Exergames for subthreshold depression among older adults
Date of Issue2017
Wee Kim Wee School of Communication and Information
The number and percentage of older adults continue to increase dramatically around the world. Subthreshold depression is not often highlighted in the field of gerontology, although it has a high prevalence rate among older adults. Subthreshold depression refers to a cluster of depressive symptoms in which the number, duration, or quality are insufficient to meet the diagnosis of a major depression. Among older adults, subthreshold depression is at least two to three times more prevalent than major depression and leads to many negative outcomes. Among the various depression treatments, which range from biological to psychosocial interventions, exercise is considered to be an effective and cost-efficient non-clinical intervention for subthreshold depression. Exergame is a special type of exercise, wherein the exercise activities are combined with video gaming. Several recent attempts to investigate the feasibility and preliminary effects of exergames as a depression intervention have been conducted. However, because of the lack of rigorous controlled studies in this domain, the true effectiveness of exergames on subthreshold depression remains unclear especially on older adults. Hence, it is important to investigate the anti-depressive effects of exergames and the potential influencing factors of using exergames as depression therapy for older adults with subthreshold depression. The current research sought to understand the application and effectiveness of exergames for subthreshold depression. A systematic review and meta-analysis of ten existing studies were conducted to investigate the anti-depressive effects of exergames. An overall significant effect size of Hedges’ g = 0.23 was identified among eleven trials, which supported the positive effects of exergames on alleviating depression. Findings from the subgroup analysis further identified several significant moderators , such as demographic factors, number of sessions, depression severity, and player interaction. The systematic review also provided the basis and guidance to develop two controlled studies, Study One and Study Two, to empirically investigate the effects and influencing factors of exergames on subthreshold depression among older adults. From the previous depression studies and psychological theories, such as Theory of Flow and Social Cognitive Theory, Study One hypothesised that exergames have a superior anti-depressive effects over traditional exercise. A controlled study with repeated measures was conducted to test the differences in the effects of exergames and traditional exercise over six weeks among 50 older adults in Singapore. Results from the two-way MANOVA indicated that participants in exergames had significantly lower subthreshold depression and higher positive affect over the intervention period than those in traditional exercise. No significant exercise platform effects were reported on self-efficacy over time. Study Two further investigated the potential effects and mechanism of play mode in exergames. A conceptual model was built based on previous theories and game studies. The model implied that play mode might affect depression through the mediation effects of social support and loneliness. This implication was tested using a between-group study with two different conditions of single-player or multiple-player (two players) exergames among 52 Singaporean older adults for six weeks. Findings demonstrated that multiple-player condition led to better improvements on subthreshold depression and loneliness among older adults, when compared to single-player condition. The examination of the conceptual model further supported the mediation role of loneliness in the association between play mode and subthreshold depression. Although social support was not confirmed to be a significant mediator, the findings suggested its potential moderation effects, which should be tested in the future research. This research has several main contributions. First, findings were promising to suggest the implementation of exergames as a regular health programme for older adults, in both general and clinical practices. Second, the introduction of play mode effects opened the theoretical discussion on optimising the anti-depressive effects of exergames and encouraged the multiple-player mode. Lastly, the research highlighted challenges and future directions in this new domain, which include examining the effects of demographic factors, such as age group, gender, and physical conditions, exploring the effects of playing with different people, and calling for more Asian-focused studies.
Nanyang Technological University