Background Few investigators have explored challenges and facilitators to exergaming, essential factors to exergaming adherence, among patients with heart failure. Objectives In this qualitative study, we explored facilitators and challenges using a home-based exergame platform, the Nintendo Wii Sports, in patients with heart failure. Methods Semistructured face-to-face interviews were conducted in 13 participants given a diagnosis of heart failure (age range, 34-69 years). Participants were asked about their experiences with exergaming. Transcribed interviews were analyzed with content analysis. Results The following 4 facilitators were identified: (1) enjoyment and competition motivated gaming, (2) accessibility at home gave freedom and lowered participants barriers to exercise, (3) physical benefits when decreasing sedentary lifestyle, and (4) psychosocial benefits on stress, mood, and family interactions. Challenges included (1) diminished engagement over time due to boredom playing similar games and (2) frustrations due to game difficulty and lack of improvement. Conclusion Exergaming can increase individuals physical activity because of easy accessibility and the fun and motivating factors the games offer. Participants initially found exergaming enjoyable and challenging. However, engagement diminished over time because of boredom from playing the same games for a period of time. Participants preferences and capacities, participants past experiences, and social support must be considered to avoid boredom and frustrations. Future studies are warranted to determine adherence to exergaming among patients with heart failure and, ultimately, increased overall well-being and healthcare delivery in this patient population.