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Randomized Controlled Trial
. 2018 Jun 13;7(12):e009173.
doi: 10.1161/JAHA.118.009173.

Loss-Framed Financial Incentives and Personalized Goal-Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial

Neel P Chokshi  1 , Srinath Adusumalli  1 , Dylan S Small  2 , Alexander Morris  3 , Jordyn Feingold  4 , Yoonhee P Ha  5 , Marta D Lynch  3 , Charles A L Rareshide  3 , Victoria Hilbert  3 , Mitesh S Patel  6   2   3   7
Affiliations
Randomized Controlled Trial

Loss-Framed Financial Incentives and Personalized Goal-Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial

Neel P Chokshi et al. J Am Heart Assoc. .

Abstract

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.

Keywords: behavioral economics; financial incentives; goal‐setting; ischemic heart disease; physical activity; wearable devices.

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Figures

Figure 1
Figure 1
CONSORT diagram. Both arms used a wearable device to track daily steps. Patients in control received no other interventions. Patients in the incentive arm received a personalized step goal and daily feedback for 24 weeks. During the first 16 weeks, patients in the incentive arm also received a $2 per day loss‐framed financial incentive.
Figure 2
Figure 2
Central illustration, Unadjusted mean change in daily steps from baseline by study arm and week. Data presented are the difference between mean daily steps and mean baseline steps by week for each arm. Gray solid line represents patients in the control arm. Black dashed line represents patients in the financial incentive arm. Solid vertical gray lines represent the end of each study phase.
See this image and copyright information in PMC

Comment in

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