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Gamification in health and fitness apps change health behaviors

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Increased physical activity due to Zombie Run

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The zombies are coming, well not really but they are on a fitness app called Zombie, Run. So what can you do? Put on the running shoes, grab your headphones and run from those sounds of zombies chasing you.

Zombies Run already has over 900,000 runners. Zombie Run is just one of more than 31,000 health and fitness apps on the market today, and one of the growing numbers of apps that use games to increase physical activity.

Gamification has been a predominant focus of the health app industry in recent years however, according to researchers to the best of their knowledge, there has yet to be a review of gamification elements in relation to health behavior constructs, or insight into the true proliferation of gamification in health apps.

According to Cameron Lister, MPH, lead author of a new Brigham Young University (BYU) study on gamified health apps commented "It's just been assumed that gamified apps will work, but there has been no research to show that they're effective for people long-term.” "Does earning a badge on your screen actually change your health behavior?"

Lister along with Joshua West, assistant professor, health sciences at BYU and colleagues set out to determine to what extent to which gamification is used in health apps, and examine gamification of health and fitness apps as a potential component of influence on a consumer’s health behavior.

An analysis of health and fitness apps related to physical activity and diet was conducted among apps in the Apple App store in the winter of 2014.

The researchers examined over 2,000 health and fitness apps and found that the majority of the most popular and widely used apps feature gamification. The team analyzed a sample of 132 of the apps personally to see how well they worked. In addition to Zombies, Run they tried out. Among the apps that analyzed were:

Pact: the app gives you money if you make your fitness goals and two new diet-oriented features.

Fitbit: Users can enlist friends to help them reach goals by sharing stats, joining fitness challenges or competing on leader boards.

DietBet: Like Pact, users put their money on the line to keep weight loss goals. Those who lose 4% of their starting weight in four weeks earn money from those who don't. \

The results showed he most common form of motivation in the apps centered on social or peer pressure (45% of apps), followed by digital rewards (24%), competitions (18%), and leader boards (14%).

The researchers are concerned that gamification is ignoring key elements of behavior change and could be demotivating in the long run. They write “This shows a lack of integrating important elements of behavioral theory from the app industry, which can potentially impact the efficacy of gamification apps to change behavior.” For example; over time people view the awards and badges as work instead of play. Once the rewards disappear, the motivation drops.

According to Professor West "There's a missed opportunity to influence healthy behavior because most gamified health apps are only aimed at motivation.” "Motivation is important, but people also need to develop skills that make behavior change easy to do."

Lister comments "It's like people assuming that you hate health and you hate taking care of your body so they offer to give you some stuff in order for you to do what they want you to do.” "But really, you should intrinsically want to be healthy and be engaged in healthy activity.”

Even though the team found the apps to be fun and engaging they are not sure that these apps can sustain major changes in healthy behavior. They write “Initial results show an abundant use of gamification in health and fitness apps, which necessitates the in-depth study and evaluation of the potential of gamification to change health behaviors.”

"I would caution developers and users to not have unrealistic expectations about the potential impact of gamified apps," West said. "Everybody wants to know if they result in more sustainable behavior change but we just don't know yet."

This study appears in the Journal of Medical Internet Research,

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