TY  - JOUR
AU  - Lukic, Yanick Xavier
AU  - Shih, Chen-Hsuan (Iris)
AU  - Hernandez Reguera, Alvaro
AU  - Cotti, Amanda
AU  - Fleisch, Elgar
AU  - Kowatsch, Tobias
PY  - 2021
DA  - 2021/2/8
TI  - Physiological Responses and User Feedback on a Gameful Breathing Training App: Within-Subject Experiment
JO  - JMIR Serious Games
SP  - e22802
VL  - 9
IS  - 1
KW  - breathing training
KW  - serious game
KW  - biofeedback
KW  - mobile health
KW  - mHealth
KW  - mobile phone
AB  - 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. 
SN  - 2291-9279
UR  - http://games.jmir.org/2021/1/e22802/
UR  - https://doi.org/10.2196/22802
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33555264
DO  - 10.2196/22802
ID  - info:doi/10.2196/22802
ER  -