Effectiveness of Game-based interventions for improving care outcomes in patients with cardiac diseases: a systematic review of randomized-controlled trials

Abstract

Background Cardiovascular diseases remain the leading cause of global morbidity and mortality. Game-based interventions, including exergaming, serious games, and gamified mobile applications, have emerged as innovative approaches to enhance patient engagement and clinical outcomes in cardiac populations. Purpose This systematic review evaluated the effectiveness of game-based interventions on physical activity, self-care behaviors, cardiovascular risk factors, quality of life, and clinical parameters in cardiac patients. Method A systematic search was conducted across PubMed, CINAHL, Web of Science, and Scopus databases. Randomized controlled trials examining game-based interventions in adult cardiac patients were included. Studies published between 2015-2025 encompassing heart failure, coronary heart disease, acute coronary syndrome, hypertension, and cardiovascular disease risk were analyzed. Results Nine randomized controlled trials with 2,861 participants across multiple countries were included. Interventions included sensor-controlled digital games, exergaming platforms, mobile health applications, and serious games. Follow-up ranged from 4 weeks to 12 months. Game-based interventions significantly improved physical activity (+492 to +868 steps/day with combined interventions), enhanced adherence to self-care behaviors and remote monitoring, improved Mediterranean diet compliance, reduced sedentary time, and favorably affected cardiovascular risk factors. Quality of life, particularly physical health, showed significant improvements with exergaming. Exercise capacity trends were positive but not consistently significant. Cognitive function improved in older hypertensive adults. Gamification combined with financial incentives demonstrated sustained effects. Safety profiles were consistently favorable with high feasibility and acceptability. Conclusion Game-based interventions represent a feasible, safe, and promising approach for cardiac disease management with beneficial effects on physical activity, self-care behaviors, and quality of life. Combining gamification with behavioral strategies appears particularly effective. However, mixed exercise capacity results, small sample sizes, and short follow-up durations limit definitive conclusions. Further large-scale, long-term trials are needed to establish clinical effectiveness, optimal designs, and cost-effectiveness for healthcare implementation.