#active gaming

“One more turn, that’s all, just one… more… turn…” 6 hours later, “maybe one more turn.” Spending an entire day without getting up, sound familiar? This is a major criticism of video games, lack of physical activity. People perceive the typical gamer to trade health and exercise for achievements and pizza. In order to combat this problem, companies released consoles promoting movement and health: Wii, Wii U, PlayStation Move, and Xbox 360 Kinect. These consoles require the player to stand up and move their body, or “active gaming”, and they have been quite successful! “Organizations like the American Heart Association now cite, even recommend, video games as a fun and entertaining way to enjoy physical activity” (Steinberg, 2011). In this same study, middle-schoolers were found to have a higher energy expenditure playing four of six games than walking on a treadmill. Don’t bother with a gym membership, go out and grab yourself a Wii! That may be a little extreme since gaming does not fully replace the need to exercise, but it certainly can be an entertaining way to work off a few pounds while handing the computer a beat-down in Wii boxing (believe me, after 20 minutes, you will have a layer of sweat). What is your favorite “active game”?

For me, though, the real lesson from this year’s Games for Health conference is that we need to be more comfortable with the idea that playing games doesn’t have to be something you do to fritter away the hours when you’re feeling bored. While some of the games featured at the conference targeted children, games and game-like experiences were on display that could effect positive change in the lives of older patients, caregivers, and health care professionals as well. Games still need to be fun, but they can strive to be more as well.

We met Dan through a friend we ran into while looking into the impressive, Boston-based, multi-disciplinary obesity initiative, Child Obesity 180. Currently pursuing a PhD in Food Policy & Applied Nutrition at Tufts University, Hatfield’s research focuses on the cardiometabolic and psychosocial impact of physical activity among children and adolescents, as well as the motivational factors that lead young people to move more. A former high-school teacher and coach, Dan is especially interested in physical activity and nutrition policies and programming for children in underserved communities. As a 2010-2011 Albert Schweitzer Fellow, he helped launch a health and fitness program for middle-school-aged boys in East Boston and remains active in that community. We interviewed Dan to discuss his hands-on experience and to glean a street level perspective on what motivates kids to change behavior, how Quantified Self technologies can work with children and the kind of collaborative effort it will require to systemically address childhood obesity.

 IT: What is your research focused on?

DH: Right now, there are a couple of pieces.  First, I’m using a national data set to look at the benefits of physical activity in terms of cardiometabolic health in children, independent of body mass index. We’re asking, what are the benefits for an overweight or obese child being active or fit, even if you hold weight status constant? In community health settings, BMI is often the metric that people focus on.  If it doesn’t move then they think they’ve failed.  To me, healthy BMI is one important outcome related to physical activity. But there are lots of other ways—not just physiologically, but also socially and psychologically—that exercise is beneficial to kids.

 For another part of my research, I’m working with an after-school physical activity program that mostly serves overweight and obese children and teens.  We’re building a theory-based curriculum that lines up with their unique needs—we’re asking, “How can we tailor what we do for kids who are underfit, or who have had limited opportunity to feel successful in physical activity and sport?”  Then we’re evaluating the program with a variety of measures, looking not just at BMI but also at other outcomes like cardiorespiratory fitness, physical activity behaviors, and child self-perceptions.

 IT: You also work with programs in East Boston – an area thathas some of the highest rates of childhood obesity in the city. What makes this particular neighborhood more vulnerable to obesity than other Boston neighborhoods?

 DH:  Demographically, East Boston’s population is mostly low-income and mostly Latino.  If you look at national trends, kids in these demographic groups are much more likely to be overweight or obese compared with the general population.

 The “why” behind these trends is more complicated.  In East Boston, like other places, the food and physical activity environments present all kinds of challenges.  For example, our children often don’t have opportunities to participate in sports programs, or access to quality PE in school. On the diet side, there’s only one grocery store in East Boston, but tons of fast-food joints. Lots of parents work long hours and financial constraints make it hard to buy and prepare healthy foods. In the end, of course kids make some choices in terms of their diets and levels of physical activity, but those choices are often very much constrained by the environments those kids occupy.

 IT: When you set out to build an after-school fitness program, what considerations, relationships and data are most influential in the design?

 DH: I’m a big fan of self-determination theory, which suggests that health behaviors can be predicted by an individual’s perceived competence, their sense of relatedness, and their level of autonomy.  In my experience, this particular theory offers a powerful framework for understanding why our kids are active or not, and so we’ve thought a lot about these constructs as we’ve developed our curriculum.  We’ve asked, how can we create a culture where kids feel related to each other and to their coaches? How can we build lessons that help kids feel more confident in physical activity and sports in ways they might not be coming into the program? And how can we empower them to make autonomous choices?  In my experience, trying to force kids to be active doesn’t really work, especially in terms of building sustainable habits.  On the other hand, I’m often amazed what happens when you give kids choices.  Even kids who really struggle fitness-wise will often choose the more challenging path if they’re just given the opportunity to make that choice for themselves.  

 IT: How do you make something like running “fun” and what aspects of the program do you think will be most influential in getting kids to continue to run after the program concludes? 

 Programs like ours have to engage kids in things they actually enjoy doing. First, we tailor the curriculum so it meets kids where they are. Early on, we don’t try to tell them, “go run two miles.”  Instead, we might have them walk a short lap and then jog another, and repeat that interval a few times.  Then we’ll help kids set different walk-to-run ratios that are challenging but achievable for them. Everyone likes to feel like they’re making progress, so once we get a kid who could only walk one lap coming in to jog two without taking a break, the pride and satisfaction really carry the child forward.  We also frame lots of our activities as relays or games, but avoid hyper-competitive scenarios where kids might feel discouraged. In some cases it’s tempting to jump right into competitive game play, but you’ve got to remember that for a kid who lacks confidence that’s not at all fun. Instead, we create lots of games that are less competitive but still fun and that build basic skills in the process.  Really, our main focus in on helping kids challenge themselves to get better, instead of focusing on beating someone else.

 IT: In a 2010 interview you said, “How we eat and move relates to so many complex physiological and emotional factors at the individual level, not to mention all the broader social and environmental issues that come into play….Viable solutions to the obesity issue will have to address this full range of factors—not just the individual child, but also the built environment, home, schools, and so on.” While fitness programs, like your own, effectively address one or two facets of the problem, what is needed from a holistic sense, to connect these disparate solutions?

 DH: It’s hard. I might help kids to be more fit, or to enjoy being active, but if they don’t have a safe place to play in their community there are limits to the behavior change we’ll see outside the context of our program.  Public health practitioners are increasingly recognizing that in order to change behavior you really have to move beyond the individual and think about environments.  Individual knowledge and skills are necessary to get people to engage in healthier behaviors, but they’re not enough if environments don’t make healthier choices the easier choices.   For people to eat healthfully, healthy food needs to be accessible.  That doesn’t just mean getting more produce in the grocery store—it also means ensuring those healthy foods are affordable and consistent with the culture of the community and what people actually want to buy. The same goes for the physical activity environment. We have to design parks and streets that are safe to walk and bike on. I talk with lots of kids who who say, “When I’m at home I have to stay inside all day because my parents don’t want me to go out and play in our neighborhood.” Those are issues that have to be addressed.  Solutions will require real investment and collaboration across sectors—federal and local governments, corporate entities, non-profits, academics, and community leaders—to make the healthier choice the easier one. 

 IT: Do you envision a useful role for technology in coalescing solutions? If so, how might that play out?

DH: Technology gets vilified a lot.  Some people think of screens of any sort and they’re immediately put off—more screens, the conventional wisdom goes, mean more sedentary time.   At the same time, technology’s not going anywhere. Kids are going to play video games, watch TV, and be on their cell phones.  We can and should encourage kids to get out from behind screens, but burying your head in the sand to modern realities doesn’t strike me as a realistic approach.  We should also think about opportunities to leverage technology to motivate and enable kids to be more physically active. There’s been some interesting work around active gaming, for example—if you can get kids to actually play video games that get them up and moving around instead of sitting in front of a TV, it’s a step in the right direction. The evidence has been mixed on active gaming consoles, but I think there’s promise there.  There are also the Quantified Self technologies like Fitbit and Runkeeper that represent other interesting opportunities. Many of these QS technologies target adults more than children, though, so I think there may be a significant, untapped opportunity in leveraging these technologies with kids.  I’m especially interested in how we can make these emerging options accessible for high-risk populations, like kids in low-income communities.  

 IT: Though I recognize the many environmental factors contributing to sedentary behavior, the idea that in 2012, kids require fitness programs, exciting products, and rewards to be physically activity elicits this sad, nostalgic response in me. It seems that under ideal conditions, children’s exercise has always just been a secondary outcome to play and having fun. Do you think that outside-offline play is losing a kind of battle with the sedentary consumption of entertainment media? If so, how do you think we can “reanimate” the outside world in children’s minds again?

 DH: I think it’s a challenge. We’re saturated with media, and it can be hard to compete with hyper-stimulating video games that are very passive and don’t require a whole lot of cognitive work for kids. But at the same time, I don’t think that the world needs to be “reanimated” exactly—engaging with the world around you in creative ways will always be fulfilling and exciting in ways that passive consumption just can’t be.

The AAHPERD National Convention & Exposition is the only event of its kind; encompassing a trade forum of over 350 products and service providers, organizations, and manufacturers in the health and physical activity fields.

On average more than 5,000 physical and health education and fitness professionals attend the AAHPERD National Convention and Exposition each year. Two-thirds of the attendees work in K-12 schools settings. The exhibit hall showcases the latest in athletic and physical education equipment; textbooks; teaching aids; curriculum materials; athletic training supplies; health and nutrition products; assessment tools; outdoor adventure, adapted physical activity, and aquatic equipment; and this year…exergaming.