Summary: Incentives and daily reminders can significantly increase physical activity among adults at risk for heart disease, raising their daily steps by over 1,500.
Key Facts: Participants increased their daily steps by 1,500 and sustained higher activity levels six months after incentives ended, demonstrating long-term behavior change.
Combining financial rewards and game-like incentives was the most effective method in promoting physical activity.
Each intervention lasted for 12 months followed by a six-month follow-up period where all participants received the same information as controls.
The group who received both incentives averaged 868 extra steps and maintained an average 576 more daily steps six months later.
Healthcare systems and organizations could also use tactics in the study to help patients increase physical activity levels.
Strategies informed by behavioral economics increase physical activity, but their longer-term effectiveness is uncertain.
The trial’s primary outcome was change in mean daily steps from baseline through the 12-month intervention period.
Summary: For adults at risk for heart disease, incentives and daily reminders can dramatically increase physical activity, increasing daily steps by more than 1,500. Six months after the trial ended, the intervention, which included monetary rewards and points similar to those in a game, had continued health benefits in addition to encouraging an extra 40 minutes of moderate exercise each week.
Important Information:.
Long-term behavior change was evident as participants maintained higher activity levels six months after the incentives ended and increased their daily steps by 1,500.
The results of the study, which associate an additional 40 minutes of moderate exercise per week with noticeably lower risks of cardiovascular-related and premature deaths, reinforce the value of this type of exercise.
NIH is the source.
According to an NSF-funded study published in Circulation, adults at risk for heart disease who received daily prompts or incentives to get active increased their daily steps by more than 1,500 after a year, and many were still maintaining their new habit six months later.
The results were concurrently presented at the Annual Session of the American College of Cardiology as late-breaking research.
In comparison to data from previous studies, the improvements, which also led to an additional 40 minutes of moderate exercise per week, correlated with a 6% reduced risk of premature death and a 10% reduced risk of cardiovascular-related deaths.
According to recommendations from the Department of Health and Human Services, most adults should engage in 150 minutes or more of moderate aerobic exercise per week, such as brisk walking, 75 minutes of vigorous exercise, such as fast cycling, or a combination of the two, combined with twice-weekly strength training sessions.
Researchers discovered that while a straightforward daily reminder was helpful in encouraging people to move more, providing monetary incentives or point-based rewards—like those found in games—was even more successful.
But the best results came from combining the two incentives. Six months after the rewards ceased, participants who received both were still recording increases in their level of activity.
“Even mild exercise can significantly lower cardiovascular risk, so it’s a big win for public health to find low-cost strategies to get people moving and stick to at-home fitness regimens,” stated Alison Brown, Ph.D. C. RdotD. , a program officer at the National Institute of Heart, Lung, and Blood (NHLBI), a division of the National Institutes of Health.
The research was conducted in the years 2019–2024. Over a thousand adults at high risk of major cardiovascular events were monitored by the researchers. Every participant was given a wearable fitness tracker, which allowed researchers to count their baseline daily step count by connecting it to an online health portal.
The participants then decided that they would like to increase their daily step count from their starting point by 33, 40, 50%, or any amount more than 1,500 steps. Following goal-setting, participants were randomly assigned to one of four groups.
Rewards in the form of money, game-like incentives, or a mix of the two were provided by three groups. Each player in the game group earned points each week, which they maintained by achieving their daily step targets. They lost points on the days when they couldn’t reach their objectives. Individuals who earned enough points advanced, while those who didn’t reach their objectives fell back a level.
One’s “support crew” could consist of friends or family, who would be updated on the participant’s progress every week. Adults who met their daily step goals and attained the highest levels at the end of the study were awarded trophies.
Participants in the financial group lost $2 daily if they did not reach their step targets, but they still received $14 per week. Financial and game-like incentives were given to the third group.
In exchange for the fitness tracker and daily messages that tracked their step count, the fourth group, which served as the control group, did not receive any incentives. All participants in each 12-month intervention received the same information as controls during the six-month follow-up period.
Prior to the start of the study, individuals in every group completed roughly 5,000 steps a day, or 2.4 miles. They increased their daily step count by over 1,500, or three-fourths of a mile, after a year.
The game-incentive group walked 538 more steps than the control group compared to baseline, and the financial incentive group walked 492 more steps. Six months later, the group that received both incentives continued to average 868 additional steps per day on average.
The adults who received single interventions maintained their increases in physical activity, but their gains were not statistically different from the 1,200 extra steps that the control group took on average 18 months after the study began.
However, according to Alexander C., “the interventions created immediate benefits for participants – and they worked.”. Fanaroff, M.DoT. , an interventional cardiologist and assistant professor of medicine in the Division of Cardiology at the University of Pennsylvania, Philadelphia; she is also a behavior change specialist and study author.
Findings indicate that it’s simpler to focus on the here and now rather than long-term goals like saving for college or retirement or increasing physical activity to maintain heart health over the long term. “.
The study’s guiding principles, which produced instant advantages or rewards for movement, can be applied by anyone wishing to modify their behavior, particularly with regard to exercise, according to the researchers.
For instance, there are fitness applications that offer incentives and daily reminders for achieving individual health objectives. People can also use these apps to recruit friends and family for support and even set up scenarios in which they forfeit money if their goals are not met.
Aside from using the study’s strategies, healthcare systems and organizations could also help patients become more physically active.
Funding: R61/R33HL141440 from the NHLBI provided funding for this research.
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Original Study: Disclosed under open access.
Fanaroff AC et al.’s BE ACTIVE randomized controlled trial examined the “effects of gamification, financial incentives, or both to increase physical activity among patients at high risk of cardiovascular events.”. Moving Around.
Inabst.
Impact of gamification, monetary rewards, or both on physical activity levels in patients at high risk of cardiovascular events: BE ACTIVE randomized controlled trial research.
Background: Guidelines recommend physical activity levels for individuals, but few people reach them. Physical activity is linked to a lower risk of major adverse cardiovascular events. Although behavioral economics-based strategies promote physical activity, it is unclear how long-term effects they will have. During a 12-month intervention and a 6-month post-intervention follow-up period, we aimed to ascertain the impact of behaviorally-designed gamification, loss-framed financial incentives, or the combination on physical activity in comparison with attention control.
Methods: A pragmatic randomized clinical trial was conducted from May 2019 to January 2024 for participants with clinical ASCVD or a 10-year risk of myocardial infarction, stroke, or cardiovascular death ≥ 7 point 5 percent by the pooled cohort equation. After setting up a baseline and choosing a step goal increase, participants received a wearable device to track their daily steps. They were then randomly assigned to one of four groups: control (n = 151), behaviorally-designed gamification (n = 304), loss-framed financial incentives (n = 302), or gamification plus financial incentives (n = 305). Changes in mean daily steps from baseline to the 12-month intervention period were the main outcome of the trial.
Results: Of the patients enrolled, 1062 had a mean age of 67 [8] years, 61% were female, and 31% were non-White. Over the course of the 12-month intervention, participants in the gamification arm (adjusted difference, 538.0; 95 percent CI, 186.2-889.9; P = 0.0027), financial incentives arm (adjusted difference, 491.8; 95 percent CI, 139.6-844.1; P = 0.0062), and gamification + financial incentives arm (adjusted difference, 868.0; 95 percent CI, 516.3-1219.7; P < 0.0001) showed significantly higher increases in mean daily steps from baseline among the participants (compared with controls). After accounting for multiple comparisons, physical activity during the 6-month follow-up was found to be significantly higher in the gamification + financial incentives arm than in the control arm (adjusted difference, 576.2; 95 percent CI, 198.5-954; P = 0.0028). However, it was not significantly greater in the gamification (adjusted difference, 459.8; 95 percent CI, 82.0-837.6; P = 0.0171) or financial incentives arm (adjusted difference, 327.9; 95 percent CI, -50.2 to 706; P = 0.09).
