Gamification of step rely results in extra exercise in diabetes-focused research


Gamification has become an increasingly popular strategy for promoting healthy behavior from drug adherence to chronic disease management.

A new study published on JAMA Network examined the effectiveness of gamification in promoting physical activity and weight loss in adults with uncontrolled type 2 diabetes.

“Gamification is widely used in wellness programs and smartphone apps, but it is often not designed to provide insight into how people behave and has not been tested well over time,” said Dr. Mitesh Patel, director of Penn Medicine’s Nudge Unit and the study’s lead author, said in a statement.

The year-long intervention gave participants a handheld electronic pedometer and electronic scale, both from Withings, and randomly divided them into four arms – a control group and three gamification groups.

Participants in the control arm only received feedback from the study devices and smartphone application. However, the intervention groups were also included in a game with points and levels and received a daily notification of their progress. The three Gamification Arms were divided into groups that focused on collaboration, competition and support.


After the one-year intervention, each gamification group increased their physical activity (measured by the number of steps) more than the control arm. The support, competition, and collaboration groups increased their steps on average by 503, 606, and 280 more than the control groups.

Although the collaboration group increased their number of steps, the researchers felt that this was not enough to be considered a significant finding.

“In this year-long study, we found that gamification is best for increasing activity levels when developed using behavioral skills to either encourage competition with others or the support of a family member or friend,” Patel said these interventions could be an effective way of building a permanent new exercise habit for this population. “

Across the board, each group lost weight and lowered their blood sugar levels. However, there was no significant difference between the groups for these measurements.

Despite the fact that the results of this study represented a modest increase in physical activity, the researchers note that even small increases or physical activity with light intensity can lead to health benefits, especially in more sedentary people.

“This study is a great first step in building a permanent exercise habit,” said Patel. “However, more work is needed to promote weight loss and better blood sugar control. Future studies may combine gamification with other approaches to change clinical outcomes.”


The four-arm randomized controlled study ran from January 23, 2017 to January 27, 2020 and included 361 adults with type 2 diabetes with hemoglobin A1c levels of at least 8% and a body mass index of at least 25%.

The mean age was 52.5 years, most (52%) were female and a majority (51.2%) identified as black.

The study included an initial face-to-face visit followed by a year of remotely monitored intervention with Way to Health, a research technology platform at the University of Pennsylvania previously used for remote monitoring and behavioral interventions.

The participants in the competition arm were divided into a group of three. Each week they received an email with a ranking that ranked them according to their accumulated points in the study at that time and indicated their level.

In the collaboration group, the participants were again divided into groups of three, but worked as a team. Each day, one member was randomly selected to represent their team for that day and to earn points and move up on behalf of everyone.

The support arm directed participants to select someone outside of the study who would receive email updates on their progress to motivate or cheer them on as it progressed.


Outside of chronic disease management, gamified treatments are popular for cognitive and neurological disorders.

An example of this is Akili Interactive’s FDA-cleared EndeavorRx digital therapeutic for children with ADHD. Akili recently announced that they are investigating EndeavorRx as a potential treatment for cognitive impairment in COVID-19 survivors.

Swiss neurogaming company MindMaze also 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.

According to research from Ohio State University’s Wexner Medical Center, neurobics, or brain games, can even prevent postoperative delirium in older adults if played in advance of surgery.


“Wearables and digital scales are becoming increasingly popular,” said Dr. Kevin Volpp, lead author on the study and director of the Penn Center for Health Incentives and Behavioral Economics, in a statement.

“In addition to our insights into gamification, we believe our clinical study shows that these technologies, when combined with behavioral science, are powerful in leading people to better habits and better health.”