Using financial incentives to promote physical activity in American Indian adolescents: A randomized controlled trial

Abstract

American Indians (AI) have high prevalence of diabetes in youth and may benefit from increasing physical activity as a strategy to improve metabolic health. We tested whether financial incentives would elicit greater frequency and/or duration of exercise in AI youth at high risk for developing diabetes. Overweight/obese AI boys and girls, 11–20 years old, were instructed to exercise on 3 days/week for 48 weeks at a tribal wellness center. The program was divided into three, 16-week-long phases to test different financial incentive strategies. Within each phase participants were randomly assigned to one of two groups that received different payments for exercise. Phase 1 was designed to test whether the size of the incentive would affect exercise frequency. In Phase 1, the number of exercise sessions did not differ between the group receiving a modest fixed-value payment per exercise session and the group receiving enhanced incentives to exercise more frequently (26 ± 3 versus 28 ± 2 sessions, respectively, p = 0.568). In Phase 2, the provision of an enhanced financial incentive to increase exercise duration resulted longer sessions, as the incentivized and standard payment groups exercised 38 ± 2 versus 29 ± 1 minutes per session (p = 0.002), respectively. In Phase 3, the effect of reducing the incentives on maintenance of exercise behaviors was inconclusive due to high participant withdrawal. Aerobic fitness increased 10% during Phase 1 but was unchanged thereafter. Insulin sensitivity and body composition were unchanged during the study. In conclusion, enhanced financial incentives increased the duration of exercise sessions, but had minimal effects on exercise participation. These results indicate that financial incentives hold promise in motivating previously sedentary, overweight/obese adolescents to exercise longer, but motivating them to sustain an exercise program remains the major challenge.Trial Registration: ClinicalTrials.gov NCT01848353.

Collaborative implementation of a community-based exercise intervention with a partnering rural American Indian community

“…In 2012, OUHSC and the Choctaw Nation embarked on a new project, funded by the National Institute of Minority Health and Health Disparities, designed to increase physical activity behavior in obese youth ages 11–20 years, at risk for developing diabetes. 13 The Choctaw Nation had successfully used incentive-based programs in the past to encourage adults and tribal employees to increase physical activity but had not yet used an incentive-based program with their youth. The primary objective of this collaborative randomized clinical trial, recently published, 13 was to test whether financial incentives would promote an increase in exercise frequency and/or duration among youth at Choctaw-operated wellness centers.…”

“…13 The Choctaw Nation had successfully used incentive-based programs in the past to encourage adults and tribal employees to increase physical activity but had not yet used an incentive-based program with their youth. The primary objective of this collaborative randomized clinical trial, recently published, 13 was to test whether financial incentives would promote an increase in exercise frequency and/or duration among youth at Choctaw-operated wellness centers. 13 The primary finding was that financial incentives promoted an increase in exercise session duration but did not result in more frequent exercise participation.…”

“…The primary objective of this collaborative randomized clinical trial, recently published, 13 was to test whether financial incentives would promote an increase in exercise frequency and/or duration among youth at Choctaw-operated wellness centers. 13 The primary finding was that financial incentives promoted an increase in exercise session duration but did not result in more frequent exercise participation. Additional details with regard to study design and outcomes are available elsewhere.…”

“…The study’s grant application was developed with collaborative input and approval from the Choctaw Nation leaders, community members, health service, and wellness center staff with specific research agreements related to data and resource sharing. 13–15 Following funding and initial implementation of the study, scheduled and frequent collaborative discussions continued, to ensure that the study remained culturally appropriate and scientific integrity was maintained. OUHSC’s previous clinical trials with American Indian communities in Oklahoma required that most clinical tests and data collection be conducted on the OUHSC Oklahoma City campus.…”

“…12,16,17 This study, however, was designed so that all clinical tests, exercise activities, and data collection be conducted within the Choctaw Nation’s community, approximately 200 miles from the university campus. 13…”