Designing Exergames for Psoriatic Arthritis: The Spy and Zen Forest Paradigms

Psoriatic Arthritis (PsA) is a rheumatic disease that affects the skin and joints, causing stiffness, impaired mobility, and chronic pain. In addition to biological interventions, traditional treatments often include physiotherapy and exercise to improve range of motion and physical function. However, a prevalence of low consistency, high costs, and lack of engagement leads to high drop-out rates, making these interventions ineffective. Exergames, short for exercise games, provide an accessible alternative to complement traditional interventions, which embed therapeutic movements into game mechanics, motivating patients to remain active and consistent in their rehabilitation routines. Here we present the design of two exergames for PsA, namely The Spy and Zen Forest. Both exergames were co-designed with 29 experts, including PsA patients, clinicians, researchers, and technical stakeholders, ensuring that they align with clinical goals, address patient needs, and support safe and effective physical engagement. In The Spy, players act as undercover agents and complete a sequence of physically engaging missions, designed to stimulate dynamic body movement that boost coordination and enhance mobility, balance, strength, and flexibility. In Zen Forest, players perform slow and calm stretching routines inspired by Pilates and Yoga exercises, improving their flexibility, relaxation, and body awareness. Both exergames can enable clinicians to monitor patient progress and recommend personalized activity plans, making therapeutic routines more accessible and motivating.