BE ACTIVE shows that small incentives increase daily steps in high-risk patients

Earning points and small amounts of money encouraged cardiovascular high-risk patients to increase their daily walking by about 10%. Patients who received both gamification and financial incentives significantly increased their daily steps up to 18 months.

The BE ACTIVE (NCT03911141) study enrolled 1,062 participants with a 10-year atherosclerotic cardiovascular disease event risk of >7.5% or established vascular disease, with a median age of 67 years [1]. The study, presented by Dr Alexander Fanaroff (Penn Medicine, Philadelphia, PA, USA), aimed to determine the effectiveness of a single intervention or combination intervention compared with control for increasing physical activity over a 12-month intervention and 6-month follow-up period. The study's primary endpoint was the change in daily steps from baseline to 12 months.

Each participant received a fitness tracker that uploaded their daily step count to a secure website. At baseline, the participants' average daily step count was approximately 5,000 steps. Each participant selected a goal to increase their daily step count by at least 1,500 steps more than their current level. The participants were randomly assigned to 4 groups. The control group got daily text messages with their step counts. The gamification group played a weekly game with loss-framed points and levels. The financial incentive group received loss-framed financial rewards (up to $14 weekly in a virtual account). The fourth group received both gamification and financial incentives.

At 12 months, all intervention groups had significantly greater increases in mean daily steps from baseline compared with the control group. Participants in the gamification group achieved an adjusted difference of 538.0 steps compared with the control group (95% CI 186.2–889.9; P=0.0027) and in the financial incentives group 492 more steps (95% CI 139.6–844.1; P=0.0062). The combined approach was most successful: Participants increased their daily steps by 2,297 steps from baseline, 868 more steps per day than the control group (95% CI 516.3–1219.7; P<0.0001).

At the 18-month follow-up, only the combination group showed a statistically significant increase in daily steps compared with the control (adjusted difference 576.2 steps; 95% CI 198.5–954; P=0.0028). However, all 3 intervention groups had a numerical average daily step increase of over 1,500 compared with baseline.

1. 
   
   1. Fanaroff AC, et al. Physical activity among patients with elevated risk for major adverse cardiovascular events. The Be Active randomised clinical trial. LB2, Session 405, ACC 2024 Scientific Session, 6–8 April, Atlanta, USA.

Medical writing support was provided by Dr Susanne Kammerer.
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Posted on 9 April, 20249 April, 2024