The Use of ExerGames to Promote Active Aging

➣ By Tiffany Shubert

According to the World Health Organization, over 1.2 billion of the world’s population will be age 60 or over in the next 15 years, and by 2050 that number will swell to 2 billion. The countries with the largest proportions of older adults are predicted to be Japan (35.1% of the population) and several Western European Countries (Italy, 34.0% Germany, 33%). This growth is not limited to developed countries, with predictions of 70% of the aging population living in developing countries, primarily concentrated in Asia. This unprecedented shift in world demographics from young to old will pose great challenges to the health care personnel and resources, especially because many of these older adults are not achieving the goals of active aging. The average American age 65 and over has 3.1 chronic health conditions requiring some form of medical management, and has a 30% chance of experiencing a fall which my result in hospitalization, morbidity and mortality. Similar statistics have been reported for other western countries. Several of these chronic health conditions (cardiovascular disease, hypertension, stroke, diabetes, arthritis, osteoporosis, etc.) and falls can be either avoided, or best managed with the appropriate health behavior interventions that empower the individual to perform appropriate exercises, increase physical activity levels, and make healthy lifestyle choices. Several programs have been validated as effective in managing health, preventing falls, minimizing physician visits, and decreasing hospitalizations due to illness or injury. However, there is minimal infrastructure and personnel to adequately disseminate these programs for the greatest impact on the individual and community health.

Gaming may be a viable health promotion dissemination mechanism for older adults. The unanticipated phenomenon of the popularity of the Nintendo Wii with older adults demonstrated older adults did have an interest in playing video games. Physical therapists have embraced the Wii, the Playstation, and other commercial games as well as virtual reality as effective interventions for older adults in several treatment settings.

Though the most popular, the Wii has several drawbacks for older adults. These drawbacks have not been discussed in the media clips highlighting the elderly playing Wii bowling. In our lab we have focus group data and usability studies which demonstrate older adults are interested in video games and exergames as a way to promote health and active aging. However the games in their current form are far too fast and cause much frustration among older players. One reason why older adults only play bowling is that they really cannot play the other Wii games with success. Even the reaction time and coordination required for Wii bowling can be problematic, and often the feedback from the avatars is so negative, that older adults discontinue playing. This sentiment was supported by data from a questionnaire distributed to physical therapists using the Wii with geriatric patients. For the most part, therapists felt that older adults enjoyed playing the games, but there was no continuity or follow through beyond the rehabilitation period.

In order for older adults to successfully change behavior, they must have support and guidance for an extended period of time. Studies show that 12 – 24 week interventions are the most effective for long term change. Physical therapy rarely lasts for that amount of time. The interest in gaming by older adults suggests that exergames may be a viable conduit to deliver these types of health promotion and behavioral change programs, as an effective adjunct to physical therapy with minimal resources and manpower hours required.

Our data suggest games which have options to increase the usability for older adults may be the easiest venue for dissemination. The ability to change font size, contrast, speed of play, and the ability to stop while playing, regroup, and start again, are all attractive qualities to an older adult player. A health game should be quite explicit as to the purpose of the game, and the desired outcomes after participating in the game. Feedback is another key component, and the ability to track progress and achieve milestones.

We are interested in using this information to develop exergames specifically for older adults to improve physical function and mobility. We feel that exergames can achieve the ultimate goal of maintaining independence for as long as possible, compressing the period of morbidity, and achieving the goals of Active Aging for as many older adults as possible.

Tiffany E. Shubert, Ph.D., P.T.
Center for Aging and Health
Institute on Aging
UNC Chapel Hill
U.S.A.
tiffany@shubertconsulting.net