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First, it is important to understand that a game/simulation is not educational just because it is a game/simulation. Instead, a game/simulation is an effective educational tool primarily because of the high level of interactivity and instant feedback. Well designed games/simulations engage the learner in a constant decision making process. The learner is forced to interact and think through the content and then witnesses immediate or near immediate feedback based on his or her actions. So the most critical aspect is not the technology (which is the focus of many when thinking about games/simulations) rather the most critical aspect is the design. The design must be interactive and provide realistic or corrective feedback as the learner progresses and the game/simulation must maintain a balance between anxiety and boredom which is known as the elusive “flow state.”

The game is not linear, but dynamic, meaning that the user is able to begin from different starting points. The game continuously captures and reflects the user's choices and actions while she or he plays.

the macro environment is the internet, drawing on its immense resources.

Information, challenges, and new tasks can be found around the elements presenting the symptom, where the learner will be provided with knowledge about the external real-world source of the symptom or change. In most cases the learner cannot solve the problem on location and will have to travel the animated body to search for and analyze other symptoms, as well as search for specific information via the Internet or other resources in the platform surrounding the game itself.

Required and enabled concentration, Challenges that are neither too easy nor too difficult, Development of individual skills and mastery, A sense of control over personal actions within the game, Clear goals for succeeding at the game, Reception of specific feedback on individual success, Effortless immersion within the game, to the exclusion of time awareness, and Social interaction opportunities.

Achieving a balance between skill and challenge, as well as between fitness and intensity, determines the success of an exergame. The difficulty of creating these two perfect balances can help explain the wide variety of successful and unsuccessful exergames in today’s market.