A Trial of Financial and Social Incentives to Increase Older Adults’ Walking

In the American Journal of Preventive Medicine, Kristin Harkins and colleagues, including LDI Senior Fellows Jason Karlawish and Karen Glanz, investigate the effects of financial incentives and donations to charity separately and combined on older adults’ uptake and retention of increased levels of walking. Despite evidence that regular physical activity confers health benefits, physical activity rates among older adults remain low. Both personal and social goals may enhance older adults’ motivation to become active. Ninety-four participants aged ≥65 years participated in this study and received digital pedometers, walking goals of a 50% increase in daily steps, and weekly feedback on goal attainment. They were randomized to one of four groups: (1) Control: received weekly feedback only; (2) Financial Incentives: received payment of $20 each week walking goals were met; (3) Social Goals: received donation of $20 to a charity of choice each week walking goals were met; and (4) Combined: received $20 each week walking goals were met that could be received by participant, donated to a charity of choice, or divided between the participant and charity. After adjusting for baseline walking, the proportion of days step goals were met during the 16-week intervention period was higher in all intervention groups versus controls (relative risk, 3.71; 95% CI=1.37, 10.01). During the 4-week follow up period, the proportion of days step goals that were met did not differ in intervention groups compared to the control (relative risk, 2.91; 95% CI=0.62, 13.64). These results show that incentive schemes that use donations to a charity of choice, personal financial incentives, or a combination of the two can each increase older adults’ initial uptake of increased levels of walking in the short-run, thus combining personal health benefits and socially important goals.