At a time when both obesity and sedentary screen-based gaming are on the rise, Zan Gao has a vision for turning the tables—using technology itself to help increase physical activity. Gao is an associate professor of kinesiology, and research projects coming out of his new lab in Williamson Hall show that it actually can be done.
Exergaming is a type of video game that is also exercise. The recent Pokémon Go phenomenon is a great example of how exergaming can be used to benefit the body, says Gao. While he was away visiting China for several weeks last summer, Pokémon Go took the world by storm, amassing 56 million users in just over a month. A location-based, augmented-reality game, Pokémon Go is a phone or tablet app that visually overlays the real world with a game interface and sends players out into the real world to find virtual creatures that appear on screen.
“Technology is a double-edged sword. One edge can lead to sedentary behavior….On the other edge, though, some technologies can actually motivate people to…start moving their bodies.”
Gao’s two boys showed him how to play the game, and now Gao is working on a proposal to examine how college students use these kinds of games and how often: Do they use them to consciously promote their own physical activity, or are the games just games? By going outside and walking or running to find virtual creatures, players are physically active, Gao points out—they are emphatically not sitting passively on a couch in front of a large-screen monitor.
“Technology is a double-edged sword,” he says. “One edge can lead to sedentary behavior, especially with use of televisions and computers. On the other edge, though, some technologies can actually motivate people to greater physical activity, where they play games and start moving their bodies.”
As a young student in China, Gao was a promising sprinter and long jumper. In college, he majored in physical education, completed his master’s degree, then worked as a sports journalist covering soccer for three years before coming to the United States for his Ph.D.
He quickly discovered his passion for research. At Louisiana State University, Gao completed his doctorate in kinesiology with a minor in experimental statistics. It was there he conducted research in public schools and was introduced to the rising problem of obesity in children. Obesity rates in Louisiana are high, especially at low-income schools. Finding ways to help children change harmful physical activity behaviors was a challenge.
In Utah for his first faculty job, Gao discovered a strategy for creating change. A medical student wanted to collaborate with him to offer after-school physical activity programs for Latino children in urban public schools. Gao jumped at the chance.
“At one particular school there was a 40 percent obesity rate, with a rate of 75 percent among Latino children alone,” he says. “We used Dance Dance Revolution in an after-school program. The teachers and principals were highly supportive.”
Dance Dance Revolution, commonly called DDR, is an activity game in which players match their steps to music and colored cues. With no physical education classes in the schools, a free program was attractive. This, along with the fact that the children actually liked the program, allowed Gao—by then funded by a Robert Woods Johnson grant—to continue his research on active video games and health and fitness levels for almost three years with the same cohort. In a study published in 2013, Gao and his colleagues found that exercise based on DDR improved cardiovascular endurance as well as math scores over time.
Why did he choose DDR instead of, for instance, baseball? Gao points to an upside of technology: Almost all kids use and like it, and most are adept at it.
“Our philosophy is that we’d like kids to continue with their traditional sports and outdoor activities but meanwhile use active screen time to replace sedentary screen time,” he explains. “Sometimes parents are very busy, so [they] don’t have time to engage in physical activity with their children. But the children know technology and how to play games, so we just help them to be active while they’re doing this.”
Active screen time is exactly what Gao’s intervention achieved using DDR.
“It’s important to start intervention early in life so the child can realize the benefits and importance of exercise and can start developing a physically active lifestyle when young,” he emphasized.
When Gao arrived in Minnesota in 2012, exergaming followed. Building on his continued success exploring exergaming in schools, this fall Gao received a $370,000 grant from the National Institutes of Health to study exergaming among preschool children.
Power to preschoolers
Recognizing the power of choice in exercise adherence, Gao’s innovative Project TEACH—Trial of Exergaming Activities on Cognition and Health—empowers young children to exercise on their own. Gao uses an approach he calls “child-led, instructor-supervised” that allows children to select games they’d like to play, difficulty level, tempo, and more. The instructor’s role is to supervise the activity, making sure the game is appropriate and, if need be, helping the child engage in more challenging games. Compared to more traditional care programs, Gao’s exergaming intervention promotes children’s physical activity levels, their fitness, and their movement skills and cognition.
A lab for Williamson Hall
In a building that has once housed the bursar, registrar, and bookstore, Gao’s Physical Activity Epidemiology Laboratory (PAEL) brings a new kind of energy. The lab in Williamson Hall is a long, thin room, lined with 14 gaming stations and traditional treadmill and cardio equipment on one end.
When Gao is not doing school-based interventions, his lab is able to accommodate college students, school-age children, and elite athletes to test physiological and psychosocial outcomes of different activities on site. It’s also much easier to run tutorial sessions for subjects using lab space.
Three graduate students—Zachary Pope, June Lee, and Nan Zeng—and many others work closely with Gao in the lab. This dedicated and enthusiastic cadre has weekly meetings where they discuss aspects of lab projects. And while Gao helps guide his students, he is also learning from them. He says he wants his students to build their own distinct lines of research that will hold their interest and investment and make them more attractive when seeking employment. He cites Pope, his third-year research assistant and doctoral student: When Pope came on board, Gao encouraged him to work with health medical devices, the Fitbit, iWatch, and other smart mobile devices.
“My focus on exergaming is just one part of what technology can do,” says Gao. “I want my grad students to explore other directions while they assist me and establish their own scholarship.”
“When people think of mobile devices, for example, they should think of Zachary Pope as the top scholar in this area,” he says.
Pope, well on his way, has now published 15 journal articles (three as first author) and 12 book chapters (four as first author).
The Pokémon Go wave occurred just as Gao and his research team finished writing a new textbook, Technology in Physical Activity and Health Promotion (forthcoming from Routledge in January 2017), a comprehensive, scholarly textbook and the first of its kind.
The PAEL website also lists an impressive number of research collaborators both at the U and other universities. For example, Gao just completed a home-based exergaming intervention with colleague Simone French in the School of Public Health funded by a $50,000 Obesity Prevention Center grant. And he is working on a paper with Department of Epidemiology and Community Health chair Dianne Neumark-Sztainer using 10 years of longitudinal data from Project EAT (Eating Among Teens).
Interventions for health
Another partner is the School of Social Work’s Hee Yun Lee, a behavioral health scientist working on health behavior interventions using mobile technology. Gao received a grant of $47,620 last spring to develop smartphone exercise apps for breast cancer survivors. Physical activity has been shown to be effective in cases of breast cancer and colon cancer, and Gao is excited about the possibilities.
“Since Dr. Lee’s work is more on nutrition and screening and mine is more on physical activity outcomes, our collaboration is a good fit,” he says.
Their research covers a lot of ground, determining quality of life and health outcomes for breast cancer survivors that use smartphone apps and social media. They include measures such as cardiovascular fitness, psychosocial beliefs, and body composition, among others.
It’s a fertile area for future study, Gao notes, as social support or competition with others via shared online data, including Facebook and Twitter, could help promote physical activity in unforeseen ways.
But Gao also recognizes the power of personalization.
“Even with more than 5,000 exercise apps currently available for smartphones, there are none that can generate individualized exercise prescriptions,” he says.
That’s why he is working with data-mining expert Rui Zhang, an assistant professor in the U’s Institute of Health Informatics, on two projects. One examines data from a large cohort of breast cancer survivors using sport watches in China’s Guangdong province. The researchers sort data biweekly to provide personalized exercise prescriptions for each of the 184 individuals. Participants from Minnesota have also been recruited, and Gao hopes to be able to conduct cross-cultural comparisons.
A second project, still in the conception phase, builds on the first to run synchronized data from body-based activity trackers, smart watches, smartphone apps, and augmented-reality games through a natural language computer program. The resulting model could make participant adherence to exercise much more likely by offering a weekly or even daily personalized and flexible exercise prescription tailored to individual health goals.
Across the lifespan
Looking ahead, Gao envisions working with the nation’s aging population as well. He credits the insight of his wife. Shortly after they arrived in Minnesota, she joined the nursing staff at a long-term health care facility and soon reported that her clients were using a pair of Nintendo Wii Fit—game boxes with handheld controllers—to play active games as part of their rehabilitation regimen.
Gao cites good evidence that exercise helps people with Alzheimer’s disease and dementia by increasing blood flow and, in some cases, helping in retention of cognitive function. The possibilities intrigue him, and he’s directed his students to comb research literature for studies that test the effectiveness of exergaming on rehabilitation.
“I really have a passion for doing this research because of the learning process,” says Gao. “And there is always new technology coming out”—he mentions watches and apps—“and then we get to learn how to apply it. I like these challenges. … In the winter I play active video games inside with my kids at home, and it’s fun for them—it’s fun for all of us.”
As technology changes and human health becomes ever more important, it will be both exciting and fun to see where Gao’s work goes next.
Story by Jonathan Sweet | Photos by Karen McCauley except as marked | Winter 2017