The Gamification Report | Episode 17: Exergamification, Depression Treatment, and more!


David Chandross: Welcome to the Gamification
Report, Episode 17. This week, we’re going to be looking at the
gamification of sports and fitness, what’s called exergamification, and we’re going to
look also at the gamification of depression treatment for LGBT youth. It’s Pride Week here in Toronto. We just finished, and so we want to look at
some of the ways we can use gamification to get at helping folks who feel excluded. That would include depression, of course,
and certain nontraditional groups that might feel excluded because of social pressures
or norms. The suicide rate in LGBT youth is still much
higher than it is in the regular adolescent population. We want to look at the gamified elements that
we might use to be of use here. Let’s get started by talking at the exergamification. This is Matallaoui’s work as of 2017, and
there’s a lot of ways to look at integrating exercise and fitness into gamification. There are what’s called novelty effects, which
is the Pokémon Go story. For example, when Pokémon Go came out two
years ago, everyone was running around with their smartphones, trying to find Pokémon
Go creatures. It had a high novelty effect. That got a lot of people interested, and when
they measured the number of walking, people were walking about another half a mile to
a mile a day when they were playing Pokémon Go. Unfortunately, the New England Journal of
Medicine later reported that they stopped doing it when they stopped playing Pokémon. Novelty effects produced a change in behavior
that was connected to the game itself. Motivation and engagement strategies are very,
very key in exergamification, and I got to tell you, if you go into the app store, there
are hundreds, if not thousands, of games about fitness. The problem and what we’re going to see as
we explore it is that motivation and engagement strategies are relatively low in these builds,
and so they’re competing with other apps, but people are not going to stay with these
apps much more than a few weeks, in many cases, and, in many cases, really aren’t going to
see the benefits of the apps. Let’s try to understand a little deeper how
we can increase engagement. A lot of social interaction and levels and
virtual rewards are going to lead to motivation in these games. It can be social pressure as well. Self-esteem, achievement, and self-competition
are part of the psychological profile, and self-monitoring – decreasing sitting and engagement,
for example – are behavior elements. We have all these motivation and psychological
and behavior elements we want to build into exergamification. Now, there are many different methods to use. This is a review article that they produced,
and we can see these various games. You can do martial arts or game activities
at home when using a VR set, and, of course, you can have various goals so that when you
are able to complete certain moves, you can get different scores. This looks great, and it’s a lot of fun to
play them. The problem is getting people to play it for
more than a few weeks. This is the difficulty in exergamification. When we talk about gamification, in this case,
we would use Jane McGonigal’s definition, that a game, in this case, should have a goal,
it should have rules, it should provide some feedback to the player to let them know how
they’re doing, and that you have to voluntarily accept one to three so that you’re going to
buy into the game and accept the general build of the game here. Now, what the findings were in his research
was that almost no games had any form of badges, and we’ve talked in previous broadcasts about
how important badges are, how they really change behavior in fundamental ways. None of these games have any kind of badges. You just simply follow along and you play
the game, but you don’t really get anywhere in the game. The game is not that interesting after a while,
and you can’t identify achievement. A few studies identified game theories used
in design. These weren’t people that had any theoretical
background in game building. They simply made something they thought would
be engaging. The exergames had a very high motivation,
mostly in younger users, but the best games they found out there had two or three mechanics. You weren’t just seeing how many push-ups
you could do. You might see how long you could hold your
breath or let’s see how many sit-ups you could do. The idea is that there might be different
mechanics and sit-ups per week or push-ups per day, or it might have to do with taking
on more challenges that are presented to you as you achieve goals. The shortcomings in the literature, when you
explore it, is that sample sizes were very small. A lot of the papers about exergamification
may only have five or ten participants. They’re generally descriptive studies and
stats. They say, “This is what we did in the game. This is what people liked and didn’t like.” There weren’t validated scales to measure
whether people really engaged, using psychological testing and psychometrics. They lacked control groups. Any studies in exergamification that are out
there just have users saying, “I liked the game. I would’ve liked this or more of this,” but
there was no control group simply doing exercise without the game to see who improved the most. They were in short time frames. These are games that are played over a few
weeks. We would like exergamification, I think, you
and I, to last for a year or two so that you could really rely on the game to take you
to a desired weight or fitness level. There was no linkage to prior theory. All these seemed to be produced as though
they were the first person to think an exercise game, and they launched it. That’s their shortcomings. There was no use of flow. That was the flow theory, where you do something
that’s difficult and then you get a challenge to do something a little more difficult. That wasn’t really used in these games. You’d think it’d be the basis of it, but it
wasn’t. It had no reference to Richard Bartle’s player
types, and, as we’ve talked about in previous broadcasts so that you’re, again, familiar,
Richard Bartle worked out four different types of players that play multi-user dungeon games. It tended to be a way we think of gamers. We have explorers and competitors, and we
have socializers and achievers. These kind of different types of people would
want something in the game. The games were geared only for one type of
player, and there was no real flow introduced. You can imagine these are relatively short-lived. They were too simplistic, and they’re simply
not sticky. What I mean by sticky is a game that you want
to play, month after month, that really gets you to your goal. You’re not going to get tired after a few
weeks. This is the problem with these simplistic
games. Again, no achievements or badges. You simply shuffle the deck. Look at this game here. You have gym mats, two or three decks of cards,
and a game poster. You assign an exercise to each card. This is where you do your sit-ups. This is where you maybe do a lion pose in
yoga. This is maybe where you do push-ups. Then you have these different stars that would
make you to do burpees and high-knees. Then you have to kind of go from mat to mat. That’s great to do it for kids for an afternoon
when you’ve got nothing else to do, but that’s not really going to motivate an adult that
really has serious goals in mind. Kind of lame things. I appreciate the effort, but look at this
one. This is an Olympics workout game. When you see Olympic rings, you have to do
30 seconds of burpees. When it cuts to commercial, you start doing
jumping jacks. When an athlete … as things go on and you’re
watching TV, you’re gaming it. This is good, but, again, long-term, this
is really not going to take you where you want to head to. An interesting reflection on how we make it. We’re going to segue away from exergames,
which, as you can see, if you can build good exergames, now, I think you can probably make
some money, ’cause there’s certainly nothing out on the market that’s compelling on the
thousands of apps on the App Store. We’re going to segue into work by Harris Marc
Ashley in 2009 called Beat the Street, and we’re going to talk a little bit about gamification
of depression and social isolation. Essentially what they did here … I want
to sort of segue into this by talking about a fitness game that they used to reach youth,
and then we’re going to segue over to how we can take these same principles and treat
other maladies of the body … or of the mind, such as depression. They were able to … When they developed
a game which had badging of some of these activities to take these youth, and they increased
their weekly walking by 180 minutes per week – I just had that back a little bit here – and
increased the weekly physical activity by 300 minutes a week – vigorous activity by
48 and moderate activity by 60 minutes a week. This was 329 people. This is getting youth to become more physically
engaged by using some of these game elements, and that’s how you can measure it. They moved around a mythical town. They had leaderboards that were developed
by team. You invented this town using kind of a game
world, and you could explore this town. When you did, you had to walk around to get
to different places in the town. It was built, and, again, when you built a
game world, when you built a more complete structure, we had great participation and
great outcomes. Exergames can be done properly. On a longer way to talk about psychological
issues, Hiroaki Uechi’s study in 2018 is interesting to look at. This is a gamification-based intervention
for health promoters. What they did is they took 53 students – 30
in a test group, 23 in a control group – and they produced a mobile phone app called The
Way of Health. They had them play it for 100 days, and they
… This time, they used points, badges, and leaderboards to look at their progress, and
everyone that played it said those were very useful. This is the whole idea of primary care sports
programs in preventive medicine. We could look at the work of Chris Sciamanna
next here in 2018, and what he did here is he used modified sports, which are easy to
play. He took 540 patients with different kinds
of health ailments, with … had a mean age of about 58 years. Those under 40 adopted the games the most. What you can do with modified sports is you
can produce games on the computer or modified activities that people that have a disability
can do to increase fitness by creating a game environment and by modifying it. Most adults between 55 and 64 really don’t
do much sports, don’t play a lot of baseball, a lot of hockey. Adult men and women are equally likely to
adopt modified games. What was interesting was the body mass index
didn’t vary. The interest was independent. Even if you were overweight or you had a good
physique, that really didn’t seem to vary. Your interest in the game was independent. It seemed to relate to the fact that you’d
modified the sporting activity – maybe half push-ups or running for 50 meters instead
of running for an hour. These sort of things, that pulled in the older
players. Now this segues across to something I think
that’s kind of interesting. We’re in the middle of a soccer week, the
World Cup, right now, and there have been 51 … As of last Thursday, there were 51
violations for audiences screaming, essentially – and forgive my language here – “Faggot,
faggot, faggot.” There’s a word called “punta” that they use
when they talk about a soccer player that’s just screwed up. The whole audience in Mexico at one point
was all screaming, “Punta, punta, punta,” which is essentially saying, “Faggot, faggot,
faggot.” There’s a lot of homophobia that are contained
in sports and fitness activities, and we can probably use gamification to make some changes
in that sphere as well. There was a key landmark study called Out
in the Field study. It was done in 2015, across six English-speaking
countries. They looked at 9,500 participants, and of
these participants, the majority were LGBT. 81% of those surveyed witnessed or experienced
homophobia in sports. The words that were used in sports most common
are “faggot” and “dyke.” Isn’t it incredible that, in this day and
age, this is still going on? I thought we were over this, but we’re not. 88% of all gay youth are not open about sexuality
with teammates. There’s a huge problem in homophobia in sports,
and what are the solutions? As we look deeper in exergamification, can
we find ways to make games more inclusive using game strategies? Indeed we can. Now, when we look at this, there’s what’s
called game-based cognitive behavioral therapy for sexual minority youth, and this is a publication
by Ioanna Iacovides in 2017. Essentially, this is a modification of what’s
called Rainbow SPARX. We’ll talk about SPARX in a moment. But SPARX stands for smart, positive, active,
and realistic and X-factor thoughts. Essentially, it was produced for youth, and
it was freely available only in New Zealand. One study was done in the UK, and it’s the
only game-based mental health intervention for sexual minority young people. People that don’t feel that they are included
can start to use Rainbow SPARX to make sense of how they fit into the world of sport. Essentially, how does SPARX work? What SPARX does is best exemplified by the
work of Dr. Sally Merry at the University of Auckland, which she’s developed this e-therapy
tool to cope with depression. Initially, SPARX was for young people treating
depression. They produced an open game world again, and
this game world gave us all these different avatars and characters. It was an app, and it was very engaging and
exciting. It was really key for depression. It’s a fantasy game format with their avatar,
and they used DVD in the first iteration. There were various challenges that you have
to do in the game, such as controlling your breathing. They then started to measure it in clinical
trials. It was really a virtual world, and when you
were able to reinvent yourself by interacting with the game. It’s a self-help depression tool. What they did is they took huge problems and
then broke them down into smaller ones. There were seven levels of the game that were
played at about 30 minutes each. The first thing they had to do was build a
shield against depression. It gives you an idea, and then it gets you
to get swords and then travel. We’ll talk about it a bit more. They had skill teaching, one to two levels
per week. That’s important when you’re using game worlds
and when you’re using them to promote individual change. You want levels to occur during the week. You don’t want it to be once every month,
you gain a new level. You want it to be so engaging that people
are hooked on getting to the next level. At one point, they take a giant eagle to the
cave province to find hope in a chest. They have a shield to guard them from depression,
and now they discover hope. It’s the Bird of Hope that offers an ancient
art to restore the mind, and they learn how to breathe in slowly through the nose, air
entering the stomach, and use mindfulness-based practice throughout this. They had to get rid of beasts in the game,
again by controlling the breathing. That allowed you to release a power gem. Then an eagle flies you back to the mentor
at that point. You begin to develop cognitive tools for coping
with depression, to focus on your breathing and to focus on various activities and to
start to understand hope and the fact that depression is something external to you, almost. It’s like a monster, but you can hold a shield
up, and the monster can’t get past the shield. This is the kind of thing we’ve done, also,
in the management of addiction in adolescents in some of our pilot studies, to get the idea
that the people develop tools, game tools, to defend them against their own cognitive
problems that they’re … That’s it for this week. I hope that you find this very helpful to
look at the whole concept of exergamification and how to take some of these principles to
do some good in the world and help everybody feel included along the way. David Chandross, Centre for Teaching & Learning
here at Humber College. Have a great, hopeful week.

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