title: "The Heart Game": Using Gamification as Part of a Telerehabilitation Program for Heart Patients.
abstract: OBJECTIVE
  The aim of this article is to describe the development and testing of a prototype application ("The Heart Game") using gamification principles to assist heart patients in their telerehabilitation process in the Teledialog project.
  
  
  METHODS
  A prototype game was developed via user-driven innovation and tested on 10 patients 48-89 years of age and their relatives for a period of 2 weeks. The application consisted of a series of daily challenges given to the patients and relatives and was based on several gamification principles. A triangulation of data collection techniques (interviews, participant observations, focus group interviews, and workshop) was used. Interviews with three healthcare professionals and 10 patients were carried out over a period of 2 weeks in order to evaluate the use of the prototype.
  
  
  RESULTS
  The heart patients reported the application to be a useful tool as a part of their telerehabilitation process in everyday life. Gamification and gameful design principles such as leaderboards, relationships, and achievements engaged the patients and relatives. The inclusion of a close relative in the game motivated the patients to perform rehabilitation activities.
  
  
  CONCLUSIONS
  "The Heart Game" concept presents a new way to motivate heart patients by using technology as a social and active approach to telerehabilitation. The findings show the potential of using gamification for heart patients as part of a telerehabilitation program. The evaluation indicated that the inclusion of the patient's spouse in the rehabilitation activities could be an effective strategy. A major challenge in using gamification for heart patients is avoiding a sense of defeat while still adjusting the level of difficulty to the individual patient.
authors.affiliation: 1 Department of Computer Science, Aarhus University , Aarhus, Denmark .
authors.forename: Marcus
authors.initials: M
authors.lastname: Dithmer
authors.affiliation: 1 Department of Computer Science, Aarhus University , Aarhus, Denmark .
authors.forename: Jack Ord
authors.initials: JO
authors.lastname: Rasmussen
authors.affiliation: 2 IT University of Copenhagen , Copenhagen, Denmark .
authors.forename: Erik
authors.initials: E
authors.lastname: Grönvall
authors.affiliation: 3 Department of Psychology and Behavioral Sciences, Aarhus University , Aarhus, Denmark .
authors.forename: Helle
authors.initials: H
authors.lastname: Spindler
authors.affiliation: 4 Laboratory for Telehealth and Telerehabilitation, Center for Sensory-Motor Interaction, Department for Health Science and Technology, Aalborg University , Aalborg, Denmark .
authors.forename: John
authors.initials: J
authors.lastname: Hansen
authors.affiliation: 5 Cardiotechnology Laboratory, Medical Informatics, Department for Health Science and Technology, Aalborg University , Aalborg, Denmark .
authors.forename: Gitte
authors.initials: G
authors.lastname: Nielsen
authors.affiliation: 6 Vendsyssel Hospital , Hjørring, Denmark .
authors.forename: Stine Bæk
authors.initials: SB
authors.lastname: Sørensen
authors.affiliation: 4 Laboratory for Telehealth and Telerehabilitation, Center for Sensory-Motor Interaction, Department for Health Science and Technology, Aalborg University , Aalborg, Denmark .
authors.forename: Birthe
authors.initials: B
authors.lastname: Dinesen
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000534:rehabilitation*; D003718:Denmark; D006333:Heart Failure / Q000534:rehabilitation*; D006801:Humans; D008875:Middle Aged; D063731:Mobile Applications; D009203:Myocardial Infarction / Q000534:rehabilitation*; D000069350:Telerehabilitation / Q000379:methods*; D018910:Video Games