Making people move is not as easy as dangling money as a carrot for a hungry horse. It appears that it is better to show them the money, and then threaten to take it away.
While the level of overweight is increasing and physical activity is declining during this sedentary period of binge-watching and being stuck to a computer at work, researchers are trying to think of the best ways to get people to move their bodies. Health insurers are already using economic incentives, often in the form of lower premiums, to encourage people and their employees to practice and embrace wellness programs.
Yet the results on what works are mixed, partly because there is little research on the subject and too many incentives are based on outdated principles, said Dr. Mitesh S. Patel. He is an assistant professor of medicine and healthcare management at the University of Pennsylvania and director of the Penn Medicine Nudge Unit, a first-of-his-unit that develops and tests “nudges” to improve healthcare delivery.
He said that many incentives are based on the idea that people are rational and motivated by rewards. “But people are often irrational, often in perfectly predictable ways, so we test how we can motivate people based on how they really behave,” he said.
The right behavioral change strategy
Dr Patel and other researchers have looked at how exercise is influenced by incentives with deterioration, giving people money and then removing it if they don’t reach a goal, as opposed to traditional profit-seeking incentives.
In a 2016 Annals of Internal Medicine study, money incentives with loss of money were effective in getting overweight and overweight people to take 7,000 steps a day. When faced with the possibility of losing $ 1.40 (± R20) per day, they achieved their goal in 45% of the cases, an increase of 50% compared to the control group.
A separate June study in the Journal of the American Heart Association found that the threat of losing $ 2 (± R30) per day motivated patients with heart disease wearing health monitoring devices to exercise more.
Dr. Patel said the study shows that “someone just gives a portable device, doesn’t make them more active. It’s important to link technology to the right behavioral change strategy.”
Another key to exercising incentives can quickly reward people, rather than delaying their payouts.
“People are driven by immediate rewards,” said Dr. Patel. “If you have a dessert, you will receive immediate satisfaction and you will not think about it in 10 years.”
Dr. Patel said that social incentives can also motivate people to practice through peer pressure. A classic example is the workout buddy.
“You go to the gym with a buddy before you go alone because you feel responsible,” said Dr. Patel. “You can help the other person if they have a bad day and vice versa.”
Thanks to smartphones and inexpensive portable fitness trackers, it is easier than ever to monitor people and reward them for exercise, and as a result, the stigma of paying people to exercise is disappearing, said Dr. Marc Mitchell, incentives researcher.
“It may be a big part of the answer to the question, how can we support physical exercise on a large scale?” said Dr. Mitchell, an assistant professor of health sciences at Western University in London, Ontario, and lead advisor to the behavioral change company CARROT Insights.
The problem, Dr. Mitchell said, is that research shows that physical activity eventually diminishes after the stimulus disappears. The ultimate goal is not to pay people their entire lives for exercise, but to design new stimulation programs that are so effective that they inspire people to keep moving long after the rewards are eliminated.
“I think if a program is innovative enough, it can increase people’s confidence, motivation and potential for sustainable change,” he said.