Letters to the Editor in Chief
We thank Thompson et al. (8) for highlighting the potential opportunities and public health implications that emerge from the multidimensional characterization of physical activity. We strongly agree that the definition of physical activity is complex, multifaceted, and goes beyond the traditional dichotomy (inactive if <150 min wk-1 or active if ≥150 min wk-1). Undoubtedly, technological advances can provide us with a more accurate and broader description of an individual's physical activity practice. In fact, as noted by the authors, a growing number of companies are seeking new commercial opportunities through physical activity monitoring. However, we disagree with the optimistic view the authors express about the potential public health benefits obtained through improvements in technology-oriented personalized feedback using a multidimensional physical activity approach (8). For example, authors suggest: “This improved awareness will allow people to take greater responsibility for managing their physical activity, which will contribute to greater self-determination via support for an individual's sense of autonomy and competence.” Indeed, they argue that opportunities arising from these emerging technologies will help people to “engage and sustain appropriate physical activity” (8). Such an argument emphasizes the view that physical activity is determined substantially by individual choices or preferences. However, it has been well established in recent years that human behaviors and daily activities are determined by multiple factors that interact at different levels (intrapersonal, interpersonal, community, national, global) (1).
In addition, these “opportunities” arising from a personalized physical activity approach disregard the fact that human behaviors, such as physical activity, are largely automatic and strongly influenced by environmental stimuli (5). This is especially true for nonexercise physical activity. Not surprisingly, a recent review concluded that most trials that included mobile technologies for changing health behaviors have failed to document significant improvements in health risk factors or health outcomes (3).
We argue that personalized physical activity monitoring by itself will not be a powerful stimulus for sustained change; it needs to be accompanied by profound environmental and cultural changes. To provide and increase sustained change of physical activity at the population level, there is a need for more investment in developing nonmotorized transport (e.g., safe bike lanes, bicycle-sharing schemes), creating walkable cities, building sports facilities and parks, and promoting physical activity at workplaces and schools (6,7). Nevertheless, to achieve these investments, we need a cultural and mindset change (e.g., multifaceted strategies, intersectoral collaboration, political endorsement, sustainable funding) (2,4).
In summary, it must be recognized that promoting physical activity in the current modern environment is challenging (4). However, the population health gains provided by personalized physical activity monitoring may be negligible. Technology is a mere bystander, not a main determinant of physical activity. What we need is an increase in the number of opportunities to become physically active, along with a marked cultural change whereby physical activity is considered the best buy for public health (4).
Leandro Fórnias Machado de Rezende
Faculdade de Medicina da Universidade de São Paulo
Departamento de Medicina Preventiva
São Paulo, Brasil
Juan Pablo Rey-López
University of Bristol
School for Policy Studies
Centre of Exercise
Nutrition, and Health Sciences
Bristol, United Kingdom
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