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ORIGINAL ARTICLE
Table 1: Physiologic Characteristics and Functional Ability V̇O2 was highest during boxing and tennis games, and lowest
Scores (nⴝ19)
during bowling and Tai Chi games on both consoles (table 2).
Characteristic Values There was a significant effect of game condition on V̇O2
Age (y) 70.7⫾6.4 (65–87)
(F4.3,77.2⫽19.5, P⬍.001), with all games resulting in greater
BMI (kg/m2) 27.6⫾6.1 (21.6–46.7) V̇O2 than rest (all P⬍.01, see table 2). Similarly EE was highest
Resting heart rate (bpm) 74.7⫾9.0 (60–93) during boxing and tennis games, and lowest during bowling
ABC score (/100) 89.1⫾10.8 (55.6–99.1) and Tai Chi games on both consoles (see table 2). There was a
Mini-BESTest (/32) 28.3⫾3.3 (19–32) significant effect of game condition on EE (F4.1,74.1⫽18.5,
TUG score (s) 10.2⫾1.8 (8–14) P⬍.001), with all games resulting in greater EE than rest (all
P⬍.01, see table 2). There was no significant difference in EE
NOTE. Values are mean ⫾ SD (range). for the equivalent games played in a standing position com-
Abbreviations: BMI, body mass index; bpm, beats per minute.
pared with a seated position (see table 2).
MET values ranged from 1.5 to 3.0 (see table 2), indicating
that all games were equivalent to light-intensity physical ac-
erate, or vigorous intensity according to American College of tivity.36 There was a significant effect of game condition on
Sports Medicine intensity categories for older adults (light, ⱕ3 METs (F4.2,10.3⫽13.8, P⬍.001), with all games resulting in
METs; moderate, 3– 6 METs; vigorous, ⬎6 METs).36 higher METs than rest (all P⬍.01, see table 2).
Accelerometer data were uploaded using ActiLife software, With the use of the 6-to-20 RPE scale,22 perceived exertion
version 5.e A 10-second epoch was used and summed to give was rated as “light” for bowling games (10.33⫾1.97) to “some-
a per minute activity count rate. Activity counts from each axis what hard” for boxing games (12.57⫾1.70) (see table 2). A
of the accelerometer were combined into a single vector. comparison of RPE scores between games showed a significant
Repeated-measurement analysis of variance and Bonferroni- effect of game condition on RPE (F8,144⫽3.6, P⫽.001). There
corrected pairwise comparisons were conducted to assess be- were no significant differences in RPE between equivalent
tween-game differences in mean V̇O2, EE, METs, wrist activity
sitting and standing games (see table 2).
counts, hip activity counts, and RPE. Data violating the as-
sumption of sphericity were adjusted using the Greenhouse- Wrist and hip activity counts were highest during boxing and
Geisser correction.37 Two-tailed paired t tests were performed tennis games, and lowest during Tai Chi and bowling games on
to compare between-console mean V̇O2, EE, METs, wrist ac- both consoles (see table 2). There was a significant effect of
tivity counts, hip activity counts, and RPE for separate pairs of game condition on both wrist (F4.7,85.0⫽19.3, P⬍.001) and hip
equivalent bowling, tennis, and boxing games. Paired t tests (F2.5,45.4⫽5.9, P⫽.003) activity counts. Wrist activity counts
were also conducted to compare differences between the seated were higher than rest during all games (all P⬍.001, table 2).
and standing video game conditions. Hip activity counts were higher than rest during all games (all
Pearson product-moment correlation coefficients were calcu- P⬍.01) except Xbox 360 Kinect Tai Chi (P⫽.02), table tennis
lated to examine the relationships between balance test scores and (P⫽.10), boxing (P⫽.02), and Nintendo Wii boxing in a seated
EE, wrist activity counts, and hip activity counts across all game position (P⫽.08). There were no differences in wrist or hip
conditions, as well as EE, wrist activity counts, and hip activity activity counts between equivalent games played sitting and
counts pooled across sitting and standing game conditions. Results standing (see table 2).
are expressed as mean ⫾ SD. SPSS 19.0f was used for analyses. There were no between-console differences in EE for equiv-
alent bowling (t18⫽⫺.69, P⫽.65), tennis (t18⫽⫺.46, P⫽.36),
RESULTS or boxing games (t18⫽⫺.94, P⫽.50). No between-console
Twenty community-dwelling older adults volunteered for differences in wrist or hip activity counts were found for
the study. Data from 1 participant were omitted from the equivalent bowling (wrist: t18⫽⫺.67, P⫽.51; hip: t18⫽⫺.81,
analysis because of a technical malfunction with the calorim- P⫽.43), tennis (wrist: t18⫽⫺2.32, P⫽.03; hip: t18⫽⫺1.95,
eter. Fifteen women and 4 men completed the study. The P⫽.07), or boxing games (wrist: t18⫽.05, P⫽.96; hip:
participant characteristics are summarized in table 1. t18⫽⫺.68, P⫽.50). There were no between-console differences
Table 2: V̇O2, EE, METs, Activity Counts, and RPE for Each Game Condition (nⴝ19)
Condition V̇O2 (mL·kg⫺1·min⫺1) EE (kJ·min⫺1) METs Wrist AC (cpm) Hip AC (cpm) RPE
Table 3: Relationships Between Balance Test Scores and Mean as well as others with physical impairments,11,41 where limited
EE, Wrist Activity Counts, and Hip Activity Counts Across All balance and mobility are barriers to activity.8
Game Conditions (nⴝ19)
All games were characterized by high wrist activity com-
Variable ABC Mini-BESTest TUG pared with hip movements, which indicates that the games
EE chosen imposed relatively small lower limb movement de-
Pooled .25 .10 .07 mands. For the age group we tested, we deliberately chose
Sitting .36 .11 .20 games that avoided high bone-loading impact activities such as
Standing .20 .09 .03 jumping or running, so our choice of activities did favor upper
Wrist AC limb movement. The apparent lack of lower limb movement
Pooled .21 .41 ⫺.19 during these games may also explain the absence of differences
Sitting .35 .30 ⫺.05 in EE and RPE between equivalent sitting and standing games.
Standing .13 .43 ⫺.24 The METs we reported for bowling in standing (2.0 METs),
Hip AC tennis (2.4 METs), and boxing in standing (3.0 METs) in older
Pooled .25 .44 ⫺.30 adults are comparable to those reported for adolescents playing
Sitting .24 .15 ⫺.13 the same Nintendo Wii active video games.20 Other studies17,18
Standing .22 .49 ⫺.32 that have compared the energy expended while playing active
video games across age groups have demonstrated slightly
NOTE. Values are r (Pearson product-moment correlation lower EE levels in adults when compared with children and
coefficient). adolescents. In contrast, higher METs have been reported for
Abbreviation: AC, activity counts. games played by young adult men (bowling, 2.7 METs; tennis,
3.0 METs; boxing, 4.2 METs).16 These higher values may be
the result of the more dynamic game play of younger adult
in RPE for equivalent bowling (t18⫽.51, P⫽.62), tennis men.
(t18⫽⫺.69, P⫽.50), or boxing games (t18⫽⫺1.03, P⫽.32). Since balance deficits and fear of falling can impair a per-
As can be seen in table 3, correlation coefficients ranged son’s mobility,40,42 an additional aim of our study was to
from ⫺.32 to .49, although none reached statistical signifi- determine whether participants with reduced balance would
cance. This may have been because of the small sample size expend less energy when playing these games. No significant
and lack of statistical power. The strongest correlations differences were found in energy cost according to balance
(r⫽.40 –.49) were between balance scores and activity counts. status. However, the balance scores reported indicate that this
group of community-dwelling older adults fell within the nor-
DISCUSSION mative ranges of balance ability. For example, the TUG scores
This study sought to quantify the energy cost of seated and achieved by our sample (8 –14s) are within the normative range
standing active video game play in older adults, and to deter- for community-dwelling people in this age group.32,43-45 The
mine whether balance status affected game play EE. To our normative score for the ABC Scale, which measures fear of
knowledge, this is the first study to describe the energy cost of falling, is 80.9% among healthy, active older adults,28 suggest-
active video games in a cohort 65 years and older. Across all ing that our group was normal to high functioning. Therefore,
conditions, active video game play resulted in 1.5- to 3-fold our findings show that older community-dwelling adults within
increases in EE compared with rest. This suggests that such a normative range of ability can use off-the-shelf active video
games could be used to promote light physical activity in older games for light to moderate exercise. Future studies that assess
people. the use of active video games in older people with more limited
Physical activity guidelines for older adults recommend balance and physical function would be useful.
higher intensity levels (ⱖ3 METs) than those reported in this
study; however, these guidelines also emphasize that any Study Limitations
amount of physical activity incurs health benefits.3,38 Indeed, Our participants were all novices to active video games, and
recent evidence suggests that any activity EE lowers mortality also, we allowed them to use whatever strategies they wished
risks6 and mobility limitation in older people.39 For the reduc- to play the games. The range of game play techniques and phy-
tion of falls, the demonstrated benefit of exercise appears to be sical engagement used by individuals may have contributed to the
dependent on the exercise frequency and duration of the pro- variability in EE, thereby obscuring possible differences between
gram rather than on the intensity of the exercise.40 Therefore, the energy demands of seated and standing postures. Further, EE
in the frail elderly, where higher intensity exercise may not be and movement strategies used to play the games may change with
achievable, low-moderate intensity exercise may be the best repeated play. Others have shown that EE was increased in ado-
option.4,7 lescents who were skilled at performing active video games when
There was no difference in EE between Nintendo Wii and compared with those who were not.46
Xbox 360 Kinect game consoles, indicating that either platform Finally, this was a laboratory-based study that did not rep-
can be used. The potential benefit of the Xbox 360 Kinect licate the home environment. However, we noted that partici-
system is that it does not require a handheld controller and can pants quickly became immersed in the games, so we do not
be played by people with impaired hand function. The advan- think engagement and energy responses would be significantly
tage of Nintendo Wii is that it can be played seated, which is different in a home environment.
not currently possible with the Xbox 360 Kinect system.
We also measured EE, activity counts, and perceived exer- CONCLUSIONS
tion for boxing and bowling games played while sitting. Inter- Both Nintendo Wii and Xbox 360 Kinect active video games
estingly, there were no significant differences in EE or any significantly increased EE and activity levels in older people
other parameter whether the games were played seated or in when compared with rest. This activity equates to light-inten-
standing, suggesting that this form of activity might be equally sity exercise. Furthermore, the chosen games played while
efficacious for increasing activity and EE in those who are sitting have a similarly beneficial effect on EE levels as while
unable to stand. This has particular relevance to the frail elderly standing.
Future research is needed to determine the continued effect 19. Maddison R, Mhurchu CN, Jull A, Prapavessis H, Rodgers A.
of playing active video games for sustained periods to deter- Energy expended playing video console games: an opportunity to
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preferences for specific games and enjoyment would be helpful 20. Graves LE, Ridgers ND, Stratton G. The contribution of upper
in ensuring continued participation with these activities. limb and total body movement to adolescents’ energy expendit-
ure whilst playing Nintendo Wii. Eur J Appl Physiol 2008;104:
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