Failing to encourage physical activity with wearable technology: what next?

Association Between Wearable Device Use and Levels of Physical Activity Among Older Adults in the US: Evidence From the 2019-2020 Health Information National Trends Survey

Objective To examine the relationship between electronic wearable device (WD) use and physical activity (PA) levels among older adults in the US. Methods Data were pooled from 3310 older adults from the 2019 and 2020 Health Information National Trends Survey. The explanatory variable was WD use, and the outcomes were weekly PA levels, resistance training, and sedentary time. Logistic regression was conducted to investigate the association between WD use and the reported outcome variables. Separate logistic models were also fitted to explore the relationship between WD use and physical activity outcomes among a subgroup of older adults with chronic conditions. Results A total of 14.4% of older adults reported WD use. Older adults who use WD were more likely to meet national guidelines for weekly levels of PA (odds ratio (OR) 1.60, 95% confidence intervals (CI) (1.10, 2.32); p = 0.015) and resistance strength training (OR 1.54, 95% CI (1.14, 2.09); p = 0.005) when compared with their counterparts not using WD. After restricting the analysis to those with chronic conditions only, WD use was only associated with a higher level of weekly strength training (OR 1.68, 95% CI 1.19, 2.38; p = 0.004). Conclusion  WD use may be associated with increased physical activity among older adults, including those with chronic health conditions. Further studies are needed to examine the factors influencing the adoption and sustained use of WD in older adults.

The Impact of Wearable Devices on Physical Activity for Chronic Disease Patients: Findings from the 2019 Health Information National Trends Survey

BACKGROUND

Wearable devices are shown to be an advanced tool for chronic disease management, but their impacts on physical activity remain uninvestigated. This study aims to examine the effect of wearable devices on physical activity in general people and chronic patients.

METHODS

Our sample was from the third cycle of the fifth iteration of the Health Information National Trends Survey (HINTS), which includes a total of 5438 residents. Genetic matching was used to evaluate the effect of wearable devices on physical activity in different populations.

RESULTS

(1) Both using wearable devices and using them with high frequency will improve physical activity for the whole population. (2) Wearable devices may have greater positive effects on physical activity for chronic patients. (3) Especially in patients with hypertension, high-frequency use of wearable devices can significantly improve the duration and frequency of physical activity.

CONCLUSIONS

Wearable devices lead to more physical activity, and the benefit is more noticeable for chronic patients, particularly those with hypertension.

An ultra-compact and wireless tag for battery-free sweat glucose monitoring

Glucose monitoring before, during, and after exercise is essential for people with diabetes as exercise increases the risk of activity-induced hyper- and hypo-glycemic events. The situation is even more challenging for athletes with diabetes as they have impaired metabolic control compared to sedentary individuals. In this regard, a compact and noninvasive wearable glucose monitoring device that can be easily worn is critical to enabling glucose monitoring. This report presents an ultra-compact glucose tag with a footprint and weight of 1.2 cm² and 0.13 g, respectively, for sweat analysis. The device comprises a near field communication (NFC) chip, antenna, electrochemical sensor, and microfluidic channels implemented in different material layers. The device has a flexible and conformal structure and can be easily attached to different body parts. The battery-less operation of the device was enabled by NFC-based wireless power transmission and the compact antenna. Femtosecond laser ablation was employed to fabricate a highly compact and flexible NFC antenna. The proposed device demonstrated excellent operating characteristics with a limit of detection (LOD), limit of quantification (LOQ), and sensitivity of 24 μM, 74 μM, and 1.27 μA cm^-2 mM^-1, respectively. The response of the proposed sensor in sweat glucose detection and quantification was validated by nuclear magnetic resonance spectroscopy (NMR). Also, the device's capability in attachment to the body, sweat collection, and glucose measurement was demonstrated through in vitro and in vivo experiments, and satisfactory results were obtained.

A Wearable Activity Tracker Intervention With and Without Weekly Behavioral Support Emails to Promote Physical Activity Among Women Who Are Overweight or Obese: Randomized Controlled Trial

Background

Physical activity (PA) plays a fundamental role in combating the current obesity epidemic; however, most women who are overweight or obese are generally physically inactive. Wearable activity tracker interventions can help increase the PA levels in this population. Supplementing such interventions with behavioral support emails may further improve their effectiveness, but this remains to be confirmed.

Objective

This study aims to determine if adding behavioral support emails to a wearable activity tracker intervention can further increase PA levels among women who are overweight or obese in comparison to a wearable activity tracker–only intervention and a control condition.

Methods

Women with a BMI ≥25 kg/m² who were not meeting the Canadian PA guidelines for aerobic and strength training were randomized into 1 of 3 groups. Group 1 received 6 weekly behavioral support emails, a wearable activity tracker, and a copy of the Canadian PA guidelines. Group 2 received a wearable activity tracker and a copy of the Canadian PA guidelines, and group 3 (control condition) received a copy of the Canadian PA guidelines. Self-reported data for walking and moderate to vigorous intensity PA were collected preintervention (week 0; prerandomization), postintervention (7 weeks postrandomization), and at follow-up (21 weeks postrandomization) and analyzed as metabolic equivalent of task minutes per week. In addition, potential mechanisms of behavior change (ie, basic psychological needs satisfaction and motivational regulations) were assessed for within- and between-group differences at all 3 time points. Data were analyzed using nonparametric statistical tests.

Results

A total of 49 women were recruited; data from 47 women (mean age 37.57 years, SD 11.78 years; mean BMI 31.69 kg/m², SD 5.97 kg/m²) were available for analysis. Group 1 reported a significant increase in walking from preintervention to postintervention (χ²₂=7.5; P=.02) but not in moderate to vigorous intensity PA (P=.24). Group 1 also reported significant increases in perceptions of competence from preintervention to follow-up (χ²₂=7.6; P=.02) and relatedness from preintervention to follow-up (χ²₂=8.7; P=.005). Increases in perceived autonomy were observed for group 2 (χ²₂=7.0) and group 3 (χ²₂=10.6). There were no significant changes in the motivational regulations within the groups. The difference between the groups was not significant for any outcome variable.

Conclusions

The results suggest that adding behavioral support emails to a wearable activity tracker intervention may help to increase time spent walking and perceptions of competence and relatedness for PA among women who are overweight or obese.

Trial Registration

ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663

Tailored physical activity behavior change interventions: challenges and opportunities

A physically active lifestyle provides innumerable benefits; yet, few individuals are physically active enough to reap those benefits. Tailored physical activity interventions may address low rates of physical activity by offering individualized strategies that consider a person's characteristics, needs, preferences, and/or context, rather than the traditional one-size-fits-all approach. However, the tailoring methodology is in its nascency, and an understanding of how best to develop such interventions is needed. In this commentary, we identify future directions to enhance the impact of tailored interventions designed to increase physical activity participation. A multi-country collaborative was established to review the literature and discuss an agenda for future research. Two overarching research opportunities are suggested for improving the development of tailored, behavioral physical activity interventions: (a) optimize the engagement of diverse knowledge users in intervention co-design and (b) examine ethical considerations that may impact the use of technology to support tailored physical activity delivery. Specifically, there is a need for better reporting and evaluation of knowledge user involvement alongside targeting diversity in the inclusion of knowledge users. Furthermore, while technology boasts many opportunities to increase the scale and precision of interventions, examinations of how it impacts recipients' experiences of and participation in tailored interventions are needed to ensure the benefits of technology use outweigh the risks. A better understanding of these research areas will help ensure that the diverse needs of individuals are met, technology is appropriately used to support tailoring, and ultimately it improves the effectiveness of tailored physical activity interventions.

Monitoring a meat-free pledge with smartphones: An experimental study

Pledges are a popular strategy to encourage meat reduction, though experimental studies of their efficacy are lacking. Three-hundred and twenty-five participants from three different countries (UK, Germany, Australia) were randomly assigned to pledge 28 days meat-free or not, and their behavior was tracked via smartphones. Participants answered daily surveys regarding their eating behavior, meat cravings, and shared photos of their meals. Baseline data was collected prior to the pledge, after the 28 days, and one-month post-intervention. Participants assigned to the pledge condition ate less meat across the 28 days, compared to control participants. Meat reductions, observed at outtake, did not endure one-month post-intervention. Overall, German participants ate the least amount of meat, and showed the sharpest decrease in consumption when pledging. Meat cravings tended to increase among pledgers, relative to control participants. Pledgers who reported high starting intentions and conflict about meat tended to eat less meat and reported fewer cravings. All participants reported reduced meat-eating justifications one-month post-intervention. These findings provide experimental evidence that pledges can encourage meat consumers to reduce their intake, though additional mechanisms are needed to sustain commitments.

The Perspectives of Persons with Arthritis on the Use of Wearable Technology to Self-Monitor Physical Activity: A Qualitative Evidence Synthesis

OBJECTIVE

We aim to broaden understanding of the perspectives of persons with arthritis on their use of wearables to self-monitor physical activity, through a synthesis of evidence from qualitative studies.

METHODS

We conducted a systematic search of 5 databases (including Medline, CINAHL, and Embase) from inception to 2018. Eligible studies qualitatively examined the use of wearables from the perspectives of persons with arthritis. All relevant data were extracted and coded inductively in a thematic synthesis.

RESULTS

Of 4358 records retrieved, 7 articles were included. Participants used a wearable during research participation in 3 studies and as part of usual self-management in 2 studies. In remaining studies, participants were shown a prototype they did not use. Themes identified were: 1) Potential to change dynamics in patient-health professional communication: Articles reported a common opinion that sharing wearable data could possibly enable them to improve communication with health professionals; 2) Wearable-enabled self-awareness; a benefit or downside?: There was agreement that wearables could increase self-awareness of physical activity levels, but perspectives were mixed on whether this motivated more physical activity; 3) Designing a wearable for everyday life: Participants generally felt the technology was not obtrusive in their everyday lives, but it was speculated certain prototypes may embarrass or stigmatize persons with arthritis.

CONCLUSION

Themes hint toward an ethical dimension, as participants perceive their use of wearables may positively or negatively influence their capacity to shape their everyday self-management. We suggest ethical questions pertinent to the use of wearables in arthritis self-management for further exploration.

A Methodologic Systematic Review of Mobile Health Behavior Change Randomized Trials

CONTEXT

Mobile health helps providers offer accessible, affordable, tailored behavior change interventions. However, research assessing mobile health interventions may feature methodologic shortcomings and poor reporting. This review aims to summarize the characteristics, methods, and intervention reporting of RCTs evaluating mobile health behavior change interventions.

EVIDENCE ACQUISITION

This was a methodologic systematic review of RCTs assessing mobile health behavior change interventions published in PubMed from January 1, 2014 to January 1, 2018, in journals with the upper half of Impact Factors (Clarivate Analytics). Three reviewers independently extracted sample characteristics. Primary outcomes were classified as patient-important or not using definitions from the literature. Any non-patient-important outcomes were then reclassified by a panel of 3 patients. Intervention reporting was assessed by the mobile health Evidence Reporting and Assessment checklist. Data were analyzed in December 2018.

EVIDENCE SYNTHESIS

Most of the 231 included RCTs assessed text messaging (51%) or smartphone app (28%) interventions aiming to change nutrition and physical activity (36%) or treatment adherence (25%). Only 8% of RCTs had a patient-important primary outcome, follow-up of ≥6 months, and intent-to-treat analysis. Most primary outcomes were behavioral measures (60%). Follow-up was <3 months in 29% of RCTs. Regarding reporting, 12 of the 16 checklist items were reported in less than half of RCTs (e.g., usability/content testing, 32%; data security, 13%).

CONCLUSIONS

Reports of RCTs assessing mobile health behavior change interventions lack information that would be useful for providers, including reporting of long-term intervention impact on patient-important primary outcomes and information needed for intervention replicability.

Anxious or empowered? A cross-sectional study exploring how wearable activity trackers make their owners feel

BACKGROUND

The market for wearable activity trackers has grown prolifically in recent years, with increasing numbers of consumers using them to track, measure, and ideally improve their health and wellbeing. Empirical evidence tends to support wearables as valid, reliable, and effective health behaviour change tools, however little research has been conducted to understand experiential aspects of the devices, particularly thier effects on users' psychological wellbeing and affect. This study addresses this literature gap by exploring wearable users' affective responses to their devices and how these relate to personality traits and individual differences.

METHODS

Data were collected from adult wearable users (N = 237) via an online survey that assessed participant demographic characteristics, personality trait profiles, and experiences of negative (guilt, self-consciousness, & anxiety) and positive affect (empowerment, motivation, & accountability) related to their wearable both during wear, and when unable to wear (e.g. if the battery ran flat). Outcomes were analysed descriptively and general linear models used to examine associations between affect scores with personality traits and individual differences.

RESULTS

Both current and previous wearable users experience more positive than negative affect related to their device whilst they were wearing it (p = <.001). When prevented from wearing their device, however, this pattern was reversed with most participants reporting stronger negative than positive affect (p = <.001). These patterns were generally consistent across demographic sub-groups and personality trait profiles, although conscientiousness and openness to experience were independently and positively associated with affect during wear (p = .001).

CONCLUSIONS

Results suggest that using a wearable is a positive experience for users with little risk of negative psychological consequences. Whilst experiences of negative affect were uncommon, individuals low in conscientiousness or openness to experience are at greater risk of negative affect and all users may experience negative affect such as anxiety or frustration when prevented from wearing their device. Findings contribute to mounting evidence of wearables' safety and appeal as health behaviour tools and highlight the importance of examining psychological and experiential aspects of activity tracking.

A Scientific Overview of Smartphone Applications and Electronic Devices for Weight Management in Adults

Worldwide, there are rising trends in overweight and obesity. Therefore, novel digital tools are discussed to improve health-related behaviors. The use of smartphone applications (apps) and wearables (e.g., activity trackers) for self-monitoring of diet and physical activity might have an impact on body weight. By now, the scientific evaluation of apps and wearables for weight management is limited. Although some intervention studies have already investigated the efficacy of aforementioned digital tools on weight management, there are no clear recommendations for its clinical and therapeutic use . Besides the lack in long-term randomized controlled trials, there are also concerns regarding the scientific quality of apps and wearables (e.g., no standards for development and evaluation). Therefore, the objective of present work is: (1) To address challenges and concerns regarding the current digital health market and (2) to provide a selective overview about intervention studies using apps and activity trackers for weight-related outcomes. Based on cited literature, the efficacy of apps and wearables on weight management is assessed. Finally, it is intended to derive potential recommendations for practical guidance.