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27 sep 2011

Exergames and health promotion – Nintendo wii sports: Physiological measures VS. perceived opinions

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Video games have become a very popular part in our society. More and more new manufactured games include real physical activity. These so-called exergames tend to be associated with sport, physical activity and health promoting effects. Among exergaming consoles, the Nintendo Wii console is the best selling and most popular one.


Autor(es):
Rolf Kretschmann
Entidades(es): University of Stuttgart
Congreso: VII CONGRESO DE LA ASOCIACIÓN INTERNACIONAL DE ESCUELAS SUPERIORES DE EDUCACIÓN FÍSICA (AIESEP)
A Coruña, 26-29 de Octubre de 2010
ISBN: 978-84-614-9946-5
Palabras claves: Energy expenditure, exergaming, health promotion

ABSTRACT

Video games have become a very popular part in our society. More and more new manufactured games include real physical activity. These so-called exergames tend to be associated with sport, physical activity and health promoting effects. Among exergaming consoles, the Nintendo Wii console is the best selling and most popular one. However, the research question remains whether a health promoting potential of the Nintendo Wii can be approved or not.

15 sport-science students (8 males and 7 females, M (age) = 24 + 1.69 years) played the Nintedo Wii Sports boxing game. To measure the physical activity level while playing, the students were attached with five accelerometers (two right above the ankles, two right above the wrists, and one around the hip) plus one heart-rate sensor on the chest. Additionally, students were filmed by two cameras from different angles. After having finished playing, participants were asked to complete a questionnaire relating to health aspects and immediate gaming experience.

The results of this study (average EE = 8.27 kJ/ min) confirm the positive benefits of playing the Nintendo Wii boxing game for promoting physical activity and a healthy lifestyle (ACSM Guidelinen). Questionnaire results also show a positive tendency that this video game might lead to a healthy lifestyle and health promotion (from students’ perspective).
Comparing “hard” physiological measures and “soft” student perceptions and opinions towards the Nintendo Wii Sports boxing game, a skeptical habitus for exergames and health promoting comes along with a positive tendency for considering health-promoting effects. However, exergaming can’t be a substitute for real sports and physical activity, but can be a starting-point to motivate physically inactive persons to be more physically active.

INTRODUCTION

Media and technology, especially computer and video games, have become part of the 21st century life (Bausch et al., 2008; Daley, 2009; Papastergiou et al., 2009). The so called exergames are proclaimed to be the next generation of video games due to containing exercise via game play and user interface, leaving sedentary digital games behind (Yang et al., 2008).
Among exergames, a couple of specific platforms and games have been in the focus of research, most of them covering DDR (Dance Dance Revolution) (Sell et al., 2007; Tan et al., 2002; Unnithan et al., 2006), Sony EyeToy (Rand et al., 2008; Larssen et al., 2004; Yavuzer et al., 2008), and/ or Nintendo Wii (Bausch et al., 2008; Graves et al., 2007; Graves et al., 2008).

AREA OF STUDY

High media presence of the Nintendo Wii console, that is the latest and most hyped exergame console in the market, leads to the main (research) question: Is the Nintendo Wii console to be seriously considered to being a factor for healthy behavior and/ or health promotion in general?   
Several sub-questions derive from the main one: What is the amount of physical activity and energy expenditure while playing Nintendo Wii? Can playing Nintendo Wii animate to be more physically active outside the living room? (Papastergiou, 2009; Yang et al., 2008).
The study tackles the Nintendo Wii Sports bundle which features the sports baseball, bowling, boxing, golf, and tennis. The boxing game is selected to be the study centre because previous studies point toward the boxing game being the most physically exhausting one compared to the others (Bausch et al., 2008; Graves et al., 2007; Graves et al. 2008; Porcari et al., 2009; Willems and Bond, 2009).

METHODOLOGY

Participants and setting

For this cross-sectional study, a convenience sample of 15 sport science students (seven female, eight male) in between the first and the 13th semester (M = 5.4 + 3.14) of the University of Stuttgart, Germany, aged from 22 to 26, participated in the study (Table 1).
None of the participants owned or regularly played Nintendo Wii. All male students and two female students had previous experience with playing computer or console games. There was a significant difference between males and females in previous gaming experience (p = 0.001). This result confirms the prejudice that males are more likely to have gaming experience than females.
All students were highly competent at sports; they performed sports at university regularly within their studies (M (doing sports) = 2.4 + 2.53 hours/) or in their leisure time (M (doing sports) = 6.53 + 3.11 hours/ week). There was a significant difference between males and females in age (p < 0.05) and BMI (p < 0.05). Students were recruited randomly during the day of study.
Students had to play the Nintendo Wii Sports boxing game against three different virtual CPU-controlled opponents. A battle is won when one of the virtual competitors wins two of three rounds; so the maximum duration of one fight was three rounds. Playing time is therefore defined by a semantic unit, and not by predefined time period.

Table 1. Descriptive statistics of study sample (+ SD)

Table 1. Exergames and health promotion – Nintendo wii sports: Physiological measures VS. perceived opinions

Contenido disponible en el CD Colección Congresos nº 16

Energy expenditure and heart rate

ActiHeart (Cambridge Neurotechnology Ltd., Papworth, Cambridge, UK) measures heart rate and heart rate variability combined by means of movement sensors. Thereby it is possible to validly measure energy expenditure (Corder et al., 2005). The ActiHeart device was attached to participants via two ECG electrodes on the chest (Figure 1). ActiHeart was set to record heart rate in short-term recording mode continuously over 15-seconds epochs. Recorded data was analyzed using ActiHeart software (Version 4.032, Cambridge Neurotechnology Ltd., Papworth, Cambridge, UK).

Accelerometry

Upgrading the approach of Graves et al. (2008), who used ActiGraph accelerometers for wrist and hip measurement, altogether five uniaxial ActiGraph (GT1M, Pensacola, FL, USA) accelerometers were used (Figure 2). Two ActiGraphs were fixed right above the right and left wrist, another two ActiGraphs right above the right and left ankle. One ActiGraph was fixed around the hip, which is the standardized position due to sensitivity to vertical accelerations (ActiGraph, 2009). The ActiGraphs were fixed via smaller or bigger straps depending on their respective position. The ActiGraphs were set to record activity in 3-seconds epochs. Data was uploaded after each trial using ActiGraph software (Version 4.1.0, ActiGraph Ltd., Pensacola, FL, USA).

Motion observation

Participants’ movements were videotaped while playing. Two video cameras from different angles (frontal and sagittal view) were used (Figure 3). Video data was evaluated with the help of an observation chart coded according to Likert scale (1 = no movement; 5 = high amount of movement). Extremities and hip were evaluated individually. The observation chart was used for each round of the boxing game. Therefore, three charts were filled out for each participant.
Retrospective video data analysis makes sure that participants’ movements can be reviewed as often as needed by the rater. Moreover, the rater can focus on specific observation tasks with each iteration and is therefore not overstrained with observing all chart items at the same time.

Student perceptions

After having finished playing, the participants had to fill out a questionnaire. The first part of the questionnaire determines individual and anthropometry data. The second part contains questions about Nintendo Wii Sports and the boxing game itself, its relation to real sport activities and its influence on motivation to encourage physical activity in real life. The questionnaire contained a total of eight dimensions/ subscales (Motivation for being more physically active during leisure time; Physical effort in general; Physical effort compared to real sports; Health promotion; Physically inactive persons; Subjective well-being; Substitution for real sports; Purchase recommendation), each consisting of three items. Items were scaled using a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree).

RESULTS

Energy expenditure and heart rate

The relationship between measured energy expenditure and heart rate was significant (r = 0.75, p < 0.01). This result was to be expected due to metabolic dependence of heart rate and energy expenditure (Meijer et al., 1989).
Playing the Nintendo Wii Sports boxing game significantly increased predicted energy expenditure above resting energy expenditure (p < 0.001). The game also significantly increased heart rate during exercise above heart rate at rest (p < 0.001). Thus, physical exposure while playing is high enough to be described as physical activity that differs from resting.
Values for energy expenditure, heart rate, and playing time are presented in Table 2. There was no significant difference between sexes.

Table 2. Energy expenditure, heart rate, and playing time (+ SD)

Table 2. Exergames and health promotion – Nintendo wii sports: Physiological measures VS. perceived opinions

Contenido disponible en el CD Colección Congresos nº 16

Accelerometry

Activity data is shown in Table 3. There was no significant difference between sexes.

Table 3. Measured motion (+ SD)

Table 3. Exergames and health promotion – Nintendo wii sports: Physiological measures VS. perceived opinions

Contenido disponible en el CD Colección Congresos nº 16

Activity counts from left wrist correlated with counts from right wrist on a significant level (r = 0.58, p < 0.05). This result was to be expected because the Wii Sports boxing game-play requires both arms.
Counts from right wrist correlated with counts from right ankle on a high significance level (r = 0.66, p < 0.01). This result might be explained by the fact that right-handed people tend to be also right-footed (Oldfield, 1971), leading to be more physically active with their right leg while exercising. All students, except for one, were right-handed.

Among multiple measure-measure models, the 5-measure (left and right hand, hip, left and right foot counts) model appears to best at explaining the variance in energy expenditure (Table 4).
There was no significant difference between right wrist and left wrist counts. There was also no significant difference between right ankle and left ankle counts. These results suggest that the game-play of the Wii Sports boxing game requires left and right extremities movement in equal measure.
Consulting the videos, students tended to have a higher amount of motion for the right foot while punching with the right arm compared to motion for the left foot while punching with the left arm.

Table 4. Prediction equations (ActiGraph counts) for energy expenditure

Table 4. Exergames and health promotion – Nintendo wii sports: Physiological measures VS. perceived opinions

Contenido disponible en el CD Colección Congresos nº 16

Motion observation

Activity counts from right wrist correlated significantly with observed motion of right wrist (r = 0.7, p < 0.05). Counts from left wrist correlated significantly with observed motion of right wrist (r = 0.63, p < 0.05), left wrist (r = 0.61, p < 0.05), and right ankle (r = 0.52, p < 0.05).
Counts from left ankle correlated significantly with observed motion of left ankle (r = 0.61, p < 0.05), heart rate (r = 0.59, p < 0.05), and energy expenditure (r = 0.76, p < 0.05). Counts from right ankle correlated significantly with observed motion of right ankle only (r = 0.52, p < 0.05). Activity counts from hip and measured energy expenditure correlated significantly with observed overall-motion (r = 0.55, p < 0.05).

Calculated correlations point to appropriateness of the observation-chart method. Only extremity ratings diverge slightly from objective accelerometry data. Thus, the observation chart gives a good rating for the amount of physical activity. It can therefore support objective measurement and might be used when objective measurement is unavailable.
Observation-chart results are shown in Table 5. There was no significant difference between sexes.

Table 5. Observed motion (+ SD)

Table 5. Exergames and health promotion – Nintendo wii sports: Physiological measures VS. perceived opinions

Contenido disponible en el CD Colección Congresos nº 16

Student perceptions

Questionnaire results are shown in Table 6.
Playing time, gender, and measured energy expenditure had no significant relation with any dimension/ subscale. There was no significant difference between sexes.

Table 6. Student perceptions

Table 6. Exergames and health promotion – Nintendo wii sports: Physiological measures VS. perceived opinions

Contenido disponible en el CD Colección Congresos nº 16

In spite of the small sample, Cronbach’s alpha values are overall acceptable. Nonetheless, the low Cronbach’s alpha values of the subscales substitution for real sports and purchase recommendation might lead to adapt included items.
In sum, participants did not suppose playing Nintendo Wii Sports increasing their motivation to be more physically active during their leisure time. They did not sense exergaming to be physically exhausting (compared to real sports and in general). In their opinion, playing Nintendo Wii Sports can’t become a substitute for real sports. Furthermore, they slightly tend to not recommend buying the Nintendo Wii console.

Regarding health promotion, participants were undecided whether Nintendo Wii Sports could contribute to physical-activity-increasing and to positive health-related effects.
Altogether, participants tended to increase their subjective well-being after playing Nintendo Wii Sports. There was a steady tendency of considering Nintendo Wii Sports being adequate for physically inactive persons, thus motivating physically inactive persons to be more physically active.

In a different approach, subscales physical effort compared to real sports, physically inactive persons, substitution for real sports, and purchase recommendation might be regarded as expert ratings (Bromme et al., 2005; Forman and Taylor, 2004). Hence, students were seen as experts in their study major in the field of sports, health, and physical activity.
Rating results’ reliability was measured by intra-correlation coefficients (ICC) (Shrout and Fleiss, 1979), regarding each student as an own rater. Physical effort compared to real sports (ICC = 0.69, p < 0.01), physically inactive persons (ICC = 0.72, p < 0.01), and purchase recommendation (ICC = 0.62, p < 0.05) provided good reliability (Fleiss, 1986). Accounting the subscale substitution for real sports does not lead to a significant ICC value.

DISCUSSION

The results of this study (average EE = 8.27 kJ/ min) confirm the positive benefits of playing the Nintendo Wii boxing game for promoting physical activity and a healthy lifestyle (American College of Sport Medicine, 2005). Graf et al. (2009) reported an average energy expenditure amount of 12 kJ/ min that coincides with the results of Graves et al. (2007) (average EE = 12.1 kJ/ min), however only for children and adolescents. Porcari et al. (2009) reported lower average energy expenditure (average EE = 7.2 kJ/ min) compared to the other results, but still high enough to match the ACSM recommendations (American College of Sports Medicine, 2005). Nonetheless, negative result by Willems and Bond (2009) has to be reported. Their study of combined Wii Sports tennis, boxing, and bowling for ten minutes each, reported significantly less energy expenditure compared to brisk treadmill walking for each game. Hence, the observed exergaming activity did not meet guidelines for physical activity of moderate intensity. However, the predominant part of research in this field, including this study, reports positive result.

Multiple-measure models for prediction equations, that most accurately accounted for variations in energy expenditure, in this study differ form the two-measure-model by Graves et al. (2008). The difference might be explained by the special focus group of sport science students. Consulting the videos, participants were very agile while playing, performing with their entire body.
Methods for motion measuring depend on specific games and their game-play. The amount of motion in extremities is more important for exergames compared to sedentary video games (Graves et al., 2008). Subjective and objective methods might be mixed. For instance, accelerometry can add to heart rate measurement and spiroergometry (Böhm et al., 2008), maybe combined with well-designed observation charts and video analysis. This study combined several methods and might serve as starting point for further creative methods.

However, video analysis in this study did not focus on movement quality. There is a difference in specific individual motor performance. Whether a movement is functional or dysfunctional conduces to a healthy or unhealthy movement effect. This dimension is evidently under-researched so far. Putting the focus on movement quality might also enlighten the negative results by Willems and Bond (2009) and differences between particular studies. In addition, the amount of motion of experienced gamers is quite likely lower compared to inexperienced gamers. Beginners usually tend to move more expansively.
The observation-chart method could be used to identify whether upper and lower limb, and hip differ according to the amount of motion on a first-sight basis. It would be interesting comparing observation-charts for different games that differ in game-play regarding upper and lower limb involvement.

The questionnaire result for a positive effect/ recommendation of Nintendo Wii Sports for physically inactive persons from the perspective of highly physically active sport science students is a result of matter. The opinion of sport science students, being experts for physical activity, is an opinion of high value. Sport science students’ ratings may be regarded as expert ratings, as ICC values are good. Nevertheless opinions/ perceptions are subjective and need inter-subjective validation. Further studies with bigger sample sizes might help validating in that case. In addition, quality education of sport science has to be secured sustainably and students have already to be taught to take over the role of an expert during their studies (Hall et al., 1996).
However, regarding this study’s sample, a small convenience-sample of sport science students surely does not represent the whole body of students. Degree of competence at and knowledge of sports differ from students of other subjects. Thus, the results must be denominated as results of a very specific group. In addition, university/ college students might react differently to exergames than other groups (Siegel et al., 2009).

Though the trivia of a significant difference between energy expenditure of seated/ sedentary video games and exergames is empirically evident (Ainsworth et al., 2009; Graves et al., 2007; Lanningham-Foster et al., 2006; Mellecker and McManus, 2008), future research might feature specific exergames, platformed on specific consoles using specific user interfaces (Caroll et al., 2009).
Though most current research on exergames focus on children and adolescends (Baranowski et al., 2007; Graf et al., 2009; Papastergiou, 2009; Yang et al., 2008), future research should “include individuals of various fitness levels, skill levels, functional capacities, ages, other active games, and measuring health outcomes from a Nintendo Wii training study” (Bausch et al., 2008). Regarding the fact that there is only limited research on interventions so far (Daley, 2009; Warburton et al., 2007), sophisticated research designs and long-term studies are highly recommended (Yang et al., 2008).

At last, the aspect of collaborative and/ or competitive gaming should not be underrated (Graves et al., 2007; Gorgu et al., 2009). Computer-human- and human-human-interaction might have different impacts on physical activity levels (according to motivation, mood, and social interaction). This study, and all other mentioned ones, did not focus on potential effects of social interaction on (social and mental) health, but these aspects might hopefully be a centre part in future research.

CONCLUSION

The answer to the (overall research) question, whether Nintendo Wii (Sports) is serious and contributes to health promotion has not been fully given yet. Only indications for a positive effect according to energy expenditure, motion, and sport science student perceptions (especially for physically inactive persons) are striking results of this study. Energy expenditure results (average EE = 8.27 kJ/ min) strongly tend toward considering the Nintendo Wii Sports (at least the boxing game) rather being serious than being just a gadget.

Comparing “hard” physiological measures and “soft” student perceptions and opinions towards the Nintendo Wii Sports boxing game, a skeptical habitus for exergames and health promoting comes along with a positive tendency for considering health-promoting effects. However, exergaming can’t be a substitute for real sports and physical activity, but can be a starting-point to motivate physically inactive persons to be more physically active.

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