PHILADELPHIA – In making a game of doing their daily steps, new research is pointing to the possibility that people with diabetes could be induced to increase their physical activity, with changes lasting an entire year. With many today using apps or other digital means to manage their diabetes, this program, which uses tools like portable pedometers and electronic scales with personalized goals, could potentially be incorporated to help individuals achieve greater success. The results of the study, conducted by a team from the Perelman School of Medicine at the University of Pennsylvania, were published today on JAMA Network Open.
“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 long periods of time,” said the newspaper’s lead author, Mitesh Patel. MD, the director of The Nudge Unit at Penn Medicine. “In this year-long study, we found that gamification is best for increasing activity levels when developed using behavioral knowledge to either encourage competition with others or the support of a family member or friend. This is encouraging and suggests that these interventions could be an effective way to build a permanent, new exercise habit for this population. “
About one in ten Americans has diabetes. One way to get better control of the disease is for patients to increase their physical activity. This makes your body “more sensitive” to insulin, a hormone that regulates blood sugar in the body. And this sensitivity makes your body less likely to experience dangerous spikes or drops in blood sugar levels.
Patel and his colleagues in the Nudge Unit have carried out several studies on how “gamification” – the application of playful concepts such as goals, competition and level – can increase physical activity.
In this study, participants – all with type 2 diabetes this time and overweight or obese – were randomly divided into four equal groups. The first, a control group, received a portable electronic pedometer and electronic scale, both of which provided feedback on step count and weight. The three gamified arms in the study received these as well, but they also received personalized goals for steps, weight, and blood sugar levels, which three things were measured for this study. These goals corresponded to a system the team had put in place to score and level up. Each patient, whether in control or in a gamified arm, participated over a period of 12 months.
The first gamified arm focused on competition, with groups of three random patients being briefed on each other’s accomplishments each week. The second group also grouped the patients into three groups but focused on working together, with one participant each day representing the group and trying to score points and move up on behalf of all. The final arm of the study focused on support, where a participant selected someone outside of the study arm to be informed of their progress via email and to motivate or cheer them on as they progressed.
A total of 361 people took part in the study, which was carried out from 2017 to 2020.
Analyzing the performance of each group, the researchers found that the number of steps for those participating in the competitive and support arms of gamification significantly increased their number of steps during the year they participated. The support group increased its steps by an average of 503 steps more than the non-gamified control group. The contest participants gained an average of 606 steps. The collaboration participants increased their steps by 280 compared to the control group, which was not enough to be considered a significant finding.
Across the board, participants experienced weight loss and a decrease in blood sugar, regardless of whether they were in a gamified or a control group. There was no significant difference in these measures from one group to the next.
“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 could combine gamification with other approaches to achieve changes in clinical outcomes. “
Patel and colleagues believe this latest study provides further evidence that gamification, when informed through behavioral science concepts, can be a powerful tool in moving people into healthier habits.
“Wearable devices and digital scales are becoming increasingly popular,” said the study’s lead author, Dr. Kevin Volpp, Penn Center Director for Health Incentives and Behavioral Economics and Professor of Health Policy. “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.”
This study was funded by a grant from the Doris Duke Charitable Foundation (2016101).
Other authors on this study include Dylan Small, Joseph Harrison, Victoria Hillbert, Michael Fortunato, Ai Leen Oon, and Charles Rareshide.
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