Small Sustainable Monetary Donation-Based Incentives to Promote Physical Activity: A Randomized Controlled Trial

Objective: To pilot test two low-cost and thus financially sustainable incentive programs to promote physical activity (PA) among low-active adults in a community setting. Method: In a three-arm randomized controlled trial the effects of small monetary incentives (cash incentives $1/day; n = 25) were compared to charitable donations (donation $1/day; n = 25) and a control group (n = 25) on PA behavior over the course of 12 months in insufficiently active, otherwise healthy adults. Incentives were based on attendance at a local YMCA. Electronic swipe card data from the YMCA was the primary outcome, with self-reported minutes of PA as a secondary outcome. Results: Quantile regression models showed promising effects of treatment allocation on the primary outcome (attendance) adjusted for age and employment. There was a difference between cash incentives and control conditions such that median attendance in the cash incentives condition was 19.24 visits more over 12 months (b = 19.24; SE = 8.26, 95% CI [2.75, 35.72]). There was a similar though only marginally significant trend for the donation condition showing that participants in the donation condition made 11.88 additional visits to the YMCA over 12 months relative to the control condition (b = 11.88, SE = 8.41,95% CI [-0.91, 28.67]). There was a significant correlation between objectively verified YMCA attendance and self-reported moderate-to-vigorous PA at the YMCA (rho = 0.587) over 12 months. Conclusions: These promising findings provide early support for small monetary incentives and charitable donations for promoting PA in community settings. Further research on the efficacy of using financially sustainable incentive programs, including charitable donations, for PA through community organizations (e.g., YMCAs) seems warranted.