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Journal of Science and Medicine in Sport

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Original research

Active video games and physical activity recommendations: A comparison of the Gamercize Stepper, XBOX Kinect and XaviX J-Mat
R.R. Mellecker , A.M. McManus
Institute of Human Performance, University of Hong Kong, Hong Kong Special Administrative Region

a r t i c l e

i n f o

a b s t r a c t
Objectives: The current study was designed to evaluate the intensity levels of three exergames and determine the association with physical activity recommendations that correspond to specic outcomes. The variation in cardiovascular responses between the three exergames was also examined. Design: We employed a cross-sectional laboratory design. Methods: We recruited 18 girls to participate in a peak VO2 test and to play Gamercize, Kinect River Rush, XaviX J-Mat at three separate exergaming sessions. Linear regression equations of heart rate and percentage of peak VO2 were calculated for each participant to determine the intensity of exergame play. Differences in intensity between the three exergames and time spent in the recommended moderate (heart rate at 55% peak VO2 ) and vigorous (heart rate at 75% peak VO2 ) intensity levels were analyzed. We calculated the coefcient of variation for the mean heart rate to determine the difference in variance in heart rate values for the three exergames. Results: When playing Gamercize and Kinect the girls did not play at recommended moderate or vigorous levels. Although the girls did not play at vigorous levels when playing XaviX J-Mat, our results showed that when playing XaviX J-Mat they did play at moderate intensity levels. No signicant differences in the coefcient of variation between the three exergames were apparent. Conclusions: If active gaming is to be used to increase physical activity levels then individual differences in levels of exertion and specic activity recommendations need to be taken into consideration. 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Article history: Received 20 April 2013 Received in revised form 9 May 2013 Accepted 18 May 2013 Available online xxx Keywords: Video games Exercise Child Health Physical activity recommendations Girls

1. Introduction Video games have become an attractive form of entertainment and have surpassed television viewing as a preferred sedentary activity choice for children.1 Media usage reports indicate that children are spending an average of 8 h playing sedentary video games a week 2 and the time spent playing video games has been implicated as factor in the rising prevalence of childhood obesity.3 The addition of an active component to this popular form of entertainment has created the optimal tool to halt declining physical activity levels. Energy expenditure,4,5 cardiovascular responses4,6 and specic health outcomes79 have been assessed highlighting some of the positive effects when engaging in active gaming activities. Although promising, results are inconclusive as to whether active games result in energy levels that are commensurate with physical activity guidelines.10 To ensure children participate in

Corresponding author. E-mail address: robmel@hku.hk (R.R. Mellecker).

adequate amounts of physical activity for health it has been suggested that they engage in at least 60 min of moderate/vigorous intensity physical activity daily.11 A recent study investigating the differences in energy cost of 6 different active gaming systems suggests that children engage in active video game play at moderate to vigorous intensity levels that correspond to physical activity recommendations for children.12 This study used general activity guidelines and absolute intensities to determine whether the participants were meeting physical activity guidelines. Anchoring intensity to an absolute value does not account for differences in cardiorespiratory tness between individuals, which may explain some of the intensity level discrepancies between active gaming studies. Cardiovascular effort during exercise or physical activity is commonly derived from predicted maximum heart rate values rather than individualized cardiovascular responses in relation to peak oxygen uptake. This may explain the differences noted in cardiovascular effort between studies, since use of predictions of maximum heart rate, rather than values relative to an individuals aerobic tness are likely to reduce accuracy and lead to misrepresentation of physical effort.

1440-2440/$ see front matter 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jsams.2013.05.008

Please cite this article in press as: Mellecker RR, McManus AM. Active video games and physical activity recommendations: A comparison of the Gamercize Stepper, XBOX Kinect and XaviX J-Mat. J Sci Med Sport (2013), http://dx.doi.org/10.1016/j.jsams.2013.05.008

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Differences in bodily movements required from various video games result in varied intensity levels and energy expenditure.6 Body movements that incorporate all of the extremities produce higher intensity levels and elicit greater energy cost.10 Active video games, which include sensor-based technologies, allow the user to control the game with body movements, move freely and engage all extremities when playing. Physiologic responses of Dance Central and Kinect Sports Boxing suggests that sensor based games result in signicant increases in energy expenditure above rest.13 When using MET values to equate these responses to generalized physical activity recommendations14 Dance Central resulted in 2 METs whereas Kinect Sports Boxing elicited a MET value of 4. Unlike sensor based systems that require an individual to use a controller, perform an activity on a dance mat or use body movements to control the game, contingent systems are connected to conventional exercise equipment. Contingent systems (game pauses when activity ceases) provide the active video game player with various game choices. Preference or choice of game increases the amount of time and intensity that children engage in physical activity.15 Active gaming (exergaming) is a promising physical activity alternative given that children are encouraged to move whilst engaging in an activity they enjoy. Limited evidence exists on whether active gaming will increase activity levels that meet recommendations commensurate with specic outcomes and the individual differences in intensity levels between active gaming systems.16,17 We aimed to determine differences in intensity between the three exergame conditions (Gamercize, Kinect River Rush, XaviX JMat) and the recommended moderate (heart rate at 55% peak VO2 ) and vigorous (heart rate at 75% peak VO2 ) intensity levels associated with body composition and cardiorespiratory tness changes, respectively. Our hypothesis was two-fold. We expected (1) the three exergames would result in moderate levels of physical activity; (2) the three exergames would not increase intensity to vigorous levels. In view of the recent literature highlighting considerable individual variations in physical effort when playing active video games,12 we investigated the variation in cardiovascular responses between the three exergames. We hypothesized that there would be signicant variation in intensity of play between the three exergames.

2. Methods We chose to recruit girls for this investigation with the knowledge that girls are less active than boys18 and that exergaming may be a more suitable physical activity alternative for meeting physical activity recommendations in this subgroup of youth.19 Twenty Hong Kong Chinese girls were recruited through a local government primary school and agreed to participate in this study. Two girls were absent during the maximal exercise testing protocol and were excluded from the nal analysis. According to local age and sex specic BMI cut-offs, 11 (61%) of the girls were considered overweight and 7 (39%) were normal weight. Written informed consent was received by all the parents and the Institutional Review Board for human ethics granted ethical approval for this study. The girls attended one session in our laboratory during which time anthropometric measures and peak oxygen uptake (peak VO2 ) were assessed. Stature was measured barefoot with an accuracy of 0.1 cm with a xed stadiometer (Invicta 2007246, Leicester, UK). Body mass and body fat were determined with an accuracy of 0.1 kg using electronic scales (Tanita Body Composition Analyzer, TBF410, Japan). Following a 10-min seated resting period, submaximal and peak oxygen uptake, as well as cardiovascular responses were

determined using an incremental treadmill protocol. The girls starting walking at 3.0 km h1 and speed was increased every 4-minutes by 1.0 km h1 (4, 5, 6, km h1 ). Speed was increased to 8 km h1 for 1-min and once RER values of 0.90 were attained gradient was increased every minute by 2% until the child reached volitional maximum. Peak VO2 was determined when two of the following three conditions were reached: (i) a respiratory exchange ratio >1.0, (ii) heart rate >85% of age predicted maximum and (iii) the participant was exhausted and refused to carry on despite strong verbal encouragement.20 We utilized a Medgraphics Ultima indirect calorimeter. Data were collected breath-by-breath and integrated to an eight-breath average. Prior to each test gases of known concentration were used to calibrate the oxygen and carbon dioxide sensors. Calibration of the volume sensor was performed using a 3l syringe. The children wore a pediatric sized Hans Rudolph mask (Model 8950), which was assessed for proper t and leakage. Heart rate was monitored continuously from heart rate telemetry (Polar E600). Linear regression equations of percentage of peak HR versus percentage of peak VO2 were calculated for each participant to determine the level of exergame play at 55% and 75% of peak VO2 . During the baseline assessment session the girls were given time to habituate to the three active gaming systems. Although none of the girls reported having any prior experience playing any of the three exergames, habituation (ability to operate the controller and game without disruption to the game or physical activity) to the three gaming systems was completed within 15-min. Following the initial baseline assessments, the girls attended three active gaming sessions on separate days in the primary school. At the beginning of each active gaming session the girls were tted with a Polar heart rate monitor (Polar E600). Heart rate was assessed continuously for 5-min and the average heart rate from the 5-min of active game play was used determine the cardiovascular effort for each session. We asked the girls to sit quietly for 5 min to ensure heart rates were at resting levels prior to the active video gaming sessions. Due to limited time period during lunch recess and to reduce the burden on the school the active video gaming sessions were limited to 5-min each. The three exergames used in this study are commercial systems, which were available and affordable to the girls at the time of the study. The girls were allowed to play freely on the three exergames and were not given any feedback during the 5-min exergaming sessions. To maintain consistency all of the XBOX video games were set at beginner level. We also allowed the girls to choose one video game from a variety of E-rated adventure video games (Bee Movie and Surfs Up) when playing on the Gamercize Stepper since this is common practice when playing with this system in a home environment. When exergaming using the Gamercize Stepper, the girls stepped and played on contingent mode, which ceases video game play when stepping stops. The Kinect XBOX system is a sensor based active video game system, which requires body movements to control the game. We choose the Kinect River Rush video game to compliment the adventure video games used when playing the Gamercize Stepper. We set the Kinect system to single player and allowed the girls choose the River Rush adventure. The girls walked/ran and dodged ninjas at their chosen pace when playing the Jackie Chan Challenge on the XaviX J-Mat, which comprises of a sensor port and a mat. Means and standard deviations were computed for all key variables. A within group only repeated measures ANOVA was conducted to examine whether there were differences in heart rate between the three exergame conditions: Gamercize, XaviX J-Mat and Kinect River Rush. We used paired t-tests to determine differences in the heart rate achieved whilst playing the three exergames and the heart rate values at 55% peak VO2 (moderate) and at 75% peak VO2 (vigorous), which were obtained during the exercise test.

Please cite this article in press as: Mellecker RR, McManus AM. Active video games and physical activity recommendations: A comparison of the Gamercize Stepper, XBOX Kinect and XaviX J-Mat. J Sci Med Sport (2013), http://dx.doi.org/10.1016/j.jsams.2013.05.008

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R.R. Mellecker, A.M. McManus / Journal of Science and Medicine in Sport xxx (2013) xxxxxx 3 Table 2 Exercise test physiological data. SD 0.2 5.6 6.4 2.7 6.9 5.0 Range 8.08.9 122.5142.1 25.348.5 1424 52.575.5 2545 N = 18 Seated HR (beats min ) Maximum HR (beats min1 ) Peak VO2 (ml kg min1 ) HR at 4 km h1 (beats min1 ) HR at 5 km h1 (beats min1 ) HR at 6 km h1 (beats min1 ) HR at 8 km h1 (beats min1 ) Heart rate (beats min1 ) 55% Peak VO2 Heart rate (beats min1 ) 75% Peak VO2
1

Table 1 Descriptive characteristics of the girls. N = 18 Age (y) Stature (cm) Body mass (kg) BMI (kg m2 ) Waist circumference (cm) %Fat Mean 8.5 133.4 34.3 19.2 63.9 35.6

Mean 92 199 41.6 120 129 142 163 146 171

SD 10 5.0 4.5 11 13 14 11 10 6

To determine the variance in heart rate values between Gamercize, Kinect and XaviX J-Mat, we calculated the coefcient of variation (CV) for the heart rate elicited whilst playing all three exergames. We performed a between subject One Way ANOVA to determine the difference in variance in heart rate values for the three exergames. 3. Results Descriptive characteristics of the girls are noted in Table 1. Means and standard deviations for resting, submaximal and maximal heart rate, as well as peak VO2 are shown in Table 2. A within-subjects repeated measures ANOVA revealed signicant differences in heart rate response during the different exergames (F(2, 30) = 16.088, p < 0.001). Post hoc Bonferroni tests revealed signicant differences between the Gamercize heart rate and Kinect River Rush (Gamercize HR: 138 14 beats min1 ; Kinect River Rush HR: 124 14 beats min1 ). Heart rate responses were also signicantly higher for XaviX J-Mat (148 16 beats min1 ), compared with playing Kinect River Rush (124 14 beats min1 ). Our results show that when playing Gamercize and Kinect the girls did not play at the recommended moderate (p = 0.033, p < 0.001) or vigorous levels (ps < 0.001). Although the girls did not play at vigorous levels when playing XaviX J-Mat (p < 0.001),

our results showed that when playing XaviX J-Mat they did play at moderate intensity levels (p = 0.642). No signicant differences were apparent between the heart rate at 55% peak VO2 and XaviX J-Mat, however, signicant differences were noted between XaviX J-Mat and heart rate at 75% peak VO2 (ps < 0.001). Fig. 1 illustrates the individual heart rate responses for the girls when playing each of the three exergames. The CV for Gamercize is 8.9%, Kinect 11.3% and XaviX J-Mat 11.4%. Results from the One Way ANOVA showed that there were no signicant differences in the CV between the three exergames (p = 0.477). 4. Discussion When comparing the three exergame conditions, we found XaviX J-Mat play was equivalent to moderate intensity levels, levels commensurate with body composition changes.17 Although heart rates were elevated above resting and sitting heart rates, most of the girls did not step and game using Gamercize or play the Kinect River Rush at moderate intensity levels.17 Our results do not concur with the proposal that the physiological response between games is an artifact of body movement.10 The XaviX J-Mat requires full body

200 180

Heart Rate (beats.min-1 )

160 140 120 100 80 60

Kinect Gamercize River Rush Stepper

XaviX J-Mat

HR 55% HR 75% Peak VO2 Peak VO2

Fig. 1. Scatterplot illustrating cardiovascular responses for the three exergames and heart rate at 55% and 75% peak VO2 .

Please cite this article in press as: Mellecker RR, McManus AM. Active video games and physical activity recommendations: A comparison of the Gamercize Stepper, XBOX Kinect and XaviX J-Mat. J Sci Med Sport (2013), http://dx.doi.org/10.1016/j.jsams.2013.05.008

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movement including jumping, stamping, and performing kneeling to standing actions whereas some video games require the user to only use the upper body or simply ick a wrist to control the video game.6 On the other hand, the heart rate responses were 124 and 148 bpm for the Kinect River Rush and XaviX J-Mat, respectively. The XaviX J-Mat and Kinect River Rush both required the girls to use upper and lower extremities to play and both video games required movements such as jumping, kneeling and lateral movements. Yet, playing the Kinect River Rush did not result in heart rate responses that correspond with moderate intensity levels. These ndings suggest that intensity levels vary between games but specic body movements alone may not explain the variance. When comparing the energy cost of various active games it appears that differences in intensity level may also be subject to the type of game played.12,21 The XaviX Jackie Chan Challenge allows the user to travel through the streets of Hong Kong whilst following an iconic Hong Kong actor, Jackie Chan. The journey through Hong Kong and the connection with Jackie Chan may have been motivating for the girls in this study. Relatedness or connection with oneself or a character22 facilitates motivation to play and persistence to continue playing.23 The XaviX Jackie Chan Challenge may have provided some sense of cultural connectivity whereas the Kinect River Rush and the video games chosen when stepping and video gaming on the Gamercize Stepper did not include characters that had cultural relevance or a personalized connection. The affect of relatedness on intensity of play is of interest given that some active games do not elicit intensity levels sufcient to meet recommendations10,24 and the possibility that relatedness inuences long-term play. The girls in this study were given a variety of video games to choose from when stepping and video gaming on the Gamercize Stepper. Autonomy (choice of many different games) increase exercise intensity, with girls more motivated by choice than boys.15 Autonomy has proven to be successful in promoting the amount of time that children are physically active25 but when comparing Wii exergames with traditional versions of sport, intensity was greater when children engaged in traditional sports.25 Our results are consistent with previous ndings.25 Most of the girls in our study did not reach moderate intensity levels associated with specic outcomes when stepping and gaming on the Gamercize Stepper despite having the autonomy to choose their game. When considering the design of exergames it has been suggested that developers match the software interface with corresponding equipment to ensure that the system offers a holistic experience for the end user.26 The video games coupled with the Gamercize Stepper may produce a video game experience that is disconnected with the motor task, which results in a subsequent decrease in the level of exertion when stepping and gaming. The individualized exercise test allowed us to examine the intraindividual differences in cardiorespiratory effort and determine an individualized assessment of whether the girls were meeting physical activity recommendations for specic health outcomes.15,16 We found no signicant difference in variation between the three exergames but the range of cardiovascular responses within each game suggests that intensity of play differs widely between individuals even when playing with the same exergame system. Of the 18 girls that participated in the study, 10 of the girls played XaviX, 3 girls played on the Gamercize Stepper and 1 girl played Kinect at moderate levels of intensity. None of the girls played any of the exergames at vigorous intensity levels. Although promising our results are not without limitations. We individualized our data and matched the cardiovascular responses during active gaming to individual heart rate responses when exercising at peak VO2 to address issues related to body composition and cardiorespiratory tness. However, we were not able to address differences in variables such as weight status due to the limited

number of participants. In an attempt to provide some resemblance to free play in a home environment we allowed the girls to choose their video game when video gaming and stepping on the Gamercize Stepper. The active gaming sessions were limited to 5-min. Although brief, short bouts of intermittent activity are characteristic movement patterns for this age group and this population.27 In addition, the 5-min play bouts mimic the short duration intervals, which are inherent in the design of active games. Future efforts to understand the physiological responses to active game play between systems (boredom, intensity level variations) are obligatory. To keep the type of game constant, we offered games that were similar in content and video games that possessed an adventure theme. At the time of this study, the XaviX Jackie Chan Challenge and the Kinect River Rush were the only games in this genre for these systems and for this reason the girls did not have game choice when playing on these systems. Furthermore, the autonomy to choose did not increase intensity levels when stepping and playing video games on the Gamercize Stepper. 5. Conclusion Our ndings suggest that not all active gaming systems result in activity levels commensurate with physical activity guidelines and intensity levels when playing active video games is variable. Specic activity recommendations and health outcomes need to be taken into consideration to ensure that specic goals are prescribed and met when implementing active gaming interventions. In addition, individual differences in levels of exertion when active gaming is in need of further investigation. Practical implications If active gaming is to be used to increase physical activity levels specic activity recommendations related to health outcomes should be taken into consideration. To ensure that children meet recommended levels of intensity commensurate with specic health outcomes active game interventions may need to consider the active gaming console being introduced. Motivational techniques to address intra-individual variation in intensity levels need to be addressed when implementing active gaming as a physical activity alternative. Acknowledgements We are extremely grateful to the participants and the primary school for assisting us with this research study. We would also like to acknowledge the generosity of Databridge Services Limited. References
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Please cite this article in press as: Mellecker RR, McManus AM. Active video games and physical activity recommendations: A comparison of the Gamercize Stepper, XBOX Kinect and XaviX J-Mat. J Sci Med Sport (2013), http://dx.doi.org/10.1016/j.jsams.2013.05.008

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Please cite this article in press as: Mellecker RR, McManus AM. Active video games and physical activity recommendations: A comparison of the Gamercize Stepper, XBOX Kinect and XaviX J-Mat. J Sci Med Sport (2013), http://dx.doi.org/10.1016/j.jsams.2013.05.008