Can wearable fitness trackers break America’s sedentary habits?

Commentary: Americans are sedentary, and physical activity levels are abysmal. It’s no secret that being active is associated with profound benefits. We hear it from our doctors, media, and even at work in the form of health promotion programs. Unfortunately, just knowing we need to be more active has been ineffective. The advent of affordable wearable devices has the potential to help individuals increase and sustain activity levels to take advantage of the benefits.

Understanding your activity levels is the first step in improving your health as “you can’t manage what you don’t measure.” However it’s only been in the last three to five years that individuals have had access to real tools that can measure their activity in an accurate manner. Before, we had to rely on recall — asking people questions such as “In the past month, on average, how many minutes per week are you active?” The approach is fraught with problems, but outside of the research setting (where scientists could fit people with expensive and accurate devices) it was the only tool we had. 

Using recall to quantify physical activity is sometimes the most appropriate tool and the only tool. In those instances it’s important to understand the limitations, so let’s look at just how bad recall can be.

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Previous national surveys indicate that people have high levels of physical activity, and the survey data suggest that the majority of the population is meeting the recommended levels of physical activity. Yet we know activity levels are low, so that can only mean when we ask people how active they are, they tend to overestimate their activity levels. A study published in 2011 by Professor Amy Luke and colleagues at Loyola University Chicago shed a blinding light on this. 

As part of the 2003-2006 National Health and Nutrition Examination Survey that tracks the health of the nation, researchers asked participants to wear specialized physical activity monitors (not unlike the ones you can now buy off the shelf). They wore them for a week. Professor Luke and her colleagues then analyzed the activity monitor data to see how many individuals were really getting the recommended amount of physical activity each day.

Activity continuum

This brings up an important technical point that is often oversimplified, and that is the difference between “physical activity” and “exercise.” Although lumped together and used interchangeably, they are different. In short, all exercise counts as physical activity but all physical activity is not exercise. Physical activity is any activity. If you are not sitting down or being still, you are being active and accumulating activity. The reason for the activity can be incidental — for example, walking to the train station or riding your bike to the store. In that case getting to the train station is the primary aim, and along the way you were active. Exercise, however, denotes intention. When you exercise, it is a planned effort; the sole purpose is to be active. 

It can seem like splitting hairs, but since activity lies on a continuum, it is an important distinction. Most people will accumulate their physical activity notby exercising, but rather by choosing to do things that require activity to complete. These tasks include: gardening, commuting, walking the dog, and even working for those individuals whose jobs require them to be active such as delivery workers.

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Back to the Loyola study — the results were shocking, showing that only 0.2% of women and 0.4% of men would qualify as doing two 10-minute blocks of moderate activity each day. Even when they loosened the manner in which they defined activity on the devices, only 1.9% of the individuals were meeting the guideline of two 10-minute blocks of moderate activity, and the majority of that activity was accumulated in just 1-minute blocks. Normally we would not define 1-minute blocks of activity as valid, and would rather consider it “noise” that was not part of being active. However the levels were so low in their first analysis that Luke and her colleagues decided to press ahead to see what the levels might look like with this looser definition. The findings suggest that, although having some minutes of activity each day, even if they were in just 1-minute periods, people were not getting the health benefits of continuous activity, which is 10 minutes or more at a time.

This study helped demonstrate how little activity people are doing in the real world when we actually measure their movement in an objective manner. Using recall and a questionnaire to assess activity levels can be useful, and is often the only tool available, but one must be cautious about how to interpret the information.

Sophisticated devices

The good news is, now more than ever, individuals have access to sophisticated devices that can accurately measure and track physical activity. This solves half of the equation in that “knowing is half the battle.” Once we start measuring our own activity levels, it opens the door for us to manage them. And these devices, although very sleek and sexy, are not just nice looking toys. A meta-analysis published in 2007 in the Journal of the American Medical Association showed that when people use them, especially with a step goal like 10,000 steps/day, they increase their activity levels above those who are not using the devices, generally to the tune of a 26% improvement. That means giving people a device that shows them how many steps they have completed, paired with telling them to try for 10,000 steps/day, is enough to help them do more activity compared to the individuals in the control groups who did not have a device or a step target.

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More encouraging is that the integration of wearable devices in health promotion programs is reaching a level of normalcy. Devices have become expected part and parcel of these programs. In some cases program vendors have been able to negotiate discounted pricing for employees, while in other instances employers have opted to fully fund or subsidize the cost for employees, therefore lowering the hurdle to use them and effectively leaving individuals little excuse not to use them. 

Other findings

All of this translates into more devices finding their way into the hands of users, and when increasing physical activity is paired with the creative application of behavioral economics and financial incentives, we really have a recipe for success. At Vitality we have tried to understand better how individuals use these wearable devices, and in the process we have produced what we think are some encouraging findings.

The first important thing we noticed was that over time, more individuals purchase devices and use them to track their activity. While this growth has been overwhelmingly in pedometers, IHS Technology predicts that activity tracker sales will increase by 300% over the next five years. We’ve not seen uptakes in that range yet, but in the past two years we have seen substantial increases in the proportion of members using activity monitors to verify their physical activity. In fact, these devices remain the No. 1 way our members log their physical activity, with around 75% of all physical activities being verified this way in the last quarter of 2014 (our most recent data analysis).

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We also noticed a slight gender bias, with about 56% of users being women. When it came to users who were overweight or obese, we found that two-thirds of activity tracker users were overweight or obese, and that indicates that these devices don’t discriminate, or rather that everyone uses them, whether they are normal weight or overweight. 

And that concept of having a daily goal? It bore out in our data where we saw a noticeable spike in the number of users hitting two goals we use to define point-earning opportunities in our program. Our interpretation is that as users get close to the communicated goals of 5,000 or 10,000 steps/day, they do the extra bit of effort that day to ensure they hit their target. There is also a marked drop in the number of users doing more on the other side of these two thresholds, and that begs the question:  Should we increase the goal to say, 15,000 steps since it seems people try for and reach these targets? Obviously there is an upper limit to how many steps individuals can do in a day, but this message is not lost on us and health promotion experts should take note.

Wearable devices are a powerful tool for individuals and for health promotion programs, helping them improve their activity levels and have fun along the way. As the technology advances, these wearables will become easier to use, more durable and last longer. In that regard they really can be seen as an investment in one’s health.

Jonathan Dugas, PhD, is director of clinical development for The Vitality Group, a wellness vendor.