Monocular-Camera-Based Mobile Exergame for Type 2 Diabetes Prevention

Development and Evaluation of a Monocular-Camera-Based Mobile Exergame for At-Home Intervention in Individuals at High Risk of Type 2 Diabetes

Exergames have demonstrated potential as effective interventions for promoting physical activity and preventing type 2 diabetes (T2D), particularly among older adults. Kinect-based exergames, in particular, have been associated with improved adherence to exercise regimens and positive health outcomes. However, widespread implementation is limited by the high cost and reduced accessibility of the required hardware, restricting their use in home-based settings. Recent advances in computer vision have enabled the development of exergames using monocular camera systems, which may represent a cost-effective and scalable alternative. This study investigates the feasibility of monocular-camera-based exergames as a cost-effective and convenient alternative for home-dwelling individuals.

A total of 45 community-dwelling older adults aged 60-74 years, identified as high risk for T2D were recruited through local community health centers. Participants were randomly assigned to one of three groups (n = 15 per group): (1) Control group (traditional offline exercise with printed instructions), (2) Kinect group (Kinect-based exergames targeting aerobic capacity, balance, and strength), and (3) Monocular group (monocular-camera-based exergames using real-time 2D pose estimation). The intervention lasted six weeks, with participants completing three 30-minute sessions per week at home. Primary outcomes included exercise performance (completion rate and movement accuracy) and intrinsic motivation. Secondary outcomes included perceived enjoyment, challenge, and usability. Data were analyzed using one-way ANOVA.

Study Overview

• Status: Completed
• Conditions: Behavior Change Interventions
• Intervention / Treatment: Behavioral: Control group; Behavioral: Kinect group; Behavioral: Monocular group

• Study Type: Interventional
• Enrollment (Actual): 45
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Shanghai
    • Shanghai, Shanghai, China, 200240
      • Hongqiao Community

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. age between 60-74;
2. a score of 25 or higher on the Chinese Diabetes Risk Score;
3. community-dwelling individuals, not reside in assisted living or long-term care facilities;
4. physically capable of engaging in light to moderate exercise, as determined by self-report and/or physician clearance;
5. normal cognitive function that enable the participant to complete the experiment independently or with minimal assistance;
6. Written informed consent provided by participants or their families.

Exclusion Criteria:

1. diagnosis of type 1 or type 2 diabetes;
2. current participation in another exercise intervention study;
3. severe cognitive impairment with MMSE < 24;
4. major mobility limitations such as severe osteoarthritis and recent orthopedic surgery.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control group; Receive traditional offline exercise with printed instructions	Behavioral: Control group; Control Group consists of six motion videos, including: crossover steps, high knees, lateral raises, punching movements, downward leg punches from a standing position, and elbow-to-chest expansions
Active Comparator: Kinect group; Use Kinect based mobile exergame	Behavioral: Kinect group; Kinect Group features the same software functionality and design as the application based on bullet-screen cameras, but the hardware is built using a Kinect sensor. The gamified platform is primarily developed and presented using Unity software. The Kinect 3D motion-sensing camera incorporates real-time dynamic capture and image recognition capabilities, offering new possibilities for interactive approaches to motion therapy
Experimental: Monocular group; Used monocular-camera-based exergame	Behavioral: Monocular group; The game employs a virtual avatar to replicate users' movements, thereby fostering an immersive and engaging experience. A monocular camera captures users' movements in real time, which are analyzed through pose estimation algorithms and subsequently mapped onto the virtual avatar. Users interact with the game by following on-screen visual demonstrations, presented as either static images or animations, to perform the prescribed exercises. Movement accuracy is evaluated by the system, with scores awarded based on performance. To enhance user motivation and adherence, the game incorporates a reward system, where points earned through accurate execution can be redeemed for in-game rewards, such as unlocking background music, avatar customization options, and new virtual environments.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Heart rate	The post-intervention heart rate was collected during the first 10 seconds post-exercise to estimate physiological responses. Considering the general physical condition of individuals at high risk of diabetes, the study used 50%-80% of the maximum heart rate as the target exercise intensity. The maximum heart rate was calculated using the formula: 208 - (age × 0.7).	Baseline, Immediately after the intervention
Perceived fatigue	perceived fatigue, a widely accepted parameter in exercise assessments for diabetes-related fields, was employed to supplement the evaluation of physical activity. The Borg RPE (Rating of Perceived Exertion) scale[18], ranging from 6 to 20, was utilized to assess subjective fatigue and compare perceived exercise intensity across groups.	Baseline, Immediately after the intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Game experience	At the first session of intervention, participants in the Kinect and monocular groups completed the Game Experience Questionnaire (GEQ) to assess their user experience[19]. The GEQ was used to evaluate and compare the impact of different technologies on immersion and the overall experience of exergames.	Immediately after the intervention
Intrinsic motivation	Furthermore, the Interest/Enjoyment Subscale of the Intrinsic Motivation Inventory (IMI) was administered to participants in the control group, Kinect group, and monocular group[20]. This subscale evaluated and compared intrinsic motivation and enjoyment associated with physical activity across the three groups.	Immediately after the intervention
User engagement	At the end of one-week experiment period, user engagement was further quantified by tracking the frequency of intervention use over the one-week period, based on participants' video-recorded usage logs.	Follow-up (one week after the intervention)

Collaborators and Investigators

• Sponsor: Shanghai Jiao Tong University School of Medicine

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2024
• Primary Completion (Actual): June 30, 2024
• Study Completion (Actual): August 1, 2024

Study Registration Dates

• First Submitted: April 10, 2025
• First Submitted That Met QC Criteria: April 25, 2025
• First Posted (Actual): April 30, 2025

Study Record Updates

• Last Update Posted (Actual): April 30, 2025
• Last Update Submitted That Met QC Criteria: April 25, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: Exergame; Individuals at High Risk of Type 2 Diabetes
• Additional Relevant MeSH Terms: Endocrine System Diseases; Metabolic Diseases; Glucose Metabolism Disorders; Diabetes Mellitus; Diabetes Mellitus, Type 2
• Other Study ID Numbers: SRSY202504100034

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: The information might be shared after the research group finished the data analysis process.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No