Blog post by Bernadette Keefe MD
“You can’t manage what you don’t measure.”
– (credited to, but not said by W. Edwards Deming)
If you are 50 years of age or older you are a Baby Boomer. By 2030, there will be 77 million people over the age of 65 in the U.S. alone. The U.S. National Institute of Aging has designated September as a Go-4-Life month: a national exercise and physical activity campaign for people 50+. The goal is to empower older adults to become more physically active. The International Council of Active Aging (ICAA) has designated the week of September 27 – October 3 as ‘Active Aging Week’ (recognized in the United States, Canada and Australia.) Each day is devoted to a specific healthy life habit: from walking to nutrition to social connection. The ICAA website has more information from this incredibly worthy organization.
The importance of our lifestyle/behaviors, to overall health is now undeniable. It is thought that 70% of chronic disease is caused directly or indirectly by the poor lifestyle choices we make. Now we can seamlessly measure our daily behaviors through fitness trackers.
The Wearable Tracker
There are numerable wearable trackers: devices to track activity/exercise, sleep, weight and nutrition. Forming healthy habits in each of these arenas is central to overall health and quality of life. Although we may feel essentially healthy, there is significant negative cumulative effect of sub-optimal lifestyle choices. Trackers provide tangible proof of where we need to improve.
While a basic fitness tracker does help track healthy habits, it is not a medical device but a consumer product meant for anyone wanting to take stock of their lifestyle and at the same time wanting to make fitness more fun. Trackers gamify simple actions such as walking, allowing one to compete with friends who also have the same device. One can compare to friends in real time throughout the day, cheer them on as they reach daily goals, while at the same pushing a little harder to triumph over them. (Note that smartphones also track activity and data can be recorded within apps on phones.)
It goes without saying that trackers don’t magically make one fit. The desire for behavior change comes first. It is nailing the behavior change ‘hook’ that will be the key to the ultimate success of these type of wearables. Impacting behavior change is the holy grail of personal and population health. The jury is still out on whether the use of current generation trackers brings improved health. While additional steps help and knowing average hours of sleep useful, the duration and intensity of exercise, number of sedentary hours, precise dietary intake and of course genetics all heavily influence our overall health. 10,000 steps alone is not a panacea, but it may be a start.
“It’s a good way to assess where you’re at, but the desire for behavior change comes first. You can think of these fitness trackers or calorie counters as companions to your motivation , but not replacement for them…”
– Nora Young (Author of The Virtual Self)
For myself, I finally recently purchased a basic Fitbit, mostly to track activity and sleep. I find it helpful to see in graph form my sleep habits and to have my steps seamlessly logged without carrying my smartphone.
Medical/Corporate applications of Fitness Tracker Data
“If its free, you’re likely the product”. – Unknown
At this point most of the personal fitness data obtained from trackers is used by the individual. In general most physicians do not consider this data (not readily analyzable, accuracy not guaranteed, time, etc) and electronic medical records do not accept this data. Private companies, however, are finding personal fitness data an invaluable treasure trove. Recently Target handed out basic Fitbits to each of its employees. Although touted as a win-win-win: for Target’s employees, Target and Fitbit, this is true depending on how you feel about personal health data, employer – employee trust and trust of corporations.
Target provides health insurance for its employees and knowing their lifestyle stats could help the company manage the risk of insuring them. For instance if too many employees make poor lifestyle choices, Target knows that insurance companies will demand a higher premium for insuring them. If Target can improve on these stats, they may be able to negotiate better contracts. Further, if Target finds it cannot afford the better health insurance policies (given too many unhealthy employees) they may be obliged to go to less employee friendly health insurance (higher deductibles with narrower physician and provider networks). The worse case scenario is that if too many in our nation have unhealthy lifestyles (with increasing obesity, diabetes, heart disease), employers may be obliged to shift so much of the out of pocket cost to employees (either through insurance of wage freeze) that middle class sinks further into poverty. This is happening now. Citizens must realize that wage stagnation and costs of medical care are intimately connected. All in healthcare must acknowledge the moral dilemma this raises.
An additional point is the status of personal health data. At this point data from fitness tracker is not considered “medical data”, and thus not protected if not incorporated into patient’s health record. Fitness device makers share the same silo mentality that electronic medical record venders have. While EHRs vendors do have protected personal health data (through HIPAA), and trackers have not demonstrated that they are HIPAA compliant (although the new Fitbit /Target deal claims that) both makers of EHRs and trackers are walled off endeavors, not interoperable. Data is not shared, but ‘owned’. Many of the fitness device makers sell the collected health data from devices to third parties (as part of business operations).
Behavior change is not easy and trackers fare similarly to workout clubs after January each year. 42% of tracker owners stop using the device within 6 months.
It is thought that effective behavior modification support systems are not present in routine trackers (not enough coaching, professional support, constructive feedback etc).
Additionally the tracker industry is missing out on marketing more directly to the population over 50 years old, a segment of the population not only large but one for who potential benefits of lifestyle change could be dramatic on brain, cardiac and overall health (obesity, diabetes, cancer). About 2% of Americans own a dedicated fitness tracker, the majority of who are under 35, well off, educated and physically active – generally not the people who could benefit the most from them.
A dramatic image of brain heat map……
…but worth noting the following about this image (heat map showing brain activity, an EEG recording). While the overall message of “exercise is good for brain health” is true the data in the image is incomplete and thus limited. Increased brain activity can come from stress as well, or from statistical manipulation of the data, data thresholds. Exercise however is thought to be protective against dementia, with scientific research into this ongoing.
Until recently I felt that current basic fitness trackers had little real utility and would be surpassed by more ‘loaded’ and sophisticated devices. I’ve changed my mind. If most adults tracked their weight, activity, sleep and nutrition, at least we would have a citizenry who would be more mindful and attentive to lifestyle habits and their own health. There is an elegant simplicity to these basic trackers that has potentially, universal appeal; they could be able to engage large segments of the population from young to old in their health.
* Note: Fitbit is the most popular basic fitness tracker. I use the word to generically, to imply all brands.
Please join the weekly #hcldr tweetchat on Tuesday September 22 2015 at 8:30pm ET (for your local time click here) where we will discuss the following topics:
- T1 Do you believe use of basic fitness trackers will improve people’s health? Why, why not?
- T2 Regarding tracker design: do you prefer a simple device, tracking only a few basic parameters (activity, sleep, nutrition, weight) or more ‘loaded’?
- T3 What should ideally happen with personal health data obtained from fitness trackers?
- T4 Would your mother or grandmother use a fitness tracker?
International Council on Active Aging http://www.icaa.cc/aboutus.htm
“Translating research into action: Go4Life Month promotes exercise”, Chhanda Dutta, National Institute on Aging, September 2 2015, https://www.nia.nih.gov/research/blog/2015/08/translating-research-action-go4life-month-promotes-exercise, accessed September 19 2015
“The best fitness trackers of 2015”, James Stables, Wearable.com, August 3 2015, http://www.wareable.com/fitness-trackers/the-best-fitness-tracker, accessed September 19 2015
“Wearable technologies and their effect on optimal aging”, McMaster Health Forum, June 24 2015, https://www.mcmasterhealthforum.org/new-at-the-forum/2015/06/24/wearable-technologies-and-their-impact-on-optimal-aging, accessed September 19 2015
“Can digital fitness trackers get you moving?”, Heidi Godman, Harvard Health Blog, August 27 2015, http://www.health.harvard.edu/blog/can-digital-fitness-trackers-get-you-moving-201508278214, accessed September 19 2015
“What happens to our brains when we exercise and how it makes us happier”, Leo Widrich, FastCompany, February 4 2014, http://www.fastcompany.com/3025957/work-smart/what-happens-to-our-brains-when-we-exercise-and-how-it-makes-us-happier, accessed September 19 2015
“The power of a well chosen image: EEG measures of brain activity and exercise”, NeuroBollocks, June 21 2014, https://neurobollocks.wordpress.com/2014/06/21/the-power-of-a-well-chosen-image-eeg-measures-of-brain-activity-and-exercise/, accessed September 19 2015
“Some doctors do want your Fitbit data”, Florence Comite, VentureBeat, September 3 2015, http://venturebeat.com/2015/09/03/some-doctors-do-want-your-fitbit-data/, accessed September 19 2015
“Guess what? Doctors don’t care about your Fitbit data”, Mark Sullivan, VentureBeat, August 15 2014, http://venturebeat.com/2015/09/03/some-doctors-do-want-your-fitbit-data/, accessed September 19 2015
“Target’s fitbit offer to workers may miss its mark”, Dan Mangan, CNBC, September 16 2015, http://www.cnbc.com/2015/09/16/targets-fitbit-offer-to-workers-may-miss-its-mark.html, accessed September 19 2015
“Target, Developing Healthier Habits, Hands Workers Fitbits”, Bree Fowler, New York Times, September 9 2015, http://www.nytimes.com/aponline/2015/09/16/us/ap-us-target-wellness.html?_r=0, accessed September 19 2015
“Sneakernomics: Wearable Technology And Sports Retail”, Matt Powell, Forbes, January 12 2015, http://www.forbes.com/sites/mattpowell/2015/01/12/sneakernomics-wearable-technology-and-sports-retail/, accessed September 19 2015
“The rise and fall of wearables”, Jane Sarasohn-Kahn, HealthPopuli, August 31 2015, http://healthpopuli.com/2015/08/31/the-rise-and-fall-of-wearables/, accessed September 19 2015
“User Experience Design”, Semantic Studios, http://semanticstudios.com/user_experience_design/, accessed September 19 2015
“Fitbit as the Wang Laboratories of Digital Health”, Bryan Vartabedian, 33charts, July 8 2015, http://33charts.com/2015/07/fitbit-wang-digital-health.html, accessed September 19 2015
“User Experience Basics”, Usability.gov, http://www.usability.gov/what-and-why/user-experience.html, accessed September 19 2015
“The AARP wants better fitness trackers for seniors”, Neal Ungerleider, FastCompany, July 13 2015, http://www.fastcompany.com/3048566/fast-feed/the-aarp-wants-better-fitness-trackers-for-seniors, accessed September 19 2015
“Wearables market missing the mark with aging consumers”, Anne Lim, LinkedIn Pulse, August 2 2015, https://www.linkedin.com/pulse/wearables-market-missing-mark-aging-consumers-anne-lim-%E8%B4%B5%E5%AE%B4?trk=mp-author-card, accessed September 19 2015
“The Ultimate Tech Product Test: “Is It Good Enough for Mom?“”, eCaring, May 19 2014, http://ecaring.com/ultimate-tech-product-test-good-enough-mom-review-hxrefactored-2014/, accessed September 19 2015