# Active Video Game Program for People with Type 2 Diabetes-a Pilot Study
## 4 Discussion  
The American Diabetes Association recommends people with diabetes should engage in at least 150 min/week moderate to vigorous-intensity exercise [2]. Recently, [PERSON] et al. reported that T2D patients were able to achieve moderate exercise during AVG with Wii Fit Plus [19]. In the present study, AVG using Xbox Kinect and/or Wii also generated moderate intensity exercise based on percentage of max HR. Some participants at times were even able to reach vigorous levels. The results of max RPE indicated between somewhat hard and hard on the scale [20]. As to the duration, the subjects in this study participated in 120-180 min of AVG exercises per week. Therefore, an AVG program may be a feasible alternative exercise training that provides equivalent intensity and duration for people of T2D to reach the established exercise recommendation. The effect of games on blood glucose levels (HbA1c) for people with diabetes has been accessed recently and their impact has been suggested to be low [21]. [PERSON] and [PERSON] conducted an RCT and provided T2D patients with a Wii Fit Plus sports games to use at home for 30 min/day for 12 weeks. They found the intervention group significantly improved HbA1c from 7.1% to 6.8% (0.3% decrease) [22]. In this study, the T2D patients participated in a supervised AVG program in a central location for 60 min/session, two to three sessions/week for eight weeks. Their HbA1c decreased from 7.5% to 7.1% (0.4% decrease), despite the variation on background characteristic between subjects was wide, which is a limitation of this study. Although the decrease was not statistically significant due to the sample size, five out of seven participants showed an improvement on HbA1c levels in only eight weeks. Therefore, playing exercise games at home or within structured settings (e.g., gyms or clinics) might be beneficial for blood glucose management on people with T2D. Another positive trend noted was the increase in LE muscle strength across the participants, even though the results were not statistically significant. The reason might be due to playing AVG requires standing and involves a significant amount of leg movement. In the same manner, although not statistically significant, the body flexibility was increased. This might be due to the various physical movements in the games, including kicking and punching in multiple directions, squats, lunges, jogging in place, and dancing. \begin{table}
\begin{tabular}{c c c c} \hline \hline  & **Initial** & **Mid** & **Final** \\ \hline
**MPAM-R** & & & \\ Enjoyment & 38.9 \(\pm\) 2.3 & 35.7 \(\pm\) 10.9 & 38.7 \(\pm\) 9.1 \\ Competence & 34.9 \(\pm\) 10.0 & 34.9 \(\pm\) 10.1 & 36.6 \(\pm\) 11.6 \\ Appearance & 29.6 \(\pm\) 11.2 & 29.1 \(\pm\) 12.3 & 29.3 \(\pm\) 13.1 \\ Fitness & 29.7 \(\pm\) 6.0 & 31.6 \(\pm\) 2.4 & 30.9 \(\pm\) 4.4 \\ Social & 23.7 \(\pm\) 7.6 & 15.7 \(\pm\) 9.1 & 18.9 \(\pm\) 8.9 \\ Cronbach’s Alpha & 0.887 & 0.955 & 0.967 \\ (Internal Consistency) & (Good) & (Excellent) & (Excellent) \\
**SIMS** & & & \\ Intrinsic Motivation & 22.9 \(\pm\) 3.8 & 22.6 \(\pm\) 4.0 & 22.9 \(\pm\) 4.7 \\ Identified Regulation & 25.3 \(\pm\) 4.2 & 24.7 \(\pm\) 3.3 & 26.0 \(\pm\) 2.2 \\ External Regulation & 9.7 \(\pm\) 4.5 & 10.1 \(\pm\) 7.5 & 9.6 \(\pm\) 4.6 \\ Amoruation & 8.3 \(\pm\) 2.9 & 7.0 \(\pm\) 4.6 & 7.6 \(\pm\) 4.3 \\ Cronbach’s Alpha & 0.686 & 0.739 & 0.567 \\ (Internal Consistency) & (Questionable) & (Acceptable) & (Poor) \\
**WHOQOL-REF** & & & \\ Physical & 13.6 \(\pm\) 1.4 & 12.2 \(\pm\) 1.6 & 13.1 \(\pm\) 1.7 \\ Psychological & 14.0 \(\pm\) 2.0 & 13.5 \(\pm\) 1.1 & 14.0 \(\pm\) 1.6 \\ Social Relationships & 15.4 \(\pm\) 2.9 & 15.8 \(\pm\) 2.6 & 15.6 \(\pm\) 1.8 \\ Environment & 16.2 \(\pm\) 2.7 & 15.7 \(\pm\) 2.2 & 16.3 \(\pm\) 1.8 \\ Cronbach’s Alpha & 0.863 & 0.893 & 0.600 \\ (Internal Consistency) & (Good) & (Excellent) & (Questionable) \\ \hline \hline \end{tabular} N = 7; Data are presented as mean \(\pm\) SD.  
\end{table} 
Table 2: Results for Psychological Assessment.