Discussion
RECRUITMENT
This study assessed the feasibility and preliminary efficacy of a socialincentive-based gamification approach for improving PA. The findings suggest that the addition of a step competition and weekly PA challenge game to an e/mHealth PA intervention among teams of insufficiently active adults with existing social ties is feasible and acceptable. While in place, this gamification intervention facilitated positive, clinically meaningful differences in Fitbit-measured daily steps and active minutes versus an identical program without gamification. However, once withdrawn, it did not result in increases in ActiGraph-measured daily steps, MVPA, and social support over and above what was observed with the traditional e/mHealth treatment alone.This is the first e/mHealth gamification PA study among teams of adults with existing social ties to measure participants’ PA using both research grade and commercial accelerometers over one year via an RCT, yielding valuable insights about both the short- and long-term effects of team-based gamification among adults. Metrics regarding adherence to self-monitoring PA using the Fitbit were high for both study arms during the intervention but slightly declined thereafter. A more favorable, self-monitoring profile was observed for TECH + Gamification versus TECH, suggesting that the gamified elements had the desired effect of creating a heightened culture of accountability [Consistent with prior studies, [The game-based strategies did not confer an added benefit in Fitbit-measured PA during the post-intervention period. Relatedly, similar, modest increases in ActiGraph-measured daily steps and MVPA were captured immediately after intervention removal in both study arms, and these improvements slightly declined to a similar degree; however, they remained above baseline by 1 year, perhaps due to factors related to being part of a team [It is possible that the gamified approach served largely as an extrinsically oriented motivating factor that had a positive effect while in place but inability to drive sustained PA participation once removed. This factor in combination with the lack of an enhanced gamification effect on social support may have stifled the chance to develop intrinsic motivation which is a strong predictor of PA adherence [Further, future research should explore whether novel “booster” gamification doses (e.g., additional challenges) should be implemented during a maintenance phase [In the current study, it was not possible to disentangle the effects of the team competition and weekly challenge game on the outcomes, which reflects one limitation. Another limitation is the predominantly female and highly educated sample, reducing the generalizability of the findings. However, this study has several strengths, including the following: 40-week post-intervention period; two device-based PA measures; use of an RCT to isolate the efficacy of a custom gamification approach delivered through technologies, enhancing scalability potential; measurement of social support; high retention; and recruitment of teams with varying combinations of existing social ties (friends; family; co-workers).