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已发表论文
基于游戏化的移动健康干预增强老年慢性病患者个性化运动依从性的随机对照试验方案
Authors Zhang G , Xia Y, Li X , Zhang Y, Xu X, Sun T
Received 16 June 2025
Accepted for publication 6 October 2025
Published 11 October 2025 Volume 2025:19 Pages 3145—3157
DOI https://doi.org/10.2147/PPA.S547361
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Ramón Morillo-Verdugo
Guoli Zhang,1 Yuxin Xia,1 Xuelei Li,1 Yun Zhang,1 Xuejie Xu,1 Ting Sun1,2
1School of Nursing, Bengbu Medical University, Bengbu, Anhui, People’s Republic of China; 2Joint Research Center for Regional Diseases of IHM, Bengbu Medical University, Bengbu, Anhui, People’s Republic of China
Correspondence: Ting Sun, School of Nursing, Bengbu Medical University, Bengbu, Anhui, People’s Republic of China, Tel +86 18005529759, Email cangwuge21@163.com
Background: Despite proven benefits, intelligent personalized exercise prescription (IPEP) adherence remains low in middle-aged and older adults with chronic diseases (MOACD). Research evidence suggests that mobile health (mHealth)-based gamification interventions can improve participation in physical activity; however, their effects on adherence to IPEP remain unclear. Moreover, most studies report that adherence often declines rapidly once gamification interventions end, and no effective strategies have been proposed to address this issue. This study embeds the Octalysis gamification framework into a smartphone-based app to investigate the effects of an mHealth-based gamification intervention on adherence to IPEP among MOACD, as well as on related physical and psychological outcomes. Additionally, the study examines whether combining gamification interventions with health education can help sustain adherence after the intervention concludes.
Methods: We propose a double-center, single-blind, three-arm randomized controlled trial. We will recruit 132 MOACD who will participate in dyads (66 pairs). Participants will be randomly assigned to three groups: a non-gamification group, a gamification group, or a health education plus gamification group. The intervention will last for 12 weeks, followed by a 12-week follow-up period. The primary outcome is adherence to IPEP, defined as the proportion of days on which participants completed their prescribed exercise tasks at 12 and 24 weeks. Secondary outcomes include biomedical risk factors, sedentary behavior, sleep quality, self-efficacy, intrinsic motivation, patient satisfaction, and the acceptability of the intervention.
Conclusion: This trial employs the Octalysis gamification framework to design an intervention aimed at enhancing adherence to the IPEP. The findings may inform the development of scalable digital interventions to promote physical activity and long-term adherence among MOACD.
Keywords: smartphone app, gamification design, low adherence, Octalysis gamification framework, self-efficacy, intrinsic motivation
1School of Nursing, Bengbu Medical University, Bengbu, Anhui, People’s Republic of China; 2Joint Research Center for Regional Diseases of IHM, Bengbu Medical University, Bengbu, Anhui, People’s Republic of China
Correspondence: Ting Sun, School of Nursing, Bengbu Medical University, Bengbu, Anhui, People’s Republic of China, Tel +86 18005529759, Email cangwuge21@163.com
Background: Despite proven benefits, intelligent personalized exercise prescription (IPEP) adherence remains low in middle-aged and older adults with chronic diseases (MOACD). Research evidence suggests that mobile health (mHealth)-based gamification interventions can improve participation in physical activity; however, their effects on adherence to IPEP remain unclear. Moreover, most studies report that adherence often declines rapidly once gamification interventions end, and no effective strategies have been proposed to address this issue. This study embeds the Octalysis gamification framework into a smartphone-based app to investigate the effects of an mHealth-based gamification intervention on adherence to IPEP among MOACD, as well as on related physical and psychological outcomes. Additionally, the study examines whether combining gamification interventions with health education can help sustain adherence after the intervention concludes.
Methods: We propose a double-center, single-blind, three-arm randomized controlled trial. We will recruit 132 MOACD who will participate in dyads (66 pairs). Participants will be randomly assigned to three groups: a non-gamification group, a gamification group, or a health education plus gamification group. The intervention will last for 12 weeks, followed by a 12-week follow-up period. The primary outcome is adherence to IPEP, defined as the proportion of days on which participants completed their prescribed exercise tasks at 12 and 24 weeks. Secondary outcomes include biomedical risk factors, sedentary behavior, sleep quality, self-efficacy, intrinsic motivation, patient satisfaction, and the acceptability of the intervention.
Conclusion: This trial employs the Octalysis gamification framework to design an intervention aimed at enhancing adherence to the IPEP. The findings may inform the development of scalable digital interventions to promote physical activity and long-term adherence among MOACD.
Keywords: smartphone app, gamification design, low adherence, Octalysis gamification framework, self-efficacy, intrinsic motivation