JMIR Publications

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 become 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 chronic heart failure patients utilizing 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 the serious content. The mobile exergame was developed iteratively in seven iterations by an interdisciplinary team involving users and stakeholders in all iterations. Stakeholders played various roles during the development process, making the team staying 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, smartphones that support augmented reality. Our findings show that the serious game P-III framework need 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) separate and thorough design of the physical activity and physical interaction; (2) early and continuously deployment of the exergame on the intended platform to enable evaluations and everyday life testing.