Gaming your way to better health

Interactive games seek to get people moving, help them manage disease

By Kristen Gerencher, MarketWatch
Last update: 7:12 p.m. EST Dec. 11, 2008

SAN FRANCISCO (MarketWatch) -- Video games aren't just for kids and couch potatoes anymore. They're increasingly being used to motivate people of all ages to move their bodies and manage their chronic health conditions more effectively.

Health electronic games represent 16% of the overall video gaming industry, amounting to a $6.6 billion worldwide market this year, according to a report from IConecto, the sponsor of Gaming4Health.com, a company that designs and distributes custom e-games for insurers and employers.

The bulk of that figure comes from the two largest subcategories known as exergames and brain fitness. Exergames such as the popular Nintendo Wii Sports and Wii Fit systems pair digital interactive technology with the player's physical motion, while brain fitness focuses on cognitive training aimed at improving or maintaining mental function.

"Exergaming is just one part of the solution to reduce health-care costs and improve health status," said Doug Goldstein, chief executive of Gaming4Health in Alexandria, Va. "We have to get people moving. If this is an engaging way to get people moving then let's do it."

Smaller health e-game categories cited in the report include healthy eating, which involves weight management and obesity-related interventions, and condition management, targeted to people with chronic ailments such as diabetes, asthma, cancer or pain.

Some health insurers are getting in on the action. Humana developed a competitive game for school children called the Horsepower Challenge. Cigna distributes a game called ReMission to teens and young adults with cancer. In a study published in the journal Pediatrics last August, ReMission, which features a sassy nanobot named Roxxi who blasts cancer cells in a fictional cancer patient, was shown to increase players' adherence to oral chemotherapy and antibiotics regimens, which can prevent cancer recurrence.

Video: Gaming For Health

Interactive video games are bringing fresh therapy and fitness approaches to players of all ages. MarketWatch's Kristen Gerencher looks at a program designed to help young cancer patients and one aimed at people with Parkinson's disease. (Dec. 11)
Health-oriented games are targeted to older adults as well. Sixty-one percent of more than 350 senior-living and older-adult centers surveyed intend to purchase some form of computer-generated or Wii-type game in the next two years, according to a November poll from the International Council on Active Aging, a trade group representing senior-living communities and centers. Another 38% were considering buying brain fitness software.

"Over the last 10 years there's been virtually zero increase in the level of activity in individuals 55-plus," said Colin Milner, the council's chief executive. "People are beginning to come in with these products transferring movements online and trying to make it fun."

Debunking stereotypes

The market's shifted in the last decade as game publishers, health plans, academics and policymakers became more enthusiastic about the potential for game applications in health care, said Debra Lieberman, director of the Health Games Research national program at the University of California-Santa Barbara, which is overseeing the disbursement of $4 million in health-gaming research grants from the Robert Wood Johnson Foundation.

"People understand that good games can be made that don't have violence or hateful portrayals of racial and ethnic groups and aren't even sedentary anymore because you're up and off the couch," she said.

"It's not seen as such a radical thing to do in your health-care organization," Lieberman said. "It's now really feasible to think about health games that could be a moneymaker."

Still, much more needs to be learned, she added. "We're still trying to discover what quality is and what games can and cannot do."

Such research is likely to speed the convergence of traditional gaming and health care, said Steve Cole, vice president for research at HopeLab, a nonprofit in Redwood City, Calif., that developed ReMission as part of its charter to support the health of teenagers with chronic disease.

"The market that we want to catalyze has the health-care industry as the consumer of these games and the commercial games industry as the producer of these games," he said. "But the commercial games industry has been quite slow to take it up because they don't really feel they know how to change health behavior. That's not what they've done in the past."

Not everyone believes gaming will improve health measures on a broad scale. It may make a mark in senior fitness or in the fight against childhood obesity, but health e-games likely will remain a niche market, said Carl Doty, a principal analyst at Forrester Research in Boston.

"I don't see it as a pragmatic way to get people engaged in fitness. I think there are some isolated examples where it can have beneficial outcomes," Doty said. "The root problem goes much deeper than getting people to have a little bit of fun. It's more about culture, diet and it's tough to get that level of behavior change with gaming."

Exergaming

Humana, the Louisville, Ky.-based health insurer, is pleased with the performance of its online game to get school children moving, said Joanna Darst, product manager for the Humana Innovation Center.

The Horsepower Challenge gives each student a pedometer, which tracks their movement and sends wireless updates to the HumanaGames.com Web site. Students also receive animated horses that represent them online, where they can see their progress. Teams of school systems compete against each other, and kids who accumulate activity earn rewards they can use to accessorize their horses.

"Our mission is basically to help people play their way to better health," Darst said. "We want to make it fun for people to get healthy."

Though Humana gives most of its games away for free, its motives aren't entirely altruistic. The company is factoring in relatively high turnover in its business.
"If they aren't a Humana member today they might be in a couple years, and if they come to us healthier because of the games then we're better for that," Darst said.
Humana also has sold a few units of a senior-focused game called Dancetown, a game similar to Dance Dance Revolution but with a safety rail that surrounds the dance pad, she said. "You can set different levels of difficulty on the pads so a grandmother can play a grandchild but it's challenging for both."

At Inland Empire Health Plan, which serves low-income beneficiaries of the state's public programs in two large counties in Southern California, doctor-referred overweight kids can work out with interactive games as part of a weight-loss program that takes place at a site called XRtainment Zone in Loma Linda, said Gary Melton, director of health administration in San Bernardino.

"It's pretty exciting, especially when you see the facility," he said. "It appeals to those children that don't typically get involved in soccer and sports and all of that stuff."

The downside is that many families live and work too far away from the site to make it a viable fitness alternative, Melton said.

But the 100 kids who do participate can exercise with a variety of games, one of which allows the rider of a stationery bicycle to do so in front of a screen where a character rides through the streets of Tokyo on a motorcycle, said Dr. Sue Gengler, Inland's health education manager.

Managing cancer, Parkinson's disease

Games such as ReMission can help young-adult cancer patients, who are prone to skipping chemotherapy doses, stay on track, Cole said. "It's not because they don't understand they should take their chemo. After months and months and months of treatment, they start to feel confident of being cured and a desire to get back to the life they led."

Getting the benefits doesn't require spending lots of time parked in front of the computer, he said. "We found that kids who played the game as little as one to two hours showed the same positive effect as kids who played for more than 20 hours."
At the University of California-San Francisco, researchers are adapting the Wii gaming platform to help patients with Parkinson's disease improve their gait and balance.
With a grant from the National Institutes of Health, researchers will test whether the custom program works to help Parkinson's patients overcome their functional impairments better than traditional methods like physical therapy, said Glenna Dowling, chair of the physiological nursing department at UCSF.

"People with Parkinson's tend to take these small stutter steps, which are very unstable," she said. "This gets them to pick up their feet and have a more normal gait. [It] has the potential to reduce falls."

Patients often don't get much physical therapy, and having a home-based game protocol would make treatment more accessible, Dowling said. The first phase of research among 20 patients, half of whom worked with the game in a lab setting, proved promising.
"We saw positive benefits by three months and even more positive benefits by six months," Dowling said.

Kristen Gerencher is a reporter for MarketWatch in San Francisco.