PMID- 33555264 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210304 IS - 2291-9279 (Print) IS - 2291-9279 (Electronic) VI - 9 IP - 1 DP - 2021 Feb 8 TI - Physiological Responses and User Feedback on a Gameful Breathing Training App: Within-Subject Experiment. PG - e22802 LID - 10.2196/22802 [doi] LID - e22802 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. CI - (c)Yanick Xavier Lukic, Chen-Hsuan (Iris) Shih, Alvaro Hernandez Reguera, Amanda Cotti, Elgar Fleisch, Tobias Kowatsch. Originally published in JMIR Serious Games (http://games.jmir.org), 08.02.2021. FAU - Lukic, Yanick Xavier AU - Lukic YX AUID- ORCID: 0000-0002-2576-6569 AD - Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland. FAU - Shih, Chen-Hsuan Iris AU - Shih CI AUID- ORCID: 0000-0002-8819-2793 AD - Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland. FAU - Hernandez Reguera, Alvaro AU - Hernandez Reguera A AUID- ORCID: 0000-0001-5640-2082 AD - Universidad de Sevilla, Sevilla, Spain. FAU - Cotti, Amanda AU - Cotti A AUID- ORCID: 0000-0001-9767-8712 AD - Centre for Digital Health Interventions, Institute of Technology Management, University of St.Gallen, St.Gallen, Switzerland. FAU - Fleisch, Elgar AU - Fleisch E AUID- ORCID: 0000-0002-4842-1117 AD - Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland. AD - Centre for Digital Health Interventions, Institute of Technology Management, University of St.Gallen, St.Gallen, Switzerland. FAU - Kowatsch, Tobias AU - Kowatsch T AUID- ORCID: 0000-0001-5939-4145 AD - Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland. AD - Centre for Digital Health Interventions, Institute of Technology Management, University of St.Gallen, St.Gallen, Switzerland. LA - eng PT - Journal Article DEP - 20210208 PL - Canada TA - JMIR Serious Games JT - JMIR serious games JID - 101645255 PMC - PMC7899808 OTO - NOTNLM OT - biofeedback OT - breathing training OT - mHealth OT - mobile health OT - mobile phone OT - serious game COIS- Conflicts of Interest: YL, IS, EF, and TK are affiliated with the Center for Digital Health Interventions, a joint initiative of the Department of Management, Technology, and Economics at ETH Zurich and the Institute of Technology Management at the University of St. Gallen, which is funded in part by the Swiss health insurer CSS. EF and TK are also the cofounders of Pathmate Technologies, a university spin-off company that creates and delivers digital clinical pathways. Pathmate Technologies is not involved in the study app described in this paper. All other authors have no conflicts to declare. EDAT- 2021/02/09 06:00 MHDA- 2021/02/09 06:01 PMCR- 2021/02/08 CRDT- 2021/02/08 12:09 PHST- 2020/07/24 00:00 [received] PHST- 2020/12/23 00:00 [accepted] PHST- 2020/11/19 00:00 [revised] PHST- 2021/02/08 12:09 [entrez] PHST- 2021/02/09 06:00 [pubmed] PHST- 2021/02/09 06:01 [medline] PHST- 2021/02/08 00:00 [pmc-release] AID - v9i1e22802 [pii] AID - 10.2196/22802 [doi] PST - epublish SO - JMIR Serious Games. 2021 Feb 8;9(1):e22802. doi: 10.2196/22802.