JMIR Publications

ABSTRACT

Background:

Gamification refers to using game design elements in nongame contexts. Using gamification to promote physical activity is a novel and promising avenue for improving lifestyle and mitigating the advancement of cardiovascular diseases. However, the literature provides mixed results regarding the effectiveness of gamification interventions for people with cardiovascular diseases.

Objective:

This systematic review and meta-analysis aim to evaluate the efficacy of gamification interventions in short-term and follow-up periods of physical activity in people with cardiovascular diseases and to explore the most effective game design elements.

Methods:

A comprehensive search was conducted across seven electronic databases for randomized controlled trials published in English from January 1st, 2010, to February 3rd, 2024. The studies were included when they used mobile health-based gamification interventions in people with cardiovascular diseases with control groups with or without gamification to promote physical activity or break a sedentary lifestyle and when they assessed relevant outcomes. Two independent reviewers screened the retrieved records for title, abstract, and full text, assessed the risk of bias, and extracted data. We conducted meta-analyses using a random-effects model approach. Sensitivity analysis and influence analysis were performed to examine the robustness of our results. All statistical analysis was performed using R Version 4.3.2.

Results:

A total of six randomized controlled trials were included. The meta-analysis of five studies revealed a small effect of gamification interventions on short-term physical activity (after sensitivity analysis: Hedges g = 0.32, 95% CI 0.19-0.45, 95% PI 0.02-0.62). The meta-analysis of four studies found the maintenance effect (measured with follow-up averaging 2.5 months after the end of the intervention) was small (Hedges g = 0.24, 95% CI 0.14-0.34, 95% PI -0.01-0.41). The meta-analysis of three studies with participants taking 696.96 more steps per day than the control group (95% CI 327.80-1066.12, 95% PI -121.39-1515.31). “Feedback” and “Avatar” are more important predictors.

Conclusions:

This meta-analysis provides evidence that gamification interventions effectively promote physical activity in people with cardiovascular disease. Importantly, this effect persists after intervention, indicating that this is not just a novel effect caused by the game nature of gamification. The 95% PI suggests that future implementation of gamification interventions in the same study population will lead to actual effects in promoting physical activity in the vast majority of cases. Clinical Trial: CRD42024518795 (PROSPERO).