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A few dollars a day, some goal setting, and a wearable device could be what it takes to increase physical activity among heart patients, according to a new study published in the Journal of the American Heart Association.

“Our trial is one of the first to test the use of mobile technology through a home-based program and found that while wearable devices alone were not effective, combining them with financial incentives and personalized goal-setting significantly increased physical activity levels during the six-month period,” stated Dr. Neel Chokshi in an American Heart Association (AHA) press release. Chokshi is first author of the study, cardiologist at the Perelman School of Medicine, and medical director of the Sports Cardiology and Fitness Program at Penn Medicine in Philadelphia.

How a few dollars can lead to a healthier heart

The clinical trial, which was published June 13, set out to learn how to get high-risk heart patients — specifically those with ischemic heart disease, the leading cause of death in the country — to exercise.

Regular exercise has been shown to reduce the risk of cardiovascular events and death by up to 30 percent among these high-risk patients, according to the AHA press release, but most don’t participate in exercise-based rehabilitation programs or get enough exercise on their own.

“There is a lot of interest in using wearable devices to increase activity levels among high-risk cardiovascular patients, but the best way to design these types of programs is unknown,” said Chokshi in the press release.

The researchers tracked 105 ischemic heart disease patients for 24 weeks in the home‐based, remotely monitored, randomized trial. Patients in the incentive group wore activity tracking devices on their wrists, received personalized step goals and daily feedback, and were allocated $14 each week to a virtual account for the first 16 weeks. If step goals weren’t achieved, these patients could lose $2 per day.

The researchers found that the patients in the incentive group logged 1,368 more steps per day during the main intervention period than the control group. Plus, after financial incentives were stopped, the incentive group still logged 1,154 steps per day compared to the control group. On the other hand, control group patients showed no significant change in their activity levels.

“It’s an interesting concept by using what is called loss aversion as an incentive for patients to comply with a particular activity,” Dr. Subbarao Myla, medical director of the Cardiovascular Catheterization Laboratories at Hoag Memorial Hospital Presbyterian in California, said of the research.

Rather than reward the patients for activity, money would be subtracted for not achieving goals.

“You lost the money, but it wasn’t yours to begin with,” said Myla. “But you lost the reward.”

Though a strategy like this could prove effective in the short term while incentives are present, according to Myla, the study was too short of a duration to ascertain whether the motivation was sustainable in the long run.

Another study limitation, pointed out by the researchers and Myla, is that the financial incentive group also received feedback and personalized goal-setting, and the control group did not.

“You can’t assume by the results of the study that paying the patients money caused them to exercise [1,368] steps per day more during that period,” said Myla. “The effect of the coaching, the motivation, the attention, also could have caused this.”

Go for a coach over a smart watch

In fact, more so than a wearable activity tracker, Myla recommends a personalized life coach to help heart patients stay on track with keeping activity levels up. And it doesn’t have to be a formal coach — it can be a trusted family member or a friend at the gym you commit to work out alongside.

“To me, a personalized life coach is more valuable,” he said. “I think the variable technology is just a tool.”

Though it’s not to say a gadget can’t come in handy in helping reach exercise goals. Devices can be set to give reminders to move around during the day, he said.

A key component of any exercise strategy, Myla said, is health education and health literacy. Heart patients need to understand the science behind the recommendations.

“I think the motivation needs to come [from] within,” he said.

Another effective strategy for self-motivating is to find a photo of your best self from the past and enlarge it so it’s as close to life-size as possible.

“And put that in your living room,” he said, adding that he’s used this strategy with nearly 100 of his own patients. “It is a powerful motivator.”

Not only does the patient become motivated to return to that version of his or herself, but others in the home offer encouragement in the form of compliments.

He said he knows of an app now in development that would show people how they would look if they lost a certain number of pounds.

“Nothing is more motivating than showing your future state by reflecting on your past,” he said.