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

Yuyu Jiang; Manyao Sun; Baiyila Nuerdawulieti; Xueying Huang; Yi Hou; Jiang Nan; Shiya Cui; Xun Nan

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

Front Med (Lausanne). 2025 Jun 19:12:1576256. doi: 10.3389/fmed.2025.1576256. eCollection 2025.

Authors

Yuyu Jiang¹, Manyao Sun¹, Baiyila Nuerdawulieti², Xueying Huang¹, Yi Hou¹, Jiang Nan¹, Shiya Cui¹, Xun Nan¹

Affiliations

¹ Research Office of Chronic Disease Management and Rehabilitation, Department of Nursing, Wuxi School of Medicine, Jiangnan University, Wuxi, China.
² School of Medicine Xinjiang College of Science & Technology, Korla, China.

Abstract

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 self-efficacy 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 self-efficacy, 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.

Clinical trial registration: Chinese Clinical Trial Registry (ChiCTR): ChiCTR1900028563; https://www.chictr.org.cn/index.html.

Keywords: behavior change; chronic obstructive pulmonary disease; gamification; randomized controlled trial; telemedicine.