title: Framing Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults: A Randomized, Controlled Trial.
abstract: BACKGROUND
  Financial incentive designs to increase physical activity have not been well-examined.
  
  
  OBJECTIVE
  To test the effectiveness of 3 methods to frame financial incentives to increase physical activity among overweight and obese adults.
  
  
  METHODS
  Randomized, controlled trial. (ClinicalTrials.gov: NCT 02030119).
  
  
  METHODS
  University of Pennsylvania.
  
  
  METHODS
  281 adult employees (body mass index ≥27 kg/m2).
  
  
  METHODS
  13-week intervention. Participants had a goal of 7000 steps per day and were randomly assigned to a control group with daily feedback or 1 of 3 financial incentive programs with daily feedback: a gain incentive ($1.40 given each day the goal was achieved), lottery incentive (daily eligibility [expected value approximately $1.40] if goal was achieved), or loss incentive ($42 allocated monthly upfront and $1.40 removed each day the goal was not achieved). Participants were followed for another 13 weeks with daily performance feedback but no incentives.
  
  
  METHODS
  Primary outcome was the mean proportion of participant-days that the 7000-step goal was achieved during the intervention. Secondary outcomes included the mean proportion of participant-days achieving the goal during follow-up and the mean daily steps during intervention and follow-up.
  
  
  RESULTS
  The mean proportion of participant-days achieving the goal was 0.30 (95% CI, 0.22 to 0.37) in the control group, 0.35 (CI, 0.28 to 0.42) in the gain-incentive group, 0.36 (CI, 0.29 to 0.43) in the lottery-incentive group, and 0.45 (CI, 0.38 to 0.52) in the loss-incentive group. In adjusted analyses, only the loss-incentive group had a significantly greater mean proportion of participant-days achieving the goal than control (adjusted difference, 0.16 [CI, 0.06 to 0.26]; P = 0.001), but the adjusted difference in mean daily steps was not significant (861 [CI, 24 to 1746]; P = 0.056). During follow-up, daily steps decreased for all incentive groups and were not different from control.
  
  
  CONCLUSIONS
  Single employer.
  
  
  CONCLUSIONS
  Financial incentives framed as a loss were most effective for achieving physical activity goals.
  
  
  BACKGROUND
  National Institute on Aging.
authors.forename: Mitesh S
authors.initials: MS
authors.lastname: Patel
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
authors.forename: Roy
authors.initials: R
authors.lastname: Rosin
authors.forename: Dylan S
authors.initials: DS
authors.lastname: Small
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Bellamy
authors.forename: Jack
authors.initials: J
authors.lastname: Heuer
authors.forename: Susan
authors.initials: S
authors.lastname: Sproat
authors.forename: Chris
authors.initials: C
authors.lastname: Hyson
authors.forename: Nancy
authors.initials: N
authors.lastname: Haff
authors.forename: Samantha M
authors.initials: SM
authors.lastname: Lee
authors.forename: Lisa
authors.initials: L
authors.lastname: Wesby
authors.forename: Karen
authors.initials: K
authors.lastname: Hoffer
authors.forename: David
authors.initials: D
authors.lastname: Shuttleworth
authors.forename: Devon H
authors.initials: DH
authors.lastname: Taylor
authors.forename: Victoria
authors.initials: V
authors.lastname: Hilbert
authors.forename: Jingsan
authors.initials: J
authors.lastname: Zhu
authors.forename: Lin
authors.initials: L
authors.lastname: Yang
authors.forename: Xingmei
authors.initials: X
authors.lastname: Wang
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Volpp
mesh_terms: D000328:Adult; D005081:Exercise Therapy / Q000191:economics* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009042:Motivation; D009043:Motor Activity; D009765:Obesity / Q000191:economics / Q000628:therapy*; D050177:Overweight / Q000191:economics / Q000628:therapy*; D012201:Reward; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000191:economics* / Q000379:methods