JMIR Publications

ABSTRACT

Background:

Children with autism spectrum disorder (ASD) exhibit cognitive, motor, and social difficulties that affect engagement, causing developmental delays, behavioral challenges, and obesity—interrelated concerns in daily functioning and well-being. Although interactive interventions have incorporated physical activity, they often rely on limited physical involvement and lack iterative, expert-informed design, as built on pre-existing game frameworks. This gap highlights the need for exergames that promote sustained, full-body participation aligned with developmental goals.

Objective:

We aim to iteratively design exercise-based serious exergames for children with ASD through an expert-informed co-design process involving 21 professionals from multiple disciplines and explore their applicability through initial field testing.

Methods:

Serious exergames were designed through an iterative co-design process that included concept generation, expert evaluation, and gameplay refinement. The games were applied with children with ASD in initial gameplay to explore engagement and interaction patterns. Engagement was labeled in real time using a binary input interface, and caregiver interviews were conducted afterward to gather complementary observations.

Results:

Two exergames-"Fruit Sorting Run" and "Hazard Avoiding Ride"-were developed and evaluated through initial field testing with children with ASD. Logistic regression analysis revealed a significant increase in engagement over time in both Fruit Sorting Run (β = 5.52, P < .001) and Hazard Avoiding Ride (β = 3.69, P < .001), indicating sustained engagement during gameplay. Caregiver interviews reinforced these findings, reporting increased attention, motivation, and enjoyment across both activities.

Conclusions:

The findings from this study support the applicability of an expert-informed design approach and the viability of the resulting exergames designed for children with ASD, integrating goal-directed physical activity, virtual agent (VA)-based prompting, and stakeholder-informed considerations such as motor-cognitive alignment, interactive scaffolding, and support for daily living skills. The resulting exergames were feasible to implement and showed increasing engagement over time during initial field testing. These findings highlight the potential of serious exergames as supportive tools in intervention settings for children with ASD.