Why fitness trackers alone won’t make you healthy
In typical Silicon Valley style, Apple’s Chief Operating Officer Jeff Williams stood at the front of the company’s auditorium unveiling the latest feature in their new Apple Watch – an electrocardiogram.
The crowd cheered as a graphic mimicking an EKG monitor pulsed on the large screen behind him. After the demo, American Heart Association President Ivor Benjamin appeared briefly on stage to show support for Apple’s latest development.
By simply holding your finger to a sensor on the watch, it can perform a test of your heart’s electrical activity typically only available in clinical settings. Using the corresponding app, you can even send a PDF to your doctor.
It marked one of the first over-the-counter FDA-approved EKG devices and another step forward for wearable devices, which have the potential to transform health care by helping us treat and manage chronic conditions. Yet as wearables become more popular and more sophisticated, research struggles to show they are actually making us healthier. The reason why has a lot to do with what motivates us and the limitations of current technology.
Use of wearables like the Apple Watch is expected to grow 20 percent each year by 2020, according to one industry analyst, with fitness trackers representing a large segment of that market. This includes fitness trackers by Fitbit, Garmin, Samsung and others that count steps, measure your heart rate, track your sleep, and provide real-time feedback when you’re inactive.
Chronic conditions like heart disease, cancer, diabetes, and obesity account for 90 percent of the country’s $3.3 trillion in health spending, according to the latest figures from the CDC. Preventing these conditions or managing symptoms would result in major cost savings, not to mention improved outcomes for patients.
Physical inactivity plays a big role in chronic conditions and fitness trackers have a lot of potential to improve these public health issues, according to Danielle Arigo, a professor at Rowan University who has studied wearable technology. Unfortunately, she said, the use of wearables to promote physical activity and weight control has not been particularly promising.
“This is likely because using wearables to our individual advantage requires a lot of knowledge and skill – what will benefit one user may not be the same for others, and most wearables don’t come with personalized behavior change plans,” she said. “Wearables may be most useful when paired with behavioral treatment to teach the skills needed to support healthy behavior change over time. When paired with behavioral skills and support, some digital tools have shown promise for helping to manage chronic conditions such as diabetes.”
A pair of studies published in 2016 revealed some of the limitations of wearable devices. Researchers at the University of Pittsburgh found fitness trackers were not effective in long-term weight loss treatment. During the 2-year trial, people who had a combination of behavioral weight loss counseling and a wearable device actually shed fewer pounds than those who just had behavioral counseling. In explaining the results, the team from the University of Pittsburgh said that while wearables provide feedback and engagement to users, they don’t guarantee adherence to healthy habits.
Another study by researchers at Duke University and the National University of Singapore measured activity among four groups – a control group, a group with only a fitness tracker, and two groups with fitness trackers and a reward. Almost half stopped wearing their activity tracker after six months, and after 12 months, one of the groups that received financial rewards was actually less active than before the study. The results showed that fitness trackers alone aren’t going to fight chronic disease, according to the lead author.
Other studies found similar results among adolescents. In one, a pair of British researchers discovered when teenagers were given Fitbits they were initially more active, but after a few weeks they became less active. One author attributed the results to the fact that Fitbit’s goals were not tailored to the individual, and teens would get discouraged when they didn’t meet the goals.
However, the research did indicate the teens were more likely to exercise when they competed with each other.
Other research has supported the idea that gamification – making an activity into a game or challenge – can lead to better outcomes. The University of Pennsylvania released a study that found families who used fitness trackers with gaming elements were more likely to reach their fitness goals. Perhaps more importantly, three months after the study, they retained their heightened activity levels.
This study also suggested that social connections can play an important role in motivating healthy behaviors.
Summit Health community health educators Nickie Fickel and Heather Myers teach GetFitNow, a 5-week program where participants are given a Fitbit and taught to measure their calorie intake versus their activity levels.
Fickel said she encourages friendly challenges in her classes and the social interaction provides a critical network of support for participants.
“I’ve had some people who already had a Fitbit and were trying to lose weight and they aren’t successful.” Myers said. “But the group helps in breaking it down a little more.”
The class setting also provides some accountability. Anita Foreman, one of the class participants, said if she were just using a fitness tracker on her own, she probably would not be as active.
“Since Nickie is counting the steps, I’m more motivated to exercise more,” she said.
This illustrates one of the major limitations of wearable devices – even though they can display encouraging messages and vibrate on your arm when you’re inactive, they’re not very effective in motivating us long-term.
A group of public health researchers at Penn State discovered similar findings in recent study, suggesting that in order for fitness trackers to be more effective, the motivational screen displays and text feedback need to have more powerful consequences. The lead author, Liza Rovniak, also wrote that additional research is needed to identify what reinforcers are most effective in different situations, as these can vary from person to person.
A separate group of researchers at Penn State is looking at ways to use the displays on a wearable system to help people struggling with addiction. When the device detects stress, it can show you immediate intervention strategies or a customized message like a picture of your child to reinforce positive behavior.
Timothy Brick, a professor who worked on the WearIT project, said one of the biggest needs in wearable development is in understanding the results in context and for the person, and applying them to real problems.
“The typical wearable app right now measures something that looks a little like stress and gives you a mindfulness intervention,” he said. “That’s great, and it works for some people, but stress looks really different on different people, and interventions work differently on each person, too. We need more progress on the theory of responsive and adaptive intervention to really be able to make a serious impact on individual people in real-life situations.”
Brick is interested in seeing how wearables work in the field of recovery, though he said there’s less movement toward this compared to stress management. He predicts wearable development will start to pick up in aging very soon as a means of keeping track of peoples’ health and mobility to keep them active and independent longer, and then the same tools will slowly work their way into all kinds of monitoring.
“From there, we’ll likely see it start with pathologies and work its way out into subclinical populations. So cases like autism, addiction, and anxiety disorders will be the start,” he said.
Arigo said one of the greatest needs for future research is determining who would benefit the most from wearables and under what circumstances.
“These include what training and/or behavioral skills are needed to maximize the potential benefits of wearables, what specific domains we should use to tailor, and how to engage people who might most benefit from using wearables,” she said. “Barriers such as cost and technology literacy need to be addressed in order to move forward.”
Looking forward, it’s very likely that wearables will be part of the solution in treating and managing chronic conditions, but they will not be a cure-all. Even with the benefits of fitness trackers that are growing more sophisticated by the day, we still have to identify how the devices can more effectively motivate us.
“What it comes down to is learning behaviors and how people can change them. That’s the hard part,” Myers said. “If they’re not ready to change, then you just bought them a Fitbit.”
