The use of technology to motivate active ageing

1. The use of Technology to Motivate
Active Ageing
Ben Heller & Anna Lowe

2. Workshop Structure:
• Introduction – what is active ageing?
• What role can technology play
• How can we use technology to measure physical activity in older people?
(sensors)
• How can we use technology to motivate physical activity in older people?
(exercise in virtual worlds)
• Chance to play with the equipment
• Facilitated discussion

3. What does Active Ageing mean?
• Active ageing aims to extend healthy life
expectancy and quality of life for all people as
they age.
• The word “active” refers to continuing
participation in social, economic, cultural,
spiritual and civic affairs, not just the ability to
be physically active or to participate in the
labour force.

4. Focus on Physical Activity
• Key risk factor for premature death.
• 16.9% of "all-cause premature
mortality" can be attributed to
physical activity (BHF 2013).
• It is MODIFIABLE!

5. PA & Older People
• PA reduces falls and fall-related injuries
• Delays the need for care, reduces decline in
functional status
• Delays onset of cognitive decline.
• 3 in 5 adults have a long term condition,
increases with age, PA is central to
management of LTCs.

6. Sustainability Health & Social Care Systems

8. Technology in Active Ageing
• Measurement
• Motivation
• Communication
• Monitoring, safety

9. Measurement of Physical Activity
• Big drivers to increase activity in older
populations.
• Need to be able to measure in order to show
improvement.

10. Measurement: Who, What & Why?
Who?
• Individuals
• Clinicians
• Researchers
• Provider of PA services
What & Why?
• Quantity of PA
• Intensity of PA
• Type of PA
• Physiological parameters
– HR
– BP
– Oxygenation

11. Direct versus Indirect Methods
• Direct measurement
– Gadget
– Objective
• Indirect measurement
– Self report, relies on recall
– Subjective

12. Indirect Measures
• Questionnaire based (paper or online)
• Physical Activity Scale for the Elderly (PASE)
• Community Healthy Activities Model Program
for Seniors (CHAMPS)
• GPPAQ (up to 74 years)

13. Direct Measures
• Pedometers
• Activity Tracker Gadgets e.g. Fitbits
• Smartphone apps

14. More on Apps
• Free (if you have a smart phone).
• Simple to use.
• Lots of options.
• Appropriate for some.

15. Sheffield Physical Activity Observatory
The Sheffield Physical Activity Observatory (SPAO) is a set of
tools and methods for capturing, storing and analysing and
displaying population-scale data on physical activity (PA) and its
associated health corollaries.
• Provide feedback to individuals
on their PA levels.
• Collect population-scale baseline
data on PA levels.
• Allow the assessment of any interventions
that may impact PA levels.
• Provide a secure repository of data for
retrospective and meta-analysis

16. Sheffield Physical Activity Observatory - detail
SPAO was established in Spring 2014 following a grant
of £90k from the Strategic Research Investment Fund of
Sheffield Hallam University
• 50 tablet computers for
e-questionnaire collection
• 1100 sensors for collection
of objective PA data
• Tools for data analysis and
presentation (infographics)
• Available for research projects
and clinical initiatives
• Contact Dr Ben Heller for details

17. Second lives for the third age:
motivating exercise adherence using
virtual worlds

18. Context: social isolation

19. Context - Falls
• Increased likelihood of falling with age
• Affects not just frail, but also independent
‘well’ elderly
• Leading cause of injury-related
hospitalisation in this population
• Fear of falling leads to reduced activity
• long-term adherence to exercise
programs is imperative to reduce fall risk.
(Vogler et al. 2012)

20. Exercise works – but you have to do it
Targeted rehabilitation through active
participation and engagement in contextually-
appropriate repetitive and intensive
movements (e.g. Otago programme) shown to
promote recovery
Exercises completed individually at home, can
be tedious => problem with motivation.
Only effective with good compliance
Can ‘serious games’ be used to motivate
rehabilitation for older people?

21. Second Lives for the Third Age
Pilot funding to:
• Explore older peoples’ opinions
and expectations of serious
games.
• Develop an age-appropriate,
safe serious game
• Develop a whole-body physical
interface to allow rich interaction
without requiring mouse or
computer skills.

22. We surveyed older people to see what would motivate them
Common themes
– Socialisation - Going dancing at the local ballroom –
getting dressed up to go out – tango, waltz etc., leave
shoes at the cloakroom and put on "dancing shoes", silver
ball, big band – meet boys!
– Travel - problems with getting insurance to travel abroad
when older – would like to revisit places, or see new ones
– 18th Century "grand tour" of Europe, Grand Canyon
– Pets - virtual dog to take for walks
– Role play - play the leading role in an opera
– Gardening – suggested possibility of "virtual garden" (to
include pruning, weeding hoeing, planting, watering,
nurturing)
– Physical - Running downhill really fast like kids do

23. Walled-garden
 Rest + socialisation area
 Lake with fish
 Trees (climbable)
 Gardening activity
 Animals (birds, butterflies, peacock)
 Walled to prevent incursion/ users getting lost

24. Physical / gesture interfaces
•Gesture-based interfaces have
been proposed to create more
natural and intuitive ways of
communicating with computers
•Identify user’s movements
(gestures).
•Send key-presses to Second Life
viewer to trigger appropriate
movements and animations
•Originally used Polhemus
electromagnetic tracking system
(wired), cost approx £10000. Now
Kinect (£100)

25. Gestures
• Walking
• Turning
• Flying
• Waving
• Rowing
• Dancing
• Jumping
• Disconnect layer between
gesture and avatar action, allows
customisation, scalability and
progression of gestures.
Facilitates use of non-
exergaming software.

26. Initial evaluation
4 older users - two women, two men (Somali)
Used both conventional and physical user interfaces
Opinions sought by interview

27. Comments
• So if you were to meet your grandchildren in Second Life, what kind of
things do you think you'd like to do?
• Well I'd still like to hear __ play his clarinet, and perhaps we could have a
bandstand. And __ a football pitch, he'd like that. And __ a netball pitch,
you know. And you could just go and watch quite easily.
• You could even join in if you wanted to
• Yeah, that's right, you could couldn't you. Yeah, I hadn't thought of that
• Do you think you'd enjoy that?
• Oh I'm sure I would, yes. Netball, I used to play when I was younger, and
that would be good.
• You can even do concerts and things in Second Life
• You could play in the concert in the orchestra!

28. Implications
• Potentially improve quality and quantity of rehabilitation exercise
whilst reducing cost.
• Potential additional benefits due to social and cognitive engagement
as well as physical exercise => need to involve multiple practitioners.
• IT and organisational issues for delivery
• Ethical issues??

29. Thank you! Any questions?

30. Show & Tell
Measure
• Accelerometers
• Pedometers
• fitbits
• Fitbug
• Runscribe
• Kinect
Monitor
• HRM (bluetooth)
• BPM
• Pulse ox
• Lumoback

31. Questions:
• Is this a vision of the future for the NHS?
• What barriers will hold-back widespread
implementation?
• What can we do within our own practice?
• What support do we need from commissioners,
policy makers, research funders, etc.

32. References
• British Heart Foundation. (2013) Making the case for physical activity: Evidence
briefing
• Lee I, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, for the Lancet
Physical Activity Series Working Group. Effect of physical inactivity on major non
communicable diseases worldwide: An analysis of burden of disease and life
expectancy. The Lancet. 2012;380(9838):219-229.
• Department of Health (2011) Start active, stay active: a report on physical activity
from the four home countries' Chief Medical Officers
• Intelligent Health (2013) Physical activity and long term conditions: A guide for GPs
• British Heart Foundation (2013) Older adults: practical strategies for increasing
physical activity.
• Kowalski K, Rhodes R, Naylor P, Tuokko H and MacDonald S (2012) Direct and
indirect measurement of physical activity in older adults: a systematic review of the
literature
• Fei Sun, Norman I and While A. (2103) Physical activity in older people: a systematic
review.
• McSeveny, K., Heller, B., Light, A., & Machaczek, K.. (2013) "You could, couldn't
you?: A preliminary investigation of older people's interaction with a bespoke virtual
environment using a gesture interface", Journal of Gaming and Virtual Worlds, Vol. 5,
No. 3, pp. 235-249.