Efficacy of Online Multi-Player Versus Single-Player Exergames on Adherence Behaviors Among Children: A Nonrandomized Control Trial.

Background: Exergames have the potential to significantly increase physical activity in children. Studies to date have shown mixed results and often rely on self-reported data. Multi-player gaming may augment participation. Purpose: The purpose of the study was to examine children's adherence behaviors in multi-player online exergames compared to a single-player condition within a home environment. Methods: Seventy-two children, aged 9-12 years, who were not meeting physical activity guidelines at baseline, were allocated to the multi-player or single-player condition. Six-week cycle-based exergaming trials took place 5 day/week in the early evening with online game supervision. Bike use was objectively recorded via game logs. Results: Adherence was high throughout the trial. Play session duration was M = 37.65 (SD = 15.39) min/day, and overall play duration was M = 133.45 (SD = 81.27) min in Week 1 and M = 77.23 (SD = 84.09) min in Week 6. Total physical activity was significantly higher at 6 weeks compared to baseline (p = .01, ηp2 = .13). There was no significant difference in play duration between conditions (p = .57, ηp2 = .01). Conclusion: This trial objectively demonstrated that exergames can promote high adherence levels. Multi-player capabilities did not augment adherence levels. Introducing new games throughout the trial may have motivated participants to keep playing, regardless of whether play was against real or artificial opponents. Weekly play duration decreased due to a significant drop in play frequency. For children who enjoy exergames, innovative solutions to promote more frequent exergame play are needed. Clinical This Registration: NCT02032667.

Force Resistance Training in Hand Grasp and Arm Therapy: Feasibility of a Low-Cost Videogame Controller.

OBJECTIVE: To design and evaluate a low-cost gaming station that supports force resistance training in pediatric arm/hand grasp therapies through mainstream videogame play. METHODS: The gaming station was developed through an iterative participatory design process and includes a force feedback game controller (Novint Falcon), custom grips, arm/wrist supports, and software to interface with mainstream games and manage difficulty settings in the controller. The station was tested for usability and feasibility with six therapists and six children with cerebral palsy, 7-16 years of age, attending weekly therapy sessions over 12 weeks. Pre- and post-assessments of perceived performance and satisfaction on self-identified goals were measured on the Canadian Occupational Performance Measure (COPM). RESULTS: The gaming station was considered highly usable by therapists with a score of 76.7 (standard deviation [SD] = 6.1) on the System Usability Scale. Overall, children enjoyed the games, achieved high repetition rates for wrist extensions and arm movements, and all made clinically significant progress on therapy goals. Increases of 3.13 (SD = 1.69) on the performance scale and 2.97 (SD = 0.98) on the satisfaction scale were reported on the COPM. Conclusiion: In-clinic force resistance training for development of upper limb functional capacities is feasible using low-cost video game components adapted to therapy through a participatory design process.

Balancing for Gross Motor Ability in Exergaming Between Youth with Cerebral Palsy at Gross Motor Function Classification System Levels II and III.

OBJECTIVE: To test how three custom-built balancing algorithms minimize differences in game success, time above 40% heart rate reserve (HRR), and enjoyment between youth with cerebral palsy (CP) who have different gross motor function capabilities. Youth at Gross Motor Function Classification System (GMFCS) level II (unassisted walking) and level III (mobility aids needed for walking) competed in a cycling-based exercise video game that tested three balancing algorithms. MATERIALS AND METHODS: Three algorithms: a control (generic-balancing [GB]), a constant non-person specific (One-Speed-For-All [OSFA]), and a person-specific (Target-Cadence [TC]) algorithms were built. In this prospective repeated measures intervention trial with randomized and blinded algorithm assignment, 10 youth with CP aged 10-16 years (X ± standard deviation = 12.4 ± 1.8 years; GMFCS level II n = 4, III n = 6) played six exergaming sessions using each of the three algorithms. Outcomes included game success as measured by a normalized game score, time above 40% HRR, and enjoyment. RESULTS: The TC algorithm balanced game success between GMFCS levels similarly to GB (P = 0.11) and OSFA (P = 0.41). TC showed poorer balancing in time above 40% HRR compared to GB (P = 0.02) and OSFA (P = 0.02). Enjoyment ratings were high (6.4 ± 0.7/7) and consistent between all algorithms (TC vs. GB: P = 0.80 and TC vs. OSFA: P = 0.19). CONCLUSION: TC shows promise in balancing game success and enjoyment but improvements are needed to balance between GMFCS levels for cardiovascular exercise.

An innovative cycling exergame to promote cardiovascular fitness in youth with cerebral palsy.

OBJECTIVE: To evaluate the effects of an internet-platform exergame cycling programme on cardiovascular fitness of youth with cerebral palsy (CP). METHODS: In this pilot prospective case series, eight youth with bilateral spastic CP, Gross Motor Functional Classification System (GMFCS) level III, completed a six-week exergame programme. Outcomes were obtained at baseline and post-intervention. The primary outcome measure was the GMFCS III-specific shuttle run test (SRT-III). Secondary outcomes included health-related quality of life (HQL) as measured by the KIDSCREEN-52 questionnaire, six-minute walk test, Wingate arm cranking test and anthropomorphic measurements. RESULTS: There were significant improvements in the SRT-III (t = -2.5, p = 0.04, d = 0.88) post-intervention. There were no significant changes in secondary outcomes. CONCLUSION: An exergame cycling programme may lead to improvement in cardiovascular fitness in youth with CP. This study was limited by small sample size and lack of a comparison group. Future research is warranted.