THE EFFECTS OF EXERGAMING VERSUS MIRROR MATCHED GYM BASED EXERCISE WITH NO VIRTUAL STIMULI ON TECHNOLOGY ACCEPTANCE, FLOW AND POSTURAL CONTROL IN A HEALTHY YOUNG SUBJECT POPULATION Gillian Barry A thesis submitted in partial fulfilment of the requirements of Teesside University for the degree of Doctor of Philosophy 2013 School of Health and Social Care Teesside University Middlesbrough, United Kingdom 1 THE EFFECTS OF EXERGAMING VERSUS MIRROR MATCHED GYM BASED EXERCISE WITH NO VIRTUAL STIMULI ON TECHNOLOGY ACCEPTANCE, FLOW AND POSTURAL CONTROL IN A HEALTHY YOUNG SUBJECT POPULATION Presented by Gillian Barry, M.Sc. B.Sc. Director of Studies Professor Denis Martin Supervisor Professor Paul van Schaik Supervisor Dr Alasdair MacSween Supervisor Dr John Dixon 2 DECLARATION: I declare that this thesis is entirely my own work and represents the results of my own research carried out at Teesside University. I declare that no material within this thesis has been used in any other submission for an academic award. 3 ACKNOWLEDGMENTS: I would first and foremost, like to thank my director of studies Professor Denis Martin for his constant belief and support throughout my PhD process and his invaluable guidance throughout the process. I am also extremely grateful to my three supervisors; Professor Paul van Schaik, Dr Alasdair MacSween and Dr John Dixon for their encouragement, guidance and fantastic mentorship throughout my PhD process to which I am eternally grateful to have been given the opportunity to work and develop a great research team. I would like to acknowledge and thank Dave Hodgson and Stuart Dixon for their technical expertise and support throughout the PhD process, and thank you to all of the participants at Teesside University who kindly volunteered to take part in this study. I would like to thank my fellow PhD researchers at the school of health and social care, in particular Jonathan Robinson, Yvonne Khoo and Gemma Wilson for all their support and encouragement throughout the process. Finally I would like to thank my family and friends for their constant support and encouragement throughout the PhD. With special thanks to my parents and sister for providing continuous support and love throughout the process. Last, but by no means least, I would like to thank my Fiancée Michael for his constant love, support and belief in me throughout my PhD. 4 Abstract This thesis investigated the effect of exergaming versus mirror matched gym based exercise with no virtual stimuli on technology acceptance, flow and postural control in healthy young adults. Firstly a review of literature was performed analysing the effects of technology acceptance and flow on exergaming, and the effects of exergaming on postural control. Results showed the plausible nature of exergaming as an immersive environment and the potential to improve postural control. However, some major gaps in the literatures were identified. Technology acceptance had never been applied in exergaming and flow had only partly been applied to exergaming in limited studies. Additionally the effects of exergaming on postural control had shown some potential benefits, however no study had truly analysed the effects of exergaming on postural control by analysing mirror matched exercise with no virtual stimulus. The purpose of this thesis was to address these important areas of research and contribute novel evidence to the field. In two separate studies, 38 non active and 50 active young healthy adults took part in either exergaming based training or mirror matched gym based exercise with no virtual stimuli. Technology acceptance (behavioural intention), flow and postural control were measured at pre and post exercise intervention. Technology acceptance results showed that performance expectancy was significantly higher in the exergaming group in both studies, as well as being a significant predictor of behavioural intention at both pre and post exercise testing. In the second study, only, performance expectancy, social influences, and behavioural intention where statistically significantly higher for the exergaming group compared to the mirror matched gym based exercise with no virtual stimuli on technology acceptance, highlighting greater levels of acceptance into the exercise environment. Flow results showed greater levels immersion in the exergaming groups, especially in terms of clear goals, unambiguous feedback, action awareness merging, transformation of time and loss of self- consciousness. 5 The effects of exergaming on postural control showed significant improvements in anterior- posterior standard deviation and range for the exergaming group in study one, and improvements in medio-lateral range in study two. Study two also showed significant improvement over time (pre-post exercise) for medio-lateral SD, range and centre of pressure. Evidence from both studies suggests that exergaming may offer an immersive environment for exercise which has a positive effect on behavioural intention to keep using the exergaming system in the future. With regards to postural control evidence from both studies suggest that exergaming may offer a new method of exercise to improve static postural control. 6 Abbreviations AE- Autotelic experience AP- Anterior- posterior AM- Action-awareness-merging β- Standardised regression coefficient BI- Behavioural intention CB- Challenge-skill balance CG- Clear goals CoP- Centre of Pressure CT- Concentration of task EE- Effort expectancy FC- Facilitating conditions FSS- Flow state scale LS- Loss of self- consciousness ML-Medial-lateral SD- Standard Deviation SI – Social influences P- Significance Level PS2- PlayStation 2 7 PC- Paradox of control PE- Performance expectancy R- Multiple correlation coefficient R2 - Squared multiple correlation coefficient sEMG- Surface electromyography TAM- Technology acceptance model TRA- The Theory of Reasoned Action TPB- Theory of planned behaviour TT- Transformation of time UF- Unambiguous feedback UTAUT- Unified theory of acceptance and use of technology VR- Virtual reality 8 Glossary of Terminology The information in the glossary of terminology refers to frequent use of the terms in the thesis. Avatars- a virtual image of a body presented in a cartoon format. Balance/postural stability –“The ability to control the centre of mass in relationship to the base of support” (Shumway-Cook & Woollacott 2007). Base of support (BOS) - the area of the body that is in contact with the support surface (typically the ground). Centre of gravity (COG) is the vertical projection of COM onto the ground. Centre of Mass (COM) “a point that is the centre of the total body mass, which is determined by findings the weighted average of the COM of each body segment” (Shumway-Cook & Woollacott 2007). Centre of Pressure (CoP) is the point location of the vertical ground reaction force vector. It represents weighted averages of pressures distributed over the surface of the area when feet are in contact with the ground. In order to keep the COM within the base of support this requires the CoP to continuously move around the COM (Shumway-Cook & Woollacott 2007). Dance Dance Revolution (DDR) an interactive dance based game created by Konami. DDR aims to get people moving on a dance mat to different music, using forward and backwards and side to side arrows. Exergaming – a combination of exercise and computer gaming for example Nintendo Wii™ or the XBOX Kinect™ ™ as an example of a commercial product. 9 Flow – a state in which an individual can become totally immersed within an activity, in the thesis flow state flow state will be assessed using a flow state scale questionnaire which comprises of a 36 item questionnaire Maximal voluntary isometric contractions (MVIC’s) – the ability to produce a “voluntarily maximal effort during an isometric contraction for a given muscle group” (Soderberg and Knutson, 2000). Nintendo Wii™- Released in 2006 the Wii is a popular exergame that uses a hand held Wii remote to control the Avatar characters by pointing the remote at the screen. Rate of Perceived exertion (RPE) – a psychological scale of physical exertion which participants can rate their own levels of exertion, this is a subjective value of exertion. Postural control- involves controlling the body’s position in space for enabling stability and orientation and is active in all positions (supine, sitting, and standing). Postural sway- Humans sway invariably to maintain balance using small forward and backward (anterior-posterior) and side-to-side (medial-lateral) motions; the magnitude or velocity of which is a measure of balance. Unified Theory of Technology Acceptance (UTAUT) - a questionnaire designed to assess people’s behavioural intention for future use. Wii-habilitation- the use of the Nintendo Wii as a method of physical therapy used within a rehabilitation setting for a variety of clinical conditions. XBOX Kinect™ – an interactive exergame which captures body movements in real-time without the need to use worn or handheld controllers, the person’s body acts as the controller using gesture recognition. 10 TABLE OF CONTENTS Abstract ..................................................................................................................... 5 Abbreviations ............................................................................................................ 7 Glossary of Terminology ........................................................................................... 9 1. INTRODUCTION………………………………………………………………..23 1.1 Overview