This article is more than 5 years old. Information may no longer be current.

Financial loss incentive most effective at increasing physical activity

A financial loss incentive in which participants who were overweight or obese were allocated a monthly sum and lost a small amount each day they did not achieve physical activity goals resulted in a 50% relative increase in the mean proportion of days those goals were met.

Researchers reported in the Annals of Internal Medicine that a gain incentive demonstrated the same efficacy as a control group that received no incentives.

Mitesh S. Patel, MD, MBA, MS, in the division of general internal medicine, Perelman School of Medicine at the University of Pennsylvania, and colleagues stated that incentive design influences success.

"Many persons know physical activity is good for their health but do not do enough of it," they wrote. "Instead, they often deviate from these goals in a predictable manner and from a common set of decision errors. For example, persons tend to be motivated by immediate rather than delayed gratification and by losses rather than gains, and they tend to avoid the feeling of regret."

Patel and colleagues conducted a randomized, controlled trial that included 13-week intervention and 13-week follow-up periods. Participants included 281 employees of the University of Pennsylvania who had a BMI of at least 27 kg/m². They were given the goal of walking at least 7,000 steps each day and they tracked these steps using a smartphone application.

They were randomly assigned to one of four groups: the control group; the gain incentive group, in which participants received $1.40 each day they achieved the step goal; the loss incentive group, in which participants were allocated $42 at the start of each month and lost $1.40 each day they failed to achieve the step goal; and the lottery incentive group, in which participants received lottery eligibility based on the previous day's step count. All groups received daily feedback on whether they met the 7,000 step goal the previous day.

Results showed that the mean proportion of participant-days meeting the 7,000 step goal was 0.3 (95% CI, 0.22-0.37) in the control group, compared with 0.35 (95% CI, 0.28-0.42) in the gain incentive group, 0.36 (95% CI, 0.29-0.43) in the lottery incentive group and 0.45 (95% CI, 0.38-0.52) in the loss incentive group.

Adjusted analyses demonstrated that the only incentive group that had a significantly greater mean proportion of participant-days that met the goal compared with the control group was the loss incentive group (adjusted difference = 0.16; 95% CI, 0.06-0.26; P = .001). The loss incentive group did not demonstrate a significant difference in mean daily steps compared with the control group (adjusted difference = 861; 95% CI, 24 to 1746; P = .056).

The researchers noted that step counts for all three incentive groups decreased during the follow-up period and were not different from the control group.

"More than half of adults in the United States do not attain the minimum recommended level of physical activity to achieve health benefits," Patel and colleagues wrote. "Although the popularity of wellness programs and the use of mobile technologies to monitor health outcomes are rising, there has been a lack of rigorous study evaluating their effectiveness and the optimal design of financial incentives had not been well-examined. Our findings suggest that the design of financial incentives is important and that incorporating insights from behavioral economics may significantly improve effectiveness." – by Chelsea Frajerman Pardes

Disclosures: Patel reports no relevant financial disclosures. Please see the full study for a list of all other authors' relevant financial disclosures.