Adults at risk of heart disease who received daily prompts or incentives to increase their activity levels managed to boost their daily step count by over 1,500 steps after a year. Even six months after the study concluded, many participants maintained their new, more active routines. This research, funded by the National Institutes of Health and published in Circulation, was a significant step forward in our understanding of cardiovascular health. It was highlighted as groundbreaking at the American College of Cardiology’s Annual Session, underscoring its importance.

The study reported a rise in physical activity, equating to an additional 40 minutes of moderate exercise per week, but also showed a 6% decrease in the risk of premature mortality and a 10% lower risk of dying from cardiovascular issues, benchmarks set against data from previous research. These findings support the U.S. Department of Health and Human Services recommendation for adults to engage in at least 150 minutes of moderate aerobic exercise weekly, such as brisk walking, 75 minutes of vigorous activities like fast cycling, and twice-weekly strength training sessions.

The research indicated that simple daily reminders were effective in promoting increased activity; however, the introduction of financial incentives or point-based rewards akin to those in a game proved significantly more motivating. The most substantial increases in activity levels were observed in participants who received a combination of these incentives. Importantly, these benefits didn’t stay strong once the incentives ceased. They persisted for six months, suggesting a potential for long-term behaviour change.

Alison Brown, Ph.D., R.D., a program officer at the National Heart, Lung, and Blood Institute (NHLBI) of the NIH, remarked on the significance of moderate exercise in dramatically lowering cardiovascular risk. She emphasized the value of affordable, accessible strategies to encourage physical activity, particularly those implemented at home, as a significant advantage for public health.

Conducted between 2019 and 2024, the study monitored over 1,000 adults at heightened risk for major cardiovascular events. Participants were equipped with wearable fitness trackers connected to an online health platform, allowing researchers to monitor their initial daily step counts. Participants then aimed to increase their daily steps by 33%, 40%, 50%, or any increment exceeding 1,500 steps from their baseline. Following this, they were randomly assigned to one of four groups, three of which included incentives.

The incentivized groups featured game-like rewards, financial incentives, or a combination. In the game-focused group, participants earned weekly points that they retained by meeting daily step targets, losing points on less active days—those accumulating enough points advanced levels, while those falling short dropped levels. Participants could also have a family member or friend as their “support crew,” receiving weekly progress updates. At the study’s conclusion, the highest achievers were awarded trophies. In the financial incentive group, participants received $14 weekly but lost $2 each day they failed to meet their step goals. The third group combined these game-like and financial incentives.

A control group received no incentives but was provided with the fitness tracker and daily updates on their step count. Each intervention lasted 12 months and was followed by a six-month period where all participants were treated as controls.

Initially, participants averaged about 5,000 steps daily (approximately 2.4 miles). By the end of the year, they had increased their step count by more than 1,500 steps. Compared to the control group, those in the game-incentive group added an average of 538 steps to their baseline, while the financially incentivized group added 492 steps. The group that received both incentives added an average of 868 extra steps and maintained an increase of 576 steps six months post-intervention. Those in the single incentive groups maintained their increased activity levels, but the improvements were not significantly different from the 1,200 additional steps observed in the control group 18 months post-study.

Alexander C. Fanaroff, M.D., a study author and expert in behaviour change, interventional cardiologist, and assistant professor of medicine at the University of Pennsylvania, emphasized the immediate benefits of the interventions. He noted that focusing on present-day actions, whether for enhancing long-term heart health or planning for future financial goals, can be more compelling than long-term planning.

The researchers suggested that similar principles could be applied by individuals seeking to improve their exercise habits, utilizing apps that offer reminders and rewards, or involving family and friends for support. They also suggested that health systems and organizations could employ these methods to help boost physical activity among patients. This practical application of the research not only underscores its relevance but also empowers individuals and health systems to take action for better cardiovascular health.

More information: Alexander C. Fanaroff et al, Effect of Gamification, Financial Incentives, or Both to Increase Physical Activity Among Patients at High Risk of Cardiovascular Events: The BE ACTIVE Randomized Controlled Trial, Circulation. DOI: 10.1161/CIRCULATIONAHA.124.069531

Journal information: Circulation Provided by NIH/National Heart, Lung, and Blood Institute