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Can Exergaming Improve Mental Health of University Students?

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Can Exergaming Improve Mental Health of University Students? Can exergaming improve mental health of university students? Esther Sampaio Santos, MA Applied Health Sciences (Behavioural and Population Health) Submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy Faculty of Applied Health Sciences, Brock University St. Catharines, Ontario © 2020 Abstract The academic, financial, and social pressures that emerge when adults begin university may lead them to encounter mental health challenges (American College Health Association [ACHA], 2016). In Ontario, 46.2% of university/college students have reported ‘excessive’ stress whereas 64.5% report ‘overwhelming’ anxiety (ACHA, 2016). One approach that may be useful for enhancing mental health is exergaming which uses motion-sensor technology requiring players to move their bodies to complete the videogame sessions (Huang et al., 2017). However, studies focused on the effectiveness of exergaming for improving mental health of university students are scarce in number and limited in scope. The overall purpose of this dissertation was to examine the role of exergaming in relation to mental health reported by university students. In Study 1, a synthesis of published intervention research using exergaming to change well-being – a psychological concept affiliated with mental health – reported by adults was conducted. Results from Study 1 indicated that less than 50.0% of the coded studies - using either multi- or single-group (pre-post-test) research designs - reported enhanced well-being as a function of exergaming. In Study 2, the link between the amount and intensity of exergaming behaviour per week and mental health reported by university students was evaluated. Results from Study 2 indicated that university students who reported more frequent exergaming behaviour during a typical week displayed lower anxiety and stress plus higher flourishing and vitality. In Study 3, the contributions of exergaming to mental health of university students were investigated using an experimental research design that compared exergaming against other physical activity behaviours and self-management approaches. Results from Study 3 showed that ‘exergamers’ did not present higher or lower mental health scores compared against ‘traditional’ exercisers but displayed less stress and anxiety when compared against pet therapy, as well as, higher vitality plus lower stress and anxiety compared to ‘non-exercisers’. The results from these studies make it apparent that exergaming may not offer anything ‘unique’ as a stimulus beyond more traditional modes of exercise, but it fosters mental health of university students. Keywords: Active Video Gaming, Mental Health, Quality of Life, Psychosocial Health, Physical Activity Acknowledgments I would be a fool to believe that this dissertation would be at all possible without the patience and endless efforts of so many people who love and support me. But first and foremost, I thank God, Nossa Senhora Aparecida, and Sao Jorge. I feel Your light guiding, protecting and giving me strengths to fight my battles. To Phil, the most dedicated and fashionable supervisor there ever was. I feel so smart to decide to email you for the first time six years ago. When we first met at The Grounds, I was anxious and insecure about the future, but you made me feel welcomed, proud of myself for being here and excited about the long road ahead. Over these past four years working together, you have provided me with the perfect balance of support, guidance, and independence to achieve my professional and academic goals. You made me a critical thinker and foremost, a better researcher, and for that, I am truly grateful. Thank you for your patience, guidance, honesty, and support. If you drank coffee instead of tea, you would be perfect! To Diane (aka the Goddess of the Intellect), the sweetest unofficial supervisor I could ask for. I am not sure if I express this enough, but I want you to know that I am very grateful to have such a smart and kind 'mother in science'. Thank you for your support, guidance and for always being available to answer my questions and guide me in my studies. Learning from you is always pleasant. Thank you for all the birthday and Christmas gifts (I know it is always you, not Phil!). And of course, thank you for all makeup treats! To my committee members, Dr. Jae T. Patterson, Dr. Melanie Gregg, Dr. Shannon Kerwin and Dr. Tony DiPetta for supporting me throughout this process and for sharing your expertise. You are for sure an inspiration to me. To Dr. Brian Roy for chairing my defence with professionalism and excellence. You greatly contributed to make my special day an amazing celebration of four years of hard work. To my Behavioural Health Sciences Research Lab family, Allie, Caitlin, Collin, Connor, Dan, Jenn, Max, Meghan, Sarah and Sydney. I am so fortunate to have had the opportunity to meet and work with you guys. You all made me feel like home. It was amazing learning from each one of you and I hope to uphold our professional and personal relationships long after this dissertation is completed and conferred. To meu bem Willian, for being my rock and the love of my life. It still hard to believe that you agreed with leaving your family and friends in Brazil to walk by my side in Canada! Thank you for being so supportive and my biggest fan. Without you and our baby Dexter, I could not make it. I wish I was as talented as you think I am. To my brother, Anderson, thank you for all the laughter and support. And finally, thank you naná Maria, and mainha Rita. When I decided to pursue my undergrad in Psychology, people said to you: “just crazy people study Psychology”. When I decided to do my master's degree in a different state very far from home, people said to you: “what is the point if she could stay here and get a job instead?”. When I decide to do my Ph.D. in Canada, people said to you: “we have so many Ph.D. programs in Brazil, why she needs to go to North America?”. Your answer always had been: “this is what Esther wants and if she believes it is the best for her, we trust and support her”. Your unconditional love and support make me feel the luckiest girl in the world. This dissertation is dedicated to you – the strongest women that I know. Eu amo vocês. Table of Contents Abstract…………………………………………………………………………………………....ii Acknowledgments……………………………………………………………………………..…iv List of Figures……………………………………………………………...……………….…….ix List of Tables……………………………………………………………………………………....x List of Abbreviations ………………………...………..……………………………………….....xi Chapter 1: Introduction………………………………………..………………………………..…1 Mental health challenges amongst university students…..……….……….……….…………...2 What on-campus initiatives can be accessed to improve mental health for university students?...........................................................................................................................................6 Impact of physical activity on mental health of university students……...……………..…...…8 Physical activity in university students……………………………………………..…………10 What is exergaming?…………………..………………………..………………………..……11 What is known about exergaming and mental health?…………………………………..……13 Exergaming and mental health of university students: What’s missing?………………...…...18 References…………..………….………….………….…..…………………….……………..23 Chapter 2……………………………………………………….………………………..……….45 Objectives of Dissertation Research……………….…………………………………………..45 Chapter 3…………………………………….…………………..……………..………………...46 Introduction….……………..…...……….……………………………………………………..47 Methods…...………………………………………………..…………………………………..48 Search Strategy……………..…………………….…………..……………..………………..48 Inclusion/Exclusion Criteria ……...……………….…………..……………………....……..48 Study Selection Process………..……………...….…………..………..……………………..49 Data Extraction…………………………………...……………..………..…………………..49 Data Analyses………………………..……...….………………..……………..………...…..50 Results…………………………………….…...…………………………..………..…………..50 Study Characteristics…………………….…..……..….………………..………..…………..50 Sample Characteristics……….……….……..………….………………………..…………..51 Intervention Characteristics……………….....……..….………………….……..…………..51 Exergaming and Mental Health………………….……..………….……..…………………..51 Discussion…...………..……….…..………………………….………………..………………..52 Study Limitations and Future Directions…..……………...………………………………..54 Conclusions…....…………….………….………………………………..…..………………..55 References……….…..………………………….………………..……………..……………..56 Chapter 4……………….……………………………………..……………………………..…...66 Introduction….………………………………..………………………....……………………..67 Justification: What do We Need to Know About Exergaming?….……..……………….…....69 Methods…...…………….............………………….......……..……………………….……….71 Participants ……...……………… …….............….......……......…………………...……….71 Instrumentation...……………......................….………..........……………………...……….72 Demographics……...……….................……....……......…………………………...……….72 Exergaming …….................………… …………………………...………………...……….72 Mental Health…………………….….....………………………………………………...…..72 Data Collection and Data Analyses……………...….……………..…………………..……..73 Results………………………………………………………..……………………..…………..74 Preliminary Analyses………….……………...……..….…………………….…..…………..75 Multiple Regression Analyses Predicting Mental Health Dimensions…………............……..75 Discussion…...…………….……………………...….………………………..………………..77 Study Limitations and Future Directions…..………...……...………………………………..81 Conclusions…...………….…..……….……………….……………………..………………..81 References…………..………..……………….……...………………..………..……………..83 Chapter 5………………………………………………….……………………………..……….92
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