By Amir Khan
When given the option to either exercise or pay more for their insurance, obese people chose to exercise and stuck with the plan, according to a study published today in the journal Translational Behavioral Medicine.
In 2010, health insurance provider Blue Care Network announced a program that gave people above a certain weight a choice between paying 20 percent more for health insurance or exercising more, according to the study. Of the 12,102 people who met criteria for the program, 6,548 agreed to participate by walking an average of 5,000 steps per day — approximately two and a half miles — for a year. Participants' walking distance was tracked by a pedometer that relayed their progress to an online program. Only 3 percent of the participants failed to meet the goal.
"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,” senior author Caroline R. Richardson, M.D., assistant professor in the University of Michigan Department of Family Medicine, said in a statement. “Wellness interventions like this clearly hold significant promise for encouraging physical activity among adults who are obese."
And while 5,000 steps is a good start, Daniel Ehlke, PhD, assistant professor of health policy and management at SUNY Downstate, said the real benefit comes from the habits the policy creates.
“It’s not a panacea, but if people begin to exercise or get in the habit of walking more, it develops and compounds on itself over time,” he said. “It’s not about getting to a certain number of steps, it’s about developing a habit that can increase over time.”
Researchers admit that there are concerns over the practice, but said that with the Affordable Care Act, also known as Obamacare, making insurance mandatory, insurers will likely resort to these types of programs to help bring down costs associated with obesity, which totals more than $140 billion annually, according to the U.S. Centers for Disease Control and Prevention.
"There are ethical debates around the idea of forcing someone to be personally responsible for health care costs related to not exercising,” Richardson said in the statement, “but we expect to see more of these approaches to financially motivate healthier behaviors."
The big problem with this type of program is that not everyone is able to meet certain criteria, said Ehlke, which could leave many people paying more for insurance.
“While some people are able to influence their weight or cholesterol based on lifestyle changes, there are others who are genetically predisposed to these conditions,” he said. “So for those, they are going to find themselves left in the cold and won’t be able to benefit from the programs.”
Another concern is that people could try to fake their progress by fooling the pedometer, but Ehlke said that likely won’t happen.
“I think that the mental expenditure required in terms of walking in place or getting the pedometer to move on its own accord would be greater than it would be to take the extra steps,” he said. “There’s going to be ways to get around it and monitoring is going to be an issue, but in cases like this, the extra effort isn’t going to be worth it.”
And despite ethical and logistical concerns, Ehlke said programs such as these seem to be a win-win.
“Consumers want to keep their premiums down, and if they can do that by changing lifestyle habits, many will choose to do so,” he said. “At the same time, insurers are looking for a way to keep payouts to a minimum, which this helps to do.”
“These are very exciting programs,” Ehlke added, “and if we continue to see many insurers developing programs like these, over time, we could begin to lessen healthcare costs across the country.”
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Take The Stairs
In 2008, a small Swiss study found that sedentary people who switched from taking escalators and elevators to taking the stairs <a href="http://news.bbc.co.uk/2/hi/7591311.stm" target="_hplink">cut their risk of dying prematurely by 15 percent</a>. "This suggests that stair climbing can have major public health implications," lead researcher Dr. Philippe Meyer, told the BBC. An earlier look at data from the Harvard Alumni Health Study also found that climbing 35 or more flights of stairs a week significantly <a href="http://aje.oxfordjournals.org/content/151/3/293.short" target="_hplink">increased longevity</a> when compared to people who climbed fewer than 10 stories a week. <em>Flickr photo by <a href="http://www.flickr.com/photos/mariachily/3381125472/" target="_hplink">mariachily</a></em>
<a href="http://www.huffingtonpost.com/2012/04/17/bicycle-bike-commuting-tips_n_1427869.html" target="_hplink">Biking to work</a> is a great way to squeeze exercise into your day, spend some time outside and even save on gas money. But a leisurely ride, while it might leave you less sweaty upon arrival at the office, won't do as much for your lifespan as if you really ride it out. A study of <a href="http://www.sciencedaily.com/releases/2011/08/110829070507.htm" target="_hplink">Copenhagen cyclists</a> found that men who pedaled the fastest lived more than five years longer than slower cycling men, and the fastest women cyclists lived almost four years longer. <em>Flickr photo by <a href="http://www.flickr.com/photos/8136496@N05/3801963043/" target="_hplink">terren in Virginia</a></em>
Take A Swim
A 2009 analysis of data from the Aerobics Center Longitudinal Study found that men who swam regularly had about a 50 percent <a href="http://www.reuters.com/article/2009/02/02/idUS159078+02-Feb-2009+PRN20090202" target="_hplink">smaller risk of dying</a> than sedentary men -- but swimmers also had a lower mortality rate than <a href="http://www.prevention.com/fitness/fitness-tips/swim-longer-life" target="_hplink">men who walked and ran</a> for their exercise. <em>Flickr photo by <a href="http://www.flickr.com/photos/west_point/4752428605/" target="_hplink">West Point Public Affairs</a></em>
Pick Up The (Walking) Pace
A <a href="http://jama.ama-assn.org/content/305/1/50.full" target="_hplink">2011 study</a> found that people who naturally walk at a pace of one meter per second, about 2.25 mph, or faster, <a href="http://www.msnbc.msn.com/id/40914372/ns/health-fitness/t/walk-faster-you-just-might-live-longer/#.T6f8JZ9Ytdo" target="_hplink">lived longer than their slower peers</a>. But walking pace might be more of an <em>indicator</em> of longevity rather than a way to increase it, the study's author cautioned. "Your body chooses the walking speed that is best for you, and that is your speed, your health indicator," lead researcher Dr. Stephanie Studenski told MyHealthNewsDaily. "Going out and walking faster does not necessarily mean you will suddenly live longer," she said. <em>Flickr photo by <a href="http://www.flickr.com/photos/29143375@N05/4012888936/" target="_hplink">Justin Scott Campbell</a></em>
Work Out For 15 Minutes A Day
Some think to get the full benefit of a good workout, you need to be sweating for a full 30 minutes -- or longer. But with so many people struggling to find a spare 30 minutes, researchers have begun to investigate if a shorter sweat session could be just as good. A 2011 study found when compared to sedentary people, <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60749-6/abstract" target="_hplink">15 minutes of daily activity</a>, like brisk walking, <a href="http://www.reuters.com/article/2011/08/15/us-exercise-taiwan-idUSTRE77E69L20110815 " target="_hplink">added three years to life expectancy</a>, according to Reuters. <em>Flickr photo by <a href="http://www.flickr.com/photos/lululemonathletica/3616976712/" target="_hplink">lululemon athletica</a></em>
Kick It Up A Notch
Walking faster, cycling harder -- there's an underlying theme to many of the benefits of exercise: <a href="http://www.ncbi.nlm.nih.gov/pubmed/7707624" target="_hplink">intensity</a>. Overall, <a href="http://jama.ama-assn.org/content/273/15/1179.short" target="_hplink">vigorous activities</a> seem to have more life-lengthening powers than nonvigorous activities, according to a 1995 study. In fact, <a href="http://archinte.ama-assn.org/cgi/content/full/165/20/2355" target="_hplink">intense exercise may double the years added</a> by moderate exercise, according to a 2005 study. Five days a week of walking for 30 minutes led to 1.3 to 1.5 additional years, <em>The Washington Post</em> reported, but intense exercise, like running half an hour five days a week, resulted in <a href="http://www.washingtonpost.com/wp-dyn/content/article/2005/11/14/AR2005111401051.html" target="_hplink">3.5 to 3.7 extra years</a>. <em>Flickr photo by <a href="http://www.flickr.com/photos/frankjuarez/2334732010/" target="_hplink">frankjuarez</a></em>