In Mexico, 34% of children are obese and overweight. During the last years, the incidence of obesity and overweight in young children (2 – 4 years old) is growing up. Sedentary lifestyles, poor nutrition, and lack of exercise adherence affect young children quality life, and motor skills development. Appropriate exercise adherence is important to help young children learn, explore the environment, gain body awareness, support self-expression and socialization.

Exergames on interactive floors can play an important role sustaining engagement when young children exercising. First, they provide a natural interaction enabling young children to appropriately use gross motor movements when playing. Second, the ability of exergames to sustain children’s engagement while exercising could positively impact their exercise adherence. And third, the ability of interactive floors inviting children to socialize could provide an informal environment where children could benefit from a shared experience when using exergames for exercising.

Literature in ubiquitous computing has explored the design and evaluation of exergames on interactive surfaces to support children’s learning and movement. Although, most of these projects indicate that children are more willing to exercise when using exergames; little has been said about what elements of persuasion truly support exercise adherence for long periods of time. These will demand to evaluate sustained attitudes and behavior change towards exercise in long-term.

Literature in persuasive computing demonstrates the Behavior Change Wheel (BCW), and the Transtheoretical Model (TTM) are appropriate to investigate and change behavior attitudes particularly those interventions with health outcomes. In this paper, we use both models to design and evaluate Hunting Relics, an exergame running on an interactive floor to encourage exercise adherence in young children.

The contribution of this paper is twofold. First we provide evidence showing the COM-B system used in BCW could be used as a framework to design exergames. Second, we provide qualitative and quantitative evidence showing how exergames on interactive floors leveraging behavior theories help young children change their behavior moving from the TTM phase of precontemplation to action.

We followed an iterative user-centered design methodology, to design our exergame, understand the current practices for exercise adherence, and determine a set of gross-motor exercises and collaboration mechanisms appropriate for young children. We conducted a qualitative study at 2 kindergartens in Mexico. Our data inquiry process  involved 6 semi-structured interviews (with 2 kindergarten, 3 physical education and 1 art teachers), 5 hours of passive observation of children conducting exercises routines, 1.5 hours of passive observation of children using a commercial interactive floor with advergames. We used the results of the qualitative study and the COM-B system to create a set of design insights that guided the design of 2 high-fidelity prototypes. We developed such prototypes using Flash. Then we installed them on a commercial interactive floor during a birthday party were 6 young children played them for 1.5 hours. We finally conducted 3 participatory design sessions with a multidisciplinary team including children who attended to such party (n=7), kindergarten teachers (n=2), HCI experts (n=3), and designers (n=1). We used qualitative and rapid contextual design techniques to analyze the collected data.

Following the results from our contextual study and using the COM-B system as a design taxonomy, we uncovered three design insights guiding the development of our exergame prototype: (1) exercise repetitions must combine appropriate physical and psychologies challenges to promote age-appropriate motor skill development (capability); (2) integrate collective and collaboration mechanisms to promote social behaviors(opportunity); and (3) provide appropriate incentives to increase exercise adherence (motivation).

Hunting Relics, is an exergame where young children help two scouts to get relics avoiding obstacles by practicing eye-foot coordination exercises (Figure 1). Hunting Relics follows a three stage model for the appropriate practice of exercise. First, during warm-up, children must get the treasure map from a safe. To open the safe, children jump on the numbers corresponding to the safe’s code. Then, during training, children practice different exercises (track a line, jump/stomp on target) following different strategies for collaboration including taking turns, task division and work together. Finally, during the phase for cooling down, children must walk around a white air balloon for coloring, and then they need to blow it to help scouts reach the Treasure Island. At the treasure islands, the scouts open the treasure and get the relic.

Hunting Relics runs in an indirect optical sensing interactive floor using the Kinect sensor to infer the user’s location and a DLP short-throw projector as an actuator (Figure 2 left).

Figure 1: Screenshot of Hunting Relics. The interactive map showing all the levels available in Hunting Relics

To evaluate the impact of the developed exergame, we conducted a deployment study, starting the second week of June and continuing to date. The interactive floor was installed in a classroom of a public kindergarten attending to close to 30 young children in Mexico. 12 children age between 4 and 6, and a teacher used the exergame and the interactive floor. To learn how to use the game and the interactive floor, the teacher received one-hour training and children about 10 minutes.

The study followed a single-subject design methodology, commonly used in behavioral interventions. First, during baseline, for around 2 days we conduct a within subject experiment where all the participants played with a traditional circuit exercise consist in eight stations (Figure 2 middle), and then the participants, exercised using Hunting Relics (Figure 2 right). After the game session, participants filled a survey [7] based on TTM to determine in what stage of exercise they were in, and also completed the FunToolkit  survey [8] to evaluate their game experience with the interactive floor and all game sessions were videotaped.

We conducted weekly interviews with the teacher and children participating in the study. Also every three weeks young children completed the Children’s stage of Exercise survey and the FunToolkit to determine any changes of the stages of behavior as a result of playing Hunting Relics. At the end of the intervention children will complete both surveys.

Data analysis followed a mixed-method approach. We used qualitative techniques to derive grounded theory and affinity diagramming (e.g., open and axial coding) to analyze interview data. And videos were transcribed and coded to understand impact on motor skills using the “Observation System for Motor skills” [9], and collaboration using the “Cooperative Performance Metrics” coding schemes.

Analysis of data is still ongoing, but so far, our results indicate the exergame was easy to use and useful, physical exercises and collaboration mechanisms are appropriate, and the exergame increases exercise adherence in young children compared to traditional practices and according to TTM.

Figure 2: General hardware architecture of the interactive floor running Hunting Relics (left); Young Children during baseline taking turns to cross a bridge by tracking a line during: a traditional circuit exercise(middle) and using the interactive floor and Hunting Relics (right).

We found that Hunting Relics is a useful tool to help children practice exercise inside the classroom. Particularly, when using Hunting Relics young children better sustaining attention reducing collaboration challenges than when excersing with the traditional circuit. Also, our study shows Hunting Relics positively impacts children exercise adherence and increase their tolerance when exercising. According to TTM our results show children using Hunting Relics move further one stage –especially those children from the phase of precontemplation to action. Once in action, our results show that even after the novelty effect wears off children find new collaboration and persuasion strategies to sustain the use of Hunting Relics.

In collaboration with Ana I. Martinez-Garcia (CICESE)

Project participants

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