Digital games emerge as new tool to foster health, exercise: Playing for health
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* Kim Krisberg

These days, students at Halcyon Elementary School in Montgomery, Ala., cannot wait to get to physical education class.

As part of Alabama’s Wee Can Fight Obesity campaign, Halcyon Elementary is one of dozens of schools that received a free Nintendo Wii Fit, a video game system that requires players to move around to earn points, also known as ‘exergaming.’

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/42/2/1.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/42/2/1.1/F1)

A woman holds a yoga pose while using a Wii Balance Board and game at an AARP event in Los Angeles in September.

Photo by Michael Buckner, courtesy WireImage/Getty Images

“They don’t even realize they’re exercising,” said Audrey Gillis, the school’s PE teacher. “It’s fabulous.”

Gillis’ students use the Wii two to three times a week during the 30-minute PE class and “they just love it — we actually had some of the little children cry because it wasn’t their Wii day,” she said.

“These kids are active for 30 minutes straight — they don’t stop,” Gillis told *The Nation’s Health*. “If we can get them to enjoy physical activity as children, then they’re more likely to stay physically active as adults.”

Gillis’ experience is just one example of the growing intersections between public health and digital games. While using game-related challenges in public health endeavors is not new, video games and avatar-based simulations are emerging as an effective way of teaching healthy behaviors. Today, gaming technology and design is being used to address a variety of public health and health care issues, such as tobacco cessation, mass vaccination, physical inactivity, health promotion, chronic disease management and rehabilitation. In fact, February marked the debut of a new scientific journal, called *Games for Health: Research, Development and Clinical Applications, or simply G4H*, devoted to the topic.

“Games can influence everything from your attitudes about health to your perception of risk to your belief in your capability to take care of your own health, which is critical,” said Debra Lieberman, PhD, director of the Health Games Research program at the University of California-Santa Barbara, an associate editor of the new journal and director of the Health Games Research program. “Games really are the most interactive media that we have today. Now, we need to bring evidence-based practices to this field, just like every other field of health and public health.”

The Health Games Research program, which is funded by the Robert Wood Johnson Foundation, has awarded millions of dollars to researchers working in the field. For example, one grantee is developing a mobile phone game called Lit2Quit to help people kick the smoking habit. Built on the premise that smokers get a sense of satisfaction from the breathing action associated with cigarettes, Lit2Quit challenges players to breathe into their phone’s microphone to move objects successfully around the screen. While the game is still in its testing phase, anecdotally, smokers have reported reduced cravings after playing, Lieberman said. Another program grantee is using robots to engage seniors in exercise games, she said. In the game, a robot sits on a table, instructing players to copy its movements and detecting whether players are doing it correctly.

“Games can provide powerful experiences,” Lieberman said. “They can help tremendously and research is showing that again and again.”

For game developer Kognito Interactive in New York City, the research looks promising. In a study published in the debut issue of *G4H*, Kognito’s “Family of Heroes” game was found to be an effective tool in helping families of veterans take an active role in encouraging veterans exhibiting psychological stress to seek help. The online simulation game brings players into a virtual environment where they learn about the signs of post-deployment stress, what to do in a mental health emergency and what kinds of Veterans Affairs services are available. Players then take part in a series of role-playing conversations with computerized veteran stand-ins that are displaying signs of stress, depression and suicide. By picking certain dialogue options, players can win or lose the challenge and in the process, learn effective communication tactics and how to connect veterans to services.

“We’re excited to see that it not only has an impact on perceptions and knowledge, but on people’s actual behavior,” said Ron Goldman, CEO and co-founder of Kognito Interactive. “For most people, face-to-face role playing is awkward and not very interesting. We wanted to create a risk-free, private and confidential environment where people feel more comfortable acting as they do in real life.”

Launched in November, the free online game was first made available to families in southern New York and New Jersey via regional VA websites. As of late January, Goldman said more than 55,000 people had played the game, which is set to launch in Virginia and Arizona as well.

Games are a powerful tool for professional training, too. With the support of public health preparedness funds, researchers at the University of Illinois-Chicago School of Public Health created the “POD Game,” or Point of Dispensing Game, which launched in 2007. The goal of the game is to replace traditional tabletop simulations with more in-depth, realistic training that workers can experience before taking part in real-life drills, said Colleen Monahan, DC, MPH, director of the university’s Center for Advancement of Distance Education. The free online simulation game drops players into a treatment and vaccination center on the day of an anthrax attack, where they try on different response roles in an effort to vaccinate all of Chicago’s nearly 3 million residents within 48 hours. To date, thousands of workers from around the country have played the training game, Monahan said.

“The concept of role playing is a big one for public health,” she told *The Nation’s Health*. “The next generation of younger people are going to be game players and that’s going to be how they learn. I think we’re short-sighted if we don’t start thinking of how to make these things available.”

It is a question Ben Sawyer is working on as well. Sawyer is co-founder of the Games for Health Project, which began in 2004 and works to bring together researchers, game developers and health professionals. Sawyer, who described the cross-section of games and health as still being in its infancy, said he hopes the project can “shorten the delta between promise and reality.” Sawyer said the project takes a more business-like outlook — “in other words, it’s great that we understand why something works, but where are the designs and the research coming together to produce efficacy and impact?” Sawyer said that while video games often get a bad rap for their sometimes sedentary nature, it’s important to note that “when you start to unpack this notion of screen time, we find a big difference between game screen time and TV screen time.”

“Understanding games as being a strategic tool is going to be critical if we’re going to maximize the gains that games offer us,” he told *The Nation’s Health*. “Video games are not going away. Computers are going to get more powerful and games are going to take advantage of those powers to do incredible things. We can’t just shame this stuff away…we’ve got to better understand it.”

For more information on games and health, visit [www.gamesforhealth.org](http://www.gamesforhealth.org) or [www.healthgamesresearch.org](http://www.healthgamesresearch.org).

*   Copyright The Nation’s Health, American Public Health Association