Getting heart disease patients to exercise: Study says wearables could help but only if money is on the line

June 13, 2018, Perelman School of Medicine at the University of Pennsylvania

Combining financial incentives and personalized goal-setting with wearable devices may be an effective way of encouraging patients with heart disease to increase their physical activity. In patients with heart disease, regular physical activity has been shown to decrease the risk of a future heart attack, but getting these patients into a regular exercise program such as cardiac rehab has remained a challenge. Results of a clinical trial led by researchers at Penn Medicine, and published today in the Journal of the American Heart Association (JAHA), show that a home based program offering payment upfront with money taken away if step goals were not met—a design that leverages the concept of loss aversion—increases activity levels and may help to form a more long-lasting habit.

"Regular exercise and has shown to have significant benefit in those with but participation in such programs is extremely low for various reasons including patient motivation and access to exercise facilities. There is interest in developing creative remote strategies to engage in exercise programs but there is little research for guidance," said Neel Chokshi, MD, MBA, medical director of the Penn Sports Cardiology and Fitness Program and assistant professor of Clinical Medicine in Cardiology. "In this clinical trial, we tested a scalable approach combining wearables and principles from behavioral economics to show significantly increased even after incentives were stopped."

The study enrolled 105 patients into a home-based, remotely monitored program using the Misfit Shine wearable device for a 24-week period to determine the impact of personalized feedback with goals coupled to for the first 16 weeks. Patients in the control arm received the wearable but no other interventions. In the intervention group, patients were given personalized step goals and allocated $14 at the beginning of each week for 16 weeks ($224 in total). Each day the step goal was not met, $2 was taken away. During the main intervention period (weeks 9 to 16), patients in the intervention had an increase in their by 1368 steps per day more than patients in control. After 16 weeks, financial incentives were stopped and patients were followed for another 8 weeks. During the 8-week follow-up period, patients in the intervention still had an increase of 1154 steps per day more than patients in control.

"While many are hopeful that can motivate high-risk patients, we found that wearables alone did not increase physical activity levels," said Mitesh Patel, MD, MBA, MS, an assistant professor of Medicine and Health Care Management, and director of the Penn Medicine Nudge Unit. "However, framing rewards as a loss—a technique from behavioral economics—led to a meaningful difference in behavior. During the 6-month trial, the average patient in the intervention arm had step counts that totaled about 100 miles more than the average patient in control."

All participants were given a wearable device with a two week startup period to establish baseline step counts. The then received weekly increases in step goals with daily feedback via text message or email on their performance. Progress was divided in two phases; during the "ramp-up incentive" phase (weeks 1-8), daily step goals increased from baseline by 15 percent each week with a maximum goal of 10,000 steps per day. After 8 weeks, step goals remained fixed and participants moved into the "maintenance incentive" phase (weeks 9-16), followed by an 8-week follow-up phase without incentives (weeks 17-24). During the 16-week intervention, participants in this arm were offered a loss-framed financial incentive. Each week, participants were informed that $14 was allocated to a virtual account. Each day the patient achieved his or her step goal, the balance remained unchanged, but each day the step goal was not achieved, the participant was informed that $2 had been deducted. The balance was refreshed with $14 every week on Monday.

Chokshi and team suggest that additional studies should be conducted to evaluate the sustainability of incentive effects over longer-term periods, to compare incentive designs that vary in magnitude, duration, or frequency, and to evaluate financial incentives and personalized feedback independently to assess effects. This study was supported in part by Grant Number UL1TR000003 from the National Center for Advancing Translational Science. The study was also supported in part by the Institute for Translational Medicine and Therapeutics (ITMAT) and the University of Pennsylvania Health System through the Penn Medicine Nudge Unit.

Explore further: Did game design elements increase physical activity among adults?

More information: Journal of the American Heart Association (2018). dx.doi.org/10.1161/JAHA.118.009173

Related Stories

Did game design elements increase physical activity among adults?

October 2, 2017
Physical activity increased among families in a randomized clinical trial as part of a game-based intervention where they could earn points and progress through levels based on step goal achievements, according to a new article ...

To increase group exercise, study suggests rewarding the individual and the team

March 15, 2016
Financial incentives aimed at increasing physical activity among teams are most effective when the incentives are rewarded for a combination of individual and team performance, according to new research from the Perelman ...

Older adults walk more for money and opportunity to donate to charity

January 13, 2017
Personal and social goals may be effective in motivating older adults to exercise, according to a study this month in the American Journal of Preventive Medicine from researchers at the Perelman School of Medicine at the ...

Friendly competition and a financial incentive increases team exercise

July 15, 2016
Would having your exercise performance compared to that of your peers motivate you do more? A new study suggests it might. And adding a financial incentive would only sweeten the deal even more. Comparing performance to average ...

Virtual coaches, fitness trackers help patients stay fit after cardiac rehab

March 15, 2018
Heart patients who participate in cardiac rehab programs typically do well during enrollment but tend to revert to unhealthy lifestyles once the formal gym-based regimens end.

Are teens more likely to take charge of their health when money is on the line?

October 23, 2017
For children with type 1 diabetes, daily monitoring of blood glucose levels is vital for since glucose level awareness dictates the rest of their diabetes care, like insulin dose adjustments, eating behaviors, and physical ...

Recommended for you

Antibodies linked to heart attacks

October 23, 2018
Levels of antiphospholipid antibodies, which are associated with rheumatic diseases, are also elevated in myocardial infarction without any autoimmune co-morbidity, a study from Karolinska Institutet in Sweden published in ...

Poor oral health linked to higher blood pressure, worse blood pressure control

October 22, 2018
People with high blood pressure taking medication for their condition are more likely to benefit from the therapy if they have good oral health, according to new research in the American Heart Association's journal Hypertension.

No sweat required: Team finds hypertension treatment that mimics effect of exercise

October 16, 2018
Couch potatoes rejoice—there might be a way to get the blood pressure lowering benefits of exercise in pill form.

New model suggests cuffless, non-invasive blood pressure monitoring possible using pulse waves

October 16, 2018
A large team of researchers from several institutions in China and the U.S. has developed a model that suggests it should be possible to create a cuffless, non-invasive blood pressure monitor based on measuring pulse waves. ...

Why heart contractions are weaker in those with hypertrophic cardiomyopathy

October 16, 2018
When a young athlete suddenly dies of a heart attack, chances are high that they suffer from familial hypertrophic cardiomyopathy (HCM). Itis the most common genetic heart disease in the US and affects an estimated 1 in 500 ...

Novel genetic study sheds new light on risk of heart attack

October 12, 2018
Loss of a protein that regulates mitochondrial function can greatly increase the risk of myocardial infarction (heart attack), Vanderbilt scientists reported Oct. 3 in the journal eLife.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.