Fitness game, exergaming or exer-gaming (a portmanteau of "exercise" and "gaming"), or gamercising [1] [2] [3] is a term used for video games that are also a form of exercise. [4] Exergaming relies on technology that tracks body movement or reaction. The genre has been credited with upending the stereotype of gaming as a sedentary activity, and promoting an active lifestyle. [5] Exergames are seen as evolving from technology changes aimed at making exercise more fun. [6]
The genre's roots can be found in game peripherals released in the eighties, including the Joyboard, [7] [8] a Atari 2600 peripheral developed by Amiga and released in 1982, the Power Pad (or Family Trainer) a peripheral for the Nintendo Entertainment System (NES), originally released by Bandai [9] in 1986, and the Foot Craz released for the Atari 2600 in 1987, [10] although all three had limited success. [7] [9] Konami's Dance Dance Revolution (1998) was cited as one of the first major successes of exergaming; when it was ported from the arcade to PlayStation, it sold over three million copies. [11] In the 2000s, a number of devices and games have used the exergame style to much success: [12] the EyeToy camera has sold over ten million units, [13] while Nintendo's Wii Fit has sold in excess of 21 million copies. [14] By June 2009, health games were generating revenues of $2 billion, largely due to Wii Fit's 18.22 million sales at the time. [15] The term exergaming entered the Collins English Dictionary in 2007. [16]
The genre has been promoted as a way to improve users' health through exercise, [11] but few studies have been undertaken to measure the health benefits. Smaller trials have yielded mixed results and have shown that the respective traditional methods of exercise are superior to their video game equivalents. [17] Design considerations for exergames include the need to balance the physical effectiveness of the exercise with the attractiveness of the gameplay, with both factors needed to be adapted to the abilities of the player, referred to as 'dual flow' [18]
Exergaming contains elements that were developed in the virtual reality community during the 1980s. The pioneer in this area was Autodesk, which developed two systems, the HighCycle and Virtual Racquetball. The HighCycle was an exercise bike that a user would pedal through a virtual landscape. If the user pedaled fast enough, the virtual bike would take off and fly over the landscape. Virtual Racquetball tracked the position and orientation of an actual racquet that was used to hit a virtual ball in a virtual environment. This environment was shared with another user equipped with another tracked racquet, allowing the two users to play each other over phone lines. In both systems, the users could wear the VPL eyephones, an early head-mounted display (HMD), that would provide more immersion for the user. [19]
The first true attempt at what would later be called Exertainment was the Atari Puffer project (1982). This was an exercise bike that would hook up to an Atari 400/800 or 5200 system. [20] [21] Forward speed was controlled by pedaling while steering and additional gameplay was handled by a handlebar-mounted Gamepad. The machine was nearly ready for production with several games (Tumbleweeds and Jungle River Cruise) when Atari declared bankruptcy and the Puffer project was abandoned. The Joyboard for the Atari 2600 was also released in 1982, by the Amiga Corporation.
In Japan, Bandai dabbled in this space with the Family Trainer pad, released in 1986 for the Famicom (the Japanese version of the Nintendo Entertainment System). In 1988, Nintendo acquired the North American rights to the pad, and marketed it as the Power Pad in North America. [7] [22]
The first exergaming system released to the market was the 1986 Computrainer. Designed as a training aid and motivational tool, the Computrainer allowed users to ride through a virtual landscape generated on an NES, while monitoring data such as power output and pedaling cadence. The product had a price that was far too high to be considered as an entertainment product, but was affordable by dedicated athletes. The product continues to this day, where it now runs using Microsoft Windows compatible software with extensive graphic and physiological capabilities.
About the same time as the Computrainer, Concept II introduced a computer attachment for their rowing machine. This has become their eRow product and is used for both individual motivation as well as competition in "indoor rowing leagues".
During the 1990s, there was a surge of interest in the application of "virtual reality" technologies to high-end gym equipment. Life Fitness and Nintendo partnered to produce the Exertainment System; Precor had an LCD-based bike product, and Universal had several CRT-based systems. The Netpulse system provided users with the ability to browse the web while exercising. Fitlinxx introduced a system that used sensors attached to weight machines in order to provide automated feedback to users.
Three issues combined to ensure the failure of these systems in the marketplace. First, they were significantly more expensive than the equivalent models that did not have all the additional electronics. Second, they were harder to maintain, and were often left broken. Lastly the additional expertise required to operate the software was often intimidating to the users, who shied away from the machines out of fear that they would look foolish while trying to master the machine.
Until 1998, nothing significant happened in the field of videogame exercise. Hardware was still too expensive for the average home consumer, and the health clubs were gun-shy about adopting any new technology. As high-performance game console capabilities improved and prices fell, manufacturers once more started to explore the fitness market.
In 1998, Konami's Dance Dance Revolution was released. Pump It Up (video game series), a dance game similar to Konami's, was released in 1999 by the company Andamiro.
In 2000, UK startup Exertris introduced an interactive gaming bike to the commercial fitness market.
Exergaming came to the mass media attention at the Consumer Electronics Show when Bill Gates showcased the Exertris Interactive Gaming Bike in 2003, and the following year the same show hosted a pavilion dedicated to video game technology that also worked as sports and exercise equipment.
The 2005 release of the EyeToy: Kinetic brought the first multi-function exergame hardware into the home market. Making the players physical movements into the game's controller. 2006 saw the launch of Gamercize, combining traditional fitness equipment with game consoles. The minimalist approach allows game play to continue only when exercising, turning all game titles into potential exergames.
Nintendo's Wii in 2006 brought acceleration detection with the Wii Remote. In late 2007, Nintendo released the exergame Wii Fit, which utilized a new peripheral, the Wii Balance Board. The popularity of the Wii lead to it being used in hospital "Wiihab" rehabilitation programs. [23]
The PCGamerBike appeared at CES in 2007 where it received an Honoree Award. It differs from other exergaming devices in that its pedal motion can be mapped to any key on the keyboard. It also has an optical encoder which detects forward and reverse pedal motion. The Fisher-Price Smart Cycle was another entry in the field.
Other examples of exergaming products include: Positive Gaming iDANCE, iSTEP, Cobalt Flux Blufit, Cyber coach, NeoRacer, Gymkids exercise equipment with interactive technology, some Wii titles such as EA Sports Active, Cybex TRAZER, Powergrid Fitness Kilowatt, Lightspace Play Floor, PlayMotion, Yourself!Fitness, Expresso Fitness S2, i.play, Cyber ExerCycle, VEQTOR Sport Trainer and Sportwall.
The Kinect (2010) represented a significant advance in how player motion was detected in games, because the player's body became the remote. [24] The exergaming trend within consoles that started with the seventh generation Wii peaked with the Nike+ Kinect Training (2012) & pedometer-pairing Wii Fit U (2013) games. These were followed up in the eighth generation by an exergaming push by Microsoft with the Xbox One launch day Xbox Fitness service (2013), which tracked metrics such as heart rate and correct form while synchronising these metrics with the Microsoft Health. By 2017, Microsoft had pivoted away from Kinect and exergaming on consoles. In 2019, Nintendo released Fitness Boxing, and Ring Fit Adventure for the Nintendo Switch, which take advantage of the Joy-Con controllers, acting as motion detectors in multiple areas of the body.
Mobile phone apps such as Zombies, Run! (2012), Run An Empire, [25] Ingress (2013), and Pokémon Go (2016) have been described as augmented reality exergames. [26] [27]
VR, or Virtual Reality, is now starting to become a major player in the world of Exergaming. Games like Beat Saber, Holodance, OhShape, and others allow players to get good exercise while playing a video game.
Exergaming gained popularity during the COVID-19 pandemic. Ring Fit Adventure (2019), an exergame, sold-out at most retailers worldwide [28] and saw a price increase from $80 to $300 on reselling websites. [29] Nintendo also released Jump Rope Challenge (2020) for free and for a limited time in an effort to keep Nintendo Switch owners active while in quarantine. [30] However, Nintendo later announced that the game would remain on the Nintendo eShop until further notice. [31] As of September 30, 2020, players of the game had recorded 2.5 billion jumps in total. [31]
The COVID-19 pandemic also caused delays in the exergaming industry. One reason Ring Fit Adventure (2019) did not have enough supply to meet demand was that China was hit early by the pandemic, leading to manufacturing shortages. [32] The pandemic also delayed several VR products, such as the Valve Index, [33] and titles such as Marvel's Iron Man VR [34] and Little Witch Academia: VR Broom Racing. [35]
Exergames also proved to be especially helpful during the COVID-19 pandemic, as they were a great motivator for physical activity, which fought the sedentary lifestyle lockdowns caused. [36] Exergames were especially important as physical activity was crucial to fight disease, as it boosted the immune system, shortened the recovery period from COVID-19, and reduced the negative effects of stress from living in isolation. [36] [37]
Overwhelmed medical centers also turned to therapeutic exergames during the COVID-19 pandemic, as they proved to be more socially distant, required less direct supervision, and used less personal protective equipment. [38] These games can be adjusted for each patients' exercise needs, making them suitable for the COVID-19 patients whose mobility became limited, or elderly patients, who were affected by COVID-19 at an increased rate. [38]
Recreational exergames can also be useful for rehabilitation. [39] While they are not always as adjustable as therapeutic exergames, recreational exergames can still help maintain an adequate amount of physical activity, can help those without access to traditional rehabilitation, and can prolong the benefits of in-hospital rehabilitation. [39] However, recreational exergames might require more supervision, as they are less likely to exercise the correct muscles as therapeutic exergames. [38] [39]
Laboratory studies have demonstrated that some exergames can provide light to moderate intensity physical activity. [40] [41]
Exercise games have also proven to be an effective supplement for rehabilitation programs during the COVID-19 pandemic, including balance rehabilitation for the elderly. [42] Children are oftentimes more receptive to the idea of exergaming, making it an especially helpful tool in motivating ill children in their rehabilitation efforts. [43]
A 2021 systematic review found that exercise games could reduce BMI, and improve body fat percentage and cardiorespiratory fitness. [44]
A 2020 systematic review found that exergames can be utilized to augment treatment for a variety of patient populations such as geriatrics, and those with Parkinson’s disease, cerebral palsy, and spinal cord injuries. [45]
A 2019 systematic review and meta-analysis found that exergames are effective for improving muscle tension, muscle strength, activities of daily living (ADL), joint range of motion, gait, balance, and kinematics. The review also suggested that exergames may be more effective at improving dynamic balance control and preventing falls in subacute and chronic stroke patients when compared to current treatment methods. [46]
A 2018 systematic review in the Journal of Medical Internet Research of 10 randomized trials studying the "Social Effects of Exergames on Older Adults" found that "the majority of exergame studies demonstrated promising results for enhanced social well-being, such as reduction of loneliness, increased social connection, and positive attitudes towards others". [47]
Another 2018 systematic review of 10 randomised controlled trials of exergaming in overweight children found that they can produce a small reduction in body mass index. [48]
As of 2016, exergaming for those with neurological disabilities had been studied in around 140 small clinical trials in people of all ages, to see if exergaming can help this group get enough physical exercise to maintain their health. This mode of getting exercise appears attractive in this population from a public health perspective because of its low cost and accessibility. [49] Exergames have the potential to provide moderate intensity exercises in this population, but the evidence was too weak on long-term follow-up to draw strong conclusions. [49]
There is significant evidence across multiple random controlled trials relating exergaming to improved cognitive functioning in healthy older adults (with a mean age of 69), and attenuated deterioration or improvement in adults with cognitive impairment from neurodegenerative diseases such as Alzheimer's disease. [50]
In addition, studies investigated if exergaming can lead to improvements in cognitive performance in clinical and non-clinical populations such as those who have ADHD and depression. [51] [52] [53] There are first encouraging results, but the empirical evidence still is limited. [4]
Studies have shown that exergaming helps manage anxiety in several ways. Exergames help lower anxiety levels in various clinical populations such as patients with Parkinson's disease, enrolled in cardiac rehabilitation, with fibromyalgia, and with systemic lupus erythematosus by introducing more permanent positive physiological changes than methods that do not involve exercise do. [54]
Exergames are accessible to many disabled patients, as some have settings that allow the game to remember a person's range of motion, whether they have any assistive devices, and general physical ability. [38]
Exergames have been shown to be safe and cost effective when used for stroke rehabilitation. [55] Virtual environments allow patients to practice skills that would otherwise be unsafe in real world scenarios. A stroke patient with compromised balance, for example, could practice crossing the street in a simulated environment, something that would be risky and unsafe in real time. [56] Exergames can also make typical rehab exercises safer. Implementing virtual obstacles instead of physical obstacles in balance training exercises, for example, mitigates the risk of falls while increasing a patient's confidence. [57]
When making an exergaming system, the manufacturer of a consumer product must make the decision as to whether the system will be usable with off-the-shelf games or if custom software must be written for it. Because it takes longer for a user to move their entire body in response to stimulation from the game, it is often the case that dedicated software must be written for the game to playable. An example of this is Konami's Dance Dance Revolution . Though designed to be played by users moving about on a specially designed dancepad, that game can alternatively be played by pushing buttons with one's fingers using a standard hand-held gamepad. When played with the dancepad at higher levels the game can be quite challenging (and physically exhausting), but if the game is played using the buttons on the hand controller, none of the sequences are physically limited.
Newer systems such as Xbox 360, PlayStation 3 and Wii use alternative input devices such as the Kinect and PlayStation Move. The Move uses image analysis to extract the motion of the user against a background and uses these motions to control the character in the game. A specifically designed exercise game Kinect, superimposes animated objects to be punched, kicked, or otherwise interacted with over a video image of the user. The Wii and PlayStation 3 both incorporate motion sensors such as accelerometers and gyroscopes into the hand-held controllers that are used to direct behaviors within the game.
Research projects such as exertion interfaces [58] that investigate the design aspects of these games [59] explore how the technological augmentation that comes with the digital gameplay component can be nurtured for additional benefits, such as utilizing the social power of exercising together even though players are connected only over a network [60] or scaling the number of players, [61] enabling novel exercise experiences not available without the technological augmentation.
Exergame resellers have developed fitness centers and specialist room designs with programmes that focus entirely on creating environments for young people using exergaming for fitness. Group fitness programmer Les Mills International has recently launched "Immersive Fitness" studios around the globe which combine exergaming with live group fitness classes. [62]
One of the newest trends is using virtual reality immersion. VR systems have several potential advantages for athletic training; environments can be precisely controlled and scenarios standardized, augmented information can be incorporated to guide performance, and the environment can be dynamically altered to create different competitive situations. [63] High frame rate display technologies for example Head-mounted display can be used to transform the user into any sporting situation e.g. a track cycling veledrome. [63] Natural movements can also be incorporated into the games, for example utilizing an omnidirectional treadmill, such as the Infinadeck. Such a system allows the user to virtually be in the game while allowing 360 degrees of movement. [64] While the technology is new, it is showing promising results in weight management as well as in high participation rates. [65]
Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, prognosis, patient education, physical intervention, rehabilitation, disease prevention, and health promotion. Physical therapists are known as physiotherapists in many countries.
Virtual reality (VR) is a simulated experience that can be similar to or completely different from the real world. Applications of virtual reality include entertainment, education and business. Other distinct types of VR-style technology include augmented reality and mixed reality, sometimes referred to as extended reality or XR.
The Wii is a home video game console developed and marketed by Nintendo. It was released on November 19, 2006, in North America and in December 2006 for most other regions of the world. It is Nintendo's fifth major home game console, following the GameCube and is a seventh generation home console alongside Microsoft's Xbox 360 and Sony's PlayStation 3.
Kinesiology is the scientific study of human body movement. Kinesiology addresses physiological, anatomical, biomechanical, and neuropsychological principles and mechanisms of movement. Applications of kinesiology to human health include biomechanics and orthopedics; strength and conditioning; sport psychology; motor control; skill acquisition and motor learning; methods of rehabilitation, such as physical and occupational therapy; and sport and exercise physiology. Studies of human and animal motion include measures from motion tracking systems, electrophysiology of muscle and brain activity, various methods for monitoring physiological function, and other behavioral and cognitive research techniques.
High-intensity interval training (HIIT) is a training protocol alternating short periods of intense or explosive anaerobic exercise with brief recovery periods until the point of exhaustion, which thereby relies on "the anaerobic energy releasing system almost maximally." The method involves exercises performed in repeated quick bursts at maximum or near maximal effort with periods of rest or low activity between bouts. The very high level of intensity, the interval duration and number of bouts distinguish it from aerobic (cardiovascular) activity, because the body significantly recruits anaerobic energy systems. Although there are varying forms of HIIT-style workouts which may involve exercises associated with both cardiovascular activity and also resistance training, HIIT's crucial features of maximal effort, duration, and short rest periods materially differentiate it from being considered a form of cardiovascular exercise. Though there is no universal HIIT session duration, a HIIT workout typically lasts under 30 minutes in total as it uses the anaerobic energy systems which are typically used for short, sharp bursts. The times vary, based on a participant's current fitness level. Traditional HIIT initially had been designed to be no longer than 20 seconds on with no more than 10 seconds off; however, intervals of exercise effort tend to range from 20 to 45 seconds but no longer than 75 seconds, at which point the aerobic system would then kick in.
Telerehabilitation (or e-rehabilitation is the delivery of rehabilitation services over telecommunication networks and the internet. Telerehabilitation allows patients to interact with providers remotely and can be used both to assess patients and to deliver therapy. Fields of medicine that utilize telerehabilitation include: physical therapy, occupational therapy, speech-language pathology, audiology, and psychology. Therapy sessions can be individual or community-based. Types of therapy available include motor training exercises, speech therapy, virtual reality, robotic therapy, goal setting, and group exercise.
Virtual reality therapy (VRT), also known as virtual reality immersion therapy (VRIT), simulation for therapy (SFT), virtual reality exposure therapy (VRET), and computerized CBT (CCBT), is the use of virtual reality technology for psychological or occupational therapy and in affecting virtual rehabilitation. Patients receiving virtual reality therapy navigate through digitally created environments and complete specially designed tasks often tailored to treat a specific ailment; and is designed to isolate the user from their surrounding sensory inputs and give the illusion of immersion inside a computer-generated, interactive virtual environment. This technology has a demonstrated clinical benefit as an adjunctive analgesic during burn wound dressing and other painful medical procedures. Technology can range from a simple PC and keyboard setup, to a modern virtual reality headset. It is widely used as an alternative form of exposure therapy, in which patients interact with harmless virtual representations of traumatic stimuli in order to reduce fear responses. It has proven to be especially effective at treating PTSD, and shows considerable promise in treating a variety of neurological and physical conditions. Virtual reality therapy has also been used to help stroke patients regain muscle control, to treat other disorders such as body dysmorphia, and to improve social skills in those diagnosed with autism.
Fall prevention includes any action taken to help reduce the number of accidental falls suffered by susceptible individuals, such as the elderly (idiopathic) and people suffering from neurological or orthopedic indications.
Virtual reality in telerehabilitation is a method used first in the training of musculoskeletal patients using asynchronous patient data uploading, and an internet video link. Subsequently, therapists using virtual reality-based telerehabilitation prescribe exercise routines via the web which are then accessed and executed by patients through a web browser. Therapists then monitor the patient's progress via the web and modify the therapy asynchronously without real-time interaction or training.
The Wii Balance Board is an accessory for the Wii and Wii U video game consoles. Unlike the usual balance board for exercise, it does not rock but instead tracks the user's center of balance. Along with Wii Fit, it was introduced on July 11, 2007 at the Electronic Entertainment Expo.
Wii Fit is an exergaming video game designed by Nintendo's Hiroshi Matsunaga for the Wii home video game console, featuring a variety of yoga, strength training, aerobics, and balance mini-games for use with the Wii Balance Board peripheral. Matsunaga described the game as a "way to help get families exercising together". It has since been adopted by various health clubs around the world, and has previously been used for physiotherapy rehabilitation in children and in nursing homes to improve posture in the elderly.
Cardiac rehabilitation (CR) is defined by the World Health Organization (WHO) as "The sum of activity and interventions required to ensure the best possible physical, mental, and social conditions so that patients with chronic or post-acute cardiovascular disease may, by their own efforts, preserve or resume their proper place in society and lead an active life". CR is a comprehensive model of care including established core components, including structured exercise, patient education, psychosocial counselling, risk factor reduction and behaviour modification, with a goal of optimizing patient's quality of life while helping to reduce the risk of future heart problems.
Balance in biomechanics, is an ability to maintain the line of gravity of a body within the base of support with minimal postural sway. Sway is the horizontal movement of the centre of gravity even when a person is standing still. A certain amount of sway is essential and inevitable due to small perturbations within the body or from external triggers. An increase in sway is not necessarily an indicator of dysfunctional balance so much as it is an indicator of decreased sensorimotor control.
Exercise is Medicine (EIM) is a nonprofit initiative co-launched on November 5, 2007 by the American College of Sports Medicine and the American Medical Association, with support from the Office of the Surgeon General and the 18th Surgeon General Regina Benjamin.
The use of electronic and communication technologies as a therapeutic aid to healthcare practices is commonly referred to as telemedicine or eHealth. The use of such technologies as a supplement to mainstream therapies for mental disorders is an emerging mental health treatment field which, it is argued, could improve the accessibility, effectiveness and affordability of mental health care. Mental health technologies used by professionals as an adjunct to mainstream clinical practices include email, SMS, virtual reality, computer programs, blogs, social networks, the telephone, video conferencing, computer games, instant messaging and podcasts.
Wii Fit U is an exergaming video game developed by Nintendo for the Wii U console, and is the successor to the Wii games Wii Fit and Wii Fit Plus. Wii Fit U utilizes both the Wii Balance Board and the Wii U GamePad in gameplay, and is bundled with the newly introduced Fit Meter, an activity meter accessory. It was released in Japan on October 31, 2013, followed by North America and Europe one day later. It is also the only game on the system to support the balance board.
A surgery simulator is computer technology developed to simulate surgical procedures for the purpose of training medical professionals, without the need of a patient, cadaver or animal. The concept goes back to the 1980s with video games, but only in the 1990s with three-dimensional graphics and the 2000s with the use of motion sensors for realistic movements has the technology been able to simulate the real situation. The most common type of surgery taught through this method is laparoscopic surgery, although it has also been used to do a trial run before other kinds of procedures. Cataract surgery and other ophthalmic procedures are also widely taught using surgical simulators.
Video game rehabilitation is a process of using common video game consoles and methodology to target and improve physical and mental weaknesses through therapeutic processes. Video games are becoming an integral part of occupational therapy practice in acute, rehabilitation, and community settings. The design for video games in rehabilitation is focused on a number of fundamental principles, such as reward, goals, challenge, and meaningful play. ‘Meaningful play’ emerges from the relationship between player action and system outcome, apparent to the player through, visual, physical and aural feedback. Platforms that feature motion control, notably the Nintendo Wii, Microsoft's Xbox Kinect, Sony's Eye Toy, and virtual reality have all been effective in this field of research. Methodologies have been applied to all age groups, from toddlers to the elderly. It has been used in a variety of cases ranging from stroke rehabilitation, cerebral palsy and other neurological impairments, to tendinitis and multiple sclerosis. Researchers have promoted such technology based on the personalization of gaming systems to patients, allowing for further engagement and interaction. Additionally, gaming consoles have the ability to capture real-time data and provide instant feedback to the patients using the systems. Currently, several researchers have performed case studies to demonstrate the benefits of this technology. Repeat trials and experiments have shown that outcomes are easily replicated among various groups worldwide. Additionally, the outcomes have increased interest in the field, growing experiments beyond simple case studies to experiments with a larger participant base.
A virtual reality game or VR game is a video game played on virtual reality (VR) hardware. Most VR games are based on player immersion, typically through head-mounted display unit or headset and one or more controllers. The headset typically provides two stereoscopic displays in front of the user's eyes to simulate a 3D space.
Virtual reality applications are applications that make use of virtual reality (VR), an immersive sensory experience that digitally simulates a virtual environment. Applications have been developed in a variety of domains, such as education, architectural and urban design, digital marketing and activism, engineering and robotics, entertainment, virtual communities, fine arts, healthcare and clinical therapies, heritage and archaeology, occupational safety, social science and psychology.
