October 03, 2017
2 min read

Gamification increases physical activity among families

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Families who participated in a game-based intervention designed to leverage insight from behavioral economics to enhance social incentives had significantly increased physical activity than those who did not, according to findings published in JAMA Internal Medicine.

“More than half of the adults in the United States do not obtain enough physical activity and are at higher risk for cardiovascular disease,” Mitesh S. Patel, MD, MBA, MS, from Perelman School of Medicine at the University of Pennsylvania, Philadelphia, and colleagues wrote. “Gamification, the application of game design elements such as points and levels in nongame contexts, is increasingly being used in digital health interventions to promote changes in health behaviors, such as physical activity. Whereas interest in these approaches is growing, evidence on their effectiveness is limited.”

Between Dec. 7, 2015, and Aug. 14, 2016, Patel and colleagues conducted the BE FIT randomized clinical trial to determine if a gamification intervention that uses insights from behavioral economics to enhance social incentives is effective at increasing physical activity among families. The researchers recruited 200 adults (mean age, 55.4 years; 56% female) comprising 94 families from the Framingham Heart Study.

All participants used either a wrist-worn device, such as Fitbit, or downloaded a smartphone application to track their daily step counts. In addition, they established their baseline step count, selected a step goal increase and received individual feedback on goal performance by text message or email daily for 24 weeks (12 weeks of intervention and 12 weeks of follow-up). Participants in the control group received no other intervention, while those in the gamification group could earn points and advance through levels based on physical activity achievement. Gamification was intended to improve collaboration, accountability and peer support.

Results indicated that during the intervention period, step goals were achieved on a significantly greater proportion of participant-days among participants in the gamification group (0.53 vs. 0.32; adjusted difference, 0.27; 95% CI, 0.20-0.33). Furthermore, there was a significantly greater increase in mean daily steps compared with baseline among participants in the gamification group (1,661 vs. 636; adjusted difference, 953; 95% CI, 505-1,401).

During follow-up, there was a decline in physical activity among participants in the gamification group; however, the proportion of participant-days achieving step goals (0.44 vs. 0.33; adjusted difference, 0.12; 95% CI, 0.05-0.19) and the mean daily steps compared with baseline (1,385 vs. 798; adjusted difference, 494; 95% CI, 170-818) remained significantly greater than those in the control group.


“Compared with a control group of families in the community, a social incentive-based gamification intervention among families was effective at increasing physical activity,” Patel and colleagues concluded. “Our findings suggest that gamification may offer a promising approach to change health behaviors if designed using insights from behavioral economics to enhance social incentives.”

In a related editorial, Ichiro Kawachi, MB, ChB, PhD, from the department of social and behavioral sciences at Harvard T.H. Chan School of Public Health, wrote that what makes a intervention “stick” is a crucial missing element for gamification.

“The future of gamification — beyond providing more rigorous evaluation of effectiveness — will be in interfacing with emerging technology,” Kawachi concluded. “With the advent of augmented reality gaming and ‘exergaming’ in virtual reality, the line between entertainment and public health is becoming progressively blurred. There is an opportunity for clinicians to turn health promotion into an engaging, fulfilling and fun activity.” – by Alaina Tedesco

Disclosures: Kawachi reports no relevant financial disclosures. Patel reports receiving support from the Department of Veterans Affairs Health Services Research and Development Service and the Doris Duke Charitable Foundation, and being a principal at Catalyst Health. Please see the study for all other authors’ relevant financial disclosures.