JMIR Publications

ABSTRACT

Background:

Subthreshold depression (StD) increases the risk of progression to major depressive disorder (MDD). While exercise is a proven intervention for depressive symptoms, adherence remains a major challenge. Exergames, such as those available on the Nintendo Switch™ platform, may enhance motivation and participation in physical activity; however, empirical evidence of their efficacy specifically for StD is limited.

Objective:

To assess the efficacy and subjective experiences of an 8-week Nintendo Switch™-based exergaming on depressive symptoms, sleep quality, anxiety in adults with StD.

Methods:

Eighty-four adults meeting criteria for StD were randomly assigned to either the intervention group (IG; n = 42), which received the Nintendo Switch™-based exergame program (2-3 sessions/week, 50-60 minutes/session for 8 weeks), or a control group (CG; n = 42), which continued with usual activities. Primary outcomes (depressive symptoms) and secondary outcomes (anxiety and sleep quality) were assessed at baseline (T0), post-intervention (T1, week 8), one-month follow-up (T2, week 12), and two-month follow-up (T3, week 16). Generalized Estimating Equations (GEE) were used to analyse longitudinal changes and time × group interactions. Additionally, semi-structured interviews were conducted with a purposive subsample of IG participants (n = 17) at T1, with thematic analysis applied to identify key themes.

Results:

Baseline characteristics were similar across groups (mean age = 22.05 ± 1.44 years; 83.3% female). Compared to the CG, the IG showed significantly greater reductions in depressive symptoms at all time points (T1: β = -4.07, 95% CI (-5.84, -2.30), p < .001; T2: β = -4.29, 95% CI (-6.14, -2.43), p < .001; T3: β = -3.81, 95% CI (-5.54, -2.08), p < .001), along with significant improvements in sleep quality (T1: β = -2.98, 95% CI (-4.55, -1.40), p < .001; T2: β = -2.19, 95% CI (-3.58, -0.80), p = .002; T3: β = -2.45, 95% CI (-3.81, -1.09). Anxiety symptoms also improved significantly at T1 (β = -2.60, 95% CI (-4.70, -0.50), p = .015). Group × time interactions were significant for depressive symptoms (β = 22.18, p < .001) and sleep quality (β = 23.21, p < .001), confirming sustained intervention effects. Qualitative findings echoed these outcomes, with participants reporting immersive engagement, perceived psychophysiological benefits, and multifaceted adherence facilitators played a key role in enhancing intervention effectiveness.

Conclusions:

The 8-week Nintendo Switch™-based exergame effectively reduced depressive symptoms and anxiety symptoms, and improved sleep quality in adults with StD, with sustained benefits. Qualitative findings highlighted experiential factors influencing engagement, supporting the need for personalized interventions to enhance adherence and outcomes. Clinical Trial: ChiCTR2300068970 (Chinese Clinical Trial Registry).