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Study: What motivates people to exercise? Money

A new study finds that a group of obese people chose to exercise regularly rather than pay 20 percent more for health insurance, even if they found the program "coercive."

Only 3 percent of enrollees didn't meet the 5,000-steps-a-day challenge. University of Michigan

A new study out of Stanford University and the University of Michigan suggests that some people appear more motivated by money than their own health.

Researchers followed a group of people insured by Blue Care Network, which -- rather controversially -- developed an incentives program that allowed its obese members to choose between paying as much as 20 percent more for health insurance or exercising. In real dollars, that added up to as much as $2,000 extra a year. (Those unable to walk due to medical reasons were exempt with a doc's note.)

Those who wanted to pay less could choose either Weight Watchers or WalkingSpree, which involves wearing a digital pedometer and uploading walking stats to a wellness tracking site.

Of the 12,102 enrollees facing this choice, almost half went with WalkingSpree. The researchers followed those 6,548 members, who had to take at least 5,000 steps every day over the course of three months or risk not qualifying for the 20 percent Healthy Blue Living Program discount. In the end, the researchers report in the journal Translational Behavioral Medicine, 97 percent managed to take at least 5,000 steps a day -- even though a third were unhappy with the financial incentives, which they considered coercive.

"There are ethical debates around the idea of forcing someone to be personally responsible for health care costs related to not exercising, but we expect to see more of these approaches to financially motivate healthier behaviors," senior author Caroline R. Richardson, M.D., assistant professor in the U-M Department of Family Medicine, said in a school news release. "Our evaluation of Blue Care's incentivized program showed a surprisingly high rate of people who enrolled in the Internet-mediated walking program and stuck with it -- even among those who were initially hostile to the idea.

"Wellness interventions like this clearly hold significant promise for encouraging physical activity among adults who are obese," she added.

The researchers were investigating a type of incentivized program that may become more widely used under the Affordable Care Act, given both employers and insurers save on health care costs when enrollees are, well, healthier.

According to the U.K.'s government-run National Health Service, 1,000 steps amounts to about 10 minutes of brisk walking, and the average person in the U.K. walks between 3,000 and 4,000 steps a day -- an amount some consider sedentary. In the U.S., one 2010 study found the average American takes just over 5,000 steps a day, which turns out to be significantly less than averages in western Australia (9,695 steps a day), Switzerland (9,650), and Japan (7,128).