Physiological Responses, Exercise Intensity, and Enjoyment During Ring Fit Adventure in Adults With Chronic Diseases: Single-Arm, Pre-Post Experimental Study.

Background: Physical inactivity and insufficient muscle-strengthening exercise remain important public health concerns among adults with chronic diseases. Active video games may offer an accessible way to support exercise participation, but many may not provide sufficient exercise intensity to produce meaningful physiological responses. Ring Fit Adventure (RFA) is an active video game that combines aerobic and resistance-based exercise. However, little is known about its physiological demands among adults with chronic diseases. Objective: This pilot study aimed to examine the acute physiological responses, exercise intensity, perceived exertion, and enjoyment during RFA gameplay in adults with stable chronic diseases. Methods: A single-arm, pre-post experimental study was conducted among 20 adults aged 40 to 65 years with at least one chronic disease. Participants were recruited through convenience and snowball sampling from a hospital-based setting and public recruitment channels. After baseline assessment and familiarization, participants completed 2 stages of RFA gameplay. Heart rate (HR) was continuously monitored, while blood pressure (BP), capillary blood glucose (BG), and the rate of perceived exertion were measured at baseline and immediately after each stage. Enjoyment was assessed using the Exergame Enjoyment Questionnaire (EEQ). Results: All 20 participants completed the study, with no adverse events or missing data. The mean age was 54.3 (95% CI 51.25-57.25) years, and 10 participants were male. Hypertension was the most common condition (n=14, 70%), followed by hyperlipidemia (n=11, 55%), obesity (n=8, 40%), and diabetes (n=5, 25%). The mean continuous HR during gameplay was 111.6 (95% CI 102.6-120.6) bpm, corresponding to 67.2% of the age-predicted maximum HR, while peak HR reached 138.6 (95% CI 128.9-148.3) bpm, corresponding to 83.5% of the age-predicted maximum HR. HR increased significantly after World 1 by 16.7 (95% CI 11.42-21.88; Conclusions: RFA elicited moderate average exercise intensity with periods of vigorous intensity, reductions in capillary BG, stable postexercise BP, and high enjoyment among adults with stable chronic diseases. These findings suggest that RFA may be a feasible and engaging home-based exercise option for this population. However, the small, heterogeneous sample, absence of a control condition, and single-session design limit generalizability. Larger controlled longitudinal studies are needed to determine its effects on exercise adherence, physical activity levels, and cardiometabolic outcomes.