Cash incentives, wearable tracker increase steps for ischemic heart disease patients

By Laura Lovett
03:54 pm

A little bit of cash paired with a wearable activity tracker could be key in motivating people with ischemic heart disease to stay active. A recent study, published in the Journal of the American Heart Association, found that participants who were given a $14 cash incentive to meet physical activity goals, that were tracked by a wearable, had significantly more steps than their counterparts who just had the device. 

“There is a lot of interest in using wearable devices to increase activity levels among high-risk cardiovascular patients, but the best way to design these types of programs is unknown," Dr. Neel Chokshi, first author and cardiologist at the Perelman School of Medicine and medical director of the Sports Cardiology and Fitness Program at Penn Medicine, said in a statement. "Our trial is one of the first to test the use of mobile technology through a home-based program and found that while wearable devices alone were not effective, combining them with financial incentives and personalized goal-setting significantly increased physical activity levels during the six-month period."

Exercise-based cardiac rehab programs have proven to reduce mortality in ischemic heart disease patients by 30 percent, but buy-in to excersise regiments has been historically low, according to the study's authors. They also noted that there has been a robust discussion around wearables’ ability to remotely monitor health behaviors, but little evidence that the devices lead to an improved behavior over a long period of time. However, past studies have showed that money does motivate behaviors. 

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The study, which took place over 24-weeks, included 105 patients with ischemic heart disease. The intervention group was given a Misfit wearable tracker, personalized step goals, and daily feedback, as well as $14 a week for the first 16-weeks, according to the study. If a participant didn’t meet their step goal each day they were deducted $2 a day. Meanwhile, members of the control arm only received an activity wearable and were tasked with the standardized goal of reaching 10,000 steps a day. 

During the first eight weeks, when the intervention group was getting paid for their step count, the group’s daily steps increased from baseline by 1,388 steps, compared to the control group’s 385 step increase. Step count remained high during the maintenance phase (where participants continued to get paid) with people in the intervention group increasing their steps by 1,501 from baseline. Researchers saw results even after the study concluded. Intervention participants continued to have on average 1,066 more steps from baseline. On the other hand, the follow-up control group only had a mean of 92 more steps than baseline. 

"This is one of the first clinical trials that used financial incentives and found increases in physical activity were sustained even after incentives stopped, a potential sign of habit formation," Dr. Mitesh Patel, senior author and assistant professor at the Perelman School of Medicine at the University of Pennsylvania and director of the Penn Medicine Nudge Unit, said in a statement. 

Researchers noted that there were several limitations to the investigation; patients were all from four hospitals in southern Pennsylvania, the study only evaluated physical activity based on steps, and the control arm had slightly more missing data points than the incentive arm. In the future, researchers said, other studies could compare different ways to frame incentives to increase physical activities. 

“Our findings demonstrate that digital health interventions that leverage insights from behavioral economics offer a promising approach to change health behaviors among patients with cardiovascular disease,” authors of the study wrote. 


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