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Fitness game,^[1]exergaming or exer-gaming (a portmanteau of "exercise" and "gaming"), or gamercising^[2][3] is a term used for video games that are also a form of exercise. ^[4] Exergaming relies on technology that tracks body movement or reaction. The genre has been credited with upending the stereotype of gaming as a sedentary activity, and promoting an active lifestyle.^[5][6] Exergames are seen as evolving from technology changes aimed at making video games more fun.^[7]

History

The genre's roots can be found in games released in the late eighties, including the Power Pad (or Family Trainer) released for the Nintendo Entertainment System (NES)^[8] in 1986, and the Foot Craz released for the Atari 2600 in 1987,^[9] although both had limited success.^[8]Konami's Dance Dance Revolution (1998) was cited as one of the first major successes of exergaming; when it was ported from the arcade to PlayStation, it sold over three million copies.^[10] In the 2000s, a number of devices and games have used the exergame style to much success:^[11] the EyeToy camera has sold over ten million units,^[12] while Nintendo's Wii Fit has sold in excess of 21 million copies.^[13] By June 2009, health games were generating revenues of $2 billion, largely due to Wii Fit's 18.22 million sales at the time.^[14] The term exergaming entered the Collins English Dictionary in 2007.^[15]

The genre has been mooted as a way to improve users' health through exercise,^[10] but few studies have been undertaken to measure the health benefits. Smaller trials have yielded mixed results and have shown that the respective traditional methods of exercise are superior to their video game equivalents.^[16]

1980s

Exergaming contains elements that were developed in the virtual reality community during the 1980s. The pioneer in this area was Autodesk, which developed two systems, the HighCycle and Virtual Racquetball. The HighCycle was an exercise bike that a user would pedal through a virtual landscape. If the user pedaled fast enough, the virtual bike would take off and fly over the landscape. Virtual Racquetball tracked the position and orientation of an actual racquet that was used to hit a virtual ball in a virtual environment. This environment was shared with another user equipped with another tracked racquet, allowing the two users to play each other over phone lines. In both systems, the users could wear the VPL eyephones, an early head-mounted display (HMD), that would provide more immersion for the user.^[17]

The first true attempt at what would later be called Exertainment was the Atari Puffer project (1982). This was an exercise bike that would hook up to an Atari 400/800 or 5200 system.^[18][19] Forward speed was controlled by pedaling while steering and additional gameplay was handled by a handlebar-mounted Gamepad. The machine was nearly ready for production with several games (Tumbleweeds and Jungle River Cruise) when Atari declared bankruptcy and the Puffer project was abandoned. Nintendo also dabbled in this space with the Power Pad, released for the Nintendo Entertainment System in 1986.

The first exergaming system released to the market was the 1986 Computrainer. Designed as a training aid and motivational tool, the Computrainer allowed users to ride through a virtual landscape generated on an NES, while monitoring data such as power output and pedaling cadence. The product had a price that was far too high to be considered as an entertainment product, but was affordable by dedicated athletes. The product continues to this day, where it now runs using Microsoft Windows compatible software with extensive graphic and physiological capabilities.

Also released for the NES in 1986 was the Family Trainer, which focused on entertainment rather than exercise.^{[citation needed]}

About the same time as the Computrainer, Concept II introduced a computer attachment for their rowing machine. This has become their eRow product and is used for both individual motivation as well as competition in "indoor rowing leagues".

1990s

During the 1990s, there was a surge of interest in the application of "virtual reality" technologies to high-end gym equipment. Life Fitness and Nintendo partnered to produce the Exertainment System; Precor had an LCD-based bike product, and Universal had several CRT-based systems. The Netpulse system provided users with the ability to browse the web while exercising. Fitlinxx introduced a system that used sensors attached to weight machines in order to provide automated feedback to users.

Three issues combined to ensure the failure of these systems in the marketplace. First, they were significantly more expensive than the equivalent models that did not have all the additional electronics. Second, they were harder to maintain, and were often left broken. Lastly the additional expertise required to operate the software was often intimidating to the users, who shied away from the machines out of fear that they would look foolish while trying to master the machine.

Until 1998, nothing significant happened in the field of videogame exercise. Hardware was still too expensive for the average home consumer, and the health clubs were gun-shy about adopting any new technology. As high-performance game console capabilities improved and prices fell, manufacturers once more started to explore the fitness market.

In 1998, Konami's Dance Dance Revolution was released along with Andamiro's Pump It Up (video game series) a couple months later.

2000s

In 2000, UK startup Exertris introduced an interactive gaming bike to the commercial fitness market.

Exergaming came to the mass media attention at the Consumer Electronics Show when Bill Gates showcased the Exertris Interactive Gaming Bike in 2003, and the following year the same show hosted a pavilion dedicated to video game technology that also worked as sports and exercise equipment.

Gamercize played on PlayStation 2

The 2005 release of the EyeToy: Kinetic brought the first multi-function exergame hardware into the home market. Making the players physical movements into the game's controller. 2006 saw the launch of Gamercize, combining traditional fitness equipment with game consoles. The minimalist approach allows game play to continue only when exercising, turning all game titles into potential exergames.

Nintendo's Wii in 2006 brought acceleration detection with the Wii Remote. In late 2007, Nintendo released the exergame Wii Fit, which utilized a new peripheral, the Wii Balance Board. The popularity of the Wii lead to it being used in hospital "Wiihab" rehabilitation programs.^[20]

The PCGamerBike appeared at CES in 2007 where it received an Honoree Award. It differs from other exergaming devices in that its pedal motion can be mapped to any key on the keyboard. It also has an optical encoder which detects forward and reverse pedal motion. The Fisher-Price Smart Cycle was another entry in the field.

Other examples of exergaming products include: Positive Gaming iDANCE, iSTEP, Cobalt Flux Blufit, Cyber coach, NeoRacer, Gymkids exercise equipment with interactive technology, some Wii titles such as EA Sports Active, Cybex TRAZER, Powergrid Fitness Kilowatt, Lightspace Play Floor, PlayMotion, Yourself!Fitness, Expresso Fitness S2, i.play, Cyber ExerCycle, VEQTOR Sport Trainer and Sportwall.

2010s

The Kinect (2010) represented a significant advance in how player motion was detected in games, because the player's body became the remote.^[21] The exergaming trend within consoles that started with the seventh generation Wii peaked with the Nike+ Kinect Training (2012) & pedometer-pairing Wii Fit U (2013) games. These were followed up in the eighth generation by a exergaming push by Microsoft with the Xbox One launch day Xbox Fitness service (2013), which tracked metrics such as heart rate and correct form while synchronising these metrics with the Microsoft Health. By 2017 Microsoft had pivoted away from Kinect and exergaming on consoles.

Mobile phone apps such as Zombies, Run! (2012), Run An Empire ^[22], Ingress (2013), and Pokémon GO (2016) have been described as augmented reality exergames.^[23][24]

Effectiveness

Laboratory studies have demonstrated that some exergames can provide light to moderate intensity physical activity.^[25][26]

A 2018 systematic review in the Journal of Medical Internet Research of 10 randomized trials studying the "Social Effects of Exergames on Older Adults" found that "the majority of exergame studies demonstrated promising results for enhanced social well-being, such as reduction of loneliness, increased social connection, and positive attitudes towards others".^[27]

Another 2018 systematic review of 10 randomised controlled trials of exergaming in overweight children found that they can produce a small reduction in body mass index.^[28]

As of 2016, exergaming for those with neurological disabilities had been studied in around 140 small clinical trials in people of all ages, to see if exergaming can help this group get enough physical exercise to maintain their health. This mode of getting exercise appears attractive in this population from a public health perspective because of its low cost and accessibility.^[29] Exergames have the potential to provide moderate intensity exercises in this population, but the evidence was too weak on long-term follow-up to draw strong conclusions.^[29]

There is significant evidence across multiple random controlled trials relating exergaming to improved cognitive functioning in healthy older adults (with a mean age of 69), and attenuated deterioration or improvement in adults with cognitive impairment from neurodegenerative diseases such as Alzheimer's disease.^[30]

In addition, studies investigated if exergaming can lead to improvements in cognitive performance in clinical and non-clinical populations such as those who have ADHD and depression. ^[31][32][33] There are first encouraging results, but the empirical evidence still is limited. ^[4]

Injury

Design trends

When making an exergaming system, the manufacturer of a consumer product must make the decision as to whether the system will be usable with off-the-shelf games or if custom software must be written for it. Because it takes longer for a user to move their entire body in response to stimulation from the game, it is often the case that dedicated software must be written for the game to playable. An example of this is Konami's Dance Dance Revolution. Though designed to be played by users moving about on a specially designed dancepad, that game can alternatively be played by pushing buttons with one's fingers using a standard hand-held gamepad. When played with the dancepad at higher levels the game can be quite challenging (and physically exhausting), but if the game is played using the buttons on the hand controller, none of the sequences are physically limited.

Newer systems such as Xbox 360, PlayStation 3 and Wii use alternative input devices such as the Kinect and PlayStation Move. The Move uses image analysis to extract the motion of the user against a background and uses these motions to control the character in the game. A specifically designed exercise game Kinetic, superimposes animated objects to be punched, kicked, or otherwise interacted with over a video image of the user. The Wii and PlayStation 3 both incorporate motion sensors such as accelerometers and gyroscopes into the hand-held controllers that are used to direct behaviors within the game.

Research projects such as exertion interfaces^[34] that investigate the design aspects of these games^[35] explore how the technological augmentation that comes with the digital gameplay component can be nurtured for additional benefits, such as utilizing the social power of exercising together even though players are connected only over a network^[36] or scaling the number of players,^[37] enabling novel exercise experiences not available without the technological augmentation.

Exergame resellers have developed fitness centers and specialist room designs with programmes that focus entirely on creating environments for young people using exergaming for fitness. Group fitness programmer Les Mills International has recently launched "Immersive Fitness" studios around the globe which combine exergaming with live group fitness classes.^[38]

One of the newest trends is using virtual reality immersion. VR systems have several potential advantages for athletic training; environments can be precisely controlled and scenarios standardized, augmented information can be incorporated to guide performance, and the environment can be dynamically altered to create different competitive situations ^[39]. High frame rate display technologies for example Head-mounted display can be used to transform the user into any sporting situation e.g. a track cycling veledrome ^[40]. Natural movements can also be incorporated into the games, for example utilizing an omnidirectional treadmill, such as the Infinadeck. Such a system allows the user to virtually be in the game while allowing 360 degrees of movement.^[41] While the technology is new, it is showing promising results in weight management as well as in high participation rates.^[42]

References

Further reading

• JMIR e-collection on Exergames, Active Games and Gamification of Physical Activity
  


• Eyetoy Kinetic – Thin AG, Howey D, Murdoch L & Crozier A (July 2007). Evaluation of physical exertion required to play the body movement controlled Eyetoy Kinetic video game. Life Sciences 2007, SECC, Glasgow, Scotland.


• IJsselsteijn, W. A., de Kort, Y. A. W., Westerink, J., de Jager, M., & Bonants, R. (2006). Virtual Fitness: Stimulating Exercise Behaviour through Media Technology. Presence: Teleoperators and Virtual Environments 15, 688-698. http://www.mitpressjournals.org/doi/abs/10.1162/pres.15.6.688
  


• Wii Sports – Professor Tim Cable (February 2007). School of Sport and Exercise Sciences, John Moores University, Liverpool, England.


• Shepherd, J., Carter, L., Pepping, G.-J., & Potter, L.-E. (2018). Towards an Operational Framework for Designing Training Based Sports Virtual Reality Performance Simulators. Proceedings, 2(6), 214. https://doi.org/10.3390/proceedings2060214.