A systematic review of financial incentives given in the healthcare setting; do they effectively improve physical activity levels?
BACKGROUND
According to current physical activity guidelines, a substantial percentage of the population in high-income countries is inactive, and inactivity is an important risk factor for chronic conditions and mortality. Financial incentives may encourage people to become more active. The objective of this review was to provide insight in the effectiveness of financial incentives used for promoting physical activity in the healthcare setting.


METHODS
A systematic literature search was performed in three databases: Medline, EMBASE and SciSearch. In total, 1395 papers published up until April 2015 were identified. Eleven of them were screened on in- and exclusion criteria based on the full-text publication.


RESULTS
Three studies were included in the review. Two studies combined a financial incentive with nutrition classes or motivational interviewing. One of these provided a free membership to a sports facility and the other one provided vouchers for one episode of aerobic activities at a local leisure center or swimming pool. The third study provided a schedule for exercise sessions. None of the studies addressed the preferences of their target population with regard to financial incentives. Despite some short-term effects, neither of the studies showed significant long-term effects of the financial incentive.


CONCLUSIONS
Based on the limited number of studies and the diversity in findings, no solid conclusion can be drawn regarding the effectiveness of financial incentives on physical activity in the healthcare setting. Therefore, there is a need for more research on the effectiveness of financial incentives in changing physical activity behavior in this setting. There is possibly something to be gained by studying the preferred type and size of the financial incentive.
Department of Tranzo, Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000LE Tilburg, The Netherlands ; National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands.
Claudia C M
CC
Molema
National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands.
G C Wanda
GC
Wendel-Vos
National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands.
Lisanne
L
Puijk
Department of Health Science, VU University, Amsterdam, The Netherlands.
Jørgen Dejgaard
JD
Jensen
National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands ; Institute of Resource Economics and Food Policy, University of Copenhagen, Copenhagen, Denmark.
A Jantine
AJ
Schuit
National Institute for Public Health and the Environment, Centre for Nutrition and Health Services, Bilthoven, The Netherlands ; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
G Ardine
GA
de Wit
Financial incentive; Healthcare setting; Physical activity; Systematic review