Alexander Fanaroff, MD, an interventional cardiologist and assistant professor of medicine at the Hospital of the University of Pennsylvania, spoke with Cardiovascular Business about his late-breaking BE ACTIVE randomized clinical trial presented at ACC.24.[1] The study looked at the effect of gamification and financial incentives to increase physical activity among patients with an elevated risk for major adverse cardiovascular events.
"The genesis for this study is that we know that physical activity is hugely beneficial for improving cardiovascular and also non-cardiovascular outcomes. It reduces cardiovascular death, it reduces all cause death, reduces heart attacks, strokes, diabetes, hyperlipidemia. But we also know that most Americans don't get enough physical activity, especially as they get older and are an increased risk for cardiovascular disease," Fanaroff said.
This study looked at how behavioral economics, gamification and financial incentives might be able to increase physical activity over the long term. They contacted patients with established atherosclerotic vascular disease and asked them to participate remotely. Every participant received a FitBit fitness tracker worn on the wrist that automatically uploaded their daily step counts to a secure website. They asked the 1,062 patients they recruited to set a goal to increase physical activity by 33-50% per day. They were then randomized into four arms for a control, gamification, financial incentives, or the combination of gamification and financial incentives.
"If you look at the control arm, participants increased physical activity by about 1,400 steps per day from baseline. There was also a very rapid up slope in the gamification of financial incentives arms.They were taking about 1,900 steps per day. By the end of 12-month followup in the combination arm, they were taking about 2,300 steps per day. So substantial increases in mean daily step counts, and we saw similar pattern with minutes. Weekly minutes of moderate physical activity over the follow-up period when the intervention went away, there was some decline, but even by the end of the study, participants were taking substantially more steps than they were in the beginning of the study, specifically more steps than even the control arm achieved in the gamification and gamification plus financial incentives arms," he explained.
He said the key to getting people to use the FitBit devices and get out and exercise is really knowing that someone is watching their progress and tracking it. He said patients liked the idea that someone cared about what they were doing.
"The conclusion is that these interventions work. So just the control condition increases physical activity by a substantial amount. And these interventions that are designed based on behavioral economic principles work even better than the control condition. And I think that is the take home message, that we have tools to increase physical activity now in patients. They are relatively simple, they are easy to deploy, and this can be done in an automated fashion," Fanaroff said.
Why insurance companies should pay attention to this data
Insurance companies offers online portals and websites with health tips, but many say more motivation is required to get patients off the couch to be more active enough reverse disease progression and to realize better outcomes. Fanaroff said insurance companies in particular should consider these types of programs to keep their customers healthier and out of the hospital.
"When you think about who should be thinking about this, who should be using it, it's insurers, it's health systems dealing with models where they have with pay for performance. I think that the evidence here shows that we can increase physical activity this way in a way that's meaningful and durable and relatively easy to implement," Fanaroff said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com