Background Supervised exercise therapy improves walking performance in patients with peripheral artery disease (PAD), but few participate. Interventions leveraging concepts from behavioral economics increase physical activity in patients at high cardiovascular risk, but barriers to physical activity differ in patients with PAD. Methods In this randomized controlled trial, conducted from October 2020 through January 2024, patients with PAD were provided with a wearable fitness tracker, established a baseline daily step count, and set a step goal increase. They were randomly assigned to attention control or to gamification. The control group received feedback from the fitness tracker but no other interventions for 24 weeks. The gamification group was entered into a 16‐week game designed using insights from behavioral economics and received educational text messages. No intervention occurred during an 8‐week postintervention follow‐up period. Results A total of 103 patients (mean age, 70±9 years; 54 52% men, 74 (72%) with exertional lower extremity symptoms) were randomized to attention control (n=52) or gamification (n=51). Compared with controls, gamification participants had a greater increase in mean daily steps from baseline during the intervention period (adjusted difference, 920 95% CI, −22 to 1861; P =0.06) that became statistically significant during the follow‐up period (adjusted difference, 1074 95% CI, 133–2015; P =0.03). Conclusions In this randomized clinical trial, gamification increased physical activity compared with attention control over a 24‐week follow‐up. This intervention may represent a scalable approach for increasing physical activity in patients with PAD who are not able to participate in supervised exercise therapy. Registration URL: https://clinicaltrials.gov/study/NCT04536012 ; Unique Identifier: NCT04536012.
Fanaroff et al. (Wed,) studied this question.