JMIR Serious Games

BioDecryptors, a Bioinformatics Escape Game for Undergraduate and Postgraduate Learners in Clinical Microbiology: Prospective Before-and-After Study

2026-11-05T16:30:23-05:00

Background: Bioinformatics is increasingly important in clinical microbiology with growing use of genomic sequencing, metagenomics, and phylogenetic analyses. However, introducing bioinformatics concepts and tools to medical learners can be challenging. Gamified educational approaches may allow introducing these concepts while supporting learner motivation. Objective: This study prospectively evaluated BioDecryptors, an educational escape game to introduce bioinformatics principles and tools in clinical microbiology, by assessing short-term changes in knowledge and self-reported motivation and evaluating participant satisfaction. Methods: We conducted a prospective before-and-after study between January and September 2025. Volunteers were recruited from undergraduate medical programs at Université Paris Cité and postgraduate programs or training activities for MDs and PharmDs at Université de Nantes, Université Paris-Saclay, and the French Society for Microbiology. Overall, 55 participants were included: 22 (40%) second-year medical students and 33 (60%) postgraduate MDs or PharmDs. Participants completed BioDecryptors in teams of 3 to 4 using versions adapted to their training level. Knowledge was assessed before and immediately after the activity using 2 distinct 10-item tests assessing the same predefined learning objectives. Motivation was assessed using a 12-item, 5-point Likert questionnaire covering 3 predefined domains, and satisfaction was assessed after the activity. Pre-post knowledge scores were compared using paired tests or Wilcoxon signed-rank tests, as appropriate. Motivation items were analyzed using paired Wilcoxon signed-rank tests with Benjamini-Hochberg correction. Statistical significance was defined as a 2-sided <.05. Results: Paired knowledge assessments were available for 50 participants. Mean knowledge scores increased from 7.0 (SD 2.0; 95% CI 6.4-7.5) before the activity to 7.9 (SD 2.0; 95% CI 7.4-8.5) afterward (<.001). The mean change was 0.93 (SD 1.39; 95% CI 0.26-1.60) points among undergraduates and 0.83 (SD 1.21; 95% CI 0.38-1.27) points among postgraduates, with no statistically significant between-group difference (=.79). Motivation increased for perceived usefulness (=.04), willingness to learn (=.01), understanding of bioinformatics in diseases (=.002), and confidence in bioinformatics abilities (=.002). Curiosity (=.46) and interest in real-life applications (=.33) did not significantly change. Among 50 satisfaction respondents, overall satisfaction was high (mean 4.7, SD 0.5; 95% CI 4.6‐4.9); 98% (48/49) of the respondents to the corresponding item indicated an interest in other escape game modules. Conclusions: Participation in BioDecryptors was associated with short-term increases in bioinformatics knowledge and self-reported motivation, together with high participant satisfaction. Unlike previously reported escape games focusing primarily on clinical or infection-control topics, BioDecryptors integrates hands-on bioinformatics analyses into a clinical microbiology scenario and offers versions adapted to undergraduate and postgraduate learners. Our findings provide preliminary evidence supporting the feasibility and acceptability of this approach as a complementary educational resource for introducing bioinformatics in health professions training. Controlled studies with longer-term assessments are needed to establish its comparative educational effectiveness and knowledge retention.

Emotion- and Performance-in-the-Loop: Multimodal Difficulty-Adaptive Exergame System—Controlled Between-Participants Study

2026-11-05T16:00:39-05:00

Background: Existing exergames predominantly adjust difficulty based on explicit performance metrics, neglecting the player’s implicit affective state, which often leads to early disengagement due to boredom or frustration. Objective: To address this gap, we present a novel exergame system that implements joint emotion- and performance-driven dynamic difficulty adjustment (DDA), using a closed-loop controller that reasons over both motor performance and affective state. Methods: The system integrates a computer-vision-based motion evaluation pipeline, a multimodal emotion recognition module that fuses facial action units (AUs), deep facial features, and motion-compensated heart rate variability (HRV) via an adaptive entropy-weighted decision-level fusion strategy, and a closed-loop difficulty controller. A controlled between-participants experiment (N=20) compared the adaptive system against a fixed-difficulty baseline during a 15-minute dance-exergame session. Results: Emotion recognition accuracy reached 81.07% (macro-F₁: 81.02%) for 7 emotional states. The adaptive group demonstrated significantly lower cognitive load (NASA-TLX [National Aeronautics and Space Administration Task Load Index], P<.05), higher positive affect (Positive and Negative Affect Schedule [PANAS], P<.05), greater system usability (System Usability Scale [SUS], P<.05), improved motion accuracy (82.5% vs 74.8%, P<.05), and a physiologically healthier training load indicated by higher HRV root mean square of successive differences (RMSSD; 34.6 vs 24.3 ms, P<.05). Conclusions: The joint emotion-and-performance difficulty-adaptation mechanism is feasible and significantly improves user experience and training outcomes compared to a fixed-difficulty baseline.

Digital Resilience-Based Course-Game Sequential Intervention for Social Participation in Stroke Survivors: Development and Usability Study

2026-11-02T16:00:28-05:00

Background: Social participation is a key goal of stroke rehabilitation, yet effective interventions remain limited. Existing approaches focus largely on functional training or general psychological support, rarely targeting resilience as a modifiable mechanism for enhancing social participation. Most interventions are delivered face-to-face, limiting accessibility and scalability. A theory-driven digital intervention that integrates resilience training with contextualized practice may offer a promising pathway to support social reintegration in stroke survivors. Objective: This study aimed to develop a theory-driven, digital resilience-based course-game sequential intervention for improving social participation in stroke survivors and to evaluate its usability among the target population. Methods: This was an intervention development and usability study. Following the first 4 steps of intervention mapping, we completed the following steps: (1) conducted a needs assessment based on prior empirical evidence identifying psychological resilience as a key determinant of social participation; (2) defined performance and change objectives grounded in the Kumpfer resilience framework, which delineates 5 protective factors (cognitive, emotional, spiritual, behavioral, and physical); (3) selected theory-based methods and practical applications; and (4) developed an intervention prototype through 4 phases: initial design integrating course learning and gamified experiential modules, expert review and refinement by an 8-member panel, development of the digital system via a WeChat mini-program, and finalization of comprehensive intervention scripts. Participants were recruited using convenience sampling from a rehabilitation hospital in Shanghai, China. Usability was evaluated with 14 stroke survivors through 5 representative tasks, the System Usability Scale (SUS), and semistructured qualitative interviews. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using conventional content analysis. Results: The intervention comprised 2 sequential modules: a 7-session course learning module targeting 5 resilience factors, delivered weekly via narrative audio and multimodal content, and a gamified experiential module featuring a supermarket shopping scenario that enabled contextualized skill application. Each weekly course session was designed to last approximately 60 minutes. The duration of a single game session was 20 minutes. Participants had a mean age of 65.4 (SD 9.75) years, and 78.6% (11/14) had experienced an ischemic stroke. All participants completed the usability tasks successfully. The mean SUS score was 73.6 (SD 12.2, 95% CI 66.5-80.6; median 77.5, IQR 61.3-80.6), indicating good usability. Qualitative feedback revealed 3 themes: perceived ease of use and accessibility, perceived usefulness and engagement, and suggestions for improvement. Conclusions: This study systematically developed a theory-driven, digital course-game sequential intervention that is innovative in targeting psychological resilience as a core mechanism for social participation, distinguishing it from conventional function-focused or generic resilience approaches. By integrating systematic course learning with contextualized gamified practice, it offers a scalable, low-burden tool that addresses key gaps in stroke rehabilitation. These findings support progression to feasibility and efficacy testing through randomized controlled trials in real-world settings.

A Home-Based Serious Game for Cognitive Control Training in Major Depressive Disorder: Randomized Controlled Trial

2026-10-30T20:30:26-04:00

Background: Serious games are increasingly explored as scalable, engaging interventions for major depressive disorder (MDD). However, most trials evaluating game-based interventions rely on weak comparators or inactive controls, making it difficult to disentangle intervention-specific effects from nonspecific benefits. Objective: This study aimed to evaluate the effectiveness and feasibility of a home-based serious game targeting cognitive control (CC) training in adults with MDD, compared against a closely matched active control game. Methods: This was a home-based, minimal-contact, parallel-group randomized controlled trial. Adults aged 18 to 65 years with a current ( [Fifth Edition]) diagnosis of MDD were recruited via clinical referrals from a mental health center in Israel between November 2021 and April 2023. Participants completed 30 sessions of 30 minutes each over 6 weeks. The experimental arm received Legends of Hoa’manu (LoH), an adaptive action-based serious game integrating CC training with emotional stimuli, whereas the control arm received a closely matched game (LoH_control) with comparable aesthetics and structure but without adaptive CC training or emotional content. The preregistered primary outcome was change on the Montgomery-Åsberg Depression Rating Scale (MADRS), and the secondary outcome was feasibility. Tertiary outcomes included depression severity, illness severity, global improvement, well-being, functioning, participation, rumination, and response and remission; CC and durability were exploratory. Participants were randomized 1:1 (computer-generated pseudorandom sequence, permuted blocks of 4), with allocation concealed until after baseline. Participants and outcome assessors were blinded to allocation. Results: Of 57 randomized participants (LoH: n=28, 49%; LoH_control: n=29, 51%), 48 (84%) completed postintervention, and 44 (77%) completed 1-month follow-up; all 57 were analyzed by intention-to-treat using linear mixed models. The mean adherence was 20.7 (SD 9.48) of 30 (69%) sessions, early abandonment was uncommon (<10% of sessions), and all 3 post hoc feasibility benchmarks were met. Both arms showed significant reductions in depressive symptoms over time (<.001; η²=0.49); MADRS reductions were 6.8 (95% CI 3.4-10.3) points in LoH and 9.8 (95% CI 6.4-13.3) in LoH_control, with no significant group×time interaction (=1.57; =.22; η²=0.03). CC composite scores improved modestly over time (=.045; η²=0.09). No intervention-related adverse events were reported. Conclusions: This is among the first randomized trials of a home-based serious game combining action-based gameplay with CC training against a closely matched active control in MDD. Both arms improved comparably, with no added benefit from the targeted training, implicating nonspecific, engagement-related processes. The findings indicate that comparator design matters in digital mental health. Home-based serious games are feasible and could widen access to care, but no-contact and dismantling trials must identify the active components. Trial Registration: Israeli Ministry of Health Clinical Trials Registry MOH_2021-07-20_005979;

Comparing Text-Based and Virtual Reality–Based Approaches for AI-Enhanced Instruction in Functional Communication Training: Exploratory Randomized Trial

2026-10-29T16:00:28-04:00

Background: Training practitioners to implement functional communication training (FCT) is resource intensive. Emerging technologies, such as virtual reality (VR) and chatbots, may deliver training at scale. Their comparative effectiveness and whether skills taught in one modality transfer to another remain uncertain. Objective: This exploratory study evaluated the effect of multicomponent training packages featuring either VR or a chatbot on (1) posttraining performance on FCT implementation probes administered in both formats and (2) changes in participants’ self-perceived knowledge, confidence, and usefulness. Methods: A convenience sample of 23 university students (mean age=24 y; 15/23, 65% female) were recruited through classroom announcements and peer referrals. Eligible participants (at least 18 years of age, available to attend trainings, and who had no history of discomfort associated with VR) were randomly assigned to either VR (n=12) or chatbot (n=11) training. Groups did not differ significantly across demographic characteristics. In-person trainings consisted of video-recorded instruction and rehearsal of steps in VR or with the chatbot during a single session. Approximate times of sessions, including tutorials and assessments, were 45 minutes (VR) and 55 minutes (chatbot). All participants’ performance on FCT procedures was measured using 2 formats: a VR-based observed mastery probe (OMP) and a text-based probe (TBP). Participants also completed a survey measuring their self-perceptions. Results: The number of FCT steps participants performed correctly (of 18) was analyzed using a binomial generalized linear mixed model, with random intercepts for participant and fixed effects of training group (chatbot vs VR), time (pretest vs posttest), and probe modality (OMP vs TBP); =.05. Results indicated a main effect of time (odds ratio [OR] 36.09, 95% CI 20.75‐62.75; <.001). A significant 3-way interaction (time × probe modality × training group) indicated that the pattern of skill transfer differed by training condition and probe type (OR 6.10, 95% CI 2.08‐17.86; .001). At posttest, the chatbot group significantly outperformed the VR group on the TBP (OR 4.14, 95% CI 1.20‐14.24; .049), completing, on average, 4 more steps in the procedure (average marginal effect 0.22, 95% CI 0.04‐0.41). Differences between groups on the OMP were not significant (OR 0.61, 95% CI 0.18‐2.07; =.43). Across all self-report measures, there was no differential improvement by training condition at posttest. Conclusions: This study provides the first comparison of chatbot- and VR-based training for FCT. This extends prior work that compared VR against didactic instruction or assessed performance using a single modality. Findings contribute to the field by supporting the viability of text-based chatbots in training and underscoring the importance of the alignment between training and assessment modalities. Chatbot-enhanced training systems may extend access to evidence-based techniques, such as FCT, in areas with limited training resources. More work is needed to confirm effects and demonstrate applicability to practice.

Game-Based Learning and Gamification in Laparoscopic Skills Education: Meta-Analysis and Systematic Review

2026-10-29T13:30:19-04:00

Background: Gamification, the integration of game elements into education and game-based learning, is increasingly applied to laparoscopic skills training. However, systematic evidence on its effectiveness and practical feasibility remains limited and fragmented. Objective: This study aimed to evaluate the effectiveness and feasibility of gamified interventions and game-based learning in improving laparoscopic skills education. Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials from January 1, 2000, to July 1, 2026, for studies evaluating gamification and game-based learning in laparoscopic skills education. Eligible studies included interventional and observational studies involving medical students, residents, or surgeons, with measurable performance outcomes. Study quality was assessed using ROBINS-I (Risk of Bias In Non-randomized Studies-of Interventions), RoB 2 (Cochrane Risk of Bias Tool 2), and NIH quality assessment tools. Standardized mean differences (SMDs) were pooled using random-effects models; between-study heterogeneity was quantified by ² and described by the ² statistic (inconsistency), while the Cochran Q test tested homogeneity. Certainty of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: A total of 39 studies involving 2102 participants were included. Video game–based interventions served mainly as training tools or assessments, whereas gamified contexts incorporated competitive or collaborative motivational elements. Three subgroup meta-analyses were performed. Game-based learning vs no training yielded a pooled Hedges g of −0.04 (95% CI −7.14 to 7.06; ²=96.7%; 95% prediction interval −13.95 to 13.61), game-based learning vs conventional laparoscopic training yielded 0.49 (95% CI −1.39 to 2.36; ²=79.4%; prediction interval −3.60 to 4.51), and gamified vs nongamified training yielded 0.87 (95% CI −5.08 to 6.81; ²=61.6%). None of the 3 comparisons reached statistical significance, and all prediction intervals crossed the null, indicating that true effects may range from beneficial to harmful across settings. Risk of bias was mostly moderate, and certainty of evidence ranged from very low to moderate. Leave-one-out analysis showed that pooled estimates in the first 2 subgroups were driven largely by individual studies and were not robust. Conclusions: Both game-based learning and gamified contexts are feasible adjuncts for basic laparoscopic skills training and may enhance motivation and deliberate practice; however, meta-analytic evidence did not demonstrate a statistically significant advantage over no training or conventional laparoscopic training, and the results were not robust to leave-one-out analysis. Generic video games showed limited efficacy for advanced, procedure-specific skills, and the evidence is constrained by heterogeneous outcome measures, small numbers of studies, moderate risk of bias, and a lack of long-term follow-up. As the first synthesis to compare video game-based and gamified context-based approaches within a unified framework, this review provides educators with guidance for integrating task-aligned gamified modules into existing curricula, while highlighting that robust efficacy and sustained operative transfer remain to be demonstrated by larger, standardized studies. Trial Registration: PROSPERO CRD42024539802; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024539802

Effects of a Virtual Interactive System (People’s War Against Pandemic) on Emergency Preparedness for Major Emerging Infectious Diseases Among Adolescents: Randomized Controlled Trial

2026-10-26T15:30:25-04:00

Background: The epidemiological situation of major emerging infectious diseases (MEIDs) continues to be severe. This requires each country and region to be vigilant, strengthen cooperation, and take effective prevention and response measures. This highlights the public’s demand for education on health and safety measures. Virtual interactive systems have played a critical role in many fields. Consequently, we designed and developed a virtual interactive system (People’s War Against Pandemic) aimed at training the public to respond to MEID outbreaks. Objective: This study aimed to evaluate the efficacy of a novel storyline-driven virtual interactive system (People’s War Against Pandemic) in enhancing emergency preparedness and infectious disease health literacy among adolescents. Methods: A single-blind (outcome assessors blinded), 2-arm, parallel-group randomized controlled trial was conducted in a secondary vocational school from October 2023 to December 2023 in Luzhou, Sichuan. A total of 120 adolescents were recruited through on-site recruitment and were randomly assigned to the intervention group (n=60) and the control group (n=60). The intervention group was trained using a virtual interactive system and traditional lectures, whereas the control group received only traditional lectures. Self-reported questionnaires assessing emergency preparedness for MEIDs and infectious disease health literacy were used to evaluate the effect of the virtual interactive system before and after the intervention. Repeated-measures ANOVA was used to scrutinize variations in outcome indicators across time points within and between groups. Results: The results showed that emergency preparedness and infectious disease health literacy scores improved in both the control and intervention groups. Additionally, emergency preparedness and infectious disease health literacy scores in the intervention group were higher than those in the control group (<.001). A repeated-measures ANOVA revealed significant group, time, and group × time interaction effects in emergency preparedness and infectious disease health literacy scores. Conclusions: The virtual interactive system was effective in improving adolescents’ self-reported emergency preparedness and infectious disease health literacy in the face of MEIDs. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200060919; https://tinyurl.com/pvbzh24t

Virtual Reality for Delirium Prevention in Intensive Care Unit Nurses and Mechanically Ventilated Patients: Descriptive Qualitative Study

2026-10-23T16:30:24-04:00

Background: Patients in the intensive care unit (ICU) who are on mechanical ventilation are at high risk of developing delirium. Virtual reality (VR) technology, as an emerging intervention method, shows promising application prospects in delirium prevention, but its specific experience in clinical practice still requires in-depth exploration. Objective: This study aims to explore the real experiences of ICU nurses and mechanically ventilated patients in participating in VR delirium prevention, with the aim of providing practical evidence for the optimization and application of this technology in clinical practice. Methods: A descriptive qualitative research design was adopted. From March to June 2025, using purposive sampling, participants were selected from the internal medicine, surgery, central, and respiratory ICU departments of a tertiary hospital in Zhengzhou. A total of 73 patients on mechanical ventilation were screened. Among them, 49 were excluded due to not meeting the Richmond Agitation-Sedation Scale (RASS) or Barthel Index (BI) score criteria, 5 had delirium at the time of enrollment, 1 was excluded due to visual impairment, and 2 voluntarily withdrew during the study. Finally, 16 patients on mechanical ventilation and 16 nurses were included for semistructured interviews. Data analysis was conducted using the inductive content analysis method. Results: Through the analysis of the interview data, a total of 3 main themes and 14 subthemes were extracted. In terms of perceived benefits, patients experienced an immersive environment and a sense of empowerment driven by tasks, while nurses felt the convenience of resource integration, the intimacy of the nurse-patient relationship, and a sense of professional significance. In terms of perceived challenges, patients faced difficulties with the interaction interface and physical and mental obstacles, while nurses encountered difficulties in communication assessment and responsibility definition. In terms of perceived needs, patients expected personalized content design and continuity of nursing services, while nurses suggested differentiated content adjustment, comprehensive functional integration, and standardized safety management. Conclusions: The participants expressed a positive attitude towards the prevention of delirium based on VR and reported various perceived benefits, challenges, and needs. Future research should prioritize content personalization, functional integration, and safety management. Meanwhile, it is necessary to recognize the limitations of this technology in specific target populations. For those who do not meet the inclusion criteria, adaptive alternative intervention measures should be developed to promote the precise and sustainable application of VR-based delirium prevention.

Application of Immersive and Semi-Immersive Extended Reality Training Systems in Acupuncture Education: Scoping Review

2026-10-21T15:15:19-04:00

Background: Acupuncture training requires precise acupoint localization and needle control, yet peer-to-peer practice raises safety concerns and physical phantoms offer limited anatomical fidelity. Extended reality (XR) is increasingly used in health professions education, but immersive and semi-immersive XR training systems for acupuncture have not been mapped. Objective: This scoping review aimed to map the applications, hardware modalities, and reported technical and educational outcomes of immersive and semi-immersive XR training systems in acupuncture education. Methods: This review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and the five-stage scoping review framework of Arksey and O’Malley, as refined by Levac and colleagues. On September 19, 2026, we searched PubMed, Embase, Scopus, IEEE Xplore, CNKI, RISS, ScienceOn, and OASIS. No language or date restrictions were applied. Backward and forward citation searching supplemented the database search. Eligible sources were peer-reviewed original studies or full conference papers describing virtual reality (VR; either fully immersive [IVR] or semi-immersive [SIVR]), augmented reality (AR), or mixed reality (MR) systems for acupuncture training. Two reviewers independently screened records and charted the study design, hardware, training task, and outcomes. Each study was assigned an evidence tier. Results: Of 6176 records, 3378 were screened after removal of duplicates and ineligible document types, 80 reports were assessed in full text, and 26 studies were included (25 from databases and 1 from citation searching). Most studies came from East Asia (25/26, 96.2%), mainly China (n=18), and 20 (76.9%) were published between 2020 and 2026. Systems used VR (n=15), AR (n=5), or MR (n=6); 19 were IVR and 7 were SIVR. Training tasks addressed acupoint localization (n=13), needling skills (n=11), and clinical reasoning (n=2). Localization errors were reported with different metrics and were not directly comparable across systems. In a randomized comparison, a VR group scored higher on practical skills than a conventional instruction group (32.52, SD 2.28 vs 28.62, SD 2.77 points; <.001). In an MR simulator with depth-responsive vibrotactile feedback active in both sessions, mean depth error decreased from 6.41 mm in the first practice session to 3.58 mm in the second. Of the 26 studies, 7 used a comparative design; the rest were technical validation (n=6), system development (n=10), or case and survey reports (n=3). Reported barriers included headset weight, narrow field of view, tracking instability, and limited tactile fidelity. Conclusions: Immersive and semi-immersive XR systems for acupuncture training have been developed mainly for acupoint localization and needling. Randomized comparisons reported higher test scores than conventional instruction, but most evidence came from system development reports and small feasibility studies. Randomized trials comparing XR-based and conventional training on objective localization and needling outcomes are needed before these systems are adopted for competency assessment. Trial Registration: OSF Registries PVU8E; https://osf.io/pvu8e/overview

Individually Prescribed In-Bed Exergaming Using Nintendo Ring Fit Adventure in Posttransplant Inpatients With Marked Functional Impairment After Intensive Care: Prospective Single-Arm Feasibility Study

2026-10-20T16:15:19-04:00

Background: Early rehabilitation is important after transplantation and critical illness, but profound weakness, fatigue, and motivational, psychological, and safety barriers may limit participation. Exergaming may facilitate rehabilitation, but the feasibility of full-body in-bed exergaming in this population remains unclear. Objective: We evaluated the feasibility and observed safety of individually prescribed in-bed exergaming using Nintendo Ring Fit Adventure (NFA; Nintendo Co, Ltd) in posttransplant inpatients after intensive care unit (ICU) care. Methods: This prospective, single-center, single-arm interventional feasibility study (October 2024-October 2025) enrolled 26 posttransplant adults with prior ICU care and Functional Ambulation Category (FAC) scores ≤3. Participants were referred after ward transfer by transplant-team advanced practice nurses, and the principal investigator confirmed eligibility based on prespecified inclusion and exclusion criteria. Ten individually prescribed, supervised in-bed NFA sessions, each scheduled for 30 minutes, including setup and operation, were planned alongside usual physical therapy. Data were obtained from medical records, standardized session logs, and prespecified clinical and questionnaire assessments. Outcomes included retention; session delivery, completion, and interruptions; exercise-item completion and interruptions; session-terminating adverse events; net exercise time; satisfaction; and exploratory strength, mobility, and health-related quality-of-life changes. Results: Participants (mean age 53.0, SD 12.4 y; 14 men) included 23 liver and 3 bilateral lung transplant recipients. Mean ICU stay and mechanical ventilation duration were 24.3 (SD 11.0) days and 21.3 (SD 11.6) days, respectively; median baseline FAC and Medical Research Council Sum Score were 0.5 (IQR 0.0-1.0) and 38.0 (IQR 30.5-42.0), respectively. None had an FAC score above 2. Twenty completed the final assessment (20/26, 76.9%, 95% CI 57.9%-89%). Of 227 delivered sessions, 223 (98.2%, 95% CI 95.8%-100%) were completed. Of 2161 prescribed exercise items, 2072 (95.9%, 95% CI 93.4%-97.9%) were completed. No session-terminating adverse events were observed (0/227, 0%, 95% CI 0%-1.6%). Median within-participant net exercise time increased by 159.0 (IQR 35.5-296.3) seconds from sessions 1 to 10 (95% CI 81.0-284.0; Wilcoxon signed-rank test, <.001). Friedman tests followed by Bonferroni-adjusted Wilcoxon signed-rank tests (2-sided α=.05) showed baseline-to-final median within-participant changes of 8.0 Medical Research Council Sum Score points (IQR 2.3-10.3; 95% CI 4.0-10.0, =.004), 2.0 Intensive Care Unit Mobility Scale points (IQR 1.0-4.3; 95% CI 1.0-3.5, <.001), and 15.0 EQ-VAS points (IQR 0.0-30.0; 95% CI 5.0-25.0, =.009). Questionnaire responses were favorable. Conclusions: Under therapist supervision, the individually prescribed in-bed NFA program showed favorable operational feasibility, with no session-terminating adverse events. By combining the accessibility of a commercial off-the-shelf exergame with individualized exercise prescription, the program extended bedside exergaming to posttransplant inpatients with substantial functional impairment after ICU care who had not achieved independent ambulation. Trial Registration: ClinicalTrials.gov NCT06937463; https://clinicaltrials.gov/study/NCT06937463