Would you exercise more if you were paid to do it?

Sometimes, you need a little push to get off the couch.

Sometimes you just need to get paid.

Researchers are increasingly experimenting with using money as a way to get people to adopt healthy behaviours, essentially paying people to quit smoking, exercise more, or eat healthier foods.

According to Marc Mitchell, an assistant professor of kinesiology at Western University, money can work.

In a review published in the British Journal of Sports Medicine, he and his co-authors found that financial incentives encourage higher levels of physical activity, measured in steps per day.

“What we found was that paying people to be physically active, so to primarily walk, increased walking by 10 or 15 per cent, which on a population level is significant,” said Mitchell, who also works on an app that provides rewards for physical activity.

Having personalized goals rather than just a 10,000-step baseline for everyone seems to help encourage people to do more, he said, as does having instant rewards — getting a dollar per day, for example, instead of getting a reward at the end of several months.

It doesn’t seem to take much money either, he said. A dollar a day, sometimes even less, seems to be enough to get people moving.

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Other studies have found that financial incentives can also help people quit smoking or get vaccinated.

Some companies are buying into the idea. Health and life insurer Manulife plans to roll out an incentive program for its 1.4 million Canadian group benefits members within the next few months. Called “Vitality,” the program awards points when participants meet their fitness goals, or get their teeth checked, or get a flu shot, said Donna Carbell, head of group benefits at Manulife Canada. People enter information into an app, or connect their fitness tracker, and it calculates how well you’re doing.

Get enough points, and you might get a gift certificate for a coffee shop, or a big discount at an online retailer.

‘We’re really keen to take the first couple of years to get people just moving’

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“We’re really keen to take the first couple of years to get people just moving and engaged and then be able to work with our employees to really evaluate the impact that it’s having in their organizations,” she said.

According to Manulife, in other countries where companies have used the Vitality program, people had 40 per cent more active days per week and were generally more active than before they started.

Participating companies have seen a reduction in absenteeism and improved employee engagement, Carbell said, which is good for the company’s bottom line.

Manulife already runs a version of the Vitality program in its individual life insurance policies. In those, people on the Vitality program pay higher or lower insurance premiums depending on their points. The group benefits program won’t be tied to premiums, Carbell said, just rewards.

Mitchell believes that these kinds of incentive programs, which are rooted in behavioural economics, might give people the nudge they need to adopt a healthy behaviour.

The benefits of going for a run are far in the future, while the benefits of watching your favourite TV show are immediate — meaning a lot of people choose short-term reward over long-term gain, he said. But if you get an immediate financial reward for running, you might be more likely to pick that, he said.

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But what happens when you stop getting paid? The jury is still out, said Dr. Andrew Pipe, a physician and clinician scientist in the division of prevention and rehabilitation at the University of Ottawa Heart Institute.

There’s evidence that in some situations, financial incentives can have an effect, he said. “Very often those effects, however, are limited to the short term and there’s not good evidence that (…) once the incentives stop, that the behaviour changes necessarily continue.”

Mitchell’s analysis found that some behaviour change persisted for six months after the intervention, but the studies he looked at ended there, so it’s hard to say whether people continued being more active.

But according to Pipe, it can happen. If someone is predisposed to being physically active and gets paid to work out for six weeks, he said, “you’ve developed a pattern of behaviour … in which you’re probably going to start to feel good.

“So it’s not surprising that that might continue even after the incentive is over.”

More research, however, needs to be done on bigger groups of people and a more diverse group of participants, he said — people with different incomes and education, as he believes some evidence suggests these programs are used most often by relatively affluent and well-educated people.

Figuring out the best way to structure an incentive program, he said, is important, too. “It must be recognized that this is not a one-size-fits-all.”