Mitesh S. Patel, MD, MBA, MS; David A. Asch, MD MBA; Roy Rosin, MBA; Dylan S. Small, PhD; Scarlett L. Bellamy, ScD; Jack Heuer, EdD; Susan Sproat, MS; Chris Hyson, MEd; Nancy Haff, MD; Samantha M. Lee, MD; Lisa Wesby, MS; Karen Hoffer, BS; David Shuttleworth, MS; Devon H. Taylor, BS; Victoria Hilbert, MPH, RD; Jingsan Zhu, MBA, MS; Lin Yang, MS; Xingmei Wang, MS; Kevin G. Volpp, MD, PhD
Disclaimer: Dr. Patel had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Grant Support: By the National Institute on Aging (grant RC4 AG039114; Drs. Asch and Volpp) and in part by the Department of Veteran Affairs (Drs. Patel, Asch, and Volpp) and Robert Wood Johnson Foundation (Drs. Patel and Asch).
Disclosures: Dr. Asch reports grant support from the National Institutes of Health during the conduct of the study; further, he is a principal and part owner of the behavioral economics consulting firm VAL Health. Ms. Hilbert reports grant support from the National Institute of Aging during the conduct of the study. Dr. Volpp reports grant support from the National Institutes of Health during the conduct of the study. Further, he reports consulting income from CVS Health and VAL Health (principal and part owner) and grants (or grants pending) from CVS Health, Humana, Merck, Weight Watchers, Discovery (South Africa), and Hawaii Medical Services Association; and stock in VAL Health, all outside of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1635.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol: Available from Dr. Patel (e-mail, mpatel@upenn.edu). Statistical code and data set: Not available.
Requests for Single Reprints: Mitesh S. Patel, MD, MBA, MS, Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, 13th Floor Blockley Hall, Philadelphia, PA 19104; e-mail, mpatel@upenn.edu.
Current Author Addresses: Dr. Patel: Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, 13th Floor Blockley Hall, Philadelphia, PA 19104.
Drs. Asch and Rosin: Penn Medicine Center for Health Care Innovation, 13th Floor Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.
Dr. Small: The Wharton School, University of Pennsylvania, 4th Floor Jon M. Huntsman Hall, 3730 Walnut Street, Philadelphia, PA 19104.
Ms. Bellamy: Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, 6th Floor Blockley Hall, Philadelphia, PA 19104.
Dr. Heuer, Ms. Sproat, and Mr. Hyson: Division of Human Resources, University of Pennsylvania, Suite 527A, 3401 Walnut Street, Philadelphia, PA 19104.
Dr. Haff: Massachusetts General Hospital, 730 Gray Bigelow, 55 Fruit Street, Boston, MA 02114.
Dr. Lee: Columbia University Medical Center, 622 West 168th Street, New York, NY 10032.
Ms. Wesby, Ms. Hoffer, Ms. Hilbert, Ms. Yang, Ms. Wang, Mr. Shuttleworth, Mr. Taylor, Mr. Zhu, and Dr. Volpp: Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute, University of Pennsylvania, 11th Floor Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.
Author Contributions: Conception and design: M.S. Patel, D.A. Asch, R. Rosin, N. Haff, D. Shuttleworth, K.G. Volpp.
Analysis and interpretation of the data: M.S. Patel, D.A. Asch, D.S. Small, S.L. Bellamy, J. Heuer, S.M. Lee, L. Wesby, D. Shuttleworth, J. Zhu, L. Yang, X. Wang, K.G. Volpp.
Drafting of the article: M.S. Patel, D.A. Asch, S.L. Bellamy, J. Heuer, D. Shuttleworth, V. Hilbert.
Critical revision of the article for important intellectual content: M.S. Patel, D.A. Asch, D.S. Small, S.L. Bellamy, L. Wesby, D. Shuttleworth, J. Zhu, K.G. Volpp.
Final approval of the article: M.S. Patel, D.A. Asch, R. Rosin, S.L. Bellamy, S.M. Lee, D. Shuttleworth, K.G. Volpp.
Provision of study materials or patients: D. Shuttleworth, D.H. Taylor.
Statistical expertise: D.S. Small, S.L. Bellamy, J. Zhu.
Obtaining of funding: D.A. Asch, K.G. Volpp.
Administrative, technical, or logistic support: M.S. Patel, R. Rosin, J. Heuer, S. Sproat, C. Hyson, N. Haff, L. Wesby, K. Hoffer, D. Shuttleworth, V. Hilbert, K.G. Volpp.
Collection and assembly of data: L. Wesby, K. Hoffer, D. Shuttleworth, V. Hilbert.
Financial incentive designs to increase physical activity have not been well-examined.
To test the effectiveness of 3 methods to frame financial incentives to increase physical activity among overweight and obese adults.
Randomized, controlled trial. (ClinicalTrials.gov: NCT 02030119)
University of Pennsylvania.
281 adult employees (body mass index ≥27 kg/m2).
13-week intervention. Participants had a goal of 7000 steps per day and were randomly assigned to a control group with daily feedback or 1 of 3 financial incentive programs with daily feedback: a gain incentive ($1.40 given each day the goal was achieved), lottery incentive (daily eligibility [expected value approximately $1.40] if goal was achieved), or loss incentive ($42 allocated monthly upfront and $1.40 removed each day the goal was not achieved). Participants were followed for another 13 weeks with daily performance feedback but no incentives.
Primary outcome was the mean proportion of participant-days that the 7000-step goal was achieved during the intervention. Secondary outcomes included the mean proportion of participant-days achieving the goal during follow-up and the mean daily steps during intervention and follow-up.
The mean proportion of participant-days achieving the goal was 0.30 (95% CI, 0.22 to 0.37) in the control group, 0.35 (CI, 0.28 to 0.42) in the gain-incentive group, 0.36 (CI, 0.29 to 0.43) in the lottery-incentive group, and 0.45 (CI, 0.38 to 0.52) in the loss-incentive group. In adjusted analyses, only the loss-incentive group had a significantly greater mean proportion of participant-days achieving the goal than control (adjusted difference, 0.16 [CI, 0.06 to 0.26]; P = 0.001), but the adjusted difference in mean daily steps was not significant (861 [CI, 24 to 1746]; P = 0.056). During follow-up, daily steps decreased for all incentive groups and were not different from control.
Single employer.
Financial incentives framed as a loss were most effective for achieving physical activity goals.
National Institute on Aging.
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Patel MS, Asch DA, Rosin R, Small DS, Bellamy SL, Heuer J, et al. Framing Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults: A Randomized, Controlled Trial. Ann Intern Med. 2016;164:385-394. doi: 10.7326/M15-1635
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© 2017
Published: Ann Intern Med. 2016;164(6):385-394.
DOI: 10.7326/M15-1635
Published at www.annals.org on 16 February 2016
Obesity.
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