Promoting Health and Fitness through Exergames: A Content Analysis of Wii Fit

Kristina TicknorCommunications ConsultantBooz Allen Hamiltonticknor_kristina@bah.com

Facts & Statistics• Average 8-18-year-old plays over 1 hour of

video games on a typical day• 7 out of 10 kids have a TV in their bedroom• 50% of kids have a video game console in room• Average number of hours spent on online gaming

has risen for the 3rd consecutive year• ‘World of Warcraft’ reached over 12 million

players in 2010…• …12.5 million kids in the U.S. are overweight• Childhood obesity has more than tripled in the

past 30 years

Purpose“The amount of time young people spend with media has grown to where it’s even more than a full-time work week. When children are spending this much time doing anything, we need to understand how it’s affecting them – for good and bad.” - Dr. Drew Altman, President and CEO of

the Kaiser Family Foundation

Defining E-Health and Exergames•E-health: the use of emerging interactive

technologies to enable health improvement and health care services

•Benefits of e-health: ▫Interactivity▫Online support groups▫Web 2.0 features

•Exergames: activity-promoting video games requiring physical movement of the entire body

Literature Review•Energy expenditure of exergames and effects

on physical activity and health outcomes in children▫Lanningham-Foster et al., 2006; Daley, 2009;

Graf, Pratt, Hester, and Short, 2009; Baily and McInnis, 2011

•Self-efficacy and self-image with avatars▫Song et al., 2011

• Interactive games attract hard-to-reach populations of less healthy children▫Buller et al., 2009; Baily & McInnis, 2011

Background on Wii Fit

•36% of kids own a Wii Fit, 69% have played

•Schools and universities offering Wii classes

•Wii Fit has energy expenditure + education

•May 2010, the American Heart Association and Nintendo announce partnership

Method•Wii Fit was played for two,

one-hour sessions •Every exercise was played

once•4 fitness categories:

▫yoga, strength training, aerobic activities, balance games

•Messages found in both text and narration were recorded

Analysis•Readability

▫Flesch Reading Ease: 87.2 (average 11-year-old)▫Flesch-Kincaid Grade Level: 2.7 (2-3rd grade)

•Grounded theory▫Constant comparative method of identifying new

categories to be mutually exclusive and exhaustive▫Axial coding to compare and contrast the data▫Compared against Baranowski et al.’s (2008)

elements of health-related behavior change

ResultsTheme Exemplar

Greetings and salutation “Well… if it isn’t Player 1! Nice to see you again!”

Health information-seeking “Have you noticed how this pose gets harder to maintain over time?”

Activity and test results “I used your test results and your actual age to calculate your Wii Fit Age.”

Safety reminders and warnings

“Clear the space around you and make sure you warm up before exercising.”

Encouragement and congratulations

“Great job! Well done.”“Keep it up… you’re doing great!”

Negative/critical feedback “I know you can do better than that! Let’s hit the gym together tomorrow.”

Game and activity instructions

“Keep the Wii remote in your pocket during the exercise.”

General health info and tips “Brain-muscle communication fades with age, making it easy to lose footing.”

Baranowski’s Elements of Health Behavior Change Games

1. Story and story genre2. Immersion3. Fantasy4. Interactivity

1. Navigation, time2. personalized content3. delivery of message4. data entry and use5. entertainment6. relationship

5. Cinematics and cut scenes

6. Choose-your-own-adventure

7. Appeal to multiple age groups

8. Attention, depth and breadth

9. Retention10.Intrinsic motivation

Additional Implications•On-screen avatars

corresponded with player’s measured weight and BMI

•Calendar feature for goal setting

•Message tailoring based on:▫BMI, goal progress, length

of game play, skill level, performance, date of last participation

Discussion

•Limitations▫Accessibility (digital divide)▫High time and cost requirements▫Sustainability of behavior change▫Evaluation of psychosocial effects

•Future research▫Microsoft’s Xbox Kinect; Sony’s Playstation

3▫Long-term effects on health, behavioral

intention, self-efficacy, sustainability

Conclusion

“The message itself remains paramount; no amount of technology is going to compensate for an ill-conceived or ill-designed message. The buck stops there… with the communicator.”- Chamberlain, 1994, p. 2

Questions?

Kristina TicknorCommunications ConsultantBooz Allen HamiltonEmail: klticknor@gmail.comTwitter: @kticknor