Gamification is defined as the use of game design elements in contexts other than gaming to increase user engagement and experience. Gamification in cardiovascular care can contribute to positively change health behaviour with possible effects and benefits on physical health and mental well-being. Based on previous literature, in this article we describe: the conceptualization of gamification, the five gamification principles for gamified digital health programmes or applications, the six most common game elements used to impact health behaviour applied in gamified digital health interventions and finally scientifically validated instruments to use for assessment of gamification in terms of self-reported psychological outcomes.

Physical activity is important for everyone to maintain and improve health, especially for people with chronic diseases. Mobile exergaming has the potential to increase physical activity and to specifically reach people with poor activity levels. However, commercial mobile exergames are not specially designed for older people with chronic illnesses such as heart failure. The primary aim of this viewpoint is to describe the underlying reasoning guiding the design choices made in developing a mobile exergame, Heart Farming, tailored specifically for sedentary older people diagnosed with heart failure. The goal of the exergame is to increase physical activity levels by increasing the daily walking duration of patients with heart failure by at least 10 minutes. The rationale guiding the design decisions of the mobile exergame is grounded in the thoughtful integration of gamification strategies tailored for application in cardiovascular care. This integration is achieved through applying gamification components, gamification elements, and gamification principles. The Heart Farming mobile exergame is about helping a farmer take care of and expand a virtual farm, with these activities taking place while the patient walks in the real world. The exergame can be adapted to individual preferences and physical condition regarding where, how, when, and how much to play and walk. The exergame is developed using augmented reality so it can be played both indoors and outdoors. Augmented reality technology is used to track the patients’ movement in the real world and to interpret that movement into events in the exergame rather than to augment the mobile user interface.

Reducing inactivity in patients with chronic disease is vital since it can decrease the risk of disease progression and mortality. Exergames are an innovative approach to becoming more physically active and positively affecting physical health outcomes. Serious games are designed for purposes beyond entertainment and exergames are serious games for physical activity. However, current commercial exergames might not optimally meet the needs of patients with special needs. Developing tailored exergames is challenging and requires an appropriate process. The primary goal of this viewpoint is to describe significant lessons learned from designing and developing an exergame for patients with chronic heart failure using the player-centered, iterative, interdisciplinary, and integrated (P-III) framework for serious games. Four of the framework’s pillars were used in the design and development of a mobile exergame: player-centered design, iterative development of the game, interdisciplinary teamwork, and integration of play and serious content. The mobile exergame was developed iteratively in 7 iterations by an interdisciplinary team involving users and stakeholders in all iterations. Stakeholders played various roles during the development process, making the team stay focused on the needs of the patients and creating an exergame that catered to these needs. Evaluations were conducted during each iteration by both the team and users or patients according to the player-centered design pillar. Since the exergame was created for a smartphone, the assessments were conducted both on the development computer and on the intended platforms. This required continuous deployment of the exergame to the platforms and smartphones that support augmented reality. Our findings show that the serious game P-III framework needs to be modified in order to be used for the design and development of exergames. In this viewpoint, we propose an updated version of the P-III framework for exergame development including (1) a separate and thorough design of the physical activity and physical interaction, and (2) early and continuous deployment of the exergame on the intended platform to enable evaluations and everyday life testing.

Students need the ability to reason about the behavior of programs when working with advanced concepts like concurrency and abstraction. To achieve this, students require core programming skills that allow them to trace and predict the outcome of a program. While previous research indicates that teachers cannot expect students to acquire all core programming skills after their introductory CS course, less is known of students’ progression in later years. In this study, we investigate 397 students’ ability to predict the outcome of short computer programs. The participants are from different programs and progressions in their studies. We find that students, regardless of program and year, struggle with predicting the outcome of short programs that require an accurate mental model of some less readily apparent concepts, such as references. Further, we discover that there is no significant improvement in the first three years. Finally, we propose further avenues of research to improve these learning outcomes.

Prolonged sedentary life is associated with several health risks. Office work is characterized by prolonged sedentary time and contributes significantly to the total sedentary exposure for office employees. This work aims to investigate the combination of casual exergames with gamification, two concepts that can impact behavior change, to decrease the prolonged sitting time for office workers, by interrupting long periods of sitting. A gamified web-based break application for micro-training using casual exergames and movement exercises was designed. A user study with office workers was conducted where workers had access to the application for 45 weeks, during which reward-based gamification was introduced in the application during an 11-week period and usage was compared before, during, and after the introduction of the reward-based game elements. The results showed that participants reported a positive experience of the application and that the number of breaks during the reward-based gamification period was statistically significantly higher compared to the period before and after the inclusion of the reward-based gamification.