Nishi Stephanie K, Kavanagh Meaghan E, Ramboanga Kimberly, Ayoub-Charette Sabrina, Modol Sébastien, Dias Goretty M, Kendall Cyril W C, Sievenpiper John L, Chiavaroli Laura
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada.
Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Reus, Spain.
EClinicalMedicine. 2024 Sep 25;76:102798. doi: 10.1016/j.eclinm.2024.102798. eCollection 2024 Oct.
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.
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).
36 trials (49 trial comparisons, n = 10,079) met eligibility criteria; most targeted physical activity or weight loss. Use of gamification in apps compared to non-gamified interventions resulted in trivial increases in steps (489 steps/day [64 to 914]; high), and reductions in body mass index (-0.28 kg/m [-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).
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.
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利用健康应用程序（应用）来支持健康生活方式的情况日益增多。不同的应用功能可能会提高其有效性，其中包括游戏化，即指在非游戏情境中运用游戏元素。具有游戏化功能的健康应用是否能影响行为改变和心血管代谢风险因素尚不清楚。我们进行了一项系统评价和荟萃分析，以确定具有游戏化功能的健康应用与非游戏化应用（对照）相比，对身体活动和心血管代谢风险因素的影响。
检索了截至2024年5月21日的MEDLINE、EMBASE和Cochrane图书馆数据库。我们纳入了所有健康背景的成年人（≥1岁）的对照试验，干预期≥8周，评估健康行为应用中使用的游戏化策略对依从性、心血管代谢风险因素、总能量和关注的膳食营养素的影响。独立 reviewers 提取了相关数据并评估了偏倚风险。结局包括身体活动和心血管代谢风险因素（肥胖、血糖、血脂、血压和膳食因素）。使用逆方差法合并数据，并以均数差（MD）和95%置信区间（CI）表示。使用推荐分级的评估、制定和评价（GRADE）评估证据的确定性。方案注册于ClinicalTrials.gov（NCT04633070）。
36项试验（49次试验比较，n = 10,079）符合纳入标准；大多数针对身体活动或体重减轻。与非游戏化干预相比，应用中使用游戏化导致步数略有增加（每天489步[64至914]；高），体重指数降低（-0.28kg/m²[-0.44至-0.12]；中等）和体重降低（-0.70kg[-1.18至-0.22]；中等），以及体脂（-1.92%[-2.71至-1.14]；高）和腰围（-1.16cm[-1.93至-0.39]；中等）有小幅度但显著的降低。其他结局未观察到差异（极低至高）。
目前的证据充分表明，与非游戏化版本相比，针对身体活动或肥胖指标的应用中的游戏化功能在这些结局方面有轻微改善。推荐使用具有游戏化功能的应用来增加身体活动或针对体重减轻。
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