The secret to motivating heart disease patients to exercise may not only involve goal-setting via wearable devices but, more importantly, clear-cut financial incentives, according to a new study published in the Journal of the American Heart Association.
Researchers from Penn Medicine enrolled 105 heart disease patients in a home-based, remotely monitored 24-week study using the Misfit Shine wearable device. Two groups were established: one received the wearables with no intervention (the control group), and the other received the wearables along with financial-based step goals (the intervention group). The intervention group would receive $14 at the beginning of each week for the first 16 weeks of the study. If their step goals were not met, $2 was deducted from their earnings.
Between week nine and week 16, patients in the intervention group reported 1,368 more steps per day than patients in control group. Between week 16 and week 24, after the financial incentives were stopped for the intervention group, they still reported 1,154 more steps per day than those in the control group.
“Regular exercise and cardiac rehab has shown to have significant benefit in those with heart disease, but participation in such programs is extremely low for various reasons including patient motivation and access to exercise facilities," Neel Chokshi, medical director of the Penn Sports Cardiology and Fitness Program and assistant professor of Clinical Medicine in Cardiology, said in a media release. "There is interest in developing creative remote strategies to engage patients in exercise programs, but there is little research for guidance. In this clinical trial, we tested a scalable approach combining wearables and principles from behavioral economics to show significantly increased activity levels even after incentives were stopped.”
Chokshi said additional research should be conducted to assess the sustainability of incentive effects over longer durations. This would allow researchers to compare incentive designs that differ in magnitude, duration or frequency, he said.
“While many are hopeful that wearable devices can motivate high-risk patients, we found that wearables alone did not increase physical activity levels,” Mitesh Patel, an assistant professor of medicine and health care management and director of the Penn Medicine Nudge Unit, said in a media release. “However, framing rewards as a loss—a technique from behavioral economics—led to a meaningful difference in behavior. During the six-month trial, the average patient in the intervention arm had step counts that totaled about 100 miles more than the average patient in control.”
Ischemic heart disease (IHD) is the leading cause of morbidity and mortality in the United States, according to the American Heart Association. Participation in exercise‐based cardiac rehabilitation has been shown to reduce mortality by up to 30 percent. However, the majority of eligible patients do not effectively participate in their cardiac rehabilitation programs.