JMIR Publications

ABSTRACT

Background:

Exergames, which combine cognitive processing with bodily movement, have been promoted as a strategy for preventing falls and preserving cognition. However, the modulatory effects of game difficulty, either cognitive or physical, on gaze behavior and in-game performance remains unclear.

Objective:

This study aimed to inform adaptive game design by determining the effects of experimentally increasing cognitive or physical load on gaze allocation and performance during exergaming, thereby informing adaptive game design.

Methods:

Eight healthy adults (mean age 20 ± 1 years; 7 men) played a squat-based exergame (Ring Fit Adventure®, Nintendo) under three randomized conditions: baseline control, enhanced cognitive load (numerical task), and enhanced physical load (single-leg squats). Total fixation duration (TFD) within three predefined areas of interest (command, avatar, and score) recorded using wearable eye-tracking glasses (100 Hz), game completion time, and squat score were then determined. Dunnett (parametric) or Steel (non-parametric) tests were used to determine changes in each load condition from baseline. Effect sizes (Hedges g, Vargha–Delaney A, Cliff’s Δ) with 95% CIs were calculated to complement the p values.

Results:

Compared to baseline, the cognitive-load condition shortened the total TFD (mean, −2092 ms; g = −1.04, 95% CI −2.13 to 0.06) and prolonged completion time (A = 0.84, 95% CI 0.59 to 1.09; p =.004). The physical-load condition markedly reduced the squat score (Δ = −0.97, 95% CI −1.00 to −0.87; p <.001) without affecting completion time.

Conclusions:

Greater cognitive load disrupted visual attention and slowed gameplay, whereas greater physical load impaired movement accuracy and intensified score monitoring. Eye tracking could therefore serve as a feasible real-time marker of cognitive motor state that could drive adaptive difficulty in exergames.