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

Assessing and Enhancing Movement Quality Using Wearables and Consumer Technologies: Thematic Analysis of Expert Perspectives

BACKGROUND

Improvements in movement quality (ie, how well an individual moves) facilitate increases in movement quantity, subsequently improving general health and quality of life. Wearable technology offers a convenient, affordable means of measuring and assessing movement quality for the general population, while technology more broadly can provide constructive feedback through various modalities. Considering the perspectives of professionals involved in the development and implementation of technology helps translate user needs into effective strategies for the optimal application of consumer technologies to enhance movement quality.

OBJECTIVE

This study aimed to obtain the opinions of wearable technology experts regarding the use of wearable devices to measure movement quality and provide feedback. A secondary objective was to determine potential strategies for integrating preferred assessment and feedback characteristics into a technology-based movement quality intervention for the general, recreationally active population.

METHODS

Semistructured interviews were conducted with 12 participants (age: mean 42, SD 9 years; 5 males) between August and September 2022 using a predetermined interview schedule. Participants were categorized based on their professional roles: commercial (n=4) and research and development (R&D; n=8). All participants had experience in the development or application of wearable technology for sports, exercise, and wellness. The verbatim interview transcripts were analyzed using reflexive thematic analysis in QSR NVivo (release 1.7), resulting in the identification of overarching themes and subthemes.

RESULTS

Three main themes were generated as follows: (1) "Grab and Go," (2) "Adjust and Adapt," and (3) "Visualize and Feedback." Participants emphasized the importance of convenience to enhance user engagement when using wearables to collect movement data. However, it was suggested that users would tolerate minor inconveniences if the benefits were perceived as valuable. Simple, easily interpretable feedback was recommended to accommodate diverse audiences and aid understanding of their movement quality, while avoiding excessive detail was advised to prevent overload, which could deter users. Adaptability was endorsed to accommodate progressions in user movement quality, and customizable systems were advocated to offer variety, thereby increasing user interest and engagement. The findings indicate that visual feedback representative of the user (ie, an avatar) should be used, supplemented with concise text or audible instructions to form a comprehensive, multimodal feedback system.

CONCLUSIONS

The study provides insights from wearable technology experts on the use of consumer technologies for enhancing movement quality. The findings recommend the prioritization of user convenience and simplistic, multimodal feedback centered around visualizations, and an adaptable system suitable for a diverse audience. Emphasizing individualized feedback and user-centric design, this study provides valuable findings around the use of wearables and other consumer technologies to enhance movement quality among the general population. These findings, in conjunction with those of future research into user perspectives, should be applied in practical settings to evaluate their effectiveness in enhancing movement quality.

Monitoring Activity and Gait in Children (MAGIC) using digital health technologies

BACKGROUND

Digital health technologies (DHTs) can collect gait and physical activity in adults, but limited studies have validated these in children. This study compared gait and physical activity metrics collected using DHTs to those collected by reference comparators during in-clinic sessions, to collect a normative accelerometry dataset, and to evaluate participants' comfort and their compliance in wearing the DHTs at-home.

METHODS

The MAGIC (Monitoring Activity and Gait in Children) study was an analytical validation study which enrolled 40, generally healthy participants aged 3-17 years. Gait and physical activity were collected using DHTs in a clinical setting and continuously at-home.

RESULTS

Overall good to excellent agreement was observed between gait metrics extracted with a gait algorithm from a lumbar-worn DHT compared to ground truth reference systems. Majority of participants either "agreed" or "strongly agreed" that wrist and lumbar DHTs were comfortable to wear at home, respectively, with 86% (wrist-worn DHT) and 68% (lumbar-worn DHT) wear-time compliance. Significant differences across age groups were observed in multiple gait and activity metrics obtained at home.

CONCLUSIONS

Our findings suggest that gait and physical activity data can be collected from DHTs in pediatric populations with high reliability and wear compliance, in-clinic and in home environments.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04823650 IMPACT: Digital health technologies (DHTs) have been used to collect gait and physical activity in adult populations, but limited studies have validated these metrics in children. The MAGIC study comprehensively validates the performance and feasibility of DHT-measured gait and physical activity in the pediatric population. Our findings suggest that reliable gait and physical activity data can be collected from DHTs in pediatric populations, with both high accuracy and wear compliance both in-clinic and in home environments. The identified across-age-group differences in gait and activity measurements highlighted their potential clinical value.

Moving together: Increasing physical activity in older adults with an intergenerational technology-based intervention. A feasibility study

Robust evidence supports the role of physical activity and exercise in increasing longevity, decreasing morbidity and helping older adults maintain the highest quality of life attainable. However, the majority of older adults are not sufficiently physically active and interventions are needed to change their behaviors. Familial or intergenerational contact has been positively linked to health and well-being in older adults. Therefore, this study aimed to i) establish acceptability and test the functionality and useability of a novel technology-driven intergenerational intervention targeting physical activity and age stereotypes, and ii) identify any potential issues with recruitment and retention. Four familial dyads (adult ≥ 65 and child 7-11 years) engaged with the intervention. Working collaboratively during a four-week trial, they combined daily step-counts (acquired via any activity of their choice, using PA trackers) to complete a virtual walk route using online platform World Walking. Thematic analysis of three post-intervention focus groups (one older adult; one child; one additional parental cohort) identified eight subthemes: Engagement; Provision of a Positive Experience; Participant Stimuli; Generated Outcomes; Operationality; Limitations; Mediators; Facilitators, and Perceptions. Participants enjoyed and successfully engaged with the intervention; when designing behaviour change interventions for older adults, flexibility within pre-established routines, individual choice, and avoiding rigidly imposed structures, is important. Strategies to challenge negative perceptions of older adults' engagement with technology and PA should be integrated into recruitment processes.

Mixed-method usability investigation of ARROWS: augmented reality for roadway work zone safety

This article explores the usability and user experience challenges of ARROWS, a novel augmented reality (AR) and wearable technology (WT) safety system for roadway work zones, an area with limited existing usability research. We utilized a mixed-method approach with two complementary experiments in indoor and outdoor settings, using the Wizard of Oz methodology and a high-fidelity prototype. We focused on identifying usability challenges, factors contributing to user experience and the distinct needs of highway workers, documenting results using the system usability scale (SUS), the rating scale mental effort (RSME) and a trust score. Participants rated the usability of ARROWS above average in both settings, while making a reasonable level of mental effort. The findings also indicate a significant correlation between perceived trust and usability, highlighting the importance of trust in user experience.

Physical activity and mental health in school-aged children: a prospective two-wave study during the easing of the COVID-19 restrictions

BACKGROUND

Because physical activity (PA) has many benefits for children's and adolescents' mental health, it has been suggested that PA may be an effective strategy to physically and mentally recover from the COVID-19 pandemic. This study tested the reciprocal relationship between PA and mental health during the easing of COVID-19 restrictions. It was hypothesized that mental health during the pandemic would determine how much children and adolescents re-engage in PA after easing the restrictions. Furthermore, it was hypothesized that PA engagement would predict mental health improvement after the pandemic.

METHODS

This was a prospective study with two measurement occasions. Pretest data collection was undertaken in February 2022, shortly before German authorities eased and lifted the COVID-19 restrictions. The follow-up (posttest) occurred six weeks later (April 2022). Both times, a sample of elementary and grammar school students aged 6 to 18 years (N = 170) reported their mental health problems and health-related quality of life. Mental health problems were assessed with the Strengths and Difficulties Questionnaire and health-related quality of life was assessed with the KIDSCREEN-52 questionnaire. PA was measured continuously during the study period using smart electronic devices with a built-in pedometer.

RESULTS

PA gradually increased after the easing of COVID-19 restrictions (p < .001). This increase was unrelated to pretest mental health problems and health-related quality of life except for emotional symptoms (p = .041). Participants with higher emotional symptoms showed a sharper increase in PA towards the end of the study period. Furthermore, hyperactivity decreased (p = .004) and physical well-being (p = .004), perceived autonomy (p < .001), and perceived quality of school environment (p = .008) improved from before to after the easing of restrictions, yet participants' PA predicted none of these changes.

CONCLUSIONS

The adverse effects of COVID-19 containment on PA seem to alleviate after children and adolescents are allowed to return to schools. This is likely to be due to the school setting, which provides many different opportunities for formal and informal PA rather than students' mental health. School-related PA programs should be part of children's and adolescents' recovery from the pandemic .

Promoting child and adolescent health through wearable technology: A systematic review

Background

Wearable technology is used in healthcare to monitor the health of individuals. This study presents an updated systematic literature review of the use of wearable technology in promoting child and adolescent health, accompanied by recommendations for future research.

Methods

This review focuses on studies involving children and adolescents aged between 2 and 18 years, regardless of their health condition or disabilities. Studies that were published from 2016 to 2024, and which met the inclusion criteria, were extracted from four academic databases (i.e. PubMed, Cochrane, Embase, and Web of Science) using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) protocol. Data on intervention purposes, interventions deployed, intervention duration, measurements, and the main outcomes of the studies were collected.

Results

A total of 53 studies involving 14,852 participants were reviewed. They focused on various aspects, including the ownership and use of wearable devices (n = 3), the feasibility (n = 22), effectiveness (n = 4), and adherence (n = 2) of intervention strategies, or a combination of multiple aspects (n = 22). Among the interventions deployed, Fitbit was the most frequently used, featuring in 26 studies, followed by ActiGraph (n = 11). In intervention studies, the majority of studies focused on pre-morbidity prevention (n = 26) and the treatment of illnesses (n = 20), with limited attention given to postoperative monitoring (n = 4).

Conclusions

The use of wearable technology by children and adolescents has proven to be both feasible and effective for health promotion. This systematic review summarizes existing research by exploring the use of wearable technology in promoting health across diverse youth populations, including healthy and unhealthy individuals. It examines health promotion at various stages of the disease continuum, including pre-disease prevention, in-disease treatment, and postoperative monitoring. Additionally, the review provides directions for future research.

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.

Machine Learning Identifies Smartwatch-Based Physiological Biomarker for Predicting Disruptive Behavior in Children: A Feasibility Study

Objective: Parents frequently purchase and inquire about smartwatch devices to monitor child behaviors and functioning. This pilot study examined the feasibility and accuracy of using smartwatch monitoring for the prediction of disruptive behaviors. Methods: The study enrolled children (N = 10) aged 7-10 years hospitalized for the treatment of disruptive behaviors. The study team completed continuous behavioral phenotyping during study participation. The machine learning protocol examined severe behavioral outbursts (operationalized as episodes that preceded physical restraint) for preparing the training data. Supervised machine learning methods were trained with cross-validation to predict three behavior states-calm, playful, and disruptive. Results: The participants had a 90% adherence rate for per protocol smartwatch use. Decision trees derived conditional dependencies of heart rate, sleep, and motor activity to predict behavior. A cross-validation demonstrated 80.89% accuracy of predicting the child's behavior state using these conditional dependencies. Conclusion: This study demonstrated the feasibility of 7-day continuous smartwatch monitoring for children with severe disruptive behaviors. A machine learning approach characterized predictive biomarkers of impending disruptive behaviors. Future validation studies will examine smartwatch physiological biomarkers to enhance behavioral interventions, increase parental engagement in treatment, and demonstrate target engagement in clinical trials of pharmacological agents for young children.

Strategies to Improve Physical Activity and Nutrition Behaviours in Children and Adolescents: A Review

Despite widespread acknowledgement of the multifarious health benefits of physical activity (PA), including prevention and control of obesity, an overwhelming majority of children and adolescents are not sufficiently active to realise such benefits. Concurrently, young people are significantly impacted by the rapid global rise of sedentarism, and suboptimal dietary patterns during key phases of development. Regrettably, the cumulative effects of unhealthy behaviours during the growing years predisposes young people to the early stages of several chronic conditions, including obesity. Clear and consistent approaches are urgently needed to improve eating and activity behaviours of children and adolescents. Based on existing evidence of "best bets" to prevent and control obesity and its comorbidities, we present a set of non-negotiable strategies as a 'road map' to achieving prevention and improving the health of children and adolescents.

Parents' Perceptions of Children's and Adolescents' Use of Electronic Devices to Promote Physical Activity: Systematic Review of Qualitative Evidence

BACKGROUND

The use of physical activity (PA) electronic devices offers a unique opportunity to engage children and adolescents in PA. For this age group (2-17 years), parents play a key role in promoting healthy lifestyles and regulating the use of electronic devices. Therefore, parents' perceptions of the use of electronic devices for PA in children and adolescents are critical for efficient intervention.

OBJECTIVE

The aim of this qualitative systematic review was to improve the understanding of parents' perceptions of the use of electronic devices for PA in children and adolescents.

METHODS

A systematic search of electronic databases (Medline/PubMed, SPORTDiscus, Web of Science, Scopus, OpenGrey, and Deep Blue) was conducted. Studies from inception (2010) to May 2022 were identified. Qualitative studies on the perceptions of healthy children's and adolescents' (aged 2-17 years) parents regarding PA interventions performed on electronic devices were included according to the Cochrane Qualitative and Implementation Methods Group Guidance Series and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used for methodological validity.

RESULTS

In total, 18 studies with 410 parents, mostly mothers, were included. Parents' perceptions were grouped into 4 categories: usefulness, advantages, general perceptions (electronic devices for health promotion, preferences for real-life PA, and concerns), and acceptability (barriers and facilitators) of electronic devices for PA. Parents perceived electronic devices as useful for increasing PA, learning new skills, and increasing motivation for PA and valued those devices that promoted socialization and family and peer bonding. In terms of general perceptions, parents had positive attitudes toward PA electronic devices; however, they preferred outdoor and real-life PA, especially for preschoolers and children. Concerns, such as physical and psychological harm, addiction, conflicts, and compliance difficulties, were found. Facilitators were identified as ease of use, appropriate feedback, promotion of socialization, and motivational strategies, such as rewards, challenges, and attractiveness. Barriers, such as discomfort, price, and difficulties in using or understanding electronic devices, were also identified. For older children and adolescents, parents were more concerned about high levels of screen time and setting limits on electronic devices and therefore preferred PA electronic devices rather than traditional ones.

CONCLUSIONS

Overall, the participants had positive attitudes toward electronic devices for PA and perceived them as an effective way to promote PA in children and adolescents. They also perceived several benefits of using electronic devices, such as health promotion, increased awareness and motivation, and socialization, as well as barriers, facilitators, and age differences. The results of this study could provide researchers with insights into designing more effective, age-appropriate PA electronic devices for children and adolescents and improving adherence to their use.

TRIAL REGISTRATION

PROSPERO CRD42021292340; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=292340.

Examining the acceptability of actigraphic devices in children using qualitative and quantitative approaches: protocol for a systematic review and meta-analysis

INTRODUCTION

Actigraphy is commonly used to record free living physical activity in both typically and atypically developing children. While the accuracy and reliability of actigraphy have been explored extensively, research regarding young people's opinion towards these devices is scarce. This review aims to identify and synthesise evidence relating to the acceptability of actigraphic devices in 5-11 year olds.

METHODS AND ANALYSIS

Database searches will be applied to Embase, MEDLINE, PsychInfo and Social Policy and Practice through the OVID interface; and Education Resources Information Center (ERIC), British Education Index and CINAHL through the EBSCO interface from January 2018 until February 2023. Supplementary forward and backward citation and grey literature database searches, including Healthcare Management Information Consortium (HMIC) and PsycEXTRA will be conducted. Qualitative and quantitative studies, excluding review articles and meta-analyses, will be eligible, without date restrictions. Article screening and data extraction will be undertaken by two review authors and disagreements will be deferred to a third reviewer. The primary outcome, actigraphic acceptability, will derive from the narrative synthesis of the main themes identified from included qualitative literature and pooled descriptive statistics relating to acceptability identified from quantitative literature. Subgroup analyses will determine if acceptability changes as a function of the key participant and actigraphic device factors.

ETHICS AND DISSEMINATION

Ethical approval is not required for this systematic review as it uses data from previously published literature. The results will be presented in a manuscript and published in a peer review journal and will be considered alongside a separate stream of codesign research to inform the development of a novel child-worn actigraphic device.

PROSPERO REGISTRATION NUMBER

CRD42021232466.

The development of a family-based wearable intervention using behaviour change and co-design approaches: move and connect

BACKGROUND

Previous research has explored the effectiveness of wearable activity trackers (wearables) for increasing child physical activity (PA) levels, but there have been mixed results. The use of theoretical frameworks and co-design techniques are recognised ways of increasing an intervention's acceptability and effectiveness.

AIMS

This study aims to use co-design workshops and an evidence-based theoretical framework (the Behaviour Change Wheel) to develop a family-based PA intervention using wearables.

METHODS

Three stages of intervention development outlined by the Behaviour Change Wheel were used. Co-design workshops with seven families (11 parents and 12 children) and seven PA experts were conducted where stakeholders discussed how to overcome previously identified barriers to families being active and using wearables. This resulted in the intervention's components being developed, with each component's mechanisms of action (e.g. intervention functions and behaviour change techniques) being retrospectively identified.

RESULTS

The 'Move & Connect' intervention was developed, which targets family PA and wearable use. The intervention takes a flexible approach and includes eight components, including wearable devices (Fitbit Alta HR), support resources, an introductory workshop, collective challenges, goal setting and reviewing, engagement prompts, social support and health-related resources (e.g. educational videos). The intervention incorporates six intervention functions targeting PA and wearable use: education, training, modelling, persuasion, incentivisation and environmental restructuring and 24 behaviour change techniques, including goal setting, social comparison, feedback on behaviour and graded task.

CONCLUSIONS

This is the first known study to use an evidence-based framework and co-design to develop a family-based wearable intervention. The identification of the intervention's mechanisms of action will prove useful when implementing and evaluating the 'Move & Connect' intervention and allow researchers to replicate its components.

Experience and Satisfaction with a Family-Based Physical Activity Intervention Using Activity Trackers and Apps: A Qualitative Study

Wearable activity trackers and smartphone apps have been shown to increase physical activity in children and adults. However, interventions using activity trackers and apps have rarely been tested in whole families. This study examined the experience and satisfaction with an activity tracker and app intervention (Step it Up Family) to increase physical activity in whole families. Telephone interviews were conducted with Queensland-based families (n = 19) who participated in the Step it Up Family intervention (N = 40, single-arm, pre/post feasibility study) in 2017/2018. Using commercial activity trackers combined with apps, the intervention included an introductory session, individual and family-level goal setting, self-monitoring, family step challenges, and weekly motivational text messages. Qualitative content analysis was conducted to identify themes, categories and sub-categories. In summary, parents reported that children were engaged with the activity tracker and app features to reach their daily step goals. Some technical difficulties were experienced with app navigation, syncing of activity tracker data, and tracker band discomfort. Although families liked that the weekly text messages reminded them to be active, they did not find them very motivating. Using text messages for physical activity motivation in families requires further testing. Overall, the intervention was well-received by families for increasing physical activity motivation.

Acceptability of wearable inertial sensors, completeness of data, and day-to-day variability of everyday life motor activities in children and adolescents with neuromotor impairments

Monitoring the patients' motor activities in a real-world setting would provide essential information on their functioning in daily life. In this study, we used wearable inertial sensors to monitor motor activities of children and adolescents with congenital and acquired brain injuries. We derived a set of clinically meaningful performance measures and addressed the following research questions: Is the target population willing to wear the sensors in their habitual environment? Which factors lead to missing data, and can we avoid them? How many measurement days are needed to obtain reliable estimates of the children's and adolescents' motor performance? The study participants wore our sensor system for seven consecutive days during waking hours. First, we derived the daily hand use of all participants, the duration of different body positions and the wheeling activity of individuals using a manual wheelchair, and walking-related measures in individuals being able to walk. Then, we analyzed the reasons for missing data and determined the reliability of the performance measures mentioned above. The large majority (41 of 43 participants) was willing to wear the sensor system for a week. However, forgetting to reattach the sensors after charging them overnight and taking them off during bathing and swimming was the main contributor to missing data. Consequently, improved battery life and waterproofness of the sensor technology are essential requirements for measurements in daily life. Besides, 5 of 11 performance measures showed significant differences between weekdays and weekend days. The reliability, measured with the intraclass correlation coefficient, ranged between 0.82 and 0.98. Seven measurement days were enough to obtain significantly higher reliability scores than the desired level of 0.8 for all but two performance measures. In children and adolescents with neuromotor impairments, we recommend monitoring everyday life motor activities on seven consecutive days. The target population accepted this measurement protocol, it covers school days and weekend days, and the number of measurement days is sufficient to obtain reliable estimates of motor performance.

Recommendations for Identifying Valid Wear for Consumer-Level Wrist-Worn Activity Trackers and Acceptability of Extended Device Deployment in Children

BACKGROUND

Self-reported physical activity is often inaccurate. Wearable devices utilizing multiple sensors are now widespread. The aim of this study was to determine acceptability of Fitbit Charge HR for children and their families, and to determine best practices for processing its objective data.

METHODS

Data were collected via Fitbit Charge HR continuously over the course of 3 weeks. Questionnaires were given to each child and their parent/guardian to determine the perceived usability of the device. Patterns of data were evaluated and best practice inclusion criteria recommended.

RESULTS

Best practices were established to extract, filter, and process data to evaluate device wear, r and establish minimum wear time to evaluate behavioral patterns. This resulted in usable data available from 137 (89%) of the sample.

CONCLUSIONS

Activity trackers are highly acceptable in the target population and can provide objective data over longer periods of wear. Best practice inclusion protocols that reflect physical activity in youth are provided.

Sensor-based outcomes to monitor everyday life motor activities of children and adolescents with neuromotor impairments: A survey with health professionals

In combination with appropriate data processing algorithms, wearable inertial sensors enable the measurement of motor activities in children's and adolescents' habitual environments after rehabilitation. However, existing algorithms were predominantly designed for adult patients, and their outcomes might not be relevant for a pediatric population. In this study, we identified the needs of pediatric rehabilitation to create the basis for developing new algorithms that derive clinically relevant outcomes for children and adolescents with neuromotor impairments. We conducted an international survey with health professionals of pediatric neurorehabilitation centers, provided them a list of 34 outcome measures currently used in the literature, and asked them to rate the clinical relevance of these measures for a pediatric population. The survey was completed by 62 therapists, 16 doctors, and 9 nurses of 16 different pediatric neurorehabilitation centers from Switzerland, Germany, and Austria. They had an average work experience of 13 ± 10 years. The most relevant outcome measures were the duration of lying, sitting, and standing positions; the amount of active self-propulsion during wheeling periods; the hand use laterality; and the duration, distance, and speed of walking periods. The health profession, work experience, and workplace had a minimal impact on the priorities of health professionals. Eventually, we complemented the survey findings with the family priorities of a previous study to provide developers with the clinically most relevant outcomes to monitor everyday life motor activities of children and adolescents with neuromotor impairments.

The Effectiveness of Wearable Devices as Physical Activity Interventions for Preventing and Treating Obesity in Children and Adolescents: Systematic Review and Meta-analysis

Background

The prevalence of obesity in children and adolescents remains a global public health issue. Wearable devices may offer new opportunities for prevention and intervention in obesity. Previous systematic reviews have only examined the effect of the wearable device interventions on preventing and treating obesity in adults. However, no systematic review has provided an evaluation of wearable devices as physical activity interventions for preventing and treating obesity in children and adolescents.

Objective

The purpose of this review and meta-analysis was to evaluate the effectiveness of wearable devices as physical activity interventions on obesity-related anthropometric outcomes in children and adolescents.

Methods

Research articles retrieved from PubMed, EMBASE, Cochrane Library, Scopus, and EBSCO from inception to February 1, 2021, were reviewed. The search was designed to identify studies utilizing wearable devices for preventing and treating obesity in children and adolescents. The included studies were evaluated for risk of bias following the Cochrane recommendation. Meta-analyses were conducted to evaluate the effectiveness of wearable devices as physical activity interventions on body weight, body fat, BMI z-score (BMI-Z), BMI, and waist circumference. Subgroup analyses were performed to determine whether the characteristics of the interventions had an impact on the effect size.

Results

A total of 12 randomized controlled trials (3227 participants) were selected for meta-analysis. Compared with the control group, wearable device interventions had statistically significant beneficial effects on BMI (mean difference [MD] –0.23; 95% CI –0.43 to –0.03; P=.03; I²=2%), BMI-Z (MD –0.07; 95% CI –0.13 to –0.01; P=.01; I²=81%), body weight (MD –1.08; 95% CI –2.16 to –0.00; P=.05; I²=58%), and body fat (MD –0.72; 95% CI –1.19 to –0.25; P=.003; I²=5%). However, no statistically significant effect was found on waist circumference (MD 0.55; 95% CI –0.21 to 1.32; P=.16; I²=0%). The subgroup analysis showed that for participants with overweight or obesity (MD –0.75; 95% CI –1.18 to –0.31; P<.01; I²=0%), in the short-term (MD –0.62; 95% CI –1.03 to –0.21; P<.01; I²=0%), wearable-based interventions (MD –0.56; 95% CI –0.95 to –0.18; P<.01; I²=0%) generally resulted in greater intervention effect size on BMI.

Conclusions

Evidence from this meta-analysis shows that wearable devices as physical activity interventions may be useful for preventing and treating obesity in children and adolescents. Future research is needed to identify the most effective physical activity indicators of wearable devices to prevent and treat obesity in children and adolescents.

Exploring Families' Acceptance of Wearable Activity Trackers: A Mixed-Methods Study

Background: The family environment plays a crucial role in child physical activity (PA). Wearable activity trackers (wearables) show potential for increasing children’s PA; however, few studies have explored families’ acceptance of wearables. This study investigated the acceptability of using wearables in a family setting, aligning experiences with components of the Technology Acceptance Model and Theoretical Domains Framework. Methods: Twenty-four families, with children aged 5–9 years, took part in a 5-week study, where all members were provided with a Fitbit Alta HR for 4 weeks. Acceptability was measured using weekly surveys and pre-post-questionnaires. Nineteen families participated in a focus group. Quantitative and qualitative data were integrated using the Pillar Integration Process technique. Results: Pillars reflected (1) external variables impacting wearable use and PA and (2) wearable use, (3) ease of use, (4) usefulness for increasing PA and other health outcomes, (5) attitudes, and (6) intention to use a wearable, including future intervention suggestions. Conclusions: Families found the Fitbit easy to use and acceptable, but use varied, and perceived impact on PA were mixed, with external variables contributing towards this. This study provides insights into how wearables may be integrated into family-based PA interventions and highlights barriers and facilitators of family wearable use.

Effectiveness of eHealth and mHealth Interventions Supporting Children and Young People Living With Juvenile Idiopathic Arthritis: Systematic Review and Meta-analysis

BACKGROUND

Juvenile idiopathic arthritis (JIA) management aims to promote remission through timely, individualized, well-coordinated interdisciplinary care using a range of pharmacological, physical, psychological, and educational interventions. However, achieving this goal is workforce-intensive. Harnessing the burgeoning eHealth and mobile health (mHealth) interventions could be a resource-efficient way of supplementing JIA management.

OBJECTIVE

This systematic review aims to identify the eHealth and mHealth interventions that have been proven to be effective in supporting health outcomes for children and young people (aged 1-18 years) living with JIA.

METHODS

We systematically searched 15 databases (2018-2021). Studies were eligible if they considered children and young people (aged 1-18 years) diagnosed with JIA, an eHealth or mHealth intervention, any comparator, and health outcomes related to the used interventions. Independently, 2 reviewers screened the studies for inclusion and appraised the study quality using the Downs and Black (modified) checklist. Study outcomes were summarized using a narrative, descriptive method and, where possible, combined for a meta-analysis using a random-effects model.

RESULTS

Of the 301 studies identified in the search strategy, 15 (5%) fair-to-good-quality studies met the inclusion criteria, which identified 10 interventions for JIA (age 4-18.6 years). Of these 10 interventions, 5 (50%) supported symptom monitoring by capturing real-time data using health applications, electronic diaries, or web-based portals to monitor pain or health-related quality of life (HRQoL). Within individual studies, a preference was demonstrated for real-time pain monitoring over recall pain assessments because of a peak-end effect, improved time efficiency (P=.002), and meeting children's and young people's HRQoL needs (P<.001) during pediatric rheumatology consultations. Furthermore, 20% (2/10) of interventions supported physical activity promotion using a web-based program or a wearable activity tracker. The web-based program exhibited a moderate effect, which increased endurance time, physical activity levels, and moderate to vigorous physical activity (standardized mean difference [SMD] 0.60, SD 0.02-1.18; I²=79%; P=.04). The final 30% (3/10) of interventions supported self-management development through web-based programs, or apps, facilitating a small effect, reducing pain intensity (SMD -0.14, 95% CI -0.43 to 0.15; I²=53%; P=.33), and increasing disease knowledge and self-efficacy (SMD 0.30, 95% CI 0.03-0.56; I²=74%; P=.03). These results were not statistically significant. No effect was seen regarding pain interference, HRQoL, anxiety, depression, pain coping, disease activity, functional ability, or treatment adherence.

CONCLUSIONS

Evidence that supports the inclusion of eHealth and mHealth interventions in JIA management is increasing. However, this evidence needs to be considered cautiously because of the small sample size, wide CIs, and moderate to high statistical heterogeneity. More rigorous research is needed on the longitudinal effects of real-time monitoring, web-based pediatric rheumatologist-children and young people interactions, the comparison among different self-management programs, and the use of wearable technologies as an objective measurement for monitoring physical activity before any recommendations that inform current practice can be given.

Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics

In this article, we provide an overview of remote monitoring of pediatric PGHD and family-generated health data, including its current uses, future opportunities, and implementation resources.

Innovation in the pediatric electronic health record to realize a more effective platform

Commercial electronic health records (EHRs) were first developed to automate business processes. As EHRs developed, design principles focused on transferring existing paper-based documentation to comparable electronic forms. In addition, a strong industry focus on adult healthcare settings and quality measures has limited attention and resources for high priority EHR functionality needed for the unique health care of children. The objective of this paper is to provide a review of innovation in the EHR, that includes a variety of established and emerging technologies that may help realize a more effective EHR in child health settings. A more effective EHR would serve as an electronic hub. Existing EHR infrastructure could provide the foundation upon which new technologies and approaches branch and extend, enabling more rapid and customizable innovation to better meet shifting stakeholder and end-user needs. Among many areas for improvement, key goals of innovation could include technology that relieves ambulatory primary care clinician documentation burden, identifies needs, and supports improved care coordination and outcomes, focused on the following key areas: identification of child and family care needs, decision support, documentation, care coordination, and family communication.

A Systematic Review on TeleMental Health in Youth Mental Health: Focus on Anxiety, Depression and Obsessive-Compulsive Disorder

Background and Objectives: The Internet is widely used and disseminated amongst youngsters and many web-based applications may serve to improve mental health care access, particularly in remote and distant sites or in settings where there is a shortage of mental health practitioners. However, in recent years, specific digital psychiatry interventions have been developed and implemented for special populations such as children and adolescents. Materials and Methods: Hereby, we describe the current state-of-the-art in the field of TMH application for young mental health, focusing on recent studies concerning anxiety, obsessive-compulsive disorder and affective disorders. Results: After screening and selection process, a total of 56 studies focusing on TMH applied to youth depression (n = 29), to only youth anxiety (n = 12) or mixed youth anxiety/depression (n = 7) and youth OCD (n = 8) were selected and retrieved. Conclusions: Telemental Health (TMH; i.e., the use of telecommunications and information technology to provide access to mental health assessment, diagnosis, intervention, consultation, supervision across distance) may offer an effective and efficacious tool to overcome many of the barriers encountering in the delivery of young mental health care.

Performing nutrition assessment remotely via telehealth

Performing nutrition assessment remotely via telehealth is a topic of significant interest given the global pandemic in 2020 that has necessitated physical distancing and virtual communications. This review presents an evidence-based approach to conducting nutrition assessments remotely. The authors present suggestions for adaptations that can be used to perform a remote nutrition-focused physical exam. Direct-to-consumer technologies that can be used in remote nutrition assessment are discussed and compared. Practice tips for conducting a telehealth visit are also presented. The aim of this publication is to provide interdisciplinary clinicians a set of guidelines and best practices for performing nutrition assessments in the era of telehealth.

The Acceptability, Feasibility, and Effectiveness of Wearable Activity Trackers for Increasing Physical Activity in Children and Adolescents: A Systematic Review

Wearable activity trackers (wearables) embed numerous behaviour change techniques (BCTs) that have previously been shown to increase adult physical activity (PA). With few children and adolescents achieving PA guidelines, it is crucial to explore ways to increase their PA. This systematic review examined the acceptability, feasibility, and effectiveness of wearables and their potential mechanisms of action for increasing PA in 5 to 19-year-olds. A systematic search of six databases was conducted, including data from the start date of each database to December 2019 (PROSPERO registration: CRD42020164506). Thirty-three studies were included. Most studies (70%) included only adolescents (10 to 19 years). There was some-but largely mixed-evidence that wearables increase steps and moderate-to-vigorous-intensity PA and reduce sedentary behaviour. There were no apparent differences in effectiveness based on the number of BCTs used and between studies using a wearable alone or as part of a multi-component intervention. Qualitative findings suggested wearables increased motivation to be physically active via self-monitoring, goal setting, feedback, and competition. However, children and adolescents reported technical difficulties and a novelty effect when using wearables, which may impact wearables' long-term use. More rigorous and long-term studies investigating the acceptability, feasibility, and effectiveness of wearables in 5 to 19-year-olds are warranted.

Remote Monitoring of Critically-Ill Post-Surgical Patients: Lessons from a Biosensor Implementation Trial

Biosensors represent one of the numerous promising technologies envisioned to extend healthcare delivery. In perioperative care, the healthcare delivery system can use biosensors to remotely supervise patients who would otherwise be admitted to a hospital. This novel technology has gained a foothold in healthcare with significant acceleration due to the COVID-19 pandemic. However, few studies have attempted to narrate, or systematically analyze, the process of their implementation. We performed an observational study of biosensor implementation. The data accuracy provided by the commercially available biosensors was compared to those offered by standard clinical monitoring on patients admitted to the intensive care unit/perioperative unit. Surveys were also conducted to examine the acceptance of technology by patients and medical staff. We demonstrated a significant difference in vital signs between sensors and standard monitoring which was very dependent on the measured variables. Sensors seemed to integrate into the workflow relatively quickly, with almost no reported problems. The acceptance of the biosensors was high by patients and slightly less by nurses directly involved in the patients’ care. The staff forecast a broad implementation of biosensors in approximately three to five years, yet are eager to learn more about them. Reliability considerations proved particularly troublesome in our implementation trial. Careful evaluation of sensor readiness is most likely necessary prior to system-wide implementation by each hospital to assess for data accuracy and acceptance by the staff.

Sensor, Wearable, and Remote Patient Monitoring Competencies for Clinical Care and Training: Scoping Review

Sensor, wearable, and remote patient monitoring technologies are typically used in conjunction with video and/or in-person care for a variety of interventions and care outcomes. This scoping review identifies clinical skills (i.e., competencies) needed to ensure quality care and approaches for organizations to implement and evaluate these technologies. The literature search focused on four concept areas: (1) competencies; (2) sensors, wearables, and remote patient monitoring; (3) mobile, asynchronous, and synchronous technologies; and (4) behavioral health. From 2846 potential references, two authors assessed abstracts for 2828 and, full text for 521, with 111 papers directly relevant to the concept areas. These new technologies integrate health, lifestyle, and clinical care, and they contextually change the culture of care and training-with more time for engagement, continuity of experience, and dynamic data for decision-making for both patients and clinicians. This poses challenges for users (e.g., keeping up, education/training, skills) and healthcare organizations. Based on the clinical studies and informed by clinical informatics, video, social media, and mobile health, a framework of competencies is proposed with three learner levels (novice/advanced beginner, competent/proficient, advanced/expert). Examples are provided to apply the competencies to care, and suggestions are offered on curricular methodologies, faculty development, and institutional practices (e-culture, professionalism, change). Some academic health centers and health systems may naturally assume that clinicians and systems are adapting, but clinical, technological, and administrative workflow-much less skill development-lags. Competencies need to be discrete, measurable, implemented, and evaluated to ensure the quality of care and integrate missions.

Young People's Use of Digital Health Technologies in the Global North: Narrative Review

BACKGROUND

A diverse array of digital technologies are available to children and young people living in the Global North to monitor, manage, and promote their health and well-being.

OBJECTIVE

This article provides a narrative literature review of the growing number of social research studies published over the past decade that investigate the types of digital technologies used by children and young people in the Global North, in addition to investigating which of these technologies they find most useful or not useful. Key findings as well as major gaps and directions for future research are identified and discussed.

METHODS

A comprehensive search of relevant publications listed in Google Scholar was conducted, supported by following citation trails of these publications. The findings are listed under type of digital technology used for health: cross-media, internet, social media, apps and wearable devices, sexual health support and information, and mental health support and information.

RESULTS

Many young people in the Global North are active users of digital health technologies. However, it is notable that they still rely on older technologies, such as websites and search engines, to find information. Apps and platforms that may not have been specifically developed for young people as digital health resources often better suit their needs. Young people appreciate the ready availability of information online, the opportunities to learn more about their bodies and health states, and the opportunities to learn how to improve their health and physical fitness. They enjoy being able to connect with peers, and they find emotional support and relief from distress by using social media platforms, YouTube, and online forums. Young people can find the vast reams of information available to them difficult to navigate. They often look to trusted adults to help them make sense of the information they find online and to provide alternative sources of information and support. Face-to-face interactions with these trusted providers remain important to young people. Risks and harms that young people report from digital health use include becoming overly obsessed with their bodies' shape and size when using self-tracking technologies and comparing their bodies with the social media influencers they follow.

CONCLUSIONS

Further details on how young people are using social media platforms and YouTube as health support resources and for peer-to-peer sharing of information, including attention paid to the content of these resources and the role played by young social media influencers and microcelebrities, would contribute important insights to this body of literature. The role played by visual media, such as GIFs (Graphics Interchange Format) and memes, and social media platforms that have recently become very popular with young people (eg, Snapchat and TikTok) in health-related content creation and sharing requires more attention by social researchers seeking to better understand young people's use of digital devices and software for health and fitness.

Towards remote monitoring in pediatric care and clinical trials-Tolerability, repeatability and reference values of candidate digital endpoints derived from physical activity, heart rate and sleep in healthy children

Background

Digital devices and wearables allow for the measurement of a wide range of health-related parameters in a non-invasive manner, which may be particularly valuable in pediatrics. Incorporation of such parameters in clinical trials or care as digital endpoint could reduce the burden for children and their parents but requires clinical validation in the target population. This study aims to determine the tolerability, repeatability, and reference values of novel digital endpoints in healthy children.

Methods

Apparently healthy children (n = 175, 46% male) aged 2–16 were included. Subjects were monitored for 21 days using a home-monitoring platform with several devices (smartwatch, spirometer, thermometer, blood pressure monitor, scales). Endpoints were analyzed with a mixed effects model, assessing variables that explained within- and between-subject variability. Endpoints based on physical activity, heart rate, and sleep-related parameters were included in the analysis. For physical-activity-related endpoints, a sample size needed to detect a 15% increase was calculated.

Findings

Median compliance was 94%. Variability in each physical activity-related candidate endpoint was explained by age, sex, watch wear time, rain duration per day, average ambient temperature, and population density of the city of residence. Estimated sample sizes for candidate endpoints ranged from 33–110 per group. Daytime heart rate, nocturnal heart rate and sleep duration decreased as a function of age and were comparable to reference values published in the literature.

Conclusions

Wearable- and portable devices are tolerable for pediatric subjects. The raw data, models and reference values presented here can be used to guide further validation and, in the future, clinical trial designs involving the included measures.

Wearable Health Devices in Health Care: Narrative Systematic Review

BACKGROUND

With the rise of mobile medicine, the development of new technologies such as smart sensing, and the popularization of personalized health concepts, the field of smart wearable devices has developed rapidly in recent years. Among them, medical wearable devices have become one of the most promising fields. These intelligent devices not only assist people in pursuing a healthier lifestyle but also provide a constant stream of health care data for disease diagnosis and treatment by actively recording physiological parameters and tracking metabolic status. Therefore, wearable medical devices have the potential to become a mainstay of the future mobile medical market.

OBJECTIVE

Although previous reviews have discussed consumer trends in wearable electronics and the application of wearable technology in recreational and sporting activities, data on broad clinical usefulness are lacking. We aimed to review the current application of wearable devices in health care while highlighting shortcomings for further research. In addition to daily health and safety monitoring, the focus of our work was mainly on the use of wearable devices in clinical practice.

METHODS

We conducted a narrative review of the use of wearable devices in health care settings by searching papers in PubMed, EMBASE, Scopus, and the Cochrane Library published since October 2015. Potentially relevant papers were then compared to determine their relevance and reviewed independently for inclusion.

RESULTS

A total of 82 relevant papers drawn from 960 papers on the subject of wearable devices in health care settings were qualitatively analyzed, and the information was synthesized. Our review shows that the wearable medical devices developed so far have been designed for use on all parts of the human body, including the head, limbs, and torso. These devices can be classified into 4 application areas: (1) health and safety monitoring, (2) chronic disease management, (3) disease diagnosis and treatment, and (4) rehabilitation. However, the wearable medical device industry currently faces several important limitations that prevent further use of wearable technology in medical practice, such as difficulties in achieving user-friendly solutions, security and privacy concerns, the lack of industry standards, and various technical bottlenecks.

CONCLUSIONS

We predict that with the development of science and technology and the popularization of personalized health concepts, wearable devices will play a greater role in the field of health care and become better integrated into people's daily lives. However, more research is needed to explore further applications of wearable devices in the medical field. We hope that this review can provide a useful reference for the development of wearable medical devices.

Intervention to Improve Preschool Children's Fundamental Motor Skills: Protocol for a Parent-Focused, Mobile App-Based Comparative Effectiveness Trial

Background

Preschool age is an important time to master fundamental motor skills (FMS) through structured physical activity, yet many young children lag behind in motor skill development.

Objective

The Promoting Lifelong Activity in Youth (PLAY) study is a pilot comparative effectiveness trial to test the acceptability, feasibility, and preliminary effectiveness of a mobile app delivered to parents to promote FMS development in their preschool children (aged 3-5 years).

Methods

We conducted a 2-arm, parallel-design, randomized comparative effectiveness trial in 72 parent-child dyads from the southeastern United States. Experts in motor development and developmental psychology developed an app designed to deliver a 12-week program to parents of preschoolers using 1 of 2 curricula: an FMS program (intervention) that involved peer modeling, parent engagement, and structured skills-based activities and an unstructured physical activity (comparator) curriculum that provided suggestions for child-led physical activity (ie, free play). Primary outcomes are feasibility and acceptability of the app and child’s FMS measured at end of intervention (week 12). Exploratory outcomes are child’s objective physical activity, perceived movement competence, and parent report of self-regulation at the end of treatment (week 12) and sustained outcomes at follow-up (week 24).

Results

This project was funded in September 2018, with institutional review board approval in August 2018. Data collection took place from May 2019 through February 2020. To date, the project team has completed data collection on 69 preschool-age children, and results are expected to be published by 2021.

Conclusions

The PLAY study examines the feasibility and preliminary effectiveness of a mobile app, parent-led curricula to promote FMS proficiency for preschool children. If found to be effective, the app has the potential for wide-scale dissemination to parents of preschoolers and to provide a model for the utilization of mobile apps to promote young children’s motor skill development.

Trial Registration

ClinicalTrials.gov NCT03901300; https://clinicaltrials.gov/ct2/show/NCT03901300

International Registered Report Identifier (IRRID)

DERR1-10.2196/19943

The Next Frontier in Pediatric Cardiology: Artificial Intelligence

Artificial intelligence (AI) in the last decade centered primarily around digitizing and incorporating the large volumes of patient data from electronic health records. AI is now poised to make the next step in health care integration, with precision medicine, imaging support, and development of individual health trends with the popularization of wearable devices. Future clinical pediatric cardiologists will use AI as an adjunct in delivering optimum patient care, with the help of accurate predictive risk calculators, continual health monitoring from wearables, and precision medicine. Physicians must also protect their patients' health information from monetization or exploitation.

Implementation of a school-based Fitbit program for youth with Autism Spectrum Disorder: A feasibility study

BACKGROUND

School settings may be optimal for physical activity interventions for youth with Autism Spectrum Disorder (ASD). Additionally, consumer-based fitness trackers may encourage youth with ASD to increase their physical activity levels, however, no studies have examined whether a fitness tracker program would be feasible in youth with ASD.

OBJECTIVE

To examine the feasibility of a 12-week school-based Fitbit© program for youth with ASD.

METHODS

Six classroom teachers and their students (n = 45) were provided with Fitbit fitness trackers to wear over 12-weeks. Classroom teachers monitored student tracker use and completed open-ended surveys to describe both their experience and their students' experience with the fitness trackers.

RESULTS

Out of the 45 eligible students, 42 (94%) opted to participate in the study. All six teachers and 32 (76%) of the 42 students wore the fitness tracker daily over 12 weeks. Teachers reported that students were most interested in tracking their daily steps, and the short batter life, and account set-up were the biggest challenges to students. All six teachers felt that this program could have long-term sustainability, especially if tracker use could be incorporated into school curriculum and classroom activities.

CONCLUSIONS

A school-based Fitbit program appears to be both feasible, and well-accepted by students with ASD. Future work should evaluate the preliminary efficacy of this type of program.

Clusters of Adolescent Physical Activity Tracker Patterns and Their Associations With Physical Activity Behaviors in Finland and Ireland: Cross-Sectional Study

Background

Physical activity trackers (PATs) such as apps and wearable devices (eg, sports watches, heart rate monitors) are increasingly being used by young adolescents. Despite the potential of PATs to help monitor and improve moderate-to-vigorous physical activity (MVPA) behaviors, there is a lack of research that confirms an association between PAT ownership or use and physical activity behaviors at the population level.

Objective

The purpose of this study was to examine the ownership and use of PATs in youth and their associations with physical activity behaviors, including daily MVPA, sports club membership, and active travel, in 2 nationally representative samples of young adolescent males and females in Finland and Ireland.

Methods

Comparable data were gathered in the 2018 Finnish School-aged Physical Activity (F-SPA 2018, n=3311) and the 2018 Irish Children’s Sport Participation and Physical Activity (CSPPA 2018, n=4797) studies. A cluster analysis was performed to obtain the patterns of PAT ownership and usage by adolescents (age, 11-15 years). Four similar clusters were identified across Finnish and Irish adolescents: (1) no PATs, (2) PAT owners, (3) app users, and (4) wearable device users. Adjusted binary logistic regression analyses were used to evaluate how PAT clusters were associated with physical activity behaviors, including daily MVPA, membership of sports clubs, and active travel, after stratification by gender.

Results

The proportion of app ownership among Finnish adolescents (2038/3311, 61.6%) was almost double that of their Irish counterparts (1738/4797, 36.2%). Despite these differences, the clustering patterns of PATs were similar between the 2 countries. App users were more likely to take part in daily MVPA (males, odds ratio [OR] 1.27, 95% CI 1.04-1.55; females, OR 1.49, 95% CI 1.20-1.85) and be members of sports clubs (males, OR 1.37, 95% CI 1.15-1.62; females, OR 1.25, 95% CI 1.07-1.50) compared to the no PATs cluster, after adjusting for country, age, family affluence, and disabilities. These associations, after the same adjustments, were even stronger for wearable device users to participate in daily MVPA (males, OR 1.83, 95% CI 1.49-2.23; females, OR 2.25, 95% CI 1.80-2.82) and be members of sports clubs (males, OR 1.88, 95% CI 1.55-2.88; females, OR 2.07, 95% CI 1.71-2.52). Significant associations were observed between male users of wearable devices and taking part in active travel behavior (OR 1.39, 95% CI 1.04-1.86).

Conclusions

Although Finnish adolescents report more ownership of PATs than Irish adolescents, the patterns of use and ownership remain similar among the cohorts. The findings of our study show that physical activity behaviors were positively associated with wearable device users and app users. These findings were similar between males and females. Given the cross-sectional nature of this data, the relationship between using apps or wearable devices and enhancing physical activity behaviors requires further investigation.

Usability of Wearable Devices With a Novel Cardiac Force Index for Estimating the Dynamic Cardiac Function: Observational Study

Background

Long-distance running can be a form of stress to the heart. Technological improvements combined with the public’s gradual turn toward mobile health (mHealth), self-health, and exercise effectiveness have resulted in the widespread use of wearable exercise products. The monitoring of dynamic cardiac function changes during running and running performance should be further studied.

Objective

We investigated the relationship between dynamic cardiac function changes and finish time for 3000-meter runs. Using a wearable device based on a novel cardiac force index (CFI), we explored potential correlations among 3000-meter runners with stronger and weaker cardiac functions during running.

Methods

This study used the American product BioHarness 3.0 (Zephyr Technology Corporation), which can measure basic physiological parameters including heart rate, respiratory rate, temperature, maximum oxygen consumption, and activity. We investigated the correlations among new physiological parameters, including CFI = weight * activity / heart rate, cardiac force ratio (CFR) = CFI of running / CFI of walking, and finish times for 3000-meter runs.

Results

The results showed that waist circumference, smoking, and CFI were the significant factors for qualifying in the 3000-meter run. The prediction model was as follows: ln (3000 meters running performance pass probability / fail results probability) = –2.702 – 0.096 × [waist circumference] – 1.827 × [smoke] + 0.020 × [ACi7]. If smoking and the ACi7 were controlled, contestants with a larger waist circumference tended to fail the qualification based on the formula above. If waist circumference and ACi7 were controlled, smokers tended to fail more often than nonsmokers. Finally, we investigated a new calculation method for monitoring cardiac status during exercise that uses the CFI of walking for the runner as a reference to obtain the ratio between the cardiac force of exercise and that of walking (CFR) to provide a standard for determining if the heart is capable of exercise. A relationship is documented between the CFR and the performance of 3000-meter runs in a healthy 22-year-old person. During the running period, data are obtained while participant slowly runs 3000 meters, and the relationship between the CFR and time is plotted. The runner’s CFR varies with changes in activity. Since the runner’s acceleration increases, the CFR quickly increases to an explosive peak, indicating the runner’s explosive power. At this period, the CFI revealed a 3-fold increase (CFR=3) in a strong heart. After a time lapse, the CFR is approximately 2.5 during an endurance period until finishing the 3000-meter run. Similar correlation is found in a runner with a weak heart, with the CFR at the beginning period being 4 and approximately 2.5 thereafter.

Conclusions

In conclusion, the study results suggested that measuring the real-time CFR changes could be used in a prediction model for 3000-meter running performance.

Using the Technology Acceptance Model to Explore Adolescents' Perspectives on Combining Technologies for Physical Activity Promotion Within an Intervention: Usability Study

Background

Wearable activity trackers and social media have been identified as having the potential to increase physical activity among adolescents, yet little is known about the perceived ease of use and perceived usefulness of the technology by adolescents.

Objective

The aim of this study was to use the technology acceptance model to explore adolescents’ acceptance of wearable activity trackers used in combination with social media within a physical activity intervention.

Methods

The Raising Awareness of Physical Activity study was a 12-week physical activity intervention that combined a wearable activity tracker (Fitbit Flex) with supporting digital materials that were delivered using social media (Facebook). A total of 124 adolescents aged 13 to 14 years randomized to the intervention group (9 schools) participated in focus groups immediately post intervention. Focus groups explored adolescents’ perspectives of the intervention and were analyzed using pen profiles using a coding framework based on the technology acceptance model.

Results

Adolescents reported that Fitbit Flex was useful as it motivated them to be active and provided feedback about their physical activity levels. However, adolescents typically reported that Fitbit Flex required effort to use, which negatively impacted on their perceived ease of use. Similarly, Facebook was considered to be a useful platform for delivering intervention content. However, adolescents generally noted preferences for using alternative social media websites, which may have impacted on negative perceptions concerning Facebook’s ease of use. Perceptions of technological risks included damage to or loss of the device, integrity of data, and challenges with both Fitbit and Facebook being compatible with daily life.

Conclusions

Wearable activity trackers and social media have the potential to impact adolescents’ physical activity levels. The findings from this study suggest that although the adolescents recognized the potential usefulness of the wearable activity trackers and the social media platform, the effort required to use these technologies, as well as the issues concerning risks and compatibility, may have influenced overall engagement and technology acceptance. As wearable activity trackers and social media platforms can change rapidly, future research is needed to examine the factors that may influence the acceptance of specific forms of technology by using the technology acceptance model.

Trial Registration

Australian and New Zealand Clinical Trials Registry ACTRN12616000899448; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370716