A Discovery Vitality and Apple-sponsored behaviour change study found that people considerably increased their exercise levels when faced with the choice of having to buy an Apple Watch or getting one free if they meet daily physical activity goals.. Picture: ANTHONY KWAN/BLOOMBERG
A Discovery Vitality and Apple-sponsored behaviour change study found that people considerably increased their exercise levels when faced with the choice of having to buy an Apple Watch or getting one free if they meet daily physical activity goals.. Picture: ANTHONY KWAN/BLOOMBERG

A Discovery Vitality and Apple-sponsored behaviour change study has  found that technology-based incentives drive dramatic and sustained improvements in physical activity levels.

As diseases of lifestyle place an increasing financial burden on governments, the findings could have important implications for health policy.

The study found that people considerably increased their exercise levels when faced with the choice of having to buy an Apple Watch or getting one free if they meet daily physical activity goals.

The insight is unique partly because of the scale and duration of the study, which tracked the behaviour of more than 420,000 Vitality Active Rewards members across the UK, the US and SA over two years.

It also provides evidence that loss-framed financial incentives — where an individual receives something upfront but can lose part or all of it if goals are not met — are more effective in improving physical activity levels than gain-framed financial incentives.

This was demonstrated by an average 34% increase in activity levels for people using Vitality Active Rewards with Apple Watch, compared to those using Vitality Active Rewards without an Apple Watch. People without the watch did, however, track more physical activity compared to those participating solely in the Vitality programme.

Vitality Active Rewards is a smartphone application that sets personalised activity goals for users each week, which, if met, are rewarded with treats such as a Starbucks coffee or a Kauai smoothie.

For an activation fee, users can also get an Apple Watch that is paid off over 24 months based on their physical activity levels. These payments can be reduced to zero if weekly physical goals are met.

The considerable increase in exercise recorded among Apple Watch users in the study equates to 4.8 days of extra activity per month, which Vitality estimates translates into two additional years on a life.

Notably, activity increased across all participants, regardless of their health, status, age or gender.

The study, which independent research institute RAND Europe conducted, normalised for baseline activity as it had data on participants’ physical activity levels before they entered the programme.

“The study captured people’s activity levels before and after the introduction of incentives linked to Apple Watch, while controlling for population characteristics. It has major implications for health policy around the world,” said Hans Pung, president of RAND Europe.

At-risk participants — people with a body mass index of 30 and above — although less likely to take up the Apple Watch benefit, showed greater improvements in activity than other groups, with increases in activity of 200% in the US, 160% in the UK and 109% in SA.

SA participants posted a 71% increase in high-intensity activity days, followed by the US at 52% and 37% in the UK.

Speaking at the launch of the study in London last Wednesday, the UK secretary of state for health and social care, Matt Hancock, said it was “absolutely necessary” that the country’s National Health Service apply Vitality Active Rewards’ incentives-based approach to health care.

Adrian Gore. Picture: RUSSELL ROBERTS
Adrian Gore. Picture: RUSSELL ROBERTS

Vitality Active Rewards is offered to VitalityLife and VitalityHealth customers in the UK and John Hancock customers in the US.

While the adoption of new technology in the NHS historically was “slow and cautious”, it is “ripe for a technology revolution”, said Hancock.

His enthusiasm is laudable, but it is unlikely that cash-strapped public health-care systems in SA could afford to offer Apple Watch-style incentives to patients.

This type of programme, aimed at people who have private health and life insurance, could widen health inequality and leave governments to care for the ill and indigent.

But Discovery CEO and Vitality founder Adrian Gore is emphatic that health policy can incorporate incentives of different kinds, which need not be as flashy as handing out Apple Watches.

Speaking on Wednesday, he said the study pointed in the direction of a potential solution to a rising global disease burden.

Preventing disease is far more cost effective than curing it. And with poor diets and unhealthy lifestyles now driving more than half of all deaths — low-income countries often also have to shoulder an infectious disease burden — governments that incentivise people to be more physically active could save taxpayers considerable costs in the long run.