GAMES FOR HEALTH JOURNAL: Research, Development, and Clinical Applications Volume 1, Number 6, 2012 ª Mary Ann Liebert, Inc. DOI: 10.1089/g4h.2012.0050
Original Articles
Comparison of Physiological and Psychological Responses to Exergaming and Treadmill Walking in Healthy Adults Rachel M. Perron, BS, Courtney A. Graham, BS, and Eric E. Hall, PhD
Abstract
The purpose of this study was to compare treadmill walking with exergame play on the ‘‘EA Sports Active’’ (Entertainment Arts, Redwood City, CA) for the Nintendo (Kyoto, Japan) Wii. Thirty healthy adults (13 male, 17 female; 24.1 – 6.6 years old) spent 30 minutes walking briskly on a treadmill and approximately 40 minutes playing ‘‘Island Cardio Blast’’ on ‘‘EA Sports Active.’’ Heart rate (HR) monitors, accelerometers, and Ratings of Perceived Exertion (RPE) were used to measure intensity. Participants also rated affect measures with the Feeling Scale and the Felt Arousal Scale and completed the Physical Activity Enjoyment Scale following completion of exercise. Participants had a significantly higher HR and RPE on the exergame but a higher percentage of minutes in moderate- or higher-intensity activity on the treadmill. Affect measures were consistent with past research, with positive affect following exercise in both conditions. Play on the ‘‘EA Sports Active’’ game for the Nintendo Wii elicited higher HR, RPE, and enjoyment measures than treadmill walking, indicating that it may be a good mode of exercise.
Introduction
T
he prevalence of overweight and obese individuals in developed nations is increasing at alarming rates. According to the 2007–2008 National Health and Nutrition Examination Study, 33.9 percent of U.S. adults 20 years and older are obese.1 Although genetics play a role in body composition, unhealthy diet and a lack of physical activity are important contributors to increased body weight. In the midst of trends toward inactivity and obesity, companies like Sony (Tokyo, Japan) and Nintendo (Kyoto, Japan) have created videogames that require players to get off the couch and move. The creation of these games, known as ‘‘exergames,’’ was in part a response to trends in both increased obesity and increase in technology usage. Specifically, statistics show that over 60 percent of American households play computer games or videogames.2 Exergames are played by moving entire limbs using sensored equipment rather than simply pushing buttons, as in traditional videogame play. These ‘‘exergames’’ are marketed as a possible strategy for addressing the inactivity and obesity problems. Previous research has found that active videogames can elicit a higher heart rate (HR) and burn calories within the American College of Sports Medicine (ACSM) recommendations for physical activity (PA).3,4 Many studies have found that exergames increase energy expenditure and PA.5–12 In a recent study, college-aged participants played three different
interactive videogames, including boxing, striking lighted pads, and riding a bike to increase the speed of a pace car.4 On average, the participants burned calories within the ACSM’s recommendations and achieved HRs of at least 60 percent of their HR reserve. This research suggests that exergames may provide participants with a viable mode of aerobic exercise. An important determinant of intent to continue exercise may be the affective response, or a general good-bad/pleasuredispleasure feeling, during PA.13 In general, research suggests that moderate-intensity exercise yields positive affect following exercise and may be an important indicator of intent to repeat the activity.14,15 In a study by Williams et al.,16 it was found that positive affect is associated with a higher likelihood of participation in PA 6 and 12 months later. Subjects reported basic affect in an acute bout of exercise and then self-reported PA levels at 6 and 12 months. It was found that an increase of 1 unit on the Feeling Scale (FS)17 correlated with an additional 41 minutes of PA per week. This suggests that positive affect during moderate PA is associated with increased exercise participation. This and other research has led Williams18 to propose a theory suggesting that self-paced exercise is associated with increased exercise adherence because of its positive influence on affective responses. Another important indicator of exercise adherence is enjoyment of activity. Little research to date has examined the enjoyment of exergames, despite the importance of enjoyment to sustained activity and exercise prescription.
Department of Exercise Science, Elon University, Elon, North Carolina.
411
412 Increased enjoyment has been linked with higher PA levels and is often thought to be important for exercise adherence.19 A study by Graves et al.3 was among the first to examine both physiological and psychological variables related to play on the Nintendo Wii Fit—an exergaming system marketed for all ages.3 This study examined energy expenditure and enjoyment in adolescents, young adults, and older adults while playing a handheld (inactive) game, playing the Wii Fit, and brisk treadmill walking. In all age groups, energy expenditure and HR were higher for the Wii than for handheld gaming but lower than for treadmill walking. Enjoyment rating was significantly higher for the Wii play. This study did not find HR during the Wii aerobics to be of a high enough intensity for cardiovascular fitness. A study by Penko and Barkley10 also examined enjoyment, but in a population of children. In this study, both lean and overweight/obese children had significantly higher enjoyment of ‘‘Wii Sports Boxing’’ versus a sedentary videogame and treadmill walking. Enjoyment is a major factor in the likelihood that an individual will devote time to an activity and thus is important to evaluate.20 The results of this research indicate that enjoyment levels for exergames are higher than for traditional modes of exercise, such as treadmill walking. In contrast, research by Lyons et al.8 compared active and sedentary videogames and found that enjoyment was lower in active games, suggesting that they may be less likely to be played. Recently, Entertainment Arts (Redwood City, CA) released a game for the Nintendo Wii called ‘‘EA Sports Active.’’ Sales of this game have exceeded $125 million, and the American Heart Association has endorsed the product.21 With such popularity and endorsements surrounding this game, it is important to evaluate its effectiveness. Information on the physiological cost and enjoyment levels is needed to evaluate the exergame as a means of achieving recommended PA levels. The purpose of this study was to compare the physiological costs and enjoyment of brisk treadmill walking with those for exergame play on the ‘‘EA Sports Active’’ game for Nintendo Wii. Subjects and Methods Participants Seventeen females (mean – SD age, 22.6 – 3.2 years; mean – SD body mass index, 22.6 – 2.4 kg/m2) and 13 males (mean – SD age, 26.2 – 9.1 years; mean – SD body mass index, 27.5 – 5.4 kg/m2) participated in this study. Participants were excluded from the study if they answered yes to any question on the Physical Activity Readiness Questionnaire.22 Although no participants reported any serious health conditions, the male participants’ body mass index was, on average, overweight (body mass index, 25.0–29.9 kg/m2, as defined by the Centers for Disease Control and Prevention). Participants were given a $10 gift card for completion of two sessions. The university’s Institutional Review Board approved the study, and each subject completed a written informed consent form prior to participation. Measures Exercise intensity was measured in three different ways. We used HR monitors (Accurex IIa; Polar, Lake Success, NY), accelerometers (model GT1M; ActiGraph, Pensacola, FL), and the Borg Ratings of Perceived Exertion (RPE) scale.23
PERRON ET AL. The circumplex model of affect24 was measured by two single-item scales: The FS17 and the Felt Arousal Scale (FAS).25 The FS is an 11-point, single-item, bipolar rating scale commonly used for the assessment of affective responses during exercise. The scale ranges from - 5 to + 5. Anchors are provided at zero (‘‘Neutral’’) and at all odd integers, ranging from ‘‘Very Good’’ ( + 5) to ‘‘Very Bad’’ ( - 5). The FAS is a 6point, single-item rating scale, ranging from 1 to 6, with anchors at 1 (‘‘Low Arousal’’) and 6 (‘‘High Arousal’’). These scales were used because each is very easy and quick to administer (approximately 15 seconds total) and because it is a single-item scale, which lends itself to administration multiple times without undue burden on the participants. Enjoyment was measured using the Physical Activity Enjoyment Scale (PACES), which consists of 18 items on a 7point Likert-type scale.26 All PACES questions pertain to the PA that has just been completed. Previous research has found the PACES to be reliable and valid in PA settings.26 Procedures Participants completed two sessions lasting less than 1 hour each. Participants were initially briefed on the purpose and procedures of the research and then fitted with an HR monitor and accelerometer. The HR monitor was worn across the chest. The accelerometer was worn on a belt at the right hip of the participant. The accelerometer was used to objectively measure exercise intensity during each of the sessions. The order of treadmill and gaming sessions was assigned at random. Gaming protocol During the gaming session, participants spent approximately 40 minutes playing ‘‘Island Cardio Blast’’ on ‘‘EA Sports Active.’’ This workout was chosen for its aerobic nature and comprises sequential activities with varied upperand lower-body involvement (Table 1). After each activity, of which there were 11 total, lasting approximately 3 minutes each depending on the activity, the participant’s HR and RPE were recorded. The participant was also asked to rate him- or herself on the FS and FAS before starting exercise, halfway through the session (after ‘‘skipping’’ game), immediately after exercise, and 20 minutes after exercise. The PACES was completed following completion of activity. Treadmill protocol Prior to the treadmill session, participants were read the following script: ‘‘According to the 2008 Physical Activity Guidelines for Americans set by the Centers for Disease Control and Prevention, to achieve health benefits individuals need to engage in at least 150 minutes of moderateintensity aerobic activity (such as brisk walking) every week. For the next 30 minutes, I would like for you to briskly walk.’’ The participants had control over the speed and elevation of the treadmill for the duration of their 30 minutes on it and were briskly walking the entire time. A brisk walk was chosen because the Centers for Disease Control and Prevention indicates that it is a moderate-intensity activity, which was desired as a comparison for the Wii activity. Every 5 minutes, the participant’s HR and RPE were recorded. The participant was also asked to rate him- or herself on the FS and FAS
EXERGAMING AND TREADMILL WALKING Table 1. ‘‘Island Cardio Blast’’ Activities on ‘‘EA Sports Active’’
413 Table 2. Physiological and Psychological Responses Variable
Activity Warm up Squat and reach Combo station 1 Follow the leader Skipping Water skiing
Stride jumps Island outrun Front/back ankle hops Paddle surfing Cool down
Description Standing stretching Squatting and reaching overhead in rapid succession Punching with right and left hands to hit targets moving from the top to the bottom of the screen Alternating between jogging and doing high knees around an island following a virtual trainer Simulating the motion of jumping rope Squatting and leaning to steer virtual water skier, as well as jumping and raising arms overhead to perform tricks One-leg hops from right to left Alternating marching and sprinting around an island against a virtual competitor Jumping forwards and backwards with feet together Rowing with both arms and hopping to steer a surfboard Stretches performed while standing and sitting down
before starting exercise, halfway (15 minutes) through, immediately after, and 20 minutes after exercise. The PACES was completed following completion of activity. Statistical analysis A Condition (2 [EA Sports Active, Treadmill]) · Time (depending on variable) Repeated Measures General Linear Model (RM GLM) was used to determine main and interaction effects of condition and time (within-subjects repeated measure) for each of the variables. Fisher’s Least Significant Difference (LSD) test was performed when main effects were found. The accelerometer data were coded such that 60-second epochs of time for each condition were categorized as either light intensity or moderate intensity based on previously determined cut points.27 Total minutes of light- and moderate-intensity exercise were summed for each of the games. Very few minutes of vigorous activity were found; thus, it was included in the moderate-intensity activity.
Total time of session (minutes) Heart rate (beats per minute) Ratings of Perceived Exertion PACES FS Pre During Post 0 minutes Post 20 minutes FAS Pre During Post 0 minutes Post 20 minutes
Treadmill EA Sports Active 30.0 – 0.0 126.4 – 16.8 11.6 – 2.0 84.0 – 17.8
40.6 – 3.1 147.5 – 17.5 13.1 – 1.9 99.7 – 18.0
2.3 – 1.6 2.2 – 1.4 2.4 – 1.8 3.0 – 1.3
2.1 – 1.7 1.9 – 1.9 3.0 – 2.0 3.0 – 1.3
1.5 – 0.8 3.0 – 0.9 3.4 – 1.2 2.1 – 1.1
1.6 – 0.7 3.6 – 0.9 3.3 – 0.9 1.8 – 1.0
Data are mean – SD values. FAS, Felt Arousal Scale; FS, Feeling Scale; PACES, Physical Activity Enjoyment Scale.
RM GLM for HR revealed a significant condition effect (F1,27 = 47.9, P < 0.001). The effect for condition was due to a greater mean HR during ‘‘EA Sports Active’’ (Table 2). RM GLM for RPE revealed a significant condition effect (F1,25 = 17.6, P < 0.001). The effect for condition was due to a greater mean RPE during ‘‘EA Sports Active’’ (Table 2). RM GLM for PACES revealed a significant condition effect (F1,26 = 12.6, P = 0.001). The effect for condition was due to a greater mean PACES reported for ‘‘EA Sports Active’’ (Table 2). RM GLM for Condition (2) · Time (4) on the FS and FAS showed a significant main effect of time (F6,14 = 24.52, P < 0.001) and Condition · Time interaction (F6,14 = 3.39, P = 0.0238) but not a significant condition effect (F2,18 = 0.11, P = 0.901). The significant time main effect was attributable to changes in both FS (P = 0.006) and FAS (P = 0.019). The time effect for FS was due to the Post 20 values being greater than pre-exercise levels (LSD post hoc test = 0.009) and during exercise (LSD post hoc = 0.002). FS immediately after exercise was greater than during exercise (LSD post hoc = 0.009). For FAS, compared with pre-exercise levels, FAS increased during (LSD post hoc < 0.001), immediately after exercise (LSD post hoc < 0.001), and 20 minutes after exercise (LSD post hoc = 0.013). FAS at 20 minutes after exercise showed significant decreases compared with during exercise (LSD post hoc < 0.001) and immediately following exercise (LSD post hoc < 0.001). Figure 1 gives a pictorial description of the circumplex model of affective responses, and Table 2 gives mean – SD values.
Results Table 2 gives mean and SD values for the physiological and psychological variables. RM GLM found that participants spent a significantly greater amount of time playing ‘‘EA Sports Active’’ compared with time on the treadmill (F1,23 = 289.0, P < 0.001). To account for this difference, accelerometer data were analyzed by looking at percentage of time that participants were in either light- or moderate-intensity exercise. RM GLM found a significant difference for condition (F1,23 = 29.9, P < 0.001), which was due to greater moderate activity occurring in the treadmill activity (66.5 percent of minutes) versus EA Sports Active (27.0 percent of minutes).
Discussion The results of this study indicate that play on the ‘‘EA Sports Active’’ game elicits a higher average HR, RPE, and enjoyment than treadmill walking. This indicates that the ‘‘EA Sports Active’’ game may be a useful mode of exercise for moderate-intensity aerobic activity. The mean HR (148 beats per minute) during the Wii play translates to 76 percent of age-predicted maximum HR, which is within ACSM recommendations.28 This is consistent with the findings of Siegel et al.,4 who also reported that interactive videogame play by college-aged subjects achieves HR levels set by ACSM
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PERRON ET AL.
FIG. 1.
Circumplex model of affective responses in ‘‘EA Sports Active’’ and treadmill exercises.
guidelines for cardiovascular health. It conflicts with the findings of Graves et al.,3 however, who reported that HR during ‘‘Wii Fit’’ aerobics was lower than the recommended intensity. These studies examined different exergames, suggesting that HR response varies depending on the specific game played. In the present study, ‘‘Island Cardio Blast’’ on ‘‘EA Sports Active’’ did elicit HR levels within the recommendations. The enjoyment results for the current study are consistent with the findings of Graves et al.,3 who found significantly higher enjoyment across age groups for ‘‘Wii Fit’’ activity. Penko and Barkley10 also found higher enjoyment for ‘‘Wii Sports Boxing’’ in comparison with sedentary videogame play and treadmill walking in both lean and overweight/ obese children. The current study finds similar results, with significantly higher enjoyment levels for the ‘‘EA Sports Active’’ game in comparison with brisk treadmill walking. Previous research has found that increased enjoyment is linked to higher levels of participation in PA,19,20 which suggests that an activity eliciting a higher level of enjoyment—such as the ‘‘EA Sports Active’’—is beneficial to sustained PA. Affective responses to exercise were mostly consistent with past research. Previous research by Ekkekakis et al.14 found that 10–15 minutes of walking is associated with increased energy and decreased tension. Results of the present study are not different from this past research, which shows improvements in positive affect as evidenced by increases in valence, as measured by the FS, and activation, as measured by the FAS, following exercise. Previous research has also found that positive affective responses during acute bouts of moderate exercise are associated with higher PA levels 12 months later.16 The positive affect seen before, during, and after the acute bout of ‘‘EA Sports Active’’ play in the present study is evidence that the exergame is a beneficial mode of PA in terms of affect, enjoyment, and adherence, to which they are linked.
Accelerometry data conflict with the HR, RPE, and enjoyment results, as they show a higher percentage of time in moderate- or higher-intensity activity for the treadmill walking rather than the exergame play. This may be due to the accelerometers being worn at the hip and failing to pick up movement in Wii games that involve primarily upperlimb movement. Future research using accelerometers at multiple limbs would be useful. Much of the research on exercise games marketed for health benefits, including the present study, has examined acute bouts of exercise. Future research on the longitudinal effects of these games is necessary. The long-term effects of exergame play on weight loss, exercise adherence, coordination, balance, and cognitive function are among the many effects that could be examined. A limitation of this study is the voluntary participation of subjects, which may lend itself to individuals who are more likely to report positive enjoyment due to a prior inclination to participate in physical activity. Also important to mention is the lack of collection of expired gases. With oxygen consumption (volume) measures, energy expenditure and metabolic equivalents could have been derived. In this study, the measures of intensity (HR, RPE, and accelerometry) were chosen so as to minimize the hindrance of bulky equipment and thereby increase the generalizability of the findings. Another limitation is the fact that the total exercise time on treadmill and exergame differed, at approximately 30 and 40 minutes, respectively. Although the ‘‘Island Cardio Blast’’ on ‘‘EA Sports Active’’ game was rated as being 30 minutes in duration, the actual play time was longer. Although the difference in exercise time between the two conditions was significant, both exercise durations were still within ACSM guidelines for daily PA. This difference was accounted for by looking at accelerometry data as a percentage of total exercise time.
EXERGAMING AND TREADMILL WALKING Conclusions The current study reports that the physiological cost of play on the ‘‘EA Sports Active’’ game is significantly greater than a self-selected brisk walk on the treadmill. The intensity on ‘‘EA Sports Active’’ was within PA recommendations for healthy adults. Enjoyment was also significantly higher on the exergame compared with treadmill walking, which suggests a greater likelihood of adherence. Future research is needed into more of the available exergames, as past research has shown varying results depending on the particular game played. Furthermore, research is needed using longitudinal and/or intervention approaches to the effects of exergaming. Through longitudinal studies, it can be determined whether enjoyment of exergames remains static, or if it wears off with the decreasing novelty of the activity. With the popularity and widespread use of exergames, it is important to continue evaluating their effectiveness as gaming manufacturers develop new versions. Acknowledgments This research was funded in part by a Summer Undergraduate Research Experience from Elon University. Author Disclosure Statement No competing financial interests exist. References 1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA 2010; 303:235–241. 2. Entertainment Software Association. Essential facts about the video game industry. 2008. www.theesa.com/facts/ pdfs/ESA_EF_2008.pdf (accessed September 2012). 3. Graves LEF, Ridgers ND, Williams K, et al. The physiological cost and enjoyment of Wii Fit in adolescents, young adults, and older adults. J Phys Act Health 2010; 7:393–401. 4. Siegel SR, Haddock BL, Dubois AM, Wilkin LD. Active video/arcade games (exergaming) and energy expenditure in college students. Int J Exerc Sci 2009; 2:165–174. 5. Graf DL, Pratt LV, Hester CN, Short KR. Playing active video games increases energy expenditure in children. Pediatrics 2009; 124:534–540. 6. Graves L, Stratton G, Ridgers ND, Cable NT. Energy expenditure in adolescents playing new generation computer games. Br J Sports Med 2008; 42:592–594. 7. Lanningham-Foster L, Jensen TB, Foster RC, et al. Energy expenditure of sedentary screen time compared with active screen time for children. Pediatrics 2006; 118:1831–1835. 8. Lyons EJ, Tate DF, Ward DS, et al. Energy expenditure and enjoyment during video game play: Differences by game type. Med Sci Sports Exerc 2011; 43:1987–1993. 9. Mellecker RR, McManus AM. Energy expenditure and cardiovascular responses to seated and active gaming in children. Arch Pediatr Adolesc Med 2008; 162:886–891. 10. Penko AL, Barkley JE. Motivation and physiologic responses of playing a physically interactive video game relative to a sedentary alternative in children. Ann Behav Med 2010; 39:162–169. 11. Straker L, Abbott R. Effect of screen-based media on energy expenditure and heart rate in 9- to 12-year-old children. Pediatr Exerc Sci 2007; 19:459–471.
415 12. Unithan VB, Houser W, Fernhall B. Evaluation of the energy cost of playing a dance simulation video game in overweight and non-overweight children and adolescents. Int J Sports Med 2006; 27:804–809. 13. Ekkekakis P, Parfitt G, Petruzzello SJ. The pleasure and displeasure people feel when they exercise at different intensities: Decennial update and progress towards a tripartite rationale for exercise intensity prescription. Sports Med 2011; 41:641–671. 14. Ekkekakis P, Hall EE, Van Landuyt LM, Petruzzello SJ. Walking in (affective) circles: Can short walks enhance affect? J Behav Med 2000; 23:245–275. 15. Ekkekakis P, Hall EE, Petruzzello SJ. The relationship between exercise intensity and affective responses demystified: To crack the forty-year-old nut, replace the forty-year-old nutcracker! Ann Behav Med 2008; 35:136–149. 16. Williams DW, Dunsinger S, Ciccolo JT, et al. Acute affective response to a moderate intensity exercise stimulus predicts physical activity participation 6 and 12 months later. Psychol Sport Exerc 2008; 9:231–245. 17. Hardy CJ, Rejeski WJ. Not what, but how one feels: The measurement of affect during exercise. J Sports Exerc Psychol 1989; 11:304–307. 18. Williams D. Exercise, affect, and adherence: An integrated model and a case for self-paced exercise. J Sport Exerc Psychol 2008; 30:471–496. 19. Dishman RK, Motl RW, Saunders R, et al. Enjoyment mediates effects of a school-based physical-activity intervention. Med Sci Sports Exerc 2005; 37:478–487. 20. Kolt GS, Driver RP, Giles LC. Why older Australians participate in exercise and sport. J Aging Phys Act 2004; 12:185– 198. 21. Lieberman DA, Chamberlin B, Medina E, et al. The power of play: Innovations in getting active summit 2011: A science panel proceedings report from the American Heart Association. Circulation 2011; 123:2507–2516. 22. Thomas S, Reading, J, Shephard RJ. Revision of the Physical Activity Readiness Questionnaire (PAR-Q). Can J Sports Sci 1992; 17:338–345. 23. Borg G. Perceived exertion and pain scales. Champaign, IL: Human Kinetics; 1998. 24. Russell JA. A circumplex model of affect. J Pers Soc Psychol 1980; 39:1161–1178. 25. Svebak S, Murgatroyd S. Metamotivational dominance: A multimethod validation of reversal theory constructs. J Pers Soc Psychol 1985; 48:107–116. 26. Kendzierski D, DeCarlo KJ. Physical activity enjoyment scale: Two validation studies. J Sports Exerc Psychol 1991; 13:50–64. 27. Freedson PS, Melanson E, Sirard J. Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc 1998; 30:777–781. 28. American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription, 7th ed. Baltimore, MD: American College of Sports Medicine; 2006.
Address correspondence to: Eric E. Hall, PhD Department of Exercise Science Elon University 2525 Campus Box Elon, NC 27244 E-mail: [email protected]
Original Articles
Comparison of Physiological and Psychological Responses to Exergaming and Treadmill Walking in Healthy Adults Rachel M. Perron, BS, Courtney A. Graham, BS, and Eric E. Hall, PhD
Abstract
The purpose of this study was to compare treadmill walking with exergame play on the ‘‘EA Sports Active’’ (Entertainment Arts, Redwood City, CA) for the Nintendo (Kyoto, Japan) Wii. Thirty healthy adults (13 male, 17 female; 24.1 – 6.6 years old) spent 30 minutes walking briskly on a treadmill and approximately 40 minutes playing ‘‘Island Cardio Blast’’ on ‘‘EA Sports Active.’’ Heart rate (HR) monitors, accelerometers, and Ratings of Perceived Exertion (RPE) were used to measure intensity. Participants also rated affect measures with the Feeling Scale and the Felt Arousal Scale and completed the Physical Activity Enjoyment Scale following completion of exercise. Participants had a significantly higher HR and RPE on the exergame but a higher percentage of minutes in moderate- or higher-intensity activity on the treadmill. Affect measures were consistent with past research, with positive affect following exercise in both conditions. Play on the ‘‘EA Sports Active’’ game for the Nintendo Wii elicited higher HR, RPE, and enjoyment measures than treadmill walking, indicating that it may be a good mode of exercise.
Introduction
T
he prevalence of overweight and obese individuals in developed nations is increasing at alarming rates. According to the 2007–2008 National Health and Nutrition Examination Study, 33.9 percent of U.S. adults 20 years and older are obese.1 Although genetics play a role in body composition, unhealthy diet and a lack of physical activity are important contributors to increased body weight. In the midst of trends toward inactivity and obesity, companies like Sony (Tokyo, Japan) and Nintendo (Kyoto, Japan) have created videogames that require players to get off the couch and move. The creation of these games, known as ‘‘exergames,’’ was in part a response to trends in both increased obesity and increase in technology usage. Specifically, statistics show that over 60 percent of American households play computer games or videogames.2 Exergames are played by moving entire limbs using sensored equipment rather than simply pushing buttons, as in traditional videogame play. These ‘‘exergames’’ are marketed as a possible strategy for addressing the inactivity and obesity problems. Previous research has found that active videogames can elicit a higher heart rate (HR) and burn calories within the American College of Sports Medicine (ACSM) recommendations for physical activity (PA).3,4 Many studies have found that exergames increase energy expenditure and PA.5–12 In a recent study, college-aged participants played three different
interactive videogames, including boxing, striking lighted pads, and riding a bike to increase the speed of a pace car.4 On average, the participants burned calories within the ACSM’s recommendations and achieved HRs of at least 60 percent of their HR reserve. This research suggests that exergames may provide participants with a viable mode of aerobic exercise. An important determinant of intent to continue exercise may be the affective response, or a general good-bad/pleasuredispleasure feeling, during PA.13 In general, research suggests that moderate-intensity exercise yields positive affect following exercise and may be an important indicator of intent to repeat the activity.14,15 In a study by Williams et al.,16 it was found that positive affect is associated with a higher likelihood of participation in PA 6 and 12 months later. Subjects reported basic affect in an acute bout of exercise and then self-reported PA levels at 6 and 12 months. It was found that an increase of 1 unit on the Feeling Scale (FS)17 correlated with an additional 41 minutes of PA per week. This suggests that positive affect during moderate PA is associated with increased exercise participation. This and other research has led Williams18 to propose a theory suggesting that self-paced exercise is associated with increased exercise adherence because of its positive influence on affective responses. Another important indicator of exercise adherence is enjoyment of activity. Little research to date has examined the enjoyment of exergames, despite the importance of enjoyment to sustained activity and exercise prescription.
Department of Exercise Science, Elon University, Elon, North Carolina.
411
412 Increased enjoyment has been linked with higher PA levels and is often thought to be important for exercise adherence.19 A study by Graves et al.3 was among the first to examine both physiological and psychological variables related to play on the Nintendo Wii Fit—an exergaming system marketed for all ages.3 This study examined energy expenditure and enjoyment in adolescents, young adults, and older adults while playing a handheld (inactive) game, playing the Wii Fit, and brisk treadmill walking. In all age groups, energy expenditure and HR were higher for the Wii than for handheld gaming but lower than for treadmill walking. Enjoyment rating was significantly higher for the Wii play. This study did not find HR during the Wii aerobics to be of a high enough intensity for cardiovascular fitness. A study by Penko and Barkley10 also examined enjoyment, but in a population of children. In this study, both lean and overweight/obese children had significantly higher enjoyment of ‘‘Wii Sports Boxing’’ versus a sedentary videogame and treadmill walking. Enjoyment is a major factor in the likelihood that an individual will devote time to an activity and thus is important to evaluate.20 The results of this research indicate that enjoyment levels for exergames are higher than for traditional modes of exercise, such as treadmill walking. In contrast, research by Lyons et al.8 compared active and sedentary videogames and found that enjoyment was lower in active games, suggesting that they may be less likely to be played. Recently, Entertainment Arts (Redwood City, CA) released a game for the Nintendo Wii called ‘‘EA Sports Active.’’ Sales of this game have exceeded $125 million, and the American Heart Association has endorsed the product.21 With such popularity and endorsements surrounding this game, it is important to evaluate its effectiveness. Information on the physiological cost and enjoyment levels is needed to evaluate the exergame as a means of achieving recommended PA levels. The purpose of this study was to compare the physiological costs and enjoyment of brisk treadmill walking with those for exergame play on the ‘‘EA Sports Active’’ game for Nintendo Wii. Subjects and Methods Participants Seventeen females (mean – SD age, 22.6 – 3.2 years; mean – SD body mass index, 22.6 – 2.4 kg/m2) and 13 males (mean – SD age, 26.2 – 9.1 years; mean – SD body mass index, 27.5 – 5.4 kg/m2) participated in this study. Participants were excluded from the study if they answered yes to any question on the Physical Activity Readiness Questionnaire.22 Although no participants reported any serious health conditions, the male participants’ body mass index was, on average, overweight (body mass index, 25.0–29.9 kg/m2, as defined by the Centers for Disease Control and Prevention). Participants were given a $10 gift card for completion of two sessions. The university’s Institutional Review Board approved the study, and each subject completed a written informed consent form prior to participation. Measures Exercise intensity was measured in three different ways. We used HR monitors (Accurex IIa; Polar, Lake Success, NY), accelerometers (model GT1M; ActiGraph, Pensacola, FL), and the Borg Ratings of Perceived Exertion (RPE) scale.23
PERRON ET AL. The circumplex model of affect24 was measured by two single-item scales: The FS17 and the Felt Arousal Scale (FAS).25 The FS is an 11-point, single-item, bipolar rating scale commonly used for the assessment of affective responses during exercise. The scale ranges from - 5 to + 5. Anchors are provided at zero (‘‘Neutral’’) and at all odd integers, ranging from ‘‘Very Good’’ ( + 5) to ‘‘Very Bad’’ ( - 5). The FAS is a 6point, single-item rating scale, ranging from 1 to 6, with anchors at 1 (‘‘Low Arousal’’) and 6 (‘‘High Arousal’’). These scales were used because each is very easy and quick to administer (approximately 15 seconds total) and because it is a single-item scale, which lends itself to administration multiple times without undue burden on the participants. Enjoyment was measured using the Physical Activity Enjoyment Scale (PACES), which consists of 18 items on a 7point Likert-type scale.26 All PACES questions pertain to the PA that has just been completed. Previous research has found the PACES to be reliable and valid in PA settings.26 Procedures Participants completed two sessions lasting less than 1 hour each. Participants were initially briefed on the purpose and procedures of the research and then fitted with an HR monitor and accelerometer. The HR monitor was worn across the chest. The accelerometer was worn on a belt at the right hip of the participant. The accelerometer was used to objectively measure exercise intensity during each of the sessions. The order of treadmill and gaming sessions was assigned at random. Gaming protocol During the gaming session, participants spent approximately 40 minutes playing ‘‘Island Cardio Blast’’ on ‘‘EA Sports Active.’’ This workout was chosen for its aerobic nature and comprises sequential activities with varied upperand lower-body involvement (Table 1). After each activity, of which there were 11 total, lasting approximately 3 minutes each depending on the activity, the participant’s HR and RPE were recorded. The participant was also asked to rate him- or herself on the FS and FAS before starting exercise, halfway through the session (after ‘‘skipping’’ game), immediately after exercise, and 20 minutes after exercise. The PACES was completed following completion of activity. Treadmill protocol Prior to the treadmill session, participants were read the following script: ‘‘According to the 2008 Physical Activity Guidelines for Americans set by the Centers for Disease Control and Prevention, to achieve health benefits individuals need to engage in at least 150 minutes of moderateintensity aerobic activity (such as brisk walking) every week. For the next 30 minutes, I would like for you to briskly walk.’’ The participants had control over the speed and elevation of the treadmill for the duration of their 30 minutes on it and were briskly walking the entire time. A brisk walk was chosen because the Centers for Disease Control and Prevention indicates that it is a moderate-intensity activity, which was desired as a comparison for the Wii activity. Every 5 minutes, the participant’s HR and RPE were recorded. The participant was also asked to rate him- or herself on the FS and FAS
EXERGAMING AND TREADMILL WALKING Table 1. ‘‘Island Cardio Blast’’ Activities on ‘‘EA Sports Active’’
413 Table 2. Physiological and Psychological Responses Variable
Activity Warm up Squat and reach Combo station 1 Follow the leader Skipping Water skiing
Stride jumps Island outrun Front/back ankle hops Paddle surfing Cool down
Description Standing stretching Squatting and reaching overhead in rapid succession Punching with right and left hands to hit targets moving from the top to the bottom of the screen Alternating between jogging and doing high knees around an island following a virtual trainer Simulating the motion of jumping rope Squatting and leaning to steer virtual water skier, as well as jumping and raising arms overhead to perform tricks One-leg hops from right to left Alternating marching and sprinting around an island against a virtual competitor Jumping forwards and backwards with feet together Rowing with both arms and hopping to steer a surfboard Stretches performed while standing and sitting down
before starting exercise, halfway (15 minutes) through, immediately after, and 20 minutes after exercise. The PACES was completed following completion of activity. Statistical analysis A Condition (2 [EA Sports Active, Treadmill]) · Time (depending on variable) Repeated Measures General Linear Model (RM GLM) was used to determine main and interaction effects of condition and time (within-subjects repeated measure) for each of the variables. Fisher’s Least Significant Difference (LSD) test was performed when main effects were found. The accelerometer data were coded such that 60-second epochs of time for each condition were categorized as either light intensity or moderate intensity based on previously determined cut points.27 Total minutes of light- and moderate-intensity exercise were summed for each of the games. Very few minutes of vigorous activity were found; thus, it was included in the moderate-intensity activity.
Total time of session (minutes) Heart rate (beats per minute) Ratings of Perceived Exertion PACES FS Pre During Post 0 minutes Post 20 minutes FAS Pre During Post 0 minutes Post 20 minutes
Treadmill EA Sports Active 30.0 – 0.0 126.4 – 16.8 11.6 – 2.0 84.0 – 17.8
40.6 – 3.1 147.5 – 17.5 13.1 – 1.9 99.7 – 18.0
2.3 – 1.6 2.2 – 1.4 2.4 – 1.8 3.0 – 1.3
2.1 – 1.7 1.9 – 1.9 3.0 – 2.0 3.0 – 1.3
1.5 – 0.8 3.0 – 0.9 3.4 – 1.2 2.1 – 1.1
1.6 – 0.7 3.6 – 0.9 3.3 – 0.9 1.8 – 1.0
Data are mean – SD values. FAS, Felt Arousal Scale; FS, Feeling Scale; PACES, Physical Activity Enjoyment Scale.
RM GLM for HR revealed a significant condition effect (F1,27 = 47.9, P < 0.001). The effect for condition was due to a greater mean HR during ‘‘EA Sports Active’’ (Table 2). RM GLM for RPE revealed a significant condition effect (F1,25 = 17.6, P < 0.001). The effect for condition was due to a greater mean RPE during ‘‘EA Sports Active’’ (Table 2). RM GLM for PACES revealed a significant condition effect (F1,26 = 12.6, P = 0.001). The effect for condition was due to a greater mean PACES reported for ‘‘EA Sports Active’’ (Table 2). RM GLM for Condition (2) · Time (4) on the FS and FAS showed a significant main effect of time (F6,14 = 24.52, P < 0.001) and Condition · Time interaction (F6,14 = 3.39, P = 0.0238) but not a significant condition effect (F2,18 = 0.11, P = 0.901). The significant time main effect was attributable to changes in both FS (P = 0.006) and FAS (P = 0.019). The time effect for FS was due to the Post 20 values being greater than pre-exercise levels (LSD post hoc test = 0.009) and during exercise (LSD post hoc = 0.002). FS immediately after exercise was greater than during exercise (LSD post hoc = 0.009). For FAS, compared with pre-exercise levels, FAS increased during (LSD post hoc < 0.001), immediately after exercise (LSD post hoc < 0.001), and 20 minutes after exercise (LSD post hoc = 0.013). FAS at 20 minutes after exercise showed significant decreases compared with during exercise (LSD post hoc < 0.001) and immediately following exercise (LSD post hoc < 0.001). Figure 1 gives a pictorial description of the circumplex model of affective responses, and Table 2 gives mean – SD values.
Results Table 2 gives mean and SD values for the physiological and psychological variables. RM GLM found that participants spent a significantly greater amount of time playing ‘‘EA Sports Active’’ compared with time on the treadmill (F1,23 = 289.0, P < 0.001). To account for this difference, accelerometer data were analyzed by looking at percentage of time that participants were in either light- or moderate-intensity exercise. RM GLM found a significant difference for condition (F1,23 = 29.9, P < 0.001), which was due to greater moderate activity occurring in the treadmill activity (66.5 percent of minutes) versus EA Sports Active (27.0 percent of minutes).
Discussion The results of this study indicate that play on the ‘‘EA Sports Active’’ game elicits a higher average HR, RPE, and enjoyment than treadmill walking. This indicates that the ‘‘EA Sports Active’’ game may be a useful mode of exercise for moderate-intensity aerobic activity. The mean HR (148 beats per minute) during the Wii play translates to 76 percent of age-predicted maximum HR, which is within ACSM recommendations.28 This is consistent with the findings of Siegel et al.,4 who also reported that interactive videogame play by college-aged subjects achieves HR levels set by ACSM
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FIG. 1.
Circumplex model of affective responses in ‘‘EA Sports Active’’ and treadmill exercises.
guidelines for cardiovascular health. It conflicts with the findings of Graves et al.,3 however, who reported that HR during ‘‘Wii Fit’’ aerobics was lower than the recommended intensity. These studies examined different exergames, suggesting that HR response varies depending on the specific game played. In the present study, ‘‘Island Cardio Blast’’ on ‘‘EA Sports Active’’ did elicit HR levels within the recommendations. The enjoyment results for the current study are consistent with the findings of Graves et al.,3 who found significantly higher enjoyment across age groups for ‘‘Wii Fit’’ activity. Penko and Barkley10 also found higher enjoyment for ‘‘Wii Sports Boxing’’ in comparison with sedentary videogame play and treadmill walking in both lean and overweight/ obese children. The current study finds similar results, with significantly higher enjoyment levels for the ‘‘EA Sports Active’’ game in comparison with brisk treadmill walking. Previous research has found that increased enjoyment is linked to higher levels of participation in PA,19,20 which suggests that an activity eliciting a higher level of enjoyment—such as the ‘‘EA Sports Active’’—is beneficial to sustained PA. Affective responses to exercise were mostly consistent with past research. Previous research by Ekkekakis et al.14 found that 10–15 minutes of walking is associated with increased energy and decreased tension. Results of the present study are not different from this past research, which shows improvements in positive affect as evidenced by increases in valence, as measured by the FS, and activation, as measured by the FAS, following exercise. Previous research has also found that positive affective responses during acute bouts of moderate exercise are associated with higher PA levels 12 months later.16 The positive affect seen before, during, and after the acute bout of ‘‘EA Sports Active’’ play in the present study is evidence that the exergame is a beneficial mode of PA in terms of affect, enjoyment, and adherence, to which they are linked.
Accelerometry data conflict with the HR, RPE, and enjoyment results, as they show a higher percentage of time in moderate- or higher-intensity activity for the treadmill walking rather than the exergame play. This may be due to the accelerometers being worn at the hip and failing to pick up movement in Wii games that involve primarily upperlimb movement. Future research using accelerometers at multiple limbs would be useful. Much of the research on exercise games marketed for health benefits, including the present study, has examined acute bouts of exercise. Future research on the longitudinal effects of these games is necessary. The long-term effects of exergame play on weight loss, exercise adherence, coordination, balance, and cognitive function are among the many effects that could be examined. A limitation of this study is the voluntary participation of subjects, which may lend itself to individuals who are more likely to report positive enjoyment due to a prior inclination to participate in physical activity. Also important to mention is the lack of collection of expired gases. With oxygen consumption (volume) measures, energy expenditure and metabolic equivalents could have been derived. In this study, the measures of intensity (HR, RPE, and accelerometry) were chosen so as to minimize the hindrance of bulky equipment and thereby increase the generalizability of the findings. Another limitation is the fact that the total exercise time on treadmill and exergame differed, at approximately 30 and 40 minutes, respectively. Although the ‘‘Island Cardio Blast’’ on ‘‘EA Sports Active’’ game was rated as being 30 minutes in duration, the actual play time was longer. Although the difference in exercise time between the two conditions was significant, both exercise durations were still within ACSM guidelines for daily PA. This difference was accounted for by looking at accelerometry data as a percentage of total exercise time.
EXERGAMING AND TREADMILL WALKING Conclusions The current study reports that the physiological cost of play on the ‘‘EA Sports Active’’ game is significantly greater than a self-selected brisk walk on the treadmill. The intensity on ‘‘EA Sports Active’’ was within PA recommendations for healthy adults. Enjoyment was also significantly higher on the exergame compared with treadmill walking, which suggests a greater likelihood of adherence. Future research is needed into more of the available exergames, as past research has shown varying results depending on the particular game played. Furthermore, research is needed using longitudinal and/or intervention approaches to the effects of exergaming. Through longitudinal studies, it can be determined whether enjoyment of exergames remains static, or if it wears off with the decreasing novelty of the activity. With the popularity and widespread use of exergames, it is important to continue evaluating their effectiveness as gaming manufacturers develop new versions. Acknowledgments This research was funded in part by a Summer Undergraduate Research Experience from Elon University. Author Disclosure Statement No competing financial interests exist. References 1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA 2010; 303:235–241. 2. Entertainment Software Association. Essential facts about the video game industry. 2008. www.theesa.com/facts/ pdfs/ESA_EF_2008.pdf (accessed September 2012). 3. Graves LEF, Ridgers ND, Williams K, et al. The physiological cost and enjoyment of Wii Fit in adolescents, young adults, and older adults. J Phys Act Health 2010; 7:393–401. 4. Siegel SR, Haddock BL, Dubois AM, Wilkin LD. Active video/arcade games (exergaming) and energy expenditure in college students. Int J Exerc Sci 2009; 2:165–174. 5. Graf DL, Pratt LV, Hester CN, Short KR. Playing active video games increases energy expenditure in children. Pediatrics 2009; 124:534–540. 6. Graves L, Stratton G, Ridgers ND, Cable NT. Energy expenditure in adolescents playing new generation computer games. Br J Sports Med 2008; 42:592–594. 7. Lanningham-Foster L, Jensen TB, Foster RC, et al. Energy expenditure of sedentary screen time compared with active screen time for children. Pediatrics 2006; 118:1831–1835. 8. Lyons EJ, Tate DF, Ward DS, et al. Energy expenditure and enjoyment during video game play: Differences by game type. Med Sci Sports Exerc 2011; 43:1987–1993. 9. Mellecker RR, McManus AM. Energy expenditure and cardiovascular responses to seated and active gaming in children. Arch Pediatr Adolesc Med 2008; 162:886–891. 10. Penko AL, Barkley JE. Motivation and physiologic responses of playing a physically interactive video game relative to a sedentary alternative in children. Ann Behav Med 2010; 39:162–169. 11. Straker L, Abbott R. Effect of screen-based media on energy expenditure and heart rate in 9- to 12-year-old children. Pediatr Exerc Sci 2007; 19:459–471.
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Address correspondence to: Eric E. Hall, PhD Department of Exercise Science Elon University 2525 Campus Box Elon, NC 27244 E-mail: [email protected]
