Setting individual goals for exercise and supporting their pursuit generates positive and lasting change


The cardiovascular implications of physical exercise can be improved by helping individuals design and accomplish key goals, resulting in lasting benefits and better behavior changes.

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Explore decision making related to exercise in low income and high risk areas

According to a new study by researchers at the Department of Medicine at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, setting exercise-related goals and pursuing them immediately results in longer lasting and more frequent physical activity.

The results, published in the journal JAMA Cardiology, considered low-income areas most at risk for developing cardiovascular disease. Indeed, many of these areas lack the facilities or resources to maintain consistent physical activities due to lack of policies and support.

In addition, behavioral changes at the individual level associated with more frequent or intense exercise remain unclear, as decision making can be disrupted by several factors.

Lead author Mitesh Patel, MD, MBA, associate professor of medicine at Penn and vice president of clinical transformation at Ascension, describes the value of this study:

Most behavior change programs involve goal setting, but the best way to think about this process is unknown. Our clinical trial showed that physical activity increased the most when patients chose their goals rather than being assigned to them, and when goals started immediately rather than starting lower and gradually increased over time. These findings are particularly important because the patients came from low-income neighborhoods and may face a number of challenges in achieving their health goals. “

Using data from 500 patients from low-income neighborhoods in West Philadelphia as well as elsewhere in and out of the city, participants were chosen based on their cardiovascular disease or of their risk of developing one in a decade. .

The lasting benefits of gamification and other induced behavioral strategies

A focal strategy often used in Patel’s previous work at the Penn Medicine Nudge Unit was the gamification of behavioral decision-making.

Gamification is a concept that refers to creating a change in behavior by turning it into a game, and previous studies have examined whether playing games with physical activity goals can increase the time spent playing the game. compared to not playing or playing with other associated goals.

Similar to their previous work, each participant wore a step tracker in the present study to determine the number of daily steps through the Penn’s Way to Health platform.

However, a new outcome was designed that sets this study apart from other work, as the analysis focused on determining the goals themselves and when to pursue the goals instead of just participating in the game.

Participants had a week or two to acclimate to the bracelet, which also provided baseline data on individual step counts. Subsequently, individuals were assigned either to the control group, which did not have step goals, to the play group, or to one of the play groups with goals.

The gamified group then made two subsets of assignments; the first was to determine if they had chosen or received a milestone goal, and the second task was to decide if participants would immediately start working on the goals or if they had incremental increases toward the goal.

The results showed that the only group of participants who achieved a higher increase in activity were those who chose their own goals and started immediately.

This group had the largest increase in steps compared to the aimless group, averaging 1,384 steps per day. In addition, the study also measured periods of sustained and intense activity, representing an average daily increase of 4.1 minutes over the 8-week period.

Determining and achieving individual goals is most effective

People who choose their own goals are more likely to be intrinsically motivated to achieve them. They feel like the goal is theirs and that probably allows for more engagement.

Kevin Volpp, MD, Ph.D., director of the Center for Health Incentives and Behavioral Economics

During the 8 weeks following the trial, the participants also kept their trackers on, and this period also showed that the group that chose their goals and started immediately maintained their progress in step count.

This improvement was only three steps less than during active play, demonstrating that the group achieved almost the exact increase than during the trial. “It’s exciting to see that the group that increased their activity levels the most number of steps maintained those levels during follow-up,” Patel said. “This indicates that gamification with personal and immediate goals has helped these patients develop a new habit. “

Often, the physical health programs offered by work or health insurances offer incentives for physical activity, but the goals are static and based on round numbers ignoring individual goals or aiding in individual decision making.

The results of this study suggest that goal setting in these programs has important effects for individuals, and if programs can adapt to help individuals set and pursue goals quickly, then it can have significant impact. great benefits to prevent the development of cardiovascular disease.

Goal setting is a fundamental part of almost every physical activity program, whether through a smartphone app or as part of a workplace wellness program. Our results reveal a simple approach that could be used to improve the impact of these programs and the health of their patients. “

Volpp

Journal reference:

  • Patel MS, Bachireddy C, Small DS, et al. Effect of goal-setting approaches as part of a gamification intervention to increase physical activity in economically disadvantaged adults at high risk of major adverse cardiovascular events: the randomized clinical trial ENGAGE. JAMA Cardiol. Published online September 01, 2021. doi: 10.1001 / jamacardio.2021.3176


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