{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:57:14Z","timestamp":1791500234686,"version":"4.3.4"},"reference-count":49,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Serious Games"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Physical activity plays a central role in the course and progression of chronic conditions in older adults. However, individuals within this population tend to have an inactive lifestyle. Exergaming, which is defined as the integration of physical activity with game-based elements, offers a promising approach to promote physical activity in individuals with chronic conditions. Despite its potential, limited evidence exists on how specific game elements influence behavioral and psychological outcomes in this population.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The aim of this study is to explore the behavioral and psychological change techniques experienced by individuals with chronic conditions using a walking-based mobile exergame, called Heart Farming.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A cross-sectional qualitative design was used based on a gamification framework, using data from semistructured interviews with 14 participants aged 67 to 92 years who used the Heart Farming exergame for 3 months. Participants with chronic conditions, including heart failure, Parkinson disease, type 2 diabetes, stroke, or rheumatic disease, were recruited from 2 ongoing studies. Data were analyzed using deductive content analysis and presented based on the gamification framework.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The data analysis revealed increased motivation to walk, which was facilitated by game elements such as goals, rewards, feedback, and planning. Participants valued not only the sense of progression and achievement within the game but also the real-world benefits, such as spending time in nature or feeling a sense of community with others. Exergaming was integrated into daily routines by supporting the planning and structuring of daily activities. It was also perceived as enjoyable, especially due to its farming theme and visual design. Behavioral change techniques such as goal setting, feedback, and social support were commonly experienced, whereas focus on past success (as described in the gamification framework) was not used as a technique by the exergame. Psychological techniques, including self-monitoring and stress management, were mentioned. A feeling of discomfort due to playing in public was reported, and participants varied in terms of the levels of digital literacy. Social interaction features were not adequately used, even though some participants created informal support groups to exergame.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study contributes to the exergaming literature by examining behavioral and psychological change techniques from the perspective of individuals with chronic conditions. Exergaming incorporates a variety of behavioral and psychological change techniques, which were experienced by the participants in various ways. Individuals\u2019 previous knowledge of exergaming, interests, and illness progression were mentioned as factors that can influence their experiences of exergaming. By increasing the understanding of how game elements are experienced and how they influence health-related behavior, the findings of this study may inform the development of exergames that are better tailored to users\u2019 needs. Further research is needed to refine behavioral change techniques and assess condition-specific adaptations to maximize engagement and health outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/78776","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T18:43:13Z","timestamp":1774636993000},"page":"e78776-e78776","source":"Crossref","is-referenced-by-count":1,"title":["User Experiences of Behavioral and Psychological Change Techniques in a Walking-Based Mobile Exergame: Cross-Sectional Qualitative Study"],"prefix":"10.2196","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6304-3942","authenticated-orcid":false,"given":"Marianna","family":"Antoniadou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3674-3946","authenticated-orcid":false,"given":"Helena","family":"Or\u00e4dd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7566-2218","authenticated-orcid":false,"given":"Aseel","family":"Berglund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9703-292X","authenticated-orcid":false,"given":"Erik","family":"Berglund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4259-3671","authenticated-orcid":false,"given":"Anna","family":"Str\u00f6mberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4197-4026","authenticated-orcid":false,"given":"Tiny","family":"Jaarsma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7493-0353","authenticated-orcid":false,"given":"Leonie","family":"Klompstra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2018.10.008","article-title":"The global burden of multiple chronic conditions: a narrative review","volume":"12","author":"Hajat","journal-title":"Prev Med Rep"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2318-14-119","article-title":"Exergaming to increase the exercise capacity and daily physical activity in heart failure patients: a pilot study","volume":"14","author":"Klompstra","journal-title":"BMC Geriatr"},{"issue":"4","key":"R3","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1177\/0269215515584382","article-title":"Video-games used in a group setting is feasible and effective to improve indicators of physical activity in individuals with chronic stroke: a randomized controlled trial","volume":"30","author":"Givon","journal-title":"Clin Rehabil"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2017.02.006","article-title":"Effectiveness of exergaming in improving functional balance, fatigue and quality of life in Parkinson\u2019s disease: a pilot randomized controlled trial","volume":"38","author":"Ribas","journal-title":"Parkinsonism Relat Disord"},{"issue":"15","key":"R5","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.011585","article-title":"Patterns of sedentary behavior in the first month after acute coronary syndrome","volume":"8","author":"Duran","journal-title":"J Am Heart Assoc"},{"key":"R6","doi-asserted-by":"crossref","unstructured":"Deterding S Dixon D Khaled R Nacke L . 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