Postural activity and motion sickness during video game play in children and adults

EXPERIMENTAL BRAIN RESEARCH

Volume 217, Number 2 (2012), 299-309,
Chih-Hui Chang, Wu-Wen Pan, Li-Ya Tseng and Thomas A. Stoffregen

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Abstract Research has confirmed that console video games give rise to motion sickness in many adults. During exposure to console video games, there are differences in postural activity (movement of the head and torso) between participants who later experience motion sickness and those who do not, confirming a prediction of the postural instability theory of motion sickness. Previous research has not addressed relations between video games, movement and motion sickness in children. We evaluated the nauseogenic properties of a commercially available console video game in both adults and 10-year-old children. Individuals played the game for up to 50 min and were instructed to discontinue immediately if they experienced any symptoms of motion sickness, however mild. During game play, we monitored movement of the head and torso. Motion sickness was reported by 67% of adults and by 56% of children; these rates did not differ. As a group, children moved more than adults. Across age groups, the positional variability of the head and torso increased over time during game play. In addition, we found differences in movement between participants who later reported motion sickness and those who did not. Some of these differences were general across age groups but we also found significant differences between the movement of adults and children who later reported motion sickness. The results confirm that console video games can induce motion sickness in children and demonstrate that changes in postural activity precede the onset of subjective symptoms of motion sickness in children.

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Determining intensity levels for selected Wii Fit activities in college aged individuals.

By Joshua D. Grieser
Master of Science in Exercise and Sports Studies thesis
May 2010

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ABSTRACT
Introduction: Physical activity is important to the proper growth, development, and overall health of an individual. Current physical activity trends show declines in activity level throughout aging. To counteract inactivity many physical activity interventions have been implemented in different age groups and yet very little change in activity level has been seen. The Nintendo Wii® offers a popular technological intervention tool with its movement oriented game play. The physiological costs and intensity of the Nintendo Wii Fit® game have not been thoroughly researched, yet the Wii is being used as a physical activity tool in many arenas.


Purpose: The purpose of this study was to determine the intensity level of playing selected Nintendo Wii Fit® games using indirect calorimetry. Using the intensity information, it was determined if playing Wii Fit® (an exercise themed game) on the Nintendo Wii® video game console is an adequate activity for meeting the ACSM moderate physical activity guidelines threshold. Participants: Twenty-five participants, 5 males and 20 females, aged 22 ± 2 years (M ± SD) with little previous Wii experience were recruited for this study.

Method: Participants randomly completed two different Wii Fit activity sessions with two difficulty levels within the strength, endurance, and yoga categories. A resting metabolic rate and exercise VO2were measured on each participant with a TrueMax 2400 metabolic cart. Oxygen consumption was then converted into metabolic equivalents to estimate activity intensity level. SPSS18.0 (Chicago, IL, USA) was use for statistical analysis.

Results: Results indicated that VO2 of the selected Wii Fit activities was significantly higher than resting 2 VO levels. For example, the least intense activity was the Yoga Warrior activity, which had a mean intensity of 2.30 ± 0.42 METs and was still significantly higher than resting 2 VO levels, t (24) = 15.5, p < .001. The calculated MET values ranged from 3.28 ± 0.71 METs to 3.43 ± 0.60 METs for the strength activities, and ranged from 4.98 ± 1.22 METs to 5.73 ± 1.36 METs for the aerobic Basic Run exercises, indicating that the intensity levels of these activities met or exceeded the ACSM moderate intensity threshold of 3 METs. In contrast, the yoga exercises were significantly lower (from 2.30 ± 0.42 METs to 2.6749 ± .48 METs) than the recommended 3 METs, t (24) = -3.347, p= .003 for moderate intensity physical activity. Finally, the results showed that the medium difficulty level aerobic exercises (5.73 ± 1.36 METs) had significantly higher MET values than the easy aerobic exercises (4.98 ± 1.22 METs), t (24) = 5.00, p < .001.

Discussion: The findings of this study illustrate the potential of the Nintendo Wii Fit® game to be an adequate physical activity tool. Furthermore, these findings will allow for the further advancement of exercise themed video games to become satisfactory replacements for traditional physical activities in future interventions.

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Changes in physical activity and fitness after 3 months of home Wii Fit(TM) use

Journal of Strength & Conditioning Research:

25(11): 3191-3197, 

11 October 2011

Owens, SG, Garner III, JC, Loftin, JM, van Blerk, N, and Ermin, K.

Original Article: PDF Only

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Abstract 
The purpose of this study was to examine changes in physical activity and fitness variables in members of 8 volunteer families after 3 months of home use of the Wii Fit(TM) interactive video game. Pre and postintervention measurements were obtained from 21 subjects relative to physical activity (5 days of accelerometry), aerobic fitness (graded treadmill test), muscular fitness (push-ups), flexibility (sit-and-reach test), balance (composite equilibrium score), and body composition (body mass index and % body fat). Use characteristics of the Wii Fit(TM) device were also determined. A series of 2 (age group) x 2 (time) repeated measures analyses of variance were conducted to assess changes over time and between adults and children. Three months of home Wii Fit(TM) use revealed no significant age group x time interactions or main effects of group or time for daily physical activity, muscular fitness, flexibility, balance, or body composition. An age group x time interaction (p = 0.04) was observed in peak [latin capital V with dot above]O2 (ml[middle dot]kg-1[middle dot]min-1) with children displaying a significant (p = 0.03) increase after 3 months of Wii Fit(TM) use, whereas adults showed no significant (p = 0.50) change. Daily Wii Fit(TM) use per household declined by 82% (p < 0.01) from 21.5 +/- 9.0 min[middle dot]d-1 during the first 6 weeks to 3.9 +/- 4.0 min[middle dot]d-1 during the second 6 weeks. Most measures of health-related fitness in this exploratory study remained unchanged after 3 months of home use of the popular Wii Fit(TM) whole-body movement interactive video game. Modest daily Wii Fit(TM) use may have provided insufficient stimulus for fitness changes. 


 (C) 2011 National Strength and Conditioning Association 


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Effects of an Interactive Video Game (Nintendo Wii™) on Older Women with Mild Cognitive Impairment

THERAPEUTIC RECREATION JOURNAL Vol,. XLIV, No. 4 • 271-287 • 2010

Elizabeth H. Weybright, CTRS
John Dattilo
Frank R. Rusch

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Abstract
Older adults with a cognitive impairment in residential care settings are often found
to be inactive throughout the day. Participation in video games holds promise for these
individuals; however, effects of video games played by older adults have not been studied
consistently and the few studies conducted have yielded mixed results. The purpose of
this study was to examine effects of an interactive video game (Nintendo Wii'" bowling)
on attention to task and positive affect of older adult women with mild cognitive impairment. A single-subject, multiple baseline design comparing a television viewing phase
and an interactive video game phase was conducted using observational measures. Results
indicated that both participants attended to task more and demonstrated higher levels of
positive affect while engaged in the interactive video game as compared to baseline. The
low-impact activity of the Nintendo Wii" bowling program may provide the appropriate amount of physical and mental challenge and stimulation for older adults with mild
cognitive impairments.

KEYWORDS: Interactive video game, mild cognitive impairment, older adult,
recreation

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Using Wii Fit to reduce fatigue among African American women with systemic lupus erythematosus: A pilot study

Lupus. 2011 Jun 23

Yuen H, Holthaus K, Kamen DL, Sword D, Breland HL.

University of Alabama at Birmingham, USA.

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Abstract

Fatigue and physical deconditioning are common, difficult to treat conditions among patients with systemic lupus erythematosus (SLE). The aim of this pilot study was to evaluate the effectiveness of a home-based exercise program using the Wii Fit system in patients with SLE. Fifteen sedentary African American women with SLE experiencing moderate to severe fatigue participated in a home exercise program using the Wii Fit 3 days a week for 30 minutes each for 10 weeks. A one-group pretest-post test design was used to evaluate the effectiveness of this program. Primary outcome measure was severity of fatigue. Secondary outcome measures were body weight, waist circumference, fatigue-related symptoms of distress, activity level, and physical fitness. At the completion of the 10-week Wii Fit exercise program, participants perceived fatigue severity as measured by the Fatigue Severity Scale to be significantly decreased (p= 0.002), and body weight and waist circumference were significantly reduced (pp= 0.01). In addition, anxiety level, as measured by Hospital Anxiety and Depression Scale, and overall intensity of total pain experience, as measured by Short-form of the McGill Pain Questionnaire, were also significantly reduced (p < 0.05). Findings provide preliminary evidence that the Wii Fit motivates this population to exercise, which leads to alleviation of fatigue and reduced body weight, waist circumference, anxiety level, and overall intensity of total pain experience.

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Evaluation of the Frails' Fall Efficacy by Comparing Treatments (EFFECT) on reducing fall and fear of fall in moderately frail older adults: study protocol for a randomised control trial

Trials. 2011; 12: 155.
Published online 2011 June 18

Boon Chong Kwok, Kaysar Mamun, Manju Chandran and Chek Hooi Wong

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Abstract

Background
Falls are common in frail older adults and often result in injuries and hospitalisation. The Nintendo® Wii™ is an easily available exercise modality in the community which has been shown to improve lower limb strength and balance. However, not much is known on the effectiveness of the Nintendo® Wii™ to improve fall efficacy and reduce falls in a moderately frail older adult. Fall efficacy is the measure of fear of falling in performing various daily activities. Fear contributes to avoidance of activities and functional decline.

Methods
This randomised active-control trial is a comparison between the Nintendo WiiActive programme against standard gym-based rehabilitation of the older population. Eighty subjects aged above 60, fallers and non-fallers, will be recruited from the hospital outpatient clinic. The primary outcome measure is the Modified Falls Efficacy Scale and the secondary outcome measures are self-reported falls, quadriceps strength, walking agility, dynamic balance and quality of life assessments.

Discussions
The study is the first randomised control trial using the Nintendo Wii as a rehabilitation modality investigating a change in fall efficacy and self-reported falls. Longitudinally, the study will investigate if the interventions can successfully reduce falls and analyse the cost-effectiveness of the programme.


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Changes in balance in older adults based on use of physical therapy vs the Wii Fit gaming system: a preliminary study - April 2011

Physiotherapy : Available online 29 April 2011.

Hamid Bateni

School of Allied Health and Communicative Disorders, Physical Therapy Program, Northern Illinois University, 1425 W. Lincoln Hwy, DeKalb, IL 60115-2828, USA

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Abstract

Objectives
To determine the effectiveness of Wii Fit training on balance control in older adults compared with physical therapy training.

Design
Quasi-experimental design.

Participants
Eight males and nine females aged 53 to 91 years.

Materials and methods
Participants were divided into three groups: one group received both physical therapy training and Wii Fit training (PW group), one group received Wii Fit training alone (WI group), and one group received physical therapy training alone (PT group). Training consisted of three sessions per week for 4 weeks.

Main outcome
Berg Balance Scale (all groups) and Bubble Test (PW and WI groups) scores.

Statistical analysis
Descriptive statistics, medians, interquartile ranges and 95% confidence intervals are reported to identify trends in balance control as a result of different types of training.

Results
All subjects showed improvement in the Berg Balance Scale and Bubble Test scores. The PT and PW groups tended to perform better than the WI group on the Berg Balance Scale following treatment. Although the differences in the Bubble Test score were not substantial between the PW and WI groups, the PW group performed slightly better than the WI group on the Berg Balance Scale.

Conclusions
Wii Fit training appears to improve balance. However, physical therapy training on its own or in addition to Wii Fit training appears to improve balance to a greater extent than Wii Fit training alone.

Keywords: Wii Fit; Postural balance; Berg Balance Scale; Computerised gaming systems

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Wii-based movement therapy to promote improved upper extremity function post-stroke: A pilot study May 2011

Journal of Rehabilitation Medicine. 2011 May;43(6):527-33.

Mouawad MR, Doust CG, Max MD, McNulty PA.
Source

Neuroscience Research Australia and University of New South Wales.

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Abstract

BACKGROUND:

Virtual-reality is increasingly used to improve rehabilitation outcomes. The Nintendo Wii offers an in-expensive alternative to more complex systems.

OBJECTIVE:

To investigate the efficacy of Wii-based therapy for post-stroke rehabilitation.

METHODS:

Seven patients (5 men, 2 women, aged 42-83 years; 1-38 months post-stroke, mean 15.3 months) and 5 healthy controls (3 men, 2 women, aged 41-71 years) undertook 1 h of therapy on 10 consecutive weekdays. Patients progressively increased home practice to 3 h per day.

RESULTS:

Functional ability improved for every patient. The mean performance time significantly decreased per Wolf Motor Function Test task, from 3.2 to 2.8 s, and Fugl-Meyer Assessment scores increased from 42.3 to 47.3. Upper extremity range-of-motion increased by 20.1º and 14.33º for passive and active movements, respectively. Mean Motor Activity Log (Quality of Movement scale) scores increased from 63.2 to 87.5, reflecting a transfer of functional recovery to everyday activities. Balance and dexterity did not improve significantly. No significant change was seen in any of these measures for healthy controls, despite improved skill levels for Wii games.

CONCLUSION:

An intensive 2-week protocol resulted in significant and clinically relevant improvements in functional motor ability post-stroke. These gains translated to improvement in activities of daily living.

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The cardiovascular and metabolic responses to Wii Fit video game playing in middle-aged and older adults Dec 2010

The Journal of Sports Medicine and Physical Fitness
2010 December;50(4):436-42 
Guderian B. 1, Borreson L. A. 1, Sletten L. E. 1, Cable K. 1, Stecker T. P. 1, Probst M. A. 1, Dalleck L. C. 2

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Abstract
AIM: The purpose of this study was (a) to assess the cardiovascular and metabolic responses to Wii Fit video games and (b) to determine if Wii Fit video games meet the American College of Sports Medicine guidelines for improving and maintaining cardiorespiratory fitness.
METHODS: Twenty men and women (mean±SD age, height, and weight: = 58.1±8.8 years, 172.1±10.5 cm, 87.1±22.8 kg, respectively) completed a 20-min Wii Fit testing session consisting of six separate aerobic and balance games. Cardiovascular and metabolic data were collected via a portable calorimetric measurement system.
RESULTS: Mean relative exercise intensity was 43.4±16.7% of heart rate reserve. Absolute exercise intensity in metabolic equivalents (METS) was 3.5±0.96. Total net energy expenditure for the Wii Fit video game playing session was 116.2±40.9 kcal/session.
CONCLUSION: Results indicate that playing Wii Fit video games is a feasible alternative to more traditional aerobic exercise modalities for middle-aged and older adults that fulfills the American College of Sports Medicine guidelines for improving and maintaining cardiorespiratory fitness.

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Lessons learned: Staff perceptions of the Nintendo Wii as a health promotion tool within an aged-care and disability service.

Health promotion journal of Australia, 2010 Dec;21(3):189-95.

Higgins HC, Horton JK, Hodgkinson BC, Muggleton SB.

Blue Care, Milton, Queensland.

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Abstract
Issue addressed: Enhancing opportunities for all older people to be physically and mentally active is an imperative in our ageing society. Lessons learned from the use of the Nintendo Wii within Queensland agedcare and disability services were assembled through eliciting staff perceptions regarding the usefulness of Wii technology within their centres.

Methods: Telephone interviews were conducted with direct care staff in 53 centres that had been using the Wii technology for at least three months. Content analysis of interview data identified the major response patterns raised by staff.

Results: Staff noted that Wii activities were easy to master for more able clients and that there was minimal risk to clients. Staff reported that these activities provided health promoting physical benefits (mobility, range of motion, dexterity, coordination, distraction from pain) and psychosocial gains (social engagement, self-esteem, mastery, ability to pacify challenging behaviours) and were a useful adjunct to other care practices within these aged-care and disabilities services.

Conclusions: Staff believed that Wii activities provided purposeful and meaningful opportunities to promote wellbeing for aged and disabled clients within an aged-care and disability service. However, Wii activities were less successful with clients who had significant cognitive and/or physical disabilities.

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Assessing and training standing balance in older adults: A novel approach using the 'Nintendo Wii' Balance Board.

Gait Posture. 2010 Nov 17. [Epub ahead of print]

Young W, Ferguson S, Brault S, Craig C.

The School of Psychology, The Queen's University Belfast

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Abstract
Older adults, deemed to be at a high risk of falling, are often unable to participate in dynamic exercises due to physical constraints and/or a fear of falling. Using the Nintendo 'Wii Balance Board' (WBB) (Nintendo, Kyoto, Japan), we have developed an interface that allows a user to accurately calculate a participant's centre of pressure (COP) and incorporate it into a virtual environment to create bespoke diagnostic or training programmes that exploit real-time visual feedback of current COP position. This platform allows researchers to design, control and validate tasks that both train and test balance function. This technology provides a safe, adaptable and low-cost balance training/testing solution for older adults, particularly those at high-risk of falling.

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The physiological cost and enjoyment of Wii Fit in adolescents, young adults and older adults.

Journal of Physical Activity and Health. 2010 May;7(3):393-401.

Graves LE, Ridgers ND, Williams K, Stratton G, Atkinson G, Cable NT.

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BACKGROUND: Active video games (exergames) increase energy expenditure (EE) and physical activity (PA) compared with sedentary video gaming. The physiological cost and enjoyment of exergaming in adolescents, and young and older adults has not been documented, nor compared with aerobic exercise. This study compared the physiological cost and enjoyment of exergaming on Wii Fit with aerobic exercise in 3 populations.

METHODS: Cardiorespiratory and enjoyment measurements were compared in 14 adolescents, 15 young adults, and 13 older adults during handheld inactive video gaming, Wii Fit activities (yoga, muscle conditioning, balance, aerobics), and brisk treadmill walking and jogging.

RESULTS: For all groups EE and heart rate (HR) of Wii Fit activities were greater than handheld gaming (P < .001) but lower than treadmill exercise. Wii aerobics elicited moderate intensity activity in adolescents, young adults, and older adults with respective mean (SD) metabolic equivalents of 3.2 (0.7), 3.6 (0.8), and 3.2 (0.8). HR during Wii aerobics fell below the recommended intensity for maintaining cardiorespiratory fitness. Group enjoyment rating was greater for Wii balance and aerobics compared with treadmill walking and jogging. CONCLUSIONS: Wii Fit appears an enjoyable exergame for adolescents and adults, stimulating light-to-moderate intensity activity through the modification of typically sedentary leisure behavior. Click here for more