Serious games: key trends for the healthcare sector

By Susi ONeill

Playing games is an activity as old as mankind, but the games industry has never before played with the healthcare industry. Now the boom in ‘exergaming’ and ‘serious’ games has seen an unlikely alliance, as game technologists are out to prove to the healthcare sector that playing computer games can be seriously good for your health.


Image: Heartlands, copyright Active Ingredient

What are serious games?

Serious games is a term used to describe applications developed using computer games technologies that have an outcome other than solely entertainment.  The serious games movement has grown rapidly in the last decade, in tandem with significant state investment – often from Higher Education Institutes.  The term serious games has been used to describe a variety of game types, particularly those associated with e-learning, online training, military and medical training and simulation environments including virtual worlds.

The growth of ‘exergaming’ in mainstream games

A new breed of games for health has taken serious games outside of institutions, led by consumers desires to improve their mental health and fitness.  ‘Exergaming’ (games linked to exercise) has existed since the 1980s when exercise bikes were linked to video screens, but uptake exploded with the launch of Nintendo’s Wii console in 2006.  Rather than sedentary couch activity, it encourages users to actively participate in a range of games which encourage sport, dance or movement.  Wii Fit was the best selling USA video game in January and February 2009; it invites gamers to try yoga, aerobic activities and balance games while moving on a movement-sensitive board, assisted by an on-screen trainer.

Nintendo Wii Fit research

Current research is testing the Wii Fit as a tool to promote fitness for those who would not usually exercise: Florida Southern College are using Wii Fit to rehabilitate athletes recovering from surgery or injury; Seacroft Hospital in Leeds, England, are using it to encourage recuperating patients to take exercise. Researchers at Liverpool John Moores University, England, monitored children playing the Wii Sports games and found Wii-ers burned an extra 60 calories an hour compared with those playing sedentary computer games. Professor Tim Cable observed:

“We saw children’s heart rates go up to 130-140bpm, similar to what you see in endurance training. It doesn’t replace real sports but it encourages people who are completely sedentary to be more active.”

The Wii platform is a best-seller, with one in four households in the UK owning one, and three million of those also purchased Wii Fit. The Wii taps into a new healthcare market for people who are interested in game play and participatory social experiences more so than participation in sports. It is the first computer game to be endorsed by the Department of Health in Britain as part of the National Health Service’s Change4Life programme to persuade people, especially children, to take more exercise and eat healthily. The popularity of Wii with women reaches a hard-to-reach group in both sports and gaming, however, the platform has come under fire from fitness instructors for focusing on narrow measures such as Body Mass Index and age in developing an individual exercise programme.

Nintendo’s Walk With Me

Nintendo have recently launched their ‘Walk With Me’ game for the Nintendo DS. It’s a simple pedometer that clips to your belt when walking and it can capture data for up to four family members – including the dog. The pedometer turns walking and every day intermittent exercise into a playful game, as the pedometer captures data and transmits this back to the portable Nintendo DS device, pictorially showing how the performance of your ‘Mii’ (Nintendo avatar) is progressing whilst creating an in-game ‘currency’ to trade for virtual objects like a round-the-world trip or a walk into space.

Games for Health Conference

Health games are booming: 60 sessions were presented this year at the fifth annual Games for Health conference in Boston, USA. Healthcare insurers have taken an interest in serious games, sponsoring the 2008 event and organising a health insurance plenary.  Presentations at the 2009 summit included a version of the popular video game Guitar Hero designed to aid arm amputee rehabilitation and Get Well Gamers, a grassroots foundation to help hospitals acquire videogame hardware and software and deploy it to support hospital patients.

The conference is sponsored by Robert Wood Johnson Foundation who recently announced US $1.85 million in grants for research to offer insight into how digital games can improve players’ health behaviours. Projects funded include research into how the popular dance pad video game Dance Dance Revolution might help Parkinson’s patients reduce the risk of falling and a mobile phone game with a breath interface designed to help smokers quit or reduce their tobacco use.

Serious games for health

Outside of mainstream commercial games, developers – particularly in the UK and USA – are producing serious games applications which are proving to have health and educational benefits, and to encourage learning and participation.

Case study: Active Ingredient

UK digital producers Active Ingredient won the International Nokia Ubimedia Award for Future Technology for its game Heartlands, a mobile game where your heart becomes the joystick.   The game has toured technology and arts events in USA, Singapore, Japan, Brazil and across Europe. Using a GPS-equipped smartphone and attaching a heart rate monitor to your forefinger, Heartlands maps your physical movement in the real world onto a virtual equivalent shown on a mobile screen, with the game’s landscape changing depending on your heart rate. Within the optimum range for your age, the pathway grows green grass and blossoming flowers but if it’s too low it turns to a desert littered with skulls and cactus.


The concept was developed in collaboration with Middlesex University Sports Science Department in London who helped to develop an algorithm to judge the active heart rate area. The game allows researchers to understand the little explored area of discontinuous exercise.

As a co-operative game, it allows children and adults of all ages to compete to achieve a personal best, like the Wii Fit combines a competitive sport-like activity with a personal gaming challenge. Gamers have reported high levels of endorphin from the fun and euphoria associated with gaming combined with increased heart rate activity associated with outdoor exercise.

Active Ingredient’s Director Matt Watkins has a vision “to develop physical activity for people who are not usually good at sports.” Watkins believes the trend towards active gaming is more than a fad:

“There’s a growing market for engagement and interaction with technology, and to make healthcare products more playful to improve the user’s experience.”

In the future, wider availability of reliable GPS in next generation smartphones may grow the market for outdoor exergaming in addition to indoor console gaming.

Case study: Playgen

Climate Health ImpactImage: Climate Health Impact, copyright Playgen

London serious games development agency Playgen are pioneering the development of simulation games for learning, assessment and behaviour change.

Climate Health Impact is a simulation based game designed to give British high school biology students a better understanding of the health impacts of climate change and to encourage them to study biomedicine at university. It focuses on identifying diseases and understanding the policies that could be implemented to help the world to adapt. It taps into a growing trend for serious games targeting younger audiences who are already engaging with interactive, rich graphic games recreationally; games can become a new tool to aid their learning and exploration.

Playgen are launching a pilot sexual health game with the British National Health Service (NHS).  The game is a training aid which adapts a six week training course for parents of 5-11 year olds dealing with difficult subjects around sex education into a more anonymised, online learning resource to increase levels of participation.  The course reduces delivery costs and creates a safe virtual learning environment to answer difficult questions.

Key trends in games for health

Playgen’s CEO Kam Star believes there is an exponential growth globally in the number of applications of serious games for health, with the sector poised for future opportunities.  He believes there are two areas of focus for the healthcare industry:

1) Simulation for practitioners

A high proportion of surgeons are performing each type of operation for the first time, with high probability of error.  Simulation through 3D modelling, gaming and e-learning can counteract this knowledge gap. Simulations range from high-end humanoid mannequins retailing at up to 300,000 Euros, through to devices to improve keyhole surgery using ‘haptics’ and computer based e-learning training courses.

Soft skills are also critical in improving medical delivery as the majority of patient problems begin with poor communications.  Simulations can improve people management skills within the context of ‘blended’ learning (combining a range of learning techniques).

The NHS has recently committed to appoint a team of Regional Directors for Simulation and open a high-tech national centre in Coventry to promote simulation and 3D learning. Coventry University is also home to the Serious Games Institute, a research centre and business lab that works with developers to research and develop serious games.

2) Patient engagement and compliance

Re-Mission is a game developed by Hope Labs for teenagers and young adults living with cancer.  The gamer plays Roxxi the nanobot, travelling through the body of a cancer patient whilst destroying cancer cells and managing side effects.  The game has been shown to help young people positively deal with treatment processes and recognise symptoms.

Future trends could include applications for web or mobile to encourage patient compliance in taking medication in a playful way: like the Obama election campaign which tapped into the competitive spirit of gaming to encourage pledges and votes using a range of  iPhone apps. The iMediLog app for iPhone allows patients to keep track of their medications, but future apps may take more inventive approach to combining personal competitiveness with enjoyable game-play.

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Meet the Author

Susi ONeill