Exercise Incentives Lead to Sustained Increases In Activity

The increase in physical activity resulted in an extra 40 minutes of moderate exercise per week, and the extra steps correlated with a 6% reduced risk of premature death, as well as a 10% decreased risk of cardiovascular-related deaths compared to data from prior studies. 

According to the researchers, a simple daily reminder was effective at helping people to move more, however offering financial incentives or point-based rewards (such as in a game) was even more effective. However, when the two incentives were combined, the results were more effective, with participants getting both incentives still logging improvements in activity levels six months after the rewards had been stopped.

"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.

For this study that took place between 2019 and 2024, over 1,000 adults at elevated risk for major cardiovascular events were followed, all participants wore a wearable fitness tracker which connected to an online health portal for monitoring. Participants set goals to increase their steps by 33%, 40%, 50%, or any amount greater than 1,500 steps per day from their starting point and were put into one of four groups randomly after setting their goals. 

Three of the groups were offered incentives like financial rewards or game-like rewards, or a combination of the two, while the control group received neither. Each intervention lasted for one year (12 months) which was followed by a six-month follow-up period where all of the participants received the same information as the controls. 

Those in the game group received points every week and kept them by achieving their daily step goals, points were lost for failing to meet their goals. Those with enough points moved up a level, and those who failed to meet goals moved down levels. At the study's conclusion, those reaching the highest level by meeting their goal received trophies. Those in the financial group received $14 per week but lost $2 a day for not reaching their step target. Those in the third group received both financial and game-like incentives. The control group received no rewards or incentives but wore the fitness tracker along with a daily message noting their step counts. 

According to the researchers, at enrollment, the participants in all groups were logging an average of 5,000 steps a day (2.4 miles), and after a year the participants increased their daily step count by more than 1,500 steps (¾ of a mile). The game incentive groups walked an extra 538 steps from baseline, the financial incentive group walked an extra 492 steps, and the group receiving both incentives averaged an extra 868 steps and maintained an average of 576 more steps daily six months later. Those in the single incentive groups maintained their step increases but they didn’t differ significantly from the average extra 1,200 steps those in the control group had taken 18 months after the start of the study. 

"The interventions created immediate benefits for participants -- and they worked," said Alexander C. Fanaroff, M.D., a study author, an expert in behavior change, and an interventional cardiologist and assistant professor of medicine in the Division of Cardiology at the University of Pennsylvania, Philadelphia. "Research shows it's easier to think about today instead of the future, whether it's exercising more to support long-term heart health or saving for a future goal, like college or retirement."

The researchers suggest that those wanting to change their exercise behavior could focus on the same principles that were used in the study, by creating immediate benefits or rewards for increased movement. There are numerous exercise apps on the market that provide daily reminders and rewards for meeting personal goals and create scenarios where rewards are lost for not meeting targets. Friends and family members could even be recruited for support or creating scenarios rather than an app. Any tactic that helps to increase physical activity safely could be the beneficial nudge that gets people up and moving and keeps them active.