Fitness trackers are a popular accessory today, but as a healthcare provider, how much should you trust patient information derived from them? Because they’re digitally measured, like in-office blood pressure or temperature readings, it’s easy to forget that fitness tracker data is a type of patient reported outcome (PRO) and that we shouldn’t overinvest in it. At the same time, quality PRO data from fitness trackers can help monitor patient wellness, if not health.
The most common reasons individuals choose to wear fitness trackers is that they want to increase their physical activity. Unfortunately, this doesn’t seem to work. Research into tracker use has revealed that, unlike most other technology, the devices aren’t addictive – one-third of users abandon them within six months and more than half will give them up entirely in the long run. Users buy them in hopes that they will motivate behavioral change, but the devices don’t come loaded with added motivation. From a provider’s perspective, we lack the ability to utilize day-to-day patient data, so short-term use isn’t very useful. If patients can individually track their activity over a long period and demonstrate significant self-monitored changes, that can be valuable, but not necessarily more so than in-office measures like blood pressure. Additionally, there are some concerns about the accuracy of these trackers for measuring movement – they seem to overestimate high-intensity workouts and underestimate more moderate activities, though newer devices are more precise.
Health Versus Wellness
Rather than focusing exclusively on fitness trackers as a tool for measuring health, as physicians, we can learn more from them by also considering wellness indicators. Newer monitors, like Garmin’s Fenix 5x Plus, for example, can measure blood oxygen levels, while most now come equipped with heart rate monitors. Most, however, still struggle with accurate sleep tracking. From a wellness perspective, on the other hand, fitness trackers can provide much more valuable information to doctors. In a study of cancer patients, for example, doctors found that they could use fitness trackers to ascertain valuable information about their patients’ quality of life during chemotherapy treatments. Data such as steps taken or amount of sleep reduces subjectivity in well-being ratings and helps doctors determine how patients are tolerating treatments. Similar insights may apply to other conditions, including mental health issues.
Discussing Trackers With Patients
Considering the limitations of fitness trackers, how should you talk to your patients about the devices? The simple answer, of course, is that there’s no downside to using a health tracker. For some users, it does offer the necessary motivation to engage in more physical activity, even if only in the short term. However, patients should not be encouraged to rely heavily on the devices in place of a critical approach to health and should be encouraged to identify data that doesn’t seem to align with their experience, such as high step estimates when they’ve been sedentary. Simply put, it’s important to use the devices for confirmation, not overconfidence. Doctors, especially physical therapists and sports medicine practitioners, should also familiarize themselves with different types of fitness trackers and their applications. Not only are some more accurate than others, but they also offer a wide range of different metrics and apply to different activities. It’s not helpful to rely on a tracker that measures walking and running if the patient’s primary form of fitness is swimming or biking. Similarly, wheelchair users can benefit from using a fitness tracker, but need to opt for the right model, such as the Fitbit Flex or even Freewheel, a wheelchair-specific device. Encourage your patients to view their fitness tracker as a tool for assessing general trends rather than focusing on specific numbers so that they don’t get discouraged. For example, most trackers default to 10,000 steps per day, but sedentary users shouldn’t aim for that immediately. Rather, with guidance from healthcare professionals, they can focus on increasing their movement rather than hitting that prescribed number. Similar rules apply to calorie values, sleep trends, or distance traveled – the emphasis should be on overall improvement in fitness and health, and patients need guidance to recognize healthy activities that may not be measured by the device. A fitness tracker can’t tell if a patient is eating vegetables or consuming low-fat sources of protein, whether they quit smoking, or spend time meditating. As doctors, we’re still learning about the relationship between health and wellness, and fitness trackers offer insights into both. If we want to learn more about our patients’ though, we need to consider the big picture data from fitness trackers alongside other health metrics. Though we shouldn’t write off the value of fitness trackers to the healthcare enterprise, we also can’t rely too heavily upon them to understand patient behavior. Like most things in medicine, it’s all about balance.