Applying Gamification Principles and Therapeutic Movement Sequences to Design an Interactive Physical Activity Game: Development Study

Abstract

Background Depression is a severe illness that has accelerated with the spread of COVID-19 and associated lockdowns. As a result, reported physical activity has substantially decreased, further increasing depressive symptoms. Objective This study aims to explain the use of gamification principles to develop content for an interactive physical activity game for depression based on clinically proven depression diagnostic criteria. Methods We discuss related work in this field, the game design framework, the users’ depression severity, how we customize the contents accordingly, the gradual progression of the game to match exercise principles, and user flow optimization. Results We provide a brief description of each of the games developed, including instructions on how to play and design aspects for flow, audio, and visual feedback methods. Exergames (interactive physical activity–based games) stimulate certain physical fitness factors such as improving reaction time, endurance, cardiovascular fitness, and flexibility. In addition, the game difficulty progresses based on various factors, such as the user’s performance for successful completion, reaction time, movement speed, and stimulated larger joint range of motions. Cognitive aspects are included, as the user has to memorize particular movement sequences. Conclusions Mental health issues are linked to behavior and movement; therefore, future physical activity–based interactive games may provide excellent stimulation for inducing user flow, while physical activity can help train various physical fitness factors linked to depression.

Positive and Negative Impacts of Gamification on the Fitness Industry

“…Recruitment and compliance [ 28 ], accessibility to technology and digital literacy [ 30 ], user responsiveness in particular contexts [ 22 ], ethical concerns [ 17 ], and the complex relationship between behavior change techniques and actual behavior change [ 37 ], I.T. identity mediating meaningful interactions [ 38 ], designing strategies that address different user preferences [ 39 ], physical limitations [ 36 ], aesthetics improvement [ 40 ], effective gamification implementation [ 41 ], and consideration of usability concerns for particular user groups [ 42 ] are just a few of the issues that need to be taken into account. For gamification interventions in fitness to be implemented and used effectively, several issues must be resolved.…”

“…It has become an effective way for people of all demographics to become healthier and more productive. These opportunities range from helping in the cardiorespiratory fitness of college students [ 32 ] to helping combat depression as a form of therapeutic intervention [ 40 ]. Also, research showed that gamification could increase motivation and adherence to exercise and overall fitness regimes and help individuals reach their health and fitness goals.…”

“…Aesthetics in Gamification needs improvement, with realistic graphic visual and sound effects that provide more fun to users by creating aesthetically pleasing environments with sensory stimulation that are not at the required levels [ 40 ].…”

Digital technology and mental health during the COVID-19 pandemic: a narrative review with a focus on depression, anxiety, stress, and trauma

“…Online physical activity sessions, such as virtual reality exercise (74), interactive physical-activity-based games (75), singing (76), and dance (77), have also been shown to be effective in reducing depressive and anxious symptoms.…”

“…Importantly, the physical performance and quality of life measures showed significant improvements after the 6 weeks session, compared to the levels seen at baseline time point. Similarly, Kim et al described a framework for use of gamification in the development of exercise-based games focussed on cardiovascular and strength training as a treatment for depression (75). The researchers are currently planning a pilot study to obtain user feedback to guide refinement of the game content.…”