Does participation in municipality-initiated incentivized health promotion programs promote physical activity among the physically inactive? Verification in six Japanese municipalities

Background: Physical activity can prevent lifestyle-related diseases, such as hypertension and diabetes. However, many people in society are physically inactive, especially middle-aged and older adults over 40. Therefore, this study examined the effects of a municipality-led incentivized health promotion program to clarify: (1) whether the average number of steps increased from the preparticipation period to the 18th month following the program; and (2) whether such increases were influenced by financial incentives. Design and methods: This study analyzed gender, age, step, and incentive type data from 5688 middle-aged and elderly participants in an incentivized health promotion program. The incentives were regional gift certificates that could only be used in local areas, national gift certificates, common points that could be used in department and convenience stores nationwide, and donations. The incentives were worth a maximum of 24,000 yen per year. Results: Both the physically active group and the physically inactive group had increased the step count markedly 18 months post-participation; however those participants chosing financial incentives showed significantly higher steps after 18 months than those who opted for non-financial incentives (time: p