App-based walking challenge boosts step count in adults

Singapore’s National Steps Challenge (NSC), as well as its two embedded sub-challenges, helps increase step counts among participants, according to a recent study.

A total of 411,528 individuals (mean age 41.5 years, 58.5 percent women) participated in the third season of the NSC. At baseline, they had a mean body mass index of 23.8 kg/m² and walked a median of 7,523 steps per day.

Of the participants, 10.3 percent (n=42,337) and 21.3 percent (n=87,718) also enrolled into the Personal Pledge and Corporate Challenge subchallenges embedded into the NSC, respectively.

During the NSC3 intervention period, median daily step count jumped to 10,056 steps. This followed a mean increase of 1,096 steps per day after the trial commenced. [Am J Epidemiol 2022;doi:10.1093/aje/kwac193]

Fuzzy regression discontinuity design analysis, adjusted for potential confounders, confirmed that the NSC3 itself was significantly associated with an increase of 1,437 (95 percent confidence interval [CI], 1,408–1,467) steps per day. This effect varied according to age and sex. Younger participants had lower step counts before the NSC3 and also saw lower increases during the Challenge, as opposed to older comparators. Meanwhile, women logged better numbers than men across all age groups.

Similar effects were reported for the subchallenges. Of the 42,337 participants in Personal Pledge, 69.7 percent completed the challenge. At baseline, enrollers in the Pledge were taking 2,446 more steps per day than nonenrollers on average. This step count further improved by 1,172 steps during the challenge. Completers and noncompleters logged 12,592 and 10,189 steps per day, respectively.

Meanwhile, 87,718 participants enrolled into the Corporate Challenge, in whom baseline step count did not significantly differ from nonenrollers. The Corporate Challenge was associated with an average increase of 896 steps per day.

All step count improvements were sustained for at least a month from the start of the NSC3.

The researchers noted that “participants tend to regress to their prepledge physical activity levels after the Personal Pledge and upon the completion of their pledge goals.” Thus, it might be valuable to calibrate pledge goals periodically, prolong the intervention duration, or deliver a booster initiative after a certain amount of time.

“Findings suggest that mHealth interventions with small incentives and peer effects are an effective strategy to increase population-wide physical activity levels,” they added.

The National Steps Challenge

Delivered using an app and activity tracker, and lasting for 5 months, the NSC3 borrows concepts from behavioural science and uses a gamified framework to incentivize participants to reach predefined daily step targets. The mHealth components also deliver daily nudges and real-time feedback, allowing participants to adjust accordingly.

After achieving the main step goals of the NSC3, participants were offered the option to enroll into the Personal Pledge, which asks them to continue reaching their daily target for a specified number of days. As in the main intervention, monetary prizes were offered at amounts that were appealing without being overly coercive.

The Corporate Challenge was available to NSC3 participants whose companies opted into the team-based step challenge.