Health Games Research Grantees Report Research Discoveries in the July 2012 Issue of Journal of Diabetes Science and Technology

Aug 20, 2012, 8:30 AM, Posted by Debra Lieberman

In July, five grantees of the Health Games Research national program have published peer-reviewed research articles in the Journal of Diabetes Science and Technology, in a special issue symposium called “Serious Games for Diabetes, Obesity, and Healthy Lifestyle.”  Their research has discovered innovative ways to improve the design and effectiveness of active video games that require physical exertion in order to play.

The studies have identified, for example, evidence-based game design strategies that motivate college students to increase their physical activity; insights into the benefits of cooperative game play that can motivate overweight and obese adolescents to put more effort into active games; and new approaches to using teamwork in active games to increase player effort and exertion.  The studies used Wii Active and Wii Fit games, stationary bikes with video screens enabling virtual tours and racing games, a motion sensor game, and an alternate reality game.  I served as a guest co-editor of the special issue symposium along with guest co-editor Deborah Thompson, PhD, an associate professor of pediatrics at Baylor College of Medicine and a USDA/ARS scientist/nutritionist. 

In addition to the five featured studies, the symposium contains two articles that provide background related to the symposium theme.  I wrote an article that discusses 14 diabetes self-management video games and their behavioral health design strategies.  Deborah Thompson wrote an article presenting theory-based approaches to the design and future research of health games.

Here are more details about the five grantee studies:

  • Staiano, A.E., Abraham, A.A., & Calvert, S.L.,  Motivating Effects of Cooperative Exergame Play for Overweight and Obese Adolescents, explored factors that motivated overweight and obese African-American high school students to play Wii Active games in a school-based lunchtime and after-school program.  The study found greater and more sustained energy expenditure over time in a cooperative play condition, compared to a competitive play condition, and found that players’ various intrinsic motivations to play also influenced their level of energy expenditure.  The study points to the advantages of cooperative game play for this population and it demonstrates that games can be especially effective when they enable players to do what is personally important, relevant, and intrinsically motivating to them.  Grantee: Georgetown University.
  • Feltz, D.L., Irwin, B., & Kerr, N., Two-Player Partnered Exergame for Obesity Prevention: Using Discrepancy in Players' Ability as a Strategy to Motivate Physical Activity, examined the influence of a virtual partner who was more capable than the player in carrying out physical challenges in an EyeToy Kinetic motion sensor exergame; study participants were college students.  Each player in the study knew that the team could perform only as well as the weaker team member, and this motivated the player to strive to complete the workout challenges, to keep up with the more capable virtual partner.  The study found that the player exerted the most effort when the virtual partner was moderately more capable than the player, compared to a virtual partner that was only slightly more capable or extremely more capable.  These findings will help future game designers use avatars and other types of virtual characters more effectively as workout partners that can motivate players to exert increased physical effort and sustain it for longer periods of time.  Grantee: Michigan State University.
  • Johnston, J.D., Massey, A.P., & Marker-Hoffman R.L., Using an Alternate Reality Game to Increase Physical Activity and Decrease Obesity Risk of College Students investigated effects of an alternate reality game (ARG), called The Skeleton Chase, on college students' physical activity.  An ARG is an interactive fictional game experience that takes place in the real world and uses a variety of media to reveal the story and engage the player.  The Skeleton Chase was designed to meet the learning preferences of today's college students: collaborative and social, experiential and media-rich.  The study compared the physical activity of students who were assigned either to participate in the ARG, which required a great deal of physical activity in order to play, or were assigned to use exercise equipment in weekly lab sessions.  It found that physical activity increased over time among students who played the ARG, while it decreased over the same time period for students who used exercise equipment.  The study demonstrates the power of immersive stories to motivate behavior change.  When specific health behaviors are aligned with the dramatic action of a story, players are motivated to carry out the behaviors in order to advance the plot and, in this case, to solve a mystery.  Grantee: Indiana University.
  • Lyons, E.J., Tate, D.F., Komoski, S.E., Carr, P.M., & Ward, D.S., Novel Approaches to Obesity Prevention: Effects of Game Enjoyment and Game Type on Energy Expenditure in Active Video Games contrasted effects of Wii Fit active games that are exercise-themed (such as a game designed to motivate and support jogging) versus those that are entertainment-themed (such as a hula hoop game), for young adults ages 18 to 35.  The study found that exercise-themed games produced more energy expenditure, while entertainment-themed games were more enjoyable.  The researchers concluded that integrating strenuous activity into entertainment-themed games, instead of exercise-themed games, may be a more successful strategy to attract players who are not very motivated to be physically active.  Grantee: University of North Carolina.
  • Anderson-Hanley, C., Arciero, P., Westen, S., Nimon, J., & Zimmerman, E., Neuropsychological Benefits of Stationary Bike Exercise and a Cybercycle Exergame for Older Adults with Diabetes: An Exploratory Analysis looked at effects of stationary biking on the cognitive functioning of older adults with and without diabetes.  Study participants included older adults ages 60 to 88 who resided in independent living facilities. The study analyzed a small dataset from a larger randomized clinical trial called the Cybercycle Study, which compared effects of traditional stationary cycling versus cybercycling that provides a video screen displaying appealing bike paths, virtual tours, and individual and team racing games with virtual competitors.  The study of the small dataset found that participants with diabetes who used stationary bikes with and without cybercycling screens significantly improved in cognitive functioning in areas such as planning and mental flexibility for shifting sets, while participants without diabetes did not improve.  The study provides evidence that exergame-based physical activity can help improve certain cognitive skills in older adults, in this case most notably for older adults who have diabetes.  Grantee: Union College.

Congratulations to our grantees for their groundbreaking work published in a leading medical journal. Also, I extend tremendous appreciation and thanks to co-editor and author Deborah Thompson for her expertise and valuable contributions to the symposium, and to the journal for featuring a special issue symposium in our field.  A growing number of top medical journals, such as the Journal of Diabetes Science and Technology, are publishing research on the design and effectiveness of health games, and so now the theoretical foundations and body of evidence to support our work are becoming more widely known among health care providers and health games researchers.  This is helping our field develop more effective health game designs, implement health games more successfully with specific target populations, and do more with digital games and game technologies to improve players’ health behaviors and outcomes – and this, of course, is our ultimate goal with health games.