Table 4.
Effectiveness of gamified chronic obstructive pulmonary disease (COPD) interventions.
| Study | Effectiveness results | Behavioral outcomes | QoLa improvements |
| Tabak et al [8], 2014 | Exacerbations: telehealth group=33 (median 2.0, IQR 1.0-3.0); hospitalizations: telehealth group=4 (median 5.5, IQR 4.8-6.3) d, CGb=5 (median 7.0, IQR 6.0-7.0) d; QoL (EQ-5D VASc): telehealth group=72.3, CG=62.4; no statistically significant difference in clinical outcomes between groups | Improved self-management of exacerbations (86.4% diary adherence) | EQ-5D VAS score: telehealth group—from 64.7 (baseline) to 72.3 (3 mo); CG—from 65.0 (baseline) to 62.4 (3 mo); CCQd score: telehealth group—from 2.0 (baseline) to 1.8 (3 mo) |
| Mazzoleni et al [14], 2014 | 6MWTe: EGf=+97.4 m, CG=+61.1 m (P=.03); TDIg score: EG=3.9, CG=2.2 (P<.001); SGRQh score: EG=−10.8, CG=−12.7 (P=.66); significant improvement in 6MWT and dyspnea for EG compared to CG | Improved patient motivation and engagement in EG | SGRQ score improved |
| Kotrach et al [15], 2015 | Exercise tolerance (6MWDi), heart rate, and oxygen saturation monitored; mean 6MWD was 306 (SD 81) m at baseline; preliminary results showed that participants could maintain exercise training after PRj using VGSk | Dyspnea and leg discomfort increased, indicating exertion during exercise | Not reported in the preliminary findings |
| Hoaas et al [12], 2016 | Average adherence: 43.3% for daily diary, 56.2% for exercise training; no dropouts; long-term adherence despite motivational challenges | Participants reported better self-management and coping with COPD | Reported improved health and increased capacity for daily activities |
| LeGear et al [16], 2016 | Energy expenditure: Wii group (mean 353.5, SD 134.1 J) vs treadmill group (mean 317.1, SD 105.2 J), mean difference 36.3 J (95% CI 31.4 to 104); heart rate: Wii group (mean 112.5, SD 13.2 bpm) vs treadmill group (mean 112.7, SD 10.2 bpm), mean difference −0.167 (95% CI −4.83 to 4.50); no significant difference in energy expenditure, heart rate, or perceived exertion between Wii and treadmill groups | Participants reported enjoyment and perceived feasibility of Wii exercises at home | Not specifically reported in this study |
| Liu et al [17], 2016 | Patients with COPD walked 27.5 m less on GRAILl vs overground 6MWT (P<.001); healthy older adults walked 23.6 m more on GRAIL (P<.001); GRAIL showed good reproducibility for both groups: ICCm of 0.80 for patients with COPD (95% CI 0.61 to 0.89) and 0.65 for healthy older adults (95% CI 0.05 to 0.86) | Improved reproducibility and patient engagement with virtual environment for patients with COPD | No QoL data reported |
| Bamidis et al [18], 2017 | Efficacy of PSAsn, e-cigarette interventions, and neurofeedback protocols; expected positive impacts on reducing smoking among groups considered high risk | Increased adherence to smoking cessation interventions using gamification and ICTo | Expected improvements in smoking-related morbidity and mortality rates |
| Burkow et al [19], 2018 | Increase in physical activity from 2.9 to 5.9 sessions per wk during the program; 77% adherence to group exercises | Positive impact on motivation to engage in physical activity | Improved well-being and mood reported |
| De Las Heras et al [20], 2018 | Positive perception of ARp glasses, particularly ease of use and exercise guidance; patients saw value in the AR glasses for telerehabilitation, although some found them heavy | Motivation to use AR glasses for physical exercise and rehabilitation | NRq |
| Parent et al [21], 2018 | Peak minute ventilation (36.8 L/min in squatting game) and peak METsr (4.4 in squatting game); high-intensity games met exercise guidelines; Borg scores for leg exertion (13-14) | High perceived enjoyment and willingness to engage in home-based rehabilitation | QoL not directly measured |
| Rutkowski et al [22], 2019 | Improved physical fitness as measured by the SFTs; significant within-group improvements (P<.05) in SFT (sit and reach test: from 0.0 to 0.7, 6MWT: from 494.9 to 469.9) | VRt group showed enhanced motivation and adherence | NR |
| Sutanto et al [23], 2019 | 6MWD, dyspnea (TDI), and health-related QoL (SGRQ); 6MWD improved significantly (EG—from 376.6 to 420.0 m; P<.001; CG—from 410.7 to 477.5 m; P<.001), without any difference between groups | NR | Significant SGRQ score reduction in both groups (EG—from 57.7 to 30.6; P<.05; CG—from 54.1 to 29.4; P<.05), without any difference between groups |
| Jung et al [13], 2020 | Improved compliance, physical health (mobility and flexibility), and psychological well-being; significant improvement in patients’ physical function, along with reduced anxiety and depression | Increased confidence and motivation to exercise | Improved self-reported health-related QoL |
| Rutkowski et al [11], 2020 | Significant improvement in SFT (arm curl, chair stand, and 6MWT; P<.05); ETu+VR superior to ET (eg, 6MWT: ET+VR=+39.11 m, ET=+16.24 m; P<.05) | Enhanced motivation and adherence in VR-based exercises | NR |
| Tu et al [24], 2020 | Feasibility of smart in-home breathing training with RSA-BTv; real-time biofeedback effectively guided breathing patterns | Improved engagement with breathing exercises due to immersive VR | NR |
| Rutkowski et al [9], 2021 | Reduction in emotional tension (P<.001), external stress (P<.001), depression (P<.001), and anxiety (P<.001); VR group showed significant stress, anxiety, and depression reduction compared to CG | Increased mood and emotional balance through immersive therapy | Statistically significant improvements in psychological well-being |
| Simmich et al [25], 2021 | Use of the game (58.6% of d logged), daily steps, and MVPAw; 9 min/d increase in MVPA (EG) and 2% decrease in steps (EG) vs 13% decrease (CG) | Positive correlation between game use and steps; weak correlation with MVPA | No significant improvements reported |
| Simmich et al [26], 2021 | Perceptions of wearables and AVGsx as tools for rehabilitation; participants found wearable trackers useful for quantifying activity, setting goals, and tracking improvements over time | AVGs were seen as fun and motivating for physical activity, but some participants felt that they were too difficult or not beneficial | No specific tools used to measure QoL, but general health benefits of physical activity were discussed |
| Baxter et al [27], 2022 | Comparable inspiration durations between QUT Inspire (mean 7.3, SD 2.0 s) and Triflo II (mean 7.5, SD 2.3 s; P=.79); no significant differences in usability or performance between the app and the clinical device | Some users preferred app due to less perceived inspiratory effort | NR |
| Oberschmidt et al [28], 2022 | Key patient values identified: independence, personal guidance, trust, and regularity; exergames supported values such as independence and challenge but hindered personal guidance and social interaction | Independence valued but personal guidance needed when using exergames | NR |
| Finkelstein et al [29], 2023 | High usability and user acceptance (mean SUSy score: 95.8); 89% of the participants successfully completed the first task, and 100% completed tasks 2 and 3 without prompts | High interest in using VR for patient empowerment and PR education | NR |
| Gabriel et al [30], 2023 | High usability scores (SUS score: 95.8/100); successful completion of PR tasks by all participants with minimal guidance | Increased willingness to engage with home-based PR through VR | NR |
| Gabriel et al [31], 2023 | High acceptability and usability of the VR-based system; increased motivation and engagement due to the novel, immersive approach | Positive feedback on ease of use and enjoyment of the exercises | NR |
| Pancini et al [32], 2023 | Reduction in anxiety, depression, and stress; increased relaxation and emotional well-being; expected to improve emotional well-being (based on prior research with similar methods) | Participants expected to experience increased emotional resilience | Expected improvements in emotional and psychological well-being |
| Pardos et al [33], 2023 | Development of personalized recommendations based on health data; early results show potential for increased adherence to care plans using personalized recommendations | Expected improvement in health-related behavior through gamification | NR |
| Colombo et al [34], 2024 | Adherence rate of 85.71%; mean 6MWT distance improved to 520.50 (SD 69.24) m; significant improvements in exercise capacity (P<.05) | Increased motivation to exercise through VR | NR |
| Jin et al [35], 2024 | Significant improvements in 6MWD and Brief-BESTestz at 3 mo after the intervention (P<.001); EG maintained higher endurance and balance for 12 mo | Enhanced exercise tolerance and balance function; motivation sustained for 3 mo | Significant balance and exercise tolerance improvement |
| Kizmaz et al [36], 2024 | Sit-to-stand test: significant improvement in PR+VR group (P<.001); COPD assessment test: significant reduction (P<.001), VR+PR group had greater improvements | Increased motivation and adherence to exercise reported in VR+PR group | Greater improvement in daily activities (London Chest Activity of Daily Living) in PR+VR group (P<.001) |
| McAnirlin et al [10], 2024 | Psychological well-being, heart rate, respiratory rate, and oxygen saturation; positive changes in well-being and presence; no cybersickness reported | Participants experienced positive emotional responses, reflective of nostalgic memories | Reported feelings of autonomy, positive emotions linked to memories, and restorative effects |
aQoL: quality of life.
bCG: control group.
cVAS: visual analog scale.
dCCQ: Clinical COPD Questionnaire.
e6MWT: 6-minute walk test.
fEG: experimental group.
gTDI: transition dyspnea index.
hSGRQ: St George’s Respiratory Questionnaire.
i6MWD: 6-minute walk distance.
jPR: pulmonary rehabilitation.
kVGS: virtual game systems.
lGRAIL: Gait Real-time Analysis Interactive Lab.
mICC: intraclass correlation coefficient.
nPSA: public service announcement.
oICT: information and communication technology.
pAR: augmented reality.
qNR: not reported.
rMET: metabolic equivalent of task.
sSFT: Senior Fitness Test.
tVR: virtual reality.
uET: exercise training.
vRSA-BT: respiratory sinus arrhythmia biofeedback-based breathing training.
wMVPA: moderate to vigorous physical activity.
xAVG: active video game.
ySUS: System Usability Scale.
zBrief-BESTest: Brief Balance Evaluation Systems Test.