title: Examining Incentives to Promote Physical Activity Maintenance Among Hospital Employees Not Achieving 10,000 Daily Steps: A Web-Based Randomized Controlled Trial Protocol.
abstract: BACKGROUND
  The economic burden of physical inactivity in Canada is estimated at Can $6.8 billion (US $5 billion) per year. Employers bear a substantial proportion of the economic costs, as they pay more for inactive workers in health care and other organizational costs. In response, many Canadian employers offer wellness programs, though these are often underutilized. While financial health incentives have been proposed as one way of increasing participation, their longer term effects (ie postintervention effects) are not clear.
  
  
  OBJECTIVE
  The objective of this paper is to outline the methodology for a randomized control trial (RCT) examining the longer term impact of an existing physical activity promotion program that is enhanced by adding guaranteed rewards (Can $1 [US $0.74] per day step goal met) in a lower active hospital employee population (less than 10,000 steps per day).
  
  
  METHODS
  A 12-week, parallel-arm RCT (with a 12-week postintervention follow-up) will be employed. Employees using Change4Life (a fully automated, incentive-based wellness program) and accumulating fewer than 10,000 steps per day at baseline (weeks 1 to 2) will be randomly allocated (1:1) to standard care (wellness program, accelerometer) or an intervention group (standard care plus guaranteed incentives). All study participants will be asked to wear the accelerometer and synchronize it to Change4Life daily, although only intervention group participants will receive guaranteed incentives for reaching tailored daily step count goals (Can $1 [US $0.74] per day; weeks 3 to 12). The primary study outcome will be mean proportion of participant-days step goal reached during the postintervention follow-up period (week 24). Mean proportion of participant-days step goal reached during the intervention period (week 12) will be a secondary outcome.
  
  
  RESULTS
  Enrollment for the study will be completed in February 2017. Data analysis will commence in September 2017. Study results are to be published in the winter of 2018.
  
  
  CONCLUSIONS
  This protocol was designed to examine the impact of guaranteed rewards on physical activity maintenance in lower active hospital employees.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02638675; https://clinicaltrials.gov/ct2/show/NCT0 2638675 (Archived by WebCite at http://www.webcitation.org/6g4pvZvhW).
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
authors.forename: Marc
authors.identifier: http://orcid.org/0000-0002-2772-9614
authors.initials: M
authors.lastname: Mitchell
authors.affiliation: Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.
authors.forename: Lauren
authors.identifier: http://orcid.org/0000-0002-9935-3732
authors.initials: L
authors.lastname: White
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
authors.forename: Paul
authors.identifier: http://orcid.org/0000-0002-0603-6958
authors.initials: P
authors.lastname: Oh
authors.affiliation: Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Matthew
authors.identifier: http://orcid.org/0000-0002-9757-2771
authors.initials: M
authors.lastname: Kwan
authors.affiliation: Green Shield Canada Inc, Toronto, ON, Canada.
authors.forename: Peter
authors.identifier: http://orcid.org/0000-0003-0383-8039
authors.initials: P
authors.lastname: Gove
authors.affiliation: University of Connecticut, Storrs, CT, United States.
authors.forename: Tricia
authors.identifier: http://orcid.org/0000-0001-8134-3838
authors.initials: T
authors.lastname: Leahey
authors.affiliation: School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Guy
authors.identifier: http://orcid.org/0000-0001-8898-2536
authors.initials: G
authors.lastname: Faulkner
keywords: behavioral economics; financial health incentives; physical activity; randomized controlled trial; workplace health