Introduction
Serious games for elderly people—what is the promise?
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Cardiovascular and cardiorespiratory system (e.g. endurance, cardiovascular fitness, prevention of cardiovascular diseases)
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Energy metabolism (e.g. weight control, prevention of obesity and diabetes mellitus)
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Strength and flexibility (e.g. posture, range of motion)
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Bone structure (e.g. prevention of osteoporosis)
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Immune system (e.g. prevention of cancer)
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Sensory–motor coordination (e.g. reaction, balance, fall prevention)
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Cognitive system (e.g. memory, perception, calculating, prevention of dementia)
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Physiological levelDepending on the respective training purpose, positive effects on physiological functions of various systems like the cardiovascular, cardiorespiratory or immune system are expected. Bavelier et al. [8] even suppose that gaming may re-establish the neural plasticity the human brain has shown during early stages of development.
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Psychological levelSerious games support a specific way of cognitive experience and learning. By solving attractive tasks, experiencing variable learning contexts, repeating the attempts to solve the problems, getting immediate feedback and background information processing can be enhanced. Transfer may be supported by more authentic and variable contexts or the appropriate symbolic representation of transfer-relevant information.Positive effects on intrinsic motivation, attitude, self-concept, emotions, perceived control and self-efficacy are also expected. Specific components of game experience like flow, challenge, tension, enjoyment, etc. are also highlighted (e.g. [45]).
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Sensory–motor level (behaviour)Depending on the quality of the (wo)man–game interface, the game tasks and the individual experiences, basic or specific sensory–motor skills and abilities can be performed, acquired and transferred (e.g. reaction and balance skills).
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Social interaction and communicationConstructivist approaches emphasize the importance of social interaction and communication for learning. This component can be addressed by a specific genre of digital games: massive(ly) multi-player online games. Mobile devices like cell phones and personal digital assistants as well as specific social settings can also be used to support interaction and communication.
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Efficiency and effectivity of the intervention: Which effects are elicited—by which effort? Is there evidence for long-term effects (sustainability)? Particularly the first criterion is a “sine qua non”. If SG are not effective and efficient in improving the respective physical, psychic, sensory–motor and/or social functions of elderly people, they cannot be considered reasonable means to enhance health or well-being.
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Additional benefits: Does the SG intervention show advantages compared to a traditional intervention (e.g. concerning barriers)? This feature is proposed by advocates of SG. Beyond effectivity and efficiency, a SG should offer additional advantages like fun, enjoyment and adherence.
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Study quality: Does the study fulfil the methodological requirements concerning sample, intervention programme and data? Does the study consider the relevant aspects of game effects including psychological, social, environmental and behavioural factors?
Serious games for prevention—exergames and games for health
Endurance training
Resistance and strength training
Sensory–motor training
Complex training intervention
Further preventive effects
Summary: prevention
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Rise of EE (to be confirmed in elderly persons)
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Improvement of strength
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Improvement of basic motor control (e.g. simple reactions, balance)
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Improvement of health-related knowledge
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Improvement of self-efficacy and other motivational, emotional and volitional components
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Improvement of social interactions and communication
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The development of appropriate game concepts for the effective and enduring enhancement of all components of health behaviour games should be tailored for specific target groups (e.g. older people with or without specific sensory–motor disabilities; see also [31])
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Performing more randomized controlled studies as the gold standard for evidence-based interventions (e.g. [2]) covering the complete range of effects
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Investigating the appropriate dose–response relationship for exergames and games for health
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Searching for the appropriate settings for intervention based on sound theoretical foundations
Serious games for rehabilitation—rehagames
Brain injury
Further diseases
Summary: rehabilitation
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Selection of appropriate sport or sport-like movements or activities of daily living in order to offer meaningful and motivating exercise contexts for older subjects
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Construction of adequate training devices offering options that combine challenge and support
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Determining appropriate dose–response relationships for the different rehabilitation purposes depending on the stage of the disease
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Performing more randomized controlled trials in order to corroborate effects and to find out moderators of game effects
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Development and evaluation of adequate training settings