Utility of Fitbit devices among children and adolescents with chronic health conditions: a scoping review

Use of activity trackers to improve blood pressure in young people at risk for cardiovascular disease: a pilot randomized controlled trial

BACKGROUND

Promoting physical activity among young individuals with cardiovascular disease (CVD) risk factors such as hypertension, diabetes, or chronic kidney disease can lower systolic blood pressure (BP). We sought to determine whether a 6-month intervention using a physical activity tracker was feasible and effective, compared with usual care.

METHODS

Participants were recruited at a single academic medical center. Those aged 8-30 years were randomized in a 2:1 ratio to either the intervention (use of a Fitbit physical activity tracker coupled with feedback regarding the participant's step count) or usual care. The primary feasibility outcomes were screening-to-enrollment ratio and 6-month retention rates; the primary clinical outcome was a change in systolic BP from 0-6 months.

RESULTS

Sixty-three participants were enrolled (57% male; mean age: 18 ± 4 years). The screening-to-enrollment ratio was 1.8:1. Six-month retention was 62% in the intervention group and 86% in the control group (p = 0.08). Mean change in systolic BP in the intervention group was not significantly different from the control group at 6 months (- 2.3 mmHg; 95% CI - 6.5, 1.8 vs. 3.0 mmHg; 95% CI - 2.5, 8.4, respectively, p = 0.12).

CONCLUSIONS

Among children and young adults at elevated CVD risk, the use of a physical activity tracker coupled with tailored feedback regarding their step count progress was feasible but not sustained over time. Physical activity tracker use did not have a statistically significant effect on BP after 6 months. Augmented strategies to mitigate risk in young patients at high risk for early-onset CVD should be explored. This trial is registered at ClinicalTrials.gov (NCT03325426).

Measuring Physical Activity in Children Who Do Not Walk and With Cerebral Palsy: An Exploratory Case Series

AIM

The purpose of this case series was to describe physical activity (PA) amount and intensity in the home and school environment. Accelerometers and heart rate (HR) monitors are reliable and valid measures of PA in children with cerebral palsy (CP) who can walk. There is limited research on PA measures in children with CP who cannot walk.

METHODS

Three 9-year-old boys with CP, Gross Motor Function Classification System levels IV and V, participated in a 1-week measurement period wearing waist- and wrist-worn triaxial accelerometers to measure PA counts and a wrist-worn HR monitor to measure PA intensity. PA intensity was calculated using an estimated HR max. Accelerometer counts were reported. Parents and school staff completed activity and eating journals.

RESULTS

Six days of PA and HR data were analyzed. Two participants spent more time in moderate/vigorous PA intensity during school compared to at home. Activities with greatest PA intensity included oral eating, communication, and social engagement. Higher activity counts were recorded from the wrist compared with the waist accelerometers. PA and eating journal adherence were high in both settings.

CONCLUSION

The findings provide preliminary data to evaluate PA amount and intensity in children with CP who have little walking ability. It is important to consider PA levels in daily activity for youth with CP when designing plans of care.

Step cadence as a novel objective postoperative recovery metric in children who undergo laparoscopic appendectomy

BACKGROUND

Daily step counts from consumer wearable devices have been used to objectively assess postsurgical recovery in children. However, step cadence, defined as steps taken per minute, may be a more specific measure of physiologic status. The purpose of this study is to define objective normative physical activity recovery trajectories after laparoscopic appendectomy using this novel metric. We hypothesized that patients would have a progressive increase in peak cadence until reaching a plateau representing baseline status, and this would occur earlier for simple compared with complicated appendicitis.

METHODS

Children aged 3 to 18 years were enrolled after laparoscopic appendectomy for simple or complicated appendicitis between March 2019 and December 2022 at a tertiary children's hospital. Participants wore a Fitbit for 21 postoperative days. The peak 1-minute cadence and peak 30-minute cadence were determined each postoperative day. Piecewise linear regression was conducted to generate normative peak step cadence recovery trajectories for simple and complicated appendicitis.

RESULTS

A total of 147 children met criteria (53.7% complicated appendicitis). Patients with simple appendicitis reached plateau postoperative day 10 at a mean peak 1-minute cadence of 111 steps/minute and a mean peak 30-minute cadence of 77 steps/minute. The complicated appendicitis recovery trajectory reached a plateau postoperative day 13 at a mean peak 1-minute cadence of 106 steps/minute and postoperative day 15 at a mean peak 30-minute cadence of 75 steps/minute.

CONCLUSION

Using step cadence, we defined procedure-specific normative peak cadence recovery trajectories after laparoscopic appendectomy. This can empower clinicians to set data-driven expectations for recovery after surgery and establish the groundwork for consumer wearable devices as a post-discharge remote monitoring tool.

Consumer Wearables Define a Normative Recovery Trajectory Following the Modified Nuss Procedure

INTRODUCTION

The modified Nuss procedure is an elective procedure associated with a lengthy recovery, uncontrolled pain, and risk of infrequent, yet life-threatening complications. The absence of objective measures of normative postoperative recovery creates uncertainty about the postdischarge period, which remains highly dependent on the patients' and their caregivers' expectations and management of recovery. We aimed to describe an objective-normative, physical activity recovery trajectory after the modified Nuss procedure, using step counts from the Fitbit.

METHODS

This observational study enrolled children ≤18 y with pectus excavatum who underwent the modified Nuss procedure from 2021 to 2022. The Fitbit was worn for 21 postoperative days. Postdischarge outcomes and health-care utilization were evaluated. For patients without postoperative complications, piecewise linear regression analysis was conducted to generate a normative recovery trajectory model of daily step counts.

RESULTS

Of 80 patients enrolled, 66 (86%) met eligibility criteria (mean age, 15.1 ± 1.3 y; 89.4% male, 62.1% non-Hispanic White). The mean number of telephone and electronic message encounters regarding concerns with the patient's recovery within 30 d postoperatively was 2.1 (standard deviation = 2.7). Ten patients (15.2%) returned to the emergency department (ED) within the 30-d postoperative period. Seven patients (10.6%) presented to the ED one time, and three patients (4.5%) presented to the ED twice. Thirty-day readmission rate was four patients (6.0%). Piecewise regression model showed that patients without complications steadily increased their daily step count on each postoperative day and plateaued on day 18.

CONCLUSIONS

We have developed a normative recovery trajectory following the modified Nuss procedure using step count data collected by a consumer wearable device. This offers the potential to inform preoperative patient expectations and reduce avoidable health-care utilization through informed preoperative counseling, thus laying the ground work for the use of consumer wearable devices as a postdischarge remote monitoring tool.

Feasibility and Utility of a Fitbit Tracker Among Ambulatory Children and Youth With Disabilities

PURPOSE

To examine the feasibility and utility of the Fitbit Charge HR to estimate physical activity among ambulatory children and youth with disabilities.

METHOD

Participants (4-17 y old) with disabilities were recruited and asked to wear a Fitbit for 28 days. Feasibility was assessed as the number of participants who adhered to the 28-day protocol. Heat maps were generated to visually examine variability in step count by age, gender, and disability group. Between-group differences for wear time and step counts by age, gender, and disability type were assessed by independent sample t tests for gender and disability group, and a 1-way analysis of variance for age group.

RESULTS

Participants (N = 157; median age = 10 y; 71% boys; 71% nonphysical disabilities) averaged 21 valid days of wear time. Wear time was higher in girls than boys (mean difference = 18.0; 95% confidence interval [CI], 6.8 to 29.1), and in preadolescents (mean difference = 27.6; 95% CI, 15.5 to 39.7) and adolescents (mean difference = -21.2; 95% CI, -33.6 to -8.7) than children. More daily steps were taken by boys than girls (mean difference = -1040; 95% CI, -1465 to -615) and individuals with a nonphysical disability than a physical disability (mean difference = -1120; 95% CI, -1474 to -765). The heat maps showed peaks in physical activity on weekdays before school, at recess, lunchtime, and after school.

CONCLUSION

The Fitbit is a feasible tool for monitoring physical activity among ambulatory children and youth with disabilities and may be useful for population-level surveillance and intervention.

The Use of Wearable Technologies in the Assessment of Physical Activity in Preschool- and School-Age Youth: Systematic Review

In recent years, physical activity assessment has increasingly relied on wearable monitors to provide measures for surveillance, intervention, and epidemiological research. This present systematic review aimed to examine the current research about the utilization of wearable technology in the evaluation in physical activities of preschool- and school-age children. A database search (Web of Science, PubMed and Scopus) for original research articles was performed. A total of twenty-one articles met the inclusion criteria, and the Cochrane risk of bias tool was used. Wearable technology can actually be a very important instrument/tool to detect the movements and monitor the physical activity of children and adolescents. The results revealed that there are a few studies on the influence of these technologies on physical activity in schools, and most of them are descriptive. In line with previous research, the wearable devices can be used as a motivational tool to improve PA behaviors and in the evaluation of PA interventions. However, the different reliability levels of the different devices used in the studies can compromise the analysis and understanding of the results.