As most of you know, apart from working full time, and this wonderful business we have here, David also is in his last year of his Sports and Exercise Science degree. Here is an essay on the effects of exergaming on self efficacy. Very interesting! Enjoy!
Effects of Exergaming on Self-Efficacy and Physical Activity in Children
Physical inactivity is a significant problem throughout the world (Organisation for Economic Co-operation and Development [OECD], 2013, p.9) and has been established as an independent risk factor for non-communicable diseases, such as cardiovascular disease (CVD) and diabetes. In fact, physical inactivity is the fourth greatest risk factor for premature death (World Health Organisation [WHO], 2015, para. 1). The Australian Physical Activity and Sedentary Behaviour Guidelines (The Department of Health, 2014) recommends that children 5-12 years accumulate at least 60 minutes of moderate to vigorous intensity physical activity every day. It is also recommended that children minimise the time they spend being sedentary every day by limiting the use of electronic media for entertainment (e.g. television, seated electronic games and computer use) to no more than two hours a day and breaking up long periods of sitting as often as possible (The Department of Health, 2014).
Longitudinal studies have shown that physical activity (PA) behaviours adopted in childhood are likely to continue in to adulthood (Telama et al., 2014). Therefore, the establishment of a physically active lifestyle during childhood is vitally important. Despite this, existing interventions aiming to promote increased PA in children are failing (Metcalf, Henley & Wilkin, 2012). This suggests that innovative interventions are required to encourage increased PA amongst children.
Although much of the blame for increased sedentary behaviour has been levelled at video games, with 8-18 year olds spending on average 7.5 hours per day on devices such as computers, television and gaming consoles (Rideout, Foehr & Roberts, 2010 as cited in Krause & Benavidez, 2014), exergaming has emerged as a possible vehicle to increase both self-efficacy toward PA and actual PA rates amongst children. Recently, studies have been conducted in exergaming and its effect on self-efficacy (and therefore PA) through three of its sources, mastery, modelling and verbal feedback (Gao, Huang, Liu & Xiong, 2012; Gao, Zhang & Stodden, 2013; Krause & Benavidez, 2014; Lwin & Malik, 2014; Staiano, Abraham & Calvert, 2013) as self-efficacy has been found to be one of the strongest mediators of PA participation (Plotnikoff, Costigan, Karunamuni & Lubans, 2013).
This review aims to evaluate the effectiveness of exergaming as a PA promotion strategy through its impact on self-efficacy toward PA. Self-efficacy and three of its sources, mastery, modelling and verbal feedback, will be defined and a review of the current literature regarding the use of exergaming to increase PA in children will be undertaken.
Exergaming is the combining of exercise with videogame play. The first generation of exergames emerged in the 1980s with the combining of stationary bicycles and game consoles. In the late 1990s, the release of Dance Dance Revolution (DDR) provided a cost-effective exergame that produced significant caloric expenditure (Lanningham-Foster et al., 2006). More recently, Nintendo’s Wii Fit console has joined DDR as being the most popular and most studied exergames (Gao et al., 2012; Gao et al., 2013; Krause & Benavidez, 2014; Staiano & Calvert, 2011).
In efforts to increase PA in children, there is a need to appeal to the so-called gaming generation and provide innovative and entertaining ways to exercise (Krause & Benavidez, 2014). Although initially designed for home use, exergames are now being used by schools, afterschool programs and fitness centres in their physical education and fitness programs (Krause & Benavidez, 2014; Staiano & Calvert, 2011).
Evidence suggests that self-efficacy is one of the key determinants of PA participation in children and that, through sources of self-efficacy, active video games (exergames) can be effective at increasing PA, self-efficacy toward PA and energy expenditure (Figure 1) (Plotnikoff et al., 2013).
Due to the nature of play, whereby children are focused on the screen rather than on one another, exergaming has also been shown to reduce self-consciousness and increase self-esteem (Staiano & Calvert, 2011).
Self-efficacy is defined as the belief an individual has in his/her ability to perform a given behaviour (Bandura, 1977). A review by Brown, Hume, Pearson and Salmon (2013) of randomised controlled trials and quasi-experimental studies involving 5-12 year olds, found that self-efficacy was the most commonly examined potential mediator of PA and that positive significant effects were found in half of the studies reviewed. In his 1977 article, Self-efficacy: Toward a unifying theory of behavioural change, (Bandura, 1977) Albert Bandura hypothesised that whether coping behaviour was initiated, how much effort was expended and how long it would be sustained when faced with obstacles was determined by expectations of personal efficacy. In the model proposed by Bandura (1977), expectations of personal efficacy are derived principally from performance accomplishments (mastery), vicarious experience (modelling), verbal persuasion (feedback) and physiological states. As shown in Figure 2, Bandura (1977) distinguished efficacy expectations from outcome expectations. Where outcome expectation is a person’s belief that a given behaviour will lead to certain outcomes, efficacy expectation is the belief that the individual can successfully carryout the behaviour required to produce the outcomes (Bandura, 1977). This distinction is important because an individual may believe that certain behaviour will lead to certain outcomes (outcome expectation) but if they do not believe that they can successfully carryout the behaviour (efficacy expectation) then the outcomes will not occur. Self-efficacy therefore is an important mediator of increased PA as people tend to avoid situations which they believe are beyond their capabilities. Not only does self-efficacy determine which activities an individual might undertake, it also affects how long they will persist in the face of initial failure (Bandura, 1977). Not only this, but the stronger the initial efficacy expectations, the more likely the individual is to persist for longer. By contrast however, weak expectations are easily overcome by initial disconfirming experiences (Bandura, 1977).
Performance accomplishments (Mastery)
Performance accomplishments are an individual’s past successes or failures and are the most influential source of self-efficacy (Bandura, 1977). Success raises mastery expectations further and failures can lower them, especially if failures are present early in the learning process (Bandura, 1977).
In this regard, exergaming may play a vital role in facilitating mastery experiences and building self-efficacy through self-selection of difficulty as it has been suggested that unsuccessful attempts at the wrong times may lead to less involvement (Bandura, 1977; Krause & Benavidez, 2014). That is, lower levels that are easily mastered can be selected initially and difficulty can be increased gradually as efficacy increases. This process could also be used to transition sedentary individuals to actual PA whereby self-efficacy can be built through exergaming before attempting more challenging and less controlled “real” sport and exercise, as once efficacy increases overtime, failures have a lessening effect on the individual (Bandura, 1977). In a 9 month long study by Gao et al. (2012) children learned how to play DDR gradually in physical education classes and during recess and could self-select difficulty levels. The study, involving 101 predominantly Latino 4th and 5th grade students reported significantly greater (p<0.05) PA, as measured by the physical activity questionnaire for children and self-efficacy as measured by the physical activity confidence scale.
Another potential benefit of exergames is the ability to trial many sports in a short time allowing the user to both discover a sport that they may do well at amongst a wide variety of sports and to move on quickly from failures in one sport to another.
Vicarious experience (Modelling)
Self-efficacy gained through vicarious experience is when an individual observes others performing threatening activities without adverse consequences (Bandura, 1977). Self-efficacy is built from the belief that if others can do it, then the given individual can expect to at least improve if they persist and/or intensify their efforts (Bandura, 1977). Although many efficacy expectations are derived from vicarious experience, the fact it relies on inferences from social comparisons means that it can be less dependable than personal performance accomplishments (Bandura, 1977).
Exergaming offers many opportunities to increase self-efficacy through modelling, such as the use of avatars, especially personal avatars. Personal avatars place the gamer in the virtual environment which may enhance the sense of accomplishment (mastery) (Gao et al., 2012; Gao et al., 2013). This may allow children to feel more comfortable in sporting settings and encourage participation in traditional exercise and sports programs. Krause and Benavidez (2014) suggest that the authentic sports experience and opportunity to become the game’s main character, or avatar a feature of many of the latest exergames, may provide first-hand mastery and modelling experience. An added benefit of the use of avatars may be that children feel that others are watching the avatar on screen rather than them (Staiano et al., 2011).
Another source of modelling is peer-modelling. In a 20-week-long intervention involving 54 overweight and obese African American adolescents (15-19 years, 55.6% female) the Nintendo Wii Active exergame console was used to assess changes in self-efficacy and bodyweight between cooperative exergaming, competitive exergaming and control groups (Staiano et al., 2013). Self-efficacy was assessed by self-report using the Exercise Confidence Survey (Sallis, Pinski, Grossman, Patterson, & Nader, 1988). The study found that students in the cooperative exergame group attended an average of 8 more sessions (31 vs 23) compared to the competitive group over the 20 weeks of the study. Researchers also found a significant (p=0.005) increase in self-efficacy and decrease in weight in the cooperative group compared to the competitive group. These findings suggest that cooperative rather than competitive exergame grouping may foster greater mastery (through working together to achieve a common goal), modelling (both through onscreen images and partner actions) and verbal feedback (from the game and partners/teammates) experiences and thus self-efficacy states over time.
Verbal persuasion (Feedback)
Verbal persuasion is the leading of an individual, through suggestion, to a point of believing that they can achieve the expected outcome (Bandura, 1977). Because of its ease of use and ready availability it is widely used however, the effect is weaker than mastery because the experiences are less authentic for the affected individual (Bandura, 1977). According to self-efficacy theory, people who receive encouragement are more likely to exert greater effort to become successful (Wood & Bandura, 1989).
Many exergames provide verbal and visual encouragement and feedback through points scores, flashing lights, sounds and cues and these seem to guide individuals towards and reinforce desired behaviours. For example, DDR provides comments such as good and perfect or quotes such as “player 1 is tearing it up” for positive actions. In contrast, incorrect execution may see the word “failed” appear on the screen (Gao et al., 2012; Gao et al., 2013). Although this may not be ideal for the user’s self-efficacy in many cases, negative feedback messages may be better received from a virtual source than a “live” one as they are often accompanied by a humorous visual display and the individual may laugh it off. Not all will take it this way though and care must be taken in selecting games and levels especially early in the learning process. There is potential for teachers and other leaders to support the process by providing their own messages i.e. children receive simultaneous feedback from the game and peers and teachers (Gao et al., 2012; Gao et al., 2013).
In a randomised controlled trial of 398 Singaporean fifth grade school students (58.5% boys, mean age 10.2 years) (Lwin & Malik, 2014), participants were exposed to a 2 x 2 factorial design, that is, either physical education lessons with or without Wii exergames, as well as with coping or threat framed messages (Figure 3). In the study, students in the exergame (with Wii) condition played Wii exergames for 45mins in one of their weekly physical education lessons for 6 consecutive weeks (Wii DDR, Tennis and Boxing on 2-week rotation). The students in the regular physical education lesson continued usual physical education lessons and were not allowed to play Wii exergames. The study showed a significant positive difference between those in the threat message/exergame condition and the threat message/regular PE condition (3.93 +/- 0.7 vs 3.61 +/-0.7) on a 3-item adapted self-efficacy scale (1=Low 5 =High) (Lwin & Malik, 2014). No significant differences were found in the coping conditions (Lwin & Malik, 2014), suggesting that threat framed health messages delivered via exergames are more effective than those delivered via other means and that the positive effects of exergaming on PA self-efficacy may be enhanced when combined with threat framed health messages. As this intervention only lasted 6 weeks and there was no follow up period, further research is needed which combines exergaming and health messages particularly with longer intervention periods (to gauge if the effect is greater with longer interventions) and follow up (to gauge longer term effects of the intervention).
In a follow-up to an earlier study of 70 fifth grade students, Sun (2013) reported light to moderate intensity PA did not meet recommended guidelines and that interest in exergames diminished over time. However, the report also showed that exergame incorporated physical education lessons were more likely to promote positive beliefs toward PA than regular physical education lessons (Sun, 2013).
In another study comparing DDR and aerobic dance for measures of PA, self-efficacy and enjoyment in 53 urban fourth grade students, it was found that children spent more time in moderate to vigorous PA for aerobic dance than DDR (31% vs 21%) but that children reported significantly higher self-efficacy (p<0.01) (4.22 +/- 0.64 vs 3.53 +/-1.12) on a 3-item adapted self-efficacy scale (1=Low 5 =High) and enjoyment (p<0.01) in DDR than aerobic dance (Gao et al., 2013). Although the level of PA was higher in the aerobic dance condition than DDR, aerobic dance is more physically active than some other physical education lesson subjects such as volleyball, therefore DDR may provide similar PA levels to other physical education lesson subjects.
Exergaming has the potential to influence self-efficacy, through mastery, modelling and feedback, and therefore future sport and PA participation, especially for those children who do not have a strong interest in sport and exercise but are interested in gaming. The combination of autonomy over game and difficulty selection as well as interest in the medium (relatedness) may serve to draw in previously inactive children and hold the interest of currently active children for longer, thus increasing the time spent in and intensity of physical activity in children. However self-efficacy and potential mechanisms of PA change are multifactorial (Brown et al., 2013), depending on several contextual factors including social, situational and temporal factors. Therefore, even success experiences need to happen in the correct context to elicit increased PA behaviour. The impact of information on efficacy expectations will depend on how it is cognitively appraised (Bandura, 1977). That is, people process, weigh and integrate diverse sources of info concerning their capability and they regulate their choice behaviour and effort expenditure accordingly. Different people can develop different efficacy expectations from similar experiences, this may be because people have had previous efficacy-altering experiences, thus one new source of efficacy info would not be expected to affect everyone the same.
As there is limited research on the effects of exergaming on self-efficacy leading to increased PA there are a number of limitations to the evidence presented in this review. Limitations include a lack of uniformity between studies, limited length of some trials (as little as 6 weeks) and a lack of follow up which may prove very important in the long run as Sun (2013) showed that motivation may plateau as the novelty effect wears off. There were also issues with non-reporting off PA outside of allotted exergaming time, children self-reporting PA levels, single or limited ranges of exergames, single school populations and limited exergaming opportunities (such as lunchtime or recess).
It is therefore recommended that further studies that focus on the sources of self-efficacy are conducted over longer timeframes and include Aboriginal and Torres Strait Islander populations, disabled populations and gender specific exergames. It is also recommended that development of exergames is encouraged as new and exciting games will be required often to combat the novelty effect.
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