User Centered Design for Exergames

This article discusses the importance of user centered design in creating exergames for the elderly population. It explores the benefits of exergames in improving physical activity and quality of life for seniors. The article also provides guidelines for designing exergames specifically for the senior population.

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User Centered Design
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Introduction
The elderly or senior population must enjoy a good quality of life and live as
independently as they can and for as long as possible. Adherence to exercise is highly
recommended so as to improve their quality of life and exercise capacity plus lower
hospitalization. Physical activity with improved balance and coordination are of great importance
at an advanced age. Exergames can help older adults to improve both their lifestyle and develop
exercise habits.
The sedentary lifestyle of the elderly population
World Health Organization (WHO) reports that the world’s elderly population will
increase from 11% to 22% by 2050 (Tobaigy, Alshehri, Timmons & Helal 20187, p. 555). Many
older adults are physically inactive as 62% of the older population enjoy insufficient levels of
physical activity. Majority of the senior population spend their day in sedentary activities (Bird,
Clark, Millar, Whetton, & Smith 2015, p. 1). The older people are prone to many diseases such
as Parkinson’s disease, balance impairment, and stroke. About 35% of the older adults in the
community experience at least one fall a year (Tobaigy, Alshehri, Timmons & Helal 20187, p.
556). The rapid aging of society highlights the need to maintain and improve motor functions in
the elderly. Recent studies show that different exercises for balance-maintaining and muscle
strength-potentiating can improve the quality of life in the seniors and decrease the risk of falls
(Nagano, Ishida, Tani, Kawasaki, & Ikeuchi 2016, p. 1). When the elderly are physically fit, they
face lower chances of anxiety and depression to enjoy an improved memory and healthy
lifestyle.
Technology-based exercise interventions

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Regular exercise can help maintain the lifestyle of the elderly physically, mentally and
socially. Moreover, they face lower hazards of obesity, diabetes and high blood pressure. Still, it
is difficult to motivate the older adults to exercise, and there could be different reasons behind
like lack of company, a practical environment and a weak social support. Advances in
technology have led to technology-based exercise interventions that can balance enjoyment and
physical activity levels. Enjoyment of physical activity can impact the popularity and
effectiveness of an exercise program (Bird, Clark, Millar, Whetton, & Smith 2015, p. 2).
Repetitive exercises can be annoying and monotonous for the elderly and tend to lower
compliance. Exercise training with a computer game is a compliance-improving training method.
The safety and exercise continuation are some of the positive effects of exergaming reported in
the elderly (Nagano, Ishida, Tani, Kawasaki, & Ikeuchi 2016, p. 2). Since exergaming is new
technological attainment, it promises new opportunities for cultivating health and fitness such as
improving cognitive performance, promoting motor skills and build mental health (Benzing &
Schmidt 2018, p. 8). It can be a viable tool to target a specific population like the children and
the seniors.
Exercise-based games - exergames
Exergames is a blend of exercise and computer game, and it carries the potential to
motivate and entertain in rehabilitation. The exergames are commonly used by stroke patients
and people with motor and cognitive impairments (Chen et al. 2018, p. 1). Exercise-based
videogames or exergames are becoming a progressively popular strategy to encourage physical
activity among the elderly population. Exergames provide enjoyable activities, raise interest in
physical activities and remove the need of leaving home for the seniors (Bird, Clark, Millar,
Whetton, & Smith 2015, p. 2). Although exergames have been there since the 1980s, it is only

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recently that the interest in exergaming has increased substantially (Benzing & Schmidt 2018, p.
2). Exergaming is diverse and is useful in many fields like prevention and rehabilitation in both
clinical and non-clinical residents. Exercise games or exergames are fast gaining prevalence in
health fields. These are video games that motivate one to exercise physically and improve health
and fitness. Exergames technology has been there for a while now and promises to have benefits
in the rehabilitation of the elderly (Tobaigy, Alshehri, Timmons & Helal 20187, p. 556). It is
observed that older people appreciate their exercises with exergames.
Exergaming is considered to be safe and enjoyable and exhibits a positive influence on
motor functions for the elderly (Nagano, Ishida, Tani, Kawasaki, & Ikeuchi 2016, p. 8).
Exergames are not only useful in motivating the elderly for their physical and mental exercises
but also provide opportunities for friendly competition and social interaction (Leinonen et al.
2012, p. 638). The older population is known to exhibit enhanced balance and improved
cognitive functions after playing exergames. Thus, exergames can serve as a beneficial
instrument for cultivating balance in older adults (Chen et al. 2018, p. 2). Recent studies on
exergames show that playing these games increase heart rate and oxygen uptake as compared to
the moderate physical activity like walking (Verheijden Klompstra, Jaarsma, & Strömberg 2018,
p. 389). Exergames can motivate these patients to exercise regularly and raise their physical
activity at home.
Acceptance of exergames
Exergaming is considered a safe and interesting form of physical activity in elderly
cardiac and stroke patients. The elderly patients report higher motivation and participation with
exergames as well as positive outcomes concerning cognitive performance and balance
(Verheijden Klompstra, Jaarsma, & Strömberg 2018, p. 396). Exergames can motivate seniors to

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exercise and thus remain physically active. As most commercial games are not suitable for
seniors aged 65 or more, there is a growing inclination to create motivational exergames for
seniors. Exergames can assist them in maintaining physical activity (Brox, Konstantinidis &
Evertsen 2017, p. 2).
How well the senior population accepts the technology relies on the attitudes of the older
population towards the technology. There is adequate evidence that older people prefer to use
user-friendly and engaging applications as asserted by Bird, Clark, Millar, Whetton, & Smith
(2015, p. 2). The older adults raise their awareness of the helpfulness of technology when they
find improving several health outcomes and postural balance. High rates of adherence are
reported for enjoyable exergames (Bird, Clark, Millar, Whetton, & Smith 2015, p. 6). When
older people were questioned about exergames and their experience, it was found that their
familiarity with the exergames motivated them to play. It is essential to keep the older population
interested and motivated to use the exergames. Majority of the older population avoid
exergames as they do not receive any training with exergames and had limited exposure
(Tobaigy, Alshehri, Timmons & Helal 20187, p. 560). Familiarity can motivate the elderly to
interact with the new technology and use exergames in their everyday life.
When designing an ‘exergame’ for the elderly
Different exergames can challenge the stability and balance requirements of older
participants during gait (Duclos, Miéville, Gagnon, & Leclerc 2012, p. 5). The requirements of
balance exercises in exergames should be organized for sufficient difficulty level and efficiently.
Several user-centered design (UCD) protocols have been prepared for exergames that focus on
seniors. Several studies have established the need for unique design for seniors (Brox,
Konstantinidis & Evertsen 2017, p. 2). As the game designers usually are young, it is essential

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for them to understand the needs of the senior population and meet the physical exercise needs of
the elderly.
User-Centered Design (UCD)is a human-centered design that focuses on applying human
ergonomics and usability knowledge to create a design (Brox, Konstantinidis & Evertsen 2017,
p. 2). UCD is a process that evokes with time and over a multistage problem-solving process.
The designer has to understand the actual users, their needs and how they will use a product. As
the functionality, needs, and wants of the seniors are different from the young; it is essential to
create a specific design for them. The interface for the design is a lot more complicated for the
seniors, for as the adults get older; they experience loss of vision, poor memory and weaker
mobility. The motoric skills, eyesight, and hearing deteriorate with age, and this limits the
abilities of the seniors (Brox, Konstantinidis & Evertsen 2017, p. 3). When developing
exergames for seniors based on UCD, diverse game elements should be taken into thought.
These include the user interface, theme, movements, and contact with games and technology.
Aspects like colors, playability, look, sounds should be given consideration (Brox,
Konstantinidis & Evertsen 2017, p. 10).
When designing games for the senior population, the designers need to keep certain
aspects into consideration. As the elderly people have reduced attention span and get bored
easily, the exergames must be simple but attractive. As the seniors have decreased motor skills,
the game controller must be simple to use and easy to follow (Leinonen et al. 2012, p. 635). As
different exergames result in varying levels of acceptance and influence among the elderly, it is
essential to focus on their designing. The existence of social interaction and relationship create a
space through art and technology (Chen et al. 2018, p. 9). The users should be contented with the

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interface of the exergame, its perceived playfulness, and appearance. The designers should also
bear those aspects mind that when designing physical exergames and subjective norms.
For an exergame to prompt the right movement, it should induce variation in step length,
weight shift, speed, and movement and promote visual independence. When playing exergames,
the movement of the player is affected by sensor technology and game settings of the game.
Based on that, there are several guidelines drawn for exergame designing for senior citizens
(Skjæret, Nawaz, Ystmark, Dahl, Helbostad, Svanæs& Vereijken 2015, p. 186). The design
elements should use physical space and sensor technology to allow actions and movements in all
directions. The player’s movements should be visible on a fully animated3-D screen that
evaluates the gaming behavior of the player. The player should be given a dynamic time interval
to get credit for playing at higher speed. A natural mapping and game narrative can help improve
the movements of the players and increases game compliance (Skjæret, Nawaz, Ystmark, Dahl,
Helbostad, Svanæs& Vereijken 2015, p. 193).
Conclusion
Physical activity is essential for all and at all age groups. The seniors need to maintain
strength, balance, and flexibility to carry out simple tasks in their daily life. Exergames are
finding increasing use in retirement homes, senior centers and at home-based exercises. As these
games provide adequate training for balance, strength, or coordination, they can help the senior
population immensely. When designing games for the senior population, the designers need to
keep certain aspects into consideration. As the seniors have reduced attention span and get bored
quickly, the exergames must be simple but attractive. Given the specific needs and
characteristics of the elderly, exergames are being considered to be beneficial for them. These
games can raise the willingness toward exercise among older adults.

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