myStep: Assessment of Small Incentives to Promote Physical Activity

Introduction: There has been limited research investigating whether small financial incentives can promote participation, behavior change, and engagement in physical activity promotion programs. This study evaluates the effects of two types of small financial incentives within a physical activity promotion program of a Swiss health insurance company.

Study design: Three-arm cluster-randomized trial comparing small personal financial incentives and charity financial incentives (10 Swiss Francs, equal to US$10.40) for each month with an average step count of >10,000 steps per day to control. Insureds’ federal state of residence was the unit of randomization. Data were collected in 2015 and analyses were completed in 2018.

Setting/participants: German-speaking insureds of a large health insurer in Switzerland were invited. Invited insureds were aged ≥18 years, enrolled in complementary insurance plans and registered on the insurer’s online platform.

Main outcome measures: Primary outcome was the participation rate. Secondary outcomes were steps per day, the proportion of participant days in which >10,000 steps were achieved and non-usage attrition over the first 3 months of the program.

Results: Participation rate was 5.94% in the personal financial incentive group (OR=1.96, 95% CI=1.55, 2.49) and 4.98% in the charity financial incentive group (OR=1.59, 95% CI=1.25, 2.01) compared with 3.23% in the control group. At the start of the program, the charity financial group had a 12% higher chance of walking 10,000 steps per day than the control group (OR=1.68, 95% CI=1.23, 2.30), but this effect dissipated after 3 months. Steps per day and non-usage attrition did not differ significantly between the groups.

Conclusions: Small personal and charity financial incentives can increase participation in physical activity promotion programs. Incentives may need to be modified in order to prevent attrition and promote behavior change over a longer period of time.

Trial registration: This study is registered at ISRCTN24436134.

Video Clips

myStep Introduction

Visual Abstract by A. Mönninghoff: Long-term effectiveness of mHealth physical activity interventions


Mönninghoff, A., Kramer, J., Hess, A.J., Ismailova, K., Teepe, G., Tudor Car, L., Müller-Riemenschneider, F., Kowatsch, T. (2021). Long-term effectiveness of mHealth physical activity interventions: a systematic review and meta-analysis of randomized-controlled trials, Journal of Medical Internet Research (JMIR) 23(4):e26699. (PDF)

Kramer, J., Tinschert, P., Scholz, U., Fleisch, E., Kowatsch, T., A Cluster-Randomized Trial on Small Incentives to Promote Physical Activity, American Journal of Preventive Medicine (AJPM), 56(2), e45-e54. (PDF)

Kramer, J., Kowatsch, T. (2017) Using Feedback to Promote Physical Activity: The Role of the Feedback Sign, Journal of Medical Internet Research (JMIR) 19(6):e192. (PDF)

Kowatsch, T., Kramer, J., Kehr, F., Wahle, F., Fleisch, E. (2016) Effects of Charitable Versus Monetary Incentives on the Acceptance of and Adherence to a Pedometer-Based Health Intervention: Study Protocol and Baseline Characteristics of a Cluster-Randomized Controlled Trial, JMIR Research Protocols, 5(3):e181. (PDF)


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Working Group

Jan-Niklas Kramer, Peter Tinschert, Annette Mönninghoff, Elgar Fleisch & Tobias Kowatsch


March 2015 – Dec 2018

Partner & Funding
CSS Insurance