Exergames: More fun with rehabilitation and exercise through games

They make you want to exercise and are perfect for young and old people: so-called exergames. These exercise games with a health objective are becoming increasingly popular in the realm of prevention measures and rehabilitation. Plus they have one unbeatable advantage: they are just plain fun.

"Serious games are games that are both fun and have at least one distinctive, serious objective," explains D. Eng. Stefan Göbel, Head of the Serious Games group at the Technical University of Darmstadt. The term exergames is used if health aspects are the objective and meant to be achieved through game-assisted exercise. Exergames is a sub-category of the so-called health games category. "The DIN Institute is currently coordinating a standardization process to accurately define the terms and concepts and specify a standard definition of serious games."

Whether they are meant to improve strength, coordination, balance or endurance – above all, exergames are fun. The game contents and mechanisms boost motivation and automatically improve the effectiveness of training. It’s crucial to ensure that the target audience is also able to participate in the respective game. That’s why the concept has to be geared towards the user group.

This aspect can be well illustrated by Göbel‘s PDExergames project. The project’s target group are people with Parkinson’s disease (PD = Parkinson’s disease). "As part of the project, we are setting up an experimental platform that offers various interaction techniques: a balance board, an ergometer, a home trainer, voice input, a general motion sensor or a sensor you place your hands on to do finger exercises. This tests and improves fine motor skills for example," says Göbel. With these various interaction techniques, it is essential for the target audience to have a stable support backing for balance exercises. Or to have another person standing by for assistance and stability.

Funded by the German Federal Ministry of Education and Research (BMBF - Bundesministerium für Bildung und Forschung) for the upcoming three years, the "KMU innovativ" initiative focuses on answering this main question: which interaction techniques are best suited for affected patients with different types of Parkinson’s disease? "Using a game-based training module designed to equally address cognitive and motor aspects, we determine what works best and achieves the desired effects and success for the individual patient," says Göbel. The main research focus here is the human-computer interaction.

The application options of exergames are not just limited to patients with Parkinson’s disease. For instance, the Pompeu Fabra University and the Catalan Institute for Research and Advanced Studies in Barcelona, Spain, have developed a virtual reality game called Rehabilitation Gaming System (RGS), which helps people to recover after suffering a stroke.

The Zurich University of the Arts in Switzerland (Zürcher Hochschule der Künste) has developed the Gabarello – Game based Rehabilitation for Lokomat game as a gait training system with a robotic leg brace (Lokomat), designed to help patients practice walking and running. What’s more, a Swiss rehabilitation facility has being using a selection of video games specifically to treat neurological disorders and chronic pain.

The MobiAssist research project is a mobilization assistance program for senior patients with dementia and was developed at the Institute of Movement and Sport Gerontology at the German Sport University Cologne (Deutsche Sporthochschule Köln). Through games, patients with dementia are encouraged to stay in motion and practice everyday life activities. Another idea here is to integrate biographical elements into the games, for example, music and movies from the person’s past or pictures and messages from family members.

Exergames have also proven to be effective in fostering medication adherence. The University of Washington was able to show that the third-person shooter game Remission helped children with cancer to better follow treatment instructions and take their medications. The same applies to children and adolescents with diabetes. In this case, special exergame apps managed to encourage them to measure their blood sugar levels at regular intervals.

The age range of the target groups is quite broad. "While many support programs and projects in Germany and Europe mainly target older people with different constraints, exergames primarily focus on children and adolescents at the international level," Göbel sums up.

Having said that, the head of the Serious Games group at the Multimedia Communications Lab (KOM) still sees a minor stumbling block when it comes to the advance of exergames. "Exergames are already more socially accepted in other countries, even by health insurance companies. The Benelux Union already has several health insurance providers that pay for the costs of prescribed game-based rehabilitation training," says Göbel. "Germany still has reservations in this regard and needs to catch up."

In addition to international events such as the Games for Health Europe Conference, there are now a number of studies and meta-analysis that prove the effectiveness of exergames. "The Games for Health Journal provides a great overview of both international and German-language studies," adds Göbel.

Whether it’s a study on the effectiveness of video games to rehabilitate stroke victims from Toronto, Canada, or a study carried out by the Macquarie University in Sydney, Australia, which researched the effects of video games on the rehabilitation of patients with traumatic brain injuries – all of these studies show that the playful approach of exergames offers the desired rehabilitation outcome.