by Carolyn Thomas ♥ @HeartSisters
It took a while to improve upon the humble 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 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 – amazingly – with only one battery change since 2008. And why would companies that make digital fitness trackers believe that their devices work better than the two tracking tools almost all of us own that already work pretty darned well: a full-length mirror and a bathroom scale?
Fast forward several years from the day I received that pedometer at Mayo. In 2014, University of British Columbia physicians give me a Fitbit as part of a lovely gift bag following my presentation at a medical conference there. But that little Fitbit sat unopened on my kitchen counter, month after month, until I finally unpacked it and tried it out. Might as well give this thing a chance, I decided, 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 or brisk outings with my walking groups Mondays and Thursdays.
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 favourite summertime activity.
Every Saturday morning, I walk downtown (about a 45-minute walk from home). After visiting with friends, we stop at a weekly farmers’ market 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 those heavy 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 2008 to track my daily walks – or better than my shiny sparkly reward stickers on that 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 technology can and will change health care as we know it.
In fact, they predict that one day 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 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 then automatically tweet your precise weight to your Twitter followers every morning):
“NOBODY CARES!”
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 another 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 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? “
It wasn’t even 30 days for me, yet I was already ready to ditch my selftracking 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 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.
♥
NOTE FROM CAROLYN: I wrote more about common sense ways to keep track of how you’re doing in my book “A Woman’s Guide to Living with Heart Disease“. You can ask for it at bookstores (please support your local independent bookseller!) or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher Johns Hopkins University Press (use their code HTWN to save 30% off the list price).
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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 forum 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.
ANOTHER UPDATE: A report on fitness trackers published on 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.
AND ONE MORE UPDATE: On August 14, 2019, NPR reported in Doctors Say Most Metrics Provided by Apple Watch, Fitbit Aren’t Helpful to Them there is “still lots of room for technological error because the trackers measure your heart rate on your wrist rather than closer to your chest, and readings can be skewed due to movement and sweat.”
♥
NOTE FROM CAROLYN: A version of this post was originally published on The Ethical Nag: Marketing Ethics for the Easily Swayed .
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See also:
Designing with the Patient in Mind
On Being a (Former) Runner (my essay in Runner’s World magazine)
Healthy Privilege: When You Just Can’t Imagine Being Sick
When the Elephant in the Room Has No Smartphone
“Us” vs “Them”: The Underserved Patient Speaks Up
The Quantified Self meets The Urban Datasexual
Can Self-Tracking Drive You Crazy?
Self-Tracking Tech Revolution? Not So Fast…
“Fewer Numbers, More Life Experiences”
Digital Temptations: “Quantifying, Tracking or Gamifying Everything”
Heart Sisters 
Hi Carolyn,
Interesting post, as are all the comments. I have to throw in my two cents, too, because this winter I downloaded a free app on my phone to track my steps. I love it. It does motivate me and I am not easily motivated to keep track of anything. (Maybe I shouldn’t admit that).
Over the past two months, I have been much more consistent about getting my daily walks in whether it be on the treadmill or outside. So for me, this works. However, all that other data – I do not care one bit about it. I cannot afford to spend the money on the fancy gizmos anyway.
So, give me one piece of data (number of steps) and that’s all I want. We’re all different in this too. Surprise, surprise, right? Thank you for the post. (I recently wrote one with a 10,000 steps challenge and plan a followup one soon). The important thing is to keep moving as much as we can and as often as we can. Easier said than done on some (okay many) days.
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Hi Nancy! I’ll go look up your 10,000 step blog post (readers: it’s here) and I look forward to your followup, too. I agree 100%: “keep moving as much as we can and as often as we can!” That’s the simple (yet sometimes hard!) answer. It’s also why my sparkly stickers on the calendar work for me (the sparklier the better!)
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Carolyn, once again you’re singing my song!
I tried a pedometer, and didn’t like that it can’t really capture 3D movement, so then I tried an accelerometer, which does, and I ended up ditching both of them.
Both of them are recipes for making yourself neurotic. And missing the point. As I tell my physical therapy patients over and over, all you really need is a watch or some other way to measure time, and the ability to move. And as recent research has demonstrated, even short periods of exercise count, and if you get several of those in a day, you get to add them up, and the cumulative total counts. And it works without making you crazy.
And, yes, neither doctors, nor phyical therapists, care about all that data. We just care about whether you’re feeling better. 😉
xo,
Kathi
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Thanks so much Kathi for weighing in here. I love that sentiment “it works without making you crazy” – it perfectly captures that fine line that often exists between a handy tool to motivate us to engage in regular exercise (= good) and one that causes some people to become obsessed (= bad). And several periods of some kind of activity throughout the day is how our caveman (and cavewoman) ancestors likely lived. I’ve recently introduced a two-minute arms-waving-marching-on-the-spot break halfway through my 90-minute women’s heart health presentations because I now believe that 90 minutes of unbroken sitting is just not “normal” for the human body. We’re meant to move, something, anything, and as much as possible!
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Interesting, as always, Carolyn. As I read your post I agreed 100%. Then I read the comments and I realized everyone had an individualized system that worked. Well done all.
At the end of a hospital stay, I was told not only to take my blood pressure at home at the same time every day, but what home BP machine was the best to buy. I did as directed, following the instructions to sit, silently, and with both feet flat on floor for for 15 minutes before and during the taking of my BP.
I recorded the results and took them to my cardiologist on my next visit. To my delight he told me I didn’t need to bother taking my BP, because it wasn’t going to change anything.
That was years ago. Until today I had forgotten about the months I wasted time every day collecting and recording useless numbers.
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Very wise reminder, Jenn – everybody does indeed seem to have grasped something that works for them. I just write about what works (or not) for me. I too have a home blood pressure monitor and careful track my BP for the week leading up to each GP visit every three months (twice a day, as she wants to know my morning vs evening readings which are always much different!) I’m guessing that your own BP tracking experiment likely resulted in nicely normal numbers so your cardio needn’t worry about them!
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Carolyn I read you faithfully and usually find my self nodding in agreement with you or feeling fortunate that you do your homework and share so much information that makes us all more knowledgable as we deal with our heart health and our own advocacy!
Like most I have struggled with keeping myself physically health, nutritionally balanced and emotionally strong.
In 2012 I started wearing a tracker instead of my simple pedometer. I consider it as important as my medication! When my cardiac rehab discontinued level 4 patients( no telemetry needed), I was on my own. The tracker held me accountable! It was my competition! I can set my goals and have often changed them to account for my physical ability ( pre and post hip surgery is a example or crunch time with large projects at work).
My cardiologist noticed my band and gave me a quick tutorial in why the sleep information was important to track, too. I was not good at getting consistent 6-8 hours a night. Using the tracker as a “bio-feedback” tool over a two year span I regularly sleep 6-7 hours a night.
It has kept me on track, I am consistent with exercise, sleep, water consumption and diet. As a 70 year old it is invigorating to utilize the miracles of technology in so many aspects of my life. If it is your blog posts, or my home INR monitoring system which can be stored in an app, I am grateful to be “clicking” along!
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Congrats Barbara on keeping yourself consistent and successful using these miracles of technology. Hope you will continue to visit Heart Sisters – despite our differing experiences with our trackers! 😉
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Of course I will continue to click on your blog postings. Like anything else, when it comes to what helps us manage our heart health issues, it is not a “one size fits all”,
Keep on blogging heart sister, you are one of the elements for many of us!
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Thanks Barbara – well said…
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I understand the rationale here, but when I had breathing problems last winter, I started a process of elimination by making a change that always helped making healthier choices. I started with a jawbone logging foods & activity & tracking sleep. I made more positive changes & I dropped 12 lbs.
When my breathing didn’t rebound I then knew it wasn’t a lifestyle-related issue & started looking at medical. A while ago I scored an open box special on a pulse oximeter which measures oxygen levels that was connected to an app in my phone. I noticed I was shorter of breath than usual. I then used it for exercise & found I needed oxygen after my levels dropped which I told my pulmonologist (lung doctor) & they ordered additional tests.
So in many ways, wearables & digital health help me manage my chronic illness better & easier. I recently upgraded to a fitbit because they had some models with a watch face & I figured it would be easier to get an all-in-one plus a heart rate monitor just to see how it compared with the heart rate monitor on my oximeter.
I’ve been satisfied, but I have a lot of health information to track that would take a signficant amount of time and require detailed spreadsheets otherwise. It’s nice that I can have it all stored in my phone & pull it up at my appointments when I need to. It’s not for everyone, & I know I’m in the minority but it’s been very helpful for me overall for health & wellness & managing flares of my illness in a more proactive manner than I could in the past.
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Sounds like these tools are really working for you,Nikki – keep up the great work!
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Carolyn – I read this blog and the comments with interest. One of your first points was: Why use these devices unless you’re going to use the data to change your behaviour? It seems that those who did use Fitbit, such as Quitting the Sitting, did and do use it to change and that’s great. However I would hazard a guess that the majority of folks do not and your points are well-taken.
However, the greatest impression I received from this discussion and from so many of your posts is how well you, personally, handle your heart condition: with common sense, humour and a sort of steady vision that’s inspiring. I never sense self-pity. Thank you.
Good luck with the writing project.
Deborah
PS – I can’t even imagine Tweeting my weight to the world every morning! Yowzer! Who would want to do that? Guess I’m still stuck in the morass of women’s body image issues. Sigh …
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Hi Deborah – lovely to hear from you again. And thanks for your kind words. There is a big difference, I might add, between the worried well who track everything they can just because they can, and a person like me living with often-debilitating daily cardiac symptoms. In fact, I very recently have decided to award myself a sparkly sticker simply for walking down to Oak Bay Village and back (2,000 steps) on the days when I’m feeling too ill to go out but do it anyway. World’s slowest-ever 2,000 step walk and I really deserve a sparkly sticker after those walks! Fitbit, on the other hand, just doesn’t give awards for “failing” to meet daily goals…
I sure agree with your perspective on Quitting The Sitting (below) – who must be the poster child for how self-tracking can really help some people to achieve very specific goals.
PS I’m with you when it comes to broadcasting my daily weight via social media, which strikes me as a particularly horrifying (and self-absorbed) prospect!
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Carolyn, I see your perspective and I completely agree with you that digital trackers aren’t the be all and end all of health care. They are certainly not inherently superior to their analog cousins. But I’ve had a completely different experience with my Fitbit that I’ve used daily since February 2012.
I think tracking devices, digital and otherwise, can be very useful (and I’d argue even essential) if you are trying to make a change. It sounds to me like you weren’t really trying to make any changes when you acquired your Fitbit. You already had a perfectly good pedometer and a terrific sticker system for tracking your activity and those terrific weekend walks. Since you already had a tracking system that was working for you, all that digital Fitbit data just becomes useless background noise.
Five years ago I was 50 pounds overweight. Like most people, I tried to lose weight on my own with little success. Recognizing I needed to change, I implemented my own tracking systems. I got a Fitbit and soon realized that I was a lot more sedentary than I thought. Even though I was walking daily, I was still sitting way too much and my Fitbit helped me change that. I also started tracking everything I ate and logging every meal. Before it went in my mouth it went on the digital food scale and got measured. Obsessive? Perhaps. But I also quickly learned… are you ready for this? I was eating a lot more than I thought. My wonderful tracking devices, my food scale, my Fitbit, my bathroom scale, and my skinny jeans were all essential tools in helping me lose 50 pounds and they continue to help me maintain that loss 4 years later.
I have no interest in tracking all my bio-systems or quantifying myself in the extreme. Collecting and tracking data is really only useful to me if it helps me achieve a goal such as feeling better or less stressed. One of my favorite lines from the 1995 movie Sabrina rings so true: “More isn’t always better. Sometimes it’s just more.”
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Denise, what an inspiring story! Congrats on maintaining that weight loss and healthier lifestyle for four whole years! Love that Sabrina quotation… 😉
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I just look forward to the day when my cardiologists allow me to exercise again. I have considered buying the Fitbit before, but I mostly think of it as a fad. Thank you for telling the true story. I like your sticker chart! I am still allowed to walk. Maybe I will try the stickers.
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Stickers work! Especially the extra-sparkly and shiny ones…
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Well, I like my fitbit. I don’t use it all the time but it is handy for me. Has the same battery it came with years ago. It is a handy gauge of activity. If I have been really sedentary seeing the relatively few steps and/or lack of flights of stairs is a reminder.
I also have a heart rate app on my phone that my cardiologist really likes – I periodically have runs of tachycardia and he always wants to know if I tracked it with the app since the info is more reliable.
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And there are millions who agree with you! Fitbit is the biggest selling manufacturer of wearable tech out there. For me, it’s no better (and more annoying) than my trusty no-tech pedometer/sparkly calendar stickers…
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I also use a Fitbit but I don’t track my numbers obsessively. When it tells me I’ve hit 10,000 steps (usually in the evening) I feel gratified but all that will change as I head towards having surgery later this month.
I also use it to track my stress levels – when I’ve had an argument or become super frustrated I have been able to go back and see the effect on my heart rate. I view this as a biofeedback opportunity to use in the future – to be more aware of how stress is affecting me and my heart.
No battery issues I recharge mine on my laptop.
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Good point about the need to adapt your step goals post-surgery. I’m aware of how some people track their stress levels digitally. When I was at a conference at Stanford (in the heart of Silicon Valley where everybody seems to track everything even remotely trackable!), I met a man who had spent four years synching his daily calendar with his stress tracking results. What he learned after four years is that two specific activities in his life resulted in greater emotional stress: 1. getting stuck in rush hour traffic, and 2. meetings at work.
I could have told him that for free and saved him four years of tracking… Just as I could tell you right now that having arguments or feeling extreme frustration WILL have an impact on your body.
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