A team of nursing researchers in China just published a scoping review in JMIR Serious Games that uses The Octalysis Framework to sort out how physical activity interventions are gamified.
The paper is “Gamification Elements in Physical Activity Interventions: Scoping Review and Taxonomy Based on the Octalysis Framework” by Sijia Li, Li Qiao, Rui-Ning Wang, Runyuan Pei, Hao-Ming Ma, and Mei-Hua Piao. It went online on September 25, 2026 (DOI: 10.2196/85804).
I want to thank the authors properly, explain what they found in plain language, and point to the one finding I think every fitness and health designer should spend time with.
⚡ Speed Run Notes
- The review covers 53 randomized controlled trials and 34 unique physical activity interventions, pulled from seven research databases.
- The authors built a taxonomy of 48 gamification elements, such as narrative, mentoring, and points loss, organized across the 8 Core Drives of Octalysis.
- Most of the behavior change techniques in those trials mapped to empowerment and accomplishment, which in The Octalysis Framework line up with Core Drive 3 (CD3): Empowerment of Creativity & Feedback and Core Drive 2 (CD2): Development & Accomplishment.
- Some behavior change techniques had no gamification element supporting them, and that gap is the most useful part of the paper for designers.
In This Article
- Author Credibility: Yu-kai Chou
- Who Wrote It and What They Set Out to Do
- 48 Gamification Elements Across the 8 Core Drives
- Where the Behavior Change Techniques Clustered
- The Gap They Found
- What This Review Does Not Claim
- Why Physical Activity Matters to Me
- One of More Than 3,700 Citations
- FAQs
- Thank You to the Authors
Author Credibility: Yu-kai Chou
Yu-kai Chou created the Octalysis Framework after studying gamification since 2003 — years before the term entered mainstream vocabulary. As a Human-Systems Architect & Behavioral Designer, his framework has been applied by LEGO, Microsoft, Porsche, Coca-Cola, Salesforce, and MrBeast, impacting over 1.5 Billion Users.
Chou has taught the Octalysis methodology at Harvard, Stanford, Yale, Tesla, Google, BCG, and IDEO.
His work has been cited by Harvard, Stanford, MIT, Forbes, Wall Street Journal, Wired, US Department of Energy, NIST, NSF, NCBI, US Department of Education, ClinicalTrials.gov, and Google Scholar — with 3,700+ more academic publications. Explore his books here.
This post covers a 2026 JMIR Serious Games scoping review that used The Octalysis Framework to map 48 gamification elements across 53 physical activity trials.
Who Wrote It and What They Set Out to Do
Five of the six authors are at the Peking Union Medical College School of Nursing, part of the Chinese Academy of Medical Sciences in Beijing. Rui-Ning Wang is with the Department of Nursing at West China Hospital, Sichuan University.
Their starting point is a public health problem. In the abstract’s words, “Physical inactivity affects approximately 1.4 billion adults globally.”
Earlier reviews mostly asked whether gamified exercise programs work. This team looked at how those programs are designed, and which motivations and behavior change functions the game elements are aimed at.
They registered the protocol in advance with PROSPERO (the International Prospective Register of Systematic Reviews), followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), and searched seven databases, including PubMed, Embase, and Web of Science. They kept only randomized controlled trials (RCTs), and they ended up with 53 RCTs covering 34 unique interventions.
48 Gamification Elements Across the 8 Core Drives
Using The Octalysis Framework, the team built a taxonomy of 48 gamification elements spread across eight core motivational drives. The abstract names narrative, mentoring, and points loss as examples.
If you are new to it, The Octalysis Framework is an octagon where each side is a Core Drive, one of the eight basic reasons people feel motivated to do anything.
The abstract describes it in one line as a framework “which emphasizes human motivation over mere functionality.”
That line is close to how I have always described gamification, which I call Human-Focused Design as opposed to Function-Focused Design. Most systems are built to get a job done efficiently, and then designers look for places to stick points and badges. Octalysis starts from the feeling a person has and works backward to the feature.
The team then mapped each element to behavior change techniques (BCTs). BCTs are a standardized list that health researchers use to describe what an intervention is trying to change. The two most common BCTs across the trials were “2.2 feedback on behavior” and “1.1 goal setting (behavior).”
Where the Behavior Change Techniques Clustered
The finding every health designer should spend time with is this sentence from the abstract: “The majority of BCTs were mapped to 2 core motivations (ie, empowerment and accomplishment).”
According to The Octalysis Framework, the first of those is Core Drive 3 (CD3): Empowerment of Creativity & Feedback, which is the feeling that your choices matter and you can see what they changed. The second is Core Drive 2 (CD2): Development & Accomplishment, which is the feeling of getting stronger and having proof of it.
That lines up with the two most common techniques. Feedback on behavior is the heart of CD3, and goal setting in an exercise app usually shows up as progress toward a target, which is how CD2 tends to appear in a product.
Both of these sit at the top of the octagon, which makes them White Hat Core Drives. White Hat motivation makes people feel good and in control, which is what you want for a habit someone has to keep for years.
The tradeoff is that White Hat motivation doesn’t create much urgency. An element like points loss is a different animal, because in my framework’s terms it runs on Core Drive 8 (CD8): Loss & Avoidance, which is the feeling of wanting to protect something you already have. The paper’s full mapping is in the article, so check it there rather than relying on my reading of the element names.
The Gap They Found
The same sentence in the abstract continues with a gap: “some BCTs were not supported by gamification elements.”
In plain terms, the behavior science says a certain lever should be pulled, and the game layer in these trials does nothing to help pull it. The abstract doesn’t list which techniques those are, so read the full paper before you design around it.
If you build fitness or health products, that list is a good place to look for your next feature. In these trials most of the design work clustered around feedback and progress, so the unsupported techniques are where a design team can do something different.
What This Review Does Not Claim
I also appreciate what the authors refuse to overstate. They write that their findings “should not be interpreted as evidence of the effectiveness of individual gamification elements.”
That caveat matters because a taxonomy can easily get treated like a recipe. Knowing that 48 elements exist, and which drives they touch, tells you what designers have tried, but it doesn’t tell you that adding a leaderboard will make anyone walk more.
The authors call for more research on how specific design configurations affect engagement and physical activity outcomes.
Why Physical Activity Matters to Me
Earlier this year I wrote about play-based weight loss. I explained there that I don’t have the discipline to win through tracking and accountability, so I leaned on fun, curiosity, and play instead.
Seeing a research team ask the same kind of question across 53 trials is useful to me as a designer and as someone who has had to apply this to my own body.
If you want the product side, I have also broken down the best gamified fitness apps and healthcare gamification apps that work through the same lens.
One of More Than 3,700 Citations
This review cites my book Actionable Gamification: Beyond Points, Badges, and Leaderboards directly. It also cites a 2023 bibliometric analysis of how the Octalysis Framework is used in training research, published in Humanities and Social Sciences Communications.
As of September 29, 2026, my Google Scholar profile lists 3,712 citations, most of them for Actionable Gamification. I keep an index of the institutional ones, from Harvard to NIST to the NIH, on my academic research and citations page.
Many of those citations come from fields I don’t work in myself, such as nursing, education, and cybersecurity training.
A nursing team using the framework to map 53 exercise trials shows how far it has traveled from the product design problems I started with.
FAQs
What is the JMIR Serious Games Octalysis review?
It is a 2026 scoping review by Li, Qiao, Wang, Pei, Ma, and Piao that uses The Octalysis Framework to classify 48 gamification elements found in 53 randomized controlled trials of physical activity interventions. You can read it at games.jmir.org or through DOI 10.2196/85804.
Does the review prove that gamification increases physical activity?
No. The authors describe it as a descriptive, design-oriented evidence map, and they say the findings should not be read as evidence that individual gamification elements are effective.
Where can I learn The Octalysis Framework in depth?
The full system is in Actionable Gamification. If your organization wants help applying it to a health or wellness program, that is the kind of work The Octalysis Group does.
Thank You to the Authors
Thank you to Sijia Li, Li Qiao, Rui-Ning Wang, Runyuan Pei, Hao-Ming Ma, and Mei-Hua Piao for doing this work so carefully and for building on Octalysis in a field that needs better design.
The article is in JMIR Serious Games, volume 14, e85804, and I would start with the section on unsupported behavior change techniques.