Gaming for Health: Investigating The Physiological Responses of Ring Fit Adventure

Objectives:

1. Investigate the physiological demands (BP, HR and BG levels) when playing Ring Fit Adventure game
2. Evaluate exercise intensity using HR response as percentage of age-predicted maximum HR and RPE levels
3. Examine enjoyment levels of the game

Hypothesis:

1. Participants will achieve at least moderate intensity 
2. Majority of the participants will report high enjoyment levels 

Study design:

1. Cross-sectional observational study

Inclusion criteria:

1. Adults with at least one chronic disease with medication
2. Independent, able to perform exercises in standing
3. Able to speak and understand English
4. Safe for exercise

Exclusion criteria:

1. History of cancer, cardiac disease or pulmonary diseases
2. Symptoms suggestive of cardiovascular disease 
3. Poor cognition
4. Pregnant

Procedure:

1. Informed consent
2. International Physical Activity Questionnaire 
3. Anthropometric measurement
4. Baseline parameters.
5. Wear HR monitor chest strap
6. Familiarisation round
7. First stage of adventure mode 
8. Reassess vital signs, BG, RPE and BG 
9. 10 minutes rest
10. Second stage of adventure mode
11. Reassess vital signs, BG and RPE 
12. Rest, reassessment every 5 minutes until close to baseline 
13. Exergame Enjoyment Questionnaire. 

• Twenty participants were recruited.
• Baseline vital signs were normal 
• HR after completing both stages were higher (p0.001). Average HR during the entire game was 111.6 +20.6 bpm. This was significantly higher compared to baseline (p0.001) and was about 67.15 +11.1% of age predicted maximum HR, classified as moderate intensity. Average peak HR recorded was 138.6 +22.1 bpm, which is about 83.5 +11.1% of age predicted max HR, classified as vigorous intensity.
• RPE values after completing both stages was significantly higher (p0.001). RPE values was 3.08 +1.15 and 4.00 +1.35, classified as moderate to somewhat hard. 
• BG levels after completing both stages was significantly lower (p=0.001). There were no hypoglycaemic episodes.
• There were no significant changes to SBP and DBP after completing World 1 and World 2. 
• Using the Exergaming Enjoyment Questionnaire, mean score was 77.6 +6.67.
• There were no adverse events during the study.

• This study demonstrates that Ring Fit Adventure is a safe and effective AVG that elicits moderate to vigorous cardiorespiratory responses. 
• The gamification enhances exercise enjoyment, as users experience a sense of accomplishment through character progression or virtual rewards
• Future work can look into the use of Ring Fit Adventure in the long term and its impact on body composition, fitness level and exercise adherence

1. Ring Fit Adventure can be recommended as a safe, effective exercise option for patients with chronic disease
2. Game developers would know design principles for future AVGs that prioritise fitness and health outcomes