A Serious Game to Self-Regulate Heart Rate Variability as a Technique to Manage Arousal Level Through Cardiorespiratory Biofeedback: Development and Pilot Evaluation Study

Tony Estrella; Carla Alfonso; Juan Ramos-Castro; Aitor Alsina; Lluis Capdevila

doi:10.2196/46351

A Serious Game to Self-Regulate Heart Rate Variability as a Technique to Manage Arousal Level Through Cardiorespiratory Biofeedback: Development and Pilot Evaluation Study

JMIR Serious Games. 2023 Aug 24:11:e46351. doi: 10.2196/46351.

Authors

Tony Estrella^{1

2}, Carla Alfonso^{1

2}, Juan Ramos-Castro³, Aitor Alsina⁴, Lluis Capdevila^{1

2}

Affiliations

¹ Laboratory of Sport Psychology, Department of Basic Psychology, Universitat Autónoma de Barcelona, Barcelona, Spain.
² Sport Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.
³ Group of Biomedical and Electronic Instrumentation, Department of Electronic Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain.
⁴ Department of Information and Communications Engineering, Universitat Autònoma de Barcelona, Barcelona, Spain.

PMID: 37616033
PMCID: PMC10485711
DOI: 10.2196/46351

Abstract

Background: Heart rate variability biofeedback (HRVB) is an established intervention for increasing heart rate variability (HRV) in the clinical context. Using this technique, participants become aware of their HRV through real-time feedback and can self-regulate it.

Objective: The aim of this study was 2-fold: first, to develop a serious game that applies the HRVB technique to teach participants to self-regulate HRV and, second, to test the app with participants in a pilot study.

Methods: An HRVB app called the FitLab Game was developed for this study. To play the game, users must move the main character up and down the screen, avoiding collisions with obstacles. The wavelength that users must follow to avoid these obstacles is based on the user's basal heart rate and changes in instantaneous heart rate. To test the FitLab Game, a total of 16 participants (mean age 23, SD 0.69 years) were divided into a control group (n=8) and an experimental group (n=8). A 2 × 2 factorial design was used in each session. Participants in the experimental condition were trained in breathing techniques.

Results: Changes in the frequency and time domain parameters of HRV and the game's performance features were evaluated. Significant changes in the average RR intervals and root mean square of differences between adjacent RR intervals (RMSSD) were found between the groups (P=.02 and P=.04, respectively). Regarding performance, both groups showed a tendency to increase the evaluated outcomes from baseline to the test condition.

Conclusions: The results may indicate that playing different levels leads to an improvement in the game's final score by repeated training. The tendency of changes in HRV may reflect a higher activation of the mental system of attention and control in the experimental group versus the control group. In this context, learning simple, voluntary strategies through a serious game can aid the improvement of self-control and arousal management. The FitLab Game appears to be a promising serious game owing to its ease of use, high engagement, and enjoyability provided by the instantaneous feedback.

Keywords: app; biofeedback; heart rate variability; mHealth; mobile health; mobile phone; serious game.

©Tony Estrella, Carla Alfonso, Juan Ramos-Castro, Aitor Alsina, Lluis Capdevila. Originally published in JMIR Serious Games (https://games.jmir.org), 24.08.2023.