Research Spotlight in SBM

Background: Physical activity is a lifestyle modification that, when implemented, can help in the management of cardiovascular diseases. Despite robust evidence, physical activity rates among adults with cardiovascular disease remains low. Financial incentives, an extrinsic reward, have been gaining popularity in these behaviour interventions over the past decade as they have the power to increase adherence to physical activity interventions. The effect of this increase in physical activity from financial incentives in those with cardiovascular disease remains unclear.

Objective: 1) Examine the effectiveness of financial incentives to increase physical activity among adults with cardiovascular disease or cardiovascular disease risk factors; 2) highlight the design and delivery of financial incentive physical activity interventions that have been effective in order to inform future research.

Significance: Various frameworks of financial incentives have the power to motivate adults with cardiovascular disease or cardiovascular disease risk factors to increase their physical activity, indirectly resulting in improved longevity and quality of life. This systematic review highlights the various frameworks used in past research and can inform future research and policies surrounding the implementation of financial incentives to promote activity at a population level.

Methods: We conducted a systematic review following the PRISMA guidelines to determine the effectiveness of financial incentives to promote physical activity among adults (18+) with cardiovascular disease or one of its risk factors. We used the following keywords: financial AND incentiv* OR rewar* AND chronic AND diseas* OR conditio* OR cardiovascular AND diseas* AND physical activit* OR exercis* OR walk*. Peer-reviewed articles published between 2010-2020 were included.
Results: The initial search yielded 1,572 publications which were reduced to nine independent studies that met our inclusion criteria. All nine studies (n=9, 100%) developed at least one intervention arm that significantly increased physical activity behaviour, relative to the control group. Gain framed incentive framework (n=8; 89%) was used more commonly than loss-framed incentives (n=1; 11%). The financial incentives were most commonly given out on an individual basis (n=8, 89%), compared to being divided among a team (n=1, 11%). Delivering the financial incentive through a mobile device (n=6, 67%) was the more prominent delivery method, rather than in-person delivery (n=3, 33%).

Conclusion: Our findings suggest that financial incentives are influential in improving physical activity levels among individuals with cardiovascular disease. More research is needed in this area to encompass the impact of financial incentives on both behaviour and clinical outcomes. Future studies need to examine how to feasibly implement financial incentives into long-term behaviour changes to help promote lifelong health.

Keywords: financial incentives, physical activity, cardiovascular disease

This video was submitted to the SBM 2021 Annual Meeting as a Research Spotlight. It explains the findings from a systematic review. Authors: Amanda Willms, Dr. Sam Liu