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Tracking the Motivational Power of Wearable Technology

Credit: Fitbit

Fitness trackers and other wearable devices are quickly becoming the world’s best-selling technology product. In fact, tech-industry analyst CSS Insight expects the wearable market to reach $25 billion by 2019, and an estimated 54 million fitness trackers to be sold by 2021.

As debate swirls around the utility, necessity and accuracy of fitness trackers - about half of the current wearable-tech market - Penn researchers are examining whether such technologies and other approaches can bring about behavioral changes that improve a patient’s health and well-being.

“If the patient knows that those numbers are being tracked by us at any given time, does that motivate them to do better?” asked James Ku, MD, medical director of LG Health Physicians Healthy Weight Management & Bariatric Surgery, and principal investigator on a new study examining whether wearing a Fitbit improves a patient’s odds of success after weight-loss surgery. “It makes sense that if they have a Fitbit and they’re thinking about their steps, they’re going to get more exercise in and possibly lose more weight. But we don’t know for sure.”

“We need more studies aimed at showing what wearable tech can and can't do, and how to harness its abilities” said Mitesh Patel, MD, MBA, director of the Penn Medicine Nudge Unit, and an assistant professor of Medicine and Health Care Management. Commenting on a study published last year in JAMA Internal Medicine which showed that simply wearing trackers does not help people lose weight, Patel told NPR that the devices are most effective when the people using them are already interested in tracking their fitness, and people who are less motivated might not get the same results. However, he adds that when paired with the right strategies for using the data – strategies that can help motivate patients to stay active – the results may be different.

While clinicians regularly track the physical activity of more than 90 bariatric patients, researchers are evaluating whether that oversight inspires the patients to exercise more than if they were left to their own devices.

Physical activity is an essential part of LG Health’s bariatric program, which has two full-time exercise physiologists and a fitness area to accommodate supervised exercise. Patients generally are cleared for exercise about two weeks after weight-loss surgery.

“We’ve always known that exercise is an important component to weight loss as part of a healthy lifestyle,” Ku said, adding that bariatric patients may face additional obstacles to weight loss, such as chronic medical conditions. “However, it’s difficult to monitor exercise, because it’s often self-reported. This is where the technology comes in.”

During the two-year study, patients in the treatment group receive a Fitbit Alta, which tracks steps, distance and calories burned. The devices then regularly send step data to electronic medical records, where it is stored securely for health care providers’ analysis, and is available for patients to view and track on their MyLGHealth accounts.

While it’s difficult to enforce, the practice regularly encourages patients to increase their physical activity soon after bariatric surgery. However, participants are not required to log a certain number of steps or commit to a specific exercise regimen.

At each post-surgery office visit, patients complete a general survey on their physical activity, which is then reviewed with a physician or exercise physiologist. Activity data uploaded from the Fitbit is also reviewed with those wearing the fitness tracker.

“By linking to patients’ electronic medical records, we, their PCPs, their orthopedic surgeons and other providers are able to look at the data,” Ku said. “In theory, it sounds great. You’re trying to motivate people to be more active, but does it make a difference in terms of health outcomes like weight loss, having better control of their diabetes and other medical issues? We don’t know the answer to that.”

Results of the study are pending, as researchers will follow the patients for up to two years. The extended view is of particular interest, given that up to one-third of all bariatric patients regain at least half of the excess weight they’ve lost, or in some cases, all of it, Ku said.

Ku described a “honeymoon period” that can last up to a year after surgery, during which patients lose more weight than with any other diet in the past. Patients feel empowered and motivated to be active because, for the first time in perhaps their entire life, they’re experiencing success.

After the “honeymoon,” can patients achieve and maintain a healthy, active lifestyle for the long term, and could a Fitbit serve as the tipping point toward success?

“There aren't many — if any — long-term studies of wearable tech," said Patel, who also studies fitness trackers. “All of these technologies are going to evolve. But the device alone isn't what's actually going to make us healthy."

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