Strategies such as earning points or small amounts of money encouraged people at high risk for heart disease or stroke to increase their daily walking by about 10% and sustain the increase for a year, according to the results of the BE ACTIVE Late-Breaking Clinical Trial presented at ACC.24 and simultaneously published in Circulation.

The pragmatic, controlled trial of a home-based intervention to promote physical activity among individuals with or at high risk for cardiovascular disease, conducted by Alexander C. Fanaroff, MD, MHS, et al., tested whether certain techniques from behavioral economics could help people increase their level of daily walking. One technique, known as gamification, uses elements of gameplaying, such as competition and point scoring. Another uses financial incentives, with people gaining or losing small amounts of money based on their behavior.

A total of 1,062 individuals (median age 67 years, 61% women, 25% Black, median annual income <$50,000) received a wearable device to track daily steps that were uploaded to a secure site, established a baseline, selected a step goal increase, and were randomized to control (n=151), behaviorally-designed gamification (n=304), loss-framed financial incentives (n=302) or gamification + financial incentives (n=305). The intervention lasted 12 months, and participants were followed for an additional six months to assess whether changes were sustained.

Results showed that the study met its primary endpoint of change in mean daily steps from baseline through 12 months, showing a statistically significant increase in participants' daily steps. Compared with controls, the adjusted difference in mean daily steps at 12 months in the gamification arm was 538.0 (95% CI, 186.2-889.9; p=0.0027), financial incentives arm was 491.8 (95% CI, 139.6-844.1; p=0.0062) and gamification + financial incentives arm was 868.0 (95% CI, 516.3-1219.7; p<0.0001).

The improvement was sustained over the six-month follow-up compared with control, with a significantly greater increase in the gamification + financial incentives arm (adjusted difference, 576.2; 95% CI, 198.5-954; p=0.0028) and nonsignificant increases in the gamification arm (adjusted difference, 459.8; 95% CI, 82.0-837.6; p=0.0171) and financial incentives arm (adjusted difference, 327.9; 95% CI, –50.2-706; p=0.09).

"This is one of the largest and longest-duration randomized trials of a home-based intervention to promote physical activity," said Fanaroff, lead author of the study. "Our findings show that interventions based on techniques from behavioral economics can achieve and sustain increased levels of physical activity in a population with risk factors for cardiovascular disease and could be another tool to help reduce cardiovascular risk."