MICA: V-Engage - Using Virtual Reality exergaming to engage adolescents with physical activity

Regular physical activity (PA) is important for good health. Adolescence is an ideal time to promote PA, particularly since active adolescents are more likely to become active adults. However, the majority of UK adolescents are not active enough, and there are a lack of high quality studies aimed at increasing PA in this group, so we don't yet know what works. Our research group believe we can learn from industries that have very successfully engaged adolescents, like the computer gaming industry. The potential of gaming to be engaging and motivating is further increased by the current virtual reality (VR) revolution. VR involves the user wearing a headset and being entirely immersed in a virtual world. Newly released headsets have taken VR from a niche product to one could really impact public health. A VR exercise game 'exergame' could be used to increase levels of activity both while the user is playing the game (replacing what is normally a sitting behaviour), and could also be used as a gateway to engage young people with other PA opportunities in the 'real world', by linking them to the game. The v-Engage project is a collaboration between researchers and expert game designers Six to Start www.sixtostart.com. We believe for a game to be appealing and high-quality enough to compete with others on the market, we must work closely with expert game designers, and with a group of young people who represent our target population. Promisingly, we know that most adolescents report that they'd like to do more PA, like trying new things, and enjoy rewards and competition (which are all parts of games).

The ultimate aim of the v-Engage project is to formally test whether a VR exergame can increase levels of PA, and whether it can increase uptake of opportunities to be active outside of the virtual environment, because we know that a multi-disciplinary and 'multi-component' intervention is most likely to be effective. We propose to achieve activity outside of the VR environment by making the game 'duel content' so people will gain rewards and points by signing up to partner PA groups in their community, or by performing other types of PA in the 'real world'. Smart technologies (like watches and activity trackers) can then be used to link activity in the real and virtual worlds. We will target adolescents aged 13-19 years.

This project will gather the necessary information required to develop the VR exergame, explore the social issues around a VR public intervention, create an early testing version of the game and then test it with users. We have already done some very promising market research and interviews with our target group, and we will build on this. There are number of important stages in the development phase involving gathering the opinions of young people and their social support networks through surveys and interviews, and drawing on learning from other disciplines that have been hugely successful in engaging the target age group in other contexts (for example commercial gaming, digital marketing, social media and online blogging or 'vlogging'). We will assemble a steering committee of experts (including a vlogger ambassador, digital marketing experts, gamers and representatives from relevant community/educational establishments) and a user panel of 30 young people. We will collect relevant data through surveys, focus groups, and user workshops to gather a range of views about gaming and PA, and which types of VR and smart technologies young people like using. As researchers we will guide this process, and provide input on the types of behaviour change theories that are important in increasing levels of PA. The game will be developed and tested by Six to Start, but this will be a multi-stage process, allowing ongoing feedback from young people and our expert steering committee.

The benefits of performing sufficient physical activity (PA) for the prevention of cardiovascular disease, some cancers, diabetes, cognitive decline and mortality are well-established. Adolescence (13-19 years) is a key developmental stage for PA intervention. However, the majority of UK adolescents are insufficiently active and there is an urgent need for high quality trials of interventions to promote PA in adolescents. Much can be learned by industries that are extremely successful in engaging adolescents, like the computer gaming industry. The current virtual reality (VR) revolution offers a platform to create a highly novel gaming experience that engages the user far beyond a 2-dimensional image. Therefore the overarching aim of the v-Engage project is to empirically test a novel theory-driven VR 'exergame' designed to promote PA in adolescents. The game will include a dual-content wearable technology link up with PA performed in the 'real' world to facilitate long-term engagement with PA. The proposed project is a collaboration between researchers and commercial game designers, and will involve substantial user input throughout. We believe such a collaboration is essential if an exergame is to be high-quality and appealing enough to have public health impact.

The current project is the formative development work required to build and test the game. This work includes assembling a Young People's Partnership Board who represent our target users, and a steering committee of experts (including academics, digital marketers, gamers and virtual blogger 'vlogger' ambassador) to guide the research. Using a mixed-methods multi-stage processes we will identifying the physical activity and technology preferences of our target group, explore in depth the social aspects of a VR public health intervention, identify which components are engaging in more traditional exergames, identify community PA partners to link with and develop a user testing version of the game.

Who will benefit from the research?

1) The public:
The economic cost of inactivity in England is estimated at £8.2 billion per year. Physical activity (PA) is too low in adolescence, and this continues into adulthood. Adolescence is an optimal developmental phase to engage with PA, but there are a lack of successful interventions, so there is urgent need to develop novel and appealing strategies. The findings of this research have the potential to engage adolescents with immediate and long-term PA, reducing their disease risk and improving immediate and long-term health. In addition, the nature of our intervention means that it could be used in a family or social setting, therefore engaging not only the target group, but their wider networks. In addition, although our development work and timing of our intervention suggest that virtual reality (VR) gaming is currently the best way to engage this population (and is likely to remain so for some time given the ability to create immersive experience), the principles of using the most appealing technology to engage adolescents in PA could be applied to other platforms in future. We believe that the dual content aspect, using VR gaming as a platform to enhance enthusiasm, motivation and self-efficacy to try real world activities will facilitate sustained behaviour change, which is crucial.

2) Digital health:
The findings from this intervention development phase will be disseminated widely and will substantially advance understanding of young people's preferences for PA and technology. This information can be applied to other PA and digital health interventions in future. We will thematically analyse public reviews of games, and this publication will be of interest not only to public health researchers but commercial game developers, and companies like Google, Amazon, Apple and Facebook who now have offices devoted to just VR. The novelty of our project, and the timing in the current VR revolution is very likely to attract substantial media interest, and with our academic and industry links we have potential to work with large social media platforms, enhancing the profile of evidence-based digital health.

3) Teachers and schools:
The pilot work conducted for this project has suggested that this work has the long-term potential to engage young people not only with physical activity, but with the scientific process. The dual content of our intervention gives potential to engage adolescents with PA in multiple ways, for example through community sports partners, encouraging active transport, utilising school break times and linking with school physical education. Our development work thus far has suggested that the proposed intervention may be appealing to both adolescent girls and boys, and across social and ethnic groups, and the proposed research will explore further these important social aspects.

4) Public health specialists:
Our development work suggests public health messages about PA and sedentary time are not necessarily reaching adolescents. VR gaming could be a useful platform to convey these public health messages. The use of vloggers (virtual bloggers) to promote evidence-based PA to our target group is novel, but the potential is huge, and if we demonstrate efficacy this be utilised by other researchers as a means of disseminating their work, or promoting public health messages.

5) Industry
A key aspect of our proposal is to utilise decades of learning from industries like marketing and gaming, that have successfully engaged adolescents, and apply this learning to public health research. We feel this collaboration could act as a model for future studies. Our intervention has to appeal and compete with other extremely popular games, and we believe an industry partner and experienced developer are crucial to this. In return, industry can gain substantially from our academic and end user input.