Researchers at the Perelman School of Medicine at the University of Pennsylvania, in collaboration with Ascension, will conduct a large-scale clinical trial aimed at reducing cardiovascular disease using smartphone-based fitness tracking and gamification. The six-year study has received $25 million in funding from the Patient-Centered Outcomes Research Institute (PCORI).
The trial seeks to determine whether an evidence-based behavioral economics approach—where participants receive points for meeting step goals and advance through game levels based on their performance—can lead to sustained increases in physical activity significant enough to prevent heart attacks and strokes. This builds on findings from the BE ACTIVE trial published in 2024, which showed that gamification can help increase daily step counts over time.
Alexander C. Fanaroff, MD, assistant professor of Cardiovascular Medicine at Penn Medicine and core faculty member at the Penn Center for Health Incentives and Behavioral Economics (CHIBE), explained: “We’re testing whether a fairly simple points system, coupled with ongoing behavioral reinforcement to encourage participants, achieves sustained increases in physical activity to a sufficient degree to prevent heart attacks and save lives.” He added: “Despite overwhelming observational evidence that higher physical activity is associated with better cardiovascular health, no prior randomized trial has been large enough to prove that increasing activity actually prevents heart attacks and strokes and to quantify the magnitude of these effects.”
The study will enroll 18,000 adults who have at least a 10% chance of experiencing major cardiovascular events within ten years as calculated by American Heart Association PREVENT equations. Participants will set personal step count goals between 33-50% above their baseline. Each participant will be assigned a support partner who receives weekly updates on progress.
Mitesh Patel, MD, MBA, Chief Clinical Transformation Officer and National Vice President at Ascension—and former director of the Penn Medicine Nudge Unit—said: “We are excited to partner with Penn Medicine on this innovative clinical trial to help support our patients and their health at scale.”
Kevin Volpp, MD, PhD, Director of CHIBE and Mark V. Pauly President’s Distinguished Professor commented: “Because of its size and scope, this trial tests whether behavioral economics applied in practice can act as the missing bridge between encouraging patients to move and actually preventing heart attacks and strokes.”
The fully remote study leverages smartphone accelerometers already present in most devices so participants do not need office visits.
Fanaroff concluded: “Results from this landmark trial have the potential to transform cardiovascular prevention guidelines, reduce mortality, improve quality of life, and dramatically lower healthcare costs.”
More information about ongoing studies by the Penn Center for Health Incentives and Behavioral Economics can be found here.
