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Cited by 402Physical Activity and HealthMobile Health and mHealth ApplicationsContext-Aware Activity Recognition Systems

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Effectiveness of activity trackers with and without incentives to increase physical activity (TRIPPA): a randomised controlled trial

Finkelstein, Eric A, Haaland, Benjamin A, Bilger, Marcel, Sahasranaman, Aarti, Sloan, Robert A, Nang, Ei Ei Khaing, Evenson, Kelly R·2016·The Lancet Diabetes & Endocrinology
DOI 10.1016/s2213-8587(16)30284-4
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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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Metadata

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
ORCID
Venue
The Lancet Diabetes & Endocrinology
Publisher
Elsevier BV
Published
2016-12
Volume
4
Issue
12
Pages
983-995
ISSN
2213-8587 (ISSN-L)
DOI
10.1016/s2213-8587(16)30284-4
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
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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 › Public Health, Environmental and Occupational Health › 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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