The rise of activity monitoring
Tiny Jaarsma, Leonie Klompstra and Anna StrömbergThe self-archived postprint version of this journal article is available at Linköping University Institutional Repository (DiVA):
http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-155563
N.B.: When citing this work, cite the original publication.
Jaarsma, T., Klompstra, L., Strömberg, A., (2019), The rise of activity monitoring, European Journal of Preventive Cardiology, 26(4), 380-381. https://doi.org/10.1177/2047487318815316
Original publication available at:
https://doi.org/10.1177/2047487318815316
Copyright: SAGE Publications (UK and US)
The rise of activity monitoring
Tiny Jaarsma, Leonie Klompstra, Anna Strömberg
Most citizens nowadays have access to some kind of activity or fitness tracker that can measure how much they walk, run, bike or sleep. Some persons use the standard applications in their smartphones or watches and others use more sophistic purchased accelerometers to inform them about steps taken, calories burned, quality and duration of sleep. Many of these activity trackers allow us to review exercise patterns over the previous weeks and months. Some applications help to set personal goals such as training for a long-distance race or losing weight.
In addition to such monitoring of the activity performed during a certain time period and to goal-setting, a user of an activity tracker can get solicited (and unsolicited) advices on food choices or for example when it is time to buy new training shoes. Some applications even connect people with each other by finding persons who want to achieve similar goals or enrol persons to take part in a joint event, either ‘real time’ or virtual. Companies and industries seem to be successful to make people engaged in health, including increasing awareness on activities.
As health care providers we could use these developments and be inspired to use activity trackers to improve healthy behaviour for primary or secondary prevention, for example in cardiac disease prevention and treatment. It is known that barriers to achieve the
recommended levels activity (and staying physically active) include lack of time, lack of money, and/or lack of motivation. (1,2) Health care providers and family members play a critical role in fostering motivation and the absence of a strong support structure may be one of the many reasons for the lack of motivation. (3) There is a need for tools that enable adults with cardiovascular disease to monitor their physical activity, set their own goals and obtain motivational feedback.
An activity trackers could be one of these tools, allowing patients to receive frequent and automatic feedback, tailored updating of goals based on achievement and possible remote contact with health care providers. Furthermore, incorporation of social components in activity trackers may support motivation through promoting relatedness to other patients. (4) Using activity trackers could help the patient to set realist goals. Currently, a lot of our advices to be more active are too general and might not feel realistic to reach for some
patients and for others they might be to ‘easy’. Activity tracking can help to personalize an activity advice.
In a recent activity program using an exergaming approach for diabetes patients, patients received a personized advice. Based on the results of the baseline test and fitness assessment of the participant exercises and respective difficulty levels were selected from a pool of
exercises. (5) A third application of using an activity tracker for motivation to be active can be to remind persons to be active for example by giving an alarm or vibrate to encourage
behaviours. (6)
All these applications are promising and in a recent patient page of the JAMA-Cardiology wearable fitness trackers are predicted to become an integral part of society and health care. (6) The authors advise that ongoing and future studies will be needed to determine whether they can actually reduce the risk of developing heart disease and its attendant complications (6). However, as described earlier, adherence is the Achilles heel to the success of exercise and this can be extrapolated to the success of activity tracking (1). In this issue of the European Journal of Preventive Cardiology, the adherence to the use of a pedometer and accelerometer are discussed and Marin and colleagues describe that there was only 59% adherence to using the activity tracker, with forgetting to put the activity monitor in the morning or when changing clothes as an important reason for non-adherence (7). Another issue is the trust in the device by patients and by health care providers. Although Marin and colleagues pose that the there is an increasing number of studies that the effectiveness and validity of using activity monitoring is well described, there is still a lot of debate on what the optimal tracking device is and how it should be optimally used. (8-10)
The article of Marin confirms that it is vital to study feasibility and usability of new applications of technology in “real-world” populations. There are great expectations of
technology, but it should also be acknowledged that patients themselves have to be engaged in doing all this. Patients not only need to give active informed consent and have their
confidentiality assured, it is important to with partnership making joint decisions and plans with the patient and if possible to integrate its use in the current care. Maybe in future some electronic health record systems will allow you to upload wearable data directly into your medical record and discuss them directly with your cardiologist or exercise physiologist, physical therapist or nurse.
1. Conraads VM, Deaton C, Piotrowicz E, Santaularia N, Tierney S, Piepoli MF, Pieske B, Schmid JP, Dickstein K, Ponikowski PP, Jaarsma T.Adherence of heart failure patients to exercise: barriers and possible solutions: A position statement of the Study Group on Exercise Training in Heart Failure of the Heart Failure Association of the European Society of
Cardiology. Eur J Heart Fail 2012 ;14(5):451-8.
2. Alharbi M, Gallagher R, Neubeck L, Bauman A, Prebill G, Kirkness A, Randall S.Exercise barriers and the relationship to self-efficacy for exercise over 12 months of a lifestyle-change program for people with heart disease and/or diabetes. Eur J Cardiovasc Nurs. 2017
Apr;16(4):309-317
3. Hardcastle, S. J., Hancox, J., Hattar, A., Maxwell-Smith, C., Thøgersen-Ntoumani, C., & Hagger, M. S. (2015). Motivating the unmotivated: how can health behavior be changed in those unwilling to change?. Frontiers in psychology, 6, 835.
4. Höchsmann C, Walz SP, Schäfer J, Holopainen J, Hanssen H, Schmidt-Trucksäss A. Mobile Exergaming for Health-Effects of a serious game application for smartphones on physical activity and exercise adherence in type 2 diabetes mellitus-study protocol for a randomized controlled trial. Trials. 2017 Mar 6;18(1):103.
5. Petit A, Cambon L. Exploratory study of the implications of research on the use of smart connected devices for prevention: a scoping review. BMC Public Health. 2016;16:552. 6. Kaiser DW, Harrington RA, Turakhia MP.Wearable Fitness Trackers and Heart Disease. JAMA Cardiol. 2016;1(2):239. doi:10.1001/jamacardio.2016.0354
7. Marin TS. Examing adherence to activity monitoring devices to improve physical activity in adults with cardiovascular disease: a systematic review. Eur J Prev Cardio (this issue) 8. Deka P, Pozehl B, Williams MA, Norman JF, Khazanchi D, Pathak D. MOVE-HF: an internet-based pilot study to improve adherence to exercise in patients with heart failure. Eur J Cardiovasc Nurs. 2018 Aug 21:1474515118796613. doi: 10.1177/1474515118796613
9. Mandigout S, Lacroix J, Ferry B, Vuillerme N, Compagnat M, Daviet JC. Can energy expenditure be accurately assessed using accelerometry-based wearable motion detectors for physical activity monitoring in post-stroke patients in the subacute phase? Eur J Prev Cardiol. 2017 Dec;24(18):2009-2016
10. Deka P, Pozehl B, Norman JF, Khazanchi D. Feasibility of using the Fitbit® Charge HR in validating self-reported exercise diaries in a community setting in patients with heart failure. Eur J Cardiovasc Nurs. 2018 Oct;17(7):605-611.
