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Older Adults' Physical Activity and Exergames: a Systematic Review

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Older Adults' Physical Activity and Exergames: a Systematic Review INTERNATIONAL JOURNAL OF HUMAN–COMPUTER INTERACTION 2019, VOL. 35, NO. 2, 140–167 https://doi.org/10.1080/10447318.2018.1441253 Older Adults’ Physical Activity and Exergames: A Systematic Review Dennis L. Kappen a, Pejman Mirza-Babaei a, and Lennart E. Nacke b aUXR Lab, University of Ontario Institute of Technology, Oshawa, Canada; bHCI Games Group, Games Institute, University of Waterloo, Waterloo, Canada ABSTRACT Exertion games, also referred to as exergames, have become popular because they combine physical activity (PA) with game mechanics, such as actions, challenges, and achievements. Exergames have been also used to encourage PA among older adults, as technological interventions to help achieve the latters’ health and wellness goals and as aids to rehabilitation. To the best of our knowledge, no systematic review of empirical studies on exergaming and older adults’ PA has been reported in the literature. Our review indicates that exergames make a measurable contribution to the improvement of health and wellness goals of older adults. Our systematic review identifies 9 categories and 19 themes of exergame applications in the domain of older adults’ PA. We aggregate these categories and themes into three broader exergaming clusters, of “training,”“rehabilitation,” and “wellness.” Additionally, we outline pathways for future empirical research into applying exergames as health and wellness inter- ventions for older adults through physical activities. 1. Introduction Marsiske, Sisco, Yam, & Mann, 2012), improvement in range of motion (ROM) (Bobeth, Schmehl, Kruijff, Given advances in technology and healthcare, it is estimated that Deutsch, & Tscheligi, 2012), and mental stimulation the number of US adults aged 65 and older will more than (Ijsselsteijn, Nap, De Kort, & Poels, 2007; Marston, 2013; double to 71 million by 2030 (Centers for Disease Control and Siriaraya, Ang, & Bobrowicz, 2012), to feelings of social Prevention, 2012). Technological interventions are helping older connectedness in their peer groups (Pedell, Vetere, Kulik, adults improve their general health and wellness, as well as Ozanne, & Gruner, 2010;Waycottetal.,2013). providing them with effective rehabilitation mechanisms. Older While older adults participate in aerobic activity classes, adults face increasing cognitive and physical challenges in their dancing, yard work or gardening, swimming and water lives, and exertion games or exergames are a way of encouraging aerobics (Elsawy & Higgins, 2010), or even Tai Chi physical activity (PA), with clear anticipated benefits. (Pigford, 2010), the cognitive and physical deterioration Exergames are innovative and interactive digital games that associated with aging tends to reduce older adults’ cap- combine exercise and video games (Sinclair, Hingston, & abilities to participate in playing digital games or video Masek, 2007). These digital games may track and react to game exercising (Lin, Mamykina, Lindtner, Delajoux, & body movements. Exergaming for older adults, whose range Strub, 2006). However, playful applications, such as of PA is often delimited, demands a greater understanding of motion-based video games, hold the promise of providing the complexities of human interaction. A systematic review of accessible PA for older adults (Gerling, Livingston, Nacke, exergames in this context is needed to advance our knowledge &Mandryk,2012). Prior research focused on an older of the development of interactive systems, from a human demographic has demonstrated the benefits to physical perspective that is specific to older adults. and emotional well-being of these game applications (Jung,Li,Janissa,Gladys,&Lee,2009;Schutzer& 1.1. Exergame applications Graves, 2004). Motivational characteristics, such as purpo- seful interactions, customization of activities, fostering Participation in recreational activities, such as playing independence, building relationships, sharing, and accom- digital games or exercising as a recreational activity, modating preferences (Kappen, Nacke, Gerling, & Tsotsos, improves older adults’ quality of life (QOL) (Marston, 2016), are common for older adults, which relate to their 2013). Video games as playful technology applications lifestyle attitudes. Significant increase in wellness scores provide entertainment (Gamberini et al., 2008; measured by the Wellness Evaluation of Lifestyle inven- Smeddinck, Gerling, & Tiemkeo, 2013)forthisdemo- tory was indicated due to decreased sedentary time and graphic. The benefits of playing range from focusing increased PA (Barwais, Cuddihy, & Tomson, 2013). players’ attention (Hwang, Hong, Jong, Lee, & Chang Additionally, prescriptive interventions using casual video 2009) increased gameplay engagement (Belchior, CONTACT Dennis L. Kappen [email protected] © 2018 Taylor & Francis Group, LLC INTERNATIONAL JOURNAL OF HUMAN–COMPUTER INTERACTION 141 games indicated an improvement in participants’ mood of technology (Wagner, Hassanein, & Head, 2010). A and reduced stress (Russoniello, O’Brien, & Parks, 2009). review of custom-designed motion-based games for older adults (Gerling & Mandryk, 2014) indicated the need to accommodate exergaming interaction activities to address 1.2. Current systematic reviews age-related changes due to cognitive, psychological, and Research on exergames has dramatically increased in the psychomotor impairments. last decade (Kharrazi, Lu, Gharghabi, & Coleman, 2012). Systematic reviews have also been undertaken that focus on This scoping review established the positive influence of the health benefits of exergames. A review of studies relating exergames in health contexts with specific focus on num- to simultaneous physical and cognitive exercises highlighted ber of publications per clinical contexts such as PA and the role of functional brain connectivity work and multimodal nutrition. This review concluded the need to include training to understand and train the aging brain through females and elderly in studies, increase the number of exergames (Bamidis et al., 2014). Review of studies using participants, increase the intervention period and user– exergames in Parkinson’s disease (PD) rehabilitation indicated game interaction, and expand the application of health improvements in balance, reduction in severity of motor games to clinical contexts other than PA and nutrition symptoms, and rehabilitate motor skills (Barry, Galna, & (Kharrazi et al., 2012). Previous reviews of the literature Rochester, 2014). Furthermore, a scoping review of exergames have also addressed specific health contexts relating exer- and implementation potential for patients with heart failure games as interventions for older adults. Review of exer- indicated that there was improved balance, improved cogni- games used as interventions to help cope with effects of tive function, enjoyment of the exergames, reduction of ageing indicated that this technology could be used as a depressive symptoms, thus improving the QOL for such therapeutic tool (Velazquez et al., 2014). Their review patients (Verheijden Klompstra, Jaarsma, & Strömberg, conducted assessments of 52 articles and concluded that 2014). Another systematic review on the training of muscu- exergames could serve as a diagnostic tool to find or loskeletal functions using exergames showed evidence of evaluate a health condition or as a therapeutic tool to delayed functional and muscle loss in the aged and helped modify a health condition (Velazquez et al., 2014). to overcome decline in motor skills (Rodrigues, Valderramas, However, this review did not focus on the PA outcome Rossetin, & Gomes, 2014). A systematic review on the percep- of using exergames. A review article of sedentary behavior tions of the efficacy of exergames and falls prevention sug- of older adults (56 articles) established the need to over- gested that these games facilitated intrinsic factors such as come sedentariness through PA and its relationship with independence, control, and the perceived need of safety to health outcomes such as mortality, metabolic syndrome, continue using exergame technologies (Hawley-Hague, cardiometabolic markers, triglycerides, high-density lipo- Boulton, Hall, Pfeiffer, & Todd, 2014). A narrative literature protein cholesterol, blood pressure, abdominal obesity, review looked at adults’ motivation to play exergames and the obesity, and cancer (Fornias, Rezende, Rey-Lopez, experience of playing such games which indicated that differ- Matsudo, & Luiz, 2014). The use of technology to help ences in older adults (e.g., age, gender, education) and game- improve these health outcomes is also critical from the play in natural setting would enable hedonic aspects of integration of technology and health contexts. In this vein, playing exergames (Loos, 2017). using mobile phones as health interventions to stimulate Themes such as mental, physical, and social health factors PA, medicine management, falls detection, dermatology, emerged in a systematic review on health benefits of digital and exercise monitoring for heart patients contributed to video games (Hall, Chavarria, Maneeratana, Chaney, & the overall improvement in the QOL of older adults (Joe Bernhardt, 2012). Similarly, research on the effectiveness and & Demiris, 2013). A review of seven randomized con- efficiency of digital games indicated that social, psychological, trolled trials (RCTs) using validated scales indicated the physiological, and sensory-motor themes facilitate in the pre- effectiveness of exergames in physical outcomes for
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