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Financial incentives for physical activity in adults: systematic review and meta-analysis
  1. Marc S Mitchell1,
  2. Stephanie L Orstad2,
  3. Aviroop Biswas3,
  4. Paul I Oh4,
  5. Melanie Jay5,
  6. Maureen T Pakosh4,
  7. Guy Faulkner6
  1. 1 Faculty of Health Sciences, School of Kinesiology, Western University, London, Ontario, Canada
  2. 2 Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, New York, New York, USA
  3. 3 Institute for Work and Health, Toronto, Ontario, Canada
  4. 4 Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto, Ontario, Canada
  5. 5 Departments of Medicine and Population Health, New York University School of Medicine, New York, New York, USA
  6. 6 Faculty of Education, School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Marc S Mitchell, Faculty of Health Sciences, School of Kinesiology, Western University, London, ON N6A 5B9, Canada; marc.mitchell{at}


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of 22 studies reported positive intervention effects and four out of 18 reported post-intervention (after incentives withdrawn) benefits.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.

  • financial incentives
  • behavioural economics
  • physical activity
  • wearable devices
  • mhealth

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  • Contributors All co-authors meet the ICMJE authorship criteria.

  • Funding Marc Mitchell received post-doctoral fellowship funding from the Canadian Institutes of Health Research to support this project. The other authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests From 2015 to 2017 Marc Mitchell was the sole proprietor of a program evaluation company called Incentive Avenue Inc. Currently, he is the Principal Behavioural Insights Advisor for an incentive-based mHealth application company called Carrot Insights Inc. He reports consulting income from Carrot Insights Inc. in the past 36 months and company stock options as well. Furthermore, Stephanie Orstad worked as an independent contractor for Incentive Avenue Inc. in 2016. The other authors declare that no competing interests exist.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.