A Kinect Based Adaptive Exergame
1
Irina Mocanu, 2Cosmin Marian
Computer Science Department
University Politehnica of Bucharest
Bucharest, Romania
1
irina.mocanu@cs.pub.ro, 2cosmin1611@gmail.com
Abstract—This paper describes an application that aims to
stimulate physical activity adapted to elderly people. The
application is implemented as a game with two avatars: user and
trainer. The user avatar must reproduce the movements of the
trainer’s avatar. The similarity between two movements is
computed using Dynamic Time Warping. Also the speed of the
trainer is adapted to the user’s movements using cross-
correlation. Thus the game can stimulate for a long time
physically activity. The preliminary evaluations with ten people
have shown that the system can be an effective tool that engages
users into physical activity.
Keywords—exergame; Dynamic Time Warping; cross
correlation; adaptation;
I. INTRODUCTION
Exercises play an important role in the overall condition of
the elderly. A structured exercise program may lead to a rapid
recovery in severe disease (stroke, fractures, surgery) and even
major benefits for the elderly with less severe disease. The
purpose of the exercise is to regain tone and normal weight and
reduce comorbidities that affect obese patients, such as:
cardiovascular disease, diabetes, osteoporosis [1].
Activities of Daily Living (ADL) are defined as activities
carried out regularly. While walking is a form of exercise with
several implications, this does not present a comprehensive
application form to the effort of the human body. Even if the
ADL can include washing the car, cleaning the house and
gardening, cooking, washing dishes are not considered exercise
that would require sufficient human body. Patients should seek
a structured exercise program to accelerate further their goals
of increasing mobility, muscle mass, stamina and eventually to
weight loss (if applicable).
A good program is well structured exercise any program
tailored to the patient's lifestyle and physical, which includes
any activity of daily program leading to a target heart rate of at
least 120 beats per minute (bpm). This is the recommended
intensity level over a period of 30-45 minutes. If health
problems arise (sweating, fatigue or breathing) and is sufficient
for 5-10 minutes three times a week. Persevering over time,
will gradually build endurance and can reach a goal of 30-45
minutes of exercise [1], [2].
We present six benefits of structured exercise combined
with daily activities, maintaining a decent balance between
both [2], [3]:
978-1-5090-3899-2/16/$31.00 ©2016 IEEE.
3
Lucia Rusu, 4Raluca Arba
Faculty of Economics and Business
Babes Bolyai University of Cluj-Napoca
Cluj-Napoca, Romania
3
lucia.rusu@econ.ubbcluj.ro, 4raluca.arba@econ.ubbcluj.ro
 The weight loss by burning a number of calories over
a period of time. The recommendation is 30 minutes
of exercise a day for at least five days a week. This
begins with daily activities: take the stairs instead of
taking the elevator, several steps in a walking
program.
 ability to combat many health problems, from
cardiovascular disease to depression. Physical activity
allows blood to flow through arteries and veins
vigorously, reducing the risk of cardiovascular
disease, reduce the risk of developing type 2 diabetes,
stroke, depression and arthritis.
 Improved mood. Exercise stimulates the release of
endorphins in the brain that are known producer of
"runner's high". Releasing tension and stress through
exercise can boost self-esteem and confidence.
 an energy boost efficiency caused by oxygen
throughout the body. As the heart and lungs working
in sync, enabling a flow body and restoring good
blood flow to muscles and tissues energy. Regular
exercise increases endurance and muscle strength,
allowing muscles and bones become stronger0
 sleep better. The body is released from stress and
allows relaxed state of mind. A relaxed mind will gain
the benefits of sleep: immune function, good memory,
relax the body and muscles and the body works better.
Also there are some (especially age-related) factors that
induce a progressive diminution of physical activity: the
discomfort caused by some health problems, the lack of
enthusiasm (apathy), social conformism. Moreover, these
factors act as a negative feed-back system (this means that the
less physical activity someone performs, the bigger these
factors become) and lead to a chronic sedentariness. Most
existing exergames are made for children or young adults, and
they have many features that do not suit to the elderly.
Exergames for elderly should follow basic requirements for
games, adapted for the abilities of the users.
This paper presents a game that increase physical activity
through a game with movements adapted to the user’s speed of
reactions.
The rest of the paper is organized as follows: Section II
describes other games with physical exercises for elderly
people or used in the rehabilitation domain. Game description
in given in Section III. Section IV presents evaluation of the
proposed game. Conclusion and future work are described in
section V.
II. RELATED WORKS
Mobility problems are very common for elderly people and
lead to reduced quality of life and limitations in everyday
activities and social participation. Game-based technologies,
social play, personalization and persuasive technologies can
motivate the elderly to perform exercises that are beneficial to
them.
A new way to use video games is to include them in
training, education and learning. This is called serious games.
Serious games can be described as ”a mental contest, played
with a computer in accordance with specific rules, that uses
entertainment to further government or corporate training,
education, health, public policy, and strategic communication
objectives” [7]. An important feature with serious games is that
they provide the opportunity to experience in real-life
situations and adventures one may otherwise not be able to
enjoy. Exergames are a type of serious video games that
combine traditional game play with physical activity. The
combination of movement and amusement is used to stimulate
exercise and engage people to be more physically active in a
fun and motivating way. A lot of research has been done within
this topic, and results show that exergames can have a positive
effect on users health [8], [9].
Paper [10] discuss important issues that need to be taken
into account when developing games for elderly. Elderly often
suffer from decline in visual acuity, decreased audition,
mobility changes and cognitive functions’ decline. In addition,
many elderly are not familiar with technology. The writers
suggest that it should be possible to customise the game for
every player’s special needs.
Font, size and colour should be adjustable, and information
should be provided in different multimedia alternatives, like
text, voice and images. The objects should be of sufficient size
and the elements should not move too fast. The overall
interface should be as simple as possible, without the need to
remember information given earlier in the gaming process, and
it should be given sufficient information and guidance
throughout the whole game. Games should also provide
motivating messages to encourage the player.
Some examples of wellbeing and motivational applications
and games for healthcare based on Kinect and/or other sensors
are given bellow:
Jewel Mine [11] is a rehabilitation therapy tool customized
to overcome health issues. Jewel Mine was created using the
Microsoft Kinect for Windows SDK and is part of a series of
game-based research prototypes using off-the-shelf video game
hardware to explore the potential of interactive games to
improve therapy in home and clinical settings. Video game
systems are increasingly being used for rehabilitation.
However, games designed for entertainment do not always
meet clinical needs. They can be too challenging for people
with impairments to complete or they can encourage the wrong
type of movements. Negative feedback often discourages
patients from trying to complete tasks. Jewel Mine is a
rehabilitation therapy tool customized to overcome these
issues. Developed at the Game Based Rehab Lab, part of
the MedVR Group (http://medvr.ict.usc.edu/research/) at
University of Southern California Institute for Creative
Technologies (ICT), this video game-based application targets
balance training and upper limb reaching exercises and is
designed to motivate people with orthopedic and neurological
injury or impairments, including stroke, traumatic brain injury,
spinal cord injury and balance issues associated with aging.
GameUP, developed in the AAL project GameUP [12]
sustains mobility of seniors over 65 years for the advancement
of older persons’ mobility [13]. The GameUp project created
seven mini exergames training mobility, strength, and balance
on Kinect for Windows and a mobility tracker from the
company Fitbit is also used for promoting endurance. Kinect
enables users to control and interact with their screen without
using a gamepad, but simply with an easy interface using
gestures and spoken commands. Thus, playing freely without
being bonded to traditional gamepads makes the game console
user-friendly and more suitable for older persons. Fitbit, with
its integrated altimeter and tri-axial accelerometer accurately
captures all daily activities. It tracks the number of steps taken,
stairs climbed, distance traveled and calories burned every day.
It’s low weight and small size, and it can easily and discreetly
be attached to clothing. The aim of this tracker is to empower
and encourage the patient, by delivering real-time feedback
that helps him/her be more active. The exergames consist of 7
mini-games, including balance, mobility, and strengthening
exercises:
 Exercise 1 called “plucking game” is a
strengthening exercise for abductor muscles. The
patient has to spread apart one leg on the side.
 Exercise 2 “apple-picking game”, exercise 4
“chicken-picking game” and exercise 7 “star-
picking game” are balance exercises where the
patient has to catch the falling objects and put
them in the correct receptacle. These three balance
exercises are based on the same training principle
where the patient has to move sideways.
 Exercise 3 called “growing game” is a
strengthening exercise for the calf muscles. The
patient has to stand on his toes to water the flower.
 Exercise 5 called “harvesting game” is a
strengthening and mobility exercise for the trunk.
It trains the torso rotation. The patient has to rotate
his trunk in order to cut the corn with the scythe.
 Exercise 6 called “pumping game” is a
strengthening exercise for quadriceps muscles
where the patient has to perform squats in order to
pump water into a glass.
Evergreen Fitness System [14] is a game-based prototype
developed to train older adult’s balance, especially lower limb
strength by exercises (knee marching, side hip raise, lunges,
partial squats, wide squats and standing knee flexion). The
system is based on the Kinect sensor, gestures are used to
select the menu while body motions are required as part of the
exercises. Immediate feedback, such as smiling face, ding
sound and entertaining background music is provided to
increase interaction. Six exercises are designed for improving
balance:
 Exercise 1 (knee marching): strengthen ankles and
hips; improve dynamic or moving balance.
 Exercise 2 (side hip raise): strengthen side hip
muscles; maintain lower body endurance to better
walk and side step around objects.
 Exercise 3 (lunges): strengthen quadriceps and
hips; improve the ability to get out of a chair and
balance.
 Exercise 4 (partial squats) and Exercise 5 (wide
squats): increase hip flexibility, quadriceps
strength and hip flexor strength: steady body for
better balance and safety.
 Exercise 6 (standing knee flexion): strengthen
hamstring muscles; help with standing balance
Out in nature [15] is a simplified exergame concept for
senior citizens, which focuses on physical activity in general,
and balance and muscle strength in particular. The game is
designed for elderly people, around 70 years old and was
created based on the seniors’ feedback. Users can choose
exercises according to different muscle groups and balance
challenges, and then, a specific exercise is chosen depending
on their own preference or the recommendation from their
physiotherapists. The design of the exergame shows clear goals
for training muscle strength and balance. One of the exercise is
focused on balance and muscle strength, where the task is to
pick apples. This activity requires players to stretch their body
to reach ripe apples (balance) and put them in a basket on the
ground.   recommendation we’ll register a set of exercises with different
Paper [16] presents a mobile based exergaming system
that targets children of different ages and that aims to
encourage them to do running and jumping exercises in an
enjoyable manner. The system uses a heart monitor that allow
interacting with a special game that can adapt to the user’s
performance.
Home-based rehabilitation system has potential to offer
greater accessibility and thus increase consistent uptake. In
[17] is presented an effective home-based rehabilitation
offering outcomes similar to those obtained through hospital-
based rehabilitation under the supervision of a therapist. The
system uses Kinect with Dynamic Time Warping method and
fuzzy logic for exercise evaluation.
III. SYSTEM DESCRIPTION
All exercise programs are customized to the particular elder
disease, so they are easily understood and executed. The
program includes muscle exercises active, moderate, consistent
with 75% load capacities cardiovascular system, respecting the
principle of Rusk (1977) "little and often" and especially the
basic principle of recovery geriatric "maximum effect -
minimal risk" [3].
For seniors, doctors prohibit certain types of exercises:
isometric exercises, anaerobic exercises, exercises with heavy
weight, exercises in the head goes below horizontal front trunk,
exercises with sudden changes of position.
An important rule consists in elimination of seeking maximal
and submaximal muscular efforts for long periods, which are
impossible in old age, and risky use [3], [4].
There are some easy exercises that can be performed by
any elderly: training mild aerobics, squats, lifting light weights,
push-ups performed on the wall, flexing side of the leg linkage
peaks, stretching lumbar, stretches upper body. Although
generally are considered valid, even these contraindications to
certain conditions for elders: hemiparesis, paresis, recent
operations, etc [5], [6].
These physical exercises must be defined in order to guide,
monitor, and encourage elderly people to perform them:
 The discomfort sensation can be attenuated by
choosing adapted exercises, in accord with physical
capabilities, and by progressively increase the
difficulty - we’ll have three type of exercises: low,
moderate and high. The exercises will be based on a
set of movements of the whole body representing
standard activities concerning physical training
exercises (e.g. straight arms pumps: lateral and upper,
lateral arm circle, lateral lunge, squats);
 The apathy can be surpassed using adequate visual
and audio stimuli: virtual animated models, rewards,
encouragements, musical sequences, etc.;
The level of the exercise will be adapted permanently in
speed. We propose a Physical Activity Trainer (PAT) that is
implemented like a game that helps users to perform physical
activities. The game consists of two avatars: the avatar of the
user and the avatar of the trainer. Based on a kineto-therapist
levels of difficulty. Each user will be registered with a personal
profile (containing medical information and recommendation
of the type for the physical exercises). When the game starts,
the user can choose a type of the exercise according with his
profile. The trainer avatar will be animated based on the
recorded exercises with the speed associated with the selected
level. The user will perform the recommended exercises, his
avatar will be animated, and the system will compute a score
(comparing the user movements and the trainer movements).
Also the speed of the game will be continuously adapted based
on the user response. In this paper we’ll focus on the game
description (animated avatars: user and trainer) and on the
evaluation and adaptation of the user’s exercises. We consider
the profile of the users already set up. Both user and trainer are
represented on the screen using 3D avatars.
A. Component description
A study performed in the AAL Project Join-In [17]
concluded that although it is not perfect, the Microsoft Kinect
is the most suitable device for exergames for elderly. This is
also the best tool to capture the movements properly and thus
ensuring that exercises are performed correctly. Also it offers
all three types of information that is needed in such an
application: infrared video stream, depth stream, skeleton
tracking. The color video stream can be ignored due privacy
concerns, since there are voices that warn about the importance
of hiding unnecessary details such as clothes, face, and
environment. The coordinators of the joins (as in Fig. 1) are
provided by the Kinect One sensor, as described in [18].
Fig. 1. Skeleton joints [18].
PAT is described as three main components, as in Fig. 2: (i)
a component that is responsible with recording the set of the
reference exercises (Capture Reference Exercises); (ii) Set up
the user profile (for setting up user information: health status
and recommendation) (Set up User Profile), (iii) exergame
creator and interpretation (Exergame Manager) and (iv) Data
Repository.
Fig. 2. PAT description.
Capture Reference Exercises - We used the features of the
Unity 3D engine to record motion using the Kinect One sensor
and then display it on the screen using a 3D avatar. First of all,
we built a humanoid 3D avatar with a skeleton animation
(using Blender 3D) and imported it in the graphics engine.
For each exercise the kineto-therapist is recorded while
performing specific movements. After that, all unnecessary
details (face, colors, clothes, and environment) are ignored.
The video containing only the depersonalized kineto-therapist’s
silhouette become the model for the subjects.
For each exercise we’ll store (i) exercise name, (ii) exercise
description, (iii) exercise category, (iv) difficulty level, (v)
relevant joints for the exercise, (vi) repeating time. For
example – exercise rotation arms is recorded exercise
description: starting position: stand up straight, your feet
slightly apart and exercise routine – put your hands on the
shoulders and rotate simultaneous your elbows four times
forward and then four times backwards. All these information
will be stored into the Exercise Database from the Data
Repository. Each exercise will have an associated XML file
containing the joints coordinates. Based on the solution from
[19] numerical information regarding the coordinates of the
joints in each video frame are recorded in a XML file (Fig. 3).
These numbers can be used to determine the similarity between
real-time movements (performed by the user) and pre-recorded
movements (that will be performed by the avatar).
Fig. 3. XML file that records (for each frame) the coordinates of the most
important joints that will be considered in PAT
Set up User Profile will save into the Data Repository –
User Profile Database all information associated with each
user. All these data will be saved at the first time when an user
will start to play the game. He will fill in: his medical
information (what is his health status, what are
recommendations regarding the physical activity that he can
perform, for example he must make physical exercises with
arms, legs, trunk and the difficulty level that is accepted for his
profile). All these information will be set up through a
questionnaire in which the user must select one option.
The Exergame Manager is responsible with both animation
of the trainer avatar and both with the animation of the user
avatar. The trainer avatar is controlled through the exercises
recorded into the Exercise Database. The user avatar is updated
real time through the movements realized by the user. These
movements are captured through the skeleton provided by the
Kinect sensor and mapped to the avatar using the Unity
package - Kinect Wrapper Package for Unity3 [20]. These
information are updated through the Replay Exercise module.
Evaluate & Adapt Exercises module will adapt and collect
the user performance in order to make decision on the intensity
level of the game during the play. The objective is to encourage
people to stay physically active during the game play. The
adaptation component controls the game speed that can be
viewed as the speed of the trainer avatar which is the speed that
the user should maintain.
The Exergame Manager is described in more detail in Fig.
4. The user skeleton is acquired through Kinect sensor
(Skeleton Acquisition module). Then skeleton is processed
through Skeleton Processing module.
+
Fig. 4. Exergame Manager Component.
In order to compute similarities between user movements
and trainer movements we extract a set of features from the
skeleton provided by the Kinect sensor. All joints coordinates
provided by Kinect are relatively to the coordinate system
associated to Kinect (as in Fig. 5). The Kinect uses a cartesian
coordinate system centered at the Kinect. The positive Y axis
points up, the positive Z axis points where the Kinect is
pointing, and the positive X axis is to the left. In order to obtain
an invariant description of the exercises we’ll consider a
description of the skeleton based on angles between vectors
determined by the skeleton joints.
Fig. 5. Coordinate system associated with a Kinect.
We define multiple sets of vectors to cover the entire body
parts and to compute the angle for each of them. In this way,
we can capture and compare movements using a more natural
approach (for example, we would compare the angle between
the arm and the forearm or the shoulder and the arm). We use a
number of 21 vector sets as follows:
 Head – Spine Shoulder – Spine Mid
 Right Wrist - Right Elbow - Right Shoulder
 Right Elbow –Right Shoulder –Spine Shoulder
 Right Ankle –Right Knee -Right Hip
 Left Wrist –Left Elbow-Left Shoulder
 Left Elbow –Left Shoulder - Shoulder Center
 Left Ankle –Left Knee – Left Hip
 Right Hip –Spine Base –Right Knee
 Left Hip – Spine Base – Left Knee
 Right Wrist – Right Hand – Right Elbow
 Left Wrist – Left Hand – Left Elbow
 Right Ankle - Right Foot - Right Knee
 Left Ankle – Left Foot – Left Knee
 Spine Base-Spine Mid-Left Hip
 Spine Base-Spine Mid-Right Hip
 Spine Shoulder – Spine Mid – Spine Base
 Neck-Head - Spine-Shoulder
 Head-Right - Shoulder-Neck
 Head-Left - Shoulder-Neck
 Spine Shoulder - Neck-Spine Mid
The distance between user and trainer movements can be
calculated using DTW (Dynamic Time Warping) algorithm
because this technique aligns the gestures so that the most
appropriate postures are compared. Based on the results from
[19], DTW has good results for comparing two gestures. The
distance between two postures is computed based on
geometrical distance between similar joints in the postures.
User Character Control will map the user movements
through the user avatar that will be displayed on the user
interface on a computer. Angles computed by the Skeleton
Processing module are used to animate the user avatar. Also
the Trainer Character Control animates the trainer avatar
based on the description from the Exercise Database – the
current exercise associated to user.
Evaluation & Adaptation Module evaluates the movements
made by the user and updates the speed of the trainer. From
practice we observed that if the user makes exercises slower
than the trainer, the score will decrease in time, and the user
will be unmotivated to continue to make physical exercises.
Thus this module will compute a score for exercises that will
be displayed on the user interface. Also it will update the speed
of the trainer. The adapted speed will be sent to the Trainer
Character Control that will animate accordingly the trainer
avatar. For speed adaptation we consider each movement as a
function of angles varying in time. Thus the adaptation will
consist in computing the delay between two signals – that is
described in next section.
B. Trainer and user movements adaptation
Cross-correlation [21] is a common concept for calculating
signal analysis, and represents correlativity between the values
of two time series, as obtained at two different time points.
Namely, the cross correlation function describes the
correlativity between the values of stochastic signals as
obtained at two different time points t1 and t2.
In fact, one useful feature of this function is measuring the
value of τ where the function is at its absolute maximum. This
value represents a time delay between the two signals. This
concept is illustrated in Fig. 6, in which we have two signals:
one original signal and the other one created by delaying the
original signal by 0.1 seconds. Fig.7 shows their cross-
correlation function. The absolute maximum of the cross-
correlation function occurs at a value τ = -0.1 s, which agrees
with the time delay between the signals. Here the minus sign
indicates that there is a lag in time as opposed to a positive sign
which would represent a lead in time [22].
user. Each exercise is repeated for different times. In this case
we can observe that time t corresponds to the starting of a new
iteration of the compound movement.
We make the speed adaption for the trainer as presented below:
Input: αt, αu - angle variations in time for user and trainer, T =
repeating time of the exercise, lt, lu = length of αt, αu (in time)
Output: new speed of the trainer
-split αt into lt/T component signals (αui)
-for each αui component
compute c = correlation coefficient between α ui and αt from
current starting time
if 0.8 ≤ |c| ≤ 1 compute lag (from cross-correlation) based
on the current starting time
-compute a medium value for all computed lags = mlag
-return new speed = speed * (1/mlag)

Fig. 6. Two signals.

Fig. 7. Correlation of signals from Figure 6.

Thus the cross correlation function gives a judgment index Fig. 8. Angle variation.
of correlation between two signals in the frequency domain.
Also we can obtain a correlation coefficient that is merely a IV. EXPERIMENTAL RESULTS
ratio, with its meaning given in Table 1. The system is implemented using Unity 3D engine. A
screenshot of the game is presented in Fig. 9 (first one contains
TABLE I. CORRELATION COEFFICIENT a syncronised movement and the other one a movement with a
delay).
Values of correlation coefficient
Slight correlation 0.00–±0.30
Actual correlation ±0.30–±0.50
Significant correlation ±0.50–±0.80
High correlation ±0.80–±1.00

We consider the exercise of moving right arm in lateral: up

and down. The variation of the angle between Right Wrist –
Right Hand – Right Elbow for user and trainer is presented in
Fig. 8. We can see the user and the trainer are synchronized
until t = 70. After that there is a lag between trainer and the

Fig. 9. Screenshot of the game.
We consider a set of exercises given in Fig. 10. The game was
tested on 10 users (not elderly people – users simulate
different speed of exercises). We can see from the table above
that the results are much more stable and the system is much
more helpful for a basic trainee. We run the same exercises
with game adaptation, using the same persons and same
exercises. The obtained scores is increased for every exercise.
The score is computed using the euclidean distance applied on
angle variations of the user and trainer. From Fig. 11 it can be
seen that the user will make exercises for long time in case of
game adaptation. The time for making exercises by the user is
increased with approximately 43% in case of the speed
adaptation for the avatar trainer (as can see in Fig. 11).
Fig. 10. Score evaluation
Fig. 11. Time evaluation of playing game
V. CONCLUSIONS ANF FUTURE WORK
This papers presents a physical exercise game adapted to
the elderly people. The game is composed of two avatars: users
and trainer. A set of physical exercises are recorded as a
recomandatoin of a kineto-therapist. The user must make the
exercises based on the trainer avatar movements. The user
recives a score based on the similarity between his movements
and avatar movements – the similarity is computed based on
angles between the relevant joints for each exercise. Also the
speed of the trainer avatar is adapted to the user condition (in
this case the user condison is measured based on his
movements). This adaptation is obtained using the cross-
correlatoin for alignment of two signals. Based on experiments
we shown that using the adapted game people make physical
exercises for a long time.  
As future work, we’ll make the adaptation of the game also
based on the medical parameters of the user. Their medical
parameters would be measured using the Zephyr Bioharness
Belt [23]. Also we’ll display on the user’s avatar body parts
that are not in line with the trainer movements.
ACKNOWLEDGMENT
This research was supported by Executive Unit for
Financing Higher Education, Research and Development and
Innovation through Partnership Program, project “Mobility
pattern assistant for elderly people”, project number PN-II-PT-
PCCA-2013-4-2241.
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