Health interventions are increasingly using gamified strategies such as badges, points and levels to encourage people to adopt new behaviors.

By creating a sense of competition among participants, the intervention’s developers hope to improve drug use, improve chronic disease management, increase physical activity, and more. However, research to date shows that giving health interventions a competitive advantage is not always enough to make significant changes in human behavior.

A new study by JAMA network open tries to test how well gamification – coupled with social support and financial incentives – can improve physical activity in overweight or obese veterans.

The study provided each participant with a Fitbit wearable pedometer and divided them into three experimental groups. These included a control group with no gamification, social support or lossy financial incentives and two intervention groups with gamification – one with pure social support and one with social support and lossy financial incentives.


During the 12-week intervention, gamification with social support and loss-related financial incentives resulted in a “modest increase in physical activity,” which the study found was not sustained during the eight-week follow-up.

Neither tracking physical activity with a wearable device alone nor with gamification and social support significantly changed the activity level of the experienced participants.

At baseline, the mean daily step count for the control group was 5,881, the gamification group with social support 6,012, and the gamification group with social support and financial incentives 6,105.

After a short period of intense physical activity at the beginning of the intervention, the number of steps in each group in the follow-up window decreased to a daily average of 6,272 steps, 6,213 steps and 6,962 steps, respectively.

In addition to monitoring participants’ step count, researchers had them create daily step count goals and tracked the percentage of days that goals were met. During the intervention, the rate of days that activity goals were met was 25% in the control group, 41% in the Gamified group with social support, and 48% in the Gamified group with social support and financial incentives.

Overall, the percentage of days on which the step count goals were met decreased to 26%, 32% and 37%, respectively, after the intervention period.

Although the results of this study were modest, the researchers note that even a small increase in physical activity can have health benefits.

“Our results suggest that these approaches can motivate physical activity for shorter periods of time, but additional work needs to focus on increasing and maintaining the effects,” said the study’s authors. “A growing body of research is testing various social supports to help motivate activity, and this study shows results that are consistent with other studies.”

For future studies, the researchers recommend testing stronger social incentives such as team-based competition in order to achieve larger and longer effects.


This randomized clinical trial ran from March 19, 2019 to August 9, 2020 and included 180 adult participants treated at Corporal Michael J. Crescenz VA Medical Center with a BMI of 25 or greater.

The median age of the participants was 57 years, most were male (60.56%), half were identified as white and 37.2% as black. The average BMI was 33.

Researchers used Way to Health, a research technology platform from the University of Pennsylvania, to monitor participants’ data.

The control arm participants only received feedback and objectives from their handheld device.

Participants in the intervention groups competed in an automated game with points and levels and received daily progress notifications. They also identified a sponsor who received a weekly progress report from its participants and offered assistance.

Those in the group with lossy financial incentives received social assistance and participated in the game, as well as a $ 120 virtual account with $ 10 subtracted each week, and failed to meet their step count goals.


Another recent study, also from the University of Pennsylvania, tested the effectiveness of gamification in promoting physical activity and weight loss in adults with uncontrolled type 2 diabetes. It found that gamification worked best for behavior change when used as a competition with others or with the support of friends and family.

Again, this study yielded modest results, but the researchers again urged that even small increases in physical activity with light intensity can lead to health benefits, especially for those who do more sedentary work.

A number of startups are using gamification in their digital health interventions.

Akili Interactive, the maker of the FDA De Novo-authorized digital therapeutic EndeavorRx, recently received $ 110 million in Series D funding. The company also recently announced that it is considering using EndeavorRx to treat cognitive impairment in COVID-19 survivors.

Mightier, a spin-out from Boston Children’s Hospital that developed a biofeedback video game platform to improve the behavior of children with mental disorders, has partnered with Magellan Health to investigate how therapy can improve children’s emotional regulation.

There’s also MindMaze, which has FDA cleared treatment for patients with stroke and traumatic injuries. The company recently expanded its geographic presence in Latin America, the Middle East, Spain and Switzerland through a number of new partnerships.

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