Penn researchers recently received a $25 million award to study the relationship between people’s step counts and cardiovascular health.
The award, funded by the Patient-Centered Outcomes Research Institute, will support a new trial that builds on the results of the 2024 BE ACTIVE study by Penn’s Center for Health Incentives and Behavioral Economics. The upcoming research seeks to evaluate whether increasing a person’s step count through gamification — a points-based system paired with behavioral reinforcement — reduces the risk of adverse cardiovascular events.
“It’s really challenging to get people to increase physical activity, and we don't necessarily have good ways of doing it besides telling them to do it,” Penn Medicine professor and lead researcher Alexander Fanaroff said in an interview with The Daily Pennsylvanian.
The BE ACTIVE trial previously investigated whether certain interventions would increase individuals’ involvement in physical activity. The researchers concluded that both financial incentives and gamification increased daily step counts.
Center for Health Incentive and Behavioral Economics Director Kevin Volpp told the DP that previous randomized trials associated with the research have demonstrated that gamification helps people remain “engaged in increasing their physical activity.”
“With this strategy, you can actually — in a very cost effective way — increase physical activity out to 18 months,” Volpp said. “That’s what we’re building on.”
Fanaroff highlighted that the new trial aims to expand upon these conclusions by studying whether an increase in exercise or activity leads to improved cardiovascular health — or if this is caused by some “confounding” factor like nutrition.
According to a Penn Medicine press release, researchers will enroll 18,000 participants — an increase from the roughly 1,000 involved in the BE ACTIVE trial — who each have a minimum 10% chance of experiencing an adverse cardiovascular event in the next decade.
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The $25 million award will primarily fund the staff involved in the trial. Beyond this, the money will be used to track clinical trials, cover participant incentives, and support Way to Health — the online platform that patients and researchers will interact with.
The researchers plan to spend a year and a half adjusting the design of the trial, according to Fanaroff. While the study will incorporate BE ACTIVE’s gamification structure, the researchers will not utilize financial incentives, given that the two treatments similarly increased exercise levels in the past.
Fanaroff added that while intervention in BE ACTIVE lasted for a year, the upcoming study will engage participants “indefinitely.”
If the intervention proves successful at reducing cardiovascular events, Volpp said he hopes that gamification can become “part of the clinical guidelines” used by hospitals. Both Fanaroff and Volpp expressed the hope that health systems or insurers could financially cover the program, which is estimated to cost around $50 per person.
“If this works, I think that it could be broadly implemented to increase physical activity of people at high risk for cardiovascular events, and ultimately reduce cardiovascular events in the population level,” Fanaroff said.
