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Active video games (AVGs) capable of inducing physical activity offer an innovative approach to combating childhood obesity. Unfortunately, children’s AVG game play decreases quickly, underscoring the need to identify novel methods for player engagement. Narratives have been demonstrated to influence behaviors.
The objective of this study was to test the hypothesis that a narrative would motivate increased AVG play, though a feasibility study that investigated the motivational effect of adding a previously developed narrative cutscene to an originally nonnarrative AVG,
A total of 40 overweight and obese 8- to 11-year-olds equally divided by sex played the AVG. Half (n=20) were randomly assigned to a narrative group that watched the narrative cutscene before game play. The other half played the game without watching it.
Children in the narrative group had significantly (
The AVG with narrative induced increased physical activity. Additional research is needed to understand the mechanisms through which narrative increases physical activity during AVG game play.
Children in the United States spend more time with electronic media than any other activity except sleep [
A critical issue for AVG interventions, however, is that players typically do not play them for sufficiently long durations [
To our knowledge, this is the first feasibility study to systematically investigate the effect of narrative on children’s AVG play, testing the hypothesis that narratives will increase physical activity during AVG play. A professionally developed narrative cutscene was developed (ie, a brief, animated movie clip) for an existing AVG requiring trunk movement at a moderate level of physical activity. Children aged 8-11 years played either the narrative or the nonnarrative version of the game by either watching or not watching the narrative cutscene before game play.
Childhood obesity is a worldwide problem [
Active video games could provide an innovative method of increasing physical activity with promising health outcomes for many children [
While AVGs may prevent childhood obesity by increasing physical activity levels, reported AVG play duration varies. One study found that a quarter of young players played AVGs for 2 days a week in bouts of 50 minutes on average [
Approaches are needed to enhance physical activity resulting from AVG play. Narratives possess unique motivational properties that may encourage AVG play [
Conceptual model of the mechanisms for narrative effects. AVG: active video game.
The narrative version of the AVG will result in a higher level of physical activity measured by steps/second count, total steps count, play duration, and total energy expenditure than the nonnarrative version.
This study used a 2-arm randomized controlled design with assessments of children’s AVG play during and after the sessions. Children were randomly assigned to narrative (n=20) or nonnarrative (n=20) groups.
Inclusion criteria were as follows: age 8-12 years, between the 85th and 99th percentiles for body mass index (BMI), ability to speak and understand English, and physically able to play the selected AVG. This group was targeted because (1) obese children in this age group are highly likely to become obese young adults [
The Institutional Review Boards of Northwestern University and the Baylor College of Medicine approved the research protocols. Children were recruited from mostly lower-income public schools in Chicago and a participant database in Houston. Parents provided written informed consent and children provided written informed assent.
Prior research has used both quantitative and qualitative methods (surveys and cognitive interviews) to explore child preferences for the type of narrative genres (eg, adventure, fable, mystery, comedy) and story plots. A total of 4 plots were developed to presage the selected AVG,
A total of 20 children were recruited from the Chicago metro area. Of the 4 narrative plots,
The selected plot was fully developed and entitled
Another 20 children from the Houston metro area were recruited to evaluate the narrative and nonnarrative cutscenes. Results indicated that children preferred the narrative cutscene over the nonnarrative cutscene [
A total of 40 children from the Houston metro area were recruited. Of these children, 8 participated in a pilot-testing session and 32 participated in the main study. The research protocol did not change between the pilot testing and main study. Thus, results were combined. Children were brought to the Metabolic Research Unit (MRU) of the Children’s Nutrition Research Center located in the Texas Medical Center in Houston, Texas. The MRU consisted of a private, semiopen space simulating a modern-day living room with home furniture and household electronics (eg, television) with a separate waiting room attached. Children played the AVG inside the room, while their parents stayed in the waiting room.
After consent and assent and facility orientation, children were randomly assigned to 1 of 2 conditions (narrative or nonnarrative) with 2 physical activity measurement instruments attached by a trained research associate. Those in the narrative condition first watched
Each of the 40 children participating in the AVG play study session received a US $25 gift card.
Children’s BMI was calculated as weight in kilograms divided by height in meters squared [
Traditionally, activity sensors have been worn on the hip or arm areas for physical activity assessment. To measure physical activity during children’s AVG play, a Sensewear Pro Armband [
Social desirability of responses was assessed with the Revised Children’s Manifest Anxiety Scale (Sample item: I never say things I shouldn’t.) [
Independent
Power analysis showed that with 40 participants (20 per randomized sequence) and an alpha of .05, a 2-sided independent
Independent 2-sample
To test whether the narrative cutscene resulted in a more even distribution of activity over the play period, information entropy was used to analyze the probability distribution of the activity monitor data. Higher entropy indicates that the data are more evenly distributed, whereas lower entropy values indicate that activity was clustered around a narrow activity range.
The demographic information for the 40 children can be found in
Children’s demographic and weight information (N=40).
Measure | Count, n | % or mean (SD) | |
Female | 20 | 50 | |
Male | 20 | 50 | |
Asian | 2 | 5 | |
African American | 14 | 35 | |
White American | 6 | 15 | |
Hispanic American | 17 | 43 | |
Multiracial | 1 | 2 | |
Age in years, mean (SD) | N/Aa | 9.6 (1.2) | |
BMIb in kg/m2, mean (SD) | N/A | 27.2 (11.9) | |
BMI percentile, mean (SD) | N/A | 94.3 (12) | |
Eighth grade or less | 1 | 2 | |
Some high school | 1 | 2 | |
High school | 4 | 10 | |
Technical school | 3 | 8 | |
Some college | 9 | 22 | |
College | 11 | 28 | |
Postgraduate | 11 | 28 | |
< 20,000 | 5 | 12 | |
20,000-39,999 | 7 | 17 | |
40,000-59,999 | 12 | 30 | |
60,000-79,999 | 5 | 13 | |
80,000-100,000 | 5 | 13 | |
>100,000 | 6 | 15 | |
Single-family house | 35 | 88 | |
Apartment | 3 | 7 | |
Other | 2 | 5 | |
1 | 6 | 15 | |
2 | 27 | 68 | |
3 | 7 | 17 |
aN/A: not applicable.
bBMI: Body mass index.
Children’s physical activity levels during game play (N=40).
Device | Variable | Narrative (n=20), mean (SD) | Nonnarrative (n=20), mean (SD) | ||
Stopwatch | Playing duration | 17.6 (3.9) | 16.2 (4.1) | 1.14 | .26 |
ActiGraph | Mean steps/10 secondsa | 3.2 (0.7) | 2.7 (0.7) | 2.22 | .03 |
Total stepsa | 523.0 (203.3) | 366.4 (172.0) | 2.63 | .01 |
a
We found that the Sensewear Pro Armband significantly overestimated physical activity (ie, total energy expenditure was more than 500 kcal for a 20-minute AVG play) and that the step count correlations between the Sensewear and ActiGraph were inconsistent for the steps per 10 seconds (
ActiGraph more accurately assessed trunk movement. This is important because many children jumped around when playing with the Wii Remotes [
Children in the narrative group had significantly lower entropy (mean 0.77, SD 0.14) than the nonnarrative group (mean 0.88, SD 0.15) according to the ActiGraph measurement (
Differences in average play duration (narrative: mean 17.6, SD 3.9 vs nonnarrative: mean 16.2, SD 4.1) and total energy expenditure (narrative: mean 566.9, SD 215.3 vs nonnarrative: mean 495.8, SD 190.7) were not statistically significant between the narrative and nonnarrative groups.
To the best of our knowledge, this is the first feasibility study of the influence of a narrative on physical activity during AVG play among overweight and obese children. Participants were from diverse backgrounds in an urban area and responded well to the project. The narrative was carefully developed with multiple empirical tests to ensure that plot and characters were closely related to the AVG and were positively received by the diverse child participants. Compared with the original nonnarrative AVG, the addition of a 3-minute narrative cutscene at the beginning of the game play session increased physical activity in children’s AVG play, as evidenced by increased average number of steps per 10 seconds and the total step counts. Our findings suggest that the participants in the narrative group were more physically active during game play and more effectively engaging their bodies in swordplay movements than those in the nonnarrative group, who played the original version of the AVG without a narrative cutscene. These findings provide preliminary evidence that an engaging narrative may influence child physical activity during AVG game play.
Children are imaginative beings who could be positively influenced by a make-believe world when a compelling narrative has been developed to meet their developmental, emotional, and recreational needs [
There are several limitations to this study. The scale of this study was small, with a small sample of children playing a single AVG session using multiple measurement devices attached to their body after watching just a 3-minute narrative cutscene in a research laboratory. Because of the feasibility nature of the study, the sample of 40 in this study was initially powered to detect a large difference; future studies should be powered to detect smaller differences. Measurement device placements and the laboratory setting may have caused participants to shorten their natural AVG play time, which could have reduced our ability to detect differences in energy expenditure and AVG play motivation between the conditions. Other studies have found similar unreliable measurement results by Sensewear Armbands among overweight and obese children [
This is the first feasibility study to systematically vary and test the effect of narrative on children’s physical activity during AVG play. Narrative increased physical activity during AVG game play among overweight and obese children as evidenced by more steps per 10-second period and total steps overall. Future research is needed to identify the underlying mechanisms through which this occurs.
active video game
body mass index
digital video disc
Metabolic Research Unit
Leia Butler, Leopoldo Castillo, Robert Dolezal, Sakina Kazmi, and Kimberlyn Shirrels helped with data collection in the narrative development stage. This project was funded by a grant from the National Cancer Institute (1R21CA158917-01A1), “The Narrative Impact of Active Video Games on Physical Activity,” and federal funds from the US Department of Agriculture’s Agricultural Research Service under Cooperative Agreement No. 58-6250-0-008.
No financial interests were reported from the authors except RB, who is president of Archimage, Inc, the company that created the narrative cutscene for the project.