{{Short description|Video games that are also a form of exercise}} [[File:HAL_2001_Power_Pong.jpg|alt=hackers playing a bicycle-powered video game|thumb|Game of Power Pong (a bicycle powered video game) being played at the "Hackers At Large" conference, held in Enschede, Netherlands]] {{Video game industry}} '''Fitness game''', '''exergame''', and '''gamercise''' (portmanteaus of "exercise" and "game")<ref>Wii Fit [https://www.nintendo.com/wiifit/launch/ 'Fitness game']. Nintendo. Retrieved on 2013-08-02.</ref><ref>{{Cite web|url=https://www.buzzfeed.com/buzz/Gamercising|title=Gamercising|website=BuzzFeed|date=December 4, 2007|access-date=January 22, 2020}}</ref><ref>[https://news.bbc.co.uk/2/hi/technology/5274960.stm Gaming gets in shape]. BBC Sport (2006-08-22). Retrieved on 2009-08-08.</ref> are terms used for video games that are also a form of exercise.<ref name=":0">{{Cite journal|last1=Benzing|first1=Valentin|last2=Schmidt|first2=Mirko|date=2018-11-08|title=Exergaming for Children and Adolescents: Strengths, Weaknesses, Opportunities and Threats|journal=Journal of Clinical Medicine|language=en|volume=7|issue=11|page=422|doi=10.3390/jcm7110422|pmid=30413016|pmc=6262613|doi-access=free}}</ref> Fitness games rely on technology that tracks body movement or reaction. The genre has been used to challenge the stereotype of gaming as a sedentary activity, and promoting an active lifestyle among gamers.<ref>{{cite news|last1=van Aarem|first1=Amy|date=January 10, 2008 |url=http://archive.boston.com/news/local/articles/2008/01/10/exergaming_helps_jump_start_sedentary_children/|title='Exergaming' helps jump-start sedentary children|newspaper=The Boston Globe|access-date=2009-08-08|url-access=subscription }}</ref> Fitness games are seen as evolving from technology aimed at making exercise more fun.<ref name= kick>{{cite news|url=https://www.wsj.com/articles/SB112837781519958894|first=Tara|last=Parker-Pope|title=The PlayStation Workout: Videogames That Get Kids to Jump, Kick and Sweat|newspaper=The Wall Street Journal|date=October 4, 2005|access-date=January 22, 2020}}</ref>
==History== The genre's roots can be found in game peripherals released in the eighties, including the Joyboard,<ref name="boingboing">{{cite web|website=Boing Boing|url=https://gadgets.boingboing.net/2008/05/15/from-atari-joyboard.html|title=From Atari Joyboard to Wii Fit: 25 years of 'exergaming'|author=Joel Johnson|date=May 15, 2008|access-date= August 26, 2020}}</ref><ref name="pmid25078529">{{cite journal|title=The Role of Exergaming in Improving Physical Activity: A Review|last1=Sween|first1=Jennifer|last2=Wallington|first2=Sherrie Flynnt|last3=Sheppard|first3=Vanessa|last4=Taylor|first4=Teletia|last5=Llanos|first5=Adana A|last6=Adams-Campbell|first6=Lucile Lauren|display-authors=1|journal=Journal of Physical Activity and Health|volume=11|number=4|date= May 2014|pages=864–870|doi=10.1123/jpah.2011-0425|pmid=25078529|pmc=4180490}}</ref> an Atari 2600 peripheral developed by Amiga and released in 1982, the Power Pad (or Family Trainer) a peripheral for the Nintendo Entertainment System (NES), originally released by Bandai<ref name="bogost">Bogost, Ian (2005). [https://web.archive.org/web/20110710211509/http://www.exergamefitness.com/pdf/The%20Rhetoric%20of%20Exergaming.pdf The Rhetoric of Exergaming]. Georgia Institute of Technology. Retrieved on 2009-08-08.</ref> in 1986, and the Foot Craz released for the Atari 2600 in 1987,{{sfn|Bogost, Montfort|2009|p=139|ref=Beam}} although all three had limited success.<ref name="boingboing" /><ref name="bogost"/> Konami's ''Dance Dance Revolution'' (1998) was cited as one of the first major fitness games; when it was ported from the arcade to PlayStation, it sold over three million copies.<ref name=Fox>Star, Lawrence (2005-01-15). [https://www.foxnews.com/story/exercise-lose-weight-with-exergaming Exercise, Lose Weight With 'Exergaming']. Fox News. Retrieved on 2009-08-08.</ref> In the 2000s, a number of devices and games have used the exergame style to much success:<ref>Armstrong, Rebecca (2007-07-17). [https://www.independent.co.uk/life-style/health-and-families/health-news/couch-athletes-how-to-get-fit-from-the-comfort-of--your-sofa-457626.html Couch athletes: how to get fit from the comfort of your sofa]. ''The Independent''. Retrieved on 2009-08-08.</ref> the EyeToy camera has sold over ten million units,<ref>Kim, Tom (2008-11-06). [https://web.archive.org/web/20081221193255/http://www.gamasutra.com/php-bin/news_index.php?story=20975 In-Depth: Eye To Eye - The History Of EyeToy]. Gamasutra. Retrieved on 2009-08-08.</ref> while Nintendo's ''Wii Fit'' has sold in excess of 21 million copies.<ref name=Q209S>{{cite web| url=https://www.nintendo.co.jp/ir/pdf/2009/090731e.pdf#page=7|title= Financial Results Briefing for the Three-Month Period Ended June 2009|publisher=Nintendo|date=2009-07-31|format=PDF|access-date =2009-07-31|page=8}}</ref> By June 2009, health games were generating revenues of $2 billion, largely due to ''Wii Fit's'' 18.22 million sales at the time.<ref>{{cite web| title= Health Games Generate $2 Billion in Worldwide Sales| first= Kris| last= Pigna| date= 2009-06-28| website= 1UP.com| url= http://www.1up.com/news/health-games-generate-2-billion| archive-url= https://web.archive.org/web/20120728181756/http://www.1up.com/news/health-games-generate-2-billion| archive-date= 2012-07-28| access-date= 2011-05-01}}</ref> The term ''exergaming'' entered the ''Collins English Dictionary'' in 2007.<ref>{{cite news| url= https://news.bbc.co.uk/cbbcnews/hi/newsid_6710000/newsid_6717900/6717923.stm| title= Wags and hoodies make dictionary| work= BBC News |date= July 4, 2007| access-date= August 8, 2009}}</ref>
The genre has been promoted as a way to improve users' health through exercise,<ref name=Fox/> but few studies have been undertaken to measure the health benefits. Smaller trials have yielded mixed results and have shown that the respective traditional methods of exercise are superior to their video game equivalents.<ref>{{cite journal| last= Daley| first= Amanda J. | date= August 2009| url= http://pediatrics.aappublications.org/cgi/content/abstract/124/2/763 | title= Can Exergaming Contribute to Improving Physical Activity Levels and Health Outcomes in Children?| journal= Pediatrics| volume= 124| number= 2 | pages= 763–771| access-date= August 8, 2009 | doi=10.1542/peds.2008-2357| pmid= 19596728 | s2cid= 8744191 | url-access= subscription}}</ref> Design considerations for fitness games include the need to balance the physical effectiveness of the exercise with the attractiveness of the gameplay, with both factors needed to be adapted to the abilities of the player, referred to as 'dual flow'.<ref>{{cite book |last1=Sinclair |first1=Jeff |last2=Hingston |first2=Philip |last3=Masek |first3=Martin |title=Proceedings of the 5th international conference on Computer graphics and interactive techniques in Australia and Southeast Asia |chapter=Considerations for the design of exergames |date=December 2007 |pages=289–295 |doi=10.1145/1321261.1321313|isbn=978-1-59593-912-8 |s2cid=12875601 }}</ref>
===1980s=== Fitness games contain elements that were developed in the virtual reality community during the 1980s. The pioneer in this area was Autodesk, which developed two systems, the ''HighCycle'' and ''Virtual Racquetball''. The ''HighCycle'' was an exercise bike that a user would pedal through a virtual landscape. If the user pedaled fast enough, the virtual bike would take off and fly over the landscape. ''Virtual Racquetball'' tracked the position and orientation of an actual racquet that was used to hit a virtual ball in a virtual environment. This environment was shared with another user equipped with another tracked racquet, allowing the two users to play each other over phone lines. In both systems, the users could wear the ''VPL eyephones'', an early head-mounted display (HMD), that would provide more immersion for the user.<ref name="Virtual Reality">Howard Rheingold. "Virtual Reality" pp188-189 ''Simon & Schuster.'' 1991. {{ISBN|0-671-77897-8}}.</ref>
The first true attempt at what would later be called Exertainment was the Atari ''Puffer'' project (1982). This was an exercise bike that would hook up to an Atari 400/800 or 5200 system.<ref>{{cite web|url=http://www.atarihq.com/othersec/puffer/index.html |archive-url=https://web.archive.org/web/20090322111652/http://www.atarihq.com/othersec/puffer/index.html |archive-date=2009-03-22 |title=AGH's Atari Project Puffer Page }}</ref><ref>{{cite web|url=http://www.atarihq.com/5200/5200faq/03_04.html |archive-url=https://web.archive.org/web/20090322111519/http://www.atarihq.com/5200/5200faq/03_04.html |archive-date=2009-03-22 |title=What Was The Top-Secret "Puffer Project"? }}</ref> Forward speed was controlled by pedaling while steering and additional gameplay was handled by a handlebar-mounted Gamepad. The machine was nearly ready for production with several games (''Tumbleweeds'' and ''Jungle River Cruise'') when Atari declared bankruptcy and the Puffer project was abandoned. The Joyboard for the Atari 2600 was also released in 1982, by the Amiga Corporation.
In Japan, Bandai dabbled in this space with the Family Trainer pad, released in 1986 for the Family Computer. In 1988, Nintendo acquired the North American rights to the pad, and marketed it for the Nintendo Entertainment System as the Power Pad in North America.<ref name="boingboing" /><ref>{{cite web|website=Mental Floss|url=https://www.mentalfloss.com/article/66183/10-very-rare-and-very-expensive-video-games|title=10 Very Rare (and Very Expensive) Video Games|author=Rob Lammle|date=March 16, 2016|access-date=August 26, 2020}}</ref>
The first fitness game system released to the market was the 1986 ''CompuTrainer'' by RacerMate Inc. Designed as a training aid and motivational tool, the CompuTrainer system allowed users to interactively ride on their own bicycle through a virtual landscape generated on an NES or Commodore 64 by connecting their bike trainer unit directly to an external port on the game cartridge. Two trainer units could be connected at a time for 2 players to race virtually on screen while also displaying data such as speed, power, pedaling cadence, heart rate, and distance. As riders raced virtually, the cartridge sent a signal back to the CompuTrainer unit to dynamically change the bicycle's actual resistance based on what was happening on screen in real time with incline, wind, and drafting. The product had a price that was far too high to be considered as an entertainment product, but was affordable by dedicated athletes. RacerMate released the "Racermate Challenge I" cartridge on the Commodore 64 and the "Racermate Challenge II" cartridge on the NES. RacerMate made the CompuTrainer until 2017, where its latest version runs using Microsoft Windows compatible software with extensive graphic and physiological capabilities.
About the same time as the Computrainer, Concept II introduced a computer attachment for their rowing machine. This has become their ''eRow'' product and is used for both individual motivation as well as competition in "indoor rowing leagues".
===1990s=== During the 1990s, there was a surge of interest in the application of virtual reality to high-end gym equipment. Life Fitness and Nintendo partnered to produce the ''Exertainment'' System;<ref>{{Cite web |title=SNES Central: Exertainment |url=http://snescentral.com/article.php?id=0793 |access-date=2022-10-10 |website=SNES Central}}</ref> Precor had an LCD-based bike product, and Universal had several CRT-based systems. The Netpulse system provided users with the ability to browse the web while exercising. Fitlinxx introduced a system that used sensors attached to weight machines in order to provide automated feedback to users.
Three issues combined to ensure the failure of these systems in the marketplace. First, they were significantly more expensive than the equivalent models that did not have all the additional electronics. Second, they were harder to maintain, and were often left broken. Lastly the additional expertise required to operate the software was often intimidating to the users, who shied away from the machines out of fear that they would look foolish while trying to master the machine.
Until 1998, nothing significant happened in the field of videogame exercise. Hardware was still too expensive for the average home consumer, and the health clubs were gun-shy about adopting any new technology. As high-performance game console capabilities improved and prices fell, manufacturers once more started to explore the fitness market.
In 1998, Konami's ''Dance Dance Revolution'' was released. ''Pump It Up'', a dance game similar to Konami's, was released in 1999 by the company Andamiro.
===2000s=== In 2000, UK startup Exertris introduced an interactive gaming bike to the commercial fitness market.
Fitness games came to the mass media attention at the Consumer Electronics Show when Bill Gates showcased the Exertris Interactive Gaming Bike in 2003, and the following year the same show hosted a pavilion dedicated to video game technology that also worked as sports and exercise equipment.
thumb|Gamercize played on PlayStation 2 The 2005 release of the ''EyeToy: Kinetic'' brought the first multi-function fitness game hardware into the home market. Making the players physical movements into the game's controller. 2006 saw the launch of Gamercize, combining traditional fitness equipment with game consoles. The minimalist approach allows game play to continue only when exercising, turning all game titles into potential fitness games.
Nintendo's Wii in 2006 brought acceleration detection with the Wii Remote. In late 2007, Nintendo released ''Wii Fit'', which utilized a new peripheral, the Wii Balance Board. The popularity of the Wii led to it being used in hospital "Wiihab" rehabilitation programs.<ref>{{cite news |url=http://www.cbsnews.com/news/hospitals-discover-the-power-of-wiihab/ |title=Hospitals Discover The Power Of 'Wiihab' |work=CBS News |date=2008-02-08 |access-date=2015-10-28}}</ref>
The PCGamerBike appeared at CES in 2007 where it received an Honoree Award. It differs from other fitness game devices in that its pedal motion can be mapped to any key on the keyboard. It also has an optical encoder which detects forward and reverse pedal motion. The Fisher-Price Smart Cycle was another entry in the field.
Other examples of fitness game products include: {{Proper name|Positive Gaming iDANCE, iSTEP}}, Cobalt Flux Blufit, Cyber coach, NeoRacer, Gymkids exercise equipment with interactive technology, some Wii titles such as ''EA Sports Active'', ''Cybex TRAZER'', ''Powergrid Fitness Kilowatt'', ''Lightspace Play Floor'', ''PlayMotion'', ''Yourself!Fitness'', ''Expresso Fitness S2'', ''i.play'', ''Cyber ExerCycle'', ''VEQTOR Sport Trainer and Sportwall''.
===2010s=== Microsoft's Kinect (2010) was the first major consumer-focused body motion tracking hardware.<ref>{{cite web|first= Michael |last= Rosenberg |url= https://theconversation.com/sorry-gamers-wii-fit-is-no-substitute-for-real-exercise-22375 |title=Sorry gamers, Wii Fit is no substitute for real exercise |publisher=The Conversation |date=2014-01-29 |access-date=2015-10-28}}</ref> Games such as ''Just Dance'' and ''Nike+ Kinect Training'' (2012) used Kinect to make physical body motion into a method of control for games. The trend within consoles that started with the Wii peaked with the pedometer-pairing ''Wii Fit U'' (2013).{{citation needed|date=June 2022}} These were followed up in the eighth generation by a fitness game push by Microsoft with the Xbox One launch day ''Xbox Fitness'' service (2013), which tracked metrics such as heart rate and correct form while synchronising these metrics with the ''Microsoft Health''. By 2017, Microsoft had pivoted away from Kinect and fitness games on consoles. In 2019, Nintendo released ''Fitness Boxing'', and ''Ring Fit Adventure'' for the Nintendo Switch, which take advantage of the Joy-Con controllers, acting as motion detectors in multiple areas of the body.
Mobile phone apps such as ''Zombies, Run!'' (2012), ''Run An Empire'',<ref>{{cite web|last1=Roberton|first1=Andy|title='Run An Empire' Is 'Pokémon GO' With Real Health Benefits|url=https://www.forbes.com/sites/andyrobertson/2016/08/22/pokemon-go-fitness-run-an-empire/|work=Forbes}}</ref> ''Ingress'' (2013), and ''Pokémon Go'' (2016) have been described as augmented reality exergames.<ref>{{cite book|editor-first1= Minhua |editor-last1= Ma |editor-first2= Lakhmi C. |editor-last2= Jain |editor-first3= Paul |editor-last3= Anderson |title=Virtual, augmented reality and serious games for healthcare 1| date= 2014| publisher= Springer Berlin Heidelberg|location=Berlin, Heidelberg |isbn= 978-3-642-54816-1 |page= 199}}</ref><ref>{{cite web| url= http://www.livescience.com/55373-pokemon-go-exercise.html| title= 'Pokémon Go' Catches High Praise from Health Experts| first= Rachael | last= Rettner| date= July 12, 2016 | website= LiveScience.com| access-date= November 22, 2016}}</ref>
Virtual reality (VR) is emerging as a new interface method for fitness games. Games like ''Beat Saber'', ''Holodance'', ''OhShape'', and others allow players to get good exercise while playing a video game.
===2020s=== Fitness games gained in popularity during the COVID-19 pandemic. ''Ring Fit Adventure'' (2019) sold-out at most retailers worldwide<ref>{{Cite web|url=https://www.usgamer.net/articles/coronavirus-outbreak-has-led-to-a-demand-surge-and-shortages-of-ring-fit-adventure|title=Coronavirus Outbreak Has Led to a Demand Surge and Shortages of Ring Fit Adventure|first=Mathew|last=Olson|website=US Gamer|date=February 21, 2020|access-date=March 17, 2021|archive-date=April 8, 2020|archive-url=https://web.archive.org/web/20200408220732/https://www.usgamer.net/articles/coronavirus-outbreak-has-led-to-a-demand-surge-and-shortages-of-ring-fit-adventure}}</ref> and saw a price increase from $80 to $300 on reselling websites.<ref>{{Cite web|url=https://www.vice.com/en/article/people-are-driving-for-hours-and-paying-hundreds-ring-fit/|title=People Are Charging $300 For Nintendo's Ring Fit During Quarantine|first=Patrick|last=Klepek|website=Vice|date=March 19, 2020}}</ref> Nintendo also released ''Jump Rope Challenge'' (2020) for free and for a limited time in an effort to keep Nintendo Switch owners active while in quarantine.<ref>{{Cite web|url=https://www.eurogamer.net/articles/2020-06-16-nintendo-surprise-launches-free-switch-skipping-exercise-game-jump-rope-challenge|title=Nintendo surprise-launches free Switch skipping exercise game Jump Rope Challenge|first=Wesley|last=Yin-Poole|date=June 16, 2020|website=Eurogamer}}</ref> However, Nintendo later announced that the game would remain on the Nintendo eShop until further notice.<ref name="jump rope">{{Cite web|url=https://www.nintendolife.com/news/2020/09/jump_rope_challenge_isnt_going_anywhere_just_yet_will_now_be_available_until_further_notice|title=Jump Rope Challenge Isn't Going Anywhere Just Yet, Will Now Be Available "Until Further Notice"|first=Liam|last=Doolan|date=September 30, 2020|website=Nintendo Life}}</ref> As of September 30, 2020, players of the game had recorded 2.5 billion jumps in total.<ref name="jump rope"/>
The COVID-19 pandemic also caused delays in the industry. One reason ''Ring Fit Adventure'' (2019) did not have enough supply to meet demand was that China was hit early by the pandemic, leading to manufacturing shortages.<ref>{{Cite magazine|url=https://www.wired.com/story/ring-fit-shortage-coronavirus-covid-19/|title=Coronavirus Fears Spark a Run on Nintendo's Ring Fit Adventure|first=Cecilia|last=D'Anastasio|magazine=Wired|date=March 10, 2020}}</ref> The pandemic also delayed several VR products, such as the Valve Index,<ref>{{Cite web|url=https://www.vg247.com/2020/02/21/coronavirus-has-affected-the-production-schedule-for-valve-index-fewer-units-to-be-made-available/|title=Coronavirus has affected the production schedule for Valve Index, fewer units to be made available|first=Stephany|last=Nunneley|date=February 21, 2020|website=VG247}}</ref> and titles such as ''Marvel's Iron Man VR''<ref>{{Cite web|url=https://www.gamespot.com/articles/iron-man-vr-for-ps4-gets-new-release-date/1100-6477159/|title=Iron Man VR For PS4 Gets New Release Date}}</ref> and ''Little Witch Academia: VR Broom Racing''.<ref>{{Cite web|url=https://www.gematsu.com/2020/05/little-witch-academia-vr-broom-racing-delayed-to-late-2020-for-oculus-quest-early-2021-for-playstation-vr-oculus-rift-and-steamvr|title=Little Witch Academia: VR Broom Racing delayed to late 2020 for Oculus Quest, early 2021 for PlayStation VR, Oculus Rift, and SteamVR|first=Sal|last=Romano|date=May 6, 2020|website=Gematsu}}</ref>
Fitness games also proved to be especially helpful during the COVID-19 pandemic, as they were a great motivator for physical activity, which fought the sedentary lifestyle lockdowns caused.<ref name="akjournals">{{Cite journal|title=Comment on: Problematic online gaming and the COVID-19 pandemic – The role of exergames|first1=Ricardo B.|last1=Viana|first2=Rodrigo L.|last2=Vancini|first3=Wellington F.|last3=Silva|first4=Naiane S.|last4=Morais|first5=Vinnycius N. de|last5=Oliveira|first6=Marília S.|last6=Andrade|first7=Claudio A. B. de|last7=Lira|date=March 4, 2021|journal=Journal of Behavioral Addictions|volume=-1|issue=aop|pages=1–3|doi=10.1556/2006.2021.00014|pmid=33666566|pmc=8969849|doi-access=free}}</ref> Physical fitness is known to aid in disease prognosis, as it boosts the immune system, shortened the recovery period from COVID-19, and reduced the negative effects of stress from living in isolation.<ref name="akjournals"/><ref>{{Cite web|url=https://jcpsp.pk/article-detail/exergaming-an-effective-way-to-maintain-physical-and-mental-health-at-home-during-covid19-pandemic|title=Exergaming: An Effective Way to Maintain Physical and Mental Health at Home during COVID-19 Pandemic|first1=Nasir |last1=Sultan|first2=Kiran|last2=Khushnood|author3=Malik Muhammad Ali Awan|website=jcpsp.pk}}</ref>
Overwhelmed medical centers also turned to therapeutic fitness games during the COVID-19 pandemic, as they proved to be more socially distant, required less direct supervision, and used less personal protective equipment.<ref name="hopkins">{{Cite web|url=https://www.hopkinsmedicine.org/news/articles/gaming-system-engages-patients-in-rehabilitation-in-the-hospital-home|title=Gaming System Engages Patients in Rehabilitation in the Hospital, Home|first=Lisa|last=Eddy|website=Hopkins Medicine}}</ref> These games can be adjusted for each patients' exercise needs, making them suitable for the COVID-19 patients whose mobility became limited, or elderly patients, who were affected by COVID-19 at an increased rate.<ref name="hopkins"/>
== Effectiveness == Laboratory studies have demonstrated that some fitness games can provide light to moderate intensity physical activity.<ref>{{cite journal|last1=Peng|first1=W|last2=Crouse|first2=JC|last3=Lin|first3=JH|title=Using active video games for physical activity promotion: a systematic review of the current state of research.|journal=Health Education & Behavior |date=April 2013|volume=40|issue=2|pages=171–92|doi=10.1177/1090198112444956|pmid=22773597|s2cid=17524879}}</ref><ref>{{cite journal|last1=Peng|first1=W|last2=Lin|first2=JH|last3=Crouse|first3=J|title=Is playing exergames really exercising? A meta-analysis of energy expenditure in active video games.|journal=Cyberpsychology, Behavior and Social Networking|date=November 2011|volume=14|issue=11|pages=681–8|doi=10.1089/cyber.2010.0578|pmid=21668370|citeseerx=10.1.1.458.9060|s2cid=77653}}</ref>
Recreational fitness games can also be useful for rehabilitation.<ref name="debiase">{{Cite journal|url=https://academic.oup.com/ageing/article/49/5/696/5848215|title=The COVID-19 rehabilitation pandemic|first1=Sarah|last1=De Biase|first2=Laura|last2=Cook|first3=Dawn A.|last3=Skelton|first4=Miles|last4=Witham|first5=Ruth|last5=ten Hove|date=August 24, 2020|journal=Age and Ageing|volume=49|issue=5|pages=696–700|via=academic.oup.com|doi=10.1093/ageing/afaa118|pmid=32470131|pmc=7314277|doi-access=free}}</ref> While they are not always as adjustable as therapeutic fitness games, recreational fitness games can still help maintain an adequate amount of physical activity, can help those without access to traditional rehabilitation, and can prolong the benefits of in-hospital rehabilitation.<ref name="debiase"/> However, recreational fitness games might require more supervision, as they are less likely to exercise the correct muscles as therapeutic fitness games.<ref name="hopkins"/><ref name="debiase"/>
Exercise games have also proven to be an effective supplement for rehabilitation programs during the COVID-19 pandemic, including balance rehabilitation for the elderly.<ref>{{Cite journal|url=http://fui.edu.pk/fumjs/index.php/fujrs/article/download/240/83|title=Elderly and Balance Rehabilitation: Current Dynamics and Future Possibilities for Pakistan|date=January 2021|journal=Foundation University Journal of Rehabilitation Sciences|via=FUJRS|volume=1|issue=1|archive-date=2022-12-03|access-date=2021-03-17|archive-url=https://web.archive.org/web/20221203222247/https://fui.edu.pk/fumjs/index.php/fujrs/article/download/240/83}}</ref> Children are oftentimes more receptive to the idea of fitness games, making it an especially helpful tool in motivating ill children in their rehabilitation efforts.<ref>{{Cite journal|title=Active Video Games and Low-Cost Virtual Reality: An Ideal Therapeutic Modality for Children With Physical Disabilities During a Global Pandemic|first1=Marika|last1=Demers|first2=Ophélie|last2=Martinie|first3=Carolee|last3=Winstein|first4=Maxime T.|last4=Robert|date=March 17, 2020|journal=Frontiers in Neurology|volume=11|article-number=601898|doi=10.3389/fneur.2020.601898|pmid=33381077|pmc=7767913|doi-access=free}}</ref>
A 2021 systematic review found that exercise games could reduce BMI, and improve body fat percentage and cardiorespiratory fitness.<ref>{{Cite journal|doi=10.2196/29981|title=Effects of Active Video Games on Health-Related Physical Fitness and Motor Competence in Children and Adolescents with Overweight or Obesity: Systematic Review and Meta-Analysis|year=2021|last1=Comeras-Chueca|first1=Cristina|last2=Marin-Puyalto|first2=Jorge|last3=Matute-Llorente|first3=Angel|last4=Vicente-Rodriguez|first4=German|last5=Casajus|first5=Jose Antonio|last6=Gonzalez-Aguero|first6=Alex|journal=JMIR Serious Games|volume=9|issue=4|article-number=e29981|pmid=34661549|pmc=8561411|s2cid=239018909 |doi-access=free }}</ref>
A 2020 systematic review found that fitness games can be utilized to augment treatment for a variety of patient populations such as geriatrics, and those with Parkinson's disease, cerebral palsy, and spinal cord injuries.<ref>{{Cite journal|last1=Qian|first1=Jiali|last2=McDonough|first2=Daniel J.|last3=Gao|first3=Zan|date=2020|title=The Effectiveness of Virtual Reality Exercise on Individual's Physiological, Psychological and Rehabilitative Outcomes: A Systematic Review|journal=International Journal of Environmental Research and Public Health|volume=17|issue=11|page=4133|doi=10.3390/ijerph17114133|issn=1661-7827|pmc=7312871|pmid=32531906|doi-access=free}}</ref>
A 2019 systematic review and meta-analysis found that fitness games are effective for improving muscle tension, muscle strength, activities of daily living (ADL), joint range of motion, gait, balance, and kinematics. The review also suggested that fitness games may be more effective at improving dynamic balance control and preventing falls in subacute and chronic stroke patients when compared to current treatment methods.<ref name="ReferenceA">{{Cite journal|last1=Link to external site|first1=this link will open in a new window|last2=Link to external site|first2=this link will open in a new window|last3=Link to external site|first3=this link will open in a new window|date=2019|editor-last=Paci|editor-first=Matteo|title=The Effects of Virtual Reality Training on Function in Chronic Stroke Patients: A Systematic Review and Meta-Analysis|journal=BioMed Research International|volume=2019|pages=1–12|language=English|doi=10.1155/2019/7595639|pmid=31317037|pmc=6604476| id={{ProQuest|2250538163}} |doi-access=free}}</ref>
A 2018 systematic review in the ''Journal of Medical Internet Research'' of 10 randomized trials studying the "Social Effects of Exergames on Older Adults" found that "the majority of exergame studies demonstrated promising results for enhanced social well-being, such as reduction of loneliness, increased social connection, and positive attitudes towards others".<ref>{{cite journal |last1=Li |first1=J |last2=Erdt |first2=M |last3=Chen |first3=L |last4=Cao |first4=Y |last5=Lee |first5=SQ |last6=Theng |first6=YL |title=The Social Effects of Exergames on Older Adults: Systematic Review and Metric Analysis. |journal=Journal of Medical Internet Research |date=28 June 2018 |volume=20 |issue=6 |article-number=e10486 |doi=10.2196/10486 |pmid=29954727|pmc=6043731 |doi-access=free }}</ref>
Another 2018 systematic review of 10 randomised controlled trials of fitness games in overweight children found that they can produce a small reduction in body mass index.<ref>{{Cite journal | doi=10.1089/chi.2017.0250| pmid=29185787|title = Impact of Game-Based Health Promotion Programs on Body Mass Index in Overweight/Obese Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials| journal=Childhood Obesity| volume=14| issue=2| pages=67–80|year = 2018|last1 = Ameryoun|first1 = Ahmad| last2=Sanaeinasab| first2=Hormoz| last3=Saffari| first3=Mohsen| last4=Koenig| first4=Harold G.}}</ref>
As of 2016, fitness games for those with neurological disabilities had been studied in around 140 small clinical trials in people of all ages, to see if it can help this group get enough physical exercise to maintain their health. This mode of getting exercise appears attractive in this population from a public health perspective because of its low cost and accessibility.<ref name=Rosly/> Fitness games have the potential to provide moderate intensity exercises in this population, but the evidence was too weak on long-term follow-up to draw strong conclusions.<ref name=Rosly>{{Cite journal|last1=Mat Rosly|first1=Maziah|last2=Mat Rosly|first2=Hadi|last3=Davis Oam|first3=Glen M.|last4=Husain|first4=Ruby|last5=Hasnan|first5=Nazirah|date=2016-04-25|title=Exergaming for individuals with neurological disability: a systematic review|journal=Disability and Rehabilitation|volume=39|issue=8|pages=727–735|doi=10.3109/09638288.2016.1161086|issn=1464-5165|pmid=27108475|s2cid=3575227}}</ref>
There is significant evidence across multiple random controlled trials relating fitness games to improved cognitive functioning in healthy older adults (with a mean age of 69), and attenuated deterioration or improvement in adults with cognitive impairment from neurodegenerative diseases such as Alzheimer's disease.<ref>{{cite journal|last1=Stanmore|first1=Emma|last2=Stubbs|first2=Brendon|last3=Vancampfort|first3=Davy|last4=de Bruin|first4=Eling|last5=Firth|first5=Joseph|title=The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials|journal=Neuroscience & Biobehavioral Reviews|date=2017|volume=78|pages=34–43|doi=10.1016/j.neubiorev.2017.04.011|pmid=28442405|doi-access=free|hdl=20.500.11850/130681|hdl-access=free}}</ref>
In addition, studies investigated if fitness games can lead to improvements in cognitive performance in clinical and non-clinical populations such as those who have ADHD and depression.<ref>{{Cite journal|last1=Benzing|first1=Valentin|last2=Schmidt|first2=Mirko|date=2017-01-10|title=Cognitively and physically demanding exergaming to improve executive functions of children with attention deficit hyperactivity disorder: a randomised clinical trial|journal=BMC Pediatrics|language=En|volume=17|issue=1|page=8|doi=10.1186/s12887-016-0757-9|issn=1471-2431|pmc=5223426|pmid=28068954 |doi-access=free }}</ref><ref>{{Cite journal|last1=Benzing|first1=Valentin|last2=Chang|first2=Yu-Kai|last3=Schmidt|first3=Mirko|date=2018-08-17|title=Acute Physical Activity Enhances Executive Functions in Children with ADHD|journal=Scientific Reports|language=En|volume=8|issue=1|page=12382|doi=10.1038/s41598-018-30067-8|issn=2045-2322|pmc=6098027|pmid=30120283|bibcode=2018NatSR...812382B}}</ref><ref>{{Cite journal|last1=Stanmore|first1=Emma|last2=Stubbs|first2=Brendon|last3=Vancampfort|first3=Davy|last4=de Bruin|first4=Eling D.|last5=Firth|first5=Joseph|date=July 2017|title=The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials|journal=Neuroscience & Biobehavioral Reviews|volume=78|pages=34–43|doi=10.1016/j.neubiorev.2017.04.011|pmid=28442405|issn=0149-7634|doi-access=free|hdl=20.500.11850/130681|hdl-access=free}}</ref> There are first encouraging results, but the empirical evidence still is limited.<ref name=":0" />
Studies have shown that fitness games help manage anxiety in several ways. Fitness games help lower anxiety levels in various clinical populations such as patients with Parkinson's disease, enrolled in cardiac rehabilitation, with fibromyalgia, and with systemic lupus erythematosus by introducing more permanent positive physiological changes than methods that do not involve exercise do.<ref>{{Cite journal|title=Exergames as Coping Strategies for Anxiety Disorders During the COVID-19 Quarantine Period|first1=Ricardo Borges|last1=Viana|first2=Claudio Andre Barbosa|last2=de Lira|date=May 4, 2020|journal=Games for Health Journal|volume=9|issue=3|pages=147–149|doi=10.1089/g4h.2020.0060|pmid=32375011|s2cid=218532113 |doi-access=}}</ref>
Fitness games are accessible to many disabled patients, as some have settings that allow the game to remember a person's range of motion, whether they have any assistive devices, and general physical ability.<ref name="hopkins"/>
===Safety=== {{see also|Video game-related health problems}} Fitness games have been shown to be safe and cost effective when used for stroke rehabilitation.<ref name="ReferenceA"/> Virtual environments allow patients to practice skills that would otherwise be unsafe in real world scenarios. A stroke patient with compromised balance, for example, could practice crossing the street in a simulated environment, something that would be risky and unsafe in real time.<ref>{{Cite journal|last1=Laver|first1=Kate E|last2=Lange|first2=Belinda|last3=George|first3=Stacey|last4=Deutsch|first4=Judith E|last5=Saposnik|first5=Gustavo|last6=Crotty|first6=Maria|date=2017-11-20|title=Virtual reality for stroke rehabilitation|journal=The Cochrane Database of Systematic Reviews|volume=2017|issue=11|article-number=CD008349|doi=10.1002/14651858.CD008349.pub4|issn=1469-493X|pmc=6485957|pmid=29156493}}</ref> Fitness games can also make typical rehab exercises safer. Implementing virtual obstacles instead of physical obstacles in balance training exercises, for example, mitigates the risk of falls while increasing a patient's confidence.<ref name="ReferenceA"/>
== Design trends == When making a fitness game system, the manufacturer of a consumer product must make the decision as to whether the system will be usable with off-the-shelf games or if custom software must be written for it. Because it takes longer for a user to move their entire body in response to stimulation from the game, it is often the case that dedicated software must be written for the game to playable. An example of this is Konami's ''Dance Dance Revolution''. Though designed to be played by users moving about on a specially designed dance pad, that game can alternatively be played by pushing buttons with one's fingers using a standard hand-held gamepad. When played with the dance pad at higher levels the game can be quite challenging (and physically exhausting), but if the game is played using the buttons on the hand controller, none of the sequences are physically limited.
Newer systems such as Xbox 360, PlayStation 3 and Wii use alternative input devices such as the Kinect and PlayStation Move. The Move uses image analysis to extract the motion of the user against a background and uses these motions to control the character in the game. A specifically designed exercise game ''Kinect'', superimposes animated objects to be punched, kicked, or otherwise interacted with over a video image of the user. The Wii and PlayStation 3 both incorporate motion sensors such as accelerometers and gyroscopes into the hand-held controllers that are used to direct behaviors within the game. Research projects such as exertion interfaces<ref>{{cite web| first1= Florian |last1= Mueller| first2=Stefan |last2= Agamanolis| first3= Rosalind |last3= Picard| title= Exertion Interfaces: Sports over a Distance for Social Bonding and Fun| date= April 2003| url= http://affect.media.mit.edu/pdfs/03.mueller-agamanolis-picard.pdf | work= CHI '03 Proceedings of the SIGCHI Conference on Human Factors in Computing Systems| access-date= November 22, 2016}}</ref> that investigate the design aspects of these games<ref>{{cite web|first1= Florian|last1= Mueller|first2= Martin R.|last2= Gibbs|first3= Frank|last3= Vetere|title= Design Influence on Social Play in Distributed Exertion Games|work= CHI '09 Proceedings of the SIGCHI Conference on Human Factors in Computing Systems|pages= 1539–48|date= April 2009|url= http://exertioninterfaces.com/cms/images/stories/pdf/design_chi09.pdf|access-date= November 22, 2016|archive-date= August 7, 2011|archive-url= https://web.archive.org/web/20110807085133/http://exertioninterfaces.com/cms/images/stories/pdf/design_chi09.pdf}}</ref> explore how the technological augmentation that comes with the digital gameplay component can be nurtured for additional benefits, such as utilizing the social power of exercising together even though players are connected only over a network<ref>[http://exertioninterfaces.com/cms/breakout-for-two.html Breakout for Two] {{Webarchive|url=https://web.archive.org/web/20161203101413/http://exertioninterfaces.com/cms/breakout-for-two.html |date=2016-12-03 }}. Exertion Interfaces. Retrieved on 2010-03-03.</ref> or scaling the number of players,<ref>[http://exertioninterfaces.com/cms/table-tennis-for-three.html Table Tennis for Three] {{Webarchive|url=https://web.archive.org/web/20161224232129/http://exertioninterfaces.com/cms/table-tennis-for-three.html |date=2016-12-24 }}. Exertion Interfaces. Retrieved on 2010-03-03.</ref> enabling novel exercise experiences not available without the technological augmentation.
One of the newest trends is using virtual reality immersion. VR systems have several potential advantages for athletic training; environments can be precisely controlled and scenarios standardized, augmented information can be incorporated to guide performance, and the environment can be dynamically altered to create different competitive situations.<ref name="doi.org">Shepherd, J., Carter, L., Pepping, G.-J., & Potter, L.-E. (2018). Towards an Operational Framework for Designing Training Based Sports Virtual Reality Performance Simulators. Proceedings, 2(6), 214. https://doi.org/10.3390/proceedings2060214</ref> High frame rate display technologies, for example head-mounted display, can be used to transform the user into any sporting situation e.g. a track cycling velodrome.<ref name="doi.org"/> Natural movements can also be incorporated into the games, for example utilizing an omnidirectional treadmill, such as the Infinadeck. Such a system allows the user to virtually be in the game while allowing 360 degrees of movement.<ref>{{cite web|title=Infinadeck|url=http://www.infinadeck.com/|access-date=18 December 2014}}</ref> While the technology is new, it is showing promising results in weight management as well as in high participation rates.<ref>{{cite journal|last1=Christison|first1=Amy|title=Exergaming for Health: A Community-Based Pediatric Weight Management Program Using Active Video Gaming|journal=Clinical Pediatrics|date=April 2012|pages=382–388| doi= 10.1177/0009922811429480|pmid=22157430|volume=51|issue=4|s2cid=24481969}}</ref>
== References == {{reflist|colwidth=30em}} {{Refbegin}} *{{cite book | title=Racing the Beam: The Atari Video Computer System | publisher=The MIT Press | year=2009 | isbn=978-0-262-01257-7 | ref=Beam| author1=Bogost, Ian | author-link1=Ian Bogost | author2=Montfort, Nick | title-link=Racing the Beam: The Atari Video Computer System }} {{Refend}}
== Further reading == * Sinclair, J., Hingston, P., & Masek, M. (2007). Considerations for the design of exergames. GRAPHITE '07: Proceedings of the 5th international conference on Computer graphics and interactive techniques in Australia and Southeast Asia, December 2007 Pages 289–295 https://doi.org/10.1145/1321261.1321313 * JMIR e-collection on [https://games.jmir.org/themes/245 Exergames, Active Games and Gamification of Physical Activity] * Eyetoy Kinetic – Thin AG, Howey D, Murdoch L & Crozier A (July 2007). Evaluation of physical exertion required to play the body movement controlled Eyetoy Kinetic video game. Life Sciences 2007, SECC, Glasgow, Scotland. * IJsselsteijn, W. A., de Kort, Y. A. W., Westerink, J., de Jager, M., & Bonants, R. (2006). Virtual Fitness: Stimulating Exercise Behaviour through Media Technology. Presence: Teleoperators and Virtual Environments 15, 688–698. [http://www.mitpressjournals.org/doi/abs/10.1162/pres.15.6.688 Virtual Fitness: Stimulating Exercise Behavior through Media Technology] * Wii Sports – Professor Tim Cable (February 2007). School of Sport and Exercise Sciences, John Moores University, Liverpool, England. * Shepherd, J., Carter, L., Pepping, G.-J., & Potter, L.-E. (2018). Towards an Operational Framework for Designing Training Based Sports Virtual Reality Performance Simulators. Proceedings, 2(6), 214. [https://doi.org/10.3390/proceedings2060214 Towards an Operational Framework for Designing Training Based Sports Virtual Reality Performance Simulators].
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Category:Fitness games Category:1980s neologisms Category:Gamification