Effect of digital health applications with or without gamification on physical activity and cardiometabolic risk factors: a systematic review and meta-analysis of randomized controlled trials
Open accessAbstract
Background: Use of health applications (apps) to support healthy lifestyles has intensified. Different app features may support effectiveness, including gamification defined as the use of game elements in a non-game situation. Whether health apps with gamification can impact behaviour change and cardiometabolic risk factors remains unknown. We conducted a systematic review and meta-analysis to determine the effect of health apps with gamification compared to non-gamified apps (control) on physical activity and cardiometabolic risk factors. Methods: MEDLINE, EMBASE, and Cochrane library databases were searched through May 21st, 2024. We included controlled trials in adults (≥1 years) of all health backgrounds, with intervention periods ≥8-weeks, assessing the effect of gamification strategies used in health behaviour apps on adherence, cardiometabolic risk factors, total energy, and dietary nutrients of concern. Independent reviewers extracted relevant data and assessed risk of bias. Outcomes included physical activity and cardiometabolic risk factors (adiposity, glycemia, lipids, blood pressure and dietary factors). Data were pooled using the inverse variance method and expressed as mean differences (MD) with 95% confidence intervals (CI). Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Protocol registration was on ClinicalTrials.gov (NCT04633070). Findings: [-0.44 to -0.12]; moderate) and body weight (-0.70 kg [-1.18 to -0.22]; moderate), and small important reductions in body fat (-1.92% [-2.71 to -1.14]; high) and waist circumference (-1.16 cm [-1.93 to -0.39]; moderate). No differences were observed for other outcomes (very low-to-high). Interpretation: Current evidence provides a good indication that gamification features in apps targeting physical activity or measures of adiposity results in slight improvements in these outcomes compared to non-gamified versions. Recommendations to use an app for increasing physical activity or targeting weight loss should consider those with gamification features. Funding: None.
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Kohl, J., Brame, J., Centner, C., Wurst, R., Fuchs, R., Sehlbrede, M., Tinsel, I., Maiwald, P., Fichtner, U. A., Armbruster, C., et al. (2023) · Journal of Medical Internet Research · doi:10.2196/43426 · Cited by 29 · see citing works
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Feasibility and Effectiveness of a Web-Based Physical Activity Intervention for Working Mothers
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Middelweerd, A., Mollee, J. S., Klein, M. C. A., Manzoor, A. F., Brug, J., & Velde, S. J. T. (2019) · JMIR Formative Research · doi:10.2196/12538 · Cited by 21 · see citing works
Greysen, S. R., Changolkar, S., Small, D. S., Reale, C., Rareshide, C., Mercede, A., Snider, C. K., Greysen, H. M., Trotta, R., Halpern, S., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.0952 · Cited by 20 · see citing works
Patnaik, L., Panigrahi, S. K., Sahoo, A., Mishra, D., Muduli, A. K., & Beura, S. (2022) · International Journal of Preventive Medicine · doi:10.4103/ijpvm.ijpvm_92_20 · Cited by 20 · see citing works
Okaniwa, F., & Yoshida, H. (2022) · JMIR Formative Research · doi:10.2196/30630 · Cited by 19 · see citing works
Monroe, C. M., Cai, B., Edney, S. M., Jake‐Schoffman, D. E., Brazendale, K., Bucko, A., Armstrong, B., Yang, C., & Turner‐McGrievy, G. M. (2023) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-023-01530-1 · Cited by 19 · see citing works
Brame, J., Kohl, J., Wurst, R., Fuchs, R., Tinsel, I., Maiwald, P., Fichtner, U. A., Armbruster, C., Bischoff, M., Farin‐Glattacker, E., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19031393 · Cited by 17 · see citing works
Influenza, Pneumococcal, Hepatitis B and Herpes Zoster Vaccinations
Husein, N., & Chetty, A. (2018) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2017.10.016 · Cited by 15 · see citing works
Robertson, M. C., Lyons, E., Liao, Y., Baum, M. L., & Basen‐Engquist, K. (2020) · JMIR mhealth and uhealth · doi:10.2196/18364 · Cited by 14 · see citing works
Willms, A., Rhodes, R. E., & Liu, S. (2023) · JMIR Formative Research · doi:10.2196/36562 · Cited by 14 · see citing works
Francis, S. L., Simmering, J. E., Polgreen, L. A., Evans, N. J., Hosteng, K. R., Carr, L. J., Cremer, J. F., Coe, S., Cavanaugh, J. E., Segre, A. M., et al. (2021) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2021.101426 · Cited by 13 · see citing works
Motivating Multigenerational Employees: Is There a Difference?
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Evaluation of an Interactive Web-Based Health Program for Weight Loss—A Randomized Controlled Trial
Fichtner, U. A., Armbruster, C., Bischoff, M., Maiwald, P., Sehlbrede, M., Tinsel, I., Brame, J., Kohl, J., König, D., Fuchs, R., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192215157 · Cited by 13 · see citing works
Work Motivation Theory: Identifying Multi-Generational Values in the Workplace
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Cáceres, N. A., Yu, Q., Lauzon, M., Diniz, M. A., Tuckerman, R., Carrillo, A. A., Philipp, M. A., Foster, G. D., Seitz, A. R., & Salvy, S. (2022) · Obesity Science & Practice · doi:10.1002/osp4.617 · Cited by 6 · see citing works
Rahimi‐Ardabili, H., Reynolds, R. C., Zwar, N. A., Briggs, N., & Vartanian, L. R. (2023) · medRxiv · doi:10.1101/2023.04.18.23288716 · Cited by 2 · see citing works
Flagged first, then by citations
2 of the 113 references couldn’t be matched to a known paper.
Cited by
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The Role of Mobile Apps in Obesity Management: Systematic Review and Meta-Analysis
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The Application of Gamification in Children’s Oral Health Management: Systematic Review
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DİJİTAL ÇAĞDA YEME FARKINDALIĞI: MOBİL SAĞLIK UYGULAMALARI ÇAĞINDA FARKINDALIKLI YEME MÜDAHALELERİ
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- Authors
- Nishi, S. K., Kavanagh, M. E., Ramboanga, K., Ayoub-Charette, S., Modol, S., Dias, G. M., Kendall, C. W. C., Sievenpiper, J. L., & Chiavaroli, L.
- Affiliations
- St. Michael's Hospital (CA)
- University of Waterloo (CA)
- Corresponding author
- Nishi, Stephanie K.
- ORCID
- Venue
- eClinicalMedicine
- Publisher
- Elsevier BV
- Published
- 2024-10
- Volume
- 76
- Pages
- 102798
- ISSN
- 2589-5370 (ISSN-L)
- PMC
- PMC11701442
- OpenAlex
- W4402831095
- Cited by
- 37
- References
- 113
- Citations by year
- 2026: 19 · 2025: 18
- FWCI
- 3.32
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- EClinicalMedicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- gamification, health apps, digital health interventions, physical activity, cardiometabolic risk factors, adiposity, body weight, fat mass, waist circumference, glycemia, blood pressure, lipids, dietary nutrients, behavior change, weight loss
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