Efeitos da gamificação na reabilitação cardiopulmonar na qualidade de vida, nível de atividade física e capacidade funcional: uma revisão sistemática e meta-análise

Abstract

Introduction: Patients with cardiopulmonary diseases often require cardiopulmonary rehabilitation to improve physical activity levels, functional capacity, and quality of life. However, lack of adherence to the training program, increased healthcare costs with these programs, and inequality in access to healthcare resources have been important challenges for participation in conventional rehabilitation programs. Gamification, defined as the use of game design elements in non-game contexts, has been used in studies that used remote rehabilitation programs. Objective: To synthesize the evidence on the effects of gamification applied in cardiopulmonary rehabilitation on the quality of life, physical activity level, and functional capacity of patients with cardiopulmonary diseases. Methods: Systematic review with meta-analysis with research up to May 11, 2025, in the electronic databases: MEDLINE via PubMed, Web of Science, Embase, Cochrane Library, PEDro, Scopus, and Trip Data Base. The PICO strategy was used, which included studies with patients with cardiopulmonary diseases, adults and elderly people of both sexes, in rehabilitation or post-cardiopulmonary rehabilitation with Gamified interventions, compared to a placebo group or no intervention, which evaluated the outcomes of physical activity level, quality of life and functional capacity. Studies involving patients with other diseases or healthy populations, with virtual reality interventions, exergames, active video games and motion detection technologies were excluded. The screening, separation and analysis of the studies were performed by two independent reviewers. The methodological quality was assessed using the PEDro scale, the risk of bias of the studies using the Cochrane ROB2 and the quality of the evidence using the GRADE methodology. The data were synthesized and presented in tables and graphs. Results: From the initial search, 1.427 articles were identified. Of these, 160 duplicates were excluded and, after screening by title and abstract, 24 studies were selected for full reading, 16 studies were then excluded, leaving eight articles for the review. The included studies totaled 2.734 participants, 50.5% of whom were male, aged 18 to 80 years, with cardiopulmonary diseases. Physical activity was assessed by steps per day, daily minutes of moderate to vigorous physical activity, wearable device as an activity tracker, total physical activity by metabolic equivalent, self-report, smartphone accelerometers and movement regimen. For the meta-analysis, data related to steps per day were used, with an overall result in favor of gamification in relation to the control group (SMD 0.39, 95% CI 0.26 - 0.52), with moderate certainty of evidence. Functional capacity was assessed by two studies and quality of life by only one study, identifying a clinically and statistically significant increase in functional status and improvement in quality of life in relation to baseline levels. Conclusion: Our results suggest that gamification has a beneficial effect on cardiovascular rehabilitation in relation to the level of physical activity, however there is a gap in the literature regarding the use of gamification in quality of life and functional capacity in cardiopulmonary rehabilitation.