Pokémon Go: A game changer for the physical inactivity crisis?

Allana G. LeBlanc PhD, Jean-Philippe Chaput PhD

PII: S0091-7435(16)30365-6
DOI: doi: 10.1016/j.ypmed.2016.11.012
Reference: YPMED 4835

To appear in: Preventive Medicine

Received date: 26 July 2016

Revised date: 4 November 2016
Accepted date: 12 November 2016

Please cite this article as: LeBlanc Allana G., Chaput Jean-Philippe, Pokémon Go:
A game changer for the physical inactivity crisis?, Preventive Medicine (2016), doi:
10.1016/j.ypmed.2016.11.012

This is a PDF file of an unedited manuscript that has been accepted for publication.
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Commentary

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Pokémon Go: a game changer for the physical inactivity crisis?

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Allana G. LeBlanc, PhDa,* and Jean-Philippe Chaput, PhDb

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a
ParticipACTION, 77 Bloor St West, Toronto, Ontario, Canada, M5S 1M2

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2
Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario
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Research Institute, 401 Smyth Road, Ottawa, Ontario, Canada, K1H 8L1
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*Corresponding author.
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E-mail addresses: aleblanc@participaction.com (A.G. LeBlanc); jpchaput@cheo.on.ca (J.-P.

Chaput).
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Number of words: 1504

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Abstract

There is an urgent need to find novel strategies aimed at motivating people to go outside and
move more. Pokémon Go blends a fun smartphone game with real-life, outdoor physical

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activity. Initial reports suggest it is a successful population level strategy to increase physical
activity levels. Further research is needed to understand the long-term risks and benefits of this

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new game. Free-to-play location-based augmented reality mobile games are likely to be a new

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model for promoting healthy active living in the future.

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Physical inactivity is the second leading cause of preventable death worldwide, second only to
smoking (World Health Organization, 2013). People of all age groups are not active enough for
optimal health benefits (Hallal et al., 2012a). Overall health status has also decreased over time
across all age groups with girls, boys, women, and men being in worse physical condition than

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their relatives who preceded them by only 20 years time (Sawada et al., 2010). These examples
hold true across all developed countries in the world with very few sub-groups considered to

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have acceptable levels of health and fitness (Hallal et al., 2012a). This is costing health care

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systems billions in additional expenditures, and workforces almost as much in lost productivity
(Bounajm et al., 2014). For example, recent conservative estimates suggest that physical
inactivity costs $53.8 billion (international adjusted currency) annually worldwide (Ding et al.,

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2016).
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Unfortunately, there has yet to be a population health intervention that can be considered
effective, feasible, sustainable, and scalable (Hallal et al., 2012b). There have been programs
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that have shown modest success, but none that have reached a level that population health
researchers can confidently consider an overall success (Hallal et al., 2012b). However, with the
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majority of those in developed countries considered to be too heavy for their stature, and few
people meeting physical activity guidelines, it is clear that in many cases we need to do more
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and that prevention alone will not work.

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The problem with prevention is amplified by a creeping technophilic society with promises of a
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“magic bullet” from celebrity pseudo-science (Caulfield, 2015). The majority of children and
youth around the world are engaging in excessive screen time (Bucksch et al., 2016). This is
spent largely engaging in sedentary-multitasking – in front of televisions, tablets, computers,
and smartphones. Over the past decade there has actually been a decrease in television usage,
with more children and youth using the computer and playing video games for entertainment
(Inchley et al., 2016).

Screens are evolving at a speed that dwarfs the ability of the research community’s ability to
follow their deleterious effects. Public health researchers, practitioners, and policy makers are
left with two options: admit failure, or strive for adaptability when messaging to the public.
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Many researchers have chosen to embrace technology, especially as the gamification of physical
activity interventions has started to flourish (Baranowski et al., 2015). However, as stated in the
Active Healthy Kids Canada’s Position on Active Video Games for Children and Youth and
informed by a systematic review of the best available evidence, “active video games are not a

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recommended strategy to help kids be more physically active” (Chaput et al., 2013; LeBlanc et
al., 2013). Some limitations that this review (and many others) have cited as to why active video

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games are not fulfilling the potential promise to change behaviors are: cost of equipment; the

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need for players to remain indoors versus outdoors; inherent “unsocial” nature of games that
can only accommodate a pre-set number of players; poor long-term adherence; and ability for
players to cheat, thereby minimizing the need for physical activity (Chaput & LeBlanc, 2015).

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Smartphone technology has proven to be one of the most fast-paced, and integrated forms of
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screen-based pursuits. The large majority of individuals in developed countries (68%) report
owning a smartphone (Poushter, 2016). Smartphone ownership in developing countries is also
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on the rise from 31% ownership in 2013, to 57% ownership in 2015 (Poushter, 2016). Since
technology has been a long-standing source of pleasure and entertainment, it is not surprising
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that many researchers have used cellphone technology for health promotion (Zimmerman et al.,
2016). A recent systematic review suggested that cellphones have great potential for physical
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activity promotion across a range of individuals (Monroe et al., 2015).

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In July 2016, Niantic released what may be the most successful population level physical activity
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program that we have seen in modern history. Pokémon Go was released in the United States
on July 6th, and has so far expanded to many other countries around the world (Pokémon GO,
2016). Soon after the release, Pokémon Go was considered the most widely downloaded and
used smartphone app in the entire world, surpassing longstanding frontrunners such as Twitter
and Candy Crush (Berkeley Lovelace Jr, 2016). Pokémon Go is a free app that is available on both
Apple and Android device platforms, making it accessible to anyone who has a smartphone
(Pokémon GO, 2016).

The goal of Pokémon Go is simple: catch as many Pokémon characters as possible (Pokémon
GO, 2016). This is done by walking throughout a player’s city, viewing the world through their
cellular device, and using the phones camera to “catch” characters. Considered an “augmented
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reality mobile game”, Pokémon Go uses gamification to get participants to increase their
walking, both through increased chances to catch Pokémon characters (i.e., you need to explore
your neighborhood for the fictional characters to appear), and to “hatch” their Pokémon eggs
(i.e., participants have to travel 2 km, 5 km, or 10 km while incubating an egg for a new

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character to be born).

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Initial reports from both objectively measured (e.g., Apple health app, and Jawbone), as well as

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subjectively measured (e.g., through anecdotal reports or in-game success) have shown that
playing Pokémon Go may be an effective strategy to increase time spent walking (Mosendz,
2016). Many have self-reported similar results, stating that since downloading the game, they

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have increased their daily step count (Belluz, 2016; Lo, 2016). Even more promising is that
people are replacing time they would have spent engaging in indoor passive screen time with
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active, outdoor time. So in addition to replacing sedentary behavior with physical activity, they
are also replacing indoor time with outdoor time. Further, it seems that many people are using
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“Poké-walks” as an excuse to go out with friends, or engage with other Pokémon players. This
combats any real or perceived fear of exploring a new area by oneself. It may also help to
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engage individuals who are not typically motivated by traditional gyms or sports venues. To
minimize the risk of waning interest levels, The Pokémon Company has reported that they will
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be releasing additional technology to support the game such as wrist worn sensors, additional
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characters, and thematic challenges (e.g., related to holidays or events) (Pokémon GO, 2016).
The newest release includes daily bonuses for frequent tracking and streaks (van Boom, 2016).
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The speed of this response shows how reactive a model like this can be.

Despite best efforts, it is not shocking that initial interest is not sustainable and since the release
of the game, there has been significant drop off in levels of engagement (see also Google Trends
data for updated statistics: https://www.google.ca/trends/explore?cat=3&date=2016-07-
01%202016-10-25&q=%2Fm%2F02zkqj) (Kawa and Katz, 2016). However, among those that are
still tracking, new data from Microsoft shows that the game can help to increase physical
activity levels by about 25% (Althoff et al., 2016).

As with many interventions, there are already some clear risks, and reports of adverse events
following engagement in Pokémon Go (Mehta & Cameron, 2016). These risks have generally
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been minor in nature, but are things like distracted driving and walking. These risks are also
possible for someone simply walking down the street and similar risks are inherent to all real-
world physical activity interventions. It is too early to fully understand all of the risks associated
with playing this game; however, given the high proportion of morbidity and pre-mature

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mortality associated with physical inactivity, it is assumed the risks associated with Pokémon Go
will not surpass those associated with physical inactivity. Most importantly, Pokémon Go has

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succeeded where most population health strategies have failed before; they have shown

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success in changing behavior among inactive individuals. As clearly demonstrated, the biggest
bang for the buck when it comes to the health benefits of moving is observed when inactive
people start to move. There is thus huge public health potential (especially for people coming

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from low socioeconomic backgrounds who are generally more inactive, and have less resources
to devote to registration and/or equipment costs) if the Pokémon Go model is not a fad.
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Given that Pokémon Go was released so recently, there have been no follow-up studies to
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examine the long-term effectiveness or sustainability, or even the accuracy of physical activity
tracking. Further examination from the research community may help to solidify this as a viable
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(or not) population health intervention aimed at increasing physical activity level (and hopefully
also reducing the associated health risks). This may include experimental studies to better
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understand the underlying physiological responses to playing games like Pokémon Go (i.e.,
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energy expenditure during a gaming session, or compensatory behaviours after playing the
game such as increased energy intake and/or decreased activity). This may also include
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additional questions on population level surveys asking participants about their experience with
mobile games, or their use of technology to support physical activity participation. In the short
term, it is sensible for researchers to participate in this naturalistic experiment ourselves and
attempt to catch as many Zubats, Golems, and Charmanders as possible.

Funding sources
This research did not receive any specific grant from funding agencies in the public, commercial,
or not-for-profit sectors.

Conflict of interest statement

The authors declare that there are no conflicts of interest.
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