Just Read: I’m in the 10% (who still wears their fitness tracker)

This is a randomized-controlled study (link here, paywalled) of “modern” wearable that has been widely reported (here, and here, among other places, with a “we told you so” tone). It casts doubt on the effectiveness of fitness trackers to promote physical activity and health.

Interestingly to me, the baseline/context study that they cite is the 2007 JAMA piece that headlines my epic post “The Art of the Walking Meeting” from that same time. So I guess I am a product of a nearly 10-year experiment to discover whether personal physical activity data can make a difference in a person’s life.

This study

The design and device selection manages much of the criticism directed at the other recent wearables study, which I wrote about previously:

Just Read: Study – Wearables don’t improve weight loss – can you outrun a bad diet?

Specifically this criticism was addressed in this study:

  • This is a “modern” wearable device (Fitbit Zip)

Actually, come to think of it, I think that was the major criticism of that study 🙂 .

This study did not include a comprehensive weight loss intervention program like the JAMA study did, so was not really set up to show weight loss. We should be surprised if it did, because there really hasn’t been much evidence that data by itself results in weight loss. Same goes for exercise by itself resulting in weight loss.

What the study did do is look at the attrition rate of wearable device use and impact on physical activity, specifically steps per day/week, and with a cool twist, the addition of cash incentives, both to the person, and to the charity of a person’s choice (from a selection of 13 options).

Two other things the researchers did that I found interesting:

  • They stratified participants by level of baseline activity, either “active” or “insufficiently active,” which allows the study of people who are already motivated
  • They required participants to pay S$10.00 up front ($7.18 US) to join the study, which today is a non-trivial percentage of the cost of a wearable device, to screen out the “marginally motivated”

And, the attrition rate for device wear was high at 12 months. 90% high. Fitbit use was slightly protective, because curiously, the group without any device became less active over the 12 months of the study (probably because they had good intentions when signing up for a study on physical activity?). The rest of the numbers are on the disappointing side, and the extrinsic/intrinsic motivation pattern that we’ve all learned about also showed itself – people who were given cash to take extra steps regressed even more when the money was taken away compared to the no-cash group:

In fact, we noted a potential undermining effect of cash incentives on MVPA bout min when comparing the cash group with the Fitbit group, driven by a net difference of 42 MVPA bout min per week (95% CI −79 to −5; p=0·0246) among participants who were already active at baseline.

Me: So I’m in the 10%

Ever since the JAMA study came out in 2007 I’ve been wearing a fitness device of some kind, from a $10 pedometer to an Apple Watch (“Apple Watch Review, by a former Google Glass Explorer“) – my fitbit interlude was very short – I admit I’m a shiny object type of person.

There’s a notable difference in the metrics of Apple Watch, by the way. It counts calories, not steps, steps are actually obfuscated in the interface. This is something the researchers noted as a limitation in their study – the idea that steps don’t mean very much to a human. Calories (in my opinion) are more translatable to other behaviors like eating that are a part of the health equation.

All of this aside, I am in the 10% of people who still wears a fitness tracker, I am already motivated to be active, mostly because of the knowledge of what it can do for me, the people I serve, and a host of INtrinsic motivational factors. Does that make a device like this by itself a strategy for a population? Probably not. Is it useful for me? Yes.

The key point for me is “by itself.” As I look back through the retrospectoscope of the mini-walking revolution I have created, I do see people who weren’t going to be motivated by the same things I was no matter how convincing I tried to be, which is the definition of diversity (and with appropriate quote: “to be convincing you have to be convinceable” – it’s about listening).

I also see people who were/are exceptionally and contagiously motivated with the smallest push. These are the people who bring an extra pair of comfortable shoes to work because they see that I’m on their calendar for a meeting (which still blows me away in terms of the kindness and compassion people bring to their relationship with me and themselves).

For the 90%

Our next “steps” are to discover how to be there for the people we serve in a way that respects their drive to achieve their life goals, because everyone has life goals. For some it may be a device by itself, for some it may be a device plus some leadership, or it may be a leader with a device. The device may not be something a person wears, it may be something the sidewalk wears (see: Quantified Community: Using population sensors instead of wearables to track health)

I am pro-technology, used at the right place and time, and pro-human, respected for who and where they are in their life journey. To an extent this is why health professionals will be around for a very long time.

It may be that computers will soon diagnose better than doctors. But the facts fed to computers will still have to be the result of intimate, individual recognition of the patient. – A Fortunate Man, 1966

And device or not, nothing’s going to stop the walking.

#activetransportation #whymetrowednesday #walking ❤️ DC

Ted Eytan, MD