{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:03:47Z","timestamp":1790647427563,"version":"4.1.0"},"reference-count":55,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"24","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,12,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">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\u2009weeks. The gamification group was entered into a 16\u2010week game designed using insights from behavioral economics and received educational text messages. No intervention occurred during an 8\u2010week postintervention follow\u2010up period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      A total of 103 patients (mean age, 70\u00b19\u2009years; 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, \u221222 to 1861];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.06) that became statistically significant during the follow\u2010up period (adjusted difference, 1074 [95% CI, 133\u20132015];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.03).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In this randomized clinical trial, gamification increased physical activity compared with attention control over a 24\u2010week follow\u2010up. 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT04536012\">https:\/\/clinicaltrials.gov\/study\/NCT04536012<\/jats:ext-link>\n                      ; Unique Identifier: NCT04536012.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.038921","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T12:05:59Z","timestamp":1764763559000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Effect of Gamification Plus Automated Coaching to Increase Physical Activity Among Patients With Peripheral Artery Disease: The GAMEPAD Randomized Controlled Trial"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9060-5307","authenticated-orcid":false,"given":"Alexander C.","family":"Fanaroff","sequence":"first","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia"]},{"name":"University of Pennsylvania","place":["Philadelphia"]},{"name":"University of Pennsylvania","place":["Philadelphia"]},{"name":"University of Pennsylvania","place":["Philadelphia"]},{"name":"University of Pennsylvania","place":["Philadelphia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Coratti","sequence":"additional","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7710-3245","authenticated-orcid":false,"given":"David","family":"Farraday","sequence":"additional","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2112-9669","authenticated-orcid":false,"given":"Laurie","family":"Norton","sequence":"additional","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia"]},{"name":"University of Pennsylvania","place":["Philadelphia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8642-4549","authenticated-orcid":false,"given":"Charles","family":"Rareshide","sequence":"additional","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingsan","family":"Zhu","sequence":"additional","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia"]},{"name":"University of Pennsylvania","place":["Philadelphia"]},{"name":"University of Pennsylvania","place":["Philadelphia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9937-9932","authenticated-orcid":false,"given":"Michael G.","family":"Levin","sequence":"additional","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia"]},{"name":"Corporal Michael J. 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