Patel MS, Small DS, Harrison JD, et al. - Via a randomized clinical trial involving 602 overweight and obese adults from 40 states across the United States, researchers evaluated the efficiency of support, collaboration, and competition within a behaviorally designed gamification intervention to enhance physical activity among overweight and obese adults. In comparison with controls, participants had a significantly greater rise in mean daily steps from baseline during the intervention in the competition arm, support arm, and collaboration arm. During follow-up, physical activity continued to be significantly greater in the competition vs the control arm; however, it was not significantly greater in the support and collaboration arms in comparison with the control arm. Thus, all three gamification interventions significantly raised physical activity during the 24-week intervention, and the competition was the most efficient. In all arms during follow-up, physical activity was lower and only persisted to be significantly greater in the competition arm vs the control arm.