Cash incentives and wearable step trackers increase physical activity in CVD patients

Combining financial incentives, personalized goal setting and wearable devices might be an effective way of encouraging heart disease patients to engage in more physical activity, according to new research published in the Journal of the American Heart Association.

Researchers sought to determine whether a home-based program, which offered payment upfront and also took money away from the participants if their step goals were not met, would encourage an increase in activity levels. They also assessed whether the participants would form a more long-lasting habit of maintaining their step goals.

“Regular exercise and cardiac rehab has shown to have significant benefit in those with heart disease but participation in such programs is extremely low for various reasons including patient motivation and access to exercise facilities,” lead author Neel Chokshi, MD, MBA, of Penn Medicine in Philadelphia, said in a statement. “There is interest in developing creative remote strategies to engage patients in exercise programs but there is little research for guidance. In this clinical trial, we tested a scalable approach combining wearables and principles from behavioral economics to show significantly increased activity levels even after incentives were stopped.”

A total of 105 patients were enrolled in the ACTIVE REWARD trial. The patients were remotely monitored for an eight-week “ramp up” incentive phase, an eight-week maintenance incentive phase and an eight-week follow-up. Their progress was assessed at the 16-week mark and at the end of the 24-week study.

The patients were asked to utilize wearable devices to track their step counts at baseline. The control group did not receive any additional interventions. Patients in the incentive group received personalized step goals and daily feedback for all 24 weeks. At each phase, the daily step goals increased weekly by 15 percent from the study baseline, which was a maximum of 10,000 steps.

Each week $14 was allocated to a virtual account and $2 could potentially be lost per day for not achieving step goals. Compared with the control group, the researchers found the incentive group had a significantly greater increase in average daily steps from baseline.

During the nine- to 16-week period, patients in the intervention increased their steps by 1,368 more steps per day than patients in the control group. After financial incentives were stopped at 16 weeks, participants in the intervention still had an increase of 1,154 steps per day more than the control group over the ensuing eight weeks.

“While many are hopeful that wearable devices can motivate high-risk patients, we found that wearables alone did not increase physical activity levels,” said co-author Mitesh Patel, MD, MBA, of Penn Medicine. “However, framing rewards as a loss—a technique from behavioral economics—led to a meaningful difference in behavior. During the 6-month trial, the average patient in the intervention arm had step counts that totaled about 100 miles more than the average patient in control.”

The researchers said additional studies should be conducted to evaluate the sustainability of incentive effects over longer term periods to compare incentive amounts that vary in magnitude, duration, or frequency and to evaluate financial incentives and personalized feedback independently to assess effects.

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