Objective: To test the feasibility and impact of a behaviorally designed gamification intervention to improve goal-directed behavior assessed by physical activity levels in Parkinson’s disease (PD).

Background: Apathy, a multidimensional behavior of motivation, planning and initiation, collectively called goal-directed behavior is highly prevalent in PD. Impairments in goal-directed behavior are associated with greater disability and caregiver burden.

Method: We conducted a 6-week randomized clinical trial in pairs of subjects with PD and study partners recruited from the University of Pennsylvania from September-December 2019. Participants wore a wearable device, established a baseline step count, selected a step goal increase and were randomly assigned to a control (n=20) or the gamification intervention (n=21). The control group received daily feedback on step counts. The gamification participants entered into a game with a signed commitment pledge and a collaborative team model where study partners received daily updates on progress and one member was randomly selected to represent the team for the day. Points and levels were given for achieving step goals. Feasibility was determined by loss to follow-up, % missing data and report of adverse events. Outcomes were change in mean daily steps and number of days that step goals were achieved. Adjusted models controlled for age, gender and baseline step count.

Results: A total of 41 individuals with PD (mean age[SD] 66.2[6.5]; 19[46%] women) were included in the study. There was 1 early discontinuation in the control arm and none in the gamification intervention arm, and very little missing step count data (<1%). Compared to controls, participants in the gamification arm had a greater increase in proportion of days that the step goal was achieved (adjusted increase 0.24, 95%CI 0.03, 0.44, p=0.03) and a greater increase in mean daily steps, but we were underpowered to evaluate for statistical significance (adjusted increase 626 steps, 95%CI -492, 1744, p=0.27). Qualitative feedback at the end of the study was universally positive with no reported adverse events.

Conclusion: A gamification intervention is feasible and may be a promising approach to increase physical activity levels and improve goal-directed behavior in PD patients. Future research should conduct larger trials to test the longer term effectiveness of this intervention.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/move-to-improve-physical-activity-in-parkinsons-disease-motivate-a-pilot-randomized-clinical-trial-of-gamification/