The document analyzes the content of health and fitness messages presented in the video game Wii Fit. It finds that the messages generally meet criteria for effective health behavior change games, including greetings, activity results, safety reminders, and encouragement. The messages also provide general health tips and information tailored based on the player's performance and goals. However, limitations include issues of accessibility, costs, and evaluating long-term impacts. Future research could explore other gaming platforms and the sustainability of behavior changes.

1. Promoting Health and Fitness
through Exergames:
A Content Analysis of Wii Fit
Kristina Ticknor
Communications Consultant
Booz Allen Hamilton
ticknor_kristina@bah.com

2. Facts & Statistics
• Average 8-18-year-old plays over 1 hour of video
games on a typical day
• 7 out of 10 kids have a TV in their bedroom
• 50% of kids have a video game console in room
• Average number of hours spent on online gaming
has risen for the 3rd consecutive year
• „World of Warcraft‟ reached over 12 million players
in 2010…
• …12.5 million kids in the U.S. are overweight
• Childhood obesity has more than tripled in the past
30 years

3. Purpose
“The amount of time young people
spend with media has grown to
where it’s even more than a full-
time work week. When children
are spending this much time doing
anything, we need to understand
how it’s affecting them – for good
and bad.”
- Dr. Drew Altman, President and CEO of
the Kaiser Family Foundation

4. Defining E-Health and Exergames
• E-health: the use of emerging interactive
technologies to enable health improvement and
health care services
• Benefits of e-health:
▫ Interactivity
▫ Online support groups
▫ Web 2.0 features
• Exergames: activity-promoting video games
requiring physical movement of the entire body

5. Literature Review
• Energy expenditure of exergames and effects on
physical activity and health outcomes in children
▫ Lanningham-Foster et al., 2006; Daley, 2009;
Graf, Pratt, Hester, and Short, 2009; Baily and
McInnis, 2011
• Self-efficacy and self-image with avatars
▫ Song et al., 2011
• Interactive games attract hard-to-reach
populations of less healthy children
▫ Buller et al., 2009; Baily & McInnis, 2011

6. Background on Wii Fit
• 36% of kids own a Wii Fit, 69% have played
• Schools and universities offering Wii classes
• Wii Fit has energy expenditure + education
• May 2010, the American Heart Association and
Nintendo announce partnership

7. Method
• Wii Fit was played for two,
one-hour sessions
• Every exercise was played
once
• 4 fitness categories:
▫ yoga, strength training,
aerobic activities, balance
games
• Messages found in both text
and narration were recorded

8. Analysis
• Readability
▫ Flesch Reading Ease: 87.2 (average 11-year-old)
▫ Flesch-Kincaid Grade Level: 2.7 (2-3rd grade)
• Grounded theory
▫ Constant comparative method of identifying
new categories to be mutually exclusive and
exhaustive
▫ Axial coding to compare and contrast the data
▫ Compared against Baranowski et al.‟s (2008)
elements of health-related behavior change

9. Results
Theme Exemplar
Greetings and salutation “Well… if it isn‟t Player 1! Nice to see
you again!”
Health information-seeking “Have you noticed how this pose gets
harder to maintain over time?”
Activity and test results “I used your test results and your actual
age to calculate your Wii Fit Age.”
Safety reminders and warnings “Clear the space around you and make
sure you warm up before exercising.”
Encouragement and “Great job! Well done.”
congratulations “Keep it up… you‟re doing great!”
Negative/critical feedback “I know you can do better than that!
Let‟s hit the gym together tomorrow.”
Game and activity instructions “Keep the Wii remote in your pocket
during the exercise.”
General health info and tips “Brain-muscle communication fades
with age, making it easy to lose footing.”

10. Baranowski’s Elements of
Health Behavior Change Games
1. Story and story genre 5. Cinematics and cut
2. Immersion scenes
3. Fantasy 6. Choose-your-own-
4. Interactivity adventure
1. Navigation, time 7. Appeal to multiple age
2. personalized content groups
3. delivery of message 8. Attention, depth and
4. data entry and use breadth
5. entertainment 9. Retention
6. relationship 10. Intrinsic motivation

11. Additional Implications
• On-screen avatars corresponded
with player‟s measured weight
and BMI
• Calendar feature for goal setting
• Message tailoring based on:
▫ BMI, goal progress, length of
game play, skill level,
performance, date of last
participation

12. Discussion
• Limitations
▫ Accessibility (digital divide)
▫ High time and cost requirements
▫ Sustainability of behavior change
▫ Evaluation of psychosocial effects
• Future research
▫ Microsoft‟s Xbox Kinect; Sony‟s Playstation 3
▫ Long-term effects on health, behavioral intention,
self-efficacy, sustainability

13. Conclusion
“The message itself remains paramount; no
amount of technology is going to compensate for
an ill-conceived or ill-designed message. The
buck stops there… with the communicator.”
- Chamberlain, 1994, p. 2

14. Questions?
Kristina Ticknor
Communications Consultant
Booz Allen Hamilton
Email: klticknor@gmail.com
Twitter: @kticknor