Exercise is important for just about anybody, but it might be even more important for people with diabetes. According to the U.S. Centers for Disease Control (CDC), “Being active makes your body more sensitive to insulin” and it also “helps control blood sugar levels and lowers your risk of heart disease and nerve damage.”
For this reason, healthcare professionals are always looking for ways to motivate their diabetes patients to exercise. Now a new report from researchers in Philadelphia suggests that a good way to do that is to make exercise a kind of game, or, as they expressed it, to use “gamification” strategies.
The Penn Medicine Nudge Unit study
The researchers were from what’s known as the Penn Medicine Nudge Unit, a cleverly named entity that does research on just what the name suggests — how to “nudge” people toward healthy behavior. As they describe their mission, “A nudge is a change in the way choices are presented, or information is framed that alters people’s behavior predictably without restricting choice.” The unit, they explain, “leverages insights from behavioral economics and psychology to design, implement, evaluate, and disseminate approaches to steer medical decision-making toward higher value and improved patient outcomes.”
The new report described how the Nudge Unit established a one-year trial in which they provided people with diabetes with a wrist device to count steps and set up a system that contained game elements, such as points and levels. The trial had 361 participants. About half were women and half were Black, while 40% were white. The average age of the group was 52, they had a average HbA1c of 9.6% (6.5% and higher is in the diabetes range), and they had an average body-mass index (BMI) of 37 (a BMI above 30 falls in the obesity range). About three out of four were using insulin and 40% were taking an oral diabetes medication.
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The subjects were randomly assigned to one of four groups. The first was a control group who were given step-counting wrist devices but no other form of intervention. The rest of the participants were placed into one of three “gratification study arms” — a competitive arm, a support arm, or a collaborative arm. The competitive arm was arranged in groups, or teams, consisting of three subjects who didn’t know one another but who were introduced by e-mail. At the end of every week, each group member received a message ranking them on a leaderboard that showed how many points they had accumulated and what level they had achieved. The second arm, the support arm, was not organized into teams. Instead, each subject chose a “sponsor” — a friend or family member — who received weekly reports on the subject’s performance during the preceding week. These sponsors were instructed to support their linked partners as best they could. The third arm, the collaborative arm, was, like the competitive arm, organized into groups of three who were introduced through e-mail. Every day, one of the three group members was chosen as the group representative. If that person had weighed in on the day before, the team got points; otherwise, they lost points. The idea was to get the team members to collaborate by being accountable to one another. As the trial progressed, records were maintained on the subjects’ step counts, as measured by their wrist monitors, as well as their body weight and their HbA1c.
Gamification linked to increases in physical activity
Clearly, all three “gamification study arms” experienced some kind of motivation to keep their step counts up. And all three groups saw significant declines in body weight and HbA1c, although there were differences among the groups in step counts. The competitive arm notably increased their steps compared to the control group (606 more steps), as did the support arm (503 steps). The collaborative arm, however, did not do as well — an increase of 280 steps. Nevertheless, the researchers pointed out that even modest increases in physical activity can bring benefits.
When the results of the trial were published online in JAMA Network Open, they were accompanied by an editorial from Paul Hebert, PhD, of the Puget Sound Healthcare System, who wrote, “Researchers at the Penn Medicine Nudge Unit have devised elegant and simple game mechanics that are rooted in behavioral economic principles and are effective. This study adds substantially to the Nudge Unit body of work by showing that gamified interventions can help people maintain higher levels of physical activity for a longer period of time in a population more economically and demographically diverse than has been shown in previous studies.”
And the techniques devised by the Nudge Unit have applications that go well beyond diabetes. Recently they have begun exploring the use of “nudges” in another health area — motivating people to get COVID-19 vaccines.
Want to learn more about exercising with diabetes? Read “Add Movement to Your Life,” “Picking the Right Activity to Meet Your Fitness Goals” and “Seven Ways to Have Fun Exercising.”
Living with type 2 diabetes? Check out our free type 2 e-course!