More than 50% of adults in the United States do not obtain enough physical activity and as a result, are at higher risk for cardiovascular disease. Gamification is the application of game design elements in non-game contexts. While gamification is increasingly being used in digital health interventions, there has been limited evidence on its effectiveness. One challenge is that most current gamification interventions are designed based on principles of standard economics. We recognize, however, that behavior change is difficult and that principles of behavioral economics could be used to address predictable barriers.
We designed a gamification intervention that leveraged insights from behavioral economics to enhance social incentives including collaboration, accountability, and peer support. We partnered with the Framingham Heart Study to launch the first clinical trial ever conducted in their cohort. Mobile technologies including smartphones and wearable devices were used to monitor daily physical activity. Families were randomly assigned to a control group or a gamification intervention for 12 weeks and then followed for an additional 12 weeks.
The gamification intervention significantly increased physical activity. Families in the gamification arm achieved step goals at higher rates (53% vs. 32%, P<0.001) and had a greater increase in daily steps from baseline (1661 vs. 636, P<0.001). The average increase from baseline for each person in the gamification arm was nearly one mile per day. Differences persisted in the three months after the game ended (44% vs. 33%, P<0.001; 1385 vs. 798, P<0.01). These findings indicate that gamification may offer a promising approach to change health behaviors if designed using insights from behavioral economics to enhance social incentives.