A Gamification mHealth Intervention to Enhance Adherence to Personalized Exercise for Older Adults with Chronic Diseases: A Randomized Controlled Trial Protocol.

Background: Despite proven benefits, intelligent personalized exercise prescription (IPEP) adherence remains low in middle-aged and older adults with chronic diseases (MOACD). Research evidence suggests that mobile health (mHealth)-based gamification interventions can improve participation in physical activity; however, their effects on adherence to IPEP remain unclear. Moreover, most studies report that adherence often declines rapidly once gamification interventions end, and no effective strategies have been proposed to address this issue. This study embeds the Octalysis gamification framework into a smartphone-based app to investigate the effects of an mHealth-based gamification intervention on adherence to IPEP among MOACD, as well as on related physical and psychological outcomes. Additionally, the study examines whether combining gamification interventions with health education can help sustain adherence after the intervention concludes. Methods: We propose a double-center, single-blind, three-arm randomized controlled trial. We will recruit 132 MOACD who will participate in dyads (66 pairs). Participants will be randomly assigned to three groups: a non-gamification group, a gamification group, or a health education plus gamification group. The intervention will last for 12 weeks, followed by a 12-week follow-up period. The primary outcome is adherence to IPEP, defined as the proportion of days on which participants completed their prescribed exercise tasks at 12 and 24 weeks. Secondary outcomes include biomedical risk factors, sedentary behavior, sleep quality, self-efficacy, intrinsic motivation, patient satisfaction, and the acceptability of the intervention. Conclusion: This trial employs the Octalysis gamification framework to design an intervention aimed at enhancing adherence to the IPEP. The findings may inform the development of scalable digital interventions to promote physical activity and long-term adherence among MOACD.