The key to fitness: walk more or lose money

A clinical trial led by researchers at the University of Pennsylvania School of Medicine has revealed that playing on our instinctive aversion to loss may be the key in the quest to bring about enduring lifestyle changes in patients.

The study, published in the Journal of the American Heart Association, provided a group of 105 patients with a wearable device which monitored their step counts over 24 weeks. The researchers gave the participants a two-week preliminary period to establish baseline counts, and then split the group in two. Half the volunteers, the control group, received the wearable and were asked to simply go ahead with their usual day-to-day activities. The other half, known as the intervention group, were asked to complete a schedule of three eight-week phases.

The first phase, which featured increasing step goals, and the second, wherein the step goals were fixed, included a financial gain framed as a loss – a technique borrowed from behavioural economics.

The patients were advised that a $14 deposit had been made into a virtual account on their behalf, with $2 being deducted for each day they fell short of their step goal. The $14 balance was restored each Monday, and the process repeated for each of the first 16 weeks. The final eight-week phase was scheduled as a ‘cool down’ phase of sorts, with no incentives offered.

The results of the study showed a greater increase in physical activity in the intervention group of patients – their daily step counts increased by an average of 1368 compared to the control group. Even after incentives ceased, patients in the intervention group maintained the good habits they’d established, showing an increase of 1154 steps compared to controls.

Regular exercise has long been established as an effective way to reduce the risk of a heart attack, but encouraging patients to make more time for physical activity has been a challenge that has stumped medical practitioners.

“Regular exercise and cardiac rehab has shown to have significant benefit in those with heart disease but participation in such programs is extremely low for various reasons including patient motivation and access to exercise facilities,” says Neel Chokshi, medical director of the Penn Sports Cardiology and Fitness Program.

His colleague Mitesh Patel adds that wearables alone were found not to increase physical activity levels, but using the loss-framing method led to significant changes in patient behaviour. During the course of the six-month trial, the step count of an average patient in the intervention group equated to 160 kilometres more walking than that of the average patient in the control group.

The research team suggests the next research phase should involve similar studies over longer periods to assess the sustainability of the incentive model, and to measure the effects of variations in size and frequency of the rewards offered.

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