Background: Physical activity is associated with a lower risk of major adverse cardiovascular events, but few individuals achieve guideline recommended levels of physical activity. Strategies informed by behavioral economics increase physical activity, but their longer-term effectiveness is uncertain. We sought to determine the effect of behaviorally-designed gamification, loss-framed financial incentives, or the combination on physical activity compared with attention control over 12-month intervention and 6-month post-intervention follow-up periods.Methods: Between May 2019 and January 2024, participants with clinical ASCVD or 10-year risk of myocardial infarction, stroke, or cardiovascular death ≥ 7.5% by the pooled cohort equation were enrolled in a pragmatic randomized clinical trial. Participants received a wearable device to track daily steps, established a baseline, selected a step goal increase, and were randomly assigned to control (n = 151), behaviorally-designed gamification (n = 304), loss-framed financial incentives (n = 302), or gamification + financial incentives (n = 305). The trial’s primary outcome was change in mean daily steps from baseline through the 12-month intervention period.Results: A total of 1062 patients (mean [SD] age 67 [8], 61% female, 31% non-white) were enrolled. Compared with controls, participants had significantly greater increases in mean daily steps from baseline during the 12-month intervention in the gamification arm (adjusted difference, 538.0; 95% CI, 186.2-889.9; P = 0.0027), financial incentives arm (adjusted difference, 491.8; 95% CI, 139.6-844.1; P = 0.0062), and gamification + financial incentives arm (adjusted difference, 868.0; 95% CI, 516.3-1219.7; P < 0.0001). During 6-month follow-up, physical activity remained significantly greater in the gamification + financial incentives arm than in the control arm (adjusted difference, 576.2; 95% CI, 198.5-954; P = 0.0028) but was not significantly greater in the gamification (adjusted difference, 459.8; 95% CI, 82.0-837.6; P = 0.0171) or financial incentives (adjusted difference, 327.9; 95% CI, -50.2 to 706; P = 0.09) arms, after adjusting for multiple comparisons.Conclusions: Behaviorally-designed gamification, loss-framed financial incentives, and the combination of both increased physical activity compared with control over a 12-month intervention period, with the largest effect in gamification + financial incentives. These interventions could be a useful component of strategies to reduce cardiovascular risk in high-risk patients.

中文翻译：

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游戏化、经济激励或两者对增加心血管事件高风险患者体力活动的影响：BE ACTIVE 随机对照试验

背景：体力活动与主要不良心血管事件的风险较低相关，但很少有人达到指导建议的体力活动水平。行为经济学指导的策略可以增加体力活动，但其长期有效性尚不确定。我们试图确定行为设计的游戏化、损失框架的经济激励或组合对体力活动的影响，与 12 个月的干预和 6 个月的干预后随访期间的注意力控制相比。方法：2019 年 5 月之间2024 年 1 月，根据汇总队列方程，临床 ASCVD 或 10 年心肌梗死、中风或心血管死亡风险≥ 7.5% 的参与者被纳入一项实用随机临床试验。参与者收到可穿戴设备来跟踪每日步数，建立基线，选择增加步数目标，并随机分配到控制组 (n = 151)、行为设计游戏化组 (n = 304)、损失框架经济激励组 (n = 302），或游戏化+经济激励（n = 305）。该试验的主要结果是在 12 个月的干预期内平均每日步数相对于基线的变化。结果：共有 1062 名患者（平均 [SD] 年龄 67 [8]，61% 女性，31% 非白人）入组。与对照组相比，在游戏化组（调整后的差异，538.0；95% CI，186.2-889.9； P = 0.0027）和经济激励组（调整后的差异）的 12 个月干预期间，参与者的平均每日步数较基线有显着更大的 增加，491.8；95% CI，139.6-844.1；P  = 0.0062），以及游戏化+财务激励组（调整后的差异，868.0；95% CI，516.3-1219.7；P  < 0.0001）。在 6 个月的随访期间，游戏化 + 经济激励组的体力活动仍然显着高于对照组（调整后差异，576.2；95% CI，198.5-954；P  = 0.0028），但游戏化 + 经济激励组的体力活动并没有显着高于对照组。 调整多重比较后，采用游戏化（调整后差异，459.8；95% CI，82.0-837.6；P  = 0.0171）或经济激励（调整后差异，327.9；95% CI，-50.2 至 706；P = 0.09）武器。 结论：行为设计的游戏化、损失框架的经济激励以及两者的结合，与 12 个月的干预期控制相比增加了体力活动，其中游戏化 + 经济激励的效果最大。这些干预措施可能是降低高危患者心血管风险策略的有用组成部分。