JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2013, 46, 568–581 NUMBER 3 (FALL 2013)

INTERNET-BASED CONTINGENCY MANAGEMENT INCREASES

WALKING IN SEDENTARY ADULTS
ALLISON N. KURTI AND JESSE DALLERY
UNIVERSITY OF FLORIDA

Despite the link between inactivity and premature mortality, most adults exercise less than the
Centers for Disease Control and Prevention (2008) recommends; thus, interventions to increase
exercise are needed. The present study employed an Internet-based intervention to increase walking
in 12 sedentary adults over 50 years of age. In Experiment 1, participants received monetary
consequences for meeting an increasing series of step goals on at least 3 days during consecutive
5-day blocks. Across participants, steps increased 182% from screening to the end of the
intervention, and 87% of step goals were met. In Experiment 2, goals were set using the same
schedule as in Experiment 1, but no monetary consequences were provided for meeting them.
Across participants, steps increased 108%, and 52% of goals were met. Across both studies, 11 of 12
participants increased their steps according to experimenter-arranged criteria. These results support
the efficacy of an Internet-based intervention to increase walking in sedentary adults.
Key words: contingency management, exercise, Fitbit, physical activity

Current physical activity guidelines recom-
mend that adults engage in 150 min of moder-
ate-intensity physical activity per week (Centers
for Disease Control and Prevention [CDC],
2008; Haskell et al., 2007). This recommenda-
tion can be met by exercising 30 min per day on
5 days during the week, in exercise bouts that last
at least 10 min (Haskell et al., 2007). Moderate
intensity can be quantified in terms of heart rate
(i.e., 40% to 60% of heart rate reserve; American
College of Sports Medicine, 2010) or defined as
any activity that requires an exertion level
equivalent to a brisk walk (Haskell et al., 2007;
Picket et al., 2002). Meeting the CDC’s physical
activity recommendation attenuates the risk of
developing heart disease, hypertension, Type 2
diabetes, osteoporosis, and certain types of cancer
This research was financially supported by the Depart-
ment of Psychology at the University of Florida. We thank
Jessica Brown, Valeria Altieri, and Tanvi Pendharkar for their
help with recruitment, data collection, and data entry. We
also thank Steven Meredith, Rachel Cassidy, Brantley Jarvis,
and Phillip Erb for providing suggestions on an earlier draft
of this manuscript.
Correspondence concerning this article should be
addressed to Allison N. Kurti, Department of Psychology,
University of Florida, P.O. Box 112250, Gainesville, Florida
32611 (e-mail: akurti@ufl.edu).
doi: 10.1002/jaba.58
(Fetcher et al., 1996). However, recent estimates
suggest that less than 5% of adults meet the
current physical activity recommendations
(Troiano et al., 2007).
Adults who meet the current physical activity
recommendations tend to engage in activities that
are simple (e.g., require minimal equipment,
coordination), convenient (e.g., can be con-
ducted in or near the home, at various times
during the day), and inexpensive (Owen,
Humpel, Leslie, Bauman, & Sallis, 2004).
Further, consistent with adults’ preference for
home-based activity programs rather than in-
structor-led programs in gyms, research shows
that participation in the former (e.g., telephone
or web-based programs) is greater than participa-
tion in the latter (Brawley, Rejeski, & King,
2003; King, Haskell, Taylor, Kraemer, &
DeBusk, 1991). Walking is one simple, conve-
nient, and inexpensive physical activity in which
adults can engage more frequently. Research
attests to the health benefits (e.g., reduced blood
pressure, body mass index, and waist and hip
circumference; improved insulin sensitivity) of
walking 10,000 steps (approximately 8 km) on
most days of the week (Iwane et al., 2000;
Schneider, Bassett, Thompson, Pronk, &

568
 CONTINGENCY MANAGEMENT INCREASES WALKING
Bielak, 2006; Yamanouchi et al., 1995). Further,
the recommendation to walk 10,000 steps per
day is consistent with the CDC’s guidelines
because individuals who walk 10,000 steps per
day are likely to elevate their heart rates to a
moderate-intensity range for at least 30 min (Le
Masurier, Sidman, & Corbin, 2003). On average,
however, American adults take approximately
half of the recommended steps per day (Bassett,
Wyatt, Thompson, Peters, & Hill, 2010).
Research suggests that activity-based programs
should be simple, convenient, and inexpensive
(Owen et al., 2004; Trost, Owen, Bauman, Sallis,
& Brown, 2002). Internet-based programs are an
example of emerging programs that meet these
requirements. Although research on Internet-
based physical activity interventions is in its
infancy, and evidence for their effectiveness is
mixed, some Internet-based interventions have
yielded promising results (Booth, Nowson, &
Matters, 2008; Carr et al., 2008; Irvine, Gelatt,
Seeley, Macfarlane, & Gau, 2013; Marcus
et al., 2007; Napolitano et al., 2003; Richardson
et al., 2010; Rovniak, Hovell, Wokcik, Winett, &
Martinez-Donate, 2005; Spittaels, Bourdeaud-
huji, Brug, & Vandelanotte, 2007; van den Berg
et al., 2006; Watson, Bickmore, Cange,
Kulshreshtha, & Kvedar, 2012; Woolf et al.,
2006). For example, Carr et al. (2008) showed
that participants who were given access to an
interactive website and sent weekly emails for
4 months walked more, decreased their waist
circumference, and decreased their coronary risk
ratio [i.e., total cholesterol (mg/dl)/HDL (mg/dl)]
relative to a delayed, intent-to-treat control
group. Because waist circumference and coronary
risk ratio predict heart disease (K. F. Petersen
et al., 2007), these results suggested that in
addition to increasing activity, the intervention
might protect against heart disease by minimizing
relevant risk factors. More recently, Watson et al.
(2012) showed that a combined treatment
involving a pedometer, website, and “virtual
coach” promoted the maintenance of activity
levels relative to a treatment in which participants
569
self-monitored activity using a pedometer and
website alone. Although the emerging literature
on Internet-based interventions to increase
activity seems promising, one limitation of
many interventions is their reliance on self-
reported physical activity, which sometimes
fails to accurately estimate activity levels (e.g.,
Siebeling, Wiebers, Beem, Puhan, & ter Riet,
2012). Objective measures of activity would
strengthen these interventions substantially.
One evidence-based treatment involving ob-
jective measurement of a target behavior is
contingency management (CM). CM allows
individuals to earn desirable consequences (e.g.,
vouchers redeemable for goods or services)
contingent on meeting an objectively verifiable
goal (e.g., drug abstinence). The three basic
requirements of CM interventions are (a) the
target behavior is readily detected (e.g., drug-
negative urine), (b) reinforcement (e.g., mone-
tary consequences) is provided contingent on
demonstrating the target behavior, and (c)
reinforcement is withheld contingent on not
demonstrating the target behavior (e.g.,
Petry, 2000). Although limited transportation
to treatment centers is sometimes a practical
limitation of CM, this problem is eliminated via
Internet-based interventions. For example,
Dallery and colleagues (Dallery & Glenn,
2005; Dallery, Glenn, & Raiff, 2007; Dallery,
Meredith, & Glenn, 2008; Meredith, Grabinski,
& Dallery, 2011; Reynolds, Dallery, Shroff,
Patak, & Leraas, 2008; Stoops et al., 2009)
employed Internet technology in which smokers
submitted breath carbon monoxide (CO) sam-
ples via a web camera. Voucher-based reinforce-
ment was contingent on breath CO levels below a
cutpoint for abstinence.
Some research already suggests that CM can be
employed to increase physical activity (Fitterling,
Martin, Gramling, Cole, & Milan, 1988;
Jeffery, 2012; Pope & Harvey-Berino, 2013;
Weinstock, Barry, & Petry, 2008). Because of
this, and to capitalize on the accessibility of
Internet-based interventions, we adapted an
570 ALLISON N. KURTI and JESSE DALLERY
Internet-based CM intervention designed for
smoking cessation (Dallery & Glenn, 2005;
Dallery et al., 2007, 2008; Meredith et al., 2011;
Reynolds et al., 2008; Stoops et al., 2009) to
promote physical activity. People 50 and older are
both the most sedentary segment of the adult
population (King, Rejeski, & Buchner, 1998;
Troiano et al., 2007) and are a fast-growing
group of Internet users (Marcus, Ciccolo, &
Sciamanna, 2009), making them good candidates
for an Internet-based CM intervention to
increase activity. Thus, the purpose of this
research was to test the feasibility, acceptability,
and efficacy of an Internet-based intervention to
increase physical activity (i.e., walking) in
sedentary adults. In Experiment 1, an Internet-
based CM intervention was delivered, in which
participants received monetary consequences for
meeting a gradually increasing series of step goals.
Because this treatment included potential con-
tributors to effectiveness other than CM (e.g.,
self-monitoring, experimenter feedback), Experi-
ment 2 was conducted to assess the effects of these
other components. Thus, the treatment delivered
in Experiment 2 was identical to the treatment
delivered in Experiment 1 except that the CM
component was removed.
GENERAL METHOD
Overview
Participants. Participants in both experiments
were recruited via classified advertisements and
flyers posted throughout the community. The
eligibility criteria were (a) 50 years old or older,
(b) self-reported physical activity of
2 days per
week for
30 min each time, and (c) computer
and Internet access at one’s place of residence.
Exclusionary criteria were (a) evidence of a major
psychiatric illness (e.g., taking psychotropic
medication within the past 6 months), (b)
evidence of any condition that might contraindi-
cate physical activity (e.g., asthma), (c) answering
“yes” to any questions on the Physical Activity
Readiness Questionnaire (PAR-Q, see phone and
in-person screening below), and (d) classifying as
high risk for cardiovascular disease according to
the Health Status Questionnaire (HSQ). The
University of Florida Institutional Review Board
approved all inclusionary and exclusionary crite-
ria and all experimental procedures.
Phone and in-person screening. Applicants who
responded to advertisements and flyers under-
went a brief telephone screening. They were
asked (a) their age, (b) how often they exercised,
(c) whether they had any medical conditions that
contraindicated physical activity, and (d) whether
they had a computer with Internet access at their
place of residence. Applicants who met the
inclusionary criteria were invited to the lab for a
60-min screening session.
During screening, participants first completed
the informed consent process. The consent stated
that the purpose of the study was to assess the
accuracy, ease of use, and likability of a motion-
sensor device (Fitbit) for recording steps during a
5-day trial period (see Procedure). Participants
were not informed that only by walking an
average of
6,000 steps per day during the trial
would they be eligible for a subsequent interven-
tion to increase activity. This information was
withheld to increase the likelihood that those
individuals who participated in the interventions
were not lowering activity levels to qualify for
inclusion.
Participants completed several questionnaires
during the screening, including a psychosocial
history, the PAR-Q (Hafen & Hoeger, 1994),
and the HSQ (Radosevich, Wetzler, &
Wilson, 1994). The psychosocial history con-
tained questions related to demographics, general
health, and medication use. The PAR-Q is a
screening measure that identifies individuals for
whom low- to moderate-intensity exercise is not
recommended. The HSQ identifies participants
as being at a low, medium, or high risk for
cardiovascular disease.
Measurement of steps. Participants in both
experiments were given a Fitbit, which is a
wearable three-dimensional motion sensor that
 CONTINGENCY MANAGEMENT INCREASES WALKING
tracks steps taken, calories burned, and distance
traveled. The device uses accelerometer technol-
ogy to measure tilt, motion, and orientation (i.e.
“raw acceleration signals” measured in m/s2) in
three-dimensional space. These accelerations are
then converted into familiar indicators of physical
activity (e.g., steps) using mathematical formulas.
All participants were instructed to wear the
Fitbit on their waistbands from waking time to
bedtime with the exceptions of sleeping and water
activities. When the Fitbit is placed on its charger,
activity data are automatically uploaded to a
website (www.fitbit.com). At this website, re-
searchers retrieved a graph of participants’ steps
over the course of the day, graphed in 5-min bins.
Participant access to this site was restricted because
the site contains other potentially influential
variables (e.g., social networking opportunities)
that, if made available to participants, would limit
our ability to assess the efficacy of the interventions
in question. However, all participants were given
the Fitbit, charger, and access to the site after
completing the interventions.
Study website. Participants logged into a secure

website (MOtiv8; see Dallery & Raiff, 2011, for
a review) on a nightly basis. After logging in

to MOtiv8, participants were taken to a personal
homepage that displayed a cumulative graph
of their daily step totals and the amount of
money they were accumulating. The homepage
also displayed a “Post Video” button, which
participants clicked to submit their step counts
each night. A fine-grained analysis of participants’
ongoing activity was available at the Fitbit
website. Participants could not access this
analysis, and thus were told that the videos
were the researchers’ only objective evidence
of their activity levels. Although participants
could receive payment at any time during
the study, all participants completed the study
before requesting to receive their earnings.
Earnings were paid in the form of a check mailed
to participants’ homes. The study was funded
by the University of Florida Department of
Psychology.
571
Activity logs. In addition to submitting videos
of their step counts, participants also completed
activity logs on a nightly basis. In the logs,
participants reported the topography of activities
in which they engaged to increase steps.
Participants received $1.00 per activity log during
the 5-day trial and $0.50 per activity log during
the intervention. Due to space limitations, an
analysis of the relation between the logs and the
step-count data is not presented.
Procedure
Screening period. Participants in both experi-
ments began the study with a 5-day screening.
Previous research suggests that 5 days is sufficient
to yield reliable estimates of sedentary behavior in
older adults (Hart, Swartz, Cashin, &
Strath, 2011). Every night before midnight,
participants submitted a video of their step total.
To submit a video, participants held the Fitbit’s
steps display before a web camera for several
seconds, typed the total into a “Results” box, and
clicked the “Post Video” button. Participants
received $5.00 per video submission during the
screening phase.
Intervention. Both experiments employed a
changing criterion design to set step goals. Step
counts were assessed over 5-day blocks, and
participants were required to exceed a goal on at
least 3 of the 5 days to advance to a higher goal.
This contingency allowed participants 2 “rest
days” per block, but they were not told what to do
on these days. Missed samples counted as days on
which participants did not meet their goals. Only
participants in Experiment 1 received monetary
consequences contingent on goal attainment.
If a participant met a 5-day goal criterion, his
or her new goal was either (a) to exceed the
fourth-highest step count from the previous
block or (b) a 1,000 step increase beyond the goal
of the previous block. Specifically, for participants
who greatly exceeded their goals, the implemen-
tation of the fourth-highest day criterion was
analogous to a percentile schedule of reinforce-
ment (Galbicka, 1994). The formula used to
572 ALLISON N. KURTI and JESSE DALLERY
calculate goals for these participants was k ¼
(m þ 1) (1–w), in which m (number of days per
block) ¼ 5, and k (rank on which the new goal is
based) ¼ 4. The exception to these methods of
calculating goals was that we added 1,000 steps to
each participant’s average steps per day, as
measured during the screening, to set their goal
for the first 5-day block of the intervention. For
example, if a participant’s screening average was
2,500 steps, his or her goal for the first 5-day
block would be to meet or exceed 3,500 steps. If
he or she walked between 3,501 and 4,000 steps
per day for at least 3 days during this block, his or
her next goal would be 4,500 steps. In contrast,
if he or she met the first block’s goal on 3 days
and his or her fourth-highest day was 4,700 steps,
the goal for the second block would be 4,700
steps. This schedule was selected based on pilot
work in our laboratory that suggested that (a) a
1,000 step increase ensured that participants who
barely met their goals made regular increases in
their steps per day, (b) participants who vastly
exceeded their goals were not limited to a 1,000-
step increase, and (c) these guidelines are
consistent with the American College of Sports
Medicine recommendation that increased activi-
ty levels are approached gradually (Nelson
et al., 2007), although it is unclear how “gradual”
should actually be quantified.
Treatment Acceptability Questionnaire (TAQ).
After completing the study, participants com-
pleted a TAQ asking them about the Internet-
based interventions (e.g., easy to use, fair, fun).
The items were answered using a visual analogue
scale, ranging from 0 (not at all) to 100
(extremely).
EXPERIMENT 1
Method
Participants. One man and five women, ranging
in age from 50 to 71 years (median ¼ 59),
participated. Although seven participants enrolled
in the intervention, one subsequently dropped
out due to self-reported dysfunctional Fitbit and
life stress. All six participants were white. Three
participants had completed some college, two
were college graduates, and one had completed
graduate school.
Procedure
Screening period. As noted above, participa-
tion commenced with a 5-day trial during which
participants self-monitored their activity using
the Fitbit and submitted daily step totals over

MOtiv8. After these 5 days, participants who
walked 6,000 steps per day were thanked for
their participation, and checks were sent to their
homes (N ¼ 4). Participants who walked

6,000 steps per day were asked to participate
in an intervention to increase their physical
activity levels (N ¼ 7).
Intervention. The intervention consisted of
successive 5-day blocks, during which partic-
ipants were required to meet their step goal on
3 days to receive compensation and advance to
a new goal. Participants received their step goals
for each block via e-mail.
Compensation. If participants met their step
goals on 3 days during a block, they were paid at
the end of that block. The amount corresponded
to the goal as follows: Participants whose goals
ranged from 2,000 to 2,999 steps per day during
a block received $2.00 at the end of the block for
meeting that goal on 3 days. If a goal ranging
from 3,000 to 3,999 steps per day was met on 3
days, the participant earned $3.00 at the end of
the block, and so on. Participants also received a
$3.00 bonus for advancing to a new goal. If
participants failed to meet a goal on 3 days
during a block, they remained at this goal until it
was met, at which point they were compensated
and received a new goal. The intervention was
terminated when participants walked 10,000
steps per day on 3 days during two consecutive
5-day blocks, or after 2 months elapsed.
Results and Discussion
Daily step totals for each participant are shown
in Figure 1. These data suggest that all six
 CONTINGENCY MANAGEMENT INCREASES WALKING 573

30000 BC014 12000 SP007

25000 10000

20000 8000

15000 6000

10000 4000

5000 2000

0 0
0 10 20 30 40 50 60 0 10 20 30 40 50 60
12000 16000
SH009 CR011
14000
10000
12000
Steps

8000
10000

6000 8000

6000
4000
4000
2000
2000

0 0
0 10 20 30 40 50 60 0 10 20 30 40 50 60
12000 CM008 12000 DJ012

10000 10000

8000 8000

6000 6000

4000 4000

2000 2000

0 0
0 20 40 60 80 0 10 20 30 40 50 60

Days

Figure 1. Experiment 1 participants’ steps per day. The dashed vertical lines represent a change in experimental
conditions from screening to intervention. The horizontal lines represent participants’ goals for each 5-day block, where
blocks are represented by each set of five connected data points. Note that the y axes are scaled differently for CR011 and
BC014, and the x axis is scaled differently for CM008.

participants increased their steps during the
intervention. For each participant, we calculated
his or her percentage improvement during the
final two blocks of the intervention (i.e., the final
10 days during which the goal was 10,000 steps
per day) relative to preintervention walking levels
(i.e., participants’ average steps per day during
the screening periods). We also calculated the
sum of money earned in the number of
days that participants were enrolled. The number
of days enrolled are shown in Figure 1, and
participants earned between $56.00 and $102.50
574 ALLISON N. KURTI and JESSE DALLERY

(median ¼ $93.25). Participants improved be-
tween 80% and 255.7% (median ¼ 182.2%)
over their screening averages.
Although participant goals could be either (a) a
1,000-step increase beyond the previous block’s
goal or (b) to exceed their fourth-highest day
from the previous block, the majority of
participants increased their steps by 1,000-step
increments (CR011 is an exception). On the
2 days per block that participants were not
required to meet their goal, several participants
(e.g., SP007, SH009, and DJ012) decreased step
totals to preintervention levels. One exception to
this is BC014, who demonstrated one unusually
high step count (25,595 steps) during his fifth
block. He reported that this was a vacation day
from work, and thus he engaged in various
activities (e.g., multiple walks).
Participant adherence and treatment accept-
ability were high. To assess adherence, we
calculated the percentage of scheduled videos
that were submitted by each participant. For
those participants who contacted the researchers
when they were unable to submit a video (e.g.,
out of town with no Internet access), these videos
were not counted as missed. On average,
participants submitted 95% of their scheduled
videos. That the treatment was well liked is
supported by the treatment acceptability data
(Figure 2). Although all participants reported that
they liked earning vouchers, two participants
(SP007 and CM008) gave relatively low ratings
when asked whether the vouchers helped them
increase their activity levels.
In sum, results from the present experiment
support the feasibility, acceptability, and efficacy

Treatment Acceptability Questionnaire

Ease of use

Helpful

Convenient

Fair

Fun

Recommend1

Liked Fitbit 2

Liked Graphs3

Liked Vouchers4

Vouchers Helpful 5

0 20 40 60 80 100

Visual Analog Scale

Figure 2. Experiment 1 (gray bars) and Experiment 2 (dark gray bars) participants’ responses to the treatment
acceptability questionnaire, where bars represent the mean rating for each item (1 ¼ I would recommend the Internet-based
walking intervention to others, 2 ¼ I liked using the Fitbit to monitor my progress, 3 ¼ I liked seeing my progress on the graph,
4 ¼ I liked earing vouchers, 5 ¼ Earning vouchers helped me increase my activity levels).
 CONTINGENCY MANAGEMENT INCREASES WALKING
of an Internet-based CM intervention to promote
walking in sedentary adults. Feasibility was
indicated by the fact that all seven participants
who qualified for the intervention enrolled,
although one subsequently dropped out. The
high percentage of scheduled videos that were
submitted (i.e., 95%) also supports the inter-
vention’s feasibility. Participant responses on the
TAQ, on which most participants rated the
intervention as easy to use, helpful, and so on,
support the acceptability of the intervention.
Finally, that all six participants increased their
steps during the intervention according to
experimenter-arranged criteria supports the effi-
cacy of this treatment. It is important to note that
the treatment delivered in Experiment 1 included
potentially influential components other than
monetary consequences (e.g., goal setting, self-
monitoring, experimenter contact). To examine
the relative contribution of these components,
Experiment 2 assessed the effects of the
intervention with no monetary consequences
for meeting step goals.
EXPERIMENT 2
Method
Participants. Six women and one man were
initially recruited to participate. One participant
demonstrated drastic increases in steps during the
intervention that were unrelated to experimenter-
arranged contingencies (i.e., she adopted a strict
diet and exercise regimen in preparation for an
upcoming wedding); thus, her data are not
discussed. The remaining six participants ranged
in age from 60 to 67 years (median ¼ 65.5). All
six participants were white. One participant had
completed some college, one was a college
graduate, and four had completed graduate
school.
Procedure
Participants in Experiment 2 received no
monetary consequences for meeting step goals,
but all other procedures were identical to those
575
used in Experiment 1 (e.g., the experiment began
with a 5-day trial, the same criteria for advancing
to new goals were used).
Results and Discussion
Daily step totals for each participant are shown
in Figure 3. These data suggest that five of six
participants (i.e., all except NP023) increased
their steps during the intervention according to
experimenter-arranged criteria. Improvement
over their screening averages ranged from
8.27% (NP023) to 186% (median ¼ 108.2%),
and participants earned between $7.50 and
$19.00 (median ¼ $17.50) for completing ac-
tivity logs.
As in Experiment 1, Experiment 2 participants
often reverted to preintervention walking levels in
the absence of experimenter-defined goals
(WL024 is an exception). In addition, most
participants advanced to new goals via 1,000-step
increments (YK017 is an exception). Despite
CD020’s and KM027’s 51% and 110.2%
increases over their screening averages, respec-
tively, their steps per day did not track the
changes in criteria as closely as MS016 or
WL024. Finally, unlike any participants in
Experiment 1, NP023 advanced to a new step
goal only once during the intervention.
As in Experiment 1, the participants demon-
strated high adherence and rated the intervention
favorably on the TAQ. The feasibility of the
intervention is supported by the 92% of
scheduled videos that were submitted, and
participant responses on the TAQ support the
intervention’s acceptability. Although the treat-
ment was well liked (on average), YK017 and
NP023 provided the lowest ratings on all items.
These ratings might be attributable to the
technical difficulties these participants experi-
enced during the experiment (e.g., Internet
outages, computer virus).
In sum, results from Experiment 2 support the
feasibility, acceptability and efficacy of an
Internet-based intervention in which goal setting,
in the absence of CM, was employed to increase
576 ALLISON N. KURTI and JESSE DALLERY

14000 MS016 14000 WL024

12000 12000

10000 10000

8000 8000

6000 6000

4000 4000

2000 2000

0 0
0 20 40 60 0 10 20 30 40 50 60 70
KM027 14000 YK017

12000
Steps

15000

10000

10000 8000

6000

5000 4000

2000

0 0
0 10 20 30 40 50 60 70 0 20 40 60
10000 NP023
14000 CD020

12000 8000

10000
6000
8000

6000 4000

4000
2000
2000

0 0
0 10 20 30 40 50 60 70 80 0 10 20 30 40 50 60 70

Days

Figure 3. Experiment 2 participants’ steps per day. The dashed vertical lines represent a change in experimental
conditions from screening to intervention. The horizontal lines represent participants’ goals for each 5-day block, where
blocks are represented by each set of five connected data points. Note that the y axis is scaled differently for NP023 and
KM027, and the x axis is scaled differently for CD020.

walking in sedentary adults. Despite removing
CM, five of six participants increased their steps
during the intervention according to experiment-
er-arranged criteria. However, we observed
greater variability across participants in Experi-
ment 2 than we observed in Experiment 1 (e.g.,
NP023 showed few to no increases in steps per
day, CD020 showed modest increases, WL024
showed increases that closely tracked experiment-
er-arranged criteria). Thus, the current data
tentatively support the efficacy of an Internet-
based intervention using goal setting (in the
 CONTINGENCY MANAGEMENT INCREASES WALKING
absence of monetary consequences) to increase
walking in sedentary adults. Further, the inter-
vention was less costly than the intervention
delivered in Experiment 1.
GENERAL DISCUSSION
Our results demonstrate the efficacy of an
Internet-based intervention to increase walking
in sedentary adults, and this intervention was
somewhat more efficacious with the CM
component. The majority of participants in
both experiments reached the 10,000-step goal;
thus, participants increased walking to a magni-
tude that was compatible with the CDC’s
physical activity recommendations. Specifically,
it is recommended that adults exercise for 30 min
at a moderate intensity most days each week (Pate
et al., 1995), which can be met by taking 10,000
steps (Le Masurier et al., 2003). Further, higher
activity levels should be approached gradually
(Nelson et al., 2007). Participants in the present
study were required to meet step goals on a
majority of days during successive 5-day blocks
to advance to new goals, and the 1,000-step
increase that most participants experienced
ensured that the final 10,000-step goal was
reached gradually. The 3-out-of-5-day criterion
used in the present study also maximized
opportunity to earn reinforcement during rela-
tively brief experiments.
Comparing the results of the experiments
suggests that Experiment 1 (monetary conse-
quences) was slightly more efficacious than
Experiment 2 (no monetary consequences).
Specifically, all six participants in Experiment 1
and five of six participants in Experiment 2
increased their steps according to experimenter-
arranged criteria. All six participants in Experi-
ment 1 reached the 10,000-step goal, although
CM008’s time elapsed before she attained this
goal on 3 days during two consecutive 5-day
blocks. Five of six participants in Experiment 2
reached the 10,000-step goal, and three of these
five attained this goal on 3 days during two
577
consecutive 5-day blocks. On average, the
percentage of goals met per participant in
Experiment 2 (63.3%) was lower than that in
Experiment 1 (91%), and Experiment 1 partic-
ipants met a higher percentage of goals (42 of 48
goals met ¼ 87.5%) than Experiment 2 partic-
ipants (24 of 46 goals met ¼ 52.2%). Experi-
ment 2 participants also demonstrated a slightly
lower percentage improvement over their screen-
ing averages (108.2%) than Experiment 1
participants (182.2%). Thus, under the present
procedures, monetary consequences contingent
on goal attainment made a small contribution to
efficacy relative to the other treatment compo-
nents combined (e.g., experimenter contact, self-
monitoring).
Similar to other research in which Internet-
based interventions increased either self-reported
activity (Carr et al., 2008; Napolitano
et al., 2003; Rovniak et al., 2005; Spittaels
et al., 2007) or objective measures of activity
(Booth, Nowson, & Matters, 2008; C. B.
Petersen et al., 2012; van den Berg et al., 2006;
Watson, Bickmore, Cange, Kulshreshtha, &
Kvedar, 2012), we delivered an Internet-based
treatment package (e.g., self-monitoring, goals,
vouchers in Experiment 1) to increase steps.
Thus, the individual components that contribut-
ed to the effectiveness of our interventions are
unclear. One possibility is that implicit social
contingencies contributed to the increased steps
observed in both experiments. For example,
experimenter monitoring of participant step
totals might act as a motivating operation for
meeting goals. Aside from experimenter contact,
the Fitbit itself provided feedback about activity
other than steps that might have influenced
behavior (e.g., calories burned, distance walked).
Future research should evaluate the relative
influence of the intervention components on
activity using a component analysis (Ward-
Horner, & Sturmey, 2010; van den Berg,
Schoones, & Vlieland, 2007).
One potential limitation of using an Internet-
based methodology for collecting activity data
578 ALLISON N. KURTI and JESSE DALLERY
was that we could not verify whether the
individual wearing the Fitbit was the intended
participant (e.g., a participant could give the
Fitbit to a more active individual and log his or
her activities). This difficulty in insuring that
remote sensors are collecting data about a specific
individual is called the one body authentication
problem (Cornelius & Kotz, 2010). The use of a
device that tracks heart rate might allow us to
address this problem more effectively. Like a
fingerprint, cardiac features are unique to
individuals (Israel, Irvine, Cheng, Wiederhold,
& Wiederhold, 2005); thus, inconsistencies in
heart rates could be used to evaluate the
likelihood that the intended individual was
wearing the device.
One limitation of our research is that the
Internet-based intervention delivered might only
be effective given suitable weather conditions.
On several days, participants reported that poor
weather accounted for their failure to meet their
step goals. The intervention’s effectiveness might
be limited to locations where the weather is
conducive to walking outdoors, or to participants
who have access to indoor tracks, treadmills, and
so on. A second limitation of the study is the lack
of male participants. Although few men expressed
interest in the study (N ¼ 8), both of our male
participants (BC014 and WL024) rated the
intervention similarly on the TAQ as the female
participants. In fact, men are less likely to use
pedometers than women and report that ped-
ometers are useful for assessing physical activity in
the short term but not for long-term use (Burton,
Walsh, & Brown, 2008).
An important direction for future research is
using more advanced devices to monitor physical
activity (e.g., devices that track heart rate and
identify physical activities based on one’s body
movements). The ability to track heart rates
would allow us to verify that participants
exercised at a moderate intensity during physical
activity. The use of a device that identifies specific
activities would also be beneficial because, in
addition to the 10,000-steps recommendation,
the CDC recommends that adults perform eight
to 10 muscle-strengthening exercises (e.g.,
weight-bearing calisthenics, stair climbing) on
at least 2 nonconsecutive days each week (Haskell
et al., 2007). Because the Fitbit is not designed to
measure these activities, the present study sought
to increase walking rather than other activities. A
device that distinguishes cardiovascular and
weight-bearing activities would allow us to design
an intervention that directly matches the CDC’s
current physical activity recommendations.
Future directions for research include determin-
ing the relative effects of the intervention
components, using more sophisticated technology
to measure and provide consequences for other
types of activity, and designing an intervention to
maintain high activity levels and promote long-
term health gains. Because walking more frequent-
ly can reduce the risk of developing heart disease,
hypertension, and cancer (Fetcher et al., 1996), as
well as prevent weight gain (Paterson &
Warburton, 2010), age-related disability (Pahor
et al., 2006), and premature mortality (Hamer &
Chida, 2008), walking is extolled as the perfect
preventive medicine (Tudor-Locke, 2012). In
addition, a significant reduction in society’s medical
expense burden could occur if a small portion of
inactive individuals walked an additional 2,000
steps per day (Aoyagi & Shephard, 2011). Because
the delivery of health-related interventions via the
Internet eliminates location as a barrier to
treatment, efficacious Internet-based interventions
like those employed in the present research stand
poised to substantially improve public health.
REFERENCES
American College of Sports Medicine. (2010). ACSM’s
guidelines for exercise testing and prescription. Philadel-
phia, PA: Lippincott Williams & Wilkins.
Aoyagi, Y., & Shephard, R. J. (2011). A model to estimate
the potential for a physical activity-induced reduction
in healthcare costs for the elderly, based on pedometer/
accelerometer data from the Nakanojo study. Sports
Medicine, 41, 695–708.
Bassett, D. R., Wyatt, H. R., Thompson, H., Peters, J. C.,
& Hill, J. O. (2010). Pedometer-measured physical
 CONTINGENCY MANAGEMENT INCREASES WALKING
activity and health behaviors in United States adults.
Medicine & Science in Sports & Exercise, 42, 1819–
1825.
Booth, A. O., Nowson, C. A., & Matters, H. (2008).
Evaluation of an interactive, Internet-based weight loss
program: A pilot study. Health Education Research, 23,
271–281. doi: 10.1093/her/cyn007
Brawley, L. R., Rejeski, W. J., & King, A. C. (2003).
Promoting physical activity for older adults: The
challenges for changing behavior. American Journal of
Preventive Medicine, 25, 172–183. doi: 10.1016/
S0749-3797(03)00182-X
Burton, N. W., Walsh, A., & Brown, W. J. (2008). It just
doesn’t speak to me: Mid-aged men’s reactions to
“10,000 steps a day.” Health Promotion Journal of
Australia, 19, 52–59.
Carr, L. J., Bartee, R. T., Dorozynski, C., Broomfield, J. F.,
Smith, M. L., & Smith, D. T. (2008). Internet-
delivered behavior change program increases physical
activity and improves cardiometabolic risk factors in
sedentary adults: Results of a randomized controlled
trial. Preventive Medicine, 46, 431–438. doi: 10.1016/j.
ypmed.2007.12.005
Centers for Disease Control and Prevention. (2008). Physical
activity for everyone. Retrieved from http://www.cdc.gov/
physicalactivity/everyone/guidelines/adults.html.
Cornelius, C., & Kotz, D. (2010). On usable authentication
for wireless body area networks. In USENIX Workshop
on Health Security and Privacy. USENIX Association.
Retrieved from http://www.cs.dartmouth.edu/dfk/
papers/cornelius-healthsec10.pdf
Dallery, J., & Glenn, I. M. (2005). Effects of an Internet-
based voucher reinforcement program for smoking
abstinence. A feasibility study. Journal of Applied
Behavior Analysis, 38, 349–357. doi: 10.1901/
jaba.2005.150-04
Dallery, J., Glenn, I. M., & Raiff, B. R. (2007). An internet-
based abstinence reinforcement for cigarette smoking.
Drug and Alcohol Dependence, 86, 230–238. doi:
10.1016/j.drugalcdep.2006.06.013
Dallery, J., Meredith, S., & Glenn, I. M. (2008). A deposit
contract method to deliver abstinence reinforcement for
cigarette smoking. Journal of Applied Behavior Analysis,
41, 609–615. doi: 10.1901/jaba.2008.41-609
Dallery, J., & Raiff, B. R. (2011). Contingency management
in the 21st century: Technological innovations to
promote smoking cessation. Substance Use and Misuse,
46, 10–22. doi: 10.3109/10826084.2011.521067
Fetcher, G. F., Balady, G., Blair, S. N., Blumenthal, J.,
Caspersen, C., Chaitman, B., … Pollock, M. L. (1996).
Statement on exercise: Benefits and recommendations
for physical activity programs for all Americans.
Circulation, 94, 857–862. doi: 10.1161/01.CIR.
94.4.857
Fitterling, J. M., Martin, J. E., Gramling, S., Cole, P., &
Milan, M. A. (1988). Behavioral management of
exercise training in vascular headache patients: An
investigation of exercise adherence and headache
579
activity. Journal of Applied Behavior Analysis, 21,
9–19. doi: 10.1901/jaba.1988.21-9
Galbicka, G. (1994). Shaping in the 21st century: Moving
percentile schedules into applied settings. Journal of
Applied Behavior Analysis, 27, 739–760. doi: 10.1901/
jaba.1994.27-739
Hafen, B. Q., & Hoeger, W. W. K. (1994). Wellness:
Guidelines for a healthy lifestyle. Englewood, CO:
Morton.
Hamer, M., & Chida, Y. (2008). Walking and primary
prevention: A meta-analysis of prospective cohort
studies. British Journal of Sports Medicine, 42, 238–
243. doi: 10.1136/bjsm.2007.039974
Hart, T. L., Swartz, A. M., Cashin, S. E., & Strath, S. J.
(2011). How many days of monitoring predict physical
activity and sedentary behaviour in older adults?
International Journal of Behavioral Nutrition and
Physical Activity, 8, 1–7. doi: 10.1186/1479-5868-8-62
Haskell, W. L., Lee, I., Pate, R. R., Powell, K. E., Blair, S. N.,
Franklin, B. A., … Bauman, A. (2007). Physical activity
and public health: Updated recommendation for adults
from the American College of Sports Medicine and the
American Heart Association. Circulation, 116, 1081–
1093. doi: 10.1249/mss.0b013e3180616b27
Irvine, A. B., Gelatt, V. A., Seeley, J. R., Macfarlane, P., &
Gau, J. M. (2013). Web-based intervention to promote
physical activity by sedentary adults: Randomized
controlled trial. Journal of Medical Internet Research,
15, 1–16. doi: 10.2196/jmir.2158
Israel, S. A., Irvine, J. M., Cheng, A., Wiederhold, M. D., &
Wiederhold, B. K. (2005). ECG to identify individuals.
Pattern Recognition, 38, 133–142. doi: 10.1016/j.
patcog.2004.05.014
Iwane, M., Arita, M., Tomimoto, S., Satani, O., Matsumoto,
M., Miyashita, K., & Nishio, I. (2000). Walking 10,000
steps/day reduces blood pressure and sympathetic nerve
activity in mild essential hypertension. Official Journal of
the Japanese Society of Hypertension, 23, 573–580. doi:
10.1291/hypres.23.573
Jeffery, R. W. (2012). Financial incentives and weight
control. Preventive Medicine, 55, S61–S67. doi: 10.
1016/j.ypmed.2011.12.024
King, A. C., Haskell, W. K., Taylor, C. B., Kraemer, H. C.,
& DeBusk, R. F. (1991). Group versus home-based
exercise training in healthy older men and women: A
community-based clinical trial. Journal of the American
Medical Association, 266, 1535–1542.
King, A. C., Rejeski, J., & Buchner, D. M. (1998). Physical
activity interventions targeting older adults: A critical
review and recommendations. American Journal of
Preventive Medicine, 15, 316–333.
Le Masurier, G. C., Sidman, C. L., & Corbin, C. B. (2003).
Accumulating 10,000 steps: Does this meet current
physical activity guidelines? Research Quarterly for
Exercise and Sport, 74, 389-395. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/14768840
Marcus, B. H., Ciccolo, J. T., & Sciamanna, C. N. (2009).
Using electronic/computer interventions to promote
580 ALLISON N. KURTI and JESSE DALLERY
physical activity. British Journal of Sports Medicine, 43,
102–105. doi: 10.1136/bjsm.2008.053744
Marcus, B. H., Lewis, B. A., Williams, D. M., Dunsiger, S.,
Jakicic, J. M., Whiteley, J. A., … Parisi, A. F. (2007). A
comparison of Internet and print-based physical
activity interventions. Archives of Internal Medicine,
167, 944–949. doi: 10.1001/archinte.167.9.944
Meredith, S. E., Grabinski, M. J., & Dallery, J. (2011).
Internet-based group contingency management to
promote abstinence from cigarette smoking: A feasibil-
ity study. Drug and Alcohol Dependence, 118, 23–30.
doi: 10.1016/j.drugalcdep.2011.02.012
Napolitano, M., Fotheringham, M., Tate, D., Sciamanna,
C., Leslie, E., Owen, N., & Bess, M. (2003).
Evaluation of an internet-based physical activity
intervention: A preliminary investigation. Annals of
Behavioral Medicine, 25, 92–99. doi: 10.1207/
S15324796ABM2502_04
Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, P. W.,
Judge, J. O., King, A. C., … Castaneda-Sceppa, C.
(2007). Physical activity and public health in older
adults: Recommendation from the American College of
Sports Medicine and the American Heart Association.
Medicine & Science in Sports & Exercise, 39, 1435–
1445. doi: 10.1249/mss.0b013e3180616aa2
Owen, N., Humpel, N., Leslie, E., Bauman, A., & Sallis,
J. F. (2004). Understanding environmental influences
on walking: Review and research agenda. American
Journal of Preventive Medicine, 27, 67–76. doi:
10.1016/j.amepre.2004.03.006
Pahor, M., Blair, S. N., Espeland, M., Fielding, R., Gill,
T. M., Guralnik, J. M., … Studenski, S. (2006). Effects
of a physical activity intervention on measures of
physical performance: Results of the lifestyle inter-
ventions and independence for elders pilot (LIFE-P)
study. The Journals of Gerontology: Series A: Biological
Sciences and Medical Sciences, 61, 1157–1165.
Pate, R. R., Pratt, M., Blair, S. N., Haskell, W., Macera,
C. A., Bouchard, C., … Wilmore, J. H. (1995).
Physical activity and public health. A recommendation
from the Centers for Disease Control and Prevention
and the American College of Sports Medicine. Journal of
the American Medical Association, 273, 181–188. doi:
10.1001/jama.1995.03520290054029
Paterson, D. H., & Warburton, D. E. (2010). Physical activity
and functional limitations in older adults: A systematic
review related to Canada’s physical activity guidelines.
International Journal of Behavioral Nutrition and Physical
Activity, 7, 1–22. doi: 10.1186/1479-5868-7-38
Petersen, C. B., Severin, M., Hansen, A. W., Curtis,
T., Gronbaek, M., & Tolstrup, J. S. (2012). A
population-based randomized controlled trial of the
effect of combining a pedometer withan intervention
toolkit on physical activity among individuals with low
levels of physical activity or fitness. Preventive Medicine,
54, 125–130. doi: 10.1016/j.ypmed.2011.12.012
Petersen, K. F., Dufour, S., Savage, D. B., Bilz, S., Solomon,
G., Yonemitsu, S., … Shulman, G. I. (2007). The role
of skeletal muscle insulin resistance in the pathogenesis
of the metabolic syndrome. Proceedings of the National
Academy of Sciences of the United States of America, 104,
12587–12594. doi: 10.1973/pnas.0705408104
Petry, N. M. (2000). A comprehensive guide to the
application of contingency management procedures
in clinical settings. Drug and Alcohol Dependence, 58,
9–25. doi: 10.1016/S0376-8716(99)00071-X
Pickett, M., Mock, V., Ropka, M. E., Cameron, L.,
Coleman, M., & Podewils, L. (2002). Adherence to
moderate-intensity exercise during breast cancer thera-
py. Cancer Practice, 10, 284–292. doi: 10.1046/j.1523-
5394.2002.106006.x
Pope, L., & Harvey-Berino, J. (2013). Burn and earn: A
randomized controlled trial incentivizing exercise
during fall semester for college first-year students.
Preventive Medicine Published online first: 4 Janu-
ary 2013. doi: 10.1016/j.ypmed.2012.12.020
Radosevich, D. M., Wetzler, H., & Wilson, S. M. (1994).
Health status questionnaire (HSQ) 2.0: Scoring compar-
isons and reference data. Bloomington, MN: Health
Outcomes Institute.
Reynolds, B., Dallery, J., Shroff, P., Patak, M., & Leraas, K.
(2008). A web-based contingency management pro-
gram with adolescent smokers. Journal of Applied
Behavior Analysis, 41, 597–601. doi: 10.1901/jaba.
2008.41-597
Richardson, C. R., Buis, L. R., Janney, A. W., Goodrich, D. E.,
Sen, A., Hess, M. L., … Piette, J. D. (2010). An online
community improves adherence in an Internet-mediated
walking program: Part I. Results of a randomized
controlled trial). Journal of Medical Internet Research,
12, Retrieved from http://www.ncbi.nlm.nih.gov/pmc/
articles/PMC3056526/ doi: 10.2196/jmir.1338
Rovniak, L. S., Hovell, M. F., Wokcik, J. R., Winett, R. A.,
& Martinez-Donate, A. (2005). Enhancing theoretical
fidelity: An e-mail-based walking program demonstra-
tion. American Journal of Health Promotion, 20, 85–95.
doi: 10.4278/0890-1171-20.2.85
Schneider, P. L., Bassett, D. R., Thompson, D. L., Pronk,
N. P., & Bielak, K. M. (2006). Effects of a 10,000 steps
per day goal in overweight adults. American Journal of
Health Promotion 21, 85–89. doi: 10.4278/0890-1171-
21.2.85
Siebeling, L., Wiebers, S., Beem, L., Puhan, M. A., & ter
Riet, G. (2012). Validity and reproducibility of a
physical activity questionnaire for older adults: Ques-
tionnaire versus accelerometer for assessing physical
activity in older adults. Clinical Epidemiology, 20, 171–
180. doi: 10.2147/CLEP.S30848
Spittaels, H., Bourdeaudhuji, I. D., Brug, J., & Vandela-
notte, C. (2007). Effectiveness of an online computer-
tailored physical activity intervention in a real-life
setting. Health Education Research, 27, 385–396. doi:
10.1093/her/cyl096
Stoops, W. W., Dallery, J., Fields, N. M., Nuzzo, P. A.,
Schoenberg, N. E., Martin, C. A., … Wong, C. J.
(2009). An Internet-based abstinence reinforcement
 CONTINGENCY MANAGEMENT INCREASES WALKING
smoking cessation intervention in rural smokers. Drug
and Alcohol Dependence, 105, 56–62. doi: 10.1016/j.
drugalcdep.2009.06.010
Troiano, R. P., Berrigani, D., Dodd, K. W., Masse, L. C.,
Tilert, T., & McDowell, M. (2008). Physical activity in
the United States measured by accelerometer. Medicine
& Science in Sports & Exercise, 40, 181–189. doi: 0.
l249/mss.0b013e31815a5lb3
Trost, S. G., Owen, N., Bauman, A., Sallis, J. F., & Brown,
W. (2002). Correlates of adults’ participation in
physical activity: Review and update. Medicine &
Science in Sports & Exercise, 34, 996–2001. doi:
10.1097/00005768-200212000-00020
Tudor-Locke, C. (2012). Walk more (frequently,
farther, faster): The perfect preventive medicine.
Preventive Medicine, 55, 540–541. doi: 10.1016/j.
ypmed.2012.07.009
van den Berg, M. H., Ronday, H. K., Peeters, A. J., le Cessie,
S., van der Giesen, F. J., Breedveld, F. C., & Vliet
Vlieland, T. P. (2006). Using Internet technology to
deliver a home-based physical activity intervention for
patients with rheumatoid arthritis: A randomized
controlled trial. Arthritis and Rheumatism, 55, 935–
945. doi: 10.1002/art.22339
van den Berg, M. H., Schoones, J. W., & Vlieland, T. V.
(2007). Internet-based physical activity interventions:
A systematic review of the literature. Journal of Medical
Internet Research, 9, Retrieved from http://www.jmir.
org/2007/3/e26/ doi: 10.2196/jmir.9.3.e26
Ward-Horner, J., & Sturmey, P. (2010). Component
analysis using single-subject experimental designs:
581
A review. Journal of Applied Behavior Analysis, 43,
685–704. doi: 10.1901/jaba.2010.43-685
Watson, A., Bickmore, T., Cange, A., Kulshreshtha, A.,
& Kvedar, J. (2012). An Internet-based virtual coach
to promote physical activity adherence in overweight
adults: Randomized controlled trial. Journal of
Medical Internet Research, 14, Retrieved from http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC3374543/. doi:
10.2196/jmir.1629
Weinstock, J., Barry, D., & Petry, N. M. (2008). Exercise-
related activities are associated with positive outcome in
contingency management treatment for substance use
disorders. Addictive Behaviors, 33, 1072–1075. doi:
10.1016/j.addbeh.2008.03.011
Woolf, S. H., Krist, A. H., Johnson, R. E., Wilson, D. B.,
Rothemich, S. F., Norman, G. J., & Devers, K. J.
(2006). A practice-sponsored web site to help patients
pursue healthy behaviors: An ACORN study. Annals of
Family Medicine, 4, 148–152. doi: 10.1370/afm.522
Yamanouchi, K., Shinozaki, T., Chikada, K., Nishikawa, T.,
Ito, K., Shimizu, S., … Sato, Y. (1995). Daily walking
combined with diet therapy is a useful means for obese
NIDDM patients not only to reduce body weight but
also to improve insulin sensitivity. Diabetes Care 18,
775–778. doi: 10.2337/diacare.18.6.775
Received April 25, 2012
Final acceptance March 4, 2013
Action Editor, Matthew Normand