More and more, health interventions are employing gamified strategies like badges, points and levels in an attempt to get people to adopt new behaviors.

By creating a feeling of competition among participants, intervention developers hope they can increase medication adherence, improve chronic condition management, up physical activity and more. But past research indicates that giving health interventions a competitive edge is not always enough to create meaningful changes in human behavior.

A new study from JAMA Network Open sought to test how well gamification – paired with social support and financial incentives – could improve physical activity among veterans who were overweight or obese.

The study supplied each participant with a wearable step counter from Fitbit and separated them into three trial groups. These included a control group without gamification, social support or loss-framed financial incentives and two intervention groups with gamification – one with just social support and one with social support and loss-framed financial incentives.

TOPLINE DATA

During the 12-week intervention, gamification with social support and loss-framed financial incentives resulted in a “modest increase in physical activity,” but it was not sustained over the eight-week follow-up, according to the study.

Neither tracking physical activity with a wearable device alone nor doing so with gamification and social support significantly changed activity levels among the veteran participants.

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

Following a short period of ramped-up physical activity at the start of the intervention, each group’s step count declined by the follow-up window to a daily average of 6,272 steps, 6,213 steps and 6,962 steps, respectively.

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

On the whole, the percentage of days where the step-count goals were met decreased following the intervention period to 26%, 32% and 37%, respectively.

Although the results from this study were modest, the researchers note that even slight increases in physical activity can have health benefits.

“​​Our findings suggest that these approaches can motivate physical activity over shorter-term periods, but additional work needs to focus on increasing the effect and sustaining it,” the authors of the study said. “A growing body of research is testing various social supports to help motivate activity, and this trial demonstrates findings consistent with those of other trials.”

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

METHODS

This randomized clinical trial ran from March 19, 2019, to Aug. 9, 2020, and included 180 adult participants who received care at the Corporal Michael J. Crescenz VA Medical Center and had a BMI greater than or equal to 25.

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

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

Participants in the control arm only received feedback and goal-setting from their wearable device.

Those 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 report of their participant’s progress and offered support.

For those in the loss-framed financial incentive group, they received social support and participated in the game, as well as having a $120 virtual account that had $10 deducted each week their step count goals weren’t met.

THE LARGER TREND

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

This study also yielded only modest results, but the researchers again urged that even small increases of light-intensity physical activity can lead to health benefits, particularly for more sedentary individuals.

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

Akili Interactive, the maker of the FDA De Novo-authorized digital therapeutic EndeavorRx, recently scored $110 million in Series D funding. The company also recently shared it is looking into using EndeavorRx as a treatment for cognitive impairments in COVID-19 survivors.

Boston Children’s Hospital spin-out Mightier, which developed a biofeedback video game platform for improving behavior in children with mental health disorders, has teamed up with Magellan Health to study how the therapy can improve emotional regulation for children.

There’s also MindMaze, which has an FDA-cleared treatment for stroke and traumatic injury patients. The company recently grew its geographical footprint in Latin America, the Middle East, Spain and Switzerland through a series of new partnerships.