Piloting PAI Health - How Effective is the PAI App at Motivating Health Improvement?

December 16, 2020| By Tasneem Harnekar | L/H General Industry | English

Earlier this year before the world changed and COVID-19 became our new reality, Gen Re launched a company-wide, international pilot with our collaboration partner PAI Health to study the impact that engaging with the customised activity level designed by the PAI solution would have on improving the health and wellbeing of those participating.

For those not familiar with PAI Health, it has created a metric, the PAI Score, that provides actionable guidance on the precise dose of exercise required in a seven-day rolling period, targeting the level at which an individual’s cardiorespiratory fitness (CRF) improvement is optimised for cardiovascular disease (CVD) and overall mortality risk reduction.1

The PAI Score draws heart rate activity information from wearables, such as Fitbit, Garmin, Huami and Apple Watch, taking account of resting and maximum heart rates adjusted for exercise intensity and duration. Any activity that increases the heart rate above a threshold and into the CRF training zone may generate points, meaning people of all ages and fitness levels can score points from any heart rate raising activity they enjoy - whether that’s kickboxing, gardening or running after the grandkids.

We initiated the pilot study with 491 participants and planned to collect data that would answer the following research questions:

  • How many would stay through to the end of the pilot study?
  • Would adherence to the PAI metric change their behaviour and activity levels?
  • Could we shift the health of those who participate?

Study Participants

The study spanned 16 weeks with participants across North America, Latin America, EMEA and Asia-Pacific, representing a truly diverse subsection of Gen Re associates with respect to region, age, gender and fitness level.

Chart 1

Although there was no incentive to stay on the anonymised pilot study, and the timing overlapped with COVID-19 restrictions, the results of the study showed much better retention than expected, with 67% of participants remaining at the end of the 16-week period.

Changes in Activity

Honing in on those who actively engaged with the pilot from start to end and splitting them into broad activity groups of “low”, “moderate”, and “high”, we saw increased activity levels in individuals with low and moderate starting levels of activity, and increased workout effectiveness for all activity groups.2

Chart 2

For each group, the composite average PAI Scores were measured at the start and the end of the pilot, providing an indication whether participants had increased the level of activity over the period. Similarly, to measure the change in intensity we compared the number of average PAI points earned per minute of exercise at the start to the end of pilot.

Chart 3

Increase in Fitness Engagement

The pilot demonstrated a change in the attitude towards achieving fitness of those participants who continued with the pilot; showing that they seemed to be more engaged with their activity levels and were far more conscientious about how much exercise they were doing, how long they were doing it for, and the level of intensity at which they did it.

The change in behaviour also directly affected the CRF levels of participants. PAI calculates an estimated VO2 Max value, a proxy for measuring CRF and the greatest oxygen an individual’s body is capable of consuming. Looking at the same activity groupings and comparing the starting month average to the end of pilot average, all starting fitness level categories showed improvement in their VO2 Max values and hence their CRF level.

Chart 4

Figure 4 shows changes in the VO2 Max levels of participants measured in mL/kg/min. A central boundary of 1 mL/kg/min (as a unit of intake) either side of the axis represents a similar fitness level to the start of the pilot. Inspection of the VO2 Max of each participant showed an overwhelming tilt toward individual improvement with very few participants decreasing their VO2 Max and even fewer displaying dramatic negative changes. For most participants, their presence on the pilot study improved their CRF and general health.

Chart 5


The results show that a significant portion of participants shifted from their original CRF-determined fitness category to better category levels, some jumping more than one level. Only seven of the original 491 shifted to lower categories.

Overall, the pilot study provided valuable insight into the prospective positive impact that partnering with PAI Health could have on a population cohort. With much of the insurance sector shifting toward prevention and ongoing engagement, PAI could provide an effective standalone or complementary tool that enables insurance companies to interact with customers and positively motivate behavioural changes in physical activity, helping customers get healthier and reducing their risk of illness and premature death.

To find out more, contact me or speak to your local Gen Re representative.

  1. Cardiorespiratory fitness (CRF) is the ability of an individual’s circulatory and respiratory system to supply oxygen to skeletal muscles and the heart during sustained levels of exercise.
  2. Grouping of initial activity levels was based on the average weekly PAI Scores earned during the first month. Those earning less than 50 on average were classified as “low”, those earning between 50 and 100 were classified as “moderate”, and those earning greater than 100 were classified as “high”.


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