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Financial incentives increase physical activity in ischemic heart disease
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Patients with ischemic heart disease who used wearable devices and received financial incentives for meeting personalized goals increased physical activity with sustained effects during follow-up, according to a study published in the Journal of the American Heart Association.
“There is a lot of interest in using wearable devices to increase activity levels among high-risk cardiovascular patients, but the best way to design these types of programs is unknown,” Neel P. Chokshi, MD, MBA, cardiologist and medical director of the sports cardiology and fitness program at the University of Pennsylvania Perelman School of Medicine, said in a press release. “Our trial is one of the first to test the use of mobile technology through a home-based program and found that while wearable devices alone were not effective, combining them with financial incentives and personalized goal-setting significantly increased physical activity levels during the 6-month period.”
ACTIVE REWARD trial
Researchers analyzed data from 105 participants (mean age, 60 years; 70% men) with ischemic heart disease in the randomized controlled ACTIVE REWARD trial. Targeted participants were eligible for cardiac rehabilitation, had recent cardiac catherization for the evaluation of CAD or had a history of ACS. Exclusion criteria include those who were enrolled in a formal cardiac rehabilitation program, did not have access to a tablet or smartphone or were admitted to the hospital and were not discharged to go home.
Eligible participants received a wrist-worn wearable device to track their steps. After a run-in period, participants were assigned to a control arm or an incentive arm. Those in the control arm were not informed of their baseline step count, whereas participants in the incentive arm received feedback on their performance for 24 weeks. These participants also had increasing daily step goals up to 10,000 steps. Money was allocated to an account each week for achieving goals, and money was taken out when goals were not met.
At the end of the 16-week intervention period and 24-week trial, participants from both arms completed a survey on health care utilization.
The primary outcome was change in mean daily steps from baseline to the maintenance incentive phase. Secondary outcomes included the change in mean daily steps from baseline to the ramp-up incentive and follow-up phases.
Increased physical activity
Participants in the incentive arm had a significantly greater increase in mean daily steps from baseline to the ramp-up period compared with the control arm (1,388 vs. 385; adjusted difference = 1,061; 95% CI, 386-1,736). They also had a greater increase in mean daily steps during the maintenance (1,501 vs. 264; adjusted difference = 1,368; 95% CI, 571-2,164) and follow-up periods (1,066 vs. 92; adjusted difference = 1,154; 95% CI, 282-2,027).
Participants did not report any adverse events during the trial.
“Our findings demonstrate that digital health interventions that leverage insights from behavioral economics offer a promising approach to change health behaviors among patients with cardiovascular disease,” Chokshi and colleagues wrote.
“Such an approach led to significant increases in step counts for patients in the incentive arm in all phases of the trial relative to patients in the control arm,” Jessica R. Golbus, MD, of the division of cardiovascular diseases at University of Michigan in Ann Arbor, and Brahmajee K. Nallamothu, MD, MPH, professor of cardiovascular disease, internal medicine and interventional cardiology at University of Michigan, wrote in a related editorial. “Future studies are necessary to demonstrate durability of results, improved short- and long-term clinical outcomes and synergy with cardiac rehabilitation. Although wearable devices continue to increase in popularity in the United States and worldwide, additional work is needed to see if this technology can truly step up to the challenge.” – by Darlene Dobkowski
Disclosures: Some of the wearable devices used in this study were donated my Misfit Inc. Chokshi, Golbus and Nallamothu report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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