A behavioral economics intervention improves compliance with the U.S. public health physical activity recommendations: Preliminary results from the REWARD (Reinforcing Exercise With Activity-Related Dividends) Trial

Background: Despite widespread public health campaigns, participation in physical activity (PA) is at a historic low in the U.S., with substantial socioeconomic cost. Behavioral economic models have been reported to be very effective in eliciting positive change in similar public health problems. Purpose: The purpose of this study was to examine if a behavioral economics paradigm would improve compliance with current physical activity recommendations in sedentary, overweight adults. Methods: University employees were enrolled in a 12-week incentivized walking program. Participants were encouraged through an interactive website, financial incentives, and weekly meetings to achieve at least 8000 steps/day. Results: To date, eight subjects (age: 43.6 ± 10.4; BMI: 37.6 ± 7.27) have completed the program and a 6-month free-living period. Baseline steps per day met the classification as sedentary (2901 ± 1051) and significantly increased through week 12 (8545 ± 655, p<0.01); with concomitant improvements in depression (week 1: 12.00 ± 16.48; week 12 5.14 ± 7.40), mood (week 1: 26.8 ± 24.86; week 12: 10.2 ± 9.97), and worker lost productivity (week 1: 6.22 ± 8.13; week 12: 1.86 ± 4.73). Exercise stage of change significantly increased from week 1 (2.4 ± 0.9) to week 12 (4.2 ± 0.7, p<0.01), and at six month follow up, remained significantly higher (3.0 ± 0.8, p<0.01). Conclusions: These preliminary findings provide compelling support for behavioral economics models to counter low compliance with current physical activity recommendations, while potentially providing a solvent way to mitigate the human and economic costs of sedentary lifestyle.