Games for Health Journal - Insider

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	The Internet has been abuzz this week due to the surprising results from Tom Baranowski’s team at Baylor, which found that children, left to their own devices, get no more health benefit from exergames than from other videogames. The paper, Impact of an Active Video Game on Healthy Children’s Physical Activity, was published in the Feb. 27 issue of Pediatrics. According to Reuters who had the initial report on the study, some public health researchers have hoped that active videogames might be an alternative to outdoor play and sports for at least some of the physical activity kids need -- especially for those who live in unsafe neighborhoods where playing outside isn’t always an option. To test this idea, researchers from Baylor College of Medicine in Houston, Texas, gave Nintendo Wii consoles to children who didn’t already have one. Half of the participants were given their choice of an active game -- such as Wii Sports or DanceDance Revolution-Hottest Party 3 -- and the other half their choice of an inactive game, such as Disney Sing-It Pop Hits or Super Mario Galaxy. Halfway through the study, the 78 participating children, all nine to 12 years old and above average weight and BMI, were given their choice of a second game from the same category as their first. The research team tracked the youngsters for 13 weeks, testing their physical activity levels with a motion-measuring device called an accelerometer. Results showed that throughout the study period, participants with the active games got no more exercise than those given inactive video games. If one simply refers to this statement of findings, it is a short step toward believing that exergames have no health value. In fact, the actual conclusion of the study was “results provide no reason to believe that simply acquiring an active videogame under naturalistic circumstances provides a public health benefit to children.” In other words, like having a bowling ball, simply owning a potentially beneficial asset doesn’t ensure success. It requires coaching for goals, motivation, technique, discipline, and so on. Many bloggers and the more sensational publications failed to read the fine print of the story which resulted in headlines such as “Wii Motion Gaming Won't Guarantee Better Fitness”, “Just because it's Wii, doesn't mean it's exercise,” and “Study rubbishes Nintendo health benefits”. The take away from the Baylor study remains powerful. The health benefits and expectations for videogames lie not within the game itself but how one chooses to employ the resource. Medicine sitting on the shelf and untaken; un-followed post-surgery exercise regimens; ignored recommendations for smoking cessation; and exergames without assistance don’t achieve the expected outcomes -- not at the fault of the medication, prescription, advice, or game. So the question becomes, given the resources, how are exergames best supported to achieve the desired results? My sense is that we have not heard the last on this study and, hopefully, other researchers will build on the results of the Baylor study to better understand exergame potentials. Meanwhile, we have received excellent feedback from our first issue of the Games for Health Journal. If you haven’t gotten your copy yet, please visit the website to see the Games for Health Table of Contents and to subscribe. Warm Regards, Bill Ferguson, PhD Editor-in-Chief Games for Health Journal: Research, Development, and Clinical Applications

Exergaming in AHA's Circulation journal!

4-25-11: My job in the clinic doesn't require me to publish like my academic colleagues, so it's cool to see something published that I co-authored with legends Debra Lieberman and Barbara Chamberlin, and others. This particular article contains a summary of exergames, state of field, and future considerations.

This was published from our presentation during the 2nd day of the Power of Play Summit, hosted by the Amer. Heart Assoc., and Nintendo. (These are pictures from the summit held Jan. 2011.)

You can check out the actual article here.

Kids' BMI's on the rise!

4-11-11: A sobering story about our efforts with pediatric obesity in our county (San Bernardino county) and CA in general. Read about that latest pediatric obesity rates in today's story that came out in the San Bernardino Sun here.

What can be done? Notice how video games" are mentionedd several times as the culprit...unfortunately, it still is in vogue to pick on the "bad video games" and not other forms of sedentary-inducing activities like TV watching, computer usage, even reading (heaven-forbid we pick on that! ;-). Exergaming (i.e. active gaming), of course, can get all these video-gaming couch potatoes active again, especially since many of these kids are not into the traditional forms of physical activity.

Video games aren't going away, so instead of blaming them, we can use them to INCREASE physical activity in the very population of kids who love video games the most! This is a win-win for everyone.

Even better, imagine a system, similar to USA Swimming where my daughter, Summer, was on the Redlands Swim Team for 6 years. She trained with the coaches 5x/wk, from 1-2 hrs a day. When she was older, they added "dry land" exercises to augment their in-pool training. She would work on her technique and times, and then once a month, enter swim meets all around the IE. Over the years, she collected hundreds of ribbons and medals which she had hanging on the walls in her bedroom.

Soon, we will have a similar non-profit org called the National Active Gaming League (NAGL) where we will have teams of kids who will train on various exergames (active video games) to learn strategy and technique, and also train with more traditional forms of exercise to improve their game scores. We will go to local, regional, and county meets, and eventually, national meets (the National Spelling Bee final is on ESPN--why not the NAGL Final?). This will give kids a structured format to train and get exercise, have fun with other kids, and train for a goal of doing their best in tournaments.

We are looking to launch a pilot of the NAGL this summer, so if any parents are interested in getting their video-gaming kids involved with the NAGL, feel free to contact us at xrgamer1@gmail.com.

By using the "enemy", we can get these rising BMI stats turned around!!!

PS. In this article, UCLA's Center for Health Research put the blame on, "They blame the increase on youths' sedentary lifestyle, which is often instigated by prevalence of video games and lack of opportunity or motivation to play outside."

The good news is that new mobile games and apps are being developed that address this! Companies such as Perpetual Motion Partners (PMP) are developing mobile app games that get players walking outside, motivating them with a fun scavenger hunt to play! One example is Mobile Adventure Walks! For more info, a promo video, and updates when the app is available, go to mobileadventurewalks.com.

President's Council on Active Gaming!

1-21-11: This is the FIRST time I can recall that I've seen active gaming (aka exergaming) blogged about on the Dept. of Health & Human Services website!

President's Council on Sport, Fitness, & Nutrition's Executive Director Shellie Pfohl recently authored a blog on the benefits of "active gaming" and the intersection between the use of this cutting-edge technology and the national objectives outlined in Healthy People 2020. To read Shellie's blog and/or post a comment, please visit http://www.health.gov/paguidelines/blog/.

I had a chance to meet with Exec Dir. Pfohl after her presentation during the Fitness Tech session at CES a couple of weeks ago, and we had a good talk about how the President's Council can be more involved with active gaming. (It didn't hurt that I was able to mention that it was our work (Dr. Haddock and I) that got the Wii Sports listed on the President's Challenge list of exercises!).

We talked about the National Active Gaming League (NAGL), and she seemed enthusiastic about it, so I look forward to collaborating more with the President's Council when we launch the NAGL in May!

Ernie Medina, Jr.
Exergaming Evangelist/Interventionist

Exercise and Alzheimer

11-19-10: Check this out...study on exercise and high-risk alzheimer...more reasons for seniors to keep exercising! What is interesting is the testing they did to measure cognitive function.

What if the exercise was COMBINED with a cognitive function, as in some of our exergaming equipment like the Makoto? Could there be an even bigger impact on protection???

An excellent idea for a study, working with the neuro or geriatric guys....we have all the equipment and resources at LLU so let's get a grant to study this effect!!! I have yet to see it presented at any of the conferences.

http://www.stonehearthnewsletters.com/exercise-link-to-alzheimers-risk-protection-cleveland-clinic-marquette-wayne-state-rosalind-franklin/alzheimers/

New article reviewing active video game studies

9-8-10: Just rec'd a PDF of this review article entitled, "Active video games to promote physical activity in children and youth", by Elaine Biddis and Jennifer Irwin. It came out in the Archives of Pediatric and Adolescence Medicine, 2010; 164(7):664-672.

The objective of this study was to "...systematically review levels of metabolic expenditure and changes in activity pattenrs associated wtih active video game (AVG) play in children and to provide directions for future research efforts." This covered published studies spanning Jan. 1, 1998 to Jan. 1, 2010.

If you'd like a copy of this study via PDF, send me an e-mail at ernie@medplaytech.com.

7-28-10: 7-28-10: Check this quote out: “The time spent sitting was independently associated with total mortality, regardless of physical activity level.”

This was from a new American Cancer Society study, titled Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults. (I put more details of the article and study below for those who want the reference) What does this study suggest? Two things:

1. We still need to promote the 2008 physical activity recommendation of 150 mins. of moderate physical activity per week.

2. We need to start focusing on reducing the amount of time we spend being a couch potato the other 23.5 hours in the day!

How does this help the exergaming cause? Well for starters, most of our research focus has been on showing how exergaming can meet objective #1. Games like wii Boxing and Xavix Jackie Chan Run and certain songs of iDance can definitely get one up to the moderate (4-6 MET) range.

Even though we have been showing this, most of the criticism towards exergaming is still focused on how it isn't "enough" to reach the moderate level of "exercise". Well now with this study, we can say that the OTHER exergames that fall below the "moderate" level can help to address this second objective! It seems that this is turning out to be a much bigger risk factor than was first thought.

So casual exergames can make a big dent reducing the negative effects of "hypokinetic disease", and if you read the study, this could be even bigger than getting people to do their 30 mins. of moderate exercise Rx 5x/wk!

Another study to support the use of exergames in getting couch potatoes all over the world moving!

Dr. Ernie Medina, Exergaming Evangelist, ernie@medplaytech.com
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Public release date: 22-Jul-2010

Contact: David Sampson
david.sampson@cancer.org
American Cancer Society

Study links more time spent sitting to higher risk of death

Risk found to be independent of physical activity level

A new study from American Cancer Society researchers finds it's not just how much physical activity you get, but how much time you spend sitting that can affect your risk of death. Researchers say time spent sitting was independently associated with total mortality, regardless of physical activity level. They conclude that public health messages should promote both being physically active and reducing time spent sitting. The study appears early online in the American Journal of Epidemiology.

Increasing obesity levels in the United States are widely predicted to have major public health consequences. A growing epidemic of overweight and obesity has been attributed in part to reduced overall physical activity. And while several studies support a link between sitting time and obesity, type 2 diabetes, cardiovascular disease risk factors (11, 16, 17), and unhealthy dietary patterns in children and adults (18-20), very few studies have examined time spent sitting in relation to total mortality (21-23). Thus, public health guidelines focus largely on increasing physical activity with little or no reference to reducing time spent sitting.

To explore the association between sitting time and mortality, researchers led by Alpa Patel, Ph.D. analyzed survey responses from 123,216 individuals (53,440 men and 69,776 women) who had no history of cancer, heart attack, stroke, or emphysema/other lung disease enrolled in the American Cancer Society's Cancer Prevention II study in 1992. They examined the amount of time spent sitting and physical activity in relation to mortality between 1993 and 2006. They found that more leisure time spent sitting was associated with higher risk of mortality, particularly in women. Women who reported more than six hours per day of sitting were 37 percent more likely to die during the time period studied than those who sat fewer than 3 hours a day. Men who sat more than 6 hours a day were 18 percent more likely to die than those who sat fewer than 3 hours per day. The association remained virtually unchanged after adjusting for physical activity level. Associations were stronger for cardiovascular disease mortality than for cancer mortality.

When combined with a lack of physical activity, the association was even stronger. Women and men who both sat more and were less physically were 94% and 48% more likely, respectively, to die compared with those who reported sitting the least and being most active.

"Several factors could explain the positive association between time spent sitting and higher all-cause death rates," said Dr. Patel. "Prolonged time spent sitting, independent of physical activity, has been shown to have important metabolic consequences, and may influence things like triglycerides, high density lipoprotein, cholesterol, fasting plasma glucose, resting blood pressure, and leptin, which are biomarkers of obesity and cardiovascular and other chronic diseases."

The authors conclude that "public health messages and guidelines should be refined to include reducing time spent sitting in addition to promoting physical activity. Because a sizeable fraction of the population spends much of their time sitting, it is beneficial to encourage sedentary individuals to stand up and walk around as well as to reach optimal levels of physical activity."

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Article: "Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults." Alpa V. Patel, Leslie Bernstein, Anusila Deka, Heather Spencer Feigelson, Peter T. Campbell, 5 Susan M. Gapstur, Graham A. Colditz, and Michael J. Thun. Am J Epid Published online July 22, 2010 (DOI: 10.1093/aje/kwq155).

Link to abstract: http://aje.oxfordjournals.org/cgi/content/abstract/kwq155
Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults

Alpa V. Patel*, Leslie Bernstein, Anusila Deka, Heather Spencer Feigelson, Peter T. Campbell, Susan M. Gapstur, Graham A. Colditz and Michael J. Thun

* Correspondence to Dr. Alpa V. Patel, Epidemiology Research Program, American Cancer Society, 250 Williams Street NW, Atlanta, GA 30303 (e-mail: alpa.patel@cancer.org ).

Received for publication January 7, 2010. Accepted for publication April 29, 2010.

The obesity epidemic is attributed in part to reduced physical activity. Evidence supports that reducing time spent sitting, regardless of activity, may improve the metabolic consequences of obesity. Analyses were conducted in a large prospective study of US adults enrolled by the American Cancer Society to examine leisure time spent sitting and physical activity in relation to mortality. Time spent sitting and physical activity were queried by questionnaire on 53,440 men and 69,776 women who were disease free at enrollment. The authors identified 11,307 deaths in men and 7,923 deaths in women during the 14-year follow-up. After adjustment for smoking, body mass index, and other factors, time spent sitting (≥6 vs. <3 hours/day) was associated with mortality in both women (relative risk = 1.34, 95% confidence interval (CI): 1.25, 1.44) and men (relative risk = 1.17, 95% CI: 1.11, 1.24). Relative risks for sitting (≥6 hours/day) and physical activity (<24.5 metabolic equivalent (MET)-hours/week) combined were 1.94 (95% CI: 1.70, 2.20) for women and 1.48 (95% CI: 1.33, 1.65) for men, compared with those with the least time sitting and most activity. Associations were strongest for cardiovascular disease mortality. The time spent sitting was independently associated with total mortality, regardless of physical activity level. Public health messages should include both being physically active and reducing time spent sitting.

mortality; motor activity; prospective studies; sedentary lifestyle

Abbreviations: CI, confidence interval; CPS-II, Cancer Prevention Study II; ICD, International Classification of Diseases; MET, metabolic equivalent