tag:theconversation.com,2011:/id/topics/fitness-trackers-23683/articlesFitness trackers – The Conversation2022-12-26T20:52:15Ztag:theconversation.com,2011:article/1948982022-12-26T20:52:15Z2022-12-26T20:52:15ZHeart rate variability – what to know about this biometric most fitness trackers measure<figure><img src="https://images.theconversation.com/files/500755/original/file-20221213-14408-pvtw3d.jpg?ixlib=rb-1.1.0&rect=1047%2C901%2C6039%2C3884&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An increase in this particular biometric is a good thing.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-man-using-smartwatch-in-bed-royalty-free-image/1371086366">visualspace/E+ via Getty Images</a></span></figcaption></figure><p>Your heart beats <a href="https://www.pbs.org/wgbh/nova/heart/heartfacts.html">around 100,000 times every day</a>. <a href="https://theconversation.com/tracking-your-heart-rate-5-questions-answered-about-what-that-number-really-means-124066">Heart rate</a> is a key marker of cardiovascular activity and an important vital sign. But your pulse is not as steady as a precision clock – nor would you want it to be.</p>
<p><a href="https://scholar.google.com/citations?hl=en&user=uXcM0scAAAAJ">As a cardiovascular physiologist</a>, I measure heart rate in nearly every experiment my students and I perform. Sometimes we use an <a href="https://medlineplus.gov/lab-tests/electrocardiogram/">electrocardiogram</a>, such as you’d see in a medical clinic, which uses sticky electrodes to measure electrical signals between two points of your body. Other times we use a chest strap monitor, like ones you might see on someone at the gym, which also detects heartbeats based on electrical activity.</p>
<p>As wearable technology has grown more popular, it’s not just researchers and cardiologists who are paying attention to heart rate. You might be monitoring your own all day long via a fitness tracker you wear on your wrist. This kind of wearable device <a href="https://help.fitbit.com/articles/en_US/Help_article/1565.htm">uses green light to detect blood flow</a> beneath your skin and deduces your heart rate.</p>
<p>Here are what heart rate and other measurements derived from this biometric can tell you about your body’s health.</p>
<h2>Pumping blood where it needs to go</h2>
<p>The heart’s primary job is to contract and generate pressure that helps pump blood to the lungs to be oxygenated and then on to the rest of the body to deliver oxygen and other nutrients. Heart rate is simply how fast your heart is beating. Sometimes called a pulse rate, it’s normally presented in beats per minute. You can <a href="https://www.health.harvard.edu/heart-health/want-to-check-your-heart-rate-heres-how">count your own heart rate</a> by feeling for your pulse inside your wrist or behind your jaw. </p>
<p>When your body demands more oxygen, such as during exercise, heart rate will increase along with the increasing workloads.</p>
<p>While many people are familiar with tracking their heart rate during exertion, the heart rate at rest can also provide valuable information. The two parts of the <a href="https://www.webmd.com/heart/what-is-heart-rate-variability">autonomic nervous system</a>, the sympathetic and parasympathetic, influence resting heart rate. The sympathetic branch helps coordinate your body’s stress response. The more active it is, the higher it dials up your heart rate, preparing you for fight or flight. </p>
<p>The parasympathetic branch of your nervous system is responsible for keeping lots of your body’s functions running smoothly while you’re at ease. Via the vagus nerve that runs from the brain all the way to the abdomen, the parasympathetic nervous system actively slows the heart down to resting values between <a href="https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/all-about-heart-rate-pulse">60 and 100 beats</a> per minute for the average healthy adult. Without any parasympathetic activity putting the brakes on the sympathetic nervous system’s signals, your heart would beat at approximately 100 beats per minute. </p>
<p>A lower resting heart rate indicates an efficient heart and a higher level of parasympathetic activity. When you’re at rest your nervous system is ideally minimizing sympathetic activity, so you’re conserving energy and avoiding unnecessary stress to the body.</p>
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<a href="https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="chart of red peaks of a heartbeat at slightly different intervals" src="https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=274&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=274&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=274&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=344&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=344&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=344&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The chart of a heart rate reveals tiny differences in spacing between the peaks representing heartbeats.</span>
<span class="attribution"><span class="source">YitzhakNat via Wikimedia Commons</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Time between each heartbeat</h2>
<p>One specific way to understand the balance of the nervous system’s influence on heart rate is to look at <a href="https://my.clevelandclinic.org/health/symptoms/21773-heart-rate-variability-hrv#:%7E:text=Heart%20rate%20variability%20is%20where,issues%20like%20anxiety%20and%20depression.">heart rate variability</a>, or HRV – the slight fluctuation in the time between each heartbeat. Even if your heart rate is 60 beats a minute, that doesn’t mean your heart is pumping exactly once every second.</p>
<p>Less variability is a sign that your body is under greater stress and that the balance in your autonomic nervous system is tipping toward the sympathetic branch being in charge. Greater variability suggests you’re more relaxed and your parasympathetic nervous system is in control. </p>
<p>For nearly 30 years, scientists have been interested in <a href="https://doi.org/10.1161/01.CIR.93.5.1043">how to measure and interpret HRV</a>, specifically as it relates to this balance of autonomic control.</p>
<p>The clinical utility of HRV emerged in patients following cardiac events, but researchers are now considering how this measure can help explain patient outcomes in a range of <a href="https://doi.org/10.2147/VHRM.S279322">cardiac</a>, <a href="https://doi.org/10.1371/journal.pone.0195166">endocrine</a> and <a href="https://doi.org/10.1016/j.jad.2018.04.071">psychiatric</a> disorders.</p>
<p>More recently, researchers have investigated <a href="https://doi.org/10.15420/aer.2018.27.2">how to use HRV</a> in <a href="https://doi.org/10.15420/aer.2018.30.2">athletic training and prognosis of medical conditions</a>.</p>
<p>Several fitness wearables also report <a href="https://support.whoop.com/WHOOP_Data/Recovery__HRV/What_is_Heart_Rate_Variability_(HRV)%3F">heart rate variability</a>, either as a <a href="https://support.ouraring.com/hc/en-us/articles/360025441974-An-Introduction-to-Heart-Rate-Variability#:%7E:text=How%20Oura%20Measures%20HRV,samples%20measured%20while%20you%20sleep.">stand-alone metric</a> or used in the calculation of “readiness” or “recovery” scores. <a href="https://doi.org/10.1055/a-1864-9726">Endurance athletes now commonly track HRV</a> as one way to monitor their overall physiological state.</p>
<p>Researchers have started checking which <a href="https://doi.org/10.3390/s22166317">commercially available wearable devices are most reliable and accurate</a> at measuring HRV, which can vary from tracker to tracker. Many of these devices use colored lights, or optical sensors, to measure pulse rate and other variables at the wrist or finger. Unfortunately, the <a href="https://www.statnews.com/2019/07/24/fitbit-accuracy-dark-skin/">accuracy of this method can vary based on skin type and skin color</a>. It is important that companies include diverse populations in the design, testing and validation of these products to help address potential racial health disparities.</p>
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<a href="https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman doing standing pose on yoga mat" src="https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Another health benefit of stress-busting activities can be an increase in heart rate variability.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-standing-on-yoga-mat-in-warrior-pose-while-royalty-free-image/1397801043">David Espejo/Moment via Getty Images</a></span>
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<h2>Nudging HRV in a good direction</h2>
<p>One of the biggest influences on heart rate variability is stress; along with increased sympathetic nervous system activity, stress is associated with lower HRV. Stress-reducing interventions, <a href="https://my.clevelandclinic.org/health/treatments/13354-biofeedback">biofeedback</a> and <a href="https://doi.org/10.1016/s0828-282x(10)70395-0">increased fitness</a> can increase heart rate variability. Remember, an increase is good for this metric. Overall, <a href="https://www.webmd.com/heart/what-is-heart-rate-variability#091e9c5e82171840-2-4">heart rate variability depends on</a> a range of physiological, psychological, environmental, lifestyle and nonmodifiable genetic <a href="https://doi.org/10.3389/fpubh.2017.00258">factors</a>.</p>
<p>The most useful way to consider heart rate variability as a metric is to look at data trends. Are there consistent changes in HRV in either direction? Examine these changes alongside other health factors such as fitness, mood, illness, sleep and dietary intake to see if you can draw any conclusions about lifestyle modifications you may want to make.</p>
<p>In general, the <a href="https://www.va.gov/WHOLEHEALTHLIBRARY/tools/heart-rate-variability-and-arrhythmias.asp">same approaches</a> you would take to lowering resting heart rate can also improve heart rate variability, such as increasing cardiovascular fitness, maintaining a healthy weight, reducing stress and getting sufficient sleep.</p>
<p>It’s important to remember that heart rate variability is the normal, healthy, very slight fluctuation of timing of heartbeats – just milliseconds of difference from beat to beat. More dramatic changes in heart rhythms or the way in which the heart contracts, known as <a href="https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668">arrhythmias</a>, may signal a more serious condition that requires medical attention.</p><img src="https://counter.theconversation.com/content/194898/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne R. Crecelius does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tiny fluctuations in the time between each beat of your heart can provide clues about how much stress your body is experiencing.Anne R. Crecelius, Associate Professor of Health and Sport Science, University of DaytonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1779002022-05-04T12:33:36Z2022-05-04T12:33:36ZA boom in fitness trackers isn’t leading to a boom in physical activity – men, women, kids and adults in developed countries are all moving less<figure><img src="https://images.theconversation.com/files/459877/original/file-20220426-22-gzk038.jpg?ixlib=rb-1.1.0&rect=11%2C23%2C7892%2C5273&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Since the mid-1990s, people have been doing less and less walking or bicycling to work and school and spending a lot more time staring at screens. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-couple-changing-channels-while-relaxing-on-royalty-free-image/1321174010?adppopup=true">RainStar/E+ via Getty Images</a></span></figcaption></figure><p>Worldwide sales of fitness trackers increased from US$14 billion in 2017 to over <a href="https://www.fortunebusinessinsights.com/fitness-tracker-market-103358">$36 billion in 2020</a>. The skyrocketing success of these gadgets suggests that more people than ever see some value in keeping tabs on the number of steps they take, flights of stairs they climb, time they spend sitting and calories they burn. </p>
<p>The manufacturers of these devices certainly want consumers to believe that tracking fitness or health-related behaviors will spur them on to increase their activity levels and make them healthier. </p>
<p>Our analysis of research published over the past 25 years suggests otherwise.</p>
<p>We are professors of kinesiology – the science of human body movement – at <a href="https://www.boisestate.edu/humanperformance/faculty-staff/dr-scott-conger/">Boise State</a>, the <a href="https://krss.utk.edu/faculty-staff/david-r-bassett-jr-ph-d/">University of Tennessee</a> and the <a href="https://webapps.unf.edu/faculty/bio/n01443361">University of North Florida</a>. To learn whether and how physical activity has changed in the years since fitness trackers became popular, we analyzed more than two decades of research from several industrialized nations – all conducted before the COVID-19 pandemic.</p>
<p>Our systematic review of data from eight developed nations around the world shows that despite the surge in sales of fitness trackers, <a href="https://doi.org/10.1249/mss.0000000000002794">physical activity declined</a> from 1995 to 2017. What’s more, we discovered that this was not an isolated effect in one or two countries, but a widespread trend. </p>
<h2>Reviewing the research</h2>
<p>To conduct the study, we first searched for published research that tracked physical activity such as walking, household activities or playing sports throughout the day. We wanted studies that obtained two “snapshots” of daily activity from a population, with the measurements separated by at least one year.</p>
<p>We found 16 studies from eight different countries that met these criteria: Canada, the Czech Republic, Denmark, Greece, Japan, Norway, Sweden and the United States. The studies were conducted between 1995 and 2017.</p>
<p>It is important to note that these snapshots did not track specific individuals. Rather, they tracked samples of people from the same age group. For example, one Japanese study of physical activity among adults ages 20 to 90 collected data each year for 22 years from people in each age group. </p>
<p>Scientists tracked the participants’ physical activity using a variety of wearable devices, from simple pedometers – step counters – to more sophisticated activity monitors like accelerometers. </p>
<p>The study groups ranged from large, nationally representative samples numbering tens of thousands of people to small samples of several hundred students from a few local schools. </p>
<p>After identifying the research studies, we calculated an “effect size” for each study. The effect size is a method of adjusting the data to allow for an “apples-to-apples” comparison. To calculate the effect size, we used the data reported in the studies. These include the average physical activity at the beginning and end of each study, the sample size and a measure of the variability in physical activity. Using a technique called meta-analysis, this allowed us to combine the results of all studies to come up with an overall trend. </p>
<p>We discovered that overall, researchers documented fairly consistent declines in physical activity, with similar decreases in each geographical region and in both sexes. Overall the decrease in physical activity per person was over 1,100 steps per day between 1995 and 2017.</p>
<p>Our most striking finding was how sharply physical activity declined among adolescents ages 11 to 19 years – by roughly 30% – in the span of a single generation. For instance, when we compared the studies reporting physical activity in steps per day, we found the total steps per day per decade declined by an average of 608 steps per day in adults, 823 steps per day in children and 1,497 steps per day in adolescents.</p>
<p>Our study doesn’t address why physical activity has declined over the past 25 years. However, the studies we reviewed mentioned some contributing factors. </p>
<h2>More staring at screens, less walking or bicycling</h2>
<p>Among adolescents, declines in physical activity were associated with increases in ownership and use of smartphones, tablets, video games and social media. </p>
<p>In the U.S., for example, screen time increased dramatically in adolescents, from <a href="https://eric.ed.gov/?id=ED527859">five hours per day in 1999</a> to <a href="https://doi.org/10.1097/dbp.0000000000000272">8.8 hours per day in 2017</a>. </p>
<p>At school, most of the physical activity that adolescents perform has traditionally come from physical education classes. However, the changes in the frequency of physical education classes during the study period are <a href="https://doi.org/10.1016/j.jsams.2014.06.002">inconsistent and vary from country to country</a>. </p>
<p>All of these factors may help to explain the decline in physical activity that we observed in our study.</p>
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<figcaption><span class="caption">Lisa Cadmus-Bertram, an assistant professor of kinesiology at University of Wisconsin – Madison, explains which fitness trackers are best at tracking.</span></figcaption>
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<p>In addition, fewer adults and children are walking or bicycling to school or work than 25 years ago. For instance, in the late 1960s, most U.S. children ages 5 to 14 <a href="https://doi.org/10.1016/j.amepre.2007.02.022">rode a bicycle or walked to school</a>. Since then, this “active transportation” has largely <a href="https://doi.org/10.1016/j.amepre.2011.04.006">been replaced by automobile trips</a>. Rates of travel by school bus or public transportation have seen little change. </p>
<h2>So why use a fitness tracker?</h2>
<p>So if levels of physical activity have dropped at the same time that the popularity of fitness tracking has grown, what makes these gadgets useful?</p>
<p>Fitness trackers can help to increase people’s awareness of their daily physical activity. However, these devices are only part of the solution to addressing the problem of sedentary lifestyles. They are <a href="https://doi.org/10.1001/jama.2014.14781">facilitators, rather than drivers, of behavior change</a>. </p>
<p>[<em>Over 150,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-150ksignup">Sign up today</a>.]</p>
<p>When a person’s physical activity goes down, it opens the door to overall reduced fitness levels and other health problems such as obesity or diabetes. On the other hand, physical activity has a dramatic positive impact <a href="https://doi.org/10.1097/hco.0b013e32833ce972">on health</a> and <a href="https://doi.org/10.1176/appi.ajp.2017.16111223">well-being</a>. The first step to increasing active movement is to measure it, which these devices can do. But successfully increasing one’s overall physical activity requires several additional factors such as goal setting, self-monitoring, positive feedback and social support.</p><img src="https://counter.theconversation.com/content/177900/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research is revealing that fitness trackers alone can be helpful facilitators toward changing a sedentary lifestyle but don’t motivate people to increase their physical activity.Scott A. Conger, Associate Professor of Exercise Physiology, Boise State UniversityDavid Bassett, Professor and Department Head of Kinesiology, Recreation and Sport Studies, University of TennesseeLindsay Toth, Assistant Professor of Kinesiology, University of North FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1734192021-12-12T19:09:02Z2021-12-12T19:09:02ZWhy wearable fitness trackers aren’t as useless as some make them out to be<figure><img src="https://images.theconversation.com/files/436841/original/file-20211210-172173-80w7n7.jpeg?ixlib=rb-1.1.0&rect=77%2C44%2C7238%2C4858&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Wearable fitness trackers will be on many Christmas shopping lists this year, with a vast range of devices (and an ever-increasing number of features) hitting the market just in time for the festive season. </p>
<p>But what does the latest research say about how effective they are? </p>
<h2>Fitness trackers are trendy</h2>
<p>Currently, <a href="https://www2.deloitte.com/au/en/pages/technology-media-and-telecommunications/articles/digitalconsumertrends.html">about one in five</a> Australians own one of these wearables, and about a quarter use a mobile app or website to monitor their activity levels and health. And sales are <a href="https://www.mordorintelligence.com/industry-reports/australia-wearables-market">predicted to grow</a> over the next five years. </p>
<p>The landscape of the market is fast changing. For years, Fitbit and Garmin were the market leaders. But Australians now <a href="https://www.statista.com/forecasts/1187946/ehealth-tracker-smart-watch-usage-by-brand-in-australia">favour</a> Apple watches (used by 43% of people owning a wearable tracker) over Fitbit (35%) and Samsung watches (16%) over Garmin (13%).</p>
<p>So far fitness trackers have mostly been taken up by younger people: about one in four Australians aged 20–40 report using one, compared to just one in ten people aged <a href="https://www.statista.com/statistics/662856/australia-tracking-health-via-apps-bands-or-smartwatches-by-gender/">60 or older</a>.</p>
<p>However, manufacturers are on a mission to change this, by adding features that allow users to monitor not just their fitness activity, but several other aspect of their health.</p>
<p>For instance, recent wearable models from all the leading manufacturers claim to measure a host of medical metrics, such as blood pressure, body fat levels, the amount of oxygen in your blood, your heart activity, and even identify when you’ve taken a fall (with a feature that lets you call for help). </p>
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Read more:
<a href="https://theconversation.com/do-we-really-need-to-walk-10-000-steps-a-day-153765">Do we really need to walk 10,000 steps a day?</a>
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<h2>Wearables get the basics right</h2>
<p>Firstly, a multitude of <a href="https://mhealth.jmir.org/2020/9/e18694/">studies</a> have looked at the accuracy of wearable fitness trackers for measurements related to physical activity, including step counts, heart rate and number of calories burned. They show step counts are generally highly accurate, while heart rate and calories burned are reasonably accurate. </p>
<p>When study participants wear two different activity trackers at the same time, the numbers of steps, minutes of activity and calories burned aren’t exactly the same, but they are <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-015-0314-1">correlated</a>. That is, when one goes up so does the other, and vice versa. This suggests they are generally capturing the same information, albeit with slightly different sensitivity.</p>
<p>Evidence for sleep tracking is a little patchier. Wearables are pretty good at detecting bed time, wake time and overall sleep duration. But estimates for more technical metrics such as the “phases” of sleep – such as REM sleep – don’t marry with medical-grade measurements taken by <a href="https://www.jmir.org/2019/11/e16273/?utm_source=dlvr.it&utm_medium=facebook">polysomnography</a>.</p>
<h2>Sometimes wearables go beyond the basics</h2>
<p>In a 2019 Apple-sponsored study <a href="https://pubmed.ncbi.nlm.nih.gov/31722151/">reported in the</a> New England Medical Journal, 419,297 participants without known atrial fibrillation wore an Apple Watch. During the study, 2,161 of them received an irregular pulse notification, of which 84% were subsequently confirmed to have atrial fibrillation (an irregular and rapid heart beat). </p>
<p>This is a serious medical condition that requires treatment to prevent stroke.
The ability to alert users of a potential undiagnosed cardiac condition seems highly beneficial. Although, <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1901183#article_letters">others</a> have cautioned the Apple Watch can also miss cases of undiagnosed atrial fibrillation – which emphasises the importance of <em>never</em> relying on wearable metrics for medical purposes.</p>
<p><a href="https://www.ahajournals.org/doi/full/10.1161/CIRCEP.121.010063">Another study</a> published in September reaffirmed the Apple watch’s electrocardiogram feature can detect serious cardiac irregularities. A similar <a href="https://pubmed.ncbi.nlm.nih.gov/33865810/">study</a> is currently underway to evaluate Fitbit’s electrocardiogram feature, but results aren’t out yet.</p>
<h2>Building a more advanced tracker</h2>
<p>In terms of detecting falls (which would be very useful for older individuals), scientists are developing wrist-worn devices that can accurately do this using <a href="https://ieeexplore.ieee.org/document/7723508">accelerometer technology</a>, which is the same underlying technology already used by wearables. So the technology is there, but at this point it’s unclear whether the promising lab results will translate to accuracy in commercial wearables.</p>
<p>Meanwhile, the newest Samsung watch claims to measure <a href="https://www.samsung.com/au/support/mobile-devices/measure-bp-on-samsung-watch/">blood pressure</a> and <a href="https://www.samsung.com/levant/support/mobile-devices/measure-your-body-composition-with-the-galaxy-watch4-series/">body composition</a> (such as fat mass, muscle mass and bone mass). Body composition is measured using a method called bioelectric impedance analysis. </p>
<p>When the user touches the watch with their opposite hand, it passes a weak electrical signal through the body and back to the watch. The body composition is then calculated using algorithms and the manually entered body weight.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Calipers" src="https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436842/original/file-20211210-25-famzi8.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Calipers can be used to try to measure body fat percentage.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>At this stage, there’s no data in the scientific literature to support the accuracy of these measurements, so we’d recommend taking them with a pinch of salt. Then again, only a few years ago the same criticism was made of electrocardiogram measurements from wearables – and these have subsequently shown to have merit. </p>
<h2>Evidence says your effort will pay off</h2>
<p>So that’s the run down on accuracy, but do fitness trackers make a difference in people’s lives?</p>
<p>Hundreds of studies have used wearable activity trackers to try to increase physical activity in various general and patient populations. Meta-analyses (which involve combining results of multiple studies) suggest the devices are effective in helping people become more <a href="https://pubmed.ncbi.nlm.nih.gov/30977740/">physically active</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597870/">lose weight</a>. </p>
<p>A <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-020-00955-2">meta-analysis</a> of 35 studies in various chronic disease populations suggested users added around 2,100 additional steps per day after they started using a wearable activity tracker. Other meta-analyses have suggested weight loss in the order of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589007/">1 to 1.5 kilograms</a>, on average, over the duration of the studies (with the duration varying between studies). </p>
<p>And <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-020-01020-8">studies</a> that look specifically at step-tracking over long periods suggest the benefits gained are still present (although smaller) up to four years after the device was first worn.</p>
<p>Accuracy and effectiveness aside, wearable users typically report being <a href="https://pubmed.ncbi.nlm.nih.gov/29141607/">satisfied with their devices</a>. So if you happen to get one in your Christmas stocking this year, keep in mind it could help with those New Year’s fitness resolutions. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/health-apps-track-vital-health-stats-for-millions-of-people-but-doctors-arent-using-the-data-heres-how-it-could-reduce-costs-and-patient-outcomes-162575">Health apps track vital health stats for millions of people, but doctors aren't using the data – here's how it could reduce costs and patient outcomes</a>
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<img src="https://counter.theconversation.com/content/173419/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carol Maher receives funding from the National Health and Medical Research Council, the Medical Research Future Fund, the National Heart Foundation, the South Australian Department for Innovation and Skills, the South Australian Department for Education, Healthway and Hunter New England Local Health District.</span></em></p><p class="fine-print"><em><span>Ben Singh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>About one in five Aussies currently own a wearable fitness tracker of some kind. Yet many people doubt their effectiveness. Let’s see what the research suggests.Ben Singh, Research fellow, University of South AustraliaCarol Maher, Professor, Medical Research Future Fund Emerging Leader, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1619462021-06-04T14:31:45Z2021-06-04T14:31:45ZIt’s far too easy for abusers to exploit smart toys and trackers<figure><img src="https://images.theconversation.com/files/404523/original/file-20210604-13-u44na8.jpeg?ixlib=rb-1.1.0&rect=0%2C0%2C5439%2C3620&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-boy-using-smartwatch-call-parents-1017040465">JpegPhotographer/Shutterstock</a></span></figcaption></figure><p>The wearable technology market is booming, with <a href="https://news.strategyanalytics.com/press-releases/press-release-details/2021/Strategy-Analytics-Half-Billion-Wearables-Sold-Worldwide-in-2020/default.aspx">half a billion wearables</a> sold globally in 2020. Apps on these devices, or the devices themselves, often claim to monitor our health to spot illnesses, track our workouts to help us reach our fitness goals, or keep an eye on our children’s whereabouts to enhance their safety.</p>
<p>But they’re also divisive. Supporters of wearable technology claim that health trackers should be <a href="https://theconversation.com/why-the-nhs-should-prescribe-wearable-fitness-trackers-60817">prescribed by the NHS</a> and could even deliver an <a href="https://theconversation.com/wearable-fitness-devices-deliver-early-warning-of-possible-covid-19-infection-143388">early warning</a> of a possible COVID-19 infection. GPS tracking devices designed to be worn by children, meanwhile, are seen as a <a href="https://www.abc.net.au/news/2019-04-04/digitally-tracking-kids-more-parents-use-devices/10957906">safety asset</a> for parents. </p>
<p>Yet studies have found fitness trackers to be too <a href="https://theconversation.com/why-fitness-trackers-may-not-give-you-all-the-credit-you-hoped-for-128585">inaccurate</a> and <a href="https://theconversation.com/do-fitness-trackers-make-you-fitter-52404">misleading</a> to be used by <a href="https://eu.usatoday.com/story/tech/2019/08/14/how-doctors-really-feel-data-your-apple-watch-fitbit/1900968001/">medical professionals</a>, and that, because they’ve been rushed to market, wearables of all kinds are an insecure “<a href="https://theconversation.com/why-health-apps-are-like-the-wild-west-with-apple-just-riding-into-town-103512">Wild West</a>” region of technology that requires urgent regulation.</p>
<p>In <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/978692/The_UK_code_of_practice_for_consumer_IoT_security_-_PETRAS_UCL_research_report.pdf">a recent report</a>, we looked at the security risks associated with wearable devices, as well as “smart toys” that can record children in their homes. We found a concerning lack of security – especially for devices aimed at children – which lack even the most basic cybersecurity precautions, leaving them open to abuse.</p>
<h2>Fitness trackers and personal data</h2>
<p>One key issue with wearables is the data they generate and share. For instance, many fitness trackers rely on data on a person’s location to map their workouts. That’s great if you’re keen to track the distance of your jogs, but it’s not especially sensible if you’re embarking on those jogs <a href="https://www.bbc.co.uk/news/technology-42853072">from a military base</a> in hostile territory.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"957318498102865920"}"></div></p>
<p>Beyond that specific example, which caused some embarrassment for the US military in 2018, it’s clear that sharing your location publicly, even in a safe civilian setting, comes with significant risks. </p>
<p>And it’s not just the real-time tracking of your running route that could expose your whereabouts. Because these trackers upload your workouts to an app and share them publicly, it’s possible for predators to use historic running, biking or hiking routes to predict where you might be at a given time. This safety issue isn’t only restricted to workouts. Even something as innocuous as <a href="https://www.wareable.com/wearable-tech/terms-and-conditions-privacy-policy-765">sharing a photo through your Apple watch</a> can give away your geolocation. </p>
<h2>Are trackers safe for children?</h2>
<p>Even more concerning are devices designed to be worn by children, sales of which are expected to reach <a href="https://www.prnewswire.com/in/news-releases/global-kids-smartwatch-market-valued-at-364-3-million-us-in-2018-and-will-reach-873-5-million-us-by-the-end-of-2025-at-a-cagr-of-13-19-between-2019-2025-valuates-reports-814713277.html">$875 million (£620 million)</a> by 2025. These watches are marketed as wearable tech to keep kids safe, tracking their location and alerting parents when the watch’s onboard “SOS” button is pressed – or if the child travels beyond a geofenced area. </p>
<p>Smart watches as safety devices on children’s wrists may sound like a <a href="https://www.cbsnews.com/news/wearable-gps-tracking-for-children-to-ease-parents-minds/">boon for anxious parents</a>, but a <a href="https://fil.forbrukerradet.no/wp-content/uploads/2017/10/watchout-rapport-october-2017.pdf">2017 survey</a> of children’s smart watches found that the all-important “SOS” button either got stuck or didn’t work at all in most cases.</p>
<p>Additionally, flaws in some smart watches’ accompanying apps have raised <a href="https://www.which.co.uk/news/2019/11/which-tests-for-security-flaws-in-kids-smartwatches/">serious safety concerns</a>. <a href="https://consumerfed.org/wp-content/uploads/2017/10/smart-watch-security-assessment.pdf">Security researchers</a> have found they could not only easily access children’s historical route data – like their path to and from school – and monitor their geolocation in real time, but they could also speak directly to the child, through the watch, without the call being reported in the parent’s app.</p>
<h2>Connected toys</h2>
<p>Fears that internet of things devices can give people unauthorised access to children also extend to <a href="https://theconversation.com/4-ways-internet-of-things-toys-endanger-children-94092">the “smart toy” market</a>. Some of these toys contain hidden cameras and microphones which, if hacked, could be used to record the interior of your home, including children’s rooms.</p>
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Read more:
<a href="https://theconversation.com/4-ways-internet-of-things-toys-endanger-children-94092">4 ways 'internet of things' toys endanger children</a>
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<p>In 2017, German regulators recognised this danger by <a href="https://www.bbc.co.uk/news/world-europe-39002142">banning the sale</a> of the Cayla “smart doll”, labelling it as the kind of “de facto espionage device” that Germany’s <a href="https://www.bundesnetzagentur.de/SharedDocs/Pressemitteilungen/EN/2017/17022017_cayla.html">Telecommunications Act</a> legislates against. In an unusual and unsettling move, the regulator went further by asking parents who’d bought one to <a href="https://www.dw.com/en/german-regulator-tells-parents-to-destroy-spy-doll-cayla/a-37601577">destroy the doll</a> to prevent illicit surveillance.</p>
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<p>Even if the manufacturers of smart toys and children’s smart watches can guarantee far better security than that which led to the Cayla ban, there remain other surveillance concerns. In 2019, a <a href="https://www.unicef.org/innovation/reports/memoAIchildrights">UNICEF-led report</a> highlighted how children’s rights – to creativity, freedom of choice and self-determination – are challenged by smart devices. Present in schools, at home, and on the wrist, this kind of round-the-clock surveillance, the report argues, restricts carefree childhood and hurts kids’ development.</p>
<h2>Making trackers safer</h2>
<p>Trackers and toys can be made safer. Before we allow these devices to flood the market, it’s essential <a href="https://discovery.ucl.ac.uk/id/eprint/10117734/">we standardise</a> the minimum security requirements that manufacturers must comply with – no matter where in the world these devices are made. </p>
<p>Key among these standards should be the removal of <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/971440/Code_of_Practice_for_Consumer_IoT_Security_October_2018_V2.pdf">factory-default passwords</a> on devices – which, like “admin” or “1234”, are easily guessed or discovered by even the most novice hacker. Manufacturers should also publish a <a href="https://www.iotsecurityfoundation.org/expanding-the-view-of-consumer-vulnerability-disclosure-practice/">vulnerability disclosure</a> to help users understand risks, and make regular software updates in response to vulnerabilities unearthed by security researchers.</p>
<p>Clearly, monitoring people’s health via wearable trackers has the potential to radically improve access to medical care. Likewise, every parent wants their child to be safe, and smart devices, like mobile phones before them, could be a reliable tool for checking in with them. But without safety standards, these devices have the potential to cause more harm than they offset. Regulators must act fast to stop this growing market from leading to significant harms.</p><img src="https://counter.theconversation.com/content/161946/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Saheli Datta Burton receives funding from UK Engineering and Physical Sciences Research Council grant number EP/S035362/1 for the PETRAS National Centre of Excellence for IoT Systems Cybersecurity, a consortium of leading UK universities dedicated to understanding critical issues in the privacy, ethics, trust, reliability, acceptability, and security of the Internet of Things. Funding for PETRAS is provided by the UKRI’s Strategic Priorities Fund as part of the Security of Digital Technologies at the Periphery (SDTaP) programme.</span></em></p><p class="fine-print"><em><span>Madeline Carr receives funding from receives funding from UK Engineering and Physical Sciences Research Council grant number EP/S035362/1 for the PETRAS National Centre of Excellence for IoT Systems Cybersecurity, a consortium of leading UK universities dedicated to understanding critical issues in the privacy, ethics, trust, reliability, acceptability, and security of the Internet of Things. Funding for PETRAS is provided by the UKRI’s Strategic Priorities Fund as part of the Security of Digital Technologies at the Periphery (SDTaP) programme.. </span></em></p>We believe fitness trackers keep us healthy, and connected toys keep children safe – but such devices are easily abused.Saheli Datta Burton, Research Fellow, Department of Science Technology Engineering and Public Policy, UCLMadeline Carr, Professor of Global Politics and Cybersecurity, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1498862021-01-07T18:02:08Z2021-01-07T18:02:08ZConnected workouts can help you get fit alongside virtual buddies during the pandemic<figure><img src="https://images.theconversation.com/files/377043/original/file-20210104-17-1cfjt5n.jpg?ixlib=rb-1.1.0&rect=135%2C692%2C7180%2C4795&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Riding together from afar can help you build the exercise habit.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/man-cycling-indoor-with-exercise-bike-trainer-royalty-free-image/1222113631">ArtistGNDphotography/E+ via Getty Images</a></span></figcaption></figure><p>Sales of exercise gear and technology-based fitness tools have <a href="https://nymag.com/intelligencer/2020/09/how-the-pandemic-has-changed-the-fitness-industry.html">exploded in the U.S.</a> as people try to maintain their workout regimens without going to the gym.</p>
<p>Purchases range from simple dumbbells and outdoor bicycles to internet-connected devices such as the Peloton stationary bike or the Tonal digital weight machine. There are exercise video games like Nintendo’s Wii Fit and PS-2’s Eye Toy: Kinetic; wearable technology like Fitbits or Apple Watches; and mobile apps like Strava. People are even using platforms like Zoom or Skype to connect with a personal trainer.</p>
<p>These <a href="https://www.techaheadcorp.com/blog/connected-fitness/">connected fitness tools</a> bring together your exercise workouts and your digital life. <a href="https://orcid.org/0000-0003-1191-4863">As researchers in</a> <a href="http://education.msu.edu/search/Formview.aspx?email=kap@msu.edu">the field of kinesiology</a>, we’ve studied the effects of connected fitness on motivation and fitness outcomes. If you’re looking for ways to beef up your fitness during pandemic-related downtime or to replace a pre-COVID-19 exercise routine, one of these tech-enabled items may work for you.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="young woman uses a Wii Fit video game" src="https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/377045/original/file-20210104-19-1satrtd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Games like the Wii Fit make users move their bodies to play.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/skylar-grey-gets-her-hands-on-wii-fit-u-while-at-the-news-photo/463355359">Neilson Barnard/Getty Images for Nintendo</a></span>
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<h2>Tapping into the tech</h2>
<p>Connected fitness is not new. The <a href="http://doi.org/10.1111/j.1750-8606.2011.00162.x">first such technology</a> was developed in the 1980s: stationary bikes connected to game consoles that required pedaling and steering on a handlebar-mounted gamepad. Exercise video games (exergames) were first created around the same time, really taking off in the late 1990s with games like Dance Dance Revolution and Nintendo Wii Fit <a href="https://doi.org/10.1089/g4h.2014.0077">that require limb or trunk movement</a> as the primary interface with the technology.</p>
<p>New and creative technologies, however, continue to make exercise more convenient, trackable and customized. <a href="http://doi.org/10.1080/15213269.2012.673850">Some exergames have become more gamified</a>, including rewards, challenge levels, leader boards and immersive story lines to <a href="https://us.humankinetics.com/products/advances-in-sport-and-exercise-psychology-4th-edition">create elements of competition and enhance engagement</a>.</p>
<p>Even before the pandemic, connected fitness devices and exergames were appealing because they eliminate some of common barriers to exercise or physical therapy. Users don’t need to worry about the scheduling problems, costs of joining exercise programs or <a href="https://doi.org/10.1016/j.psychsport.2008.11.002">social physique anxiety</a> that can be associated with working out in public. These tools also shift the focus away from what can be unpleasant parts of exercising – like exertion, fatigue and boredom – to novel and engaging aspects of the activity.</p>
<p>One hitch, though, is that so far there are no independent “Consumer Reports”-type evaluations of how much these technologies affect performance outcomes or influence behavior. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="older woman on exercise bike" src="https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/377046/original/file-20210104-17-1ha81ke.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Inspiring gameified content doesn’t help your fitness if you don’t make it a habit.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-woman-on-exercise-bike-royalty-free-image/1182742824">MoMo Productions/DigitalVision via Getty Images</a></span>
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<h2>Connected in more than one way</h2>
<p>Purchasing fitness equipment and technology-based devices is a great first step toward adding more physical activity to your life. But just like with a gym membership that’s paid for but never used, a high-tech piece of gear can gather dust.</p>
<p>Luckily, exercise psychology researchers have figured out frameworks that are more likely to help folks keep up the intensity of their exercise regimens and turn them into habits. Setting exercise goals, having individual choices in the type of workout, seeing improvements in your performance and exercising with others all make you more likely to stick with it. <a href="https://doi.org/10.4018/978-1-4666-9522-1.ch011">Working out in a group</a>, in particular, enhances the experience. The added social elements – including cooperation, coordination, obligation to the group, social comparison and even competition – all contribute.</p>
<p>Of course, finding the right exercise partner or group in these pandemic times can be difficult. Gyms are closed and social distancing guidelines are in effect. Can a virtual buddy do the job?</p>
<p>Our research team, which began investigating partnered exergames long before the pandemic, was the first to examine the use of virtual as well as nonhuman, software-generated exercise partners.</p>
<p>Based on principles of social comparison and what it takes to be a valued teammate, we customized our partners to be somewhat faster than the exerciser to provide a challenge to keep up. We also electronically “tethered” the partner to the exerciser in such a way that if the exerciser slowed down below their target pace, the partner had to slow down too. So if you start slacking, you slow down the team. This tool builds in some obligation to your partner.</p>
<p>We found that motivation and performance improve when the partner is slightly better than the exerciser. This finding held whether the partner is real, but virtually presented, <a href="https://doi.org/10.1519/JSC.0000000000003732">or unreal and software-generated</a>, and with a stationary bike <a href="https://doi.org/10.1016/j.chb.2018.07.004">or a walking app</a>.</p>
<p>Even if you don’t have a software-generated exercise buddy, you can team up with someone on FaceTime or Zoom while you are on a stationary bike, treadmill or even doing dance aerobics. That way you can challenge and encourage each other to keep up the pace. Teaming up with someone who will also hold you accountable to keep showing up is also helpful. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CJJu4z1h4E6","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>Even if you can’t find someone who can work out virtually with you at the same time, you can still share your workout results, compare notes and set future team challenges. A number of running apps, like Strava and RunKeeper, for instance, allow you to keep in touch with running buddies. Pricey indoor cycling classes like Peloton offer many options for how much or how little you want to compare with others, and let you share workouts with friends.</p>
<p>But you can apply the same motivational principles without spending money on such programs. Choose your activity, set your workout goals and search out an exercise buddy where you both challenge and encourage each other. If finding a workout pal is difficult, <a href="https://www.getmotivatedbuddies.com">GetMotivedBuddies</a> provides a low-cost membership.</p>
<h2>Just having fun or really working up a sweat</h2>
<p>Certainly, any movement is superior to a sedentary lifestyle in terms of health benefits. But to meet U.S. Department of Health and Human Services <a href="http://health.gov/paguidelines/">recommendations</a>, adults should attain at least 150 minutes per week of physical activity that is of at least the intensity of a brisk walk.</p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p>
<p><a href="https://us.humankinetics.com/products/advances-in-sport-and-exercise-psychology-4th-edition">Few of the companies that sell technology-based tools</a> to increase physical activity have provided evidence of objective changes in long-term physical activity. Exergames may or may not help you meet recommended levels of physical activity.</p>
<p>In one systematic review of 28 studies, researchers found that when playing the game outside of structured settings, <a href="https://doi.org/10.1177/1090198112444956">exergamers rarely hit moderate to vigorous physical activity levels</a>. The most common exergames reviewed were DDR, Wii Fit, Playstation2 and GameBike.</p>
<p>An important consideration is how tools are used. For example, people can cheat to avoid exercise with a Wii controller by simply flicking the wrist instead of performing full-body movements. People still must commit to using tools for their intended purpose. </p>
<p>Physical activity is good for you in so many ways – including lowering the risk of developing multiple forms of cancer, diabetes and cardiovascular disease. Importantly, physical activity is also positively linked to <a href="https://doi.org/10.1007/s10238-020-00650-3">immune system function</a> and <a href="https://doi.org/10.1080/17437199.2015.1022901">mental health</a>, which are paramount concerns during a pandemic like COVID-19.</p>
<p>So figure out your personal preferences and what motivates you. See what resources you can access. Fortunately, there are creative options available for those wishing to be physically active, and many of them involve technology-based tools. Now is a great time to get connected to fitness.</p><img src="https://counter.theconversation.com/content/149886/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah L. Feltz has received funding from the Robert Wood Johnson Foundation, the National Space Biomedical Research Institute, and National Institutes of Health. She currently does not receive funding from any company or organization that would benefit from this article. </span></em></p><p class="fine-print"><em><span>Karin Pfeiffer has previously received funding from the Robert Wood Johnson Foundation. She has previously received and currently receives funding from the National Institutes of Health. </span></em></p>From step counters and active video games to apps for exercisers and tech-enabled gear, there are a lot of ways to combine your workouts with your digital life.Deborah Feltz, Distinguished Professor Emerita of Kinesiology, Michigan State UniversityKarin Pfeiffer, Professor of Kinesiology, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1433882020-08-07T12:35:59Z2020-08-07T12:35:59ZWearable fitness devices deliver early warning of possible COVID-19 infection<figure><img src="https://images.theconversation.com/files/350944/original/file-20200803-24-1x9uoce.jpg?ixlib=rb-1.1.0&rect=0%2C16%2C5615%2C3715&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fitness information from wearable devices can reveal when the body is fighting an infection.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/runner-in-the-park-using-smart-watch-royalty-free-image/636251614?adppopup=true">Nico De Pasquale Photography/Stone via Getty Images</a></span></figcaption></figure><p>The difficulty many people have getting tested for SARS-CoV-2 and delays in receiving test results make early warning of possible COVID-19 infections all the more important, and <a href="https://advances.sciencemag.org/content/early/2020/06/30/sciadv.abd4794.full">data from wearable health and fitness devices shows promise</a> for identifying who might have COVID-19. </p>
<p>Today’s wearable device gather data about physical activity, heart rate, body temperature and quality of sleep. This data is typically used to help people track general well-being. Smartwatches are the most common type of wearable. There are also smart wrist bands, finger rings and earbuds. Smart clothing, shoes and eyeglasses can also be considered “wearables.” Popular brands include Fitbits, Apple Watches and Garmin watches.</p>
<p>Several studies are <a href="https://med.stanford.edu/snyderlab/news/20202-covid-19-research.html">testing algorithms</a> that <a href="https://wvumedicine.org/news/article/wvu-rockefeller-neuroscience-institute-announces-capability-to-predict-covid-19-related-symptoms-up-/">assess data</a> from wearable devices to detect COVID-19. Results to date show that the concept is sound. However, wearables can be expensive and sometimes challenging to use. Addressing these issues is important to allow as many people as possible to benefit from them.</p>
<h2>Detecting flu-like illness</h2>
<p>Because wearables are excellent tools for monitoring general health conditions, researchers began studying ways of using them to detect illness before the COVID-19 pandemic. For example, researchers used Fitbit data <a href="https://doi.org/10.1016/S2589-7500(19)30222-5">to identify people who could have an influenza-like illness</a> from their resting heart rate and daily activity patterns. An elevated resting heart rate can be related to an infection. </p>
<figure class="align-right ">
<img alt="Fitbit fitness tracker" src="https://images.theconversation.com/files/350946/original/file-20200803-24-t4cbmc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/350946/original/file-20200803-24-t4cbmc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=775&fit=crop&dpr=1 600w, https://images.theconversation.com/files/350946/original/file-20200803-24-t4cbmc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=775&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/350946/original/file-20200803-24-t4cbmc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=775&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/350946/original/file-20200803-24-t4cbmc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=974&fit=crop&dpr=1 754w, https://images.theconversation.com/files/350946/original/file-20200803-24-t4cbmc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=974&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/350946/original/file-20200803-24-t4cbmc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=974&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fitness trackers like this Fitbit monitor heart rate, activity and quality of sleep. Elevated resting heart rate is a sign of infection.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/185603127@N05/49111707501/">Krystal Peterson/Flickr</a></span>
</figcaption>
</figure>
<p>Most Fitbit models measure and record heart rate, so the devices can be used to spot periods of increased resting heart rate. They also measure and record activity, so they can identify reduced levels of daily activity. Combining these two measures allowed the researchers to better predict who had an influenza-like illness. </p>
<p>It’s not possible to determine if a smart device wearer has a particular illness from just these data measures. But seeing a sudden change in these conditions can prompt people to isolate themselves and get diagnostic tests, which can reduce the spread of communicable diseases like COVID-19.</p>
<h2>Body temperature</h2>
<p>Fever and persistent cough are the <a href="https://doi.org/10.1371/journal.pone.0234765">most common symptoms of COVID-19</a>. This has sparked widespread screening using thermometers, most commonly contactless infrared thermometers. </p>
<p>Despite the ubiquity of thermometers, temperature sensors in wearables are uncommon. This is due in part to <a href="https://dx.doi.org/10.3390%2Fs18061714">how complicated it is</a> to obtain true body temperature from skin-based measurements. Skin temperature varies depending on environmental conditions and stress levels, sweat evaporation can lower skin temperature, and temperature sensors sometimes have less-than-ideal contact with the skin.</p>
<p>There are wearable temperature patches that communicate with smart devices and record temperature continuously. But body temperature isn’t 100% predictive of illness, and it’s impossible to diagnose a particular infection, such as COVID-19, using body temperature alone. Nonetheless, a fever alert could lead to earlier intervention.</p>
<h2>Sweat and tears</h2>
<p>Research into sensing technology continues to expand the possibilities for wearables as health monitoring and diagnosis devices. The COVID-19 outbreak is likely to influence the direction of this research as well as accelerate it. </p>
<figure class="align-right ">
<img alt="backside of Garmin smartwatch" src="https://images.theconversation.com/files/350948/original/file-20200803-14-1c653hn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/350948/original/file-20200803-14-1c653hn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/350948/original/file-20200803-14-1c653hn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/350948/original/file-20200803-14-1c653hn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/350948/original/file-20200803-14-1c653hn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/350948/original/file-20200803-14-1c653hn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/350948/original/file-20200803-14-1c653hn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The backside of this Garmin smartwatch shows the sensors that use light to illuminate blood vessels in order to measure heart rate.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/185627742@N03/49108710981/">Tina Arnold/Flickr</a></span>
</figcaption>
</figure>
<p>One approach is to create sensors that <a href="https://doi.org/10.1002/elan.201800677">detect compounds in sweat</a> from the skin. These compounds can provide a lot of information about a person’s health. pH, sodium ions, glucose and alcohol content are just some of the things that emerging sweat sensors can detect. Tears also contain compounds from the body, so researchers are investigating <a href="https://doi.org/10.1039/C9LC01039D">chemical sensing using contact lenses and smart lenses</a>. </p>
<p>Sweat rate can also be measured, which can be used as an indicator of temperature, so these sensors are being examined for use in <a href="https://spectrum.ieee.org/view-from-the-valley/the-institute/ieee-member-news/sweat-sensing-patch-aimed-athletes-takes-covid19">helping detect COVID-19</a>. </p>
<h2>Toward detecting viruses</h2>
<p>The drawback of many existing wearable sensors is that they can’t actually detect the presence of a virus such at SARS-CoV-2. To do this, they would have to detect virus-specific RNA. </p>
<p>RNA detection typically involves several steps, including extracting RNA from a sample, making many copies of the RNA and identifying the RNA. Although there has been a lot of progress in miniaturizing RNA detection equipment for use in rapid, point-of-care testing, there’s still a ways to go before it can fit in wearable devices.</p>
<p>Much of the ongoing research on developing rapid, point-of-care pathogen detection uses “lab-on-a-chip” technology. Lab-on-a-chip refers to the goal of shrinking laboratory tests that once required many large pieces of equipment to the size of a computer chip or microscope slide. </p>
<p>An example is a <a href="https://www.engineering.com/DesignerEdge/DesignerEdgeArticles/ArticleID/20451/Lab-on-a-Chip-LoC-COVID-19-Test-Advances-to-Clinical-Trials.aspx">COVID-19 diagnostic test</a> undergoing clinical trials. The test’s sensor is a specialized <a href="https://ieeexplore.ieee.org/document/6189704">ion-sensitive field-effect transistor</a> (ISFET) that is designed to respond to the presence of the virus RNA. The device can perform a test in less than one hour, but requires a sample collected by nasal swab. </p>
<p>While this technology is not wearable, it could become the launching point for future virus-detecting wearables because these can be made small and use little power. A wearable device that continuously monitors a person and indicates that they’ve contracted or been exposed to the virus would allow the person to seek treatment and isolate themselves to prevent further spread.</p>
<h2>Sonic screwdrivers and tricorders</h2>
<p>Fans of Dr. Who know the <a href="https://en.wikipedia.org/wiki/Sonic_screwdriver">sonic screwdriver</a>, and Star Trek followers know the <a href="https://en.wikipedia.org/wiki/Tricorder">tricorder</a>. The ideal wearable of the future would be similar to these wondrous fictional devices. It would be able to detect the presence of the virus in the environment around the wearer, providing the opportunity to leave before becoming exposed. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>But airborne virus detection requires significant equipment to <a href="https://dx.doi.org/10.1371%2Fjournal.pone.0174314">collect air samples and analyze them</a>. Other methods, such as the <a href="https://doi.org/10.1021/acsnano.0c02439">plasmonic photothermal biosensor</a>, provide promising results, but still require the user to perform the analysis. It will be some time before a smartwatch will be able to alert its wearer to the presence of a dangerous virus.</p>
<h2>Wearable and accessible</h2>
<p>For all the promise of wearables as tools to tackle the COVID-19 pandemic, and future pandemics, there are barriers to widespread use of the devices. Most wearables are expensive, can be difficult to learn to use by non-native English speakers, or are developed without data from a broad population base. There’s a risk that <a href="https://doi.org/10.2196/mhealth.6494">many people won’t accept the technology</a>. </p>
<p>Continued development of broadly accepted health-based wearables should include community input, as outlined in a <a href="https://doi.org/10.17226/23439">National Academies Workshop Summary</a>. By ensuring that everyone has access to wearables, and accepts them, the devices can help keep people healthy in the midst of a global pandemic. Ongoing research should result in improved technology that, with care, will benefit all of society.</p><img src="https://counter.theconversation.com/content/143388/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Albert H. Titus has received research funding from the National Science Foundation, the National Institutes of Health, and the Department of Defense. He has also received funding for research in this area from Garwood Medical Devices.
He is a Senior Member of the IEEE, a member of BMES, ASEE, and is a member of the BME Council of Chairs.</span></em></p>Fitness information like resting heart rate collected by wearable devices can’t diagnose diseases, but it can signal when something is wrong. That can be enough to prompt a COVID-19 test.Albert H. Titus, Professor of Biomedical Engineering, University at BuffaloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1410142020-06-23T13:54:25Z2020-06-23T13:54:25ZFitness tracker data could predict your marathon performance – new research<p>Eliud Kipchoge last year became the first athlete to run a marathon in <a href="https://www.bbc.co.uk/sport/athletics/50025543#:%7E:text=Eliud%20Kipchoge%20has%20become%20the,in%20Vienna%2C%20Austria%20on%20Saturday.">under two hours</a> after much training and careful preparation. Regardless of whether you’re aiming for a new world record or you just want to achieve a respectable time for your age, if you’re training for a marathon you might well want to know what you’re on course to accomplish.</p>
<p>There are so <a href="https://pubmed.ncbi.nlm.nih.gov/31575820/">many different equations</a> claiming to predict marathon performance. But these are not always very accurate because predicting marathon performance is difficult. However, in our <a href="https://journals.lww.com/acsm-msse/Abstract/9000/Calculation_of_Critical_Speed_from_Raw_Training.96275.aspx">new study</a>, we showed that analysing the abundance of data produced during training and racing by wearable fitness trackers may be helpful. We found it’s possible to calculate a critical speed value that we can use to predict a runner’s marathon time with a good degree of accuracy.</p>
<p>Many things determine how fast you can run a marathon. First, your physiology plays a huge role <a href="https://journals.physiology.org/doi/abs/10.1152/japplphysiol.00793.2019">in your performance</a>. For example, elite marathon runners tend to be slim with long limbs, which offers them <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2375555/">greater running economy</a> and means they will use less energy to move at a given speed. Fast marathon runners also tend to have a higher maximum rate of oxygen use <a href="https://theconversation.com/vo-max-the-gold-standard-for-measuring-fitness-explained-109486">(VO2max)</a> and can operate at a high percentage of this maximum for a long time without developing fatigue.</p>
<p>But there are <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.00167.2020">many</a> <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.01259.2010">other</a> factors involved. The right shoes can make running more economical in terms of how much energy you use. Running with pacers can help runners manage their timing and can reduce air resistance. And of course, choosing a flat course with optimal weather conditions can help too.</p>
<h2>Critical speed</h2>
<p>Endurance running is essentially determined by the fastest speed you can sustain for a given distance, or how long you can run at a given speed. It’s clear that if you go very fast, then you can only sustain that speed for a short time. And if you want to run for longer times, you need to slow down.</p>
<p>However, small changes can have a large impact on how long we can maintain our speed. This suggests there is a critical speed at which, in theory, we can sustain for quite a long time.</p>
<p>It is quite possible that critical speed is useful for predicting endurance performance. <a href="https://pubmed.ncbi.nlm.nih.gov/28332113/">For example</a>, elite athletes appear to run their best marathons at around 96% of their critical speed.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/343494/original/file-20200623-188916-102bmpj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/343494/original/file-20200623-188916-102bmpj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/343494/original/file-20200623-188916-102bmpj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/343494/original/file-20200623-188916-102bmpj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/343494/original/file-20200623-188916-102bmpj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/343494/original/file-20200623-188916-102bmpj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/343494/original/file-20200623-188916-102bmpj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fitness tracker data enabled highly accurate predictions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/runner-wearing-smartwatch-on-wrist-closeup-465520748">Maridav/Shutterstock</a></span>
</figcaption>
</figure>
<p>This is where activity data collected from fitness trackers (distance, speed, time, heartrate and cadence) can come in. We wanted to know whether all of the data recorded by tracking devices can be used to support runners preparing for a marathon. </p>
<p>By analysing training data from 25,000 athletes, we found we could estimate their critical speed and predict their marathon performance with 92% accuracy. Considering how many things can impact marathon performance (during training and on race-day) and the different levels of fitness across recreational athletes, this is a high degree of accuracy.</p>
<p>We also found that, on average, runners ran the marathon at speeds around 85% of their critical speed. Faster athletes ran their marathons closer to 93% of their critical speed, but slower runners did so at 79% of their critical speed.</p>
<p>This means that using raw training data to estimate your critical speed, your smart watch or favourite fitness app may soon be able to predict your finish time to an even higher degree of accuracy, as well as providing real-time feedback and advice about how best to pace your race.</p><img src="https://counter.theconversation.com/content/141014/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Training data collected by fitness trackers may be useful to predict marathon performanceDaniel Muniz, Senior Lecturer, Exercise Physiology, University of HertfordshireBarry Smyth, Professor of Computer Science, University College DublinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1410522020-06-23T03:42:35Z2020-06-23T03:42:35ZEvery step you take: why Google’s plan to buy Fitbit has the ACCC’s pulse racing<figure><img src="https://images.theconversation.com/files/343130/original/file-20200622-75522-5r1j5p.jpg?ixlib=rb-1.1.0&rect=89%2C107%2C5901%2C3880&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bangkok-thailand-october-06-2018-view-1381312625">Shutterstock</a></span></figcaption></figure><p>The Australian Competition and Consumer Commission (ACCC) has <a href="https://www.accc.gov.au/media-release/google%E2%80%99s-purchase-of-fitbit-raises-preliminary-competition-concerns">expressed concern</a> about Google’s <a href="https://investor.fitbit.com/press/press-releases/press-release-details/2019/Fitbit-to-Be-Acquired-by-Google/default.aspx">proposed acquisition</a> of fitness tracker company Fitbit. </p>
<p>The acquisition will let Google add years’ worth of Fitbit users’ data to its already unequalled consumer data collection. This could reduce competition in certain health services and other markets in Australia.</p>
<p>Google revealed its plans to acquire Fitbit Inc. for US$2.1 billion last November. But the deal will only go ahead if it gets clearance from competition regulators around the world. </p>
<p>While the ACCC is the first regulator globally to announce its concerns, the <a href="https://www.usnews.com/news/technology/articles/2020-06-16/eu-antitrust-regulators-set-july-20-deadline-for-google-fitbit-deal">European Commission</a> and <a href="https://nypost.com/2020/04/03/feds-ramp-up-probe-of-2-1b-google-fitbit-deal-amid-privacy-worries/">US Department of Justice</a> are also evaluating the deal. Both will likely take an interest in the ACCC’s views, for which <a href="https://www.accc.gov.au/public-registers/mergers-registers/public-informal-merger-reviews/google-llc-proposed-acquisition-of-fitbit-inc">submissions are being accepted</a>.</p>
<h2>Collective concern is called for</h2>
<p>With more than <a href="https://investor.fitbit.com/press/press-releases/press-release-details/2019/Fitbit-to-Be-Acquired-by-Google/default.aspx">28 million people</a> using Fitbit wearable devices, many have <a href="https://www.theguardian.com/technology/2019/nov/05/fitbit-google-acquisition-health-data">raised concerns</a> about Google adding Fitbit’s sensitive data to its <a href="https://www.wired.com/story/google-tracks-you-privacy/">already extensive tracking</a> of consumers. </p>
<p>Google has left many <a href="https://www.wired.co.uk/article/google-buying-fitbit-health-data-privacy">questions unanswered</a> about how it would use the data. Consumers have reason to be sceptical about Google’s <a href="https://blog.google/products/hardware/agreement-with-fitbit">privacy promises</a>, and the competitive effects of the merger. </p>
<h2>Sharing your intimate details</h2>
<p><a href="https://www.fitbit.com/legal/privacy-policy#info-we-collect">Fitbit collects</a> highly personal information, including sleep patterns, heart rate, active minutes, height and weight, date of birth, food logs, mobile number, biography and precise location data. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">According to estimates by Forbes, Fitbit co-founders James Park and Eric Friedman will each receive as much as US$150 million (before taxes) as a result of selling their shares in Fitbit.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/techcrunch/48843669166/in/photolist-2hq9za1-2hq9zds-2hq9z2R-2hq7Fg5-2hqatFu-2hqatD5-2hq7DuV-gK72e8-gK85aV-v4bND4-onq9rn-K5d9iM-yF6L5x-yF2fNJ-HckB8b-K2cXLo-y1zRxj-yYpUqp-yWBmV9-yF2h3Y-MQCAUc-o4aupd-w1yGoX-oksFeJ-o4aGe3-yXChSp-yF2gwC-yXChcg-o4auZ1-o4aME4-yYpTJz-oiCtsm-oiCsUs-JXiS9P-o4aaab-okC9V5-JXj216-okCuEq-y1Jqi2-okEevr-oknxmr-o4arwE-okE3Hz-K5d7Nn-okEiRR-okEhDF-onqgXp-o4bAMZ-onqayT-okC7rY">TechCrunch/Flickr</a></span>
</figcaption>
</figure>
<p>For those using Fitbit’s live coaching services, it also collects wellness plans and goals, calendar events, and communications with a coach. If you’re a woman using “female health tracking”, data can also include your periods, fertile times, ovulation days and health symptoms. </p>
<p>The ACCC regards Fitbit data as having “<a href="https://www.accc.gov.au/system/files/public-registers/documents/Google%20Fitbit%20-%20Statement%20of%20Issues%20-%2018%20June%202020.pdf">unique attributes</a>”, noting that datasets from other wearable devices are “not as voluminous, reliable or broad”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-accc-is-suing-google-over-tracking-users-heres-why-it-matters-126020">The ACCC is suing Google over tracking users. Here's why it matters</a>
</strong>
</em>
</p>
<hr>
<h2>Google’s privacy reassurances are not binding</h2>
<p>Last November, Google and Fitbit were quick to <a href="https://investor.fitbit.com/press/press-releases/press-release-details/2019/Fitbit-to-Be-Acquired-by-Google/default.aspx">reassure consumers</a> that “Fitbit health and wellness data will not be used for Google ads”. A Google spokesperson told The Conversation: </p>
<blockquote>
<p>Similar to our other products, with wearables, we will be transparent about the data we collect and why. And we do not sell personal information to anyone.</p>
</blockquote>
<p>However, the ACCC points out <a href="https://www.accc.gov.au/system/files/public-registers/documents/Google%20Fitbit%20-%20Statement%20of%20Issues%20-%2018%20June%202020.pdf">Google is not bound</a> by its commitment to not use the data in its advertising businesses. As the competition watchdog’s <a href="https://www.accc.gov.au/media-release/digital-takeovers-transactions-may-harm-consumers">Chair Rod Sims</a> said:</p>
<blockquote>
<p>It is a stretch to believe any commitment Google makes in relation to Fitbit users’ data will still be in place five years from now.</p>
</blockquote>
<p>When Google acquired online advertising business DoubleClick, it reassured users it <a href="https://slate.com/technology/2016/10/google-changed-a-major-privacy-policy-and-no-one-really-noticed.html">would only combine personal data</a> from the two businesses if users opted into this combination. Eight years later, <a href="https://www.accc.gov.au/system/files/Digital%20platforms%20inquiry%20-%20final%20report.pdf">Google simply deleted this promise</a> from its privacy policy. </p>
<p>It’s also worth noting Google has not promised to refrain from using Fitbit data in its <em>non-advertising</em> businesses. This could include <a href="https://www.ft.com/content/50e1f042-06f3-11ea-a984-fbbacad9e7dd">health services</a> or, in future, <a href="https://www.ft.com/content/b7b3b08a-d4a3-11e9-8d46-8def889b4137">health or life insurance</a>. Google would not need to “sell” your data to use it for these commercial purposes.</p>
<h2>Google’s huge data advantage</h2>
<p>Google already has the most extensive collection of consumer data on the planet. This includes data from Google search, YouTube, Gmail, Google Maps, Google Nest, Android and Google devices – as well as consumer data collected from millions of third-party websites using Google’s services such as Google Analytics, Google Ads and reCAPTCHA. </p>
<p>The ACCC acknowledges Google already uses its pervasive data collection to create <a href="https://www.accc.gov.au/system/files/public-registers/documents/Google%20Fitbit%20-%20Statement%20of%20Issues%20-%2018%20June%202020.pdf">unique profiles of individual users</a>. It points out acquiring Fitbit would give Google “one of the largest and most detailed existing fitness and health datasets, as well as another avenue through which it can continue to gather consumer data”. </p>
<p>The ACCC is particularly concerned the proposed acquisition could substantially reduce competition between Fitbit, Google and others in “data-dependent health services” such as those supplying: </p>
<ul>
<li>tailored digital advice based on individual health signals to users of Fitbit and other wearables on how to improve their health or manage a medical condition</li>
<li>insights to insurance companies or employers wishing to compile risk profiles, reduce costs or enhance productivity </li>
<li>diagnostic tools for medical institutions and doctors to determine early indicators of chronic disease and</li>
<li>insights or raw data for health researchers. </li>
</ul>
<p>If Google acquires Fitbit’s user data, it could gain a significant advantage over other suppliers of these services and prevent them from accessing the dataset. </p>
<p>According to the ACCC, it could also have an incentive hinder rivals such as Apple, Samsung and Garmin, by removing their access to Google Maps, Google Play Store and Wear OS (a Google operating system for wearables).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/amazon-facebook-and-google-dont-need-to-spy-on-your-conversations-to-know-what-youre-talking-about-108792">Amazon, Facebook and Google don't need to spy on your conversations to know what you're talking about</a>
</strong>
</em>
</p>
<hr>
<h2>Entrenching Google’s power in digital advertising</h2>
<p>Google makes most of its annual revenue (more than US$100 billion) from online advertising services. Privacy advocates have <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3587239">criticised the ad tech industry</a>, including dominant players like Google and Facebook, for creating a “<a href="https://medium.com/clearcode/taming-the-wild-west-of-consumer-data-sharing-in-adtech-b3cab26adbe8">data free for all</a>” where consumers’ intimate information is exchanged between hundreds of companies engaged in targeted advertising.</p>
<p>The ACCC says it is concerned that by acquiring Fitbit’s datasets, Google could entrench its market power in certain ad tech markets. For example, it could “even more effectively target advertising to consumers with health-related issues”. </p>
<h2>What can the ACCC actually do about it?</h2>
<p>The ACCC plans to announce its final stance by mid-August on whether Google’s merger with Fitbit would contravene Australia’s competition legislation. If it decides the merger is likely to substantially lessen competition, it could seek orders from the Federal Court to prevent the merger.</p>
<p>But practically speaking, regulators will likely try to coordinate their response internationally, with the overall outcome decided in larger markets such as the United States and European Union. </p>
<p>The <a href="https://www.usnews.com/news/technology/articles/2020-06-16/eu-antitrust-regulators-set-july-20-deadline-for-google-fitbit-deal">European Commission</a> is expected to release its ruling in July. And past <a href="https://www.rferl.org/a/1096891.html">events indicate</a> the commission could impose conditions, or prevent the merger going ahead internationally – even if the US Department of Justice gives it the green light.</p><img src="https://counter.theconversation.com/content/141052/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katharine Kemp receives funding from The Allens Hub for Technology, Law and Innovation. She is a Member of the Advisory Board of the Future of Finance Initiative in India, the Centre for Law, Markets & Regulation and the Australian Privacy Foundation.</span></em></p>The watchdog has voiced concerns over the proposed US$2.1 billion merger, from which both users and Australian health services could lose out.Katharine Kemp, Senior Lecturer, Faculty of Law, UNSW, and Academic Lead, UNSW Grand Challenge on Trust, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1285852020-01-15T13:54:52Z2020-01-15T13:54:52ZWhy fitness trackers may not give you all the ‘credit’ you hoped for<figure><img src="https://images.theconversation.com/files/310080/original/file-20200114-93792-nu0yk9.jpg?ixlib=rb-1.1.0&rect=144%2C99%2C5862%2C3539&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Wearable fitness trackers have less accuracy when used in certain ways.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-athlete-royalty-free-image/943022276?adppopup=true">bogdankosanovic/E+ via Getty Images</a></span></figcaption></figure><p>January is a time when many people make resolutions – and then break them. <a href="https://www.apaservices.org/practice/update/2012/02-23/willpower">Almost 60% of Americans will resolve to exercise more</a>, but <a href="https://advanced-hindsight.com/blog/a-new-years-resolution-for-you-exercise-for-pleasure-and-enjoyment/">fewer than 10% will stick with their resolution</a>. A key to keeping resolutions is ensuring they are <a href="https://www.nytimes.com/guides/smarterliving/resolution-ideas">measurable</a>, and a simple way to track activity is through <a href="https://www.forbes.com/sites/paullamkin/2018/10/23/smart-wearables-market-to-double-by-2022-27-billion-industry-forecast/#596130522656">a wearable smartwatch or fitness tracker</a>. Indeed, <a href="https://doi.org/10.1371/journal.pone.0189298">almost one in five adults has used a fitness tracker</a>.</p>
<p>Wearable fitness trackers can also help improve medical care by providing insights into physical activity, heart rate, location and sleep patterns. My <a href="https://wphomes.soic.indiana.edu/ksiek/">research team</a> uses wearable fitness tracker data with smart home sensors to help <a href="https://crihomeshare.wordpress.com/">older adults live safely and independently</a>. We also study wearable fitness tracker data along with electronic medical records and genomic data to <a href="https://precisionhealth.iu.edu/current-studies/hoosier-moms.html">investigate the causes of gestational diabetes</a>. Many <a href="https://allofus.nih.gov/news-events-and-media/announcements/all-us-research-program-expands-data-collection-efforts-fitbit">other researchers</a> utilize wearable fitness trackers to better understand how lifestyles can impact health.</p>
<p>Unfortunately, I’ve found in my health informatics research that wearable devices may not give all the credit their users deserve, and in some cases, users may want to consider how secure and private their data is.</p>
<h2>Giving credit when it’s due</h2>
<p>People who use fitness trackers have been <a href="https://doi.org/10.1145/1124772.1124840">frustrated with how they get “credit” for their activities</a>, which drives some users to <a href="http://www.doi.org/10.1145/2750858.2807554">abandon fitness trackers</a>. In my research team’s work, we find that people who have limited arm movement report that fitness trackers are not accurately recording their activities. This can happen as well with those who do not have traditional gaits because they may shuffle.</p>
<p>The lack of credit is especially obvious when people are walking but keeping their arms still – such as pushing a stroller or walking while holding an infant. New mothers also report accuracy issues with respect to their sleep patterns. When they wake up multiple times a night, the next morning the device will show them as “lightly sleeping.” This is frustrating when the new mother wants to use this data to negotiate with her partner on child care because a device may credit the mother with more sleep than she actually gets. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/310068/original/file-20200114-151829-14mw9d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/310068/original/file-20200114-151829-14mw9d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/310068/original/file-20200114-151829-14mw9d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/310068/original/file-20200114-151829-14mw9d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/310068/original/file-20200114-151829-14mw9d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/310068/original/file-20200114-151829-14mw9d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/310068/original/file-20200114-151829-14mw9d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Were you ‘lightly sleeping’ or did you wake up multiple times?</span>
<span class="attribution"><span class="source">fizkes/iStock via Getty Images</span></span>
</figcaption>
</figure>
<p>These inaccuracies make sense from a technical point of view. When people keep their wrists still, as in pushing a stroller, the wrist is not changing directions. Thus, the software cannot detect changes in movement from the accelerometer sensor on a wrist tracker which is looking for changes in up-down, forward-backward and side-to-side movements. Researchers have also shown that <a href="https://dl.acm.org/citation.cfm?id=3025690">500 or fewer steps can be recorded without wearing the device</a>, reflecting how devices can over count activity sometimes. In the case of detecting sleep, most people do not wake up multiple times a night, so the algorithms used by wearable devices may throw these short bursts of movement away. </p>
<p>The companies that make these wearable devices have significant intellectual property involved in detecting these movements and then using algorithms to decide how much people are moving or sleeping, so these algorithms are not shared publicly. There currently do not exist any mechanisms to give feedback on what was detected. Imagine if a person could push a button and tell a wearable fitness device, “I did wake up three times tonight!”</p>
<p>Since people are not getting the credit they deserve for some of their activities, I am concerned about what type of lifestyle data we researchers can accurately assess from a commodity wearable for our health research. In computing, there is a saying, “Garbage in, garbage out.” If wearable fitness trackers are putting inaccurate step and sleep data into the algorithms that quantify our activities, then people will be making health-related decisions based on inaccurate data.</p>
<h2>Who has the data?</h2>
<p>Typically, consumers assess how much “credit” they are getting from a fitness tracker by transferring the data to an app. Most people likely assume that when people transfer the data to the app, the data is not shared widely. Users may assume, for instance, that they can see the data, people they shared data with can view it and the company who has the device and app can see the data. But this is only part of the story.</p>
<p>A company, however, could change its terms of service – which, studies have shown, <a href="https://cmci.colorado.edu/%7Ecafi5706/CSCW2016_Fiesler.pdf">people have difficulty understanding</a> – and decide to make this health data available to third parties. For example, wearable fitness data could be sold to help our employers understand our <a href="https://www.wsj.com/graphics/company-tracking-employees/">fitness and productivity</a> or <a href="https://theconversation.com/could-your-fitbit-data-be-used-to-deny-you-health-insurance-72565">insurance companies to assist with or deny health coverage</a>. Although there’s no evidence of this practice being done, I believe consumers would do well to be aware that it is a possibility in the future. </p>
<p>[ <em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/128585/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Siek receives funding from Indiana University Precision Health Initiative. </span></em></p>A health informatics researcher explains why people don’t always get the ‘credit’ they think they should from using wearable fitness trackers.Katie Siek, Associate Professor of Informatics, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1216632019-08-22T11:14:51Z2019-08-22T11:14:51ZFitness trackers and eating disorders – is there a link?<figure><img src="https://images.theconversation.com/files/288585/original/file-20190819-123710-12kcvaa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-tourist-looking-fitness-bracelet-on-1018256575?src=wKn3IVG21d3xaKI36t0t4Q-1-11">nelen/Shutterstock</a></span></figcaption></figure><p>Fitness and health tracking devices are becoming <a href="https://www.statista.com/statistics/610433/wearable-healthcare-device-revenue-worldwide/">increasingly popular</a> and a huge variety of wearable tech and apps now exist. Indeed, many <a href="https://theconversation.com/social-media-isnt-causing-more-eating-disorders-in-young-people-new-study-119959">smartphones</a> and smart watches now come primed and ready to track our activity, sleep and nutrition.</p>
<p><a href="https://psycnet.apa.org/record/1982-26944-001">Research has</a> for a long time highlighted how monitoring behaviours can help to lead to positive changes in our lifestyles. It can be an effective way to help increase <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370453/">physical activity, and to achieve weight loss</a>. </p>
<p>But monitoring physical activity and food intake may not be useful for everyone. Indeed, people with <a href="https://theconversation.com/understanding-body-signals-could-be-a-key-factor-in-eating-disorders-111559">eating disorders</a> often have unhealthy relationships with food and exercise. Obsessive behaviours such as calorie counting, rigid, driven exercise and unhealthy perfectionism are common among those with eating issues. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/anorexia-is-an-illness-not-something-we-can-simply-blame-on-the-media-39954">Anorexia is an illness – not something we can simply blame on the media</a>
</strong>
</em>
</p>
<hr>
<p>A small body of research has started to explore how fitness trackers and calorie counting apps <a href="https://www.techradar.com/news/do-fitness-trackers-have-an-impact-on-eating-disorders">might be linked to disordered eating</a> and exercise. Higher levels of <a href="https://www.tandfonline.com/doi/abs/10.1080/07448481.2018.1431905?journalCode=vach20">body dissatisfaction</a> and <a href="https://www.sciencedirect.com/science/article/pii/S1471015316303646?via%3Dihub">disordered eating</a> have been identified among those who use tracking tools, compared to those who do not. And many patients with eating disorders report using calorie counting tools such as <a href="https://www.myfitnesspal.com/">MyFitnessPal</a>. And these tools have been identified as having a <a href="https://www.sciencedirect.com/science/article/pii/S1471015317301484?via%3Dihub">negative impact</a> on their eating disorder symptoms. </p>
<p><a href="https://www.bbc.co.uk/news/uk-england-birmingham-48842898">App creators say</a> “they promote healthy lifestyles, and safeguards [are] in place to deter those wishing to pursue harmful habits.” MyFitnessPal, for example, includes <a href="https://myfitnesspal.desk.com/customer/en/portal/articles/1575987-eating-disorder-resources">resources on eating disorders</a> on their website and has previously <a href="https://blog.myfitnesspal.com/myfitnesspal-empowered-beat-eating-disorder/">published blog posts</a> claiming the app can help people to recover from eating disorders. But out research seems to indicate otherwise.</p>
<h2>The rise of wearables</h2>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1002/eat.22966">In a recent study</a>, we explored the broader mental health and well-being of users of fitness and food intake monitoring tools. We also tried to understand why people used such devices. </p>
<p>In our sample of young people, 65% of them reported currently using a fitness or food intake tracking device. Those using devices reported higher levels of both disordered eating and compulsive exercise than non-users. Those who tracked their activity or food intake primarily to manage their weight or shape (as opposed to health or fitness related reasons) and who used the devices frequently showed the highest levels of disordered eating and exercise. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/288586/original/file-20190819-123710-1yv28qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288586/original/file-20190819-123710-1yv28qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288586/original/file-20190819-123710-1yv28qd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288586/original/file-20190819-123710-1yv28qd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288586/original/file-20190819-123710-1yv28qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288586/original/file-20190819-123710-1yv28qd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288586/original/file-20190819-123710-1yv28qd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Calorie counting apps have been accused of exacerbating unhealthy food behaviours.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-using-calorie-counter-application-on-343475045?src=R5zlL4iQokqKXwg_YQuHWw-1-0">Shutterstock/Dragon Images</a></span>
</figcaption>
</figure>
<p>Eating disorders are incredibly complex and are caused by many different interacting factors. It would be overly simplistic to suggest that tracking of eating and exercise behaviours could cause an eating disorder. </p>
<p>But monitoring activity and food intake could inadvertently validate disordered eating and exercise attitudes and behaviours among vulnerable people. And the pressure from devices to be constantly active, and to meet revised, increasing step targets could exacerbate obsessive and self-critical tendencies. </p>
<h2>Quit the counting</h2>
<p>It’s likely though that many people’s feelings towards, and use of, tracking devices changes over time. <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(16)30284-4/fulltext">Recent evidence</a>, for example, has indicated that just 10% of people will continue to use their fitness tracker beyond 12 months, even when there is an incentive to do so. While the reasons behind this drop off are unclear, it’s possible that the devices induce feelings of guilt or shame when one fails to reach goals or make progress. A shift in attitudes from “wanting” to exercise to “having” to exercise may be a sign that the relationship with the tracker has gone sour, and potentially indicate an <a href="https://doi.org/10.1002/erv.1122">increased vulnerability</a> to disordered eating. </p>
<p>It’s clear then that further research is needed to clearly identify whether tracking devices may be helpful or harmful for certain individuals. Indeed, it may be pertinent for companies developing such technologies to work alongside eating disorder professionals to develop and provide appropriate signposting and support via their devices. </p>
<p>In the meantime, it’s important to think about how often we’re using tracking tools – and our reasons for doing so. Indeed, it’s important to be able to enjoy a walk, run, swim or cycle without worrying about the pace, distance or calories burned.</p>
<p>So next time you’re taking part in some exercise, instead of worrying about how many miles you’ve done, maybe just try to take the time to enjoy your activity and your surroundings – as <a href="https://www.sciencedirect.com/science/article/pii/S0013935118303323">research shows</a> being outdoors can, in and of itself, have a positive impact on your long-term health and well-being.</p>
<hr>
<p><em>If you’re worried about your relationship with food or activity, then you can contact your GP or the <a href="https://www.beateatingdisorders.org.uk/">UK Eating Disorders Charity</a> for further advice and support.</em></p><img src="https://counter.theconversation.com/content/121663/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carolyn Plateau does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A small body of research has started to explore how fitness trackers and calorie counting apps might be linked to disordered eating and exercise.Carolyn Plateau, Lecturer in Psychology, Loughborough UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1198062019-07-07T20:10:37Z2019-07-07T20:10:37ZTreat or trick: we asked people how they feel about sharing fitness data with insurance companies<figure><img src="https://images.theconversation.com/files/282596/original/file-20190704-126345-kbotut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Insurance companies collect data from fitness trackers to help improve business decisions. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-using-smart-watch-christmas-tree-529126072?src=ktc2Nxyyl-oaKNcjsDiP4g-1-0&studio=1">Shutterstock</a></span></figcaption></figure><p>From the Fitbit to Apple’s smartwatch, wearable tech is becoming <a href="https://www.ipsos.com/en/who-are-worlds-biggest-wearable-tech-buyers">increasingly popular across the globe</a>. Compared to other nations like US, which has seen higher adoption of fitness trackers, uptake in Australia is still <a href="https://www.statista.com/outlook/319/107/wearables/australia#market-revenue">less than 10%</a> in 2019. But news reports indicate that Australians are taking to fitness monitoring <a href="https://www.channelnews.com.au/fitness-martket-booming-in-os-apple-fitbit-samsung-big-winners/">more than ever before</a>.</p>
<p>And wearable devices are not only being embraced by consumers, but also across insurance industries. Health and life insurance companies collect data from fitness trackers with the goal of improving business decisions. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/VxCrnskf5gE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Hollywood actor Christopher Walken was the spokesperson for Qantas’s 2016 Assure campaign.</span></figcaption>
</figure>
<p>Currently, these business models work as a “carrot” incentive. That means consumers can benefit from <a href="https://www.finder.com.au/save-on-life-insurance">discounts and cheaper premiums</a> if they are willing to share their Fitbit data. </p>
<p>But we could see voluntary participation become mandatory, shifting the incentive from carrot to stick. John Hancock, one of the largest life insurance companies in the United States, has added fitness tracking with wearable devices to <a href="https://www.bbc.com/news/technology-45590293">all of its policies</a>. Though customers can opt out of the program, some industry experts <a href="https://internetofbusiness.com/john-hancock-fitness-tracking-life-insurance/">argue</a> that this “raises ethical questions around privacy and equality in leaving the traditional life insurance model behind”.</p>
<p>Is this the beginning of a major trend? And, more importantly, how do consumers feel about being “persuaded” into fitness tracker-based insurance policies?</p>
<p>In a <a href="https://eprints.qut.edu.au/125673/">study</a> conducted with my colleague Professor Stefanie Paluch at RWTH University in Germany, we investigated people’s perceptions of fitness tracker-based insurance policies. </p>
<h2>What are the concerns?</h2>
<p><strong>Unfair price discrimination</strong> </p>
<p>People are concerned that the data monitoring will lead to personal disadvantages. They don’t want to be penalised with higher insurance rates if they stop using the fitness tracker. One Fitbit user said:</p>
<blockquote>
<p>The problem lies in the disadvantage if I don’t wear it. </p>
</blockquote>
<p><strong>Data protection</strong></p>
<p>Consumers are concerned about how insurance firms will access, use, and store their fitness data. One person said:</p>
<blockquote>
<p>I find it very important to have strict regulations, especially in these times, when personal data is collected and stored everywhere, but can also be shared, exchanged, sold and passed on to third parties, to those I don’t want […] to have my data.</p>
</blockquote>
<p><strong>Privacy</strong> </p>
<p>People have a wide range of privacy concerns. In general, they fear becoming “observable”, “transparent”, “predictable”, “easy to manipulate” and “rated” by the insurance provider. One user said:</p>
<blockquote>
<p>The risk is that you will become so transparent and […] institutions will know about you, that is actually not their right at all, only on the basis that they somehow want to make a profit […] it’s none of their business.</p>
</blockquote>
<h2>How to reduce the risks?</h2>
<p>Our study shows that the strongest opposition is based on people’s fear of unfair and exploitative behaviour of commercial data users, in particular switching from voluntary to mandatory enrolment. To avoid backlash, insurance firms should follow the following four recommendations.</p>
<p><strong>1. Understand your customer</strong> </p>
<p>Insurance firms need to first segment their customer base to better understand consumer lifestyles and motivations to use a fitness tracker. While some consumers have a personal affinity towards self-tracking, other individuals will not change their habits. One user said:</p>
<blockquote>
<p>I am not sure how this helps? If you lie on the sofa for 12 hours a day with a fitness tracker. Do you see a result? No! The insurance cannot force you to move your ass. Normally only people who are active already and do sports regularly, they wear such trackers.</p>
</blockquote>
<p><strong>2. Provide value</strong> </p>
<p>People wish to receive a benefit for their participation. This ranges from financial value (discounts, lower premium) to functional value, such as the quality of the device (design features, ease of use), as well as its reliability and accuracy in tracking data.</p>
<blockquote>
<p>I like sports, and fitness trackers are important to me. As I said, to follow my progress, and if I can get them cheap, then I find that very positive.</p>
<p>The tracker itself must be good. […] I have to have a feeling that I really benefit from it.</p>
</blockquote>
<p><strong>3. Be transparent</strong> </p>
<p>In order to reduce privacy concerns, insurance firms need to offer transparent and fully informative privacy policies and should more clearly educate and inform users about the terms and conditions. One Fitbit user said:</p>
<blockquote>
<p>…if a little more is published [about] what happens with our data, […] one can inform oneself about it […] Perhaps general education in schools or so would be desirable, too.</p>
<p>For me, the personal contact is important, because if someone explains that to me, then I will trust this person, and then I do not think that he/she will try to conceal any things […]. Once this has been explained to me, then I’m ok with it.</p>
</blockquote>
<p><strong>4. Give customers control</strong> </p>
<p>People are more willing to participate in fitness tracker-based insurance policies when they are in control of their participation. Greater empowerment increases their perceived self-determination and acceptance. Thus, participation should remain voluntary and be flexible regarding the timeframe. Two respondents said:</p>
<blockquote>
<p>Well, if they [fitness trackers] are on a voluntary basis […] then I would use them.</p>
<p>That I can choose this bonus program myself, that I can choose the different functions from it and that I can resign at any time without any financial, health or insurance disadvantages.</p>
</blockquote>
<p>As the sharing of personal biometric data increases further, we hope that our findings will contribute to an emerging public policy and legal debate about the practice.</p><img src="https://counter.theconversation.com/content/119806/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sven Tuzovic does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People are more willing to participate in fitness tracker-based insurance policies when they are in control of their participation.Sven Tuzovic, Senior Lecturer, QUT Business School, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1187142019-06-17T13:41:59Z2019-06-17T13:41:59ZFitness trackers and personalised training programmes – the way to get healthier at work<figure><img src="https://images.theconversation.com/files/279758/original/file-20190617-118518-13fjyin.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/529126072?src=qqetc4jCDP5FaPYmMNJGXA-1-0&size=medium_jpg">Zivica Kerkez/Shutterstock</a></span></figcaption></figure><p>On average, people spend over <a href="https://www.independent.co.uk/life-style/british-people-work-days-lifetime-overtime-quit-job-survey-study-a8556146.html">3,500 days</a> (or 84,000 hours) at work over a lifetime. This makes work the <a href="https://www.who.int/dietphysicalactivity/WHOWEF_report_JAN2008_FINAL.pdf">ideal place</a> to encourage and support physical activity and exercise. And a <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(19)30075-1/fulltext">new study</a> from Germany shows that doing so can help employees increase their fitness, improve their cardiovascular and mental health, and even increase productivity.</p>
<p>Many jobs today are <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/1479-5868-9-128">sedentary</a>, which has a damaging effect on our health, increasing the risk of <a href="https://www.ncbi.nlm.nih.gov/pubmed/20577058">developing type 2 diabetes and cardiovascular disease</a>. The <a href="https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC2027542&blobtype=pdf">London bus study</a> in the 1950s showed that workers with sedentary jobs (bus drivers) had much higher levels of heart disease compared with workers with active jobs (bus conductors). </p>
<p>Our work environments can also increase stress, which leads to <a href="https://www.ncbi.nlm.nih.gov/pubmed/15829761">poor mental health</a>. This is partly because of higher workloads <a href="https://jech.bmj.com/content/jech/62/1/42.full.pdf">creating increased pressure</a> and also because, through technological advances, work increasingly <a href="https://www.ncbi.nlm.nih.gov/pubmed/21329557">encroaches on personal time</a>.</p>
<p>Keeping employees healthy is an important consideration for employers, especially with an ageing workforce. <a href="https://www.ncbi.nlm.nih.gov/pubmed/10658308">Previous research</a> has shown healthier employees are more productive and are less likely to take sick leave. </p>
<p>The results of workplace exercise studies have been mixed, however. Some studies report improvements in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689804/#b6">total physical activity levels</a> and <a href="https://link.springer.com/article/10.1007%2Fs40279-019-01125-6">cardiovascular fitness</a>. Others have reported limited benefits on <a href="https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.116.003516">metabolic health</a> and on <a href="https://www.ncbi.nlm.nih.gov/pubmed/29493713">work productivity</a> – the latter being important to convince employers of the benefits of these interventions. </p>
<p>The new study, published in The Lancet Public Health, randomly allocated 314 employees to a six-month “lifestyle programme”, focusing on regular exercise, or to a control group where participants were not given any specific lifestyle recommendations. </p>
<p>All the participants had <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)67402-8/fulltext">metabolic syndrome</a> – a <a href="https://www.nhs.uk/conditions/metabolic-syndrome/">cluster of conditions</a>, such as high blood pressure, high blood sugar and unhealthy weight, that tend to occur together and increase a person’s risk of type 2 diabetes, heart disease and stroke.</p>
<p>The lifestyle programme group received an individualised package of support to help them achieve the <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0042-123700">German government’s guidelines for exercise</a> – 150 minutes of moderate intensity exercise per week. The focus of the intervention was on increasing structured exercise, such as gym classes and sport, rather than just increasing overall daily physical activity. </p>
<p>The lifestyle programme group also received behavioural support, such as individualised exercise training schedules, an activity tracker for monitoring progress and revising goals, regular chats with a sports scientist via an app, and monthly face-to-face meetings with the research team. </p>
<p>At the end of the six months, the intervention group showed greater improvements in fitness, fasting blood sugar levels, waist circumference and blood pressure compared with the control group. This suggests that the intervention reduced the severity of their metabolic syndrome. But the observed changes were smaller than would be expected with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190779/">supervised lab-based exercise training</a>.</p>
<p>The exercise group also improved their productivity, with the greatest improvements observed in employees who showed the highest improvement in fitness. However, this was measured by self-report questionnaire and there are clear limitations to this method.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/279769/original/file-20190617-118505-juto5j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/279769/original/file-20190617-118505-juto5j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/279769/original/file-20190617-118505-juto5j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/279769/original/file-20190617-118505-juto5j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/279769/original/file-20190617-118505-juto5j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/279769/original/file-20190617-118505-juto5j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/279769/original/file-20190617-118505-juto5j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Participants had regular online meetings with a sports scientist via an app.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1035889723?src=nfgI4FeA0acgHty4uSKUkw-1-5&size=medium_jpg">Maridav/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Scaling it up</h2>
<p>Adherence to the exercise programme was high in this trial. On average, participants achieved 147 minutes of the 150-minute physical activity target. </p>
<p>It’s important to consider why this was the case and whether this could be replicated on a much larger scale. But given that it was such a complex multi-component support package, it is difficult to tease out which particular elements – or combinations of elements – contributed to the high adherence and hence the improved health, well-being and productivity of the participants. </p>
<p>A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009209/full">review</a> of workplace interventions using pedometers alone has shown mixed results on physical activity and health. But many of the technology-enabled behaviour change techniques used in this study, such as goal-setting, feedback and self-monitoring, have been shown to be effective for increasing physical activity <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-017-0494-y">when used with counselling</a>. </p>
<p>This is not always the case, though. A <a href="https://jamanetwork.com/journals/jama/fullarticle/2553448">large study</a> found that adding a wearable physical activity monitor to a counselling-based weight-loss intervention hampered people’s efforts to lose weight. In contrast, <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002210">another study</a> found that giving people a pedometer increased physical activity regardless of whether further counselling support was provided from a healthcare practitioner. </p>
<h2>Complex intervention</h2>
<p>Complex interventions might work because different elements of the programme are effective for different people, driving up the overall effect. Put another way, we might expect individual responses for each of the elements. For example, some people may respond well to the activity tracking feedback and goal setting, whereas others may rely on the frequent interactions from a trainer. This is important to consider because achieving the results of the current study on a much larger scale (in thousands of employees rather than hundreds) would be very expensive.</p>
<p>The new study was also conducted on a relatively young and mainly male workforce, and this population probably responds well to the push towards structured exercise rather than increasing total daily physical activity. Other demographics of workers in different industries may not respond as well to this approach.</p>
<p>The study highlights the benefits of promoting exercise at work. Whether this would be replicated on the scale required to improve population health meaningfully is far from certain.</p><img src="https://counter.theconversation.com/content/118714/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Metcalfe receives funding from The Diabetes Research and Wellness Foundation. </span></em></p><p class="fine-print"><em><span>Max Western receives funding from the EPSRC via the GetAMoveOn Network. </span></em></p>German study shows that a multi-pronged approach works best.Richard Metcalfe, Lecturer in Sport and Exercise Science, Swansea UniversityMax Western, Lecturer in Behavioural Science, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1035122018-10-18T10:27:53Z2018-10-18T10:27:53ZWhy health apps are like the Wild West, with Apple just riding into town<figure><img src="https://images.theconversation.com/files/240829/original/file-20181016-165924-1k4n0t3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Jeff Williams, chief operating officer of Apple, talks about the Apple Watch 4 and its ability to detect irregularities in heartbeat on Sept. 12, 2018 in Cupertino, California.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Apple-Showcase/96a0a48962604e9c8b03bc2a18af12cc/33/0">Marcio Jose Sanchez/AP Photo</a></span></figcaption></figure><p>The heart rate monitor built into the new Apple Watch has sparked sharp <a href="https://www.marketwatch.com/story/apple-watch-wants-to-monitor-your-hearts-health-and-cardiologists-say-it-could-make-you-worry-instead-2018-09-13">debate</a> over its risks and benefits, even though the feature was <a href="https://www.theverge.com/2018/9/13/17855006/apple-watch-series-4-ekg-fda-approved-vs-cleared-meaning-safe">cleared</a> by the Food and Drug Administration. </p>
<p>But out of the spotlight, the FDA has been <a href="https://www.fda.gov/medicaldevices/digitalhealth/mobilemedicalapplications/default.htm">doing away with regulatory action altogether</a> on many diagnostic health apps targeting consumers, seeking to accelerate digital health adoption by defining many of these as “low risk” medical devices.</p>
<p>As the <a href="https://research2guidance.com/325000-mobile-health-apps-available-in-2017/">number of mobile health apps surged to a record 325,000</a> in 2017, app performance is going largely unpoliced, leading to what’s been dubbed a “Wild West” situation. Unfortunately for health consumers, the public can’t rely on the research community to play the role of sheriff.</p>
<p>When colleagues and I recently examined the medical literature on direct-to-consumer diagnostic apps in <a href="https://www.degruyter.com/view/j/dx.2018.5.issue-3/dx-2018-0009/dx-2018-0009.xml">a study published in Diagnosis</a>, we repeatedly found studies marred by bias, technological naïveté or a failure to provide crucial information for consumers. There was also a glaring lack of studies with actual consumers to see how they use these apps and what the impact on individual health, whether for better or worse, might be. </p>
<h2>The app will see you now?</h2>
<p>Interactive diagnostic apps now go well beyond “Dr. Google” keyword searches. They promise personalized information on whether a nagging symptom can likely be relegated to self-care or whether a visit to the doctor’s office or even the emergency room may be needed. Some of these apps become so popular that they have been downloaded <a href="https://www.degruyter.com/view/j/dx.2015.2.issue-2/dx-2014-0068/dx-2014-0068.xml?format=INT&intcmp=trendmd">tens of millions of times</a>. </p>
<p>To understand whether the promising nature of these apps is backed up by the evidence, we searched both the peer-reviewed literature and nonacademic sources. The disturbing unreliability of that evidence for the average consumer is starkly visible when you consider apps that “advise” (a carefully chosen word) whether you might have skin cancer.</p>
<p>There are hundreds of cancer-related apps. Perhaps because <a href="https://www.skincancer.org/skin-cancer-information/skin-cancer-facts">melanoma rates</a> have been rising for decades and it’s one of the most common young adult cancers, the largest group of articles we found focused on dermatology apps. One of the most prominent is <a href="https://www.skinvision.com">Skin Scan</a>.</p>
<p>If you’re a physician or reasonably savvy consumer, Google Scholar provides the easiest access to evidence-based information. One of the first results that pops up is <a href="https://www.jaad.org/article/S0190-9622(12)01181-4/abstract">a 2013 article</a> entitled, “Skin Scan: A demonstration of the need for FDA regulation of medical apps on iPhone.” If that title suggests a certain lack of objectivity, the problem isn’t limited to dermatology. We also found an orthopedist examining <a href="http://journals.sagepub.com/doi/abs/10.1007/s11552-014-9707-x">whether a symptom checker could “guess” the right diagnosis</a>, and an ear, nose and throat doctor investigating whether an app could diagnose his own patients as well as he could.</p>
<p>That Skin Scan study sounding the alarm on regulation warned of a substantial potential for harm. Yet <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jdv.12648">a separate study</a> of the same app published online two years later was much more positive. Did app developers pour in improvements, or was it that the first researchers used their own skin growth photos while the second group used the smartphone’s images? </p>
<p>The answer is unclear. More broadly, however, researchers often seemed unaware of the impact of basic technological distinctions such as whether an app relied on user answers to questions, “crowdsourced” answers to others or used inputs from a smartphone’s camera and sensors.</p>
<p>More troubling was researchers’ lack of understanding of the public’s pressing need for reliable information. So, for instance, a <a href="https://jamanetwork.com/journals/jamadermatology/fullarticle/1557488?__hstc=102463454.337ee291351309f40c7c5d244ce0fc11.1412640000403.1412640000404.1412640000405.1&__hssc=102463454.1.1412640000406&__hsfp=1314462730">study</a> of four smartphone apps found that their sensitivity in detecting malignant skin lesions ranged from 7 percent to 98 percent. Yet the researchers chose not to identify any of the apps by name. Similarly, few studies mentioned cost (CrowdMed, for example, charges users<a href="https://www.crowdmed.com/faqs"> a minimum of US$149 per month</a>), and those that did sometimes gave only a price range for a group of apps.</p>
<p>With scientific evidence sparse, consumers are left to rely upon online reviews – which, as <a href="https://www.scientificamerican.com/article/blood-pressure-apps-may-be-dangerously-wrong/">a just-published study of popular blood pressure apps warned</a>, can be dangerously wrong.</p>
<p>Or there’s always a random web search.</p>
<p>In the case of Skin Scan, my search found that in July the company that developed the app reported a melanoma detection sensitivity of 96 percent. That “report,” however, was part of a <a href="https://www.mobihealthnews.com/content/skinvision-gets-76m-continue-expanding-skin-cancer-app">trade publication interview</a> with SkinVision CEO Erik de Heus as the company announced it had raised another $7.6 million from investors.</p>
<p>Three years ago, a National Academy of Medicine report on diagnostic error called upon professionals to direct patients to reliable online resources. However, we found that search terms used by the National Library of Medicine’s PubMed Life Sciences search engine have lagged the digital health revolution, and medical journals do a hit-or-miss job of simply indexing every app mentioned in an article. The English National Health Service has launched <a href="https://digital.nhs.uk/news-and-events/latest-news/nhs-apps-library-reaches-70-apps-in-honour-of-the-nhs-birthday">an Apps Library</a> to cut through the confusion, but there’s no similar resource in this country. </p>
<h2>Is there a way to bring some order, if not law?</h2>
<p>Some web-savvy researchers at sites like iMedicalApps are advising physicians about apps they can use themselves or others they can trust to recommend to their patients. Others trying to bring law and order to the wide-open health app field have suggested various frameworks, such as combining stakeholders’ expertise in collaborative health app rating teams. The goal would be to get innovators, policymakers and evidence-generators to jointly help corral confusing and contradictory information.</p>
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<img alt="" src="https://images.theconversation.com/files/240831/original/file-20181016-165891-ofaqp1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/240831/original/file-20181016-165891-ofaqp1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=855&fit=crop&dpr=1 600w, https://images.theconversation.com/files/240831/original/file-20181016-165891-ofaqp1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=855&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/240831/original/file-20181016-165891-ofaqp1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=855&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/240831/original/file-20181016-165891-ofaqp1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1074&fit=crop&dpr=1 754w, https://images.theconversation.com/files/240831/original/file-20181016-165891-ofaqp1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1074&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/240831/original/file-20181016-165891-ofaqp1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1074&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Gunslinger, gambler and lawman Wyatt Earp.</span>
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<p>And as the debate over using Apple Watch data to measure heart health shows, FDA approval alone doesn’t remove the risk of consumers jumping to the wrong conclusion about what the information they’re receiving actually means. Nonetheless, as the pioneering stage of health apps starts to settle into the medical mainstream, the health of the American public requires apps and devices we know we can trust.</p><img src="https://counter.theconversation.com/content/103512/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael L. Millenson receives funding from the Gordon and Betty Moore Foundation.</span></em></p>As health care grows more digital, an array of health apps promise to track steps, count heartbeats and look at moles. But without more FDA oversight, could we be shooting ourselves in the foot?Michael L. Millenson, Adjunct Associate Professor of Medicine, Feinberg School of Medicine, Northwestern UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1039932018-10-04T04:44:23Z2018-10-04T04:44:23ZAn insurance discount for your fitness data is a bad deal in the long run<figure><img src="https://images.theconversation.com/files/239059/original/file-20181003-101555-40lyoz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In the brave new world of information capital, data collected from wearables and other technologies could be a slippery slope to a new social hierarchy.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTUzODU1NTA1OCwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTE4ODYxMzkyNyIsImsiOiJwaG90by8xMTg4NjEzOTI3L2h1Z2UuanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJMZTA0WnlZVzloVksvYkZZSFk4dnZ0Tks4OFEiXQ%2Fshutterstock_1188613927.jpg&pi=41133566&m=1188613927&src=I54XOIyx6pnXBWXPfzz0Ow-1-9">Shutterstock</a></span></figcaption></figure><p>John Hancock Insurance, the US division of Canadian insurance company Manulife, came under <a href="https://www.theverge.com/2018/9/26/17905390/john-hancock-life-insurance-fitness-tracker-wearables-science-health">scrutiny</a> last month for offering lower premiums to individuals who agreed to share their fitness tracking data with the company.</p>
<p>It’s another example of the new era of information capital, in which companies commercially benefit from users’ data. Aside from health data, companies around the world currently <a href="https://www.forbes.com/sites/forbestechcouncil/2017/12/08/turning-data-into-profits-what-does-it-take/#52dc899974d6">make money</a> from tracking location information, purchasing patterns, sleep data, and social interests.</p>
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Read more:
<a href="https://theconversation.com/the-social-factors-that-influence-whether-youll-use-your-wearable-device-89080">The social factors that influence whether you’ll use your wearable device</a>
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<p>According to French sociologist Pierre Bourdieu, those in society who hold capital <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/9780470755679.ch15">can grow advantage and pass it on</a>. But it doesn’t always follow that accumulated advantage is put to ethical use, or that the benefits are passed on to serve the greater good.</p>
<p>When it comes to information capital, often the result is the <a href="https://www.huffingtonpost.com/nathan-newman/why-googles-spying-on-use_b_3530296.html">opposite</a>. And often advantage is gained in the first place by what can only be deemed as perverse incentives.</p>
<h2>What is a perverse incentive?</h2>
<p>A perverse incentive refers to the unintended consequences, or harms, of a reward that’s on offer.</p>
<p>For example, a company might suggest that the adoption of a fitness tracking program is positive because it will produce health benefits for the individual and the community. But, in the long term, these incentives could create economic inequities, or serve to frame some groups negatively.</p>
<p>Consider if a fitness tracking program offered by an insurer was linked with an employer. If data about who adopted the fitness tracking program and who didn’t was made public, employers might offer additional rewards and benefits to those who take part. One consequence of this could be that people who choose not to participate in the program are stigmatised, or portrayed as social deviants through noncompliance. A culture of competition for rewards could emerge.</p>
<p>In the brave new world of information capital, sharing data collected from wearables and other technologies could be a slippery slope towards the kind of social hierarchy evident in China’s much-criticised <a href="http://www.abc.net.au/news/2018-03-31/chinas-social-credit-system-punishes-untrustworthy-citizens/9596204">social credit system</a>. </p>
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Read more:
<a href="https://theconversation.com/chinas-social-credit-system-puts-its-people-under-pressure-to-be-model-citizens-89963">China’s Social Credit System puts its people under pressure to be model citizens</a>
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<p>These kinds of incentives could also lead to loss of personal autonomy, particularly in cases where companies prescribe the devices and the brands that support their programs. When a person’s right to choose is impinged upon, these devices start to shape our private and social lives.</p>
<h2>Is this happening in Australia?</h2>
<p>Similar incentives to those offered by John Hancock Insurance are already available from <a href="https://www.comparingexpert.com.au/life-insurance/health-and-wellness-incentives/">Australian insurance firms</a>.</p>
<p>To be eligible for premium discounts and rewards, you need only to complete regular online health assessments, join partnered gyms, use a prescribed fitness tracker and the associated health program, or show a body mass index of lower than, or equivalent to, 28. Some insurers also request a complete blood test to be stored on their files.</p>
<p>Aside from being used to determine premium costs, what other uses this data is put to is unknown.</p>
<p>Genetic discrimination by insurers has previously been <a href="https://theconversation.com/australians-can-be-denied-life-insurance-based-on-genetic-test-results-and-there-is-little-protection-81335">identified in Australia</a>. This means that people with identifiable health conditions, or predispositions to future risk, are charged increased premiums, excluded from certain covers or refused insurance outright. </p>
<p>In 2017, an Australian parliamentary enquiry was held into discrimination by insurers regarding predictive genetic information and the use of medical information. A <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Joint/Corporations_and_Financial_Services/LifeInsurance/Report">moratorium</a> was imposed on the use of predictive genetic information by life insurers. Other recommendations included the development of standards and protocols around storage of medical files and access by insurers, and disclosure to consumers about any requests made for medical information. </p>
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Read more:
<a href="https://theconversation.com/why-life-insurance-companies-want-your-fitbit-data-103732">Why life insurance companies want your Fitbit data</a>
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<h2>Where is the consumer advantage?</h2>
<p>In the new era of information capital, it’s essential that we better understand what data government and companies are collecting, how it’s being used and who it might be shared with.</p>
<p>This can be a lot of work. Look at what’s happening with My Health Record: you must <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/eHealth-framework">explicitly opt out</a> to prevent your data from being used for secondary purposes, such as to inform research, policy and planning. The new <a href="https://www.oaic.gov.au/engage-with-us/submissions/new-australian-government-data-sharing-and-release-legislation-submission-to-department-of-prime-minister-and-cabinet">Data Sharing and Release Legislation</a> will play help determine how data can be shared and and consumer data rights.</p>
<p>Like all forms of capital, information capital has the ability to shape advantage. In this case, those in the top tier receive the economic and social benefits, while those in the bottom tier are punished with higher costs, possible exclusion and maybe even less access to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3937885/">treatments in the future</a>. So, information capital is creating an advantage that almost certainly will not be passed on here.</p><img src="https://counter.theconversation.com/content/103993/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Victoria J Palmer receives funding from the National Health and Medical Research Council and the Network Society Institute of The University of Melbourne. </span></em></p>An offer that appears beneficial on the surface, but can lead to unintended negative consequences is called a “perverse incentive”.Victoria J Palmer, Senior Research Fellow & Honorary Fellow (Applied Ethics) Melbourne Networked Society Institute, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1037322018-09-23T15:30:40Z2018-09-23T15:30:40ZWhy life insurance companies want your Fitbit data<figure><img src="https://images.theconversation.com/files/237563/original/file-20180923-129844-ypitj4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Industry representatives wear fitness trackers at the International Consumer Electronics Show in January 2014 in Las Vegas. Health and fitness information is being increasingly shared with insurance companies.</span> <span class="attribution"><span class="source">(AP Photo/Julie Jacobson)</span></span></figcaption></figure><p>I recently predicted that health data from electronic sources could soon be compiled <a href="https://theconversation.com/turning-your-health-data-into-a-wellness-score-might-not-be-good-for-you-100641">into a health or wellness report</a> and shared with insurance companies to help them determine who they’ll cover.</p>
<p>And now John Hancock, the U.S. division of Canadian insurance giant Manulife, <a href="https://www.cbc.ca/news/business/john-hancock-manulife-1.4831629">requires customers to use activity trackers</a> for life insurance policies in their Vitality program if they want to get discounts on their premiums and other perks.</p>
<p>Customers can withhold their fitness data, but that will result in higher premiums, which may put life insurance out of reach for low-income earners. This in turn could have an impact on whether would-be homeowners can take out mortgages, some of which can require a life insurance policy on the principle borrower.</p>
<p>The fact that insurance companies track the physical activities of customers <a href="https://www.forbes.com/sites/parmyolson/2014/06/19/wearable-tech-health-insurance/#bb045aa18bd5">has been making headlines for years</a>, but previous initiatives were pilot projects. </p>
<p>Now, customers who don’t want to offer up their health data to John Hancock have two choices: Don’t report it and pay higher premiums, or go somewhere else for their insurance. </p>
<p>But what’s going to happen if other companies follow suit? </p>
<h2>Figuring out when you’re having sex?</h2>
<p>Your privacy will be infringed upon by apps that pass on to your insurer all of the activities you do while wearing your smartwatch. </p>
<p>That could include steps walked, heart rate, blood pressure – your insurer may even be able to figure out when you’re having sex.</p>
<p>This is nothing new. We’ve long known that wearable technology records <a href="https://www.priv.gc.ca/en/privacy-topics/technology-and-privacy/digital-devices/02_05_d_73_wd/">“data about you and your condition, activities and day-to-day choices.”</a> </p>
<p>And we know that that data collected by these devices and through our internet activities “continually leak.” In fact, researchers have discovered that <a href="https://www.forbes.com/sites/leemathews/2017/06/13/70-percent-of-mobile-apps-share-your-data-with-third-parties/">70 per cent of third-party apps collect data that can then be used to create a profile of buying and spending habits</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tech-gifts-for-unsavvy-seniors-may-put-your-loved-ones-at-risk-88913">Tech gifts for unsavvy seniors may put your loved ones at risk</a>
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<p>So is it really a problem that customers use wearable technology like Fitbit and report their healthy activities, such as workouts and healthy eating, to their insurer?</p>
<p>Well, yes. One problem is that this information is not always correct. <a href="https://help.fitbit.com/articles/en_US/Help_article/1136">Fitbit itself acknowledges</a> that “the algorithm is designed to look for intensity and motion patterns that are most indicative of people walking and running” and that it may not always be accurate in reporting other activities, such as riding a bike or working.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237565/original/file-20180923-117383-scb2yr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Will insurers be able to dictate how much time mothers need to recover from childbirth before they start exercising again?</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Then there’s the question of what happens with your premiums if you stop engaging in these activities. How much time will insurance companies allow women to recover from childbirth before they have to get back to their insurance plan’s requirements for physical activity? </p>
<p>What about people recovering from joint replacements or heart surgery? How long will these people have before their premiums go up?</p>
<h2>Older adults at risk</h2>
<p>Older adults are especially vulnerable to this sort of data-based gatekeeping. The glitches in wearable technology’s data collection may be amplified with older people, whose exercise behaviour might not be as strenuous as that of younger adults, and therefore subject to more recording errors. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/237566/original/file-20180923-43466-1a2h5pn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237566/original/file-20180923-43466-1a2h5pn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237566/original/file-20180923-43466-1a2h5pn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237566/original/file-20180923-43466-1a2h5pn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237566/original/file-20180923-43466-1a2h5pn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237566/original/file-20180923-43466-1a2h5pn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237566/original/file-20180923-43466-1a2h5pn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Older adults’ exercise activities may not be accurately detected by wearable technology.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>In addition to the potential under-recording of their fitness activities, many people over 65 years old have at least one illness, which, when combined with data errors, may make them ineligible for discounted insurance programs. This could change the retirement opportunities for many older adults.</p>
<p>And what about the healthy lifestyles that insurance companies reward their customers for living? </p>
<p>Diet, fitness and medication regimes go in and out of favour. Taking “baby aspirin,” for example, to prevent heart attacks and stroke <a href="https://www.vox.com/2018/9/17/17869872/aspirin-heart-disease-cancer-prevention">has recently been shown to be ineffective</a> for healthy adults.</p>
<p>Another example of the fickleness of health trends involves healthy eating guru Brian Wansink, <a href="https://www.vox.com/science-and-health/2018/9/19/17879102/brian-wansink-cornell-food-brand-lab-retractions-jama">who’s had some academic articles retracted,</a> including those that told us not to go grocery shopping when we’re hungry and not to use large bowls when we’re eating. </p>
<p>This all suggests that the food and activity choices of insurance companies are linked to scholarly research. </p>
<h2>Conflict of interest?</h2>
<p>But what happens if a multinational business owns both insurance and manufacturing companies? Is it possible that insurance perks and discounts could be linked to purchases from their subsidiaries, disguised as “health initiatives?” </p>
<p>In other words, the insurer could reward customers for adhering to a health regimen that might be helpful, but could also be bogus or, in the worst-case scenario, harmful or exploitative while financially benefiting the insurance company.</p>
<p>If legislators don’t get involved, Big Business could end up literally dictating to us what we can and can’t do, or eat, if we want or need insurance. </p>
<p>For those who can’t afford healthy food or recreational fitness, and those who refuse to allow their data to be harvested, life insurance premiums, and other products like mortgages, may drift out of reach.</p><img src="https://counter.theconversation.com/content/103732/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>L.F. Carver does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Insurer John Hancock now requires customers to use activity trackers for life insurance policies. Here’s how that will put life insurance and even mortgages out of reach for many people.L.F. Carver, Post Doctoral Fellow, Queen's University and Ageing + Communication + Technologies (ACT) (SSHRC funded), Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1033752018-09-18T12:23:56Z2018-09-18T12:23:56ZNew Apple Watch adds heart tracking: here’s why we should welcome ECG for everyone<figure><img src="https://images.theconversation.com/files/236854/original/file-20180918-158243-1km8z6o.jpg?ixlib=rb-1.1.0&rect=46%2C0%2C5184%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/women-wear-hand-watch-running-motion-331673009?src=Hb2rY9pOMnx1gNDCY2OcYQ-1-5">Shutterstock</a></span></figcaption></figure><p><a href="https://www.forbes.com/sites/gordonkelly/2018/08/28/apple-iphone-9-x-plus-xplus-release-date-specs-price-cost-iphone-xs/#5cad5ce925dd">Leaked details</a> of the new iPhone models were quickly relegated to second tier headlines after Apple’s latest product announcement. More people seem to be excited about the fact that <a href="https://www.apple.com/uk/newsroom/2018/09/redesigned-apple-watch-series-4-revolutionizes-communication-fitness-and-health/">the new Apple Watch</a> will come with a built-in heart monitoring electrocardiogram (ECG) function.</p>
<p>An ECG <a href="https://www.nhs.uk/conditions/electrocardiogram/">is a simple test</a> that can be used to check your heart’s rhythm and electrical activity, designed to detect any underlying issues. The Apple Watch 4 will be the first mainstream wearable gadget to integrate this kind of medical diagnostic technology. (<a href="https://theconversation.com/how-reliable-is-your-wearable-heart-rate-monitor-98095">Other devices</a> such as the Fitbit typically measure blood flow by <a href="https://arstechnica.com/gadgets/2017/04/how-wearable-heart-rate-monitors-work-and-which-is-best-for-you/">shining a light</a> through the skin. This should be an exciting breakthrough, but Apple’s revelation has been met with a <a href="https://www.wired.co.uk/article/apple-watch-heart-ecg-fda">mixed reception</a>.</p>
<p><a href="https://jamanetwork.com/journals/jama/fullarticle/2684614">There isn’t yet enough evidence</a> to show that using an ECG in general to screen people for cardiovascular diseases ultimately makes them healthier. In fact, <a href="https://jamanetwork.com/journals/jama/fullarticle/2684613">it’s not recommended</a> for screening people who are at low risk of developing problems because it could produce false positive results (indicating a problem where none really exists). This can then lead healthy people to seek unnecessary, invasive and potentially harmful treatments, at a cost to the health service provider, as well as producing increased anxiety. For those who are at high risk of disease, ECG results might suggest medical intervention when lifestyle changes could actually be more beneficial. But does this really mean the technology shouldn’t be made more widely available?</p>
<p>It would be naive to assume that everyone who is at risk of heart problems knows, never mind consults with a doctor, about it. Often, people don’t realise until it is too late and they need emergency treatment and lengthy retrospective investigation – or, at worse, they die. To ignore the current digital health movement, and surging enthusiasm for it among early adopters of devices, health enthusiasts and growing numbers of people more generally would also be foolish. </p>
<p><a href="https://www.statista.com/topics/4393/fitness-and-activity-tracker/">The industry is booming</a>. The growing numbers paying to monitor their health with fitness trackers and smart watches has shown how <a href="http://www.mdpi.com/2227-9709/4/1/5/htm">engaged and motivated</a> people can become. We shouldn’t be denying people opportunities to take greater responsibility for their health, particularly as health services come under growing pressure from an ageing and <a href="https://www.theguardian.com/society/2018/jan/24/number-of-britons-living-with-chronic-illnesses-set-to-rise">increasingly ill</a> population.</p>
<p>The physical risks associated with performing ECGs are minimal. Sensors attached to the skin are used to detect the electrical signals produced by your heart each time it beats. It is <a href="https://www.nhs.uk/conditions/electrocardiogram/">quick, safe and painless</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/236855/original/file-20180918-158243-u83va1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/236855/original/file-20180918-158243-u83va1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/236855/original/file-20180918-158243-u83va1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/236855/original/file-20180918-158243-u83va1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/236855/original/file-20180918-158243-u83va1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/236855/original/file-20180918-158243-u83va1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/236855/original/file-20180918-158243-u83va1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The first mainstream wearable device with ECG.</span>
<span class="attribution"><span class="source">Apple</span></span>
</figcaption>
</figure>
<p>We shouldn’t <a href="https://www.wired.com/story/ecg-apple-watch/">ignore concerns</a> that an ECG test in a commercially available watch could encourage many people to make additional trips to the doctor when they have recorded any anomalous activity. A rush of gadget-adorned people descending on clinics demanding services is a worry. But many people already self-diagnose conditions or agonise about symptoms unnecessarily, often caused by using the internet and other technology. Those who do use the Apple Watch ECG may well include large numbers of <a href="https://www.iol.co.za/lifestyle/health/fitness/fitbit-fad-threatens-to-drive-up-gp-visits-from-worried-well-17065632">“worried well”</a>. But the impact of uncontrolled use of ECG technology seems likely to be limited for the moment, especially as many people will still simply be unable to afford it.</p>
<p>If ECG is added to the list of readily available health technology applications, it will be little different from enabling people to detect their pulses, count their steps, track their periods and analyse their sleep. An Apple Watch ECG won’t be conducted under controlled conditions, but this is true of so many health consultations.</p>
<h2>Personal health tech is already common</h2>
<p>Medical staff now give out many interventions that can be performed independently at home. This includes some <a href="http://journals.sagepub.com/doi/10.1177/2055207616678498">self-tracking</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6001233/">technologies</a> and sensitive diagnostic tests, such as those for <a href="https://www.nhs.uk/live-well/healthy-body/how-to-use-self-test-kits-safely/">sexual health and bowel screening</a>. In some places, you can even swap the GP’s surgery for a <a href="https://www.gpathand.nhs.uk/">smartphone app</a>.</p>
<p>While accuracy may be an issue with the Apple Watch ECG, the same is true for ECG tests performed in clinics and interpreted by professionals, according to <a href="https://scholar.google.co.uk/scholar?as_ylo=2018&q=ecg+accuracy&hl=en&as_sdt=0,5">many papers published on this topic</a>. Of course, technologies can always be improved, but waiting until a test is close to perfect isn’t necessarily the best way to use it. </p>
<p>Ultimately, we are living in a digital age and healthcare has so far been slow to revolutionise. We should be <a href="https://digital.nhs.uk/about-nhs-digital">harnessing technology to improve healthcare</a>. Everyday ECG won’t replace medical care but might help people to spot important warning signs and seek expert opinion. The real-time data the device has already collected may then help inform a medical expert’s interpretation and diagnosis.</p>
<p>What we should really be thinking about is how we can widen appropriate access for this kind of technology to those who it would most benefit, so that it might identify more people at risk, earlier. This would help make health services more efficient, reduce waste and perhaps even save lives.</p><img src="https://counter.theconversation.com/content/103375/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heather May Morgan led a feasibility study (unfunded) in partnership with CloudTag Inc. (<a href="http://www.cloudtag.com/">http://www.cloudtag.com/</a>) in summer 2017, which used its Onitor Track (unpublished). She previously received funding for research into digital health from The Wellcome Trust through the University of Aberdeen’s Institutional Strategic Support Fund under Grant RG12724-13. Heather is presently an Apple Watch 3 user for research and life purposes.</span></em></p>Gadgets that tell too many people to go to the doctor are a worry, but the growing enthusiasm for health monitoring should be encouraged.Heather May Morgan, Lecturer in Applied Health Sciences, University of AberdeenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/980952018-06-19T14:33:17Z2018-06-19T14:33:17ZHow reliable is your wearable heart-rate monitor?<figure><img src="https://images.theconversation.com/files/223603/original/file-20180618-85858-jj0j42.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/407841229?size=medium_jpg">Sergey Nivens/Shutterstock.com</a></span></figcaption></figure><p>Fitbit, Garmin and other consumer heart-rate monitors are increasingly being used in clinical trials. The problem is, they’re not always very accurate.</p>
<p>A search of <a href="https://clinicaltrials.gov/ct2/results?intr=fitbit">ClinicalTrials.gov</a>, the world’s largest clinical trials database, reveals nearly 200 trials involving Fitbit devices. Makers of consumer heart-rate monitors, however, clearly state that they are not intended for medical purposes. For example, <a href="https://www.fitbit.com/legal/safety-instructions">Fitbit declares</a> that their product is “not a medical device” and “accuracy of Fitbit devices is not intended to match medical devices or scientific measurement devices”. Similarly, <a href="https://support.garmin.com/en-US/?productID=154886&tab=manuals">Garmin makes it clear</a> that its Vivosmart device is for “recreational purposes and not for medical purposes” and that “inherent limitations” may “cause some heart rate readings to be inaccurate”.</p>
<p>Despite these disclaimers, monitors that include a heart-rate reading can elicit consumer expectations. Disappointment with device performance has led to a <a href="https://www.lieffcabraser.com/pdf/Fitbit-060518-Order-re-Motion-to-Dismiss.pdf">class action lawsuit in California against Fitbit</a>, alleging that its heart-rate monitors are “grossly inaccurate and frequently fail to record any heart rate at all”. </p>
<p>So how do optical heart-rate monitors work, and why aren’t they always accurate?</p>
<h2>How they work</h2>
<p>The science behind optical heart-rate monitors is something called <a href="https://www.news-medical.net/health/Photoplethysmography-(PPG).aspx">photoplethysmography</a> (PPG): the measurement of artery volume using light. When light emitted by the monitor enters the skin, most of it is absorbed by body tissues, but some is reflected. The amount of reflected light depends on several factors, one of which is the volume of arteries near the skin’s surface. </p>
<p>Blood in the arteries absorbs light better than the surrounding body tissues so, as arteries contract and swell in response to the pulsating blood pressure, the intensity of the reflected light rises and falls. PPG devices detect this variation in reflected light and use it to estimate heart rate.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=174&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=174&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=174&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=219&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=219&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223032/original/file-20180613-32307-154t37v.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=219&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Optical heart rate sensing. Left: lower pressure preceding the pulse wave means narrower arteries and less absorption (higher reflectivity) of the green light source. Right: a higher blood pressure pulse causes wider arteries and more light absorption (lower reflectivity).</span>
<span class="attribution"><span class="source">Tim Collins</span></span>
</figcaption>
</figure>
<p>The reflected light variation due to heart rate is typically no more than about 2% – a change that is imperceptible to the human eye. Physical movement, however, causes much greater effects, so much so that even small movements can make the much weaker pulse signal impossible to detect. Signal losses caused by movement at the sensor-skin interface can mean that simply walking can be enough to mask the pulse signal.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=205&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=205&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=205&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=258&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=258&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222976/original/file-20180613-32327-1bge2xh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=258&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">PPG sensor outputs. Left: while sitting still, showing an easily identified heart-rate signal. Right: the same sensor minutes later while walking.</span>
<span class="attribution"><span class="source">Tim Collins</span></span>
</figcaption>
</figure>
<p>It can be very difficult to accurately estimate heart rate from a corrupted PPG signal. Mathematical techniques can help in some cases, but often the motion interference and heart-rate signals overlap so much that the two are impossible to separate. For example, repeating interference signals caused by walking at 100 steps per minute can be indistinguishable from a heart rate of 100 beats per minute.</p>
<p>To reduce the chances of incorrect heart-rate readings, a common strategy is to stop recording when high levels of motion interference are detected. Unfortunately, this means that during periods of vigorous exercise, when many users are most interested in their heart rates, their PPG activity monitor might fail to record anything at all.</p>
<p>Detecting when a signal is corrupted is also not easy. Inevitably, some bad estimates of heart rate will be recorded in error. In <a href="https://www.researchgate.net/publication/325828687_Reliability_Assessment_of_New_and_Updated_Consumer-Grade_Activity_and_Heart_Rate_Monitors">recent experiments we conducted</a>, using four identical heart-rate monitors (two on each wrist), we observed recorded heart rates as low as half and as high as nearly double the person’s actual heart rate. Consistency between the devices varied depending, largely, on the level of activity.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=216&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=216&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=216&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=271&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=271&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223038/original/file-20180613-32313-1siutyt.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=271&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Example of experimental results comparing four identical Garmin VivoSmart 3 monitors during an 80 minute treadmill walking exercise. Walking speeds were increased every 20 minutes, from slow (2.4km/h) to vigorous (6.4km/h). Electrocardiogram (ECG) data for comparison was recorded using a chest-strap heart-rate monitor.</span>
<span class="attribution"><span class="source">Tim Collins</span></span>
</figcaption>
</figure>
<h2>Cheap and convenient</h2>
<p>The popularity of optical heart-rate monitors that can be worn on the wrist is largely due to the convenience and low cost of the devices. However, during periods of physical activity, accurately estimating a person’s heart rate using these devices remains challenging. And we should not expect dramatic improvements in reliability unless there are fundamental changes in the sensor technology. This is not a reflection of the quality of the devices, but rather an inevitable technological limitation of optical sensing. </p>
<p>Whether the labelling of these devices as a “heart-rate monitor” risks creating unrealistic expectations is a different matter.</p><img src="https://counter.theconversation.com/content/98095/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Heart-rate monitors can be accurate – as long as you don’t move.Tim Collins, Senior Lecturer in Electronic Engineering, Manchester Metropolitan UniversityIvan Miguel Pires, PhD Researcher, University of Beira InteriorSalome Oniani, PhD Researcher, Georgian Technical UniversitySandra Woolley, Senior Lecturer, Software and Systems Engineering Research, Keele UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/917212018-02-14T14:33:18Z2018-02-14T14:33:18ZWearable technologies help Olympians achieve top performance<figure><img src="https://images.theconversation.com/files/206251/original/file-20180213-44639-1guroyi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Wearable systems can reveal just how hard these skaters' bodies are working.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Pyeongchang-Olympics-Figure-Skating-Pairs/d2c7a6a70c354034b03970b52f87bb2d/5/0">AP Photo/Bernat Armangue</a></span></figcaption></figure><p>As Fitbits and other <a href="https://theconversation.com/your-mobile-phone-can-give-away-your-location-even-if-you-tell-it-not-to-65443">wearable activity monitors</a> change how regular people exercise and track their activity, they’re having similar effects on how Olympians train and recover between workouts.</p>
<p>It’s long been common for <a href="https://blog.teamsnap.com/general-sports/benefits-of-using-video-analysis-in-sports-practices">coaches to use video cameras</a> to show athletes what their form and movements look like, to track progress, and to fine-tune exactly the right technique for, say, taking off for a jump or landing after a particular trick. But those only show what’s going on from the outside.</p>
<p>Now, wearables, biometrics and apps analyzing their data are becoming much more common for athletes at all levels, giving indications of what’s going on inside an athlete’s body. I have worked as a sport physiologist with elite athletes for two decades, including with <a href="https://www.usaswimming.org/">USA Swimming</a> and <a href="http://www.usfsa.org/story?id=84039">U.S. Figure Skating</a>; there’s not yet much research about the results in figure skating, but <a href="https://DOI.org/10.1123/ijspp.2014-0324">wearables have helped coaches</a>, athletes and sport scientists in other sports like swimming, cycling, soccer and volleyball.</p>
<h2>Beating how fast?</h2>
<p>The most basic measurement of <a href="https://doi.org/10.1007/s40279-014-0253-z">how hard an athlete’s body is working</a> is how fast her heart is beating; many wearable devices track their user’s heart rate in real time. Trainers can measure how fast an athlete’s <a href="https://doi.org/10.2165/00007256-200838010-00004">heart beats during maximum exertion</a> in a test on a treadmill or skating increasingly fast across the rink.</p>
<p>Then, during workouts, a coach can determine how hard the athlete is working by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831892/">comparing his real-time heart rate</a> to his maximum. When a person’s heart is beating almost as fast as it can, that’s pushing nearly as hard as a person’s body can. When an athlete’s heart rate is <a href="https://doi.org/10.3389/fphys.2014.00073">closer to half its maximum</a>, the body is working at an intensity that allows the skater to recover from more demanding efforts. By tuning the workout to keep the athlete’s heart rate in certain ranges for certain periods, a coach or sport scientist can optimize both exertion and recovery time. That way, the body’s muscles and cardiovascular system are well trained and <a href="https://www.cnet.com/news/finding-an-edge-gold-medalist-lindsey-vonn-talks-tech/">in top form for competition</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/206253/original/file-20180213-44660-18ene30.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/206253/original/file-20180213-44660-18ene30.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206253/original/file-20180213-44660-18ene30.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206253/original/file-20180213-44660-18ene30.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206253/original/file-20180213-44660-18ene30.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206253/original/file-20180213-44660-18ene30.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206253/original/file-20180213-44660-18ene30.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206253/original/file-20180213-44660-18ene30.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Wearable monitors can measure activity level and heart rate, among other vital signs.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/File:FitbitIonicMomentDisplay.jpg">DReifGalaxyM31</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>How many landings?</h2>
<p>Figure skaters and many snowboarders and skiers are among those whose competitive performances include jumps – which means they have to practice intensively for each one. Those leaps, and their landings, exert enormous amounts of stress on athletes’ bodies – ranging from <a href="https://news.byu.edu/news/figure-8-skaters-feel-eight-times-their-body-weight-when-they-land-jump">eight to 14 times</a> the person’s body weight for a brief moment. A 100-pound skater who jumps 50 times in a typical daily workout for five training days is loading 160 tons of cumulative weight on her bones during that training week. The forces are absorbed by muscles and bones in the feet and legs, as well as the torso.</p>
<p>That’s a lot of stress, and a lot of potential for injury. In figure skating, for example, <a href="https://doi.org/10.1177/03635465030310040601">70 percent of injuries are from overuse</a> – primarily from the accumulated effects of those impacts. Wearable monitors can track <a href="https://dx.doi.org/10.5114%2Fbiolsport.2017.66000">how many jumps a person takes</a> and measure the rotational, gravitational and other <a href="https://doi.org/10.1088/0957-0233/25/12/125901">forces involved in the jumps and landings</a>. These readings can help coaches ensure athletes develop strength and endurance while warning of potential for injury.</p>
<p>More sophisticated <a href="https://www.recode.net/2015/3/16/11560246/are-smart-clothes-the-wearables-of-the-future">biosensors embedded in clothing</a> keep track of an athlete’s body temperature, movement and breathing rate and other data, also helping coaches fine-tune workouts to optimize performance. </p>
<h2>Getting enough rest?</h2>
<p>Crucial elements of Olympians’ top performance come while away from practice sessions – including when they’re eating and sleeping. Athletes can use <a href="https://doi.org/10.2196/mhealth.3345">smartphone apps to record what they eat</a> and when, tracking how many calories they take in, as well as amounts of nutrients like proteins, carbohydrates and fats.</p>
<p>Similarly, <a href="https://doi.org/10.1586/17434440.2016.1171708">sleep-tracking devices</a> use accelerometers to track a person’s movements – and sometimes heart and breathing rates – while they’re asleep. The data can reveal indicators of <a href="https://www.nytimes.com/2018/02/12/sports/olympics/figure-skating-schedule.html">how well the person rested</a>, such as how much a person moved around in bed at night. That can help coaches choose appropriate workouts depending on how tired an athlete is.</p>
<p>Wearables make available all these data – about nutrition, exertion, stress forces, rest and recovery – that coaches and athletes alike can use to improve training, boost performance and, ideally, make it to the top of a medal podium.</p><img src="https://counter.theconversation.com/content/91721/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jaci VanHeest is affiliated with USA Figure Skating Sports Sciences and Medicine Committee.</span></em></p>Wearables help regular people track their activity, but sophisticated technology can give deeper insights to elite athletes.Jaci VanHeest, Associate Professor of Education, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/654432018-02-06T11:37:10Z2018-02-06T11:37:10ZYour mobile phone can give away your location, even if you tell it not to<figure><img src="https://images.theconversation.com/files/204617/original/file-20180202-162082-escm9.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fitness trackers report their location and map the Burning Man festival in the Nevada desert.</span> <span class="attribution"><a class="source" href="https://labs.strava.com/heatmap/#13.00/-119.22766/40.77968/hot/all">Screenshot of Strava Heat Map</a></span></figcaption></figure><p>U.S. military officials were recently caught off guard by revelations that servicemembers’ digital fitness trackers were <a href="https://labs.strava.com/heatmap/">storing the locations</a> of their workouts – including at or near <a href="https://www.washingtonpost.com/world/a-map-showing-the-users-of-fitness-devices-lets-the-world-see-where-us-soldiers-are-and-what-they-are-doing/2018/01/28/86915662-0441-11e8-aa61-f3391373867e_story.html">military bases and clandestine sites</a> around the world. But this threat is not limited to Fitbits and similar devices. My group’s recent research has shown how mobile phones can also track their users through stores and cities and around the world – even when users turn off their phones’ location-tracking services.</p>
<p>The vulnerability comes from the wide range of sensors phones are equipped with – not just GPS and communications interfaces, but gyroscopes and accelerometers that can tell whether a phone is being held upright or on its side and can measure other movements too. Apps on the phone can use those sensors to perform tasks users aren’t expecting – like <a href="https://doi.org/10.1109/MSP.2017.25">following a user’s movements turn by turn</a> along city streets.</p>
<p>Most people expect that turning their phone’s location services off disables this sort of mobile surveillance. But the research I conduct with my colleagues <a href="https://www.ccis.northeastern.edu/people/sashank-narain/">Sashank Narain</a>, <a href="https://www.ccis.northeastern.edu/people/triet-vo-huu/">Triet Vo-Huu</a>, <a href="https://www.ccis.northeastern.edu/people/ken-block/">Ken Block</a> and <a href="http://www.ccs.neu.edu/home/amirali/">Amirali Sanatinia</a> at Northeastern University, in a field called “<a href="https://doi.org/10.1007/3-540-68697-5_9">side-channel attacks</a>,” uncovers ways that apps can avoid or escape those restrictions. We have revealed how a phone can listen in on a user’s finger-typing to discover a secret password – and how simply carrying a phone in your pocket can tell data companies where you are and where you’re going.</p>
<h2>Making assumptions about attacks</h2>
<p>When designing protection for a device or a system, people make assumptions about what threats will occur. Cars, for instance, are designed to protect their occupants from crashes with other cars, buildings, guardrails, telephone poles and other objects commonly found in or near roads. They’re not designed to keep people safe in cars driven off a cliff or smashed by huge rocks dropped on them. It’s just not cost-effective to engineer defenses against those threats, because they’re assumed to be extremely uncommon.</p>
<p>Similarly, people designing software and hardware make assumptions about what hackers might do. But that doesn’t mean devices are safe. One of the first side-channel attacks was identified back in 1996 by cryptographer Paul Kocher, who showed he could break popular and supposedly secure cryptosystems by <a href="https://doi.org/10.1007/3-540-68697-5_9">carefully timing how long it took</a> a computer to decrypt an encrypted message. The cryptosystem designers hadn’t imagined that an attacker would take that approach, so their system was vulnerable to it.</p>
<p>There have been many other attacks through the years using all sorts of different approaches. The recent <a href="https://meltdownattack.com/">Meltdown and Spectre</a> vulnerabilities that exploit design flaws in computer processors, are also side-channel attacks. They enable malicious applications to snoop on other applications’ data in the computer memory. </p>
<h2>Monitoring on the go</h2>
<p>Mobile devices are perfect targets for this sort of attack from an unexpected direction. They are <a href="https://source.android.com/devices/sensors/sensor-types">stuffed with sensors</a>, usually including at least one accelerometer, a gyroscope, a magnetometer, a barometer, up to four microphones, one or two cameras, a thermometer, a pedometer, a light sensor and a humidity sensor.</p>
<p>Apps can access most of these sensors without asking for permission from the user. And by combining readings from two or more devices, it’s often possible to do things that users, phone designers and app creators alike may not expect.</p>
<p>In <a href="https://dl.acm.org/citation.cfm?doid=2627393.2627417">one recent project</a>, we developed an app that could determine what letters a user was typing on a mobile phone’s on-screen keyboard – without reading inputs from the keyboard. Rather, we combined information from the phone’s gyroscope and its microphones.</p>
<p>When a user taps on the screen in different locations, the phone itself rotates slightly in ways that can be measured by the <a href="https://learn.sparkfun.com/tutorials/gyroscope/all">three-axis micromechanical gyroscopes</a> found in most current phones. Further, tapping on a phone screen produces a sound that can be recorded on each of a phone’s multiple microphones. A tap close to the center of the screen will not move the phone much, will reach both microphones at the same time, and will sound roughly the same to all the microphones. However, a tap at the bottom left edge of the screen will rotate the phone left and down; it will reach the left microphone faster; and it will sound louder to microphones near the bottom of the screen and quieter to microphones elsewhere on the device.</p>
<p>Processing the movement and sound data together let us determine what key a user pressed, and we were right over 90 percent of the time. This sort of function could be added secretly to any app and could run unnoticed by a user.</p>
<h2>Identifying a location</h2>
<p>We then wondered whether a malicious application could infer a user’s whereabouts, including where they lived and worked, and what routes they traveled – information most people consider very private.</p>
<p>We wanted to find out whether a user’s location could be identified using only sensors that don’t require users’ permission. The route taken by a driver, for instance, can be simplified into a series of turns, each in a certain direction and with a certain angle. With another app, we used a phone’s compass to observe the person’s direction of travel. That app also used the phone’s gyroscope, measuring the sequence of turn angles of the route traveled by the user. And the accelerometer showed whether a user was stopped, or moving. </p>
<p>By measuring a sequence of turns, and stringing them together as a person travels, we could make a map of their movements. (In our work, we knew which city we were tracking people through, but a similar approach could be used to figure out what city a person was in.) </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/204660/original/file-20180202-19925-l501qg.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/204660/original/file-20180202-19925-l501qg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/204660/original/file-20180202-19925-l501qg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=559&fit=crop&dpr=1 600w, https://images.theconversation.com/files/204660/original/file-20180202-19925-l501qg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=559&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/204660/original/file-20180202-19925-l501qg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=559&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/204660/original/file-20180202-19925-l501qg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=703&fit=crop&dpr=1 754w, https://images.theconversation.com/files/204660/original/file-20180202-19925-l501qg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=703&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/204660/original/file-20180202-19925-l501qg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=703&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Matching the route of a smartphone with a trip through Boston.</span>
<span class="attribution"><a class="source" href="https://www.google.com/maps/dir/42.3470281,-71.0987153/42.3370778,-71.0897429/@42.3420599,-71.1012985,16z/am=t/data=!3m1!4b1!4m9!4m8!1m5!3m4!1m2!1d-71.1020206!2d42.3414756!3s0x89e379f4bcf581f7:0x79d33d7b8d6345e4!1m0!3e0">Screenshot of Google Maps</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Imagine we observe a <a href="https://www.google.com/maps/dir/42.3470281,-71.0987153/42.3370778,-71.0897429/@42.3424719,-71.0982838,16z/data=!4m9!4m8!1m5!3m4!1m2!1d-71.1020206!2d42.3414756!3s0x89e379f4bcf581f7:0x79d33d7b8d6345e4!1m0!3e0">person in Boston heading southwest</a>, turning 100 degrees to the right, making a sharp U-turn to the left to head southeast, turning slightly to the right, continuing straight, then following a shallow curve to the left, a quick jog to the right, bumping up and down more than usual on a road, turning 55 degrees right, and turning 97 degrees left and then making a slight curve right before stopping.</p>
<p>We developed an algorithm to match those movements up against a digitized map of the streets of the city the user was in, and determined which were the most likely routes a person might take. Those movements could identify a route driving from Fenway Park, along the Back Bay Fens, past the Museum of Fine Arts and arriving at Northeastern University.</p>
<p>We were even able to refine our algorithm to incorporate information about curves in roads and speed limits to help narrow options. We produced our results as a <a href="https://doi.org/10.1109/MSP.2017.25">list of possible paths</a> ranked by how likely the algorithm thought they were to match the actual route. About half the time, in most cities we tried, the real path a user followed was in the top 10 items on the list. Further refining the map data, sensor readings and the matching algorithm could substantially improve our accuracy. Again, this type of capability could be added to any app by a malicious developer, letting innocent-appearing apps snoop on their users. </p>
<p>Our research group is continuing to investigate how side-channel attacks can be used to reveal a variety of private information. For instance, measuring how a phone moves when its owner is walking could suggest how old a person is, whether they are male (with the phone in a pocket) or female (typically with the phone in a purse), or even health information about how steady a person is on his feet or how often she stumbles. We assume there is more your phone can tell a snoop – and we hope to find out what, and how, to protect against that sort of spying.</p><img src="https://counter.theconversation.com/content/65443/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Guevara Noubir has received funding for communications security research from the U.S. Department of Defense, the National Science Foundation, Google, Raytheon and Microsoft.</span></em></p>It’s not just fitness trackers – mobile phones can reveal users’ whereabouts too, even with location tracking turned off.Guevara Noubir, Professor of Computer and Information Science, Northeastern UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/898842018-01-11T14:42:04Z2018-01-11T14:42:04ZA brief history (and a look into the future) of fitness technology<figure><img src="https://images.theconversation.com/files/201617/original/file-20180111-60756-u6idf1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/kaunas-lithuania-febryary-06-2016-activity-373912909?src=8CO3imS85C5qsS8M2Jsk-w-1-23">Shutterstock</a></span></figcaption></figure><p>Have you recently taken ownership of a shiny new activity tracking device? For many people, the essential fitness kit now includes gadgets designed not for sitting and staring at a screen, but for encouraging users to get up and move. </p>
<p>And they even come with political recommendations. For the UK Government, apps like <a href="http://www.mapmyrun.com/">MapMyRun</a> and <a href="https://www.strava.com/">Strava</a> and wearable technologies made by <a href="https://www.fitbit.com/uk/home?utm_source=&utm_medium=paidsearch&dclid=CNj64svLz9gCFcmmUQodROcDpw">Fitbit</a> and <a href="https://jawbone.com/">Jawbone</a> are the future. According to <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/486622/Sporting_Future_ACCESSIBLE.pdf">one official document</a>: “[They] will define the world of sport and physical activity in the coming decade.”</p>
<p>But health and fitness technologies also have a long history. </p>
<p>At the beginning of the 20th century, physical activity was seen by some as a bulwark against the ills of modernisation, such as the increasingly sedentary nature of work. As the American educator Dudley Sargent <a href="https://archive.org/stream/physicaleducatio00sarg#page/44/mode/2up/search/whereas">put it</a> in his 1906 book <a href="https://www.amazon.co.uk/Physical-Education-Dudley-Allen-Sargent/dp/114263762X">Physical Education</a>:</p>
<blockquote>
<p>A large portion of the population never use half their faculties, and if they pursue the same employment for a term of years they are apt to acquire defects of structure, if not of constitution and character, that are transmitted to the next generation. </p>
</blockquote>
<p>Physical activity as a leisure pursuit became highly significant. Mechanical apparatus such as wall-attachable weight-pulley devices were designed to guard against such “defects of structure” – and of character, too. In other words, the point was to bolster the body and mind. According to some, this would ensure the well-being of the population.</p>
<p>These were not just devices for men. The 1904 book Physical Culture for Women, authored by the world champion woman bag-puncher Belle Gordon, <a href="https://archive.org/stream/physicalculturef01gord#page/n97/mode/2up/search/exerciser">featured an advertisement</a> for the “Fox Exerciser” weight-pulley machine. As a resistance training device, the Fox Exerciser was similar to exercise equipment promoted by other proponents of physical culture, such as famous strongman <a href="https://archive.org/stream/strengthandhowt00sandgoog#page/n36/mode/2up/search/exerciser">Eugen Sandow</a>.</p>
<p>Nearly a century later, another movement was afoot: the fitness boom of the 1970s and 1980s. At this point, electronic technology became especially important in combating the sedentary nature of modern living. </p>
<p>Electronic technology meant communication devices like the VCR (videocassette recorder). Actress Jane Fonda’s exercise videos modelled what an “ideal” body looked like and <a href="http://www.sunypress.edu/p-2843-sport-and-postmodern-times.aspx">how it might be attained</a>. And they sold in their millions.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/deKHYCsjseg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Meanwhile, devices such as electronic treadmills and exercise bikes became staples in fitness gyms, and were also widely available as home equipment. In its July 1989 edition, outdoors magazine Field and Stream highlighted the merits of these electronic devices, <a href="https://books.google.co.uk/books?id=8ZO7cJuYfFsC&pg=PA64&lpg=PA64&dq#v=onepage&q&f=false">claiming they were</a> “smoother and quieter, more convenient to use than most mechanical systems, and provide a workout customised to your fitness level”.</p>
<h2>The future of fitness</h2>
<p>Today, digital and wearable health and fitness technologies are seamlessly integrated into our everyday lives. Your smartphone itself is a <a href="https://www.routledge.com/Fitness-Technology-and-Society-Amusing-Ourselves-to-Life/Millington/p/book/9781138948037">fitness tracking device</a>. So what makes our present day technologies unique?</p>
<p>For one thing, their personalisation. The health and fitness entrepreneurs of the early 1900s spoke to the masses, but while the treadmills of the 1970s and 1980s marked an important step towards customisation, today’s wearable devices and health and fitness apps are deeply personal. They track and monitor seemingly everything, from what we eat, to how we sleep, to how often we move, to the composition of our bodies.</p>
<p>Then there’s portability. In the late 1800s, the American orator, preacher, and educator <a href="https://archive.org/details/physicalculture00collgoog">Charles Wesley Emerson</a> lamented that while exercise equipment such as dumb bells <a href="https://archive.org/stream/physicalculture00emer#page/18/mode/2up/search/rings">had value</a>, they hindered mobility: “We cannot carry gymnasiums about with us.” Even near the end of the 20th century, health and fitness practices were largely confined to the gymnasium and the home. </p>
<p>Today’s technologies are for anywhere and anytime. They travel with us <a href="https://doi.org/10.1080/15295036.2014.973429">wherever we go</a>. Technology facilitates, rather than hinders, mobility.</p>
<p>A final factor is commercialisation – that is, beyond the simple selling of Fox Exercisers and Jane Fonda workout videos. Whereas in the past it was just the technologies themselves that were sold for profit, today, so is our data. <a href="http://adage.com/article/privacy-and-regulation/ftc-signals-focus-health-fitness-data-privacy/293080/">A study</a> by the US Federal Trade Commission found that 12 health and fitness apps shared user data with 76 third parties, advertisers among them. Or, as a Wall Street Journal report bluntly <a href="https://www.wsj.com/articles/SB10001424052748704694004576020083703574602">put it</a>: “Your apps are watching you.”</p>
<p>So where next? We should expect the health and fitness technologies of the future to be even more personalised in assessing our bodies and daily habits. We should also expect them to be further integrated into our daily lives, to the point where their presence is undetectable. And we should expect technologies to be more sophisticated than ever in producing data from which value can be extracted (such as helping companies know consumer habits and preferences).</p>
<p>For the UK government, the future of health and fitness technology is cause for optimism. But ever more personalisation should not overshadow what we know about the <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/286/286.pdf">social determinants of health</a>, meaning the wider conditions in which people are born, grow, live and work. </p>
<p>The combination of ever more intimate data and the profit motive to mine these data is also cause for concern when it comes to <a href="https://openeffect.ca/fitness-tracker-privacy-and-security/">privacy and security</a>. So while trackers might make us feel like we have more control and a more personal relationship with fitness, a degree of scepticism would be healthy.</p><img src="https://counter.theconversation.com/content/89884/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brad Millington receives funding from the Social Sciences and Humanities Research Council of Canada. He is the author of the book "Fitness, Technology and Society: Amusing Ourselves to Life" (2018, Routledge, <a href="https://www.routledge.com/Fitness-Technology-and-Society-Amusing-Ourselves-to-Life/Millington/p/book/9781138948037">https://www.routledge.com/Fitness-Technology-and-Society-Amusing-Ourselves-to-Life/Millington/p/book/9781138948037</a>).</span></em></p>Fitbits and other trackers are just the latest iteration of the fitness industry’s relationship with technology.Brad Millington, Lecturer, Department for Health, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/890802017-12-19T19:24:00Z2017-12-19T19:24:00ZThe social factors that influence whether you’ll use your wearable device<figure><img src="https://images.theconversation.com/files/199611/original/file-20171218-17884-lqxhud.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sales of Apple smartwatches are increasing, while Fitbit sales are on the decline.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File%3ASmartwatch-828786.jpg">By Crew [CC0 or CC0], via Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Christmas is upon us, and the New Year fast approaching. Many of us are buying wearable self-tracking devices for loved ones, or as part of our own New Year self-improvement regimes. </p>
<p>Wearable devices, as the name suggests, are technologies with digital sensors that can be worn in various ways on the body. It’s estimated that worldwide shipments of wearables this year will reach <a href="https://www.idc.com/getdoc.jsp?containerId=prUS42818517">125 million</a>. </p>
<p>But how useful are they, and what benefits do they provide to users?</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/fitbits-decline-is-a-reflection-of-the-end-of-the-over-hyped-promise-of-wearables-73823">Fitbit's decline is a reflection of the end of the over-hyped promise of wearables</a>
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<h2>The wearable craze</h2>
<p>There is a now <a href="https://www.amazon.com/Wearable-Technology/b?ie=UTF8&node=100487000110">huge range</a> of wearable devices available: smart sneakers to analyse your walking pattern, smartwatches to count your calories, wristbands to assess your sleep quality, and smart gloves to help you with your golf swing.</p>
<p>It makes sense that the companies that sell wearables, and the entrepreneurs who develop them, talk up these devices. However, industry blogs and market research suggest the excitement is beginning to wear off. </p>
<p>While sales for smartwatches, such as the Apple Watch, <a href="https://techcrunch.com/2017/08/01/apple-watch-sales-up-over-50-since-last-year">are healthy</a>, Fitbit – one of the market leaders – has seen its <a href="https://www.smartcompany.com.au/technology/one-five-australians-use-wearables-business-smartwatch-friendly/">fortunes decline</a>. </p>
<p>Most research into wearable use involves surveys. For example, <a href="https://www.smartcompany.com.au/technology/one-five-australians-use-wearables-business-smartwatch-friendly/">a 2016 survey of the Australian market</a> showed that fewer than one in five respondents used wearables. </p>
<p>Colleagues and I have conducted three different qualitative studies with Australians aged from 18 to 75 years old about their use of wearables and smartphone apps for health and fitness. </p>
<p><a href="http://journals.sagepub.com/doi/pdf/10.1177/2053951717700924">The first study</a> involved ten male and eight female cyclists who used digital devices to monitor their rides. <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3085751">The second study</a> included 40 people (split evenly by gender) who were self-tracking for any purpose. The final study involved 55 women using a range of digital health technologies.</p>
<p>The research revealed some of the key reasons people use wearables and health apps, and why they give them up. </p>
<h2>What wearables are good for</h2>
<h3>Taking control over health and wellbeing</h3>
<p>Michael, a 35-year-old father, uses apps to track his food intake and physical activity. In his interview, he said,</p>
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<p>To be a responsible husband, father and son, I need to track things, whether it be health or finances. </p>
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<h3>Providing motivation to achieve personal bests</h3>
<p>Damon, 48, is a keen cyclist who uses a bike computer to monitor his cycling trips and he uploads his data to the cycling platform, Strava. In his interview, he confessed that,</p>
<blockquote>
<p>I’m kind of obsessed with going for local course records or testing myself on certain courses.</p>
</blockquote>
<h3>Spurring healthy competition</h3>
<p>Embarking on fitness tracking together with others can also increase motivation. Valerie, 62, uses the same type of fitness band as her husband. She commented that,</p>
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<p>It’s fair to say that we engage in a little friendly competition. </p>
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<p>This may mean that one of them sets out for a late-night walk, just to reach their target for the day.</p>
<h3>Giving real-time feedback</h3>
<p>Fitness trackers that allow users to review data in real-time can spur them to work harder to improve their numbers. Valerie said that,</p>
<blockquote>
<p>If I actually get up to my 10,000 steps, you get the buzz and the flashing lights….So that’s pretty exciting!</p>
</blockquote>
<h3>Learning healthy behaviours</h3>
<p>Some fitness trackers are useful for a limited time while they teach users healthy behaviours. </p>
<p>Jessica, 22, is a keen team sports player, and uses a calorie-counting app to help her lose weight and eat better. She commented that after using the app for some months,</p>
<blockquote>
<p>I can now take a look at a plate of food and pretty accurately guess how many calories it has. </p>
</blockquote>
<h3>Creating a sense of community</h3>
<p>Devices that plug into an online community of fellow fitness trackers can support efforts to improve fitness. Danielle, 35, shares her Fibit and Strava data and photos of her cycling trips with her friends. She said,</p>
<blockquote>
<p>All my friends are very encouraging and I’m encouraging of them, particularly when they’re getting into cycling.</p>
</blockquote>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/downside-of-fitness-trackers-and-health-apps-is-loss-of-privacy-69870">Downside of fitness trackers and health apps is loss of privacy</a>
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<h2>Why people give up on wearables</h2>
<h3>Goals feel unachievable</h3>
<p>At times, fitness trackers can become a source of negativity by reminding users of what they’re failing to achieve. </p>
<p>Carolyn, 33, is a new mother who used to wear a Fibit to track physical activity, energy expended and sleep patterns. However, now that she has a small baby, she doesn’t want a device to make her feel even worse about her poor sleep and lack of exercise through detailed monitoring. She said,</p>
<blockquote>
<p>My baby’s having a clingy day today - I could barely put him down this morning. As if I’m going to get 10,000 steps! </p>
</blockquote>
<h3>Reminders can become annoying</h3>
<p>If circumstances prevent users from reaching fitness targets, constant alerts can prompt them to switch off. Valerie has a demanding desk-bound job and can’t easily jump to her feet just because her device is asking her to. She describes her wearable as sometimes “pestering” her.</p>
<h3>Lack of community support</h3>
<p>If friends, partners or family members aren’t supportive, this can make a big difference to success with wearables. </p>
<p>Friends of sportswoman Jessica sometimes criticise her for paying so much attention to her diet and weight using a calorie-counting app. She said,</p>
<blockquote>
<p>I think there’s a real stigma about calorie counting. It’s like a bad thing and it means you’re preoccupied with the way you look or you’re not happy within yourself. </p>
</blockquote>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-way-we-walk-can-be-used-to-power-and-secure-our-devices-76152">The way we walk can be used to power and secure our devices</a>
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<p>As these participants’ stories show, people’s social networks, employment conditions and life stages are integral to their use of wearable devices. Understanding how these factors have an impact on the use of fitness trackers can help you make the best use of your wearable device.</p>
<p>So if you’re considering buying a Fitbit for a relative who’s a new mother, you should think about whether she has the time or inclination for self-tracking right now. If you’re chained to a desk job, you might choose a device that won’t send you alerts during the day. And if your friends and family won’t support your self-tracking activities, you might want to join an online community that will.</p><img src="https://counter.theconversation.com/content/89080/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Lupton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research shows that people’s social networks, employment conditions and life stages all impact their use of wearable devices. Understanding these factors can help you achieve your fitness goals.Deborah Lupton, Centenary Research Professor, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/843112017-09-22T09:16:53Z2017-09-22T09:16:53ZYoung people oppose Fitbits in schools<figure><img src="https://images.theconversation.com/files/187100/original/file-20170921-20978-1n63e33.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/581194492?src=u8gLLrzz-X30cIg4_X-XNw-1-98&size=medium_jpg">tetxu/Shutterstock</a></span></figcaption></figure><p>Secondary school pupils are not keen on digital fitness trackers being used in physical education, according to our <a href="http://www.tandfonline.com/doi/full/10.1080/13573322.2017.1375907">latest research</a>. Wearing a Fitbit for eight weeks reduced pupils’ motivation to be physically active and made some pupils feel fat. </p>
<p>It is important to find new ways to motivate young people to be physically active, given that regular exercise is important for physical and mental well-being. Health apps and wearable trackers may provide new opportunities for physical activity, especially if they are seen as a <a href="https://www.thetimes.co.uk/article/the-latest-status-symbol-for-children-the-fitbit-znx26lddn">status symbol</a>, as some reports suggest. However, little is known about how young people use these devices, their perspectives on them, or how it motivates them to be active. </p>
<p>For our study, we recruited 100 pupils, aged 13 to 14 from two UK schools. Participants were given a fitness tracker to wear on their wrist for eight weeks. To see if the participants’ physical-activity motivation changed as a result of wearing the device, they were asked to complete a questionnaire before and after the eight-week period. </p>
<p>The participants also took part in a focus group interview at the end of the study, where they were given the opportunity to talk about how they found wearing the fitness tracker. They discussed a number of things in the interviews such as what they liked or disliked about wearing the device, how the device made them feel and what features of the device they used the most. They were also asked whether they felt the device made them more or less physically active. </p>
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<img alt="" src="https://images.theconversation.com/files/187169/original/file-20170922-15786-i2czeh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/187169/original/file-20170922-15786-i2czeh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/187169/original/file-20170922-15786-i2czeh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/187169/original/file-20170922-15786-i2czeh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/187169/original/file-20170922-15786-i2czeh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/187169/original/file-20170922-15786-i2czeh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/187169/original/file-20170922-15786-i2czeh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Not welcome in schools.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/572394862?src=a5ElEmpO9JW8hxE47Eixrw-1-2&size=medium_jpg">Antony McAulay/Shutterstock</a></span>
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</figure>
<h2>Demotivating</h2>
<p>The results showed that after eight weeks, the pupils’ motivation for physical activity decreased. The pupils said that initially the fitness tracker encouraged them to be more active, but after four to five weeks their motivation declined. </p>
<p>Their reasons for taking part in physical activity also changed. For example, after the eight weeks, more pupils reported taking part in physical activity because they felt pressurised. When wearing the device, they took part in physical activity through feelings of guilt or through pressure to beat their friends’ step count, or achieve <a href="http://www.tandfonline.com/doi/full/10.1080/19325037.2017.1343161">10,000 steps</a>. </p>
<p>Wearing the device made some pupils lose confidence in their physical ability. Others said the device made them feel fat and uncomfortable. </p>
<p>Pupils were aware that the fitness tracker only made a few people feel good about themselves, for example, those people that were already active and could easily achieve their activity goals, such as completing 10,000 steps in a day.</p>
<p>The pupils said that fitness trackers should not be used in PE lessons. They felt it might make some of the less able students feel bad about themselves if they didn’t achieve certain criteria, such as step count. They were also worried that they would be punished if they didn’t meet 10,000 steps and therefore felt that it would be unfair if it was <a href="http://www.tandfonline.com/doi/full/10.1080/13573322.2017.1375907">introduced as a teaching aid</a>. </p>
<p>Our research shows that just because young people are the <a href="https://www.ofcom.org.uk/__data/assets/pdf_file/0034/93976/Children-Parents-Media-Use-Attitudes-Report-2016.pdf">biggest users of digital technologies</a>, doesn’t mean that health apps and devices will be effective health promotion tools. Fitness trackers are marketed as devices that help increase motivation to be more active, but our study suggests that we need to be mindful of the type of motivation these devices create. If they only achieve short-term motivation, brought about by feelings of guilt, perhaps they are best avoided.</p><img src="https://counter.theconversation.com/content/84311/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlotte Kerner receives funding from Richard Benjamin Trust. </span></em></p><p class="fine-print"><em><span>Victoria Goodyear receives funding from Richard Benjamin Trust. </span></em></p><p class="fine-print"><em><span>Mikael Quennerstedt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Digital fitness trackers may look cool, but many teenagers don’t want them in PE lessons.Charlotte Kerner, Lecturer, Brunel University LondonMikael Quennerstedt, Professor of Physical Education and Health, Örebro UniversityVictoria Goodyear, Lecturer, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/725652017-02-17T02:00:57Z2017-02-17T02:00:57ZCould your Fitbit data be used to deny you health insurance?<figure><img src="https://images.theconversation.com/files/157171/original/image-20170216-17922-xw57nf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A log of your preexisting conditions?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/timo_w2s/31731774776/">Timo Newton-Sims/timo_w2s/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Wearing a fitness tracking device could earn you <a href="http://www.investopedia.com/news/fitbit-healthcare-deal-unitedhealth">cash from your health insurance company</a>. At first, this sounds lucrative for the people who participate, and good for the companies, who want healthier insurance customers. But it’s not quite so simple.</p>
<p>Under the program, people who have certain health insurance coverage plans with UnitedHealthcare can elect to wear a Fitbit activity tracker and share their data with the insurance company. The data would be analyzed by Qualcomm Life, a company that processes medical data from wireless sensors for doctors, hospitals and insurance companies. Depending on how active participants are, as measured by the Fitbit, they could <a href="https://www.uhc.com/news-room/2017-news-release-archive/wearables-and-wellness-program">earn as much as US$1,500</a> toward health care services each year.</p>
<p>Interest in wearable fitness trackers is <a href="https://www.fool.com/investing/general/2016/03/20/7-wearable-tech-trends-to-watch-over-the-next-5-ye.aspx">booming</a>. More than half of people who already own one believe their devices will help them <a href="http://www.digitaltrends.com/wearables/wearables-healthcare/">increase their life expectancy by 10 years</a> – even though it’s impossible to actually know that because the clinical trials necessary would take at least a decade. Adding free money to the mix only makes the devices seem more attractive.</p>
<p>Before we celebrate this new partnership, though, it’s important to consider potential costs to the patients. We are not far from days when wearable health devices will be able to diagnose illnesses. While this is not legal now, if Obamacare were repealed, as Republicans have vowed to do, corporate partnerships like this one with UnitedHealthcare and Fitbit could pave the way for insurance companies to use fitness tracker data to deny coverage or hike up rates for consumers.</p>
<h2>Diagnosis by device</h2>
<p>There are positive elements to pairing wearable fitness trackers with health data. </p>
<p>An existing flu treatment medication <a href="http://dx.doi.org/10.1016/S0140-6736(00)02288-1">works best when administered within 24 hours of onset of symptoms</a>. But it’s difficult to catch the flu so quickly. A Fitbit could make that much easier. If the device measures a sudden decrease in the number of steps the person takes per day, plus perhaps an elevated resting heart rate, that <a href="https://www.clinicalkey.com/#!/content/book/3-s2.0-B9781455750177003640?scrollTo=%23hl0000450">could signal the presence of a virus</a>.</p>
<p>If an insurance company has access to those data, it could send a message to the patient. If the person really was feeling poorly (rather than just having decided to watch TV all day or gotten snowed in), she could be directed to go to her doctor or an urgent care clinic. The person could see a health professional quickly, get an effective treatment and be on the mend sooner – thanks to her Fitbit data. </p>
<p>This ability will only increase in the future. There are <a href="http://www.mobihealthnews.com/content/21-clinical-trials-are-using-fitbit-activity-trackers-right-now">more than 20 clinical trials using Fitbits underway</a>, studying the role of activity in treating pediatric obesity and cystic fibrosis, and even how it can boost chemotherapy’s effectiveness and speed in recovery from surgery. As those studies are published in the coming years, researchers and doctors will get even better at identifying signals of specific diseases in wearable devices’ data.</p>
<h2>Beyond the Fitbit</h2>
<p>Similar efforts include one to <a href="https://pdfs.semanticscholar.org/d31e/26af4fbe33f99f86597ef3af89bf500d611f.pdf">detect influenza with a portable heart-rate monitor</a>. Other researchers are <a href="https://www.technologyreview.com/s/603200/voice-analysis-tech-could-diagnose-disease/">analyzing voice and speech patterns</a> to reveal neurological disorders and other diseases – and are <a href="https://www.newscientist.com/article/2120426-algorithms-crunch-calls-to-health-insurer-for-signs-of-disease/">using calls to a health insurance company</a> as a data source. Even <a href="https://doi.org/10.1109/MC.2013.339">eye-tracking software could measure cognitive understanding</a>, which could identify signs of dementia. Detecting symptoms earlier through Fitbit data could allow faster, more effective treatment.</p>
<p>The biggest push, though, is coming from Qualcomm, which has offered a <a href="http://tricorder.xprize.org/">$10 million prize</a> to the team who can develop a specific type of multifunction medical device. Without involving a health care worker or facility, the device must be able to accurately diagnose 13 health conditions, including pneumonia and diabetes. It must also be able to capture in real time five vital signs, such as heart rate and breathing rate, and process the data locally.</p>
<p>The global competition is down to finalists; the winner will be announced early this year. That could bring wearables’ insights to doctors – and insurance companies – much sooner than we might think.</p>
<h2>Cause for concern</h2>
<p>Wearables’ data can definitely be used to help patients. But it could also be used to harm them, particularly in light of recent political developments. With the passage of the <a href="https://www.gpo.gov/fdsys/granule/PLAW-111publ148/PLAW-111publ148/content-detail.html">Affordable Care Act</a> (also called Obamacare), insurance companies were barred from denying coverage to customers who had preexisting medical conditions at the time they signed up for insurance. If that rule is <a href="https://www.washingtonpost.com/powerpost/obama-to-huddle-with-democrats-on-protecting-his-signature-health-care-law/2017/01/04/34b655e8-d1f9-11e6-945a-76f69a399dd5_story.html">lifted by Republicans in Congress</a>, insurers might look to wearable devices for evidence they could use to refuse to pay for patients’ health care.</p>
<p>This development would have enormous consequences. According to the Centers for Medicare and Medicaid Services, as many as <a href="https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/preexisting.html">half of all Americans</a> have some sort of condition that could be used to exclude them from coverage, such as asthma, cancer or mental illness. Might insurance companies ask prospective customers for their Fitbit data, in addition to – or even in lieu of – a physical exam or laboratory tests? If that provision of Obamacare were repealed, could insurance companies set rates based on what those data show – or deny coverage entirely? </p>
<p>Car insurance companies are already using similar methods. Some insurers provide their customers with <a href="https://www.allstate.com/tools-and-resources/car-insurance/telematics-device.aspx">devices to install in their cars</a>, measuring drivers’ behavior and calculating the risk involved – and the rate they pay for coverage.</p>
<h2>Assembling the data</h2>
<p>At the moment, the algorithms connecting activity tracker data and health conditions are still under development. But the biggest thing UnitedHealthcare would need is a large data set of customer Fitbit measurements, so it can link them to insurance claims. Its new cash-for-data program will begin to assemble that information.</p>
<p>As insurance customers signed up to use a Fitbit and get some extra cash for sharing their data, United would be able to match their Fitbit measurements with any health conditions identified in their medical records. Over time, the company could build up enough information from, say, people with asthma and people without it to be able to tell asthma patients apart by looking just at their data. The company could do this for other common diseases, too, or even adapt the algorithms from the contestants in the Qualcomm competition. </p>
<p>It’s unclear what the company would do with what it learned. But one possibility is that when evaluating a prospective customer, the company could look at his data and know all about any preexisting conditions. That might mean a person doesn’t get insurance, or has to pay more for coverage.</p>
<h2>Making coverage decisions</h2>
<p>The <a href="https://dx.doi.org/10.1007/978-3-319-28887-1_22">financial power of the health insurance industry</a> is enormous. Not only are there many large companies, but they have the ability to determine whether a sick person gets well or doesn’t – and whether the cost is ruinous or merely expensive.</p>
<p>Would people feel able to object if insurance companies required customers to wear fitness trackers or other monitoring devices? Would new patients provide access to past data a Fitbit collected? Could an insurance company consider it fraud if a user didn’t wear the device?</p>
<p>If used – and regulated – well, the devices can help individual patients change their daily habits to become healthier, saving insurance companies money, and passing some of those savings along to customers. Alternatively, the devices could provide justification for denying coverage to the inactive or unhealthy, or boosting their insurance rates.</p>
<p>Consumers should not assume their insurance companies will use their data only to improve patient care. With millions of dollars on the line, insurers will be sorely tempted. With the legal landscape around preexisting conditions in flux, people should think twice before signing up.</p>
<p><em>Editor’s note: This article was updated to correct the spelling of UnitedHealthcare’s corporate name and the fact that Fitbits cannot detect tremors, and also to reiterate that the Affordable Care Act presently bars insurance companies from denying coverage to patients with preexisting conditions.</em></p><img src="https://counter.theconversation.com/content/72565/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Boyd receives funding from the National Institute of Health, National Institute of Aging, National Center for Advancing Translational Sciences, McKesson Foundation, Agency for Healthcare Research and Quality. He has previously received research funding from the Department of Defense, Baxter, Office of the National Coordinator for Health Information Technology.</span></em></p>Soon, wearable fitness devices will be able to diagnose diseases. Could that lead insurers to deny coverage to people based on their data alone?Andrew Boyd, Assistant Professor, Biomedical and Health Information Sciences, University of Illinois ChicagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/700462016-12-22T19:09:28Z2016-12-22T19:09:28ZFive things you need to know about fitness trackers<figure><img src="https://images.theconversation.com/files/149816/original/image-20161213-1625-cbtn4r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Can technology keep you moving? </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/531961363?src=mk95qU3WX6M4gs6Z6SNguA-1-0&id=531961363&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Most modern fitness trackers are electronic devices you wear on your wrist to track steps, overall physical activity, sedentary behaviour and sleep. They typically work with a smartphone app or website that allow you to track your progress over time using graphs and figures. Advanced fitness trackers can also record heart rate and GPS related outcomes, like your route, speed and distance.</p>
<p>People can be active without using fitness trackers, but their self-monitoring features help you set realistic goals and track your progress. Self-monitoring is an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3333811/">effective</a> behaviour change technique. </p>
<p>So let’s have a look at the evidence about these trackers.</p>
<h2>1. Fitness trackers work in the short term</h2>
<p>Basic pedometers (mechanical step counters) have been around for a long time and when people use them their activity levels <a href="http://jamanetwork.com/journals/jama/article-abstract/209526">increase</a>. Today’s fitness trackers are essentially fancy pedometers. So, there’s little reason to believe their added features and functionality makes them less effective. </p>
<p>Of the few rigorous randomised controlled trials of advanced fitness trackers, most found positive short-term outcomes. For example, a <a href="http://www.ajpmonline.org/article/S0749-3797(15)00044-6/abstract">study</a> comparing people using pedometers to those using Fitbits found Fitbit users were 62 minutes more physically active a week. <a href="http://www.sciencedirect.com/science/article/pii/S2211335515000960">Other</a> <a href="http://www.jmir.org/2016/2/e34/">studies</a> also found people using fitness trackers took significantly more steps compared with those in a control group, but only measured outcomes over a short period.</p>
<h2>2. For long-term outcomes fitness trackers work best with other strategies</h2>
<p>Too few studies have looked at how people use fitness trackers beyond three months to say if they work in the long term. Numerous <a href="http://endeavourpartners.net/assets/Endeavour-Partners-Wearables-and-the-Science-of-Human-Behavior-Change-Part-1-January-20141.pdf">reports</a> suggest many people soon stop using them. Reasons include the need to repeatedly recharge and sync the device with an app or website.</p>
<p>More importantly, fitness trackers need to be part of an <a href="http://jamanetwork.com/journals/jama/article-abstract/2089651">overall behaviour change strategy</a> to promote a lifelong fitness habit. But this mostly doesn’t happen. </p>
<p>For example, one <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-016-0441-3">workplace study</a> showed physical activity increased after 12 months when fitness trackers were combined with organisational support in the first three months. Support included educational information, goal setting, social support and team challenges.</p>
<p>A <a href="http://www.thelancet.com/journals/landia/article/PIIS2213-8587(16)30284-4/abstract">high-profile study</a> showed that when people were financially rewarded for using fitness trackers, this didn’t improve their health in the long term. However, such external rewards are not a strong behaviour change strategy, as they don’t increase the <a href="http://ijbnpa.biomedcentral.com/articles/10.1186/1479-5868-9-78">motivation</a> needed to keep going after the incentives are removed. </p>
<p>So behavioural support is needed with fitness trackers to form healthy lifelong activity habits.</p>
<h2>3. Basic fitness tracker functions are accurate</h2>
<p><a href="http://ijbnpa.biomedcentral.com/articles/10.1186/s12966-015-0314-1">Several</a> <a href="http://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-015-0018-5">reviews</a> indicate most fitness trackers provide valid and reliable measures of physical activity, for instance counting steps and activity minutes. Most users consider step counting as the <a href="http://bmjopen.bmj.com/content/6/7/e011243.full">most important function</a> of fitness trackers. </p>
<p>But these reviews also indicate energy expenditure, calorie counts and sleep measures are less accurate. This isn’t necessarily a problem for recreational users as the measurement error tends to be <a href="http://www.jmir.org/2016/9/e239/">consistent</a>. This means you still can accurately assess whether you are making progress as the device always over- or under-estimates the same way.</p>
<h2>4. Fitness trackers affect your mood</h2>
<p>Some people <a href="https://www.academia.edu/3129923/Always-on_always-on-you_The_tethered_self">report</a> feeling guilty or naked when not wearing their fitness tracker; others suggest it may <a href="https://theconversation.com/will-fitness-trackers-damage-our-relationships-with-our-doctors-52611">damage their relationship</a> with their doctor.</p>
<p>But there are many studies demonstrating the <a href="http://www.tandfonline.com/doi/abs/10.1080/17437199.2015.1022901?journalCode=rhpr20">strong positive effects</a> of regular physical activity on mental health, including improved mood, quality of life, stress, anxiety and depression. While there is no direct evidence, it is likely the positive mental health effects of being active outweigh the potential negative mental health effects of wearing fitness trackers.</p>
<h2>5. Fitness trackers are here to stay, despite media reports</h2>
<p>A recent <a href="http://www.theaustralian.com.au/business/technology/fitbits-pulse-is-slowing/news-story/5489685750477f1afd6ceb5675d05a15">article</a> highlighted the financial troubles for market leader Fitbit and others such as Jawbone. Sales are slowing and profits are down. This has many believing fitness trackers are a temporary fad. </p>
<p>We don’t think this will happen; the global wearables market is forecast <a href="http://www.forbes.com/sites/paullamkin/2016/02/17/wearable-tech-market-to-be-worth-34-billion-by-2020/#65fe15613fe3">to grow</a> to more than US$34 billion a year by 2019.
More importantly, fitness trackers are still evolving rapidly, with different brands developing new models boasting improved features and performance. It is difficult to stay on top as market leader in a dynamic and quickly changing environment.</p>
<p>Health professionals are also willing to use fitness trackers for specific patient groups, like people recovering from <a href="http://link.springer.com/article/10.1007%2Fs11764-016-0571-2">breast cancer</a> or having <a href="http://www.karger.com/Article/FullText/441314">haemodialysis</a>. This demonstrates the potential for trackers to be integrated into the health care system.</p><img src="https://counter.theconversation.com/content/70046/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Corneel Vandelanotte receives funding from Queensland Health (for maintaining the 10,000 Steps Australia program), the National Health and Medical Research Council (project funding) and the National Heart Foundation of Australia (salary support). He does not receive any funding or support from fitness tracker manufacturers or suppliers. </span></em></p><p class="fine-print"><em><span>Stephanie Alley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Do fitness trackers work? For how long? And are they more than just a passing fad? We explore what you need to know about fitness trackers.Corneel Vandelanotte, Professorial Research Fellow: Physical Activity and Health, CQUniversity AustraliaStephanie Alley, Postdoctoral research fellow, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/650792016-09-08T22:18:28Z2016-09-08T22:18:28ZApple Watch pivots to fitness – and focuses on a different style of self-help<p>When Apple <a href="https://youtu.be/bdyVH5LqneU">unveiled its original watch in 2014</a>, the California company touted <a href="http://web.archive.org/web/20150509040832/http://www.apple.com/watch/">three tent-pole features</a> of the new wearable: style, communication and fitness. <a href="http://www.apple.com/apple-events/september-2016/">Rolling out</a> the second-generation Apple Watch this week, Apple has positioned fitness, and fitness alone, as the device’s main selling point. High-end fashion, and friend-to-friend gestures like the <a href="http://www.imore.com/how-send-someone-your-heartbeat-apple-watch">heartbeat share</a>, were hardly mentioned. Exercise was the unrivaled star of the watch reveal. </p>
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<figcaption><span class="caption">Introducing Series 2 – with an emphasis on physicality.</span></figcaption>
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<p><a href="http://www.apple.com/apple-events/september-2016/">Tim Cook’s keynote</a> introduced the new <a href="http://www.apple.com/watch/">“Series 2” device</a> with a <a href="http://www.apple.com/apple-watch-series-2/">promotional video</a> dominated by sports: color bursts of swimming, tennis, basketball, cycling, stairs, skateboarding, jogging and on and on. The watch’s featured hardware changes, in addition to the requisite processor upgrade, were a GPS chip and a new “swimproof” water rating.</p>
<p>The upgraded operating system, <a href="http://www.apple.com/watchos/">watchOS 3</a>, is all about fitness too: new Activity watch faces, workout sharing, additional health metrics, and a new “Breathe” app. Cook called the watch the “ultimate device for a healthy life.” He said he expected the new version to be “especially popular with runners” – and proceeded to invite Nike’s brand chief to introduce a full-fledged, standalone unit: the <a href="http://www.apple.com/apple-watch-nike/">Apple Watch Nike+</a>. The Nike version, with its own specialized bands and watch faces, was hailed as the “perfect running partner.”</p>
<p>The Series 2 announcement did include a brief mention of new Hermés bands, as well as enhanced emojis and a “Scribble” finger-drawn input system. But the original tripartite pitch – style, communication and health – was reduced to a single, focused sell: the Apple Watch is a fitness device. And with that shift Apple has substituted a strand of self-improvement – disciplined and quantitative – for its longstanding appeals to iconoclastic self-expression. </p>
<h2>Forget fashion, follow the market to fitness</h2>
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<a href="https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=773&fit=crop&dpr=1 600w, https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=773&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=773&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=971&fit=crop&dpr=1 754w, https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=971&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/137103/original/image-20160908-25249-1ofegob.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=971&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Fitness doesn’t appear to be top of mind for this high-fashion model sporting the original Apple Watch.</span>
<span class="attribution"><a class="source" href="http://cdn.macrumors.com/article-new/2014/10/voguecover.jpg?retina">Vogue China</a></span>
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<p>Recall that the original watch was promoted with <a href="https://youtu.be/dAFEoUc3JNw">videos narrated by designer Jony Ive</a>, with purring, pornographic attention to design and exotic materials. Crucial to the original roll-out campaign was a relentless effort to link the watch to the fashion world: the <a href="http://www.self.com/flash/celebrity-blog/2015/02/march-cover-girl-candice-swanepoel-apple-watch/">Self</a>, <a href="http://www.macrumors.com/2015/04/02/apple-watch-flare-magazine/">Flare</a> and <a href="http://www.digitaltrends.com/wearables/apple-watch-vogue-china-cover-iphone-6-preorders-start/">Vogue China</a> covers, the <a href="http://www.digitaltrends.com/apple/apple-watch-splashed-across-12-pages-of-vogues-march-issue/">12-page ad spread</a> (and <a href="http://www.vogue.com/1415025/apple-design-genius-jonathan-ive/">glowing Ive profile</a>) in U.S. Vogue, the in-store boutiques at <a href="http://www.theverge.com/2015/4/10/8380993/apple-watch-tokyo-paris-london-shopping">Galleries Lafayettes and Selfridges</a>, the high-profile hires from Burberry to L.V.M.H.</p>
<p>Equally prominent, in that <a href="https://youtu.be/bdyVH5LqneU">first unveiling</a>, were the watch’s communication features. The Dick Tracy phone calls, the intimate “Digital Touch” messaging, the dedicated “Friends” side button: The stress, back in 2014, was on new, “subtle ways to communicate.” With the Series 2 version, most of that fell away. Even the side button has been repurposed as an app-loading dock. And now it’s your Activity rings – the addictive circles that track standing, movement and exercise – you’re <a href="http://www.apple.com/apple-watch-series-2/">encouraged to share</a>.</p>
<p>The business angle of Apple’s pivot to fitness isn’t that interesting. The company is following its customers and the broader wearables market – where lower-cost wristbands like Fitbit are reportedly <a href="http://www.cnbc.com/2016/09/07/heres-why-apple-needs-a-new-watch-sales-are-plunging.html">picking up market share</a>. The Nike+ deal isn’t an aspirational bid to tap an underserved market. Instead, right now at least, exercise tracking is the reason consumers are buying smart watches and “basic” wearables like the Fitbit.</p>
<p>The intriguing thing about Apple’s shift in marketing is its elevation of self-improvement over self-expression. The original watch was promoted as a custom display of personal style – as an identity statement on par with clothing. Cook <a href="https://youtu.be/bdyVH5LqneU">described the original watch</a> as the “most personal device Apple has ever created,” and the device’s <a href="http://web.archive.org/web/20150509040832/http://www.apple.com/watch/">web copy</a> reinforced the point: Apple Watch is “more than a tool. It’s a true expression of your personal taste.” Or, in a <a href="http://web.archive.org/web/20160406034110/http://www.apple.com/watch/">later rendition</a>: “From the way it works to the way it looks, Apple Watch isn’t just something you wear. It’s an essential part of who you are.”</p>
<p>The <a href="http://www.apple.com/apple-watch-series-2/">new web copy</a>, however, drops all the expressive language: The Series 2 Watch is “designed for all the ways you move,” full of features that “help you stay active, motivated and connected.”</p>
<h2>Apple switches its flavor of self-help</h2>
<p>The shift represents a victory of one mode of self-help over another. As sociologist Micki McGee observed in <a href="https://global.oup.com/academic/product/self-help-inc-9780195337266?cc=us&lang=en&">Self-Help, Inc.</a>, a pair of ethics have long competed in the American self-improvement market, one emphasizing self-mastery and the other self-discovery. Think <a href="https://www.tonyrobbins.com/">Tony Robbins</a> versus Oprah Winfrey: Robbins asks us to treat ourselves as objects to (relentlessly) work on, while Winfrey preaches meditative fulfillment.</p>
<p>Each ideal, in turn, <a href="http://www.hup.harvard.edu/catalog.php?isbn=9780674824263">draws on a different strand of Western individualism</a>: the notion that the self is something we own, versus the competing idea that the self is to be discovered and expressed. The first ethic, the <a href="http://www.oupcanada.com/catalog/9780195444018.html">possessive individualism</a> of philosopher John Locke, helped provoke the second notion of self discovery, as expressed in the <a href="https://muse.jhu.edu/article/508124">literary and artistic Romanticisms</a> of the 19th century. Since then – for <a href="http://www.worldcat.org/title/fables-of-abundance-a-cultural-history-of-advertising-in-america/oclc/30547687">over a century in the American case</a> – these two ideals have been hitched to selling consumer goods. </p>
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<figcaption><span class="caption">Apple’s traditionally been more about self-expression than self-mastery.</span></figcaption>
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<p>Apple has traditionally wrapped its products in the second ideal of self-expression and discovery: the iconic <a href="https://m.youtube.com/watch?v=R706isyDrqI">1984 sledgehammer ad</a>, the “<a href="https://en.wikipedia.org/wiki/Think_different">Think Different</a>” and “<a href="https://en.wikipedia.org/wiki/Get_a_Mac">I’m a Mac/I’m a PC</a>” campaigns, <a href="https://en.m.wikipedia.org/wiki/IMac_G3">candy-colored iMacs</a> and all those <a href="https://m.youtube.com/watch?v=mpM5nzSEyXE">silhouetted iPod dancers</a>. Apple is selling the Series 2 Watch, by contrast, on the self-mastery ethic. It’s less “<a href="https://m.youtube.com/watch?v=tjgtLSHhTPg">Here’s to the crazy ones</a>” and more <a href="http://www.apple.com/apple-watch-series-2/">lap-counts and “achievement” badges</a>.</p>
<p>What’s novel about Apple’s move is that self-discipline is getting delegated to a device. In a sense, watch wearers are outsourcing their superegos to a publicly traded company, the world’s most valuable. With every tap-to-stand and Activity report – “<a href="http://www.apple.com/apple-watch-series-2/">a nudge when you need it</a>” – the watch becomes more like a personal trainer, one coded by Apple engineers. By baking in fitness-sharing (“<a href="http://www.apple.com/apple-watch-series-2/">Healthy loves company</a>”), the new watch appeals to social comparison and competition too – “whether it’s to send encouragement or a little smack talk.” And Apple’s exercise-centric messaging is built around <a href="http://www.polity.co.uk/book.asp?ref=9781509500598">quantitative self-monitoring</a>, via bar graphs and calorie counts and beats-per-minute tallies. The Series 2 “tracks all the ways you move throughout the day,” reads new <a href="http://www.apple.com/apple-watch-series-2/">web copy</a>. “Select up to five metrics to view at once.”</p>
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<a href="https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/137112/original/image-20160908-25231-vl7t41.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Will this pivot affect the physical health of Apple zealots?</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/shinyasuzuki/16924905779">Shinya Suzuki</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>Exercise is a good thing. But we shouldn’t pretend the design and promotion of devices like the Apple Watch are value-neutral. By the time they’re slotted under flawless in-store glass, they already have a <a href="http://www.worldcat.org/title/social-shaping-of-technology/oclc/39713267">set of ideals preinstalled</a>. In the Apple Watch case, those values reflect their California origins: Our selves are objects to work on, to sculpt and measure, in competition with others. Indeed, the watch echoes the subculture of <a href="http://www.polity.co.uk/book.asp?ref=9781509500598">dedicated self-quantifiers</a>, who – to a deliberate extent – define themselves in metrical terms. </p>
<p>The watch’s new <a href="http://www.apple.com/apple-watch-series-2/">“Breathe” app</a> is a fascinating case in counterpoint. The app, which encourages periodic deep breathing, is meant to “help you practice mindfulness every day.” Here is a reminder of Silicon Valley’s <a href="http://press.uchicago.edu/ucp/books/book/chicago/F/bo3773600.html">long flirtation with New Age mysticism</a> – as well as the <a href="http://revije.ff.uni-lj.si/as/article/view/3941">gauzy repurposing of Buddhist meditation</a> for the self-help industry. If anything, the Breathe app is a throwback to Apple’s expressivist marketing campaigns. And in that respect the new watch echoes a century-old American injunction: <a href="http://www.jeffpooley.com/pubs/PooleyConsumingSelf2010.pdf">If you want to get ahead, go find yourself</a>.</p><img src="https://counter.theconversation.com/content/65079/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jefferson Pooley does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Forget high-end design and cutting-edge communication. The new Watch is a fitness device and heralds a shift for the company – from enabling self-expression to nudging users toward self-mastery.Jefferson Pooley, Associate Professor of Media & Communication, Muhlenberg CollegeLicensed as Creative Commons – attribution, no derivatives.