Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 7:8:e50063.
doi: 10.2196/50063.

The Application of a Serious Game Framework to Design and Develop an Exergame for Patients With Heart Failure

Aseel Berglund  1 , Tiny Jaarsma  2 , Helena Orädd  1 , Johan Fallström  1 , Anna Strömberg  2   3 , Leonie Klompstra  2 , Erik Berglund  1
Affiliations

The Application of a Serious Game Framework to Design and Develop an Exergame for Patients With Heart Failure

Aseel Berglund et al. JMIR Form Res. .

Abstract

Reducing inactivity in patients with chronic disease is vital since it can decrease the risk of disease progression and mortality. Exergames are an innovative approach to becoming more physically active and positively affecting physical health outcomes. Serious games are designed for purposes beyond entertainment and exergames are serious games for physical activity. However, current commercial exergames might not optimally meet the needs of patients with special needs. Developing tailored exergames is challenging and requires an appropriate process. The primary goal of this viewpoint is to describe significant lessons learned from designing and developing an exergame for patients with chronic heart failure using the player-centered, iterative, interdisciplinary, and integrated (P-III) framework for serious games. Four of the framework's pillars were used in the design and development of a mobile exergame: player-centered design, iterative development of the game, interdisciplinary teamwork, and integration of play and serious content. The mobile exergame was developed iteratively in 7 iterations by an interdisciplinary team involving users and stakeholders in all iterations. Stakeholders played various roles during the development process, making the team stay focused on the needs of the patients and creating an exergame that catered to these needs. Evaluations were conducted during each iteration by both the team and users or patients according to the player-centered design pillar. Since the exergame was created for a smartphone, the assessments were conducted both on the development computer and on the intended platforms. This required continuous deployment of the exergame to the platforms and smartphones that support augmented reality. Our findings show that the serious game P-III framework needs to be modified in order to be used for the design and development of exergames. In this viewpoint, we propose an updated version of the P-III framework for exergame development including (1) a separate and thorough design of the physical activity and physical interaction, and (2) early and continuous deployment of the exergame on the intended platform to enable evaluations and everyday life testing.

Keywords: exergames; heart failure; human-computer interaction; mobile health apps; mobile phone; physical activity; player-centered design.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
The three phases of the iterative design and development of the serious game according to the P-III: player-centered, iterative, interdisciplinary, and integrated framework [27].
Figure 2
Figure 2
Heart Farming interdisciplinary team.
Figure 3
Figure 3
The Heart Farming exergame design and development process.
Figure 4
Figure 4
The final version of the Heart Farming exergame showcasing its interface and key features: (A) the main scene with buttons and information, (B) the main menu, (C) sell orders, (D) a mission book containing different missions, and (E) all available crops on the farm displayed and accessed by a field menu.
Figure 5
Figure 5
Low-fidelity prototypes were developed by the game designer and usability expert to illustrate and examine concepts and designs: (A) start menu, (B) main scene, (C) sell orders, and (D) sell card.
Figure 6
Figure 6
An updated version of the P-III framework established for the design and development of exergames.
See this image and copyright information in PMC

References

    1. Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U, Lancet Physical Activity Series Working Group Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012;380(9838):247–257. doi: 10.1016/S0140-6736(12)60646-1.S0140-6736(12)60646-1 - DOI - PubMed
    1. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, Chastin SF, Altenburg TM, Chinapaw MJ. Sedentary behavior research network (SBRN)—terminology consensus project process and outcome. Int J Behav Nutr Phys Act. 2017;14(1):75. doi: 10.1186/s12966-017-0525-8. https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-017-0525-8 10.1186/s12966-017-0525-8 - DOI - DOI - PMC - PubMed
    1. Sedentary Behaviour Research Network Letter to the editor: standardized use of the terms "sedentary" and "sedentary behaviours". Appl Physiol Nutr Metab. 2012;37(3):540–542. doi: 10.1139/h2012-024. https://cdnsciencepub.com/doi/abs/10.1139/h2012-024?url_ver=Z39.88-2003&... - DOI - DOI - PubMed
    1. Ekelund U, Tarp J, Steene-Johannessen J, Hansen BH, Jefferis B, Fagerland MW, Whincup P, Diaz KM, Hooker SP, Chernofsky A, Larson MG, Spartano N, Vasan RS, Dohrn I, Hagströmer M, Edwardson C, Yates T, Shiroma E, Anderssen SA, Lee I. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ. 2019;366:l4570. doi: 10.1136/bmj.l4570. http://www.bmj.com/lookup/pmidlookup?view=long&pmid=31434697 - DOI - PMC - PubMed
    1. Stamatakis E, Gale J, Bauman A, Ekelund U, Hamer M, Ding D. Sitting time, physical activity, and risk of mortality in adults. J Am Coll Cardiol. 2019;73(16):2062–2072. doi: 10.1016/j.jacc.2019.02.031. https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(19)33789-1 S0735-1097(19)33789-1 - DOI - PubMed