Friday, September 23, 2016

My critique of the JAMA activity tracker + weight loss study

Many people have seen reports of the recent JAMA study titled, "Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial." Published in Sept, 2016, this study would appear to be a reflection of recent trends in activity tracking and weight loss strategies. However, the study used an antiquated wearable device that is no longer sold (the BodyMedia FIT which is worn on the upper arm) and it was conducted from 2010-2012. How many people in 2010 were wearing activity trackers? The popular Fitbit Flex launched in May 2013. The Apple Watch launched in April 2015.


Back in 2010, relatively few people wore activity trackers. Moreover, hardly anyone wore them on their upper arm. So although the authors acknowledge that "The multisensor wearable device was worn on the upper arm, which may not reflect the effectiveness of more contemporary devices worn on the wrist..."

The term "effectiveness" is an interesting term for this type of study, since the accuracy of worn activity trackers has wide variability. In order for a digital tool to effectively change behavior in a sustainable way, people have to use it regularly and the device should provide useful feedback to the user.

I've personally tried the BodyMedia Fit and I can attest that:

  1. It draws a lot of attention (maybe not as much as Google Glass, but you'll get a lot of questions from random strangers asking, "what is that on your arm?"). How self-conscious would you be if were constantly telling everyone that you were taking part of a weight loss study? 
  2. It's not something you'll be wearing 24/7 (fabric stretch band around the arm, so you probably won't be taking a shower with it, plus I don't believe that it was water resistant) - so that can impact daily adherence. Plus, the device needs to be charged on a regular basis.
  3. The tracker is not very comfortable (imagine strapping a pager to your upper arm all day). 
  4. The device doesn't really provide any type of useful feedback such as vibration alerts, cues, smart notifications, etc. You may eventually forget that it's there. It's not nearly as engaging as modern activity trackers that have lights, screens, and vibrating alerts.

The authors also state, "the use of wearable technology was not initiated at the onset of the intervention, which may have influenced how the participants adopted and used the technology during their weight loss efforts..." Many people are missing this point. Adoption and engagement are critical factors that can impact the success of any type of sustainable behavior change.

So, if the goal is to sustain lasting behavior changes that will lead to weight loss and healthy eating, then you need to study devices that people will easily wear daily, devices that will provide useful feedback in real-time, and devices that won't make people self-conscious about their attempt to lose weight.

Finally, keep in mind that the study began with intensive weight loss interventions for 6 months (weekly group sessions), then the groups continued to participate in monthly group sessions (and received phone calls, text message reminders, etc.) Most people who choose to purchase and use a wearable device don't gain access to this type of support and structure. Most consumers are curious or they may be in a contemplative stage where they want to see how an activity tracker may help them achieve a healthier lifestyle.

Intensive, structured weight loss programs are great ways to kick-start a new journey towards healthy living, but people need to be taught how to use tools in a way that is natural to their workflow and daily habits. If you're not accustomed to strapping a large device to your arm, then you'll be one of the first ones to stop using the device after a few weeks or months. In contrast, if you normally wear a watch and use a smartphone, then it'll be much easier to wear a device that is simple and that provides useful feedback (such as smart notifications that you can customize so that you don't run into alert fatigue).

In many ways, it's unfortunate that the JAMA article was positioned by the media as a disappointment regarding the "effectiveness" of wearable technology. It's unfortunate that many consumers may now have a misconception regarding how their activity trackers may benefit them.

I'm sure we'll see many more studies in the near future assessing the "effectiveness" of modern activity trackers. Until then, we'll have to wait patiently as people read stories with misleading titles like, "Activity Trackers Are Ineffective at Sustaining Weight Loss" or "Weight Loss On Your Wrist? Fitness Trackers May Not Help" (the BodyMedia device was worn on the arm, not the wrist!)

Wednesday, August 3, 2016

Polar M600 Android Wear fitness smartwatch - waterproof, GPS, optical HR, touch screen

The upcoming Polar M600 is the type of Android Wear fitness smartwatch that I've been waiting for. Waterproof. GPS. Touch screen. Optical HR. Made by Polar.

At a glance, it may somewhat resemble the Polar V800 or M400, but don't be fooled. The M600 is a modular Android Wear that is suitable for swimming (thanks to its novel proprietary charging connector) and incorporates Polar Smart Coaching features to help you achieve your optimal fitness performance. You can swap color bands.

There aren't that many waterproof Android Wear watches that are suitable for swimming. If you don't need that level of water resistance, then you'll probably be fine with other Android Wear watches like the Moto 360 Sport. However, if you're looking for a serious fitness smartwatch that can handle the swimming pool, then wait for the M600.

Monday, May 16, 2016

Garmin vĂ­vosmart HR+ now with GPS

Garmin is aggressively trying to catch up with Fitbit in the activity wearable market. Garmin has launched a host of new devices recently and the latest addition is the vivosmart HR+ which includes built-in GPS (along with built-in optical heart rate, activity monitoring, smart notifications, etc.).

At some point, the line between an activity tracker and a smartwatch gets blurred. The vivosmart HR+ has many features that are found on a smartwatch, but Garmin is not positioning this device as a smartwatch. It's listed as a "Smart Activity Tracker with Wrist-based Heart Rate plus GPS." I think I'd call it a smartwatch.

If you don't need such a small and slim device, then the Garmin vivoactive HR might be a better buy since it's listed as a "GPS Smartwatch with Wrist-based Heart Rate." The vivoactive HR can run some proprietary apps based on the Garmin ecosystem of the Connect IQ "app store."



Monday, April 25, 2016

Fitbit and Corporate Wellness Programs

Fast Company has an interesting article about how Fitbit grew its presence in the corporate wellness arena. "How Fitbit Became The Next Big Thing In Corporate Wellness"

It's really encouraging to see busy working professionals embracing the importance of health, wellness, fitness, and nutrition. At the same time, it's critical for corporations to recognize the sensitivities and privacy concerns that some employees may have, especially if they are unable to actively participate in fitness challenges. The other reality is that some employees may be "gaming" the system and using dishonest tactics to artificially increase their step counts (unfitbits).

Some examples of corporate fitness challenges to motivate their employees to move:
BP AMERICA: The Million Step Challenge
More than 23,000 employees enrolled in the com­pany’s challenge, and nearly 2,000 surpassed 2 million steps within a year. Employees who reached step goals earned points toward eligibility for a lower-deductible health plan. 
KIMBERLY-CLARK: Live Well Challenge
As an incentive for completing biometric screenings, employees were challenged to take 10,000 steps a day. Forty-seven percent of participants increased their cardiovascular fitness; 50% of them lost weight and increased strength  and flexibility.
The next major step will be to link physical activity parameters with key clinical parameters such as weight, glucose and cholesterol levels, etc. Some insurance companies are doing this to see the direct correlation between physical activity and wellness. That should help to filter those employees who are trying to game the system by cheating (see unfitbits).

Sunday, February 7, 2016

The Garmin fenix 3 now comes with an optical HR option

Recently, Garmin announced that they will be selling a version of their popular fenix 3 fitness watch with an optical heart rate (HR) built-in so that you don't need to wear a separate HR monitor. Garmin has added the optical wrist-based HR feature into several of their GPS running watches. However, serious runners may still choose to wear the Garmin HRM-Run strap around the chest since the HRM-Run also provides:

  • Cadence — the number of steps per minute. It displays the total steps (right and left combined).
  • Vertical oscillation — the bounce in your running motion. It displays the vertical motion of your torso (measured in centimeters).
  • Ground contact time — the amount of time in each step that your foot spends on the ground while running (measured in milliseconds).
I'm not sure if we'll ever see all these metrics accurately captures from a wrist-based device (you can easily capture cadence, but I'm not sure about the vertical oscillation or ground contact time). 

Thursday, January 21, 2016

Are you still wearing that activity tracker you got for Christmas?

In 2015, wearable fitness/activity trackers were very popular gifts. In fact, they were so popular that Fibit became the #1 app on the Apple App Store right after Christmas.


Surveys have shown that the average person will use a wearable fitness device for approximately 3 months. Some will lose their device. Others will lose motivation to wear it. A few will see the health benefits and persist beyond 3 months.


We're almost 2 months out from Christmas. The gyms are still packed with people who are trying to stick with their New Years resolutions. Some have made resolutions that involved dusting off and recharging the old activity tracker that had been sitting in their drawer.


I went away from wearing a dedicated activity tracker in the early part of 2015 and moved to wearing different types of smartwatches that have built-in activity tracking. So, whether I'm wearing Android Wear or a Polar V800, I'm still capturing my activity level and beaming that data to the cloud.

Wednesday, January 20, 2016

Using Tictrac to aggregate data from several wearable fitness activity trackers

The wearable fitness/activity tracker landscape is analogous to the health IT work of electronic health records (EHRs). There are challenges with the interoperability of data. If you use a Fitbit, you can share data and compete against other Fitbit users. If you have a Jawbone UP, you can't operate within the Fitbit ecosystem. Although these trackers may collect similar data like total # of steps and calories burned, they run on proprietary sets of data living within their own ecosystems.

Some trackers and fitness apps use an open API so that you can link your data with other health and fitness apps (like Google Fit or Apple's Health app). Under Armour is probably leading the pack since MyFitnessPal and MapMyFitness both integrate nicely a number of wearable trackers and fitness apps. In some instances, you may end up with duplication of data (especially if you are using several platforms).

There's another option for those of you who are serious about quantifying your data: Tictrac

Tictrac syncs with the activity trackers and fitness apps that you already use. The Tictrac platform delivers high user engagement because it has been developed by a unique team that combines practical expertise in user experience design, behavioral economics, data science, and predictive analytics.