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Activity trackers fail to improve health outcomes, with or without incentives
Adults in Singapore who regularly used a fitness tracker for 6 months did not increase physical activity levels enough to benefit health, even with a financial incentive, according results from a randomized trial.
“Over the course of the yearlong study, volunteers who wore the activity trackers recorded no change in their step count but moderately increased their amount of aerobic activity by an average of 16 minutes per week,” Eric Finkelstein, MD, of Duke-NUS Medical School in Singapore, said in a press release. “However, we found no evidence that the device promoted weight loss or improved blood pressure or cardiorespiratory fitness, either with or without financial incentives.”
Finkelstein and colleagues analyzed data from 800 full-time employees from 15 work sites in Singapore, recruited between June 2013 and August 2014. Researchers randomly assigned participants to one of four study groups: use of an activity tracker and website (n = 203), activity tracker with charitable incentives (n = 199), activity tracker plus cash incentives (n = 197) and no-intervention control group (n = 201).
Researchers tied incentives to weekly steps; moderate to vigorous physical activity (MVPA) bout minutes per week were measured via a sealed accelerometer and assessed at 6 months (end of intervention) and again at 12 months.
Researchers also measured number of participants meeting a target of 70,000 steps per week, as well as weight, BP and quality-of-life measures.
Researchers found that the cash-incentive group logged an additional 29 MVPA bout minutes per week (95% CI, 10-47); the charity-incentive group logged an additional 21 MVPA bout minutes per week (95% CI, 2-39). There were no between-group differences for the group assigned to a tracker with no incentives vs. controls.
Increases in MVPA bout minutes per week in the cash and charity groups were not significantly greater than that of the activity tracker-only group. At 12 months, the activity tracker-only group logged an additional 37 MVPA bout minutes per week (95% CI, 19-56); the charity group logged an additional 32 MVPA bout minutes per week (95% CI, 12-51) vs. controls. There was no between-group difference for the cash-incentive group vs. control in MVPA bout minutes per week (P = .1363).
When comparing the cash-incentive group with the tracker group with no incentives, researchers observed a decrease in physical activity of –23 MVPA bout minutes per week (P = .0184).
Researchers did not observe any improvements in health outcomes at 6 or 12 months across groups.
“While there was some progress early on, once the incentives were stopped, volunteers did worse than if the incentives had never been offered, and most stopped wearing the trackers,” Finkelstein said in the release.
The researchers noted that approximately 40% of participants stopped using the activity tracker in the first 6 months; only 10% of participants were still using the activity tracker at 1 year.
“People use these devices for a while, but with time the novelty wears off,” Robert Sloan, PhD, assistant professor at Kagoshima University Graduate School of Medical and Dental Sciences in Kagoshima, Japan, said in the release. “This is consistent with how people use trackers in real life.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Donna H. Ryan
The wearable devices for monitoring activity are a major consumer trend. But are they effective or just for fun? The concept is simple enough: If one measures an outcome it is possible to change the behaviors that influence it. Thus, measuring activity and getting feedback on it should make it easier to increase physical activity. The current study by Finkelstein demonstrates the problems with counting on wearable devices to change behavior. That study showed no health benefit and minimal increases in weekly moderate to vigorous physical activity, even when combined with incentives, as compared to control conditions. What's going on here?
Self-monitoring may be one of the foundational elements of behavioral intervention, but it's not the only one. Goal-setting, contingency management, environmental control are also important skills for changing behaviors. The message for our patients: That fancy monitor won't change your physical activity. Patients need to set a goal, develop a plan and troubleshoot barriers to succeed in increasing activity. And it is the provider's job to help the patient do exactly that.
Disclosure: Ryan reports serving as a consultant for Astra Zenica, Eisai, Gila Therapeutics, Janssen, Merck, Novo Nordisk, Orexigen, Takeda, Real Appeal and Scientific Intake.