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PHILADELPHIA — Want to increase your physical activity? Grab a buddy and an activity tracker – such as a wearable device or smartphone app – that incorporates gaming elements like points and levels (known as gamification) to achieve your goals. New research shows families who used activity trackers with specially designed gaming elements increased daily step counts by nearly one mile per day and achieved daily fitness goals 27 percent more than families who did not. A novel feature of the game, which the researchers say was likely key to the findings, was use of behavioral economics to design the features in a way that would address predictable barriers to increasing physical activity and enhance social incentives. The results of the clinical trial, co-led by researchers at the Perelman School of Medicine at the University of Pennsylvania and Boston University School of Medicine, are published today in JAMA Internal Medicine.

“Our social connections – family members, friends, and even colleagues – can be powerful motivators, but most programs target individuals instead of leveraging these social networks,” said lead author Mitesh Patel, MD, MBA, MS, an assistant professor of Medicine and Health Care Management, and director of Penn Medicine’s Nudge Unit. “Our findings demonstrate how gamification can be designed to harness these social influences to improve health behaviors. Since these relationships are often longstanding, the impact of these interventions has the potential to be long-lasting. For example, our study showed that three months after the game ended, increases in physical activity levels persisted.”

In the study, known as the Behavioral Economics Framingham Incentive Trial (BE FIT), researchers analyzed data from 200 adults comprising 94 families. Participant data came from families enrolled in the Framingham Heart Study. All participants tracked daily step counts using a wearable device or smartphone, established a baseline, set a step goal increase, and received daily feedback on goal performance for 24 weeks. For the first 12 weeks, families randomly assigned to the gamification arm could earn points and progress through levels based on physical activity. The researchers say the gaming elements using principles from behavioral economics including loss aversion and variable rewards and were designed to enhance social incentives including collaboration, accountability and peer support.

During the 12-week intervention period, participants in the gaming arm achieved step goals 27 percent more often than participants in the control arm who did not have gaming elements built into their activity trackers. At the start of the study period, average baseline step counts were 7,662 and 7,244 for the control and intervention groups, respectively. Over the course of the study period, the control group increased step counts by an overall average of 636 steps, whereas the intervention group increased their overall step counts by an average of 1661 steps, the equivalent of nearly one mile. During the 12-week follow-up period, step counts declined slightly in the gamification arm, but still remained significantly higher than that of the control arm.

“While many are hopeful that digital health interventions can increase healthy behaviors, there have been few clinical trials demonstrating meaningful differences in community settings,” said senior author Joanne Murabito, MD, ScM, research center director of the Framingham Heart Study and an associate professor of Medicine at the Boston University School of Medicine. “By engaging families in an interactive game-based intervention using activity trackers, we found significant increases in physical activity. This approach is exciting because it has the potential to be scaled more broadly.”

The authors say further study is needed to evaluate the approaches tested in the new study among more diverse and high-risk populations, as well as measures of health outcomes and physical activity beyond daily step counts.

Funding for the study was provided by the National Heart, Lung and Blood Institute (1RO1HL128914, 2RO1HL092577, and P30AG034546). The Framingham Heart Study is funded by contracts NO1-HC-25195 and HHSN268201500001I from the National Institutes of Health.

Other Penn authors on the study include Kevin G. Volpp, Dylan S. Small, Victoria Hilbert, Devon H. Taylor, Jingsan Zhu, and Wenli Wang.

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $6.7 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2016 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2016, Penn Medicine provided $393 million to benefit our community.

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