Behaviorally Designed Gamification and Physical Activity Among Breast and Prostate Cancer Survivors
Alexander C. Fanaroff, Jennifer A. Orr, Chinyere Anucha, Emily Kim, Charles Rareshide, Jingsan Zhu, Meagan Echevarria, Stephanie Rodarte, Mareen Kassabian, Elina Balasian, Bonnie Ky, Kevin G. Volpp, Saro H. Armenian
Abstract
BACKGROUND: Black and Hispanic cancer survivors exposed to cardiotoxic therapies are at higher risk for cardiovascular events than non-Hispanic White survivors, attributed to greater cardiovascular risk factors and lower physical activity. OBJECTIVES: This study sought to determine the effect of a remotely delivered and behaviorally designed gamification intervention vs attention control on physical activity in Black and Hispanic cancer survivors with cardiovascular risk factors. METHODS: Between May 2022 and February 2025, Black and Hispanic breast and prostate cancer survivors who had received cardiotoxic cancer therapy and had ≥1 cardiovascular risk factor were enrolled in a randomized clinical trial with a 24-week intervention and 12-week postintervention period. Participants received a wearable device to track daily steps, established a baseline, selected a step goal increase, and were assigned to attention control (n = 76) or gamification (n = 74). The primary outcome was change in mean daily steps from baseline through the intervention period. RESULTS: Mean participant age was 64 years; 81% women, 64% Black, and 35% Hispanic. Gamification arm participants had a greater change from baseline in mean daily steps than control participants during the intervention period (+759; 95% CI: 209-1,309; P = 0.007) and follow-up (+581; 95% CI: -47 to 1,208; P = 0.070), and a greater increase in weekly minutes of moderate-vigorous physical activity during intervention (+16; 95% CI: 4-29; P = 0.010) and follow-up (+11; 95% CI: 0-22; P = 0.048). CONCLUSIONS: Gamification increased physical activity compared with attention control in Black and Hispanic cancer survivors, and represents a scalable intervention to reduce cardiovascular risk in this high-risk population (RCT of Strategies to Augment Physical Activity in Black and Hispanic Breast and Prostate Cancer Survivors [ALLSTAR]; NCT05176756).