Annals of Long Term Care

Introduction
Over the past 18 months, sales of the Nintendo Wii™, Electronic Arts Sports Active™, and Konami’s Dance Dance Revolution (DDR)™ totaled $2 billion worldwide.¹ Gamers today represent a broad range of ages and backgrounds. The average gamer is 39 years old, 40% are women, and more than 25% are age 50 and over.² It was estimated that by the end of 2009, 68% of American households would have a gaming console in the home.2

Older persons have not missed out on this trend, with several media reports of entire nursing home chains and senior centers purchasing gaming systems and offering games as a part of their programming. Game developers have also expanded their demographics by focusing on developing and marketing games with greater appeal to the general public. Over 84% of the games available on the market today are labeled “E,” meaning they are appropriate for everyone, and these “E” games accounted for the largest market share of all games sold in 2008.²

Why the surge in interest and participation in video games by older adults? One major reason is the fun factor. Innovative technologies such as motion sensors and smart homes have been developed to facilitate healthy aging or aging in place, but these technologies are not interactive or engaging. Virtual reality and spatial 3D user interfaces have been utilized as effective adjuncts to or components of rehabilitation for the past 20 years, but until recently these technologies were quite expensive and not portable. Through recent technological innovations, off-the-shelf gaming consoles can replicate several aspects of a costly virtual reality system, and these systems can be played in an individual’s home.

The combination of improved technology, cheaper price, and age-appropriate games has captured the interest of older adults. These games offer fun and convenient activities that are cross-generational, social, and could have health benefits. Commercially available health games have the potential to be a health promotion intervention to increase an older adult’s physical activity levels; however, these types of games have only been available since 2007, and several questions remain unanswered about the efficacy, feasibility, and safety of these games for older persons. The purpose of this review article is to provide an overview of the commercial health video games available that could promote physical activity, review the research being done with these games, and discuss future directions.

A Brief History of Health Video Games
The video game industry began in the mid-1970s with the advent of the video arcade. During the 1980s and 1990s, the technology and graphics improved, prices dropped, and video games effectively moved out of the arcade and into the home. Few individuals purchased the first home games with their large and expensive consoles and rudimentary graphics. Games from that period through today typically consisted of a console connected to a television or computer to display the game and a controller that the player manipulated to interact with the game. Some would say that the technology may have evolved too much during this period, as the games and controllers became quite complicated, and market share was lost due to lack of interest from the general public.³

The current generation of games and gamers are quite different. The games incorporate advanced technologies, but they couple those technologies with relatively simple user interfaces and easy-to-manipulate controllers. Gamers now can use their entire body to play the games developed for the Sony PlayStation® 2 EyeToy™, perfect a real yoga move using Wii Fit, or manipulate real physical props like guitars and drums to play Guitar Hero®.

The gaming industry has evolved as well, with entirely new areas of research and development in “Health Games” to best meet the demands of the ever growing market.