Investigating the Physiological Response and Exercise Intensity During Ring Fit Adventure Gaming in Adults with Chronic Diseases: A Cross-Sectional Study (Preprint)

BACKGROUND Physical inactivity remains a major global public health concern and is a key modifiable risk factor for non-communicable diseases such as cardiovascular disease, diabetes and obesity. Although the benefits of regular physical activity are well established, many adults fail to meet recommended aerobic and muscle strengthening guidelines, particularly those living with chronic disease. Home-based exercise strategies may help overcome common barriers such as time constraints, accessibility, and low motivation. Active Video Games (AVGs) offer a potentially engaging alternative. However, many existing AVGs do not provide sufficient exercise intensity to elicit meaningful cardiovascular or metabolic benefits. Ring Fit Adventure (RFA) is a commercially available AVG for the Nintendo Switch that integrates aerobic and resistance exercise through whole-body movements. It has the potential to increase physical activity levels yet evidence evaluating its physiological effects in adults with chronic disease remains limited. OBJECTIVE This study aimed to investigate the acute physiological responses to playing RFA in adults with chronic diseases. It examined changes in heart rate (HR), blood pressure (BP), blood glucose (BG), exercise intensity, and perceived exertion, as well as enjoyment levels during gameplay. METHODS A cross-sectional observational pilot study was conducted involving 20 adults aged 40–65 years with at least one chronic disease (hypertension, hyperlipidaemia, diabetes, or obesity). Participants completed two stages (“World 1” and “World 2”) of Ring Fit Adventure following baseline assessment and a familiarisation session. Heart rate was continuously monitored using a chest strap, while BP, BG, oxygen saturation, and rate of perceived exertion (RPE) were measured at baseline and after each stage. Enjoyment was assessed using the Exergame Enjoyment Questionnaire. Statistical analyses compared baseline and post-exercise physiological measures. RESULTS All participants completed the protocol without adverse events. Mean continuous HR during gameplay reached 67.2% of age-predicted maximum, indicating moderate-intensity exercise, with peak HRs reaching vigorous-intensity levels (83.5% of maximum). HR and RPE increased significantly after both game stages (P