June 30, 2017


Let's Enjoy Walking for the Benefits of Better Health -- Smart Wellness Point Project

Keywords: Aging Society Newsletter Policy / Systems Well-Being 

JFS Newsletter No.178 (June 2017)

Image by Tsippendale.

Japan leads the world in terms of longevity. It is also the fastest aging country in the world. According to data from the Ministry of Health, Labour and Welfare (MHLW), the proportion of elderly aged 65 or over among the overall population was 26.7 percent in 2015, and has been increasing each year. In line with this trend, national medical expenditures have been rising year by year as well, reaching 40.807 trillion yen (about US$364.35 billion) in FY 2014.

Under these circumstances, Japan is seeing a movement to create a sustainable, prevention-oriented society in which people can lead happy and healthy lives regardless of the population's advancing age. The aim is to build Smart Wellness Cities where residents are encouraged to walk voluntarily. Local governments together with industry and academia have established "Smart Wellness City Comprehensive Special Zones to Achieve Health and Longevity." By doing so, they aim to facilitate behavioral changes among residents, including those indifferent to health promotion.

In this newsletter, we introduce the Smart Point Project in which even people who are not interested in health can have fun participating by walking to promote health. This was conducted as an experimental project in the comprehensive special zones.

Overview of the Project

Tsukuba Wellness Research Inc., a company that analyzes health measures and policies based on medical science data, took the lead in conducting the "Six-City-Partnership Smart Wellness Point Project," collaborating with six cities participating in the Smart Wellness City Comprehensive Special Zone from December 2014 to March 2017. These cities were Date in Fukushima Prefecture, Ohtawara in Tochigi Prefecture, Mitsuke in Niigata Prefecture, Urayasu in Chiba Prefecture, Takaishi in Osaka Prefecture, and Okayama in Okayama Prefecture.

In this program, people received points for participation and continuation in the health promotion programs offered by each city, and for daily health promotion efforts toward better health. It was possible to gain as many as 24,000 points a year, equivalent to 24,000 yen (about US$ 214.29).

Here are some examples of points given. "Doing My Best" points were given at a rate of 800 points a month when a participant's number of steps increased by a certain amount compared with the standard number of steps or when it reached the recommended number of steps. "I Did It" points were given according to the number of days participating in designated programs. Participants received 20 points per day, up to 200 points a month. Also, 500 points were given each six months if the participants' body-mass index (BMI) and muscle percentage measured each three months had improved, or if they stayed within the standard range.

The points saved could be exchanged for Ponta points (another reward point system with cards that can be used nationwide), community certificates or social contributions (donations). The incentive system was aimed at motivating people who did not exercise regularly or enough to promote health.

Participants needed to be over 40 years old and live in the municipality. Provided with pedometers, they could earn points calculated by an algorithm constructed from the viewpoint of health promotion efforts and achievements, based on the number of steps accumulated on the pedometers and body composition data measured by equipment installed at centers.

Outcomes of the Project

Over the course of three years, the project achieved three successes.

1. Many people with no interest in exercising participated.

Of the approximately 12,600 participants, 76 percent were people with no interest in exercise, such as those who did not exercise regularly (no exercise group) or who had participated in health promotion programs but failed to exercise enough (insufficient exercise group).

The participants' step count increased by about 2,000 steps per day. From an average of 6,473 per day during the first week of the program it climbed to over 8,000 per day -- the national recommendation for physical activity -- six months later. This increase was not temporary. Participants maintained an average of 8,647 steps, above the recommended activity level, even 18 months later. Even those who lacked interest in exercise increased their step count by nearly 3,000 from 4,800 at the start of program to 7,500 18 months later.

The project showed that providing participants incentives, health workshops and exercise programs suitable to them could motivate them to exercise more and promote behavioral changes among those with no interest in exercise, resulting in increased and ongoing physical activity.

* The "no exercise group" in this pilot project was defined as people not meeting the national recommendation for physical activity before the project started, who had never participated in municipal or private sports or exercise programs. The "insufficient exercise group" was people who did not meet the national recommendation for physical activity before the project started but had participated in municipal or private sports or exercise programs.

2. Health Improvements in BMI and Metabolism

As the volume of physical activity increased, 26 percent of the participants whose initial BMI exceeded 25 before the project started improved their BMI to below 25 in 18 months. Also, 35 percent who had suffered or were likely suffer from metabolic syndrome before the project started improved their health and were diagnosed as free from metabolic syndrome at their health check-up two years later. The effect of ongoing exercising on health was clearly demonstrated.

3. Medical Cost Control and Spillover Effects on the Local Economy

According to surveys of Japanese National Health Insurance program members conducted before and after the launch of the project, the total annual medical costs of the six participating cities were reduced by 43,000 yen (about US$384) per person in their 60s, and 97,000 yen (about US$866) per person in their 70s and over. The spillover effects on the local economy amounted to 120 million yen (about US$1.07 million). The net profit for the entire project (total decrease in medical spending plus spillover effects on the local economy minus total annual project costs) is estimated to be 470 million yen (about US$4.2 million).

Participants surveyed in Ohtawara, one of the participating municipalities, replied that the points system served as an impetus and that it was fun to join health classes with many friends. Many of them were satisfied with the project and wanted it to continue.

This is because their efforts and the results of exercise were visibly demonstrable, including numbers and points. At the same time, they saw their own physical condition improving. This has also contributed to each participant's continued exercising.

Actions after the Pilot Project

The project ended in March, 2017, but five of the six municipalities, Ohtawara, Mitsuke, Okayama, Date and Takaishi plan to continue the project with their own budgets. Even outside the special zones, more and more municipalities are conducting their own Smart Wellness Point programs.

In the private sector, some companies have decided to expand the results of the pilot project, aiming to provide services to more than 1 million residents by FY 2020 through information communication technology (ICT) systems. Others have started in-house initiatives to promote employee health.

In this rapidly aging society, achieving health and longevity is an important challenge for both individuals and society. On the other hand, many feel that actions to promote health are hard to establish as personal habits. We hope that this initiative can expand nationally, leading to better health for more people.

Written by Yuka Kume