Game On!

Just by lowering my heart rate, I can make flowers bloom.

The flowers aren’t real—they’re on my computer screen—but the effects on my heart are real: I’m calmer, breathing more deeply, and my blood pressure is lower. I’m playing "Garden Game,"part of a computer program by HeartMath that trains people to control their heart rhythms with breathing patterns and positive visualization. An ear sensor that plugs into my computer detects how long I maintain this optimal heart rhythm. As long as I do, my virtual garden is rewarded with colorful flowers and forest animals.

But aren’t these kinds of games supposed to be bad for my health by promising to keep me pinned to my potato chip covered couch? Not necessarily. New research shows us that, used smartly, games and gamification principles may help us reach our health goals.


At their most sophisticated, "serious games," as they are known in the gaming world, refer to simulations of real-world events designed to teach a new behavior, like learning to drive a car. They can involve storylines, role-playing and well-developed characters. One example is Squire’s Quest, an educational, multimedia game that teaches kids to eat more fruits and vegetables—a task that notoriously requires superhero powers. In Squire’s Quest, animated characters interact with the player, a Squire, who must save the medieval Kingdom of Fivealot by meeting FJV (fruit, juice, vegetable) goals and earning enough achievements (in the form of digital badges within the game) to become a Knight.

"Most [obesity] intervention programs are boring. We work to make activities that kids actually want to do," said Dr. Thomas Baranowski, co-developer of Squire’s Quest at the Children’s Nutrition Research Center at Baylor College of Medicine in Houston and Editor-in-Chief of Games for Health Journal. "Games attract players because they’re expected to be fun, but through them, you have more thorough exposure to behavior-changing procedures."

And Dr. Baranowski’s game has been proven to change behaviors at an impressive rate. A study of 1,400 children showed that playing Squire’s Quest for just five weeks increased fruit and vegetable consumption by one serving a day. Traditional or non-game interventions often take a year or two to create similar changes. In fact, buoyed by the success of Squire’s Quest, Baranowski and his team are currently developing Mommio, which teaches parents to choose effective ways of responding to children who refuse to eat their vegetables.


On the other end of the gaming spectrum is gamification. Picture this: Someone asks you to go on a diet and be weighed on national television in front of 10 million people. This is the stuff nightmares are made of, right? But wait! What if you were on a team that depended on you? What if there was a leaderboard that begged for your name to be at the top? What if there was a big prize at the end? That sounds a little more fun, like a game. This is NBC’s hit weight-loss show The Biggest Loser. And this is gamification—the biggest trend in health right now.

Unlike games, which have a self-defined domain and rules, gamification applies game elements, like rewards and positive reinforcement, to a real-life context, like exercise or household chores, to make them more fun and engaging. At its most basic, gamification means creating a system that motivates people to do things they wouldn’t normally want to do. With a game, they become part of the game world. In gamification, the game becomes part of their world.

Gamification works on the principle of motivation, which has three main components:

⇒ Activation, the decision to initiate a behavior (I am going to jog!)

⇒ Persistence, our commitment to the behavior even when challenges and setbacks arise: (I’d rather go to happy hour with my co-workers, but I’m going to jog anyway!)

⇒ Intensity, the drive or determination that goes into pursuing a goal (I’m going to join a running club and sign up for a race!)

Gamification appears to work because it addresses all three aspects of motivation. To a sedentary person, running sounds hard, not fun. However, the idea of running becomes a little more intriguing when you pretend that hundreds of lives are at stake and that you’re outrunning zombies, as in the popular running program, Zombies, Run! In it, players listen to a zombie apocalypse story through their headphones, and literally run to collect virtual ammunition, medicines and other supplies to survive a zombie apocalypse. The program tracks distance, calories, time and pace. This kind of approach makes running novel and fun.

Gamification increases persistence and intensity by rewarding desired behavior. Humans naturally crave status and accomplishment. A simple gold star by our names releases dopamine, a feel-good chemical, in our brains. By rewarding mundane daily tasks, we can create persistence we might not have otherwise. And as we get more invested other words, where our internal motivation is waning, gamification can support us with outside motivation (gold stars, money, status, praise), making us more likely to persist through challenges and do even more.

For example, FitBit, the popular activity tracker, motivates users with "badges," which are nothing more than virtual stickers proclaiming that a user has walked 5,000 steps or climbed 50 flights of stairs. Despite the simplicity, such incentives are highly effective. It allows users to reflect on what they’ve done and then try to do more. Utilizing social networks or competition features also increases the motivation.


HabitRPG is a video game that helps users transform their lives into a role-playing game. Players turn their tasks—anything from completing their daily walk to taking medication to meeting their dietary goals—into little monsters that must be conquered throughout the day. The more monsters a player conquers, the more the player progresses, gathering gold, clothes and accessories for their avatar (an online alter-ego), and graduation through levels. HabitRPG boasts 150,000 active users per month. Though one might assume that mostly kids and teens use the free program with animated characters, most users fall in the 18-34 age range, with the most stable, long-term users being over 44.

"Grandparents use it with their grandkids—a three generation usage of HabitRPG," said Siena Leslie, Chief Design and Marketing Officer of HabitRPG. "You can join a group with your friends or your family, and you can fight monsters together. If you succeed at your tasks, then you help defeat the monster; if you slip up, the monster will attack the whole party. So it becomes ‘Grandma, remember to take your heart medicine, or the Griffin will attack us!’" Further, players can join "guilds" that are working towards a common goal. There are guilds for weight loss and for managing chronic illness. Members of the guilds can create challenges for the entire group, encouraging everyone to get their daily exercise or check their blood sugar regularly.

The creators of HabitRPG and their users appear to know what research has been proving for years: goals can be reached alone, but people are generally more successful when they collaborate, compete, hold each other accountable, and most important ‘have fun.’ "When gamification fails, it’s because people lose track of the game," Leslie said. "It’s the fun that makes it effective." And isn’t having more fun one of our reasons for staying healthy in the first place?

Bottom line: we often don’t do things well or consistently if we don’t feel rewarded or enjoy doing them, and that applies to our health, too. Dr. Baranowski of Squire’s Quest insists that the future of health games research will be devoted to defining exactly what fun is. Siena Leslie believes that HabitRPG is successful because their company focuses on fun to inspire and motivate. It’s true. As I play Garden Game, I am having fun. I don’t know why. I’m just breathing like Darth Vader and waiting for a pixelated deer to appear on my screen. Then he does appear! My brain releases that sweet dopamine, and I’m satisfied. I feel happy. And that does a heart good.

EDITOR’S NOTE: Have you found ways to make working toward your health goals more fun? If so, share them with us at

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