Neel Chokshi, MD, MBA
Penn Medicine Heart and Vascular Center
Institute for Translational Medicine and Therapeutics, University of Pennsylvania
Cardiovascular disease is the leading cause of morbidity and mortality in the United States.
Physical activity has been demonstrated to improve health and reduce cardiovascular events. However, only about 30 percent of patients with ischemic heart disease participate in exercise-based rehabilitation, and most patients do not get enough regular physical activity on their own.
We designed a home-based remote monitoring intervention that used loss-framed financial incentives, personalized goal setting, and wearable devices to increase physical activity. More than 100 patients with ischemic heart disease were enrolled to participate in the 24-week trial. Way to Health was used to administer and manage the program.
Patients established a baseline step count and were randomly assigned to a control arm with no intervention or a financial incentive arm. Patients in the control group received a wearable device to track their activity but no other intervention. Patients in the incentive arm received wearable devices, personalized step goals, daily feedback, and $14 per week for the first 16 weeks. If participants in the financial incentive arm did not meet their daily step goal, we withdrew $2 from their virtual accounts.
The loss-framed intervention led to significant increases in physical activity compared to the control, with results sustained in the follow-up period. Patients in the intervention arm took 1,368 more steps per day during the maintenance intervention period and 1,154 more steps per day in the two months after the intervention. During the six-month trial, the average patient in the intervention group walked about 100 miles more than the average patient in the control group.