The Messy Truth About Activity Trackers And Weight Loss
I'm going to get straight to the point, and this is from someone who has been going to the gym for 25 years and owns 20 smartwatches/fitness trackers.
Buying and even using a fitness tracker, actvity tracker or smartwatch ALONE, will not help you lose weight. It sure would be cool if all we had to do was strap on a band and watch the pounds melt. Life ain't that easy.
I know, it's really disappointing. All that wonderful technology still can't crack the code.
And no, this is NOT my opinion.
This is based on many scientific studies (peer-reviewed studies) that I've read and analyzed, many of which I will set out below as I untangle the messy truth about weight loss and wearable technology.
BUT, this doesn't mean wearable technology is useless for fitness and health pursuits either. They're a tool that when used properly MAY help you lose weight.
What really excites me about wearable technology and fitness is where these devices are headed. In fact, one company is already there at a rudimentary level, which is very, very cool.
Let's dig into the research.
I'll start with the bad news first, which is to tell you that based on a clinical study involving 471 adult participants, "activity trackers are ineffective at sustaining weight loss" [Source: Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss].
Actually, it's worse, much worse than that if you're pinning your weight loss hopes on an activity tracker. Not only did this 2 year study show that activity trackers failed to sustain weight loss, the group NOT using activity trackers in the same study lost nearly twice the weight as those wearing activity trackers.
This study went on for a period of over 24 months so it wasn't some fly-by-night approach. The 2 groups were split into one using activity trackers while the other group was in a behavioral weight loss program with no activity tracker. The behavioral aspect included telephone counseling sessions, text message prompts and study materials.
One problem here, though, and I don't think it renders the study useless, is that it would be interesting to see if activity trackers would outperform people without such a device and not in a behavioral weight loss program. After all, most people setting out to lose weight don't participate in a behiavoral program. Moreover, it wasn't as if the group wearing activity trackers didn't lose weight. They lost on average 7.7 pounds (versus an average of 13 pounds by the group not wearing activity trackers but instead in a behavioral weight loss program).
How could this happen?
I think it's pretty simple.
Wearable technology on its own, is not a motivator [Source: Wearable Tracking Devices Alone Won't Drive Health Behavior Change].
Don't despair quite yet. Keep reading; technology isn't totally useless. In fact, there's an interesting twist to all this as I unravel the evidence surrounding wearable technology.
Which brings me to my next point: the key driver for successful weight loss is tapping into a motivator [Source: Motivation and Its Releationship to Adherence to Self-monitoring and Weight Loss in a 16-week Internet Behavioral Weight Loss Intervention].
Interesting and Messy
Here's where it gets interesting and messy.
We all aren't motivated by the same thing. A motivator must be powerful enough to achieve behavioral changes sufficient to lose weight. Sustained weight loss should not be undermined because it requires significant adjustments involving food and time. Eating is integral to life and therefore eating patterns are hard to disrupt.
Moreover, exercising takes time, which most of us already don't have enough of. We live busy lives; fitting in a 30 to 60 minute workout or walk or yoga session isn't easy. I know from personal experience. While I've been a gym-goer for decades, there have been periods during those 25 years where I didn't go.
For example, after the birth of our first son, life was crazy busy. I was busy with work and adding a baby into the mix left me no time for the gym. I gained 20 pounds. Fortunately, once we settled into being parents, I managed to get back to the gym, but it wasn't without gaining weight.
Therefore, changing our life that includes changing our eating and requiring us to set aside time is a HUGE change. This is why it's been shown over and over that the right motivator must be tapped and pursuing that motivator requires a behavioral change.
Which explains the conclusion of the study above that wearable technology is ineffective. The activity tracker wearing group was up against a group receiving behavioral weight loss help. It's not contest.
Proven Weight Loss Motivators
What are proven motivators for weight loss?
Steven Reiss, a professor of Psychology at Ohio State University, who authored the popular book "The 16 Basic Desires That Motivate Our Actions and Define Our Personalities", suggests there "16 basic desires that guide nearly all meaningful behavior" [Source: Intrinsic Motivation Doesn't Exist, Researcher Says].
The thing is, and this is important, the effectiveness of the 16 basic desires are different for each person. For instance, we all aren't equally curious or equally driven by power or romance, etc.
Another conclusion Steven Reiss arrives at is that there really isn't such a thing as intrinsic motivation. Intrinsic motivation is doing something because they want to do it versus doing it for some extrinsic reward.
He suggests there is nothing wrong that extrinsic motivators such as power or money can't be an effective motivator.
And so it makes sense that counseling during a weight loss program helps achieve successful weight loss if that counseling continues to tap the participant into the appropriate motivator(s). On our own, with or without technology, our brains will sabotage our best-intentions, but if there is someone or some group reminding us and supporting us of why we want to lose weight, the chances of success are much better.
Activity Trackers & Behavioral Counseling
What About Fitness Trackers Combined with Behavioral Counseling?
It's never black and white, is it?
Dr. Carol Kennedy-Armbruster and Brian Kiessling conducted a study looking into the effectiveness of activity trackers combined with coaching for sustainably increasing activity [Source: MOVE MORE, SIT LESS, AND BE WELL: Behovioral Aspects of Activity Trackers].
What they found was that the activity trackers did help the 173 participants take more steps in a day based on the trackers' reminders and tracking data.
What's interesting about this study is that the focus was on increasing activity (steps per day). It didn't study weight loss. Moreover, the participants learned that they could increase their exercise by making small efforts to walk more without having to go to the gym or some fitness class. The participants REPORTED that the activity trackers were important in helping them to take more steps per day. All participants enjoyed wellness coaching throughout the study.
Lower Your Expectations
Many people, when envisioning their weight loss program, envision horrors of going to the gym and eating only salad. The thing is many people hate the gym. Many people also love to eat food other than greens. While I like the gym, I don't wish to subsist on greens alone. I did the vegan thing for 2 years and not once felt satiated... but I digress.
I think one interesting take-away from the the Kennedy-Armbruster and Kiessling study is that you can increase your activity without going to the gym or starting some grandiose running regimen. You can simply make a concerted effort to walk more steps per day.
In other words, a weight loss regimen need not be a regimen or some crazy program that is so intense you're bound to fail.
How many steps per day should you do?
The 10,000 steps per day is bandied about as if it's the be-all and end-all for being a healthy person. For the average height, 10,000 steps is nearly 5 miles. Unless you deliver the mail or go on a 1 hour walk every day, you're likely not going to hit that 10,000 steps per day. I know I don't.
It's time to change your mindset. You don't need to take 10,000 steps per day. In fact, it's been shown that you can enjoy significant health benefits with fewer steps if you do some of them at a higher intensity such as 100 steps per minute for 150 minutes per week [Source: Want to optimize those 10,000 (or fewer) steps? Walk faster, sit less].
Of course, to make a concerted effort to walk 100 steps per minute for 150 minutes per week, you must be sufficiently motivated, which takes us back to finding out what motivates you and implementing systems such as wellness coaching or a competition to consistently be more intensely active. The plus side is it's clear you need not go to a gym for 3 hours per week or train for a marathon in order to improve your health and even lose weight.
Wearable Technology Gets Interesting
This is Where Wearable Technology Gets Interesting
It's all well and good to say fewer steps at higher intensity offers benefits, but how will an activity tracker help with this? While activity trackers count steps and even monitor heart rate, it's 2 distinct pieces of data that don't really help us advance our pursuit of health.
For example, one day I may take 1,000 steps at a slightly higher heart rate. The next day I may take 1,500 steps averaging a different heart rate and so on. What I end up with is a jumble of data that doesn't really step me in the right direction.
What would be helpful, and this is where I think wearable technology can be very helpful in getting healthier and losing weight, is offering its own algorithm (formula) that applies all the data into a single metric I can pursue. That to me is a cool idea. Simply trying to walk more and take more steps at a higher intensity seems like a never-ending treadmill. However, pursuing a single empirically proven metric or score that takes into account duration of activity, frequency and intensity into a score based on personal health data is very, very interesting. This is where computers come in and can be super helpful.
Does such wearable technology exist?
Yes it does, and this is, in my opinion, where wearable technology for health and fitness is headed and should have been headed for years.
On August 27, 2016 The European Society of Cardiology released a study that looked at the effectiveness of an activity tracker that uses your personal heart rate to personalize the amount of exercise needed to prevent death [Source: Activity tracker uses heart rate to personalize amount of exercise needed to prevent death]. While this didn't look at the amount needed to lose weight, this concept can easily be applied to weight loss. It's the concept I find exciting.
This personalized approach to health is called "Personalized Activity Intelligence" or PAI for short.
The basis for the study was to question the universal "150 minutes of moderate or 75 minutes of vigorous exercise weekly" for everyone. Is this what every person needs?
The researchers hypothesized that the duration and intensity of exercise needed for each person varied, depending on their heart rate over time. The researchers used data from the massive and famous HUNT Study that included 39,298 Norwegian men and women over 28.7 years which came up with the PAI formula based on heart rate.
The scoring, based on the HUNT study is simple. A PAI score greater than 100 reduced premature death from cardio vascular disease from 17% to 23%. And so the PAI scoring was set up so that each person should pursue a PAI score of 100. Again, this is a personalized score based on personal heart rate levels. Accordingly, some people may need to be more active, while other people less active.
Why is this helpful?
Having a meaningful, personalized, simple health score to target is helpful because it reduces guess work. It's one thing to say "walk 10,000 steps per day" which may or may not be ideal for you while it's totally different to say "reach a PAI score of 100 each day, which is a personalized goal scientifically proven to reduce your risk of cardio vascular disease."
I much prefer the specific over the general direction. I think we all prefer something more specific and personalized knowing that it's what we specifically need instead of "it's generally good for people on average."
While a PAI score greater than 100 is shown to reduce risk of cardio vascular disease, it's not been proven to lose weight. That's not the point. The point is the concept of how technology that collects our personal health/lifestyle data can then be transformed into a personal, realistic, meaningful goal for each of us to achieve.
The potential of the PAI concept is amazing, in my view. I'm very excited by it. Algorithms could be created for all kinds of goal pursuits that are individual. If I want to add 5 pounds of muscle, the algorithm can prescribe for me a workout and even a diet. Same thing with losing weight in a healthy manner.
I bet by now you're wondering whether you can buy a wearable technology device that calculates PAI? After all, it's based on heart rate and there are no shortage of activity trackers and smartwatches that track heart rate. The only thing that's needed is incorporating the PAI algorightm. I know as soon as I stumbled on the PAI concept that I immediately started searching for such a device.
Fortunately I found a company that does make and sell such devices. It's Mio Global.
Wearable Technology and PAI
Is There a Wearable Technology Device that Tracks PAI?
Yes. Mio Global develops and sells activity trackers with an accompanying app that will track your heart rate and then report your PAI score. I'm waiting for their latest product, the MIO Slice which I should have in my hands in February 2017.
Mio Global activity trackers report the PAI score derived from the famous HUNT study. Moreover, these trackers are based on the theory that not all steps are the same, which I totally agree with. If, after all, higher intensity steps are better than slow walking steps, clearly not all steps are equal. However, most trackers count all steps equal.
Mio Global's devices therefore report a PAI score based on your type of activity which is dictated by your heart rate. The score incorporates all activity, not just steps. Therefore, if you lift weights or cycle or do yoga, these healthy activities are included in your overall, daily PAI score.
This to me makes total sense as a truly effective activity tracker because it's actually harnessing computing power to help you pursue and achieve a healthier lifesytle.
Watch the video on the latest Mio Global fitness tracker which is called "Slice"
Did Mio Global Come Up with PAI?
No. Mio Global simply created a fitness tracker that calculates your PAI score. PAI is a health metric based on heart rate developed as a result of the HUNT study, one of the biggest health studies every conducted. Mio Global simply recognized that a wearable technology device could be developed to use the PAI score as personalized measurement.
But, Does PAI Motivate People to Be More Active?
Obviously PAI isn't going to be some magic elixir where everyone who is overweight or unhealthy to lose weight and/or get healthy. Studies are a numbers game. Usually a 10 to 20% improvement is very much statistically significant.
While I did not find any studies concluding that a PAI tracker such as Mio Global's trackers actually result in more weight loss or even more activity, here's what I've found.
Confidence helps motivation. So too, does knowledge when it comes to patients having better health outcomes and incurring fewer health care costs [Source: UO study highlights important role that patients play in determining outcomes].
The PAI score concept to health and fitness does 2 things:
- Increases knowledge; and
- Increases confidence.
It increases our knowledge of how various activities impact our health via the personalized score. For example, and this is merely speculating, but one issue I have with activity trackers is that it doesn't incorporate the health benefits of a yoga class or weight lifting in the data. All I can do is input "yoga class" or "weight lifting". This isn't really helpful.
However, the PAI will track heart rate during these activities and incorporate it into the daily score which then gives these activities more tangible meaning.
It increases our confidence in that as long as I achieve the PAI score greater than 100 each day, I know I'm enjoying health benefits based on empirical evidence stemming from the HUNT study. This confidence inspires me to continue striving each day to hit 100. The 100 score is a tangible goal that I can reach.
Again, I'm using the PAI score as an example because it's the only such algorithm concept available... but this concept could easily be applied to so many health goals including weight loss, muscle gain, etc.
Future of the PAI Concept
What is the Possible Future of the PAI Score Concept?
I'm not necessarily advocating that the PAI score is the best score for any individual to follow. The PAI score of 100 or higher is designed to reduce risk of cardio vascular disease. This may or may not be your goal.
My point is that the concept is exciting.
If something like PAI can be calculated from heart rate, think about all the potential metrics and algorithms that could be developed from all the data that wearable technology does track such as heart rate, food intake (if you input it), sweat levels, breath (not currently a metric tracked, but could be). The sky really is the limit.
It's not the data that's tracked that matters. It's how that personalized data is used for personalized health goals that matters.
And that is why I'm extremely excited about the potential of wearable technilogy with respect to improving health.
I realize even scores such as PAI will not be a sole motivator. Scores and goals will only motivate so much, but the fact such personalized goals and metrics can give us more knowledge and confidence, I believe that these new generate activity trackers will help motivate people lose weight and get healthier and therefore in the future will be definitively show to actually help people lose weight and get healthier.