Targeted digital games improve physical CV health—but do little for mental wellness

Digital games developed for cardiovascular disease self-management improve exercise capacity and energy expenditure among their users, according to a review published Sept. 18 in the Games for Health Journal, but the approach does little to overcome mental hurdles like depression, anxiety and quality of life.

First author Kavita Radhakrishnan, PhD, RN, MSEE, and colleagues at the University of Texas said digital games—popularized by the spread of smartphones and handheld gadgets—could be a useful addition to CVD self-management (SM) programs, which aim to boost self-awareness of heart health with a series of lifestyle changes that include monitoring symptoms, watching diets and quitting tobacco. 

“Attaining proficiency in CVD SM is difficult, however, because it requires patients to become adept in a wide range of skills within the context of their daily routines and comorbidities,” Radhakrishnan et al. wrote in the journal. The authors said patients who benefit from self-management are often tired as is, or unable to travel far to meet with cardiac specialists or support groups.

“Digital games...have emerged as an alternative to traditional patient education and offer a new and exciting avenue to learn about and engage in CVD SM behaviors,” they wrote. “Digital games can provide flexible, accessible and appealing educational environments, within which patients can learn about disease SM by seeking information, practicing skills and receiving social support.”

Radhakrishnan’s team assessed the utility of digital games for CVD SM in a scoping review of studies filed in the CINAHL, PubMed and Web of Science databases. Eight articles met the researchers’ inclusion criteria, seven of which involved patients in their 50s or older who might not be as well-versed in handheld technology.

The authors said using the digital platforms greatly improved the exercise capacity and energy expenditure of those who used them, and were found enjoyable by between 79 percent and 93 percent of participants. Still, the games didn’t seem to promote mental health or self-efficacy, and users reported being tired of the games or lacking interest in them. Other barriers to using the platform were sensor limitations, conflicts with daily life and preferences for group exercise.

Adherence to the SM strategy soared, though, ranging from 70 percent to 100 percent over the course of the study. Studies that included human contact through supervision or social support saw higher adherence rates.

“The overall adherence rates were still much higher than that for cardiac rehabilitation approaches, which achieve about only 10- to 50-percent adherence,” Radhakrishnan et al. wrote. “In-home convenience is highly valuable to participants with cardiac diseases, which is why the game interventions delivered at home typically had higher adherence rates in our review.”

The authors said future work should include larger sample sizes, longer durations, less emphasis on physical activity and game design guided by behavioral change theoretical frameworks.