Evidence
Alert

A workplace voucher reward scheme failed to boost physical activity

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.

 

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.

Produced by the University of Southampton and Bazian on behalf of NIHR through the NIHR Dissemination Centre

 

Commentaries

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