Blasco-Peris Carles, Alcolea Garrido Juan Pedro, Seguí Barbara, Zaragoza Rocio, Climent-Paya Vicente, Fuertes-Kenneally Laura, Manresa-Rocamora Agustín, Sanz-Rocher Ana, Baladzhaeva Sabina, Sarabia José M
Instituto de investigación sanitaria y biomédica de Alicante, Alicante, Spain.
Department of Physical Education and Sport, Universitat de València, Valencia, Spain.
JMIR Serious Games. 2025 Jul 16;13:e71385. doi: 10.2196/71385.
Heart failure (HF) is a growing global health concern, and adherence to early cardiac rehabilitation (CR) remains suboptimal. Exergaming is a promising alternative to conventional exercise programs for patients with HF. However, existing research has limitations, and the integration of exergaming into clinical practice remains challenging. Most notably, current studies often rely on commercially available systems that are not tailored to needs specific to patients with HF, lack long-term adherence strategies, and have limited evaluation in the initial phases of cardiac rehabilitation.
This study aimed to design, develop, and assess the usability of a novel exergaming prototype (ie, HEFMOB), integrating immersive virtual reality (VR), real-time biometric monitoring, and autonomous session management to support early-phase, exercise-based CR in patients with HF.
A multidisciplinary team developed HEFMOB through iterative prototyping. The final system included a pedal-based VR cycling game and an upper-limb mobilization minigame, with real-time monitoring of heart rate, blood pressure, and peripheral capillary oxygen saturation. Usability was assessed in two phases: (1) an expert evaluation and refinement phase and (2) a single-session usability phase involving 10 patients with HF (4 female). The sessions were recorded and individually evaluated by 2 researchers using the Serious Game Usability Evaluator tool. After each session, the participants completed the System Usability Scale (SUS) and a subscale of Intrinsic Motivation Inventory (IMI) to rate the usability of the exergaming prototype and enjoyment, respectively. Descriptive statistics were reported.
The participants had a mean age of 64.8 (SD 8.4) years, BMI of 26.7 (SD 4.6) kg/m2, and left ventricular ejection fraction of 40.5% (SD 7.4%). All participants completed the session without adverse events. The SUS score averaged 71.5, SD 17.8 (indicating good usability) and IMI scores indicated very high enjoyment (mean 25.1, SD 3.5). A total of 136 gameplay-related events were recorded: negative (n=76, mostly confusion), neutral (n=49), and positive (n=11). Interface-related issues (n=61) were most common, followed by design (n=52) and hardware (n=23).
HEFMOB appears to be a promising, engaging, and well-tolerated tool for delivering tailored exergaming interventions in patients with HF. High usability and enjoyment ratings support its acceptability, while structured user experience analysis provided valuable insights for system refinement. This study marks a critical step toward integrating personalized, gamified exercise in inpatient settings, especially where early mobilization is lacking. Building on these findings, future research will assess long-term usability and clinical impact through a multicenter randomized controlled trial.
心力衰竭（HF）是一个日益受到全球关注的健康问题，而对早期心脏康复（CR）的依从性仍然不理想。运动游戏是心力衰竭患者传统运动项目的一个有前景的替代方案。然而，现有研究存在局限性，将运动游戏纳入临床实践仍然具有挑战性。最值得注意的是，当前研究通常依赖于市售系统，这些系统并非针对心力衰竭患者的特定需求定制，缺乏长期依从性策略，并且在心脏康复的初始阶段评估有限。
本研究旨在设计、开发并评估一种新型运动游戏原型（即HEFMOB）的可用性，该原型整合了沉浸式虚拟现实（VR）、实时生物特征监测和自主会话管理，以支持心力衰竭患者的早期、基于运动的心脏康复。
一个多学科团队通过迭代原型设计开发了HEFMOB。最终系统包括一个基于踏板的VR自行车游戏和一个上肢活动迷你游戏，可实时监测心率、血压和外周毛细血管血氧饱和度。可用性评估分两个阶段进行：（1）专家评估和完善阶段；（2）单会话可用性阶段，涉及10名心力衰竭患者（4名女性）。会话进行了记录，并由2名研究人员使用严肃游戏可用性评估工具进行单独评估。每次会话后，参与者完成系统可用性量表（SUS）和内在动机量表（IMI）的一个子量表，分别对运动游戏原型的可用性和趣味性进行评分。报告了描述性统计数据。
参与者的平均年龄为64.8（标准差8.4）岁，体重指数为26.7（标准差4.6）kg/m²，左心室射血分数为40.5%（标准差7.4%）。所有参与者均完成了会话，无不良事件发生。SUS评分平均为71.5，标准差17.8（表明可用性良好），IMI评分表明趣味性非常高（平均25.1，标准差3.5）。共记录了136个与游戏玩法相关的事件：负面事件（n = 76，主要是困惑）、中性事件（n = 49）和正面事件（n = 11）。与界面相关的问题（n = 61）最为常见，其次是设计问题（n = 52）和硬件问题（n = 23）。
HEFMOB似乎是一种有前景、有趣且耐受性良好的工具，可用于为心力衰竭患者提供量身定制的运动游戏干预。高可用性和趣味性评分支持其可接受性，而结构化的用户体验分析为系统完善提供了有价值的见解。本研究标志着在住院环境中整合个性化、游戏化运动方面迈出了关键一步，特别是在缺乏早期活动的情况下。基于这些发现，未来的研究将通过多中心随机对照试验评估长期可用性和临床影响。
