The Enjoyability of Physical Exercise: Exergames and Virtual Reality as New Ways to Boost Psychological and Psychosocial Health in Astronauts. A Prospective and Perspective View

Abstract

On Earth, physical activity plays a tremendous role to preserve and improve the physical, psychological, and social well-being of people. The enjoyability, the appreciation, and the variability of the exercises are fundamental factors for the production of lifestyle benefits. Currently, exercise countermeasures for astronauts during long-duration missions focus more on the physiological side, frequently overlooking the relevant psychosocial one. Exergames are a form of physical activity that have taken hold in the last decades on Earth and has been widely accepted as a more enjoyable and engaging rehabilitation, reconditioning, and training tool compared to the previous conventional ones. After a review of the current needs of astronauts and of the positive effects of exergames on people on Earth, we suggest that exergaming should be implemented in space missions to improve physical, psychological, and social well-being of astronauts. We also propose practical methods on how exergames can be effectively implemented.

Full text

Emerging Topics
Abstract — On Earth, physical activity plays a tremendous
role to preserve and improve the physical, psychological, and
social well-being of people. The enjoyability, the appreciation,
and the variability of the exercises are fundamental factors for
the production of lifestyle benefits. Currently, exercise
countermeasures for astronauts during long-duration missions
focus more on the physiological side, frequently overlooking
the relevant psychosocial one. Exergames are a form of
physical activity that have taken hold in the last decades on
Earth and has been widely accepted as a more enjoyable and
engaging rehabilitation, reconditioning, and training tool
compared to the previous conventional ones. After a review of
the current needs of astronauts and of the positive effects of
exergames on people on Earth, we suggest that exergaming
should be implemented in space missions to improve physical,
psychological, and social well-being of astronauts. We also
propose practical methods on how exergames can be
effectively implemented.
Index Terms — engagement, social-relationships, sport, team-
spirit, well-being
Impact Statement — Exergaming can be a novel key support for
astronauts’ physiological, psychological, and social well-being during
long-duration space missions.
I. INTRODUCTION.
HYSICAL exercise is an essential and well-established
tool to support and improve health and well-being of the
G. Ciocca is with the Italian Ministry of Education (Secondary Schools)
(correspondence e-mail: gianmarco.ciocca1@gmail.com). H. Tschan is with
the Centre for Sports Science and University Sports, University of Vienna,
Vienna, Austria.
people, and for the same reason it has been applied by space
agencies to counteract and mitigate the physiological
impairments caused by the long permanence of astronauts in
the microgravity environment [1]. The exercise protocols
followed by the astronauts are developed based on the
scientific evidence of their effectiveness and on the existing
availability of exercise hardware and equipment designed for
space application. The design phase of exercise devices to be
used in space is significantly slower and more complex
compared with that for ground-application because factors like
volume, mass, power, transportation, cost, load capacity,
transmission of forces, and vibration isolation must be
carefully considered and align with the characteristics of the
spacecraft and its operational environment. The current
training schedule on the International Space Station (ISS)
consists of 1.5 net hours of exercise daily, and is a
combination of strength, endurance, and cardiovascular
protocols executed on different devices (Advanced Resistive
Exercise Device, or ARED, treadmill, cyclo ergometer) [1].
Crew members alternate loads between 60 – 85% of maximal
oxygen consumption (VO2) for cardiovascular protocols, and
60 – 85% of the 1 Repetition Maximum (RM) for the
resistance ones, respectively [1], [2].
It must be acknowledged and highlighted that exercise
countermeasure programs developed in the last decades for
astronauts aboard the ISS have been at least partly effective in
avoiding or limiting muscular deconditioning, bone density
loss, cardiovascular deficiencies, and hormonal
disequilibrium, allowing astronauts to partly maintain their
health and performance [1]-[5].
However, these exercises are always performed on an
individual basis and consist of only the same physical load
parameters, with a huge rate of repetitiveness from a
qualitative point of view. Therefore, several sport-related
positive psychological and psychosocial outcomes are not
The Enjoyability of Physical Exercise:
Exergames and Virtual Reality as New Ways to
Boost Psychological and Psychosocial Health in
Astronauts. A Prospective and Perspective View.
Gianmarco Ciocca1, Harald Tschan2
1 IIS “Antonio Orsini – Osvaldo Licini”, Italian Ministry of Education, Ascoli Piceno, Italy
2 Centre for Sports Science and University Sports, University of Vienna, Vienna, Austria
CORRESPONDING AUTHOR: Gianmarco Ciocca (e-mail: gianmarco.ciocca1@gmail.com)
P
This article has been accepted for publication in IEEE Open Journal of Engineering in Medicine and Biology. This is the author's version which has not been fully edited and
content may change prior to final publication. Citation information: DOI 10.1109/OJEMB.2023.3234014
This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/

Emerging Topics
being addressed, targeted, and considered.
A. ASTRONAUTS NEEDS AND PSYCHOSOCIAL
CHARACTERISTICS OF EXERCISE
Sport and physical activity can significantly contribute to
the psychological and social well-being of a person improving
aspects like self-confidence, self-efficacy, fun, satisfaction,
pleasure, enjoyment, stability, sense of meaning, social
belonging, peer-support, team-spirit, motivation, sense of
community, social harmony, and can help to reduce anxiety
and depression [6], [7], especially when performed with other
persons (i.e.: team, couple, group activities) [8], [9]. Such
aspects may be extremely useful and supportive for astronauts,
given the variety of psychological and social challenges they
face during their long-duration missions in a challenging
confined environment [10]-[13]. Accordingly, NASA
currently reports that psychological and social risks for long-
duration human space flights require monitoring and
mitigation, with further counter and preventive measures to be
taken [14]. In addition, boredom and monotony have been
linked to psychological states of under-arousal and indicated
as important mediators of mental fatigue [15].
Moreover, on Earth, the enjoyability of physical exercise
and fun are of paramount importance to maintain the
adherence to exercise protocols, to enhance the participation in
sport, and to improve the outcomes of physical exercises [16],
[17]. This is true also for astronauts after their return from a
mission [18]. Social interaction and peer-related aspects like
communication, experiencing novel activities (to daily
routines) have been associated with the emergence of positive
emotions during sport and exercise [19]. It also has been
shown that performing novel and varied activities is a basic
psychological need, and can promote intrinsic motivation,
physical activity adherence, and other physical and
psychological parameters [20].
Astronauts themselves believe that practicing enjoyable and
varied exercise protocols is paramount to reduce boredom and
improve their psychological status for space missions longer
than 30 days, which is value under which a mission can be
considered as short-duration and does not place the same
psychosocial challenges of the long-duration ones [21].
Specifically, these considerations have been released by three
astronauts referring to the design and implementation of
exercise countermeasure protocols for the forthcoming lunar
orbital missions [21]. One astronaut reported that “Exercise in
space needs to be an activity that the crew will enjoy,
contributing to both physical and mental well-being” [21].
Such a need has long been acknowledged, pursued, and
followed by several space agencies [22]. Astronauts also
report that they try to engage in some parallel activity while
exercising, like watching movies or imagine themselves to be
participating in some sort of activities on Earth such as
marathons [23].
Therefore, considering the above-mentioned challenges and
constraints in updating and developing new exercise devices
for space applications and the well-identified astronauts’
psychological and social needs for the future long-term
missions, the aim of this paper is to present and discuss a
promising exercise approach that makes the exercise protocol
more enjoyable and foster more of the psychological and
psychosocial aspects of physical activity. We present the
characteristics of exergaming, which is a training and
rehabilitation tool which has been effectively used on Earth
and may represent a new promising approach to improve the
exercise countermeasure protocols during long-term missions.
The third section of the paper (III) will focus on how
exergaming platforms and activities can be effectively and
practically implemented in current and future space missions.
II. EXERGAMING: A NEW SOLUTION?
In the last decade, several gaming platforms and
videogames have been designed and released commercially to
let the user be more physically active while playing indoor,
and has subsequently been a useful training and rehabilitation
tool on Earth (Figures 1-5). There is an ongoing debate on
how to best define exergames giving the appropriate relevance
to the exercise and gaming components [24]. Despite the lack
of an official recognized definition, exergames are currently
described as an interactive video gaming system that requires
bodily movement to play and function, thereby stimulating a
form of physical activity [24]. While virtual reality (VR) is a
broader term for an experience that can have multiple uses
(entertaining, training, communication, etc.) including
exercise, exergame refers to interactive video games (often in
a VR environment) specifically designed to require physical
activity or exercise to be played. In exergames, the user or
player performs activities and movements that mimic those
of well-known sports, such as basketball, golf, tennis,
bowling, boxing, dancing, archery, biking, in front of a screen
or using a VR device. In the VR environment, an avatar
replicates the user’s actual movements to avoid virtual
obstacles, defeat “enemies”, or follow a track. These
exergames can be played individually or with other persons,
together in the same room or online, with or without any
additional equipment (like racquets, weights, VR headsets,
etc.), to unlock and overcome new challenges and achieving
new records. The gaming atmosphere encourages the user to
be progressively more engaged in a physical activity
environment while being entertained and incentivized to face
challenges and play with peers simultaneously. Based on the
characteristics of the sport or activity displayed, the user will
consequently perform specific movements and actions to
respond to the presented situation, like squats, lunges, jumps,
arm-presses, skips, pulls, bending, and many other muscle-
group or whole-body functional movements that stimulates
both the cardiovascular and musculoskeletal system.
Research has shown that exergames can improve several
physiological (muscle strength, balance, cardiovascular,
metabolic), cognitive (executive functioning, visuospatial
skills, attention, processing speed, etc.), psychological, and
psychosocial functions and aspects on Earth [25], [26], and
This article has been accepted for publication in IEEE Open Journal of Engineering in Medicine and Biology. This is the author's version which has not been fully edited and
content may change prior to final publication. Citation information: DOI 10.1109/OJEMB.2023.3234014
This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/

Emerging Topics
can meet the levels of physical activity recommended by
health authorities [27], [28]. In these studies, exergame
protocols are typically assigned for several weeks (8-12) with
3-4 sessions per week. Then, the results are often compared to
a control population or to other physical training interventions.
Here, physiological improvements are specific to the activity
performed by the user or player, and specific stimuli or load
parameters are necessary. Hence, it is paramount to choose an
exergame modality (e.g.: type of exergame like rowing for
upper limbs and core muscles, dancing for lower limbs and
whole-body coordination, etc.; volume; intensity; etc.) that
targets the desired muscle groups, body movements, and
physiological mechanisms. The game modalities of exergames
may vary and can be set at easy (light physical load) or hard
(heavy physical load) levels. Exergames can improve several
strength and balance parameters in some populations [29],
[30], and can be used to reach higher workloads while
perceiving less exertion due to a higher enjoyment of the
activity than traditional exercise protocols [31]. Previous
demonstrations show that an acute bout of high intensity
interval training (HIIT) is more enjoyable when delivered
using an exergaming platform relying on VR [32]. These
participants were shown to achieve higher intensities when
competing against their own previous performance as a target
[32]. In particular, Farrow et al. showed that participants
managed to reach up to 84 % of their personal maximum
power output during a HIIT cycling exergaming protocol [32].
This is an important finding because HIIT protocols have been
shown to be an effective method to improve cardiovascular
health, neuromuscular functionality, muscle power, with the
advantage of being a more efficient time-saving activity than
other lower-intensity exercise protocols [33]-[36]. Similarly,
Keller et al. [37] showed that a rowing exergame HIIT
protocol elicited more positive outcomes for some cognitive
and psychological metrics (motivation, affect, mood
restoration, visual short-term memory, reaction times) than the
control condition (simple physical exercise without VR).
Bronner et al. demonstrated that dancing exergames allowed
to reach moderate and vigorous metabolic equivalents (MET)
with a maximum value of 9.18 (MET levels can range from
low values of 2.0 for light activities such as walking, to high
values above 10.0 for vigorous activities such as rope
jumping), and the users’ engagement and flow were positively
associated with the intensity level reached during the activity
[38].
Fig. 1: A cycling exergaming platform, Holodia Holofit ©. Image taken from
Holodia Holofit’s official website.
Fig. 2: A rowing exergaming platform, Holodia Holofit ©. Image taken from
Holodia Holofit’s official website.
Fig. 3: Exergaming platform requiring only a screen and a manual device,
Nintendo Ring Fit Adventure ©. Image taken from Nintendo’s official
website.
This article has been accepted for publication in IEEE Open Journal of Engineering in Medicine and Biology. This is the author's version which has not been fully edited and
content may change prior to final publication. Citation information: DOI 10.1109/OJEMB.2023.3234014
This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/

Emerging Topics
Fig. 4: Exergaming platform allowing running, jumping, and crouching,
OmniOne Virtuix ©. Image taken from OmniOne Virtuix’s official website.
Fig. 5: NASA astronaut Megan McArthur (Expedition 65, 2021) using a VR
device for inflight operational training onboard the ISS. Image taken from
NASA’s official website.
A systematic review and meta-analysis reported that people
often achieved up to moderate intensity (calculated as % of
their maximal Heart Rate - HR - , VO2, and MET) during
boxing exergames [39]. However, it has been warned that
available exergaming modalities may not always allow elite
athletes to reach their personal maximal power output and
therefore their needed training load [40]. This highlights that a
careful analysis should always be made regarding whether the
planned and desired physiological and metabolic outcomes
can be achieved with a given exergaming platform, device, or
protocol [40]. Specifically, Chung et al. reported that elite
athletes could reach only 57-64 % of personal maximum HR
in males, and 67-82 % in females in a rowing exergame, while
VO2 max reached only 40 % of the athletes’ personal
maximum [40].
Interestingly, research has also shown that playing
exergames with other players, known as multiplayer
modalities, where it is possible to cooperate and/or to compete
together bears some physiological and psychosocial
advantages compared to the single modality, thanks to
enhanced social interaction, interactivity, and immersion [41],
[42]. For instance, it was reported that playing football and
boxing exergames against another player elicited higher
physiological outcomes than playing alone (minute
ventilation, oxygen uptake and HR at least 18% higher; energy
expenditure 21 % higher), even though the absolute intensity
remained low (probably due to the backwardness of the
exergame device used in that study) [43]. The authors
suggested that the increase could be explained by
psychological (more enjoyment and engagement), and
technical reasons (human competitor’s actions are more
unpredictable than artificial intelligence’s (AI), making the
game more intense). In the most recent study, it was found that
a cycling exergame elicited slightly higher HR and VO2 values
when performed against a competitor than alone, suggesting
the superiority of exergaming with other people as a more
effective training tool [44]. Mackintosh et al. found that while
no differences in energy expenditure were found between
single and multiplayer conditions in a 30-minute boxing
exergame, female players reported higher perceived vitality in
the multiplayer scenario [45]. Similar results were also
obtained by McDonough et al., who reported no differences in
physiological variables between single and double player
exergaming modalities in elite athletes, but a lower perceived
exertion in the double condition [46]. It is also possible that
higher loads and physiological outcomes can be elicited only
when participants compete with each other and not just
exercise together (cooperative modality, like performing the
same dance) [47]. This is supported by the findings of
Giancotti et al., who found no differences in physiological and
metabolic outcomes between individual vs couple exergaming
modalities [47].
Alongside the physical and psychological considerations
and beyond the already mentioned effects on enjoyment of the
exercise, the psychological side of practicing exergames has
been deeply considered, with several studies investigating the
impacts on enjoyment, flow, and/or immersion [41].
But how can exergames be applied in a space environment,
in microgravity or hypogravity conditions, inside an orbital
spacecraft or on a surface base?
III. IMPLEMENTATION OF EXERGAMES AND VIRTUAL REALITY
IN CURRENT AND FUTURE SPACE STATIONS.
The astronauts’ exercise schedule depends on the available
equipment and devices, which, in turn, depends on the
characteristics and specifications of the given space station or
spacecraft (volume, mass, power availability, etc.), as well as
the environmental conditions (microgravity, hypogravity,
etc.). For instance, the ISS has access to several exercise
devices (ARED, treadmill, cyclo ergometer, plus prototype
rowing machines and elastic bands) [1]. Whilst smaller
This article has been accepted for publication in IEEE Open Journal of Engineering in Medicine and Biology. This is the author's version which has not been fully edited and
content may change prior to final publication. Citation information: DOI 10.1109/OJEMB.2023.3234014
This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/

Emerging Topics
spacecrafts, such as the new Orion Multi-Purpose Crew
Vehicle, will only have a small but efficient rowing machine,
and future planetary bases will have more available volume
allowing the implementation of more complex activities and
exercise devices [21], [48], [49].
To kick off the exergaming era during the space missions
and to start providing astronauts with similar psychosocial
benefits as those mentioned above, the first step would be
integrating the VR in already existing and operational devices,
for example within the treadmill and the cyclo ergometer on
board the ISS, resulting in an immersive training [50]. The
implementation of VR would simply consist of a VR headset
and a software update of the existing exercise devices, thereby
resulting in the previously described exergaming training
scenario [31], [32], [51]-[53]. This same VR approach can be
applied to the rowing equipment planned for the upcoming
Orion spacecraft, which will host astronauts for a short
duration orbital mission around the Moon [40], [48], [54].
Such implementations in exercise protocols have also been
suggested and welcomed by astronauts themselves [21].
Although the ISS, Orion, and future Lunar Gateway
environments would not allow the crew to exercise together at
the same time on site, the astronauts would still benefit from
social and competitive stimuli because of the nature of
exergames, which provide challenges to be overcome,
achievements to be unlocked, and records to be beaten among
crewmembers. In other words, the system could provide daily
or weekly challenges in several different VR scenarios, that
astronauts should achieve individually or as a team by
summing all individual performances. Moreover, the new
telecommunication capabilities could allow astronauts to
perform an exergame like cycling, running, or rowing with a
family member on Earth within the same VR scenario (with
shared environmental location and tasks), alongside the added
possibility to communicate with one another at the same time.
Talking and sharing moments with their families has been
indicated by astronauts as precious and meaningful
psychological source of support for their mission [23]. These
opportunities would benefit astronauts’ physiology,
psychology, and social interactions [41], [51]. Murray et al.
demonstrated benefits of cooperative rowing exergame when
the user plays with another person in a VR scenario [54].
Here, the VR environment displayed the river and the
participants’ boats, and participants had common tasks to be
achieved [54]. The study showed that cooperative rowing
leads to better performance, higher physiological load, and
more enjoyable than rowing without VR [54]. Nunes et al.
reported a similar outcome when participants ran on a
treadmill in a competitive exergame context [53]. The
competition involves the player and a competitor running on a
treadmill simultaneously within the same shared VR
environment [53].
We think that exergaming might have a greater impact on
incoming activities of human exploration of space for the
following reasons. First, the humans will land on the Moon
and live in a surface base with a reduced gravitational pull.
Second, human settlements might have higher habitable
volume than a spacecraft. Several concepts and proposals
regarding future Moon bases have been released, including a
Base Camp resulting from the upcoming Artemis missions
[55], the transformation of a SpaceX Starship Human Landing
System into a horizontal habitable volume after its landing
[49], and a detailed long-term roadmap by the Moon Village
Association [56]. A higher available volume would result in
an increased number of exercise devices and equipment that
can be stored and used by the astronauts, also allowing
crewmembers to train together, with all the related
psychosocial [45] and physiological benefits [43], [54].
Exercising with cooperative and competitive exergames
amongst crew members can be a useful tool to cultivate a
more cohesive and multicultural environment [57]. This is an
important aspect because astronauts typically have different
nationalities and cultures. Sport benefits team cohesion and
increases opportunities for socializing between groups [57].
The reduced gravitational pull might allow astronauts to
perform new general exercises and, therefore, Earth-based
sport exergames. For example, exergames designed for human
settlements may likely have additional features than those
designed for orbiting spacecraft, such as the ISS. Such new
features may allow astronauts to conduct a wider variety of
activities, such as dancing [38] and boxing [39] that, in turn,
may increase the benefits they can get, and comply with their
psychological necessities [21], [23]. Moreover, additional
weight could be applied to astronauts with the use of
weighted-vests or elastic/rigid harnesses attached to floors or
walls, and training sessions could be performed with
crewmembers or via internet with family members on Earth,
within the same VR environment. By using the proper
equipment, plyometric activities could also be performed,
thereby stimulating an increase in bone strength,
neuromuscular functionality, and cardiovascular efficiency
[58]. Plyometric activities are cyclical movements
characterized by short-duration and high-force loading that
can counteract hypogravity-related decrements, primarily
muscle power and bone strength [58].
TABLE I
SUMMARY EXAMPLES OF EXERGAME ACTIVITIES (INDIVIDUAL OR GROUP),
AND RELATED ESTABLISHED AND POTENTIAL BENEFITS FOR ASTRONAUTS AND
PEOPLE ON EARTH
Exergame
(Exercise)
Mission
type
Potential benefits
for astronauts
Established and
potential benefits
for ground
application
Jogging /
Track &
Field
(running)
[27], [53]
Orbital /
Planetary
Cardiovascular,
Coordination,
Strength, Cognitive,
Psychosocial
Cardiovascular [27],
[53], Coordination,
Strength, Cognitive,
Psychosocial [27],
[53]
Cycling
[31], [32],
[44]
Orbital
Cardiovascular,
Cognitive,
Psychosocial
Cardiovascular [31],
[32], [44],
Cognitive [26],
Psychosocial [31],
[32]
Rowing
[37], [40],
Orbital /
Planetary
Cardiovascular,
Strength, Cognitive,
Cardiovascular [40],
[54], Strength,
This article has been accepted for publication in IEEE Open Journal of Engineering in Medicine and Biology. This is the author's version which has not been fully edited and
content may change prior to final publication. Citation information: DOI 10.1109/OJEMB.2023.3234014
This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/

Emerging Topics
[54]
Psychosocial
Cognitive [37],
Psychosocial [37],
[54]
Dancing
[38]
Planetary
Cardiovascular,
Strength,
Coordination,
Cognitive,
Psychosocial
Cardiovascular [38],
Strength,
Coordination,
Cognitive [26],
Psychosocial [38]
Boxing
[39], [43],
[45]
Planetary
Cardiovascular,
Strength,
Coordination,
Cognitive,
Psychosocial
Cardiovascular [39],
[43], Strength,
Coordination,
Cognitive,
Psychosocial [45]
Basketball
(jumping,
throwing,
running)
Planetary
Cardiovascular,
Strength,
Coordination,
Cognitive,
Psychosocial
Cardiovascular,
Strength,
Coordination,
Cognitive,
Psychosocial
Bowling
(squats &
lunges)
Planetary
Strength,
Coordination,
Cognitive,
Psychosocial
Strength,
Coordination,
Cognitive,
Psychosocial
It is important for astronauts to be able to break monotony
and have access to more interesting activities when deployed
[21], [23]. There have been reports of improvised games, such
as a sort of Quidditch (a fictional team-sport made popular by
the fantasy novel series Harry Potter, where players fly and try
to score points by throwing or catching different flying balls)
and a sort of jumping/flying-exercise within ISS’ modules
[21]. Due to the physical and psychological demands required
of astronauts during missions, the activities provided by
mission planners must attempt to closely resemble an
astronaut’s daily routine on Earth [23]. However, these
exercises must also exploit the unique environment observed
during spaceflight whilst also being engaging and entertaining
for the astronauts.
Moreover, exergames might stimulate the perceptual and
cognitive parts of the human brain [26]. The rapid execution
of movements in response to unpredicted situations requires
the simultaneous use of physiological, cognitive, and
biomechanical functions [25], [26], which, in turn, might
increase performance in rapid multi-joint, multi-plane, or
whole-body functional movements in instability conditions
[59]-[61]. Published literature shows that practicing physical
activities and sports in groups (with teammates and
opponents) stimulates perceptions, cognitions, and tactical
abilities, because players are in new or unpredictable
situations [62], [63]. Studies show increased production of
neurotrophic factors such as the brain-derived neurotrophic
factor, which regulates several cognitive functions like
memory, working memory, inhibition, self-regulation, and
goal-oriented behaviors [64], [65].
High intensities are hard to reach with some exergaming
protocols [40]. Hence, exergames shall not be the only training
methodology and shall be part of a broader exercise program
allowing for the variability of the training stimuli and the
astronauts’ enjoyment [1], [23]. Additionally, such a mixture
of methodologies shall account for the specificity of
exergames concerning muscle groups, body movements, and
physiological mechanisms to target to gain the desired
outcome [25], [29].
IV. CONCLUSIONS
Exergaming might represent a valuable solution to improve
astronauts’ psychological and social well-being and health
during long-duration missions, in addition to providing valid
and novel physiological stimuli. On Earth, the effectiveness of
exergames to improve health of people with a variety of
conditions as well as the healthy is well established [25], [26],
[29], [30], [66], [67], and their implementation in space
mission is therefore encouraged. As mentioned previously,
astronauts encouraged and welcomed the adoption of new
exercise countermeasures focusing on the physiological and
psychosocial well-being [21], [23]. Exergames may result in
the technology that allows astronauts to conduct variable and
enjoyable physical activities [31], [41], [45]. Yet, further
studies are needed to assess exergames’ technology for use in
space and for investigating if alterations of astronauts’
performance follow similar trends of that seen in human
studies on the ground.
ACKNOWLEDGMENT
The authors would like to thank Ms. Swathy Jayakrishnan
(B.Sc. Hons) for her kind and precious English language
editing.
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This article has been accepted for publication in IEEE Open Journal of Engineering in Medicine and Biology. This is the author's version which has not been fully edited and
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This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/