative and to improve the games and the evaluation process. The initial evaluation was followed by a pilot evaluation, which was performed for all proposed games, in all partner countries. Results: In an initial evaluation with 51 participants from Slovenia consisting of a pretest, followed by intelligent serious game intervention and concluding with a posttest, we observed statistically significant improvement in social and cognitive competences measured by tests. Based on these findings and observations, we improved the games and evaluation process. In the pilot test, conducted in all participating countries on a sample of 93 participants, the mean score on the teachers' observation form on the pretest (before students began using the intelligent serious games) was 3.9. In the posttest, after students had used intelligent serious games, the mean score was 4.1. Conclusions: We focused on developing and evaluating intelligent serious games for persons with learning disabilities, particularly for students with disabilities who are integrated into the mainstream educational system. Such games provide an opportunity for personalized learning and should be tailored to ensure that every learner can achieve the highest standard possible. However, we recommend that the games be adapted based on the students' needs and capabilities and a specially developed curriculum. The collected feedback showed that (1) children with learning disabilities need appropriately developed intelligent serious games, and (2) intelligent serious games, and the pertaining didactic methodology, should be based on an interoperable curriculum, so that teachers and trainers can use them. The student survey confirmed improvements in all aspects. ",
doi="10.2196/13190",
url="https://games.jmir.org/2020/2/e13190",
url="http://www.ncbi.nlm.nih.gov/pubmed/32297864"
}


@Article{info:doi/10.2196/14549,
author="Bossen, Dani{\"e}l
and Broekema, Aline
and Visser, Bart
and Brons, Annette
and Timmerman, Annieck
and van Etten-Jamaludin, Faridi
and Braam, Katja
and Engelbert, Raoul",
title="Effectiveness of Serious Games to Increase Physical Activity in Children With a Chronic Disease: Systematic Review With Meta-Analysis",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="1",
volume="22",
number="4",
pages="e14549",
keywords="video games",
keywords="computer games",
keywords="pediatrics",
keywords="chronic disease",
keywords="exercise therapy",
keywords="health education",
abstract="Background: Physical activity (PA) is important for children with a chronic disease. Serious games may be useful to promote PA levels among these children. Objective: The primary purpose of this systematic review was to evaluate the effectiveness of serious games on PA levels in children with a chronic disease. Methods: PubMed, EMBASE, PsycINFO, ERIC, Cochrane Library, and CINAHL were systematically searched for articles published from January 1990 to May 2018. Both randomized controlled trials and controlled clinical trials were included to examine the effects of serious games on PA levels in children with a chronic disease. Two investigators independently assessed the intervention, methods, and methodological quality in all articles using the Cochrane risk of bias tool. Both qualitative and quantitative analyses were performed. Results: This systematic review included 9 randomized controlled trials (886 participants). In 2 of the studies, significant between-group differences in PA levels in favor of the intervention group were reported. The meta-analysis on PA levels showed a nonsignificant effect on moderate to vigorous PA (measured in minutes per day) between the intervention and control groups (standardized mean difference 0.30, 95\% CI --0.15 to 0.75, P=.19). The analysis of body composition resulted in significantly greater reductions in BMI in the intervention group (standardized mean difference --0.24, 95\% CI --0.45 to 0.04, P=.02). Conclusions: This review does not support the hypothesis that serious games improve PA levels in children with a chronic disease. The meta-analysis on body composition showed positive intervention effects with significantly greater reductions in BMI in favor of the intervention group. A high percentage of nonuse was identified in the study of serious games, and little attention was paid to behavior change theories and specific theoretical approaches to enhance PA in serious games. Small sample sizes, large variability between intervention designs, and limited details about the interventions were the main limitations. Future research should determine which strategies enhance the effectiveness of serious games, possibly by incorporating behavior change techniques. ",
doi="10.2196/14549",
url="https://www.jmir.org/2020/4/e14549",
url="http://www.ncbi.nlm.nih.gov/pubmed/32234697"
}


@Article{info:doi/10.2196/14182,
author="Brauner, Philipp
and Ziefle, Martina",
title="Serious Motion-Based Exercise Games for Older Adults: Evaluation of Usability, Performance, and Pain Mitigation",
journal="JMIR Serious Games",
year="2020",
month="Apr",
day="1",
volume="8",
number="2",
pages="e14182",
keywords="serious games",
keywords="exercise game",
keywords="health care",
keywords="pain",
keywords="ambient assisted living",
keywords="technology acceptance",
abstract="Background: Many societies are facing demographic changes that challenge the viability of health and welfare systems. Serious games for health care and ambient assisted living (AAL) offer health benefits and support for older adults and may mitigate some of the negative effects of the demographic shift. Objective: This study aimed to examine the acceptance of serious games to promote physical health in AAL environments. Since AAL environments are designed specifically to support independent living in older adults, we studied the relationship among age and user diversity, performance in the game, and overall usability and acceptance evaluation. Methods: We developed a motion-based serious exercise game for prototypical AAL environments. In two evaluations, outside (n=71) and within (n=64) the AAL environment, we investigated the influence of age, gender, self-efficacy in interacting with technology, need for achievement on performance, effect of the game, usability evaluation of the game, and overall acceptance. Results: Both games were evaluated as easy to use and fun to play. Both game interventions had a strong pain-mitigating effect in older adults (game 1: ?55\%, P=.002; game 2: ?66\%, P=.01). Conclusions: Serious exercise games outside and inside AAL environments can contribute to individuals' health and well-being and to the stability of health care systems. ",
doi="10.2196/14182",
url="https://games.jmir.org/2020/2/e14182",
url="http://www.ncbi.nlm.nih.gov/pubmed/32234703"
}


@Article{info:doi/10.2196/12388,
author="Khalili-Mahani, Najmeh
and Assadi, Atousa
and Li, Kate
and Mirgholami, Mahsa
and Rivard, Marie-Eve
and Benali, Habib
and Sawchuk, Kim
and De Schutter, Bob",
title="Reflective and Reflexive Stress Responses of Older Adults to Three Gaming Experiences In Relation to Their Cognitive Abilities: Mixed Methods Crossover Study",
journal="JMIR Ment Health",
year="2020",
month="Mar",
day="26",
volume="7",
number="3",
pages="e12388",
keywords="silver gaming",
keywords="serious games",
keywords="stress",
keywords="cognitive training",
keywords="brain training games",
keywords="exercise games",
keywords="ICT",
abstract="Background: The gamification of digital health provisions for older adults (eg, for rehabilitation) is a growing trend; however, many older adults are not familiar with digital games. This lack of experience could cause stress and thus impede participants' motivations to adopt these technologies. Objective: This crossover longitudinal multifactorial study aimed to examine the interactions between game difficulty, appraisal, cognitive ability, and physiological and cognitive responses that indicate game stress using the Affective Game Planning for Health Applications framework. Methods: A total of 18 volunteers (mean age 71 years, SD 4.5; 12 women) completed a three-session study to evaluate different genres of games in increasing order of difficulty (S1-BrainGame, S2-CarRace, and S3-Exergame). Each session included an identical sequence of activities (t1-Baseline, t2-Picture encode, t3-Play, t4-Stroop test, t5-Play, and t6-Picture recall), a repeated sampling of salivary cortisol, and time-tagged ambulatory data from a wrist-worn device. Generalized estimating equations were used to investigate the effect of session{\texttimes}activity or session{\texttimes}activity{\texttimes}cognitive ability on physiology and cognitive performance. Scores derived from the Montreal Cognitive Assessment (MoCA) test were used to define cognitive ability (MoCA-high: MoCA>27, n=11/18). Kruskal-Wallis tests were used to test session or session{\texttimes}group effects on the scores of the postgame appraisal questionnaire. Results: Session{\texttimes}activity effects were significant on all ambulatory measures ($\chi$210>20; P<.001) other than cortisol (P=.37). Compared with S1 and S2, S3 was associated with approximately 10 bpm higher heart rate (P<.001) and approximately 5 muS higher electrodermal activity (P<.001), which were both independent of the movement caused by the exergame. Compared with S1, we measured a moderate but statistically significant drop in the rate of hits in immediate recall and rate of delayed recall in S3. The low-MoCA group did not differ from the high-MoCA group in general characteristics (age, general self-efficacy, and perceived stress) but was more likely to agree with statements such as digital games are too hard to learn. In addition, the low-MoCA group was more likely to dislike the gaming experience and find it useless, uninteresting, and visually more intense ($\chi$21>4; P<.04). Group differences in ambulatory signals did not reach statistical significance; however, the rate of cortisol decline with respect to the baseline was significantly larger in the low-MoCA group. Conclusions: Our results show that the experience of playing digital games was not stressful for our participants. Comparatively, the neurophysiological effects of exergame were more pronounced in the low-MoCA group, suggesting greater potential of this genre of games for cognitive and physical stimulation by gamified interventions; however, the need for enjoyment of this type of challenging game must be addressed. ",
doi="10.2196/12388",
url="http://mental.jmir.org/2020/3/e12388/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32213474"
}


@Article{info:doi/10.2196/15428,
author="Almeida, Jo{\~a}o
and Nunes, Francisco",
title="The Practical Work of Ensuring the Effective Use of Serious Games in a Rehabilitation Clinic: Qualitative Study",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Feb",
day="28",
volume="7",
number="1",
pages="e15428",
keywords="serious games",
keywords="exergames",
keywords="physiotherapy rehabilitation",
keywords="practical rehabilitation work",
keywords="qualitative research",
abstract="Background: Many rehabilitation clinics adopted serious games to support their physiotherapy sessions. Serious games can monitor and provide feedback on exercises and are expected to improve therapy and help professionals deal with more patients. However, there is little understanding of the impacts of serious games on the actual work of physiotherapists. Objective: This study aimed to understand the impact of an electromyography-based serious game on the practical work of physiotherapists. Methods: This study used observation sessions in an outpatient rehabilitation clinic that recently started using a serious game based on electromyography sensors. In total, 44 observation sessions were performed, involving 3 physiotherapists and 22 patients. Observation sessions were documented by audio recordings or fieldnotes and were analyzed for themes using thematic analysis. Results: The findings of this study showed that physiotherapists played an important role in enabling the serious game to work. Physiotherapists briefed patients, calibrated the system, prescribed exercises, and supported patients while they played the serious game, all of which amounted to relevant labor. Conclusions: The results of this work challenge the idea that serious games reduce the work of physiotherapists and call for an overall analysis of the different impacts a serious game can have. Adopting a serious game that creates more work can be entirely acceptable, provided the clinical outcomes or other advantages enabled by the serious game are strong; however, those impacts will have to be assessed on a case-by-case basis. Moreover, this work motivates the technology development community to better investigate physiotherapists and their context, offering implications for technology design. ",
doi="10.2196/15428",
url="http://rehab.jmir.org/2020/1/e15428/"
}


@Article{info:doi/10.2196/16031,
author="Lu, Shirong Amy
and Green, C. Melanie
and Thompson, Debbe",
title="Using Narrative Game Design to Increase Children's Physical Activity: Exploratory Thematic Analysis",
journal="JMIR Serious Games",
year="2019",
month="Nov",
day="21",
volume="7",
number="4",
pages="e16031",
keywords="narrative",
keywords="physical activity",
keywords="active game",
keywords="children",
keywords="thematic analysis",
abstract="Background: Physical activity is crucial for child obesity prevention and intervention. Narratives embedded in active games can increase children's physical activity. Objective: Little is known about the narrative characteristics that would motivate children to exercise. We attempted to fill the gaps in understanding regarding narrative design for active video games. Methods: In this exploratory study, four animated narratives of different genres were professionally generated. Children (N=41) between the ages of 8 and 12 years were interviewed to identify their preferences. Sessions were digitally recorded, transcribed, and analyzed using exploratory thematic analysis. Results: Findings revealed that the children rated the dystopian science fiction story as their favorite across all weight, race, and gender groups. The physical activity-friendly narrative strategies included virtuous characters, extraordinary character actions, interesting plots, super powers, and engaging cliffhangers. Alternatively, information not related to physical activity, difficult-to-follow plot lines, passive protagonists, and repetitive narrative tropes were less appealing for physical activity. Conclusions: This research provides preliminary evidence that narratives have characteristics that may increase child physical activity when playing active games. Future empirical studies should verify and test these design principles. ",
doi="10.2196/16031",
url="http://games.jmir.org/2019/4/e16031/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31750833"
}


@Article{info:doi/10.2196/13833,
author="Faric, Nu{\vs}a
and Potts, W. Henry W.
and Hon, Adrian
and Smith, Lee
and Newby, Katie
and Steptoe, Andrew
and Fisher, Abi",
title="What Players of Virtual Reality Exercise Games Want: Thematic Analysis of Web-Based Reviews",
journal="J Med Internet Res",
year="2019",
month="Sep",
day="16",
volume="21",
number="9",
pages="e13833",
keywords="virtual reality",
keywords="exercise",
keywords="video games",
keywords="sedentary lifestyle",
keywords="weight loss",
keywords="behavior",
keywords="obesity",
keywords="sports",
abstract="Background: Physical activity (PA) is associated with a variety of physical and psychosocial health benefits, but levels of moderate-to-vigorous intensity PA remain low worldwide. Virtual reality (VR) gaming systems involving movement (VR exergames) could be used to engage people in more PA. Objective: This study aimed to synthesize public reviews of popular VR exergames to identify common features that players liked or disliked to inform future VR exergame design. Methods: We conducted a thematic analysis of 498 reviews of the 29 most popular exergames sold in the top 3 VR marketplaces: Steam (Valve Corporation), Viveport (Valve Corporation), and Oculus (Oculus VR). We categorized reviews as positive and negative as they appeared in the marketplaces and identified the most common themes using an inductive thematic analysis. Results: The reviews were often mixed, reporting a wide variety of expectations, preferences, and gaming experiences. Players preferred highly realistic games (eg, closely simulated real-world sport), games that were intuitive (in terms of body movement and controls), and games that provided gradual increases in skill acquisition. Players reported feeling that they reached a high level of exertion when playing and that the immersion distracted them from the intensity of the exercise. Some preferred features included music and social aspects of the games, with multiplayer options to include friends or receive help from experienced players. There were 3 main themes in negative reviews. The first concerned bugs that rendered games frustrating. Second, the quality of graphics had a particularly strong impact on perceived enjoyment. Finally, reviewers disliked when games had overly complex controls and display functions that evoked motion sickness. Conclusions: Exergames prove to be a stimulating avenue for players to engage in PA and distract themselves from the negative perceptions of performing exercise. The common negative aspects of VR exergames should be addressed for increased uptake and continued engagement. ",
doi="10.2196/13833",
url="https://www.jmir.org/2019/9/e13833/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31538951"
}


@Article{info:doi/10.2196/12324,
author="Feodoroff, Boris
and Konstantinidis, Ippokratis
and Frob{\"o}se, Ingo",
title="Effects of Full Body Exergaming in Virtual Reality on Cardiovascular and Muscular Parameters: Cross-Sectional Experiment",
journal="JMIR Serious Games",
year="2019",
month="Aug",
day="28",
volume="7",
number="3",
pages="e12324",
keywords="exergaming",
keywords="gamification",
keywords="Immersive virtual reality",
keywords="exercise",
keywords="cybersickness",
keywords="flight simulation",
abstract="Background: In recent years, many studies have associated sedentary behavior in front of screens with health problems in infants, children, and adolescents. Yet options for exergaming---playing video games that require rigorous physical exercise---seem to fall short of the physical activity levels recommended by the World Health Organization. Objective: The purpose of this study was to investigate the effect of a fully immersive virtual reality (VR)-based training system on cardiovascular and muscular parameters of young adults. Methods: A cross-sectional experiment design was used to analyze muscle activity (surface electromyography), heart rate, perceived exertion (RPE), cybersickness symptoms, perceived workload, and physical activity enjoyment (PACES) in 33 participants performing two 5-minute flights on a new training device. Results: Participants' performance of the planking position required to play the game resulted in moderate aerobic intensity (108 [SD 18.69] bpm). Due to the mainly isometric contraction of the dorsal muscle chain (with a mean activation between 20.6\% [SD 10.57] and 26.7\% [SD 17.39] maximum voluntary isometric contraction), participants described the exercise as a moderate to vigorous activity (RPE 14.6 [SD 1.82]). The majority reported that they enjoyed the exercise (PACES 3.74 [SD 0.16]). However, six participants had to drop out because of cybersickness symptoms and two because of muscle pain due to prior injuries. Conclusions: Our findings suggest that fully immersive VR training systems can contribute to muscle-strengthening activities for healthy users. However, the dropout rate highlights the need for technological improvements in both software and hardware. In prevention and therapy, movement quality is a fundamental part of providing effective resistance training that benefits health. Exergaming on a regular basis has the potential to develop strong muscles and a healthy back. It is essential that future VR-based training systems take into account the recommendations of sport and exercise science. ",
doi="10.2196/12324",
url="http://games.jmir.org/2019/3/e12324/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31464194"
}


@Article{info:doi/10.2196/13643,
author="Hall, Cougar
and Hoj, H. Taylor
and Julian, Clark
and Wright, Geoff
and Chaney, A. Robert
and Crookston, Benjamin
and West, Joshua",
title="Pedal-Assist Mountain Bikes: A Pilot Study Comparison of the Exercise Response, Perceptions, and Beliefs of Experienced Mountain Bikers",
journal="JMIR Form Res",
year="2019",
month="Aug",
day="13",
volume="3",
number="3",
pages="e13643",
keywords="public health",
keywords="physical activity",
keywords="heart rate",
abstract="Background: Mountain biking is an aerobic physical activity that has experienced rapid growth. The emergence of the electric pedal-assist mountain bike (eMTB), while not without its critics, presents the potential for an even larger segment of the population to enjoy the health benefits of mountain biking. Although the research focused on the use of e-bikes generally is growing, there is limited research specifically targeting eMTB use. Research is needed exploring the potential exercise response of riding an eMTB, together with the beliefs and perceptions of mountain bikers who have and have not experienced eMTB riding. Objective: This study aimed to compare conventional mountain bike and eMTB use. This was done by investigating 2 questions: (1) What proportion of exercise response is retained for an experienced mountain biker while using an eMTB when compared with a conventional mountain bike? and (2) What are the perceptions and beliefs of experienced mountain bikers toward eMTBs both before and after riding an eMTB? Methods: A convergent mixed methods data collection approach was used in the study. Participants completed both a pre- and postride questionnaire, and data regarding heart rate were collected. Heart rates from each ride were compared against each other. Results: The average heart rate during eMTB use was 94\% (31/33) of the average heart rate during conventional mountain bike use. Therefore, eMTB use in this study achieved a majority of the exercise response and exceeded established biometric thresholds for cardiovascular fitness. Paired t test statistics were calculated to compare beliefs of conventional mountain bikes and eMTBs and to compare mean heart rate and speed between conventional mountain bike and eMTB use on the study loop. Participants overwhelmingly perceived the potential impact of eMTB use to be positive on both pre- and post-eMTB ride questionnaires. Conclusions: Despite the measured benefit, participants' perceived exertion while riding the eMTB was low. ",
doi="10.2196/13643",
url="http://formative.jmir.org/2019/3/e13643/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31411139"
}


@Article{info:doi/10.2196/13575,
author="Wu, Shanshan
and Jo, Eun-Ah
and Ji, Hongqing
and Kim, Kyung-Hee
and Park, Jung-Jun
and Kim, Hyun Bo
and Cho, Im Kyoung",
title="Exergaming Improves Executive Functions in Patients With Metabolic Syndrome: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2019",
month="Jul",
day="31",
volume="7",
number="3",
pages="e13575",
keywords="exercise",
keywords="executive functions",
keywords="event-related potential",
keywords="games",
keywords="metabolic syndrome",
abstract="Background: Recent studies indicate that participation in exercise-related games can improve executive function, attention processing, and visuospatial skills. Objective: The aim of this study was to investigate whether exercise via exergaming (EXG) can improve executive function in patients with metabolic syndrome (MetS). Methods: A total of 22 MetS patients were recruited and randomly assigned to an EXG group or a treadmill exercise (TE) group. The reaction time (RT) and electrophysiological signals from the frontal (Fz), central (Cz), and parietal (Pz) cortices were collected during a Stroop task after 12 weeks of exercise. Results: During the Stroop congruence (facilitation) judgment task, both the EXG and TE groups showed significantly faster RT after 12 weeks of exercise training. For N200 amplitude, the EXG group demonstrated significantly increased electrophysiological signals from the Fz and Cz cortices. These changes were significantly larger in the EXG group than in the TE group. Separately, for the P300 amplitude, the EXG groups presented significantly increased electrophysiological signals from the Fz, Cz, and Pz cortices, whereas the TE group showed significantly increased electrophysiological signals from the Cz and Pz cortices only. During the Stroop incongruence (interference) judgment task, both the EXG and TE groups showed significantly faster RT. For P300 amplitude, the EXG group had significantly increased electrophysiological signals from the Fz and Cz cortices only, whereas the TE group had significantly increased electrophysiological signals from the Fz, Cz, and Pz cortices. Conclusions: EXG improves executive function in patients with MetS as much as normal aerobic exercise does. In particular, a unique benefit of EXG beyond increased aerobic capacity is the improved selective attention among cognitive functions. Thus, EXG could be recommended to someone who needs to improve their brain responses of concentration and judgment as well as physical fitness. Trial Registration: ClinicalTrials.gov?NCT04015583;?https://clinicaltrials.gov/ct2/show/NCT04015583 ",
doi="10.2196/13575",
url="https://games.jmir.org/2019/3/e13575/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31368441"
}


@Article{info:doi/10.2196/13335,
author="O'Loughlin, Kathleen Erin
and Barnett, A. Tracie
and McGrath, J. Jennifer
and Consalvo, Mia
and Kakinami, Lisa",
title="Factors Associated with Sustained Exergaming: Longitudinal Investigation",
journal="JMIR Serious Games",
year="2019",
month="Jul",
day="31",
volume="7",
number="3",
pages="e13335",
keywords="video games",
keywords="physical activity",
keywords="adolescents",
abstract="Background: Exergaming is technology-driven physical activity (PA) which, unlike traditional video game play, requires that participants be physically active to play the game. Exergaming may have potential to increase PA and decrease sedentary behavior in youth, but little is known about sustained exergaming. Objective: The objectives of this study were to describe the frequency, correlates, and predictors of sustained exergaming. Methods: Data were available in AdoQuest (2005-11), a longitudinal investigation of 1843 grade 5 students in Montr{\'e}al, Canada. This analysis used data from grade 9 (2008-09) and 11 (2010-11). Participants at Time 1 (T1; mean age 14 years, SD 0.8 ) who reported past-week exergaming (n=186, 19.1\% of AdoQuest sample) completed mailed self-report questionnaires at Time 2 (T2; mean age 16 years, SD 0.8). Independent sociodemographic, psychological, and behavioral correlates (from T2)/predictors (from T1 or earlier) were identified using multivariable logistic regression. Results: Of 186 exergamers at T1, 81 (44\%) reported exergaming at T2. Being female and having higher introjected regulation (ie, a type of PA motivation indicative of internalizing PA as a behavior) were independent correlates. None of the predictors investigated were associated with sustained exergaming. Conclusions: Almost half of grade 9 exergamers sustained exergaming for 2 years. Exergaming may be a viable approach to help adolescents engage in and sustain PA during adolescence. Sex and PA motivation may be important in the sustainability of exergaming. ",
doi="10.2196/13335",
url="https://games.jmir.org/2019/3/e13335/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31368440"
}


@Article{info:doi/10.2196/13962,
author="Santos, Oliveira Luciano Henrique De
and Okamoto, Kazuya
and Funghetto, Schwerz Silvana
and Cavalli, Sch{\"u}ler Adriana
and Hiragi, Shusuke
and Yamamoto, Goshiro
and Sugiyama, Osamu
and Castanho, Denise Carla
and Aoyama, Tomoki
and Kuroda, Tomohiro",
title="Effects of Social Interaction Mechanics in Pervasive Games on the Physical Activity Levels of Older Adults: Quasi-Experimental Study",
journal="JMIR Serious Games",
year="2019",
month="Jul",
day="22",
volume="7",
number="3",
pages="e13962",
keywords="aged",
keywords="physical activity",
keywords="pervasive games",
keywords="social interaction",
abstract="Background: The novel genre of pervasive games, which aim to create more fun and engaging experiences by promoting deeper immersion, could be a powerful strategy to stimulate physical activity among older adults. To use these games more effectively, it is necessary to understand how different design elements affect player behavior. Objective: The aim was to vary a specific design element of pervasive games for older adults, namely social interaction, to test the effect on levels of physical activity. Methods: Over 4 weeks, two variations of the same pervasive game were compared: social interaction for the test group and no social interaction for the control group. In both versions, players had to walk to physical locations and collect virtual cards, but the social interaction version allowed people to collaborate to obtain more cards. Weekly step counts were used to evaluate the effect on each group, and the number of places visited was used as an indicator of play activity. Results: A total of 32 participants were recruited (no social interaction=15, social interaction=17); 18 remained until the end of the study (no social interaction=7, social interaction=11). Step counts during the first week were used as the baseline (no social interaction: mean 17,099.4, SE 3906.5; social interaction: mean 17,981.9, SE 2171.1). For the following weeks, changes to individual baseline were as follows for no social interaction (absolute/proportional): 383.8 (SE 563.8)/1.1\% (SE 4.3\%), 435.9 (SE 574.5)/2.2\% (SE 4.6\%), and ?106.1 (SE 979.9)/?2.6\% (SE 8.1\%) for weeks 2, 3, and 4, respectively. For social interaction they were 3841.9 (SE 1425.4)/21.7\% (SE 5.1\%), 2270.6 (SE 947.1)/16.5\% (SE 4.4\%), and 2443.4 (SE 982.6)/17.9\% (SE 4.7\%) for weeks 2, 3, and 4, respectively. Analysis of group effect was significant (absolute change: $\eta$2=.19, P=.01; proportional change: $\eta$2=.27, P=.009). Correlation between the proportional change and the play activity was significant (r=.34, 95\% CI 0.08 to 0.56), whereas for absolute change it was not. Conclusions: Social interaction design elements of the pervasive game may have some positive effects on the promotion of physical activity, although other factors might also have influenced this effect. Trial Registration: Japan Medical Association Clinical Trial Registration Number JMA-IIA00314; https://dbcentre3.jmacct.med.or.jp/JMACTR/App/JMACTRS06/JMACTRS06.aspx?seqno=7274 (Archived by WebCite at http://www.webcitation.org/761a6MVAy) ",
doi="10.2196/13962",
url="http://games.jmir.org/2019/3/e13962/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31333202"
}


@Article{info:doi/10.2196/13051,
author="Joyner, Damon
and Wengreen, Heidi
and Aguilar, Sheryl
and Madden, Gregory",
title="Effects of the FIT Game on Physical Activity in Sixth Graders: A Pilot Reversal Design Intervention Study",
journal="JMIR Serious Games",
year="2019",
month="Jun",
day="18",
volume="7",
number="2",
pages="e13051",
keywords="children",
keywords="accelerometer",
keywords="step count",
abstract="Background: The FIT Game is a low-cost intervention that increases fruit and vegetable consumption in elementary school children. For this study, the FIT Game was adapted into an intervention designed to increase children's physical activity at school. Objective: We aimed to evaluate if the FIT Game could increase children's physical activity relative to their baseline levels. Methods: A total of 29 participants were recruited from a sixth-grade classroom. An ABAB reversal design was used. Participants wore an accelerometer while at school during pre/postintervention baseline (A) and intervention (B) phases. During the FIT Game intervention, daily physical activity goals encouraged the class to increase their median daily step count above the 60th percentile of the previous 10 days. When daily goals were met, game-based accomplishments were realized. Results: Children met their activity goals 80\% of the time during the intervention phases. Physical activity at school increased from a median of 3331 steps per day during the baseline to 4102 steps during the FIT Game phases (P<.001, Friedman test). Conclusions: Preliminary evidence showed that playing the FIT Game could positively influence children's physical activity at school. ",
doi="10.2196/13051",
url="http://games.jmir.org/2019/2/e13051/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31215508"
}


@Article{info:doi/10.2196/11960,
author="Faric, Nu{\vs}a
and Yorke, Eleanor
and Varnes, Laura
and Newby, Katie
and Potts, WW Henry
and Smith, Lee
and Hon, Adrian
and Steptoe, Andrew
and Fisher, Abigail",
title="Younger Adolescents' Perceptions of Physical Activity, Exergaming, and Virtual Reality: Qualitative Intervention Development Study",
journal="JMIR Serious Games",
year="2019",
month="Jun",
day="17",
volume="7",
number="2",
pages="e11960",
keywords="exercise",
keywords="obesity",
keywords="video games",
keywords="adolescent",
keywords="adolescence",
keywords="sports",
keywords="health",
keywords="leisure activities",
keywords="virtual reality",
abstract="Background: Novel strategies to promote physical activity (PA) in adolescence are required. The vEngage study aims to test whether a virtual reality (VR) exergaming intervention can engage younger adolescents (aged 13 to 15 years) with PA. Objective: This study aimed to gather adolescents' views of using VR to encourage PA and identify the key features they would like to see in a VR exergaming intervention via interviews. Methods: Participants were recruited through 2 schools in London, United Kingdom. Semistructured interviews were conducted with adolescents about their views on PA and what might work to increase PA, technology, knowledge and experience of VR, and desired features in a VR exergaming intervention. Data were analyzed using Framework Analysis. Results: A total of 31 participants aged between 13 and 15 years (58\% female, 62\% from nonwhite ethnicities) participated in this interview study. The vast majority had no awareness of government PA recommendations but felt they should be more thoroughly informed. All participants were positive about the use of VR in PA promotion. Rewards, increasing challenges, and a social or multiplayer aspect were identified by participants as crucial aspects to include in a VR exercise game. Barriers were related to cost of high-end systems. Being able to exercise at home was very appealing. VR exergaming was viewed as a way to overcome multiple perceived social and cultural barriers to PA, particularly for girls. Conclusions: Key elements that should be incorporated into a VR game for health intervention were identified and described. These also included the use of rewards, novelty and enjoyment in immersive game play, multiplayer options, and real-world elements, as well as continual updates and new challenge levels. The use of VR to promote PA in adolescents is promising, but some barriers were raised. ",
doi="10.2196/11960",
url="http://games.jmir.org/2019/2/e11960/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31210135"
}


@Article{info:doi/10.2196/10116,
author="Simmich, Joshua
and Deacon, J. Anthony
and Russell, G. Trevor",
title="Active Video Games for Rehabilitation in Respiratory Conditions: Systematic Review and Meta-Analysis",
journal="JMIR Serious Games",
year="2019",
month="Feb",
day="25",
volume="7",
number="1",
pages="e10116",
keywords="video games",
keywords="exercise",
keywords="physical activity",
keywords="COPD",
keywords="cystic fibrosis",
keywords="asthma",
abstract="Background: Exercise and physical activity are key components of treatment for chronic respiratory diseases. However, the level of physical activity and adherence to exercise programs are low in people with these diseases. Active video games (AVGs) may provide a more engaging alternative to traditional forms of exercise. Objective: This review examines the effectiveness of game-based interventions on physiological outcome measures, as well as adherence and enjoyment in subjects with chronic respiratory diseases. Methods: A systematic search of the literature was conducted, with full texts and abstracts included where they involved an AVG intervention for participants diagnosed with respiratory conditions. A narrative synthesis of included studies was performed. Additionally, meta-analysis comparing AVGs with traditional exercise was undertaken for 4 outcome measures: mean heart rate (HR) during exercise, peripheral blood oxygen saturation (SpO2) during exercise, dyspnea induced by the exercise, and enjoyment of the exercise. Results: A total of 13 full-text papers corresponding to 12 studies were included in the review. Interventions predominantly used games released for the Nintendo Wii (8 studies) and Microsoft Xbox Kinect (3 studies). There were 5 studies that examined the acute effects of a single session of AVGs and 7 studies that examined the long-term effects after multiple sessions of AVGs. Trials conducted over more than 1 session varied in duration between 3 and 12 weeks. In these, AVG interventions were associated with either similar or slightly greater improvements in outcomes such as exercise capacity when compared with a traditional exercise control, and they also generally demonstrated improvements over baseline or nonintervention comparators. There were a few studies of unsupervised AVG interventions, but the reported adherence was high and maintained throughout the intervention period. Additionally, AVGs were generally reported to be well liked and considered feasible by participants. For outcome measures measured during a single exercise session, there was no significant difference between an AVG and traditional exercise for HR (mean difference 1.44 beats per minute, 95\% CI --14.31 to 17.18), SpO2 (mean difference 1.12 percentage points, 95\% CI --1.91 to 4.16), and dyspnea (mean difference 0.43 Borg units, 95\% CI --0.79 to 1.66), but AVGs were significantly more enjoyable than traditional exercise (Hedges g standardized mean difference 1.36, 95\% CI 0.04-2.68). Conclusions: This review provides evidence that AVG interventions, undertaken for several weeks, can provide similar or greater improvements in exercise capacity and other outcomes as traditional exercise. Within a single session of cardiovascular exercise, an AVG can evoke similar physiological responses as traditional exercise modalities but is more enjoyable to subjects with chronic respiratory diseases. However, there is very limited evidence for adherence and effectiveness in long-term unsupervised trials, which should be the focus of future research. ",
doi="10.2196/10116",
url="http://games.jmir.org/2019/1/e10116/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30801256"
}


@Article{info:doi/10.2196/11444,
author="H{\"o}chsmann, Christoph
and Infanger, Denis
and Klenk, Christopher
and K{\"o}nigstein, Karsten
and Walz, P. Steffen
and Schmidt-Trucks{\"a}ss, Arno",
title="Effectiveness of a Behavior Change Technique--Based Smartphone Game to Improve Intrinsic Motivation and Physical Activity Adherence in Patients With Type 2 Diabetes: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2019",
month="Feb",
day="13",
volume="7",
number="1",
pages="e11444",
keywords="behavior change",
keywords="exercise adherence",
keywords="gamification",
keywords="intrinsic motivation",
keywords="mhealth",
keywords="mobile phone game",
keywords="physical activity",
keywords="type 2 diabetes",
abstract="Background: Regular physical activity (PA) is an essential component of a successful type 2 diabetes treatment. However, despite the manifest evidence for the numerous health benefits of regular PA, most patients with type 2 diabetes remain inactive, often due to low motivation and lack of PA enjoyment. A recent and promising approach to help overcome these PA barriers and motivate inactive individuals to change their PA behavior is PA-promoting smartphone games. While short-term results of these games are encouraging, the long-term success in effectively changing PA behavior has to date not been confirmed. It is possible that an insufficient incorporation of motivational elements or flaws in gameplay and storyline in these games affect the long-term motivation to play and thereby prevent sustained changes in PA behavior. We aimed to address these design challenges by developing a PA-promoting smartphone game that incorporates established behavior change techniques and specifically targets inactive type 2 diabetes patients. Objective: To investigate if a self-developed, behavior change technique-based smartphone game designed by an interdisciplinary team is able to motivate inactive individuals with type 2 diabetes for regular use and thereby increase their intrinsic PA motivation. Methods: Thirty-six inactive, overweight type 2 diabetes patients (45-70 years of age) were randomly assigned to either the intervention group or the control group (one-time lifestyle counseling). Participants were instructed to play the smartphone game or to implement the recommendations from the lifestyle counseling autonomously during the 24-week intervention period. Intrinsic PA motivation was assessed with an abridged 12-item version of the Intrinsic Motivation Inventory (IMI) before and after the intervention. In addition, adherence to the game-proposed PA recommendations during the intervention period was assessed in the intervention group via the phone-recorded game usage data. Results: Intrinsic PA motivation (IMI total score) increased significantly in the intervention group (+6.4 (SD 4.2; P<.001) points) while it decreased by 1.9 (SD 16.5; P=.623) points in the control group. The adjusted difference between both groups was 8.1 (95\% CI 0.9, 15.4; P=.029) points. The subscales ``interest/enjoyment'' (+2.0 (SD 1.9) points, P<.001) and ``perceived competence'' (+2.4 (SD 2.4) points, P<.001) likewise increased significantly in the intervention group while they did not change significantly in the control group. The usage data revealed that participants in the intervention group used the game for an average of 131.1 (SD 48.7) minutes of in-game walking and for an average of 15.3 (SD 24.6) minutes of strength training per week. We found a significant positive association between total in-game training (min) and change in IMI total score (beta=0.0028; 95\% CI 0.0007-0.0049; P=.01). Conclusions: In inactive individuals with type 2 diabetes, a novel smartphone game incorporating established motivational elements and personalized PA recommendations elicits significant increases in intrinsic PA motivation that are accompanied by de-facto improvements in PA adherence over 24 weeks. Trial Registration: ClinicalTrials.gov NCT02657018; https://clinicaltrials.gov/ct2/show/NCT02657018 ",
doi="10.2196/11444",
url="http://games.jmir.org/2019/1/e11444/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30758293"
}


@Article{info:doi/10.2196/10724,
author="Hino, Kimihiro
and Asami, Yasushi
and Lee, Su Jung",
title="Step Counts of Middle-Aged and Elderly Adults for 10 Months Before and After the Release of Pok{\'e}mon GO in Yokohama, Japan",
journal="J Med Internet Res",
year="2019",
month="Feb",
day="05",
volume="21",
number="2",
pages="e10724",
keywords="augmented reality",
keywords="location-based games",
keywords="mobile phone",
keywords="pedometer",
keywords="physical activity",
keywords="Pok{\'e}mon GO",
keywords="smartphone",
abstract="Background: Smartphones have been integrated into our society and are expected to serve as tools to improve health outcomes. In the summer of 2016, Pok{\'e}mon GO, a location-based augmented reality game for smartphones was released; it attracted attention from the perspective of health, especially with its potential to increase physical activity (PA). A few studies have compared objectively measured step counts before and after the release of the game; however, they were conducted over a short study period and evaluated only young people. Objective: The objective of this study was to confirm whether there was a difference in step counts between middle-aged and elderly players and nonplayers before and after the release of Pok{\'e}mon GO. Methods: A total of 46 players and 184 nonplayers aged ?40 years were matched for sex, age group, and PA level; they were respondents to a questionnaire randomly sent to citizens who were given free pedometers by Yokohama city. Their play status was identified through the questionnaire. To investigate the change in step counts before and after the release of Pok{\'e}mon GO according to play status, a 2-way repeated-measures analysis of variance was performed. Step counts 1 month before the release of the game were compared with those 8 months after the release. In addition, subgroup analyses according to sex, age group, PA level, and subjective health status were performed. Results: The mean ages of players and nonplayers were 56.5 (SD 9.9) years and 57.3 (SD 9.6) years, respectively, and the mean baseline step counts of players and nonplayers were 7641.8 (SD 2754.5) and 7903.3 (SD 2674.7), respectively. There was no significant difference in the age and baseline step counts according to a t test (2-tailed). In the analysis of all samples, the interaction between play status and time effect was significant for 3 of 8 months after release. In the subgroup analyses, the interaction was significant for 3 months in men, 7 months in the 55-64-year-old group, 2 months in workers, 4 months in the active group in PA level, and 2 months in participants with subjectively good health. The interaction was significant for only 1 month, at most, in other subgroups. Conclusions: The present study confirmed a difference in step counts between players and nonplayers before and after the release of Pok{\'e}mon GO. According to our analysis, step counts were higher until 7 months after the release. The player group maintained their step counts in winter, despite the decrease in step counts of nonplayers. In subgroup analyses, players were more likely to be men, aged <55 years, workers, active, and subjectively in good health. ",
doi="10.2196/10724",
url="https://www.jmir.org/2019/2/e10724/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30720438"
}


@Article{info:doi/10.2196/11326,
author="Malone, A. Laurie
and Thirumalai, Mohanraj
and Padalabalanarayanan, Sangeetha
and Neal, N. Whitney
and Bowman, Sean
and Mehta, Tapan",
title="Energy Expenditure and Enjoyment During Active Video Gaming Using an Adapted Wii Fit Balance Board in Adults with Physical Disabilities: Observational Study",
journal="JMIR Serious Games",
year="2019",
month="Feb",
day="01",
volume="7",
number="1",
pages="e11326",
keywords="exergaming",
keywords="video games",
keywords="exercise",
keywords="physical activity",
keywords="disability",
keywords="energy expenditure",
keywords="enjoyment",
abstract="Background: Individuals with physical disabilities have fewer opportunities to participate in enjoyable physical activity. One option for increasing physical activity is playing active video games (AVGs); however, many AVGs are inaccessible or offer limited play options. Objective: This study aimed to examine energy expenditure and enjoyment in adults with mobility impairment during AVG play using off-the-shelf (OTS) and adapted versions of the Wii Fit balance board (Nintendo). Methods: During visit 1, participants completed a functional assessment and the familiarization period. During visit 2, metabolic data were collected during a 20-minute baseline and four 10-minute bouts of Wii Fit Plus game play, with two bouts on each of the boards. During the resting period, participants completed the Physical Activity Enjoyment Scale (PACES). Statistical analyses were computed using SPSS software. Data were analyzed separately for individuals who were able to play while standing on both boards (StdStd); those who could not play while standing on the OTS board, but were able to play while standing on the adapted board (aStd); and those who could only play while sitting on the adapted board (aSit). Results: Data were collected for 58 participants (StdStd, n=17; aStd, n=10; aSit, n=31). The sample included 31 men and 27 women with a mean age of 41.21 (SD 12.70) years. Energy expenditure (metabolic equivalent [MET]) during game play was significantly greater than that during rest for all players. Only 17 participants (StdStd group) were able to play using the OTS board. During game play on the adapted board, the average MET values for the two game sets were 2.261 (SD 0.718) kcal/kg/hour and 2.233 (SD 0.751) kcal/kg/hour for the aSit group, 3.151 (SD 1.034) and 2.990 (SD 1.121) for the aStd group, and 2.732 (SD 0.655) and 2.777 (SD 0.803) for the StdStd group. For game play on the adapted board, self-reported ratings of perceived exertion on a 0-10 scale suggested greater exercise intensity levels, with median scores ranging from moderate (3) to very hard (7). The PACES scores indicated that all players enjoyed using the adapted board, with a median score of 4 on a 5-point scale. Conclusions: The adapted Wii Fit balance board provided an opportunity for individuals with mobility impairments, including wheelchair users, to engage in AVG. All participants were able to utilize the adapted controller and enjoyed the AVG activity. Although the average MET values achieved during AVG represented light-intensity exercise (<3 METs), 16\% of sitting participants and 41\% of standing participants achieved moderate-intensity exercise (3-6 METs) in at least one of the games. Factors not accounted for, which may have influenced the intensity of exercise, include game selection, limited familiarization period, and discomfort wearing the COSMED portable metabolic system for measurement of oxygen consumption. Accessible AVG controllers offer an innovative approach to overcome various barriers to participation in physical activity. The next steps include assessment of an AVG intervention using an adapted board gaming controller on health and fitness outcomes. Trial Registration: ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by Webcite at http://www.webcitation.org/75fc0mN39). ",
doi="10.2196/11326",
url="http://games.jmir.org/2019/1/e11326/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30707098"
}


@Article{info:doi/10.2196/10307,
author="Levac, Danielle
and Dumas, M. Helene
and Meleis, Waleed",
title="A Tablet-Based Interactive Movement Tool for Pediatric Rehabilitation: Development and Preliminary Usability Evaluation",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Nov",
day="26",
volume="5",
number="2",
pages="e10307",
keywords="equipment design",
keywords="rehabilitation",
keywords="pediatrics",
keywords="tablets",
keywords="software",
abstract="Background: Motivating interactive tools may increase adherence to repetitive practice for children with disabilities, but many virtual reality and active video gaming systems are too challenging for children with significant needs. Objective: The objective of this study was to develop and conduct a usability evaluation of the Fun, Interactive Therapy Board (FITBoard), a movement toy bridging digital and physical interactions for children with disabilities. Methods: The FITBoard is a tablet app involving games controlled by hand, head, or foot touch of configurable, wired surfaces. Usability evaluation involved a cognitive walkthrough and think-aloud processes. Participants verbalized aloud while completing a series of 26 task actions involved in selecting a game and configuring the FITBoard to achieve the therapeutic goal. Therapists then responded to questions about usability perceptions. Unsuccessful actions were categorized as goal or action failures. Qualitative content analysis supported understanding of usability problems. Results: Participants included 5 pediatric physical therapists and 2 occupational therapists from 2 clinical sites. Goal failure was experienced by all participants in 2 tasks, and action failure was experienced by all participants in 2 tasks. For 14 additional tasks, 1 or more patients experienced goal or action failure, with an overall failure rate of 69\% (18 of 26 tasks). Content analysis revealed 4 main categories: hardware usability, software usability, facilitators of therapy goals, and improvement suggestions. Conclusions: FITBoard hardware and software changes are needed to address goal and action failures to rectify identified usability issues. Results highlight potential FITBoard applications to address therapeutic goals and outline important practical considerations for product use by therapists. Subsequent research will evaluate therapist, parent, and child perspectives on FITBoard clinical utility when integrated within regular therapy interventions. ",
doi="10.2196/10307",
url="http://rehab.jmir.org/2018/2/e10307/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30478025"
}


@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/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518294"
}


@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"
}