Financial incentives for physical activity in adults: systematic review and meta-analysis

Mitchell, Marc S; Orstad, Stephanie L; Biswas, Aviroop; Oh, Paul I; Jay, Melanie; Pakosh, Maureen T; Faulkner, Guy

doi:10.1136/bjsports-2019-100633

Cited by 145Physical Activity and HealthBehavioral Health and InterventionsMobile Health and mHealth Applications

Financial incentives for physical activity in adults: systematic review and meta-analysis

Mitchell, Marc S, Orstad, Stephanie L, Biswas, Aviroop, Oh, Paul I, Jay, Melanie, Pakosh, Maureen T, Faulkner, Guy·2020·British Journal of Sports Medicine

DOI 10.1136/bjsports-2019-100633

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Abstract

Objective: The use of financial incentives to promote physical activity (PA) has grown in popularity due in part to technological advances that make it easier to track and reward PA. The purpose of this study was to update the evidence on the effects of incentives on PA in adults. Data sources: Medline, PubMed, Embase, PsychINFO, CCTR, CINAHL and COCH. Eligibility criteria: Randomised controlled trials (RCT) published between 2012 and May 2018 examining the impact of incentives on PA. Design: A simple count of studies with positive and null effects (‘vote counting’) was conducted. Random-effects meta-analyses were also undertaken for studies reporting steps per day for intervention and post-intervention periods. Results: 23 studies involving 6074 participants were included (64.42% female, mean age = 41.20 years). 20 out of 22 studies reported positive intervention effects and four out of 18 reported post-intervention (after incentives withdrawn) benefits. Among the 12 of 23 studies included in the meta-analysis, incentives were associated with increased mean daily step counts during the intervention period (pooled mean difference (MD), 607.1; 95% CI: 422.1 to 792.1). Among the nine of 12 studies with post-intervention daily step count data incentives were associated with increased mean daily step counts (pooled MD, 513.8; 95% CI:312.7 to 714.9). Conclusion: Demonstrating rising interest in financial incentives, 23 RCTs were identified. Modest incentives ($1.40 US/day) increased PA for interventions of short and long durations and after incentives were removed, though post-intervention ‘vote counting’ and pooled results did not align. Nonetheless, and contrary to what has been previously reported, these findings suggest a short-term incentive ‘dose’ may promote sustained PA.

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Previous randomized studies reported significant positive effects of financial incentives on physical activity.
“Indeed, previous randomized studies have reported significant positive effects of financial incentives on physical activity (17).”
From Which Components of a Smartphone Walking App Help Users to Reach Personalized Step Goals? Results From an Optimization Trial (2020) · cites this paper as [17]
The amount of CHF 1 per day was chosen because the lowest incentive value that has produced significant changes in physical activity in previous studies is around US$1 per day.
“We chose the amount of CHF 1 per day because the lowest incentive value that has produced significant changes in physical activity in previous studies is around US$ 1 per day (≈ CHF 1 per day) (17).”
From Which Components of a Smartphone Walking App Help Users to Reach Personalized Step Goals? Results From an Optimization Trial (2020) · cites this paper as [17]

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“In total, 16 physiological and behavioral data groups were identified using the ICF tool, such as looking after one’s health (physical activity; 14/31, 45%) [39,40,43-48,52,55-57,64,68]; walking (11/31, 36%) [39-43,52,56,57,61,62,68]; heart rhythm (7/31, 23%) [49,51,53,54,66,67,69]; and weight maintenance functions (7…”
BackgroundMethodResultInfluential
Commercial app use linked with sustained physical activity in two Canadian provinces: a 12-month quasi-experimental study
Mitchell, M., Lau, E. Y., White, L., & Faulkner, G. (2020) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-020-00926-7 · Cited by 53 · see citing works
“(2019) concluded that incentives increased mean daily step counts for short and long duration interventions by 607 steps [44].”
Self-citation
Examining Responsiveness to an Incentive-Based Mobile Health App: Longitudinal Observational Study
Brower, J., LaBarge, M., White, L., & Mitchell, M. (2020) · Journal of Medical Internet Research · doi:10.2196/16797 · Cited by 57 · see citing works
“Although monetary health incentives (eg, paying people to walk more) have shown promise with evidence of short- and long-term effects [18], only a limited amount of research has examined alternative types of financial incentives [19].”
BackgroundSelf-citation
Effects of an mHealth App (Kencom) With Integrated Functions for Healthy Lifestyles on Physical Activity Levels and Cardiovascular Risk Biomarkers: Observational Study of 12,602 Users
Hamaya, R., Fukuda, H., Takebayashi, M., Mori, M., Matsushima, R., Nakano, K., Miyake, K., Tani, Y., & Yokokawa, H. (2021) · Journal of Medical Internet Research · doi:10.2196/21622 · Cited by 48 · see citing works
“Furthermore, the meta-analysis had high heterogeneity due to the constituent small-sized RCTs and was also likely to be confounded by publication bias [11].”
BackgroundMethodResultInfluential
A multi-stakeholder approach to eHealth development: Promoting sustained healthy living among cardiovascular patients
Breeman, L. D., Keesman, M., Atsma, D. E., Chavannes, N. H., Janssen, V., van Gemert-Pijnen, L., Kemps, H., Kraaij, W., Rauwers, F., Reijnders, T., et al. (2021) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2020.104364 · Cited by 37 · see citing works
Evaluation of the Effectiveness of Behavioral Economic Incentive Programs for Goal Achievement on Healthy Diet, Weight Control and Physical Activity: A Systematic Review and Network Meta-analysis
Boonmanunt, S. W., Pattanaprateep, O., Ongphiphadhanakul, B., McKay, G. J., Attia, J., Vlaev, I., & Thakkinstian, A. (2022) · Annals of Behavioral Medicine · doi:10.1093/abm/kaac066 · Cited by 41 · see citing works
“However, their effectiveness is largely dependent on their design [7, 11, 12].”
Background
Using Theories of Behavior Change to Develop Interventions for Healthy Aging
Klusmann, V., Gow, A. J., Robert, P. H., & Oettingen, G. (2021) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbab111 · Cited by 39 · see citing works
“In the domain of physical activity, financial incentives have been shown to be effective across the life span and in old age (Finkelstein et al., 2008; Kullgren et al., 2014; Mitchell et al., 2020).”
Background
Evaluation of a Population‐Wide Mobile Health Physical Activity Program in 696 907 Adults in Singapore
Yao, J., Lim, N., Tan, J., Müller, A. M., van Dam, R. M., Chen, C., Tan, C. S., & Müller‐Riemenschneider, F. (2022) · Journal of the American Heart Association · doi:10.1161/jaha.121.022508 · Cited by 35 · see citing works
Assessing the Acceptability and Effectiveness of Mobile-Based Physical Activity Interventions for Midlife Women During Menopause: Systematic Review of the Literature
AlSwayied, G., Guo, H., Rookes, T., Frost, R., & Hamilton, F. L. (2022) · JMIR mhealth and uhealth · doi:10.2196/40271 · Cited by 33 · see citing works
“In 2017, there were >325,000 commercially available health and fitness apps on the market [39]; approximately 30% of them targeted PA [38].”
Background
What works to reduce sedentary behavior in the office, and could these intervention components transfer to the home working environment?: A rapid review and transferability appraisal
Morton, S., Fitzsimons, C. F., Jepson, R. G., Saunders, D. H., Sivaramakrishnan, D., & Niven, A. G. (2022) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2022.954639 · Cited by 29 · see citing works
Do employees hold the key to environmental sustainability in tourism businesses? Empirical evidence from a field study
Cvelbar, L. K., Grün, B., & Dolničar, S. (2022) · Journal of Sustainable Tourism · doi:10.1080/09669582.2022.2131796 · Cited by 28 · see citing works
“…incentives translate into desired behaviours only on the short term, potentially undermining long-term behavioural change (e.g. Moller et al., 2012), or whether the short-term behavioural change triggered by the incentive translates into long-term behavioural change (e.g. Mitchell et al., 2020).”
Background
A randomized controlled mHealth trial that evaluates social comparison-oriented gamification to improve physical activity, sleep quantity, and quality of life in young adults
Sañudo, B., Sánchez-Trigo, H., Domínguez, R., Aguilar, G. F., Sánchez-Oliver, A. J., del Moral, J. E. V., & Oviedo‐Caro, M. Á. (2024) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2024.102590 · Cited by 35 · see citing works
Adaptive Goals and Reinforcement Timing to Increase Physical Activity in Adults: A Factorial Randomized Trial
Adams, M. A., Todd, M. W., Angadi, S. S., Hurley, J. C., Stecher, C. D., Berardi, V., Phillips, C. B., McEntee, M. L., Hovell, M. F., & Hooker, S. P. (2021) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2021.09.014 · Cited by 23 · see citing works
“Meta-analyses indicate that modest financial incentives with various types, delays, and probabilities were more effective than no-incentive controls at increasing and maintaining PA levels,(18) even after incentives were removed.(19) mHealth technologies (e.”
Background
The Link Between Physical Activity, Nutrition, and Health: A Cross-Sectional Study with Multivariate Analysis in a Young and Predominantly Female Spanish Sample
Sandri, E., Capoferri, M., Luciani, G., & Piredda, M. (2025) · Nutrients · doi:10.3390/nu17091486 · Cited by 21 · see citing works
“For example, family discounts on gym memberships have been linked to more than a 20% increase in participation in certain urban areas [34].”
Adding team-based financial incentives to the Carrot Rewards physical activity app increases daily step count on a population scale: a 24-week matched case control study
Pearson, E., Harry Prapavessis, A., Higgins, C., Petrella, R. J., White, L., & Mitchell, M. (2020) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-020-01043-1 · Cited by 21 · see citing works
Self-citation
Mental fatigue, anticipated effort, and subjective valuations of exercising predict choice to exercise or not: A mixed-methods study
Harris, S., & Bray, S. R. (2021) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2021.101924 · Cited by 21 · see citing works
Charity-based incentives motivate young adult cancer survivors to increase physical activity: a pilot randomized clinical trial
Keadle, S. K., Meuter, L., Phelan, S., & Phillips, S. M. (2021) · Journal of Behavioral Medicine · doi:10.1007/s10865-021-00218-w · Cited by 20 · see citing works
The bright, dark, and dim light colors of motivation: Advances in conceptualization and measurement from a self-determination theory perspective
Ntoumanis, N. (2022) · Advances in motivation science · doi:10.1016/bs.adms.2022.11.002 · Cited by 22 · see citing works
A Digital Health Program Targeting Physical Activity Among Adolescents With Overweight or Obesity: Open Trial
Cummings, C., Crochiere, R. J., Lansing, A. H., Patel, R., & Stanger, C. (2022) · JMIR Pediatrics and Parenting · doi:10.2196/32420 · Cited by 19 · see citing works
“A recent meta-analysis found that incentives also promote improved physical activity goal achievement for adults participating in a physical activity intervention program [21].”
Background
Implementation determinants of physical activity interventions in primary health care settings using the TICD framework: a systematic review
Silva, C. S., Godinho, C. I. A., Encantado, J., Rodrigues, B., Carraça, E. V., Teixeira, P. J., & Silva, M. N. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09881-y · Cited by 19 · see citing works
“Financial incentives for patients have also gathered evidence in increasing patients’ PA in the short and long term [113], which can be an effect of an increased patients’ adherence to the intervention.”
Background
Bright spots, physical activity investments that (almost) worked: Carrot Rewards app, driving engagement with pennies a day
Rondina, R., Pearson, E., Harry Prapavessis, A., White, L., Richard, S., & Mitchell, M. (2019) · British Journal of Sports Medicine · doi:10.1136/bjsports-2019-100969 · Cited by 18 · see citing works
Self-citation
Digital Citizen Science for Responding to COVID-19 Crisis: Experiences from Iran
Vahidi, H., Taleai, M., Yan, W., & Shaw, R. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18189666 · Cited by 18 · see citing works
Active Use and Engagement in an mHealth Initiative Among Young Men With Obesity: Mixed Methods Study
Gorny, A. W., Chee, D., & Müller‐Riemenschneider, F. (2022) · JMIR Formative Research · doi:10.2196/33798 · Cited by 18 · see citing works
“However, the moral underpinnings of offering a reward in return for health behaviors have been the subject of debate [25,26], and several studies have questioned whether HPFIs can produce sustained behavior change [27-30].”
Background
Intermittent incentives to encourage exercising in the long run
Arad, A., Uri Gneezy, B., & Mograbi, E. (2022) · Journal of Economic Behavior & Organization · doi:10.1016/j.jebo.2022.11.015 · Cited by 16 · see citing works
The Development of a Hypertension Prevention and Financial-Incentive mHealth Program Using a “No-Code” Mobile App Builder: Development and Usability Study
Willms, A., Rhodes, R. E., & Liu, S. (2023) · JMIR Formative Research · doi:10.2196/43823 · Cited by 16 · see citing works
“Furthermore, the research team explored evidence on past financial-incentive PA interventions and the type of PA to incentivize (ie, daily steps, MVPA, or leisure-time PA) to complement the M-PAC framework as a means of increasing the outcome expectation of performance [35,36].”
Background
Effects of Incentives on Adherence to a Web-Based Intervention Promoting Physical Activity: Naturalistic Study
Wurst, R., Maliezefski, A., Ramsenthaler, C., Brame, J., & Fuchs, R. (2020) · Journal of Medical Internet Research · doi:10.2196/18338 · Cited by 15 · see citing works
“To increase program and behavior adherence of web-based interventions, many providers such as health insurers revert to financial incentives such as cash, bonus points, or charity rewards [12,19].”
BackgroundResultInfluential
Investigating Rewards and Deposit Contract Financial Incentives for Physical Activity Behavior Change Using a Smartphone App: Randomized Controlled Trial
de Buisonjé, D. R., Reijnders, T., Rodrigues, T. C., Santhanam, P., Kowatsch, T., Lipman, S. A., Bijmolt, T. H. A., Breeman, L. D., Janssen, V. R., Kraaijenhagen, R. A., et al. (2022) · Journal of Medical Internet Research · doi:10.2196/38339 · Cited by 18 · see citing works
“Retrieving step counts for 7 consecutive days should accurately estimate habitual activity levels of individuals [52], and providing an individualized and realistic goal should increase intervention effectiveness [14].”
Influential
Cost-Effectiveness Analysis of a Commercial Physical Activity App
Rondina, R., Hong, M., Sarma, S., & Mitchell, M. (2020) · BMC Public Health · doi:10.1186/s12889-021-11988-y · Cited by 14 · see citing works
“, by weaning users off daily incentives after 3–4 months) [33] may yield greater cost-effectiveness.”
BackgroundInfluentialSelf-citation
Design of financial incentive interventions to improve lifestyle behaviors and health outcomes: A systematic review
Miranda, J. J., Pesantes, M. A., Lazo‐Porras, M., Portocarrero, J., Diez‐Canseco, F., Carrillo-Larco, R. M., Bernabé‐Ortiz, A., Trujillo, A. J., & Aldridge, R. W. (2021) · Wellcome Open Research · doi:10.12688/wellcomeopenres.16947.2 · Cited by 13 · see citing works
Racial and Ethnic Disparities in Laryngeal Cancer Care
Cox, S. R., & Daniel, C. (2021) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-021-01018-3 · Cited by 14 · see citing works
Embedding action on social and structural determinants of mental health into a national framework: An “immunisation schedule” for the prevention of common mental disorders
Grummitt, L. R., Barrett, E. L., Halladay, J. E., Bailey, S., Birrell, L., Hunter, E., Kelly, E. V., Champion, K. E., Gardner, L. A., Nguyen, A., et al. (2023) · Mental Health & Prevention · doi:10.1016/j.mhp.2023.200308 · Cited by 15 · see citing works
Process Evaluation of Project FFAB (Fun Fast Activity Blasts): A Multi-Activity School-Based High-Intensity Interval Training Intervention
Weston, K. L., Innerd, A. L., Azevedo, L. B., Bock, S., & Batterham, A. M. (2021) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2021.737900 · Cited by 13 · see citing works
Behavioral Interventions to Improve Home-Based Office-Workers’ Health
Bartmann, N., Cloughesy, J. N., Probst, B. M., Romagnoli, G., & Woerner, A. (2022) · Trends in Psychology · doi:10.1007/s43076-021-00122-x · Cited by 15 · see citing works
Can incentives improve antipsychotic adherence in major mental illness? A mixed-methods systematic review
Hodson, N., Majid, M., Vlaev, I., & Singh, S. P. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-059526 · Cited by 13 · see citing works
Physical Activity Trends Among Adults in a National Mobile Health Program: A Population-Based Cohort Study of 411,528 Adults
Ang, G., Edney, S. M., Tan, C. S., Lim, N., Tan, J., Müller‐Riemenschneider, F., & Chen, C. (2022) · American Journal of Epidemiology · doi:10.1093/aje/kwac193 · Cited by 13 · see citing works
“Meta-analyses indicate that financial incentives are an effective intervention component (37).”
Background
Effects of Mobile-Based Financial Incentive Interventions for Adults at Risk of Developing Hypertension: Feasibility Randomized Controlled Trial
Willms, A., Rhodes, R. E., & Liu, S. (2023) · JMIR Formative Research · doi:10.2196/36562 · Cited by 14 · see citing works
“Small-to-moderate effect sizes have been documented for overall increases in PA in previous financial incentive and PA studies [15,60].”
Effectiveness of Incentives for Improving Diabetes-Related Health Indicators in Chronic Disease Lifestyle Modification Programs: a Systematic Review and Meta-Analysis
Hulbert, L. R., Michael, S. L., Charter-Harris, J., Atkins, C. Y., Skeete, R. A., & Cannon, M. J. (2022) · Preventing Chronic Disease · doi:10.5888/pcd19.220151 · Cited by 15 · see citing works
“Also, several did not examine the effect of different kinds of incentives on program outcomes (10,12,13,15,16).”
Incentivising public transport use for physical activity gain: process evaluation of the COVID-19 disrupted trips4health randomised controlled trial
Jose, K., Sharman, M. J., Stanesby, O., Greaves, S. P., Venn, A., Blizzard, L., Palmer, A. J., Cooper, K., Williams, J., & Cleland, V. J. (2022) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-022-01394-x · Cited by 12 · see citing works
“Related studies have assessed the impact of incentivebased interventions on adult health behaviours [27, 28] including PA [9, 10], although none specifically on transport-related PA.”
Background
Do economic incentives promote physical activity? Evidence from the London Congestion Charge
Nakamura, R., Albanese, A., Coombes, E. G., & Suhrcke, M. (2023) · Journal of the Royal Statistical Society Series A (Statistics in Society) · doi:10.1093/jrsssa/qnad112 · Cited by 11 · see citing works
The Importance of Activating Factors in Physical Activity Interventions for Older Adults Using Information and Communication Technologies: Systematic Review
Bentlage, E., Nyamadi, J. J., & Dubbeldam, R. (2023) · JMIR mhealth and uhealth · doi:10.2196/42968 · Cited by 11 · see citing works
“Other BCTs, such as self-rewards [50] and reduced rewards [55], were also not used.”
Background
Integrating health geography and behavioral economic principles to strengthen context-specific behavior change interventions
Barber, B. V., Kephart, G. C., Martin‐Misener, R., Vallis, M., Matthews, S. A., Atkins, L., Cassidy, C. E., Curran, J., & Rainham, D. G. C. (2023) · Translational Behavioral Medicine · doi:10.1093/tbm/ibad065 · Cited by 13 · see citing works
“A meta-analysis of physical activity interventions shows modest financial incentives ($1.40 US/day) were associated with positive intervention effects and increased mean daily step counts during an intervention period of 12–23 weeks and post intervention after 17-week follow-up [87].”
Influential
Reduction of Financial Health Incentives and Changes in Physical Activity
Spilsbury, S., Wilk, P., Taylor, C. M., Harry Prapavessis, A., & Mitchell, M. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.42663 · Cited by 10 · see citing works
Self-citation
Put your money where your feet are: The real-world effects of StepBet gamified deposit contracts for physical activity
de Buisonjé, D. R., Brosig, F., Breeman, L. D., Bloom, E. L., Reijnders, T., Janssen, V. R., Kraaijenhagen, R. A., Kemps, H., & Evers, A. W. M. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100610 · Cited by 10 · see citing works
A Systematic Literature Review on Health Benefits, Incentives, and Applications to Promote Walking in Urban Areas
Karolemeas, C., Mitropoulos, L. K., Koliou, K., Tzamakos, D., Stavropoulou, E., Moschou, E., & Kepaptsoglou, K. L. (2023) · Future Transportation · doi:10.3390/futuretransp3040076 · Cited by 10 · see citing works
Framing Social Comparison Feedback With Financial Incentives for Physical Activity Promotion: A Randomized Trial
Patel, M. S., Asch, D. A., Rosin, R. M., Small, D. S., Bellamy, S. L., Hoffer, K., Shuttleworth, D., Hilbert, V., Zhu, J., Yang, L., et al. (2020) · Journal of Physical Activity and Health · doi:10.1123/jpah.2019-0313 · Cited by 9 · see citing works
Leveraging family dynamics to increase the effectiveness of incentives for physical activity: the FIT-FAM randomized controlled trial
Finkelstein, E. A., Lim, R. S. M., Ward, D. S., & Evenson, K. R. (2020) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-020-01018-2 · Cited by 9 · see citing works
“Discussion Given that financial incentives are commonly used to motivate both children and adults to increase PA [7, 8], identifying optimal strategies for leveraging incentives is needed.”
Background
Financial incentives for bowel cancer screening: Results from a mixed methods study in the United Kingdom
Wilding, S., O'Connor, D. B., & Conner, M. T. (2021) · British Journal of Health Psychology · doi:10.1111/bjhp.12570 · Cited by 8 · see citing works
Factors influencing reducing sedentary time in home office employees
Coffey, A., Parés-Salomón, I., Bort‐Roig, J., Proper, K. I., Walsh, D. M. J., Reckman, P., Vaqué-Crusellas, C., Señé-Mir, A. M., Puig-Ribera, A. M., & Dowd, K. (2025) · Scientific Reports · doi:10.1038/s41598-025-08831-4 · Cited by 9 · see citing works
“A recent systematic review and meta-analysis also highlighted that increases in physical activity were sustained after incentives (financial and non-financial) were removed 57 .”
A novel behavioral science-based health checkup program and subsequent metabolic risk reductions in a workplace: Checkup championship
Nagata, H., Sato, K., Haseda, M., Kobayashi, Y., & Kondo, N. (2022) · Preventive Medicine · doi:10.1016/j.ypmed.2022.107271 · Cited by 8 · see citing works
The impact of financial incentives on physical activity for employees in the context of workplace health promotion: a systematic review
Vitzthum, M. A., Krüger, K., & Weyh, C. (2024) · Journal of Occupational Health · doi:10.1093/joccuh/uiae048 · Cited by 9 · see citing works
Designing financial incentives for health behaviour change: a mixed-methods case study of weight loss in men with obesity
Pol, M. M. V. D., McDonald, M., Collacott, H., Dombrowski, S. U., Harris, F., Kee, F., Avenell, A., Gray, C. M., Skinner, R., Hoddinott, P., et al. (2022) · Journal of Public Health · doi:10.1007/s10389-022-01785-1 · Cited by 7 · see citing works
“Several systematic reviews of financial incentives highlight the potential for incentives to support individuals in their behaviour change (Mantzari et al. 2015, Mitchell et al. 2019, Coupe et al. 2019).”
Comparison of low-dose maximal-intent versus controlled-tempo resistance training on quality-of-life, functional capacity, and strength in untrained healthy adults: a comparative effectiveness study
Pearson, L. T., Fox, K. T., Keenan, A., Behm, D. G., Stuart, S., Goodall, S., & Barry, G. (2024) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-024-00847-z · Cited by 7 · see citing works
“Unfortunately, many adults fail to meet basic levels of PA due to various reasons such as perceived time constraints, lack of social support [27], cost [28, 29], and psychological barriers such as nervousness or stigma [30].”
Background
Effects of group communication norms on daily steps in a team-based financial incentive mobile phone intervention in Shanghai, China
Jia, Y., Xiao, Y., Chen, H., Gebel, K., Li, C., Sun, S., Yang, Q., Wang, S., Zhang, L., Wang, J., et al. (2025) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-025-01707-w · Cited by 6 · see citing works
Financial incentives for physical activity in adults: Systematic review and meta-analysis update
Salmani, B., Harry Prapavessis, A., Vanderloo, L. M., & Mitchell, M. (2025) · Preventive Medicine · doi:10.1016/j.ypmed.2025.108237 · Cited by 6 · see citing works
Self-citation
Factors Influencing the Implementation of a Fall Prevention Exercise Program for Community-Dwelling Older Adults: A Qualitative Study Guided by the PRECEDE-PROCEED Model
Ong, R. H. S., Nurjono, M., Oh, H. C., Lien, C. T. C., Jumala, J., Teo, R. C. C., Gan, P., Kan, K. L. M., Rosle, L. F. B., Wee, M. K., et al. (2024) · Clinical Interventions in Aging · doi:10.2147/cia.s454043 · Cited by 5 · see citing works
Like Adding a Small Weight to a Scale About to Tip: Personalizing Micro-Financial Incentives for Digital Wellbeing
Jang, S., Seo, Y., Choi, W., & Lee, U. (2025) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3706598.3714208 · Cited by 5 · see citing works
Cost-effectiveness of physical activity-oriented interventions for improving mental health: a systematic review
Alhusseini, N. K., Lin, T. K., Werner, K., Lin, G., Altwaijri, Y. A., Baattaiah, B. A., Bruckner, T. A., AlAhmed, R. S., Alkabbani, A. G., Alsukait, R. F., et al. (2025) · BMC Public Health · doi:10.1186/s12889-025-22207-3 · Cited by 5 · see citing works
“Numerous reviews have shown that use of very modest incentives can sustain increases in physical activity over time, even once the incentives have ceased [48, 49].”
Design of financial incentive interventions to improve lifestyle behaviors and health outcomes: A systematic review
Miranda, J. J., Pesantes, M. A., Lazo‐Porras, M., Portocarrero, J., Diez‐Canseco, F., Carrillo-Larco, R. M., Bernabé‐Ortiz, A., Trujillo, A. J., & Aldridge, R. W. (2021) · Wellcome Open Research · doi:10.12688/wellcomeopenres.16947.1 · Cited by 6 · see citing works
Comparative effectiveness of interventions on promoting physical activity in older adults: A systematic review and network meta-analysis
Wu, S., Li, G., Shi, B., Ge, H., Chen, S., Zhang, X., & He, Q. (2024) · Digital Health · doi:10.1177/20552076241239182 · Cited by 6 · see citing works
“At the same time, the booming of mobile and wireless technology, or information and communication technology render electronic Health (eHealth) and mobile health (mHealth)-based intervention a useful tool for increasing PA. Electronic and mobile Health intervention technologies included modalities like smartphone appl…”
BackgroundInfluential
An evaluation of public initiatives to change behaviours that affect water quality
Grilli, G., & Curtis, J. A. (2022) · Environmental Policy and Governance · doi:10.1002/eet.1999 · Cited by 5 · see citing works
“, 2017), though there is evidence that changed behaviours can persist over time (Maki et al., 2016; Mitchell et al., 2020).”
Background
Examining Ways to Improve Weight Control Programs’ Population Reach and Representativeness: A Discrete Choice Experiment of Financial Incentives
You, W., Yuan, Y., Boyle, K., Michaud, T. L., Parmeter, C., Seidel, R. W., & Estabrooks, P. A. (2021) · PharmacoEconomics - Open · doi:10.1007/s41669-021-00310-6 · Cited by 5 · see citing works
Predictors of physical activity and public safety perception regarding technology adoption for promoting physical activity in Jeddah, Saudi Arabia
Alshahrani, N. Z. (2024) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2024.102753 · Cited by 5 · see citing works
“This is a common issue in many urban centers globally, where the design of public spaces does not always encourage physical activity (Mitchell et al., 2020).”
Background
Hourly step recommendations to achieve daily goals for working and older adults
Ang, G., Tan, C. S., Lim, N., Tan, J., Müller‐Riemenschneider, F., Cook, A. R., & Chen, C. (2024) · Communications Medicine · doi:10.1038/s43856-024-00537-4 · Cited by 4 · see citing works
“Previous research involving wearables and physical activity has traditionally aggregated steps into daily step counts and analysed the changes across time 12,13,53 – 57 .”
Does participation in municipality-initiated incentivized health promotion programs promote physical activity among the physically inactive? Verification in six Japanese municipalities
Chijiki, S., Tanabe, K., Tsukao, A., & Kuno, S. (2023) · Journal of Public Health Research · doi:10.1177/22799036231204331 · Cited by 4 · see citing works
“The study’s purpose was to clarify: (1) whether the average number of steps increased from the preparticipation period to 18 months after the program commencement; and (2) whether such increases were influenced by the financial incentives.”
Background
MoodMover: Development and usability testing of an mHealth physical activity intervention for depression
Tang, Y., Gierc, M. S. H., La, H., Kim, J., Liu, S., Lam, R. W. M., Puterman, E. M., & Faulkner, G. (2025) · Digital Health · doi:10.1177/20552076251317756 · Cited by 4 · see citing works
Self-citation
Evaluation of the effectiveness of behavioural economic incentive programmes for the promotion of a healthy diet and physical activity: a protocol for a systematic review and network meta-analysis
Boonmanunt, S. W., Pattanaprateep, O., Ongphiphadhanakul, B., McKay, G. J., Attia, J., & Thakkinstian, A. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-046035 · Cited by 4 · see citing works
Digital and innovative tools for better health and productivity at the workplace
Vazquez-Venegas, P. I., Devaux, M., Aihara, H., & Cecchini, M. (2024) · OECD health working papers · doi:10.1787/2ce05eb6-en · Cited by 7 · see citing works
Less stick more carrot? Increasing the uptake of deposit contract financial incentives for physical activity: A randomized controlled trial
de Buisonjé, D. R., Reijnders, T., Rodrigues, T. C., Santhanam, P., Kowatsch, T., Breeman, L. D., Janssen, V. R., Kraaijenhagen, R. A., Kemps, H., & Evers, A. W. M. (2023) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2023.102532 · Cited by 3 · see citing works
“We used tailoring of step goals because individualized and realistic goals should increase intervention effectiveness (Mitchell et al., 2019).”
BackgroundMethodResultInfluential
The Impact of Monetary Incentives on Delay Discounting Within a Year-Long Physical Activity Intervention
Berardi, V., Phillips, C. B., McEntee, M. L., Stecher, C. D., Todd, M. W., & Adams, M. A. (2024) · Annals of Behavioral Medicine · doi:10.1093/abm/kaae009 · Cited by 3 · see citing works
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Effectiveness of a digital health and financial incentive intervention to promote physical activity in patients with type 2 diabetes: study protocol for a randomised controlled trial with a nested qualitative study—ACTIVATE trial
Sanders, J. P., Daley, A., Esliger, D., Roalfe, A. K., Colda, A., Turner, J., Hajdu, S., Potter, A., Humayun, M. A., Spiliotis, I., et al. (2024) · Trials · doi:10.1186/s13063-024-08513-y · Cited by 2 · see citing works
“This value of reward is based on previous research which has suggested that modest incentives of (approximately £1 a day) can increase physical activity for interventions in the short and long term [37].”
Influential
Ongoing incentives' 36-month effect on physical activity in a Japanese insurance-based health-promotion program
Kanai, M., Onozato, N., Fujisawa, Y., Hamatani, T., Tateyama, K., Miki, T., Toda, T., Sugawara, T., & Hagiwara, Y. (2025) · Preventive Medicine · doi:10.1016/j.ypmed.2025.108327 · Cited by 3 · see citing works
Effectiveness of Financial Incentives for Health Behavior Change: A Narrative Review and Analysis
Glanz, K., Thirumurthy, H., & D'cruze, N. A. (2025) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-081624-060027 · Cited by 4 · see citing works
A Pilot Study for Testing the Effectiveness and Cost-Efficiency of Lottery Incentive in mHealth App that Promotes Walking
Lee, C., & Chung, K. (2022) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/00469580221091398 · Cited by 3 · see citing works
“55 Such differences in cost indicate that lottery incentives are a cost-efficient strategy suitable for mHealth, the goal of which is to provide effective intervention to multiple users at a low cost.”
Background
Promoting exercise behavior with monetary and social incentives: An empirical study based on an online fitness program
Zhang, Z., Zhang, J., Zhang, J., & Zhang, J. (2022) · JUSTC · doi:10.52396/justc-2022-0062 · Cited by 3 · see citing works
Loss-Framed Adaptive Microcontingency Management for Preventing Prolonged Sedentariness: Development and Feasibility Study
Choi, W., & Lee, U. (2022) · JMIR mhealth and uhealth · doi:10.2196/41660 · Cited by 3 · see citing works
“For example, socioeconomic status probably contributes to incentive effectiveness [30,31].”
Influential
What moves truck drivers? A person-centered perspective on workplace physical activity promotion
Gawlik, A., Haberstock, S., Beckert, J., & Zepp, C. (2024) · International Journal of Occupational Safety and Ergonomics · doi:10.1080/10803548.2024.2315898 · Cited by 3 · see citing works
“Providing financial resources might thus represent a door-way to engagement in PA. Generally, there is a rising interest in financial incentives for PA, and it has been shown that they can sustainably increase PA levels, even after the incentives are removed [64].”
Background
Effect of Group Contingency Type on Walking: Comparisons of Effectiveness and Cost Efficiency
Kim, H., Lee, C., Lee, S., & Chung, K. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.655663 · Cited by 4 · see citing works
“It Goes Hand in Hand with Us Trying to Get More Kids to Play” Stakeholder Experiences in a Sport and Active Recreation Voucher Program
Foley, B. C., Turner, N., Owen, K. B., Cushway, D., Nguyen, J., & Reece, L. J. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20054081 · Cited by 2 · see citing works
“Most financial incentives have been studied among adult populations, finding that even short-term financial incentives can lead to long-term increases in physical activity [20].”
Background
An mHealth Intervention With Financial Incentives to Promote Smoking Cessation and Physical Activity Among Black Adults: Protocol for a Feasibility Randomized Controlled Trial
Alexander, A. C., Businelle, M. S., Cheney, M. K., Cohn, A. M., McNeill, L. H., Short, K. R., Frank-Pearce, S. G., Bradley, D., Estrada, K., Flores, I., et al. (2024) · JMIR Research Protocols · doi:10.2196/69771 · Cited by 2 · see citing works
“In addition to evidence-based tobacco cessation treatment [66], HealthyCells will incentivize daily smoking abstinence, while an enhanced version of the intervention, HealthyCells+, will also include incentives for meeting physical activity goals [36,67].”
Promoting healthy behaviour with financial incentives: three challenges and solutions for large scale implementation
Lipman, S. A., de Buisonjé, D. R., & van der Swaluw, K. (2026) · The European Journal of Health Economics · doi:10.1007/s10198-025-01893-1 · Cited by 2 · see citing works
“…reviews and meta-analytic studies, for example, show that financial incentives may be a prom - ising intervention for promoting healthier diets in adults [4–6] and children [7, 8], encouraging smoking cessation [9], particularly during pregnancy [10], and to stimulate physical activity [4, 11, 12].”
Evaluating an Incentive-Based mHealth App for Physical Activity Promotion Using the Obesity-Related Behavioral Intervention Trial Model: Small Cohort Study
Salmani, B., Hiemstra, M. S., Harry Prapavessis, A., Vanderloo, L. M., & Mitchell, M. (2026) · JMIR Formative Research · doi:10.2196/85484 · Cited by 3 · see citing works
“For example, in a review of RCTs examining PA incentives, Mitchell et al [14] found that FI, worth on average about US $1.50 per day, produced short-term (ie, 6 mo), long-term (ie, ≥6 mo), and follow-up (ie, after incentive withdrawal) effects.”
InfluentialSelf-citation
Small Monetary Incentives Lead to Greater Adherence in a Weight Loss Program
Shetty, A., Yang, Q., Pendergast, J., LEVERSON, G. E., Shaw, R. J., Voils, C. I., & Gavin, K. L. (2023) · American Journal of Health Promotion · doi:10.1177/08901171231213160 · Cited by 2 · see citing works
Free bus fares, bus use and physical activity: An exploratory cross‐sectional study
Sharman, M. J., Stanesby, O., Jose, K., Greaves, S. P., & Cleland, V. J. (2024) · Health Promotion Journal of Australia · doi:10.1002/hpja.881 · Cited by 2 · see citing works
Cadence-Based Pedometer App With Financial Incentives to Enhance Moderate-to-Vigorous Physical Activity: Development and Single-Arm Feasibility Study
Hayashi, K., Imai, H., Oikawa, I., Ishihara, Y., Wakuda, H., Miura, I., Uenohara, S., Kuwae, A., Kai, M., Furuya, K., et al. (2024) · JMIR Formative Research · doi:10.2196/56376 · Cited by 2 · see citing works
“Furthermore, several studies have investigated the effectiveness of different financial structures, such as gain frame incentives, loss frame incentives, and lottery incentives [14].”
Background
One Size Does Not Fit All: Financial Incentives Needed to Change Physical Exercise Levels for Different Groups
Longo, A., Mitchell, E., Markandya, A., & Galarraga, I. (2021) · Medical Decision Making · doi:10.1177/0272989x211011606 · Cited by 2 · see citing works
Effects of Bluetooth-Enabled Desk Ellipticals on Office Work Performance: Rationale, Design, and Protocol for a Randomized Trial With Overweight and Obese Adults
Rovniak, L. S., Adams, M. A., Sciamanna, C., Kong, L., Sullivan, N., Costalas, S., Bopp, M., & Kuzmik, A. (2020) · JMIR Research Protocols · doi:10.2196/16275 · Cited by 2 · see citing works
A behavioral science framework to address latent demand in mental healthcare
Rondina, R., Quan, C., Duke, K. E., & Soman, D. (2022) · Nature Medicine · doi:10.1038/s41591-022-01782-7 · Cited by 1 · see citing works
Cost-effectiveness of incentives for physical activity in coronary heart disease in Germany: pre-trial health economic model of a complex intervention following the new MRC framework
Mohebbi, D., Ogurtsova, K., Dyczmons, J., Dintsios, M., Kairies‐Schwarz, N., Jung, C., & Icks, A. (2024) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2024-001896 · Cited by 1 · see citing works
“39 While the monetary incentive group returned to baseline PA after the 24-week intervention (as the financial contributions were not paid any longer), the social incentive group was assumed to achieve the mean PA of the previous intervention weeks.”
Background
Understanding the “how” and “why”: A mixed methods process evaluation for the PRO-HIIT intervention
Liu, Y., Barker, A. R., Li, M., Adlam, A., Duncombe, S. L., Agbaje, A. O., Gu, Y., Zhou, H., & Williams, C. A. (2026) · PLoS ONE · doi:10.1371/journal.pone.0352772 · Cited by 1 · see citing works
“The teachers believed that incentives provide only short-term motivation and concerned about relying on extrinsic rewards to influence students’ motivation for PA participation, an proposition similar to that of Mitchell et al. [42].”
Are cash incentives always king? A randomized controlled trial evaluating hedonic versus cash incentives (TEH-C)
Finkelstein, E. A., Chow, M. T. N., & Gandhi, M. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1354814 · Cited by 1 · see citing works
“As shown in several studies, if the incentives are large enough, they will induce greater levels of activity (6–10).”
Background
Relationship between participation in projects of incentives to promote walking and healthy aging among the older population: A four-year longitudinal study
Iizuka, G., Tsuji, T., Ide, K., & Kondo, K. (2024) · Preventive Medicine · doi:10.1016/j.ypmed.2024.108125 · Cited by 1 · see citing works
Mechanism Design for Personalized Policy: A Field Experiment Incentivizing Exercise
Dizon-Ross, R., & Zucker, A. (2025) · Econometrica · doi:10.3386/w33624 · Cited by 1 · see citing works
“Second, evidence identifies a realistic daily goal as a key component of effective physical activity incentives (Mitchell et al., 2020), as it may improve the perfor-2 For a given net cost function, the cost-minimizing step target and linear-after-step-target contracts pay the same amount to…”
Boosting Physical Activity Among Individuals With Low Engagement Through Double-Point Incentives in a Community-Based mHealth Intervention: Retrospective Observational Study
Joo, J., Lee, M., Yoon, J., Cho, H., Warrier, G., Thrul, J., & Cho, J. (2025) · JMIR mhealth and uhealth · doi:10.2196/66227 · Cited by 1 · see citing works
Can We Trust Green Apps? Mapping out 14 Trustworthiness Indicators
Lawson, B. T., Coulentianos, M. J., & Mitchell, O. (2025) · Sustainability · doi:10.3390/su17146444 · Cited by 1 · see citing works
Association Between Sociodemographic and Lifestyle Factors and Type 2 Diabetes Risk Scores in a Large Working Population: A Comparative Study Between the Commerce and Industry Sectors
Vicioso, M. P. F.-F., Sbert, P. R., Ramírez‐Manent, J. I., López‐González, Á. A., Fernández, J. L. D. B., & Herrero, M. T. V. (2025) · Nutrients · doi:10.3390/nu17152420 · Cited by 4 · see citing works
Physical activity adherence: Worldwide trends, barriers and facilitators and tools to improve it
Harkin, K., Pascal, B. M., Irvine, S., Tangalakis, K., & Apostolopoulos, V. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-89843-0.00015-5 · Cited by 1 · see citing works

Financial incentives for physical activity in adults: Systematic review and meta-analysis update
Salmani, B., Harry Prapavessis, A., Vanderloo, L. M., & Mitchell, M. (2025) · Preventive Medicine · doi:10.1016/j.ypmed.2025.108237 · Cited by 6 · see citing works
Self-citation
The Impact of Financial Incentives on Physical Activity: A Systematic Review and Meta-Analysis
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Effect of Different Financial Incentive Structures on Promoting Physical Activity Among Adults
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Are financial incentives effective at increasing physical activity for adults? A systematic review and meta-analysisPreprint
Luong, M.-L. N. (2019) · OSF Preprints (OSF Preprints) · doi:10.17605/osf.io/q3gyz
(Pre-print) The impact of financial incentives on physical activity: a systematic review and meta-analysisPreprint
Luong, M.-L. N. (2020) · doi:10.17605/osf.io/4gzdy

Authors: Mitchell, M. S., Orstad, S. L., Biswas, A., Oh, P. I., Jay, M., Pakosh, M. T., & Faulkner, G.
Affiliations: Western University (CA)
New York University (US)
Institute for Work & Health (CA)
University Health Network (CA)
University of British Columbia (CA)
Corresponding author: Mitchell, Marc S
ORCID: Mitchell, Marc S
Orstad, Stephanie L
Biswas, Aviroop
Oh, Paul I
Jay, Melanie
Pakosh, Maureen T
Faulkner, Guy
Venue: British Journal of Sports Medicine
Publisher: BMJ
Published: 2019-05-15
Volume: 54
Issue: 21
Pages: 1259-1268
ISSN: 0306-3674 (ISSN-L)
1473-0480
DOI: 10.1136/bjsports-2019-100633
OpenAlex: W2945344227
Semantic Scholar: bfe04d845af60ca550cb3e4a4a1c234ec34621b8
Cited by: 143
References: 72
Citations by year: 2026: 6 · 2025: 17 · 2024: 29 · 2023: 20 · 2022: 31 · 2021: 28 · 2020: 10 · 2019: 2
FWCI: 2.16
Type: journal article
Language: en
Open access: closed
Locations: British Journal of Sports Medicine (publishedVersion)
PubMed (publishedVersion)
HighWire Press Open Archive (submittedVersion)
Funders: Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Physiology › Physical Activity and Health
Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords: financial incentives, physical activity promotion, step count, adults, sustained physical activity, health behavior change, wearable activity trackers
MeSH terms: Fitness Trackers, Adult, Health Promotion, Humans, Motivation, Time Factors, Token Economy, Health Behavior, Exercise

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Financial incentives for physical activity in adults: systematic review and meta-analysis

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