Exergame Intervention for Habit Formation, Lifestyle Adjustment, and Health Ownership Enhancement Among Hong Kong’s Older Adults: Multisession, Single-Group, Pre-Post Pilot Study

Abstract Background Regular physical activity is critical for healthy aging, yet older adults face persistent barriers to exercise adherence. Exergames, such as video games that require physical movement, have emerged as a promising tool to engage older adults in regular exercise. However, most existing research focuses on physical and cognitive outcomes, with limited understanding of whether exergames are associated with behavioral changes, including sustained exercise habits, healthier lifestyles, and a sense of health ownership, which underpin older adults’ environmental mastery and self-management of their health. Objective This pilot study investigated how participation in a community-based exergame program was associated with exercise habits, healthy lifestyles, and health ownership and examined the motivational factors driving longer-term adherence. Methods This study used a single-group, pre-post pilot design. It involved 33 older adults participating in an exergame program across 2 community centers in Hong Kong. The program was meticulously designed to include 12 supervised training sessions (6 wk), followed by a 4-week free-play period to assess long-term adherence. A package of exergames, covering physical, social, and cognitive health, was selected. Each exergame session lasted 30 minutes. During this time, older adults played 3 different games, with each game taking 10 minutes. Changes in health status, well-being, physical activity level, exercise habits, healthy lifestyles, health ownership, and motivations to play exergames at 4 stages were continuously measured. We applied repeated-measures generalized linear model for health and habit outcomes, Mann-Whitney U to examine the relationship between motivational factors and adherence, and Spearman correlation to test links between motivation and play frequency during the free-play period. Results The linear mixed model results suggest that participation in the exergame program was positively associated with older adults’ healthy lifestyles ( mean difference 0.70, 95% CI 0.14 to 1.25, F 3,96 =6.52; P <.001, η 2 =0.17), exergame play habits ( mean difference 0.50, 95% CI −0.03 to 1.03, F 2.77,88.57 =4.88; P =.004, η 2 =0.13), total physical activity metabolic equivalent of task levels ( mean difference 2100.83, 95% CI −249.16 to 4450.82, F 2.44,78.05 =3.15; P =.04, η 2 =0.09), and health ownership ( mean difference 0.24, 95% CI 0 to 0.48, F 1.61,51.44 =4.23; P =.03, η 2 =0.12). Posttraining adherence was high at 75.80% (25/33). Further, Spearman rank correlation analysis indicated positive associations between adhered gameplay frequency and social (coefficient=0.41; P =.02) and enjoyment motivations (coefficient=0.39; P =.02). Conclusions This pilot study examines exergames as an innovative approach to healthy aging by encouraging sustained behavioral change. Unlike prior research that emphasized health outcomes, these findings suggest potential benefits in formulating physical activity habits, lifestyle adjustment, and health ownership. Enjoyment and social connection emerged as key motivational factors. The study indicates potential for nongovernmental organization–led community programs to foster active aging, lifestyle adjustment, and social cohesion.