Faculdade de Medicina da Universidade do Porto Introdução à Medicina II 2009

The effects of Nintendo Wii on physical health: a systematic review

Adviser: Professor Doutor Ricardo CorreiaClass 9

SUMMARY

• Introduction• Aims• Participants and

Methods• Results• Discussion • Conclusions• References

INTRODUCTION• Playing video games is traditionally a very

sedentary activity.

• Because players usually spend a lot of time sitting still and they also show an augmented tendency for snacking, videogame playing is associated with increasing obesity rates[1].

• Also, there have been reports of several injuries caused by traditional consoles. These include “Nintendonitis”, Nintendo elbow, Nintendo neck and other afflictions[2-7].

INTRODUCTION

• However, in 2005, Nintendo has released a new type of gaming console: Nintendo Wii [8].

• This console is innovative in the fact that it enables players to perform movements similar to those an actual player would perform.

• A special remote controller, the Wiimote, allows the player to be at a certain distance from the console itself and to mimic movements typical of tennis, bowling, boxing or even sword fighting[9].

The varied designs the Wiimote can assume are good

indicators of the type of movements

implied while playing Nintendo Wii.

Swinging and punching are common types of movement, as well as

twisting of the arms[9].

Positive effects

• The greater movement promoted by Nintendo Wii leads to an increased caloric burn and consequently more energy expenditure thus showing potential to fight the epidemic obesity in modern societies[10].

• On the other hand, Nintendo Wii can be used on rehabilitation as it masks the repetitive physiotherapeutic movements[11]. As a consequence, the term “Wiihabilitation” has been coined by specialists[12].

Negative effects

• As any typical sport and the old generation consoles, Nintendo Wii can induce injuries to the human body. A new form of Nintendonitis, Wiiitis, has been reported to occur after intense use [13].

• Most of these injuries are caused by the strong, repetitive and sudden movements implying the upper members and affect both the joints and muscles[14].

AIMS

• Our aim is to search and describe scientific evidence on the existence of effects of the usage of Nintendo Wii on physical health.

PARTICIPANTS AND METHODS

• Like any systematic review, our study’s population consists of articles.

• These were searched on 5 different databases:

• Medline (through Pubmed)• Scopus• ISI Web of Knowledge• ACM (Association for Computing Machinery)• IEEE Xplore

PARTICIPANTS AND METHODS

• For each database we defined a specific query.

• We only searched for articles published from 2005 to the present.

• Several medical/scientific areas were excluded, such as psychology or psychiatry.

PARTICIPANTS AND METHODS

• On Pubmed:

“Nintendo Wii” AND

“Physical Health related words and MeSH terms”

(e.g.: Obesity, Injury, Rehabilitation, Joint, Pain, Weightloss)

PARTICIPANTS AND METHODS

• On Scopus:

“Nintendo Wii” AND

Excluding non-related areas(e.g.: Agriculture, Chemistry, Physics, Mathmatics,

…)

PARTICIPANTS AND METHODS

• On ISI:

“Nintendo Wii” AND

Excluding non-related areas(e.g.: Agriculture, Chemistry, Physics, Mathmatics,

…)

ANDExcluding Patent Registration

PARTICIPANTS AND METHODS

• ACM and IEEE are databases related to Engineering.

• In an effort to increase the sensitivity of our search our queries were only:

“Nintendo Wii”

PARTICIPANTS AND METHODS

• After the retrieval of the articles, it was necessary to check for duplicated articles.

• The pairs were reduced in order to obtain a final number of articles.

PARTICIPANTS AND METHODS

• After excluding duplicates, a total number of 183 articles were gathered.

ACM(138)Scopu

s(26)

IEEE(9)

Medline(18)

ISI(22)

6

132

1

13

1

11

3

1 2

7

1

6

General Criteria of inclusion

• Articles published from 2005 to the 20th of May of 2009;

• Articles published in English, Spanish, French or Portuguese;

• Articles referring to the impact of the use of Nintendo Wii on physical health;

• Original articles.

General Criteria of exclusion

• Articles referring to the psychological impact of Nintendo Wii;

• Articles referring to the technologic background or programming system of Nintendo Wii or to the design of the Wiimote controller;

• Editorials;

• Any article not fitting the inclusion criteria.

FLUXOGRAMAAAA

Article count after selection process

• After three stages of selection, 8 articles were obtained from our search.

Medline

(8)

Scopus

(4)

4

2

1

1 ISI

(2)IEEE

Number Title

1 Activity promoting games and increased energy expenditure

2 Monitoring 3D movements for the rehabilitation of joints in physiotherapy

3 Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy.

4 The contribution of upper limb and total body movement to adolescents' energy expenditure whilst playing Nintendo Wii.

5 Wii knee

6 Magnetic resonance imaging of acute wiiitis of the upper extremity

7Comparison of energy expenditure in adolescents when playing new generation and sedentary computer games: cross sectional

study.

8 Nintendo Wii remote for computer Simulated arm and wrist therapy in stroke survivors with upper extremity hemipariesis

1st Author

Lorraine Lanningham-Foster

Javier Martín-Moreno

JE Deutsch

Lee Graves

Richard J. Robinson

Michael P. Nett

Lee Graves

R.S Leder

Journal

The Journal of Pediatrics

IEEE EMBC 2008

American Physical Therapy

Association

European Journal of Applied Physiology

American Society Emergency Radiology

Skeletal Radiology

Brittish Medical Journal

Virtual Rehabilitation

Database

Pubmed and Scopus

Pubmed

Pubmed

Pubmed, Scopus and ISI

Pubmed and Scopus

Pubmed

Pubmed

Scopus, ISI and IEEE

Year of Publishing

2009

2008

2008

2008

2008

2008

2007

2008

Studied Variables

• Numerical discrete variable– Number of participants

• Numerical continuous variable– Date • (allows an analysis of time evaluation of the

publication of articles on the theme).

Studied Variables

• Categorical ordinal variables

– Age group

– Health condition• can include a relatively broad range of answers

such as normal, obese or heart condition.

Studied Variables

• Categorical nominal variables

–Weightloss/Greater Energy Expenditure (YES/NO)

– Useful in Rehabilitation? (YES/NO)

– Causes Injuries? (YES/NO)

Number Title

1 Activity promoting games and increased energy expenditure

2 Monitoring 3D movements for the rehabilitation of joints in physiotherapy

3Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of

an adolescent with cerebral palsy.

4The contribution of upper limb and total body movement to adolescents' energy

expenditure whilst playing Nintendo Wii.

5 Wii knee

6 Magnetic resonance imaging of acute wiiitis of the upper extremity

7

Comparison of energy expenditure in adolescents when playing new generation

and sedentary computer games: cross sectional study.

8

Nintendo Wii remote for computer Simulated arm and wrist therapy in stroke

survivors with upper extremity hemipariesis

Number of participants Age of participants and health condition

42 22 healthy children from 10 to 14 years old20 healthy adults from 23 to 45 years old

1 A man displaying left radial head fracture

1 A 13 years old patient with spastic diplegic cerebral palsy

13 6 girls and 7 boys aged 11-17, all healthy

1 A 16 years old boy with a knee injury

1 A 22 years old man with left upper extremity pain and swelling.

11 6 boys and 5 girls aged 13-15, all healthy

- Upper extremity hemipariesis-Wiimote can be used to

monitor arm, wrist and finger movements while playing

videogames

-

--125.5, 190.6, 198.1, 202.5

kJ/kg/min for XBOX 360 and Wii bowling, boxing and tennis

respectively

Acute Wiiitis--

Lateral patella dislocation while playing Nintendo

Wii--

--115.8, 182.1, 200.5 and 267.2

kJ/kg/min for sedentary gaming and Wii bowling,

tennis and boxing respectively

-Improvements were reported in the

visual-perceptual processing, postural control, and functional mobility-

-Full recovery of mobility of wrist,

elbow and shoulder after undergoing WiiTherapy

-

--Mean increase of 189+/-63

kcal/hr and 148+/-71 kcal/hr for children and adults

respectively over resting

INJURIESREHABILITATIONENERGY EXPENDITURE

RESULTS• Article evaluation - Trends

• Of the 8 articles: 1 was published in 2007, 6 in 2008 and 1 in 2009. However, several articles from 2009 were found that weren’t yet published in full text or were not available so a model that could be used to predict article publication could be represented by: Articles published and a projection for 2009

02468

10121416

2007 2008 2009

RESULTS• Article evaluation – Trends

• The 11 articles were published in different journals. These journal weren’t only medical: 2 corresponded to engineering sources.

• The 11 articles had different authors, except for three of them in wich the first author was Lee Graves.

RESULTS

• 6 studies included healthy subjects

• 1 study focused on an individual with splastic diplegy cerebral palsy.

• 4 studies referred subjects with muscular or joint problems

RESULTS

• All studies are use children, adolescents or adults as subjects of study;

• 5 of the articles were related with Energy Expenditure;

• 4 of the articles were related with Increase Rehabilitation;

• 4 of the articles were related with Injuries.

DISCUSSIONMETHODS DISCUSSION

• From the initial 183 articles retrieved by our search only 8 were kept after selection (4,37%). This probably means that our queries, especially in ACM were too broad. However, they seemed to gather all the articles available about the theme in the 5 databases;

• The efficiency of our queries was different. The most efficient one was the one we used on Pubmed (7 out of 18) and the least efficient was ACM (0 out of 183);

• Some articles were unavailable due to librarian and journal embargos and couldn’t be included in our study. Thus, we expect that repeating our searches in 6 months would retrieve more articles valid for this study.

DISCUSSION

METHODS DISCUSSION

• Searching in ACM proved to be useless as no article coming from that database was included in the study and searching IEEE proved to be unnecessary as the only final article found there was also found in Scopus and ISI;

• Pubmed was the most productive database as 8 of the 11 articles came from this database;

• The first articles approaching the effects of Nintendo Wii were published only one year after its release;

• The tendency is for an increased rate of publication in the forthcoming years;

DISCUSSION

• The analysis of age group and number of participants allow us to see that the studies are being applied mainly to youngsters with age from 11-18 years old. One of the studies referred a 22 years old man;

• We conclude that there is clearly a lack of development of studies related to the effects of Wii on the elderly;

• We also recorded that studies referring to adult subjects are mainly related to rehabilitation so, studies focusing on these age group should be more developed;

DISCUSSION

• Studies referring other conditions such as high arterial blood pressure weren’t found and it would probably be interesting to study the long term effect of playing Nintendo Wii in this health condition;

• Despite having retrieved studies showing potential to weightloss, there is a lack of studies referring specifically to obese subjects. Studying this factor would provide data as to how effective is Nintendo Wii to fight this disease.

DISCUSSION

• LIMITATIONS

– The main limitation to our study was the lack of bibliography about the theme due to the recent releasing of Nintendo Wii;

– Some articles are too recent to be found in full text (around 5 articles);

– Some articles couldn’t be found in full-text due to nonresponsive authors;

– At least two articles were found using Google Scholar and couldn’t be included in the study.

CONCLUSIONS• With our study we concluded that:

• Wii shows more energy expenditure and caloric burn than traditional console games;

• Wii can successfully be used for rehabilitation of some muscular and joint affections as an alternative to traditional physiotherapy;

• Also, Wii shows potential to cause injuries derived from its extensive and unsafe use.

CONCLUSIONS

• Recommendations:

• New studies are required to fully understand Wii’s effects on physical health;

• These new studies should focus more on adult subjects and on the elderly;

• New studies should use obese subjects;

• New studies could focus on arterial pressure control as it is an affection typical of the Modern World.

REFERENCES[1] Vicente-Rodríguez G, Rey-López JP, Martín-Matillas M, Moreno LA, Wärnberg J, Redondo C,

Bueno M; AVENA Study Group, Television watching, videogames, and excess of body fat in Spanish adolescents: the AVENA study. Nutrition 2008 Jul-Aug;24(7-8):654-62

[2] Miller DL, Nintendo neck. CMAJ. 1991 Nov 15;145(10):1202[3] Macgregor DM, Nintendonitis? A case report of repetitive strain injury in a child as a result of

playing computer games. Scott Med J, 2000 Oct;45(5):150.[4] Koh TH, Ulcerative "nintendinitis": a new kind of repetitive strain injury. Med J Aust. 2000 Dec

4-18;173(11-12):671.[5] Brasington R, Nintendinitis. N Engl J Med. 1990 May 17;322(20):1473-4.[6] Bright DA, Bringhurst DC, Nintendo elbow. West J Med. 1992 Jun;156(6):667-8.[7] Schinck JC, Nintendo enuresis. Am J Dis Child. 1991 Oct;145(10):1094.[8] Nintendo Wii official website http://www.wii.com [9] http://www.wii-consoles.co.uk/wii_hardware_specification.asp[10] Graves, L.E., Ridgers, N.D., Stratton, G. (2008). The contribution of upper limb and total

body movement to adolescents` energy expenditure whilst playing Nintendo. European journal of applied physiology . 104(4)

[11] Leder RS, Azcarate G, Savage R, Savage S, Sucar LE, Reinkensmeyer D, Toxtli C, Roth E, Molina A, Nintendo Wii Remote for Computer Simulated Arm and Wrist Therapy in Stroke Survivors with Upper Extremity Hemipariesis. Virtual Rehabilitation 2008; 74-74

[12] Break a leg? Try ‘Wiihabilitation’ http:77www.msnbc.msn.com/id/23070190/[13] Bonis, J. (2007). Acute Wiiitis, The New England Journal of Medicine. 356(23):2431-2432 [14] Nett M. P., Collins M. S. and Sperling J. W. (2008). Magnetic resonance imaging of acute

“wiiitis” of the upper extremity. Skeletal Radio. 37- 481-483;

Authors

• Ana Fraga • Ana Cunha • Irina Ramires • Joana Pereira

• João Maia • Marta Antunes• Nuno Dias• Pedro Pereira• Sofia Farinha

Pubmed – Full Query

("wii" or "wiiitis” or ("nintendo" and "wii")) and

("energy" or "joint" or "pain" or "traumatic" or "trauma" or "expenditure" or "obesity" or "injury"

or "injuries" or "lesion" or "sedentarism" or "sedentary" or "rehabilitation" or

"physiotherapy" or "health" or "knee" or "motor" or "children" or "old" or "adolescent" or

"physical")

Scopus – Full Query

TITLE-ABSTRACT-KEY WORD ("Nintendo Wii") AND

SUBJAREA(mult OR agri OR bioc OR immu OR neur OR phar OR mult OR medi OR nurs OR vete OR

dent OR heal OR mult OR ceng OR CHEM OR comp OR eart OR ener OR engi OR envi OR mate

OR math OR phys)

Articles selected by Title

• After the first stage of title selection was completed we obtained 52 articles and excluded 131.

ACM(17)Scopu

s(13)

IEEE(4)

Medline(17)

ISI(14)

15

13

1

12

1

3

1

10

32

Articles selected by Abstract

• After the second stage of abstract selection was completed we obtained 20 articles and excluded 32.

7

5

1

1

3

ACM

Scopus

(6) IEEE

(4)

Medline

(8)

ISI

(6)

4