18 LISTENER JUNE 8 2019
incentives, a third of wearers abandon their
trackers within six months.
But research by Patel and his colleagues
has shown how financial incentives – if
framed as a loss rather than a gain – can have
a big effect. They followed 280 overweight
or obese adults and randomly assigned them
to one of four groups using a smartphone
to track their steps, with a goal of 7000 a
day. The control group received a text mes-
sage each day, either congratulating them
for achieving the goal or pointing out that
the goal wasn’t met. The other participants
received a financial incentive: getting either
$1.40 a day for meeting their step goal, entry
to a lottery, or losing $1.40 from an upfront
pool of $42 each day if they failed to meet
their goal. Those in the “loss-incentive”
group achieved their step goal 50% more
than the other groups.
In reality, however, Patel says such incen-
tives are often tied to health-insurance
premiums and become invisible, buried in
a pay cheque or going directly out of a bank
account – or even coming at the end of the
year. Without financial or social incentives,
such as workplace or friend-group chal-
lenges, users often abandon their devices.
“You can’t expect the devices on their
own to motivate people who aren’t that
motivated or have chronic conditions.
We need to combine the technology with
behaviour change and get them into the
hands of patients who can benefit the
most.” When his group gave a wearable
device alone to patients who’d been dis-
charged from hospital after a heart attack,
the strategy failed. But those who received
the device and a $2 a day loss-framed incen-
tive walked 160km further in the six monthsafter the heart attack.
But just how many daily steps are required
to be life-extending is open to debate – do we
really need to get to the 10,000 a day recom-
mended by the World Health Organisation
and cardiac specialists? In a study published
by Harvard Medical School researchers in
JAMA Internal Medicine at the end of May,
data from 18,000 older women in the US
Women’s Health Study showed that thosewho walked about 4400 steps a day lived
longer than women who averaged just 2700
steps, but there was no reduction in mortal-
ity rates for those who averaged 10,000 steps
rather than 7500.“HEALTHY BEHAVIOUR CHANGE”
Professor Holly Thorpe, from the University
of Waikato’s Faculty of Health, Sport and
Human Performance, says she and post-doc-
toral student Marianne Clark wore fitness
trackers for several weeks at the end of last
year for a study analysing whether litera-
ture about the devices matched up with the
wearer’s experience.
“I found myself surprised at how motivat-
ing it was,” says Thorpe. “I was in Australia
for a conference and I’d been doing quite a
bit of walking. That evening at the hotel I
checked my device and I was almost at my
10,000-step goal at 10pm after a very long
day. But I went outside and up and down
the stairs to make sure I got my steps. When
I got the vibration saying I’d achieved it, I
was quite happy with myself. It got me.”
Although that appears to be a good thing,
Thorpe says it could work both ways. “Do
you need at the end of a very busy work-
ing day to feel that you haven’t quite got
your 10,000 steps?” She says although many
women appeared to find a lot of supportFITNESS
“If you enjoy wearing and
seeing the data, then you
should use one. But if you
feel controlled by it, orthe device is controlling
your behaviour ... thenit’s probably best not to.”
Left, Australian
researcher
Deborah
Lupton, and,
right, Waikato
researcher Holly
Thorpe.