Background:  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.

Objective:  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.

Methods:  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.

Results:  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.

Conclusions:  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' 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' needs. Further research is needed to refine behavioral change techniques and assess condition-specific adaptations to maximize engagement and health outcomes.

Thorough consideration of user experiences and the weighing of advantages and disadvantages are essential when implementing new technology in clinical practice. This article describes a primary care nurse's experience using two technologies to monitor lung congestion in six patient cases: a remote dielectric sensing device for non-invasive lung fluid measurement and a portable handheld ultrasound device. Both can support decision-making when assessing lung congestion in heart failure patients. However, technical difficulties and interpretational complexities are inherent in their use. Balancing these advantages and disadvantages and finding effective strategies to address challenges is crucial for successful clinical implementation.

Aims This study aimed to explore effects of exergaming and medical yoga on exercise capacity, fatigue, shortness of breath, health-related quality of life, depression, and anxiety in patients with heart failure.Methods and results A randomized sub-study with a 3-month intervention and outcomes measures at baseline, 3, 6, and 12 months. Participants were recruited from heart failure clinics in Sweden. Treatment effects in change of outcomes were tested in an analysis of mixed-effects models with repeated measures. Change in outcomes was the dependent variable. The independent fixed-effect parameters were treatment group, time, and the interaction between treatment group and time. In total, 104 patients (37% women, mean age 71 +/- 12, 48% in New York Heart Association Class II and 42% in III) were randomized to exergaming (n = 35), medical yoga (n = 33), or an active control group (n = 36). No statistically significant differences were found between these three groups on any of the outcome measures. Exergaming significantly improved exercise capacity, fatigue, shortness of breath, and physical health-related quality of life and medical yoga improved symptoms of fatigue and emotional health-related quality of life. The control group did not change on the exercise capacity, symptoms, health-related quality of life, or depressive or anxiety symptoms. The well-being score in patients in the control group significantly decreased at 3 months.Methods and results A randomized sub-study with a 3-month intervention and outcomes measures at baseline, 3, 6, and 12 months. Participants were recruited from heart failure clinics in Sweden. Treatment effects in change of outcomes were tested in an analysis of mixed-effects models with repeated measures. Change in outcomes was the dependent variable. The independent fixed-effect parameters were treatment group, time, and the interaction between treatment group and time. In total, 104 patients (37% women, mean age 71 +/- 12, 48% in New York Heart Association Class II and 42% in III) were randomized to exergaming (n = 35), medical yoga (n = 33), or an active control group (n = 36). No statistically significant differences were found between these three groups on any of the outcome measures. Exergaming significantly improved exercise capacity, fatigue, shortness of breath, and physical health-related quality of life and medical yoga improved symptoms of fatigue and emotional health-related quality of life. The control group did not change on the exercise capacity, symptoms, health-related quality of life, or depressive or anxiety symptoms. The well-being score in patients in the control group significantly decreased at 3 months.Conclusion Both exergaming and medical yoga demonstrated positive impacts on outcomes when compared with a control group. Exergaming, characterized by its elevated physical intensity, exerted effects primarily on physical health, while medical yoga, as a mind-body intervention, exhibited influences on emotional well-being.Registration ClinicalTrial.gov: NCT01785121

Background: Physical activity is beneficial and recommended to improve outcomes for patients with heart failure (HF). Exergaming combines gaming technology with physical activity. Therefore, we developed a mobile exergame in a co-design process, the exergame would engage participants in physical activity anywhere and anytime. This study aims to assess the feasibility of a newly developed mobile exergame, heart farming, for patients with HF.Methods: A total of 14 participants with HF used the exergame on their smartphones for one month (9 Swedish and 5 Spanish participants; 9 males, mean 72 years, range 61-82 years). Participants were provided an introduction to the exergame, and follow-up was carried out regularly by telephone. Participants were advised to increase the daily walking duration by 10 minutes a day, based on the number of meters walked in the 6-minute walk test (6MWT). Areas of feasibility identified were acceptability, demand, implementation, and practicality, which were examined during telephone follow-ups and interviews, and data downloaded from the exergame.Results: Participants found the farming theme appealing, and coaching encouraged them to perform the exergame on a regular basis (acceptability). Based on the 6MWT, the personal goal for daily walking was set (mean of 704 meters, range 250-900 meters). Participants reported that daily goals and tasks were manageable. The exergame was perceived as appropriate to decrease sedentary time, and participants reported improved physical health (demand). The exergame was perceived as easy to learn and use, and adjustable to individual needs (implementation). Exergaming while walking and conversing with others was described as less convenient (practicality).Conclusion: Participants with HF valued personalized support and the exergame's farming theme was appealing. The goal to increase walking by 10 minutes a day was seen as a realistic way to reduce sedentary behavior. When introducing the exergame, it is essential to emphasize the importance of proper lighting, so meters walked are accurately recorded.

Fluid restriction is frequently recommended to patients with chronic heart failure, but randomized clinical trials assessing the effects of fluid restriction remain scarce. In this multicenter open-label trial, outpatients with chronic heart failure were randomized to receiving advice for liberal fluid intake versus receiving advice for fluid restriction, up to 1,500 ml per day of fluid intake. The primary outcome of the trial was health status after 3 months, as assessed by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS). Secondary outcomes included thirst distress and safety events. Among 504 randomized patients (67.3% male), the KCCQ-OSS after 3 months was 74.0 in the liberal fluid intake group versus 72.2 in the fluid restriction group, with a mean difference after adjustment for baseline scores of 2.17 (95% confidence interval -0.06 to 4.39; P = 0.06), indicating that the primary outcome was not met. Thirst distress was higher in the fluid restriction group and no differences were observed for safety events between the two groups. These findings question the benefit of fluid restriction in chronic heart failure. ClinicalTrials.gov registration: NCT04551729.

Health care systems are confronted with an increasing burden of (multi-)morbidity and a shortfall of healthcare providers. Coordination and continuity of care in chronic and multi-morbid patient is especially important. As qualitative patient experience data within care processes is scarce, we aim to increase the understanding of chronically ill patient's perspectives by assessing patient experiences in different health systems while treated in primary care. Patients were recruited via GPs from Germany, Sweden, Switzerland, and the British island of Jersey. To ascertain regular healthcare utilisation, inclusion criteria were either a stroke, and/or a myocardial infarction or heart failure during the past year, and an underlying metabolic syndrome. Identical semi-structured interview-guides were used in the respective language. Transcribed interviews were analysed according to inductive-deductive qualitative content analysis. Based on 22 interviews we derived four main categories (patient centeredness, continuity, coordination, access). Overall, healthcare processes were considered positive if information flow was personal and functional. Non-physician staff seemed to create reassurance. A long-lasting doctor-patient relationship was connected to the context of trust and security. Patients were critical of a perceived lack of time, inducing insufficient counselling and information-flow. This international explorative study suggests that patients' experiences can provide important information about care provision. Patients consistently focused more on relational aspects rather than on structures or functions. This has connotations for healthcare planning; for example, by providing non-physician staff to support patients through their care pathway and to improve the cooperation between providers.

Good self-care can improve survival, decrease health care costs, and improve quality of life of persons with cardiovascular illness. Health care professionals from different disciplines have a role in self-care support. Many definitions, theories, and measurement instruments exist addressing self-care and this plethora might be confusing to clinicians and researchers. In this discussion article, we will guide the reader to find the right terminology and discuss theoretical foundations and instruments available to frame patient care and research addressing the self-care of persons with cardiovascular illness.