An incentive-based intervention utilizing principles of behavioral economics significantly increased physical activity in individuals at risk for cardiovascular disease. His year-long study demonstrated sustained improvements in daily step counts and physical activity levels, providing a powerful strategy to reduce cardiovascular risk.

Rewards and small financial incentives motivate individuals to increase their physical activity levels.

Incentives such as earning points and small monetary rewards encouraged people at high risk of heart disease and stroke to increase their daily walking by about 10%, and this increase was maintained over a year. The study results, presented at the American College of Cardiology’s Annual Scientific Sessions, demonstrate that participants’ daily step counts increased significantly from the beginning to the end of a 12-month period. revealed that the study achieved its main objectives.

“This is one of the largest and longest-running randomized trials of a home-based intervention to promote physical activity,” said Alexander Fanarov, MD, assistant professor at the Perelman School of Medicine at the University of Pennsylvania and lead author of the study. . . “Our findings show that interventions based on behavioral economics techniques can achieve and maintain increased levels of physical activity in populations with risk factors such as: cardiovascular disease It could be another tool to help reduce cardiovascular risk. ”

Behavioral economics is a field that uses concepts from economics and psychology to better understand and influence how people make decisions. Insights from behavioral economics can be applied to many other fields, including medicine and public health, Fanaroff said.

BE ACTIVE Research method

The BE ACTIVE study tested whether certain behavioral economics techniques could help people improve their daily walking levels. One technique known as gamification is the use of gameplay elements such as competition and point-earning. The other uses financial incentives, where people win or lose small amounts of money based on their actions.

“We know that physical activity is important for cardiovascular health,” Fanaroff said. “Many studies show that people who engage in more physical activity are healthier and have fewer heart attacks and strokes than those who engage in less physical activity. This also applies to people who have had heart failure, or who are at risk for cardiovascular disease.

According to Fanaroff, only about 1 in 5 Americans regularly engage in 150 minutes of moderate-intensity physical activity per week (the amount recommended by many public health organizations), and that number increases with age. It is said that it will further decrease as time goes by. Although the widely known advice to take 10,000 steps a day is not based on scientific evidence, research has shown that increasing the number of steps you take by up to 7,500 steps per day can reduce your risk of dying from heart disease. He said there are. In fact, in one study, JACC: Heart failure We found that an increase in daily steps was associated with improved health over a 12-week period.

Study demographics and procedures

The BE ACTIVE study enrolled 1,062 people with a median age of 67 years, of whom 60% were women and 25% were non-white. One-third had household incomes of less than $50,000 per year. All participants either had cardiovascular disease or were at high risk for it. All participants received a wrist-worn fitness tracker that automatically uploaded their daily step counts to her secure website.

At the start of the study, participants averaged about 5,000 steps per day. Each participant was asked to select whether his goal was to increase his daily step count by 33%, 40%, 50%, or at least 1,500 steps above his level at the start of the study. Fanarov said previous research has shown that when people choose their own goals, they’re more likely to achieve them.

Participants were then randomly assigned to one of four groups. People assigned to the control group received a daily text message telling them how many steps they had taken the previous day. Participants assigned to the gamification group were awarded 70 points each week. Every day I met my step goal and maintained my points. I failed to reach my goal each day and lost 10 points. If at the end of the week she has earned 40 points or more, she has moved up a level. If you got less than 40 points, you moved down.

Participants assigned to the financial incentive group received $14 in their virtual account each week. Each day they met their step goal, but their balance remained the same. Every day he didn’t reach his goal, his balance decreased by $2. The fourth group received both gamification and financial incentive interventions. All participants in the three intervention groups received daily text messages informing them whether they had achieved their goals the previous day and encouraging them to keep trying.

Research results and impact

The intervention continued for 12 months, after which all participants were followed up for an additional 6 months. During the follow-up period, participants no longer received the intervention but continued to receive daily text messages informing them of their step counts from the previous day. The study’s primary endpoint was change in daily step count from the start of the study to 12 months. Secondary endpoints included changes in daily steps and average weekly minutes of moderate-to-vigorous physical activity from the start of the study to 18 months.

A total of 954 participants (89.8%) completed the entire 18-month study. After 12 months, compared to the control group, participants in the gamification group’s average daily steps increased by 538 steps, and those in the monetary incentive group increased by 491 steps. For participants who received both interventions, the average number of steps per day increased by 868 steps compared to the control group.

At 18-month follow-up, the group receiving both interventions was the only intervention group to demonstrate statistically significantly greater daily step counts compared to the control group. Nevertheless, across all three intervention groups, participants’ average daily step count increased by more than 1,500 at 18 months, and their average weekly hours of moderate-to-vigorous physical activity increased compared to their step count at the start of the study. increased by more than 40 minutes.

“While the gamification and financial incentive interventions were similarly effective, the combined intervention was significantly more effective than either intervention alone,” Fanaroff said.

No previous fully home-based physical activity promotion intervention lasted longer than 24 weeks or had a total follow-up of more than 36 weeks, he said. Participant engagement in the study remained high throughout the study period, he said. “During the 18-month follow-up period, step counts were uploaded on more than 80% of the participants’ days,” he said.

“In all three intervention groups, we observed an increase in daily step count from about 5,000 steps at baseline to about 10% more than the control group,” he said. “This trial did not collect data on participants’ health status. However, based on data from observational studies, an increase of this size was associated with a 6% lower risk of death from any cause and a lower risk of heart attack or stroke. We estimate a 10% reduction in the risk of death due to the changes achieved in this trial.”

Fanaroff said a limitation of the study is that participants chose to enroll voluntarily and may not be representative of everyone eligible to enroll. Second, the researchers assessed physical activity using steps and active minutes, but did not assess whether other measures of participants’ health or functional status changed.

Reference: “Efficacy of Gamification, Financial Incentives, or Both to Increase Physical Activity in Patients at High Risk of Cardiovascular Events: The BE ACTIVE Randomized Controlled Trial” Alexander C. Fanaroff, Mitesh S. Patel, Neel Chokshi, Samantha Coratti, David Faraday, Laurie Norton, Charles Leashid, Jinsang Zhu, Tamer Kleiman, Julia E. Szymczak, Louise B. Russell, Dylan S. Small, Kevin GM Volpp, 2024 April 7th, Circulation.
DOI: 10.1161/circulationAHA.124.069531

This research was funded by a grant from the National Heart, Lung, and Blood Institute, part of the National Heart, Lung, and Blood Institute. National Institutes of Health.

Fanaroff published a study titled “Efficacy of gamification, financial incentives, or a combination of both to increase physical activity in patients at high risk for major cardiovascular events.” “Be Active Randomized Clinical Trial” to be held on Sunday, April 7, 2024 at 8:00 a.m. ET / 12:00 p.m. UTC Inside the main tent of Hall B-1.