Currently there is an explosion of interest in personal digital devices and apps that track an individual’s health data primarily for their own consumption and interpretation. Every week new products are launched that aim to measure something new or bring together a set of measures into a more useful package (e.g. Athos digital clothing that tracks muscle recruitment, heart rate etc). Around these devices is a growing community of early adopters who are testing, experimenting and sharing their experiences. These self-confessed self-tracking geeks refer to this new domain as the Quantified Self (see Wikipedia’s definition of QS).
Some examples of the types of data being tracked by these Quantified Selfers that are of particular interest to PT include:
- Activity levels (exercise) – devices generally the record number of steps taken but also can record elevation gained (number of stairs and floors) and even estimate a measure of calories burned. Example devices include the Fitbit, Nike Fuelband, Jawbone Up,Striiv and Withings Pulse.
- Body health measures – devices that track a wide variety of health measures such as heart rate, skin temperature, perspiration (e.g. the Basis watch), blood pressure (e.g. the iHealth blood pressure monitor), blood oxygen saturation (e.g. the iHealth Pulse Oximeter), heart ECG trace (e.g. Alivecor), blood sugar (e.g. iBGStar) etc.
So why should physical therapists and physiotherapists be paying attention to this trend?
Because I believe this could be the start of a significant change in healthcare where patients are increasingly encouraged and enabled to take control of and take responsibility for their own health and managing their own chronic conditions, and they are going to need our help in order to do this.
NCDs and Quantified Self
The global health course we recently completed made stark the huge and growing challenge that non-communicable diseases present for the health of the world’s population in both high, middle and low income countries. An increasing part of our work as a profession is going to be helping the suffers of these conditions manage their illnesses and also to strive to prevent these conditions developing in others through early interventions. Probably the most significant weapon at our disposal is getting patients to adopt a healthy lifestyle:
- Stopping smoking and limiting alcohol intake.
- Eating a nutritious diet based on whole foods, vegetables and fruits.
- And regular exercise.
These components of a healthy lifestyle are widely known but not widely adopted, why is this? People need to be very motivated to make the necessary changes in their lives but fostering this commitment is not easy. Several studies have shown that even one-to-one health counselling is not an effective tool for promoting appropriate lifestyle changes (Ebrahim et al 2011 studying heart disease).
How could self tracking help motivate and sustain lifestyle change
Enter the new health tracking technologies. Now it is affordable and time effective for a person to monitor their own health using many of the same metrics used by healthcare professionals and draw their own conclusions on the impact of any changes they do make in their life styles. These technologies usually incorporate an on-line component (dashboard) which adopts a variety of different techniques to encourage appropriate behaviours. For example through rewarding achievement when targets are met, allowing your progress to be shared with friends and family and even encouraging an element of competition with others through the display of leader boards showing progress.
Key aspects and role of PT/Physio
The following are what I feel to be the most important characteristics of self tracking and the related on-line support systems which will be key to its effectiveness as a tool for promoting long term life style change. In each case there is an opportunity for the PT/Physio to maximise the impact of the feature:
- Ease of use – the best devices are simply worn as a wrist band/watch or clipped to a belt and need no other user input to record data. The on-line support system needs to be clear and simple with only elements appropriate for that user and their particular condition and circumstances displayed. The PT/Physio can assist by identifying the best device and on-line support system for the patient, they could initially set up a user’s account to focus their dashboard on only the relevant features and even provide a hands-on introduction to using the tools.
- Ownership of and access to your own health data - rather than your data being held by the healthcare system and being viewed only by healthcare professionals, your health data is now yours and you can view your progress whenever it is appropriate for you and you can also chose to share this with your family, friends and peers (who may have the same condition) as well as appropriate healthcare professionals. The PT/Physio can assist the patient in understanding how to interpret their data. Also a PT/Physio following a patient’s health care data over time can provide timely feedback and interventions on progress and for problems when they occur.
- Goal setting and achievement - systems such as the FitBit provide automated rewards for predefined achievements (e.g. 5000 steps in a day) and also the ability to define your own targets. There is an important role for the PT/Physio to help a patient set appropriately challenging but realistic goals, particularly for individuals suffering from conditions where the system’s built in targets are not appropriate.
- Peer support and encouragement - sharing your data and achievements with your family, friends and peers (who could be patients with a similar condition) allows a self-support network to develop where progress can be congratulated and the progress of others used as a source of inspiration. The PT/Physio is in an excellent position to establish and monitor appropriate on-line peer groups for the maximum benefit of all participants.
- Competition - where the on-line dashboard displays leader boards comparing your data with that of your peers, inevitably competitive instincts will be aroused in some. This could be positive in encouraging greater commitment and effort, it could also be dangerous where this encourages exertion beyond safe levels. In addition the element of competition may be de-motivating for some individuals. Again the PT/Physio has a role here to help the user identify if they would benefit from viewing leader boards and on setting what limits and expectations they should apply to their competitive instincts.
Opportunities for research
This is a new and rapidly changing field which appears to hold significant promise in tackling some of our most pressing health challenges. It is clear that the Physical Therapy / Physiotherapy profession is in an excellent position to utilise these technologies to positively affect many areas of treatment, in particular the encouragement of healthier lifestyles with increased levels of appropriate exercise. What is needed is research to identify the characteristics of the best devices and support systems and to develop the most effective protocols for their use for particular user groups.
If you have already done research or are interested in research in this field please contact me at firstname.lastname@example.org as I am in the process of establishing a network of interested parties who can collaboratively develop research in this area.
Please refer to and also contribute to the Self Tracking page on Physiopedia. Thanks!