Implementation of a workplace intervention using financial rewards to promote adherence to physical activity guidelines: a feasibility study

Abstract

Background: We designed and implemented the Brigham and Women's Wellness Initiative (B-Well), a single-arm study to examine the feasibility of a workplace program that used individual and team-based financial incentives to increase physical activity among sedentary hospital employees.

Methods: We enrolled sedentary, non-clinician employees of a tertiary medical center who self-reported low physical activity. Eligible participants formed or joined teams of three members and wore Fitbit Flex activity monitors for two pre-intervention weeks followed by 24 weeks during which they could earn monetary rewards. Participants were rewarded for increasing their moderate-to-vigorous physical activity (MVPA) by 10% from the previous week or for meeting the Centers for Disease Control and Prevention (CDC) physical activity guidelines (150 min of MVPA per week). Our primary outcome was the proportion of participants meeting weekly MVPA goals and CDC physical activity guidelines. Secondary outcomes included Fitbit-wear adherence and factors associated with meeting CDC guidelines more consistently.

Results: B-Well included 292 hospital employees. Participants had a mean age of 38 years (SD 11), 83% were female, 38% were obese, and 62% were non-Hispanic White. Sixty-three percent of participants wore the Fitbit ≥4 days per week for ≥20 weeks. Two-thirds were satisfied with the B-Well program, with 79% indicating that they would participate again. Eighty-six percent met either their personal weekly goal or CDC physical activity guidelines for at least 6 out of 24 weeks, and 52% met their goals or CDC physical activity guidelines for at least 12 weeks. African Americans, non-obese subjects, and those with lower impulsivity scores reached CDC guidelines more consistently.

Conclusions: Our data suggest that a financial incentives-based workplace wellness program can increase MVPA among sedentary employees. These results should be reproduced in a randomized controlled trial.

Trial registration: Clinicaltrials.gov, NCT02850094 . Registered July 27, 2016 [retrospectively registered].

Keywords: Exercise; Financial incentives; Physical activity; Workplace.

Conflict of interest statement

Ethics approval and consent to participate

B-Well was approved by the Partners HealthCare Human Research Committee as protocol 2014P000970/BWH. Participants provided written, informed consent.

Consent for publication

Not applicable.

Competing interests

All authors report being employed by Brigham and Women’s Hospital. EL and JK are Deputy Editors for Methodology and Biostatistics for the Journal of Bone and Joint Surgery. JK is President of the Osteoarthritis Research Society International and a medical editor for Healthwise. EL is a statistical consultant to Tissuegene. There are no other competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Average minutes of physical activity by week. The average minutes of physical activity at baseline and each week throughout the study are depicted for all study participants and for Fitbit adherent study participants. Fitbit adherence was defined as wearing the activity monitor ≥4 days per week for ≥20 weeks throughout the intervention. Baseline measures of physical activity were obtained during the two-week pre-intervention phase. The black circles show the average PA for all participants, and the light gray diamonds show the average PA for Fitbit adherent participants. The solid dark line shows the pre-intervention PA level for all participants, and the light dashed line shows the pre-intervention PA level for Fitbit adherent participants. Abbreviations: PA, physical activity

Fig. 2

Percent of participants meeting personal goal or CDC guidelines, and percent wearing Fitbit at least 4 days of the week. This figure shows the proportion of the 292 participants meeting their personal goals or the CDC physical activity guidelines for each week of the study. The solid black line indicates the percent of participants wearing the Fitbit at least 4 days of the given week. Personal weekly goals were defined as a 10% increase in minutes of physical activity compared to the previous week. The total height of the bars represents the total percentage of participants who met either their personal weekly PA goals or the CDC physical activity guidelines. The black portions of the bars show the percent of participants meeting CDC guidelines, and the light gray portions show the percent of participants who met weekly PA goals, but not CDC guidelines. Participants without data were assumed to not have met guidelines or weekly goals

Fig. 3

Average number of weeks meeting or exceeding CDC guidelines by baseline characteristic. The average (and 95% confidence interval) number of weeks that participants met or exceeded CDC physical activity guidelines is depicted for several baseline characteristics. Results are adjusted for age and comorbidities. Q4 is the highest quartile for delay discounting (immediate rewards preferred). Abbreviations: AA, African American