Use Of Activity Trackers Research Articles

Use of an activity tracker as a measurement tool in a knee osteoarthritis clinical trial (active-oa trial)

Purpose: In osteoarthritis (OA) clinical trials, reliable and responsive outcome measures to document improvements in function are limited. Current measures predominately rely on self-reported function tests, but they are poorly responsive, subject to misreporting and the placebo response. Functional measures such as observed timed-up-and-go test (TUG) and six-minute walk test (6MWT) are advocated, but their relevance may be limited in the context of a patient’s real-world functional capabilities. Using physical activity tracking devices/wearables as a way to measure improvements in function in day-to-day life is potentially an attractive and easily available alternative to conventional OA trial outcome measures. Consumer-level activity monitors have shown high validity for measurement of steps when compared with research-grade devices. The aim of this study is to assess if the use of an activity tracker in an OA clinical trial is a responsive measurement tool. Secondary objectives include the assessment of the feasibility of an activity tracker use and validity of an activity tracker in an OA clinical trial. Methods: This was a prospective cohort study nested in the Platelet-rich Plasma as a Symptom and Disease-Modifying Treatment for Knee Osteoarthritis - the RESTORE trial (ACTRN12617000853347). Consecutive participants recruited to the RESTORE trial were invited to join this study. Participants ≥ 50 years old with painful knee OA and Kellgren and Lawrence (KL) grade 2-3 were included. Participants were asked to wear an activity tracker (Fitbit Flex (2), Fitbit Inc, San Francisco, CA, USA) for seven consecutive days at the time of baseline assessment (week 0, before their injection therapies), and at the 2-month follow-up assessment. The primary outcome was mean steps per day calculated from a seven-day wear of an activity tracker. To determine the responsiveness of the activity tracker, the standardised response mean (SRM) was calculated for mean steps per day between baseline and 2 months; dividing the mean change scores by the standard deviation of the mean change scores. To investigate validity, correlation coefficient (r) was used to examine the relationship between change in the mean steps per day between baseline and 2 months and participant-perceived global ratings of change (global improvement in function) at 2 months. The relationship of change in mean steps per day and change in secondary outcomes between baseline and 2 months was examined: global improvement (pain and overall improvement), 6MWT, TUG, numeric rating scale (NRS) for pain, knee osteoarthritis outcome score (KOOS), and the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Correlation coefficients were estimated for continuous variables. The activity tracker wear was deemed feasible if >70% of patients comply with wearing the trackers at least six out of seven days for each measurement period. Results: 65 participants were recruited (mean age = 61.3 years; 46% female; mean BMI 28.7 kg/m2; 41.5% KLG 2 and 58.5% KLG 3). 8 participants dropped out or had activity tracker misuse/failure at the 2-month follow-up. The SRM was -0.02 (95% CI -0.38 to 0.35) for mean steps per day between baseline and 2 months. The proportion of participants who wore the trackers for six out of seven days was 98% at baseline and 100% at 2-months follow-up. The correlation with change in mean steps per day at baseline and 2 months and outcome measures are detailed in table 1. Conclusions: The use of an activity tracker in a real-world OA clinical trial demonstrated small correlations between change in steps at baseline and 2 months follow-up with global improvement overall and WOMAC function. The use of a tracker is a feasible option with demonstration of good compliance amongst the trial participants. This study has not shown significant responsiveness or validity of the activity trackers in comparison with other regularly utilised outcome measures in OA clinical trials. However, the main challenge of this study is the lack of a gold standard outcome measure to validate against. Due to the complex nature of pain, perceived quality of life, and the interplay between these factors and measured function, a lack of correlation does not necessarily represent a failed validation in this context.

759 Use of Activity Trackers to Monitor Activity Patterns in Cardiac Rehabilitation Patients

759 Use of Activity Trackers to Monitor Activity Patterns in Cardiac Rehabilitation Patients

Older adults' experiences of using a wearable activity tracker with health professional feedback over a 12-month randomised controlled trial.

ObjectiveWearable activity trackers can help older adults remain physically active. However, knowledge of the user experience during long-term use is scarce. Therefore, this study examined older adults’ experiences with, and perceptions of, wearable activity trackers combined with health professional feedback after a year’s use as part of a randomised controlled trial.MethodsTwenty older adults (73.6 ± 5.5 years) who had used a Jawbone UP24 activity tracker for 12 months during a randomised controlled trial were recruited for this study. All participants had at least one chronic condition. Acceptability data relating to activity tracker wear time was combined with focus group data to explore participants experiences of long-term activity tracker use. Data was analysed using thematic analysis.ResultsThe activity tracker was well-accepted with the device worn on an average of 86% of possible days and participants reported an overall positive experience. Four themes were identified: (a) increased sense of awareness of activity levels is related to motivation; (b) the level of engagement with the activity tracker influences the user experience; (c) the role of feedback from a health professional in providing ongoing support; d) the role of habits in supporting long-term behaviour change.ConclusionsThe use of an activity tracker combined with health professional support can assist older adults to maintain their activity levels over 12 months. Consideration should be given to the previous technology experience of users and the design and accuracy of an activity tracker when recommending their use in a research or clinical setting.

Usefulness of Modern Activity Trackers for Monitoring Exercise Behavior in Chronic Cardiac Patients: Validation Study.

BackgroundImproving physical activity (PA) is a core component of secondary prevention and cardiac (tele)rehabilitation. Commercially available activity trackers are frequently used to monitor and promote PA in cardiac patients. However, studies on the validity of these devices in cardiac patients are scarce. As cardiac patients are being advised and treated based on PA parameters measured by these devices, it is highly important to evaluate the accuracy of these parameters in this specific population.ObjectiveThe aim of this study was to determine the accuracy and responsiveness of 2 wrist-worn activity trackers, Fitbit Charge 2 (FC2) and Mio Slice (MS), for the assessment of energy expenditure (EE) in cardiac patients.MethodsEE assessed by the activity trackers was compared with indirect calorimetry (Oxycon Mobile [OM]) during a laboratory activity protocol. Two groups were assessed: patients with stable coronary artery disease (CAD) with preserved left ventricular ejection fraction (LVEF) and patients with heart failure with reduced ejection fraction (HFrEF).ResultsA total of 38 patients were included: 19 with CAD and 19 with HFrEF (LVEF 31.8%, SD 7.6%). The CAD group showed no significant difference in total EE between FC2 and OM (47.5 kcal, SD 112 kcal; P=.09), in contrast to a significant difference between MS and OM (88 kcal, SD 108 kcal; P=.003). The HFrEF group showed significant differences in EE between FC2 and OM (38 kcal, SD 57 kcal; P=.01), as well as between MS and OM (106 kcal, SD 167 kcal; P=.02). Agreement of the activity trackers was low in both groups (CAD: intraclass correlation coefficient [ICC] FC2=0.10, ICC MS=0.12; HFrEF: ICC FC2=0.42, ICC MS=0.11). The responsiveness of FC2 was poor, whereas MS was able to detect changes in cycling loads only.ConclusionsBoth activity trackers demonstrated low accuracy in estimating EE in cardiac patients and poor performance to detect within-patient changes in the low-to-moderate exercise intensity domain. Although the use of activity trackers in cardiac patients is promising and could enhance daily exercise behavior, these findings highlight the need for population-specific devices and algorithms.

Parental Perspectives of a Wearable Activity Tracker for Children Younger Than 13 Years: Acceptability and Usability Study.

BackgroundThere is increasing availability of, and interest in, wearable activity trackers for children younger than 13 years. However, little is known about how children and parents use these activity trackers or perceive their acceptability.ObjectiveThis study primarily aimed to ascertain parental perspectives on the acceptability and usability of wearables designed to monitor children’s physical activity levels. Secondary aims were to (1) identify practical considerations for future use in physical activity interventions and promotion initiatives; (2) determine use of different features and functions incorporated into the accompanying app; and (3) identify parents’ awareness of their child’s current physical activity levels.MethodsIn total, 36 children (18 boys and 18 girls) aged 7-12 years were asked to wear a wrist-worn activity tracker (KidFit) for 4 consecutive weeks and to use the accompanying app with parental assistance and guidance. Each week, one parent from each family (n=25; 21 mothers and 4 fathers) completed a Web-based survey to record their child’s activity tracker use, app interaction, and overall experiences. At the end of the 4-week period, a subsample of 10 parents (all mothers) participated in face-to-face interviews exploring perceptions of the acceptability and usability of wearable activity trackers and accompanying apps. Quantitative and qualitative data were analyzed descriptively and thematically, respectively. Thematic data are presented using pen profiles, which were constructed from verbatim transcripts.ResultsParents reported that they and their children typically found the associated app easy to use for activity tracking, though only step or distance information was generally accessed and some difficulties interpreting the data were reported. Children were frustrated with not being able to access real-time feedback, as the features and functions were only available through the app, which was typically accessed by, or in the presence of, parents. Parents identified that children wanted additional functions including a visual display to track and self-monitor activity, access to the app for goal setting, and the option of undertaking challenges against schools or significant others. Other barriers to the use of wearable activity trackers included discomfort of wearing the monitor because of the design and the inability to wear for water- or contact-based sports.ConclusionsMost parents reported that the wearable activity tracker was easy for their child or children to use and a useful tool for tracking their children’s daily activity. However, several barriers were identified, which may impact sustained use over time; both the functionality and wearability of the activity tracker should therefore be considered. Overall, wearable activity trackers for children have the potential to be integrated into targeted physical activity promotion initiatives.

Use of Activity Trackers in Orthopaedics.

Activity trackers are relatively inexpensive, easily available, and widely used by consumers. There has been increased interest in healthcare practice and research to use activity tracker data. Continuous collection of health variables including step count, heart rate, and calorimetry provides researchers and clinicians data to monitor patients after an intervention and/or encourage physical activity. The purpose of this article is to review the current use of activity trackers in orthopaedics and discuss potential applications in clinical research.

Factors Associated with Older Adults' Long-Term Use of Wearable Activity Trackers.

Background: Wearable activity trackers (WATs) have the potential to improve older adults' health; yet, many adopters of WATs are not able to use them on a long-term basis. Methods: A survey was conducted with an online panel of adults 65 and older (N = 214) to explore factors associated with long-term use of WATs, including initial adoption motivations, usage patterns, as well as differences in sociodemographic factors, health status, and activity levels. Results: Results from the logistic regression analysis indicated that being a long-term WAT user was significantly associated with using a wider variety of WAT functions, wearing WAT every day, being female, exercising more frequently, having higher education, not engaging in step count competition, and not having chronic conditions. Conclusions: Understanding long-term use of WATs among older adults is important given that this technology is prone to be abandoned quickly after initial adoption and such abandonment negates its potential in supporting long-term health behavior change. Findings of this study will inform innovative WAT designs that afford long-term use and offer helpful strategies for future interventions using WATs among older adults.

“My smartwatch told me to see a sleep doctor”: a study of activity tracker use

PurposeThe purpose of this paper is to investigate the use of wearable health and fitness trackers in everyday life, and users’ motivations and their understanding and use of the data derived from devices, and understand the results using the lens of information behaviours.Design/methodology/approachThe study used a qualitative, constructionist approach, based on 21 interviews with users of a range of wearable activity trackers used for health and fitness.FindingsFindings show that the lifelogging devices have become companion tools that enable users to take information from their bodily indicators and make some decisions about their health and fitness, and also track the results when they act on it, thus giving them a sense of gratification and a sense of control over their own health.Practical implicationsThe findings have implications on how health professionals can talk to their lifelogging patients about how to deal with and understand the information provided by their activity-tracking devices. Some participants in the study already discuss these data regularly with their health professionals.Originality/valueAs the self-tracking practices attract wide range research interests from human–computer interaction, information systems, digital sociology, health informatics and marketing among others. This study provides important everyday information-seeking perspective that contributes to the understanding of the practices of how people make sense of the data, how the data improves their wellbeing, i.e. physical health improvement or fitness, and implications to users health behaviour. Additionally the study adds to the lifelogging literature through a constructionist, qualitative approach rather than a technological deterministic approach.

Test-retest reliability of survey items on ownership and use of physical activity trackers

Background: Researchers are interested in using digital tools, such as physical activity trackers (PAT), to promote and measure physical activity. PAT is a fast-growing research area that measures movement therefore, reliable questions on the ownership and use of PATs among adolescent populations need to be developed. Objective: The aim of this study was to conduct an intra-rater test-retest reliability study on PAT survey items used for surveillance purposes among young adolescents in ownership and use of smartphone applications (apps) and heart rate monitors (HRM). Methods: Young adolescents (N = 755; 11-, 13-, and 15-year-olds) in the Olomouc region of the Czech Republic were recruited to complete the questionnaire with a three-week gap during autumn 2017. Kappa statistics were used for measuring reliability. Results: When items were dichotomised into owners and non-owners, there was moderate agreement for boys (apps Kappa = .563, HRM Kappa = .575) and girls (apps Kappa = .447, HRM Kappa = .443). Conclusions: Measures in ownership and use of PAT can be assumed reliable among young adolescents.

Use of Wearable Activity Trackers to Improve Physical Activity Behavior in Patients With Rheumatic and Musculoskeletal Diseases: A Systematic Review and Meta-Analysis.

Wearable activity trackers (WATs) could be a promising strategy to improve physical activity in patients with rheumatic and musculoskeletal diseases (RMDs). The aim was to assess the adherence to and effectiveness of WATs to increase physical activity levels in patients with RMDs. A systematic review was performed to identify all cohorts and controlled trials evaluating WATs in patients with RMDs, published between 2000 and 2018, by searching Medline, Embase, PsycINFO, and Cochrane. Data collected pertained to adherence, effectiveness on physical activity, or effectiveness on symptoms (pain, function, quality of life, or fatigue). Meta-analyses were performed with a random effects model. Of 2,806 references, 17 studies were included, with a total of 1,588 patients: 8 studies (47%) in osteoarthritis, 5 (29%) in low-back pain, and 3 (18%) in inflammatory arthritis. Adherence assessed in 4 studies was high (weighted mean ± SD time worn was 92.7% ± 4.6%). A significant increase in physical activity was noted (mean difference 1,520 steps [95% confidence interval (95% CI) 580, 2,460], I² = 77%; or 16 minutes [95% CI 2, 29] of moderate-to-vigorous physical activity, I² = 0%). A significant increase in pain was found for long interventions (>8 weeks) (standardized mean difference 0.25 [95% CI 0.07, 0.43], I² = 0%). WATs in patients with RMDs had a high short-term adherence, with a significant increase in the number of steps and time spent in moderate-to-vigorous physical activity, although pain should be monitored. WATs may be an effective option to increase physical activity in this at-risk population.

Consumer-Based Wearable Activity Trackers Increase Physical Activity Participation: Systematic Review and Meta-Analysis.

BackgroundThe range of benefits associated with regular physical activity participation is irrefutable. Despite the well-known benefits, physical inactivity remains one of the major contributing factors to ill-health throughout industrialized countries. Traditional lifestyle interventions such as group education or telephone counseling are effective at increasing physical activity participation; however, physical activity levels tend to decline over time. Consumer-based wearable activity trackers that allow users to objectively monitor activity levels are now widely available and may offer an alternative method for assisting individuals to remain physically active.ObjectiveThis review aimed to determine the effects of interventions utilizing consumer-based wearable activity trackers on physical activity participation and sedentary behavior when compared with interventions that do not utilize activity tracker feedback.MethodsA systematic review was performed searching the following databases for studies that included the use of a consumer-based wearable activity tracker to improve physical activity participation: Cochrane Controlled Register of Trials, MEDLINE, PubMed, Scopus, Web of Science, Cumulative Index of Nursing and Allied Health Literature, SPORTDiscus, and Health Technology Assessments. Controlled trials of adults comparing the use of a consumer-based wearable activity tracker with other nonactivity tracker–based interventions were included. The main outcome measures were physical activity participation and sedentary behavior. All studies were assessed for risk of bias, and the Grades of Recommendation, Assessment, Development, and Evaluation system was used to rank the quality of evidence. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. A random-effects meta-analysis was completed on the included outcome measures to estimate the treatment effect of interventions that included an activity tracker compared with a control group.ResultsThere was a significant increase in daily step count (standardized mean difference [SMD] 0.24; 95% CI 0.16 to 0.33; P<.001), moderate and vigorous physical activity (SMD 0.27; 95% CI 0.15 to 0.39; P<.001), and energy expenditure (SMD 0.28; 95% CI 0.03 to 0.54; P=.03) and a nonsignificant decrease in sedentary behavior (SMD −0.20; 95% CI −0.43 to 0.03; P=.08) following the intervention versus control comparator across all studies in the meta-analyses. In general, included studies were at low risk of bias, except for performance bias. Heterogeneity varied across the included meta-analyses ranging from low (I2=3%) for daily step count through to high (I2=67%) for sedentary behavior.ConclusionsUtilizing a consumer-based wearable activity tracker as either the primary component of an intervention or as part of a broader physical activity intervention has the potential to increase physical activity participation. As the effects of physical activity interventions are often short term, the inclusion of a consumer-based wearable activity tracker may provide an effective tool to assist health professionals to provide ongoing monitoring and support.

The Use of Wearable Activity Trackers Among Older Adults: Focus Group Study of Tracker Perceptions, Motivators, and Barriers in the Maintenance Stage of Behavior Change.

BackgroundWearable activity trackers offer the opportunity to increase physical activity through continuous monitoring. Viewing tracker use as a beneficial health behavior, we explored the factors that facilitate and hinder long-term activity tracker use, applying the transtheoretical model of behavior change with the focus on the maintenance stage and relapse.ObjectiveThe aim of this study was to investigate older adults’ perceptions and uses of activity trackers at different points of use: from nonuse and short-term use to long-term use and abandoned use to determine the factors to maintain tracker use and prevent users from discontinuing tracker usage.MethodsData for the research come from 10 focus groups. Of them, 4 focus groups included participants who had never used activity trackers (n=17). These focus groups included an activity tracker trial. The other 6 focus groups (without the activity tracker trial) were conducted with short-term (n=9), long-term (n=11), and former tracker users (n=11; 2 focus groups per user type).ResultsThe results revealed that older adults in different tracker use stages liked and wished for different tracker features, with long-term users (users in the maintenance stage) being the most diverse and sophisticated users of the technology. Long-term users had developed a habit of tracker use whereas other participants made an effort to employ various encouragement strategies to ensure behavior maintenance. Social support through collaboration was the primary motivator for long-term users to maintain activity tracker use. Short-term and former users focused on competition, and nonusers engaged in vicarious tracker use experiences. Former users, or those who relapsed by abandoning their trackers, indicated that activity tracker use was fueled by curiosity in quantifying daily physical activity rather than the desire to increase physical activity. Long-term users saw a greater range of pros in activity tracker use whereas others focused on the cons of this behavior.ConclusionsThe results suggest that activity trackers may be an effective technology to encourage physical activity among older adults, especially those who have never tried it. However, initial positive response to tracker use does not guarantee tracker use maintenance. Maintenance depends on recognizing the long-term benefits of tracker use, social support, and internal motivation. Nonadoption and relapse may occur because of technology’s limitations and gaining awareness of one’s physical activity without changing the physical activity level itself.

Activity trackers are not valid for step count registration when walking with crutches

BackgroundThe use of activity trackers has been proposed in rehabilitation where resuming physical activity is deemed crucial, e.g. after total knee arthroplasty (TKA). As patients initially often walk with crutches, it is of importance that clinicians can rely on the information provided by activity trackers. Research questionTo determine concurrent validity of 2 activity trackers for step count, positioned on different locations on the body during gait with crutches. MethodsThirty healthy participants performed normal gait and gait with one crutch and two crutches over a distance of 400 m while wearing a Garmin Vivofit 3 and Nokia Go on both wrists and both sides at the waist (only Nokia Go). The gold standard was manual step count. Inter-device reliability (within brand) was assessed by calculating Intraclass Correlation Coëfficients (ICC) and concurrent validity was determined by performing paired sample t-tests, ICC and Bland-Altman Plots with % bias and 95% CI Limits of Agreement (LoA). ResultsDuring normal gait, both the Nokia and Garmin showed good to excellent inter-device reliability (ICC > 0.75). Both devices showed concurrent validity compared to manual step count, with slightly better results for the Garmin compared to the Nokia at the wrist (% bias = respectively 0.0% and -1.4% with 95% CI LoA: respectively -1.7%;1.7% and -8.6%;5.8%; ICC: respectively 0.995 and 0.859). During gait with crutches, however, overall 95% CI of LoA were beyond clinically acceptable differences and ICC values with the gold standard were poor. Therefore, notwithstanding a sometimes reported small average % bias, validity of the activity trackers for step count during gait with crutches was not established, independent of tracker position. SignificanceActivity trackers showed no concurrent validity when monitoring step count during gait with crutches. This should be taken into account when implementing this technology in e.g. post-operative goal setting in patients with TKA.

Evaluating Motivational Interviewing and Habit Formation to Enhance the Effect of Activity Trackers on Healthy Adults' Activity Levels: Randomized Intervention.

BackgroundWhile widely used and endorsed, there is limited evidence supporting the benefits of activity trackers for increasing physical activity; these devices may be more effective when combined with additional strategies that promote sustained behavior change like motivational interviewing (MI) and habit development.ObjectiveThis study aims to determine the utility of wearable activity trackers alone or in combination with these behavior change strategies for promoting improvements in active and sedentary behaviors.MethodsA sample of 91 adults (48/91 female, 53%) was randomized to receive a Fitbit Charge alone or in combination with MI and habit education for 12 weeks. Active and sedentary behaviors were assessed pre and post using research-grade activity monitors (ActiGraph and activPAL), and the development of habits surrounding the use of the trackers was assessed postintervention with the Self-Reported Habit Index. During the intervention, Fitbit wear time and activity levels were monitored with the activity trackers. Linear regression analyses were used to determine the influence of the trial on outcomes of physical activity and sedentary time. The influence of habits was examined using correlation coefficients relating habits of tracker use (wearing the tracker and checking data on the tracker and associated app) to Fitbit wear time and activity levels during the intervention and at follow-up.ResultsRegression analyses revealed no significant differences by group in any of the primary outcomes (all P>.05). However, personal characteristics, including lower baseline activity levels (beta=–.49, P=.01) and lack of previous experience with pedometers (beta=–.23, P=.03) were predictive of greater improvements in moderate and vigorous physical activity. Furthermore, for individuals with higher activity levels at the baseline, MI and habit education were more effective for maintaining these activity levels when compared with receiving a Fitbit alone (eg, small increase of ~48 steps/day, d=0.01, vs large decrease of ~1830 steps/day, d=0.95). Finally, habit development was significantly related to steps/day during (r=.30, P=.004) and following the intervention (r=.27, P=.03).ConclusionsThis study suggests that activity trackers may have beneficial effects on physical activity in healthy adults, but benefits vary based on individual factors. Furthermore, this study highlights the importance of habit development surrounding the wear and use of activity trackers and the associated software to promote increases in physical activity.Trial RegistrationClinicalTrials.gov NCT03837366; https://clinicaltrials.gov/ct2/show/NCT03837366

Wearable Activity Trackers in Clinical Research and Practice

In recent years, there has been tremendous growth in the use of wearable activity trackers in biomedical research. Activity trackers are also becoming more popular with consumers, who are able to s...

Using Physical Activity Trackers in Arthritis Self-Management: A Qualitative Study of Patient and Rehabilitation Professional Perspectives.

To compare and contrast the perspectives of patients with arthritis and those of rehabilitation professionals regarding starting and sustaining use of physical activity trackers (PATs). We conducted focus group sessions with patients, physiotherapists, and occupational therapists in Ontario, Alberta, or British Columbia, Canada. To be eligible, patients must have self-reported a diagnosis of inflammatory or osteoarthritis. Rehabilitation professionals reported that at least 40% of their caseload was dedicated to arthritis care. Participants had any level of experience with PATs. A thematic analytic approach was used. The following 3 themes were identified: 1) anticipating sharing objective measures of physical activity. Participants agreed that use of PATs had the potential to improve consultations between patients with arthritis and rehabilitation professionals but were uncertain how to achieve this potential; 2) perceived or experienced barriers to start or continue using a PAT. Participants shared doubts about whether existing PATs would meet specific needs of patients with arthritis and expressed concerns about possible negative impacts; and 3) bolstering motivation? Although there was agreement that use of PATs could bolster the motivation of patients who were already active, patients and rehabilitation professionals had different opinions regarding whether use of PATs alone would motivate patients to start increasing activity levels. Our study highlights similarities and differences between the perspectives of patients and rehabilitation professionals regarding the potential value and risks of integrating PATs into arthritis self-management. Despite agreement about the potential of PATs, participants were uncertain how to effectively incorporate these tools to enhance patient-clinician consultations and had differing views about whether use of PATs would support a patient's motivation to be active.

The validity of two commercially-available sleep trackers and actigraphy for assessment of sleep parameters in obstructive sleep apnea patients.

ObjectiveThe use of activity and sleep trackers that operate through dedicated smartphone applications has become popular in the general population. However, the validity of the data they provide has been disappointing and only Total Sleep Time (TST) is reliably recorded in healthy individuals for any of the devices tested. The purpose of this study was to evaluate the ability of two sleep trackers (Withings pulse 02 (W) and Jawbone Up (U)) to measure sleep parameters in patients suffering from obstructive sleep apnea (OSA).MethodsAll patients evaluated for OSA in our sleep laboratory underwent overnight polysomnography (PSG). PSG was conducted simultaneously with three other devices: two consumer-level sleep monitors (U and W) and one actigraph (Bodymedia SenseWear Pro Armband (SWA)).ResultsOf 36 patients evaluated, 22 (17 men) were diagnosed with OSA (mean apnea-hypopnea index of 37+ 23/h). Single comparisons of sleep trackers (U and W) and actigraph (SWA) were performed. Compared to PSG, SWA correctly assessed TST and Wake After Sleep Onset (WASO), and U and W correctly assessed Time In Bed (TIB) and light sleep. Intraclass correlations (ICC) revealed poor validity for all parameters and devices, except for WASO assessed by SWA.ConclusionsThis is the first study assessing the validity of sleep trackers in OSA patients. In this series, we have confirmed the limited performance of wearable sleep monitors that has been previously observed in healthy subjects. In OSA patients, wearable app-based health technologies provide a good estimation of TIB and light sleep but with very poor ICC.

Wearable Activity Tracker Use in Young Adults Through the Lens of Social Cognitive Theory

ABSTRACTBackground: Young adults are adopting wearables ahead of research. Purpose: The purpose of this study was to explore the use of trackers through Social Cognitive Theory (SCT). Methods: SCT-guided individual interviews were conducted with young adults (n = 57). Typical case sampling was used to recruit college students (n = 35) and straight-to-work (STW) young adults (n = 22) for in-person/online interviews. Interviews were recorded, transcribed, and analyzed using NVivo. Results: There were few differences between the two groups. Most reported little knowledge of the benefits/risks associated with their health behavior (eg, physical activity) but high expectations of how devices would assist them in developing/maintaining behavior. Self-regulatory aspects were seen as benefits. Many reported not setting goals other than those set by their device. Most reported increased self-efficacy and viewed their device as positive, nonjudgmental social support. Discussion: Young adult device use can be health directed or health related. Utilizing devices and SCT-based education may increase young adults’ knowledge, self-efficacy, and self-regulation while managing expectations. Translation to Health Education Practice: Health Educators should focus on increasing health knowledge, managing expectations, and setting goals. Building on the increased self-efficacy and social support that young adults reported as part of their wearable activity tracker use could provide a solid foundation for Health Education efforts. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI)http://portal.shapeamerica.org/trn-Webinars

Beyond novelty effect: a mixed-methods exploration into the motivation for long-term activity tracker use.

ObjectivesActivity trackers hold the promise to support people in managing their health through quantified measurements about their daily physical activities. Monitoring personal health with quantified activity tracker-generated data provides patients with an opportunity to self-manage their health. Many have been conducted within short-time frames; makes it difficult to discover the impact of the activity tracker’s novelty effect or the reasons for the device’s long-term use. This study explores the impact of novelty effect on activity tracker adoption and the motivation for sustained use beyond the novelty period.Materials and methodsThis study uses a mixed-methods approach that combines both quantitative activity tracker log analysis and qualitative one-on-one interviews to develop a deeper behavioral understanding of 23 Fitbit device users who used their trackers for at least 2 months (range of use = 69–1073 days).ResultsLog data from users’ Fitbit devices revealed 2 stages: the novelty period and the long-term use period. The novelty period for Fitbit users in this study was approximately 3 months, during which they might have discontinued using their devices.DiscussionThe qualitative interview data identified various factors that users to continuously use the Fitbit devices in different stages. The discussion of these results provides design implications to guide future development of activity tracking technology.ConclusionThis study reveals important dynamics emerging over long-term activity tracker use, contributes new knowledge to consumer health informatics and human-computer interaction, and offers design implications to guide future development of similar health-monitoring technologies that better account for long-term use in support of patient care and health self-management.

Patient Experience Connecting Mobile-Based Self-Monitoring of Diet and Physical Activity to Diabetes Educators through a Connected Interface in an Electronic System for Diabetes Education

Background: Smartphone applications and wearable activity trackers have become popular tools in recent years in managing chronic diseases such as diabetes. More recently, studies have focused on connecting patient-generated health data from mobile devices directly to health care providers and educators. However, not much is known regarding the patient experience in using these mobile devices for diabetes management, particularly the implications of allowing educators direct access to patients’ diet and exercise data. Objective: The objective of this study was to identify patients’ perceived benefits and concerns about using a smartphone application and wristband activity tracker to monitor diet and physical activity, as well as the perceived benefits and concerns of allowing educators access to such data. Methods: We conducted a qualitative, descriptive study as an axillary study to a clinical trial testing a connected interface to link patient self-monitoring diet and physical activity to a nationally used electronic diabetes education system. Our axillary study examined 13 type 2 diabetes patients’ views on perceived benefits and concerns about using a smartphone application and wristband activity tracker to monitor diet and physical activity for three months. A focus group interview was administered to obtain general and specific understanding of the use of smartphone applications and activity trackers during the study period. The central interview questions guiding the discussion included “What did you think about the UP24 wristband and app?”, “What are your thoughts about the connection of UP24 data with Chronicle, the Web-based diabetes education system, so that your diabetes educators can see your behavior?”, and “Has knowing that someone else has access to your diet and exercise data affected your behavior and self-monitoring?” The interviewer also asked specific questions to gain deeper understanding of the following topics: (1) the app and wristband features used to record and monitor diet and physical activity, (2) materials used for intervention orientation, (3) additional data (eg, weight and blood glucose) that participants would like to share with educators, and (4) suggestions for improvement in diabetes self-management and communication with educators and physicians. The focus group sessions were audio-recorded and transcribed. Transcribed data were analyzed to identify key themes based on interpretive coding procedures. Results: We identified 11 key themes under three major categories and described these themes with illustrative quotations. The three major categories of themes covered (1) self-monitoring themes: varied experience and self-monitoring patterns and adherence exist among patients using the wearable tracker and its companion smartphone application; (2) themes related to sharing self-monitoring of diet and physical activity data with diabetes educators: sharing self-monitoring diet influences patient self-monitoring adherence and dietary and activity changes, and communication with educators; and (3) research study-related themes: technical barriers, utilization of manuals and tutorial videos in beginning use of the connected health tools, and desired features on combining lifestyle data with glucose data and caregiver access. Conclusions: Connected technology aiming to incorporate patient-generated health lifestyle data into clinical workflow should consider patient perspectives in terms of their experience and motivation for generating and sharing such data and technical barriers in using such tools.