Archive for the ‘Games for health’ Category

Kata Project logo

Kata Project logo

Stroke. The word is enough to drive fear deep into the stoutest of hearts. They strike with little or no warning, and without rapid and adept medical attention, they can be fatal. For survivors, recovery is by no means certain: about half come through the experience permanently disabled—debilitated and dependent, cutoff from bodies they can no longer control. Every year, nearly 800,000 people in the United States fall victim to stroke’s crushing hammer, their lives often irreparably altered.

Sadly, the standard approach to stroke therapy offers little hope. It’s rooted in the science of centuries past, is driven by economics, and at best is often too little, too late. The current model—an hour each of speech, physical, and occupational therapies per session—is 150 years old, says Justin McArthur, director of the Department of Neurology at Johns Hopkins University, and “not adequate or up to today’s scientific knowledge.”

Dr. John Krakauer, professor of neurology and neuroscience at Hopkins, is less diplomatic. He has only one word for the contemporary state of stroke rehabilitation therapy: medieval.

If you have a stroke in the United States,” he says, “you’re better off if you’re a rodent than if you’re a human being.”

In his eyes, it’s high time for a revolution. And he knows just the dolphin to lead it.

Dr. Krakauer has a reputation for challenging the status quo—and ruffling not a few feathers in the process. He came to Johns Hopkins in 2010, and immediately began recruiting for a bleeding-edge stroke recovery research center, taking a wrecking ball to the traditional staffing model. Krakauer’s BLAM lab (brain, learning, animation, and movement) includes robotics and software engineers, an animator, a computer scientist, and, as consultants, an animal intelligence expert and the director of animal programs at the National Aquarium in Baltimore. Together, they form the brain powering BLAM lab’s Kata Project, whose mission is to create computer games for post-stroke rehab and neurological research. But the heart and soul of the project is a dolphin named Bandit.

Bandit’s no ordinary marine mammal: he’s a digital amalgam of three of the National Aquarium’s bottlenose dolphins, with a pinch of spinner dolphin for spice. The team spent countless hours studying the animals, distilled their research into the essence of dolphin-ness, translated that into digital form, and gave virtual birth to Bandit—a cybernetic dolphin that moves with the grace and fluidity of the real thing. A user (ideally, a post-stroke patient) controls Bandit on a screen, via movement of his or her arm placed in a robotic sling. For all intents and purposes, the player becomes Bandit. Omar Ahmad, director of the Kata Project, describes the effect as being “jacked into the creature.”

It’s visceral feedback; every subtle movement you do is reflected in the dolphin.”

But why go to all this trouble? Why create such a hyper-realistic, detailed virtual creature in the first place? Because movement—early and often—is key to recovering from a stroke, and taking on the role of a beautiful aquatic mammal is far more engaging and fun than anything conventional physical therapy has to offer. According to Krakauer, there’s no reason why the PT environment has to be bleak and depressing.

Why shouldn’t a hospital be more like a gaming arcade? Why can’t it be a place where you want to explore and play?”

He makes a valid point, but the idea of using games for therapy is not exactly groundbreaking. Physicians and therapists have turned to the Nintendo Wii to aid in stroke recovery for years. Others, like Yale University’s Dr. Adam Noah, have noted the ability of Dance Dance Revolution and other so-called exergames to reduce symptoms of Parkinson’s disease (and they may even help repair damaged areas of the brain). And senior centers and assisted living facilities often have the Wii on hand so that residents can get up and moving, and stay active with something that’s both enjoyable and accessible (I’ve covered this in previous blog posts, as well as in my book, Virtual Ascendance: Video Games and the Remaking of Reality).

What’s new with Krakauer’s team is their intent, their focus. Bandit is the first virtual creature designed to help stroke patients get better (of course, he’ll have many other uses, but that’s his original purpose). And the BLAM lab is the first medical research facility dedicated to the idea of creating computer and video games specifically for physical therapy (as opposed to adapting off-the-shelf games to the task).

But more than that, it’s Bandit himself. He is delightful and engaging, and he responds so intuitively to the motions of the person controlling him that it effectively erases the line between player and object: you become him, and you can’t help but get caught up in his gracefulness, his antics, and his sheer joy at simply being alive. Stroke rehabilitation can be a lonely and forbidding process. For those setting out on this journey, slipping into Bandit’s skin and moving through his watery world—creating a deeply emotional connection to a creature whose every movement is the paragon of grace—may be the beacon guiding them down the long, hard road to recovery.

You can read more about Dr. Krakauer’s research in the National Geographic article here.

To watch a video of Bandit in action, check out this link.

You can learn more about the Kata Project here.

Krakauer’s team is also developing an iOS game based on Bandit called I Am Dolphin. You can read about it here.

And there are two more articles about video games and stroke therapy here

… and here.

 

 

Lara CroftFor a few years now, I’ve been raving about Crystal Dynamics’ reboot of Tomb Raider and their reimagining of its protagonist, Lara Croft, from a scantily clad, hypersexualized, adolescent male fantasy to a more realistic, appropriately dressed and anatomically restrained, tough, gritty survivor (see my earlier post here). I applauded their depiction of her as an imperfect woman forced by circumstance to make difficult choices and carry out some fairly gruesome acts in order to stay alive and save her friends. Lara’s not proud of what she does, nor does she take pleasure in it. She does it because she has to, because her only other option is to give up.

That both gamers and critics praised Tomb Raider came as no surprise. At long last, the franchise had a game that looked stunning, played beautifully, and featured a tough, intelligent heroine that both men and women cared about and could believe in. Here, at last, was the Lara Croft we’d all been waiting for.

And now, Crystal Dynamics has done it again. At Microsoft’s E3 press conference this past Monday, they revealed a teaser trailer for Rise of the Tomb Raider, slated for a late 2015 release. The trailer features all the energy and excitement of the first game, including a few very tense moments of Lara in peril—no surprise there. But it features something else, something unprecedented in the history of gaming.

Rise of the Tomb RaiderThe video begins, not with Lara escaping death or brutally overcoming an attacker, but with her in therapy. You read that right: therapy. We see her on the edge of a chair, cloaked in a hoodie, head downcast. As the therapist talks, Lara digs her fingers into the upholstery, clenches her fist, bounces her leg. She can’t sit still. She’s clearly anxious and uncomfortable. This is not the bulletproof heroine we’ve come to expect, casually shaking off the death she’s dealt. Lara has experienced horrors the likes of which most of us can’t imagine, and she’s been deeply affected by them. But neither is she a broken woman. Battered and scarred yet alive, she’s found away to exist in between. Her therapist continues:

For many people, these traumas become a mental trap. They get stuck, like a ship frozen in ice.”

Lara HoodiePTSD. That’s what he’s talking about. This is classic Post-Traumatic Stress Disorder. Lara is suffering from something that affects nearly eight million American adults, that’s all too common among veterans of war and survivors of abuse, that can strike at any age, and that can tear families and communities apart. She has PTSD, and she’s dealing with it. That a video game is so directly dealing with this is extraordinary. And that Lara is working through and recovering from the trauma of her ordeal may provide hope to those facing traumas of their own. I’ll leave you with the experience of a young woman suffering from PTSD who, while playing Tomb Raider, discovered just that:

It didn’t hold any punches, but it didn’t need to… it affected me in a way years of therapy never did. It healed me in a way that no one’s physical comfort, words, and condolences could ever do. It made me realize that, much like Lara Croft, I survived as well—and that I had my own path to walk. That my experiences were real and tangible and yes, they defined me, but that I’d have it no other way. I am a survivor and I am alive.”

After years of buried trauma and hidden pain, this young woman had found solace and salvation by her own hand, through Lara Croft and the game. By reimagining Lara, Crystal Dynamics has done the impossible: from a game heroine, they’ve created a human being.

drwietimg_4481In 1999, the Institute of Medicine published a study that concluded the following: medical errors in the US cost the lives of as many as 98,000 people each year (and run up a $17- $29 billion bill to boot). Ten years later, the Safe Patient Project reported that, rather than showing improvement, in the intervening decade the situation may have actually gotten worse—to the tune of more than 100,000 deaths each year as a result of “preventable medical harm.” Given that the CDC puts the number of deaths from hospital infections alone at around 99,000 annually, the SPP’s number seems conservative.

Let me put this into perspective. A Boeing 737—the most popular aircraft family in service today—seats 360 people, give or take. So consider this: the Safe Patient Project’s estimate of preventable fatalities is akin to 277 airliners plummeting to Earth and killing everyone on board—every year. How long do you think the FAA—or the public, for that matter—would stand for that?

Fortunately there’s a solution: video games.

Being a videogamer doesn’t get a lot of respect in a lot of mainstream professions, but it has been instrumental to me in becoming a surgeon.”

red_dragon

Red Dragon simulator, ISIS

That’s Dr. Andy Wright, surgeon and core faculty member at the University of Washington’s Institute for Simulation and Interprofessional Studies (ISIS). The Institute’s goal is to use technology to improve the quality of healthcare education, patient safety, and surgical outcomes. Simulations are particularly effective as they allow trainees to easily repeat procedures until they’re successful, and provide a safe place for them to fail when they’re not. In Dr. Wright’s experience, the skill and manual dexterity necessary to play video games proficiently translate directly to surgical simulators—resulting in more effective training and fewer accidents in the OR.

Gamers have a higher level of executive function. They have the ability to process information and make decisions quickly, they have to remember cues to what’s going around [them] and [they] have to make split-second decisions.”

Accomplished gamers show heightened abilities to focus on critical elements while maintaining peripheral awareness of the surrounding environment, function amidst distraction, and effectively improvise if a situation doesn’t go according to plan. Past studies have repeatedly demonstrated this, and it makes sense: effectively navigating through and surviving a video game’s virtual world demands it. There are other characteristics of video games that make them particularly well-suited to prepare surgeons for the operating room: you interact with the game’s world through a video screen, and you have to be adept at manipulating images and items with a handheld controller. These skills are especially useful in the areas of laparoscopic (see my previous post here) and robot-assisted surgery.

da Vinci Surgical System

da Vinci Surgical System

Take da Vinci, for example. It’s a robotic surgical system that allows surgeons to perform delicate, complex procedures through tiny incisions. The da Vinci system combines 3D, high definition video with four interactive robot arms (there’s even a dual-console option where trainees can watch an actual procedure, and a switching mechanism that allows surgeons and trainees to exchange control during an operation). Surgeons manipulate these arms using precision controllers that scale the speed and range of their movements down to the much smaller size of the surgical instruments, allowing for unparalleled accuracy. Put simply, the most advanced robotic surgical system in the world employs an interface intimately familiar to video gamers.

Take gaming into the land of simulation, though, and you can start tapping into the medium’s real power. Virtual reality (VR) simulators are an effective means of getting fledgling surgeons comfortable with a variety of procedures, allowing them to perform a given surgery dozens of times before ever opening up a live patient. They also provide an environment in which surgeons can, in essence, fail safely. Within a simulation, they can develop critical skills and expertise without putting anyone at risk, experimenting with different techniques, learning what does—and doesn’t—work, and becoming safer and more effective. A 2002 Yale University study provided strong evidence for this: surgical residents trained in VR were 29 percent faster and six times less likely to make mistakes than their non-VR trained colleagues.

virtual_surgery-chirurgie_virtuelle_1You can also customize a simulation to closely reflect reality, matching the conditions and characteristics of actual patients. In 2009, Halifax neurosurgeon Dr. David Clarke made history when he became the first person to remove a brain tumor in a patient less than 24 hours after removing the same tumor virtually, on a 3D rendering of that same patient. Two years later, doctors in Mumbai performed PSI knee replacement surgery on a patient after first running the operation virtually on an exact 3D replica of the patient’s knee.

Earlier this year, VR training took another leap forward: using the online virtual world Second Life, London’s St. Mary’s Hospital developed three VR environments—a standard hospital ward, an intensive care unit, and an emergency room—and built modules for three common scenarios (at three levels of complexity, for interns, junior residents, and senior residents) within them. According to Dr. Rajesh Aggarwal, a National Institute for Health Research (NIHR) clinician scientist in surgery at St. Mary’s Imperial College,

The way we learn in residency currently has been called ‘training by chance,’ because you don’t know what is coming through the door next. What we are doing is taking the chance encounters out of the way residents learn and forming a structured approach to training. What we want to do—using this simulation platform—is to bring all the junior residents and senior residents up to the level of the attending surgeon, so that the time is shortened in terms of their learning curve in learning how to look after surgical patients.”

After running interns and junior and senior residents through the VR training, researchers compared their performances of specific procedures against those of attending surgeons. They found substantial performance gaps between interns, residents, and attendings—validating the VR scenarios as training tools. As Dr. Aggarwal explained,

What we have shown scientifically is that these three simulated scenarios at the three different levels are appropriate for the assessment of interns, junior residents, and senior residents and their management of these cases.”

In the future, the team at St. Mary’s plans to study how this type of VR training can improve clinical outcomes of patients treated by residents—ultimately using this tool to bring their interns’ and residents’ skills up to the level of the attendings, help them better manage clinical patients, and, at the end of the day save lives.

surgery-2-300x200What can surgeons do for six minutes that enhances performance, reduces errors, and improves patient outcomes?

Play video games.

As unlikely as it sounds, specialists in laparoscopic surgery are finding that they can improve their results in less time than it takes to boil water, simply by picking up a controller and getting their game on. I can hear the protests already. Video games are a scourge, a blight. They’re incubators of violence, and responsible for the downfall of modern society. They can’t possibly offer anything positive.

Actually, they can. Laparoscopic surgery is minimally invasive and very small-scale: surgeons insert a tiny video camera and set of miniature surgical instruments into a patient and use video game-style controllers—like joysticks and d-pads—to manipulate these tools from outside the body. This requires precise hand-eye coordination, keen depth perception, and a high level of manual dexterity—the exact skills needed to excel at video gaming, and which games are uniquely suited to develop. According to Dr. James C. Rosser, a laparoscopic surgeon at Florida’s Celebration Health hospital,

I use the same hand-eye coordination to play video games as I use for surgery… I could come in, sit down, and put this [the surgical tool controller] in my hand and not find it foreign to look on that screen and do something with my hands.”

Dr. RosserDr. Rosser proved this in 2002, while practicing at Beth Israel Medical Center. He had 33 surgeons participate in a three-month study that involved, among other activities, playing a series of video games before simulating laparoscopic surgery. About half of the participants had a history of game play, though all of them played throughout the study. Researchers compared the results between participants, as well as against non-gaming colleagues. Across the board, they found that surgeons who played video games were faster and more accurate than those who didn’t—dramatically so: at the low end of the skill spectrum, gaming docs made a third fewer errors and were a quarter faster than their non-playing counterparts. Among participants, the most skilled surgeon gamers were nearly half again as accurate and more than a third faster than those at the bottom of the heap. Further, after controlling for extent of training and number of cases completed, the best predictors of surgical success were video game skill and amount of past gaming experience. Said surgeon and participant Asaf Yalif,

We were surprised and actually awed by the fact that your video game skill, meaning how well you play, as well as the number of hours you have spent on video games were very highly correlating — meaning if you do this well you will be less error-prone, you will be faster and you will perform better at laparoscopic surgery.”

Dr. Rosser recently conducted a follow-up at Celebration Health hospital with 300 laparoscopic surgeons, half playing a video game just prior to scrubbing in. The results? A six-minute video game warm-up resulted in more effective performance and better patient outcomes.

Another study at the University of Rome, Italy, published this past February in the journal PLOS ONE, provides further evidence of gaming’s impact on laparoscopy. Researchers gathered 42 post graduate students in general, vascular and endoscopic surgery, and split them into two groups. Both groups received standard training, but one group also trained on the Nintendo Wii. After four weeks, the Wii group showed significant performance improvement in several areas, including economy of instrument movements and efficient cautery. The authors’ conclusions? The Wii could be a valuable tool for laparoscopic training, and an effective, inexpensive, and entertaining means of enhancing standard surgical education.

Surgeons can’t operate on live patients every day. It’s a numbers game: there just aren’t enough people who need surgery to go around. Other means of honing surgical skills—such as simulators—are therefore critical. The catch is that typical medical simulators run into the hundreds of thousands of dollars—an expense that can be hard for many hospitals to swallow. A game console—like the Wii, Xbox, or Playstation—costs a fraction of that, and provides a viable and effective way to keep surgeons sharp.

Consider this: According to both the Institute of Medicine and the Safe Patient Project, medical errors in the United States run up between 17 and 29 billion dollars in hospital expenses, and result in around 100,000 deaths each year. If video games can reduce even a fraction of these, then perhaps it’s time to get our surgeons playing.

You can find Dr. Rosser’s JAMA Surgery article here.

The New York Times has a piece about Dr. Rosser here.

And you can learn more about Dr. Rosser’s recent work here.

For information about the study at the University of Rome, check the link to PLOS ONE

… and the write-up in Science Daily.

 

It’s official: summer vacation’s ended, taking with it the days of unscheduled freedom and marking a return to the sharp contrast between weekday and weekend—something that I, as a self-employed writer, don’t experience as keenly when my son’s not in school. As such, I thought it appropriate that I bring my long blogging hiatus to a close and get back to business (plus, people were beginning to wonder what happened to me, and I couldn’t give them a good answer).

Hand-in-hand with this, I decided to pick up my exercise routine where I’d left it languishing about two months ago, so I woke up early this morning, threw on some sweats, and got to it. My trainer seemed happy that I was back, and didn’t even lay the “nice-to-see-your-lazy-butt-again, didn’t-know-you-still-lived-around-here” guilt trip on me. He ran me through a full workout—cardio, strength training, upper and lower body, core. I did 35 exercises (including eight stretches) in just under 48 minutes, averaged a heart rate of 136 bpm, and burned 223.9 calories.

And I did it all by playing a videogame.

Okay, an exergame, really. Electronic Arts’ Sports Active 2, to be exact. And I can tell you, though it’s a game by classification, it’s serious exercise by any other measure. Designed by both game developers and certified professional trainers, it includes more than 70 different exercises and fitness activities that target all the major muscle groups—core, upper and lower body—and cover everything from flexibility and strength training to cardio and aerobic health. You can pick from several canned workouts (designed, again, by professional trainers), have EASA 2 create a custom workout based on the amount of time you have and what area you want to work, or build your own to meet your specific needs. And the system tracks everything: heart rate (there’s a monitor included in the package), calories burned, miles traveled, reps, number and duration of workouts, lifestyle and nutrition info (through surveys you can fill out). There’s even a virtual personal trainer (two, actually) to guide you through the exercises and help keep you motivated.

“Alright,” you say, with perhaps a degree of skepticism, “but does it really work?” In a word, yes. For those who prefer a longer answer, it ranges from “provides an excellent workout” to “kicks my ass six ways to Sunday.” And I love it. I’ve lowered my resting heart rate, gotten stronger and more physically fit, gained energy, and even rehabbed an injury to my arm—and, heaven forefend, I’ve had fun doing it. The variety keeps me engaged, and the results keep me coming back for more.

As a country, we all need to exercise more. According to the CDC, almost 36 percent of US adults and 17 percent of our children are obese. Obesity currently costs us around $140 billion a year, and it’s rising: by some estimates, additional healthcare spending on obese Americans could reach more than half a trillion dollars over the next 20 years. If you’re still standing, you might want to read that again. I don’t know about you, but I can’t even conceive of that amount. But I do know this: it’s absolutely critical that we reverse this trend. Our physical and economic survival depends on it—and getting us off the couch and moving is a good place to start.

And if videogames can do that, maybe they’ll save us after all.

For more on EA Sports Active 2, check out their website here (though be advised that it’s an older title, so you may be better off just Googling it).

To check out the CDC’s statistics on obesity, click here.

And here’s an LA Times article on obesity in the US.

When you’re talking about pain, nothing comes close to the excruciating intensity of burning alive. Survivors of severe burns report trying anything—anything—to stop the pain, sometimes resigning themselves to death and hoping they won’t be on fire much longer before the end.

And that’s just during the event. Those who are lucky enough to live through the experience have another nightmare to look forward to: recovery. Burn wounds are especially susceptible to infection, and have to be cleaned daily. For the victim, this amounts to reliving the torture of being burned over and over again. The pain is nearly as severe, and the drugs to alleviate it are woefully inadequate. Morphine and other opioids are effective when patients are resting, but during treatment, they just don’t cut it: invented to relieve pain in 1804, morphine hasn’t changed since. For all intents and purposes, pain management’s been stuck in the 19th century.

Until recently, that is. Beginning in late 2006, caregivers received a new tool for fighting pain, one that doesn’t require a prescription and has no risk of dependency. It’s a videogame called SnowWorld, and it’s the first immersive virtual world designed specifically for reducing pain.

The environment of SnowWorld is as far from hot as you can get: icy, snow-covered, and populated with penguins, snowmen, and woolly mammoths. Patients undergoing treatment for severe burns don a VR headset or look through a pair of goggles, and find themselves transported into this world where they can run around and toss snowballs at the inhabitants for as long as the PT session lasts. And, believe it or not, it gets results. Says University of Washington researcher Hunter Hoffman, who worked with combat veterans from Iraq and Afghanistan,

What was encouraging was the ones that needed it the most showed the most pain reduction, so the patients that were in the most pain showed the most pain reduction from SnowWorld.”

The idea behind SnowWorld predates the game by a decade. It’s called immersive VR distraction, and it was co-developed in 1996 by Hoffman and Dr. David Patterson, head of the Division of Psychology of the University of Washington’s Department of Rehabilitation Medicine. Dr. Patterson also works with patients at the university’s Harborview Burn Center, studying psychological techniques for reducing severe burn pain. According to Patterson, the concept is simple:

It takes a certain amount of attention to process pain. If you are able to put that attention elsewhere, there is less attention to process pain, and consequently, people will feel less pain.”

This is born out not only in interviews with patients, who universally report drastic pain reduction, but in MRI scans that clearly show less activity in the brain’s pain centers when physical rehab is combined with immersion into SnowWorld.

GQ Magazine just reported the case of First Lieutenant Sam Brown, horribly burned after his Humvee rolled over an IED in Iraq. His full story is here, but some of the descriptions are a bit gruesome, so those of a more delicate constitution might want to read the NPR story here.

Sergeant Oscar Libretto experienced a similar event in 2009, and you can find his story here.

These are only two of the hundreds of veterans from Iraq and Afghanistan who’ve returned after surviving one of the most horrific experiences a human being can endure. But survival is only the beginning of their struggle. Wound care and rehab is taxing and painful, both physically and mentally—on the servicemen and women, the caregivers, and their families. For all of them, the immersive distraction of videogames like SnowWorld is a nothing less than a godsend, improving recovery, providing relief from unimaginable suffering, and offering a glimpse—however fleeting—of a future beyond pain.

To learn more about the Harborview Burn Center, click here.

You can read about immersive VR for pain control here.

And you can watch a video of SnowWorld in action here.

This morning, I woke up, put on sweats and a T-shirt, and got my ass moving. I ran, practiced my soccer skills, got on the skateboard, did some dedicated strength training, cardio, and stretching, even set up with a sparring partner and worked on jabs, hooks and uppercuts—all in the space of about 30 minutes, and all in the comfort of home.

How is this possible, you ask? Do I have an athletic facility in the basement, complete with my own personal trainer? No… well, not exactly. What I’ve got is a Wii and Electronic Arts’ most advanced exergame, EA Sports Active 2, which transforms the humble gaming console into a state-of-the-art fitness machine—and it comes with not one but two personal trainers dedicated to the sole purpose of keeping me healthy.

The beauty of EASA 2 comes from two factors: the variety of available exercises and the flexibility to combine them into a virtually limitless array of workout routines. You can target upper body, lower body, strength, balance, coordination, aerobics, your legs, your core… it was actually a bit overwhelming, at first. So I had my personal trainer create a workout for me. EASA 2 asked me a few simple questions—how long did I want to exercise, at what intensity, and what did I want to focus on (I chose a general workout for strength and conditioning)—and a few clicks of the Wiimote later I was ready to roll.

And I loved it. EASA 2’s environment is visually engaging and transforms with each exercise (sometimes, as with running, even while you’re exercising). The exercises are fun to do, they got me working hard, and they change frequently enough to keep things interesting—thus avoiding the often mind-numbing repetition that causes people to abandon many traditional workout programs. Your trainer is always there, helping you through your workout and providing encouragement and motivation. And most importantly, you’re there as well—in the form of an avatar that you create as part of your personal profile. This is powerful: Not only do you see yourself performing the exercises, you get immediate visual feedback as to how well you’re doing. I identified with my avatar, and really wanted it to succeed—and often pushed myself a little harder—running faster than my trainer, timing jumps better or trying to jump higher—to ensure that it did.

But is it as good as real exercise? No. It is real exercise—as real as any of the glut of exercise videos on the market today (if not more so). EASA 2 goes far beyond what any video can offer, though. Consider this: an exercise video is static. It’s always the same length, looks the same each time you watch it, you perform the same exercises in the same order for the same duration… in a word, boring. EASA 2 provides a degree of variety and gives you a level of customization beyond even the best video’s wildest aspirations. You can create and revisit favorite routines as often as you like, or you can go through an entirely different routine every time you workout. The choice is yours—but as with any form of exercise, what you get out of it depends entirely on what you put in. I can tell you this: I gave each exercise everything I had, and by the end I’d done some serious work.

Now let’s see how I feel tomorrow…

To learn more about EASA 2, navigate over to EA’s website here.