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

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. Trial registration Current Controlled Trials ISRCTN17975376. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 15. See the NIHR Journals Library website for further project information.

Predicting Outcomes from Engagement With Specific Components of an Internet-Based Physical Activity Intervention With Financial Incentives: Process Analysis of a Cluster Randomized Controlled Trial

“…Participants randomly assigned (in clusters) to the control arm received no intervention during the 6-month intervention period but were placed on a waiting list to participate in the scheme at the end of the study period (ie, 12 months). A more detailed overview of the trial procedures, including the Consolidated Standards of Reporting Trials (CONSORT) flow diagram, and intervention program has been published [4] and is summarized in Multimedia Appendix 1. The Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth (CONSORT-EHEALTH) checklist has been completed for this study [24].…”

“…The PAL scheme was a complex physical activity intervention that offered financial incentives and other behavior change techniques delivered via the study website to increase workplace physical activity (recorded by outdoor sensors located within 2 km of the workplace). Paradoxically, results showed that there was a small but significant decline in pedometer steps per day at 6 months relative to the baseline for the intervention group compared with controls, which dissipated at 12 months [4]. Mediation and moderation analyses showed that decreases in physical activity were partially mitigated by positive indirect effects through the constructs of integrated regulation, intrinsic motivation, and habit measured at 6 months, whereas the negative intervention effect was moderated by participants’ perceptions of availability of physical activity opportunities in the workplace environment [5].…”

Mechanisms of physical activity behavior change in an incentive-based intervention: Mediation analysis.

“…The primary outcome was steps/day objectively measured over seven consecutive days using sealed pedometers (Yamax Digiwalker CW-701, Japan) (Bassett et al, 1996;Bravata et al, 2007;Schneider, Crouter, Lukajic, & Bassett, 2003), considered valid if the participant provided ≥250 steps/day for three or more days (Tudor-Locke et al, 2005). These cut-points are in line with those used in the study's main outcomes analyses (Hunter et al, 2019(Hunter et al, , 2018. This outcome was collected at baseline, six and 12 months.…”

“…Whilst the study was specifically powered to detect between-group differences in primary outcome (i.e. pedometer steps/day) (Hunter et al, 2019(Hunter et al, , 2018, post-hoc power calculations have been conducted to determine power levels for all mediator analyses using the app developed by Schoemann and colleagues specifically for mediation analyses (Schoemann, Boulton, & Short, 2017). Results are reported in tables 2 and 3.…”

“…People who work in predominantly office-based occupations tend to spend a large part of their day inactive, and public organizations have been shown to have higher sickness absenteeism rates than private sector organizations (Black, Frost, & Frost, 2011;Hamilton, Hamilton, & Zderic, 2007). For example, whilst our objective measure of physical activity behavior (pedometer steps/day) indicated that participants assigned to both the intervention and control groups had a fairly high level of baseline physical activity, over 50% of participants were categorized as having 'low' physical activity levels according to self-reported General Physical Activity Questionnaire (GPAQ) (Hunter et al, 2019(Hunter et al, , 2018. However, evidence regarding the effectiveness of workplace physical activity interventions is mixed especially for long-term behavior change (Hutchinson & Wilson, 2012;Malik, Blake, & Suggs, 2014).…”