Effect of Goal-Setting Approaches Within a Gamification Intervention to Increase Physical Activity Among Economically Disadvantaged Adults at Elevated Risk for Major Adverse Cardiovascular Events: The ENGAGE Randomized Clinical Trial.

Autor:	Patel MS; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.; The Wharton School, University of Pennsylvania, Philadelphia.; Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia.; Penn Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia.; Crescenz Veterans Affairs Medical Center, Philadelphia.; Now with Ascension Health, St Louis, Missouri., Bachireddy C; Virginia Department of Medical Assistance Services, Richmond.; Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond., Small DS; The Wharton School, University of Pennsylvania, Philadelphia.; Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia.; Penn Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia.; Crescenz Veterans Affairs Medical Center, Philadelphia., Harrison JD; Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia., Harrington TO; Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia., Oon AL; Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia., Rareshide CAL; Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia., Snider CK; Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia., Volpp KG; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.; The Wharton School, University of Pennsylvania, Philadelphia.; Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia.; Penn Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia.; Crescenz Veterans Affairs Medical Center, Philadelphia.
Jazyk:	angličtina
Zdroj:	JAMA cardiology [JAMA Cardiol] 2021 Dec 01; Vol. 6 (12), pp. 1387-1396.
DOI:	10.1001/jamacardio.2021.3176
Abstrakt:	Importance: Health promotion efforts commonly communicate goals for healthy behavior, but the best way to design goal setting among high-risk patients has not been well examined. Objective: To test the effectiveness of different ways to set and implement goals within a behaviorally designed gamification intervention to increase physical activity. Design, Setting, and Participants: Evaluation of the Novel Use of Gamification With Alternative Goal-setting Experiences was conducted from January 15, 2019, to June 1, 2020. The 24-week randomized clinical trial included a remotely monitored 8-week introductory intervention period, 8-week maintenance intervention period, and 8-week follow-up period. A total of 500 adults from lower-income neighborhoods in and around Philadelphia, Pennsylvania, who had either an atherosclerotic cardiovascular disease (ASCVD) condition or a 10-year ASCVD risk score greater than or equal to 7.5% were enrolled. Participants were paid for enrolling in and completing the trial. Interventions: All participants used a wearable device to track daily steps, established a baseline level, and were then randomly assigned to an attention control or 1 of 4 gamification interventions that varied only on how daily step goals were set (self-chosen or assigned) and implemented (immediately or gradually). Main Outcome Measures: The primary outcome was change in mean daily steps from baseline to the 8-week maintenance intervention period. Other outcomes included changes in minutes of moderate to vigorous physical activity. All randomly assigned participants were included in the intention-to-treat analysis. Results: Of the 500 participants, 331 individuals (66.2%) were Black, 114 were White (22.8%), and 348 were women (69.6%). Mean (SD) age was 58.5 (10.8) years and body mass index was 33.2 (7.8). A total of 215 participants (43.0%) had an ASCVD condition. Compared with the control arm, participants with self-chosen and immediate goals had significant increases in the number of daily steps during the maintenance intervention period (1384; 95% CI, 805-1963; P < .001) that were sustained during the 8-week follow-up (1391; 95% CI, 785-1998; P < .001). This group also had significant increases in daily minutes of moderate to vigorous physical activity during the maintenance intervention (4.1; 95% CI, 1.8-6.4; P < .001) that were sustained during follow-up (3.5; 95% CI, 1.1-5.8; P = .004). No other gamification arms had consistent increases in physical activity compared with the control arm. No major adverse events were reported. Conclusions and Relevance: In this trial among economically disadvantaged adults at elevated risk for major adverse cardiovascular events, a gamification intervention led to increases in physical activity that were sustained during 8 weeks of follow-up when goals were self-chosen and implemented immediately. Trial Registration: ClinicalTrials.gov Identifier: NCT03749473.
Databáze:	MEDLINE
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