Making Activity Trackers Work for Chronic Disease

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Most of us are familiar with wearable activity trackers at this point. In the last few years, big name manufacturers such as Fitbit and Misfit have continued to saturate the market. Even though 2016 was a slower year for wearables, the overall trend continues upward. In fact, market data suggests that as of 2016, 12% of patients use a wearable to keep track of their health and fitness. Thus far, though, wearables have largely been used by a select group: namely, people who can afford them as a luxury.

But in my opinion, this represents a missed opportunity for using these devices in a powerful way, i.e. as a tool to help patients self-manage and co-manage their chronic disease. The good news is, wearables don’t have to be luxury, and we can put them to effective work.

The Problem

Chronic diseases, such as hypertension, diabetes, metabolic syndrome, and obesity/overweight take a toll not only on individuals living with the disease but also on the healthcare system overall. In all of these cases, increasing physical activity is beneficial and may prevent numerous complications and decrease morbidity and mortality. Although we PCPs are encouraged to counsel our patients on the importance of nutrition and exercise, there often isn’t adequate time allotted to address these issues.

Motivational interviewing is a valuable tool to help our patients resolve ambivalence and develop new, permanent habits. But it takes time, which is in short supply, even for the patients who we see most often.

So, how can we get the information we need in the brief time we have?

The Wearable Witness

Here’s where wearable activity trackers can help. The data generated from activity trackers offer us a window into the patient’s life, revealing true activity levels, and giving us an opportunity for counseling. For example, when I see a patient proudly displaying a Fitbit in my office, I will ask them about it and ask how many steps they are taking on average. Their answer tells me not just their level of activity, but also how engaged they are in their healthcare. While patients often overestimate their subjective activity levels, the wearable provides objective data that can be a catalyst for more individualized motivational interviewing.

While there are limitations to the technology (It’s not yet perfect for sleep and HR monitoring.), the benefits of accurate simple step counting are clear. There also seems to be a significant advantage to the social aspect of wearable companion apps.

A Study with a Helping Hand

While the study of activity trackers is in its infancy, our group has done some pilot work by incorporating them into the Wellness Group that we started at my practice. By teaming with (a nonprofit that refurbishes used wearables for underserved populations and research studies), we could provide trackers to our patients free of charge.

With these devices, we monitored patients’ steps and assessed feasibility, barriers, and benefits to tracker use. We found that patients liked their trackers and that their attitudes towards them improved with time. We also found that wearing them made patients accountable to themselves and the group; the devices served as a physical reminder of their commitment to a healthy lifestyle. A number of similar positive studies are beginning to emerge in the literature.

Putting Tools to Use

While activity trackers may be useful tools for patients with chronic diseases, they are simply that — tools. Much like purchasing a gym membership won’t help you lose weight, buying a Fitbit won’t make you healthy. A tool is only useful when it’s used, consistently, for a long period of time, until it becomes a permanent habit. Fortunately, it seems this is a habit worth forming.

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