In today's world, where physical activity levels are often insufficient, interactive video dance games (IVDGs) like Dance Dance Revolution (DDR) are emerging as engaging alternatives. They offer a unique blend of recreation and exercise, potentially increasing adherence to physical activity programs and providing numerous health benefits. This article explores the benefits of DDR, focusing on its potential for weight loss and its positive impact on various populations, including individuals with Parkinson's disease (PD).
The Appeal of Dance-Based Videogames
Videogames have become a widespread form of recreation, with newer games requiring whole body activity. DDR combines the recreational nature of a videogame with the benefits of dance, such as increased balance, coordination, and strength. Adherence to dance-based aerobic exercise programs has been relatively high, with low injury rates. Because dance-based videogames are intentionally engaging and give rapid feedback and rewards, adherence to physical activity may be promoted.
DDR and Weight Loss: Evidence and Motivation
Increased energy expenditure is the basis of exercise programs with the goal of weight loss. A study by Lanningham-Foster et al showed an increase in energy expenditure while children were participating in IVDGs compared to both sedentary video game playing and walking on a treadmill. An international survey of 556 DDR players (mean age: 18.7 years; range 12-50) found that 66% began playing IVDGs because they are “fun, amusing, and cool.” Reasons given for continuing to play after the novelty wore off included weight loss, improved physical condition, social connectivity, improved quality of sleep, and stress relief. Höysniemi surveyed DDR players about their primary motivation to continue playing. Results showed that 87.5% of self-identified overweight players reported losing weight due to playing.
DDR and Cardiorespiratory Health
A study was conducted to determine the effects of a 6-week IVDG program on adult cardiorespiratory status and body mass index (BMI). Twenty-seven healthy adult participants attended IVDG sessions over a 6-week period. Participants completed pre- and post-testing consisting of a submaximal VO2 treadmill test, assessment of resting heart rate (RHR) and blood pressure (BP), BMI, and general health questionnaires. Twenty participants attended at least 75% of available sessions and were used in data analysis. Mean BMI decreased significantly (from 26.96 kg/m2 to 26.21 kg/m2; 2.87%) and cardiorespiratory fitness measured by peak VO2 increased significantly (from 20.63 ml/kg/min to 21.69 ml/kg/min; 5.14%). Most participants reported that the IVDG program was a good workout, and that they were encouraged to continue or start an exercise routine. Forty percent reported improvements in sleep, and nearly half stated they had or were considering purchasing a home version of a video dance game.
DDR for Individuals with Parkinson's Disease
Physical therapy, including exercise, improves gait and quality of life in Parkinson's disease (PD). Many programs promoting physical activity have generated significant short-term gains, but adherence has been a problem. A recent evidence-based analysis of clinical trials using physical therapy in PD patients produced four key treatment recommendations: cognitive movement strategies, physical capacity, balance training, and cueing. Sixteen medically stable participants with mild to moderate PD were given the opportunity to try DDR with supervision by a research staff member. Interactive dance exercise was appealing to participants with PD and may help promote adherence to physical activity. Concerns regarding familiarity with the technology may be addressed with simplification of the interface or additional training for participants.
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In PD, additional hurdles to increasing physical activity include cognitive dysfunction, apathy, and impaired mobility and balance. There has yet to be a program that incorporates all of these features while providing rewarding stimuli to promote adherence. The primary aim of one study was to investigate perceived advantages and disadvantages of a dance-based videogame among a small number of participants diagnosed with PD. Subjects, in groups of up to six, received an orientation to the dance system and observed a demonstration by research staff. Each participant was then given the opportunity to try DDR under direct supervision of a research staff member.
Study Details and Findings
In “Dance Dance Revolution,” participants dance on a 3-foot×3-foot mat with squares marked by arrows: forward, backward, left, and right. The monitor instructs the dancer by a system of scrolling arrows (up, down, left, and right). Steps are synchronized to music chosen by the participant and become more complex and faster as movements improve. Sixteen medically stable PD patients were enrolled. Inclusion criteria were as follows: Meeting the United Kingdom PD Society Brain Bank Clinical Criteria; 40 years of age or older; Hoehn and Yahr score of ≤3; and not currently participating in regular physical exercise. Regular physical exercise was defined as at least 30 minutes of physical activity three times per week associated with increased heart rate. Patients were required to be capable of walking ½ mile and climbing one flight of stairs without an assistive device or help from another person.
The interactive videogame DDR includes a 3-foot×3-foot mat with 1-foot squares marked by four arrows designating the directions forward, backward, left, and right. The monitor instructs the participant by a system of scrolling arrows of four types (up, down, left, and right), which arise from the bottom to the top of the screen. As the arrows scroll up to the top of the screen, they cross over a set of four arrow silhouettes (up, down, left, and right). The participant's goal is to step on the arrow on the mat corresponding to the scrolling arrow as it crosses its respective silhouette. The steps are synchronized to participant-chosen music and increase in complexity and speed as game skills are mastered. After each dance or lesson (about 90 seconds), the participant is given feedback on the number of correct steps with an overall letter grade. A letter grade, ranging from A to E, is assigned based on the number of correct steps, how well timed those steps are, and the complexity of the given song.
The results of this case series provide suggestive evidence that DDR is well tolerated, fun, easy to use, and perceived to be of benefit in PD participants. Common concerns included a distracting interface and financial expense. Reports of fear, distress, or discomfort were minimal. There was no report of pain or loss of balance. Activities such as dance-based videogames are emerging as a popular way to exercise and may be relevant to PD patients. In particular, this activity meets all four of the key treatment recommendations for physical therapy in this patient population. Given findings that DDR is enjoyable, thus increasing the likelihood of adherence to this physical activity, further studies are needed to assess the long-term benefits of this form of exercise. Interactive videogames that promote physical activity may be beneficial and appealing forms of exercise for the PD population. Findings suggest that DDR is feasible in PD and that such an intervention may be well suited to address the needs of this population.
Considerations and Potential Drawbacks
While DDR offers numerous benefits, it's important to consider potential drawbacks. Concerns regarding technical competence among participants may indicate that the interface should be simplified, or that participants need training to become familiar with the technology. Financial expense and a distracting interface were also identified as common concerns.
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