Implementation of a workplace intervention using financial rewards to promote adherence to physical activity guidelines: a feasibility study Challenges in improving fitness: results of a community-based, randomized, controlled lifestyle change intervention. Cost effectiveness of a community based exercise programme in over 65 year olds: cluster randomised trial Adherence to a physical activity intervention among older adults in a post-transitional middle income country: A quantitative and qualitative analysis Prevalence of Physical Activity in the United States: Behavioral Risk Factor Surveillance System, 2001 Prompting primary providers to increase community exercise referrals for older adults: a randomized trial. A randomized study of financial incentives to increase physical activity among sedentary older adults. Can Financial Incentives Help People Trying to Establish New Habits? Experimental Evidence with New Gym Members Prevalence and correlates of physician recommendations to exercise among older adults. Effect of a Web-Based Intervention to Promote Physical Activity and Improve Health Among Physically Inactive Adults: A Population-Based Randomized Controlled Trial Health Opportunities with Physical Exercise (HOPE): social contextual interventions to reduce sedentary behavior in urban settings. Intervention Components Promoting Adherence to Strength Training Exercise in Breast Cancer Survivors With Bone Loss The Newcastle exercise project: a randomised controlled trial of methods to promote physical activity in primary care Individual Versus Team-Based Financial Incentives to Increase Physical Activity: A Randomized, Controlled Trial Population-based randomized controlled trial of a stage-targeted physical activity intervention Four years of practice-based and exercise-supported behavioural medicine in one community of the German CINDI area. Countrywide Integrated Non-Communicable Diseases Intervention. Predicting older adults' maintenance in exercise participation using an integrated social psychological model.
Background We design ed and implemented the Brigham and Women ’s Wellness Initiative ( B-Well ) , a single-arm study to examine the feasibility of a workplace program that used individual and team-based financial incentives to increase physical activity among sedentary hospital employees . Methods We enrolled sedentary , non-clinician employees of a tertiary medical center who self-reported low physical activity . Eligible participants formed or joined teams of three members and wore Fitbit Flex activity monitors for two pre-intervention weeks followed by 24 weeks during which they could earn monetary rewards . Participants were rewarded for increasing their moderate-to-vigorous physical activity ( MVPA ) by 10 % from the previous week or for meeting the Centers for Disease Control and Prevention ( CDC ) physical activity guidelines ( 150 min of MVPA per week ) . Our primary outcome was the proportion of participants meeting weekly MVPA goals and CDC physical activity guidelines . Secondary outcomes included Fitbit-wear adherence and factors associated with meeting CDC guidelines more consistently . Results B-Well included 292 hospital employees . Participants had a mean age of 38 years ( SD 11 ) , 83 % were female , 38 % were obese , and 62 % were non-Hispanic White . Sixty-three percent of participants wore the Fitbit ≥4 days per week for ≥20 weeks . Two-thirds were satisfied with the B-Well program , with 79 % indicating that they would participate again . Eighty-six percent met either their personal weekly goal or CDC physical activity guidelines for at least 6 out of 24 weeks , and 52 % met their goals or CDC physical activity guidelines for at least 12 weeks . African Americans , non-obese subjects , and those with lower impulsivity scores reached CDC guidelines more consistently . Conclusions Our data suggest that a financial incentives-based workplace wellness program can increase MVPA among sedentary employees . These results should be reproduced in a r and omized controlled trial . Trial registration Clinical trials.gov , NCT02850094 . Registered July 27 , 2016 [ retrospectively registered ] OBJECTIVE This study tested the efficacy of an 8-week culturally targeted nutrition and physical activity intervention on body composition . METHODS A r and omized , attention-controlled , two-group trial was conducted in a blackowned commercial gym with a sample of 366 predominantly healthy , obese African American women . A free 1-year membership to the study site gym was provided to participants in both groups . Data were collected at baseline , 2 , 6 , and 12 months . RESULTS Sample retention at 1 year was 71 % . Between-group longitudinal analysis including only participants with complete data revealed a trend toward weight stability in the intervention group at 2 months compared with controls ( + 0.05 kg/m(2 ) , p = 0.75 ; + 0.32 kg/m(2 ) , p = 0.08 , respectively ) , disappearing at 12 months ( + 1.37 kg/m(2 ) , p = 0.0001 ; + 1.02 kg/m(2 ) , p = 0.001 , respectively ) . Within-group analysis demonstrated that intervention and control participants ' fitness ( 1-mile run-walk ) improved by 1.9 minutes ( p = 0.0001 ) and 2.3 minutes ( p = 0.0001 ) , respectively , at 12 months . Mixed model regression analyses demonstrated a significant main effect of the intervention on fitness ( p = 0.0185 ) and a marginally significant effect on body mass index ( BMI ) ( p = 0.057 ) , at 2 months , disappearing by 6 months . By 12 months , however , the controls exhibited a significant advantage in waist circumference stability compared with intervention participants ( + 1.1 cm , p = 0.2763 ; + 2.1 cm , p = 0.0002 , respectively ) . CONCLUSIONS The intervention produced modest short-term improvements in body composition , but the economic incentive of a free 1-year gym membership provided to all participants was a more potent intervention than the education and social support intervention tested . However , longer-term fitness enhancement remains elusive and dem and s research and policy attention . These findings have policy implication s in that employer-/insurer-subsidized gym memberships may require interventions targeting other levels of change ( e.g. , physical or social/environmental ) to foster sustainable fitness improvements Objective : To assess the cost effectiveness of a community based exercise programme as a population wide public health intervention for older adults . Design : Pragmatic , cluster r and omised community intervention trial . Setting : 12 general practice s in Sheffield ; four r and omly selected as intervention population s , and eight as control population s. Participants : All those aged 65 and over in the least active four fifths of the population responding to a baseline survey . There were 2283 eligible participants from intervention practice s and 4137 from control practice s. Intervention : Eligible subjects were invited to free locally held exercise classes , made available for two years . Main outcome measures : All cause and exercise related cause specific mortality and hospital service use at two years , and health status assessed at baseline , one , and two years using the SF-36 . A cost utility analysis was also undertaken . Results : Twenty six per cent of the eligible intervention practice population attended one or more  exercise sessions  . There were no significant differences in mortality rates , survival times , or admissions . After adjusting for baseline characteristics , patients in intervention practice s had a lower decline in health status , although this reached significance only for the energy dimension and two composite scores ( p<0.05 ) . The incremental average QALY gain of 0.011 per person in the intervention population result ed in an incremental cost per QALY ratio of € 17 174 ( 95 % CI = € 8300 to € 87 120 ) . Conclusions : Despite a low level of adherence to the exercise programme , there were significant gains in health related quality of life . The programme was more cost effective than many existing medical interventions , and would be practical for primary care commissioning agencies to implement Objectives The effectiveness of community level interventions depends to a great extent on adherence . Currently , information on factors related to adherence in older adults from developing countries is scarce . Our aim was to identify factors associated to adherence to a physical activity intervention in older adults from a post-transitional middle income country . Design , setting and participants Using a combination of quantitative and qualitative methods we studied 996 older Chilean subjects ( 65–67.9 years at baseline ) with low to medium socioeconomic status from 10 health centers r and omized to receive a physical activity intervention as part of the CENEX cluster trial ( IS RCT N48153354 ) . Measurements Using a multilevel regression model , the relationship between adherence ( defined a priori as attendance at a minimum of 24 physical activity classes spread over at least 12 months ) and individual , intervention-related and context ual factors was evaluated . We also conducted 40 semi-structured interviews with older adults ( n=36 ) and instructors ( n=4 ) . Transcripts of the interviews were analyzed using content analysis to identify barriers and facilitators to adherence . Results Adherence to physical activity intervention was 42.6 % ( CI 95 % 39.5 to 45.6 ) . Depression , diabetes mellitus , percentage of impoverished households and rate of arrests for violent crimes in the neighborhood predicted less adherence ( p<0.05 ) while being retired , participation in physical activity prior to the intervention , and green areas per habitant were positively associated with adherence ( p<0.05 ) . The qualitative interviews identified three primary barriers to adherence : current health problems , lack of time due to commitments for caring for family members , and being employed , and two primary facilitators to adherence : the health benefits attributed to the intervention and the opportunity the classes provided for social interaction with others . Conclusion In order to enhance effectiveness of community exercise interventions , strategies to improve participation should be targeted to older adults from deprived areas and those with psychological and medical conditions Introduction The health benefits of regular cardiovascular exercise are well-known . Such exercise , however , has traditionally been defined as vigorous physical activity , such as jogging , swimming , or aerobic dance . Exercise of moderate intensity also promotes health , and many U.S. adults may be experiencing the health benefits of exercise through lifestyle activities of moderate intensity , such as yard work , housework , or walking for transportation . Until recently , public health surveillance systems have not included assessment s of this type of physical activity , focusing on exercise of vigorous intensity . We used an enhanced surveillance tool to describe the prevalence and amount of both moderate-intensity and vigorous-intensity physical activity among U.S. adults . Methods We analyzed data from the 2001 Behavioral Risk Factor Surveillance System , a state-based , r and om-digit  – dialed telephone survey administered to U.S. adults aged 18 years and older ( n = 82,834 men and 120,286 women ) .  Physical activity behavior was assessed using questions design ed to quantify the frequency of participation in moderate- or vigorous-intensity physical activities performed during leisure time or for household chores and transportation . Results Overall , 45 % of adults ( 48 % of men and 43 % of women ) were active at recommended levels during nonworking hours ( at least 30 minutes five or more days per week in moderate-intensity activities , equivalent to brisk walking , or at least 20 minutes three or more days per week in vigorous activities , equivalent to running , heavy yard work , or aerobic dance ) . Less than 16 % of adults ( 15 % of men and 17 % of women ) reported no moderate or vigorous activity in a usual week . Conclusion Integrating surveillance of lifestyle activities into national systems is possible , and doing so may provide a more accurate representation of the prevalence of recommended levels of physical activity . These results , however , suggest that the majority of U.S. adults are not active at levels associated with the promotion and maintenance of health OBJECTIVES To determine whether a clinic-based physical activity promotion intervention can lead to more community-based exercise referrals by providers and higher exercise motivation in patients . DESIGN Cluster r and omized , controlled trial . SETTING Seattle Veterans Affairs General Internal Medicine Clinic . PARTICIPANTS Thirty-one physicians and nurse practitioners were r and omized to a physical activity counseling intervention  or control condition ( counseling about tobacco cessation ) . Three hundred thirty-six patients aged 50 and older and visiting a study provider were enrolled . INTERVENTION Intervention providers were trained to offer referrals to community exercise programs for patients who reported before their clinic visit that they were " contemplative " about regular exercise . MEASUREMENTS Process measures of health behavior assessment and provider advice , exercise stage-of-change , proportion of participants reporting regular physical activity . RESULTS At baseline , 172 intervention patients and 164 controls were similar with respect to sex , age , comorbidity score , and exercise motivation level . Forty-five percent of all intervention patients and 35 % of controls reported receiving exercise advice ( P=.07 ) . Intervention patients who were contemplative about exercise were even more likely to receive  exercise advice than contemplative controls ( 59 % vs 38 % ; P=.02 ) . After 4 months , 35 % of all intervention patients reported regular exercise , compared with 28 % of controls ( P=.06 ) . CONCLUSION Primary providers are more likely to offer exercise advice when informed whether patients are contemplative about exercise . Patients may be more likely to start regular exercise as a result of this advice OBJECTIVE Less than half of all U.S. adults meet public health recommendations for physical activity , and even fewer older adults ( aged 50 years and over ) are sufficiently active . Because inactivity increases the risk of costly medical complications , successful efforts to increase physical activity among older adults may potentially be cost-effective . We sought to test if financial incentives for walking could increase physical activity among sedentary older adults . METHODS We conducted a 4-week r and omized controlled study using pedometers .  A total of 51 adults age 50 + from the Raleigh-Durham area of North Carolina participated in the study in April-May 2007 . Individuals were r and omized into one of two arms . The control group received a fixed payment of $ 75 ; the intervention group received a fixed payment of $ 50 plus up to $ 25 more per week depending on the number of weekly aerobic minutes  , defined as 10 + minutes of continuous walking or jogging . RESULTS The control group logged 2.3 h per week , on average . The intervention group logged 4.1 h per week and received an additional weekly payment of $ 17.50 , on average . CONCLUSION Modest financial incentives tied to aerobic minutes are an effective , and potentially cost-effective , approach for increasing physical activity among sedentary older adults We conducted a r and omized controlled trial testing the effect of modest incentives to attend the gym among new members of a fitness facility , a population that is already engaged in trying to change a health behavior . Our experiment r and omized 836 new members of a private gym into a control group , receiving a $ 30 payment unconditionally , or one of 3 incentive groups , receiving a payment if they attended the gym at least 9 times over their first 6 weeks as members . The incentives were a $ 30 payment , a $ 60 payment , and an item costing $ 30 that leveraged the endowment effect . These incentives had only moderate impacts on attendance during members ’ first 6 weeks and no effect on their subsequent visit trajectories . We document substantial overconfidence among new members about their likely visit rates and discuss how overconfidence may undermine the effectiveness of a modest incentive program BACKGROUND This study explored the prevalence of and factors associated with physician suggestions to exercise in a sample of older adults . METHODS We conducted telephone interviews of a r and om sample of members of two Medicare health maintenance organizations ( HMOs ) in Northern California . Participants were 893 community-dwelling older adults of whom 63 % were women , 52 % were married , and 12 % were in a minority group . Mean years of education was 14.8 + /- ( 2.6 ) and mean years of age was 74.9 + /- ( 6.5 ) . The associations between patient self-reports of ever receiving physician recommendations to exercise and the following categories of variables were assessed : demographics , health-related quality of life , medical conditions , health/risk behaviors , and health knowledge/interest/satisfaction . RESULTS The prevalence of older adults in this study ever receiving a  physician suggestion to exercise  was 48.2 % . In a multivariate logistic regression model , being younger , sedentary , and having a higher body mass index were independently ( p < or = .05 ) and positively associated with increased reports of having ever received a  physician 's advice to exercise .  Those who were precontemplators ( not thinking about changing physical activity behavior ) , and those who reported greater frequency of endurance exercise were less likely to report receiving a physician recommendation to exercise  ( p < or = .05 ) . CONCLUSIONS Although physician advice appeared to be targeted to subgroups that could benefit , physician advice on exercise could be particularly increased for patients over 75 years of age , those currently not thinking about an increase in physical activity , and those currently active patients who may benefit from ongoing physician advice to promote maintenance Background Many people in Western countries do not follow public health physical activity ( PA ) recommendations . Web-based interventions provide cost- and time-efficient means of delivering individually targeted lifestyle modification at a population level . Objective To examine whether access to a website with individually tailored feedback and suggestions on how to increase PA led to improved PA , anthropometrics , and health measurements . Methods Physically inactive adults ( n = 12,287 ) participating in a nationwide eHealth survey and health examination in Denmark were r and omly assigned to either an intervention ( website ) ( n = 6055 ) or a no-intervention control group ( n = 6232 ) in 2008 . The intervention website was founded on the theories of stages of change and of planned behavior and , apart from a forum page where a physiotherapist answered questions about PA and training , was fully automated . After 3 and again after 6 months we emailed participants invitations to answer a Web-based follow-up question naire , which included the long version of the International Physical Activity Question naire . A subgroup of participants ( n = 1190 ) were invited to a follow-up health examination at 3 months . Results Less than 22.0 % ( 694/3156 ) of the participants logged on to the website once and only 7.0 % ( 222/3159 ) logged on frequently . We found no difference in PA level between the website and control groups at 3- and 6-month follow-ups . By dividing participants into three groups according to use of the intervention website , we found a significant difference in total and leisure-time PA in the website group . The follow-up health examination showed no significant reductions in body mass index , waist circumference , body fat percentage , and blood pressure , or improvements in arm strength and aerobic fitness in the website group . Conclusions Based on our findings , we suggest that active users of a Web-based PA intervention can improve their level of PA . However , for unmotivated users , single-tailored feedback may be too brief . Future research should focus on developing more sophisticated interventions with the potential to reach both motivated and unmotivated sedentary individuals . Trial Registration Clinical trials.gov NCT01295203 ; http:// clinical trials.gov/ct2/show/NCT01295203 ( Archived by WebCite at http://www.webcitation.org/6B7HDMqiQ Physical activity interventions targeting social and physical environments of the urban poor hold promise in improving health outcomes in underserved communities . This study r and omly assigned overweight , sedentary , economically disadvantaged adults to one of three intervention conditions at The Hope and Healing Center , a large inner-city health facility providing numerous options for exercise . Within the tenets of Social Action Theory , the Health Opportunities with Physical Exercise ( HOPE ) trial will test the efficacy of two behavior change models , social support and patient-provider interaction , to increase physical activity . In addition to a st and ard care condition , in which patients have open access to Hope and Healing physical activity programming , patients were assigned to one of two behavior change interventions . Those assigned to patient-peer receive face-to-face , systematic and scheduled encouragement from study -trained ' peer ' interventionists at the facility . Patients assigned to patient-provider receive face-to-face , systematic and scheduled encouragement provided by study -trained ' provider ' interventionists also at the facility . The primary outcomes of change in exercise behavior will be documented by self-reported physical activity and confirmed by fitness testing at baseline , 6 , 12 and 24 months during the 1 year of active intervention and 1 year of relapse prevention follow-up . Intervention conditions will be compared on psychosocial mediators including motivational appraisal s , ratings of social support , rapport , problem solving and self-efficacy for overcoming barriers to increased physical activity . Novel aspects of this intervention include : ( 1 ) delivery of socially based physical activity interventions to an economically disadvantaged urban population , ( 2 ) reduction of environmental barriers to be physically active and ( 3 ) emphasis on social interactions influencing health habit change . Results of this study have the potential to identify mechanisms of behavior change that could be adopted by physical activity interventions aim ed at reducing sedentary behavior and health disparities in high-risk , underserved population Numerous studies have reported that exercise is safe and beneficial for breast cancer survivors ; however , long-term adherence to exercise programs is not easy to accomplish . This secondary analysis examined the demographic and clinical characteristics , adherence to exercise , and cognitive — behavioral intervention components data collected on 120 postmenopausal women with a history of breast cancer and bone loss who had been r and omized to the exercise group in a 24-month study . Hierarchical regression was used to identify variables that predicted adherence to  exercise . Mean adherence to  exercises  was 61.89 % .  Feedback and support were the most frequently used cognitive — behavioral intervention components . In hierarchical regression , predictors for adherence to exercise were feedback ( β = .40 , p < .001 ) and adherence to exercise  in the previous time period ( β = .31 , p < .001 ) . Participants receiving more frequent feedback had higher adherence to exercise Abstract Objective : To evaluate the effectiveness of combinations of three methods to promote physical activity . Design : R and omised controlled trial . Baseline assessment with post-intervention follow up at 12 weeks and 1 year . Setting : One urban general practice , 1995 - 7 . Participants : 523 adults aged 40 to 64 years , r and omised to four intervention groups and a control group . Interventions : Brief ( one interview ) or intensive ( six interviews over 12 weeks ) motivational interviewing based on the stages of change model of behaviour change , with or without financial incentive ( 30 vouchers entitling free access to leisure facilities ) . Main outcome measures : Physical activity score ; sessions of moderate and vigorous activity in the preceding four weeks . Results : Response rate was 81 % at 12 weeks and 85 % at one year . More participants in the intervention group reported increased physical activity scores at 12 weeks than controls ( 38 % v 16 % , difference 22 % , 95 % confidence interval for difference 13 % to 32 % ) , with a 55 % increase observed in those offered six interviews plus vouchers . Vigorous activity increased in 29 % of intervention participants and 11 % of controls ( difference 18 % , 10 % to 26 % ) , but differences between the intervention groups were not significant . Short term increases in activity were not sustained , regardless of intensity of intervention . Conclusions : The most effective intervention for promoting adoption of exercise was the most intensive . Even this did not promote long term adherence to exercise . Brief interventions promoting physical activity that are used by many schemes in the United Kingdom are of question able effectiveness . Key messages Schemes promoting physical activity are currently popular in general practice in Britain , but few have been rigorously evaluated and their effectiveness is unknown . In this study , the most effective intervention for promoting adoption of physical activity was the most intensive , involving six motivational interviews and a financial incentive A comparatively brief intervention ( one interview ) was only effective in the short term in around a third of participants Short term increases in physical activity were not maintained at one year follow up and even the most intensive intervention was ineffective in promoting long term adherence to increased physical activity . National and local government , health authorities , and primary healthcare teams should be cautious about current and future expenditure on , and implementation of , exercise prescription or referral ABSTRACT BACKGROUND More than half of adults in the United States do not attain the minimum recommended level of physical activity to achieve health benefits . The optimal design of financial incentives to promote physical activity is unknown . OBJECTIVE To compare the effectiveness of individual versus team-based financial incentives to increase physical activity . DESIGN R and omized , controlled trial comparing three interventions to control . PARTICIPANTS Three hundred and four adult employees from an organization in Philadelphia formed 76 four-member teams . INTERVENTIONS All participants received daily feedback on performance towards achieving a daily 7000 step goal during the intervention ( weeks 1– 13 ) and follow-up ( weeks 14– 26 ) periods . The control arm received no other intervention . In the three financial incentive arms , drawings were held in which one team was selected as the winner every other day during the 13-week intervention . A participant on a winning team was eligible as follows : $ 50 if he or she met the goal ( individual incentive ) , $ 50 only if all four team members met the goal ( team incentive ) , or $ 20 if he or she met the goal individually and $ 10 more for each of three teammates that also met the goal ( combined incentive).MAIN MEASURES Mean proportion of participant-days achieving the 7000 step goal during the intervention . KEY RESULTS Compared to the control group during the intervention period , the mean proportion achieving the 7000 step goal was significantly greater for the combined incentive ( 0.35 vs. 0.18 , difference : 0.17 , 95 % confidence interval [ CI ] : 0.07–0.28 , p < 0.001 ) but not for the individual incentive ( 0.25 vs 0.18 , difference : 0.08 , 95 % CI : -0.02–0.18 , p = 0.13 ) or the team incentive ( 0.17 vs 0.18 , difference : -0.003 , 95 % CI : -0.11–0.10 , p = 0.96 ) . The combined incentive arm participants also achieved the goal at significantly greater rates than the team incentive ( 0.35 vs. 0.17 , difference : 0.18 , 95 % CI : 0.08–0.28 , p < 0.001 ) , but not the individual incentive ( 0.35 vs. 0.25 , difference : 0.10 , 95 % CI : -0.001–0.19 , p = 0.05 ) . Only the combined incentive had greater mean daily steps than control ( difference : 1446 , 95 % CI : 448–2444 , p ≤ 0.005 ) . There were no significant differences between arms during the follow-up period ( weeks 14– 26 ) . CONCLUSIONS Financial incentives rewarded for a combination of individual and team performance were most effective for increasing physical activity . Trial Registration Clinical trials.gov identifier : NCT02001194 Background : Intervention trials with self-selected participants have shown that mailed stage-targeted print material s can increase participation in physical activity in the short term . We examined the effects of a mailed stage-targeted print intervention design ed to promote physical activity , in a r and om sample of adults living in a regional city . Method : Participants ( n = 462 , 40–60 years of age ) were r and omly allocated to an intervention in - 227 ) or control group ( n - 235 ) . Measures included vali date d 2-week physical activity recall and stage of motivational readiness for physical activity . The intervention consisted of a single mailing of a letter and full-color stage-targeted booklets ( specific to precontemplation , contemplation , preparation , and action/maintenance ) 1 week postbaseline . Follow-up interviews were conducted at 2 and 6 months postbaseline . Results : After 2 months , participants in the intervention group were significantly More likely to meet the current American College of Sports Medicine/Centers for Disease Control and Prevention recommendation for sufficient physical activity than those in the control group ( adjusted odds ratio [ OR ] - 2.40 ; 95 % confidence interval [ CI ] = 1.44–3.99 ) . After 6 months , intervention participants who reported receiving and reading the intervention material s were significantly more likely to be meeting the sufficient physical activity criterion compared with the control group ( adjusted OR = 2.03 ; 95 % Cl = 1.16–3.56 ) . Conclusions : The stage-targeted print intervention was effective in promoting short-term increases in physical activity and was most effective for participants who recognized and used the material s. This low-cost , generalizable intervention has demonstrated potential as a practical population -based physical activity promotion strategy . Further research is required before widespread dissemination would be justified , as additional strategies may be required to ensure sustained change The main goal of the preventive intervention study in one community of the German CINDI ( Countrywide Integrated Non-Communicable Diseases Intervention programme of the WHO ) area was to improve cardiovascular health by reducing the risk factors smoking , hypertension , obesity , hypercholesterolaemia , and by changing sedentary lifestyle . The intervention was performed by using the special " Three-Level- Strategy " , which is characterised by activities of primary care physicians in the usual consulting hour ( 1st level ) , with patient groups in their practice s ( 2nd level ) , and at community level ( 3rd level ) where a special work group and a co-ordinating general practice are co-operating . To evaluate the occurrence of the risk factors in practice and the local population , four cross-sectional r and om sample s ( N(total ) = 4881 ) were carried out in seven practice s from 1992 to 1995 . On the community level , 23 special exercise-based health groups ( N(total ) = 600 ) were established and were investigated by means of a question naire , related to behaviour and health beliefs . A " Local Health Information System " facilitated the evaluation , the management of the data , and the organisation of the health programme . The results of the practice sample s showed a significant reduction of smoking ( -17.8 % ) and hypertension ( -31.5 % ) ( p < 0.01 ) . The exercise-based groups were combined with nutritional counselling or relaxation and were accepted very well by the participants ( 83.8 % ) . The participants considerably improved their health behaviour : 82 % discussed health in their family , 37.3 % stated an increase of healthy nutrition , 52 % of relaxation ; 86.2 % intended to regularly increase physical activity in leisure time and 82 % could not imagine regular health training without exercise meetings . We conclude that the practice -based " Three-Level- Strategy " provides a strong support for successful long-term prevention of cardiovascular risk , particularly , when exercise-based health training sessions are performed in order to change sedentary lifestyle . When organised on community level , they might have a positive impact on the health behaviour of the whole community . Physical activity can be used as a " prodrug " for health promotion in a holistic way Little is known about the predictors of maintenance in organized exercise programmes . The aim of this study was to investigate the behavioral predictors of maintenance of exercise participation in older adults , using an integrated social psychological model . To this end , we carried out a prospect i ve cohort study ( n = 1,725 ; age 50 years or older ) involving 10 different types of exercise programmes , with measurements at baseline and after 6 months . Predictors of intention to continue participating and the actual maintenance of  exercise participation in the exercise programme were assessed using a step-wise logistic regression model . Significant odds ratios ( ORs ) predicting the intention to continue with the  exercise programme  were found for female sex , younger age , being married , being a non-smoker , being in paid employment , having a positive attitude towards exercise and having a high self-efficacy at baseline . Significant ORs predicting actual maintenance of exercise participation  were short lapses , absence of lapses , high intention at baseline , high perceived quality of the programme , positive attitude at baseline and few risk situations at baseline . In order to promote maintenance of exercise participation for older adults , effort should be taken to prevent lapses , to help people cope with risk situations for lapses , to improve the attitude towards exercise participation and to improve the quality of the programme
Assured , or " sure thing , " incentives and objective behavioral assessment in particular appear to moderate incentive effectiveness .
The effect estimate from the meta- analysis suggests that financial incentives increase exercise session attendance for interventions up to 6 months in duration .
CONTEXT Less than 5 % of U.S. adults accumulate the required dose of exercise to maintain health .
Behavioral economics has stimulated renewed interest in economic-based , population -level health interventions to address this issue .
Despite widespread implementation of financial incentive-based public health and workplace wellness policies , the effects of financial incentives on exercise initiation and maintenance in adults remain unclear .