Do portable step counters such as Fitbits and Apple Watches promote healthy exercise in people at high risk of heart attacks?
No, says a new study by Penn. But modest financial incentives can change that.
In the study, physicians from the University of Pennsylvania and the Icahn School of Medicine used portable step meters, exercise targets and $ 14 per week payments to promote walking in subjects with ischemic heart disease, the main cause of death in the USA UU
According to the American Heart Association, regular exercise reduces the risk of heart attacks and other cardiovascular events by up to 30 percent among people with heart disease. But most patients do not get enough exercise by themselves. The Push Unit of Penn Medicine has conducted a series of experiments in recent years to apply knowledge of behavioral economics and psychology to motivate healthy behavior. [LEER MÁS: Rehabilitación después de un ataque al corazón: cómo Penn's Nudge Unit se asegura de que suceda] 19659006] "There are so many reasons why patients do not end up in programs [exercise]," said Neel P. Chokshi, a cardiologist and lead author of the study. "Motivation is a big part and access to facilities is another."
The study, published this week in the Journal of the American Heart Association attempted to address these two obstacles to exercise. The motivation came in the form of weekly checks. The facilities came in the form of step counters worn by the wrist.
A group of 105 subjects (mostly older men) were issued wearables and divided into two groups. The control group received no payments and showed no significant changes in activity, as measured by the count of daily steps during the six-month test.
The experimental group received "incentives with loss frameworks": money distributed every week, unless they are not met. Each lost day cost participants $ 2 of their allocated funds.
On average, participants in the paid group walked 100 more miles during the duration of the trial than those in the control group. The researchers paid an average of $ 104 to each incentivized walker. "It's a tremendous amount [of exercise] for something that did not cost much," said lead author Mitesh S. Patel, an internist and behavioral economist who helped design the payment plan.
The experimental group averaged 1,368 daily steps more than its unpaid peers.
At the four month mark, the controls stopped arriving, but the same group still maintained an advantage of 1,154 steps per day.
"We were pleasantly surprised," Patel said. "As far as we know, this is one of the first trials that uses financial incentives in which we can build long-lasting habits that were maintained after the financial incentives were deactivated."
Why $ 2 per day? "Nationwide, 85 percent of large employers offer financial incentives for health promotion," Patel said. "Many people do not even know it, but you can go to your employer or your insurance company and you can get a financial incentive to do things like being physically active." The national average is about $ 750 per year, which is $ 2. per day ".
Patel also believes that $ 2 per day may be enough to avoid the "peanut effect," a tendency to discard rewards that are considered too small.  Does an additional 1,000 steps per day for heart health matter? "It remains to be seen," said Chokshi.
"The next set of studies that must be done is to evaluate not only step counts but also clinical outcomes, analyzing whether patients have fewer heart attacks or lower rates of stents in the future," he said.
If financial payments are linked to the exercise, patients may cheat. Step counters that fall into the dryer, for example, can produce exaggerated daily step counts. The research team anticipated this.
"We noticed a person who had extremely high step counts: from 25,000 to 40,000 steps per day," Patel said. "We call them to say: 'Hey, what's going on? What have you been doing?'"
The man reported that he walked every day for 20 to 40 minutes and did not confess any other activity to indicate that he was trying to deceive the investigators.
But he also revealed that he had recently joined a band, as a drummer. "He practiced quite rigorously," Chokshi said.