On Dec. 16, 2025, The largest-ever study testing the effectiveness of an evidence-based approach to increasing physical activity using smartphone fitness trackers gamification to reduce the risk of cardiovascular disease launched at the Perelman School of Medicine at the University of Pennsylvania and Ascension, one of the nation’s leading non-profit health systems , thanks to a $25 million award.

The six-year study, funded by the Patient-Centered Outcomes Research Institute (PCORI), will build on the highly successful BE ACTIVE trial, published in 2024, which demonstrated sustained increases in daily step counts using a behavioral economics based approach to gamification to enhance ongoing engagement, where participants were awarded points for meeting daily step goals and progress through levels based on accumulated points.

This new study will enroll 18,000 adults with at least a 1-in-10 chance of having a heart attack, stroke, hospitalization for heart failure, or dying from heart disease within the next decade, as calculated by the American Heart Association PREVENT equations.

The trial is fully remote from start to finish and requires no office visits. Participants simply use the technology that already exists in nearly every smartphone; a tiny sensor called an accelerometer that measures movement and motion.

Those taking part in the trial will establish a baseline step count over two weeks and then set a goal to increase their daily step count by 33-50% above their own baseline. They will then be entered into a game designed using principles from behavioral economics, in which they receive points each week and lose points on days they miss their goal. Participants get a text message each day letting them know if they met their goal or not. As they earn or lose points, they move up and down to different levels of the game. A support partner, identified by each participant, will receive weekly updates on how the participant is doing.