Ketelhut, Sascha Institute of Sport Science, University of Bern, Bremgartenstrasse 145, 3012, Bern, Switzerland
Brand, Ralf;Hug, Daniel;Mueller, Florian ‘Floyd’ et al

Sports Medicine – Open,10/15/2025

Maximal exercise testing is a fundamental component of sports medicine and clinical practice, essential for evaluating physical fitness, tailoring training programs, and diagnosing health conditions. A crucial aspect of maximal exercise testing is ensuring that participants exert maximal effort, as insufficient effort can compromise the validity of results, potentially leading to misdiagnoses, misinterpretation of outcomes, and inappropriate exercise recommendations. Various strategies, including verbal, audio, and video-based methods, have been used in research and practice to encourage maximal effort. Despite the recognized importance of these strategies, understanding of them remains limited, with recommendations being either inconsistent or entirely lacking. Notably, innovative approaches that harness the potential of digital methods are still relatively scarce. In this article, we discuss the potential of incorporating game elements as an innovative encouragement strategy during maximal exercise testing. Drawing from research on exergaming, we provide examples of impactful game features and discuss their potential integration into exercise testing. This innovative approach has the potential to improve test reliability, enhance validity, streamline workflows, and positively influence attitudes toward exercise testing. We advocate for establishing a new area of research focused on gamifying maximal exercise tests to elevate exercise diagnostics to the next level. Key Points: • Maximal exercise testing is an important tool for assessing physical fitness and diagnosing health conditions. A critical factor in ensuring the validity of these tests is confirming that participants exert maximal effort, which can be particularly challenging in certain target groups. • Currently, verbal encouragement is predominantly used in research and practice. However, this is difficult to standardize and often lacks engagement, as it heavily depends on the individual delivering it. Game design elements may offer a more effective approach by fostering a dissociative focus, enhancing motivation, and increasing effort investment. • Immersive and engaging game design elements used as encouragement strategies may improve the validity of maximal exercise tests and enhance compliance, especially in populations with lower motivation.