Higher levels of moderate-to-vigorous physical activity (MVPA), and maybe even light
physical activity (LPA), have been related to better health,
1
motor skills,
2
and cognitive
3
outcomes in virtually all age and ability groups. Problematically, however, most people
in general are not prone to enjoy and participate in substantial amounts of physical
activity (PA),
4
and it has been challenging to find ways to increase the number of minutes of PA per
day to a high enough level to achieve the aforementioned benefits.
5
Low levels of PA may also in part be due to possible compensation with lower activity
later in the day, or the next day, in response to bouts of PA.6, 7
Serious games, that is, games designed to achieve an outcome in addition to entertainment,
have been developed to enhance health outcomes
8
and have been demonstrated to yield broad positive effects.
9
Serious games have influenced self-efficacy, or confidence, for doing a behavior (e.g.,
PA), which is a determinant of doing the behavior and thereby on the pathway to behavior
change.
9
Exergames are a genre of serious games and games for health, but the game mechanic,
or method of game play, requires body movement to move the game forward, thereby increasing
levels of PA. Exergames appeal to some age groups
10
owing to their intrinsic motivation (or fun) enhancing aspects.
11
Some have argued that given the high appeal of gaming in general, exergames hold the
promise of being even more effective than other PA-promoting programs in initiating
and maintaining PA.
12
Some scholars, however, have concluded that exergames are a blight on humanity because
they may not provide higher levels of PA intensity and may displace naturally occurring
outside sports and PA,
13
whereas others
12
emphasize the possible replacement of sedentary gaming with active gaming and the
broad, even international, reach of some games (e.g., the recent Pokémon Go release).
14
Alternatively, among children, simply providing a selection of exergames did not increase
children's PA levels,
15
suggesting that more than just the games needs to be provided.
Exergames were originally introduced using PA as an innovative gaming mechanic that
was hoped and expected to enhance the games' attractiveness to some groups and thereby
enhance sales, not promote the public's health. As a result, some investigators have
experimented with exergame mechanics to further enhance the healthfulness (it is hoped
without impairing the enjoyment). Three groups have been identified for special interest
in and benefit from exergames: children, who generally play extensive amounts of games
and thereby may be prone to exergaming, and seniors
10
and people with disabilities,
16
who can perform and benefit from the somewhat lighter intensity activities associated
with exergaming.
The interesting articles in this special issue of the Journal of Sport and Health
Science address these important and diverse issues. Exergaming may be a “gateway”
to PA (i.e., increasing diverse kinds of activity from earlier playing of exergames),
but little research has addressed this hypothesized effect. Staiano and colleagues
17
tested in an experimental design whether dance exergaming offered 3 times per week
over 12 weeks under coaching supervision to 37 adolescent girls (randomly assigned
to groups) affected psychosocial variables that influenced PA or had the gateway effect.
The investigators introduced an interesting free-play period with diverse activities
available to test the gateway effect. The intervention group girls, in comparison
to the control group, increased self-reported intrinsic motivation, self-efficacy,
and PA from before to after the 12 weeks of exergames, but this had no impact on objectively
assessed PA or sedentary behavior. Because attendance at the exergaming sessions was
high (80%), PA was increased during the intervention, but this was LPA, not MVPA.
The increased LPA did not transfer to the free-play period or to after the intervention,
thereby providing no evidence of a gateway to other PA. This does not terminate the
gateway speculation because it might exist for younger children, adults, or boys,
or in response to more intense activity, but the findings do not exactly stoke the
fires of hope, either. Alternatively, the adolescent girls, who are famously inactive,
did engage in mostly LPA during the intervention, suggesting that supervised dance
exergaming could be offered to increase their usual PA.
Continuing the focus on children, Gao and colleagues
18
tested whether a choice of exergames could be offered on a population basis to otherwise
underserved children (second and third graders) to increase their amount and level
of PA at school. The 2 participating schools' policies offered 125 min/week of physical
education or PA and daily 20 min recess. The experiment revealed no school differences
in change in any aspect of PA, energy expenditure, or sedentary behavior, indicating
that while the exergaming did not increase PA, it was no worse than usual physical
education. Unfortunately, we do not know the impact of these exergames on PA outside
school (i.e., the possible compensation or gateway effects).
Moving a bit up the age gradient to college students, Pasco and colleagues
19
changed the exergame mechanic from free play or movement in front of a screen to exercise
bicycling while viewing a mobile application-based exergame and introduced an underutilized,
and it is hoped explanatory, construct: situational interest (i.e., a highly interesting
activity that attracts attention and provides positive feelings). Intervention group
participants were randomly assigned to play the game for one 15 min session in conjunction
with a bicycle ergometer connected to game play, whereas the control group was provided
with a bicycle ergometer with feedback on amount of time left (often 15 min), cycling
cadence, and power output. Although intervention group participants spent 90% of their
time engaged in MVPA while on the exerbike, control group participants spent 95% of
their time in such activity, with the authors potentially explaining away the unexpected
disparity by the nature of the students involved: sport science students. Situational
interest explained the level of activity among experimental group students but not
control group students, perhaps owing to a ceiling effect (i.e., there was little
variability in PA in the control group to correlate with situational interest). Nevertheless,
the new game did show promise of promoting high levels of PA among college students,
but this needs to be verified with samples with other characteristics.
Shifting to children with autism spectrum disorder (ASD), a group with low levels
of PA and underdeveloped fundamental movement skills, Edwards and colleagues
20
tested whether 6 exergame sessions of 45 min apiece played at home over 2 weeks could
increase the fundamental movement skill of object control (OC) (i.e., a skill necessary
to being physically active) among elementary school children with ASD in comparison
to a group of children without ASD. Unfortunately, neither group demonstrated an enhancement
of OC after playing the exergames. It wasn't clear from the results whether exergames
could not impact OC skills, there wasn't enough game play, or the game play sessions
needed the supervision of a professional. Alternatively, the children willingly played
the games, suggesting that this was a viable mode for promoting PA among children
with ASD.
Last but not least, Zeng and colleagues
21
conducted a systematic review of exergames' effects on rehabilitative outcomes among
seniors. Only 1 of 19 studies had no effect on any rehabilitative outcome; 9 affected
all outcomes; and 9 others affected some but not all the outcomes. Ten of 11 studies
demonstrated an impact of exergames on balance. Alternatively, the poor quality and
reporting of many of the included studies limited what could be concluded. No studies
indicated that exergames were preferred over more usual rehabilitation therapy.
So what can we surmise from these interesting studies? First, it appears that using
commercially available exergames had measured evidence of success. When incorporated
into supervised programs, exergame players got levels of PA comparable to, but not
better than, physical education or after-school programs. Exergame play also affected
measures of intrinsic motivation and self-efficacy, which are on the pathway to behavior
change and thereby support exergames' potential for promoting PA. Unfortunately, there
was no evidence to support a gateway effect, and there was no effect on fundamental
movement skills among children with ASD. Although there is evidence that exergames
enhance rehabilitative outcomes among seniors, higher quality research is required
to more confidently come to this conclusion. One study changed the usual game mechanic
(free play in front of a screen) to a bicycle ergometer with a mobile application
and showed somewhat less, but still very high, MVPA.
Each of these studies raises questions requiring additional research. An assumption
in all these studies is that exergame play is more “fun” than other forms of PA. Unfortunately
for the field, it is not clear what about the exergames could be considered fun;
11
if we knew, this could be used to further enhance the fun and by inference the PA.
What constitutes fun may vary across age, gender, and ability groups. Unfortunately,
fun has never been considered a respectable academic topic. We need to change that.
A characteristic of most entertainment games has been an associated story, or narrative,
that captures the players' attention and immerses them in an alternative world in
which they are more likely to attend to inserted health-promoting messages.8, 22 Adding
story or narrative to exergames could substantially enhance their appeal and effectiveness.22,
23 What kinds of stories are the most appealing across age, gender, and ability groups24,
25 and whether a story should be inserted into the game or be offered in parallel
(so as not to interrupt the interactivity of game play)
26
are critical topics that deserve substantially more research.
The recent enormous international response to the release of Pokémon Go, an augmented
reality geocaching exergame wherein players walked extensively to find and capture
Pokémon characters in their neighborhoods, suggests that the game industry has other
potentially impactful ways to increase PA yet to be released.
14
The relatively short duration of this impact, however, indicates that research is
needed to better understand its appeal and to use that information to design more
appealing and longer-lasting programs.
We need to be grateful to the authors of the papers in this special issue for clarifying
some issues and raising others. Although in their current form, exergames may not
be the salvation for promoting PA that some may have hoped, they are not a blight
on humanity either. More research is needed, soon.
Competing interests
The author has no financial disclosures and declares no conflicts of interest.