Incentivizing Physical Activity Using Gamification, A Pilot Study
Condition: Obesity; Physical Activity
Study type: Interventional

Summary: 
      Juniors and seniors will be recruited to participate in the study, which will begin in the
      fall 2016 and run through May. The intervention will be a randomized-controlled trial, where
      students are randomized to either a control or incentive condition. Physical activity will be
      automatically tracked throughout the study period using FitBit activity trackers wirelessly
      linked to the gaming application on students' Chromebooks or mobile phones. Students who
      achieve 30 minutes of MVPA during the school day and/or 60 minutes of MVPA over the entire
      day will receive in-game rewards moving them up leaderboards in the game, providing them with
      more game points, or allowing them access to more game elements. Baseline outcome measures
      will be collected at the beginning of the school year in the fall, and post-intervention
      outcome measures will be collected in May.
    

Detailed description: 
      Physical Activity Goals and Options Two physical activity goals will be reinforced during the
      intervention. First, reinforcement will be delivered contingent on achieving the CDC target
      of 60 minutes of moderate and vigorous physical activity (MVPA) over the whole day. Because
      in-school activity is important for student health, participants will also earn in-game
      reinforcement for achieving 30 minutes of MVPA during the school day as targeted by the VT
      State Board of Education. Students who meet both goals will receive the most in-game rewards.

      In order to help students achieve the physical activity targets, opportunities for completing
      short bouts of physical activity or taking extra steps throughout the school day and
      before/after school will need to be offered. Youth input as well as BHS teacher and staff
      input will be integral in determining which types of additional activity opportunities are
      feasible. Other Vermont schools have integrated physical activity into Teacher Advisor time
      as well as offering physical activity breaks during or between academic classes. Active
      transport to school, or taking advantage of before and after school activity options already
      offered at BHS will be additional ways for students to meet the 60 minutes/day target. The
      gamification aspect of the intervention will allow students to use the layout of BHS to
      accumulate more minutes of physical activity throughout the day. Students will be able to
      check-in at various locations around the high school using QR codes to earn physical activity
      points in the game. MVPA accumulation will be tracked automatically using a FitBit, which
      indicates the number of minutes the student was active at a moderate or vigorous level during
      the day. The FitBit will then automatically and wirelessly communicate with the gaming app on
      the student's Chromebook to determine the quantity of game rewards awarded daily. Rewards
      will be available immediately upon meeting MVPA goals.

      Mobile Game Incentivizing Physical Activity The specific elements to be used in the game have
      been determined by conducting focus groups with BHS sophomores and juniors as well as working
      with the game developers, GameTheory, a local game development company with experience
      designing games that transform tedious tasks into fun ones (gametheoryco.com). Basic game
      theory suggests certain gaming elements that are especially effective at encouraging
      engagement, which will be incorporated into the game design. Elements of effective games such
      as self-representation with avatars, 3D environments, narrative context, unpredictability,
      leaderboards, options to work in teams or clans, and check-in based mechanisms where the game
      continues to evolve even when the player is not logged in are all aspects of our game design.
      Furthermore, the game design incorporates theories of behavioral economics that can be
      capitalized on in a game environment such as present-bias and loss aversion. Lastly,
      principles of monetary incentive interventions successfully used to promote sustained
      accomplishment of various health behaviors in previous research, such as escalating rewards
      with a reset contingency for missed goals and random ratio reinforcement schedules are
      integrated. Game "points" will be awarded for achieving the two physical activity daily
      goals, with an extra daily bonus for meeting both goals.

      The premise of the game is that students are involved in a water balloon clash at a
      woodsy-feeling summer camp. Each week, participants will be divided into two "teams" who will
      engage in a series of water balloon clashes during the week. Students will be able to
      customize an avatar that represents them during the game. They will be able to select an
      avatar name (which will be approved by investigators before becoming active), as well as
      customize the look of their character. Furthermore, they will be able to see their
      character's "stats" in terms of how strong, how healthy, and how much speed their character
      has. The amount of physical activity participants record on their FitBit each day will
      determine how much their character's stats improve from day to day. Students will be rewarded
      for recording real-world physical activity on their FitBits with the translation of steps
      they take into "coins" which students can use to buy items for their avatars. Items coins can
      purchase will include supplies for upcoming water balloon clashes, costumes and special
      clothing pieces like sneakers, healthy snacks, and pets. Therefore, students will be able to
      create a customized world for their characters using the coins they earn from their
      real-world steps. Students will also be rewarded for improvements in their physical activity
      status, being top physical activity performers, and meeting the two daily physical activity
      goals in the form of gems. On certain days, multiple gems will be given for meeting goals,
      providing a random bonus that will serve as variable-interval reinforcement for game players.
      Therefore, every step participants take with their FitBit lets them obtain coins in the game,
      whereas meeting the bigger goals or showing improvement will earn participants gems, which
      have a higher value than coins.

      Each day, the game will automatically run a water balloon skirmish between the two teams'
      treehouses. Students will choose where to position their avatar for attack or defense, and
      see where their teammates are positioned. The game will then use an algorithm based on the
      avatars' positions as well as the accumulated strength, speed, and health of the various
      avatars on each team to determine which team wins the daily battle. Students can then log-in
      and watch replays of the battle as well as see the results in terms of which team got hit the
      most, how many water balloons their avatar threw, how many defensive actions they
      successfully carried out, and who on the other team hit them with a water balloon. Students
      will receive in-game prizes or gems for achieving certain milestones throughout the clash
      such as being the "Best defender," "Most balloons landed," etc. Teams will aim to win the
      most clashes each week, and then the teams will be reshuffled.
    

Intervention name(s): gaming application to encourage physical activity; FitBit
Intervention type(s): Behavioral; Device
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention