Way to Health


Use social incentives and gamification to increase physical activity among overweight and obese adults.

Sep 9, 2019

Mitesh Patel, MD, MBA, MS Mitesh Patel, MD, MBA, MS
Kevin Volpp, MD, PhD Kevin Volpp, MD, PhD

Aim and Key Question

Gamification, the use of game design elements in non-game contexts, is increasingly being used in workplace wellness programs and digital health applications. However, the best way to design social incentives in gamification interventions has not been well examined.

In this study, the objective was to use a randomized clinical trial to test the effectiveness of gamification interventions that leverage insights from behavioral economics to enhance supportive, competitive, or collaborative social incentives to increase physical activity among overweight and obese adults. Partnered with a large consulting firm to test a scalable approach that enrolled individuals from across the United States and remotely monitored physical activity levels for 9 months with wearable devices and an automated technology platform.

Intervention and Design

This 36-week randomized clinical trial with a 24-week intervention and 12-week follow-up assessed 602 adults from 40 states with body mass indexes (calculated as weight in kilograms divided by height in meters squared) of 25 or higher from February 12, 2018, to March 17, 2019.

Interventions - Participants used a wearable device to track daily steps, established a baseline, selected a step goal increase, were randomly assigned to a control (n = 151) or to 1 of 3 gamification interventions (support [n = 151], collaboration [n = 150], and competition [n = 150]), and were remotely monitored. The control group received feedback from the wearable device but no other interventions for 36 weeks. The gamification arms were entered into a 24-week game designed using insights from behavioral economics with points and levels for achieving step goals. No gamification interventions occurred during follow-up.

Main Outcomes and Measures - The primary outcome was change in mean daily steps from baseline through the 24-week intervention period.

Way to Health Use

Findings and Conclusions

A total of 602 participants were included in the study. Compared with controls, participants had a significantly greater increase in mean daily steps from baseline during the intervention in the competition arm (adjusted difference, 920; 95% CI, 513-1328; P < .001), support arm (adjusted difference, 689; 95% CI, 267-977; P < .001), and collaboration arm (adjusted difference, 637; 95% CI, 258-1017; P = .001). During follow-up, physical activity remained significantly greater in the competition arm than in the control arm (adjusted difference, 569; 95% CI, 142-996; P = .009) but was not significantly greater in the support (adjusted difference, 428; 95% CI, 19-837; P = .04) and collaboration (adjusted difference, 126; 95% CI, −248 to 468; P = .49) arms than in the control arm.

All 3 gamification interventions significantly increased physical activity during the 24-week intervention, and competition was the most effective. Physical activity was lower in all arms during follow-up and only remained significantly greater in the competition arm than in the control arm.

Publications and Press

  • Effectiveness of Behaviorally Designed Gamification Interventions With Social Incentives for Increasing Physical Activity Among Overweight and Obese Adults Across the United States The STEP UP Randomized Clinical Trial