Table 3.

Summary of intervention characteristics.

Study	Intervention	Type	Platform or technology used	Game elements	Tailoring	Integration with health care
Tabak et al [8], 2014	Condition Coach COPD telehealth program	Motivational cues	Wearable device, smartphone app, and web-based portal	Motivational cues and daily feedback	Exercise schemes tailored by physiotherapists	Integrated with primary and secondary care; health care professionals monitored progress
Mazzoleni et al [14], 2014	Exergaming with Nintendo Wii	Exergames using Nintendo Wii Fit Plus	Nintendo Wii and Wii Balance Board	Real-time feedback and visual and auditory cues	Exercise intensity adjusted by physiotherapist	Supervised by health care professionals
Kotrach et al [15], 2015	Virtual game system for home exercise	Exergames using Nintendo Wii Fit U	Nintendo Wii Fit U	11 prevalidated games, with real-time feedback on performance	Individualized training sessions based on patient needs	Monitored by physiotherapists during in-hospital and home training
Hoaas et al [12], 2016	Telerehabilitation program	Telerehabilitation via self-management and telemonitoring	Treadmill, pulse oximeter, and iPad with a web page for telemonitoring	Regular feedback and remote support	Individually tailored exercise program	Weekly videoconferencing sessions with a physiotherapist
LeGear et al [16], 2016	Nintendo Wii-based exercise	Exergame using EA Sports Active on Nintendo Wii	Nintendo Wii with SenseWear Armband	Physical activities, including marching, dancing, and punching	Exercise intensity adjusted based on perceived exertion	NRa
Liu et al [17], 2016	GRAILb	NR; focus on GRAIL technology and 6MWTc	GRAIL, 3D motion capture, and VRd treadmill	VR environment used to simulate walking conditions	Not personalized beyond adjusting walking pace	NR
Bamidis et al [18], 2017	SmokeFreeBrain	Smoking cessation intervention using gamified apps, mini-games, and social media	Gamification app, neurofeedback, social media, mobile SMS text messaging, and pharmacological interventions	Tasks, goals, achievements (eg, “Crushing cigarettes” game, breathing control, and exercise gamification)	Interventions customized by demographic and geographic needs	Public health campaigns, electronic health records, and open data integration
Burkow et al [19], 2018	Virtual group intervention for behavior change	Virtual group exercise with follow-along videos and exercise diaries	Tablet-based app	Virtual group status, rewards, and exercise diary	Self-chosen individual exercises	Peer group exercises combined with remote support
De Las Heras et al [20], 2018	ARe glasses	Use of AR glasses	Laster WAVƎ AR glasses	Visual and audio guidance during exercises	Adjustable brightness, head fixation, and interface improvements	Remote communication and feedback
Parent et al [21], 2018	High-intensity active video game	High-intensity exergames	Kinect motion capture (Xbox One) and Shape Up game	Repetitive exercise mini-games	Adjustments to exercise difficulty	NR
Rutkowski et al [22], 2019	VR training program	Virtual rehabilitation using Kinect-based motion training	Xbox 360 Kinect system and Kinect Adventures! game	Avatar-based mini-games involving rafting, ball hitting, and roller coaster riding	VR exercises tailored for each patient	Integrated into a structured pulmonary rehabilitation program
Sutanto et al [23], 2019	Videogame-assisted exercise training	Wii Fit–based exercise training	Wii Fit balance board and television system	Yoga, strength training, aerobic exercises, feedback system, and virtual trainer	Individualized program with game duration, difficulty, and scores recorded	Integrated into a hospital-based outpatient exercise program
Jung et al [13], 2020	VR pulmonary rehabilitation program	VR-supported pulmonary rehabilitation	VR headset (Pico Goblin) and pulmonary rehabilitation in VR app	3D avatars, educational modules, and immersive experience	Exercises tailored to severity level (MRCf breathlessness scale level 4 or 5) of patient with COPDg	Real-time remote monitoring of heart rate and oxygen saturation
Rutkowski et al [11], 2020	VR rehabilitation for COPD	VR-based rehabilitation using Xbox Kinect and Kinect Adventures! software	Xbox 360, Kinect, and Kinect Adventures!	Mini-games involving rafting, ball hitting, dynamic balance, and coordination	Exercises adapted to patients’ abilities	Supervised by physiotherapists; heart rate monitored
Tu et al [24], 2020	BreathCoach	VR-assisted biofeedback breathing training using RSA-BTh	Smartphone, smartwatch (Empatica E4), and VR viewer (Google Cardboard)	Breathing control, interactive VR environments, avatars, and real-time biofeedback	Dynamic adjustment of breathing patterns based on real-time physiological data	NR
Rutkowski et al [9], 2021	Immersive VR therapy	Immersive VR therapy	VR TierOne device	Virtual therapeutic garden and metaphoric health recovery	Emotional balance recovery and mood improvement	Supervised by therapists
Simmich et al [25], 2021	Wearable technology and video games	AVGsi	Wearable activity trackers, smartphones, and AVGs such as Wii and Xbox Kinect	AVGs and wearable trackers	NR	Data shared with clinicians for feedback and improved clinical care
Simmich et al [26], 2021	AVG for physical activity	AVG focusing on physical activities	Smartphone app with Fitbit integration	Single-player and multiplayer modes, progress tracking, and rewards for completing exercises	Players selected difficulty levels for each exercise	Clinicians monitored progress via a web interface
Baxter et al [27], 2022	Virtual respiratory therapy	Virtual incentive spirometry via smartphone app	QUT Inspire app and smartphone	Visual rewards, breath timer, and inspiration counter	Adjustable microphone sensitivity and text or video instructions	NR
Oberschmidt et al [28], 2022	Exergame for COPD treatment	Exergame used as part of physiotherapy treatment	Television screen with motion-sensing camera	Audiovisual feedback during exercises and score tracking	Feedback based on exercise accuracy and adjustable difficulty levels	Integrated into routine physiotherapy treatment
Finkelstein et al [29], 2023	VR app for pulmonary rehabilitation	VR educational app	Oculus Quest 2	Interactive educational modules, MCQsj, and visual feedback	Simplified user interface with preset controls for ease of use	NR
Gabriel et al [30], 2023	VR-based system for pulmonary rehabilitation	VR-based system for pulmonary rehabilitation	Oculus Quest 2	Educational modules, MCQs, and guided exercises	Simplified interface, single-button navigation, and custom instructions	NR
Gabriel et al [31], 2023	VR-based system for pulmonary rehabilitation	VR-based exercise app for pulmonary rehabilitation	VR headset and controllers	Interactive guided exercises and visual feedback	Simplified controls and visual guidance for exercises	Focused on self-management
Pancini et al [32], 2023	Overcoming COPD	VR-based relaxation combined with savoring strategies	VR headset with immersive natural scenarios	Narrated virtual walks, visual and audio feedback, and positive emotion amplification	Personalized savoring exercises	Incorporated into standard pulmonary rehabilitation
Pardos et al [33], 2023	Remote monitoring and gamification platform	Personalized coaching with exergames and mental health games	Smartphone app, smartwatches, and Bluetooth-enabled devices	Credit-based system, scores, rewards, and health recommendations	Customized recommendations	Integration with PHRk and third-party apps
Colombo et al [34], 2024	VR endurance training	Semi-immersive VR cycling in a virtual park environment	Cycle ergometer, pulse oximeter, and wide screen projection	Visual feedback, real-time cycling metrics, and first-person navigation	Exercise intensity based on baseline conditions	Continuous supervision by physiotherapists
Jin et al [35], 2024	Somatosensory interactive game	Somatosensory interactive games involving arm movements for exercise	Motion-based games: Kitchen Sharp Knife, Swimming Master, and Table Tennis Master	Real-time visual feedback and engaging tasks	Patients adjusted exercise based on comfort level	Integrated with physiotherapist-supervised pulmonary rehabilitation programs
Kizmaz et al [36], 2024	VR for COPD exacerbation	VR cycling simulation in the forest combined with pulmonary rehabilitation	Oculus Quest 2	Immersive cycling simulation in a forest environment	NR	Integrated with pulmonary rehabilitation sessions, supervised by physiotherapists
McAnirlin et al [10], 2024	Nature-based VR experiences	Nature-based VR experiences	Oculus Quest 2	Cocreated 360-degree videos of personalized, nature-based scenes	Personalized VR based on participants’ outdoor memories	NR

^aNR: not reported.

^bGRAIL: Gait Real-time Analysis Interactive Lab.

^c6MWT: 6-minute walk test.

^dVR: virtual reality.

^eAR: augmented reality.

^fMRC: Medical Research Council.

^gCOPD: chronic obstructive pulmonary disease.

^hRSA-BT: respiratory sinus arrhythmia biofeedback-based breathing training.

ⁱAVG: active video game.

^jMCQ: multiple-choice question.

^kPHR: personal health record.