Behavioral Economic Approaches to Increase Physical Activity among Patients with Elevated Risk for Cardiovascular Disease

项目摘要/摘要 动脉粥样硬化性心血管疾病(ASCVD)是美国发病率和死亡率的主要原因。 有规律的体力活动已被证明可以降低患ASCVD的风险，并与许多其他疾病相关 健康福利。然而，在美国，只有不到50%的成年人能够进行足够的体育锻炼来真正获得这些好处。 美国的这种不活跃程度在过去十年中基本没有变化；创新和可扩展的方法 实现体力活动的持续增加是必要的。 来自行为经济学的见解被证明既能更好地反映人类的“可预测的非理性”，也能 有效地设计干预措施，以实现健康行为的持续改善。我们之前的工作是 演示了使用财务激励和游戏化的干预措施可以利用来自行为的原则 经济学：在3个月的干预期间增加体力活动，并在3个月的随访期内保持效果。 这些发现为进一步研究更长期的影响提供了依据。 在这项研究中，我们建议进行一项四臂随机对照试验，干预时间为12个月，然后是6个月。 一个月的随访期，以解决以下目标：目标1：评估游戏化的效果，财务 激励措施，或两种方法相结合，在为期12个月的干预期间增加相对于对照组的体力活动 在动脉粥样硬化性心血管事件的高危人群中。目标2：评估该计划的可持续性 在6个月内增加体力活动的三种干预措施(游戏化、经济激励或两者兼而有之 随访期。目标3：比较使用每种干预方法的成本效益 控制增加体力活动。我们将通过使用可穿戴设备监控物理设备来测试可扩展的干预 活动水平和远程提供干预措施的自动化研究技术平台。

PROJECT SUMMARY/ABSTRACT Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in the United States (US). Regular physical activity has been demonstrated to reduce the risk of ASCVD and is associated with a number of other health benefits. Yet, less than 50% of adults in the US achieve enough physical activity to actually obtain these benefits. This level of inactivity in the US has been mostly unchanged for the past decade; innovative and scalable approaches that achieve sustained increases in physical activity are needed. Insights from behavioral economics have been shown to both better reflect the `predictable irrationality' of humans and to be effective in designing interventions that achieve sustained improvements in health behavior. Our prior work has demonstrated that interventions using financial incentives and gamification can leverage principles from behavioral economics to increase physical activity during 3-month interventions and sustain effects in 3-month follow-up periods. These findings warrant further investigation of longer-term effects. In this study, we propose to conduct a four-arm randomized, controlled trial with a 12-month intervention and then a 6- month follow-up period to address the following aims: Aim 1: To evaluate the effectiveness of gamification, financial incentives, or both approaches combined on increasing physical activity relative to control during a 12-month intervention among individuals at elevated risk for atherosclerotic cardiovascular events. Aim 2: To evaluate the sustainability of the three interventions (gamification, financial incentives, or both combined) in increasing physical activity during a 6-month follow-up period. Aim 3: To compare the cost-effectiveness of using each of the intervention approaches relative to control in increasing physical activity. We will test a scalable intervention by using wearable devices to monitor physical activity levels and an automated research technology platform to deliver interventions remotely.