Creating Exercise Habits Using Incentives: The Tradeoff between Flexibility and Routinization

Acceptability of two mobile applications to support cross-sectoral, person-centred and empowering stroke rehabilitation - a process evaluation

AIM

To evaluate the acceptability of two co-designed mobile applications Mit Sygehus [a knowledge-based solution] and Genoptræn.dk [a self-training solution] to support a cross-sectoral, person-centred and empowering stroke rehabilitation.

SETTING

The applications were implemented and tested throughout two stroke rehabilitation trajectories in Southern Denmark, comprising two acute, two sub-acute and two municipal stroke rehabilitation settings.

METHODS, PARTICIPANTS AND ANALYSIS

A process evaluation focusing on acceptability was conducted. Individual and dyadic interviews were performed with ten stroke survivors (three women and seven men, aged 50-84) with moderate stroke and seven significant others (five women and two men, aged 50-78) post-rehabilitation. A constructivist Grounded Theory analysis was used to explore what, why, when, and how the apps worked or did not work throughout the stroke rehabilitation trajectory and if adaptions were needed.

RESULTS

Participants found that Mit Sygehus provided adequate and sufficient knowledge and was easy to use, however, acceptability of Mit Sygehus declined throughout the rehabilitation process. Also, knowledge on 'return-to-work' and 're-gaining driver's license/permission to drive' needed to be developed. The content in Genoptræn.dk was perceived as acceptable, through content being person-centred, motivating and meaningful. Genoptræn.dk furthermore, supported the transfer between rehabilitation settings, provided a sense of progress throughout the rehabilitation process, facilitated positive habits regarding self-training, and relieved the burden on significant others. Genoptræn.dk was perceived most acceptable in the sub-acute rehabilitation setting and declined when rehabilitation continued in the municipal setting.

CONCLUSION

Stroke survivors and their significant others found Mit Sygehus and Genoptræn.dk acceptable to support cross-sectoral, person-centred and empowering stroke rehabilitation, however acceptability declined throughout the rehabilitation process. Further investigations are required to determine how cognitive rehabilitation can play a greater role in app-supported stroke rehabilitation and how the need for more long-term follow-up can be supported.

Combining anchoring with financial incentives to increase physical activity: a randomized controlled trial among college students

The purpose of this study was to: (1) compare the relative efficacy of different combinations of three behavioral intervention strategies (i.e., personalized reminders, financial incentives, and anchoring) for establishing physical activity habits using an mHealth app and (2) to examine the effects of these different combined interventions on intrinsic motivation for physical activity and daily walking habit strength. A four-arm randomized controlled trial was conducted in a sample of college students (N = 161) who had a self-reported personal wellness goal of increasing their physical activity. Receiving cue-contingent financial incentives (i.e., incentives conditional on performing physical activity within ± one hour of a prespecified physical activity cue) combined with anchoring resulted in the highest daily step counts and greatest odds of temporally consistent walking during both the four-week intervention and the full eight-week study period. Cue-contingent financial incentives were also more successful at increasing physical activity and maintaining these effects post-intervention than traditional non-cue-contingent incentives. There were no differences in intrinsic motivation or habit strength between study groups at any time point. Financial incentives, particularly cue-contingent incentives, can be effectively used to support the anchoring intervention strategy for establishing physical activity habits. Moreover, mHealth apps are a feasible method for delivering the combined intervention technique of financial incentives with anchoring.

Duration- and sex-dependent neural circuit control of voluntary physical activity

RATIONALE

Exercise participation remains low despite clear benefits. Rats engage in voluntary wheel running (VWR) that follows distinct phases of acquisition, during which VWR escalates, and maintenance, during which VWR remains stable. Understanding mechanisms driving acquisition and maintenance of VWR could lead to novel strategies to promote exercise. The two phases of VWR resemble those that occur during operant conditioning and, therefore, might involve similar neural substrates. The dorsomedial (DMS) dorsal striatum (DS) supports the acquisition of operant conditioning, whereas the dorsolateral striatum (DLS) supports its maintenance.

OBJECTIVES

Here we sought to characterize the roles of DS subregions in VWR. Females escalate VWR and operant conditioning faster than males. Thus, we also assessed for sex differences.

METHODS

To determine the causal role of DS subregions in VWR, we pharmacologically inactivated the DMS or DLS of adult, male and female, Long-Evans rats during the two phases of VWR. The involvement of DA receptor 1 (D1)-expressing neurons in the DS was investigated by quantifying cfos mRNA within this neuronal population.

RESULTS

We observed that, in males, the DMS and DLS are critical for VWR exclusively during acquisition and maintenance, respectively. In females, the DMS is also critical only during acquisition, but the DLS contributes to VWR during both VWR phases. DLS D1 neurons could be an important driver of VWR escalation during acquisition.

CONCLUSIONS

The acquisition and maintenance of VWR involve unique neural substrates in the DS that vary by sex. Results reveal targets for sex-specific strategies to promote exercise.

The mediating roles of demand and satisfaction in formation process of physical exercise habits among college students

Considering the situation and disadvantages of being physically inactive as well as the nature and advantages of doing physical exercise regularly, there is a need to explore how physical exercise habits are cultivated and formed. The study was to examine the formation process of physical exercise habits. According to the Model of Physical Exercise and Habit, It was speculated that satisfaction, demand or chain from satisfaction to demand could mediate the relationship between physical exercise behavior and physical exercise habit. Cross-sectional design with 3202 college or university students from China was employed. Data about physical exercise habits, physical exercise behaviors as well as related questions was measured by the Self-Report Exercise Habits Index and direct questions. Structural Equation Modeling (SEM) was constructed to evaluate the mediating effects of demand and/or satisfaction by Asymptotically Distribution-Free and BOOTSTRAP. The inferential statistics was to estimate path coefficient and mediation effect. Findings suggested physical exercise behaviors could develop into physical exercise habits through a direct path, single mediators of demand or satisfaction, or a chain mediator from demand to satisfaction.

Seven Ways to Inspire Innovation in the Health Technology Industry

This article explores ways in which technological innovation can be bolstered in organizations that operate in the health technology industry. We present seven interventions at the team level (employee empowerment, servant leadership, hiring innovators, and scheduling time for innovation) and organizational level (intrapreneurship, flat management, and allowing for failure) that organizations can use to encourage and inspire innovation among employees. Given the increasingly dynamic nature of work within the health technology fields, in terms of both manufacturing processes and clinical developments, creating a culture of innovation and creativity and emboldening employees to regularly engage in such behaviors within these workplaces are critical.

Megastudies improve the impact of applied behavioural science

Policy-makers are increasingly turning to behavioural science for insights about how to improve citizens' decisions and outcomes¹. Typically, different scientists test different intervention ideas in different samples using different outcomes over different time intervals². The lack of comparability of such individual investigations limits their potential to inform policy. Here, to address this limitation and accelerate the pace of discovery, we introduce the megastudy-a massive field experiment in which the effects of many different interventions are compared in the same population on the same objectively measured outcome for the same duration. In a megastudy targeting physical exercise among 61,293 members of an American fitness chain, 30 scientists from 15 different US universities worked in small independent teams to design a total of 54 different four-week digital programmes (or interventions) encouraging exercise. We show that 45% of these interventions significantly increased weekly gym visits by 9% to 27%; the top-performing intervention offered microrewards for returning to the gym after a missed workout. Only 8% of interventions induced behaviour change that was significant and measurable after the four-week intervention. Conditioning on the 45% of interventions that increased exercise during the intervention, we detected carry-over effects that were proportionally similar to those measured in previous research^3-6. Forecasts by impartial judges failed to predict which interventions would be most effective, underscoring the value of testing many ideas at once and, therefore, the potential for megastudies to improve the evidentiary value of behavioural science.

Promoting Healthy Eating Behaviors by Incentivizing Exploration of Healthy Alternatives

Incentive-based intervention programs aimed at promoting healthy eating behaviors usually focus on incentivizing repeating the desired behavior. Unfortunately, even when effective, these interventions are often short-lived and do not lead to a lasting behavioral change. We present a new type of intervention program focused on incentivizing exploration of new healthy alternatives rather than incentivizing repeated healthy behaviors. This intervention aims to help participants find long-lasting "personal treasures" -new foods that are both healthy and tasty for them. Our field study included a final sample of 48 students with low or medium daily consumption of fresh salads. Participants in the control group received a fixed payment for completing the program, while the participants in the incentivized exploration group received a lower fixed fee for completing the task and a bonus for each new salad they tried. Results show that participants in the incentivized exploration group reported eating more salads even 1 year after the program ended compared to the participants in the control group. Though preliminary, our results paint a promising picture for the successful application of incentivizing exploration interventions to promote healthy lifestyle.