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Cash and a fitness device could help motivate people to exercise, study finds

iStock/Thinkstock
iStock/Thinkstock

(NEW YORK) — Wearable fitness trackers can help people log their 10,000 daily steps, but can the devices help get heart-disease patients off the couch to start exercising?

A new study published in the Journal of the American Heart Association said the trackers — when paired with a little cold, hard cash — might just give people that push to start a regular exercise routine.

The 10,000-step goal adds up to 5 miles each day, arbitrarily. But it also approximates the 30 minutes of daily exercise recommended by the American College of Sports Medicine.

The total recommendation of at least 150 minutes of moderate-intensity exercise per week is challenging for many people, especially those with known heart disease — the leading cause of death in the U.S.

Regular physical activity can reduce the risk of stroke and heart attacks in those with heart disease, but many don’t do it.

Participation in programs such as cardiac rehab, targeted to help those with heart conditions, is “extremely low for various reasons, including patient motivation and access to exercise facilities,” Dr. Neel Chokshi, medical director of the Penn Sports Cardiology and Fitness Program and assistant professor of clinical medicine in cardiology, told ABC News.

So the study researchers were looking at different incentives that could give people the motivation to get up and start moving more.

“There is interest in developing creative remote strategies to engage patients in exercise programs, but there is little research for guidance,” Chokshi said.

Wearable fitness devices can track daily steps, but this alone might not be enough to change exercise behavior.

Money might be that extra cherry on top. The researchers found that combining financial rewards with personalized goal setting and using wearable devices could be effective. Chokshi and his colleagues decided to test this approach through a clinical trial.

The study enrolled 105 patients into a home-based trial, using the Misfit Shine wearable device. For 24 weeks, they offered payment up front, into an “account,” and then took money away based on whether daily step goals were reached.

All participants were given the device and a two-week startup period to establish baseline step counts, and $50 just for completing enrollment and the trial.

The participants were randomized into a control group — the members of which received only the device — and an intervention group, which also got money. In the intervention group, participants were given personalized step goals with daily feedback on their performance and got paid a small amount to a virtual account — $14 per week for 16 weeks, or $224 total. Each day the step goal was missed, $2 was taken back.

The 24-week trial had two phases: The 16-week intervention phase ramped up incentives and then asked people to maintain the workout — then they had an eight-week follow-up phase. During the “ramp-up incentive” phase, daily step goals increased from the baseline by 15 percent each week with a maximum goal of 10,000 steps per day. During the eight-week follow-up phase, they weren’t paid.

But people continued to increase their activity — even after financial incentives stopped.

During the maintenance phase, those who got the money increased their physical activity by 1,368 steps per day more than those just wearing a device. And, surprisingly, that held up during the follow-up period. Even without money, people in the intervention group still had an increase of 1,154 steps per day more than patients in the control group.

“Framing rewards as a loss — a technique from behavioral economics — led to a meaningful difference in behavior,” said Dr. Mitesh Patel, an assistant professor of medicine and health care management, and director of the Penn Medicine Nudge Unit. “During the six-month trial, the average patient in the intervention arm had step counts that totaled about 100 miles more than the average patient in control.”

The wearable alone did not increase physical activity levels, researchers noted.

They suggested that more studies need to be done to evaluate whether the incentives work over a long period of time and if the financial incentives are maintainable. Studies of different groups, time periods or other differing designs could help isolate the effects of the financial incentives and personalized feedback.

For now, using a wearable device and having a friend dock your “pay” if you slack off could get you off the couch.

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