In this study, we focused on the PA of health benefits of digital games (even before the games were introduced), and showed its effect on biomarkers of stress, namely cortisol, electrodermal activity (EDA), and heart rate (HR) during play. Drawing on Lazarus’s Transactional Theory of Stress Appraisal and Coping, AGPHA deploys an iterative evaluation of interactions between primary appraisal (PA) and secondary appraisal (SA) of the game challenge in relation to individual beliefs, as well as cognitive and physiological abilities, to predict whether players choose to learn and master the game further. To address this question, we have previously proposed an empirical framework, Affective Game Planning for Health Applications (AGPHA). However, the novelty of the digital medium of play, as well as the implicit expectation of cognitive performance can create stressful experiences for them. To create games that target older adults’ interests in engaging in cognitively-boosting activities is a rising trend. An individual approach to training should be adoptedand low adherence should not preclude enrolment to CT programmes. Reasons for drop-out and low adherence were identified, with recommendations provided for the design of future CT studies in dementia. Participants made a number of key recommendations to improve adherence and minimise drop-out to future CT studies. Quantitative and qualitative analysis demonstrated that the majority of participants (n=24) benefited across outcomes, with no clear profile of individuals who benefited more than others. High adherers were more resilient to negative emotions, and poorer or fluctuating performance. Quantitative and qualitative data were integrated using joint displays of quantitative outcomes arrayed against themes from the qualitative interviews.ĭrop-outs and lower adherence to training were more common in dementia participants who had higher number of barriers, of which fewer were modifiable. Quantitative outcomes included:cognition, mood, quality of life and activities of daily living.Subsequently, twenty-five training participants were invited to a semi-structured interview with their carer. This was an explanatory sequential mixed methods study involving a quantitative randomised trial of 12 weeks multi-domain CT in healthy older adults (n=20), and people living with mild cognitive impairment (MCI n=12) and dementia (n=24). The aim of this study was to use a mixed methods approach to identify those who may selectively benefit from CT. CT has been evaluated quantitatively and qualitatively, but none have used mixed methods approaches. Comparatively, the neurophysiological effects of exergame were more pronounced in the low-MoCA group, suggesting greater potential of this genre of games for cognitive and physical stimulation by gamified interventions however, the need for enjoyment of this type of challenging game must be addressed.Ĭognitive training (CT) may bebeneficial in delaying the onset or slowing dementia progression. Our results show that the experience of playing digital games was not stressful for our participants. Group differences in ambulatory signals did not reach statistical significance however, the rate of cortisol decline with respect to the baseline was significantly larger in the low-MoCA group. Session×activity effects were significant on all ambulatory measures (χ210>20 P4 P<.04). Kruskal-Wallis tests were used to test session or session×group effects on the scores of the postgame appraisal questionnaire. Scores derived from the Montreal Cognitive Assessment (MoCA) test were used to define cognitive ability (MoCA-high: MoCA>27, n=11/18). Generalized estimating equations were used to investigate the effect of session×activity or session×activity×cognitive ability on physiology and cognitive performance. Each session included an identical sequence of activities (t1-Baseline, t2-Picture encode, t3-Play, t4-Stroop test, t5-Play, and t6-Picture recall), a repeated sampling of salivary cortisol, and time-tagged ambulatory data from a wrist-worn device. This crossover longitudinal multifactorial study aimed to examine the interactions between game difficulty, appraisal, cognitive ability, and physiological and cognitive responses that indicate game stress using the Affective Game Planning for Health Applications framework.Ī total of 18 volunteers (mean age 71 years, SD 4.5 12 women) completed a three-session study to evaluate different genres of games in increasing order of difficulty (S1-BrainGame, S2-CarRace, and S3-Exergame). This lack of experience could cause stress and thus impede participants' motivations to adopt these technologies. The gamification of digital health provisions for older adults (eg, for rehabilitation) is a growing trend however, many older adults are not familiar with digital games.
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