By Professor Joan Costa-i-Font
Financial incentives have a long history in high-income countries as a tool to encourage healthier lifestyles. Programmes such as Singapore’s, the UK’s Vitality Active Rewards, and a range of US employer wellness schemes reviewed by the RAND Corporation rewarded physical activity, weight loss, or other healthy behaviours. Similar incentive-based interventions have also been tested for smoking cessation in randomised trials, including in a landmark study.
In January 2027, building on this tradition by using loyalty-style rewards to promote everyday walking at population scale, NHS England will launch Movement 26.2 – a walking-rewards scheme fronted by Sir Brendan Foster and Keith Mills, encouraging people to log 20–30 minutes of walking a day (a “marathon a month”) in exchange for digital badges and retailer vouchers, tracked through an app or wearable device. NHS chief executive Jim Mackey has tied it to the government’s 10-Year Health Plan, pitching it as a way to make movement “part of everyday life” without demanding gym memberships or expensive equipment.
It’s a genuinely interesting moment – not because the scheme itself is revolutionary, but because of what it reveals about how hard it is to design incentives that actually change behaviour.
The details of Movement 26.2 are still thin, and that’s worth saying plainly. What’s promising is the framing: this is a prevention-focused intervention, not another treatment pathway bolted onto an already-stretched NHS. But several structural questions remain open. Is the scheme NHS-funded, retailer-funded, or some hybrid – and does that funding model hold up over years, not just a launch cycle? Will it be genuinely universal, or effectively opt-in for people who are already digitally engaged? And critically: is there a baked-in evaluation plan, ideally something close to a randomised trial, to establish whether the scheme actually shifts activity levels – or is this a launch with no mechanism to ever answer that question? None of this makes the scheme a bad idea. It just means the interesting part hasn’t happened yet.
How do incentives change behaviour?
The behavioural science on habit formation is fairly consistent, and it starts with a simple loop: cue, routine, reward. Digital nudges anchored to a specific, prespecified trigger – a set time of day, for instance – tend to outperform open-ended targets, because they help build automatic routines rather than relying on people to remember on their own.
This is sometimes called the “habit loop” and it’s worth noting that the loop works identically whether the habit being reinforced is healthy or not – which means good scheme design has to deliberately engineer the cue and the routine, not simply dangle a prize at the end. Schemes such as Singapore’s National Steps Challenge and the UK’s Vitality programme have used this approach, with the latter associated with substantial increases in physical activity.
Two other design principles matter more than people tend to assume. First, frequency and immediacy of feedback often matter more than the size of the reward. Evidence suggests that small, frequent incentives tied closely to behaviour can be more effective than large, delayed payments. Second, and often overlooked, is what happens when the incentive stops. A scheme that only works while rewards are flowing has not necessarily built a habit. Reviews of financial incentive programmes find that effects often fade once incentives are withdrawn.
There’s a persistent assumption that more money means more behaviour change. The evidence doesn’t really back that up. A US trial found that financial incentives of equivalent value did not increase colorectal cancer screening uptake compared with no incentive, while a comparable UK trial found that offering a financial incentive failed to increase NHS Health Check attendance. The presence of a reward often matters more than its size – throwing more money at a scheme isn’t a reliable lever if the design and framing are off.
What does move the needle more reliably is loss aversion. Incentives that are loss-framed – where someone is paid upfront and loses part of the money if they miss their goal – tend to outperform equivalent gain-framed rewards for physical activity specifically, though this is still built on a relatively small evidence base. Personal relevance also matters: generic vouchers land very differently from rewards tied to something a person actually values, which is one reason retailer partnerships, done with genuine choice and variety, can outperform a single fixed reward type.
Who will the scheme actually reach?
Here’s the sharpest critique to raise about Movement 26.2, and incentive-based health schemes generally: they tend to attract people who are already engaged – already active, already comfortable with apps and wearables – which is precisely the opposite of who the NHS most needs to reach. Incentive schemes can widen health inequalities rather than close them, if uptake skews toward people who were always going to participate anyway.
Reaching genuinely low-activity and hard-to-engage groups is likely to require more than an app and a voucher. Success may depend on trusted messengers, community-based delivery, and communication strategies that resonate with people’s daily lives rather than feeling prescriptive. In this respect, approaches based on education-entertainment and social norm change may prove more effective than conventional loyalty-points schemes in generating sustained behavioural change.
One target doesn’t fit everyone
A related design flaw sits inside the headline target itself. A single national goal – 20–30 minutes a day, a marathon a month – risks failing in two directions simultaneously: it’s trivial for someone already active, so it changes nothing for them, and it can feel unreachable for someone starting from very low activity, particularly older adults or people with mobility constraints. Older adults are already the group least likely to meet standard activity guidelines, so a flat national target risks either alienating them or simply being irrelevant.
This question has particular relevance in the East of England, where some areas have much older populations than the national average. At the 2021 Census, the median age was 49 in East Suffolk, compared with 40 across England, while North Norfolk had the highest median age of any local authority in England, at 54. A national scheme designed to increase physical activity therefore needs to work for people with very different starting levels of mobility.
Goal-setting research consistently favours personalised, graduated targets that start from someone’s actual baseline and build up, rather than measuring everyone against the same bar. There’s also a quieter, less obvious problem worth flagging: even people who are already active don’t reliably claim rewards they’re entitled to. Engagement with the reward mechanism itself is a design problem, not purely a motivation problem.
Tracking brings problems of its own
Digital tracking – smartwatch, phone GPS, app-based logging – is what makes a scheme like this scalable and low-admin compared to manual reporting. But it introduces a trust problem. The familiar stories of people strapping fitness trackers to dogs, bike wheels, or washing machines aren’t just funny anecdotes – they’re a reminder that any verification system built on device motion data alone can be gamed, and the more valuable the reward, the stronger the incentive to game it.
This creates a genuine trade-off. Tighter verification – GPS combined with heart-rate cross-checks, for example – reduces fraud, but raises the bar to participate and can exclude people without capable devices, which loops straight back to the equity problem above. Not everyone owns a smartwatch or a smartphone capable of running the app, so verification design effectively decides who’s eligible in practice, regardless of who’s eligible on paper.
What happens when the rewards stop?
The honest success metric for Movement 26.2 isn’t “did people walk more while the scheme was running.” It’s “did anything stick once the rewards stop or move on.” The wider literature is fairly consistent that short-term incentivised behaviour often doesn’t persist once the incentive is withdrawn – which means the scheme needs to be treated as scaffolding for habit formation, not the habit itself.
Two things matter for that scaffolding to actually hold. The environment has to support the behaviour once the reward disappears – safe, walkable local environments, workplaces and routines that make daily movement genuinely easy. And the scheme itself needs to keep evolving rather than staying static, because fixed targets lose their motivational pull once people habituate to them. Moving or escalating targets, novelty in rewards, and social or community elements – rather than a purely individual, transactional relationship with an app – all help sustain engagement past the initial novelty phase.
Movement 26.2 is a well-intentioned, prevention-focused idea sitting on top of a genuinely solid evidence base – the problem is that good evidence doesn’t guarantee good execution. Whether it succeeds will come down to details that haven’t been announced yet: how targets are personalised, how rewards are structured and verified, how hard the NHS works to reach people outside the already-engaged, and what plan – if any – exists to measure whether it works at all. Get those right, and it could be a genuinely useful nudge in a country that badly needs to move more. Get them wrong, and it risks becoming another well-funded scheme that rewards the people who needed it least.
This article originally published on LSE Blogs is reproduced under a Creative Commons licence (CC BY 4.0). Read the original here.
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