Using Behavioral Economics to Promote Exercise among Inactive Overweight Adults

 描述(由申请人提供)：大约60%的美国人口超重或肥胖，肥胖与许多健康问题有关。建议超重和肥胖的成年人进行体育锻炼，以促进减肥和/或保持体重，并降低慢性病的风险，包括心脏病和乳腺癌和结肠癌。尽管锻炼有好处，但只有20%的超重或肥胖成年人达到了国家推荐的最低标准(每周150分钟的中等强度锻炼--例如快步走)，而且在锻炼计划的头几个月里，退出锻炼的比例高达50%。鉴于这些数据，有必要提高对运动计划的遵从性，特别是对于超重和肥胖的成年人。我们建议进行一项试点研究，以测试两个激励计划的可行性和概念验证，以促进低活跃、超重和肥胖成年人的锻炼。为了解决文献中的缺陷，这些计划将(A)由大普罗维登斯基督教青年会在社区环境中实施，(B)在财务上可持续，这样它们就不需要在指定的时间段后取消激励措施。在这两个奖励计划中，参与者将支付每月49美元的标准月费。在返点激励计划中，参与者将有机会在他们参加基督教青年会的每一天的会员费中赚取1美元的返点(由客观的刷卡数据验证)，每周最多5美元。在捐赠激励计划中，参与者将有机会获得每天1美元的捐款(使用相同的激励计划)，捐赠给参与者选择的注册当地慈善机构。因此，拟议的研究将比较三种实验条件：(A)回扣激励(n=25)；(B)捐赠激励(n=25)；(C)对照(即不激励)(n=25)。我们的主要目标是检验(1)两个激励计划的可行性，(2)评估两个激励计划初步效果的研究方法的可行性，以及(3)两个激励计划(相对于对照)的概念验证，通过比较一年中每周平均激励课程的数量。次要结果将是一年内每周自我报告的锻炼分钟数。这项拟议的研究将对两个以社区为基础、经济上可持续的激励计划进行初步调查，以促进癌症风险增加的成年人的锻炼。在论证了可行性和概念验证之后，我们计划申请R01来测试RCT中的激励计划。这样一项试验的积极结果将为以社区为基础的随时可实施的运动促进干预提供快车道。此外，这些发现将对通过其他社区组织(例如私人拥有的健身俱乐部)、医疗保健组织或雇主(例如雇主健身设施)使用财务上可持续的锻炼激励计划具有重大影响，并为其他与健康相关的行为(例如戒烟、减肥)的激励计划提供一个模式。

 DESCRIPTION (provided by applicant): Approximately 60% of the U.S. population is overweight or obese, and obesity has been linked to numerous health problems. Physical activity has been recommended for overweight and obese adults to enhance weight- loss and/or weight-maintenance, and to reduce risk of chronic disease, including heart disease and cancers of the breast and colon. Despite the benefits of exercise, only 20% of overweight or obese adults meet the minimum national recommendations (150 minutes/week of moderate intensity exercise-e.g., brisk walking), and drop out in the first few months of exercise programs is as high as 50%. Given these data, there is a need to improve adherence to exercise programs, especially for overweight and obese adults. We propose to conduct a pilot study to test feasibility and proof-of-concept for two incentive programs to promote exercise among low-active overweight and obese adults. To address weaknesses in the literature, the programs will be (a) conducted in a community setting by the Greater Providence YMCAs and (b) financially sustainable, such that they do not require removal of the incentives after a specified period of time. In both incentive programs, participants will pay the standard monthly YMCA membership fee of $49/month. In the Rebate incentive program, participants will have the opportunity to earn $1/day in rebates on their membership fee for each day that they attend the YMCA (verified by objective swipe-card data), with a maximum of $5/week. In the Donation incentive program, participants will have the opportunity to earn $1/day (using the same incentive schedule) in donations to a registered local charity of the participant's choice. Thus, the proposed study will compare three experimental conditions: (a) Rebate incentives (n=25); (b) Donation incentives (n=25); and (c) Control (i.e., no incentives) (n=25). Our Primary Aims are to test (1) feasibility f the two incentive programs, (2) feasibility of the research methods to evaluate the preliminary efficacy of the two incentive programs, and (3) proof-of- concept for the two incentive programs (relative to control), through comparison of average number of incented sessions/week over one year. Secondary outcomes will be self-reported minutes per week of exercise over one year. The proposed research will provide a preliminary investigation into two community-based, financially sustainable incentive programs to promote exercise for adults who are at increased risk for cancer. Following demonstration of feasibility and proof-of-concept we plan to apply for an R01 to test the incentive programs in an RCT. Positive findings from such a trial would provide a fast-track for a community-based ready-to- implement exercise promotion intervention. Additionally, such findings would have significant implications for the use of financially sustainable incentive programs for exercise through other community organizations (e.g., privately-owned health clubs), healthcare organizations, or employers (e.g., employer fitness facilities), as well as providing a model for incentive programs for other health-related behaviors (e.g., smoking cessation, weight loss).