Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
New generation active computer games in osteoarthritis
- Stefan Siebert, Brian Rhys-Dillon (22 December 2007)
-
possible limitations of the measurements used
- gregory s hooper (28 December 2007)
-
Further Research Required to Determine Efficacy of Interactive Computer Games
- Jeanne D. Johnston (28 December 2007)
-
Watch out for the New Year Diagnosis of Wii Shoulder!
- Andrew D Cowley, Gregory Minnaar (8 January 2008)
-
Wii Energy Expenditure Promote Metabolic Adaptations?
- Stephen F. Burns (10 January 2008)
-
Wii Fit – a balance board as an easy measure of proprioception?
- Karsten Knobloch (4 August 2008)
-
A Wii for Christmas ?
- Ronak Rajani, Alexander Kumar, Mateem Jiwani (12 December 2008)
|
|
|||
|
Stefan Siebert, Senior Lecturer in Rheumatology Princess of Wales Hospital, Bridgend, CF71 7SB, Brian Rhys-Dillon
Send response to journal:
|
Graves et al (1) report that playing new generation active computer games (Wii Sports) uses significantly more energy than sedentary computer games. However, the level of energy expenditure was not sufficient to contribute towards the recommended daily amount of exercise in adolescents. We would like to present an anecdote that suggests these active computer games may have a clinically beneficial role in adults. We recently overheard a middle-aged woman with osteoarthritis of the knees describing the benefits of boxing, golf and tenpin bowling to her friend in our rheumatology waiting area. As a result of a combination of these pursuits, she had lost several kilograms in weight, resulting in marked improvement in her knee pain and mobility. It subsequently transpired that she had become fascinated by her grandson’s Wii computer sport games. Instead of spending her time watching daytime television, she now “actively” played these computer games, resulting in the benefits described above. The benefits of gentle, regular exercise and weight-loss for osteoarthritis of the knees are well documented. Unfortunately most patients fail to comply with these strategies. These new generation active computer games offer a real opportunity for this population group to partake in regular activities and are worthy of further study. Furthermore, as entire household could benefit from a Wii gaming console, prescribing these games on the NHS may even prove to be a cost-effective strategy in the fight against obesity in adults. 1. Graves L, Stratton, Ridgers ND and Cable NT. Comparison of energy expenditure in adolescents when playing new generation and sedentary computer games: cross sectional study. BMJ 2007;335:1282-4. Competing interests: None declared |
|||
|
|
|||
|
gregory s hooper, artist in residence Queensland Brain Institute, University of Queensland, Brisbane, Australia, 4072
Send response to journal:
|
Graves et al quite rightly recognise the limitations of the measurement apparatus, which is biased away from measuring movement of the arms. The Welk et al study they reference as justification of the validity of their measurements is also biased away from the narrowly targetted interaction movements of a device like the Wii. As someone with children who use the Wii - and rope me into using it quite often - I can vouch for the interaction being almost entirely driven by arm movements. These movements can be quite tiring and my impression is that they must use more energy than the movements required by the traditional games controllers. It therefore seems quite possible that the study underestimates the energy expenditure of the children when using the Wii. It would seem further research is needed, using apparatus specifically designed to measure limb movements, to understand the energy load of the new modes of computer interaction and game play. With childhood - and adult - obesity of such concern it is to be hoped that further research can aid in the development of healthier interaction with computational devices as it seems unlikely that the time spent with such devices will diminish. Competing interests: None declared |
|||
|
|
|||
|
Jeanne D. Johnston, Assistant Professor Indiana University, Bloomington, IN 47405
Send response to journal:
|
Childhood obesity is becoming one of the major diseases of this century. The percentage of overweight children and adolescents has worldwide has increased steadily over the past 40 years. The increasing trend in weight within this population is primarily due to an imbalance between energy intake and expenditure which may be partially attributable to decreases in physical activity. More specifically, a positive association between screen time (television, videos, and computer games) and the prevalence of overweight in children of both sexes has been identified (1). Researchers have recently begun to examine the potential role interactive computer games, such as Dance Dance Revolution and Wii Sports, may play in increasing physical activity within this population. The investigation by Graves et al (2) is significant in that it demonstrates that energy expenditure is 51% greater during active gaming as compared to sedentary gaming. However, the authors state that the intensity of exercise was not sufficient to contribute to the recommended amount of daily activity for children. The authors acknowledge the limitations of a small sample size and a laboratory based investigation. In addition, they note that the device used to estimate energy expenditure did not capture arm movement. This is likely to have contributed to low estimates of energy expenditure as the activities that were monitored (bowling, tennis, and boxing) involve significant arms movements. Furthermore, the metabolic equivalents that were utilized to describe energy expenditure of the activities in a non-gaming setting are not valid for children and adolescents as they are derived from an adult population (3,4). The research conducted by Graves, et al (2) is an important first step in examining the potential role of interactive computer games and physical activity promotion in children and adolescents. Given the current level of engagement of this population with computer games it appears this may be a viable method to increase physical activity and combat childhood obesity. Further research is required in this area to: (1) establish energy expenditure during interactive computer games versus traditional physical activities, (2) examine usability and adoption parameters, (3) determine sex differences, and (4) examine the long term efficacy of this medium with respect to physical activity levels and obesity in children and young adults. 1. Berkey CS, Rockett HRH, Field AE, et al. Activity, dietary intake, and weight changes in a longitudinal study of preadolescent and adolescent boys and girls. Pediatrics 2000; 105; 56-64. 2. Graves L, Stratton, Ridgers ND and Cable NT. Comparison of energy expenditure in adolescents when playing new generation and sedentary computer games: cross sectional study. BMJ 2007;335:1282-4. 3. Harrell JS, McMurray RG, Baggett CD, Pennell ML, Pearce PF, and Bangdiwala SI. Energy costs of physical activities in children and adolescents. Med Sci Sports Exerc 2005; 37; 329 – 336. 4. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000;32:498-516. Competing interests: None declared |
|||
|
|
|||
|
Andrew D Cowley, Consultant Paediatrician Shrewsbury and Telford Hospital NHS Trust, SY3 8XQ, Gregory Minnaar
Send response to journal:
|
As discussed by Graves et al [1] playing new generation active computer games uses significantly more energy than playing sedentary computer games. We would like to present a case that unless asked for in a history may be overlooked in children who are over-weight or have been inactive for a while. In the first clinic after Christmas I encountered a child who was complaining of tiredness and a sore shoulder. This child had done less exercise over the past 3 years whilst he was unwell. Having had to play the new Nintendo Wii for Christmas myself; I asked them what they were given for Christmas. The answer was a Nintendo Wii. Having checked everything else I made the diagnosis of “Wii shoulder”. Anyone who has played the Nintendo Wii will know exactly what I mean and will relate to the shoulder pain with a laugh. This is not a typical games console where you just sit down and play. Playing tennis and boxing are just two interactive games on Wii sport. It does however get you using muscles you have not used for a long time and hence the next day you can complain of some discomfort. Within a day the discomfort wears off and then you are back to normal. This musculoskeletal discomfort typically occurs with exercise after a period of inactivity. Anyone who goes to the gym also feels this “post exercise” discomfort but soon recovers. With the Nintendo Wii being a Christmas sell out, we are all likely to see the new diagnosis “Wii shoulder”. This diagnosis I am sure will be seen in all age groups because of it’s popularity with everybody [2]. With increasing childhood obesity maybe the use of the Nintendo Wii can help if used in conjunction with a specialised obesity clinic. Further research is needed. 1. Graves L, Stratton G, Ridgers ND, Cable NT.Comparison of energy expenditure in adolescents when playing new generation and sedentary computer games: cross sectional study. BMJ. 2007 Dec 22;335(7633):1282-4. 2. Allen D. You're never too old for a Wii. Nurs Older People. 2007 Oct;19(8):8 Competing interests: None declared Editorial note
|
|||
|
|
|||
|
Stephen F. Burns, Research Associate Weight Management and Wellness Center, Children's Hospital Pittsburgh
Send response to journal:
|
Graves and colleagues report that use of the interactive computer game, the Nintendo Wii, results in significantly greater energy expenditure than more traditional sedentary computer consoles. Energy expenditure reported in Table 1 of the study reads incorrectly as kJ/kg/min rather than J/kg/min. More important however - having personal experience of using a Wii - Graves and colleagues correctly recognise that they may have underestimated energy expenditure during gaming using a monitor that does not detect arm movements well. Nevertheless, the significant increase in energy expenditure reported by Graves and colleagues with the use of this game is exciting and important if future widespread use of this and similar games contributes to increased activity in children and adolescents. Research is needed to examine if the exercise stimulus from interactive computer games promotes healthy metabolic adaptations in muscle such as improved insulin action and lipoprotein lipase activity and rapid clearance of postprandial triacylglycerols. Stephen F. Burns, PhD
Competing interests: None declared |
|||
|
|
|||
|
Karsten Knobloch, Plastic, Hand and Reconstructive Surgery Hannover Medical School, Hannover, 30625, Germany
Send response to journal:
|
I appreciate the study from Dr. Graves and coworkers focusing on the current interactive computer consoles. In the meantime, more reports are accumulating in this regard [1]. Dr. Robinson reported on a 16-year old boy who injured his knee whilst playing on the video games console Nintendo Wii [2]. The patient presented with an acutely swollen and painful knee to the emergency department of our institution. Initial radiographs revealed an effusion and an osteochondral fracture. Further imaging with magnetic resonance imaging demonstrated evidence of lateral patella dislocation with medial patello-femoral ligamentous damage and a large femoral osteochondral fracture. Currently, Nintendo has launched a balance board with its program Wii Fit. More than 40 exercises focusing on balance and posture are implemented. Besides muscle workouts and yoga poses balance games as well as aerobic exercise involving the whole body and not dominantly the upper extremity as in Wii Sports are part of Wii Fit. From a proprioceptive point of view it might be feasible to use the Wii Fit Balance Board for serial evaluations of some balance exercises during an intervention. Furthermore, it needs to be tested whether the implemented balance training might substantially increase proprioceptive capacity. Given the recent recommendations of the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) a balance training is advised in older subjects >60 years to prevent or at least reduce the number of falls [3]. Thus, the Wii Fit balance board might be an option in this regard. Karsten Knobloch, MD, PhD Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Germany References [1] Graves L, Stratton G, Ridgers ND, Cable NT.Comparison of energy expenditure in adolescents when playing new generation and sedentary computer games: cross sectional study. BMJ. 2007 Dec 22;335(7633):1282-4. [2] Robinson RJ, Barron DA, Grainger AJ, Venkatesh R. Emerg Radiol 2008;15(4):255-7. [3] Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007;39(8):1423-34. Competing interests: None declared |
|||
|
|
|||
|
Ronak Rajani, Cardiology Specialist Registrar Royal Sussex County Hospital, Eastern Road, Brighton. BN2 5BE. United Kingdom, Alexander Kumar, Mateem Jiwani
Send response to journal:
|
In 2006 Nintendo released their 7th generation gaming console, the Wii. Within 12 months this became the best selling games console in history and outstripped global sales of both the Microsoft Xbox 360 and the Sony Playstation 3. Despite its popularity, concerns exist regarding the safety of the Wii console in patients with cardiac pacemakers. The Nintendo Wii utilises a remote control that utilises Bluetooth technology (2.4 GHz) to communicate with the gaming console. This frequency falls within electromagnetic interference (EMI) testing to the Association for the Advancement of Medical Instrumentation (450 MHz to 3 GHz), (AAMI PC69). Since cardiac pacemakers often incorporate similar technology, EMI may occur. Nintendo accordingly advise that the console, or remote, should not be operated within 9 inches of a pacemaker, and that prior to use, patients should consult their doctor or the manufacturer of their medical device. We approached Nintendo and consulted with various pacemaker device companies to investigate this further. Nintendo were unhappy to issue a generalised statement whilst Table 1 summarizes the advice received from BIOTRONIK GmbH & Co. KG (Berlin, Germany), the Sorin Group (Milan, Italy), Medtronic, Inc. (Minneapolis, USA) and Boston Scientific (Massachusetts, USA).
Note: ? in the table above stands for a greater than or equal to symbol. Despite EMI concerns, there have been no reported incidences of Wii gaming consoles interfering with cardiac pacemaker function. Precautionary advice appears based either on theoretical interaction or translational evidence from mobile phone use. The Nintendo Wii appears safe for use by patients with pacemakers. EMI is unlikely, provided that a distance 9 inches or more is maintained. Competing interests: None declared |
|||
