Assessing the role of incentives in promoting physical activity

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Discovery, and its insurance partners, offer wellness participants the opportunity to join a traditional wellness incentive programme, Vitality Active Rewards, in which an Apple Watch is provided as an incentive up front and repayment is dependent on level of activity.

Researchers found that this loss-framed incentive is associated with higher physical activity levels, and that these associations persist over time.


Benefits of physical activity include a lower risk of some major diseases, such as hypertension, cardiovascular disease, diabetes, and cancer. Physical exercise can also have positive effects on maintaining a healthy body weight and mental health. However, roughly about one third of the global adult population is not meeting the minimum weekly level of physical activity recommended by the World Health Organisation.

With the goal of tackling inactivity, Discovery, a multi-national insurance group based in South Africa, offers two types of incentives to its members: Vitality Active Rewards and Vitality Active Rewards with Apple Watch. The Vitality Active Rewards scheme rewards individuals for tracking and reaching different thresholds of physical activity, whereas the Vitality Active Rewards with Apple Watch benefit is a loss-framed incentive where monthly repayment amounts for an Apple Watch are linked to different levels of physical activity thresholds the individuals reach per month.

Against this background Discovery commissioned RAND Europe to conduct an independent evaluation of the Vitality Active Rewards with Apple Watch benefit programme.


The objective of the study was to assess whether the Vitality Active Rewards with Apple Watch benefit is associated with increased physical activity levels for Vitality members that take up the benefit, compared to those individuals that only participate in the Vitality Active Rewards programme. The study also examined whether these associations persist over time.


The study used statistical regression methods, combined with large-scale population data from 422,643 Vitality programme members across the United Kingdom, the United States and South Africa, from 2015 to 2018. The empirical analysis examined whether the uptake of benefit led to an increase in tracked physical activity levels across different types of activity levels.


  • Taking-up the Vitality Active Rewards with Apple Watch benefit is associated with an average increase of tracked activity days per month of about 34 per cent, leading to an additional 4.8 days of activity per month. This is compared to the Vitality members who only participate in the Vitality Active Rewards gain-framed incentive programme.
  • There is some variation across the three country samples, with the largest percentage increase in total activity days in South Africa (44.2 per cent), followed by the United States (30.6 per cent) and the United Kingdom (27.7 per cent).
  • Looking at the different exercise intensity categories — light, standard and advanced activity — the largest relative increase for members is among the advanced activity days, suggesting that there is not only an overall increase in activity levels but also an increase in more intense exercise events. The largest absolute increase in advanced activity days is reported in the UK sample, where taking part in the benefit is associated with an average increase of 1.6 days of tracked activity per month, followed by SA and USA with an increase of 1.3 and 1.2 days per month respectively.
  • Further findings suggest that the benefit motivates groups such as obese people who are inactive to be more active. In this at-risk group the uptake of the benefit is associated with an average increase in tracked activity levels in the range of 109 per cent (SA), 160 per cent (UK) and 200 per cent (US), corresponding to an absolute increase in activity days per month of 4.5 days (SA), 5.7 days (UK) and 1.8 days (US). However, it is important to highlight that the uptake rate of the benefit is generally lower among this group.
  • The positive associations between the benefit and physical activity persist over time (at least over the 24-month repayment period of the Apple Watch).


The findings of this study suggest that incentivising physical activity to tackle inactivity and a sedentary lifestyle can lead to better activity levels. Specifically, this study confirms that a loss-framed incentive such as the Vitality Active Rewards with Apple Watch benefit can improve physical activity levels beyond the incentive induced by a gain-framed incentive which provides individuals only with rewards for physical activity such as the Vitality Active Rewards programme. Though more unhealthy individuals are much less likely to take up an incentive of this nature, when they do the results can lead on average to a more pronounced behaviour change than we see in already relatively more active and healthy individuals. This is important when designing health promotion programmes.