BACKGROUND: Physical activity is associated with a lower risk of major adverse cardiovascular events, but few individuals achieve guideline-recommended levels of physical activity. Strategies informed by behavioral economics increase physical activity, but their longer-term effectiveness is uncertain. We sought to determine the effect of behaviorally designed gamification, loss-framed financial incentives, or their combination on physical activity compared with attention control over 12-month intervention and 6-month postintervention follow-up periods. METHODS: Between May 2019 and January 2024, participants with clinical atherosclerotic cardiovascular disease or a 10-year risk of myocardial infarction, stroke, or cardiovascular death of >= 7.5% by the Pooled Cohort equation were enrolled in a pragmatic randomized clinical trial. Participants received a wearable device to track daily steps, established a baseline, selected a step goal increase, and were randomly assigned to control (n = 151), behaviorally designed gamification (n = 304), loss-framed financial incentives (n = 302), or gamification plus financial incentives (n = 305). The primary outcome of the trial was the change in mean daily steps from baseline through the 12-month intervention period. RESULTS: A total of 1062 patients (mean +/- SD age, 67 +/- 8; 61% female; 31% non-White) were enrolled. Compared with control subjects, participants had significantly greater increases in mean daily steps from baseline during the 12-month intervention in the gamification arm (adjusted difference 538.0 (95% CI 186.2 to 889.9); p = 0.0027), financial incentives arm (adjusted difference 491.8 (95% CI 139.6 to 844.1); p = 0.0062), and gamification plus financial incentives arm (adjusted difference 868.0 (95% CI 516.3 to 1219.7); p < 0.0001). During the 6-month follow-up, physical activity remained significantly greater in the gamification plus financial incentives arm than in the control arm (adjusted difference 576.2 (95% CI 198.5 to 954); p = 0.0028), but it was not significantly greater in the gamification (adjusted difference 459.8 (95% CI 82.0 to 837.6); p = 0.0171) or financial incentives (adjusted difference 327.9 (95% CI -50.2 to 706); p = 0.09) arms after adjustment for multiple comparisons. CONCLUSIONS: Behaviorally designed gamification, loss-framed financial incentives, and the combination of both increased physical activity compared with control over a 12-month intervention period, with the largest effect in gamification plus financial incentives. These interventions could be a useful component of strategies to reduce cardiovascular risk in high-risk patients. REGISTRATION: URL: https://clinicaltrials.gov; Unique Identifier: NCT03911141.
For more information on this journal, please visit http://www.lww.com.

Full text (sometimes free) may be available at these link(s):      help

• PubMed Central
• DOI
• PubMed
• PDF locator
• publisher