Exercise Incentives that last can Result in Long-term Gain in Activity


A study funded by the NIH demonstrates that some benefits can encourage long-term behavioral change in persons at risk for cardiovascular disease.

According to a National Institutes of Health-sponsored study, adults at risk for heart disease who got daily prompts or incentives to improve their physical activity increased their daily steps by more than 1,500 after a year, and many were still maintaining their new routine six months later.

In comparison to data from previous research, the improvements, which also led to an additional 40 minutes of moderate activity per week, linked with a 6% lower risk of premature mortality and a 10% reduced risk of cardiovascular-related fatalities.

Most adults should engage in 150 minutes or more of moderate aerobic exercise each week, such as brisk walking, 75 minutes of strenuous exercise, such as fast cycling, or a combination of the two, in addition to twice-weekly strength training sessions, according to the Department of Health and Human Services.

Researchers discovered that although a straightforward daily reminder was useful in encouraging people to move more, providing monetary incentives or point-based rewards—like those seen in games—was significantly more successful. Nevertheless, the best results came from combining the two incentives. Six months after the prizes ceased, participants who received both were still recording increases in their levels of activity.

“Even moderate exercise can drastically reduce cardiovascular risk, so finding low-cost ways to get people moving and stay in a fitness program that they can do at home is a huge win for public health,” said Alison Brown, Ph.D., R.D., a program officer at the National Heart, Lung, and Blood Institute (NHLBI), part of NIH.

The research was conducted from 2019 to 2024. More than a thousand adults at high risk of serious cardiovascular events were monitored by researchers. Every participant was given a wearable fitness tracker that allowed researchers to count their baseline daily step count by connecting it to an online health portal. After that, participants established a target to improve their daily step count by 33, 40, 50%, or any amount above 1,500 steps from where they had started. Following goal-setting, individuals were randomly assigned to one of four groups.
Three sets of incentives were provided: money awards, in-game rewards, or a mix of the two. Every week, each player in the gaming group earned points, which they maintained by achieving their daily step targets.

They lost points on the days when they couldn’t reach their objectives. Individuals who earned enough points advanced, while others who didn’t reach their objectives fell back a level. A participant’s “support crew” could consist of friends or family, who would be updated on their progress every week. Adults who met their daily step objectives and attained the highest levels at the end of the trial were awarded prizes. Participants in the financial group lost $2 daily if they did not reach their step targets, but they still got $14 per week. The third group was given cash and in-game rewards.

The fitness tracker and daily messages tracking their step count were given to the fourth group, which served as the control group. They did not receive any incentives. Following a 12-month intervention, each participant had a six-month follow-up phase during which they were given the same information as controls.

Prior to the start of the trial, individuals in every group completed 2.4 miles, or roughly 5,000 steps, per day on average. They walked an extra 1,500 steps a day, or three-quarters of a mile, after a year.

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