# A Randomized Controlled Trial of Gamification and Social Incentives to Increase Adherence to Physical Activity Among Patients with Heart Failure with Preserved Ejection Fraction

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2024 · $809,029

## Abstract

PROJECT SUMMARY/ABSTRACT
Heart failure with preserved ejection fraction (HFpEF), a syndrome characterized by exercise
intolerance due to breathlessness and fatigue, is a major public health problem rising in
prevalence. No pharmacologic strategy has been shown to improve exertional symptoms in
HFpEF patients, but exercise training is beneficial. For this reason, guidelines strongly
recommend that patients with HFpEF engage in regular exercise. Despite this recommendation,
physical activity in patients with HFpEF is dismally low, and a recent NHLBI working group
identified strategies to increase adoption and adherence to physical activity recommendations
among patients with HFpEF as a research priority.
Insights from behavioral economics have been shown to both better reflect the ‘predictable
irrationality’ of humans and to be effective in designing interventions that achieve sustained
improvements in health behavior. Our group has tested the ability of interventions guided by
behavioral economic insights using our NIH-funded Way to Health software platform, which
captures physical activity from wearable devices and automates the processing of incentives
and feedback. In randomized controlled trials enrolling obese patients and older adults with or at
risk for atherosclerotic vascular disease, we have shown that interventions using gamification
and social incentives increase physical activity during 3-month interventions, which are
sustained over 3-month follow-up. If these effects could be translated to patients with HFpEF, it
would represent a safe and readily implementable exercise strategy that could lead to sustained
improvements in quality of life and functional capacity, and heart failure hospitalizations in a
cohort of patients with few therapeutic options.
In this study, we propose to conduct a 3-arm randomized, controlled trial with a 6-month
intervention and then a 3-month follow-up period to address the following aims: Aim 1: To
evaluate the effectiveness of gamification plus either ‘support’ or ‘competition’ to increase
adherence to physical activity in HFpEF patients. Aim 2: To evaluate whether increased
adherence to physical activity recommendations in the intervention arms translates to improved
quality of life and functional capacity. Aim 3: To determine the association between increases in
step count and improvements in quality of life and functional capacity, establishing a minimum
clinically important difference in daily steps for patients with HFpEF. If this low-cost, highly
scalable intervention increases adherence to physical activity recommendations and improves
quality of life, it would warrant a larger trial to assess its effects on HF hospitalizations.

## Key facts

- **NIH application ID:** 10942387
- **Project number:** 1R01HL174691-01
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Alexander Craig Fanaroff
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $809,029
- **Award type:** 1
- **Project period:** 2024-08-01 → 2029-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10942387

## Citation

> US National Institutes of Health, RePORTER application 10942387, A Randomized Controlled Trial of Gamification and Social Incentives to Increase Adherence to Physical Activity Among Patients with Heart Failure with Preserved Ejection Fraction (1R01HL174691-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10942387. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*