A mature woman in fitness attire checks her smartwatch while walking over a bridge

Turning lifestyle intervention for type 2 diabetes into a game significantly increased participants ’physical activity, especially if one of the elements of the competition was included, a random iDiabetes trial found.

In this 1-year trial of the intervention, which included a wrist device for tracking steps and elements of the game, such as points and levels, randomly selected participants in small groups competing in the standings significantly increased the average number of daily steps with a control group. (606 more steps, 95% CI 201 to 1,011, P= 0.003), said colleagues at Mitesh Patel, MD, MBA, Philadelphia Crescenz Veterans Affairs Medical Center and Penn Medicine Nudge Unit.

Participants who dared to join a group that received social support from a family member or friend increased the average number of daily steps significantly compared with controls (503 more steps, 95% CI 103, and 903, respectively). P= 0.01). However, those who dared to collaborate in small groups did not significantly increase their daily steps (adjusted for difference 280 steps, 95% CI -115 and 674, P= 0.16), the group reported online during the year JAMA open network.

All groups had significant reductions in body weight and A1c (HbA1c) levels from baseline, but there were no significant differences in these results between gamification interventions and the control group, which also had a wrist device to follow steps, but without any game elements.

“In this study, our goal was to conduct a long-term randomized clinical trial that collected behavioral information and used supportive, collaborative, or competitive incentives to test the effectiveness of gamification interventions to promote overweight or physical activity and weight loss among adults. and uncontrolled type 2 diabetes. Patients were monitored remotely for a year using smart devices, a smart weight scale, and an automated technology platform, ”the researchers wrote.

There were 361 participants in the trial; the mean age was 52 years, the mean HbA1c was 9.6%, and the mean body mass index was 37. Approximately half (56%) were women, 40% were white, and 51% were black. Nearly three-quarters (72%) took insulin and 40% cured oral diabetes.

Participants randomly went to a control group that received feedback from the wrist devices, but had no other intervention, and one of three arms to examine gamification: the competitive arm, the support arm, and the collaborative arm.

The competition arm was made up of three teams. These patients usually did not know each other before the examination, but were submitted by e-mail. At the end of each week, they received an email classifying them with the accumulated points in the exam and showing their level. This was intended to encourage participants to compete for first place in the team.

Support arms were not included in the group. Instead, participants chose a family member or friend to be their sponsor. Sponsors sent out weekly reports to participants about their performance in the game over the past week and their goals for next week. Sponsors were told to make an effort to help participants move forward.

The collaborative arm was also made up of groups of three who were introduced to each other by email. Each day, a member was randomly selected to represent the group that day. If that person had weight the day before, the team would save the points earned. Unless that person did, the team lost points. In this design, the responsibility to share with others was to encourage a collaborative effort to meet daily goals.

The main results of the trial were changes in the amount of daily steps, body weight, and HbA1c levels from baseline. The increase in the number of steps has been between 12% and 13%, the Patel group said, noting that even modest growth in physical activity could have health benefits.

Along with that, Paul Hebert, a doctor at the Puget Sound Healthcare System in Seattle, said the elements of the game are increasingly being incorporated into health interventions. “The results of the iDiabetes test by Patel et al reveal new research examining the implications of the inclusion of game mechanics interventions in helping people improve their health behaviors. rooted and effective mechanics, ”he wrote.

“This research significantly adds to the overall Nudge Unit work that gamified interventions can help people maintain higher levels of physical activity for a longer period of time in a population that is economically and demographically more diverse than previous research has shown.” he added.

However, the research collaboration arms could have better results with better design, Hebert said. The loss to the individual was a collective loss, a standard principle of cooperation, but he did not allow teammates to come to each other’s support, which is another game principle that has been shown to be effective, he explained.

Another limitation was that the study did not collect data on daily activity that did not include data on daily steps, which could have an impact on the results, Patel’s team said. In addition, the study did not gather information on communications or interactions between people in the arms of competition or collaboration, which could help explain the success and failure of these groups, they noted.

“The results of the IDiabetes test indicate that gamification through a platform designed to access behavioral knowledge and controlled remotely is promising to increase physical activity among adults with type 2 diabetes, but may combine gamification with other approaches. Weight loss or promote changes in glycemic control.” they concluded.

  • Jeff Minerd is a freelance writer of medicine and science in Rochester, NY.


The research was supported by the Doris Duke Charitable Foundation.

Patel reports that it has received personal dues from Catalyst Health LLC as owner, Life.io personal dues as a member of the advisory board, stock options and personal fees HealthMine Services as a member of the advisory board, and personal opportunities and personal dues Holistic Industries the company as a consultant. member of the committee outside the work submitted.

The co-authors reported other links to the industry.

Hebert has not reported any conflicts of interest.