Gamification and financial incentives increase physical activity in patients at risk for CV events

ACC.24 – In the BE ACTIVE trial, home-based incentives related to behavioral economics increased physical activity in patients at risk for CV events over 12 month intervention period.

This summary is based on the presentation of Alexander Fanaroff, MD (Pennsylvania, PA, US) at the ACC.24 Scientific Session - Effect of Gamification, Financial Incentives or Both Combined to Increase Physical Activity Among Patients With Elevated Risk For Major Adverse Cardiovascular Events. The Be Active Randomized Clinical Trial.

Introduction and methods

Physical activity has many health benefits. The Centers for Disease Control and Prevention (CDC) recommends 150 min/week of moderate to vigorous physical activity (MVPA). However, many people, in particular older adults at highest risk for CVD, do not reach these amounts of weekly physical activity. In previous studies, techniques from behavioral economics such as gamification and financial incentives increased physical activity in the short term. It is unclear whether these effects last long-term, and which incentives work best to promote physical activity.

The goal of the BE ACTIVE study was to determine the long-term effectiveness of gamification, financial incentives, or a combination of both approaches for increasing physical activity in patients at risk for cardiovascular events compared with control.

BE ACTIVE was a RCT in which patients with 10-years ASCVD event risk ≥7.5% or established ASCVD could participate. Participants received a wearable to register physical activity, and entered a 2 week run-in period to establish baseline activity values. Participants with an average daily step count of <7500 could participate further in the study. After a goal for daily step count was set (33-50% increase compared with baseline), a total of 1062 patients were randomized to gamification (n=304), financial incentives (n=302), gamification + financial incentives (n=305) or control (n=151) for 12 months. The gamification group participated in a weekly game with loss-framed points, levels, and social support partner. The financial incentive group had loss-framed incentives (up to $14 per week). The gamification + financial incentive group had both incentives of the aforementioned groups, whereas the control group only received daily text messages. Patients were followed for an additional 6 month period, in which all patients received daily text messages.

The primary outcome was the change in daily steps compared with baseline.

Main results

• Changes in daily steps from baseline to month 12 were +1418 in the control group, +1954 in the gamification group, +1915 in the financial incentive group, and +2297 in the combination group.
• Daily steps counts were increased in all intervention groups compared with the control group (difference of +538 in the gamification group; +492 in the financial incentives group; and +868 in gamification + financial incentives group).
• From baseline to month 18, changes in daily steps were +1245, +1708, +1576, and +1831 in the control, gamification, financial incentives, and combination groups, respectively.
• Changes in weekly amount of MVPA from baseline to month 12 were +40, +55, +57, and +65 minutes in the control, gamification, financial incentives, and combination groups, respectively.
• These changes in MVPA attenuated in the follow-up period. Changes in weekly amount of MVPA from baseline to month 18 were +37, +51, +51, and +58 minutes in the control, gamification, financial incentives, and combination groups, respectively.

Conclusion

In the BE ACTIVE trial, gamification, financial incentives and gamification + financial incentives increased physical activity in patients at risk for cardiovascular events over a long-term period. A combination of both gamification and financial incentives appeared to be the most effective for promoting physical activity. Physical activity was also increased in the control group, which suggests that goal setting in combination with daily text messages also leads to improvements in physical activity in patients with elevated risk for cardiac events.

- Our reporting is based on the information provided at the ACC.24 Scientific Session -