JMIR Publications

ABSTRACT

Background:

Physical inactivity affects approximately 1.4 billion adults globally, representing a major public health challenge. Gamification shows potential in addressing global inactivity by boosting motivation. The widely recognized Gamification Octalysis Framework, which emphasizes human motivation over mere functionality, can be used to summarize gamification elements in physical activity (PA) applications. However, no review has been conducted to assess the current status of gamification utilization in PA applications. Additionally, the integration of identified behavior change techniques (BCTs) can help connect game elements and health behavior change.

Objective:

To systematically map and categorize gamification elements in PA applications using the Octalysis Framework and identify associated BCTs to inform the design of future interventions.

Methods:

The systematic review protocol was prospectively registered with PROSPERO (CRD420251077817). The systematic review was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of seven databases [i.e., PubMed, Embase, Cochrane library, Web of Science, Cumulative Index to Nursing & Allied Health Literature (CINAHL), SPORTDiscus, and PsycINFO] were selected and searched for relevant randomized controlled trials (RCTs) published in English from inception to February 28, 2025. Two independent reviewers conducted the study selection, BCTs and gamification elements extraction, taxonomic development and quality assessment using the Cochrane Risk of Bias 2.0 tool.

Results:

A total of 43 RCTs and 27 unique interventions were included in this review. The studies assessed a variety of outcomes, including user retention, behavioral changes, psychological impacts, and health-related indicators. The most frequently adopted BCT elements were “2.2 feedback on behavior” and “1.1 goal setting (behavior)”. Moreover, using the Octalysis framework, a taxonomy was developed, identifying 41 gamification elements (e.g., narrative, mentoring, and points loss) across eight core motivational drives. The majority of BCTs were mapped to two core motivations (i.e., empowerment and accomplishment), while some BCTs were not supported by gamification elements.

Conclusions:

Over the past decade, gamification has evolved rapidly and demonstrated significant potential in promoting PA. This systematic mapping provides the first comprehensive taxonomy of gamification elements in PA interventions, offering evidence-based guidance for intervention designers and researchers. Future research should prioritize more rigorously designed RCTs involving diverse populations and explore how these gamification elements, aligned with specific motivational drives, can be optimized to enhance the effectiveness of PA promotion. Clinical Trial: The study was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD420251077817.