Impact of Playing Exergames on Mood States: A Randomized Controlled Trial

Abstract

To examine how playing exergames impacts the mood states of university students and staff, and whether such an impact depends on gender and players' previous exercise time. This study was designed as a randomized controlled trial. It enrolled 337 participants and randomly assigned them to an intervention group (n = 168) or a control group (n = 167). A 2-week exergame program was designed for the participants in the intervention group. They were required to play exergames for 30 consecutive minutes each week for 2 weeks and respond to the items measuring vigor, happiness, and perceived stress. All measures were administered before and after the study. Repeated measures analysis of variances were conducted. Playing exergames enhanced vigor and happiness for participants in the intervention group. This group exhibited more positive change in vigor and happiness than the control group. This effect of playing exergames was not moderated by gender, age, occupation (student or staff), or previous exercise time. Playing exergames may induce positive mood states among university students and staff.

Introduction

Exergames are growing in popularity, with sales of the exergame “Your Shape: Fitness Evolved 2012” having reached more than 1.16 million units worldwide.¹ The related hardware, Xbox 360, has sold 76 million consoles worldwide.² Such figures indicate the importance of further research on exergame users' behavior and psychology.

Current research on exergames has focused mainly on the impact of playing them, including the enhancement of children's motor skills³ and physical activity,⁴ physical function and cognition in older people,⁵ exergame intention for high school students,⁶ the rehabilitation of stroke patients,⁷ and balancing function among undergraduate students.⁸ However, insufficient research has investigated how playing exergames may impact mood states among healthy university students and staff, indicating a gap. Research filling this gap could enrich the knowledge of the positive aspects of playing exergames among healthy adults.

Therefore, the purpose of this study is to investigate the relationship between playing exergames and changes in mood states. This study contributes to the literature in four ways. First, playing exergames has been found to be positively related to improved motor skills more than the use of “traditional” exercise, and the enjoyment generated by playing them was investigated.³ The present study further explores the positive impact on mood states after playing, and how such impacts differ across genders and individuals with previous exercise experience.

Second, individuals with a high degree of independence displayed negative affective responses after playing exergames.⁹ The present study is new in examining the relationship between playing exergames and positive mood states.

Third, playing exergames can help relieve depression and improve quality of life.¹⁰ The present study also explores how playing exergames can help relieve negative psychological impacts; it not only investigated the relationship between playing exergames and reducing users' negative mood states (i.e., stress) but also increasing users' positive mood states (i.e., happiness), highlighting the value of playing exergames.

Fourth, body image dissatisfaction (i.e., high versus low) has been linked to exergaming (i.e., solitary versus group).¹¹ The present study also investigated how playing exergames can impact psychological well-being, but is new in examining how gender and previous exercise experience can moderate such an impact.

Theoretical Background and Hypotheses

Vigor

Vigor refers to an individual's perception of his/her energy level¹² and, thus, is important for psychological health. A high level of vigor is related to one's optimal psychological functions.¹³ Vigor and exercise are associated.¹⁴ According to relevant literature, individuals can increase vigor after doing low- and moderate-intensity exercise.¹⁵ Applying this concept to exergames, playing them is a form of moderate exercise¹⁶ and, thus, should invigorate the players.

H1: Playing exergames is related to enhanced vigor.

Happiness

Happiness is the pleasurable or satisfying experience brought on by events, occasions, or activities.¹⁷ People who are happy enjoy positive relationships with family, partners, and friends.¹⁸ Exercise should be related to pleasure as doing a moderate amount of exercise can enhance pleasure.¹⁹ Moreover, doing exercise can induce human brains to release endorphins, which can give individuals a sense of pleasure.²⁰ According to past literature, playing exergames can have similar effects to doing “conventional” exercise.¹⁶ Playing exergames can thus help to release endorphins. Therefore, playing exergames should be related to enhanced happiness.

H2: Playing exergames is related to enhanced happiness.

Perceived stress

Perceived stress is the mental state in which an individual feels unable to deal with problems,²¹ and it thus can degrade personal health. Studies indicate that perceived stress is associated with low levels of longevity.²² Doing exercise can help reduce stress²³ and causes the brain to release endorphins, helping individuals feel relaxed.²⁰ According to relevant literature, playing exergames can have similar effects as doing conventional exercise.¹⁶ Feeling relaxed can help individuals feel less stress. Therefore, playing exergames should be related to a reduced level of perceived stress.

H3: Playing exergames is related to a reduced level of perceived stress.

Methods

Sample and data collection processes

This study was a randomized controlled trial that recruited university students and staff at a university in northern Taiwan who were at least 20 years old. It evaluated outcome variables before and after the study to calculate any change resulting from participation. This study excluded university students and staff that suffered from anemia, hypertension, arrhythmia, angina, vertigo, asthma, or mental illnesses.

This study was approved by an institutional review board (103-6878C) and recruited participants from February to May 2015. Participants were informed that the study was about evaluations of exergames. No deception was made on the participants throughout the process. Moreover, participants were all volunteers. Written consent forms were obtained from all eligible participants. Both intervention and control participants started in March and completed their participation by June 2015. Before the experiment began, the research staff briefly explained the study to eligible participants, who were told that they could withdraw from the study at any time without giving reasons. After completing the 2-week experiment, each participant in the intervention group received US$17, while each participant in the control group received US$7, as a token of gratitude for their participation.

Before implementing the exergames, the research team was separated into several groups to increase the rigor of the research design. Specifically, one research assistant generated a random digit table to create a series of digits, while another (central office) reserved the series of digits for later use. Both were blind to the research purpose. After recruiting qualified participants, the project managers obtained the digits from the central office for assigning the participants to the experimental or control groups (with digits ranging from 0 to 4 representing the intervention group and digits ranging from 5 to 9 representing the control group). The treatment givers contacted the participants in the intervention group and asked them to engage in the program. Outcome evaluators provided questionnaires to all the participants. At the end of study, the analyzer analyzed the results of this experiment. The outcome evaluators and the analyzer were blind to the participant assignment result (i.e., which participants had been assigned to the experimental or the control group). No research team member took on multiple roles.

Participants in the intervention group were asked to play randomly selected exergames for 30 consecutive minutes once a week for 2 weeks. They filled in the questionnaire before playing the exergames for the first time, and after playing for the last time. The participants in the control group were not required to play exergames during the 2 weeks, but were also required to fill in the study questionnaire. Following the guidelines in The Lancet Handbook of Essential Concepts in Clinical Research,²⁴ the present study maintained contact with participants unless they voluntarily withdrew from the experiment.

Measurement

In this study, the eight items measuring vigor came from the scale of Shacham,²⁵ while the four measuring happiness came from Lyubomirsky and Lepper.²⁶ Items measuring perceived stress were derived from Cohen et al.²¹ The items were in Taiwanese. The items were assessed using response options ranging from 1 (strongly disagree) to 5 (strongly agree). Participants also self-reported their average previous time spent exercising per week.

The measurement tools exhibited sufficient validity and reliability. Specifically, the analytical results of the factor analyses indicated that the items measuring each construct were loaded on the theoretically assumed factors (i.e., with loadings >0.50) with minimum cross-loadings (i.e., nearly all of the cross-loadings <0.30), implying acceptable validity. Moreover, Cronbach's alpha values ranged from 0.79 to 0.90, indicating adequate reliability.

Experimental equipment and materials

For hardware, this study adopted the Xbox 360 because it enables participants to use their body movements to directly operate the avatars on the TV screen during exergames. The software used was “Your Shape: Fitness Evolved,” which emphasizes on using whole-body movements. This software contained gaming activities, including aerobics, Tai Chi, floor exercises, and yoga positions, indicating its suitability for this study. The game to play was randomized everytime. The researchers set up a room containing the Xbox and the software to standardize the intervention procedures. All participants in the intervention group were asked to play the exergames there.

Results

Sample profile

In total, 337 participants were enrolled, including 170 participants assigned to the intervention group and 167 to the control group. In the intervention group, one participant lost contact and another did not comply with the study process. Therefore, the intervention group comprised 168 participants and the control group comprised 167. The participants in the two groups did not significantly differ in gender (p = 0.13) and age (p = 0.96). Moreover, the two groups did not significantly differ in previous time spent exercising (p = 0.92), happiness (p = 0.91), vigor (p = 0.95), or perceived stress (p = 0.60).

Hypotheses testing

This study measured the dependent variables in two time points and, thus, conducted the mixed repeated measure analysis of variance (RM-ANOVA, hereafter). The within-subject factor is time (before vs. after the participation). The between-subject factors are: group (control vs. intervention), gender (male vs. female), and previous exercise time (short vs. long).

The analytical results indicate that time significantly interacted with group to impact happiness and vigor (F = 5.94, p = 0.02, F = 7.12, p = 0.01), but not perceived stress (F = 1.35, p = 0.25). Such an interaction preliminarily supported H1 and H2, but not H3. Analytical results of the interactions are the first steps leading to formal tests on hypotheses.

To formally test H1 and H2, we examined the simple main effects of time and group, respectively. In the beginning of this study, the two groups did not exhibit significant difference in happiness and vigor (mean difference = 0.02 and 0.06, p = 0.85 and 0.41). However, at the end of this study, the intervention group reported a significantly higher level in vigor (mean difference = 0.28, p = 0.001), but not a significantly higher level of happiness (mean difference = 0.16, p = 0.12). That is, H1 (but not H2) was strongly supported, as the most important information among analytical results.

As in the aforementioned analytical results, the interaction term did not provide any support for H3. Hence, we further examined the main effects of time and group. Perceived stress was not significantly different between the two groups (F = 1.86, p = 0.17), but significantly different before and after participation (i.e., time) (F = 8.16, p = 0.01). Such a pattern did not support any effect of playing exergames on alleviating perceived stress, thus did not support H3. The reason may be that perceived stress can be caused by personal problems and these cannot be alleviated in a short period of time.

Analytical results indicate that the participants in the control group showed decreased vigor with time. The reason may be that this study recruited the participants in the early weeks of a semester when the school workload may not have been heavy. As weeks went by, the school work might have had an impact on the participants' vigor.

The RM-ANOVA results did not indicate a significant interaction among time, group, and gender, that is, F = 1.34, 0.00, 3.31, p = 0.25, 0.99, 0.07. That is, the effect of playing exergames on happiness, vigor, and perceived stress did not significantly differ between genders. Female participants had improved perceived stress, but it was not significant, either in one-tailed or two-tailed tests.

The RM-ANOVA results did not indicate a significant interaction among time, group, and previous exercise time, that is, F = 0.02, 0.09, 0.23, p = 0.88, 0.77, 0.63. That is, the effect of playing exergames on happiness, vigor, and perceived stress did not significantly differ between participants who were stratified into the more or less previous exercise time subgroups.

Additional analyses

The RM-ANOVA results indicated that neither occupation (student vs. staff) nor age (low vs. high) interacted with the effect of playing exergames on happiness, vigor, and perceived stress (F ranged from 0.22 to 1.35, p ranged from 0.25 to 0.88). That is, the effect of playing exergames was not significantly different between students and staff and between elder and younger participants.

Discussion

Main findings and contributions

This study is the first examining whether playing exergames can improve positive mood states, including an increase in vigor and happiness and a reduction in perceived stress. The most important information is that participants experienced significant changes in vigor after playing exergames. The effect of playing exergames was not altered by gender, age, occupation (student or staff), or previous exercise time.

Implications

This study contributes to exergaming literature in several aspects. First, playing exergames has been shown to improve sensory weighting and dynamic balance,²⁷ implying that it can enhance physical functions. The results of the present study also indicate that playing exergames can induce positive changes. However, this study added psychological benefits to the physical improvements.

Second, the expectancy-value model has been used to examine expectancy beliefs and task values for university students.²⁸ Moreover, in comparison with physical activities, the results found that playing exergames could be more attractive to inactive university students and motivate a higher intention to participate in exergames rather than “conventional” physical education activities. This study investigates university students and staff as participants, but found that playing exergames could enhance vigor for both frequent and infrequent exercisers in the intervention group.

Third, it has been found that playing through normal or obese avatars in exergames influenced participants' physical activities in real life.²⁹ This study is in line with that in examining participants who were not only more likely to enjoy the benefits of playing exergames but also investigated the psychological aspects of vigor, happiness, and perceived stress. The findings of the present study provide further evidence of enhanced positive mood states after playing exergames.

Fourth, exergamers' attitudes and intentions toward other forms of exercise have been examined after playing exergames for 12 weeks.³⁰ Specifically, it was found that playing exergames enhanced the intention to do other forms of exercise among frequent exercisers, but not among infrequent exercisers. The present study is in line with that in examining the differences in results between frequent and infrequent exercisers after playing exergames. However, the present study further investigated how frequent and infrequent exercisers differed in positive mood states after playing. The results of the present study show that the effect of playing exergames is not significantly different between frequent and infrequent exercisers.

Fifth, the relationship between exergame exercise intention and self-presence was examined in one recent study.⁶ Specifically, it found that the level of pleasure (i.e., enjoyment) could partially mediate the relationship between identification with the avatar and exergame intention. The present study is in line with theirs in examining how playing exergames impacts psychological aspects but with adopted gender and previous exercise time as novel moderators on the links between playing exergames and pleasurable experience (i.e., happiness).

This research found that playing exergames could improve positive mood states. Currently, in an effort to increase the sales of their exergames, Microsoft, Sony, and Nintendo promote the use of exergames for the improvement of physical fitness and health. According to the findings of this study, we suggest that exergame providers highlight the use of exergames for increased psychological well-being, adding to their usefulness.

The findings of this study indicate that playing exergames can enhance vigor. Exergame providers could encourage customers suffering from burnout and stress to use exergames to regain vigor and return to optimal health. They could highlight that playing exergames can enhance mood states.

Research limitations and future research directions

Because of homogeneity, this study recruited university students and staff aged 20–40 years. Using a sample of university students and staff can enhance internal validity. However, future research could replicate this study by recruiting participants who are outside the current age range.

Future research could also investigate the relationship between the length of time spent playing exergames and a positive mood state. In this study, we adopted 30-minute exercise routines once a week in a 2-week program. Future research can increase the exergaming duration. An increased period of time spent playing exergames may result in even greater physical health improvements, but there is not yet a study exploring the relationship between the physical and psychological states after playing exergames. Therefore, this study suggests that future research could explore how increased playing time influences both physical and psychological aspects.

Future research could explore the differences in user mood states when playing alone, with friends and family, or with strangers. This study examined the psychological response when playing exergames alone. However, social in-game interactions might encourage continual use of exergames and, thus, strengthen their impact on users' behavior and psychology.

Playing games has been regarded as a response to stress³¹ or negative mood.³² The reason may be that playing games has an effect on perceived stress.³³ Such an effect should have biological foundation.³⁴ Therefore, future studies are encouraged to examine the effect of gaming experiences on stress and mood.

The two groups in this study did not significantly differ in whether participants played computer games (t = 0.60, p = 0.55) and whether participants played exergames (t = 1.40, p = 0.16). Therefore, this study regarded that whether participants are gamers or nongamers does not create critical impact on the present findings. However, the distinction between gamers or nongamers is one issue in gaming literature.³⁵ Hence, future studies can consider whether gamers or nongamers differ in other aspects of gamer psychology or behavior when playing exergames.

This study randomized the exergame to play everytime. This approach should minimize the impact of specific exergames. However, this approach restrains this study from answering whether playing any specific exergame (e.g., aerobic) brings better (worse) mood than one another (e.g., yoga). Future studies are suggested to extend the present study to further explore the most impactful exergame in creating good moods.

Another interesting future research direction is to include the previous experience with playing commercially available exergames. That is, the present study provided a foundation for future studies to explore whether previous experience interferes with the impact of playing exergames on gamers' mood.

Conclusions

Overall, this study identified the potential positive impact of playing exergames on some indices of mood states. Moreover, gender, age, occupation (student or staff), and previous exercise time may not moderate such impacts. The findings of this study provide new insight showing that playing exergames may be a means for improving mood states. Although the analysis of this study was based on a randomized controlled trial, that is, using 337 eligible participants, further studies could explore whether the positive impacts of playing exergames can be sustained for extended periods. Moreover, future qualitative studies can use the present study as the foundation to explore how and why playing exergames contributes to mood states of the participants.

Footnotes

Acknowledgment

The authors thank Chang Gung Memorial Hospital, Taiwan for financial support (CMRPD3D0022).

Author Disclosure Statement

No competing financial interests exist.

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