Gamification Interventions May Help Economically Disadvantaged Adults at Elevated Risk for Major Adverse Cardiovascular Events

The findings of a new study indicate that a gamification intervention may benefit economically disadvantaged adults at high risk for adverse cardiovascular events. The study was published in JAMA Cardiology.

“Health promotion efforts commonly communicate goals for healthy behavior, but the best way to design goal setting among high-risk patients has not been well examined,” the researchers wrote.

This study, called Evaluation of the Novel Use of Gamification With Alternative Goal-setting Experiences, was conducted from January 15, 2019, to June 1, 2020. This was a 24-week randomized clinical trial comprised of 500 adult participants (66.2% Black, 22.8% White, and 69.6% Women) from lower-income neighborhoods in and around Philadelphia. The population of interest had either an atherosclerotic cardiovascular disease (ASCVD) or a 10-year ASCVD risk score greater than or equal to 7.5%. Overall, 43% of the population had an ASCVD condition.  The study consisted of a remotely monitored 8-week introductory intervention period, 8-week maintenance intervention period, and 8-week follow-up period.

The study subjects all used a wearable device to track daily steps, established a baseline level, and were then randomly assigned to an attention control or 1 of 4 gamification interventions that varied only on how daily step goals were set (self-chosen or assigned) and implemented (immediately or gradually), the researchers noted.

The primary outcome was defined as was change in mean daily steps from baseline to the 8-week maintenance intervention period. Secondary outcomes were changes in minutes of moderate to vigorous physical activity. All randomly assigned participants were included in the intention-to-treat analysis.

According to the results, participants with self-chosen and immediate goals had significant increases in the number of daily steps during the maintenance intervention period compared to the control group, and these findings were sustained during the 8-week follow-up. Moreover, the intervention group also had significant increases in daily minutes of moderate to vigorous physical activity during the maintenance intervention that were sustained during follow-up.  The researchers noted that no other gamification arms had consistent increases in physical activity compared with the control arm.


“In this trial among economically disadvantaged adults at elevated risk for major adverse cardiovascular events, a gamification intervention led to increases in physical activity that were sustained during 8 weeks of follow-up when goals were self-chosen and implemented immediately,” the researchers concluded.