Effectiveness of activity trackers with and without incentives to increase physical activity (TRIPPA): a randomised controlled trial
Abstract
Background Despite the increasing popularity of activity trackers, little evidence exists that they can improve health outcomes. We aimed to investigate whether use of activity trackers, alone or in combination with cash incentives or charitable donations, lead to increases in physical activity and improvements in health outcomes.Methods In this randomised controlled trial, employees from 13 organisations in Singapore were randomly assigned (1:1:1:1) with a computer generated assignment schedule to control (no tracker or incentives), Fitbit Zip activity tracker, tracker plus charity incentives, or tracker plus cash incentives. Participants had to be English speaking, full-time employees, aged 21-65 years, able to walk at least ten steps continuously, and non-pregnant. Incentives were tied to weekly steps, and the primary outcome, moderate-to-vigorous physical activity (MVPA) bout min per week, was measured via a sealed accelerometer and assessed on an intention-to-treat basis at 6 months (end of intervention) and 12 months (after a 6 month post-intervention follow-up period). Other outcome measures included steps, participants meeting 70 000 steps per week target, and health-related outcomes including weight, blood pressure, and quality-of-life measures. This trial is registered at ClinicalTrials.gov, number NCT01855776.Findings Between June 13, 2013, and Aug 15, 2014, 800 participants were recruited and randomly assigned to the control (n=201), Fitbit (n=203), charity (n=199), and cash (n=197) groups. At 6 months, compared with control, the cash group logged an additional 29 MVPA bout min per week (95% CI 10-47; p=0·0024) and the charity group an additional 21 MVPA bout min per week (2-39; p=0·0310); the difference between Fitbit only and control was not significant (16 MVPA bout min per week [-2 to 35; p=0·0854]). Increases in MVPA bout min per week in the cash and charity groups were not significantly greater than that of the Fitbit group. At 12 months, the Fitbit group logged an additional 37 MVPA bout min per week (19-56; p=0·0001) and the charity group an additional 32 MVPA bout min per week (12-51; p=0·0013) compared with control; the difference between cash and control was not significant (15 MVPA bout min per week [-5 to 34; p=0·1363]). A decrease in physical activity of -23 MVPA bout min per week (95% CI -42 to -4; p=0·0184) was seen when comparing the cash group with the Fitbit group. There were no improvements in any health outcomes (weight, blood pressure, etc) at either assessment.Interpretation The cash incentive was most effective at increasing MVPA bout min per week at 6 months, but this effect was not sustained 6 months after the incentives were discontinued. At 12 months, the activity tracker with or without charity incentives were effective at stemming the reduction in MVPA bout min per week seen in the control group, but we identified no evidence of improvements in health outcomes, either with or without incentives, calling into question the value of these devices for health promotion. Although other incentive strategies might generate greater increases in step activity and improvements in health outcomes, incentives would probably need to be in place long term to avoid any potential decrease in physical activity resulting from discontinuation.Funding Ministry of Health, Singapore.
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17 studies reported activity tracker adherence data, with 13 of these reporting activity tracker wear on at least 50% of the study intervention days.
“Moreover, 17 studies reported activity tracker adherence data [21,22,30,32,34,35, 37,38,40,41,43-45,50-52,54], with 13 of these studies [21,22,30,34,35,40,41,43,44,50-52,54] reporting activity tracker wear on at least 50% of the study intervention days.”
From Consumer-based wearable activity trackers increase physical activity participation: systematic review and meta-analysis (2019) · cites this paper as [34]
The Results passage accompanying Figure 2 reports tracker-wear adherence in this trial: 62% of participants in the Fitbit or charity groups and 88% in the cash group were still wearing the device at six months. But its measure is the percentage who wore it for at least one day in a given week, not whether participants wore it on at least 50% of intervention days. As one trial, it also cannot establish the citing paper’s totals of 17 and 13 studies. (LLM, conf=0.86)
Experimental — accuracy not yet measured4 studies included either an unstructured follow-up phase or an additional intervention phase utilizing a nonblinded activity tracker for all participants.
“In addition, 4 studies included either an unstructured follow-up phase [34,42] or additional intervention phase utilizing a nonblinded activity tracker for all participants [41,50].”
From Consumer-based wearable activity trackers increase physical activity participation: systematic review and meta-analysis (2019) · cites this paper as [34]
The Methods describe a six-month post-intervention follow-up, supporting the follow-up part of the sentence. But the Randomisation and masking section assigns the control group no tracker, and the paper does not describe an additional phase in which all participants received a nonblinded tracker. This source also cannot establish that four studies had either design. (LLM, conf=0.83)
Experimental — accuracy not yet measuredA total of 26 studies were included across all meta-analyses.
“A total of 26 studies were included across all meta-analyses [21,22,29-48,50-53].”
From Consumer-based wearable activity trackers increase physical activity participation: systematic review and meta-analysis (2019) · cites this paper as [34]
13 studies included young adults (≤39.9 years), 15 included middle-aged adults (40-64.9 years), and 1 included adults over 65 years.
“Thirteen studies included young adults (≤39.9 years) [30-34,37,38,42,44,46-48,50], 15 included middle-aged adults (40-64.9 years) [21,22,29,35,36,39-41, 43,45,51-54], and 1 study included adults aged over 65 years [49].”
From Consumer-based wearable activity trackers increase physical activity participation: systematic review and meta-analysis (2019) · cites this paper as [34]
8 studies included more than 1 intervention group.
“Overall, 8 studies included more than 1 intervention group [34,43,45-47,52-54].”
From Consumer-based wearable activity trackers increase physical activity participation: systematic review and meta-analysis (2019) · cites this paper as [34]
Two of the included studies reported a significant increase in daily steps, four reported a significant increase in MVPA, and two reported a significant increase in energy expenditure for the intervention group compared with control.
“Two of the included studies [34,44] reported a significant increase in daily steps, 4 studies [30,34,36,53] reported a significant increase in MVPA, and 2 studies [45,47] reported a significant increase in energy expenditure for the intervention group compared with control.”
From Consumer-based wearable activity trackers increase physical activity participation: systematic review and meta-analysis (2019) · cites this paper as [34]
Physical activity interventions did not show long-term behavioural changes or did not improve clinical outcomes.
“PA interventions did not show long-term behavioural changes or did not improve clinical outcomes”
From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [44]
Despite improvement in MVPA at 12 months with activity tracking, with or without incentives, there was no improvement in health outcomes such as weight and BP reduction at 12 months.
“Moreover, despite the improvement in MVPA at 12 months with activity tracking, with or without incentives, these findings did not translate into an improvement in health outcomes, such as weight and BP reduction, at 12 months.”
From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [44]
In a four-arm Singapore trial, a cash incentive was most effective at increasing MVPA at 6 months, but this effect was not sustained 6 months after removal of incentives.
“The trial showed that a cash incentive was most effective at increasing MVPA at 6 months, but this effect was not sustained 6 months after the removal of incentives.”
From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [44]
The use of behavioural economics and cognitive psychology to develop novel social and financial incentives can potentially sustain good habits, especially when initiated at a very young age.
“Therefore, the use of behavioural economics and cognitive psychology to develop novel social and financial incentives can potentially sustain good habits, especially when initiated at a very young age44.”
From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [44]
A trial with 800 participants questioned the value of wearables in sustaining long-term behavioural changes and improving clinical outcomes.
“As mentioned previously, a trial with 800 participants questioned the value of wearables in sustaining long-term behavioural changes and improving clinical outcomes44.”
From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [44]
Sedentary behavior was measured objectively, except in two studies that utilized a self-reported questionnaire to obtain daily sitting time or sedentary behavior.
“Sedentary behavior was measured objectively, except in two studies [82,104] that utilized a self-reported questionnaire to obtain daily sitting time or sedentary behavior.”
From Fitbit-based interventions for healthy lifestyle outcomes: systematic review and meta-analysis (2020) · cites this paper as [82]
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- Authors
- Finkelstein, E. A., Haaland, B. A., Bilger, M., Sahasranaman, A., Sloan, R. A., Nang, E. E. K., & Evenson, K. R.
- Affiliations
- National University of Singapore (SG)
- Georgia Institute of Technology (US)
- Duke-NUS Medical School (SG)
- Kagoshima University (JP)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Finkelstein, Eric A
- Venue
- The Lancet Diabetes & Endocrinology
- Publisher
- Elsevier BV
- Published
- 2016-12
- Volume
- 4
- Issue
- 12
- Pages
- 983-995
- ISSN
- 2213-8587 (ISSN-L)
- OpenAlex
- W2528113844
- Cited by
- 402
- References
- 27
- Citations by year
- 2026: 11 · 2025: 17 · 2024: 23 · 2023: 24 · 2022: 33 · 2021: 62 · 2020: 102 · 2019: 53 · 2018: 43 · 2017: 30 · 2016: 4
- FWCI
- 34.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Diabetes & Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- WU Research (publishedVersion)
- Funders
- Health Services Research Competitive Research Grant (HSRG/0022/2012)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Context-Aware Activity Recognition Systems
- Keywords
- wearable activity trackers, Fitbit, physical activity, cash incentives, moderate-to-vigorous physical activity, step count, workplace health promotion, employee health, blood pressure, body weight, quality of life, accelerometer-measured activity, gamification
- MeSH terms
- Adult, Charities, Female, Habits, Humans, Male, Motivation, Exercise, Occupational Health, Accelerometry
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