Physiological Responses and User Feedback on a Gameful Breathing Training App: Within-Subject Experiment
Journal
JMIR Serious Games
Type
journal article
Date Issued
2021-02-02
Author(s)
Lukic, Yanick Xavier
;
Shih, Chen-Hsuan (Iris)
;
Reguera, Álvaro Hernández
;
;
;
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.
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.
Language
English
Keywords
digital health intervention
breathing training
biofeedback
smartphone
digital health
mobile health
artificial intelligence
breathing detection
HSG Classification
contribution to scientific community
HSG Profile Area
SoM - Business Innovation
Refereed
Yes
Publisher
JMIR Publications
Volume
9
Number
1:e22802
Official URL
Division(s)
Eprints ID
261815
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Name
Lukic et al 2021 Breathing Training JMIR SG.pdf
Size
2.04 MB
Format
Adobe PDF
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