Khalili-Mahani Najmeh, Assadi Atousa, Li Kate, Mirgholami Mahsa, Rivard Marie-Eve, Benali Habib, Sawchuk Kim, De Schutter Bob
PERFORM Centre, Concordia University, Montreal, QC, Canada.
McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
JMIR Ment Health. 2020 Mar 26;7(3):e12388. doi: 10.2196/12388.
The gamification of digital health provisions for older adults (eg, for rehabilitation) is a growing trend; however, many older adults are not familiar with digital games. This lack of experience could cause stress and thus impede participants' motivations to adopt these technologies.
This crossover longitudinal multifactorial study aimed to examine the interactions between game difficulty, appraisal, cognitive ability, and physiological and cognitive responses that indicate game stress using the Affective Game Planning for Health Applications framework.
A total of 18 volunteers (mean age 71 years, SD 4.5; 12 women) completed a three-session study to evaluate different genres of games in increasing order of difficulty (S-BrainGame, S-CarRace, and S-Exergame). Each session included an identical sequence of activities (t-Baseline, t-Picture encode, t-Play, t-Stroop test, t-Play, and t-Picture recall), a repeated sampling of salivary cortisol, and time-tagged ambulatory data from a wrist-worn device. Generalized estimating equations were used to investigate the effect of session×activity or session×activity×cognitive ability on physiology and cognitive performance. Scores derived from the Montreal Cognitive Assessment (MoCA) test were used to define cognitive ability (MoCA-high: MoCA>27, n=11/18). Kruskal-Wallis tests were used to test session or session×group effects on the scores of the postgame appraisal questionnaire.
Session×activity effects were significant on all ambulatory measures (χ>20; P<.001) other than cortisol (P=.37). Compared with S and S, S was associated with approximately 10 bpm higher heart rate (P<.001) and approximately 5 muS higher electrodermal activity (P<.001), which were both independent of the movement caused by the exergame. Compared with S, we measured a moderate but statistically significant drop in the rate of hits in immediate recall and rate of delayed recall in S. The low-MoCA group did not differ from the high-MoCA group in general characteristics (age, general self-efficacy, and perceived stress) but was more likely to agree with statements such as digital games are too hard to learn. In addition, the low-MoCA group was more likely to dislike the gaming experience and find it useless, uninteresting, and visually more intense (χ>4; P<.04). Group differences in ambulatory signals did not reach statistical significance; however, the rate of cortisol decline with respect to the baseline was significantly larger in the low-MoCA group.
Our results show that the experience of playing digital games was not stressful for our participants. Comparatively, the neurophysiological effects of exergame were more pronounced in the low-MoCA group, suggesting greater potential of this genre of games for cognitive and physical stimulation by gamified interventions; however, the need for enjoyment of this type of challenging game must be addressed.
针对老年人的数字健康服务（如康复治疗）游戏化是一个日益增长的趋势；然而，许多老年人并不熟悉数字游戏。这种经验的缺乏可能会导致压力，从而阻碍参与者采用这些技术的积极性。
本交叉纵向多因素研究旨在使用健康应用情感游戏规划框架，研究游戏难度、评价、认知能力以及表明游戏压力的生理和认知反应之间的相互作用。
共有18名志愿者（平均年龄71岁，标准差4.5；12名女性）完成了一项为期三阶段的研究，以按难度递增顺序评估不同类型的游戏（S-脑游戏、S-赛车游戏和S-健身游戏）。每个阶段都包括相同的活动顺序（t-基线、t-图片编码、t-游戏、t-斯特鲁普测试、t-游戏和t-图片回忆）、唾液皮质醇的重复采样以及来自腕戴设备的带时间标记的动态数据。使用广义估计方程来研究阶段×活动或阶段×活动×认知能力对生理和认知表现的影响。蒙特利尔认知评估（MoCA）测试得出的分数用于定义认知能力（MoCA高：MoCA>27，n = 11/18）。使用Kruskal-Wallis检验来测试阶段或阶段×组对游戏后评价问卷分数的影响。
除皮质醇外（P = 0.37），阶段×活动效应在所有动态测量指标上均具有显著性（χ>20；P < 0.001）。与S和S相比，S与心率高出约10次/分钟（P < 0.001）以及皮肤电活动高出约5微西门子（P < 0.001）相关，这两者均与健身游戏引起的运动无关。与S相比，我们在S中测量到即时回忆命中率和延迟回忆率有适度但具有统计学显著性的下降。低MoCA组在一般特征（年龄、一般自我效能感和感知压力）方面与高MoCA组没有差异，但更有可能同意诸如数字游戏太难学之类的说法。此外，低MoCA组更有可能不喜欢游戏体验，并认为其无用、无趣且视觉上更刺激（χ>4；P < 0.04）。动态信号中的组间差异未达到统计学显著性；然而，低MoCA组中皮质醇相对于基线的下降速率明显更大。
我们的结果表明，玩数字游戏的体验对我们的参与者来说并不具有压力。相比之下，健身游戏的神经生理效应在低MoCA组中更为明显，这表明这种类型的游戏通过游戏化干预在认知和身体刺激方面具有更大的潜力；然而，必须解决对这种具有挑战性的游戏的喜爱需求。
