How incentives and games promote exercise

In a recent study published in the journal Circulationresearchers evaluated the effects of gamification and financial incentives on physical activity in individuals at risk of adverse cardiovascular events.

Higher physical activity is associated with lower risk of adverse cardiovascular events and improved control of cardiovascular risk factors. By leveraging behavioral economics concepts such as loss-framing, immediacy, and endowment effects, short-term analyzes introduce financial incentives and gamification interventions to reduce the risk of atherosclerotic cardiovascular disease (ASCVD). Increased physical activity has been observed in some patients or patients with atherosclerotic cardiovascular disease (ASCVD). Nevertheless, the long-term effects of these interventions remain unclear.

study: Effects of gamification, financial incentives, or both on increasing physical activity in patients at high risk of cardiovascular events: BE ACTIVE randomized controlled trial. Image credit: Alliance Images / Shutterstock

About research

In this study, the researchers evaluated the following: efficacy of Financial incentives, gamification, or both to improve long-term physical activity in individuals at risk of serious cardiovascular events. This randomized controlled trial was conducted between May 2019 and January 2024. Eligible participants had ASCVD or a 10-year risk of stroke, myocardial infarction, or cardiovascular death.

Eligible subjects were given a wearable device to track their steps. During a 2-week run-in period, a baseline step count was established. Participants were then instructed to set a goal to increase their step count compared to baseline. Participants were then randomly assigned to attentional control, financial incentives, gamification, or financial incentives and gamification (a combination).

The control group received a daily text message for 18 months asking whether they had met their step goal the previous day. In the gamification category, participants signed a pre-commitment to meet their step goal. They received 70 points at the beginning of each week. If you meet your daily goals, you will keep your points. Otherwise 10 points will be removed.

Their levels i.e. Platinum, Gold, Silver, Bronze and Blue changed based on their points at the end of the week. All participants started at the Silver level. Participants at the Blue or Bronze level were restarted at the Silver level every 8 weeks. Gold or platinum level participants were awarded a trophy after the intervention.

Meanwhile, the financial incentive group was informed that $14 would be deposited into their virtual account each week. Even if the goal is achieved, the balance remains the same. Otherwise, $2 will be deducted. In the combination group, participants completed interventions from both groups. After 12 months, the intervention was discontinued. However, daily text messages recording counts continued for an additional 6 months (follow-up).

The primary outcome was change in daily step count from baseline to end of intervention. Secondary outcomes were mean change in daily step count from baseline to follow-up, weekly moderate-to-vigorous physical activity (MVPA) minutes, and weekly percentage of participants recording at least 150 MVPA minutes. did.

Investigation result

Overall, 151, 304, 302, and 304 individuals were randomly assigned to the control, gamification, financial incentive, and combination groups, respectively. The average age of participants was 66.7 years. 60.5% were female and 25% were black. At baseline, average daily steps were 5081, average MVPA minutes was 5.8, and average step increase was 1867.

In total, 89.8% of participants completed the 18-month study. The control, financial incentive, gamification, and combination groups achieved average increases of 1418 steps, 1915 steps, 1954 steps, and 2297 steps from baseline to the intervention period, respectively. The corresponding figures during the follow-up period were 1245, 1576, 1708, and 1831 people, respectively.

During the 12-month intervention period, participants significantly increased their average number of steps per day compared to the control group. Combination therapy was superior to financial incentives during the intervention period. His weekly MVPA increased by an average of 39.6, 56.6, 54.7, and 65.4 minutes from baseline to intervention in the control, financial incentive, gamification, and combination arms.

During the follow-up period, weekly MVPA minutes increased by 37.3 minutes in the control group, 50.7 minutes with gamification, 50.9 minutes with financial incentives, and 57.6 minutes in the combination group. The weekly percentage of participants using at least 150 MVPA minutes was 0.16, 0.24, 0.23, and 0.27 in the control, financial incentive, gamification, and combination groups, respectively. The combination group had a higher probability of using at least 150 minutes of his MVPA in his week.

conclusion

In summary, interventions with financial incentives, gamification, or both significantly improved physical activity in adults at risk for cardiovascular events compared to attentional control over a 12-month intervention. This effect persisted over a 6-month follow-up period after the end of the intervention in the combination group. The combination group also increased his MVPA minutes per week more than the control group. These interventions may be useful components of strategies aimed at reducing cardiovascular risk.