Exercise as it relates to Disease/Older Adults embracing Fit-bits when managing chronic illness

The following page is an analysis of the journal article titled: Mercer, K., Giangregorio, L., Schneider, E., Chilana, P., Li, M., & Grindrod, K. (2016). Acceptance of Commercially Available Wearable Activity Trackers Among Adults Aged Over 50 and With Chronic Illness: A Mixed-Methods Evaluation. JMIR Mhealth Uhealth, 4(1), e7. http://dx.doi.org/10.2196/mhealth.4225



Background
The health benefits from regular physical activity is both dramatic and extensive. Only small increases in daily activity levels are needed to improve blood pressure, body composition, avoid frailty, and improve overall health. However a systematic review by Harvey et al. in 2013 found that the level of physical activity often declines steadily with age. The Australian Physical activity guidelines recommend adults accumulate weekly an equivalent of 150 to 300 minutes of moderate intensity physical activity such as a brisk walk or 75 to 150 minutes of vigorous intensity physical activity. It is suggested that "Older" adults above 65 years and older should be aiming for at least 30 minutes of moderate a day.

Several previous studies demonstrate meaningful success in encouraging adults to be active with home-based physical activity programs. However daily adherence to home-based programs tends to be low with successful interventions often expensive, time intensive, and requiring supervision. So persuasive fitness technologies can be an attractive alternative as they are relatively inexpensive and simple in nature but have a good effect on behavioural change, promote self-awareness, and encourage self monitoring. A previous study that looked at self-monitoring using either a website or mobile phone app found that participants were 20 times more likely to achieve 10,000 steps daily when using such technology. Self-monitoring can be achieved via wearable activity trackers, these devices automatically record information such as step counts, time, and duration. These wearable trackers have exploded in popularity in the health and wellness industry in the past several years.

Question The Study Is Asking
There is scarce evidence about how older adults perceive new and emerging mobile health tools, in particular wearable activity trackers such as Fitbits, Ifit, or Garmin watches. The objective of this study was to: examine the acceptance, the usability, and usefulness of wearable activity trackers for older adults living with chronic illness.

Where Is The Research From?
The study was conducted through the School of Pharmacy at the University of Waterloo in Canada. University of Waterloo is a large public facility that has become one of Canada's leading research universities with a score of 152 on the World University Rankings (2015–2016). This article was initially published in the Journal of Medical Internet Research, which is a peer-reviewed open-access medical journal. There was no evidence of conflicts of interest present.

Type of Research
This was a small-sized non-blinded qualitative research study. The study used mixed methods for its research using both a questionnaire developed from the Technology Acceptance Model (see Further information section) combined with focus groups to explore the participants initial experiences when using several devices. Data analysis and collection was done by way of a thematic analysis, this involves pinpointing, examining, and recording patterns within a qualitative data set.

Method
32 participants over the age of 50, with a broad range of existing chronic illness, age, gender, education, and physical activity were non-randomly selected. 2 participants dropped out in the initial stages of the test leaving 30. Participants ages ranged from between 52 and 84 years of age with a mean 64 years of age. 72% were women and the mean body mass index (BMI) across the all participants was 31. Each participant tested in random order 5 different trackers that were readily available in Canada in 2014. Each device was worn for at least 3 days. No quantitative data was recorded other than participants physical characteristics including blood pressure a body weight prior to the study commencing.

Study Limitations

 * Short period the participants used each device for. This was somewhat intentional at the study sort initial impressions rather than long term reviews.
 * The study was run in winter to spring months rather than the summer, this is significant as several participants reported being less active in the colder months.
 * Participants were not randomly selected, instead they were cherry-picked from several clinics and community settings around Waterloo.
 * No blinding of both assessors or participants.
 * Small cohort of participants, 30 leads to a high margin for error.
 * Study was qualitative in nature with no quantitative data on things such as weight loss, fitness improvements or even tracking step counts.
 * Usage was self-reported.
 * Study upwards of 2 years old now, market has rapidly changed in regards to activity trackers. Costs, features, availability, acceptability has all changed.

Findings
Users' perception of activity trackers.


 * Initially may be out of older users perceived comfort zone.
 * After a brief trial period users appreciated their usefulness in improving self-awareness and goal-setting.
 * More useful as motivators than as quantifiers.
 * Less likely to purchase them if they are sold as entertainment/lifestyle devices and not managed as a specific health-care treatment/aid.

Conclusion Taken From This Research
Although somewhat limited in scope this research provides an initial understanding into how there is a meaningful potential for wearable fitness trackers to be part of a multifaceted intervention in older adults. It is evident that there is a need for health professionals to aid older adults in overcoming the initial barriers of: awareness of such devices, set up, and interpretation of data. Once an older adult is familiarised with activity trackers they are perceived as both useful and acceptable additions to their health management of their chronic disease.

Practical Advice
Before recommending or purchasing an activity tracker, the following may need to be considered:

Pros:
 * Increased activity levels throughout the day.
 * Good for targets/goal setting.
 * Increased health awareness.
 * No manual data entry.
 * Allows for extra information for example: time stamps, intensity, frequency, duration, all without input from user.
 * Cost.
 * Promote goal-setting, self-efficacy, and tailored feedback.

Cons:
 * Wearability and style.
 * Doesn't take into account diet.
 * Activity trackers usually don't measure exertion, only motion.
 * Don't function well with high-resistance, low-movement exercises.
 * Data ownership, will makers of the fitness bands sell personal information?
 * No paper-based instruction manuals.
 * Display size, poorer vision in elderly.
 * Access to device, need computer or mobile phone.
 * Cost.
 * May be less accurate for older adults with a shuffling, abnormal, or slow gait; for example conditions such as stroke or Parkinson’s disease.

Further Information/Resources

 * Information about Technology Acceptance Model: Chatter M.Y. (2009). "Overview of the Technology Acceptance Model: Origins, Developments and Future Directions ," Indiana University, USA . Sprouts: Working Papers on Information Systems, 9(37). http://sprouts.aisnet.org/9-37
 * Best fitness trackers 2016 - by James Stables for Wearable: http://www.wareable.com/fitness-trackers/the-best-fitness-tracker
 * Australia's Physical Activity and Sedentary Behaviour Guidelines: http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines
 * Exercise interventions for adults with a variety of chronic illnesses: T. C. Hoffmann, C. G. Maher, T. Briffa, C. Sherrington, K. Bennell, J. Alison, M. F. Singh, P. P. Glasziou. Prescribing exercise interventions for patients with chronic conditions. Canadian Medical Association Journal, 2016; DOI: 10.1503/cmaj.150684