An alarming number of adolescents experience obesity and related health issues, in part because of a lack of exercise. Increased mobile technology availability can have negative effects on amount of exercise, but they can have positive effects as well. Leveraging mobile technology to encourage and motivate exercise has potential to decrease unhealthy lifestyles, especially among young people. Mobile exergaming is an emerging field that has the potential to motivate users to exercise while also having fun. However, much of the early development work on mobile exergames has been ad-hoc, with little guidance available for designers. This work seeks to identify heuristics catered for mobile exergaming. This thesis presents four mobile exergaming heuristics were identified based on recent literature and on the author's mobile exergame design and development efforts: 1) Motivational game concepts that promote physical activity; 2) Game cues that engage active users; 3) Physically and temporally appropriate game structure to encourage continual, recurring play; 4) Game play movements that are safe for the user and for the device. This thesis describes the development of the mobile exergame heuristics, along with the creation and distribution of an ExergameApp Suite comprised of three mobile exergames: Fish Out of Water, Color Hunt and Space Rayders. / Master of Science

Aim The purpose of this study is to compare the level of activity between playing wii Sports Tennis and wii Sports boxing, and the usual sports, and to see how the two variants are perceived.Issues:- How much strain ratio and energy consumption it gives to exercise wii sports compared with the playing of sport for real?- How do the test participants experience the different tests?- How are the two wii sports games against each other in terms of activity and fitness in the school environment? Method This is an experimental study in which 10 test participants (5 men and 5 women) have carried out four different physical tests. The tests consisted of either playing an exergame or playing a sport for 25 minutes. Physical activity was measured during the test using a heart rate monitor. All test participants completed all tests in the same order. After each test, all test participants filled out a questionnaire concerning their immediate subjective experiences of the test. The results from the questionnaire where later compiled with the results from the physical tests. Results The results showed that the physical activity of the tennis and wii tennis differed. Tennis generated in 30% higher average heart rate and 88% higher average energy expenditure. The comparison between boxing and wii boxing, gave no significant results. Wii boxing generated 32% higher average heart rate and 81% higher average energy expenditure compared to wii tennis. Test Study participants also considered wii boxing to be more suitable in physical education than wii tennis. They also felt that both wii boxing and tennis was more enjoyable than wii tennis. Conclusion Wii tennis generated the lowest physical activity as compared to the three other forms of exercise. The real sports were most suitable for school sports, however, wii boxing was more suitable than wii tennis. Test participants also considered the wii boxing as more enjoyable than wii tennis and tennis / Syfte och frågeställningar Syftet med denna studie är att jämföra aktivitetsgraden mellan att spela wii sports tennis och wii sports boxning och, de vanliga idrotterna, samt att se hur de båda varianterna upplevs. Frågeställningar: - Hur stor ansträngsningsgrad och energiförbrukning innebär utövande av wii sports jämfört med att utöva idrotterna på riktigt? - Hur upplever testdeltagarna de olika testerna? - Hur skiljer sig de två wii sportspelen beträffande aktivitet och lämplighet i skolmiljö? Metod Detta är en experimentell studie där 10 testdeltagare (5 män och 5 kvinnor) har genomfört 4 olika fysiska tester. Testerna bestod av att antingen spela ett träningsspel eller utöva en idrott i 25 minuter. Den fysiska aktiviteten mättes under testet med hjälp av pulsklocka. Alla testdeltagare genomförde alla tester i samma ordning. Efter varje avslutat test fick alla testdeltagare fylla i en enkät om deras omedelbara subjektiva upplevelser kring testet. Dessa sammanställdes sedan tillsammans med de fysiska resultaten. Resultat Resultaten visade att tennis och wii tennis skiljde sig åt. Tennis genererade 30% högre genomsnittlig arbetspuls och 88% högre genomsnittlig energiförbrukning. I jämförelsen mellan boxning och wii boxning fanns inga signifikanta resultat. Wii boxning genererade 32% högre genomsnittlig arbetspuls och 81% högre genomsnittlig energiförbrukning jämfört med wii tennis. Testdeltagarna i studien ansåg även att wii boxning passar bättre i skolidrotten jämfört med wii tennis. De upplevde även att både wii boxning och tennis var roligare än wii tennis. Slutsats Wii tennis genererade lägst fysisk aktivitet jämfört med de övriga tre motionsformer. De riktiga idrotterna ansågs mest appliceringsbara till skolidrotten, dock ansågs wii boxning lättare att applicera än wii tennis. Testdeltagarna ansåg också wii boxning som roligare än wii tennis och tennis.

This thesis presents an exercise-based edutainment system intended for children. It is designed to enhance their cognitive development by encouraging movement in a fun way. The main idea behind the system is that children will have fun constructing a physical, tangible user interface. In addition, they will learn how to spell many words that represent objects and entities by stepping on a collection of coloured pads and receiving responses through a set of multimedia outputs related to these entities. For this purpose we have designed and implemented a tangible user interface that facilitates interaction with the system. This tangible user interface is called "SmartPads" and is composed of coloured tiles that can be physically connected to each other to form any shape. The pads are mapped onto a computer screen in real-time. A user interacts with the interface by stepping on the pads. We have incorporated two games that allow children of different ages to benefit from the system's functionalities and encourage them to interact with it. This thesis provides detailed information about the proposed system and its related components, discusses the design and development of the two games, and measures the system's performance when used by the children.

abstract: Sustaining a fall can be hazardous for those with low bone mass. Interventions exist to reduce fall-risk, but may not retain long-term interest. "Exergaming" has become popular in older adults as a therapy, but no research has been done on its preventative ability in non-clinical populations. The purpose was to determine the impact of 12-weeks of interactive play with the Wii Fit® on balance, muscular fitness, and bone health in peri- menopausal women. METHODS: 24 peri-menopausal-women were randomized into study groups. Balance was assessed using the Berg/FICSIT-4 and a force plate. Muscular strength was measured using the isokinetic dynamometer at 60°/180°/240°/sec and endurance was assessed using 50 repetitions at 240°/sec. Bone health was tracked using dual-energy x-ray absorptiometry (DXA) for the hip/lumbar spine and qualitative ultrasound (QUS) of the heel. Serum osteocalcin was assessed by enzyme immunoassay. Physical activity was quantified using the Women's Health Initiative Physical Activity Questionnaire and dietary patterns were measured using the Nurses' Health Food Frequency Questionnaire. All measures were repeated at weeks 6 and 12, except for the DXA, which was completed pre-post. RESULTS: There were no significant differences in diet and PA between groups. Wii Fit® training did not improve scores on the Berg/FICSIT-4, but improved center of pressure on the force plate for Tandem Step, Eyes Closed (p-values: 0.001-0.051). There were no significant improvements for muscular fitness at any of the angular velocities. DXA BMD of the left femoral neck improved in the intervention group (+1.15%) and decreased in the control (-1.13%), but no other sites had significant changes. Osteocalcin indicated no differences in bone turnover between groups at baseline, but the intervention group showed increased bone turnover between weeks 6 and 12. CONCLUSIONS: Findings indicate that WiiFit® training may improve balance by preserving center of pressure. QUS, DXA and osteocalcin data confirm that those in the intervention group were experiencing more bone turnover and bone formation than the control group. In summary, twelve weeks of strength /balance training with the Wii Fit® shows promise as a preventative intervention to reduce fall and fracture risk in non-clinical middle aged women who are at risk. / Dissertation/Thesis / Ph.D. Exercise and Wellness 2014

This thesis presents an exercise-based edutainment system intended for children. It is designed to enhance their cognitive development by encouraging movement in a fun way. The main idea behind the system is that children will have fun constructing a physical, tangible user interface. In addition, they will learn how to spell many words that represent objects and entities by stepping on a collection of coloured pads and receiving responses through a set of multimedia outputs related to these entities. For this purpose we have designed and implemented a tangible user interface that facilitates interaction with the system. This tangible user interface is called "SmartPads" and is composed of coloured tiles that can be physically connected to each other to form any shape. The pads are mapped onto a computer screen in real-time. A user interacts with the interface by stepping on the pads. We have incorporated two games that allow children of different ages to benefit from the system's functionalities and encourage them to interact with it. This thesis provides detailed information about the proposed system and its related components, discusses the design and development of the two games, and measures the system's performance when used by the children.

Obesity has become a worldwide problem that most countries are trying to fight. It affects many people, irrespective of age, race, gender, or religion; anyone can suffer from obesity, which leads to serious problems, both for individuals and for society as a whole. In this study we have selected two groups of people: the basic people who do not exercise on a weekly basis, and the average people who exercise regularly, every week. We have explored the attitude of the two groups in regards to mixing exercises with games, in order to motivate the people with basic activity levels to exercise more frequently. We have used a qualitative standard online questionnaire from AttrakDiff, which evaluates user experience through four important aspects: a) quality; b) subjective understanding of quality and subjective evaluation of quality; c) pragmatic and hedonic features; and d) emotional and behavioural effects. We also did a qualitative study and a quantitative study of some of the important factors present during exercise. The results of the qualitative and quantitative studies were very encouraging as they revealed that mixing games with exercise can transform boring exercises into entertaining ones. It can also motivate players to continue and repeat the exercises. The ANOVA test was applied and it shows that combining games with a stationary bike has a significant effect on the speed and the average rotation per minute of the participants.

Active video games (AVG) have been shown to acutely increase energy expenditure when compared to seated video games; however, the compensatory effects on energy intake and subsequent energy expenditure are largely unknown. The main objective of this thesis was to examine the acute effects of AVG on energy intake and expenditure in male adolescents. Our results suggest that male adolescents compensate for one hour of AVG play by decreasing their physical activity levels for the remainder of the day. There was no compensation in acute energy intake with AVG play. The results from this thesis suggest that the benefits of one hour of Kinect™ AVG play are offset within 24 hours in male adolescents. Therefore, caution must be exercised when prescribing AVG for interventions aimed at preventing/treating childhood obesity.

Obesity has become a worldwide problem that most countries are trying to fight. It affects many people, irrespective of age, race, gender, or religion; anyone can suffer from obesity, which leads to serious problems, both for individuals and for society as a whole. In this study we have selected two groups of people: the basic people who do not exercise on a weekly basis, and the average people who exercise regularly, every week. We have explored the attitude of the two groups in regards to mixing exercises with games, in order to motivate the people with basic activity levels to exercise more frequently. We have used a qualitative standard online questionnaire from AttrakDiff, which evaluates user experience through four important aspects: a) quality; b) subjective understanding of quality and subjective evaluation of quality; c) pragmatic and hedonic features; and d) emotional and behavioural effects. We also did a qualitative study and a quantitative study of some of the important factors present during exercise. The results of the qualitative and quantitative studies were very encouraging as they revealed that mixing games with exercise can transform boring exercises into entertaining ones. It can also motivate players to continue and repeat the exercises. The ANOVA test was applied and it shows that combining games with a stationary bike has a significant effect on the speed and the average rotation per minute of the participants.

The research reported in the thesis investigated exergaming acceptance and expe-rience in older people with special reference to technology acceptance, flowstate, chronic pain and balance control. In recent years, there has been an increasing amount of literature on the beneficial effects of exergaming on older people’s health, well-being and balance, including the use of exergaming as a method of pain con-trol. Nevertheless, when taken separately, specific studies vary in methodology and in type(s) of exergaming topics studied. Health benefits from exergaming may only be gained if older people take part in it. There is evidence in the literature to indicate that usage of a technology is preceded by user acceptance. Few studies, to date, have investigated how older people perceive and experience exergaming in relation to their perceived abilities and future intention to use it, from a technology acceptance point of view. Therefore, the purpose of this thesis was to see if (1) the exergaming technology was acceptable to healthy older people and older people with chronic pain and (2) it had any effect in the self-reported health status, pain conditions and balance in older people with chronic pain. The current thesis consists of two separate studies. In Study 1, twenty-eight healthy older people participated in six 40-minute exergaming sessions within a three-week period. In Study 2, fifty-four older people with chronic musculoskeletal pain attended a twelve 40-minute exercise intervention within a six-week period, either randomised into an exergaming group (IREXTMsystem) or standard physical exercises. A modified version of the Unified Theory of Acceptance and Use of Technology (UTAUT) was analysed at baseline and upon completion of the intervention, including specific time points throughout the study. Self-perceived chronic pain and flow state were analysed at baseline and after exercise intervention. Rate of perceived expended physical and mental effort was recorded after every exercise session and compared between groups. Heart rate was recorded in the second study. Postural sway was assessed at the start and the end of the intervention with Centre of Pressure data being extracted via a Kistler force plate (AP SD, AP range ,ML SD, ML range and CoP velocity), where the conditions were quiet bipedal standing with eyes open and eyes closed. Evidence from both studies showed that exergaming technology was acceptable to healthy older people and older people with chronic musculoskeletal pain. Recorded high levels of flow indicated the occurrence of flow during the intervention. Perfor-mance expectancy emerged as the strongest predictor of older people’s behavioural intention to use exergaming. Previous behaviour was an important influence of future behaviour, within the context of exergaming. In Study 1, there were significant increases throughout the intervention in most of the flow state variables except challenge-skill-balance, paradox of control and transformation of time. Thematic analysis of olde rpeople’s responses relating to exergaming revealed that enjoyment was the most frequently cited theme. The significant increase of perceived physical exertion suggested that exergaming provided light-to-moderate intensity exercise for this cohort of healthy older people. In Study 2, an interesting pattern emerged over time where earlier on in the interven-tion, effort expectancy significantly predicted older people’s behavioural intention to use exergaming (instead of performance expectancy). This role was then taken over by performance expectancy midway through the intervention. This indicated that this sample of older people with chronic pain prioritised their personal ability to play the exergames, after which, they then considered the usability of the exergaming technology in choosing whether to use it in future, if it were readily made available. In addition, there was evidence of improvement in post-intervention pain intensity in the exergaming group, suggesting that exergaming may have alleviated older people’s experience of pain to some extent. Flow levels significantly increased from the start to the end of the intervention. Significant improvements over time in postural sway parameters in the control and exergaming groups suggested that short-term exercise contributed to improved balance in older people with chronic musculoskeletal pain. The indication of improved postural sway due to significant mediolateral reductions in the eyes-closed condition in the both groups suggested that older people with chronic pain could benefit from at least subtle improvements in balance after taking part in short-term exercise. Nevertheless, exergaming may have an effect on postural sway when visual sensory information is removed, as found in the experimental group that demonstrated a statistically significantly lower reduction of CoP excursion in the medio-lateral direction, than in the control group.

Introduction: Fall risk, occurrence and injury is increasing as the world ages, and Africa and other emerging regions will not be spared. Similarly, the rise of noncommunicable diseases, compressed morbidity and lack of physical activity present major challenges. This novel feasibility study explored the use of an exergaming technology compared with a conventional, evidence-based exercise programme (Otago Exercise Programme) to reduce fall risk by improving balance, and to inform a large-scale randomised control trial. Methodology: Mixed methods study in independent older adults with established fall risk. The quantitative component employed feasibility RCT methodology. Cluster randomisation assigned interventions to sites. Single blinding was used. Both interventions were offered for six months. A variety of balance-related endpoints (e.g., Timed Up and Go, Dynamic Gait Index, Mini-BESTest) were used to find the most applicable. Patient-centred variables included questionnaires regarding depression, physical activity levels, quality of life and estimates of self-efficacy for exercise. Qualitative focus groups explored participants' experiences of falls and the exergaming intervention using a phenomenology lens. Results: Site and participant recruitment was simple and readily achievable, with low numbers need to screen required. Eligibility criteria were confirmed and more added. Adherence and attrition were major challenges. Cluster randomisation appeared to exacerbate between-group differences at baseline. The exergaming intervention produced preliminary evidence in its favour, with results approaching Minimal Clinically Important Difference compared with the evidence-based intervention. The experience of the exergaming intervention was regarded as positive by focus group participants. Barriers and facilitators are reported. Discussion: Methodological issues in the literature have prevented firm consensus on the use of exergaming in falls prevention, although studies are abundant. The current study used rigorous methodology in the novel context of a developing region, which offers numerous challenges for older adults. Implications for a large-scale, fully funded RCT are discussed. Lessons learned can be used to scale up service delivery for an under-served population; and promote the aim of well-being for all at all ages.