Packet #20 - UNCW Randall Libraryof B2 or B3. Athletes with a B2 classification have the ability to recognize the shape of a hand up to visual acuity of 20/600, and athletes with a

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Original Research

Enjoyment Levels of Youth with VisualImpairments Playing Different Exergames

Nicholas Boffoli, MSJohn T. Foley, PhD*

State University of New YorkCortland, NY

Barbara Gasperetti, MSThe Jean Black School

Middletown, NY

Stephen P. Yang, MSState University of New York

Cortland, NY

Lauren Lieberman, PhDThe College at Brockport

Brockport, NY

Abstract

One possible method to engage youth with visual impairments in physical activity may be exergaming.The purpose of this study was to measure differences in the enjoyment levels of youths with visualimpairments playing three commercially available exergames. Participants (n = 12) ages 9 to 16 yearsold with a visual impairment were randomly assigned one of three games on three separate nights andplayed each game for 10 minutes. Games played were Dance Dance Revolution Extreme 2 (DDR),EyeToy Kinetic, and Wii Boxing. After each game participants filled out the Physical Activity EnjoymentScale. The scores were summed for final analysis with a highest aftainable score of 144. A Friedman'sANOVA was used to analyze the data. Players of the three different games showed no significantdifference in their enjoyment between games. The consistently high mean scores attained by all three ofthe exergames (DDR = 129 [20.9], EyeToy = 127 [23.4], Wii = 137.67 [9.4]) indicate that theparticipants enjoyed playing these games. This result suggests that youth with visual impairments canenjoy being physically active through use of the exergames.

Keywords: physical activity, exergames, physical education. Physical Activity Enjoyment Scale

Introduction^ — • — — ^ ^ ^ i — ^ i ^ ^ ^ — ^ — • — i The U.S. Department of Health and Human* Please address correspondence to Services (2008) has released the most recent [email protected]; [email protected]. activity guidelines for both adults and children. These

Received February 1, 2011; Accepted August 25, 2011 | 171

Enjoyment of Exergames

guidelines are based on an extensive review of thescientific literature and determined that children benefitfrom an hour or more of physical activity a day. Apositive relationship between physical activity andcardiorespiratory fitness in youth has been suggested(Shephard, 1992; Payne & Morrow, 1993). Moderatephysical activity has been shown to improve children'sself-esteem and body image as well as reducedepression and anxiety levels (Bryant et al., 2010).Getting children active is critical since studies haveshown that obesity in childhood may be a precursor toobesity in adulthood, and children who are physicallyactive are more likely to become active adults who willbenefit from exercise throughout their lives.

Wankel (1985) has suggested that enjoymentplays an imporfant role in exercise and sporfparficipation. A direct infiuence on behavior, enjoy-ment can provide an immediate reward for beingphysically active (Dishman et al., 2005). Therefore, itcan be assumed that an increase in enjoyment couldlead to an increase in physical activity. Enjoymentof an activity serves as a key determinant whenone decides whether or not to allocate time towardthat activity (Graves et al., 2010). In response todeclining rates of physical activity among adoles-cents, more opporfunities for physical activity thatchildren enjoy must be discovered.

The increasingly sedentary lifestyles of children aresetting them up for negative health outcomes includingdiabetes, hyperfension, and cardiovascular disease(Stephens, 2002). Little has been done to successfullycombat the lack of physical activity seen inadolescents. Nader and colleagues (2008, 2009)indicate that the average moderate-vigorous physicalactivity (MVPA) rate of children decreases between theages of 9 and 15 years of age during both the weekdayand weekend. While approximately 99 percent of 9-year-olds were engaged in at least 60 minutes ofMVPA during the weekday, less than 32 percent of the15-year-olds were engaged in 60 minutes of MVPAduring the weekday. This ultimately brings childrenbelow the recommended amount of 60 minutes ofMVPA. This is consistent with other data that suggestthat two-thirds of adolescents did not reach therecommendation of at least 60 minutes of moderatephysical activity, 5 days a week (Kerr, 2007).

While disparities in MVPA exist between youth withand without disabilities, they also exist between typesof disabilities. Research by Longmuir and Bar-Or

(2000) suggested that individuals with visual impair-ments tend to have lower physical activity levels thantheir peers with physical and chronic disabilities.Furfher, they concluded that only 27 percent ofchildren with some visual impairment are habituallyactive. Hence, the greatest risk of a sedentary lifestyleis by youths with visual impairment. It is clear thatmore opporfunities for physical activity for thoseindividuals are needed.

Boone, Gordon-Larsen, Adair, & Popkin (2007)point to the growth in home technology for theincreased sedentary behavior of youth today. Clocksin,Watson, and Ransdell (2002) have argued that se-dentary leisure-time activities are gaining popularityamong children and adolescents, and that theseactivities are linked to decreased physical activityand increased body mass index (BMI). It is believedthat leisure-time sedentary behaviors can be ad-dressed by reducing media use including television,nonacademic computer use, and inactive video gameplaying. Conversely, there has been research donethat provides evidence that video games may bebeneficial to both those with visual impairments andthose without (Wang & Perry, 2006; Morelli, Foley,Lieberman, & Folmer, 2011). Cerfain video games canincrease both visual field and reaction time of theparficipants (Green & Bavelier, 2003). Yang & Foley(2011) recommend exergames as a way to improvemotor skills and increase physical activity levels ofyouth with disabilities.

Gasperetti et al. (2010) suggests that youth withvisual impairments may receive health benefits byparficipating in exergames. Research by Morelli andcolleagues (2010, 2011) provided evidence thatyouth with visual impairments can reach MVPAlevels that provide health benefits while playingexergames specifically designed with a tactical inter-face. However, little information exists on whetheryouth with visual impairments actually enjoy playingexergames, specifically those with a graphic userinterface. The purpose of this study was toinvestigate if youths with visual impairments expe-rience different enjoyment levels after playing threecommercially available exergames.

MethodsParticipants

The youths attended a 1-week overnight sporfscamp in upstate New York for youth with visual

172 I Insight: Research and Practice in Visual Impairment and Blindness

Table 1. Descriptive Data of the Participants

Age (years)

Height (cm)

Weight (kg)

BMI

M

131484822

SD

214146

Note: Height, weight, and BMI are listed for 11of the 12 participants.

impairments. Prior to their arrival at camp, 15 youthswere identified as being qualified to participate inthis study. To limit confounding variables, inclusioncriteria were the following: no orthopedic impairment,no intellectual disability, and a United StatesAssociation for Blind Athletes (2009) classificationof B2 or B3. Athletes with a B2 classification havethe ability to recognize the shape of a hand up tovisual acuity of 20/600, and athletes with a B3 have avisual acuity between 20/600 and 20/200. Of thoseidentified, seven males and five females volunteeredto participate in the study. Parents signed consentforms and the participants signed an assentdocument that was offered in both large print andbraille. Descriptive data of the participants can befound in Table 1.

ProcedureThe participants were randomly assigned to play

three exergames previously modified for use in thisstudy and others (Gasperetti et al., 2010). Gameswere projected on a large screen from a projectorpositioned overhead; this allowed the participants tostand approximately 6 feet from the screen. Theinteractive games used in the study were DanceDance Revolution Extreme 2 {DDR), EyeToy Kinetic,and Wii Boxing. All of the games provide the userwith both visual and auditory feedback.

All of the campers had one-on-one counselorswho were responsible for getting their athlete to thegaming area when the study was taking place. Theparticipants played one of the three interactivegames a night for 10 minutes. When playing DDR,participants were asked to choose five songs andwere also allowed to pick the difficulty level at whichthey played. The EyeToy Kinetic game calledBreakspeed runs for about 3 minutes at a time sothe participants played the game three times. During

Enjoyment of Exergames

Wii Boxing the participants were allowed to play

as many rounds as they could within the allotted

10 minutes.

After playing each of the interactive games, which

were played on separate nights, the camp counselor

would ask the participant the questions that make

up the Physical Activity Enjoyment Scale (PACES),

which was developed by Kendzierski and DeCarlo(1991). The questions in the survey are meant tomeasure the enjoyment levels of physical activity in agiven area or event. In this case, it measures theenjoyment levels of players who participated in thephysically active video games. The 18 questions thatmake up the PACES are answered on a 1 (lowest) to8 (highest) Likert scale. The scale was modified froma 7-point to an 8-point scale to force a positive ornegative response.

In the original work by Kendzierski and DeCarlo(1991), they studied the construct validity as well asthe intemal consistency of the PACES with under-graduate students. Their results found a high internalconsistency (a = .93) and item correlations rangingfrom r = .35 to /• = .89. Similar results were reportedby Crocker, Bouffard, & Gessaroli (1995) with youth ata sports camp; they reported high internal consistency(a = .90) and item correlations ranging from r = .38to f = .79. The inductive nature of this study can shedsome light on what types of physical activityopportunities youth with visual impairments enjoy ornot enjoy physical activity, as we can draw from theexperiences of the participants.

AnalysisData were analyzed using SPSS for Windows

V.16 (SPSS Inc., Chicago, IL). Data from the sur-veys were entered into an Excel (Microsoft, Bellevue,WA) spreadsheet and converted to SPSS withSTATtransfer (Circle Systems Inc., Seattle, WA).Scores were totaled by adding up the values fromeach question on the PACES. Each question can beanswered on a score of 1 to 8, with 1 representingthe least enjoyment and 8 representing the mostenjoyment. The highest score a game could achievewas 144 and the lowest score a game could achievewas 18.

A visual check of histograms and boxplots of thedata revealed a nonparametric distribution. Thereforeto investigate the differences between groups, aFriedman's ANOVA was employed. Alpha was setat .05.

Volume 4, Number 4, Fall 2011 I 173

Enjoyment of Exergames

140 -

120 -

100 -

80 -

60 -

40 -

. 20 -

n -u

Ti

Wii

-

EyeToy DDR

Figure 1. Mean PACES scores for 1 each game played.

ResultsThe findings indicated that there was no significant

difference in the enjoyment levels between DDR(M = 129, SD = 20.99), EyeToy (M = 127, SD =23.47), and Wii (M = 137.67, SD - 9.40), x'(2) =3.41, ns. It is interesting to note that the least variabilityin scores, as measured by standard deviation, wasfound after playing Wii Boxing (SD = 9.40). That ishalf as much as the 20.99 in DDR and 23.47 inEyeToy Overall, the results of this study, as seen inFigure 1, suggest that youths with visual impairmentsenjoyed being physically active through the use ofexergames.

DiscussionThe purpose of this study was to measure

differences in the physical activity enjoyment levelsof youths with visual impairments after playing DDRon Playstation 2, EyeToy Kinetic on Playstation 2, andWii Boxing on Nintendo Wii. The results showed thatthere was no significant difference in enjoyment levelsof the participants after playing the three differentexergames. While Wii Boxing had the highest meanscore, although not significant, it also had the leastamount of variability of enjoyment amongst the par-ticipants. High mean scores expressed for all threegames indicate a high level of enjoyment for most, ifnot all participants. A score of 144 is the highest scoreaftainable on the PACES.

Among youth with disabilities, youth with visualimpairments are at greatest risk for a sedentarylifestyle (Longmuir & Bar-Or, 2000). Therefore, studieslike this are important in furthering the understandingof potential opportunities for physical activity. Takingthe enjoyment level of the participants into consider-ation is essential since it serves as a large motivatingfactor for children deciding to participate in physicalactivity and sports (Gill, Gross, & Huddleston, 1983).While there are issues surrounding the dynamic stateof enjoyment, the PACES provides researchers with away to measure the subjective feature. It is importantto utilize the PACES in an eftort to provide moreenjoyable opportunities for physical activity for youthswith visual impairments.

Studies have provided evidence that supports theidea that youth without visual impairments enjoyinteractive games or exergames (Epstein, Beecher,Graf, & Roemmich, 2007). Epstein's study describesinteractive gaming as combining exercise andentertainment and has coined the term "exertain-ment." The study was able to conclude that childrenmay be motivated to be active if they are given theopportunity to play an interactive video game.

One of the limitations in this study was the smallsample size of 12, which may have decreased ourability to detect a significant difterence between gamesif one exists. Also, the participants played thesegames only at night and only for 10 minutes at a time.It would be interesting to see if enjoyment levels

174 I Insight: Research and Practice in Visual Impairment and Blindness

decrease over time. There also was the fact that theparticipants spent all day being active at a sportscamp so they may have already been tired whenplaying the games. Judging by the scores, we do notthink this fatigue played a factor. Regarding thePACES, sometimes the language was not understoodby the younger participants and had to be explainedby the coaches, this may have affected the validity.Future research in this area should include moreparticipants and research should be conducted over alonger period of time.

This study and others have provided evidence thatexergames are enjoyable to the participant playingthem (Epstein et al., 2007). Another study using amodified PACES found an enjoyment percentageranging from 60 to 65 percent among adolescentswho played an inactive video game, walked brisklyon a treadmill, or jogged on a treadmill (Graves et al.,2010). The enjoyment percentages for the exer-games used in this study ranged from 88 to 96percent among adolescents. The importance ofenjoyment in an effort to increase physical activityamong children cannot be overlooked. Limitedresearch has been done concerning whether or notexergames, which have a graphic user interface, areenjoyed by youth with visual impairments. However,the consistently high mean scores and the fact thatthere was no significant difference in the enjoymentlevels expressed after playing these three exer-games suggests that youth with visual impairmentssee exergames as an enjoyable way to be physicallyactive.

ReferencesBoone, J., Gordon-Larsen, P., Adair, L., & Popkin, B.(2007). Screen time and physical activity during adoles-cence: Longitudinal effects on obesity in young adulthood.International Journal of Behavioral Nutrition and PhysicalActivity, 4, 26. doi: I O.I 186/1479-5868-4-26

Bryant, C , Courtney, A., McDermott, R., Alfonso, M.,Baldwin, J., Nickelson, J., et al. (2010). Promoting physicalactivity among youth through community-based preven-t ion marketing. Journal of School Health, 80, 214-224.doi:IO.I I I l/j.1746-1561.2010.00493.x

Clocksin, B., Watson, D., & Ransdell, L (2002).Understanding youth obesity and media use: Implicationsfor future intervention programs. Quest, 54, 259-275.Retrieved from EBSCOhost.

Crocker, P.E., Bouffard, M.M., & Gessaroli, M.E. (1995).Measuring enjoyment in youth sport settings: A confir-matory factor analysis of the physical activity enjoyment

Enjoyment of Exergames

scale, journo/ of Sport & Exercise Psychology, 17, 200-205.Retrieved from EBSCOhost.

Dishman, R., MotI, R., Saunders, R., Felton, G., Ward, D.,Dowda, M., et al. (2005). Enjoyment mediates effects of aschool-based physical-activity intervention. Medicine andScience in Sports and Exercise, 37, 478-487. Retrievedfrom EBSCOhost.

Epstein, L.H., Beecher, M.D., Graf, J.L., & Roemmich,J.N. (2007). Choice of interactive dance and bicyclegames in overweight and non-overweight youth. Annalsof Behavioral Medicine, 33, 124-131. doi: 10.1080/08836610701307835

Gasperetti, B., Milford, M., Blanchard, D., Yang, S.,Lieberman, L, & Foley, j . (2010). Dance DanceRevolution and EyeToy Kinetic modifications for youthswith visual impairments. Journal of Physical Education,Recreation and Dance, 8/(4), 15-17. Retrieved fromEBSCOhost.

Gill, D.L., Gross, J.B., & Huddleston, S. (1983). Participa-tion motivation in youth sports. International Journal ofSport Psychology, I4(\), 1-14. Retrieved from EBSCOhost.

Graves, L, Ridgers, N., Williams, K., Stratton, G.,Atkinson, G., & Cable, N. (2010). The physiological costand enjoyment of Wii Fit in adolescents, young adults, andolder adults. Journo/ of Physical Activity and Health, 7, 3 9 3 -401. Retrieved from EBSCOhost.

Green, C.S., & Bavelier, D. (2003). Action video gamemodifies visual selective attention. Nature, 423, 534-537.Retrieved from EBSCOhost.

Kendzierski, D., & DeCarlo, K.J. (1991). Physical activityenjoyment scale: Two validation studies. Journal of Sportand Exercise Psychology, I3(\), 5 0 - 6 4 . Retrieved f romEBSCOhost.

Kerr, J. (2007, Fall). Designing for active living amongchildren. Active Living Research. Retrieved from: http://v\'v\^w.activelivingresearch.org/files/Built_Design.pdf

Longmuir, P.E., & Bar-Or, O. (2000). Factors influencingthe physical activity levels of youths with physical andsensory disabilities. Adapted Physical Activity Quarterly, 17,40-53. Retrieved from EBSCOhost.

Morelli, T., Foley, J., Columna, L, Lieberman, L., &Folmer, E. (2010). Vl-Tennis: A Vibrotactile/Audio Ex-ergame for Players who are Visually Impaired Proceedingsof the Fifth International Conference on the Foundationsof Digital Games (pp. 147-154). New York: ACM.doi: I O.I 145/1822348.1822368

Morelli, T., Foley, J., Lieberman, L, & Folmer, E. (201 I).Pet-N-Punch: Upper Body Tactile/Audio Exergame toEngage Children with Visual Impairments into PhysicalActivity. Proceedings of Graphics Interface (pp. 223-230).New York: ACM. Retrieved from http://portal.acm.org/citation.cfm?id= 1992954

Nader, P.R.. Bradley, R.H., Houts, R.M., McRitchie, S.L.,& O'Brien, M. (2008). Moderate-to-vigorous physicalactivity from ages 9 to 15 years. Journal of the AmericanMedical Association, 300(3). 295-305. doi: I O.I 001/jama.300.3.295

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Nader, P.R., Bradley, R.H., & Houts, R.M. (2009). Data errorin study of moderate-to-vigorous physical activity from ages 9to 15 years. Journal of the American Medical Association,301(20). 2094-2095. doi:IO.IOOI/iama.2009.70l

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U.S. Association of Blind Athletes. (2009). IBSA VisualClassifications, Retrieved May 18, 2009, from http://v\^ww.usaba.org/Pages/spo rtsinformation/visualclassifications.html

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Yang, S.P., & Foley, J.T. (2011). Exergames get kidsmoving. In Gray, T. & Silver-Pacuilla, H. (Eds.) Break-through teaching and learning: How educational andassistive technologies are driving innovation. New York:Springer.

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Record: 1

The jury's back on video games, and the news is good

Canberra Times. 10/09/2013.

Video games, whether violent or not, are a lightning rod for speculation and fear regarding their impact on children and adults alike.Yet, we don't have to go far back in time when almost identical expressions of concern were made regarding comic books, fictionnovels and various genres of music - from rock to punk. While it would be foolish to suggest that every instance of a particular type ofmedia is appropriate to all age groups (clearly Grand Theft Auto and A Clockwork Orange were not made to be consumed bychildren), it is also essential that we take a balanced approach.

0157-6925

SYD-6C67FVMG4TWQJE8NNHB

Newspaper Source Plus

Edition: First, Section: Opinion, pg. 5

The jury's back on video games, and the news is good

Video games, whether violent or not, are a lightning rod for speculation and fear regarding their impact on children and adults alike. Yet, we don't have to go far back in timewhen almost identical expressions of concern were made regarding comic books, fiction novels and various genres of music - from rock to punk. While it would be foolish tosuggest that every instance of a particular type of media is appropriate to all age groups (clearly Grand Theft Auto and A Clockwork Orange were not made to be consumed bychildren), it is also essential that we take a balanced approach.

Our research has shown several benefits associated with playing video games, whatever their content. We have shown improvements in mood as well as feelings ofcompetence and autonomy resulting from playing video games. Our studies of play with others have revealed benefits for young people in terms of social wellbeing and feelingsof relatedness. We have also found co-operative video game play to be associated with increased brain activity for younger people. More broadly, using a well validatedmeasure of mental health and wellbeing, we have found that for adult players, a positive impact on wellbeing resulted from playing video games with others.

Looking to studies in other countries, support for the positive impacts of video game play abounds. In a randomised controlled trial with a sample of clinically depressed adults,the positive influences of video games have been shown to include a reduction in tension, anger, depression and fatigue and increase in vigour. These improvements weresupported by associated changes in brain activity and heart rate variability.

Research focusing on video game play among children has suggested that the best outcomes are associated with moderate video game play as opposed to no play orexcessive play. These benefits have extended to greater positive emotions, having less risky friendship networks, better self-esteem and higher levels of family closeness.

Of course, dysfunctional patterns of play can occur. Researchers at the University of Rochester, New York, have shown that whether people engage with video games in ahealthy way is a consequence of whether certain basic needs (for example, feelings of competence, autonomy and relatedness) are being met in their lives. If your needs are notbeing met and you are less satisfied in your everyday life, you are more likely to engage unhealthily with video games and for play to result in less enjoyment and more tension.

In contrast, if you're broadly happy and satisfied, you are more likely to engage with video games in a balanced and healthy way and your engagement is likely to lead tofeelings of enjoyment and increased energy following play.

There is a range of evidence that suggests video games can impact a young player's wellbeing positively. Translating this research into practical guidelines about gaming andwellbeing that can be used by parents and professionals is critical.

Importantly, there are also clear opportunities to use video games as a way to empower young people to manage their own mental health and wellbeing, and perhapscircumvent psychological distress.

One of the most important things is that players (and their parents) engage thoughtfully with what they are playing. Games like Minecraft and Portal 2 are appropriate for a wideage range and encourage creativity and co-operation. Even more adult-themed and violent video games can have a positive influence on the player - but who the player is andthe nature of their engagement will influence the impact of such games.

Dr Daniel Johnson is director of the Queensland University of Technology's games research lab and leads the gaming research group at the Young and Well Co-operativeResearch Centre.

Copyright of Canberra Times is the property of Canberra Times. The copyright in an individual article may be maintained by the author in certain cases. Content may not becopied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles forindividual use.Source: Canberra Times, Oct 09, 2013, p5Item: SYD-6C67FVMG4TWQJE8NNHB

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