JMIR Publications

ABSTRACT

Background:

Slow-paced breathing trainings (6 breaths/min) improve physiological and psychological well-being by inducing relaxation characterized through an increased heart rate variability (HRV). However, classical breathing trainings have a limited target group and retention rates are very low. While a gamified approach may help to overcome these challenges, it is crucial to enable them in a scalable context (e.g., smartphone-only) and ensure a balance between experiential (user experience) and instrumental (increased HRV) values. Nevertheless, well-founded design principles (DPs) that lead to this outcome remain largely unexplored, especially in the context of mobile applications.

Objective:

This study aims to identify and evaluate DPs for mobile gamified biofeedback-guided breathing trainings that balance between instrumental and experiential values.

Methods:

Prior work was used to derive informed DPs, which, in turn, were applied to build the breathing training application Breeze. Then, through a pretest (N=3), mobile-specific design principles (M-DPs) have been formulated and Breeze adjusted accordingly. The DPs were then qualitatively evaluated in a pilot study (N=16). To ascertain that the instrumental values are maintained despite the introduction of gamified elements, recordings of breathing rates and HRV derived measures (e.g., RMSSD) were collected. For each participant, the recordings were then compared during baseline, a standard breathing training deployed on a smartphone, and Breeze.

Results:

Overall, 5 DPs were identified that propose to use cool colors, natural settings, tightly incorporated gamified elements, game mechanics that reflect physiological measures, and a light narrative and progression model. Moreover, 2 M-DPs were proposed that focus on the visual accentuation and alignment of guidance and biofeedback elements. Also, Breeze was effective as it resulted in a slow-paced breathing rate of 6 breaths per minute, which, in turn, resulted in significantly increased HRV measures compared to baseline (P<.001 for RMSSD).

Conclusions:

The implemented DPs have a positive resonance in respondents but require further substantiation. Nevertheless, when compared to a standard breathing training, they lead to an increase in experiential value while maintaining the instrumental value.