Lorna Boschman at Serious Play 2011

Lorna Boschman Serious Play 2011 in Redmond Washington USA August 24, 2011 everyday design lab SSHRC Doctoral Award

In industrialized countries, fewer than half of adults exercise as frequently as national fitness guidelines suggest (Shields et al., 2010, Biddle & Mutrie, 2008) Adults over forty have an increased risk of developing chronic health conditions that can be prevented or controlled through regular exercise: cardiovascular disease, type 2 diabetes, non-clinical depression (Warburton, 2007b, 2006)

Review of evidence supporting international physical activity guidelines: most recommend moderate physical activity most days of the week (Warburton et al., 2007b) Newly released Canadian guidelines suggest at least 150 minutes per week (in bouts of 10+ minutes) of moderate to vigorous-intensity activities like brisk walking, bicycling, swimming or jogging – shortness of breath & elevated heartbeat (CSEP, 2011)

Studies of perceived barriers to fitness – most say they don’t have time or energy (Biddle & Mutrie, 2008) Fast paced modern lifestyle – may not have time for hour at the gym but do have time for short bursts of exercise (McElroy, 2002) Women begin to lose lower body strength and balance in 50’s, leading to increased chance of falling by 70’s (Low Chow, Brauer & Nitz, 2007)

Physical and brain fitness titles are among the most popular console-based games purchased by Canadian adults over forty (ESA Canada, 2009); Wii Fit Plus with Balance Board ranks #5 in Canada’s console game sales (ESA Canada, 2011) People intend to exercise when they buy the game, but are commercial exergames collecting dust? How are strategies developed for using exergames to support ongoing physical activity?

Fitness trainer and researcher: + to begin, one title to learn + variety of exercise types + nothing on your knees + no lying on the ground + doesn’t say “feel it burn!”

Wii Fit (Plus) Dance Dance Revolution EA Sports Active Just Dance Your Shape My Fitness Trainer Gold’s Cardio Workout (pre-Kinect and current generation user interface)

I am managing the study with a certified fitness trainer, financially supported by Tom Calvert and Ron Wakkary (Simon Fraser University) through GRAND NCE Interested in how women use active games to support a program of physical activity Looking at overall program rather than trying to prove that active games are “the answer” Look at how women approach the question of increasing and maintaining physical activity

What are the factors that encourage women over forty to adopt exercise fitness games as one component of a program of physical activity? How do the actions of exercise partners and the social environment influence exercise adherence and fitness levels of co-exercisers?

The study design simulates real world conditions: women over 40 have access to a range of physical activities they can undertake Let the participants choose a path and track their choices Two groups – those who have a Wii Fit (Plus) system at home and those who use the game exclusively at Britannia Community Centre Our only requirement is that they attend testing sessions at beginning, middle and end of the study

Point of contact are weekly sessions held on Saturday mornings at a Vancouver community centre in their 55+ lounge Two Wii Fit Plus and one dancing station Three exergaming stations at Britannia Community Centre

Began as a six-month longitudinal study – women liked coming back every week and didn’t lose interest after initial enthusiastic response – reporting on first 14 7 participants from six month group, and 7 were enrolled for three months Outcome for regular patrons of the Britannia Seniors’ group: Liked playing Wii Fit Plus game so much that they will purchase their own system for the 55+ Centre to continue playing when study ends

Standard fitness testing: Six Minute Walking Test (aerobic endurance), Chair Stand – # stands from seated position in 30 sec. (lower body strength) and Standing Balance (on one leg) up to 30 seconds BMI, weight, balance left to right measurements using Wii Balance Board Site for Six Minute Walking Test (Rikli & Jones. (2001). Senior Fitness Test Manual )

Ask participants to chart minutes of activity for one week at beginning, middle and end of study Walking was the most common physical activity by far – reported as fast or casual walking Remember the Canadian guidelines of 150 minutes moderate to vigorous aerobic activity per week? Wondered how the reported activities compared to empirical testing

Participants 1-14 (February to August, 2011) Recorded and transcribed digital audio files between 8 - 35 minutes long First interview: background questions about physical activity and exergaming history Second interview: participant provided with transcript of first interview – questions grow out of first interview and themes emerging through concurrent analysis Final interview: summary of previous interviews to confirm interpretation with participant

Bring these three forms of data together to develop a theory based on multiple perspectives of a common process, growing out of a systematic analysis Research process is iterative – participants help to inform the direction of the study as well as the fitness trainer – examining a whole system of interaction including the game, the social environment, and resulting participant profile

Initial codes developed from first 14 interviews: Assessing ability Exercising alone/group Identifying barriers Identifying benefits Looking back Looking forward Tracking activity

“ My thinking slows me down…I’m lazy” – several dealing with stress and/or depression or are discouraged Gym: too crowded, people talking, don’t like being around other people Walking: do not like to go out when it is raining Childcare: did not have time when working and taking care of their children (“no time for myself”)

Competition: “I am not good at competitive sports and I find that competition comes into anything you do as a group context - it’s not something that I’m comfortable with.” Second round of interviews, asked explicitly about participant’s relationship to setting and achieving goals and to views on competition Some participants proposed the concept of commitment as an alternative to competition

Physical activity and games sound like fun, but exercise sounds like work Many women (and men) like to be active outdoors during pleasant weather Need strategies to get back into fitness routine after interruption like illness, emergency, or life gets in the way Work with participants to find strategies to stay active and increase mobility for life

63 years old, recently retired from communications, had hip replacement, insulin dependent with diabetes and family history of cardio disease Being in the study helps her to keep physical activity intentions conscious, but didn’t want pressure Lulu is learning to manage stress, responds to the enjoyment and pleasurable aspects of exergames. She want to learn how to just do it : “ I don’t play a lot of games because I get too competitive. And then I get humiliated… As soon as I get competitive, I lose my competitive edge. ”

Good at sticking to short term goals, but long term ones are more difficult Attended Saturday drop-in for 45 minutes Cited technical and space barriers to prevent her from having exergaming system in her home Due to foot injury, she had a lower aerobic endurance total at the end of the study than in the beginning but increase number of chair stands and was able to stand on one leg almost twice as long as before Summary: prefers variety of physical activities, is committed to concept not to a specific activity

72 year old grandmother whose daughter and two grandchildren lived with her and shared a Wii console Gave children a time limit so she could get her workout done on the Wii Fit Plus Walks 30 minutes to 2 hours daily; used the Wii Fit Plus from 2.5 to 8 hours weekly during the study Began to be more physically active since her husband passed away Considers herself competitive + goal oriented Standing balance improved, aerobic endurance stable but not likely to improve due to foot injury

Likes the idea of being active and is able to just do it Enjoyed social aspects of Saturday morning drop-in, as she knew many of the women who attend Britannia Seniors’ functions Advantage in coming to group every week as well as playing at home – maximum benefit Summary: very committed to physical activity; began playing Wii Sports and likes Wii Fit Plus even better for exercising; looks for variety in her physical activities

49 year old graduate student, no major health conditions or complaints Study made her realize that she was not as active as she thought she was Walks to and from work; cycles a lot with her husband Has Wii and Kinect products in her home, prefers Kinect When weather improves, she has to be outdoors Her dislike of the Wii Fit game is partially aesthetic – she dislikes the avatar characters, describing them as “Weebles” and “small child-like characters” Sees Wii Fit as episodic like TV commercials

Among the highest aerobic endurance scores to date No health problems affecting her fitness Would prefer to be outdoors rather than using indoor fitness activity (has done Yoga but not committed, a winter activity) Summary: more committed to her work goals than physical activity goals at this time

63 years old, has had double knee replacement surgery Broke her wrist last year after losing her balance and falling At start of study, said she was definitely not the kind of person who did much physical activity After 6 months, becoming more confident, improved aerobic endurance score A good friend in the study (Roo) encouraged her and often gave her personal challenges

Recently lost her balance – was in same situation as when she broke her wrist Remembered playing Tightrope Balance game in Wii Fit Plus and was able to correct her balance and avoid a fall Not competitive, came up with the idea of commitment instead Summary: encouragement from fitness trainer and friends in the study and her own determination to change helped her to increase her level of physical activity; Wii Fit Plus was catalyst for change

Factors in adopting exergames: friends are doing it, ability to overcome financial barriers, resources to overcome technical barriers, enough room to move and owns a modern television Influence of friends and social environment: a few of the participants like to exercise alone and don’t interact; those who knew each other made deeper friendships by exercising together Enjoy customized individual program among others who perform a common activity – group situation “normalized” exergaming

Instruction: helped to learn strategies to perform well from researcher; learned safe ways to push themselves from fitness trainer Between two modes of instruction, all participants who attended Saturday morning drop-in were able to find activities in which they excelled Novelty of exergames helped to persuade previously inactive participants to try Previous use of Wii Sports by some participants helped overcome hesitation using new technology

Study of midlife women showed that goals to lose weight or become fit were not nearly as effective as goal to enhance quality of life (Segar, Eccles & Richardson, 2008) Nintendo senior managing director Shigeru Miyamoto led the Wii Fit development team (Iwata & Miyamoto, 2010a) According to Miyamoto, Wii Fit is not a fitness game – it is a game that helps people to become more aware of their bodies (Iwata & Miyamoto, 2010b)

Tom Calvert, Suzanne de Castell and Ron Wakkary And to the Britannia Community Services Centre And to Margaret Dragu, the fitness trainer (participants sometimes underestimate her expertise but I never will) And to financial support of the Canadian GRAND Network of Centres of Excellence, SFU, and SSHRC Doctoral Award

Biddle, S.J.H. and Mutrie, N. (2008). Psychology of physical activity: Determinants, well-being and interventions (2 nd ed.). London: Routledge. Canadian Society for Exercise Physiology (CSEP). Retrieved May 5, 2011 from http://www.csep.ca/english/view.asp?x=804 Entertainment Software Association of Canada. (2009/2010). 2009/2010 Essential facts about the Canadian computer and video game industry . Retrieved January 31, 2010 from http://www.theesa.ca/essential.php Graves, L., Stratton, G., Ridgers, N.D. and Cable, N.T. (2008). Energy expenditure in adolescents playing new generation computer games. British Journal of Sports Medicine 2008 42(7): 592-5944. Iwata, S. and Miyamoto, S. (2010a). Wii.com – Iwata Asks: Wii Fit. Retrieved August 4, 2010 from http://us.wii.com/wii-fit/iwata_asks/vol1_page1.jsp Iwata, S. and Miyamoto, S. (2010b). Wii.com – Iwata Asks: Wii Fit. Retrieved August 4, 2010 http://us.wii.com/wii-fit/iwata_asks/vol1_page5.jsp Low Chow, N.L., Brauer, S.G., and Nitz, J.C. (2007). Age-Related Changes in Strength and Somatosensation during Midlife: Rationale for Targeted Preventive Intervention Programs. Annals of the New York Academy of Sciences 2007, 1114(1): 180-193. McElroy, M. (2002). Resistance to exercise: A social analysis of inactivity . Champaign, IL: Human Kinetics

Nitz, J.C., Kuys, S., Isles, R., and Fu, S. (2009). Is the Wii Fit™ a new-generation tool for improving balance, health and well-being? A pilot study. CLIMACTERIC 2009 , Early Online: 1-6. Original article International Menopause Society 2009. Segar, M.L., Eccles, J.S., and Richardson, C.R. (2008). Types of physical activity goal influences participation in health midlife women. Women’s Health Issues 2008 , 18(4): 281-291. Shields, M., Tremblay, M.S., Laviolette, M., Craig, C.L., Jansses, I., and Gorber, S.C. (2010). Fitness of Canadian adults: Results from the 2007-2009 Canadian Health Measures Survey. Statistics Canada 20 (4). Retrieved August 4, 2010 from http://www.statcan.gc.ca/cgi-bin/af-fdr.cgi?l=eng&loc=http://www.statcan.gc.ca/pub/82-003-x/2010001/article/11064-eng.pdf&t=Fitness%20of%20Canadian%20adults:%20Results%20from%20the%202007-2009%20Canadian%20Health%20Measures%20Survey Warburton, D.E.R., Nicol, C.W. and Bredin, S.S.D. (2006). Health benefits of physical activity: The evidence. Canadian Medical Association Journal 174 (6): 801-809. Warburton, D.E.R., Bredin, S.S.D, Horita, L.T.L., Zbogar, D., Scott, J.M., Esch, B.T.A., and Rhodes, R.E. (2007a). The health benefits of interactive video game exercise. A ppl. Physiol. Nutr. Metab. 32 : 255-263. Warburton, D.E.R., Katzmarzyk, P.T., Rhodes, R.E., and Shephard, R.J. (2007b). Evidence-informed physical activity guidelines for Canadian adults. Appl. Physio. Nutr. Metab. 32: S16-S68.

HCI: How women use digital games to increase and maintain physical activity – contribute concepts or requirements for designers Community health: Aging adults can sustain good health and mobility through regular exercise; exergames can support these strategies Gaming entrepreneurs: Market for fitness games geared toward aging adults is growing, but suitable products are limited to a few titles

Lorna Boschman at Serious Play 2011

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