Effects of home-based exergaming on cardio-metabolic and cognitive health in physically inactive individuals.

AIMS: To examine the effects of a home-based exergame training over 6 weeks on cardio-metabolic and cognitive health, as well as training adherence, in physically inactive individuals. MATERIALS AND METHODS: Twenty participants were equipped with an exergame system specifically designed for use at home. Each participant performed at least three weekly exercise sessions at ≥80% of their individual maximum heart rate, over 6 weeks. Exercise duration increased biweekly until 75 min of vigorous exercise were performed in Weeks 5 and 6. Maximum oxygen uptake (VO2max), cardio-metabolic profiling, and neuro-cognitive tests were performed at baseline and study end. Additionally, training adherence was assessed via training diaries. RESULTS: After 6 weeks of home-based exergaming, VO2max increased significantly, while there was a significant decrease in heart rate (resting and maximum), blood pressure (systolic, diastolic and mean), and low-density lipoprotein cholesterol. Dynamic balance and reaction time improved after 6 weeks of exergaming. Training adherence was 88.4%. CONCLUSIONS: Home-based exergaming induced a clinically relevant increase in VO2max, a determinant of cardiovascular health, accompanied by further improvements in cardiovascular, metabolic and neuro-cognitive parameters. Exergaming may, therefore, offer an innovative approach to increasing regular physical activity, improving metabolic risk profile, and preventing chronic diseases.

Dose-response relation between the duration of a cognitively challenging bout of physical exercise and children's cognition.

Acute bouts of physical exercise have the potential to benefit children's cognition. Inconsistent evidence calls for systematic investigations of dose-response relations between quantitative (intensity and duration) and qualitative (modality) exercise characteristics. Thus, in this study the optimal duration of an acute cognitively challenging physical exercise to benefit children's cognition was investigated, also exploring the moderating role of individual characteristics. In a within-subject experimental design, 104 children (Mage = 11.5, SD = 0.8, 51% female) participated weekly in one of four exergaming conditions of different durations (5, 10, 15, 20 min) followed by an Attention Network task (ANT-R). Exergame sessions were designed to keep physical intensity constant (65% HRmax ) and to have a high cognitive challenge level (adapted to the individual ongoing performance). Repeated measures ANOVAs revealed a significant effect of exercise duration on reaction times (RTs; p = 0.009, ƞ2 p = 0.11), but not on response accuracy. Post hoc analyses showed faster information processing speed after 15 min of exercise compared to 10 min (p = 0.019, ƞ2 p = 0.09). Executive control, alerting and orienting performances and interactions were unaffected by exercise duration (ps > 0.05). Among individual characteristics, habitual physical activity moderated duration effects on RTs. For more active children, exercise duration influenced the interaction between executive control and orienting (p = 0.034; ƞ2 p = 0.17) with best performances after the 15 min duration. Results suggest that an acute 15 min cognitively high-challenging bout of physical exercise enhances allocable resources, which in turn facilitate information processing, and-for more active children only-also executive processes. Results are interpreted according to the arousal theory and cognitive stimulation hypothesis.

ExerG: adapting an exergame training solution to the needs of older adults using focus group and expert interviews.

BACKGROUND: Exergames are playful technology-based exercise programs. They train physical and cognitive functions to preserve independence in older adults (OAs) with disabilities in daily activities and may reduce their risk of falling. This study gathered in-depth knowledge and understanding of three different user groups' experiences in and relevant needs, worries, preferences, and expectations of technology-based training, to develop an exergame training device for OAs. METHODS: We conducted a qualitative study using semi-structured focus group interviews of primary (OAs in geriatric or neurological rehabilitation) and secondary (health professionals) end users, as well as expert interviews of tertiary end users (health insurance experts or similar), exploring user perspectives on adjusting an existing exergame to OAs' needs. Voice-recorded interviews were transcribed by researchers and analyzed using thematic analysis (TA) following an inductive, data-driven, iterative approach. RESULTS: We interviewed 24 primary, 18 secondary, and 9 tertiary end users at two rehabilitation centers in Austria and Switzerland. Our TA approach identified five to six themes per user group. Themes in the primary end user group reflected aspects of safety, training goals, individuality, game environment, social interactions, and physical and technical overload. Themes in the secondary end user group comprised facets of meaningfulness, distraction through the game environment, safety, gamification elements, the availability and accessibility of the exergame. Tertiary end users' themes addressed aspects of financial reimbursement, suitable target populations, professional training for the handling of exergame devices, training goals, and concerns about the use of exergames in geriatric rehabilitation. CONCLUSIONS: In conclusion, an exergame for OAs must be safe, motivating and fully adaptable to the target group while promoting the return to or preservation of autonomy and independence in daily life. Our findings contribute to developing hard- and software extensions for the ExerG training device. Further research is needed to expand the validity of our findings to larger populations.

Evaluating Changes in Perceived Enjoyment throughout a 12-Week School-Based Exergaming Intervention.

This study assessed whether a high-intensity exergame represents an enjoyable training tool for children in the elementary school setting. Furthermore, it evaluated whether gender, body mass index (BMI), waist-to-height ratio (WHtR), fitness level, weekly physical activity level, and general interest in sports moderate perceived enjoyment during the 12-week intervention. Thirty fifth- and sixth-grade students (10.5 ± 0.7 years; 50% girls) participated in this study. During baseline assessments, anthropometric measurements and a shuttle run test were conducted. Throughout the intervention period, the students participated in 15−20-min exergaming sessions (ES) in the ExerCube twice a week during school hours. Enjoyment was assessed after an ES in weeks 2 and 12. Additionally, enjoyment was evaluated after a physical education (PE) class in week 2. The results reveal no significant changes in enjoyment (p = 0.164) over time. The modest changes over time were significantly affected by BMI (p = 0.027), WHtR (p = 0.007), and weekly activity level (p = 0.016). Compared to the PE class, enjoyment was significantly higher during the ES (p < 0.001). None of the covariates showed a significant effect. Mean HR during the ES reached 87.1 ± 1.9% of students' individual maximum HR. In conclusion, the ExerCube provides a promising tool for schools to promote enjoyable moderate-to-vigorous physical activity.

Acute exercise and children's cognitive functioning: What is the optimal dose of cognitive challenge?

Acute bouts of exercise have the potential to benefit children's cognition. Inconsistent evidence on the role of qualitative exercise task characteristics calls for further investigation of the cognitive challenge level in exercise. Thus, the study aim was to investigate which "dose" of cognitive challenge in acute exercise benefits children's cognition, also exploring the moderating role of individual characteristics. In a within-subject experimental design, 103 children (Mage = 11.1, SD = 0.9, 48% female) participated weekly in one of three 15-min exergames followed by an Attention Network task. Exergame sessions were designed to keep physical intensity constant (65% HRmax) and to have different cognitive challenge levels (low, mid, high; adapted to the ongoing individual performance). ANOVAs performed on variables that reflect the individual functioning of attention networks revealed a significant effect of cognitive challenge on executive control efficiency (reaction time performances; p = .014, ƞ2p = .08), with better performances after the high-challenge condition compared to lower ones (ps < .015), whereas alerting and orienting were unaffected by cognitive challenge (ps > .05). ANOVAs performed on variables that reflect the interactive functioning of attention networks revealed that biological sex moderated cognitive challenge effects. For males only, the cognitive challenge level influenced the interactive functioning of executive control and orienting networks (p = .004; ƞ2p = .07). Results suggest that an individualized and adaptive cognitively high-challenging bout of exercise is more beneficial to children's executive control than less challenging ones. For males, the cognitive challenge in an acute bout seems beneficial to maintain executive control efficiency also when spatial attention resources cannot be validly allocated in advance. Results are interpreted referring to the cognitive stimulation hypothesis and arousal theory.

Impact of an exergame intervention on cognitive-motor functions and training experience in young team sports athletes: a non-randomized controlled trial.

Introduction: Team sports athletes need excellent perceptual-cognitive skills, particularly executive functions (EF) to strategically perform on the field. The transfer effect of cognitive training might be accomplished by the inclusion of cognitive stimuli into a physically active environment as these couplings are required in real game situations. A training approach that combines both components is exergaming. The primary objective of this study was to gain preliminary insights into the effects of exergaming on cognitive-motor functions in young team sports athletes. The secondary objective was to investigate participants' training experience and well-being over time. Methods: Participants were assigned to the intervention or control group. In the intervention group, participants trained with the ExerCube-a mixed reality exergame. The training was planned for 10 weeks (two sessions per week à 25 min) but had to be shortened by 2 weeks due to COVID-19 restrictions. The control group had no additional training. Outcomes included a computer-based alertness test and a cognitive-motor test battery to assess different EF (flexibility, divided attention, and inhibition) via a FitLight Trainer setup. Results: Twenty-four athletes [mean age (±SD) 15.0 ± 0.7 years], evenly split into the intervention group (N = 12; male N = 6; female N = 6; 14.7 ± 0.5 years) and the control group (N = 12; male N = 7; female N = 5; 15.3 ± 0.8 years), participated in the study. Participants in the intervention group performed on average 9.4 ± 3.3 training sessions over 8 weeks. Significant time x group interaction effects were evident for the cognitive-motor sub-tests flexibility (F = 12.176, p < 0.001, d = 1.488) and divided attention for auditive stimuli (F = 9.776, p = 0.002, d = 1.404) in favour of the intervention group. For the alertness test, a medium effect size (time x group interaction) was seen for the variability of the reaction time (F = 2.196, p = 0.138, d = 0.632) in favour of the intervention group. Training experience and well-being were consistently at medium to high levels. Conclusion: The ExerCube training yielded positive effects on concentration, flexibility, and divided attention indicating that exergaming can be an innovative training approach for team sports athletes.

Integrating Regular Exergaming Sessions in the ExerCube into a School Setting Increases Physical Fitness in Elementary School Children: A Randomized Controlled Trial.

This study aimed to investigate the effects of a school-based exergame intervention on anthropometric parameters and physical fitness. Fifty-eight students (10.4 ± 0.8 years; 48% girls) were randomized into an intervention (IG) and a control (CG) group. Both groups participated in regular physical education classes during the three-month intervention period. The IG additionally received a 20-minute exergame intervention twice per week. At baseline and following the intervention period, body mass index (BMI) and waist-to-height ratio (WHtR) were assessed. Furthermore, a sprint test (ST), a countermovement jump test (CMJ), and a shuttle run test (SRT) were performed. Due to prescribed quarantine measures, only 34 students (18 IG; 16 CG) were included in the final analysis. A significant group−time interaction was determined in CMJ performance (p < 0.001; η2 = 0.403), with a significant increase (+2.6 ± 2.4 cm; p < 0.001; η2 = 0.315) in the IG and a significant decrease (−2.0 ± 3.1 cm; p = 0.009; η2 = 0.190) in the CG. Furthermore, ST performance significantly improved in the IG (−0.03 ± 0.08 s; p = 0.012; η2 = 0.180) but not in the CG (0.13 ± 0.16 s; p = 0.460; η2 = 0.017), revealing significant interaction effects (p = 0.02; η2 = 0.157). Significant group−time interaction was observed for the SRT (p = 0.046; η2 = 0.122), with a significant increase (+87.8 ± 98.9 m; p = 0.028; η2 = 0.147) in the IG and no changes (−29.4 ± 219.7 m; p = 0.485; η2 = 0.016) in the CG. Concerning BMI (p = 0.157; η2 = 0.063) and WHtR (p = 0.063; η2 = 0.114), no significant interaction effects were detected. School-based exergaming is a suitable tool to influence students' physical fitness positively.

Gaming Instead of Training? Exergaming Induces High-Intensity Exercise Stimulus and Reduces Cardiovascular Reactivity to Cold Pressor Test.

INTRODUCTION: The present study assessed if an exercise session in an innovative exergame can modulate hemodynamic reactivity to a cold pressor test (CPT) to a similar extent as a typical moderate endurance training (ET). Furthermore, cardiorespiratory, and affective responses of an exergame session and an ET were compared. METHODS: Twenty-seven healthy participants aged 25 ± 4 years (48% female; BMI 23.0 ± 2.1 kg/m2) participated in this cross-sectional study. All participants completed both an ET on a treadmill and training in the ExerCube (ECT). HR and oxygen consumption were recorded during both training sessions. Before and after both exercise sessions, the hemodynamic reactivity to a CPT was determined. RESULTS: During ECT, HR, oxygen consumption, energy expenditure, and the metabolic equivalent of the task were significantly higher than those obtained during ET (p < 0.001). With regard to the CPT, the participants showed significantly lower responses in peripheral systolic (p = 0.004) and diastolic blood pressure (p = 0.009) as well as central systolic (p = 0.002) and diastolic BP (P = 0.01) after ECT compared to ET. The same was true for pulse wave velocity (p = 0.039). CONCLUSION: The ECT induced a significantly higher exercise stimulus compared to the ET. At the same time, it attenuated hemodynamic stress reactivity. The ECT presents a relevant training stimulus that modulates cardiovascular reactivity to stress, which has been proven as a predictor for the development of hypertension. TRIAL REGISTRATION: ISRCTN registry, ISRCTN43067716, 14 April 2020, Trial number: 38154.

Acute Effects of Heart Rate-Controlled Exergaming on Vascular Function in Young Adults.

Objective: Acute and regular moderate-intensity endurance exercise (MIEE) is known to positively affect vascular function. The present study assessed if an exercise session in an innovative exergame called the ExerCube can induce similar vascular reactions as an MIEE session. Materials and Methods: Twenty-eight healthy recreationally active participants (13 females and 15 males; aged 24.8 ± 3.9 years; with body mass index 23.2 ± 2.3 kg/m2) completed an exergaming session (EGS) in the ExerCube (25 minutes) and an MIEE session on a treadmill (35 minutes, 65%-70% of maximal heart rate [HR]) in a randomized order. Both before and throughout the 45 minutes after the training sessions, pulse wave velocity (PWV), total peripheral resistance (TPR), stroke volume (SV), and HR were recorded. The study was approved by the Research Ethics Board of the Martin-Luther-Universität Halle-Wittenberg (Medical Faculty of the Martin-Luther-Universität 2019-177). Results: There were different hemodynamic responses to both types of exercises. PWV was significantly decreased 45 minutes after the EGS (P < 0.001). No significant changes were detected after MIEE (P = 0.109). TPR was significantly lower after both exercise sessions (P < 0.01). Only the EGS resulted in a significant decrease in SV 15 minutes after exercise (P < 0.001). The HR was significantly (P < 0.05) higher after both exercise sessions. After the EGS, the increase in HR was still significantly higher (P = 0.011) 45 minutes after the session. The interaction effects revealed significant differences in PWV (15 minutes, P = 0.035; 30 minutes, P = 0.004; and 45 minutes, P < 0.001), favoring the EGS. Conclusion: The EGS seems to induce a relevant exercise stimulus that can modulate vascular function. Therefore, this exergame may present an effective tool for prevention of cardiovascular diseases.

A Game-Based Approach to Lower Blood Pressure? Comparing Acute Hemodynamic Responses to Endurance Exercise and Exergaming: A Randomized Crossover Trial.

The present randomized crossover study aimed to determine whether an exergaming session in an innovative, functional fitness game could be an effective exercise approach that elicits favorable blood pressure (BP) responses, such as a typical moderate endurance exercise (ET). Therefore, acute hemodynamic responses after a training session in the ExerCube and an ET on a treadmill were assessed and compared. Twenty-eight healthy recreational active participants (13 women; aged 24.8 ± 3.9 years) completed an exergaming session (EX) and an ET in a randomized and counterbalanced order. Before and throughout the 45 min after the training, the peripheral and central BP were measured. After the ET, there was a moderate decrease in both peripheral systolic (-1.8 mmHg; p = 0.14) and diastolic (-0.8 mmHg; p = 0.003), as well as central diastolic (-1.5 mmHg; p = 0.006) pressure compared to the resting value before the exercise. After the EX, there was a significant decrease in peripheral systolic (-6.3 mmHg; p < 0.001) and diastolic (-4.8 mmHg; p < 0.001), as well as central systolic (-5.8 mmHg; p < 0.001) and diastolic (-5.3 mmHg; p < 0.001) pressure compared to baseline. The interaction effects showed significant differences in peripheral and central systolic BP as well as in peripheral diastolic BP (p = 0.05). The EX seems to be an effective training approach that triggers relevant peripheral and central BP-responses, which are more pronounced than after a typical ET. Therefore, the ExerCube can be a time-efficient training tool to improve cardiovascular health.

Development of a Novel Home-Based Exergame With On-Body Feedback: Usability Study.

BACKGROUND: With more than 1.4 billion adults worldwide classified as physically inactive, physical inactivity is a public health crisis leading to an increased risk of cardiometabolic diseases. Motivating and engaging training strategies are needed to tackle this public health crisis. Studies have shown that exergames, games controlled by active body movements, are potentially usable, attractive, and effective tools for home-based training. The ExerCube (by Sphery Ltd) has been developed as a physically immersive and adaptive functional fitness game. The development of a home-based version of the ExerCube could increase accessibility, reduce barriers to exercise, and provide an attractive solution to improve physical and cognitive health. OBJECTIVE: The aim was threefold: (1) to develop a usable home-based exergame system, (2) to evaluate the usability and training experience of the home-based exergame and its early-stage on-body feedback system, and (3) to identify avenues for further user-centered design iterations of the system. METHODS: A total of 15 healthy participants (mean age 25, SD 3 years) completed 2 laboratory visits consisting of four 5-minute exergame sessions. In each session, the on-body feedback system provided a different feedback modality (auditory, haptic, and visual feedback) to the participant. Following the second visit, participants completed a range of assessments, including the System Usability Scale (SUS), the Physical Activity Enjoyment Scale (PACES), the Flow Short Scale (FSS), the Immersive Experience Questionnaire (IEQ), and a rating of perceived exertions (RPEs) both physically and cognitively. Participants answered questions regarding the on-body feedback system and completed a semistructured interview. RESULTS: Usability was rated as acceptable, with a SUS score of 70.5 (SD 12). The questionnaires revealed medium-to-high values for the training experience (FSS: 5.3, SD 1; PACES: 5.3, SD 1.1; IEQ: 4.7, SD 0.9. Physical (mean 4.8, SD 1.6) and cognitive (mean 3.9, SD 1.4) RPEs were moderate. Interviews about the on-body feedback system revealed that the majority of participants liked the haptic feedback and the combination of haptic and auditory feedback the best. Participants enjoyed the distinct perceptibility, processing, and integration of the exergame and its supportive and motivating effect. The visual feedback was perceived less positively by participants but was still classified as "potentially" helpful. The auditory feedback was rated well but highlighted an area for further improvement. Participants enjoyed the training experience and described it as motivating, interactive, immersive, something new, interesting, self-explanatory, as well as physically and cognitively challenging. Moreover, 67% (n=10) of the participants could imagine exercising at home and continuing to play the exergame in the future. CONCLUSIONS: The home-based exergame and its early-stage on-body feedback system were rated as usable and an enjoyable training experience by a young healthy population. Promising avenues emerged for future design iterations.

Comparing the Impact of Heart Rate-Based In-Game Adaptations in an Exergame-Based Functional High-Intensity Interval Training on Training Intensity and Experience in Healthy Young Adults.

Physical inactivity remains one of the biggest societal challenges of the 21st century. The gaming industry and the fitness sector have responded to this alarming fact with game-based or gamified training scenarios and thus established the promising trend of exergaming. Exergames-games played with the (whole) body as physical input-have been extolled as potential attractive and effective training tools. Simultaneously, researchers and designers are still exploring new approaches to exploit the full potential of this innovative and enjoyable training method. One way to boost the attractiveness and effectiveness of an exergame is to individualize it with game adaptations. A physiological parameter that is often used to balance the physical challenge and intensity of exergames to the player's fitness skills is the heart rate (HR). Therefore, researchers and designers often rely on age-based, maximum HR (HRmax) formulas originating from performance diagnostics. In combination with the player's assessed real-time HR during an exergame session, the pre-determined HRmax is used to adapt the game's challenge to reach a pre-defined HR and physical intensity level (in-exergame adaptations), respectively. Although the validity and reliability of these age-based HRmax formulas were proven in heterogeneous target populations, their use is still often criticized as HR is an individual parameter that is affected by various internal and external factors. So far, no study has investigated whether the formula-based pre-calculated HRmax compared to a standardized individually pre-assessed HRmax elicits different training intensities, training experiences, and flow feelings in an exergame. Therefore, we compared both variants for in-exergame adaptation with the ExerCube - a functional high-intensity interval training exergame - in healthy young adults. Comparing the results of the two conditions, no significant differences were found for HR parameters and perceived physical and cognitive exertion, nor for overall flow feelings and physical activity enjoyment. Thus, the formula-based in-exergame adaptation approach was suitable in the presented study population, and the ExerCube provided an equally reliable in-exergame adaptation and comparable exergame play experiences. We discuss our findings in the context of related work on exergame adaptation approaches and draw out some implications for future adaptive exergame design and research topics.

Physical Activity and Health Promotion in Esports and Gaming-Discussing Unique Opportunities for an Unprecedented Cultural Phenomenon.

Due to long periods of sedentary behavior, and unhealthy diets gamers and esports players are at risk for numerous chronic diseases and all-cause mortality. Health research has started addressing the public health implications of the esports phenomenon, drawing a bleak picture of this megatrend. However, instead of just highlighting adverse public health implications of this trend, it is recommended to become involved in this phenomenon and positively influence it. Esports has an enormous potential for physical activity and health-promoting efforts, provides a context for broadly disseminating interventions, and offers new ways of gaining access to an often-neglected population. This paper presents: the potential of the esports phenomenon to promote physical activity, health, and well-being in gamers and esports players; the strategic and preventive solutions to ameliorate esports possible adverse health impacts; and the utilization of esports technology (streams, media platforms, exergames, etc.) as an innovative health promotion tool, especially reaching gamers and esports players with attractive and interactive interventions. This is to encourage systematic scientific research so that evidence-based guidelines and intervention strategies involving regular physical activity, healthy diet, and sleep hygiene for esports will be developed. The goal is to promote public health approaches that move toward a better integration of esports and gaming.

Adaptive High-Intensity Exergaming: The More Enjoyable Alternative to Conventional Training Approaches Despite Working Harder.

Objective: The purpose of this study was to assess psychological and physiological responses to an exergaming session in the ExerCube (EX) and compare them with the responses of a moderate endurance run (ER). Materials and Methods: Twenty-eight healthy adults (13 women) aged 24.8 ± 3.8 years took part in this study. The first test day, participants performed a graded exercise test on a treadmill to determine maximal heart rate (HR) and lactate levels. The following test days 2 and 3, the participants completed an EX session and an ER on a treadmill in a randomized counterbalanced order. HR, rate of perceived exertion (RPE), and lactate levels were assessed during both sessions. After the sessions, the participants completed the "Physical Activity Enjoyment Scale" and the "Flow Short Scale." Results: The analysis of variance revealed that enjoyment (P = 0.036), flow (P = 0.042), RPE (P = 0.005), as well as mean and peak HR (P < 0.001) during the EX session were significantly higher compared with the ER. Gender did not affect the differences between the two conditions for mean HR (P = 0.61), maximal HR (P = 0.122), RPE (P = 0.862), flow (P = 0.376) nor enjoyment (P = 0.867). During the EX session, the lactate levels of all participants exceeded the individual lactate threshold (LT). During the ER, lactate values remained below the LT. Conclusion: The ExerCube presents both a physiological relevant exercise stimulus and a joyful gaming experience. Despite the higher exercise intensity achieved during the EX session, enjoyment was significantly higher compared with the ER. Therefore, the EX can be a promising and appealing tool to facilitate physical activity. Trial registration: ISRCTN registry, ISRCTN43067716, April 14, 2020. Trial number: 38154.

Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies.

BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Patients with MS experience a wide range of physical and cognitive dysfunctions that affect their quality of life. A promising training approach that concurrently trains physical and cognitive functions is video game-based physical exercising (ie, exergaming). Previous studies have indicated that exergames have positive effects on balance and cognitive functions in patients with MS. However, there is still a need for specific, user-centered exergames that function as a motivating and effective therapy tool for patients with MS and studies investigating their usability and feasibility. OBJECTIVE: The aim of this interdisciplinary research project is to develop usable and feasible user-centered exergames for the pressure-sensitive plate Dividat Senso by incorporating theoretical backgrounds from movement sciences, neuropsychology, and game research as well as participatory design processes. METHODS: Focus groups (patients and therapists) were set up to define the user-centered design process. This was followed by the field testing of newly developed exergame concepts. Two sequential usability and feasibility studies were conducted on patients with MS. The first study included a single exergaming session followed by measurements. Between the first and second studies, prototypes were iterated based on the findings. The second study ran for 4 weeks (1-2 trainings per week), and measurements were taken before and after the intervention. For each study, participants answered the System Usability Scale (SUS; 10 items; 5-point Likert Scale; score range 0-100) and interview questions. In the second study, participants answered game experience-related questionnaires (Flow Short Scale [FSS]: 13 items; 7-point Likert Scale; score range 1-7; Game Flow questionnaire: 17 items; 6-point Likert Scale; score range 1-6). Mixed methods were used to analyze the quantitative and qualitative data. RESULTS: In the first study (N=16), usability was acceptable, with a median SUS score of 71.3 (IQR 58.8-80.0). In the second study (N=25), the median SUS scores were 89.7 (IQR 78.8-95.0; before) and 82.5 (IQR 77.5-90.0; after), and thus, a significant decrease was observed after training (z=-2.077; P=.04; r=0.42). Moreover, high values were observed for the overall FSS (pre: median 5.9, IQR 4.6-6.4; post: median 5.8, IQR 5.4-6.2) and overall Game Flow Questionnaire (pre: median 5.0, IQR 4.7-5.3; post: median 5.1, IQR 4.9-5.3). A significant decrease was observed in the item perceived importance (FSS: z=-2.118; P=.03; r=0.42). Interviews revealed that user-centered exergames were usable, well accepted, and enjoyable. Points of reference were identified for future research and development. CONCLUSIONS: The project revealed that the newly developed, user-centered exergames were usable and feasible for patients with MS. Furthermore, exergame elements should be considered in the development phase of user-centered exergames (for patients with MS). Future studies are needed to provide indications about the efficacy of user-centered exergames for patients with MS.

Correction: Design and Evaluation of User-Centered Exergames for Patients With Multiple Sclerosis: Multilevel Usability and Feasibility Studies.

[This corrects the article DOI: 10.2196/22826.].

Let the Body'n'Brain Games Begin: Toward Innovative Training Approaches in eSports Athletes.

The phenomenon of eSports is omnipresent today. International championships and their competitive athletes thrill millions of spectators who watch as eSports athletes and their teams try to improve and outperform each other. In order to achieve the necessary cognitive and physical top form and to counteract general health problems caused by several hours of training in front of the PC or console, eSports athletes need optimal cognitive, physical and mental training. However, a gap exists in eSports specific health management, including prevention of health issues and training of these functions. To contribute to this topic, we present in this mini review possible avenues for holistic training approaches for cognitively, physically and mentally fitter and more powerful eSports athletes based on interdisciplinary findings. We discuss exergames as a motivating and promising complementary training approach for eSports athletes, which simultaneously combines physical and cognitive stimulation and challenges in an attractive gaming environment. Furthermore, we propose exergames as innovative full-body eSports-tournament revolution. To conclude, exergames bring new approaches to (physical) eSports, which in turn raise new topics in the growing eSports research and development community.