Evaluating the Effectiveness of Gamification on Physical Activity: Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Background Gamification refers to the use of game elements in nongame contexts. The use of gamification to change behaviors and promote physical activity (PA) is a promising avenue for tackling the global physical inactivity pandemic and the current prevalence of chronic diseases. However, there is no evidence of the effectiveness of gamified interventions with the existence of mixed results in the literature. Objective The aim of this systematic review and meta-analysis is to evaluate the effectiveness of gamified interventions and their health care potential by testing the generalizability and sustainability of their influence on PA and sedentary behavior. Methods A total of 5 electronic databases (PubMed, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials) were searched for randomized controlled trials published in English from 2010 to 2020. Eligibility criteria were based on the components of the participants, interventions, comparators, and outcomes framework. Studies were included when they used gamified interventions in daily life with an active or inactive control group and when they assessed a PA or sedentary behavior outcome. We conducted meta-analyses using a random-effects model approach. Sensitivity analyses, influence analyses, and publication bias analyses were performed to examine the robustness of our results. Results The main meta-analysis performed on 16 studies and 2407 participants revealed a small to medium summary effect of gamified interventions on PA behavior (Hedges g=0.42, 95% CI 0.14-0.69). No statistical difference among different subgroups (adults vs adolescents and healthy participants vs adults with chronic diseases) and no interaction effects with moderators such as age, gender, or BMI were found, suggesting good generalizability of gamified interventions to different user populations. The effect was statistically significant when gamified interventions were compared with inactive control groups, such as waiting lists (Hedges g=0.58, 95% CI 0.08-1.07), and active control groups that included a nongamified PA intervention (Hedges g=0.23, 95% CI 0.05-0.41). This suggests that gamified interventions are not only efficient in changing behavior but also more effective compared with other behavioral interventions. The long-term effect (measured with follow-up averaging 14 weeks after the end of the intervention) was weaker, with a very small to small effect (Hedges g=0.15, 95% CI 0.07-0.23). Conclusions This meta-analysis confirms that gamified interventions are promising for promoting PA in various populations. Additional analyses revealed that this effect persists after the follow-up period, suggesting that it is not just a novelty effect caused by the playful nature of gamification, and that gamified products appear effective compared with equivalent nongamified PA interventions. Future rigorous trials are required to confirm these findings.

Digital intervention promoting physical activity among obese people (DIPPAO) randomised controlled trial: study protocol

“…By gamifying PA, participants are encouraged to move and walk to play, and this tends to make their activity more playful and motivating 20. A recent meta-analysis21 revealed that gamified interventions improved PA with an increase of more than 1600 daily steps. Importantly, additional analyses indicated that (1) gamified interventions appear more effective than equivalent non-gamified interventions and (2) PA improvement persists in the long-term 21.…”

“…A recent meta-analysis21 revealed that gamified interventions improved PA with an increase of more than 1600 daily steps. Importantly, additional analyses indicated that (1) gamified interventions appear more effective than equivalent non-gamified interventions and (2) PA improvement persists in the long-term 21. This suggests that gamification is more than a novelty effect, and that is a promising healthcare approach, as it can be easily implemented in daily life without adding demands to people’s schedules.…”

“…In sum, gamified interventions seem to be a critical strategy to engage participants in digital interventions. However, more rigorous trials are needed to confirm these promising results, to better understand the mechanisms explaining gamification effects, and to test the healthcare potential of gamified interventions 21…”

Learning More About the Effects of Gamification on Physical Activity. Comment on “Evaluating the Effectiveness of Gamification on Physical Activity: Systematic Review and Meta-analysis of Randomized Controlled Trials”

“…We read with great interest the article, “Evaluating the Effectiveness of Gamification on Physical Activity: Systematic Review and Meta-analysis of Randomized Controlled Trials” by Mazeas et al [ 1 ]. The authors conducted a systematic review and meta-analysis to evaluate the effectiveness of gamification on physical activity (PA).…”

Authors’ Reply to: Learning More About the Effects of Gamification on Physical Activity. Comment on “Evaluating the Effectiveness of Gamification on Physical Activity: Systematic Review and Meta-analysis of Randomized Controlled Trials”

“…We appreciated and read with attention Hung and Kao’s [ 1 ] feedback on our recent systematic review and meta-analysis [ 2 ], which examined the effectiveness of gamified interventions on physical activity. These authors have pointed out 3 aspects that we will discuss in this letter.…”