Patients with end-stage renal disease that undergo dialysis treatment, visit a hospital on average 3 times a week. Such involved treatment means the patients lead very sedentary lifestyles. The sedentary lifestyle in turn makes the patient less capable and willing to participate in physical activity, worsening the patient’s overall health-related quality of life. Video games, more specifically exercise-based games, are an existing solution played by many across the world. It offers entertainment and while providing the player a means of exercising. An exercise based game played during treatment may potentially lead to a more active and healthy patient. This thesis explores the design of an exercise-based game for the patients that are required to play, similar to the circumstances the patients that the research project, Cyclescapes is being made for. We will learn the design considerations for making the challenges in an exercise based game for an audience that requires it and how to keep the player engaged and moving with respect to their own personal abilities and fitness levels. We then apply the knowledge in the design and creation of Cyclescapes, providing the patients with end-stage renal disease a safe and entertaining player experience that can challenge their physical fitness and improve their health related quality of life. / Thesis / Master of Applied Science (MASc)