The scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) [22]. The study was registered on the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420251077817). The review was originally registered in PROSPERO as a systematic review. Following editorial guidance and reconsideration of the review objectives, we revised the study as a scoping review because the primary purpose was evidence mapping and taxonomy development rather than pooled effectiveness estimation. This methodological change is reported transparently as a deviation from the original registration.

The seven databases (ie, PubMed, Embase, Cochrane library, Web of Science, CINAHL, SPORTDiscus, and PsycINFO) were selected and searched for relevant randomized controlled trials (RCTs) published in English from inception to February 28, 2025. The searches were updated on July 7, 2026, by rerunning the database-specific search strategies in all seven databases. No limits on language, age, sex, health condition, or publication date were applied during the database search. Terms relating to RCTs were incorporated into the search strategies because the review was restricted to interventions evaluated using an RCT design. Relevant previous reviews were consulted to identify potentially relevant terminology; however, no previous search strategy was substantively reused or adapted [11,12]. The search strategy was developed specifically for the objectives of the present review. The systematic search was developed and reported in accordance with the PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension) guidelines [23]. The comprehensive search strategy, including all controlled vocabulary (eg, MeSH and the Embase subject headings EMTREE terms), field modifiers, and synonyms used across all seven databases, is detailed in Supplementary Table 1 in Multimedia Appendix 1, and the completed PRISMA-S checklist is provided in Checklist 1. The search strategy was internally reviewed by another member (MHP) of the review team for conceptual relevance, completeness, and database-specific syntax. Although CINAHL, SPORTDiscus, and PsycINFO were accessed through Elton B. Stephens Company host (EBSCOhost; EBSCO Information Services), each database was searched separately; therefore, no simultaneous multidatabase search was performed. No clinical trial registries were searched. In addition, no other online or print sources, such as websites, tables of contents, or conference proceedings, were purposefully searched or browsed. The review focused on published full-text RCT reports because sufficiently detailed descriptions of intervention components were required for the reliable coding of gamification elements and BCTs.

Backward and forward citation searching was conducted for all included RCT reports. For backward citation searching, the reference lists of these articles were examined. For forward citation searching, articles citing these reports were identified using Web of Science Core Collection and OpenAlex. Citation searching was completed on July 21, 2026. All newly identified records were deduplicated and screened according to the same eligibility criteria applied during the main database screening process. No additional search methods were used beyond database searching and backward and forward citation searching. Authors were contacted through ResearchGate to request full-text articles that could not otherwise be accessed.

All retrieved studies were imported into EndNote 21 (Clarivate). Duplicate records were identified using the find duplicates function in EndNote. The deduplicated records were exported to the Rayyan website (Rayyan Systems, Inc.) for the study selection process [24]. Two authors (SJL and RNW) independently screened the titles and abstracts of the retrieved studies, and the full texts of potentially eligible studies were reviewed to finalize the included studies. Any disagreements were resolved by a third author (QL).

Articles were considered eligible if they met the following criteria according to the PCC framework (Population, Concept, Context):

Conference papers and full-text articles with missing or inaccessible extracted data were excluded. Only full-text reports published in English were eligible for inclusion.

Data were charted using a standardized Excel (Microsoft)-based form developed according to the review objectives and the prespecified data items. The form was initially tested on a subset of included studies and refined to improve clarity and consistency before full data charting. One reviewer (SJL) charted the data, and a second reviewer (QL) verified all charted information. Any discrepancies were resolved through discussion and, when necessary, consultation with a third reviewer (MHP). When multiple reports described the same intervention, the reports were treated as one unique intervention for the analysis of BCTs and gamification elements, while study characteristics and outcomes were charted separately for each report. Information was obtained from the main articles and, where available, associated protocols, supplementary materials, intervention screenshots, and other reported intervention materials. When relevant information remained unclear or unavailable, the study authors were contacted for clarification or access to additional materials.

Articles information (ie, author, year, country, and study arms), population characteristics (including health status, sample sizes, average age, and sex distribution), intervention and control descriptions, primary and secondary outcomes, and study conclusions were charted. To provide a comprehensive understanding of behavior change interventions using gamification strategies, the following information was also charted:

Charted data were synthesized using descriptive statistics and qualitative conceptual mapping. Basic study characteristics, intervention descriptions, and diverse outcome domains were summarized narratively and presented in tabular formats. To address the primary objectives and construct the taxonomy, gamification elements were categorized into the 8 core drives of the Octalysis Framework, and identified BCTs were aggregated by frequency. Finally, a cross-mapping analysis between the BCTs and gamification elements was conducted. Data visualizations, including evidence gap maps, were generated to illustrate research concentrations and explicitly identify behavioral strategies currently lacking corresponding gamification support.

The complete literature selection process is illustrated in Figure 1. A total of 9242 records were identified through database searches. After removing 3929 duplicates using EndNote 21, the titles and abstracts of 5313 studies were screened. Among these, 5225 records were excluded for failing to meet the eligibility criteria, leaving 88 studies for full-text review. Following this, 35 records were excluded due to wrong study design (n=2), wrong intervention (n=24), wrong outcome (n=6), duplicates (n=2), and full-text unavailable (n=1; reasons documented in Table S3 in Multimedia Appendix 4). Ultimately, 53 RCTs were included in this review [26-78].

Backward citation searching identified 2682 records, and forward citation searching identified 2641 records, resulting in 5323 records in total. After 1803 duplicate records were removed, 3520 unique records remained. A further 110 records had already been identified and screened through the database searches, leaving 3410 additional records for screening. Of these, 925 review articles were excluded because they did not meet the eligible study design criterion, leaving 2485 records for further screening. Finally, no additional eligible RCTs were identified through backward or forward citation searching.

The characteristics of the 53 included studies are summarized in Table 1. The RCTs were published between 2014 and 2026. Among them, 20 studies (20/53, 37.74%) were conducted in the USA, 17 (17/53, 32.08%) in European countries, 9 (9/53, 16.98%) in Asia, 2 (2/53, 3.77%) in Canada, 2 (2/53, 3.77%) in Australia, 1 (1/53, 1.89%) in New Zealand, and 2 (2/53, 3.77%) in Brazil. Most of the studies (n=40) implemented a 2-arm RCT design, while 8 studies used a 3-arm design, 4 used a 4-arm design, and 1 study used a 5-arm RCT design. The included studies encompassed a diverse range of populations, such as insufficiently active adults, cancer survivors, and individuals who were overweight or obese. Sample sizes varied from 12 to 1062 participants, and mean participant ages ranged from 4.9 to 70.4 years. Two studies included only male participants, while one study included only female participants [45,46,57].

The characteristics of the study interventions are summarized in Table S2 (Multimedia Appendix 5). A majority of studies (38/53, 71.70%) incorporated a theoretical basis to guide the design of gamification interventions. These included behavioral economics principles (n=16), SDT (n=12), socio-cognitive theory (n=3), theory of planned behavior (n=3), health action process approach model (n=1), behavior change techniques (n=5), attribution theory (n=2), cognitive evaluation theory (n=1), transtheoretical model (n=2), self-regulation theory (n=1), fun theory (n=1), and social network theory (n=1), and the social identity approach (n=1). The duration of the interventions ranged from 1 to 48 weeks, with an average length of 14.4 weeks. Moreover, the types of systems used in these interventions varied, mainly consisting of software-based digital technologies (ie, applications, websites, and text messages) alongside hardware-based digital technologies (ie, wearable devices, accelerometers, and weight scales).

Table S2 (Multimedia Appendix 5) details the specific outcome changes observed in each included study, whereas Table 2 synthesizes the targeted outcome domains and the significance of intervention effects across studies. Collectively, these tables offer a comprehensive understanding of outcome selection and the effects of gamification interventions in the original studies. Among 53 studies included, outcomes were classified into 5 categories: PA-related outcomes, psychological outcomes, health outcomes, user retention outcomes, and knowledge-related cognitive outcomes. PA-related outcomes were reported 59 times, including step counts (n=34), minutes of moderate to vigorous physical activity (MVPA; n=13), minutes of walking (n=3), self-reported PA (n=5), PA intensity (n=1), PA frequency (n=1), and total amount of PA (n=2). Of these, 40 outcomes demonstrated statistically significant effects. Psychological outcomes are another area that has drawn researchers’ attention, particularly the constructs that support the theoretical foundations used in the studies. These outcomes included competency (n=3), PA self-efficacy (n=3), perceived enjoyment (n=2), autonomy (n=2), relatedness (n=2), PA motivation (n=2), as well as intention to engage in PA (n=1), life satisfaction (n=1), and mental well-being (n=1). Health outcomes were assessed in 8 of the included studies, with 5 showing significant results. User retention was examined in 4 studies, half of which reported statistically significant findings. Additionally, 2 studies whose interventions incorporated knowledge components also examined knowledge-related cognitive outcomes, with one reporting a significant effect.

Among the 53 selected studies, 34 unique and independent interventions were included, with some interventions being repeated across different studies. Therefore, the BCT element analysis was conducted exclusively on these 34 distinct interventions. The most frequently used BCT categories were “2 feedback and monitoring” (34/34, 100%), “1 goals and planning” (31/34, 91.18%), and “6 comparison of behavior” (28/34, 82.35%), followed by “3 social support” (26/34, 76.47%), “10 reward and threat” (26/34, 76.47%), “12 antecedents” (17/34, 50.00%), “7 associations” (15/34, 44.12%), “4 shaping knowledge” (13/34, 38.24%), and “8 repetition and substitution” (9/34, 26.47%). The three least frequently used BCT categories were “5 natural consequences” (6/34, 17.65%), “9 comparison of outcomes” (3/34, 8.82%), and “11 regulation” (3/34, 8.82%).

The frequency of BCT element adoption is illustrated in Figure 2. Five BCTs were used in more than half of the included interventions: “2.2 feedback on behavior” (32/34, 94.12%), “1.1 goal setting (behavior)” (31/34, 91.18%), “6.2 social comparison” (27/34, 79.41%), “2.3 self-monitoring of behavior” (27/34, 79.41%), and “10.3 nonspecific reward” (23/34, 67.65%). Moreover, more than 30% of the specific interventions used the following 5 BCTs, “12.5 adding objects to the environment” (15/34, 44.12%), “7.1 prompts or cues” (15/34, 44.12%), “4.1 instruction on how to perform the behavior” (13/34, 38.24%), “3.1 social support (unspecified)” (12/34, 35.29%), and “3.3 social support (emotional)” (12/34, 35.29%).

The BCT—gamification element mapping showed that several BCTs were conceptually aligned with gamification elements through shared motivational targets. The detailed mapping results are shown in Figure 4. The majority of BCTs were mapped to empowerment (n=10) and accomplishment (n=5), with no BCTs classified under the core motivations of scarcity or unpredictability. Feedback on or outcomes of behavior and social support were represented by the widest range of gamification elements, with 8 and 5 elements mapped to these BCTs, respectively. Some BCTs (ie, information about consequences, review behavior goals, conserving mental resources, credible source, action planning, demonstration of the behavior, behavioral contract, and problem solving) were not explicitly represented by gamification elements in the included interventions, suggesting potential gaps in the integration of reflective, planning-oriented, and instructional BCTs into gamified PA intervention designs.

The scoping review mapped the evidence on gamification elements used in PA interventions, categorized these elements according to the Octalysis Framework, and identified their links with BCTs. Following a comprehensive search across seven databases, 53 RCTs and 34 unique interventions were included in this review. The majority of studies were conducted in developed regions, such as the USA and European countries. These studies targeted diverse populations, including individuals both with and without medical conditions, spanning age groups from children to older adults. Behavioral economics principles emerged as the most commonly applied theoretical framework. Most interventions were integrated with digital hardware technologies, such as wearable devices. The studies reported a variety of outcomes, including user retention, behavioral changes, psychological impacts, and health-related indicators. The most frequently adopted BCT elements were “2.2 feedback on behavior” and “1.1 goal setting (behavior).” Moreover, using the Octalysis framework, 48 gamification elements across 8 core motivational drives were identified among the 34 interventions. These findings offer meaningful insights for informing the design of future gamification strategies aimed at promoting PA.

The main contribution of this review is not to estimate the overall effectiveness of gamified PA interventions, but to show how these interventions are designed. Specifically, this review provides 3 main findings: a summary of existing gamified PA trials, a classification of the gamification elements used in these interventions based on the Octalysis framework, and a comparison between these gamification elements and BCTs. Together, these findings show how game design is used to support motivation in current interventions and highlight areas where intervention design could be improved. The resulting taxonomy and mapping may serve as a design-oriented resource for researchers and digital health developers by supporting the more deliberate selection, combination, and reporting of gamification elements according to the intended motivational and behavioral objectives of future PA interventions.

Gamification interventions in PA promotion have rapidly emerged and developed over the past decade, with the majority of studies conducted in developed countries. However, the reach of these interventions may be limited in developing and underdeveloped regions, where access to technology and health care resources is often restricted. This raises concerns about health equity, as disadvantaged populations may be left out of the potential benefits of gamified PA programs [79]. Future research should focus on addressing these barriers, considering the technological and socio-economic challenges faced by underserved areas.

Behavioral economics principles were the most frequently used theoretical framework in the 53 studies, with 13 of these studies conducted by a team from the University of Pennsylvania, USA, who applied these principles to guide their interventions. Although widely accepted and used in original studies, the long-term sustainability of behavioral economics-informed interventions to promote PA remains uncertain [80,81]. This may be due to the fact that behavioral economics principles primarily rely on strategies and techniques such as loss aversion, prospect theory, and nudges, which provide short-term incentives to influence immediate health behavior decisions [82]. However, these interventions are often driven by short-term interests, and without continued incentives, the health behavior changes are unlikely to be sustained [83]. Another commonly used theory was SDT, which highlights the crucial role of motivation in promoting behaviors. Compared to other theoretical frameworks, it has the potential to foster long-term health behaviors if individuals’ autonomous or intrinsic motivation is effectively stimulated [8]. Therefore, different theories serve distinct purposes, reflecting different motivational pathways and intervention design priorities. Future research should examine how different theoretical traditions are represented and operationalized in gamified PA interventions and how they may support different motivational mechanisms. Intervention duration is a crucial aspect of intervention design, as the timeframe plays a key role in establishing sustainable health behaviors such as PA. In the included studies, the average intervention period was 14.4 weeks, falling short of the recommended 24-week duration needed for PA maintenance [84,85]. Therefore, more long-term intervention studies are needed in the future to better understand longitudinal changes in PA behavior and to refine intervention design, reporting, and long-term evaluation.

The outcomes examined in the 53 included studies varied, covering aspects such as user retention, psychological responses, behavioral changes, and health-related indicators, reflecting the full pathway of health behavior change. Gamification, as a persuasive technology, plays a critical role in supporting this process by enhancing user retention [86]. Continued engagement with gamified elements may influence users’ psychological states, which can subsequently drive behavioral changes like increased PA, and may contribute to improved health-related outcomes. The included studies reported heterogeneous outcome patterns, with light PA, such as step counts and minutes of walking, showing the most significant improvements. To achieve greater health benefits, future research should focus more on moderate to vigorous PA, as well as the psychological responses that underpin these behaviors.

The three most commonly used BCTs were “2.2 feedback on behavior,” “1.1 goal setting (behavior),” and “6.2 social comparison.” These techniques are popular due to their broad acceptance and ease of implementation. However, this distribution indicates that current gamified PA interventions rely heavily on a small group of BCTs. Given the complexity of behavioral interventions, assessing the effectiveness of any single BCT is challenging. Rather than focusing on the quantity of BCTs used, the quality of their application is of greater importance [87,88]. Taking “2.2 feedback on behavior” as an example, feedback can vary in terms of being generalized or personalized, static or dynamic, and visualized or nonvisualized, all of which significantly impact user experiences [89]. Therefore, the integration of BCTs with design strategies is crucial, yet also challenging. The mapping also revealed several BCTs that were weakly represented or not clearly embodied by gamification elements, such as action planning, problem solving, credible source, and information about consequences. These gaps suggest that future gamified PA interventions should more deliberately align game mechanics with behavior change functions, rather than simply adding more game elements.

To the best of our knowledge, this is the first review to comprehensively summarize the use of gamification elements in existing published PA promotion applications, providing a valuable reference for the design of future gamified PA interventions. The core contribution and essence of the Gamification Octalysis Framework lies in its ability to connect gamification elements with individual motivation [16]. From the perspective of human-focused design, it emphasizes that personal motivation takes precedence over functionality [16]. The framework identifies 8 core motivational drives. Our findings show that the accomplishment drive was the most commonly used, as the gamified elements associated with this drive were easy to implement. Traditional gamified elements, such as points, badges, and leaderboards (PBL), were categorized under this drive. However, the presence of a gamification element alone does not necessarily indicate that its intended motivational mechanism has been achieved. Another significant contribution of the Gamification Octalysis Framework is its classification of core drives into intrinsic motivation (ie, empowerment, social influence, and unpredictability) and extrinsic motivation (ie, accomplishment, ownership, and scarcity) [16]. The ultimate goal of PA stimulation may lie in the combined use of both extrinsic and intrinsic gamified elements, with the transformation of extrinsic motivation into intrinsic motivation based on SDT [8].

Beyond the use of gamified elements, the underlying rules and mechanisms of these games may play an even more crucial role. The design of gamification presents a significant challenge in current PA promotion applications. Involving users in the design of gamification elements could offer a potential solution to this problem [90,91]. Other approaches, such as personalization, should also be taken into account when designing future gamification interventions [92,93]. Taken together, these findings suggest that future gamified PA interventions should be designed by first identifying the intended motivational pathway, rather than by simply adding common game elements. For example, if the goal is to support competence and progress, accomplishment-based elements such as goals, levels, progress bars, and feedback may be appropriate; if the goal is to strengthen social connectedness, social influence elements such as group quests, peer support, and shared challenges may be more suitable. The mapping between gamification elements and BCTs also suggests that future interventions should give more attention to underrepresented behavior change functions, such as action planning, problem solving, and information about consequences. Therefore, the design value of this review lies in helping researchers select game elements more deliberately and align them with both motivational drives and behavior change functions.

Firstly, we exclusively included RCTs in this review, while we acknowledge that other types of study designs, such as quasi-experimental studies, have also investigated gamified PA application interventions, our focus on RCTs was intentional. We limited the sources of evidence to RCTs because our objective was to map gamification elements and BCTs in interventions that had been formally tested. However, this decision may have excluded formative studies, feasibility studies, qualitative evaluations, and design papers that could contain innovative or emerging gamification elements. Secondly, we identified BCTs and summarized the gamification elements present in the 34 unique interventions included in our review. Although the coding was conducted independently by 2 researchers (SJL and LQ) and discrepancies were resolved through discussion, the process is inherently subject to some degree of subjective interpretation. This subjectivity may have influenced the final coding outcomes. Thirdly, due to the wide range of outcomes assessed across the original RCTs and the limited number of studies reporting each specific outcome, we were unable to perform a meta-analysis to quantitatively estimate pooled effects. Instead, we provided a descriptive summary of reported outcome patterns. Nevertheless, the primary focus of this review was the systematic identification and analysis of gamification elements, guided by the Gamification Octalysis Framework. Lastly, although the eligibility criteria allowed studies involving any human population, the identified evidence was predominantly based on adults, with only a small number of studies involving children or adolescents. Therefore, the findings of this review should be interpreted mainly in relation to adult populations and generalized to children and adolescents with caution.

This scoping review complements previous effectiveness-focused reviews by examining how gamified PA interventions are designed and which motivational and behavior change functions they target. By developing an Octalysis-based taxonomy of 48 gamification elements and mapping these elements against BCTs, this review provides a descriptive, design-oriented evidence map of commonly used design patterns and underrepresented behavior change functions. The findings may support more deliberate and transparent selection, combination, and reporting of gamification elements in future PA interventions. However, they should not be interpreted as evidence of the effectiveness of individual gamification elements, and further research is needed to evaluate how specific design configurations influence engagement and PA outcomes.