Gamifying accelerometer use increases physical activity levels of individuals pre-disposed to type II diabetes
Open accessAbstract
Physical activity is important for preventing obesity and diabetes, but most obese and pre-diabetic patients are not physically active. We developed a Fitbit-based game called MapTrek that promotes walking. We recruited obese and pre-diabetic patients. Half were randomly assigned to the control group and given a Fitbit alone. The others were given a Fitbit plus MapTrek. The MapTrek group participated in 6 months of weekly virtual races. Each week, participants were placed in a race with 9 others who achieved a similar number of steps in the previous week's race. Participants moved along the virtual route by the steps recorded on their Fitbit and received daily walking challenges via text message. Text messages also had links to the race map and leaderboard. We used a Bayesian mixed effects model to analyze the number of steps taken during the intervention. A total of 192 (89%) participants in the control group and 196 (91%) in the MapTrek group were included in the analyses. MapTrek significantly increased step counts when it began: MapTrek participants walked almost 1,700 steps more than the control group on the first day of the intervention. We estimate that there is a 97% probability that the effect of MapTrek is at least 1,000 additional steps per day throughout the course of the 6-month intervention and that MapTrek participants would have walked an additional 81 miles, on average, before the effect ended. Our MapTrek intervention led to significant extra walking by the MapTrek participants.
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A 6-month study of 200 patients in a Fitbit-based game found participants walked 1700 steps more than the control group, though only 50% were consistently wearing their Fitbit by the end.
“Similarly, a 6-month study of 200 patients who participated in a Fitbit based game found participants walked 1700 steps more than the control group, though only 50% of participants were consistently wearing their Fitbit by the end of the trial.”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [104]
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Cites
R: A Language and Environment for Statistical Computing
R Core Team (2000) · doi:10.32614/r.manuals · Cited by 355,706 · see citing works
Kytle, J., & Bandura, A. (1978) · Contemporary Sociology · doi:10.2307/2065952 · Cited by 25,422 · see citing works
A theory of social comparison processes
Festinger, L. (1954) · Human Relations · doi:10.1177/001872675400700202 · Cited by 20,926 · see citing works
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
(2002) · New England Journal of Medicine · doi:10.1056/nejmoa012512 · Cited by 19,011 · cited 1× · see citing works
“…tissue, and lower blood pressure (Colberg et al., 2010; Swartz et al., 2003; Boulé et al., 2001; Snowling and Hopkins, 2006; Mahar et al., 2006; Knowler et al., 2002; Laaksonen et al., 2005; Li et al., 2008; Tuomilehto et al., 2001; Eriksson et al., 1994; Hu et al., 2001; Hu, 2003; Thorp et…”
BackgroundTuomilehto, J., Lindström, J., Eriksson, J. G., Valle, T. T., Hämäläinen, H., Ilanne-Parikka, P., Keinänen-Kiukaanniemi, S., Laakso, M., Louheranta, A., Rastas, M., et al. (2001) · New England Journal of Medicine · doi:10.1056/nejm200105033441801 · Cited by 10,873 · cited 1× · see citing works
“…et al., 2003; Boulé et al., 2001; Snowling and Hopkins, 2006; Mahar et al., 2006; Knowler et al., 2002; Laaksonen et al., 2005; Li et al., 2008; Tuomilehto et al., 2001; Eriksson et al., 1994; Hu et al., 2001; Hu, 2003; Thorp et al., 2011; Levine et al., 1999; Van Dijk et al., 2012; Sigal et…”
The Physical Activity Guidelines for Americans
Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., George, S. M., & Olson, R. D. (2018) · JAMA · doi:10.1001/jama.2018.14854 · Cited by 9,755 · see citing works
Building a practically useful theory of goal setting and task motivation: A 35-year odyssey.
Locke, E. A., & Latham, G. P. (2002) · American Psychologist · doi:10.1037/0003-066x.57.9.705 · Cited by 7,766 · cited 1× · see citing works
“(Locke and Latham, 2002) To minimize discouragement from being placed in a less-active league, participants were purposefully not informed of their league placement.”
Background<i>Stan</i> : A Probabilistic Programming Language
Carpenter, B., Gelman, A., Hoffman, M. D., Lee, D., Goodrich, B., Betancourt, M., Brubaker, M., Guo, J., Li, P., & Riddell, A. (2017) · Journal of Statistical Software · doi:10.18637/jss.v076.i01 · Cited by 7,754 · cited 2× · see citing works
“(Team SD, 2018) Stan and the No U-Turns Sampler (Carpenter et al., 2017; Team SD, 2018) were used to perform the Hamiltonian Monte Carlo (HMC) sampling to fit the model.”
MethodPrevalence and trends in obesity among US adults, 1999–2000
Flegal, K. M. (2002) · JAMA · doi:10.1001/jama.288.14.1723 · Cited by 6,190 · see citing works
A taxonomy of behavior change techniques used in interventions
Abraham, C., & Michie, S. (2008) · Health Psychology · doi:10.1037/0278-6133.27.3.379 · Cited by 2,525 · see citing works
Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012
Menke, A., Casagrande, S., Geiss, L., & Cowie, C. C. (2015) · JAMA · doi:10.1001/jama.2015.10029 · Cited by 2,362 · see citing works
Boulé, N. G., Haddad, E., Kenny, G. P., Wells, G. A., & Sigal, R. J. (2001) · JAMA · doi:10.1001/jama.286.10.1218 · Cited by 1,889 · see citing works
Persuasive Systems Design: Key Issues, Process Model, and System Features
Oinas-Kukkonen, H., & Harjumaa, M. (2009) · Communications of the Association for Information Systems · doi:10.17705/1cais.02428 · Cited by 1,663 · see citing works
Li, G., Zhang, P., Wang, J., Gregg, E. W., Yang, W., Gong, Q., Li, H., Li, H., Jiang, Y., An, Y., et al. (2008) · The Lancet · doi:10.1016/s0140-6736(08)60766-7 · Cited by 1,600 · see citing works
Arem, H., Moore, S. C., Patel, A., Hartge, P., Berrington de Gonzalez, A., Visvanathan, K., Campbell, P. T., Freedman, M., Weiderpass, E., Adami, H. O., et al. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.0533 · Cited by 1,498 · see citing works
Sedentary Behaviors and Subsequent Health Outcomes in Adults
Thorp, A. A., Owen, N., Neuhaus, M., & Dunstan, D. W. (2011) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2011.05.004 · Cited by 1,455 · see citing works
Role of Nonexercise Activity Thermogenesis in Resistance to Fat Gain in Humans
Levine, J. A., Eberhardt, N. L., & Jensen, M. D. (1999) · Science · doi:10.1126/science.283.5399.212 · Cited by 997 · see citing works
Physical Activity/Exercise and Type 2 Diabetes
Sigal, R. J., Kenny, G. P., Wasserman, D. H., Castaneda-Sceppa, C., & White, R. D. (2006) · Diabetes Care · doi:10.2337/dc06-9910 · Cited by 949 · see citing works
Physical Activity and Television Watching in Relation to Risk for Type 2 Diabetes Mellitus in Men
Hu, F. B., Leitzmann, M. F., Stampfer, M. J., Colditz, G. A., Willett, W. C., & Rimm, E. B. (2001) · Archives of Internal Medicine · doi:10.1001/archinte.161.12.1542 · Cited by 828 · see citing works
Snowling, N. J., & Hopkins, W. G. (2006) · Diabetes Care · doi:10.2337/dc06-1317 · Cited by 813 · see citing works
Trends in Obesity Prevalence by Race and Hispanic Origin—1999-2000 to 2017-2018
Ogden, C. L., Fryar, C. D., Martin, C. B., Freedman, D. S., Carroll, M. D., Gu, Q., & Hales, C. M. (2020) · JAMA · doi:10.1001/jama.2020.14590 · Cited by 775 · see citing works
Lin, X., Zhang, X., Guo, J., Roberts, C. K., McKenzie, S., Wu, W., Liu, S., & Song, Y. (2015) · Journal of the American Heart Association · doi:10.1161/jaha.115.002014 · Cited by 758 · see citing works
Effects of a classroom-based program on physical activity and on-task behavior
MAHAR, M. T., MURPHY, S. K., ROWE, D. A., GOLDEN, J., SHIELDS, A. T., & RAEDEKE, T. D. (2006) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000235359.16685.a3 · Cited by 674 · cited 1× · see citing works
“…decrease adipose tissue, and lower blood pressure (Colberg et al., 2010; Swartz et al., 2003; Boulé et al., 2001; Snowling and Hopkins, 2006; Mahar et al., 2006; Knowler et al., 2002; Laaksonen et al., 2005; Li et al., 2008; Tuomilehto et al., 2001; Eriksson et al., 1994; Hu et al., 2001;…”
BackgroundAssociation of daily step count and step intensity with mortality among US adults
Saint-Maurice, P. F., Troiano, R. P., Bassett, D. R., Graubard, B. I., Carlson, S. A., Shiroma, E. J., Fulton, J. E., & Matthews, C. E. (2020) · JAMA · doi:10.1001/jama.2020.1382 · Cited by 660 · cited 2× · see citing works
“(Saint-Maurice et al., 2020) Another recent study found S.L. Francis et al. older women walking 4,400 steps/day had a 41% lower mortality rate compared to women walking 2,700 steps/day.”
BackgroundMethodInfluentialColberg (2010) · doi:10.2337/dc10-1548 · Cited by 656 · see citing works
Physical Activity in the Prevention of Type 2 Diabetes
Laaksonen, D. E., Lindström, J., Lakka, T. A., Eriksson, J. G., Niskanen, L., Wikström, K., Aunola, S., Keinänen-Kiukaanniemi, S., Laakso, M., Valle, T. T., et al. (2005) · Diabetes · doi:10.2337/diabetes.54.1.158 · Cited by 614 · see citing works
Sedentary Activity Associated With Metabolic Syndrome Independent of Physical Activity
Bankoski, A., Harris, T. B., McClain, J. J., Brychta, R. J., Caserotti, P., Chen, K. Y., Berrigan, D., Troiano, R. P., & Koster, A. (2011) · Diabetes Care · doi:10.2337/dc10-0987 · Cited by 535 · see citing works
Schellenberg, E. S., Dryden, D. M., Vandermeer, B., Ha, C., & Korownyk, C. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-159-8-201310150-00007 · Cited by 520 · see citing works
Physical activity in U.S. adults with diabetes and at risk for developing diabetes, 2003
Morrato, E. H., Hill, J. O., Wyatt, H. R., Ghushchyan, V., & Sullivan, P. W. (2007) · Diabetes Care · doi:10.2337/dc06-1128 · Cited by 482 · see citing works
Accelerometer-Determined Steps per Day inUS Adults
TUDOR-LOCKE, C., JOHNSON, W. D., & KATZMARZYK, P. T. (2009) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318199885c · Cited by 355 · see citing works
Effect of lifestyle intervention in patients with type 2 diabetes: A meta-analysis
Chen, L., Pei, J.-H., Kuang, J., Chen, H.-M., Chen, Z., Li, Z.-W., & Yang, H.-Z. (2015) · Metabolism · doi:10.1016/j.metabol.2014.10.018 · Cited by 343 · see citing works
Sedentary lifestyle and risk of obesity and type 2 diabetes
Hu, F. B. (2003) · Lipids · doi:10.1007/s11745-003-1038-4 · Cited by 324 · see citing works
Increasing daily walking improves glucose tolerance in overweight women
Swartz, A. M., Strath, S. J., Bassett, D. R., Moore, J. B., Redwine, B. A., Groër, M., & Thompson, D. L. (2003) · Preventive Medicine · doi:10.1016/s0091-7435(03)00144-0 · Cited by 192 · see citing works
Theng, Y., Lee, J. W. Y., Patinadan, P. V., & Foo, S. S.-B. (2015) · Games for Health Journal · doi:10.1089/g4h.2014.0114 · Cited by 132 · see citing works
Racial/Ethnic Differences in Multiple Self-Care Behaviors in Adults with Diabetes
Nwasuruba, C., Khan, M., & Egede, L. E. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-007-0120-9 · Cited by 106 · see citing works
Gamifying Accelerometer Use Increases Physical Activity Levels of Sedentary Office Workers
Gremaud, A. L., Carr, L. J., Simmering, J. E., Evans, N. J., Cremer, J. F., Segre, A. M., Polgreen, L. A., & Polgreen, P. M. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.117.007735 · Cited by 89 · cited 1× · see citing works
“(Gremaud et al., 2018) However, neither the longterm effectiveness of MapTrek nor the effectiveness among participants at risk for T2D have been evaluated.”
BackgroundSelf-citationSelf-tracking of Physical Activity in People With Type 2 Diabetes: A Randomized Controlled Trial
Kooiman, T. J. M., de Groot, M., Hoogenberg, K., Krijnen, W. P., van der Schans, C. P., & Kooy, A. (2018) · CIN: Computers, Informatics, Nursing · doi:10.1097/cin.0000000000000443 · Cited by 78 · see citing works
Exercise Therapy in Type 2 Diabetes
van Dijk, J., Tummers, K., Stehouwer, C. D. A., Hartgens, F., & van Loon, L. J. C. (2012) · Diabetes Care · doi:10.2337/dc11-2112 · Cited by 75 · see citing works
Messé, L. A., Hertel, G., Kerr, N. L., Jr. Lount Robert, B., & Park, E. S. (2002) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.82.6.935 · Cited by 72 · see citing works
Exercise Habits and Exercise Relapse in Persons With Non-Insulin-Dependent Diabetes Mellitus
KRUG, L. M., Haire-Joshu, D. L., & HEADY, S. A. (1991) · The Science of Diabetes Self-Management and Care · doi:10.1177/014572179101700314 · Cited by 72 · see citing works
Novel Smartphone Game Improves Physical Activity Behavior in Type 2 Diabetes
Höchsmann, C., Müller, O., Ambühl, M., Klenk, C., Königstein, K., Infanger, D., Walz, S. P., & Schmidt-Trucksäss, A. (2019) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2019.02.017 · Cited by 67 · see citing works
Activity Patterns of Obese Adults with Type 2 Diabetes in the Look AHEAD Study
Jakicic, J. M., Gregg, E. W., Knowler, W. C., Kelley, D. E., Lang, W., Miller, G. D., Pi‐Sunyer, F. X., Regensteiner, J. G., Rejeski, W. J., Ribisl, P. M., et al. (2010) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181e054f0 · Cited by 65 · see citing works
Effects of Exergaming on Physical Activity in Overweight Individuals
Höchsmann, C., Schüpbach, M., & Schmidt‐Trucksäss, A. (2015) · Sports Medicine · doi:10.1007/s40279-015-0455-z · Cited by 62 · see citing works
Messé, L. A., Hertel, G., Kerr, N. L., et al. (2002) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.82.6.935 · Cited by 54 · see citing works
Keeping Users Engaged through Feature Updates
Zhao, Z., Arya, A., Whitehead, A. D., Chan, G., & Etemad, S. A. (2017) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3025453.3025982 · Cited by 52 · see citing works
Eriksson, K.-F., Saltin, B., & Lindgärde, F. (1994) · Diabetes · doi:10.2337/diab.43.6.805 · Cited by 44 · see citing works
Games and Health Education for Diabetes Control: A Systematic Review with Meta-Analysis
Martos-Cabrera, M. B., Membrive‐Jiménez, M. J., Suleiman‐Martos, N., Mota‐Romero, E., la Fuente, G. A. C., Gómez‐Urquiza, J. L., & Albendín‐García, L. (2020) · Healthcare · doi:10.3390/healthcare8040399 · Cited by 28 · see citing works
Women Workers and Women at Home Are Equally Inactive
Steeves, J. A., Murphy, R. A., Zipunnikov, V., Strath, S. J., & Harris, T. B. (2014) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000000582 · Cited by 23 · see citing works
Carr, L. J., Dunsinger, S., & Marcus, B. H. (2016) · Journal of Physical Activity and Health · doi:10.1123/jpah.2015-0482 · Cited by 11 · see citing works
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Vetrovsky, T., Borowiec, A., Juřík, R., Wahlich, C., Śmigielski, W., Steffl, M., Tufano, J. J., Drygas, W., Stastny, P., Harris, T., et al. (2022) · British Journal of Sports Medicine · doi:10.1136/bjsports-2021-105198 · Cited by 68 · see citing works
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. (2024) · eClinicalMedicine · doi:10.1016/j.eclinm.2024.102798 · Cited by 37 · see citing works
Data Analytics in Physical Activity Studies With Accelerometers: Scoping Review
Liang, Y., Wang, C. I., & Hsiao, C. K. (2024) · Journal of Medical Internet Research · doi:10.2196/59497 · Cited by 25 · see citing works
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Bassin, S. R., & Srinath, R. (2025) · American Journal of Lifestyle Medicine · doi:10.1177/15598276231180541 · Cited by 17 · see citing works
Jeem, Y. A., Andriani, R. N., Nabila, R., Emelia, D. D., Lazuardi, L., & Josef, H. K. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192013638 · Cited by 19 · see citing works
Teo, J. Y. C., Jiang, Y., Seah, A. C. W., Yeo, T. M., Lim, S. T., & Wang, W. (2025) · Journal of Clinical Nursing · doi:10.1111/jocn.17764 · Cited by 5 · see citing works
Gamified Mobile Health Strategies for Promoting Physical Activity in Autistic Adults
Lee, D., Frey, G. C., & Shih, P. C. (2024) · Exercise and Sport Sciences Reviews · doi:10.1249/jes.0000000000000353 · Cited by 3 · see citing works
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Simmering, J. E., Polgreen, L. A., Francis, S. L., Strom, A. J., Segre, A. M., & Polgreen, P. M. (2024) · Military Medicine · doi:10.1093/milmed/usae280 · Cited by 2 · see citing works
Self-citationZhang, K., Jiang, Y., Xi, K., & Sun, N. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1718371 · Cited by 3 · see citing works
Gamified Interventions for Obesity and Overweight Prevention and Treatment: A Scoping Review
Pesce, S., Villa, G., Poliani, A., Rosa, D., Marcomini, I., & Manara, D. F. (2025) · AJN American Journal of Nursing · doi:10.1097/ajn.0000000000000056 · Cited by 2 · see citing works
Zhang, G., Meng, Y., Wang, J., Xia, Y., Zhang, Y., Li, X., Xu, X., & Sun, T. (2025) · doi:10.2196/preprints.81094
Baumann, H., Thomas, G., Alley, S., Duncan, M. J., Browne, M., Wollesen, B., Vandelanotte, C., & Gilson, N. D. (2026) · Frontiers in Digital Health · doi:10.3389/fdgth.2026.1801405
Li, S., Qiao, L., Wang, R.-N., Pei, R., Ma, H., & Piao, M. (2026) · JMIR Serious Games · doi:10.2196/85804
- Authors
- 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., & Polgreen, P. M.
- Affiliations
- University of Iowa (US)
- Corresponding author
- Polgreen, Philip M.
- ORCID
- Venue
- Preventive Medicine Reports
- Publisher
- Elsevier BV
- Published
- 2021-09
- Volume
- 23
- Pages
- 101426
- ISSN
- 2211-3355 (ISSN-L)
- PMC
- PMC8209749
- OpenAlex
- W3168328595
- Cited by
- 13
- References
- 48
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 1 · 2022: 2
- FWCI
- 1.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Preventive Medicine Reports (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health (UL1TR002537)
- National Institute of Diabetes and Digestive and Kidney Diseases (5R21DK108019)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
- Keywords
- gamification, physical activity, walking, type 2 diabetes prevention, prediabetes, obesity, Fitbit, wearable accelerometers, step count, leaderboards
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