It’s only a game!

Callum Leese (pictured) is a GP trainee, SCREDs lecturer at the University of Dundee and co-lead for physical activity and lifestyle medicine at the RCGP

Ben Wilkins is a University of Oxford graduate with a career in physical activity promotion, now CEO of ‘Good Boost’*

Hussain Al-Zubaidi is a Lifestyle GP, media medic and RCGP physical activity and lifestyle medicine champion.

Video games are ubiquitous but divisive. If you’re reading this, you’re likely to sit in one of two camps. Camp one: fond of a quiet evening in, playing Fortnite or Minecraft. Camp two: indignation that someone you love (often child or partner) spends all their time in front of a screen. Generally, if you’re in camp two (self-confessed) discussion around gaming are loaded with judgement. But maybe there’s the potential to depolarise the discussion.¹

Gaming has seen a significant rise in popularity in the UK, with 39% of UK adults aged 16 and above engaging in online gaming, and 56% of UK children aged 3 to 15 playing online games.² On average, UK gamers spend 7 hours and 33 minutes per week gaming.² This increase in gaming and screen time has been linked to a rise in sedentary behaviour, contributing to the growing issue of childhood obesity.³ Physical inactivity poses a considerable public health concern, placing strain on healthcare services already burdened by non-communicable diseases.⁴ Globally, the annual cost of treating non-communicable diseases attributable to physical inactivity is estimated at US$27 billion.⁴ Adolescents are disproportionately affected, with 85% of school-age girls and 78% of boys failing to meet the World Health Organisation’s guidelines for physical activity.⁵

However, the very same addictive nature of gaming that keeps people sedentary can be harnessed to promote health through the concept of gamification. Gamification is defined as “…the use of game design elements in non-game contexts…” and is used to enhance engagement, motivation, and overall user experience.⁶ It aims to encourage participation, collaboration, and achievement across various fields, including business, education, marketing, medicine, and lifestyle, serving as a catalyst for positive behaviour change. It achieves these aims via two main motivational drivers: positive and negative reinforcement and emotions.¹ This is designed into games often by applying the mechanics, dynamics and emotions framework (MDE). The interaction between the three areas keeps players engaged and prolongs participation and enjoyment.¹

Examples of Gamification:  

Pokémon Go 

If you have not heard about this gamified app then I am not sure where you have been hiding. Launched in 2016 it has been downloaded over 500 million times! I remember seeing scores of people walking and cycling endlessly, trying to get Charmander or Pikachu. A study in 2016 showed a 25% increase in steps from baseline, with an average increase daily step count of 1473 (7). And most interestingly the research highlighted Pokémon Go increased activity levels regardless of gender, age, weight, socio-economic status or prior activity level.⁷

Good Boost 

Originating as a community health research initiative, Good Boost delivers A.I. personised exercise programmes for people living with health-conditions. The group focused sessions involve collaborative group challenges, aiming to create lasting behaviour change through shared experiences and social contracts. Good Boost was recently recognised as leading solution in swimming pool wellbeing.⁸

 Zwift  

This gamification platform for virtual cycling and running, stands out as a highly popular tool for physical activity. An analysis of its user’s experiences found the keys to its success was the platform’s community-driven approach, with social identity enhancing user belonging and motivation.⁹

Almost all fitness tracker applications offer a degree of gamification, and thankfully Ihan and Fietkiewicz compared them all so we don’t have to!¹⁰ In truth all platforms adopted similar methods of gamification, with the most common being documentation, goal setting, progress monitoring and avatar use. So next time you get a KOM on strava or a garmin badge…remember you’re gaming too!

Zombies, Run!

An audio adventure story that unfolds alongside a jog. Zombies, Run! has been used by over 1 million players to find the motivation to run more often. As you run, the GPS leads you to collecting supplies and avoiding zombies to survive the apocalypse. The depth of the narrative in the audio playback has been identified to be a key element of the apps success in distracting the runner from the actual running.¹¹

In conclusion

While research on the effectiveness of gamification in promoting physical activity exists, it is limited and often lacks long-term follow-up.^6,12,13 However, the potential for gamification to drive positive health outcomes is promising and warrants further exploration.

So watch this space. And whether as an individual or health professional, consider how you can use gamification to encourage movement, and embrace an alternative future of gaming!

*Declaration of interests: Ben Wilkins is CEO of ‘Good Boost’

References

1. Robson K, Plangger K, Kietzmann JH, McCarthy I, Pitt L. Is it all a game? Understanding the principles of gamification. Business horizons. 2015;58(4):411-20.
2. Ofcom. Online Nation 2022 Report. In: Communications Oo, editor. London: Ofcom; 2022.
3. Jones A, Armstrong B, Weaver RG, Parker H, von Klinggraeff L, Beets MW. Identifying effective intervention strategies to reduce children’s screen time: a systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2021;18(1):126.
4. Bull F, Cho M, Friedman D, Santos A, Willumsen J. Global status report on physical activity 2022. In: World Health Orgnanisation, editor. Geneva2022.
5. Guthold R, Stevens GA, Riley LM, Bull FC. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1· 6 million participants. The Lancet Child & Adolescent Health. 2020;4(1):23-35.
6. Johnson D, Deterding S, Kuhn K-A, Staneva A, Stoyanov S, Hides L. Gamification for health and wellbeing: A systematic review of the literature. Internet interventions. 2016;6:89-106.
7. Althoff T, White RW, Horvitz E. Influence of Pokémon Go on physical activity: study and implications. Journal of medical Internet research. 2016;18(12):e315.
8. McNally S. Scarlett McNally: Boosting swimming for health and joy. British Medical Journal Publishing Group; 2024.
9. Richards T, Figgins S, Day M, Slater M, Easterbrook M. O. 5.1-6 Bucking the mid-life inactivity trend: a study of 40–64-year-olds’ participation in Zwift, a real-time online exercise community, through a social identity lens. European Journal of Public Health. 2023;33(Supplement_1):ckad133. 236.
10. Ilhan A, Fietkiewicz KJ. Learning for a healthier lifestyle through gamification: a case study of fitness tracker applications. Perspectives on Wearable Enhanced Learning (WELL) Current Trends, Research, and Practice. 2019:333-64.
11. Farič N, Potts HW, Rowe S, Beaty T, Hon A, Fisher A. Running app “Zombies, Run!” users’ engagement with physical activity: A qualitative study. Games for Health Journal. 2021;10(6):420-9.
12. Mazeas A, Duclos M, Pereira B, Chalabaev A. Evaluating the effectiveness of gamification on physical activity: systematic review and meta-analysis of randomized controlled trials. Journal of medical Internet research. 2022;24(1):e26779.
13. Edwards EA, Lumsden J, Rivas C, Steed L, Edwards L, Thiyagarajan A, et al. Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps. BMJ open. 2016;6(10):e012447.

Featured Image: created using DALL·E on 23/3/24 by Richard Armitage