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Ann Intern Med. 2016 Mar 15;164(6):385-94. doi: 10.7326/M15-1635. Epub 2016 Feb 16.

Framing Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults: A Randomized, Controlled Trial.

Abstract

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 the intervention. Secondary outcomes included the mean proportion of participant-days achieving the goal during follow-up and the 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.

PMID:
26881417
PMCID:
PMC6029433
DOI:
10.7326/M15-1635
[Indexed for MEDLINE]
Free PMC Article

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