Usability and Feasibility of an Occupational Exergame-based Intervention
Condition: Healthy
Study type: Interventional

Summary: 
      High levels of sustained sedentary time in office workers are associated with
      non-communicable diseases as e.g. cardio-vascular diseases or diabetes. Moreover, recent
      evidence has further suggested a relationship between prolonged sitting periods and adverse
      mental health outcomes. Based on these facts, various types of occupational health-related
      interventions have already been undertaken, thereby mostly focusing on physical aspects.
      However, a promising intervention option that has only rarely been investigated in this
      context, are so-called exergames, which allow a combined physical and cognitive training in a
      motivating and time-efficient manner. This pilot trial aims to determine the usability and
      feasibility of an exergame-based intervention targeting occupational health aspects, whilst
      secondarily exploring potential effects on physical and cognitive functions.

      The study is planned for healthy (self-reported) office workers, aged between 18 and 65
      years. Participants are asked to perform a minimum of 18 training sessions with a duration of
      10-20 minutes during a period of six weeks. The design is planned as a two-arm crossover
      trial, where participants will randomly get allocated to a group, and either start with the
      training period or the control period (no training). After having completed the six-week
      training period, participants will evaluate the usability and report their experience with
      the exergame device. In terms of evaluation of the feasibility, adherence and attrition rates
      will be calculated at the end of the study. Before, after six weeks, as well as after 12
      weeks, cognitive and physical assessments will be performed and questionnaires on behalf of
      stress experience and management will be elicited.

      The findings of this pilot trial will help to explore the possibilities of designing
      occupational health interventions by the implementation of motor-cognitive exergames. In
      addition, this trial offers the possibility of exploratorily analyzing the effects of
      exergame training in office-workers.
    

Detailed description: 
      Office workers spend around 65-75% of their working hours in a seated position, whereby more
      than 50% of this time is accumulated in prolonged periods of sustained sitting. Growing
      evidence has shown, that such prolonged periods of sitting have deleterious health effects,
      even in adults meeting the usual physical activity guidelines of 150 minutes of weekly
      physical activity. These negative health effects include cardiovascular disease, general
      higher all-cause mortality and diabetes, whose strength of association is the most
      consistent. Moreover, sedentary behavior is negatively associated with reduced cognitive
      functions, whereby the associations are largely dependent on the assessed outcomes. Reducing
      sedentary phases by implementing intermittent physical activity was reported providing
      beneficial effects on multiple systems that are relevant for brain health, such as blood
      pressure, sympathetic function, or vascular function.

      In addition to these direct physical consequences of working seated in an office,
      occupational stress can exert a further negative influence on employees. Such persisting
      increased levels of stress can lead to high costs in both human and economic aspects, and are
      associated with an increased risk of high blood pressure, depression, anger, anxiety, and
      irritability. For this reason, companies are more and more engaging in monitoring and
      preventing the occurrence of a stressful working environment, by addressing office vitality.
      This provides the further advantage of lowering the health care costs of employees while
      secondarily reducing absenteeism rates.

      There exists already many studies in this area, which have dealt with the topic of
      occupational health. A common intervention in this regard is the implementation of sit-stand
      working stations or dynamic workstations with pedaling or walking tasks, mainly aiming to
      reduce the occurrence of musculoskeletal discomfort symptoms. However, a systematic review by
      Shrestha et al. showed that such sit-stand desks could not imply a considerable effect on
      working performance, and only an inconsistent effect on musculoskeletal symptoms. Moreover,
      walking breaks did not affect workplace sitting time whereas computer prompts to stand up had
      an inconsistent effect.

      This indicates, that most current studies focus on promoting occupational health through
      physical interventions, with the main outcome being workplace sitting time and a strong focus
      on musculoskeletal outcomes. However, largely neglected so far are identified links of
      physical activity and sedentary behavior with cognition and mental health. It seems justified
      to assume that increasing physical activity or reducing sedentary behavior in office workers
      will also effect on mental health and cognition. As a way of example, the effect of a
      technology-based, combined physical and cognitive training, which has already been studied in
      various clinical settings, has only been rarely established in the context of healthy office
      workers. Research that analyses how this combination affects employees' health and well-being
      is therefore justified.

      An emerging field that targets both physical and cognitive functions, are so-called exergames
      Exergames are games, which require the user to move his/her body to engage with a playful
      environment. The simultaneous cognitive task is thereby embedded in the game design, which
      helps to target multiple physical and cognitive functions in a combined manner. Due to the
      experienced enjoyment whilst playing the games, several studies reported such exergames to
      increase intrinsic motivation and thus adherence. Furthermore, most of the studies have shown
      exergames to be feasible, safe and proved them to have a high usability, as well as
      acceptance in geriatric, neurological, and cardiac patients. An exergame device that was
      developed based on this concept of combined cognitive-motor training and specifically
      designed for the needs of the mentioned target groups is the Dividat Senso. The ETH spin-off
      Dividat AG has developed this technology-based training system, with the main target of
      providing an optimal system for rehabilitation purposes and usage by older adults. With its
      hardware consisting of a pressure-sensitive step plate, surrounded by a handrail, it allows
      the user to interact with the software, presented on the screen in front, by the execution of
      steps or shifting of the body weight.

      Findings from several studies in this area of cognitive-motor training have shown above all
      that the addition of such a cognitive training to the conventional balance and strength
      exercises of elderly people provide an additional positive effect on gait initiation, divided
      attention, and dual-task costs while walking. Due to this evidence base, the Dividat Senso
      was up till now mainly deployed in the field of (geriatric) research, training centers,
      rehabilitation clinics, and hospitals. However, with its simple operation, as well as the
      short intervals of the different games (2-5 minutes), the Dividat Senso could be an optimal
      addition to the field of occupational health, by playfully motivating employees to exercise
      during short work break intervals. This is supported by the study of Glazer et al. which
      showed that accruing physical activity in bouts of <10 minutes may already lead to a
      favorable influence on the general cardiometabolic risk.

      The aim of this trial is, therefore, to explore whether such a combined cognitive-motor
      training with the Dividat Senso could be a usable and acceptable option to promote beneficial
      active breaks for healthy office workers. Moreover, this trial aims to assess whether this
      exergame training could be a way to not only interrupt the sedentary office periods with
      short movement bouts but also provide an optimal cognitive stimulus, leading to positive
      effects regarding stress and frustration levels.
    

Intervention name(s): Exergame training
Intervention type(s): Behavioral
Intervention description(s): During the exergame intervention period, the participants in the respective group will be asked to train at least two times per week for 10 minutes per session. The proposed 10 to 15 min-sessions can also be split up into multiple short training slots during the day, to thus reach the targeted 10 minutes. Moreover, the participants are allowed to train even more during their "exergame-intervention" period of six weeks. However, during the control period of six weeks, they are prohibited from training on the device.
The training program will start with four pre-defined programs of the Dividat Senso (Dividat AG, Schindellegi, Switzerland; CE certification) program. This training program will be adapted weekly by the investigator to generate new stimuli through varying games and thereby also further support the motivation.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: The study is designed as a two-arm crossover pilot trial. The 12-week lasting study includes three assessment points (T0, T1, T2). After signing informed consent, participants will be randomly allocated to either group 1 (G1) or group 2 (G2), using simple (unrestricted) randomization based on a random-number table. All participants perform baseline assessments at T0. Depending on their random allocation to group 1 (G1) or group 2 (G2), they will either continue with their usual daily work life (G2), or they will start the intervention period (G1) , where they will implement the exergame training plan in their working schedule. After six weeks, both groups will perform the T1 assessments, and the program will be switched, meaning G2 will perform the exergame training and G1 will have their control period. After completing the intervention at week 12, both groups will perform the final assessments (T2).
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: occupational health; cognitive-motor intervention; exergame; well-being