Ongoing incentives' 36-month effect on physical activity in a Japanese insurance-based health-promotion program

Although incentive-based interventions have shown promise in promoting physical activity, evidence on their long-term effectiveness remains limited. This study aimed to evaluate ongoing, structured incentives' long-term effects on physical activity in a large, real-world population.

This retrospective cohort study used a pre-post observational design using data from the SUMITOMO LIFE Vitality program in Japan. Participants enrolled from January to June 2021 with three years of uninterrupted participation. Participants earning weekly incentives for step goals received tangible rewards, such as beverages or food, reinforcing engagement. Additionally, accumulated points contributed to improving their insurance status, which resulted in greater reductions in insurance premiums and access to a broader range of benefits. The primary outcome was an upward trend in average daily step counts that were continuously tracked over 36-months with wearable devices and smartphone applications.

Included in the final analysis were 86,175 participants (mean [standard deviation] age, 43.4 [12.1] years; 57.7 % men). Model-adjusted average daily step counts increased from 7239.7 (95 % CI, 7213.4 to 7266.0) steps/day at Month 1 to 9054.9 (95 % CI, 9023.7 to 9086.2) at Month 12, 9350.1 (95 % CI, 9318.4 to 9381.8) at Month 24, and 9392.7 (95 % CI, 9361.1 to 9424.3) at Month 36. These increases were statistically significant (P < 0.001), and sensitivity analyses confirmed consistent results.

Ongoing, structured incentives were associated with sustained increases in physical activity over 36 months, providing evidence for incentive-based interventions' long-term effectiveness in real-world settings.