Do Health Apps and Fitness Wearables Work?

smartwatches

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I get a lot of real-world questions and feedback about health apps and fitness wearables as an online health coach.

So I thought it would be interesting to look at the current state of the industry and try and answer the question:

Do Health Apps and Fitness Wearables Work?

The answer might surprise you…

For many years, I have personally used lots of health apps and wearables in multiple roles: Executive Health Coach, Health Psychology Coach, Ultra Distance Racer & Triathlete, Silicon Valley Angel Investor, High Tech Executive, and Systems Engineer. I used to track my calories on a PalmPilot, remember those?

My point is not to brag, its just that I’ve experimented as this market has evolved for over a decade. You can read my latest experiences with apps and wearables here and here and here.

health app categories

Health App and Wearable Industry Snapshot

Here is a quick snapshot of the health app and fitness wearable industry:

  • Almost $1B was invested in digital health in Q1 2016 alone [2].
  • There are now more than 100,000 apps on the iOS and Android app stores, double the market size of two and a half years ago [3].
  • The fitness tracker industry is set to almost triple from one valued at $2 billion in 2014, to $5.4 billion by 2019 [4].
image

Two 800 Pound Gorillas

There are two 800 pound gorillas in the health app and fitness wearable space:

  1. Consumer-grade wellness health apps and fitness wearables ARE effective at tracking but ARE NOT effective in creating lifestyle changes.
  1. Medical-grade illness apps and wearables are subject to ponderous US FDA regulatory oversight [5].
  • In 2014 I was an EIR to advise on the feasibility of a venture capital fund specializing in health apps for personal genetic data. Due to opaque Regulatory risks intrinsic to government agencies, I advised the fund be aborted.
  • Doctors and hospitals are not remotely prepared to make effective use of digital health data.
Health Apps Track versus Guide

Track Versus Guide: A Useful Distinction

A very useful distinction to make for health apps and fitness wearables is:

Track But Don’t Guide

Health apps and fitness wearables are well-suited to providing educational health and fitness information, reminding or altering users, recording and tracking health information, and displaying and summarizing health information (see graphic).

Tracking can be very helpful because:

What Gets Measured Gets Done

Guidance requires a higher level of engagement with the user, and in many cases is regulated by the government [6]. Guidance is based on an individuals personal situation and includes privacy-protected health and fitness information, person-to-person communication, reciprocity and accountability, caregiver and social support, and coaching for behavior change (see graphic).

Wearable Usage Tapers Off

Health App and Fitness Track Effectiveness

Below are 28 studies and insights into the effectiveness of health apps and fitness wearables.

This body of evidence can be summarized as follows:

1. An app or wearable alone IS NOT going to make you healthy in the long run.
2. Tracking DOES give you objective data on specific lifestyle changes you need to make [7].
3. Apps and wearables LACK a crucial Missing Ingredient.

Here is the detailed evidence (feel free to skip ahead to the Missing Ingredient).

  • Studies show that while 1 in 10 consumers own a digital wearable device, 50% of those consumers no longer use it and 1/3 stopped within the first six months (‘Inside Wearables’ , Endeavor Partners)
  • One study called out “the dirty secret of wearables,” citing that
  • “these devices fail to drive long-term sustained engagement for a majority of users.” according to this research.
  • Fitness trackers may be a trendy way to monitor every step we take, but these gadgets are actually pretty bad at keeping tabs on how much energy we burn, a new study suggests. Scientists pitted 12 devices like the Fitbit Flex and Jawbone Up24 against two proven methods of monitoring energy expenditure — locking people in a room to assess every calorie consumed and burned, or asking people at home to drink specially treated water that makes it possible to detect energy output with a urine test.
  • Despite thousands of apps and devices emerging in the digital health universe, the sad fact is that most have no demonstrable outcomes — they don’t clearly improve anyone’s health, and they haven’t proved they can reduce costs — ultimately leading to a lack of viability. It’s time for the sector to mature and start demonstrating its value according to a panel of digital health experts at SXSW.
  • In the first of its kind, a study published in the Annals of Internal Medicine found that while health tracking apps may help those who want to lose weight, the apps do not produce results by themselves. But the study found a subgroup of those who stuck with tracking their calories with MyFitnessPal were successful with their weight loss. “Eighty-eight percent of people who log in for seven days will lose weight,” Rebecca Silliman, a spokesperson for MyFitnessPal said. “The more you use it, the more weight you lose.”
  • Devices can even interfere with — instead of help — your workout. “I’ve noticed students bring their phones and in between sets, sit down, and seven or eight minutes go by before they get up again,” says John Raglin, Ph.D., professor of kinesiology at Indiana University. “Even if they’re entering information into a fitness-tracking app, they’re still getting distracted and not working out as hard as they could. In my opinion, it makes your workout an incomplete experience.”
  • Millions of Americans use smartphone apps that help them track how many calories they consume each day, but a new study finds that people who used a popular one after their doctor recommended it did not lose any weight. The study appears in the Nov. 18 issue of Annals of Internal Medicine.
  • If you’re rooting for smartphones to solve all our health problems, you’re not going to like what the researchers found. The smartphone app didn’t help young adults lose any more weight than if they hadn’t been using the app at all. The study, which was published in the journal Obesity.
  • Most fitness apps fail because they miss a critical component of what it takes to change long-term behaviors. For one, exercise causes many people to overeat by giving them permission to indulge. The phenomenon is called moral licensing — the psychological tendency to splurge in one area of our life when we’re being good in another.
  • Health apps are actually only helpful to those who are already healthy, according to new data. Carnegie Mellon University’s Integrated Innovation Institute has been working on an ongoing study, which has surveyed 2,000 men and women, ages 18–34, on topics ranging from financial habits to professional pursuits. Their latest report showed that while 66 percent of people who maintain a healthy diet said they find apps helpful to monitor diet and exercise, 67 percent of people who don’t maintain a healthy diet don’t find those apps helpful. Translation: health-related apps only help if you’re already doing the work to stay healthy.
  • A recent study found that fitness trackers could actually be doing you a disservice — by tracking your activity for you, you lose out on an important self-tracking step that enables you to actually modify behavior. So if you’re solely relying on a tracker to maintain good health habits, any changes you make might last only as long as you wear that tracker.
Apple Watch Health App
  • What the fitness bands do is to keep the issue front-of-mind. There it is, every time you turn on your phone: the latest stats on your progress. Most also show the results of friends who wear the same brand; it’s fitness through humiliation. In other words, the accuracy really makes little difference; the point is to keep us aware, to gamify our efforts.
  • A recent article in Forbes claims that most doctors “don’t know what to do with” data that their patients have gathered through wearable fitness devices and applications.
  • “Research has shown that if you want to stick to a new habit, monitoring is one of the best ways to make a change,” says Joshua Klapow, Ph.D., clinical psychologist at the University of Alabama at Birmingham. Since these devices have eliminated the burden of having to physically keep track of everything yourself, monitoring is easier than ever, he says. And it works: A recent study presented at the annual meeting of the American College of Sports Medicine showed that people who wore pedometers spent less time sitting, more time being active, and lost more weight than those who didn’t sport the device.
  • Over-monitoring syndrome. “You can get so caught up in tracking that it overtakes you emotionally and psychologically,” says Joshua Klapow, Ph.D., clinical psychologist at the University of Alabama at Birmingham. “Over-tracking syndrome can be problematic when the behavior you’re trying to engage in becomes secondary to the numbers.” What that means: You may lose site of overall goals (improved fitness or weight loss) in favor of meeting a steps-per-day goal. And while, sure, making 10,000 steps a day is great, if it’s keeping you out of the gym (and not necessarily helping you boost your cardiovascular fitness), you could become a slave to the wrong figures.
  • a 2014 study at Iowa State University found fitness trackers could be inaccurate when it came to measuring calories burned. Those researchers tested eight different models, and showed that error ratings ranged from 9 percent to a more startling 23.5 percent, which could have a real impact on achieving health goals.
  • A simple pedometer seems to be effective at just getting people to move, regardless of calories burned or other personal health measurements. When the pedometer became popular, a 2007 Stanford University doctor reviewed 26 studies that involved the assessment of pedometer use to determine its effectiveness as a fitness motivator. After the analysis, researchers concluded that the tool did, in fact, increase physical activity among wearers, and was also associated with significant decreases in BMI and blood pressure.
  • a 2008 study by researchers at University of Michigan Health System found that pedometer-based walking programs resulted in a consistent pattern of weight loss. Not to mention that it’s a much cheaper investment — the most basic pedometers can cost less than $10, while the more complex activity trackers can be more than $100.
  • Consumer research shows devices often fail to drive long-term engagement with users — one survey sponsored by the American Council on Exercise found a third of consumers stopped using their tracker within six months of receiving it. Nearly half stopped within a year.
  • While apps have tremendous potential to engage high-need, high-cost populations, a minority of patient-facing health applications on both the Apple and Android stores appear likely to be useful to patients.
  • On the skeptical side of the fitness app argument comes new research published in the American Journal of Preventive Medicine. When researchers from the University of Massachusetts looked at popular fitness apps, they found that while most are good for planning and calculating nutrition, their stick-to-it strategies are too narrow, meaning there’s no real behavior change.
  • Healthcare providers are often looking for ways to objectively monitor and improve their patients’ health and fitness, especially in between patient visits. Some insurance companies are using applications data as incentives to improve health and lower premiums.
  • This article from the American Journal of Medicine introduces evidence that apps can better help patients reach their health and fitness goals. It then discusses what features to look for in an app, followed by an overview of popular health and fitness apps. Last, patient scenarios with app recommendations, limitations of apps, and future research are discussed.
  • “Many app developers are not including proven behavioral strategies in their apps,” says Dr. Lenard Lesser, author of a study by University of Massachusetts Medical School, in which they compared 30 popular weight-loss apps with traditional weight-loss strategies.
  • An editorial in The New England Journal of Medicine cautions that unreliable and unregulated health apps could pose a significant threat.
  • Apps like Daily Burn , Livestrong, and FitBit, promise to help dieters shed pounds by providing calorie counts for foods, tallying up how many calories a brisk walk will melt away, and inspiring people exercise with friendly reminders and motivational messages. But researchers reporting in the American Journal of Preventive Medicine found that these digitally-based approaches to weight loss may not be as successful as old-school diet and exercise.
  • Statistics show that the rate of downloading mobile health and fitness apps is high — but so is the uninstall rate. Why is the uninstall rate so high? Industry studies all agree the number one reason is time. People don’t like the tedious process of manually entering the data, especially for calories.
  • One study showed that 41.6% of respondents had downloaded five or more health-related apps. Yet consumers are more likely to download and test the apps than really use them, the study found.
missing ingredient

A Crucial Missing Ingredient

So why aren’t health apps and fitness wearables more effective?

It can be explained quite simply:

Lack of Human Guidance

It’s tempting to say the problem is regulatory in nature, that the government is the problem. But this only applies to medical conditions, not general health and fitness.

No, the lack is something else altogether:

Human Reciprocity

We are hardwired socially, psychologically, and even genetically to respond to other people.

Human reciprocity is something apps and wearables haven’t been able to duplicate [8,9].

Think about your experience: how many times have you ignored a badge/notification/alert/email from an app? How often has your wearable graphed data that you haven’t looked after 2 weeks? The simple truth is we have no relationship with our app or wearable, so its easy to ignore it.

Think about your experience with health or fitness professionals (doctors, nurses, clinicians, nutritionists, health coach, trainer, etc). They provide us collaboration, activation and participation, information-sharing, and decision-making in your health.

Humans interaction provides levels of guidance and reciprocity that apps and wearables cannot:

  • Authoritative Information
  • Personalized Attention
  • Empathy
  • Accountability
  • Postive Psychology
  • Support
  • Sounding Board
  • Behavior Change
  • Challenge
  • Lifestyle Design
best of both worlds

The Best Of Both Worlds

An emerging trend in digital health combines human guidance with digital health and fitness tracking.

For instance, research shows that health coaching is a highly effective behavior change strategy. It increases habit adherence, decreases health costs, improves fitness, and maximizes health related goal achievement [10,11,12,13,14]. But the price and logistics of in-person coaching are not an option for many people.

Online or digital health coaches are experts who use digital tools to cost-effectively deliver services to geographically diverse groups of clients. When coaching is combined with data from wearables and apps, coaches can provide almost instant feedback on behavior. A digital health coach is trained to interpret data on both a social and psychological level and trigger new habits sustainable results (see Online Health Coaching — Is It Right For You?).

The next wave of best-in-class solutions are poised to create personal transformation by combining human guidance and reciprocity with technology, data, and psychology.

psychology trumps technology

References


  1. Do You Read Fast Enough To Be Successful?, Forbes
  2. As tracked by Rock Health..
  3. According to this mhealth industry report.
  4. According to Parks Associates.
  5. The Federal Trade Commission (FTC) has released a new interactive tool on its website, with help from the Office of National Coordinator for Health Information Technology (ONC), Office for Civil Rights (OCR) and the Food and Drug Administration (FDA), to help health app developers to determine whether certain regulations apply to their app.
  6. There are a few niche exceptions on providing medical guidance. For instance, people can voluntarily disclose their tracking data to doctors or third parties. These so-called ‘dry or ‘tracking’ studies can result in big-data insights not possible in small clinical or lab trials (so called ‘wet’ studies). The FDA also offers a limited number of waivers for new medicines or technology for ‘end of life’ scenarios such as Stage 4 disease or cancer.
  7. “People tend to overestimate how much activity they’re getting and underestimate how many calories they’re eating,” says John Raglin, Ph.D., professor of kinesiology at Indiana University. “With more objective information, you can get more specific about the changes you need to make.”
  8. “The problem, say the study authors from the University of Massachusetts Medical School, is that the apps don’t include features that help people stick with weight loss programs over the long term and help them to make permanent changes in the way they eat and exercise. They do incorporate some proven strategies for weight loss, including food logging, but the apps don’t seem as successful in generating the lasting behavior changes needed to keep the pounds off.”
  9. Developing a Framework for Evaluating the Patient Engagement, Quality, and Safety of Mobile Health Applications.

Originally published at The Healthy Executive.

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