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Playing at Health

Metia Interactive managing director Maru Nihoniho

Metia Interactive managing director Maru Nihoniho demonstrating the SPARX video game, which teaches teenagers how to deal with feeling depressed or stressed.

Credit: Neil Sands / AFP / Getty Images

Patricia Kahlbaugh's dad was an avid tennis player in his day, but after he lost his leg to diabetes, he was sidelined permanently. Once his family bought him a Wii, however, he would spend hours playing the virtual version of the game, and seemed engaged in the device's imagined universe.

That sparked Kahlbaugh, an associate professor of psychology at Southern Connecticut State University, to wonder whether playing such "exergames" could benefit the elderly beyond such obvious gains as providing exercise. She recruited 35 people with an average age of 82 from independent living elderly housing in the New Haven area and divided them into three groups. One group was assigned to play a Wii game of their choice for one hour a week with a graduate student; the second spent an hour a week watching television with a student; the third watched TV by themselves.

Over the 10 weeks of the study, participants who played Wiithey all chose bowling as their gamereported being in a better mood and feeling less lonely. Those who did not play did not show those gains.

Because the study was small and limited in scope, Kahlbaugh says, it is difficult to tell if it was the game itself, or the exercise and social interaction that went with it, that benefited the participants. "Is it the competition? Is it just being stimulated by a computer?" she asks. What did seem clear, though, was that playing the game made people feel better.

Many researchers are coming to believe that video games can, in fact, be good for you. The games have to be properly designed and appropriately used, and researchers are still gathering evidence of what exactly the effects might be, but they say the right games might teach both physical and social skills, affect mood, and generally improve well-being.

Research from the University of California, San Diego (UCSD), seems to back up Kahlbaugh. Scientists there recruited adults between the ages of 63 and 94 and had them play Wii Sports three times a week for 12 weeks. They assessed players for symptoms of mild depression, and found that at the end of the 12-week period, those symptoms had decreased. Those benefits were still there when researchers followed up two months and three months later.

Ipsit Vahia, a geriatric psychiatrist who helped perform the UCSD study, says the game certainly seemed to help with what is known as subsyndromal depressionfleeting or intermittent episodes of sadness that don't rise to the level of full depression, but nevertheless hurt people's quality of life. Vahia says such depression is about three times as common as major depression in older adults, and not easily treated with antidepressant medication, so having games as an alternative form of therapy is appealing.

There has not yet been enough study for the Food and Drug Administration to approve games for therapeutic use. Researchers are working to build that evidence, and in the meantime Vahia says there is no harm in older people using exergames to improve their moods. "I have recommended it for clinical use with reasonably good results," he says.

He and other scientists worry, though, that some companies that market games as tools for training memory are exaggerating the benefits of those games. A 2010 study at Kings College London and the University of Manchester, for instance, found that brain training games improved performance on a task they trained users for, but the skills were not transferred to other tasks. "There is contradictory evidence about those games that are designed for memory and cognition and brain speed," Vahia says.

The area where there has been the most study is in the effects of violent video games on the behavior of children, which show that "playground-level aggression" does in fact increase, says Douglas Gentile, a child psychologist at Iowa State University, although that is only one of many risk factors for childhood aggression. "The overall meta-analysis made it clear there is an effect; not a huge one," Gentile says.

It is not surprising, when children learn that violence helps them succeed in a game, that they would transfer that to other areas of life, he says. "Whatever you're practicing, you get better at," Gentile observes. In the same way, though, games that are more "pro-social" can teach empathy and cooperation. Gentile recently completed a study that followed more than 2,000 children in Singapore who played pro-social games for two years, which showed their scores on standard methods of measuring childhood empathy improved over that period.

Gentile says studying both the positive and negative effects of video games can help game designers come up with new strategies for building beneficial games. "The dichotomous way of thinking, that games are good or bad, is probably the wrong way to think about it," Gentile says. "Once we know what the effects are, we can be more thoughtful, so we are maximizing the benefits and minimizing the harms."

Adam Gazzaley, a neuroscientist at the University of California, San Francisco, is trying to develop games that can bolster cognitive controla variety of skills that include sustained attention, selective attention, task switching, and working memory (the ability to temporarily remember bits of information necessary to a task). Cognitive control is important to a variety of everyday tasks, such as driving a car, that draw on multiple mental skills at the same time. Gazzaley and a team of researchers developed NeuroRacer, a video game in which players use a joystick to navigate a car along a windy road while watching out for road signs. If a green circle pops up, which it does at random intervals, players were to shoot it, while ignoring green, blue, or red pentagons and squares.

After four weeks of playing the game, the players, adults between 60 and 85 years old, had improved their performance, scoring better than 20-year-olds who had not been trained on the game. Follow-up tests six months later showed the players had maintained the skills they had acquired, without practice. Even cognitive skills not specifically targeted by the game improved for all the players.

Many researchers are coming to believe that video games can, in fact, be good for you.

"We know cognitive control abilities are a critical tool that people use to navigate the world around them," Gazzaley says. "The leap is not so far that if these skills are better, they might translate into improvements in their lives."

The study also used electroencephalograms to look at what was happening in the brains of the game players. Participants who improved the most also had the greatest increase in brain activity in the pre-frontal cortex, which Gazzaley says makes researchers more confident they are right about how such training affects the brain.

Gazzaley is also interested in how games can improve cognitive abilities in children. His lab, which includes computer scientists and game developers, is working on five more video games with the aim of testing them for both educational and therapeutic uses. He is also the founder of a company, Akili Interactive Labs, in Boston, MA, which is developing therapeutic games for mobile platforms. He hopes the research will reach the point where therapeutic games could win FDA approval.

Other companies are also working on developing games that can be certified as beneficial. Posit Science, of San Francisco, CA, is conducting clinical trials in the hopes of winning FDA approval for a game that can help treat schizophrenia. Atentiv, of Waltham, MA, is working on a game to treat Attention Deficit Hyperactivity Disorder. Cogmed, a European company bought in 2010 by the London-based educational publishing company Pearson, makes games it says are designed to improve working memory.

Alvaro Fernandez, CEO of Sharp-Brains, a San Francisco market research firm that tracks what it calls the cognitive and brain fitness market, says such companies sprang up to fill a niche that was being ignored by established video game manufacturers. Those manufacturers are not interested in marketing games as beneficial, because they feel it makes them sound less fun, Fernandez says. "The mainstream publishers could not care less about this," he says, but companies in this market have seen a substantial increase in worldwide revenues, from $200 million in 2005 to $1 billion in 2012.

Gazzaley says properly designed and scientifically validated video games might be made to aid in all sorts of areas, from education to therapy to social skills. "Games are just so broad in what they can do that if you really take your time and think through the principles, you can pretty much work anything into a game platform," he says.

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Further Reading

Revving up Brain Skills

Anguera, JA, Boccanfuso, J, Rintoul, JL, Al-Hashimi, O, Faraji, F, Janowich, J, Kong, E, Larraburo, Y, Rolle, C, Johnston, E, Gazzaley, A
Video game training enhances cognitive control in older adults, Nature 501, Sept. 5, 2013.

Owen, AM, Hampshire, A, Grahn, JA, Stenton, R, Dajani, S, Burns, AS, Howard, RJ, Ballard, CG
Putting brain training to the test, Nature 465, June 10, 2010.

Rosenberg, D, Depp, CA, Vahia, IV, Reichstadt, J, Palmer, BW, Kerr, J, Norman, G, Jeste, DV
Exergames for Subsyndromal Depression in Older Adults: A Pilot Study of a Novel Intervention, Am J Geriatr Psychiatry 18(3), March 2010.

Kahlbaugh, PE, Sperandio, AJ, Carlson, AL, Hauselt, J
Effects of Playing Wii on Well-Being in the Elderly: Physical Activity, Loneliness, and Mood, Activities, Adaptation & Aging 35, Dec. 16, 2011.

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Neil Savage is a science and technology writer based in Lowell, MA.

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UF1Figure. Metia Interactive managing director Maru Nihoniho demonstrating the SPARX video game, which teaches teenagers how to deal with feeling depressed or stressed.

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