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NIHR Signal A workplace voucher reward scheme failed to boost physical activity

Published on 19 November 2019

doi: 10.3310/signal-000839

Staff enrolled on a workplace reward scheme to encourage them to become more physically active took fewer steps per day than their colleagues in the control group after six months.

Employees at two public sector organisations in Northern Ireland took part in the Physical Activity Loyalty scheme, which worked in a similar way to a high street loyalty card. Their activity levels during the workday were monitored using key fobs and remote sensors. The participants were rewarded for physical activity with loyalty points that could be redeemed for vouchers for some local shops.

Despite not boosting their physical activity levels, those who took part in the scheme had slightly better self-reported ratings of wellbeing at the end of the intervention.

The evidence for workplace schemes generally is mixed, and these results partly add to our knowledge. It is unclear from this research how great the rewards were. More effective incentive schemes will be needed to affect physical activity.

Share your views on the research.

Why was this study needed?

Physical inactivity is a significant health risk. It is estimated that it causes 6 to 10% of deaths worldwide, through heart disease, type 2 diabetes, and certain cancers. Inactivity is estimated to cost the NHS more than £1 billion per year.

As many adults spend much of their time at work, encouraging employees to be more active could have significant benefits for their health, increase productivity and reduce sickness absence.

Previous NIHR-funded research into financial incentive schemes to promote healthy behaviours has shown that while some schemes do produce some benefit, the effects are often not sustained over time. There is little evidence on the cost-effectiveness of such interventions.

This randomised controlled trial investigated whether a loyalty-card type scheme would have any sustained impact on activity levels and be cost-effective.

What did this study do?

This cluster randomised controlled trial signed up 853 healthy employees at two public sector mainly office-based organisations, average age 44 (71% female).

Half were allocated to wear a fob key for six months that could be picked up by Wi-Fi sensors placed in a 2 km radius around the workplace. They could log-on to a study website to get motivational messages and feedback. Physical activity during their working day gained points, as did achieving weekly activity targets. These points could be converted to vouchers redeemable at local businesses, though their value to participants is unclear.

Both the intervention and control group wore a sealed pedometer for seven days at baseline and at 6 and 12 months to assess physical activity levels – the primary outcome of the study.

Data were only collected on 485 (57%) of those recruited, weakening the usefulness of the study.

What did it find?

  • By the end of the six-month intervention, the average number of steps per day was significantly lower for the intervention group at 6,990 compared with 7,576 for the control group (adjusted mean difference [aMD] ‑336 steps, 95% confidence interval [CI] ‑612 to ‑60 steps).
  • There was no significant difference in physical activity by 12 months, at 7,790 steps for the intervention group compared with 8,203 for the control group (aMD ‑570 steps, 95% CI ‑1,267 to +127 steps).
  • The intervention group had a very small but statistically significant enhancement of mental wellbeing compared with the control group at six months (1.34 points on the Warwick-Edinburgh Mental Wellbeing Scale, 95% CI 0.48 to 2.20 points; score range 14 to 70 with higher scores indicating better well-being).
  • Overall, the scheme was not found to be cost-effective. The intervention cost £25.85 more per person than no intervention (95% CI ‑£29.89 to +£81.60) and had no effect on quality-adjusted life years (incremental quality-adjusted life-years -0.0000891, 95% CI ‑0.008 to +0.008).

What does current guidance say on this issue?

In its Public Health guideline on physical activity in the workplace (PH13), NICE says that employers in organisations of all sizes should develop a plan to support employees to become more physically active. Incentives should be designed to encourage uptake.

NICE says that employers should encourage staff to walk or cycle to work, and take more physical activity during the working day. Examples given include encouraging use of the stairs rather than lifts and supporting people to set physical activity goals.

NICE recommends all adults do a minimum of 150 minutes of moderate exercise per week.

What are the implications?

Workplace initiatives have the potential to play an important role in health promotion and disease prevention. But designing the right type of scheme, with a sufficiently attractive reward, is vital to uptake, particularly as work commitments may override the ability to spend time being walking near the office. The restricted timing of this intervention, with the physical activity only counting towards incentives during office hours, may also have affected outcomes.

The poor results from the intervention group in this trial underline the importance of evaluating and testing any such initiatives before a costly, large scale roll-out.

Citation and Funding


Hunter RF, Gough A, Murray JM et al. A loyalty scheme to encourage physical activity in office workers: a cluster RCT. Public Health Research. 2019;7(15).

This project was funded by the NIHR Public Health Programme (project number 12/211/82).

Bibliography

Allender S, Foster C, Scarborough P and Rayner M. The burden of physical activity-related ill health in the UK. J Epidemiol Community Health. 2007;61(4):344-8.

NICE. Physical activity in the workplace. PH13. London: National Institute for Health and Care Excellence; 2008.

NICE. Physical activity and the environment. NG90. London: National Institute for Health and Care Excellence; 2018.

NIHR. Financial incentives for patients. NIHR Highlight. Southampton: National Institute for Health Research; 2019.

Why was this study needed?

Physical inactivity is a significant health risk. It is estimated that it causes 6 to 10% of deaths worldwide, through heart disease, type 2 diabetes, and certain cancers. Inactivity is estimated to cost the NHS more than £1 billion per year.

As many adults spend much of their time at work, encouraging employees to be more active could have significant benefits for their health, increase productivity and reduce sickness absence.

Previous NIHR-funded research into financial incentive schemes to promote healthy behaviours has shown that while some schemes do produce some benefit, the effects are often not sustained over time. There is little evidence on the cost-effectiveness of such interventions.

This randomised controlled trial investigated whether a loyalty-card type scheme would have any sustained impact on activity levels and be cost-effective.

What did this study do?

This cluster randomised controlled trial signed up 853 healthy employees at two public sector mainly office-based organisations, average age 44 (71% female).

Half were allocated to wear a fob key for six months that could be picked up by Wi-Fi sensors placed in a 2 km radius around the workplace. They could log-on to a study website to get motivational messages and feedback. Physical activity during their working day gained points, as did achieving weekly activity targets. These points could be converted to vouchers redeemable at local businesses, though their value to participants is unclear.

Both the intervention and control group wore a sealed pedometer for seven days at baseline and at 6 and 12 months to assess physical activity levels – the primary outcome of the study.

Data were only collected on 485 (57%) of those recruited, weakening the usefulness of the study.

What did it find?

  • By the end of the six-month intervention, the average number of steps per day was significantly lower for the intervention group at 6,990 compared with 7,576 for the control group (adjusted mean difference [aMD] ‑336 steps, 95% confidence interval [CI] ‑612 to ‑60 steps).
  • There was no significant difference in physical activity by 12 months, at 7,790 steps for the intervention group compared with 8,203 for the control group (aMD ‑570 steps, 95% CI ‑1,267 to +127 steps).
  • The intervention group had a very small but statistically significant enhancement of mental wellbeing compared with the control group at six months (1.34 points on the Warwick-Edinburgh Mental Wellbeing Scale, 95% CI 0.48 to 2.20 points; score range 14 to 70 with higher scores indicating better well-being).
  • Overall, the scheme was not found to be cost-effective. The intervention cost £25.85 more per person than no intervention (95% CI ‑£29.89 to +£81.60) and had no effect on quality-adjusted life years (incremental quality-adjusted life-years -0.0000891, 95% CI ‑0.008 to +0.008).

What does current guidance say on this issue?

In its Public Health guideline on physical activity in the workplace (PH13), NICE says that employers in organisations of all sizes should develop a plan to support employees to become more physically active. Incentives should be designed to encourage uptake.

NICE says that employers should encourage staff to walk or cycle to work, and take more physical activity during the working day. Examples given include encouraging use of the stairs rather than lifts and supporting people to set physical activity goals.

NICE recommends all adults do a minimum of 150 minutes of moderate exercise per week.

What are the implications?

Workplace initiatives have the potential to play an important role in health promotion and disease prevention. But designing the right type of scheme, with a sufficiently attractive reward, is vital to uptake, particularly as work commitments may override the ability to spend time being walking near the office. The restricted timing of this intervention, with the physical activity only counting towards incentives during office hours, may also have affected outcomes.

The poor results from the intervention group in this trial underline the importance of evaluating and testing any such initiatives before a costly, large scale roll-out.

Citation and Funding


Hunter RF, Gough A, Murray JM et al. A loyalty scheme to encourage physical activity in office workers: a cluster RCT. Public Health Research. 2019;7(15).

This project was funded by the NIHR Public Health Programme (project number 12/211/82).

Bibliography

Allender S, Foster C, Scarborough P and Rayner M. The burden of physical activity-related ill health in the UK. J Epidemiol Community Health. 2007;61(4):344-8.

NICE. Physical activity in the workplace. PH13. London: National Institute for Health and Care Excellence; 2008.

NICE. Physical activity and the environment. NG90. London: National Institute for Health and Care Excellence; 2018.

NIHR. Financial incentives for patients. NIHR Highlight. Southampton: National Institute for Health Research; 2019.

A loyalty scheme to encourage physical activity in office workers: a cluster RCT

Published on 3 September 2019

Hunter RF, Gough A, Murray JM, Tang J, Brennan SF, Chrzanowski-Smith OJ et al.

Public Health Research Volume 7 Issue 15 , 2019

Abstract Background Increasing physical activity in the workplace can provide physical and mental health benefits for employees and economic benefits for the employer through reduced absenteeism and increased productivity. However, there is limited evidence on effective behaviour change interventions in workplace settings that led to maintained physical activity. This study aimed to address this gap and contribute to the evidence base for effective and cost-effective workplace interventions. Objectives To determine the effectiveness and cost-effectiveness of the Physical Activity Loyalty scheme, a multicomponent intervention based on concepts similar to those that underpin a high-street loyalty card, which was aimed at encouraging habitual physical activity behaviour and maintaining increases in mean number of steps per day. Design A cluster randomised controlled trial with an embedded economic evaluation, behavioural economic experiments, mediation analyses and process evaluation. Setting Office-based employees from public sector organisations in Belfast and Lisburn city centres in Northern Ireland. Participants A total of 853 participants [mean age 43.6 years (standard deviation 9.6 years); 71% of participants were female] were randomly allocated by cluster to either the intervention group or the (waiting list) control group. Intervention The 6-month intervention consisted of financial incentives (retail vouchers), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of the workplaces allowed participants to monitor their accumulated minutes of physical activity. Main outcome measures The primary outcome was mean number of steps per day recorded using a sealed pedometer (Yamax Digiwalker CW-701; Yamax, Tasley, UK) worn on the waist for 7 consecutive days and at 6 and 12 months post intervention. Secondary outcomes included health, mental well-being, quality of life, work absenteeism and presenteeism, and the use of health-care resources. Results The mean number of steps per day were significantly lower for the intervention group than the control group [6990 mean number of steps per day (standard deviation 3078) vs. 7576 mean number of steps per day (standard deviation 3345), respectively], with an adjusted mean difference of –336 steps (95% confidence interval –612 to –60 steps; p = 0.02) at 6 months post baseline, but not significantly lower at 12 months post baseline. There was a small but significant enhancement of mental well-being in the intervention group (difference between groups for the Warwick–Edinburgh Mental Wellbeing Scale of 1.34 points, 95% confidence interval 0.48 to 2.20 points), but not for the other secondary outcomes. An economic evaluation suggested that, overall, the scheme was not cost-effective compared with no intervention. The intervention was £25.85 (95% confidence interval –£29.89 to £81.60) more costly per participant than no intervention and had no effect on quality-adjusted life-years (incremental quality-adjusted life-years –0.0000891, 95% confidence interval –0.008 to 0.008). Limitations Significant restructuring of participating organisations during the study resulted in lower than anticipated recruitment and retention rates. Technical issues affected intervention fidelity. Conclusions Overall, assignment to the intervention group resulted in a small but significant decline in the mean pedometer-measured steps per day at 6 months relative to baseline, compared with the waiting list control group. The Physical Activity Loyalty scheme was deemed not to be cost-effective compared with no intervention, primarily because no additional quality-adjusted life-years were gained through the intervention. Research to better understand the mechanisms of physical activity behaviour change maintenance will help the design of future interventions.

Expert commentary

Incentive schemes to support behaviour change can be of benefit but are underused because of ethical concerns about nudging people into being good and come with the whiff of manipulation. This study had, however, the opposite effect reporting a reduced step count at six months for those being offered shopping vouchers, as part of a work-based physical activity programme. What to make of this?

Incentive schemes are tricky, and their trialling is difficult. In this study, blinding participants to steps per day as the main outcome measure, efforts to reduce the risk of gaming, the cumbersome way of redeeming vouchers and the constraints of the work setting all may have had demotivating effects rather than the intended incentive function. Perhaps new approaches to reduce prolonged sitting at work are needed, focusing on the organisation of office work itself rather than bolted-on schemes?

Jörg Huber, Professor of Health Sciences, University of Brighton; Director Research Design Service South East, University of Brighton

The commentator declares no conflicting interests