Can Financial Incentives Promote Exercise Adherence Amongst Cardiac Rehabilitation Graduates? A 24-week Pilot Randomized Controlled Trial

Abstract

The health benefits of cardiac rehabilitation (CR) and sustained physical activity (PA) post-CR are well known; yet, CR graduates often fail to adhere to their exercise prescriptions post-program. Financial incentives have shown promise in increasing PA in adults but have been rarely evaluated in a CR context. PURPOSE: To examine the impact of adding financial incentives to a multi-component eHealth (MCE) intervention on moderate-vigorous physical activity (MVPA) amongst CR graduates. Second, to determine whether financial incentives increased eHealth platform engagement compared to non-incentive controls. METHODS: In this 24-week pilot randomized controlled trial participants were recruited from a large outpatient CR program and randomized to control (CT) or intervention (FI) conditions. CTs were instructed to track their exercise daily using a MCE website that included self-monitoring, individual and group-level feedback, and virtual (non-monetary) rewards for exercise session completion. Only FIs could earn $1.00 CAD per day when exercise was tracked and completed. Group differences in MVPA minutes per day (min/d) during the final intervention month were made using a one-way ANOVA. Participants with five or more ‘valid’ days during the final month (days with objectively measured step counts between 500 and 40000) were included in the analysis. RESULTS: Seventy-four CR graduates (63% male; mean age 69±11 years) were randomized to CT (n=38) or FI (n=36) groups, and 34 participants (15/38 CT, 19/36 FI) had at least five valid days (mean 19.7±6.4 days). No significant group difference in mean MVPA min/d in the final intervention month was observed (CT: 21.90±18.56; FI: 27.18±15.52; p=0.41), nor between the mean number of eHealth website logins over the six month intervention (CT: 101.2±129.5; FI: 109.7±91.5; p=0.75). CONCLUSION: While this pilot trial was not powered to detect group differences, our initial results suggest that adding modest financial incentives ($1 per day) to a MCE intervention may not boost engagement (a main driver of eHealth program effectiveness), nor MVPA in a sample of Canadian CR graduates. However, higher study retention, mean MVPA min/d, and total logins in the FI compared to the CT shows intervention promise. These data will inform the design of a fully powered trial.