It took a while to improve upon the humble little pedometer. This wearable device, typically attached on or near one’s waist, has been tracking how many steps and how much distance we travel each day ever since its invention by Abraham-Louis Perrelet back in 1780.
But with the relatively recent explosion of wearable digital activity trackers on the market, I’m now waiting for the randomized control trial that compares those fancy-schmancy new devices head to head with that simple old-fashioned pedometer. In other words:
Q: Just because you make it digital, does it make it better?
Consider the inexpensive little pedometer I’ve been using since Mayo Clinic cardiologists gave one to me in 2008 following my heart attack. My low-tech pedometer works just fine for my daily walks, and believe it or not, without even so much as a battery change since 2008.
Fast forward several years from the day I received that pedometer at Mayo. In 2014, Vancouver physicians give me a Fitbit as part of a lovely gift bag following my presentation at a medical conference there. But that little Fitbit sits unopened on my kitchen counter, month after month, until I finally unpack it and try it out. Might as well give this thing a chance, I decide, even though I am perfectly happy with my combination of pedometer-measured walks and the shiny, sparkly stickers I award myself on a small bathroom calendar for each one hour period of exercise activity, from my Friday morning weight training classes to Zumba or long brisk outings with my walking groups.
So here’s what I learned from test-driving my new Fitbit – but first let me paint you this simple picture of one fairly typical part of my week.
Every Saturday morning, I walk downtown (about a 45-minute very fast walk from home). After visiting with friends, we stop at a weekly farmers’ market en route to stock up on fruit/veggies. We browse the vendor tables, chat with the farmers, enjoy the live music, and then, if I’m feeling up to it and my ongoing cardiac symptoms are not flaring, I’ll have a coffee while we enjoy the music onstage or watch the local guest chef’s weekly cooking demo. After a pleasant morning like this, I hug my friends goodbye and continue walking home (albeit a bit slower by now because I’m feeling more fatigued and am also loaded down with shopping bags of produce).
So here’s what my Fitbit tells me about a recent Saturday morning adventure (high intensity activity in green, moderate intensity in orange, light intensity in yellow; total steps tracked that day: 13,484):
– high intensity exercise activity from about 8:15 to 9:00 a.m. while walking downtown
– no activity while sitting with friends
– a brief moderate activity blip as we walk to the farmers’ market
– very light intensity activity while browsing the market
– another blip of moderate-to-high intensity activity while I walk home for lunch (but you can see that I’m slower, tired and now carrying two heavy shopping bags)
– several no-activity chunks of time while I’m resting/napping to recuperate from my morning’s outing (and a major symptom flare that afternoon)
– crash into bed by 8 p.m.
But what good is this information to me?
Will knowing what my Saturday morning looks like on a Fitbit graph change at all what I do or how I do it on Saturdays? Will I now start jogging through the farmers’ market to try to boost that moderate intensity walk up to high intensity? Will I stop buying all those heavy veggies that seem to slow me down on the walk home?
No. No. And no.
The question is not so much about Fitbit data. It’s about whether – despite the hype – any activity tracker is any better than my good ol’ pedometer I’ve used almost every single day since May 2008 to track my daily walks – or better than my shiny sparkly reward stickers on my little bathroom calendar.
What is the purpose of obsessively tracking such information unless one intends to actually do something new with that information?
I already know the difference between a slow stroll around the grocery store aisles (Fitbit includes that useless info in my step total, too) and a good sweat-producing walk up the steep Quadra Street hill. My shiny sparkly calendar reward stickers are faster – and better – at tracking that climb (a steep hill gets a much bigger sparkly sticker!) And like anybody who has regularly used even a simple pedometer, I already know by heart the number of steps on every one of my regular walking routes (2,000 steps to my daughter’s home, 5,500 to the grocery store, 8,700 around the golf course trail, 4,350 to the beach and back, etc.)
Yet the happily-tracking hypemeisters of the Quantified Self movement (motto: “Self Knowledge Through Numbers”) will tell you that self-tracking using technology like that of my Fitbit can and will change health care as we know it.
In fact, they predict that one day even our physicians will be able to keep informed in real time about our physical activity, our blood pressure, our blood glucose readings, our mood, or any other trackable health indicator. One fine day, we are told, our doctors will be able to track a digital pill signal via mobile phone to inform them that we’ve just taken the medication they prescribed for us. Instant solution to the nasty problem of non-compliance.
Unless, of course, you believe the recent flurry of realists who remind us that more data is not in fact the answer to better health care.
As Mark Sullivan wrote in his VentureBeat column called “Guess What? Doctors Don’t Care About Your Fitbit Data”:
“Most doctors have little time for, or interest in, using wellness data collected by wearable devices. They don’t want to spend money on additional (and unproven clinical systems), and most of all, they don’t want to worry about keeping the data private.
And let me break the news to those of you who own a digital scale like Withings (able to not only weigh you, but to automatically tweet your precise weight to your Twitter followers every morning):
If your own overworked and exhausted doctor doesn’t have time or interest or energy to cope with the minutiae of all of those endlessly fascinating self-tracking numbers, why would you believe that casual acquaintances give a flying fig about such self-centred navel-gazing?
Or, as Telecare Aware’s Donna Cusano more bluntly concludes:
“The self-absorption of some Quantified Self adherents has a whiff of stark raving narcissism about it all.“
Want a good example of a no-tech self-tracking tool that really works? The delightful Susannah Fox famously points out her own favourite – the pair of skinny jeans in her closet. Every woman alive knows the precise personal feedback value that such a tool provides to its owner.
From no-tech to multi-tech, consider also the cautionary tale provided by Alexandra Carmichael, one of the founders of the self-tracking/sharing site, CureTogether. In 2010, she explained why she decided she had to stop self-tracking (up to 40 different health indicators about herself each day via devices or mobile phone apps):
“Each day my self-worth was tied to the data. One pound heavier this morning? You’re fat. Skipped a day of running? You’re lazy. It felt like being back in school. Less than 100 percent on an exam? You’re dumb.
“I won’t let it be an instrument of self-torture. Any. More.”
Consider also Sara Watson’s experience with her tracking device while recuperating from hip surgery. In her essay in The Atlantic, she reminded us that patients in recovery have far different goals than our Fitbit thinks we do. The device is interested only in how we can move more and push ourselves further. But as Sara reported, her goals post-op had changed – she was interested only in going slower and being more careful while she was healing.
“The day after my hip surgery, I took a total of 48 steps from the couch, to the bathroom, and back. I had managed to successfully rest and recuperate.
“My definition of fitness is changing over time as my body changes over time.
“I used to think running and doing yoga at least a couple times a week was what made me feel fit. Today, my metric is how long I lay on my stomach to stretch my mending hip. In the future, it will be the physical therapy that preemptively strengthens my loose joints to support a child. And long after that, it will how much time I can spend in the vegetable garden before I get tired.”
This view may help explain another issue that many tech hypemeisters haven’t picked up on yet.
As Sara observes, although the new Apple Watch looks compelling for its fitness tracking features, its default settings aren’t very adaptable. It rewards “globally recommended 30 minutes” of brisk activity, or minutes of standing per 12 hours, or stairs in a day. Sara wonders, however:
“Those metrics might be good for average global health, but how adaptable are they to meet individual needs? “
We know that only 5% of phone apps (including health-tracking apps) are still in use within 30 days of initial download. Approximately 26% of apps are used only once, and 74% are ditched by the tenth use.
It hasn’t even been 30 days for me so far, and I’m already ready to ditch this device.
As a former distance runner, I’m already well aware of the importance of daily exercise. But as a current heart patient with ongoing debilitating cardiac issues, I also know it’s often easier said than done compared to my old life of healthy privilege – before being diagnosed with a chronic and progressive illness.
I don’t need motivating via wearable technology. I need to not feel sick.
And unlike the worried well who embrace their blow-by-blow results on their digital devices, numbers themselves mean little to me, all things considered. (I now give myself a shiny sparkly sticker for the days when I feel like hell but get out and try something, anything, anyway – like walking to my daughter’s house- 2,000 steps).
And I’m simply not interested in adopting yet another tech device on top of everything else it takes just to get through the average day. Like many people living with chronic illness, I’m already more focused on my heart condition every moment of every day than I want to be, so I won’t use anything that adds to my burden of treatment. See also: “Fewer Numbers, More Life Experiences”
As Stanford University’s Dr. BJ Fogg reminds us about what motivates human behaviour:
“If it’s hard to do, don’t boost motivation! Instead, make it easier to do!”
In other words, I simply do not care how many badges, rewards, bells and whistles a Fitbit or other digital device offers when I’m too ill to do more than I am able to do.
When I wake up each day, for example, I do not need to check a tiny screen to assess the hour-by-hour quality of last night’s sleep (and then, good Lord, broadcast this fascinating update to all my friends) because, like most of you, I can already tell if I’ve slept well – or not.
In fact, the digital tracking devices/apps that are much loved by the worried well of the Quantified Self movement may have just the opposite effects on real live patients, by making us feel bad about what we’re not able to do.
NEWS UPDATE: My Fitbit Zip battery died just seven weeks after I started using it (despite the 4-6 month battery life its corporate website promises). Other users on the company’s online support community report similar battery issues – one, in fact, reporting going through one battery per week.
FURTHER UPDATE: In the words of Dr. Aaron Carroll, “I TOLD YOU SO!” A study published in the Journal of the American Medical Association (September 20, 2016) reports that people who used wearable tracking technology actually lost significantly less weight than people whose diet and exercise were the same, but who didn’t use self-trackers.
AND ANOTHER UPDATE: A study on fitness trackers published April 11, 2017 in The Annals of Internal Medicine found that in subjects exercising at a moderate-intensity pace, the performance of all heart rate trackers studied was deemed “relatively poor.” Compared with an electrocardiograph’s readings, trackers reported heart rates that were as many as 41 beats per minute too slow and as many as 39 beats per minute too fast.
NOTE FROM CAROLYN: A version of this post was originally published on The Ethical Nag: Marketing Ethics for the Easily Swayed in September of 2014.
On Being a (Former) Runner (my essay in Runner’s World magazine)