Impact of Pokémon Go on Physical Activity: A Systematic Review and Meta-Analysis

Hourly step recommendations to achieve daily goals for working and older adults

BACKGROUND

The widespread use of physical activity trackers enables the collection of high-resolution health data, such as hourly step counts, to evaluate health promotion programmes. We aim to investigate how participants meet their daily step goals.

METHODS

We used 24-h steps data from the National Steps ChallengeTM Season 3, wherein participants were rewarded with vouchers when achieving specified goals of 5000, 7500, and 10,000 steps per day. We extracted data from 3075 participants' including a total of 52,346 participant-days. We modelled the hourly step counts using a two-part model, in which the distribution for step counts was allowed to depend on the sum of step counts up to the previous hour and participant demographics.

RESULTS

Participants have a mean age of 44.2 years (standard deviation = 13.9), and 40.4% are males. We show that on weekdays, the hourly mean step counts among participants aged 60 and above are higher than participants aged 30 to 59 from the start of the day till 6 p.m. We also find that participants who accumulate at least 7000 steps by 7 p.m. are associated with higher success of achieving 10,000 steps.

CONCLUSIONS

We provide recommendations on the hourly targets to achieve daily goals, based on different participants' characteristics. Future studies could experimentally test if prompts and nudges at the recommended times of day could promote reaching step goals.

Virtual fitness buddy ecosystem: a mixed reality precision health physical activity intervention for children

6-11-year-old children provide a critical window for physical activity (PA) interventions. The Virtual Fitness Buddy ecosystem is a precision health PA intervention for children integrating mixed reality technology to connect people and devices. A cluster randomized, controlled trial was conducted across 19 afterschool sites over two 6-month cohorts to test its efficacy in increasing PA and decreasing sedentary behavior. In the treatment group, a custom virtual dog via a mixed reality kiosk helped children set PA goals while sharing progress with parents to receive feedback and support. Children in the control group set PA goals using a computer without support from the virtual dog or parents. 303 children had 8+ hours of PA data on at least one day of each of the 3 intervention time intervals. Conversion of sedentary time was primarily to light-intensity PA and was strongest for children with low baseline moderate-to-vigorous PA than children above 45 min of baseline moderate-to-vigorous PA. Findings suggest that the VFB ecosystem can promote sustainable PA in children and may be rapidly diffused for widespread public health impact.

KIJANI App to Promote Physical Activity in Children and Adolescents: Protocol for a Mixed Method Evaluation

BACKGROUND

The prevalence of physical inactivity among children and adolescents is alarmingly high despite the well-documented and comprehensive benefits of regular physical activity (PA). Therefore, PA promotion should start early in childhood and adolescence. Although reducing recreational screen time in children and adolescents is an urgent concern, digital approaches have the potential to make activity promotion attractive and age appropriate for the target group. KIJANI is a mobile app approach to promote PA in children and adolescents via gamification and augmented reality.

OBJECTIVE

This study protocol aims to describe the KIJANI intervention in detail, as well as the evaluation approach.

METHODS

KIJANI is based on the concept that virtual coins can be earned through PA, for example, in the form of a collected step count. With these coins, in turn, blocks can be bought, which can be used to create virtual buildings and integrate them into the player's real-world environment via augmented reality. PA of users is detected via accelerometers integrated into the smartphones. KIJANI can be played at predefined play locations that were comprehensively identified as safe, child-friendly, and attractive for PA by the target group in a partner project. The evaluation process will be divided into 2 different stages. The phase-I evaluation will be a mixed methods approach with one-on-one semistructured interviews and questionnaires to evaluate the user experience and receive feedback from the target group. After the implementation of results and feedback from the target group, the phase-II evaluation will proceed in the form of a 2-arm randomized controlled trial, in which the effectiveness of KIJANI will be assessed via objectively measured PA as well as questionnaires.

RESULTS

The study received ethical approval from the ethical board of the Technical University of Munich. Participants for the phase-I evaluation are currently being recruited.

CONCLUSIONS

The study will help to determine the efficacy, applicability, and user experience of a gamified activity promotion application in children and adolescents. Overall, digital health approaches provide easy and wide reachability at low cost and are age appropriate and attractive for the target group of adolescents. Strategies have to be developed to apply digital health approaches in the best possible way for activity promotion.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55156.

A randomized controlled mHealth trial that evaluates social comparison-oriented gamification to improve physical activity, sleep quantity, and quality of life in young adults

INTRODUCTION

The integration of gamification in mHealth interventions presents a novel approach to enhance user engagement and health outcomes. This study aims to evaluate whether comparison-oriented gamification can effectively improve various aspects of health and well-being, including physical activity, sedentary behavior, sleep, and overall quality of life among young adults.

METHODS

Potential 107 young adults (from 19 to 28 years old) participated in an 8-week trial. Participants were assigned to either a gamified mHealth intervention (LevantApp) with daily leaderboards and progress bars (n = 53, 26 % dropped-out), or a control condition without gamification (n = 52, 29 % dropped-out). Physical activity (number of steps, moderate and moderate-to-vigorous physical activity -MVPA-) and sleep quantity were measured objectively via accelerometry and subjectively using the International Physical Activity Questionnaire(IPAQ), Pittsburgh Sleep Quality Index(PSQI), Sedentary Behavior Questionnaire(SBQ), and Short Form Health Survey(SF-36).

RESULTS

This mHealth intervention with social comparison-oriented gamification significantly improved moderate physical activity to a greater extent than the control group. Additionally, the intervention group showed improvements in the number of steps, moderate physical activity, sedentary time, emotional wellbeing, and social functioning. However, no significant group by time interaction was observed. No significant differences were observed in sleep quality or quantity.

CONCLUSION

s: The LevantApp gamified mHealth intervention was effective in improving moderate physical activity, physical functioning, and role-emotional in young adults. No significant effects were found on step counts, MVPA or sleep, suggesting that while gamification can enhance specific aspects of physical activity and quality of life, its impact may vary across different outcomes.

Effectiveness of mHealth App-Based Interventions for Increasing Physical Activity and Improving Physical Fitness in Children and Adolescents: Systematic Review and Meta-Analysis

BACKGROUND

The COVID-19 pandemic has significantly reduced physical activity (PA) levels and increased sedentary behavior (SB), which can lead to worsening physical fitness (PF). Children and adolescents may benefit from mobile health (mHealth) apps to increase PA and improve PF. However, the effectiveness of mHealth app-based interventions and potential moderators in this population are not yet fully understood.

OBJECTIVE

This study aims to review and analyze the effectiveness of mHealth app-based interventions in promoting PA and improving PF and identify potential moderators of the efficacy of mHealth app-based interventions in children and adolescents.

METHODS

We searched for randomized controlled trials (RCTs) published in the PubMed, Web of Science, EBSCO, and Cochrane Library databases until December 25, 2023, to conduct this meta-analysis. We included articles with intervention groups that investigated the effects of mHealth-based apps on PA and PF among children and adolescents. Due to high heterogeneity, a meta-analysis was conducted using a random effects model. The Cochrane Risk of Bias Assessment Tool was used to evaluate the risk of bias. Subgroup analysis and meta-regression analyses were performed to identify potential influences impacting effect sizes.

RESULTS

We included 28 RCTs with a total of 5643 participants. In general, the risk of bias of included studies was low. Our findings showed that mHealth app-based interventions significantly increased total PA (TPA; standardized mean difference [SMD] 0.29, 95% CI 0.13-0.45; P<.001), reduced SB (SMD -0.97, 95% CI -1.67 to -0.28; P=.006) and BMI (weighted mean difference -0.31 kg/m2, 95% CI -0.60 to -0.01 kg/m2; P=.12), and improved muscle strength (SMD 1.97, 95% CI 0.09-3.86; P=.04) and agility (SMD -0.35, 95% CI -0.61 to -0.10; P=.006). However, mHealth app-based interventions insignificantly affected moderate to vigorous PA (MVPA; SMD 0.11, 95% CI -0.04 to 0.25; P<.001), waist circumference (weighted mean difference 0.38 cm, 95% CI -1.28 to 2.04 cm; P=.65), muscular power (SMD 0.01, 95% CI -0.08 to 0.10; P=.81), cardiorespiratory fitness (SMD -0.20, 95% CI -0.45 to 0.05; P=.11), muscular endurance (SMD 0.47, 95% CI -0.08 to 1.02; P=.10), and flexibility (SMD 0.09, 95% CI -0.23 to 0.41; P=.58). Subgroup analyses and meta-regression showed that intervention duration was associated with TPA and MVPA, and age and types of intervention was associated with BMI.

CONCLUSIONS

Our meta-analysis suggests that mHealth app-based interventions may yield small-to-large beneficial effects on TPA, SB, BMI, agility, and muscle strength in children and adolescents. Furthermore, age and intervention duration may correlate with the higher effectiveness of mHealth app-based interventions. However, due to the limited number and quality of included studies, the aforementioned conclusions require validation through additional high-quality research.

TRIAL REGISTRATION

PROSPERO CRD42023426532; https://tinyurl.com/25jm4kmf.

A Smartphone-Based Shopping Mall Walking Program and Daily Walking Steps

Importance

Because shopping malls are considered safe places for walking, several mall walking programs have been developed. Research on the association between the use of walking programs and the number of daily steps taken is limited.

Objective

To evaluate the association between use of a smartphone-based shopping mall walking program and daily steps taken after the COVID-19 pandemic.

Design, Setting, and Participants

This cohort study evaluated a nationwide longitudinal data set of 217 344 registered smartphone app users at least 18 years of age residing in Japan. Daily step counts were collected from January 1 to December 31, 2021.

Exposures

The mall walking program Mall Challenge integrated a global positioning system with a smartphone app's incentive system to reward achieving a goal of 1000 daily steps with lottery-based coupons to win from 0 to 500 shopping points (1 point equaled 1 yen or approximately US $0.01).

Main Outcomes and Measures

Daily step records were collected from the smartphone app's walking program and adjusted for gender and age. Multilevel analyses using mixed-effect linear regression models were used to estimate the coefficients for the association between daily participation in the walking program and daily step counts. Cross-level interaction terms of age and gender by walking program participation were included in one model.

Results

Among the 217 344 registered mall app users (23 638 110 daily step records; 154 616 [71.1%] women; 18 014 [8.3%] participants 65 years or older, and 199 330 [91.7%] adults younger than 65 years), the mean (SD) daily steps were 7415 (4686) on walking program participation days and 5281 (4339) on days without participation in the program. Walking program participation days were associated with 1219 additional daily steps (95% CI, 1205-1232) compared with nonparticipation days after adjusting for gender and age. By geographic region, participation in the walking program was associated with 1130 (95% CI, 1113-1146) more steps in rural malls, 1403 (95% CI, 1379-1428) more steps in suburban malls, and 1433 (95% CI, 1408-1457) more steps in urban malls than nonparticipation. Moreover, participation in the walking program was associated with 1422 (95% CI, 1405-1439) more steps in large malls and 1059 (95% CI, 1041-1077) more steps in small malls compared with nonparticipation. Regarding cross-level interactions, women were associated with walking 728 (95% CI, 698-758) more steps than men, and older adults were associated with walking 228 (95% CI, 183-273) more steps than younger adults on walking program participation days.

Conclusions and Relevance

This cohort study found that the use of a smartphone-based mall walking program combined with physical shopping mall facilities and lottery-based digital incentive coupons may motivate people to increase their daily number of walking steps.

Influence of Pokémon GO on Physical Activity and Psychosocial Well-Being in Children and Adolescents: Systematic Review

BACKGROUND

Pokémon GO, an augmented reality game with widespread popularity, can potentially influence players' physical activity (PA) levels and psychosocial well-being.

OBJECTIVE

This review aims to systematically examine the scientific evidence regarding the impact of Pokémon GO on PA and psychosocial well-being in children and adolescents.

METHODS

Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, we conducted keyword and reference searches in the PubMed, CINAHL, Web of Science, and Scopus databases. We performed title and abstract screening, full-text review, evidence synthesis, and identified research gaps.

RESULTS

Our review included 10 studies that explored the effect of Pokémon GO on PA or psychosocial well-being among children and adolescents. These studies used diverse designs across multiple countries and regions. Pokémon GO use measures encompassed frequency, experience, adherence, and motivation. PA assessment methods ranged from self-reported questionnaires to technology-based evaluations and qualitative approaches. Psychosocial well-being measures included emotional intelligence, personal well-being, self-control, emotionality, and sociability. In general, the estimated impact of Pokémon GO on PA was positive, with gaming elements and engagement correlating with increased PA levels. However, the effect on psychosocial well-being presented mixed results, with positive associations for sociability but a complex relationship involving well-being and internet gaming disorder. The limitations of these studies comprised the absence of randomized controlled trials, heterogeneity in study designs and outcome measures, and potential confounding bias.

CONCLUSIONS

Overall, Pokémon GO tends to positively affect PA levels, while the impact on psychosocial well-being remains complex and requires further investigation. Future research should investigate the mechanisms connecting Pokémon GO use with PA and psychosocial well-being and the potential risks of excessive gameplay. These findings can help inform public health interventions to harness gaming technologies for promoting PA and enhancing well-being among the younger generation.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42023412032; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=412032.

Influence of Pokémon Go Playing Style on Physical Activity and Its Effect on Kinanthropometry Variables and Body Composition in Adolescents

BACKGROUND

Pokémon Go is a mobile app that offers both continuous and intermittent (gamified) gameplay, but no previous research in adolescents is known to have addressed changes in physical activity and body composition according to playing style. For this reason, the aims of the present investigation were (1) to establish the differences in the level of physical activity, and its influence on the kinanthropometric and body composition, of the adolescent population, considering their Pokémon Go playing style; and (2) to analyze whether the practice of previous physical activity has an influence on the effects of the use of Pokémon Go on the level of physical activity and changes in kinanthropometric and body composition variables.

METHODS

A total of 94 adolescents (50 males and 44 females; mean age: 13.66 [1.17] years-old; mean body mass index: 20.82 [4.03] kg/m2) whose physical activity level and body composition were measured, participated in the investigation. Two groups of adolescents completed a 10-week intervention using Pokémon Go continuously (n = 30) or intermittently (n = 31), while the control group (n = 33) did not use any after-school app. A one-way analysis of variance (ANOVA), a multivariate analysis of variance, and 2 repeated-measures ANOVA were performed to analyze the data.

RESULTS

Inactive adolescents in the continuous use group increased their physical activity between the pretest and posttest (P = .038), but this did not occur in the active group. Regarding body composition variables, the increase in body mass (P < .001) and body mass index (P = .006) in the control group was significantly higher than in the continuous use group of adolescents who were inactive, but not in the active group, while the decrease in fat mass (P < .001-.036) and sum of 3 skinfolds (P < .001-.003) was significantly higher in both Pokémon Go use groups as compared to the control group, regardless of the previous physical activity level.

CONCLUSIONS

The continuous style of play seems to be more effective in increasing physical activity in adolescents, but the changes in body composition and kinanthropometric variables occur similarly with continuous and intermittent gameplay. Therefore, the playful use of Pokémon Go can be used in educational and health fields to produce changes in body composition in this population.

Mandatory after-school use of step tracker apps improves physical activity, body composition and fitness of adolescents

Previous scientific research on the use of mobile applications to increase physical activity level and improve health among adolescents does not provide conclusive results, one of the main reasons being the lack of adherence to the intervention after the first weeks. For this reason, the main objectives of the research were to determine the changes produced by a compulsory ten-week period of after-school intervention with mobile step-tracking applications on adolescents' health; and the final objective to compare the benefits obtained by each of the mobile applications. To meet the objectives, a longitudinal study with non-probability convenience sampling was proposed. The sample consisted of 400 adolescents from two public compulsory secondary schools in the Region of Murcia, Spain, whose body composition, level of physical activity, adherence to the Mediterranean diet, and physical fitness were measured. The SPSS statistical software was used for statistical analysis. The results showed that adolescents in the experimental group showed a higher level of physical activity and better body composition and physical fitness variables after the intervention compared to the control group, with differences between the different applications used. In conclusion, this research shows the usefulness of mobile applications if they are used in a compulsory way after school hours. The relevance of these results for policymakers lies in the fact that they provide statistical data on the usefulness of mobile applications as an educational resource, being an option to make up for the lack of sufficient physical education teaching hours to meet global physical activity recommendations.

Young Adults' Perspectives on the Implications of an Augmented Reality Mobile Game for Communities' Public Health: A Qualitative Study

Objectives: Several physical, psychological, and social health consequences are caused by smartphone users' addiction to games. A location-based game (LBG), Pokémon GO, recently garnered significant attention from young people. This study aims to explore their experiences with this game and motivations for playing, investigating their perspectives on the game's implications for themselves and the public health of their communities. Methods: Ten qualitative focus group interviews were conducted. Young adults, aged 18-25 years (n = 60), were recruited in Hong Kong. Data were analyzed using a thematic approach. Results: Five themes emerged: 1) missing out or self-regulation, 2) childhood memories of Pokémon, 3) extending virtual-reality exploration, 4) spending more time outdoors walking and exercising, and 5) getting together with others and social interaction. Conclusions: This study showcases the motivational factors of young adults and their cohorts in societies worldwide. LBGs may impact players' physical and social activity levels, and behavior. Nonetheless, certain negatives were identified (i.e., addiction and behavior resulting from a loss of self-control). These negatives deserve health practitioners' attention and future studies should explore possible public health interventions.

Testing the Mystic School Mobile Application to Promote Active Commuting to School in Spanish Adolescents: The PACO Study

Active commuting to and/or from school (ACS) is an opportunity to increase daily physical activity (PA) levels in young people. Mobile-device interventions focused on promoting the practice of health-related PA can be more cost-effective than traditional interventions in this population.

OBJECTIVE

To analyze the adolescents' opinion of the mobile application (app) Mystic School, which was designed to promote ACS in Spanish adolescents.

METHODS

A total of 44 students (14-15 years old) from Granada and Jaén participated in the test of the Mystic School app during two phases: phase 1 (n = 10) for 2 weeks and phase 2 (n = 34) for 1 month. Each phase included an app presentation, a follow-up, and focus group sessions. The qualitative analysis was carried out through NVivo software.

RESULTS

In phase 1, adolescents reported improvements in the design and functioning, such as the avatar movement, virtual steps utilities, and multiplayer function. These suggestions were included in phase 2. After phase 2, adolescents reported that it is important to add the possibility of playing without an Internet connection to the game, to include more competitive options, prizes, and to increase the difficulty of the levels. In both phases, problems with the step number counting remained.

CONCLUSION

The Mystic School app can be a useful tool for the physical education teacher to integrate the content from this curriculum related to the promotion of PA, such as ACS.

Playing Pokemon Go: Increased Life Satisfaction Through More (Positive) Social Interactions

Pokemon Go (PoGo) is a social mobile game requiring both physical activity and social interaction, and previous research has reported positive effects of PoGo on physical health. However, little research has been conducted on the effects of PoGo on social functioning and life satisfaction, which are important factors for good mental health. The current study investigated the effects of PoGo on life satisfaction and social functioning in participants with and without self-reported diagnoses of mental disorders. Participants were 434 current PoGo players aged 18–69 of diverse genders and nationalities, with a subsample (N = 138) self-reporting diagnoses of various mental disorders with impairments in social functioning. Participants provided retrospective and current self-report measures about their PoGo use, life satisfaction, social functioning (sociality and social ability) and clinical symptom severity. Results showed higher self-reported social functioning and life satisfaction since playing PoGo compared to the time period before playing, which involved a shift from negative to positive ratings. The increases in self-reported life satisfaction and sociality (but not social ability) were more pronounced for the clinical compared to the non-clinical subsample. Results also showed the effect of the social ability change on the life satisfaction change was mediated by the sociality change and moderated by the number of daily in-person player interactions (including strangers). The findings here, using subjective judgements, show that PoGo motivates social interactions and increases life satisfaction, demonstrating that social mobile gaming provides an easy to implement tool to subjectively improve social functioning. This has important implications for populations with social difficulties and reduced social motivation.

mHealth Interventions to Reduce Physical Inactivity and Sedentary Behavior in Children and Adolescents: Systematic Review and Meta-analysis of Randomized Controlled Trials

Background

Children and adolescents increasingly do not meet physical activity (PA) recommendations. Hence, insufficient PA (IPA) and sedentary behavior (SB) among children and adolescents are relevant behavior change domains for using individualized mobile health (mHealth) interventions.

Objective

This review and meta-analysis investigated the effectiveness of mHealth interventions on IPA and SB, with a special focus on the age and level of individualization.

Methods

PubMed, Scopus, Web of Science, SPORTDiscus, and Cochrane Library were searched for randomized controlled trials published between January 2000 and March 2021. mHealth interventions for primary prevention in children and adolescents addressing behavior change related to IPA and SB were included. Included studies were compared for content characteristics and methodological quality and summarized narratively. In addition, a meta-analysis with a subsequent exploratory meta-regression examining the moderating effects of age and individualization on overall effectiveness was performed.

Results

On the basis of the inclusion criteria, 1.3% (11/828) of the preliminary identified studies were included in the qualitative synthesis, and 1.2% (10/828) were included in the meta-analysis. Trials included a total of 1515 participants (mean age (11.69, SD 0.788 years; 65% male and 35% female) self-reported (3/11, 27%) or device-measured (8/11, 73%) health data on the duration of SB and IPA for an average of 9.3 (SD 5.6) weeks. Studies with high levels of individualization significantly decreased insufficient PA levels (Cohen d=0.33; 95% CI 0.08-0.58; Z=2.55; P=.01), whereas those with low levels of individualization (Cohen d=−0.06; 95% CI −0.32 to 0.20; Z=0.48; P=.63) or targeting SB (Cohen d=−0.11; 95% CI −0.01 to 0.23; Z=1.73; P=.08) indicated no overall significant effect. The heterogeneity of the studies was moderate to low, and significant subgroup differences were found between trials with high and low levels of individualization (χ21=4.0; P=.04; I2=75.2%). Age as a moderator variable showed a small effect; however, the results were not significant, which might have been because of being underpowered.

Conclusions

Evidence suggests that mHealth interventions for children and adolescents can foster moderate reductions in IPA but not SB. Moreover, individualized mHealth interventions to reduce IPA seem to be more effective for adolescents than for children. Although, to date, only a few mHealth studies have addressed inactive and sedentary young people, and their quality of evidence is moderate, these findings indicate the relevance of individualization on the one hand and the difficulties in reducing SB using mHealth interventions on the other.

Trial Registration

PROSPERO CRD42020209417; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209417

Effects of Gamified Smartphone Applications on Physical Activity: A Systematic Review and Meta-Analysis

INTRODUCTION

This systematic review and meta-analysis aims to examine the impacts of standalone gamified smartphone application-delivered interventions on physical activity.

METHODS

Web of Science, Scopus, PubMed, PsycINFO, and ACM Digital Library were searched for publications that were published between January 1, 2008 and August 31, 2021. Eligibility criteria were RCTs or single-arm pre-to-post interventions delivered by standalone gamified applications and targeting physical activity. Study-specific results were analyzed using random-effects meta-analysis, with a standardized mean difference. Meta-regressions, subgroup analyses, and sensitivity analyses were performed. PRISMA guidelines were followed, and the Grading of Recommendations Assessment, Development and Evaluation system was used to determine the strength of the evidence.

RESULTS

A total of 19 studies with 24 gamified applications were eligible, and 16 studies were included in the meta-analysis. Standalone gamified applications had a small-to-moderate effect on physical activity in both the between-group RCTs (n=12 applications, standardized mean difference=0.34, 95% CI=0.06, 0.62, I²=72%, p<0.01; Grading of Recommendations Assessment, Development and Evaluation: moderate) and the within-group pre-to-post interventions (n=18 applications, standardized mean difference=0.38, 95% CI=0.17, 0.59, I²=74%, p<0.01; Grading of Recommendations Assessment, Development and Evaluation: very low). Leave-one-out sensitivity analyses sustained the main effects with lower heterogeneity (I² of 31.0% and 47.8%, respectively).

DISCUSSION

Using gamified smartphone applications as standalone interventions may increase physical activity. Future research could investigate the impacts of gamified applications on physical activity by isolating the role of specific single or clustered groups of application features.

Augmented Reality Games and Presence: A Systematic Review

The sense of presence in augmented reality (AR) has been studied by multiple researchers through diverse applications and strategies. In addition to the valuable information provided to the scientific community, new questions keep being raised. These approaches vary from following the standards from virtual reality to ascertaining the presence of users’ experiences and new proposals for evaluating presence that specifically target AR environments. It is undeniable that the idea of evaluating presence across AR may be overwhelming due to the different scenarios that may be possible, whether this regards technological devices—from immersive AR headsets to the small screens of smartphones—or the amount of virtual information that is being added to the real scenario. Taking into account the recent literature that has addressed the sense of presence in AR as a true challenge given the diversity of ways that AR can be experienced, this study proposes a specific scope to address presence and other related forms of dimensions such as immersion, engagement, embodiment, or telepresence, when AR is used in games. This systematic review was conducted following the PRISMA methodology, carefully analysing all studies that reported visual games that include AR activities and somehow included presence data—or related dimensions that may be referred to as immersion-related feelings, analysis or results. This study clarifies what dimensions of presence are being considered and evaluated in AR games, how presence-related variables have been evaluated, and what the major research findings are. For a better understanding of these approaches, this study takes note of what devices are being used for the AR experience when immersion-related feelings are one of the behaviours that are considered in their evaluations, and discusses to what extent these feelings in AR games affect the player’s other behaviours.

Scale development for analyzing the fit of real and virtual world integration: an example of Pokémon Go

Purpose

Augmented reality (AR) has become a trend, and the effects of Pokémon Go, the most popular online and mobile game, have been explored in many studies. However, few studies have developed questionnaires of fit to investigate the relationship between the fit and the integration of the game's virtual world and reality. The paper intends to integrate the models of stimulus-organism-response (S-O-R) and information systems success with cognitive fit theory to explore the fit and reactions of users in the integration of real and virtual worlds.

Design/methodology/approach

Following MacKenzie's scale development, two surveys were conducted. The first survey was conducted to perform a scale development of fit. The second survey was collected from 315 Pokémon Go players to validate the fit scale and it was analyzed via structural equation modeling.

Findings

The results show that scale development of fit has good reliability and validity. Furthermore, game information quality, game system quality and virtual (Pokémon) characteristics have significantly positive effects on cognitive and emotional fit. Cognitive and emotional fit have significant positive effects on user satisfaction, and user satisfaction has significant positive effects on continued intention to play. The results suggest that maintaining the quality of the game and improving the virtual interface will provide a better fit between the real and virtual worlds, enhancing user satisfaction with the fit as well as their intention for continued use.

Originality/value

Although fit has been widely studied in various contexts, the application of AR has been rarely discussed. This study develops a scale of fit and takes Pokémon Go as the subject to validate the fit measurement and discuss players' cognition and feelings regarding the game. The authors measure user reactions to different stimuli and explore cognitive and emotional fit as well as the integration of virtual worlds and reality. In sum, to the best of the authors’ knowledge, this is one of the earliest studies to explore and develop a cognitive and emotional fit scale for future researchers and practitioners.

The Use of Gamification and Incentives in Mobile Health Apps to Improve Medication Adherence: Scoping Review

Background

Emerging health care strategies addressing medication adherence include the use of direct-to-patient incentives or elements adapted from computer games. However, there is currently no published evidence synthesis on the use of gamification or financial incentives in mobile apps to improve medication adherence.

Objective

The aim of this scoping review is to synthesize and appraise the literature pertaining to the use of mobile apps containing gamification or financial incentives for medication adherence. There were two objectives: to explore the reported effectiveness of these features and to describe and appraise the design and development process, including patient involvement.

Methods

The following databases were searched for relevant articles published in English from database inception to September 24, 2020: Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science. The framework by Arksey and O’Malley and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist guided this scoping review. Using a systematic screening process, studies were included if incentives or game features were used within mobile apps to specifically address medication adherence. An appraisal using risk of bias tools was also applied to their respective study design.

Results

A total of 11 studies from the initial 691 retrieved articles were included in this review. Across the studies, gamification alone (9/11, 82%) was used more than financial incentives (1/11, 9%) alone or a combination of the two (1/11, 9%). The studies generally reported improved or sustained optimal medication adherence outcomes; however, there was significant heterogeneity in the patient population, methodology such as outcome measures, and reporting of these studies. There was considerable variability in the development process and evaluation of the apps, with authors opting for either the waterfall or agile methodology. App development was often guided by a theory, but across the reviewed studies, there were no common theories used. Patient involvement was not commonly evident in predevelopment phases but were generally reserved for evaluations of feasibility, acceptance, and effectiveness. Patient perspectives on gamified app features indicated a potential to motivate positive health behaviors such as medication adherence along with critical themes of repetitiveness and irrelevance of certain features. The appraisal indicated a low risk of bias in most studies, although concerns were identified in potential confounding.

Conclusions

To effectively address medication adherence via gamified and incentivized mobile apps, an evidence-based co-design approach and agile methodology should be used. This review indicates some adoption of an agile approach in app development; however, patient involvement is lacking in earlier stages. Further research in a generalized cohort of patients living with chronic conditions would facilitate the identification of barriers, potential opportunities, and the justification for the use of gamification and financial incentives in mobile apps for medication adherence.

Effects of Shopping Rehabilitation on Older People's Daily Activities

In an aged society, the deterioration of physical and cognitive functions is prevalent. To motivate the rehabilitation of older persons, an initiative known as “shopping rehabilitation” incorporates shopping as an element of a nudge. The purpose of this study was to clarify motor function changes and cognitive functions of participants during shopping rehabilitation, through a semi-experimental study. We measured changes in the Kihon Checklist score before and after rehabilitation interventions. A paired t-test was used to analyze changes in the overall score of the basic checklist before and after the rehabilitation intervention. In December 2020, 59 participants answered the Kihon Checklist after their shopping rehabilitation intervention. During the 6-month intervention period, the number of participants with a checklist score of 8 or higher was significantly reduced after the intervention (p = 0.050). In the sub-analysis, the score improved significantly for the group with families (p = 0.050). Improvement was observed in the group living alone, but the difference was not significant (p = 0.428). The shopping rehabilitation intervention improved the Kihon Checklist score. Continuous observations and research are necessary to measure the long-term effects of shopping rehabilitation and the mechanisms that foster their maintenance and effects.

A gamified mobile application for first-year student orientation to promote library services

This study proposes a mobile application as a new approach for first-year student orientation to promote knowledge of library services using the gamification concept. The application is based on mobile devices with GPS to locate students, allowing them to catch, collect, and battle monsters around the library with questions on library service instructions. To evaluate the learning effectiveness of the approach, we performed a comparative experiment in which the control group used e-learning, while the experimental group used the mobile application of the CMU Journey. We evaluated the pre-and post-test scores, delayed 1-month post-test scores, and intrinsic motivation based on the IMI questionnaire. The results demonstrated that the preference for gamified experience among students can enhance knowledge retention and intrinsic motivation compared to other groups.

Impact of gamification on glycaemic control among patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials

Aims 

The prevalence of type 2 diabetes mellitus (T2DM) is very high and still rising. Optimal medical therapy and lifestyle management are essential in reducing the long-term complications of T2DM. Gamification, which is the use of design elements, and characteristics of games in a non-gaming context, is an innovative approach to improve healthy behaviour. It thereby could be able to improve glycaemic control in T2DM. The aim of this systematic review and meta-analysis is to evaluate the effect of gamification on glycaemic control expressed by haemoglobin A1c (HbA1c) levels in T2DM patients.

Methods and results 

All articles from 2000 to 2021 were searched in electronic databases (PubMed, Cochrane Library, Embase). The total number of patients was 704. The rate of male participants and their mean ages ranged, respectively, from 46% to 94% and 60 to 63 years. Inclusion criteria were randomized controlled trials of T2DM management using gamification which included HbA1c as an outcome measure. A meta-analysis was performed. After removing duplicates, 129 articles were screened and a total of 3 articles corresponding to the inclusion criteria were identified. Haemoglobin A1c was significantly reduced [mean difference −0.21; 95% confidence interval (−0.37 to −0.05); P = 0.01; I² = 0%] in the intervention group using gamification as compared to the control group.

Conclusion 

Gamification has a positive effect on glycaemic control expressed by HbA1c changes in patients with T2DM. However, only three studies were included in this review. More research is needed to confirm the effectiveness of gamification in T2DM.

Promoting Navigation Health Literacy at the Intersection of Schools and Communities. Development of the Game-Based Intervention Nebolus

Emerging empirical evidence indicates a limited health literacy for a substantial proportion of children and adolescents. Although it is generally agreed upon promoting health literacy as early as possible in the lifespan, there is a lack of interventions addressing children and adolescents and their primary living environments. This article describes the development of Nebolus, a game-based intervention aiming to promote navigation health literacy at the intersection of schools and communities. Its intervention foundation lies in a socio-ecological understanding of health as well as in the Entertainment Education approach. Following an extensive literature search on health-related location-based games, a co-creation process was initiated that involved adolescents, community stakeholders, and design/IT professionals in all phases of the intervention development. The final Nebolus intervention includes three core activities: (1) a Nebolus rally app for adolescents aged 12 to 16 years, (2) an online planning tool allowing local health service providers/professionals to set up own Nebolus rallies, and (3) accompanying teaching material on health literacy in the school setting to be used before and after the Nebolus rallies. This article provides an overview of the intervention layout and discusses strengths and challenges of its development and implementation.

Is It Really Home-Based? A Commentary on the Necessity for Accurate Definitions across Exercise and Physical Activity Programmes

Background: There is wide discrepancy in how published research defines and reports home-based exercise programmes. Studies consisting of fundamentally different designs have been labelled as home-based, making searching for relevant literature challenging and time consuming. This issue has been further highlighted by an increased demand for these programmes following the COVID-19 pandemic and associated government-imposed lockdowns. Purpose: To examine what specifically constitutes home-based exercise by: (1) developing definitions for a range of terms used when reporting exercise and physical activity programmes and (2) providing examples to contextualise these definitions for use when reporting exercise and physical activity programmes. Methods: A literature search was undertaken to identify previous attempts to define home-based exercise programmes. A working document, including initial definitions and examples were developed, which were then discussed between six experts for further refinement. Results: We generated definitions for universal key terms within three domains (and subdomains) of programme design: location (home-based, community/centre-based, or clinical setting), prescription (structured or unstructured) and delivery (supervised, facilitated, or unsupervised). Examples for possible combinations of design terms were produced. Conclusions: Definitions will provide consistency when using reporting tools and the intention is to discuss the issues presented as part of a Delphi study. This is of paramount importance due to the predicted increase in emerging research regarding home-based exercise.

Effects of an mHealth App (Kencom) With Integrated Functions for Healthy Lifestyles on Physical Activity Levels and Cardiovascular Risk Biomarkers: Observational Study of 12,602 Users

Background

Mobile health (mHealth) apps are considered to be potentially powerful tools for improving lifestyles and preventing cardiovascular disease (CVD), although only few have undergone large, well-designed epidemiological research. “kencom” is a novel mHealth app with integrated functions for healthy lifestyles such as monitoring daily health/step data, providing tailored health information, or facilitating physical activity through group-based game events. The app is linked to large-scale Japanese insurance claims databases and annual health check-up databases, thus comprising a large longitudinal cohort.

Objective

We aimed to assess the effects of kencom on physical activity levels and CVD risk factors such as obesity, hypertension, dyslipidemia, and diabetes mellitus in a large population in Japan.

Methods

Daily step count, annual health check-up data, and insurance claim data of the kencom users were integrated within the kencom system. Step analysis was conducted by comparing the 1-year average daily step count before and after kencom registration. In the CVD risk analysis, changes in CVD biomarkers following kencom registration were evaluated among the users grouped into the quintile according to their change in step count.

Results

A total of 12,602 kencom users were included for the step analysis and 5473 for the CVD risk analysis. The participants were generally healthy and their mean age was 44.1 (SD 10.2) years. The daily step count significantly increased following kencom registration by a mean of 510 steps/day (P<.001). In particular, participation in “Arukatsu” events held twice a year within the app was associated with a remarkable increase in step counts. In the CVD risk analysis, the users of the highest quintile in daily step change had, compared with those of the lowest quartile, a significant reduction in weight (–0.92 kg, P<.001), low-density lipoprotein cholesterol (–2.78 mg/dL, P=.004), hemoglobin A_1c (HbA_1c; –0.04%, P=.004), and increase in high-density lipoprotein cholesterol (+1.91 mg/dL, P<.001) after adjustment of confounders.

Conclusions

The framework of kencom successfully integrated the Japanese health data from multiple data sources to generate a large, longitudinal data set. The use of the kencom app was significantly associated with enhanced physical activity, which might lead to weight loss and improvement in lipid profile.

Effects of Pokémon GO on Physical Activity and Psychological and Social Outcomes: A Systematic Review

Augmented reality (AR) mobile game, Pokémon GO, leverages gamification and location tracking technology to encourage players to walk in different places to catch Pokémon characters in real-world settings. The systematic review sought to explore the impact Pokémon GO has on players' physical activity (PA), and psychological and social outcomes. Six research databases (PubMed, SPORTDiscus, PsycInfo, Web of Science, Science Direct, and Scopus) were used. Study inclusion criteria were: (1) quantitative research published in English; (2) examined the relationships between or impact of Pokémon GO on PA, psychological, and/or social outcomes; and (3) included participants played or exposed to Pokémon GO. Thirty-six studies were included with a total sample of 38,724 participants. Players had significantly greater PA than non-players in terms of daily steps and number of days spent in moderate PA. Pokémon GO game also improved players' social interactions and their mood/affects. Selective attention and concentration improved in adolescents and memory improved in young adults after playing the game. Findings suggest playing Pokémon GO could promote meaningful improvements in walking behavior, as well as psychological and social well-being. More multidimensional research with randomized controlled trial design is needed to identify factors that influence adoption and sustainability of Pokémon GO playing.

Advances and Trends in Pediatric Minimally Invasive Surgery

As many meta-analyses comparing pediatric minimally invasive to open surgery can be found in the literature, the aim of this review is to summarize the current state of minimally invasive pediatric surgery and specifically focus on the trends and developments which we expect in the upcoming years. Print and electronic databases were systematically searched for specific keywords, and cross-link searches with references found in the literature were added. Full-text articles were obtained, and eligibility criteria were applied independently. Pediatric minimally invasive surgery is a wide field, ranging from minimally invasive fetal surgery over microlaparoscopy in newborns to robotic surgery in adolescents. New techniques and devices, like natural orifice transluminal endoscopic surgery (NOTES), single-incision and endoscopic surgery, as well as the artificial uterus as a backup for surgery in preterm fetuses, all contribute to the development of less invasive procedures for children. In spite of all promising technical developments which will definitely change the way pediatric surgeons will perform minimally invasive procedures in the upcoming years, one must bear in mind that only hard data of prospective randomized controlled and double-blind trials can validate whether these techniques and devices really improve the surgical outcome of our patients.

Cartographic Vandalism in the Era of Location-Based Games—The Case of OpenStreetMap and Pokémon GO

User-generated map data is increasingly used by the technology industry for background mapping, navigation and beyond. An example is the integration of OpenStreetMap (OSM) data in widely-used smartphone and web applications, such as Pokémon GO (PGO), a popular augmented reality smartphone game. As a result of OSM’s increased popularity, the worldwide audience that uses OSM through external applications is directly exposed to malicious edits which represent cartographic vandalism. Multiple reports of obscene and anti-semitic vandalism in OSM have surfaced in popular media over the years. These negative news related to cartographic vandalism undermine the credibility of collaboratively generated maps. Similarly, commercial map providers (e.g., Google Maps and Waze) are also prone to carto-vandalism through their crowdsourcing mechanism that they may use to keep their map products up-to-date. Using PGO as an example, this research analyzes harmful edits in OSM that originate from PGO players. More specifically, this paper analyzes the spatial, temporal and semantic characteristics of PGO carto-vandalism and discusses how the mapping community handles it. Our findings indicate that most harmful edits are quickly discovered and that the community becomes faster at detecting and fixing these harmful edits over time. Gaming related carto-vandalism in OSM was found to be a short-term, sporadic activity by individuals, whereas the task of fixing vandalism is persistently pursued by a dedicated user group within the OSM community. The characteristics of carto-vandalism identified in this research can be used to improve vandalism detection systems in the future.