CLINICAL TRIAL article
Front. Med.
Sec. Pulmonary Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1576256
Effectiveness of remote gamification pulmonary rehabilitation intervention based on the health action process approach theory in older adults with chronic obstructive pulmonary disease: A pilot randomized controlled trial
Provisionally accepted
- 1Jiangnan University, Wuxi, China
- 2Xinjiang College of Science & Technology, Korla, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Remote pulmonary rehabilitation (PR) is widely used in the management of chronic obstructive pulmonary disease (COPD), but there is a problem of adherence. Health Action Process Theory (HAPA) is an effective behavior change theory, and combining it with gamification is expected to further improve PR adherence. This study explored the improvement effect of remote gamification PR intervention based on HAPA theory on rehabilitation adherence, clinical symptoms, quality of life and psychological outcome indicators of COPD patients, and compared it with selfefficacy theory and HAPA theory based remote PR.Methods: 159 COPD patients were randomly divided into three groups: PR group, HAPA-PR group, and HAPA-gamification-PR (HAPA-Ga-PR) group. All three groups received 12 weeks of intervention and 12 weeks of follow-up. The primary outcome indicators were quality of life of patients and PR adherence. Secondary outcome measures were dyspnea symptoms, exercise selfefficacy, exercise motivation and positive affect.Results: A total of 147 patients completed the experiment. At the 12th week of intervention, there were statistically significant differences in PR adherence (p=0.015), exercise self-efficacy (p=0.039), exercise motivation (p=0.008) and positive affect (p=0.004) between the PR group and the HAPA-Ga-PR group. There were statistically significant differences in exercise motivation (p=0.044) and positive affect (p=0.046) between HAPA-PR group and HAPA-Ga-PR group. At week 24, there were statistically significant differences in quality of life (p=0.039), PR adherence (p=0.001), exercise motivation (p=0.027) and positive affect (p=0.015) between the PR group and the HAPA-Ga-PR group. Compared to baseline, at week 24, only the HAPA-Ga-PR group showed statistically significant improvement in exercise self-efficacy (p=0.013) in COPD patients. Conclusion: Remote gamification PR intervention based on HAPA theory shows significant advantages in improving PR adherence, quality of life and psychological outcome of COPD patients, providing a new way for chronic disease management and personalized digital health services. This model can be extended to more chronic disease rehabilitation scenarios in the future.
Keywords: chronic obstructive pulmonary disease, randomized controlled trial, Gamification, behavior change, Telemedicine
Received: 13 Feb 2025; Accepted: 04 Jun 2025.
Copyright: © 2025 Jiang, Sun, Nuerdawulieti, Huang, Hou, Nan, Cui and Nan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yuyu Jiang, Jiangnan University, Wuxi, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.