Exercise in Exchange for Protection Against Losing Financial Incentives

Financial-incentive programs for exercise motivate by either placing deposits at risk or by issuing cash payments. Looming losses better motivate, while cash programs enjoy higher enrollment. We combine positive features of each with “loss protection”: A person exchanges exercise for a cash reward she has a small chance of not receiving the following week; later that week, she may protect against losing the reward with additional exercise. In a health system serving low-income patients that offered exercise classes by physician referral, we randomly assigned 79 patients to a 12-week class series offering “loss protection” and 74 patients to a control series offering independent rewards in the same expected monetary value. Classes were held twice a week. Both groups received lottery vouchers in exchange for exercise after the first—and either loss protection or a fixed-value voucher in the amount of the insurance after the second—class of the week. Mean relative frequency of attended days was 55.5% (95% CI, 53.2% to 57.8%) for controls and 64.8% (95% CI, 62.6% to 67.0%) for loss protection. In adjusted analyses, loss protection participants had greater mean relative frequency of attended days (adjusted difference, 15.5% [95% CI, 0.2% to 31.2%]; p<0.05) and lower attrition than controls. A bi-weekly exercise program over 12 weeks incorporating loss protection resulted in more exercise than a program with equal expected payments. Incentives of the same monetary value had different behavioral effects in encouraging exercise.