Opportunity 

Many interventions challenge participants to identify and reach a goal. However, the best way to design the goal-setting process for high-risk patients has not been well examined. 

Intervention 

We designed a 24-week clinical trial called ENGAGE to compare four goal-setting methods in a gamification intervention and recruited more than 500 adults from lower-income neighborhoods in and around Philadelphia to participate. To be eligible, participants had to have a documented atherosclerotic cardiovascular disease (ASCVD) condition or a 10-year ASCVD risk score greater than or equal to 7.5 percent.   

All participants tracked daily steps via wearable devices, established a baseline level, and were randomly assigned to one of four gamification interventions that varied only on how daily step goals were set (self-chosen or assigned) and implemented (immediately or gradually). Way to Health was used to administer the study. 

Impact 

We observed a significant increase in physical activity when daily step goals were self-chosen rather than assigned and implemented immediately rather than gradually. Participants in this group also sustained increases in daily steps and minutes of moderate to vigorous physical activity during the two-month follow-up period.  

To our knowledge, this is one of the first randomized trials to demonstrate the effect that goal-setting design can have on physical activity, particularly among adults from lower-income neighborhoods at elevated risk for major adverse cardiovascular events.