Game-Based Interventions Increase Physical Activity
Gamification, which uses game design elements such as points and levels, is increasingly used in health interventions to increase physical activity and other behaviors, but evidence of its effectiveness is limited. Now, a new study co-authored by School of Public Health researchers shows physical activity increased among families in a game-based intervention leveraging collaboration, accountability, and peer support.
In the study, published in JAMA Internal Medicine, participants tracked their daily step counts with a FitBit or a smartphone app. Participants in the game-based intervention took about 1,700 more steps than they did at baseline, or almost an additional mile per day, compared to an increase of about 660 steps for the control group. Physical activity decreased after the 12-week intervention, but participants who had played the game continued to take more steps than the control group during the 12-week follow-up.
“The study indicates the potential benefits of harnessing families, mobile health technologies, and gamification to improve physical activity and lifestyle,” says co-author Emelia J. Benjamin, professor of epidemiology and professor of medicine at the School of Medicine.
The clinical trial included 200 adults from 94 families enrolled in the BU-based Framingham Heart Study, a longstanding community-based cohort of families. After establishing a baseline number of average steps per day, participants selected a goal for how many more steps they wanted to try to take. They were all given performance feedback by text or email for 24 weeks.
About half of the adults participated in the gamification arm of the study, working in family teams to progress through levels in a point-based system. The game mechanics were based on behavioral economics, including evidence that loss is a greater motivator than gain, and behavior is often better sustained by variable reinforcement.
The families began each week with 70 points. Every day, they were informed of which member was randomly selected to represent their team. If that member had failed to achieve their step goal the previous day, the team lost 10 points, but if the team finished the week with at least 50 points remaining, they would advance to the next level (bronze, silver, gold, and platinum). Each individual also had five lifelines to use on days when they were sick or activity was infeasible, allowing for some forgiveness and encouraging individuals to seek help from a family member.
Families were not informed of the progress of other teams. If a team finished the intervention period at the gold or platinum level, each team member would receive a modest material award: a coffee mug with the study logo.
“This approach is exciting because it has the potential to be scaled more broadly,” says co-author Joanne Murabito, associate professor of medicine at MED and co-principal investigator of the Framingham Heart Study, noting the intervention is driven by existing social ties.
Other co-authors of the study include Joseph Massaro, professor of biostatistics.