{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T20:41:45Z","timestamp":1792442505305,"version":"4.5.0"},"reference-count":17,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Physical inactivity and insufficient muscle-strengthening exercise remain important public health concerns among adults with chronic diseases. Active video games may offer an accessible way to support exercise participation, but many may not provide sufficient exercise intensity to produce meaningful physiological responses. Ring Fit Adventure (RFA) is an active video game that combines aerobic and resistance-based exercise. However, little is known about its physiological demands among adults with chronic diseases.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This pilot study aimed to examine the acute physiological responses, exercise intensity, perceived exertion, and enjoyment during RFA gameplay in adults with stable chronic diseases.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A single-arm, pre-post experimental study was conducted among 20 adults aged 40 to 65 years with at least one chronic disease. Participants were recruited through convenience and snowball sampling from a hospital-based setting and public recruitment channels. After baseline assessment and familiarization, participants completed 2 stages of RFA gameplay. Heart rate (HR) was continuously monitored, while blood pressure (BP), capillary blood glucose (BG), and the rate of perceived exertion were measured at baseline and immediately after each stage. Enjoyment was assessed using the Exergame Enjoyment Questionnaire (EEQ).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n All 20 participants completed the study, with no adverse events or missing data. The mean age was 54.3 (95% CI 51.25-57.25) years, and 10 participants were male. Hypertension was the most common condition (n=14, 70%), followed by hyperlipidemia (n=11, 55%), obesity (n=8, 40%), and diabetes (n=5, 25%). The mean continuous HR during gameplay was 111.6 (95% CI 102.6-120.6) bpm, corresponding to 67.2% of the age-predicted maximum HR, while peak HR reached 138.6 (95% CI 128.9-148.3) bpm, corresponding to 83.5% of the age-predicted maximum HR. HR increased significantly after World 1 by 16.7 (95% CI 11.42-21.88;\n P<\/jats:italic>\n <.001) bpm and after World 2 by 20.7 (95% CI 13.28-28.12;\n P<\/jats:italic>\n <.001) bpm. Rate of perceived exertion also increased significantly after World 1 by 2.83 (95% CI 2.32-3.33;\n P<\/jats:italic>\n <.001) points and after World 2 by 3.75 (95% CI 3.18-4.32;\n P<\/jats:italic>\n <.001) points. Capillary BG decreased after World 1 by 1.4 (95% CI \u22121.95 to 0.78;\n P<\/jats:italic>\n <.001) mmol\/L and after World 2 by 1.6 (95% CI \u22122.46 to \u22120.80;\n P<\/jats:italic>\n =.01) mmol\/L, with no hypoglycemic events. No significant changes were observed in systolic or diastolic BP. The mean enjoyment score was 77.6 out of 100 (95% CI 74.7-80.5).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n RFA elicited moderate average exercise intensity with periods of vigorous intensity, reductions in capillary BG, stable postexercise BP, and high enjoyment among adults with stable chronic diseases. These findings suggest that RFA may be a feasible and engaging home-based exercise option for this population. However, the small, heterogeneous sample, absence of a control condition, and single-session design limit generalizability. Larger controlled longitudinal studies are needed to determine its effects on exercise adherence, physical activity levels, and cardiometabolic outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/92345","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T14:55:06Z","timestamp":1786546506000},"page":"e92345-e92345","source":"Crossref","is-referenced-by-count":0,"title":["Physiological Responses, Exercise Intensity, and Enjoyment During Ring Fit Adventure in Adults With Chronic Diseases: Single-Arm, Pre-Post Experimental Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6783-1528","authenticated-orcid":false,"given":"Muhammad Jazimin","family":"Haron","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5668-2395","authenticated-orcid":false,"given":"Shiek Abdullah","family":"Ismail","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5587-2760","authenticated-orcid":false,"given":"Gilbert Tian Seng","family":"Yeo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"R1","unstructured":"Physical activity. World Health Organization. URL: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/physical-activity [Accessed 11-09-2026]"},{"issue":"24","key":"R2","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"Bull","journal-title":"Br J Sports Med"},{"issue":"8","key":"R3","doi-asserted-by":"publisher","first-page":"e1232","DOI":"10.1016\/S2214-109X(24)00150-5","article-title":"National, regional, and global trends in insufficient physical activity among adults from 2000 to 2022: a pooled analysis of 507 population-based surveys with 5\u00b77 million participants","volume":"12","author":"Strain","journal-title":"Lancet Glob Health"},{"key":"R4","unstructured":"National population health survey 2024. Ministry of Health, Singapore; 2025. URL: https:\/\/isomer-user-content.by.gov.sg\/3\/38583351-2fdc-4a01-8bf7-88d24889af78\/NPHS%202024%20Survey%20Report.pdf [Accessed 11-09-2026]"},{"issue":"9838","key":"R5","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/S0140-6736(12)61031-9","article-title":"Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy","volume":"380","author":"Lee","journal-title":"Lancet"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","first-page":"C40","DOI":"10.1152\/ajpcell.00056.2021","article-title":"Mechanisms of exercise as a preventative measure to muscle wasting","volume":"321","author":"Graham","journal-title":"Am J Physiol Cell Physiol"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1177\/19417381231175665","article-title":"Home-based indoor physical activity programs for community-dwelling older adults: a systematic review","volume":"16","author":"Santos","journal-title":"Sports Health"},{"issue":"2","key":"R8","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1177\/1090198112444956","article-title":"Using active video games for physical activity promotion: a systematic review of the current state of research","volume":"40","author":"Peng","journal-title":"Health Educ Behav"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","first-page":"79","DOI":"10.70252\/DSAH2790","article-title":"Physiological and perceptual responses to Nintendo\u00ae Wii Fit\u2122 in young and older adults","volume":"5","author":"Mullins","journal-title":"Int J Exerc Sci"},{"issue":"6","key":"R10","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1089\/g4h.2013.0100","article-title":"Therapeutic uses of active videogames: a systematic review","volume":"3","author":"Staiano","journal-title":"Games Health J"},{"issue":"18","key":"R11","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17186714","article-title":"Assessment of active video games\u2019 energy expenditure in children with overweight and obesity and differences by gender","volume":"17","author":"Comeras-Chueca","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"R12","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1089\/g4h.2023.0159","article-title":"Energy expenditure validation of an exergame platform: Ring Fit Adventure use in adults with overweight and obesity","volume":"13","author":"Moreno Carbajal","journal-title":"Games Health J"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.51015\/jdl.2023.3.12","article-title":"A proposal concerning exercise intensity with the Nintendo Ring Fit Adventure exergame among older adults: a preliminary study","volume":"3","author":"Onishi","journal-title":"J Digit Life"},{"issue":"2","key":"R14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.47275\/2692-0948-134","article-title":"Get fit with Ring-Fit Adventure: physiological outcomes of a novel active video game intervention among women","volume":"3","author":"Suire","journal-title":"J Womens Health Care Manage"},{"issue":"2","key":"R15","doi-asserted-by":"publisher","first-page":"44","DOI":"10.20473\/spmrj.v3i2.21549","article-title":"Cardiovascular responses, physical activity intensity, and enjoyment level of Nintendo Switch exergaming, comparing different tempos and playing modes: a pilot study","volume":"3","author":"Putra","journal-title":"Surabaya Phys Med Rehabil J"},{"issue":"1","key":"R16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsem-2020-000744","article-title":"Game on: a cycling exergame can elicit moderate-to-vigorous intensity. A pilot study","volume":"6","author":"Berg","journal-title":"BMJ Open Sport Exerc Med"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2022.780059","article-title":"Enjoyment as a predictor of exercise habit, intention to continue exercising, and exercise frequency: the intensity traits discrepancy moderation role","volume":"13","author":"Teixeira","journal-title":"Front Psychol"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T20:14:13Z","timestamp":1792440853000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e92345"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":17,"URL":"https:\/\/doi.org\/10.2196\/92345","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"article-number":"v10i24e92345"}}