Q&A: Health care practitioners see potential in activity monitors for COPD

Key takeaways:

• Some health care practitioners hesitate to recommend activity monitors to patients with COPD despite their positive views of the devices.
• Guidelines on device usage in this patient population are needed.

Among patients with COPD, activity monitors in the form of apps and wearable devices are being utilized to track physical activity and encourage more daily movement, according to research published in Respiratory Medicine.

Despite this seemingly positive usage, research focused on how health care practitioners perceive activity monitor use in this patient population is lacking.

In an effort to address this research gap, Laura J. Wilde, PhD, postdoctoral research fellow at the Centre for Healthcare and Communities at Coventry University, and colleagues interviewed 17 health care practitioners supporting patients with COPD using these devices between September 2020 and May 2021 to understand the benefits and challenges behind supporting activity monitors.

Healio spoke with Wilde to learn more about activity monitors, device use among patients with pulmonary diseases/conditions and the experiences of health care practitioners supporting these patients.

Healio: Why has there been a rise in activity monitor use?

Wilde: We know physical activity is important for our health and well-being, and more people are using activity monitors to increase their activity and keep track of it. Technological advancements have made more devices available to people, the technology is more user-friendly, and devices are getting cheaper to buy (depending on the features, brand, etc).

More people are also able to buy activity monitors. There are a range of devices available now with different features at prices to suit many budgets. During COVID-19, when gyms were closed, people were only able to leave the house for exercise, so activity monitors were a great way for people to keep track of their exercise, map their walks and note how many steps they were doing. The benefits and excitement of keeping track of activity and sharing achievements with others has continued and is rising.

Healio: What are some general benefits associated with using these types of devices?

Wilde: Generally, activity monitors offer real-time data on physical activity levels, which can help with goal setting and motivation. They provide objective measures, which can be useful for exercise prescription, support self-management and can enhance patient-practitioner communication. Activity monitors can empower and motivate individuals to actively engage in their health and well-being.

They can be great for helping people to be more aware of their activity levels and remind them to stand or move more. Additionally, these devices are not just for monitoring your activity but can help you keep an eye on other health metrics, such as heart rate, ECG test, monitor your oxygen saturation and track your sleeping patterns.

Healio: Are these monitors recommended for patients with pulmonary diseases/conditions? If yes, why are they encouraged in this patient population? Are there concerns over the use of these devices in this patient population?

Wilde: Activity monitors are not yet routinely or formally recommended for patients with pulmonary diseases. More research evidence is needed along with guidelines and information. However, activity monitors can be a really useful tool as mentioned above, such as to increase activity levels.

My research has found that although there are many benefits and health care practitioners recognize the benefits of using activity monitors, there is not enough information and guidance to safely recommend devices to patients. My current research project is looking at what information and guidance is needed and to co-create this with patients and practitioners.

There are some concerns, including potential disparities in access to technology (digital divide/digital poverty) and the accuracy of the data and using it in health assessments and treatment. Also, some clinicians worry about the monitors replacing therapy (eg, pulmonary rehabilitation), so it is suggested that activity monitors are used alongside other treatments.

There are also worries about people getting “too focused” on the numbers and not paying attention to how they feel or what their body is telling them and that seeing constant health data can increase anxiety — but it can also reduce anxiety.

Health care practitioners in my research also noted that the risks and concerns (eg, around data privacy and security), were often “overplayed” and the benefits outweighed the potential adverse effects and risks.

In terms of patients with COPD, often they will be limited by their breathlessness when doing activity, so there is more concern about managing the breathlessness and potentially doing too little rather than too much. Walking more is a good way to improve health and well-being, and activity monitors are great for monitoring step counts, time spent walking and distance walked.

Healio: How do health care professionals learn how to use these devices, and how do they teach their patients how to use them?

Wilde: From my research so far, health care practitioners learn from their own personal experience and use with activity monitors, which is self-directed. There are limited opportunities for training and little information on how to use devices, especially when it comes to specific health conditions. Therefore, when it comes to teaching patients, if health care practitioners are interested, have the time and resources, and are willing, they might share knowledge they have gained to recommend certain apps or wearables.

Otherwise, activity monitors may not be discussed with patients in health care settings due to a lack of knowledge and understanding, and the technology may not be used to its full potential.

Healio: From a health care practitioners’ perspective, what are some of the benefits of supporting the use of activity monitors among patients with COPD?

Wilde: The benefits of supporting patients with COPD using activity monitors can include improving the practitioner-patient interaction; gaining a better understanding of their activity levels from the objective monitoring which can help with exercise/activity prescription; helping patients to be more motivated and interested in their health and treatments; and helping patients to better understand what is going on with their body and essentially help with self-management. For example, because activity monitors provide insights into exercise levels, patients can better understand their exercise tolerance and when they may be feeling more tired or fatigued. Overall, a better understanding of their health can help practitioners to tailor treatment, goals and support patients remotely, especially during situations such as the COVID-19 pandemic.

Healio: What challenges did health care practitioners report when asked about their experience supporting these patients?

Wilde: Health care practitioners reported challenges with engaging with patients. For example, older adults tended to be less tech-savvy. Practitioners also had concerns about costs to patients, digital poverty and accessibility, so some people in research studies did not have the option to engage or learn to use technology because they did not have internet access or a smartphone.

Due to a lack of guidelines, information and uncertainties about the role of technology in their profession, some practitioners were hesitant to recommend monitors. Surprisingly, privacy and data protection were less of a concern with practitioners when patients were using their own activity monitors outside of a research study, although this is still a concern when recommending devices and apps.

Healio: What should clinicians take away from these findings?

Wilde: Clinicians should recognize that although there are a number of concerns and barriers, there are huge potential benefits of activity monitors in COPD care. Formal guidelines, education and support systems are needed to ensure activity monitors can effectively be integrated into patient care. In the meantime, having conversations with patients about the use of technology may be helpful and surprising if patients are already using technology but perhaps not to its full potential.

Healio: What needs to be looked at further in future research on this topic?

Wilde: Future research should focus on developing guidelines, evaluating the cost-benefit of HCPs supporting patients with activity monitors and understanding the long-term impact on patient outcomes.

It is also really important to consider the digital divide, find ways to bridge the gap and be mindful of increasing gaps.

If people are using technology, such as smartphones and smartwatches, we need to understand how we can make the most of this and support patients to utilize it to help manage their health and COPD.

My current research is co-creating information for people with COPD and health care practitioners on using smartwatches to support self-management.

Activity monitors can be a positive tool in supporting patients to engage with health care, motivate healthy behaviors such as increasing physical activity, and improve confidence and self-efficacy for better COPD management. Technology is advancing rapidly with more and more people using technology in their everyday lives, including activity monitors and smartwatches. If we can understand how to make the most of this technology, there is potential for it to be integrated into health care services to provide patients with “seamless care.”

For more information:

Laura J. Wilde, MSc, BSc, PhD, can be reached at wildel5@uni.coventry.ac.uk and https://www.laurawilde.co.uk/.

References:

• Wilde LJ, et al. Disabil Rehabil. 2024;doi:10.1080/09638288.2024.2304095.
• Wilde LJ, et al. Respir Med. 2023;doi:10.1016/j.rmed.2023.107395.