JMIR Publications

ABSTRACT

Background:

Physical activity (PA) is closely related to the health of children and adolescents. Gamification interventions are highly potential measures to promote PA. However, the effects of gamification interventions on PA and sedentary behavior (SB) in children and adolescents remain a controversial topic. This review aims to resolve this controversy.

Objective:

This systematic review aims to evaluate the effectiveness of gamification interventions in improving PA and reducing SB in children and adolescents and to summarize potential moderators of gamification interventions to promote PA participation.

Methods:

RCTs of the effects of gamification interventions on PA participation in children and adolescents were retrieved from PubMed, Web of Science, Embase, EBSCO, and the Cochrane Library electronic databases. Meta-analyses were performed using RevMan 5.4 and Stata 18 software. Studies of the effects of gamification interventions on PA and SB in children and adolescents were included in the analysis, and due to high heterogeneity, meta-analysis was performed using a random-effects model, and the risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool (Cochrane RBAT). Egger tests and sensitivity analyses were used to ensure the robustness of the results, and subgroup analyses were used to explore the possible effects of different factors on the results.

Results:

We included 16 RCTs with a total of 7,472 children and adolescents were ultimately included. A meta-analysis of the results showed that the gamification intervention had a positive effect on MVPA（SMD=0.15,95% CI:0.01 to 0.29; P=.04) and BMI (SMD 0.11,95% CI 0.05 to 0.18; P=.0004). However, there was no significant improvement in SB (SMD 0.07, 95% CI -0.07 to 0.22; P=.33), VPA (SMD 0.12, 95% CI -0.03 to 0.55; P=.56), MPA (SMD 0.16, 95% CI -0.2 to 0.53; P=.38), LPASMD (SMD -0.00, 95% CI -0.49 to 0.48; P=.99), and Daily Step (SMD 0.22, 95% CI -0.51 to 0.94; P=.55). Results of subgroup analyses indicated that theoretical paradigm, game elements, intervention duration, and study setting had a significant moderating effect on MVPA in children and adolescents.

Conclusions:

Meta-analyses indicated that gamification interventions effectively increased MVPA in children and adolescents, and this effect persisted beyond the follow-up period. Theoretical paradigms, game elements, and intervention duration may be associated with the efficacy of gamification interventions, and further exploration of the optimal implementation of game elements and theoretical features is needed to maximize PA engagement. Clinical Trial: CRD42023426532