Scientific Background

Physical inactivity poses a major challenge in cardiac care, particularly when it comes to sustaining healthy behaviours in the long-term health. Despite participation in cardiac rehabilitation programs, patients with cardiovascular disease (CVD) often relapse into sedentary routines. Research indicates that incentive-based interventions, especially those that involve the social environment, can effectively increase physical activity levels and promote long-term behaviour change.

At times, the social environment can unintentionally act as a barrier, for instance, family members or teachers may discourage physical activity out of concern, or friends and family may offer unhealthy temptations. Yet, social support can also be a powerful motivator for behaviour change. For example, being sponsored by friends, family, or colleagues to achieve a physical activity goal, where every milestone triggers a donation to charity, can turn exercise into a shared, purposeful experience. For patients, this added sense of purpose and social connection can make all the difference.

Programs like The Box and BENEFIT have already demonstrated the feasibility of integrating interventions based on social, care-related and financial elements into healthcare systems. However, tailoring these programs to the preferences of specific subgroups—such as patients with coronary artery disease (CAD), congenital heart disease, and women who experienced hypertensive disorders of pregnancy (HDP)—is critical for maximizing their acceptability and effectiveness. In addition, individual factors like gender, age, and socioeconomic position play an important role in determining what types of incentives are most effective.

Recognizing that motivation is highly individual, the national FIT-HEART consortium will investigate how to personalize various forms of incentives—such as motivational messages from friends and family, buddy support, or charitable donations—to support diverse groups of cardiac patients to stay active and healthy.

Research Objectives

This project aims to design, implement, and evaluate tailored incentive-based physical activity programs for CVD patients.

1. Co-create social incentive strategies in participatory workshops with patients and assess the acceptability and relevance of social rewards—such as motivational messages, buddy systems, and donations to charitable causes.
2. Evaluate program usage, engagement and (cost)effectiveness through a randomized controlled trial (RCT) and pre-post designs to identify the most appealing incentives for diverse patient subgroups.
3. Explore how these programs can be integrated into healthcare systems and scaled for broader implementation.

Study Design and Methods

A multi-phase study leveraging co-creation, prototyping, and large-scale trials.

1. Development Phase (Months 0–18): Stakeholder interviews, focus groups, and co-creation workshops will refine program components to align with patient needs and preferences. Iterative prototyping and usability testing will ensure program design acceptability.
2. Testing Phase (Months 18–48):

• Conduct an RCT among 894 CAD patients, divided into control, intervention, and intervention-plus-incentives groups.
• Perform pre-post cohort studies with 75 adolescents with congenital heart disease and 75 women who experienced HDP.

Evaluation: Primary outcomes include physical activity levels (step counts), while secondary outcomes assess adherence, acceptability, engagement, activity intensity, and patient-reported measures.

Strategic Priorities

Interdisciplinarity, Translational, One Institute.

• cardiovascular disease
• co-creation
• exercise
• incentive-based interventions
• personalised healthcare
• physical activity
• social rewards

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