Gotta catch’em all! Pokémon GO and physical activity among young adults: difference in differences studyBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6270 (Published 13 December 2016) Cite this as: BMJ 2016;355:i6270
All rapid responses
Pokémon Go instantly became a worldwide phenomenon as soon as it was released. However it was banned in Saudi Arabia where involvement in physical activity is very low. We therefore read with great interest the study of the effect of this software application (app) on physical activity by Howe et al., 2016. Whilst most apps engender sedentary behavior; this augmented reality roaming game increased physical activity and may even have improved health.
This increase in activity, and by inference, enjoyment of the game, was not sustained. However even short term increases in physical activity may significantly improve long term outcomes in specific situations. Pre-operative exercise interventions (prehabilitation), for example, can reduce postoperative complications. So, the use of apps to promote physical activity alongside prehabilitation programs could reduce peri-operative morbidity and mortality.
There are many reasons why the initial mania surrounding Pokémon Go faded away. Players often lose interest when they complete all the available challenges i.e. when they ‘caught them all’. Presumably the developers did not receive sufficient financial incentive to continue to actively update Pokémon Go with new challenges or characters to unlock. These revenues could be significantly increased by tapping into new markets such as Saudi Arabia where smartphone use is high and participation in physical activities is among the lowest in the world.
Vision 2030 for the Kingdom of Saudi Arabia aims to reverse this effect of the ‘camel to Cadillac transition’ and increase the ratio of Saudis exercising at least once a week from 13% to 40%. To achieve this new parks and sports facilities have been developed and gym memberships have been subsidised. Sadly, these initiatives have been largely ineffective despite the weather in Saudi Arabia which is tolerable for more than six months of the year.
Pokémon Go would seem to be an entertaining solution to this problem of physical inactivity. However, the game play involves gambling, which is prohibited in Islam. So when Pokémon Go spread to Saudi Arabia the General Secretariat of the Council of Senior Scholars renewed their previous ‘fatwa’ (law) which forbade Muslims from playing with Pokémon.
This ban was of relatively little consequence to Saudis because the lack of an Arabic language setting limited the uptake of Pokémon Go far more than the fatwa. However this element of gambling will certainly have reduced use of Pokémon Go by Muslims throughout the world.
Participating in public physical activities is particularly difficult for women in Saudi Arabia. Their movement is restricted; women are not allowed to drive, a ‘mahram’ (male chaperone) is often required when they go out and most public places are segregated. Some Saudi women did overcome these challenges with their drivers; gathering at PokéStops, exploring new areas of cities and interacting with other Pokémon trainers.
However, playing the game is not without risk. Gamers who ignored safety advice have caused road traffic accidents (RTA), trauma and even some deaths whilst trying to catch Pokémon. Deaths from RTA account for 4.7% of all fatalities in Saudi Arabia and have increased from 17.4 to 24 per 100,000 people over the last decade (compared with 5 per 100,000 in the UK). Further increase is highly undesirable. These injuries could easily be prevented by minor changes to the game such as ensuring that reality is not augmented near roads.
Unfortunately, it is possible to manipulate the game. Players can jiggle their phones or drive rather than walk or run to catch Pokémon. It is therefore unlikely that the physical activity of Pokémon trainers in Saudi Arabia would increase as much as those in the American cohort studied by Hunt et al., 2016.
Other apps that promote physical activity include Strava Running, Fitness Buddy and JEFIT Workout Tracker. The use of Fitness Buddy in particular has exploded in Saudi Arabia because of its accessibility, ease of use and availability at home as well as in the gym. Its use has been sustained by regular updates with new challenges and leader boards that promote competition with friends and family. Similar apps have been shown to increase physical activity. However these apps have been developed for people who want increase their fitness and so are less appealing to the general population than games like Pokémon Go.
Apps are powerful modern tools for social engineering which can engage individuals of all ages, creeds, and cultures. By considering ergonomics, providing Arabic language settings, embracing Islamic values in game design and improving safety, developers could insidiously improve population health within the Middle East whilst boosting their revenues. Healthcare professionals may be able to increase uptake of exercise based interventions (e.g. prehabilitation) and thereby improve outcomes by ‘prescribing’ the use of apps that promote physical activity.
1. Sisson SB, Katzmarzyk PT. International prevalence of physical activity in youth and adults. Obesity Reviews. 2008;9:606-614
2. Howe KB, Suharlim C, Ueda P, Howe D, Kawachi I, Rimm EB. Gotta catch'em all! Pokémon GO and physical activity among young adults: difference in differences study. BMJ. 2016;355:i6270.
3. Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, Moriarty J, Wilson F. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: A systematic review and meta-analysis. Surgery. 2016;160:1189-1201.
4. Vision 2030 for the Kingdom of Saudi Arabia. http://vision2030.gov.sa/sites/default/files/report/Saudi_Vision2030_EN_... (downloaded 22/12/160
5. Mansuri FA, Al-Zalabani AH, Zalat MM, Qabshawi RI. Road safety and road traffic accidents in Saudi Arabia. A systematic review of existing evidence. Saudi Med J. 2015;36:418-24.
6. Coughlin SS, Whitehead M, Sheats JQ, Mastromonico J, Smith S. A Review of Smartphone Applications for Promoting Physical Activity. Jacobs J Community Med. 2016;2 pii: 021.
Competing interests: No competing interests
I Wanna Be the Very Best! Ideas on how to bolster adherence to health promoting games based on the Pokémon GO experience.
Despite being directly related to well-known, dire physical (e.g. high blood pressure, heightened risk of developing coronary diseases and obesity) and psychological (e.g. heightened risk of anxiety and depression) consequences, physical inactivity remains rampant among adolescents and young adults [1,2]. This trend of physical inactivity starts at a young age: only 29% of high school students report engaging in at least 60 minutes of physical activity during last week, while 15.2% of adolescents reported doing no physical activity whatsoever. This tendency continues as people age . While health authorities have seized the problem, for example by creating guidelines to help teachers promote physical activity among students, other ways of changing health behaviours have recently emerged that do not incur strong involvement and commitment from people, such as nudges  or, notably for psychiatric and addiction issues, the use and gamification of Cognitive Bias Remediation Procedures . Following that trend, the release in early July 2016 of the smartphone application “Pokémon GO” (Niantic, Inc) caught our attention. Claims of its -at the time- supposed beneficial effects on health and physical activity flourished , soon supported by empirical data , culminating with Howe et al. (2016)’s publication in the BMJ . A central finding of Howe and collaborators paper is that players’ motivation to play unfortunately declines quickly, which considerably reduces beneficial outcomes in terms of improved physical activity.
We believe that Howe and collaborators’ paper provides crucial data on the “gamification” of health-based intervention, as they were able to show that an authentic - or “real”- game, has measurable although unintentional effects on a target behaviour. Participants in their study, however, were not authentic players but people who started playing for the sake of the study. We believe that at least a part of the dropout effect they encountered can be attributed to the fact that people did not decide to play in the first place for intrinsic reasons. If one wanted to promote a given game for its side beneficial health outcomes, one should look at the factors that maintain actual players active and willing to play. The challenge is then to identify the factors, cognitive or motivational, that predict maintaining playing in the long run. The question is, which reasons would make one keep on playing and, as a side effect, sustain his efforts? Furthermore, what are the cognitive factors that could lead one to get involved, and be more likely to maintain playing one the long term?
To answer these questions, we conducted a two-phase study on actual Pokémon GO players from many English- (i.e., the USA, the UK, Ireland, Canada, Australia and New Zealand) and French-speaking countries (i.e. France, Switzerland, Belgium and Canada). Participants were recruited through social media and especially through Pokémon GO Facebook groups. Four hundred and two participants (55% female) completed the first phase of the study in August 2016 when they had been playing for 4 to 92 days (M = 50, SD = 11). They provided some indicators from their game statistics and completed an extensive assessment of personality traits, such as a personality inventory (i.e. HEXACO), measures of trait Impulsivity (i.e. UPPS), Need for Closure (NFCS), Competitiveness (RCI), Need for Cognition (NFC) and Self-Efficacy (GSE). Participants had been walking an average of 2.56 km/day (SD = 2.00), with men (M = 3.06, SD = 2.23) walking significantly more than women (M = 2.15, SD = 1.70), b = -.71 [-1.07, -.36], t(368) = -3.95, p < .001, η2p = .04, and older adults (age +1SD = 38 years old: estimate M = 2.96) walking more than younger adults (age -1SD = 20 years old: M = 2.16), b = .66 [.30, 1.02], t(368) = 3.63, p < .001, η2p = .04. Interestingly, no difference arose from the country of origin, nor from any personality variables at baseline.
At mid-December, 151 participants completed the second phase of the study. Among them, 108 (72%; hence “players”) reported continuing playing while 43 (28%, hence “quitters”) had quit. Various reasons were reported for stopping playing, mainly a complaint that the game became boring and repetitive (42%), but also having less time to play than in holiday (30%) and being less willing to go out during wintertime as compared to summer (28%). Among players, the distance walked per day was significantly lower than in the summertime but still non-negligible (M = 2.40, SD = 1.99), F(1,91) = 9.13, p = .003, η2p = .09. Moreover, self-report measures conveyed similar results than those reported by Howe et al. as participants overall estimated that Pokémon GO “had made them more active” and that they “had been walking more since playing” the game. Finally, players showed a small but significant weight loss in mid-December (M = 75.8, SE = 1.75) as compared to the summertime (M = 76.5, SE = 1.81), F(1,77) = 4.51, p = .04, η2p = .06; and that this effect was more pronounced for participants with high self-efficacy, F(1,77) = 5.87, p = .02, η2p = .07.
What about personality? We conducted a binary logistic regression with “players” and “quitters” as categorical variables and the personality variables as continuous predictors. We found that trait perseverance (as a subscale of impulsivity) measured in the summer positively predict continuing playing in December, b = .66, Wald = 5.23, p = .02. Similarly, agreeableness (i.e. tendency to cooperate, be social and compliant; b = -.57, Wald = 5.03, p = .03) and emotionality (i.e., the tendency to feel and be overcome by negative emotions) b = .44, Wald = 4.06, p = .04, predicted playing respectively negatively and positively. Need for Closure (i.e. desire for a firm answer to a question and dislike for ambiguity), b = .50, Wald = 3.47, p = .06, also positively –although marginally- predicted playing (sex, age, and BMI had no effect).
Overall, more perseverant and high in need-for-closure, less agreeable and more emotional participants were more likely to still be playing Pokémon GO five months after the game release. Conversely, participants that should have been more sensitive to the “fun” components of the game were more likely to have quit the game, which is coherent with the fact that the most frequently reported reason for quitting playing was the game perceived dullness. While a category of participants seems to stay involved in the game for the sake of completion (i.e., for catching them all!) or grind up levels (i.e. be the very best!), others may just not be that sensitive to this aspect. Therefore, one could wonder what aspects of the game need to be bolstered to keep players aboard. An easy answer would be that, to attract individuals from both sides, the game needs to be at the same time deep and complex enough to attract “completionists”, and fun enough to keep more “casual” players.
However, while “fun” and overall enjoyability are necessary determinants of sustained playing [5,9], they are not sufficient to maintain playing, as more agreeable and social individuals might be more attracted to activities outside of video gaming. Another way to look at this would be the inclusion in the game of more social aspects , allowing the participant to be part of a larger social network in which he/she is likely to create bonds, and which would keep him/her into returning to the game. While Pokémon GO tried to integrate this aspect through the development of “gyms” (i.e., places where players can battle others’ Pokémons and earn virtual money), future attempts at designing health-changing games would probably need to better incorporate elements of social networking into a strong gameplay to retain a high number of players through time, which would eventually convert into substantial improvement in health behaviours. In conclusion, the actual phenomenon of Pokémon GO has (1) proven efficient in increase physical activity, even in the long run for a certain type of people, (2) opened new perspectives for the development of other outside-playing, physical activity-inducing, applications and games, but also lets several questions open. Should we incite players to “Catch’Em All”? Exhort them to “Be the very best!”? Or, that “there’s no better team” and their Pokémon is their best friend? 
1 Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA. 2004; 291:2847–2850
2 Knight, J, “Physical Inactivity: Associated Diseases and Disorders”, Annals of Clinical and Laboratory Science, 2012; 42:320-337
3 CDC. Youth Risk Behavior Surveillance—United States. MMWR 2014;63(SS-4) https://www.cdc.gov/healthyschools/npao/pdf/tips-for-teachers.pdf
4 Thaler R, Sunstein C, Nudge. 2008. Penguin Books.
5 Boendermaker, WJ, Boffo, M, Wiers, RW. Exploring Elements of Fun to Motivate Youth to Do Cognitive Bias Modification. Games Health J, 2015;4:434–443.
6 Article retrieved online: https://www.theguardian.com/technology/2016/aug/10/pokemon-go-health-pla...
7 Althoff, T, White, RW, Horvitz, E. Influence of Pokémon Go on Physical Activity: Study and Implications. J Med Int Res, 2016:18(12), e315. http://doi.org/10.2196/jmir.6759
8 Howe KB, Suharlim C, Ueda P, Howe D, Kawachi I, Rimm EB. Gotta catch’em all! Pokémon GO and physical activity among young adults: difference in differences study. BMJ 2016;355:i6270.
9 Dovis, S, van der Oord, S, Wiers, RW, Prins, PJ. Can motivation normalize working memory and task persistence in children with attention-deficit/hyperactivity disorder? The effects of money and computer-gaming. J Abnorm Child Psychol, 2012;40:669–681.
10 Adams, E. Fundamentals of Game Design, 3rd ed. 2013. San Francisco: New Riders.
11. Pokémon Opening, retrieved from: http://www.metrolyrics.com/pokemon-theme-lyrics-pokemon.html
Competing interests: No competing interests
Peruvians also on the move: Pokémon GO associated with physical activity… and with some potential risks too
Peruvians also on the move: Pokémon GO associated with physical activity… and with some potential risks too
Milagros Marllorie Enriquez-Miranda1, Jeannette Melgarejo-Ghiggo1, Luisa Gómez-Pastor1, Diana Carolina Ramirez-Moreno1, Alejandra Vanessa Geri-Romero1, Reneé Pereyra-Elías2
1 School of Physical Therapy, Universidad Peruana de Ciencias Aplicadas, Lima, Perú.
2 School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Perú.
The recently published article by Howe et al. in The BMJ caught our attention.1 Their findings support the hypothesis that the use of Pokémon Go (Niantic, Inc.) could be associated with higher physical activity (PA).2 Other research groups have found similar results; however, to our knowledge, all available reports come from the United States.3-4 In order to contribute with primary evidence on this question, our study aimed to evaluate the association between playing Pokémon Go and physical activity in a sample of young adults in Peru. Given that traffic accidents and varied injuries have been described to be related to the game5-7, we also assessed potential risks on our study sample.
We carried out a cross-sectional study during the last two weeks of October 2016 (about three months after the game was first released). We handed paper-based, self-administered and anonymous surveys to a convenience sample of students from a private university in Lima, Peru. Participants were invited while they were around the PokeStops inside the university campus (places were players congregate to get game’s items and catch Pokémon). We included subjects who voluntarily accepted to participate and had no evident temporary or permanent physical disability. For the users of Pokémon GO, no restriction of smartphone type−iPhone or Android devices− was made.
We measured the main outcome using the short-form of the International Physical Activity Questionnaire (IPAQ). This 7-day recall instrument classifies PA levels in “low”, “moderate” and “high” .8 Its validated version in Spanish has been previously used in Peruvian university students9. The exposure was assessed through the question “Have you played Pokémon GO during the last 7 days?”. Covariates evaluated included sex, age, belonging to a formal sports team and the average number of hours per day (in the previous 7 days) they spent sleeping, watching television and using a computer. Among Pokémon GO players, we gathered information regarding: i) transportation when playing (i.e walking, by car or bus, riding a bicycle or skating) and ii) accidents while playing (falls, injuries, thefts). Additionally, at the end of the questionnaire, we asked the participants if they perceived their PA had increased since they started playing Pokémon GO.
Data analysis was performed using the statistical package Stata 12.0 (StataCorp, TX, US). We described medians, frequencies and used the chi-square test to compare proportions. Crude and adjusted odds ratios and their 95% confidence intervals were calculated through ordinal logistic regression models. Proportionality of odds assumption was verified.10
From 464 students invited, 21 refused to participate and 27 returned incomplete questionnaires. From the 416 subjects included in the analysis, 220 (52,7%) were male and the median age was 21 years (range: 18 to 36). About 5% belonged to a formal sports team. Median (interquartile range) number of hours per day spent sleeping, watching television and using a computer were 6(1), 2(1) and 4(2), respectively. About half of participants (202/416) reported they had played Pokémon GO in the previous week. Regarding levels of PA, 19,2%, 38,6% and 42,2% of participants were categorized as low, moderate and high, respectively. Subjectively, 68,0% perceived that their PA had increased since they play the game.
The proportions of having played Pokémon GO during the previous week differed between levels of PA: 32.5% for those with “low PA”, 44.7% among those with “moderate PA” and 59.1% in the “high PA” group (p<0,001). Regression models showed that, even after adjusting for potential confounders, the odds of a higher level of PA was 70% greater for those participants who did play Pokémon GO [95%CI:1.13 to 2.55]. (Table 1)
Amongst Pokémon GO players, nearly 90% of them report to play walking; but an important proportion used other ways of transportation (Table 2). Furthermore, 14,8% of gamers experienced at least one accident while playing. Falls were the most frequently reported event (9%). This information is also detailed in Table 2.
Our results must be interpreted considering some limitations. We acknowledge that the outcome measure is not quite accurate as the one used by Howe et al.1; nevertheless, it has been established as a standard tool in epidemiological studies8. Self-report of our variables may have also introduced recall and desirability bias. It would have been important to assess other variables with potential confounding effects, such as socioeconomic and nutritional status. Additionally, convenience sampling within PokeStops entails an intrinsic selection bias that limits generalization.
Despite these limitations, our study has also strengths. To our knowledge, this is the first research report in a low-resource setting, where the different contextual factors may substantially influence any given phenomenon. Likewise, our sample size allows us to perform proper adjustment including different potential confounders.
We conclude that physical activity levels were higher among Peruvian university students who reported to play Pokémon GO. Moreover, an important proportion of players reported potential risks. This and other similar virtual games need to be further studied because of their potential as interventions to increase physical activity. Evidently, these strategies must be accompanied by safety recommendations.
1. Howe KB, Suharlim C, Ueda P, Howe D, Kawachi I, Rimm EB. Gotta catch'em all! Pokémon GO and physical activity among young adults: difference in differences study. BMJ 2016;355:i6270.
2. McCartney M. Game on for Pokémon Go. BMJ 2016;354:i4306.
3. Althoff T, White RW, Horvitz E. Influence of Pokémon Go on Physical Activity: Study and Implications. J Med Internet Res 2016;18(12):e315.
4. Nigg CR, Mateo DJ, An J. Pokémon GO May Increase Physical Activity and Decrease Sedentary Behaviors. Am J Public Health 2017;107(1):37-38.
5. Ayers JW, Leas EC, Dredze M, Allem JP, Grabowski JG, Hill L. Pokémon GO-A New Distraction for Drivers and Pedestrians. JAMA Intern Med 2016;176(12):1865-1866.
6. Sharma P, Vassiliou V. Pokémon Go: cardiovascular benefit or injury risk? Oxf Med Case Reports 2016;2016(10):omw085.
7. Wagner-Greene VR, Wotring AJ, Castor T, Kruger J, Mortemore S, Dake JA. Pokémon GO: Healthy or Harmful? Am J Public Health 2017;107(1):35-36.
8. Bauman A, Bull F, Chey T, Craig CL, Ainsworth BE, Sallis JF, et al. The International Prevalence Study on Physical Activity: results from 20 countries. Int J Behav Nutr Phys Act 2009;6:21.
9. Ocampo-Mascaró J, Silva-Salazar V, da Costa-Bullón AD. Correlación entre conocimientos sobre consecuencias de la obesidad y grado de actividad física en universitarios. Medwave 2015;15(11):e6329.
10. Warner P. Ordinal logistic regression. J Fam Plann Reprod Health Care 2008;34(3):169-70.
Acknowledgements: To F Quincho for logistical support.
Competing interests: No competing interests
Thanks to The BMJ for giving us such entertaining content for Christmas, and thanks to Howe et al.1 for their very instructive and well-illustrated paper.
Pokémon-GO is the little brother of another location-based smartphone application, Ingress, also developed by Niantic (USA). This augmented reality massively multiplayer online (MMPO) game was released in 2014, and attracted a relatively large community of enthusiastic gamers. This game promotes player movement from one physical location to another, but to our knowledge, it has not gained much attention among health and fitness professionals (no reference in PubMed). The association of the Ingress platform with the well-known Pokémon brand name (The Pokémon Company, Japan) has popularized the concept on a global scale, and linked it with potential physical activity-mediated health benefits.2-8
To date, two studies have investigated the Pokémon-GO effect by using objective measurements of physical activity, and they tempered initial enthusiasm with regard to potential health benefits.1,9 Althoff et al.9 conducted a survey of 32,000 American people, in which they described a moderate increase in daily step-count (1473 in the most dedicated players), which was sustained for only a short period of time only (~25 days). This observation was consistent with the work of Howe et al.1 Their results indeed indicated that Pokémon-GO is far from both the 2500 daily step-increase reached with traditional pedometer-based interventions,10 and the 150 minutes of weekly moderate-to-vigorous physical activity recommended by the World Health Organization (WHO).11 Because pedometers do not have the potential to become as popular as smartphone applications that are developed by famous brand names and released on a global scale, we believe that they have limitations in promoting physical activity on a large scale. Additionally, when compared to the WHO guidelines, some national physical activity promotion policies have a more progressive approach for achieving higher healthy life expectancy for people. These policies include recommendations for low-dose exercise.12,13 For example, the Japanese Ministry of Health, Labor, and Welfare recommends Japanese people start their journey to a more active lifestyle by engaging in "+10 minutes of daily physical activity," which is in line with the Pokémon-GO -induced +11 minutes estimated by Howe et al.1
Apart from its low magnitude, the short duration of the Pokémon-GO effect,1,2 is described as another limitation by Howe et al.1 However, before the Pokémon-GO release, no one expected the application to replace structured exercise, or regular physical activity. The results reported by Howe et al.1 and Althoff et al.9 can be considered encouraging, given that we are talking about one pioneering application. The Pokémon-GO concept could be used as a model to develop location-based, augmented reality, smartphone-based games which are more effective at increasing the activity level of the user. We are enthusiastic in our view that this game genre can become a fruitful collaboration between the health and fitness community and the gaming industry, with significant health benefit to the general public.
Because the Pokémon-Go –induced activity increase seems to be short-lived, future applications can be designed so that they are used for a limited period, perhaps for only a few weeks during special occasions. A treasure hunting game for Easter, a zombie-survival game for Halloween, a Santa-tracking game for Christmas are few possibilities. Keeping people active for short periods of time throughout the year might be an effective strategy to yield longer-term benefits, making this genre more attractive to health and fitness professionals. Several game storylines have already been suggested. Location-based smartphone games with potential for health promotion were described as early as 2013.14 The augmented reality dimension only gives this genre much more promise.
In the current Pokémon-GO gameplay, the main physical activity promoter is the egg hatching activity, which consists of walking several kilometers to be able to hatch eggs, and obtain new Pokémon creatures. To the best of our knowledge, the intensity of the activity required to move from one physical location to another is not assessed. Distance is evaluated from users’ GPS information. Smartphones are now all equipped with 3-axis accelerometers (acceleration range: ±12g, sampling rate: 2000-4000Hz for the current generation of IPhones, Apple, USA) and gyro sensors that are more than sufficient for sensing human movements, so that acceleration data can be used to characterize displacement modes, and to assess the intensity of movement, making it possible to reward the more vigorously active players. Moreover, contemporary smartphone handsets and active video games controllers (e.g. the Nintendo Wii Remote, Japan) present similar sensing capabilities. Active video games have been linked with moderate-to-vigorous physical activity.15 It is therefore reasonable to think that more active gameplays could be designed in the near future. If we look at Pokémon-GO, the current battle modes could be improved to increase the variation and intensity of body movements.
Finally, Pokémon-GO has been praised for its social dimension. Users spontaneously gather at physical locations designated as “Gyms” in the virtual Pokémon-GO world. However, the game offers only a few possibilities for player interactions in this virtual world. Small-scale cooperation has been proven to be effective at increasing physical activity in console-based active video games.16 Improving the competitive and cooperative dimensions of the game might also lead to higher levels of physical activity and motivation in the player.
In conclusion, while the Pokémon-GO effect is already considered gone by some observers, the application opened a new era for location-based, augmented reality, MMOP games. It gave a global audience to the genre, and showed new opportunities for health and fitness professionals. More active gameplays seem to be within easy reach, offering new opportunities for collaborations between health and fitness experts and the gaming industry.
1. Howe KB, Suharlim C, Ueda P, Howe D, Kawachi I, Rimm EB. Gotta catch'em all! Pokémon GO and physical activity among young adults: difference in differences study. BMJ. 2016 Dec 13;355:i6270.
2. Is Pokémon Go the answer to America’s obesity problem? Guardian. 2016 Jul 13.
3. McCartney M. Margaret McCartney: Game on for Pokémon Go. BMJ. 2016 Aug 9;354:i4306.
4. Baranowski T. Pokémon Go, go, go, gone? Games Health J. 2016 Aug 15. [Epub ahead of print]
5. Sharma P, Vassiliou V. Pokémon Go: cardiovascular benefit or injury risk? Oxf Med Case Reports. 2016 Oct 28; 2016(10):omw085. eCollection 2016.
6. Ghosh A, Misra A. Pokémon Go, Obesity and Diabetes: A Perspective from India. Diabetes Technol Ther. 2016 Nov;18(11):725-726. Epub 2016 Oct 18.
7. Nigg CR, Mateo DJ, An J. Pokémon GO May Increase Physical Activity and Decrease Sedentary Behaviors. Am J Public Health. 2017 Jan;107(1):37-38.
8. LeBlanc AG, Chaput JP. Pokémon Go: A game changer for the physical inactivity crisis? Prev Med. 2016 Nov 14. pii: S0091-7435(16)30365-6. [Epub ahead of print]
9. Althoff T, White RW, Horvitz E. Influence of Pokémon Go on Physical Activity: Study and Implications. J Med Internet Res. 2016 Dec 6;18(12):e315.
10. Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, Stave CD, Olkin I, Sirard JR. Using pedometers to increase physical activity and improve health: a systematic review. JAMA. 2007 Nov 21;298(19):2296-304.
11. WHO. Global recommendations on physical activity for health.World Health Organisation, 2010.
12. Wen CP, Wai JP, Tsai MK, Chen CH. Minimal amount of exercise to prolong life: to walk, to run, or just mix it up? J Am Coll Cardiol. 2014 Aug 5;64(5):482-4.
13. Murakami H, Tripette J, Kawakami R, Miyachi M. "Add 10 min for your health": the new Japanese recommendation for physical activity based on dose-response analysis. J Am Coll Cardiol. 2015 Mar 24;65(11):1153-4.
14. Boulos MN, Yang SP. Exergames for health and fitness: the roles of GPS and geosocial apps. Int J Health Geogr. 2013 Apr 5;12:18.
15. Miyachi M, Yamamoto K, Ohkawara K, Tanaka S. METs in adults while playing active video games: a metabolic chamber study. Med Sci Sports Exerc. 2010 Jun;42(6):1149-53.
16. Peng W, Crouse J. Playing in parallel: the effects of multiplayer modes in active video game on motivation and physical exertion. Cyberpsychol Behav Soc Netw. 2013 Jun;16(6):423-7.
Competing interests: No competing interests
We welcome attempts from Howe et al to evaluate the impact of Pokémon Go, which is the most downloaded smartphone app of all time. This and nearly all other known Pokémon Go analyses limit their investigations to the number of steps taken, or other markers of physical activity[2,3]. But what about changes in diet?
Central to players’ progression through the game is accessing “gyms”, where captured Pokémon can battle each other and earn rewards. These virtual gyms are placed next to or inside buildings or objects that are meant to have local cultural significance. If players succeed in a gym, they receive virtual money at the rate of 10 “PokeCoins” (about 0.079 GBP) per day to reinvest in other in-game items to help “catch ‘em all”. Pokémon Go players therefore tend to congregate around gyms. But what if gyms are not buildings of cultural significance, and instead fast food restaurants?
It is perhaps unsurprising that a game that promotes physical activity has succumbed to the commercial power of the fast food industry. McDonald’s was the first sponsor of Pokémon Go, and when the game was launched in Japan nearly all 3,000 McDonald’s chains were converted into gyms. Alongside giving Pokémon toys away with children’s meals, McDonald’s even created designated seating areas for Pokémon Go players to battle their little monsters without disturbing non-playing customers. The footfall attracted to Pokémon gyms in McDonald’s restaurants is evident given that CEO Steve Easterbrook is quoted as saying “We are enjoying what [Pokémon Go] is doing for business at the moment.” Presumably that means business is up.
With research suggesting that the physical activity benefits of Pokémon Go are short term at best, and with users being drawn to fast food restaurants to meet other gamers, we suggest that future Pokémon Go evaluations should be counting the number McFlurries consumed in addition to the number of steps taken.
 Howe K, Suharlim C, Ueda P, Howe D, Kawachi I, & Rimm EB. Gotta catch’em all! Pokémon GO and physical activity among young adults: difference in differences study. BMJ 2016;355:i6270
 Nigg RN, Mateo DJ, & An J. Pokémon GO May Increase Physical Activity and Decrease Sedentary Behaviors. American Journal of Public Health: January 2017, Vol. 107, No. 1, pp. 37-38.
 Althoff T, White RW, Horvitz R. Influence of Pokémon Go Physical Activity: Study and Implications. [online] Available at: http://bit.ly/2gNYd0K [Accessed 15.12.16]
 Marketing Week. McDonald’s on Pokémon Go: ‘We are enjoying what it is doing for our business’ [online]. Available at: http://bit.ly/2a49CD9 [Accessed 15.12.16]
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Competing interests: No competing interests