Incentives and physical activity: An assessment of the association between Vitality's Active Rewards with Apple Watch benefit and sustained physical activity improvements
... The main exposure variable in the model was PA, as the available literature shows that there is a relationship between PA and QoL level. The model derived from ordinal logistic regression showed a certain stability of QoL levels in physically active individuals [5,31,32]. This is because the benefits of PA go beyond the improvement of the clinical and biological condition since it promotes social interaction, the establishment of bonds of friendship, and emotional balance, which are subjective and integral elements of the multidimensional aspect of the QoL construct [32]. ...
... The results of studies show that PA induces behavioral change, which is fundamental for disease control and prevention. Thus, the incorporation of PA in daily life becomes an important therapeutic alternative, capable of improving general health conditions, which necessarily results in better QoL levels for workers [31,32]. ...
Background:
This study aimed to identify the factors associated with the quality of life of young workers of a Social Work of Industry Unit.
Methods:
This was a cross-sectional study conducted on 1270 workers. Data were collected using a digital questionnaire built on the KoBoToolbox platform that included the EUROHIS-QOL eight-item index to assess quality of life. Demographic, socioeconomic, behavioral, and clinical variables were considered explanatory. The associations were analyzed using the ordinal logistic regression model at a 5% significance level.
Results:
Men and women had a mean quality of life of 31.1 and 29.4, respectively. Workers that rated their health as "very good" had an odds ratio of 7.4 (95% confidence interval (CI) = 5.17-10.81), and those who rated it as "good" had an odds ratio of 2.9 (95% CI = 2.31-3.77). Both these groups of workers were more likely to have higher levels of quality of life as compared to workers with "regular", "poor", or "very poor" self-rated health. Physically active individuals were 30% more likely to have higher levels of quality of life (odds ratio = 1.3; 95% CI = 1.08-1.65). After adjusting the model by gender, age group, marital status, socioeconomic class, self-rated health, nutritional status, and risky alcohol consumption, the odds ratio of active individuals remained stable (odds ratio = 1.3; 95% CI = 1.05-1.66).
Conclusions:
In the present study, self-rated health, physical activity, and gender were associated with young workers' quality of life.
... However, strong evidence is still lacking on the effectiveness of these approaches in young adults [19,20]. Conversely, mHealth programs that feature health promoting financial incentives (HPFIs) have been shown to provide powerful extrinsic motivation in young persons and adults [21][22][23][24]. However, the moral underpinnings of offering a reward in return for health behaviors have been the subject of debate [25,26], and several studies have questioned whether HPFIs can produce sustained behavior change [27][28][29][30]. ...
Background
The effectiveness of mobile health (mHealth) approaches that employ wearable technology to promote physical activity have been the subject of concern due to the declining active use observed in trial settings.
Objective
To better contextualize active use, this study aimed to identify the barriers and enablers to engagement in a tracker-based mHealth initiative among young men who had recently completed a 19-week residential weight loss program.
Methods
A mixed methods study was conducted among 167 young men who had voluntarily enrolled in the national steps challenge (NSC), an mHealth physical activity promotion initiative, following a residential weight loss intervention. A subsample of 29 enrollees with a body mass index of 29.6 (SD 3.1) participated in semistructured interviews and additional follow-up assessments. Quantitative systems data on daily step count rates were used to describe active use. Qualitative data were coded and analyzed to elicit barriers and enablers to microlevel engagement in relation to the NSC, focusing on tracker and smartphone use. We further elicited barriers and enablers to macrolevel engagement by exploring attitudes and behaviors toward the NSC. Using triangulation, we examined how qualitative engagement in the NSC could account for quantitative findings on active use. Using integration of findings, we discussed how the mHealth intervention might have changed physical activity behavior.
Results
Among the 167 original enrollees, active use declined from 72 (47%) in week 1 to 27 (17%) in week 21. Mean daily step counts peaked in week 1 at 10,576 steps per day and were variable throughout the NSC. Barriers to engagement had occurred in the form of technical issues leading to abandonment, device switching, and offline tracking. Passive attitudes toward step counting and disinterest in the rewards had also prevented deeper engagement. Enablers of engagement included self-monitoring and coaching features, while system targets and the implicit prospect of reward had fostered new physical activity behaviors.
Conclusions
Our study showed that as the NSC is implemented in this population, more emphasis should be placed on technical support and personalized activity targets to promote lasting behavior change.
... The insurance products underpinned by the "Vitality" platform of Discovery, Ltd., a financial services corporation, are the first in this case. Similar products are offered in countries such as South Africa, the UK, and the USA, as described by Hafner, Pollard, and Van Stolk (2018). 1 Under this arrangement, individuals consent to having their physical activity tracked through wearable devices or smartphones. Consequently, individuals receive Vitality Points and rewards for attaining the designated activity thresholds. ...
This study aims to demonstrate the effect of the cost of telematics and loss ratio improvement on the coverage demand for health promotion medical insurance. Real-time monitoring via telematics is expected to alleviate moral hazard of insured persons through the “analogical experience rating system,” resulting in a decreased claim cost and an improved loss ratio. In reality, however, the real-time monitoring on a continuous basis imposes a cost burden on insurers and thus, certain expense loadings apply to insurance premiums. The analysis based on the modified separating market equilibrium model reveals that people tend to opt for partial insurance coverage, and high-risk individuals even stay uninsured unless the expense loadings are not excessive. This result implies that the demand for health promotion medical insurance can decrease, and may conduce a market shrinkage, unless the improvement of loss ratio sufficiently surpasses the cost of telematics utilization.
... Doing physical activity has become an increasingly important social issue in recent decades because, among other reasons, physical inactivity and sedentary lifestyles have contributed to the growing prevalence of pathologies such as obesity, diabetes mellitus, heart disease, hypertension, and cerebrovascular accidents, nowadays the scourge of modern societies [5] Low levels of PA and sedentarism have been associated with the onset of different pathologies and health problems [6][7]. Numerous studies have demonstrated that doing regular PA is beneficial for body composition [8][9][10], bone health [11][12], psychological health and stress [13][14], and cardiorespiratory capacity, among others [15][16][17][18]. The prevalence of these illnesses is still increasing, leading to greater morbidity and mortality, and the consequent the urgent need to implement effective PA programmes to reduce the sedentary behaviour of the population [19]. ...
Low levels of physical activity (PA) and sedentarism are associated with the onset of different pathologies and health problems. Regular physical activity has been linked with being beneficial to the health of the general population. Within this framework of analysis, the aim of the present study is to analyse the existing association between the time spent doing physical activity and the expressed motives for doing so, from which the first innovative aspect of the paper emerges: the use of the time spent doing PA as a study variable of the phenomenon. The data analysed come from the latest special Eurobarometer survey about the sport and physical activity done in Europe. Using an exploratory factorial analysis and a structural equations model, we were able to find a six-dimensional factorial model that explains the reasons for doing PA, demonstrating that there is no relationship between the reasons for and time spent doing PA. Therefore, motivation is not a variable that explains the time spent doing PA and another type of variable must be used to explain the phenomenon if PA is to be incentivised.
... Indeed, attention should be given to innovative strategies to enhance participant adherence and retention in programs, considering retention rates in our study. A recent study has reported the success of incentivizing lifestyle programs to improve adoption and retention in community programs in the UK, USA and South Africa [58]. ...
Abstract Background Our objective was to determine the influence of the HealtheSteps™ lifestyle prescription program on physical activity and modifiable risk factors for chronic disease in individuals at risk. Methods One hundred eighteen participants were recruited from 5 sites in Southwestern Ontario, Canada and randomized to either the intervention (HealtheSteps™ program, n = 59) or a wait-list control group (n = 59). The study comprised three phases: an Active Phase (0 to 6 months) consisted of bi-monthly in-person lifestyle coaching with access to a suite of eHealth technology supports (Heathesteps app, telephone coaching and a private HealtheSteps™ social network) followed by a Minimally-Supported Phase I (6 to 12 months), in which in-person coaching was removed, but participants still had access to the full suite of eHealth technology supports. In the final stage, Minimally-Supported Phase II (12 to 18 months), access to the eHealth technology supports was restricted to the HealtheSteps™ app. Assessments were conducted at baseline, 6, 12 and 18 months. The study primary outcome was the 6-month change in average number of steps per day. Secondary outcomes included: self-reported physical activity and sedentary time; self-reported eating habits; weight and body composition measures; blood pressure and health-related quality of life. Data from all participants were analyzed using an intent-to-treat approach. We applied mixed effects models for repeated measurements and adjusted for age, sex, and site in the statistical analyses. Results Participants in HealtheSteps™ increased step counts (between-group [95% confidence interval]: 3132 [1969 to 4294], p
... Participants in the active rewards program with an Apple Watch benefit engaged in 34% more physical activity than participants in the active rewards program without an Apple Watch. 8 In 2018, participants in UnitedHealthcare's Motion program completed an average of nearly 12 000 steps per day. 4 Beyond the direct benefits to patients, if mobile health devices meet expectations for physical activity, they could reduce hospitalizations and the incidence of preventable cardiovascular disease, potentially saving private and public health insurers significant costs. However, randomized clinical trials with long-term follow-up of clinically meaningful end points will be necessary to determine whether these benefits materialize. ...
Promoting and incentivizing healthy lifestyle practices in the United States is of national importance. Digital health devices, such as mobile and wearable devices and software applications, have potential for promoting healthy lifestyle practices and preventing the development or progression of cardiovascular disease. The use of mobile health devices has increased substantially in recent years; a national survey of 4000 adults in the United States in 2017 found that 24% of respondents reported using wearable devices.
This article demonstrates, for the first time, a zero-power ultrasonic wakeup receiver for intra-body communication with Implantable Medical Devices (IMDs). The system is based on a 10 x 10 Piezoelectric Micromachined Ultrasonic Transducer (pMUT) array, a zero-power 500 nm gap MEMS plasmonic switch, a low-leakage CMOS load-switch, and an ad hoc sensing circuit. An ultrasonic signal of 10 mVpp is received by the pMUT array at a distance of 5 cm and brings the MEMS switch from the off-state (1 pA) to the on-state (20 μ A) when biased at 9.09
$V_{DC}$
. This small current then wakes up the load-switch (<10 nW when off), which powers up the sensing circuit to decode the pMUT signal. The system is demonstrated in a tissue phantom, making it ideal for intrabody communication.
Zusammenfassung
Der Artikel analysiert den Einzug Big Techs (der Fokus liegt auf Apple und Alphabet) in den Gesundheitsmarkt und beschreibt in Anlehnung an Michel Foucault und Shoshana Zuboff das Konzept einer „überwachungskapitalistischen Biopolitik“. Ziel ist, die Ausweitung des „Datenextraktivismus“ im Gesundheitswesen und der Gesundheitsforschung machtkritisch einzuordnen und damit einen Trend in der digitalen Gesundheitsfürsorge zu problematisieren, der sich in den letzten Jahren und, wie wir zeigen, besonders während der Coronakrise beschleunigt und ausgefächert hat. Anhand wissenschaftlicher und kommerzieller Projekte sowie Kooperationen im Bereich public health wird deutlich, dass zeitgenössische Formen der Biopolitik keineswegs auf staatliche Regime beschränkt sind. Stattdessen sind sie zunehmend über private Technologieunternehmen vermittelt, die dabei nicht nur intime Verhaltens- und Vitaldaten akkumulieren, sondern – qua proprietärer Algorithmen – auch den Zugang zu diesen kontrollieren und schließlich ihren Einfluss in exklusive Services und Produkte überführen. Ein besonderer Akzent des Artikels liegt zudem auf der voranschreitenden Verbreitung sogenannter Wearable-Technologien (Smartwatches etc.), über die sich nicht nur die herausgehobene Marktposition der Konzerne, sondern – in der Entwicklung von einem „quantifizierten Selbst“ zu einem „quantifizierten Kollektiv“ – auch ihre epistemische bzw. „infrastrukturelle Macht“ konkretisiert. Entgegen einer einseitig repressiven Perspektive auf biopolitische Praxen zeigen wir schließlich Ansätze einer Demokratisierung „überwachungskapitalistischer Biopolitik“ auf. Hierbei heben wir vier Topoi hervor, die von zentraler Bedeutung sind: Privatsphäre bzw. individuelle Souveränität, demokratische Deliberation, Pluralismus und epistemische Gleichheit.
Objectives:
The Scientific Pandemic Insights group on Behaviours (SPI-B) as part of England's Scientific Advisory Group on Emergencies (SAGE), were commissioned by the UK Cabinet Office to identify strategies to embed infection control behaviours to minimize Covid-19 transmission in the long term.
Methods:
With minimal direct evidence available, three sources of information were used to develop a set of proposals: (1) a scoping review of literature on sustaining behaviour change, (2) a review of key principles used in risk and safety management, and (3) prior reports and reviews on behaviour change from SPI-B. The information was collated and refined through discussion with SPI-B and SAGE colleagues to finalize the proposals.
Results:
Embedding infection control behaviours in the long-term will require changes to the financial, social, and physical infrastructure so that people in all sections of society have the capability, opportunity, and motivation needed to underpin those behaviours. This will involve building Covid-safe educational programmes, regulating to ensure minimum standards of safety in public spaces and workspaces, using communications and social marketing to develop a Covid-safe culture and identity, and providing resources so that all sections of society can build Covid-safe behaviours into their daily lives.
Conclusions:
Embedding 'Covid-safe' behaviours into people's everyday routines will require a co-ordinated programme to shape the financial, physical, and social infrastructure in the United Kingdom. Education, regulation, communications, and social marketing, and provision of resources will be required to ensure that all sections of society have the capability, opportunity, and motivation to enact the behaviours long term.
Low levels of Physical Activity (PA) and sedentarism are associated with the onset of different pathologies and health problems. Regular physical activity has been linked with being beneficial to the health of the general population. Within this framework of analysis, the aim of the present study was to analyze the association between the time spent doing physical activity and the expressed motives for doing so, from which the innovative aspect of the paper emerges: the use of the time spent doing PA as a study variable of the phenomenon. The data analyzed come from the latest special Eurobarometer survey about the sport and physical activity done in Europe. Using an exploratory factorial analysis and a structural equations model, a six-dimensional factorial model was found that explains the reasons for doing PA, demonstrating that there is no relationship between the reasons for and time spent doing PA. The motivation is not a variable that explains the time spent doing PA, and another type of variable must be used to explain the phenomenon if PA is to be incentivized. Weaknesses of the study are that it works with individuals as a group and that the fundamental dependence on age is not introduced, which could determine interest in practicing PA. Similarly, the impact of the conditions of implementing PA, education, and family history should also be introduced into the model.
Background:
Insufficient physical activity is a leading risk factor for non-communicable diseases, and has a negative effect on mental health and quality of life. We describe levels of insufficient physical activity across countries, and estimate global and regional trends.
Methods:
We pooled data from population-based surveys reporting the prevalence of insufficient physical activity, which included physical activity at work, at home, for transport, and during leisure time (ie, not doing at least 150 min of moderate-intensity, or 75 min of vigorous-intensity physical activity per week, or any equivalent combination of the two). We used regression models to adjust survey data to a standard definition and age groups. We estimated time trends using multilevel mixed-effects modelling.
Findings:
We included data from 358 surveys across 168 countries, including 1·9 million participants. Global age-standardised prevalence of insufficient physical activity was 27·5% (95% uncertainty interval 25·0-32·2) in 2016, with a difference between sexes of more than 8 percentage points (23·4%, 21·1-30·7, in men vs 31·7%, 28·6-39·0, in women). Between 2001, and 2016, levels of insufficient activity were stable (28·5%, 23·9-33·9, in 2001; change not significant). The highest levels in 2016, were in women in Latin America and the Caribbean (43·7%, 42·9-46·5), south Asia (43·0%, 29·6-74·9), and high-income Western countries (42·3%, 39·1-45·4), whereas the lowest levels were in men from Oceania (12·3%, 11·2-17·7), east and southeast Asia (17·6%, 15·7-23·9), and sub-Saharan Africa (17·9%, 15·1-20·5). Prevalence in 2016 was more than twice as high in high-income countries (36·8%, 35·0-38·0) as in low-income countries (16·2%, 14·2-17·9), and insufficient activity has increased in high-income countries over time (31·6%, 27·1-37·2, in 2001).
Interpretation:
If current trends continue, the 2025 global physical activity target (a 10% relative reduction in insufficient physical activity) will not be met. Policies to increase population levels of physical activity need to be prioritised and scaled up urgently.
Funding:
None.
Background:
Regular physical activity reduces the risk of cardiovascular events, but most ischemic heart disease (IHD) patients do not obtain enough.
Methods and results:
ACTIVE REWARD (A Clinical Trial Investigating Effects of a Randomized Evaluation of Wearable Activity Trackers with Financial Rewards) was a 24-week home-based, remotely monitored, randomized trial with a 16-week intervention (8-week ramp-up incentive phase and 8-week maintenance incentive phase) and an 8-week follow-up. Patients used wearable devices to track step counts and establish a baseline. Patients in control received no other interventions. Patients in the incentive arm received personalized step goals and daily feedback for all 24 weeks. In the ramp-up incentive phase, daily step goals increased weekly by 15% from baseline with a maximum of 10 000 steps and then remained fixed. Each week, $14 was allocated to a virtual account; $2 could be lost per day for not achieving step goals. The primary outcome was change in mean daily steps from baseline to the maintenance incentive phase. Ischemic heart disease patients had a mean (SD) age of 60 (11) years and 70% were male. Compared with control, patients in the incentive arm had a significantly greater increase in mean daily steps from baseline during ramp-up (1388 versus 385; adjusted difference, 1061 [95% confidence interval, 386-1736]; P<0.01), maintenance (1501 versus 264; adjusted difference, 1368 [95% confidence interval, 571-2164]; P<0.001), and follow-up (1066 versus 92; adjusted difference, 1154 [95% confidence interval, 282-2027]; P<0.01).
Conclusions:
Loss-framed financial incentives with personalized goal setting significantly increased physical activity among ischemic heart disease patients using wearable devices during the 16-week intervention, and effects were sustained during the 8-week follow-up.
Clinical trial registration:
URL: https://www.clinicaltrials.gov. Unique identifier: NCT02531022.
The aim of this review is to give an overview of the available evidence on the effects of financial incentives to stimulate physical activity. Therefore, a systematic literature search was performed for randomized trials that investigate the effects of physical-activity-related financial incentives for individuals. Twelve studies with unconditional incentives (e.g. free membership sport facility) and conditional incentives (i.e. rewards for reaching physical-activity goals) related to physical activity were selected. Selected outcomes were physical activity, sedentary behavior, fitness, and weight. Results show that unconditional incentives do not affect physical activity or the other selected outcomes. For rewards, some positive effects were found and especially for rewards provided for physical-activity behavior instead of attendance. In conclusion, rewards seem to have positive effects on physical activity, while unconditional incentives seem to have no effect. However, it should be kept in mind that the long-term effects of financial incentives are still unclear.
Uncertainty remains about whether personal financial incentives could achieve sustained changes in health-related behaviours that would reduce the fast-growing global non-communicable disease burden. This review aims to estimate whether: i. financial incentives achieve sustained changes in smoking, eating, alcohol consumption and physical activity; ii. effectiveness is modified by (a) the target behaviour, (b) incentive value and attainment certainty, (c) recipients' deprivation level.
Multiple sources were searched for trials offering adults financial incentives and assessing outcomes relating to pre-specified behaviours at a minimum of six months from baseline. Analyses included random-effects meta-analyses and meta-regressions grouped by timed endpoints.
Of 24,265 unique identified articles, 34 were included in the analysis. Financial incentives increased behaviour-change, with effects sustained until 18months from baseline (OR: 1.53, 95% CI 1.05-2.23) and three months post-incentive removal (OR: 2.11, 95% CI 1.21-3.67). High deprivation increased incentive effects (OR: 2.17; 95% CI 1.22-3.85), but only at >6-12months from baseline. Other assessed variables did not independently modify effects at any time-point.
Personal financial incentives can change habitual health-related behaviours and help reduce health inequalities. However, their role in reducing disease burden is potentially limited given current evidence that effects dissipate beyond three months post-incentive removal.
Copyright © 2015. Published by Elsevier Inc.
Background:
Physical activity (PA) interventions typically include components or doses that are static across participants. Adaptive interventions are dynamic; components or doses change in response to short-term variations in participant's performance. Emerging theory and technologies make adaptive goal setting and feedback interventions feasible.
Objective:
To test an adaptive intervention for PA based on Operant and Behavior Economic principles and a percentile-based algorithm. The adaptive intervention was hypothesized to result in greater increases in steps per day than the static intervention.
Methods:
Participants (N = 20) were randomized to one of two 6-month treatments: 1) static intervention (SI) or 2) adaptive intervention (AI). Inactive overweight adults (85% women, M = 36.9 ± 9.2 years, 35% non-white) in both groups received a pedometer, email and text message communication, brief health information, and biweekly motivational prompts. The AI group received daily step goals that adjusted up and down based on the percentile-rank algorithm and micro-incentives for goal attainment. This algorithm adjusted goals based on a moving window; an approach that responded to each individual's performance and ensured goals were always challenging but within participants' abilities. The SI group received a static 10,000 steps/day goal with incentives linked to uploading the pedometer's data.
Results:
A random-effects repeated-measures model accounted for 180 repeated measures and autocorrelation. After adjusting for covariates, the treatment phase showed greater steps/day relative to the baseline phase (p<.001) and a group by study phase interaction was observed (p .017). The SI group increased by 1,598 steps/day on average between baseline and treatment while the AI group increased by 2,728 steps/day on average between baseline and treatment; a significant between-group difference of 1,130 steps/day (Cohen's d = .74).
Conclusions:
The adaptive intervention outperformed the static intervention for increasing PA. The adaptive goal and feedback algorithm is a "behavior change technology" that could be incorporated into mHealth technologies and scaled to reach large populations.
Trial registration:
ClinicalTrials.gov NCT01793064.
Financial incentives are widely used in health behavior interventions. However, self-determination theory posits that emphasizing financial incentives can have negative consequences if experienced as controlling. Feeling controlled into performing a behavior tends to reduce enjoyment and undermine maintenance after financial contingencies are removed (the undermining effect). We assessed participants' context-specific financial motivation to participate in the Make Better Choices trial-a trial testing four different strategies for improving four health risk behaviors: low fruit and vegetable intake, high saturated fat intake, low physical activity, and high sedentary screen time. The primary outcome was overall healthy lifestyle change; weight loss was a secondary outcome. Financial incentives were contingent upon meeting behavior goals for 3 weeks and became contingent upon merely providing data during the 4.5-month maintenance period. Financial motivation for participation was assessed at baseline using a 7-item scale (α = .97). Across conditions, a main effect of financial motivation predicted a steeper rate of weight regained during the maintenance period, t(165) = 2.15, P = .04. Furthermore, financial motivation and gender interacted significantly in predicting maintenance of healthy diet and activity changes, t(160) = 2.42, P = .016, such that financial motivation had a more deleterious influence among men. Implications for practice and future research on incentivized lifestyle and weight interventions are discussed.
The core methods in today's econometric toolkit are linear regression for statistical control, instrumental variables methods for the analysis of natural experiments, and differences-in-differences methods that exploit policy changes. In the modern experimentalist paradigm, these techniques address clear causal questions such as: Do smaller classes increase learning? Should wife batterers be arrested? How much does education raise wages?Mostly Harmless Econometricsshows how the basic tools of applied econometrics allow the data to speak.In addition to econometric essentials,Mostly Harmless Econometricscovers important new extensions--regression-discontinuity designs and quantile regression--as well as how to get standard errors right. Joshua Angrist and J rn-Steffen Pischke explain why fancier econometric techniques are typically unnecessary and even dangerous. The applied econometric methods emphasized in this book are easy to use and relevant for many areas of contemporary social science.An irreverent review of econometric essentialsA focus on tools that applied researchers use mostChapters on regression-discontinuity designs, quantile regression, and standard errorsMany empirical examplesA clear and concise resource with wide applications.
Background:
Physical inactivity is a key risk factor for chronic disease, but a growing number of people are not achieving the recommended levels of physical activity necessary for good health. Australians are no exception; despite Australia's image as a sporting nation, with success at the elite level, the majority of Australians do not get enough physical activity. There are many options for intervention, from individually tailored advice, such as counselling from a general practitioner, to population-wide approaches, such as mass media campaigns, but the most cost-effective mix of interventions is unknown. In this study we evaluate the cost-effectiveness of interventions to promote physical activity.
Methods and findings:
From evidence of intervention efficacy in the physical activity literature and evaluation of the health sector costs of intervention and disease treatment, we model the cost impacts and health outcomes of six physical activity interventions, over the lifetime of the Australian population. We then determine cost-effectiveness of each intervention against current practice for physical activity intervention in Australia and derive the optimal pathway for implementation. Based on current evidence of intervention effectiveness, the intervention programs that encourage use of pedometers (Dominant) and mass media-based community campaigns (Dominant) are the most cost-effective strategies to implement and are very likely to be cost-saving. The internet-based intervention program (AUS$3,000/DALY), the GP physical activity prescription program (AUS$12,000/DALY), and the program to encourage more active transport (AUS$20,000/DALY), although less likely to be cost-saving, have a high probability of being under a AUS$50,000 per DALY threshold. GP referral to an exercise physiologist (AUS$79,000/DALY) is the least cost-effective option if high time and travel costs for patients in screening and consulting an exercise physiologist are considered.
Conclusions:
Intervention to promote physical activity is recommended as a public health measure. Despite substantial variability in the quantity and quality of evidence on intervention effectiveness, and uncertainty about the long-term sustainability of behavioural changes, it is highly likely that as a package, all six interventions could lead to substantial improvement in population health at a cost saving to the health sector. Please see later in the article for Editors' Summary.
The authors sought to determine whether a greater academic incentive would improve the effectiveness and student adherence to a 12-week voluntary exercise program designed to decrease students' percentage of body fat. They randomly assigned 210 students to 1 of 2 groups with different academic reward structures. The group with the greater reward structure showed better exercise adherence and lost more body fat than those without the additional incentive. These findings suggest that an academic incentive can increase overall student adherence to a voluntary exercise program and can boost the effectiveness of the program in a university environment. The findings also have potential implications for on-campus promotion of physical activity.
Background:
The pandemic of physical inactivity is associated with a range of chronic diseases and early deaths. Despite the well documented disease burden, the economic burden of physical inactivity remains unquantified at the global level. A better understanding of the economic burden could help to inform resource prioritisation and motivate efforts to increase levels of physical activity worldwide.
Methods:
Direct health-care costs, productivity losses, and disability-adjusted life-years (DALYs) attributable to physical inactivity were estimated with standardised methods and the best data available for 142 countries, representing 93·2% of the world's population. Direct health-care costs and DALYs were estimated for coronary heart disease, stroke, type 2 diabetes, breast cancer, and colon cancer attributable to physical inactivity. Productivity losses were estimated with a friction cost approach for physical inactivity related mortality. Analyses were based on national physical inactivity prevalence from available countries, and adjusted population attributable fractions (PAFs) associated with physical inactivity for each disease outcome and all-cause mortality.
Findings:
Conservatively estimated, physical inactivity cost health-care systems international $ (INT$) 53·8 billion worldwide in 2013, of which $31·2 billion was paid by the public sector, $12·9 billion by the private sector, and $9·7 billion by households. In addition, physical inactivity related deaths contribute to $13·7 billion in productivity losses, and physical inactivity was responsible for 13·4 million DALYs worldwide. High-income countries bear a larger proportion of economic burden (80·8% of health-care costs and 60·4% of indirect costs), whereas low-income and middle-income countries have a larger proportion of the disease burden (75·0% of DALYs). Sensitivity analyses based on less conservative assumptions led to much higher estimates.
Interpretation:
In addition to morbidity and premature mortality, physical inactivity is responsible for a substantial economic burden. This paper provides further justification to prioritise promotion of regular physical activity worldwide as part of a comprehensive strategy to reduce non-communicable diseases.
Funding:
None.
BACKGROUND
More than half of adults in the United States do not attain the minimum recommended level of physical activity to achieve health benefits. The optimal design of financial incentives to promote physical activity is unknown. OBJECTIVE
To compare the effectiveness of individual versus team-based financial incentives to increase physical activity. DESIGNRandomized, controlled trial comparing three interventions to control. PARTICIPANTSThree hundred and four adult employees from an organization in Philadelphia formed 76 four-member teams. INTERVENTIONSAll participants received daily feedback on performance towards achieving a daily 7000 step goal during the intervention (weeks 1– 13) and follow-up (weeks 14– 26) periods. The control arm received no other intervention. In the three financial incentive arms, drawings were held in which one team was selected as the winner every other day during the 13-week intervention. A participant on a winning team was eligible as follows: $50 if he or she met the goal (individual incentive), $50 only if all four team members met the goal (team incentive), or $20 if he or she met the goal individually and $10 more for each of three teammates that also met the goal (combined incentive). MAIN MEASURESMean proportion of participant-days achieving the 7000 step goal during the intervention. KEY RESULTSCompared to the control group during the intervention period, the mean proportion achieving the 7000 step goal was significantly greater for the combined incentive (0.35 vs. 0.18, difference: 0.17, 95 % confidence interval [CI]: 0.07–0.28, p <0.001) but not for the individual incentive (0.25 vs 0.18, difference: 0.08, 95 % CI: -0.02–0.18, p = 0.13) or the team incentive (0.17 vs 0.18, difference: -0.003, 95 % CI: -0.11–0.10, p = 0.96). The combined incentive arm participants also achieved the goal at significantly greater rates than the team incentive (0.35 vs. 0.17, difference: 0.18, 95 % CI: 0.08–0.28, p < 0.001), but not the individual incentive (0.35 vs. 0.25, difference: 0.10, 95 % CI: -0.001–0.19, p = 0.05). Only the combined incentive had greater mean daily steps than control (difference: 1446, 95 % CI: 448–2444, p ≤ 0.005). There were no significant differences between arms during the follow-up period (weeks 14– 26). CONCLUSIONS
Financial incentives rewarded for a combination of individual and team performance were most effective for increasing physical activity. Trial RegistrationClinicaltrials.gov identifier: NCT02001194.
Background:
Financial incentive designs to increase physical activity have not been well-examined.
Objective:
To test the effectiveness of 3 methods to frame financial incentives to increase physical activity among overweight and obese adults.
Design:
Randomized, controlled trial. (ClinicalTrials.gov: NCT 02030119).
Setting:
University of Pennsylvania.
Participants:
281 adult employees (body mass index ≥27 kg/m2).
Intervention:
13-week intervention. Participants had a goal of 7000 steps per day and were randomly assigned to a control group with daily feedback or 1 of 3 financial incentive programs with daily feedback: a gain incentive ($1.40 given each day the goal was achieved), lottery incentive (daily eligibility [expected value approximately $1.40] if goal was achieved), or loss incentive ($42 allocated monthly upfront and $1.40 removed each day the goal was not achieved). Participants were followed for another 13 weeks with daily performance feedback but no incentives.
Measurements:
Primary outcome was the mean proportion of participant-days that the 7000-step goal was achieved during intervention. Secondary outcomes included mean proportion of participant-days achieving the goal during follow-up and mean daily steps during intervention and follow-up.
Results:
The mean proportion of participant-days achieving the goal was 0.30 (95% CI, 0.22 to 0.37) in the control group, 0.35 (CI, 0.28 to 0.42) in the gain-incentive group, 0.36 (CI, 0.29 to 0.43) in the lottery-incentive group, and 0.45 (CI, 0.38 to 0.52) in the loss-incentive group. In adjusted analyses, only the loss-incentive group had a significantly greater mean proportion of participant-days achieving the goal than control (adjusted difference, 0.16 [CI, 0.06 to 0.26]; P = 0.001), but the adjusted difference in mean daily steps was not significant (861 [CI, 24 to 1746]; P = 0.056). During follow-up, daily steps decreased for all incentive groups and were not different from control.
Limitation:
Single employer.
Conclusion:
Financial incentives framed as a loss were most effective for achieving physical activity goals.
Primary funding source:
National Institute on Aging.
Less than 5% of U.S. adults accumulate the required dose of exercise to maintain health. Behavioral economics has stimulated renewed interest in economic-based, population-level health interventions to address this issue. Despite widespread implementation of financial incentive-based public health and workplace wellness policies, the effects of financial incentives on exercise initiation and maintenance in adults remain unclear.
A systematic search of 15 electronic databases for RCTs reporting the impact of financial incentives on exercise-related behaviors and outcomes was conducted in June 2012. A meta-analysis of exercise session attendance among included studies was conducted in April 2013. A qualitative analysis was conducted in February 2013 and structured along eight features of financial incentive design.
Eleven studies were included (N=1453; ages 18-85 years and 50% female). Pooled results favored the incentive condition (z=3.81, p<0.0001). Incentives also exhibited significant, positive effects on exercise in eight of the 11 included studies. One study determined that incentives can sustain exercise for longer periods (>1 year), and two studies found exercise adherence persisted after the incentive was withdrawn. Promising incentive design feature attributes were noted. Assured, or "sure thing," incentives and objective behavioral assessment in particular appear to moderate incentive effectiveness. Previously sedentary adults responded favorably to incentives 100% of the time (n=4).
The effect estimate from the meta-analysis suggests that financial incentives increase exercise session attendance for interventions up to 6 months in duration. Similarly, a simple count of positive (n=8) and null (n=3) effect studies suggests that financial incentives can increase exercise adherence in adults in the short term (<6 months).
Background:
Improving diet quality is a key health promotion strategy. There is much interest in the role of prices and financial incentives to encourage healthy diet, but no data from large population interventions.
Purpose:
This study examines the effect of a price reduction for healthy food items on household grocery shopping behavior among members of South Africa's largest health plan.
Methods:
The HealthyFood program provides a cash-back rebate of up to 25% for healthy food purchases in over 400 designated supermarkets across all provinces in South Africa. Monthly household supermarket food purchase scanner data between 2009 and 2012 are linked to 170,000 households (60% eligible for the rebate) with Visa credit cards. Two approaches were used to control for selective participation using these panel data: a household fixed-effect model and a case-control differences-in-differences model.
Results:
Rebates of 10% and 25% for healthy foods are associated with an increase in the ratio of healthy to total food expenditure by 6.0% (95% CI=5.3, 6.8) and 9.3% (95% CI=8.5, 10.0); an increase in the ratio of fruit and vegetables to total food expenditure by 5.7% (95% CI=4.5, 6.9) and 8.5% (95% CI=7.3, 9.7); and a decrease in the ratio of less desirable to total food expenditure by 5.6% (95% CI=4.7, 6.5) and 7.2% (95% CI=6.3, 8.1).
Conclusions:
Participation in a rebate program for healthy foods led to increases in purchases of healthy foods and to decreases in purchases of less-desirable foods, with magnitudes similar to estimates from U.S. time-series data.
Chinese translation
Data on the effectiveness of employer-sponsored financial incentives for employee weight loss are limited.
To test the effectiveness of 2 financial incentive designs for promoting weight loss among obese employees.
Randomized, controlled trial. (ClinicalTrials.gov: NCT01208350)
Children's Hospital of Philadelphia.
105 employees with a body mass index between 30 and 40 kg/m2.
24 weeks of monthly weigh-ins (control group; n = 35); individual incentive, designed as $100 per person per month for meeting or exceeding weight-loss goals (n = 35); and group incentive, designed as $500 per month split among participants within groups of 5 who met or exceeded weight-loss goals (n = 35).
Weight loss after 24 weeks (primary outcome) and 36 weeks and changes in behavioral mediators of weight loss (secondary outcomes).
Group-incentive participants lost more weight than control participants (mean between-group difference, 4.4 kg [95% CI, 2.0 to 6.7 kg]; P < 0.001) and individual-incentive participants (mean between-group difference, 3.2 kg [CI, 0.9 to 5.5 kg]; P = 0.008). Twelve weeks after incentives ended and after adjustment for 3-group comparisons, group-incentive participants maintained greater weight loss than control group participants (mean between-group difference, 2.9 kg [CI, 0.5 to 5.3 kg]; P = 0.016) but not greater than individual-incentive participants (mean between-group difference, 2.7 kg [CI, 0.4 to 5.0 kg]; P = 0.024).
Single employer and short follow-up.
A group-based financial incentive was more effective than an individual incentive and monthly weigh-ins at promoting weight loss among obese employees at 24 weeks.
National Institute on Aging.
To implement effective non-communicable disease prevention programmes, policy makers need data for physical activity levels and trends. In this report, we describe physical activity levels worldwide with data for adults (15 years or older) from 122 countries and for adolescents (13-15-years-old) from 105 countries. Worldwide, 31·1% (95% CI 30·9-31·2) of adults are physically inactive, with proportions ranging from 17·0% (16·8-17·2) in southeast Asia to about 43% in the Americas and the eastern Mediterranean. Inactivity rises with age, is higher in women than in men, and is increased in high-income countries. The proportion of 13-15-year-olds doing fewer than 60 min of physical activity of moderate to vigorous intensity per day is 80·3% (80·1-80·5); boys are more active than are girls. Continued improvement in monitoring of physical activity would help to guide development of policies and programmes to increase activity levels and to reduce the burden of non-communicable diseases.
This paper reviews research studies evaluating the use of financial incentives to promote weight control conducted between 1972 and 2010. It provides an overview of behavioral theories pertaining to incentives and describes empirical studies evaluating specific aspects of incentives. Research on financial incentives and weight control has a history spanning more than 30years. Early studies were guided by operant learning concepts from Psychology, while more recent studies have relied on economic theory. Both theoretical orientations argue that providing financial rewards for losing weight should motivate people to engage in behaviors that produce weight loss. Empirical research has strongly supported this idea. However, results vary widely due to differences in incentive size and schedule, as well as contextual factors. Thus, many important questions about the use of incentives have not yet been clearly answered. Weight-maintenance studies using financial incentives are particularly sparse, so that their long-term efficacy and thus, value in addressing the public health problem of obesity is unclear. Major obstacles to sustained applications of incentive in weight control are funding sources and acceptance by those who might benefit.
This paper describes goal setting components used for behavior change specific to diet and physical activity in community-based interventions targeting overweight and obese adults.
A systematic literature review was conducted. Studies were evaluated using the S.T.A.R.T. (Specificity, Timing, Acquisition, Rewards and feedback, and Tools) criteria which were developed for the purposes of this paper in order to elucidate which intervention features elicit optimal health behavior outcomes.
Eighteen studies were included. Based on the S.T.A.R.T. criteria, it was determined that developing specific goals that are in close proximity, involve the participant in acquisition, and incorporate regular feedback, are common features in this context.
Goal setting can be useful for effecting health behavior changes in this population. However, as different intervention components were often implemented concurrently (e.g., education sessions, self-monitoring records), it was not possible to ascertain which were responsible for positive changes independently.
Goal setting shows promise as a tool that can be incorporated into weight reduction programs by health care professionals and researchers. Studies are warranted to identify the specific mechanisms through which individuals with overweight or obesity can apply the S.T.A.R.T. criteria with respect to goal setting for the purposes of weight loss.
Over the past decade, there has been a substantial increase in the use of financial incentives by private employers and public programs to encourage healthy behaviors, wellness activities, and use of preventive services. The research evidence regarding the effectiveness of this approach is reviewed, summarizing relevant findings from literature reviews and from recent evaluations. The article concludes that financial incentives, even relatively small incentives, can influence individuals' health-related behaviors. However, the findings regarding health promotion and wellness are based primarily on analyses of a limited number of private sector initiatives, whereas the evidence regarding preventive services is based on evaluations of initiatives sponsored predominantly by public programs and directed at low-income populations. In either case, there are several important limitations in the ability of the published findings to provide clear guidance for public program administrators or private purchasers seeking to design and implement effective incentive programs.
Can incentives be effective when trying to encourage the development of good habits? We investigate the effect of paying people a non-trivial amount of money to attend an exercise facility a number of times during a one-month period. In two separate studies, we find that doing so leads to a large and significant increase in the average post-intervention attendance level relative to the control group. This result is entirely driven by the impact on people who did not previously attend the gym on a regular basis, as the average attendance rates for people who had already been using the gym regularly are either unchanged or diminished. In our second study, we also obtain biometric evidence that this intervention improves important health indicators such as weight, waist size, and pulse rate. Thus, even though personal incentives to exercise are already in place, it appears that providing financial incentive to attend the gym regularly for a month serves as a catalyst to get some people past the threshold of actually getting started with an exercise regimen. We argue that there is scope for financial intervention in habit formation, particularly in the area of health.
This review evaluates the effectiveness of physical activity interventions among older adults.
Computerized searches were performed to identify randomized controlled trials. Studies were included if: (1) the study population consisted of older adults (average sample population age of > or =50 years and minimum age of 40 years); (2) the intervention consisted of an exercise program or was aimed at promoting physical activity; and (3) reported on participation (i.e., adherence/compliance) or changes in level of physical activity (e.g., pre-post test measures and group comparisons).
The 38 studies included 57 physical activity interventions. Three types of interventions were identified: home-based, group-based, and educational. In the short-term, both home-based interventions and group-based interventions achieved high rates of participation (means of 90% and 84%, respectively). Participation declined the longer the duration of the intervention. Participation in education interventions varied widely (range of 35% to 96%). Both group-based interventions and education interventions were effective in increasing physical activity levels in the short-term. Information on long-term effectiveness was either absent or showed no difference of physical activity level between the study groups.
Home-based, group-based, and educational physical activity interventions can result in increased physical activity, but changes are small and short-lived. Participation rates of home-based and group-based interventions were comparable, and both seemed to be unrelated to type or frequency of physical activity. The beneficial effect of behavioral reinforcement strategies was not evident. Comparative studies evaluating the effectiveness of diverse interventions are needed to identify the interventions most likely to succeed in the initiation and maintenance of physical activity.
Improving participation in preventive activities will require finding methods to encourage consumers to engage in and remain in such efforts. This review assesses the effects of economic incentives on consumers' preventive health behaviors. A study was classified as complex preventive health if a sustained behavior change was required of the consumer; if it could be accomplished directly (e.g., immunizations), it was considered simple. A systematic literature review identified 111 randomized controlled trials of which 47 (published between 1966 and 2002) met the criteria for review. The economic incentives worked 73% of the time (74% for simple, and 72% for complex). Rates varied by the goal of the incentive. Incentives that increased ability to purchase the preventive service worked better than more diffuse incentives, but the type matters less than the nature of the incentive. Economic incentives are effective in the short run for simple preventive care, and distinct, well-defined behavioral goals. Small incentives can produce finite changes, but it is not clear what size of incentive is needed to yield a major sustained effect.
To review research evidence on the effectiveness of monetary incentives in modifying dietary behavior, we conducted a systematic review of randomized, controlled trials (RCTs) identified from electronic bibliographic databases and reference lists of retrieved relevant articles. Studies eligible for inclusion met the following criteria: RCT comparing a form of monetary incentive with a comparative intervention or control; incentives were a central component of the study intervention and their effect was able to be disaggregated from other intervention components; study participants were community-based; and outcome variables included anthropometric or dietary assessment measures. Data were extracted on study populations, setting, interventions, outcome variables, trial duration, and follow-up. Appraisal of trial methodological quality was undertaken based on comparability of baseline characteristics, randomization method, allocation concealment, blinding, follow-up, and use of intention-to-treat analysis. Four RCTs were identified as meeting the inclusion criteria. All four trials demonstrated a positive effect of monetary incentives on food purchases, food consumption, or weight loss. However, the trials had some methodological limitations including small sample sizes and short durations. In addition, no studies to date have assessed effects according to socioeconomic or ethnic group or measured the cost-effectiveness of such schemes. Monetary incentives are a promising strategy to modify dietary behavior, but more research is needed to address the gaps in evidence. In particular, larger, long-term RCTs are needed with population groups at high risk of nutrition-related diseases.
Nine studies met the criteria for inclusion in this systematic review of randomized controlled trials of treatments for obesity and overweight involving the use of financial incentives, with reported follow-up of at least 1 year. All included trials were of behavioural obesity treatments. Justification of sample size and blinding procedure were not mentioned in any study. Attrition was well described in three studies and no study was analysed on an intention to treat basis. Participants were mostly women recruited through media advertisements. Mean age ranged from 35.7 to 52.8 years, and mean body mass index from 29.3 to 31.8 kg m(-2). Results from meta-analysis showed no significant effect of use of financial incentives on weight loss or maintenance at 12 months and 18 months. Further sub-analysis by mode of delivery and amount of incentives although also non-statistically significant were suggestive of very weak trends in favour of use of amounts greater than 1.2% personal disposable income, rewards for behaviour change rather than for weight, rewards based on group performance rather than for individual performance and rewards delivered by non-psychologists rather than delivered by psychologists.
Less than half of all U.S. adults meet public health recommendations for physical activity, and even fewer older adults (aged 50 years and over) are sufficiently active. Because inactivity increases the risk of costly medical complications, successful efforts to increase physical activity among older adults may potentially be cost-effective. We sought to test if financial incentives for walking could increase physical activity among sedentary older adults.
We conducted a 4-week randomized controlled study using pedometers. A total of 51 adults age 50+ from the Raleigh-Durham area of North Carolina participated in the study in April-May 2007. Individuals were randomized into one of two arms. The control group received a fixed payment of $75; the intervention group received a fixed payment of $50 plus up to $25 more per week depending on the number of weekly aerobic minutes, defined as 10+ minutes of continuous walking or jogging.
The control group logged 2.3 h per week, on average. The intervention group logged 4.1 h per week and received an additional weekly payment of $17.50, on average.
Modest financial incentives tied to aerobic minutes are an effective, and potentially cost-effective, approach for increasing physical activity among sedentary older adults.
- S Pischke
Pischke, S. 2005. 'Empirical Methods in Applied Economics-Lecture Notes.' As of 9 November
2018: http://econ.lse.ac.uk/staff/spischke/ec524/evaluation3.pdf
Physical Activity Guidelines Advisory Committee Report
Physical Activity Guidelines Advisory Committee. 2008. 'Physical Activity Guidelines Advisory
Committee Report, 2008.' Washington, DC: US Department of Health and Human Services 2008:
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- S Pischke
Pischke, S. 2005. 'Empirical Methods in Applied Economics -Lecture Notes.' As of 9 November
2018: http://econ.lse.ac.uk/staff/spischke/ec524/evaluation3.pdf
Global Action Plan on Physical Activity 2018-2030: More Active People for a Healthier World
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People for a Healthier World.' As of November 9 2018:
http://apps.who.int/iris/bitstream/handle/10665/272722/9789241514187-eng.pdf