{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:25:48Z","timestamp":1792524348580,"version":"4.5.0"},"reference-count":80,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n College students commonly experience suboptimal health conditions, including insufficient physical activity (PA), excessive body weight, and declining physical fitness. Traditional interventions face low adherence, while gamified mobile health (mHealth) programs may improve engagement and outcomes.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to evaluate the feasibility and effectiveness of a novel gamified, incentive-based mHealth intervention on primary outcomes (PA and adherence) and secondary outcomes (physical fitness, body composition, executive function [EF], and mental health).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A 2-arm parallel-group randomized controlled trial (RCT) was conducted in 2025 at Yantai University with 160 college students (18\u201025 years; BMI 18.5\u201030.0) who were randomized 1:1 (computer-generated, sex-stratified blocks of 4; concealed allocation) to the intervention group (IG) or control group (CG; n=80 each); major exclusions were contraindications to exercise, severe physical\/mental illness, recent PA interventions, or psychotropic medication use. Both used the same fitness watch\u2013app system and identical PA targets (\u2265150 min moderate-to-vigorous physical activity [MVPA] per week or \u2265900 metabolic equivalent-minutes [MET-min] per week); IG additionally received team-based gamification (competition, points\/leaderboards, feedback, and rewards), while CG received monitoring only. PA and adherence were monitored throughout the 8-week intervention; other outcomes were assessed at baseline and 8 weeks (fitness, body composition, EF, and mental health). Open-label with blinded outcome assessors\/analysts; intention-to-treat (ITT) with multiple imputation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n At 8 weeks, data were available for 154 participants (IG 78; CG 76); all 160 were analyzed per ITT. Compared to the CG, the IG demonstrated significantly higher mean levels in all primary PA outcomes over 8 weeks (daily steps: mean 10,356, SD 1245 versus 8242, SD 1087; \u0394=2114;\n d<\/jats:italic>\n =1.81, 95% CI 1.44\u20102.18;\n P<\/jats:italic>\n <.001; daily MVPA: mean 71, SD 15 versus 43, SD 12 min; \u0394=28 min;\n d<\/jats:italic>\n =2.06, 95% CI 1.68\u20102.45;\n P<\/jats:italic>\n <.001; and weekly MET-min: mean 1650, SD 310 versus 1340, SD 285; \u0394=310;\n d<\/jats:italic>\n =1.04, 95% CI 0.71\u20101.37;\n P<\/jats:italic>\n <.001). Adherence was also higher in the IG (both\n P<\/jats:italic>\n <.001). Key secondary outcomes, including skeletal muscle mass (\u0394 +0.54 kg), body fat percentage (\u0394 \u22120.46 percentage points), 800\/1000 m run time (\u0394 \u22126.5 s), and depressive symptoms (\u0394 \u22122.0 points), significantly favored the IG (all\n P<\/jats:italic>\n <.001). No serious adverse events occurred.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This RCT demonstrated that integrating gamification into an mHealth platform significantly enhanced PA, intervention adherence, and selected health outcomes among college students. The key innovation lies in the trial design, which held the technology platform and activity goals constant across groups, thereby allowing a clearer estimate of the incremental contribution of gamification. Unlike many existing studies, this approach reduces confounding from co-occurring intervention components in between-group comparisons. It therefore provides more comparable and methodologically robust evidence on the specific efficacy of gamification in mHealth interventions. For real-world implementation, this model leverages the existing smartphone and wearable ecosystem, offering a low-cost, scalable strategy for university health-promotion programs.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/82769","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T11:45:10Z","timestamp":1772797510000},"page":"e82769-e82769","source":"Crossref","is-referenced-by-count":5,"title":["A Gamified Mobile Health Intervention to Promote Physical Activity, Executive Function, and Mental Health in College Students: Randomized Controlled Trial"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4849-1732","authenticated-orcid":false,"given":"Ming","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4708-3140","authenticated-orcid":false,"given":"Yingjun","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1432-7472","authenticated-orcid":false,"given":"Zhen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8591-6805","authenticated-orcid":false,"given":"Lei","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3641-5449","authenticated-orcid":false,"given":"Yanan","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3907-6356","authenticated-orcid":false,"given":"Sen","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3369-1429","authenticated-orcid":false,"given":"Zhixiong","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"issue":"9","key":"R1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xcrm.2025.102309","article-title":"Revisiting obesity thresholds for cardiovascular disease and mortality risk in Chinese adults: age- and gender-specific insights","volume":"6","author":"Jia","journal-title":"Cell Rep Med"},{"issue":"12","key":"R2","doi-asserted-by":"publisher","first-page":"e994","DOI":"10.1016\/S2468-2667(22)00110-4","article-title":"Healthy lifestyle and life expectancy at age 30 years in the Chinese population: an observational study","volume":"7","author":"Sun","journal-title":"Lancet Public Health"},{"issue":"6","key":"R3","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/S2213-8587(25)00131-7","article-title":"China launches National Obesity Campaign","volume":"13","author":"Sun","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"1","key":"R4","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-025-01827-4","article-title":"Systematic review and meta analysis of standalone digital behavior change interventions on physical activity","volume":"8","author":"Lee","journal-title":"NPJ Digit Med"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1089\/tmj.2012.0328","article-title":"The impact of mobile health interventions on chronic disease outcomes in developing countries: a systematic review","volume":"20","author":"Beratarrechea","journal-title":"Telemed J E Health"},{"issue":"4","key":"R6","doi-asserted-by":"publisher","DOI":"10.2196\/26699","article-title":"Long-term effectiveness of mHealth physical activity interventions: systematic review and meta-analysis of randomized controlled trials","volume":"23","author":"M\u00f6nninghoff","journal-title":"J Med Internet Res"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","DOI":"10.2196\/26779","article-title":"Evaluating the effectiveness of gamification on physical activity: systematic review and meta-analysis of randomized controlled trials","volume":"24","author":"Mazeas","journal-title":"J Med Internet Res"},{"issue":"3","key":"R8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0173403","article-title":"Does gamification increase engagement with online programs? 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