MOVE MORE, SIT LESS, AND BE WELL

Behavioral Aspects of Activity Trackers

Abstract

Learning Objectives 

1. Provide suggestions to help fitness professionals understand how wearable activity trackers (ATs) affect human movement patterns.

2. Describe the role of ATs in physical activity programming

3. Critique a programming case study using ATs in the workplace, including comments by participants

INTRODUCTION

The American College of Sports Medicine’s (ACSM’s) annual fitness trends named wearable technology as the top trend for 2016 and 2017 (¹⁹). Recent information from Endeavour Partners wearable research shows that sales of activity trackers (ATs) have tripled (⁴), and, by 2019, the smart wearable market is expected to generate $53 billion in sales (¹²). Although a recent article by Hongu et al. (⁸) outlines how to select a mobile device for promoting health and physical activity (PA), only a limited amount of research has been focused on how ATs affect personal perception about movement and associated behavioral outcomes. Schulte et al. (¹⁵) believe a broader perspective to workplace wellness includes a focus on well-being. ATs are multidimensional and focus on many of the behavioral aspects that affect a person’s health and well-being. ATs can track movement, sleep, and nutrition. They have the ability to broaden an employee’s focus and consider his or her well-being at work. Many tools designed to increase movement have come and gone in the industry, yet somehow, these small yet significant devices have drawn attention to movement for millions of people.

This brings forth the question: Are wearable ATs reaching a population that has not been reached by the fitness industry? Research by Mandic et al. (¹¹) found that the greatest health benefits are achieved for an entire population when the least fit individuals increase their PA levels. Michelle Segar’s book No Sweat: How the Simple Science of Motivation Can Bring You a Lifetime of Fitness, describes numerous accounts of clients who did not know that moving throughout the day counted toward health and fitness (¹⁶). Many of her clients thought the only way to get fit was to join a gym. With an estimated 33% of the U.S. population predicted to own a wearable AT by 2017 (⁴), further research targeting the usage and benefits of ATs is needed.

A FOCUS ON MOVEMENT NOT IN A GYM?

In the last 20 years, 14% to 17% of the U.S. population has joined a fitness center (¹⁸). There are obvious barriers to joining and attending a fitness center such as cost, being comfortable using equipment, or attending classes at a specific time or day. For the majority of people who do not use a fitness center, the idea of wearing an AT may seem like an easier and less threatening place to start. Could wearable ATs be a more economical and effective way to attract participants who may be part of the majority not currently participating in a fitness facility-based program? Amanda Vogel asks a related question in her article, “Fitness Technology Conundrum” (²²): “Fitness technology is a new normal and the trend is poised for growth. Will the fitness industry grow with it?” Technology experts believe that getting wearable ATs into the hands of people who are thinking about movement is important (⁷). Perhaps, more fitness professionals and fitness centers should consider using ATs because they present a tremendous opportunity to facilitate physical movement within the population of people who remain unreached by our traditional delivery of fitness.

Sforzo et al. (¹⁷), in their article on “Health and Wellness Coaching Competencies for Exercise Professionals,” discuss the potential benefits of integrating coaching skills with personal training. Informatics researchers at the 2013 Consumer Health Informatics show in Paris demonstrated that ATs are beneficial when used in combination with coaching because they hold users accountable for step goals and log the movement in an easy and convenient manner (¹). Could wearable ATs combined with training or coaching help to change personal movement patterns? ATs may serve as a reminder of the need for behavior change by increasing awareness. The evaluation of human movement patterns outlined as follows provides perspective on who may be helped by ATs.

TABLE 1: Human Movement Patterns

TABLE 2: AT Features (Wrist-Worn)

HUMAN MOVEMENT PATTERNS

Exercise

ACSM regularly publishes and updates evidence-based recommendations for exercise. The ACSM guidelines fall under the exercise portion of human movement patterns and focus on cardiorespiratory exercise as well as strength, flexibility, and neuromotor training. Ewing Garber et al. and ACSM recommend that most adults engage in moderate-intensity cardiorespiratory exercise training for 30 minutes or more per day on 5 days or more per week for a total of 150 minutes or more per week, vigorous-intensity cardiorespiratory exercise training for 20 minutes or more per day on 3 days or more per week (≥75 min/wk), or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of 500 to 1,000 MET minutes or more per week (⁵).

Physical Activity

In 2008, the Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services published evidence-based PA guidelines that state the following: “adults should do at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic PA, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. It is recommended that aerobic activity should be performed in episodes of at least 10 minutes, and preferably spread throughout the week” (²¹).

Sedentary Living

Sitting-time evidence-based research is growing and no official recommendations have been endorsed. Katzmarzyk et al. (⁹) reveal extended sitting results in metabolic alterations that cannot be compensated for by an isolated exercise session. Levine’s (¹⁰) work at Mayo Clinic found the negative effects of 6 hours of sedentary time on fitness levels were similar in magnitude to the benefit of 1 hour of exercise. Dwyer et al. (³) found a higher daily step count at baseline was associated with lower all-cause mortality rate. New studies reveal the importance of looking at all movement through time in relation to mortality rate. ATs can be an effective tool for increased awareness of human movement patterns.

Wearable ATs could be useful for participants who are struggling with PA challenges such as time limitations for those who are forced to commute for work and then sit for extended periods of time. Looking at the various movement patterns we do throughout the day introduces the bigger picture of improving physical activity levels for the masses.

As previously mentioned, the behavioral aspect of using wearable ATs has largely been neglected in the current published research. An iPod/iPad (Apple^® Cupertino, CA) proof-of-concept study found phone/tablet devices to be accurate with tracking steps (¹⁴) via the accelerometer devices in them, but behaviorally, many people do not always carry phones or iPads to track movement. Companies like Fitbit^®, Jawbone^®, Apple^®, Microsoft^®, Garmin^®, and others have produced wrist-worn wearable tracking devices as a solution for tracking movement throughout the day. It seems that many of the major AT-producing companies are moving toward a wrist-worn device for ease of use. However, each company has introduced various ways of motivating behavior change to encourage continued AT usage.

ACTIVITY TRACKERS AND PA PROGRAMMING

To experiment with ATs, a Ready to Move (RTM) program was established by the authors of this article in collaboration with the university employee wellness program. Student coaches and clients met a minimum of 8 times during 10 weeks for coaching sessions. Most sessions were in person, but because of time constraints of both students and clients, online or telephonic sessions were occasionally used. During the RTM program, there were 100 student participants as well as 173 employee participants (152 women and 21 men). The majority of employee participants were staff or clerical rank.

As part of the program, students and employee participants were given a Fitbit (San Francisco, CA) Flex® AT. The university wellness directors chose the FitBit Flex® AT with cost consideration, availability, and ease of use in mind. A focus on the behavioral outcomes of wearable ATs in combination with student coaching was emphasized. Coaching was administered by students who shared a passion for helping others improve their health and well-being through movement. The importance of mutual respect, co-learning between partners, and individual and community engagement within the workplace was stressed (²). It should be noted that a coaching versus expert approach was emphasized to facilitate client behavioral change. Sforzo et al.’s (¹⁷) expert versus coach approach encourages coaches to facilitate participants “driving the bus” versus leading with expert advice. Student coaches were taught to facilitate self-directed vision and goal setting throughout the RTM program. Behavioral strategies, such as motivational interviewing and coaching skills, as described in Nigg’s (¹³) ACSM’s Behavioral Aspects of Physical Activity and Exercise also were used.

The practical experience gained by students allowed for the integration of movement and behavioral best practices. Students analyzed their clients’ goals to monitor and evaluate PA intervention strategies. Pre- and post-surveys measured behavioral outcomes that were used to evaluate the impact of the program on employees. At first, it was difficult for the Kinesiology students to work with clients outside of a typical gym setting. However, as the program progressed, both students and clients began to appreciate the importance of communication, goal setting, AT logging/feedback, and how movement can happen anywhere and at any time during the day.

PARTICIPANT COMMENTS REGARDING ATs

Responses recorded on the pre-RTM survey indicated that 83% of participants had previously used a movement tracking device (including pedometers). Before receiving an AT, the majority of the participants envisioned the Fitbit Flex® acting as a motivator and a reminder to move. Post-RTM program, participants were asked what they liked the most about the ATs. Top responses included being a reminder to move, a motivator, and the ease and convenience of its use. Participants also reported enjoying sleep-tracking capabilities of the Fitbit even though they did not envision using this feature pretracker use. Finally, post-RTM program participants stated their day-to-day movement was positively influenced by AT use. Users reported getting more steps/activity and having increased awareness of sleep. Other common responses included using the device as encouragement, a reminder, and a motivator to get moving. In addition, using the AT to set and meet goals was seen as beneficial by users. Table 3 describes participants’ actual comments regarding their ATs.

TABLE 3: Participant Comments on ATs

TABLE 4: Practical Programming Strategies

TABLE 5: Participant Comments on Movement

SIDEBAR: AT FEATURES (WRIST-WORN)

PROGRAMMING STRATEGIES FOR ATs

According to Green (⁶), 72% of ACE-certified fitness professionals reported clients/class participants asking about ATs, yet only 51% of fitness professionals felt they were prepared to answer questions on ATs. Education on AT usage is essential before instructing others on AT use. The RTM program found coaches had more success coaching clients after they were educated on AT use and had acquired personal experience using the devices. Coaches were educated on using the AT interfaces, including lessons on movement, sleep, nutrition, and social capabilities of the device. Employees enjoyed using such capabilities as sleep and nutrition tracking and coaches appreciated social features such as “friending” and participating in movement challenges with others.

The RTM program focused on the sedentary living and PA portions of the human movement patterns. It also encouraged increasing PA based on steps achieved at baseline movement levels. Most employees improved their confidence in their ability to reach and sustain regular PA/movement when they focused on moving more throughout the day. The RTM program used Tudor-Locke et al.’s (²⁰) translation of accelerometer data to daily movement. This study suggested that 30 min/d of moderate to vigorous PA translated to approximately 7,900 steps/day for men and 8,300 steps/day for women, whereas 150 min/wk of moderate to vigorous PA translated to approximately 7,000 steps/day or 49,000 steps/week (²⁰). To encourage those with the lowest levels of PA at baseline, the program reminded employees that starting at a low movement level provides the greatest initial improvement of health benefits (¹¹). Participating employees were coached on the benefits of increasing movement gradually. Employees began walking to restrooms or water fountains on different floors and found creative ways to take additional movement breaks throughout the day. Being physically active was a milestone for numerous participating employees, and by the end of the RTM program, many began thinking more about the exercise portion of human movement patterns.

SUMMARY

Overall, the RTM postsurvey results revealed that a combination of coaching and AT usage increased the importance of regular PA for employees as well as their confidence to sustain PA and movement. Ninety-three percent of employees agreed working with a student coach helped them develop effective health and fitness goals. Ninety percent agreed that the combination of coaching and AT usage helped employees sustain their health goals after their coaching ended. When asked about their social connection with students, 92% of employees agreed that engaging with students connected them better with the university.

For the Kinesiology students, it was initially hard to focus on PA and sedentary living rather than the exercise portion of human movement patterns, but they eventually appreciated the difference a small amount of movement throughout the day can make in participants’ lives. Breaking the traditional focus on what counted as movement was enlightening for both students and employees. Could ATs better meet the needs of those who have not joined a gym? Could this concept help account for the mass popularity of these devices? ATs might be reaching a market that is untapped by the fitness industry but also could appeal to a much larger portion of the population. The fitness profession’s perception of human movement patterns has traditionally been focused on the exercise portion of human movement patterns. ATs could help the fitness professional transition to include the PA and sedentary living portions of human movement patterns.

There are many unanswered questions about AT usage and for whom they are the most beneficial. Additional behavioral research on ATs is needed. The popularity of wearable ATs cannot be denied. Most likely, health and fitness professionals will be using ATs at an accelerated rate in the near future. Becoming familiar with ATs is encouraged for all fitness professionals because their use could lead to a larger portion of the population taking interest in and engaging with more opportunities for physical movement. A focus that includes PA and sedentary living could potentially broaden the reach of human movement and help populations move more, sit less, and be well.

BRIDGING THE GAP

The American College of Sports Medicine annual fitness trends named wearable technology as the top trend for 2016 and 2017 (19). The popularity of wearable activity trackers (ATs) is on the rise. Many worksite wellness programs use ATs as incentives to help clients move more and sit less. This article will enhance the reader’s understanding of how wearable ATs may influence human movement patterns and physical activity programming. Published research has focused on wearable AT accuracy. This article focuses on the behavioral aspects of ATs and presents a programming case study on how to integrate ATs into a useable program for clients.