One of the themes that we repeat here at Health Tech Insider is our market analysis that the wearables market is shifting. Instead of selling single units to individual consumers, companies will sell tens or hundreds (or thousands) of units at a time to large organizations that will benefit financially from a healthier population: large employers, insurance companies, and healthcare systems. We have covered lots of pilot programs and broad adoptions at the enterprise level, many of which demonstrate significant returns on investment.

One question stands out, however: what are the attributes of a successful employee exercise program? The Rand Corporation undertook a study to find the answer. They conducted an analysis of more than 400,000 participants in a wellness incentive program in three countries: South Africa, the United Kingdom, and the United States. In their free report, “Incentives and Physical Activity,” they looked at the records from a South African insurance company, Discover, that offers “Vitality Active Rewards” programs to members. One version of the program is “gain-framed”: as employees reach certain goals, they earn rewards. The other version is a “loss-framed” design, in which members can purchase an Apple Watch at a discount, and then pay for it over time. The monthly payments are tied to physical activity goals, and the member pays less if the goals are met.

The results showed regional variations among the three countries, but in general, the loss-framed system resulted in increased physical activity compared with the gains-framed program. Members had about 34% more tracked activity days, or about 4.8 additional activity days per month. Another interesting finding related to members who were at risk for poor health due to obesity or other factors. This group tended to participate at a lower rate in these incentive programs, but among those who did, the loss-framed program produced even greater increases in activity levels. For the U.S. at-risk members, tracked activity days doubled. Finally, the programs showed persistent behavior changes, including the two-year repayment period for the Apple Watch incentive.

The bottom line here is that organizations would do well to consider how they structure employee exercise incentive programs. It can make a difference in how effective and lasting the impact will be on employee health.