Disclosure before anything else: we make Pushup RPG, which is itself a gamified fitness app. None of the studies below tested it. If it made our product look good, that would be a coincidence, and mostly it does not.
The short answer
Gamification can increase physical activity in some settings, but the pooled effects reported by systematic reviews are modest, vary enormously between studies, and are usually measured in steps rather than in strength work.
The largest recent review compared health apps with gamification against non-gamified apps. That comparator matters more than any single number on this page: every participant in every arm was using an app, so the finding is not "an app beats no app". Across 36 randomised trials, 49 comparisons and 10,079 participants, its step-count analysis pooled 34 of those trials (n = 5,119) and found an average difference of 489 steps per day (95% CI 64 to 914). The authors classified that as trivial, because the difference they had prespecified as minimally important was 2,000 steps per day.
Evidence at a glance
| Finding | What the source measured | What it does not establish |
|---|---|---|
| 31% of adults worldwide, about 1.8 billion people, did not meet recommended physical-activity levels in 2022, projected to reach 35% by 2030 if the trend continues | WHO estimates of insufficient activity: under 150 minutes moderate or 75 minutes vigorous per week, self-reported, counting work, transport and household activity | That 1.8 billion people never exercise, or anything about push-ups, app adoption or gamification |
| 31.0% of US adults met the muscle-strengthening guideline in the 2020 NHIS, with or without also meeting the aerobic guideline; 24.2% met both, and 6.8% met strengthening alone | Self-reported leisure-time activity in a nationally representative survey | How many people do push-ups. The 31.0% and 24.2% overlap and must not be added |
| Gamified apps averaged 489 more steps per day than non-gamified apps (95% CI 64 to 914) in a 2024 review's step-count subset of 34 trials, n = 5,119 | Step counts. The authors rated the change trivial against a prespecified 2,000-step threshold, with I² = 93.8% | A clinically important effect, a lasting effect, an effect versus using no app at all, or any effect on push-ups |
| No significant effect on moderate-to-vigorous physical activity across the 15 trials reporting it, at low GRADE certainty | MVPA outcomes in the included comparisons | That no design can work. The pooled studies did not show a clear difference |
| A separate review of standalone gamified apps reported a standardised mean difference of 0.34 (95% CI 0.06 to 0.62) across 12 applications in between-group randomised comparisons | Mixed physical-activity measures, graded moderate certainty for this estimate | A universal effect size for any given product or user. The lower bound of 0.06 is barely above zero |
Why the problem is worth studying
The World Health Organization reported that 31% of adults worldwide, approximately 1.8 billion people, did not meet recommended physical-activity levels in 2022, and that if the 2010 to 2022 trend continues the figure would reach 35% by 2030. The underlying study puts the 2022 figure at 31.3% (95% uncertainty interval 28.6 to 34.0), pooled from 507 self-reported surveys covering 5.7 million participants across 163 countries.
Read that measure carefully, because it is the most commonly broken statistic in this field. It counts insufficient activity of every kind, including work, transport and housework. It does not say 1.8 billion people never exercise, and it says nothing about strength training.
In the United States, the 2020 National Health Interview Survey found that 31.0% of adults met the muscle-strengthening guideline, with or without also meeting the aerobic one. 24.2% met both, and only 6.8% met the strengthening guideline without the aerobic one, so the two headline figures overlap and cannot be added. The guideline is self-reported leisure-time activity of moderate or greater intensity involving all major muscle groups on two or more days a week. Push-ups are not reported separately. 2020 was a COVID-disrupted collection year, with telephone-only interviewing from April to June, so year-over-year comparisons should be avoided.
What the randomised-trial reviews found
Gamified apps versus non-gamified apps
A 2024 systematic review and meta-analysis in eClinicalMedicine searched MEDLINE, Embase and the Cochrane Central Register of Controlled Trials from inception to 21 May 2024. It included 36 randomised trials, representing 49 comparisons and 10,079 participants. In every trial the control arm also used an app. What varied was whether that app was gamified.
Compared with non-gamified apps, gamified apps produced an average increase of 489 steps per day (95% CI 64 to 914) in the 34 trials, n = 5,119, that reported step counts. The authors classified the difference as trivial, because their prespecified minimally important difference was 2,000 steps per day. The lower confidence bound of 64 steps is roughly thirty seconds of walking. Heterogeneity was substantial (I² = 93.8%), and Egger's and Begg's tests indicated significant publication bias for both steps and MVPA, although trim-and-fill did not suggest small-study effects. GRADE certainty was high for the step estimate.
Across the 15 trials reporting moderate-to-vigorous physical activity, no significant effect was observed, at low certainty.
Standalone gamified apps
A 2022 review in the American Journal of Preventive Medicine examined standalone gamified smartphone apps rather than gamification layered into a broader programme. Nineteen studies covering 24 apps were eligible and 16 entered the meta-analysis. In between-group randomised comparisons the pooled standardised mean difference was 0.34 (95% CI 0.06 to 0.62) across 12 applications, which the authors described as small to moderate and graded moderate certainty. That grade attaches only to the between-group estimate; their within-group pre-to-post estimate was graded very low. Heterogeneity was substantial (I² = 72%), although leave-one-out analyses sustained the effect with lower heterogeneity (I² = 31.0%).
Which mechanics appear in the literature
A 2022 systematic review in JMIR mHealth and uHealth covered 50 studies. The most frequently used game elements were goal setting, followed by progress bars, rewards, points and feedback. Thirty of the 50 studies, 60%, combined gamification with wearable devices, most of them wrist-worn. The review concluded that gamification interventions could increase physical-activity participation, but that "the results were mixed, and modest changes were attained".
Two limits are worth stating plainly, because they are easy to over-read. It is a narrative review rather than a meta-analysis, so there is no pooled effect size behind the word modest. And on the authors' own account 19 of the 50 studies had no control group and 38 of 50 had no follow-up period, so durability is untested. Its literature search closed on 20 December 2020, which makes it a review of pre-2021 evidence despite the 2022 publication date.
The distinction the research mostly does not make
Almost every trial above studied an app that reports on activity happening elsewhere, usually walking measured by a phone or a wrist tracker. Very few studied a game in which the movement itself is the input, and none of them studied camera-counted strength work. That is a gap in the literature, not evidence in anyone's favour.
We wrote a separate breakdown of how currently available products differ on exactly this axis, and which of them can see you move: best fitness RPG apps, compared by how they actually work.
What this evidence cannot say about Pushup RPG
- No study here tested it. Nothing on this page is evidence about our app, and we will not present it as such.
- The outcomes do not match. These reviews measure steps and MVPA. Pushup RPG counts push-ups, squats, sit-ups, pull-ups and dips and times a plank. No pooled estimate above speaks to bodyweight strength work.
- The comparator does not match. The headline 489-step figure compares two apps, not an app against nothing.
- Effects here are small and heterogeneous. An I² near 94% means the studies disagree with each other far more than they agree, so an average is a weak guide to any individual product.
What a useful study of this app would measure
Adherence over at least twelve weeks, not a two-week novelty window. Reps completed against reps prescribed, verified rather than self-reported. Dropout, reported honestly, including everyone who installed and never returned. And a control arm using the same training programme without the game layer, which is the only comparison that isolates what gamification contributes.
We have not run that study. Until someone does, the honest position is that the research supports gamification as a plausible aid to activity, with small average effects that vary widely, and says nothing specific about turning push-ups into combat.
Method
Every figure on this page was read from the primary source rather than from secondary coverage, and each is linked below. Where a source is bot-protected and could not be fetched automatically, it was confirmed against an independent primary record, noted in the source list. Sources last checked on the date shown at the top of this page. The newest literature search among the cited reviews closed on 21 May 2024; the others close earlier, which is stated in each entry above.
Sources
- World Health Organization. Nearly 1.8 billion adults at risk of disease from not doing enough physical activity. News release, 26 June 2024. Underlying study: Strain T, Flaxman S, Guthold R, et al. National, regional, and global trends in insufficient physical activity among adults from 2000 to 2022. The Lancet Global Health 2024;12(8):e1232 to e1243.
- Elgaddal N, Kramarow EA, Reuben C. Physical Activity Among Adults Aged 18 and Over: United States, 2020. NCHS Data Brief No. 443. National Center for Health Statistics, August 2022. Cross-checked against MMWR QuickStats 2022;71(18):631.
- Nishi SK, et al. Effect of digital health applications with or without gamification on physical activity and cardiometabolic risk factors: a systematic review and meta-analysis of randomized controlled trials. eClinicalMedicine 2024. doi:10.1016/j.eclinm.2024.102798.
- Yang Y, Hu H, Koenigstorfer J. Effects of Gamified Smartphone Applications on Physical Activity: A Systematic Review and Meta-Analysis. American Journal of Preventive Medicine 2022 Apr;62(4):602 to 613. PMID 34893387, e-published 7 December 2021.
- Xu L, Shi H, Shen M, et al. The Effects of mHealth-Based Gamification Interventions on Participation in Physical Activity: Systematic Review. JMIR mHealth and uHealth 2022 Feb 3;10(2):e27794. PMID 35113034.
If you are writing about this and want anything here checked or expanded, the press kit has verified product facts and contact details.
