AUTHOR=Jiang Yuyu , Sun Manyao , Nuerdawulieti Baiyila , Huang Xueying , Hou Yi , Nan Jiang , Cui Shiya , Nan Xun 

TITLE=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

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1576256

DOI=10.3389/fmed.2025.1576256

ISSN=2296-858X

ABSTRACT=BackgroundRemote 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 self-efficacy theory and HAPA theory based remote PR.Methods159 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 self-efficacy, exercise motivation and positive affect.ResultsA 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.ConclusionRemote 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.Clinical Trial RegistrationChinese Clinical Trial Registry (ChiCTR): ChiCTR1900028563; https://www.chictr.org.cn/index.html.