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The study included 105 heart disease patients, average age 60, who used wrist-worn step counters for 24 weeks. The participants were divided into two groups.
One group received personalized step goals, daily feedback and $14 each week for the first 16 weeks. They could also lose $2 a day for not achieving step goals. The other group (the "control" group) also used step counters but received no incentives or feedback.
While receiving money, patients in the incentive group significantly increased their physical activity levels, walking about 1,368 more steps per day than those in the control group, the findings showed.
Even after they stopped getting paid, the patients in the incentive group still did about 1,154 more steps per day than those in the control group, the researchers said.
Patients in the control group had no significant change in their physical activity levels, according to the study published online June 13 in the Journal of the American Heart Association.
"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," senior author Dr. Mitesh Patel said in a journal news release. He is an assistant professor in the University of Pennsylvania School of Medicine.
"A key element of our study was that incentives were designed to leverage the behavioral economic principle of loss aversion, which finds that for the same reward size, most people are more motivated when they are told they might lose a reward than when told they could earn a reward," Patel said.
The study's first author, Dr. Neel Chokshi, said, "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."
Chokshi is a cardiologist at the School of Medicine and medical director of the Sports Cardiology and Fitness Program at Penn Medicine.
"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," he added.
Heart disease is the leading cause of death in the United States. Regular exercise reduces heart disease patients' risk of cardiovascular events and death by up to 30 percent, but most don't get enough physical activity, the study authors said.
-- Robert Preidt
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