Physiological Responses and User Feedback on a Gameful Breathing Training App: Within-Subject Experiment

Abstract

Background Slow-paced breathing training (6 breaths per minute [BPM]) improves physiological and psychological well-being by inducing relaxation characterized by increased heart rate variability (HRV). However, classic breathing training has a limited target group, and retention rates are very low. Although a gameful approach may help overcome these challenges, it is crucial to enable breathing training in a scalable context (eg, smartphone only) and ensure that they remain effective. However, despite the health benefits, no validated mobile gameful breathing training featuring a biofeedback component based on breathing seems to exist. Objective This study aims to describe the design choices and their implementation in a concrete mobile gameful breathing training app. Furthermore, it aims to deliver an initial validation of the efficacy of the resulting app. Methods Previous work was used to derive informed design choices, which, in turn, were applied to build the gameful breathing training app Breeze. In a pretest (n=3), design weaknesses in Breeze were identified, and Breeze was adjusted accordingly. The app was then evaluated in a pilot study (n=16). To ascertain that the effectiveness was maintained, recordings of breathing rates and HRV-derived measures (eg, root mean square of the successive differences [RMSSDs]) were collected. We compared 3 stages: baseline, standard breathing training deployed on a smartphone, and Breeze. Results Overall, 5 design choices were made: use of cool colors, natural settings, tightly incorporated game elements, game mechanics reflecting physiological measures, and a light narrative and progression model. Breeze was effective, as it resulted in a slow-paced breathing rate of 6 BPM, which, in turn, resulted in significantly increased HRV measures compared with baseline (P<.001 for RMSSD). In general, the app was perceived positively by the participants. However, some criticized the somewhat weaker clarity of the breathing instructions when compared with a standard breathing training app. Conclusions The implemented breathing training app Breeze maintained its efficacy despite the use of game elements. Moreover, the app was positively perceived by participants although there was room for improvement.

The Impact of a Gameful Breathing Training Visualization on Intrinsic Experiential Value, Perceived Effectiveness, and Engagement Intentions: Between-Subject Online Experiment (Preprint)

“…Furthermore, no significant differences were found regarding perceived effectiveness among the Breeze and Circle condition. Thus, the gameful visualization of Breeze had no impairing impact on the instrumental value of the breathing training, which is crucial as gamification should not reduce the instrumental value even if the experiential value increased [19,25]. These results are in line with our hypotheses and confirm results from previous work where the influences of gameful and nongameful breathing training on the physiological outcomes were investigated [27].…”

“…The study compared Breeze (Error: Reference source not found), a gameful breathing training visualization, to a standard breathing training visualization, hereafter referred to as Circle (Error: Reference source not found). The standard breathing training visualization was adapted from previous studies, [15,19,27]. The videos that were used to instruct and guide the participants before and during breathing training can be found in Multimedia Appendences 1-4.…”

“…Liu et al [25] suggested that meaningful engagement consist of experiential values and instrumental values. An earlier study [19] had collected recordings of breathing rates and heart rate variabilityderived measures, to ensure that the instrumental values are maintained when using Breeze. Therefore, this study focused mainly on the second category: the experiential value to evaluate experiential outcomes.…”

“…This study was conducted with the users' feedback via video, and, therefore, did not contain biofeedback, as previous studies employing Breeze did [19,27]. Biofeedback is essential to provide individuals with real-time feedback information, so that they can adjust their behavior by modifying their physiological functions.…”

“…One approach to address the issue of low long-term adherence might be to approach intrinsic motivation through gamification [19]. Gamification adds game elements to nongame tasks to make them more engaging and enjoyable.…”