The gamification of health and fitness

By Asia Lie

Gamification is the addition of game-like features to certain tasks or processes.^1,2 Due to the positive reinforcement system of games that works by rewarding certain behaviors, we tend to maintain or enjoy those behaviors more. This is especially important when it comes to health because the results are not immediate and can be hard to see. Healthy habits are some of the hardest to build and remain consistent with, so the gamification of health helps us connect our fitness habits with the payoff.

It has been estimated that about 60% of health initiatives use games or game-like elements.^3,4 Gamification components can be narrowed down to about 6 key elements: leaderboards, levels, digital rewards (points), real-world prizes, competitions, and social or peer pressure³. By using these types of components, health programs and fitness tracking apps can reel in their users and keep them using the program on a more regular basis. 

The clear advantage of the gamification of health is that it will increase engagement and motivation for a variety of people who find it hard to maintain healthy habits or don’t have access to the resources to do so. A fitness app can track someone’s activity, provide videos and guidance, and monitor certain aspects of health.⁵ By adding game-like elements, people tend to stick to their routines more due to an increased level of enjoyment in partaking in them.³ Another advantage is the reach that these gamified health apps and devices have. With the widespread use of mobile phones, companies can engage rural communities or other diverse populations that may have been previously hard to reach, especially in a pandemic/post-pandemic world.^3,5

One major challenge with the gamification of health and fitness is the regulation of these games. In the age of social media, body image issues and disordered eating are common across both men and women, and the gamification of fitness can fan these flames by providing inaccurate and impersonalized health advice.^2,3 A review of gamified health apps available in 2014 found that more than 90% of apps sampled did not provide any citations or sources to accompany or verify the information given in the app.³ An example of this dangerous practice is in the popular Wii Sports game of the last decade, where one mode of tracking a player’s health was through their BMI. While BMI can be informative, it is largely inaccurate and outdated^6,7, especially for younger children who are attracted to playing the fitness game. Another such example is the app MyFitnessPal, which allows users to track and count their calories. Tracking calories is a symptom of eating disorders.⁹ In a study investigating MyFitnessPal’s effect on eating disorders, 73.1% reported it somewhat contributed to their eating disorders, with 30.3% of participants saying it heavily contributed to their eating disorders.¹⁰ While no causal relationship was established in this study, it reiterates the importance of designing fitness apps with safety in mind. It is important to create a set of rules and regulations that game designers need to adhere to in order to prevent users from creating unhealthy habits and relationships with their body or food.^3,8  

The positive reinforcement system can also have its drawbacks in general, promoting certain users to become “obsessed” with the rewards and points to an unhealthy degree. This is a phenomenon also commonly seen in social media: social media addiction. Users get addicted to the likes and followers on social media due to the correlation they have between these rewards and their personal value.¹¹ This could apply to gamified fitness apps as well, causing an addiction to “leveling up” and possibly promoting an unsafe level of physical activity. While it may be out of the game producers’ control, it is an issue they should be aware of and actively trying to solve or avoid. 

As our understanding of health and technology grows, steps towards gamifying programs for mental health are also being made. Using these programs in conjunction with virtual reality (VR) set ups may provide new benefits as well as some hidden consequences. VR uses equipment such as glasses to cut its user off from the real world and simulate a virtual world that the user can interact with.¹² Some new VR programs are aimed at treating anxiety or other mental health issues, including those related to neurodivergence or autism. This type of program could be instrumental in tackling unique mental challenges that our population faces today as well as understanding the complexities behind mental and emotional health in humans. The disadvantages outlined in a survey of these technologies include possible addiction to these games, but also the issue of high-cost equipment.¹² On the other hand, important advantages include creating stronger motivation to use the program, more precise measurements of the user, and the ability to tailor the program to an individual by modifying the environment the program is set in¹². 

Physical and mental health are essential to a human being, but some gamified apps and programs call into question the sustainability of gamification practices. While using game elements to keep motivation up works initially, there is a lack of studies looking into how this could affect users in the long term.³ It is an important innovation to keep populations in an age of fast food and obesity more active, but it could come at a cost depending on the regulations and designs of these elements. How can we communicate personalized and safe fitness practices to widespread and unique populations? Will upcoming VR technologies be instrumental in this, or will they promote a whole new area of disordered habits?

References:

1. Playfitt. Gamified Fitness Apps: How Gaming Makes Exercise Addicting [Internet]. http://www.playfitt.ca. 2021. Available from: https://www.playfitt.ca/post/gamified-fitness-apps
2. Arora C, Razavian M. Ethics of Gamification in Health and Fitness-Tracking. International Journal of Environmental Research and Public Health [Internet]. 2021 Oct 21;18(21):11052. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8583052/
3. Lister C, West JH, Cannon B, Sax T, Brodegard D. Just a Fad? Gamification in Health and Fitness Apps. JMIR Serious Games [Internet]. 2014 Aug 4;2(2):e9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307823/
4. Ferguson B. Games for Wellness—Impacting the Lives of Employees and the Profits of Employers. Games for Health Journal [Internet]. 2012 Jun [cited 2021 Mar 11];1(3):177–9. Available from: https://www.liebertpub.com/doi/10.1089/g4h.2012.0023
5. Liu Y, Avello M. Status of the research in fitness apps: A bibliometric analysis. Telematics and Informatics [Internet]. 2020 Sep;57:101506. Available from: https://www.sciencedirect.com/science/article/pii/S0736585320301659
6. Rich E, Miah A. Prosthetic Surveillance: The medical governance of healthy bodies in cyberspace. Surveillance & Society. 2009 Mar 13;6(2):163–77.
7. Nuttall FQ. Body Mass Index: Obesity, BMI, and Health A Critical Review. Nutrition Today [Internet]. 2015 May;50(3):117–28. Available from: https://journals.lww.com/nutritiontodayonline/Fulltext/2015/05000/Body_Mass_Index__Obesity
8. Ferrara J. Games for Persuasion: Argumentation, Procedurality, and the Lie of Gamification. Games and Culture [Internet]. 2013 Jul 1 [cited 2019 Nov 24];8(4):289–304. Available from: https://journals.sagepub.com/doi/10.1177/1555412013496891
9. Tchanturia K, Lloyd S, Lang K. Cognitive remediation therapy for anorexia nervosa: Current evidence and future research directions. International Journal of Eating Disorders [Internet]. 2013 May 9 [cited 2019 Sep 7];46(5):492–5. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/eat.22106?saml_referrer
10. Levinson CA, Fewell L, Brosof LC. My Fitness Pal calorie tracker usage in the eating disorders. Eating Behaviors [Internet]. 2017 Dec;27:14–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700836/
11. Andreassen CS, Pallesen S, Griffiths MD. The relationship between addictive use of social media, narcissism, and self-esteem: Findings from a large national survey. Addictive Behaviors [Internet]. 2017 Jan;64:287–93. Available from: https://www.sciencedirect.com/science/article/pii/S0306460316301095
12. Fu Y, Hu Y, Sundstedt V, Fagerström C. A Survey of Possibilities and Challenges with AR/VR/MR and Gamification Usage in Healthcare. Proceedings of the 14th International Joint Conference on Biomedical Engineering Systems and Technologies [Internet]. 2021; Available from: http://www.scitepress.org/Papers/2021/103862/103862.pdf