Gamification and goal setting to increase physical activity among patients with elevated risk for a major adverse cardiovascular event


Many interventions challenge participants to identify and reach a goal. However, the best way to design the goal-setting process for high-risk patients has not been well examined.


We designed a 24-week clinical trial to compare four different goal-setting methods in a gamification intervention. We engaged more than 500 adults from lower-income neighborhoods in and around Philadelphia who had either an atherosclerotic cardiovascular disease (ASCVD) condition or a 10-year ASCVD risk score greater than or equal to 7.5 percent to participate. All participants tracked daily steps via wearable devices, established a baseline level, and were randomly assigned to one of four gamification interventions that varied only on how daily step goals were set (self-chosen or assigned) and implemented (immediately or gradually).


Participants who were asked to select a daily step goal and then strive for it immediately increased their activity significantly. The increase in daily steps and minutes of moderate to vigorous physical activity were sustained during the 2-month follow-up period. To our knowledge, this is one of the first randomized trials to demonstrate the effect that differences in the design of goal setting can have on physical activity, particularly among adults from lower-income neighborhoods who were at elevated risk for a major adverse cardiovascular event.


Center for Health Incentives and Behavioral Economics