5th Annual Games For Health Conference

How do certain Web 2.0 technologies impact people’s health and fitness decisions? Are the audiences who spend hours of screen time in online destinations like Facebook, Twitter, YouTube and Second Life similar to the audiences who are drawn to exergaming and other games for health? Which outcomes from playing video games parallel those who micro-blog, engage in online social networks and nurture their avatars in virtual worlds? As programmers and researchers, what can we learn from making these observations?

Since the advent of broadband technology and the increased prevalence of wireless networks, the web has evolved into a powerful, interactive and ‘real-time’ environment – allowing content to be much more user-centric and user-generated. And because of this shift in digital culture, more fitness professionals are embracing online tools to create everything from fitness podcasts to cyber coaching sessions.

The objective of this brief, informal session is to bring these ideas to the forefront of our conversations, as they relate to games for health. More research is needed in this area and potential collaborative efforts could benefit from having gaming/web-based hybrids.

Lisa Hansen
Here is the ‘food’ chain to implementation
1. Let’s make an active game
2. Game developer/ Manufactuer
3. Distributer
4. Company - Customer
5. Teacher/trainer/director
6. User - Player

The disconnect/problem in implementation occurs from steps 3-6. It is really important for the implementer to create successful experiences. What is NOT working: focusing on the product vs. Process

Ernie Medina
Problem facing healthcare / medical industry: They look at exergaming and video games as an enemy. By 2048 ALL American adults will be overweight. And because technology is a reality of our digital culture, exergames should be embraced. Therefore, there has been more talk in the US healthcare about pushing technology to achieve positive health-related outcomes.

In medical community, the concept of Exercise IS medicine is being pushed. Organizations like ACSM is trying to encourage physicians to prescribe exercise. Doctors generally want to know “Does exergaming work?” Yes. Major medical and health/fitness journals have published plenty of documentation and research that show the positive benefits of exergaming.

Summary of research of exergames on energy expenditure
- Apporximately equal to what would be found in moderate PA (most of the research started out with measuring energy expenditure)
- % body fat was significantly decreased at 12-weeks post-exercise, even though that weight didn’t change very much (looking a physiological and/or fitness assessments pre/post.) The only difference is that exergames are much more fun – even though one of the criticism for exergames is “is it the game or is it that player is simply being active?”

(But isn’t it interesting that even though health professionals and doctors know the importance of exercise – they, themselves don’t meet the daily recommended doses.) Which by the way, the latest PA recommendations: 150-300 mins of moderate activity per week. Ernie asks: “how exergaming can be couched in those recommendations?”

In order to market exergaming to the medical community, these medical implications/outcomes should be stressed: targets Obestity, application in rehab treatment, special populations (physical disabilities, cognitive/mental disabilities), lifestyle-related diseases, seniors – “Medical exergaming”

Medical fitness centers. And looking at the senior centers to implement these exergames.

Unanswered Questions
- Rehab
- biometric outcomes
- long-term compliance
- negative effects
- impact on cognitive functions
- “gateway” effect
- adoption of healthy behaviors
- RWJF keep fueling the research

Considerations/Needs: Do exergames have supervision and home support. You can’t just buy the games and expect the implementation to work.

“Become an exergaming evangelist,” urges Ernie. And eventually there will be more and more games specifically for exergaming and nutrition in the medical community.

Barbara Chamberlin

Part of “Learning games lab” at New Mexico State University, which entered the exergaming discussion by developing full-body games. There doesn’t have to be a search or development towards finding the one perfect game. Instead, there should be a search for finding a better gaming process.

ExergamesUnlocked.com
It is meant to be a resource and/or a practical guide for the teacher, the physician, the implementer, personal trainer. It includes research, video/youtube clips, media, case studies – everything from summary of multiple exergames research to videos on how to hook up the Nintendo Wii and success stories. There is even an article on how doctors should and could prescribe exergaming written by Ann Maloney.

But the website still needs more – game reviews, evaluation models, community-generated content, more case-studies and specific guides. It is not enough to say the game is good or bad…

If you want to help provide content, please contact Barbara Chamberlin.

Barriers we find in implementation of exergaming:
1) Enough games do not have a “get me started right now” function (aka “quick start” button). Programmers need to recognize that these games are being used in public games. Features should allow user to skip things like “build your avatar” etc.

2) Take out scantily clad images out of the games – more appropriate physical images in gameplay.

3) Programming accessible for customization, particularly for use by personal trainers and/or physical education instructors.

4) One Wii application that congregated into one application, so we can save and/or pull data across various games (independent of the game).

5) Let’s try to avoid taking the fun out of experience because programmers/developers seem to be focusing too much on exercise or the medical applications and/or outcomes instead of the ‘game’ and entertainment.

6) Some consumers are still not familiar with the term “exergaming”. Maybe there should be efforts made to market that term exergaming (or active gaming, interactive fitness, etc) On the other hand, since most games are leaning towards being more immersive, this term may soon be irrelevant.

7) “Reporting” features for tracking data needs to have better metrics, either for practioners or researchers.

(activeadventuregame.com)

Seth Sivak, ETC @ Crnegie Melon University

Student Pitched Project: Make a fun exercise game and use the wii

Research with Doctors: Use a dancepad, understand the exercise experience (what is the ideal ex experience for kids)

Seth is simply repeating the history of exergaming (25 years… add URL)

Says DDR is not as popular anymore because the dreamcast version of DDR in 2000 looks the same as wii version of DDR from 2009. Just goes to show you that there hasn’t really been much innovation in games.

Not much has changed over 20 years (sports, dance, training)

Exergames require a peripheral
Games should be designed with/for the hardware
Inputs should be interesting and fun (and varied) (one of problems w/ balance board is that it is limited)
No deep gameplay experiences

High Concept
- Active video game for children
- Utilize Traditional action-adventure concepts (deep game play, have a story, similar to WoW)
-

It’s about actively playing the hero
Full Tutorial Level (~20 minutes)

Core Design Ideas
- Avoid Chocolate covered broccoli (things like gamercize where you can’t play unless you are moving)
- Use Flow (time flies when you’re having fun)
- Design gameplay & Exercise Together (usually exercise is something they tag on at the end of a game)
- Give Juicy Feedback (as you progress through the game, your character becomes fitter/bigger)
- Map interaction Closely (if you climb slower, avatar goes slower, etc)

Gameplay & Input Design
- Make it FEEL right (natural vs. intuitive) – running is running, but climbing mimicks gesture
- Teach the desired behavior (they put a ‘home base’ on the dance pad (which was innovative and diagonally positioned) by putting stickers of feet on the pad))

- Personalize the controls
- Test, test, test

Development Focus
- interate on Core Gameplay (How combat and controls were going to work hand-in-hand, no pun intended)
- Rapid Prototypes
- Modular design
- Test, test, test

Playtesting: tested outside their demographic. Work places, hospitals, girls/boys, celebrities, etc. to find and/or expand the application of the game.

They were looking to make sure the GAME was fun…

George Washington University, School of Public Health will be testing out (medical/scientific) testing.

Motivation:
Tethered vs. Tailored
Tethered – DDR
Tailored - ActiveAdventure

Active-Adventure Advantage
- Deep Gameplay experience
- Large Market Potential
- Incentive based statistics (in order to be at the marathon runner status you need to run 26.2 miles)
- RPG Exercise Statistics
- Story Based Learning (you can integrate nuggets of information within the story – how can you teach nutrition, about energy, etc within the game without it coming across forced)

Contact: ssivak@andrew.cmu.edu
Website: sethsivak.com
Twitter: @sjsivak

If you are a researcher looking for a game developers please come see me – what are the needs?

Session notes from Games for Health 2009 - Pilot Study on Older Adults & Exergaming
(Speaker Paul Blair from UCSD/SDSU)

- The older adult population is growing and they are facing many challenges - overweight, chronic disease, risk of falling, mental difficulties. And physical activity can positively affect the onset of these issues.

- Unfortunately, older adults are the least active among the population. 2.5% of adults over 60 meet the PA recommendations and 8-9 hours a day being sedentary.

- Wii comes into mainstream ‘fitness’ and rehabilitation centers, senior community centers, and other places are purchasing the Wii consoles because studies are showing the benefits of playing Wii and increasing activity levels.

- Publicity brings attention/buzz to this senior-wii movement (i.e., bowling leagues with wii players/seniors, etc)

STUDY- Purpose: to determine the feasibility, acceptability, and short term effects of Wii.
- Method: Participants recruited from 4 locations (senior centers) in SD, CA. Played wii 3X for 12 weeks. Under supervision. Assessments at Base Line, 6 weeks and 12 weeks
- Participants: N=59 (Ineligible N=34). Age range 63-94. 86% retention rate. N (at 12 weeks)=19.
- Wii Intervention 1: participants selected one or more games to play from the 5 Wii Sports games. Each person created a Mii. Played games alone over 3-weekly 30 minute sessions held at their site.
- Support Components: Trainers were on-hand during game play (warm-up / cool-down). Manuals provided with instructions on each game (w/ safety tips)
- Week 1: Participants were taught how to play
- After Week 1: Staff member was present to assist a needed. Participants were encouraged to become independent in the Wii Play. Only played during their allotted time. Played alone.
- Assessments: Depression; Beck Anxiety Inventory; Quality of Life Survey; Pittsburg Sleep quality Index; Attendance; study Satisfaction and qualitative interviews.
- Results: Depression decreased significantly; overall mental, emotional, social functioning and pain improved; Sleep scores improved but not significantly; anxiety scores also improved (but didn’t drop in category); fave games were bowling & tennis; least fave were boxing and baseball.

Overall conclusion: implementation of Wii-Sports was positive on bowling ad tennis.

It may seem a little ironic to bring a card game to a conference that is focused on technology, but that’s part of the diversity that you should expect from the Robert Wood Johnson Foundations Games for Health conference.

The card game I’m talking about is just for fun - Top Exergames - that I have had a few packs made and brought these over to raise awareness that “exergames” is far wider than just Nintendo Wii. Each pack contains 38 different exergames from EA SPORTS Active to the Atari Family Trainer. Each card has a number of categories that can be compared between cards - the highest number wins!

I grew up Top Trump style cards games and the game is second nature to me but it does appear, from initial  reactions, that people today have lost the skills how to have fun without computers and games consoles! So to bring back a little traditional skill here’s the rules.

• Shuffle the pack of cards and deal them evenly to all players
• One card is “Wii Fit” - the person who has this card goes first
• Players now place their cards face down in front of them

• Everyone takes the top card from their own deck
• The starting player calls out a category and the value of this on the card
• All cards are compared and the player with the highest value wins all the cards (lowest for year introduced) in that hand
• The winner of the hand takes the next card and calls the next category and value
• Play continues until one player has won all the cards

There’s a few packs that will be available to delegates just outside the main conference hall at during lunch break - enjoy them!

What Does the Research Say? Ten minutes of aerobic exercise before a cognitive task (like reading or math) resulted in better success at that task

· Students who did 10 minutes of physical activity before a standardized test, did up to 25% better at that test than students who received 20 minutes of test-specific tutoring.[1]

The above research is profoundly relevant to today’s health and fitness crisis. At the same time the fitness-overweight dilemma is growing, funding for programs like physical education in schools are being reduced or eliminated. Preparing healthy, active children for life has taken a backseat to preparing the K-12 student for standardized tests. Educators have been mandated to address both the fitness and the test-score issues, but they need help. ExerLearning® and tools like FootGaming™ and FootPOWR Pads™ tackle fitness and academic goals simultaneously-while saving teachers time and saving Districts money.

• We can help you connect solid physical activity and fitness benefits to programs eligible for NCLB, technology, Title I and SES funding.
• What could happen on a national level if grade 3-12 students became ExerLearning experts? That TEAM e3 - ask us for more info (genfit@bendbroadband.com)
• We can work with you to deliver outcomes that are of a high priority for our nation’s schools

Imagine the impact on standardized test results if the 30% lowest performing students:

• 1. Attended school 23% more days per quarter (Gen FIT field study results)
  2. Gained confidence and focus (Gen FIT teacher reporting)
  3. Gained eye-tracking, patterning, sequencing and vestibular balance practice (proven predictors of fitness and academic success)
  4. Lead and manage a valuable classroom program for their teachers

Explore FootGaming and Exerlearning! Lots of videos online

www.footgaming.com http://exerlearning.blogspot.com info@generation-fit.com

In an attempt to create a online destination during the G4H conference and build on the conversations being had among the attendees and presenters, I have asked my colleagues to join my documenting efforts on this blog. We hope it will explore new dimensions to our discussions and increase awareness of the possibilities that exist within the games for health industry!

For information about the conference, go here.

If you are attending the conference, here are some things you can do to participate:

1) Twitter: tag all tweets with #G4H09
2) Flickr: tag all conference photos with G4H09
3) Slideshare: Upload your presentation to SlideShare and add it to the Games For Health Group/Events page

If would like to be a contributor to this blog, contact Biray via email here:  Biray [at]FITTmaxx  [dot]   com or ping her @befitt