{ "count": 1546, "exportDate": "2026-04-14", "items": [ { "title": "Movement toward a novel activity monitoring device", "author": "Montgomery-Downs, H.E., Insana, S.P. and Bond, J.A.", "year": "2012", "journalProceedings": "Sleep and Breathing", "category": "Validation", "devices": "Classic", "population": "Adults", "dataUsed": "Sleep", "abstract": "Purpose: Although polysomnography is necessary for diagnosis of most sleep disorders, it is also expensive, time-consuming, intrusive, and interferes with sleep. Field-based activity monitoring is increasingly used as an alternative measure that can be used to answer certain clinical and research questions. The purpose of this study was to evaluate the reliability and validity of a novel activity monitoring device (Fitbit) compared to both polysomnography and standard actigraphy (Actiwatch-64).\nMethods: To test validity, simultaneous Fitbit and actigraph were worn during standard overnight polysomnography by 24 healthy adults at the West Virginia University sleep research laboratory. To test inter-Fitbit reliability, three participants also wore two of the Fitbit devices overnight at home.\n\nResults: Fitbit showed high intradevice reliability =96.5–99.1. Fitbit and actigraph differed significantly on recorded total sleep time and sleep efficiency between each other and polysomnography. Bland–Altman plots indicated that both Fitbit and actigraph overestimated sleep efficiency and total sleep time. Sensitivity of both Fitbit and actigraphy for accurately identifying sleep was high within all sleep stages and during arousals; specificity of both Fitbit and actigraph for accurately identifying wake was poor. Specificity of actigraph was higher except for wake before sleep onset; sensitivity of Fitbit was higher in all sleep stages and during arousals.\n\nConclusions: The web-based Fitbit, available at a markedly reduced price and with several convenience factors compared to standard actigraphy, may be an acceptable activity measurement instrument for use with normative populations. However, Fitbit has the same specificity limitations as actigraphy; both devices consistently misidentify wake as sleep and thus overestimate both sleep time and quality. Use of the Fitbit will also require specific validation before it can be used to assess disordered populations and or different age groups.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s11325-011-0585-y", "newWindow": true } ] }, { "title": "Accuracy of the Fitbit pedometer for self-paced and prescribed physical activity", "author": "Ramirez, E., Peterson, C., Wu, W. and Norman, G.J.", "year": "2012", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Classic", "population": "Adults", "dataUsed": "Steps", "abstract": "PURPOSE: The purpose of this study was to examine the validity of the Fitbit pedometer (FB; Fitbit Inc.) for measuring steps taken during self-paced and prescribed physical activity.\nMETHODS: A total of 17 adults (8 males, 9 females; age = 41.19, BMI = 28.82 kg/m2) participated in this study. Participants completed four to eight bouts of physical activities in a laboratory condition and in a simulated free-living condition. During the laboratory (treadmill) condition participants completed walking bouts at a slow pace (1.5 mph), a normal pace (3.0 mph), a brisk pace (4.0 mph) and one jogging bout (5.5 mph). Each bout lasted three minutes. Participants then completed 400m self-paced walking bouts at slow, normal, and brisk paces as well as one 400m jog on an outdoor track.. Male participants wore one FB and one Omron HJ-720IT (OM) on the right hip attached to an elastic belt and one FB in the right front pocket. Female participants wore the devices in the same configuration but also wore an additional FB attached to the front/center of the sports bra. Absolute and percent differences were calculated for FB vs. directly observed (DO) steps. Linear mixed models were determined effects of body location, speed, condition (laboratory vs. free-living) on FB accuracy.\n\nRESULTS:The magnitude of the difference between DO and the FB devices (M(SD); range) across all activities was small for both the FB-waist (2.0%(4.7%); -6 - 23%) and FB-bra (0.8%(4.3%); -11 - 15%) and moderate for the FB-pocket (8.8%(16.8%); 4 - 74%). Model parameter estimates from the full factorial mixed-model indicated the FB under estimated by 24 (SE = 2.83) steps across all conditions compared to direct observation. Significant parameter estimates for body location, speed and the body location × speed interaction (all p textless .001) indicated that the FB in the pocket underestimated steps more than on the waist, both devices underestimated steps more as speed increased, and the magnitude of the underestimation increased more for the pocket compared to the waist as speed increased.\n\nCONCLUSIONS:The FB appears to be a valid device for assessing step counts in adults when worn on the waist. Caution should be taken when assessing activities at higher ambulatory speeds. Further research is needed to better understand the validity of the FB in free-living conditions.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2012/05002/Abst_D_FreeCommPosters.5.aspx", "newWindow": true } ] }, { "title": "Evaluating Physical Activity Monitors for Use in Personal Health Research", "author": "Wilcox, L. and Feiner, S.", "year": "2012", "journalProceedings": "Ubicomp 2012 Workshop on Evaluating Off- the-Shelf Technologies for Personal Health Monitoring", "category": "Usability", "devices": "Classic", "population": "NA", "dataUsed": "NA", "abstract": "We propose to evaluate end-user physical activity monitors that can record and display information such as distance, pace and/or cadence information, and physiological information such as current and average heart rate and calories burned. This evaluation will be conducted to aid us in framing high-level approaches for evaluating physical activity monitoring devices used in research systems and studies. The devices we evaluate need not only comply with standard development technologies employed in research systems (such as web-based programming languages and data acquisition protocols), but must also be usable by study participants who will rely on them to capture activity data in a range of scenarios.", "links": [ { "caption": "URL", "url": "http://laurenwilcox.net/papers/WilcoxFeiner.pdf", "newWindow": true } ] }, { "title": "Functional recovery in the elderly after major surgery: assessment of mobility recovery using wireless technology.", "author": "Cook, D.J., Thompson, J.E., Prinsen, S.K., Dearani, J.A. and Deschamps, C.", "year": "2013", "journalProceedings": "The Annals of Thoracic Surgery", "category": "Usability,Medical", "devices": "Classic", "population": "Older Adults,Patients", "dataUsed": "Steps", "abstract": "PURPOSE: Hospitalization and surgery in older patients often leads to a loss of strength, mobility, and functional capacity. We tested the hypothesis that wireless accelerometry could be used to measure mobility during hospital recovery after cardiac surgery.\n\nDESCRIPTION: We used an off-the-shelf fitness monitor to measure daily mobility in patients after surgery. Data were transmitted wirelessly, aggregated, and configured onto a provider-viewable dashboard.\n\nEVALUATION: Wireless monitoring of mobility after major surgery was easy and practical. There was a significant relationship between the number of steps taken in the early recovery period, length of stay, and dismissal disposition.\n\nCONCLUSIONS: Wireless monitoring of mobility after major surgery creates an opportunity for early identification and intervention in individual patients and could serve as a tool to evaluate and improve the process of care and to affect postdischarge outcomes.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0003497513012538", "newWindow": true } ] }, { "title": "A comparison of energy expenditure estimation of several physical activity monitors.", "author": "Dannecker, K.L., Sazonova, N.A., Melanson, E.L., Sazonov, E.S. and Browning, R.C.", "year": "2013", "journalProceedings": "Medicine and Science in Sports and Exercise", "category": "Validation", "devices": "Classic", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "NTRODUCTION: Accurately and precisely estimating free-living energy expenditure (EE) is important for monitoring energy balance and quantifying physical activity. Recently, single and multisensor devices have been developed that can classify physical activities, potentially resulting in improved estimates of EE.\n\nPURPOSE: This study aimed to determine the validity of EE estimation of a footwear-based physical activity monitor and to compare this validity against a variety of research and consumer physical activity monitors.\n\nMETHODS: Nineteen healthy young adults (10 men, 9 women) completed a 4-h stay in a room calorimeter. Participants wore a footwear-based physical activity monitor as well as Actical, ActiGraph, IDEEA, DirectLife, and Fitbit devices. Each individual performed a series of postures/activities. We developed models to estimate EE from the footwear-based device, and we used the manufacturer's software to estimate EE for all other devices.\n\nRESULTS: Estimated EE using the shoe-based device was not significantly different than measured EE (mean ± SE; 476 ± 20 vs 478 ± 18 kcal, respectively) and had a root-mean-square error of 29.6 kcal (6.2%). The IDEEA and the DirectLlife estimates of EE were not significantly different than the measured EE, but the ActiGraph and the Fitbit devices significantly underestimated EE. Root-mean-square errors were 93.5 (19%), 62.1 kcal (14%), 88.2 kcal (18%), 136.6 kcal (27%), 130.1 kcal (26%), and 143.2 kcal (28%) for Actical, DirectLife, IDEEA, ActiGraph, and Fitbit, respectively.\n\nCONCLUSIONS: The shoe-based physical activity monitor provides a valid estimate of EE, whereas the other physical activity monitors tested have a wide range of validity when estimating EE. Our results also demonstrate that estimating EE based on classification of physical activities can be more accurate and precise than estimating EE based on total physical activity.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3800491/", "newWindow": true } ] }, { "title": "Quantified Recess: Design of an Activity For Elementary Students Involving Analyses of Their Own Movement Data", "author": "Lee, V.R. and Drake, J.", "year": "2013", "journalProceedings": "Proceedings of the 12th International Conference on Interaction Design and Children", "category": "Usability", "devices": "Ultra", "population": "Children", "dataUsed": "Steps", "abstract": "Recess is often a time for children in school to engage recreationally in physically demanding and highly interactive activities with their peers. This paper describes a design effort to encourage fifth-grade students to examine sensitivities associated with different measures of center by having them analyze activities during recess using over the course of a week using Fitbit activity trackers and TinkerPlots data visualization software. We describe the activity structure some observed student behaviors during the activity. We also provide a descriptive account, based on video records and transcripts, of two students who engaged thoughtfully with their recess data and developed a more sophisticated understanding of when and how outliers affect means and medians.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=2485760.2485822", "newWindow": true } ] }, { "title": "An evaluation of wearable activity monitoring devices", "author": "Guo, F., Li, Y., Kankanhalli, M.S. and Brown, M.S.", "year": "2013", "journalProceedings": "Proceedings of the 1st ACM international workshop on Personal data meets distributed multimedia - PDM '13", "category": "Validation", "devices": "Ultra,One,Zip", "population": "Adults", "dataUsed": "Steps,Distance", "abstract": "This paper examines an increasingly relevant topic in the multimedia community of wearable devices that record the physical activity of a user throughout a day. While activity and other accelerometry-based data has been shown effective in various multimedia applications -- from context-aware music retrieval to approximating carbon footprint -- the most promising role of these target application for healthcare and personal fitness. Recently, several low-cost devices have become available to consumers. In this paper, we perform an evaluation on the most popular devices available on the market (in particular Fitbit and Nike+) and report our findings in terms of accuracy, type of data provided, available APIs, and user experience. This information is useful for researchers considering incorporating these activity-based data streams into their research and for getting a better idea of the reliability and accuracy for use in life-logging and other multimedia applications.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?id=2509352.2512882", "newWindow": true } ] }, { "title": "Phases of Accuracy Diagnosis: (In)visibility of System Status in the Fitbit", "author": "Mackinlay, M.Z.", "year": "2013", "journalProceedings": "Intersect: The Stanford Journal of Science, Technology and Society", "category": "Usability", "devices": "One", "population": "Older Adults", "dataUsed": "NA", "abstract": "This paper analyzes the Fitbit – an all-in-one step, floor, distance, calorie, and sleep tracker – in order to discover how users approach and deal with the question of accuracy in black-box systems. Due to learned expectations of system unreliability, users are skeptical of the authenticity of Fitbit-recorded data. However, due to the limited visibility of system status their efforts to test and calibrate their data are ultimately flawed. Users move through four main phases in which they perform a number of tests to diagnose and understand the Fitbit's level of precision, while revising their mental model of the Fitbit itself and attempting to calibrate their personal use of the device. This paper examines the results of seven interviews with Fitbit users, hypothesizes and describes four phases of use many Fitbit users undergo, and critiques the usability problems that these interviews unearthed.", "links": [ { "caption": "URL", "url": "http://ojs.stanford.edu/ojs/index.php/intersect/article/view/555", "newWindow": true } ] }, { "title": "Live Long and Prosper: Potentials of Low-Cost Consumer Devices for the Prevention of Cardiovascular Diseases", "author": "Meyer, J. and Hein, A.", "year": "2013", "journalProceedings": "Medicine 2.0", "category": "Usability,Measurement", "devices": "Ultra", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Background: Cardiovascular diseases (CVD) are one of the major causes of death worldwide. Personal behavior such as physical activity considerably influences the risk of incurring a CVD. In the last years numerous products such as pedometers have become available on the mass market that allow monitoring relevant behaviors and vital parameters. These devices are sufficiently precise, affordable, and easy to use. While today they are mostly lifestyle oriented they also have considerable potential for health and prevention. Objective: Our goal is to investigate how recent low-cost devices can be used in real-life settings for the prevention of CVD, and whether using these devices has an advantage over subjective self-assessment. We also examine whether it is feasible to use multiple of such devices in parallel. Methods: We observe whether and how persons are willing and able to use multiple devices in their daily lives. We compare the devices&8217; measurements with subjective self-assessment. We make use of existing low-cost consumer devices to monitor a user's behavior. By mapping the devices' features with pre-defined prevention goals we ensure that the system collects meaningful data that can be used to monitor the individual's behavior. We conducted a user study with 10 healthy adults to measure usability and to identify problems with sensor use in real life. The participants used the devices' original portals to monitor their behavior. The subjects (age range 35-75) used an off-the-shelf pedometer and a sports watch for 4 weeks. Results: The participants responded in principle positively to the use of the devices. Analyzing the sensor data, we found that the users had some difficulties in operating the devices. We also found that the participants' self-assessment of their health behavior was too optimistic compared to the monitored data. They rated the usability of the overall system with 71 of up to 100 points in the &34;System Usability Scale&34;. Conclusions: Our study indicates that today's devices are suitable for a long term monitoring of health for the prevention of CVD. Using the devices provides more precise data than a subjective self-assessment. However usability and acceptance of the systems are still major topics.", "links": [ { "caption": "URL", "url": "http://www.medicine20.com/2013/2/e7/", "newWindow": true } ] }, { "title": "Comparison of steps and energy expenditure assessment in adults of Fitbit Tracker and Ultra to the Actical and indirect calorimetry.", "author": "Noah, A.J., Spierer, D.K., Gu, J. and Bronner, S.", "year": "2013", "journalProceedings": "Journal of Medical Engineering & Technology", "category": "Validation", "devices": "Classic,Ultra", "population": "Adults", "dataUsed": "Steps,Energy Expenditure", "abstract": "Epidemic levels of inactivity are associated with chronic diseases and rising healthcare costs. To address this, accelerometers have been used to track levels of activity. The Fitbit and Fitbit Ultra are some of the newest commercially available accelerometers. The purpose of this study was to determine the reliability and validity of the Fitbit and Fitbit Ultra. Twenty-three subjects were fitted with two Fitbit and Fitbit Ultra accelerometers, two industry-standard accelerometers and an indirect calorimetry device. Subjects participated in 6-min bouts of treadmill walking, jogging and stair stepping. Results indicate the Fitbit and Fitbit Ultra are reliable and valid for activity monitoring (step counts) and determining energy expenditure while walking and jogging without an incline. The Fitbit and standard accelerometers under-estimated energy expenditure compared to indirect calorimetry for inclined activities. These data suggest the Fitbit and Fitbit Ultra are reliable and valid for monitoring over-ground energy expenditure.", "links": [ { "caption": "URL", "url": "http://www.tandfonline.com/doi/abs/10.3109/03091902.2013.831135?journalCode=ijmt20", "newWindow": true } ] }, { "title": "Monitoring daily function in persons with transfemoral amputations using a commercial activity monitor: A feasibility study", "author": "Albert, M.V., Deeny, S., McCarthy, C., Valentin, J. and Jayaraman, A.\t", "year": "2014", "journalProceedings": "PM and R", "category": "Usability", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps,Energy Expenditure,Distance", "abstract": "Objective: To assess in a feasibility study the mobility of persons with transfemoral amputations using data collected from a popular, consumer-oriented activity monitor (Fitbit). Design: Observational cohort study.\nSetting: Research hospital outpatient evaluation. Participants: Nine subjects with transfemoral amputations (4 women and 5 men, ages 21-64 years) and Medicare functional assessments (K level) of K3 (n= 7), K2 (n= 1), and K4 (n= 1).\n\nMethods: One-week monitoring of physical activity using the Fitbit One activity monitor. Main Outcome Measures: Daily estimates of step counts, distance walked, floors/stairs climbed, calories burned, and proprietary Fitbit activity scores. For each day, the amount of time in each of the following levels of activity was also reported: sedentary, lightly active, fairly active, and highly active.\n\nResults: The percentage of movement time above the fairly active level had a predictable relationship to the designated K level. The average activity measures show decreased levels of activity for obese subjects (body mass index > 30). Estimated step counts were highly predictive/redundant with estimated miles walked without setting individual stride lengths. Using linear regression prediction models, calorie estimates were found to be highly dependent on subject age, height, and weight, whereas the proprietary activity score was independent of all 3 demographic factors.\n\nConclusions: This feasibility study demonstrates that the Fitbit activity monitor estimates the activity of subjects with transfemoral amputations, producing results that correlate with their K-level functional activity classifications. The Fitbit activity score is independent of individual variations in age, weight, and height compared with estimated calories for this small sample size. These tools may provide useful insights into prosthetic use in an at-home environment.", "links": [ { "caption": "URL", "url": "http://www.pmrjournal.org/article/S1934-1482(14)00279-2/abstract", "newWindow": true } ] }, { "title": "Enhancing physical activity promotion in midlife women with technology-based self-monitoring and social connectivity: A pilot study.", "author": "Butryn, M.L., Arigo, D., Raggio, G.a., Colasanti, M. and Forman, E.M.", "year": "2014", "journalProceedings": "Journal of Health Psychology", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Sleep,Weight,Food", "abstract": "This pilot study tested a novel program to promote adoption and maintenance of aerobic activity in midlife women. Lifestyle modification group sessions were held weekly for 3 months, followed by two booster sessions during the 3-month maintenance phase. During all 6 months of the program, participants used a physical activity sensor to automate self-monitoring and a web platform to facilitate social connectivity. Aerobic exercise increased from 63 to 132?minute/week from baseline to 3 months (p?textless?.01), and activity was maintained at 6 months (135?minute/week). Technology enhancements have strong potential to promote maintenance of behavior change.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/25488937", "newWindow": true } ] }, { "title": "P.\tHealthyTogether: Exploring Social Incentives for Mobile Fitness Applications", "author": "Chen, Y. and Pu, P.\t", "year": "2014", "journalProceedings": "Proceedings of the Second International Symposium of Chinese CHI", "category": "Intervention", "devices": "Ultra,One", "population": "Adults", "dataUsed": "Steps", "abstract": "A crucial element in many mobile fitness applications is gamification that makes physical activities fun. While many methods focus on competition and individual users' interaction with the game, the aspect of social interaction and how users play games together in a group remains an open subject. To investigate these issues, we developed a mobile game, HealthyTogether, to understand how users interact in different group gamification settings: competition, cooperation, or hybrid. We describe the results of a user study involving 18 dyads (N=36) over a period of two weeks. Results show that users significantly enhanced physical activities using HealthyTogether compared with when they exercised alone by up to 15%. Among the group settings, cooperation (21% increase) and hybrid (18% increase) outperformed competition (8% increase). Additionally, users sent significantly more messages in cooperation setting than hybrid and competition. Furthermore, physical activities are positively correlated with the number of messages they exchanged. Based on the findings, we derive design implications for practitioners.", "links": [] }, { "title": "Feasibility of Using Fitbit Flex to Motivate People with Rheumatoid Arthritis to BE Physically Active", "author": "Feehan, L., Clayton, C., Carruthers, E. and Li, L.", "year": "2014", "journalProceedings": "Annals of the Rheumatic Diseases", "category": "Usability", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps,Energy Expenditure,Intensity", "abstract": "Background: Physical activity (PA) can reduce pain and fatigue and improve quality of life in people with rheumatoid arthritis (RA), but adherence to an active lifestyle is poor. Wearable digital devices, such as Fitbit Flex™, are commercially available for people to track their PA and obtain on-demand feedback, with a goal to motivate users to be physically active. Most devices are designed for the general public. It is unclear whether it is feasible for people with RA, who have unique challenges with physical activity, to use these devices.\nObjectives: To examine the feasibility for people with RA to use Fitbit Flex for tracking their PA and motivating them to be active.\n\nMethods: Participants were recruited from rheumatologists' offices and online in Vancouver, Canada. Individuals were eligible if they were age 19 or older, had physician-diagnosed RA, were available for an orientation session, and had daily access to computer and internet service. Individuals with comorbid conditions that prevented them from being physically active were excluded. Eligible participants were given a Fitbit Flex to wear on the non-dominant wrist for 4 weeks. Instructions were provided to set up the device and their online personal profile, where they could view at real time their step count, caloric output, number of active minutes and sleep quality of the previous night. Participants also wore a SenseWear Mini™ accelerometer, a validated tool for measuring physical activity in RA patients, during the first and last 7 days of the study. Step count, energy expenditure, active time and sedentary time were compared between the two monitors using paired t-test. Participants were also asked to rate on a 5-point scale their experience with Fitbit at the end of 4 weeks.\n\nResults: 10 people with RA were recruited in September 2013. The majority were women (n=8) with a median age of 57 years (IQR=17; 67). All participants adhered to the 4-week protocol. The mean rating of the overall experience with the device and the online profile was 4.7 and 4.1, respectively. Compared to Sensewear, Fitbit recorded significantly higher step counts and total sedentary time, and lower total energy expenditure and light activity time. No significant difference was found in the moderate/vigorous physical activity (MVPA) time between the two devices.\n\nConclusions: Participants enjoyed using Fitbit Flex to monitor their physical activity. However, it appeared to overestimate the number of steps and sedentary time, and underestimate light activity time and total energy expenditure. Our findings suggest that Fitbit may be more suitable for motivating patients with RA to increase MVPA than to decrease sedentary behaviours.", "links": [ { "caption": "URL", "url": "http://ard.bmj.com/content/73/Suppl_2/1204.3.abstract", "newWindow": true } ] }, { "title": "Validity of using tri-axial accelerometers to measure human movement - Part II: Step counts at a wide range of gait velocities.", "author": "Fortune, E., Lugade, V., Morrow, M. and Kaufman, K.", "year": "2014", "journalProceedings": "Medical Engineering & Physics", "category": "Validation", "devices": "Classic", "population": "Adults", "dataUsed": "Steps", "abstract": "A subject-specific step counting method with a high accuracy level at all walking speeds is needed to assess the functional level of impaired patients. The study aim was to validate step counts and cadence calculations from acceleration data by comparison to video data during dynamic activity. Custom-built activity monitors, each containing one tri-axial accelerometer, were placed on the ankles, thigh, and waist of 11 healthy adults. ICC values were greater than 0.98 for video inter-rater reliability of all step counts. The activity monitoring system (AMS) algorithm demonstrated a median (interquartile range; IQR) agreement of 92% (8%) with visual observations during walking/jogging trials at gait velocities ranging from 0.1 to 4.8m/s, while FitBits (ankle and waist), and a Nike Fuelband (wrist) demonstrated agreements of 92% (36%), 93% (22%), and 33% (35%), respectively. The algorithm results demonstrated high median (IQR) step detection sensitivity (95% (2%)), positive predictive value (PPV) (99% (1%)), and agreement (97% (3%)) during a laboratory-based simulated free-living protocol. The algorithm also showed high median (IQR) sensitivity, PPV, and agreement identifying walking steps (91% (5%), 98% (4%), and 96% (5%)), jogging steps (97% (6%), 100% (1%), and 95% (6%)), and less than 3% mean error in cadence calculations.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1350453314000289", "newWindow": true } ] }, { "title": "Accuracy of 2 activity monitors in detecting steps in people with stroke and traumatic brain injury.", "author": "Fulk, G.D., Combs, S.A., Danks, K.A., Nirider, C.D., Raja, B. and Reisman, D.S.", "year": "2014", "journalProceedings": "Physical Therapy", "category": "Medical,Validation", "devices": "Ultra", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Advances in sensor technologies and signal processing techniques provide a method to accurately measure walking activity in the home and community. Activity monitors geared toward consumer or patient use may be an alternative to more expensive monitors designed for research to measure stepping activity.\nOBJECTIVE: The objective of this study was to examine the accuracy of 2 consumer/patient activity monitors, the Fitbit Ultra and the Nike+ Fuelband, in identifying stepping activity in people with stroke and traumatic brain injury (TBI). Secondarily, the study sought to compare the accuracy of these 2 activity monitors with that of the StepWatch Activity Monitor (SAM) and a pedometer, the Yamax Digi-Walker SW-701 pedometer (YDWP).\n\nDESIGN: A cross-sectional design was used for this study. METHOD: People with chronic stroke and TBI wore the 4 activity monitors while they performed the Two-Minute Walk Test (2MWT), during which they were videotaped. Activity monitor estimated steps taken were compared with actual steps taken counted from videotape. Accuracy and agreement between activity monitor estimated steps and actual steps were examined using intraclass correlation coefficients (ICC [2,1]) and the Bland-Altman method.\n\nRESULTS: The SAM demonstrated the greatest accuracy (ICC [2,1]=.97, mean difference between actual steps and SAM estimated steps=4.7 steps) followed by the Fitbit Ultra (ICC [2,1]=.73, mean difference between actual steps and Fitbit Ultra estimated steps=-9.7 steps), the YDWP (ICC [2,1]=.42, mean difference between actual steps and YDWP estimated steps=-28.8 steps), and the Nike+ Fuelband (ICC [2,1]=.20, mean difference between actual steps and Nike+ Fuelband estimated steps=-66.2 steps). LIMITATIONS: Walking activity was measured over a short distance in a closed environment, and participants were high functioning ambulators, with a mean gait speed of 0.93 m/s.\n\nCONCLUSIONS: The Fitbit Ultra may be a low-cost alternative to measure the stepping activity in level, predictable environments of people with stroke and TBI who can walk at speeds =0.58 m/s.", "links": [ { "caption": "URL", "url": "http://ptjournal.apta.org/content/94/2/222.short", "newWindow": true } ] }, { "title": "Comparison of FitBit® Ultra to ActiGraph™ GT1M for Assessment of Physical Activity in Young Adults During Treadmill Walking", "author": "Gusmer, R., Bosch, T., Watkins, A., Ostrem, J. and Dengel, D.", "year": "2014", "journalProceedings": "The Open Sports Medicine Journal", "category": "Validation", "devices": "Classic", "population": "Adults", "dataUsed": "Steps,Energy Expenditure", "abstract": "Introduction: Accelerometers are used to quantify energy expenditure in field research. The ActiGraph™ GT1M (ActiGraph™) is a commonly used accelerometer for research. The FitBit® Ultra (FitBit®) is a low-cost alternative to the ActiGraph™; however, there is limited research on the validity of this device.\nPurpose: The pilot study compares the FitBit® against the ActiGraph™ and metabolic cart for measurement of energy expenditure and step counts during treadmill walking.\n\nMethods: Thirty-two (25 female) adults, mean age 22±2 years, performed two thirty-minute phases of walking (slow and brisk) on a treadmill while concurrently wearing the FitBit® and the ActiGraph™. Energy expenditure estimates were compared against energy expenditure measured by a metabolic cart. The Pearson’s correlation and t-tests determine the linear association and similarity between the accelerometers.\n\nResults: Energy expenditure estimate is moderately correlated between the two accelerometers during slow walking (r=0.584, p=0.011) and strongly correlated during brisk walking (r=0.910, p<0.001). Step count is strongly correlated between the accelerometers during slow (r=0.974, p<0.001) and brisk (r=0.996, p<0.001) walking. The FitBit® significantly underestimated energy expenditure during brisk walking compared to metabolic cart data. There is no difference between the slow and brisk phases’ step counts using either accelerometer.\n\nConclusion: The results of this pilot study suggest that the FitBit® and the ActiGraph™ can be used interchangeably to measure steps, but not to measure kilocalories. Furthermore, the FitBit® underestimates energy expenditure, compared to a metabolic cart, as exercise intensity increases. This limits its ability to accurately measure energy expenditure in active populations.", "links": [ { "caption": "URL", "url": "http://benthamopen.com/ABSTRACT/TOSMJ-8-11", "newWindow": true } ] }, { "title": "A Qualitative Analysis of User Experiences With a Self-Tracker for Activity, Sleep, and Diet", "author": "Kim, J.\t", "year": "2014", "journalProceedings": "Interactive Journal of Medical Research", "category": "Usability", "devices": "Classic", "population": "Adults", "dataUsed": "NA", "abstract": "Background: The recent increase in chronic diseases and an aging population warrant the necessity of health self-management. As small electronic devices that track one&8217;s activity, sleep, and diet, called self-trackers, are being widely distributed, it is prudent to investigate the user experience and the effectiveness of these devices, and use the information toward engineering better devices that would result in increased efficiency and usability.\n\n Objective: The aim of this study was to abstract the constructs that constitute the user experiences of the self-tracker for activity, sleep, and diet. Additionally, we aimed to develop and verify the Health Information Technology Acceptance Model-II (HITAM-II) through a qualitative data analysis approach. \n\nMethods: The study group consisted of 18 female college students who participated in an in-depth interview after completing a 3-month study of utilizing a self-tracker designed to monitor activity, sleep, and diet. The steps followed in the analysis were: (1) extraction of constructs from theoretical frameworks, (2) extraction of constructs from interview data using a qualitative methodology, and (3) abstraction of constructs and modeling of the HITAM-II. \n\nResults: The constructs that constitute the HITAM-II are information technology factors, personal factors, social factors, attitude, behavioral intention, and behavior. These constructs are further divided into subconstructs to additionally support the HITAM-II. \n\nConclusions: The HITAM-II was found to successfully describe the health consumer&8217;s attitude, behavioral intention, and behavior from another perspective. The result serves as the basis for a unique understanding of the user experiences of HIT.", "links": [ { "caption": "URL", "url": "http://www.i-jmr.org/2014/1/e8/", "newWindow": true } ] }, { "title": "Increasing physical activity in young adults with autism spectrum disorders", "author": "LaLonde, K.B., MacNeill, B.R., Eversole, L.W., Ragotzy, S.P. and Poling, A.", "year": "2014", "journalProceedings": "Research in Autism Spectrum Disorders", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Although regular physical exercise is clearly beneficial, many people with autism spectrum disorders do not exercise regularly. The present study used a multiple-baseline-across-participants design with a reversal to demonstrate that a treatment package comprising goal-setting and reinforcement substantially increased walking by young adults with autism spectrum disorders while at school. During the initial baseline condition participants were given pedometers to wear. Once each participant's number of steps stabilized, she/he sets daily goals for minimum number of steps taken and received access to valued objects or activities (reinforcers) for meeting those goals. By the end of the first treatment condition each of five participants was successfully meeting his or her goal and walking at or above 10,000 steps each day. Walking decreased when a return to baseline was implemented, then increased when treatment was reinstated. Social validity assessment indicated that both the participants and their teacher found the intervention highly acceptable. These findings suggest that simple strategies based on goal setting and reinforcement merit further investigation as interventions for increasing exercise.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1750946714002104", "newWindow": true } ] }, { "title": "Validity of consumer-based physical activity monitors.", "author": "Lee, J.-M., Kim, Y. and Welk, G.J.", "year": "2014", "journalProceedings": "Medicine and Science in Sports and Exercise", "category": "Validation", "devices": "One,Zip", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "BACKGROUND: Many consumer-based monitors are marketed to provide personal information on the levels of physical activity and daily energy expenditure (EE), but little or no information is available to substantiate their validity.\nPURPOSE: This study aimed to examine the validity of EE estimates from a variety of consumer-based, physical activity monitors under free-living conditions.\n\nMETHODS: Sixty (26.4 ± 5.7 yr) healthy males (n = 30) and females (n = 30) wore eight different types of activity monitors simultaneously while completing a 69-min protocol. The monitors included the BodyMedia FIT armband worn on the left arm, the DirectLife monitor around the neck, the Fitbit One, the Fitbit Zip, and the ActiGraph worn on the belt, as well as the Jawbone Up and Basis B1 Band monitor on the wrist. The validity of the EE estimates from each monitor was evaluated relative to criterion values concurrently obtained from a portable metabolic system (i.e., Oxycon Mobile). Differences from criterion measures were expressed as a mean absolute percent error and were evaluated using 95% equivalence testing.\n\nRESULTS: For overall group comparisons, the mean absolute percent error values (computed as the average absolute value of the group-level errors) were 9.3%, 10.1%, 10.4%, 12.2%, 12.6%, 12.8%, 13.0%, and 23.5% for the BodyMedia FIT, Fitbit Zip, Fitbit One, Jawbone Up, ActiGraph, DirectLife, NikeFuel Band, and Basis B1 Band, respectively. The results from the equivalence testing showed that the estimates from the BodyMedia FIT, Fitbit Zip, and NikeFuel Band (90% confidence interval = 341.1-359.4) were each within the 10% equivalence zone around the indirect calorimetry estimate.\n\nCONCLUSIONS: The indicators of the agreement clearly favored the BodyMedia FIT armband, but promising preliminary findings were also observed with the Fitbit Zip.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/pages/articleviewer.aspx?year=2014&issue=09000&article=00020&type=abstract", "newWindow": true } ] }, { "title": "Behavior Change Techniques Implemented in Electronic Lifestyle Activity Monitors: A Systematic Content Analysis", "author": "Lyons, E.J., Lewis, Z.H., Mayrsohn, B.G. and Rowland, J.L.\t", "year": "2014", "journalProceedings": "Journal of Medical Internet Research", "category": "Review", "devices": "Force", "population": null, "dataUsed": null, "abstract": "Background: Electronic activity monitors (such as those manufactured by Fitbit, Jawbone, and Nike) improve on standard pedometers by providing automated feedback and interactive behavior change tools via mobile device or personal computer. These monitors are commercially popular and show promise for use in public health interventions. However, little is known about the content of their feedback applications and how individual monitors may differ from one another. \n\nObjective: The purpose of this study was to describe the behavior change techniques implemented in commercially available electronic activity monitors. \n\nMethods: Electronic activity monitors (N=13) were systematically identified and tested by 3 trained coders for at least 1 week each. All monitors measured lifestyle physical activity and provided feedback via an app (computer or mobile). Coding was based on a hierarchical list of 93 behavior change techniques. Further coding of potentially effective techniques and adherence to theory-based recommendations were based on findings from meta-analyses and meta-regressions in the research literature. \n\nResults: All monitors provided tools for self-monitoring, feedback, and environmental change by definition. The next most prevalent techniques (13 out of 13 monitors) were goal-setting and emphasizing discrepancy between current and goal behavior. Review of behavioral goals, social support, social comparison, prompts/cues, rewards, and a focus on past success were found in more than half of the systems. The monitors included a range of 5-10 of 14 total techniques identified from the research literature as potentially effective. Most of the monitors included goal-setting, self-monitoring, and feedback content that closely matched recommendations from social cognitive theory. \n\nConclusions: Electronic activity monitors contain a wide range of behavior change techniques typically used in clinical behavioral interventions. Thus, the monitors may represent a medium by which these interventions could be translated for widespread use. This technology has broad applications for use in clinical, public health, and rehabilitation settings.", "links": [ { "caption": "URL", "url": "http://www.jmir.org/2014/8/e192/", "newWindow": true } ] }, { "title": "Can Patient Use of Daily Activity Monitors Change Nurse Practitioner Practice?", "author": "Mancuso, P.J., Thompson, M., Tietze, M., Kelk, S. and Roux, G.\t", "year": "2014", "journalProceedings": "The Journal for Nurse Practitioners", "category": "Review", "devices": "One,Flex", "population": "NA", "dataUsed": "NA", "abstract": "Expanding markets of empowered health care consumers have spurred entrepreneurs to develop innovative fitness devices designed to be worn on a daily basis. The purpose of this article is to discuss challenges, usability, and privacy issues and highlight physiological and psychological parameters of 5 common fitness devices for clinical use in advanced practice. Nurse practitioners can educate patients on the use of these devices for health promotion or therapeutic interventions to foster self-management of chronic conditions, such as diabetes and obesity. Future research on clinical applications of activity monitors is needed with large samples representing diverse populations.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1555415514005881", "newWindow": true } ] }, { "title": "Becoming Reflective: Designing for Reflection on Physical Performances", "author": "Moher, T., Ching, C., Schaefer, S., Lee, V., et al. ", "year": "2014", "journalProceedings": "ICLS 2014 Proceedings", "category": "Usability", "devices": "One,Zip", "population": "Children", "dataUsed": "Steps", "abstract": "Learners' physical performances can serve as focal objects for reflection and insight across a variety of contexts and content areas. This session brings together a set of projects that leverage the physical performances of learners, construct concrete and abstract representations of those performances, and investigate how learners reflect on and understand the relationships between their performances and target content—physics, health and fitness, data literacy and navigation, animal foraging, and climate change. The session will share findings and design principles from each of the studies around constructing technological scaffolds for physical performance reflections. The symposium highlights the various ways performance can be used to engage learners, and how different settings and learning goals affect the designs of performance representations.", "links": [ { "caption": "URL", "url": "http://digitalcommons.usu.edu/itls_facpub/490/http://", "newWindow": true } ] }, { "title": "Effect of walking speed and placement position interactions in determining the accuracy of various newer pedometers", "author": "Park, W., Lee, V.J., Ku, B. and Tanaka, H.", "year": "2014", "journalProceedings": "Journal of Exercise Science & Fitness", "category": "Validation", "devices": "Ultra", "population": "Adults", "dataUsed": "Steps", "abstract": "Older types of pedometers had varied levels of accuracy, which ranged from 0% to 45%. In addition, to obtain accurate results, it was also necessary to position them in a certain way. By contrast, newer models can be placed anywhere on the body; however, their accuracy is unknown when they are placed at different body sites. We determined the accuracy of various newer pedometers under controlled laboratory and free walking conditions. A total of 40 participants, who varied widely in age and body mass index, were recruited for the study. The numbers of steps recorded using five different pedometers placed at the waist, the chest, in a pocket, and on an armband were compared against those counted with a hand tally counter. With the exception of one, all the pedometers were accurate at moderate walking speeds, irrespective of their placement on the body. However, the accuracy tended to decrease at slower and faster walking speeds, especially when the pedometers were worn in the pockets or kept in the purse (p < 0.05). In conclusion, most pedometers examined were accurate when they were placed at the waist, chest, and armband irrespective of the walking speed or terrain. However, some pedometers had reduced accuracy when they were kept in a pocket or placed in a purse, especially at a slower and faster walking speeds.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1728869X14000057", "newWindow": true } ] }, { "title": "Comparative assessment of sleep quality estimates using home monitoring technology", "author": "Perez-Macias, J.M., Jimison, H., Korhonen, I. and Pavel, M.", "year": "2014", "journalProceedings": "2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society", "category": "Validation", "devices": "One", "population": "Adults", "dataUsed": "Sleep", "abstract": "Poor sleep quality is associated with chronic diseases, weight increase and cognitive dysfunction. Home monitoring solutions offer the possibility of offering tailored sleep coaching interventions. There are several new commercially available devices for tracking sleep, and although they have been tested in sleep laboratories, little is known about the errors associated with the use in the home. To address this issue we performed a study in which we compared the sleep monitoring data from two commercially available systems: Fitbit One and Beddit Pro. We studied 23 subjects using both systems over a week each and analyzed the degree of agreement for different aspects of sleep. The results suggest the need for individual-tailoring of the estimation process. Not only do these models address improved accuracy of sleep quality estimates, but they also provide a framework for the representation and harmonization for monitoring data across studies.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/document/6944742/?arnumber=6944742", "newWindow": true } ] }, { "title": "An inexpensive device for monitoring patients' weights via automated hovering", "author": "Shaffer, J.A., Diaz, K., Alcántara, C., Edmondson, D., Krupka, D.J., Chaplin, W.F. and Davidson, K.W.\t", "year": "2014", "journalProceedings": "International Journal of Cardiology", "category": "Validation", "devices": "Aria", "population": "Adults", "dataUsed": "Weight", "abstract": "Daily weight monitoring is integral to the management of heart failure (HF). Indeed, weight gain is a marker of HF decompensation, and daily weight monitoring has been associated with favorable prognosis. Until now, assessment of weight has required patients to attend an in-person visit, which provides only an infrequent snapshot of their weight. Remote hovering practices have gained considerable traction during the past several years, but their use outside of research settings has been limited. We tested the accuracy of remote weight monitoring using the Fitbit® Aria™ weight scale, a commercially available, inexpensive device that communicates data wirelessly, can transmit data remotely to healthcare providers, and yields data that can be banked into medical data repositories. We recruited 33 healthy employees from an academic medical center. Participants were at least 18 years of age, could read or write in English, and were routinely on campus at least 4 days per week. Participants were excluded if they failed to complete their daily weight assessments. Each day participants weighed themselves using both the Fitbit® Aria™ and seca 769 scales, the latter of which served as a gold standard comparator. Participants recorded the date and time of their scale reading and the weights reported by both scales to the nearest 0.1 lb. Participants provided informed consent, and the study protocol was approved by the local institutional review board. 32 participants provided at least 10 weight readings (minimum, 12; maximum, 41; mean, 26; standard deviation [SD], 7.2). Participants' weights ranged from 89.8 lbs to 224.6 lbs, with a mean weight of 150.9 lbs (31.2 lbs) on the Aria™ scale and a mean weight of 150.2 lbs (31.0 lbs) on the seca 769. The Aria™ demonstrated excellent agreement with the seca 769. Multilevel linear regression analysis revealed that the Aria™ systematically provided a weight reading that was 0.6 lbs greater than the seca 769, although the two scales did not differ in their assessment of weight over time. The flood of inexpensive monitoring devices to the consumer market has introduced new possibilities for remote HF management, but little is known about their accuracy. We demonstrated the accuracy of the Fitbit® Aria™ scale compared to the seca 769, a conventional scale designed for use in clinical practice. Daily information about patients' weights can alert clinicians to HF patients who are at high risk for hospitalization. Hovering remotely over patients may also engage patients in their own self-management.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0167527313023358", "newWindow": true } ] }, { "title": "Caloric expenditure assessment among older adults: criterion validity of a novel accelerometry device.", "author": "Stahl, S.T. and Insana, S.P.", "year": "2014", "journalProceedings": "Journal of Health Psychology", "category": "Validation", "devices": "Classic", "population": "Older Adults", "dataUsed": "Energy Expenditure", "abstract": "Criterion validity of a novel accelerometry device that measures caloric expenditure (Fitbit) was evaluated against a self-report estimation of caloric expenditure (Community Healthy Activities Model Program for Seniors) in older adults. Community Health Activities Model Program for Seniors and Fitbit estimates of total caloric expenditure per day were significantly correlated (r = .61, p textless .05). Bland-Altman plots indicated that 70 percent of participants' data were within 1 standard deviation of the mean difference between measures. These preliminary findings suggest that the Fitbit may be considered a viable instrument for measuring daily caloric expenditure among older adults. However, further work is required to determine the optimal measurement technique for caloric expenditure among older adults.", "links": [ { "caption": "URL", "url": "http://hpq.sagepub.com/content/19/11/1382", "newWindow": true } ] }, { "title": "Validation of the Fitbit One activity monitor device during treadmill walking.", "author": "Takacs, J., Pollock, C.L., Guenther, J.R., Bahar, M., Napier, C. and Hunt, M.A.", "year": "2014", "journalProceedings": "Journal of Science and Medicine in Sport", "category": "Validation", "devices": "One", "population": "Adults", "dataUsed": "Steps,Distance", "abstract": "OBJECTIVES: In order to quantify the effects of physical activity such as walking on chronic disease, accurate measurement of physical activity is needed. The objective of this study was to determine the validity and reliability of a new activity monitor, the Fitbit One, in a population of healthy adults. DESIGN: Cross-sectional study.\nMETHODS: Thirty healthy adults ambulated at 5 different speeds (0.90, 1.12, 1.33, 1.54, 1.78 m/s) on a treadmill while wearing three Fitbit One activity monitors (two on the hips and one in the pocket). The order of each speed condition was randomized. Fitbit One step count output was compared to observer counts and distance output was compared to the calibrated treadmill output. Two-way repeated measures ANOVA, concordance correlation coefficients, and Bland and Altman plots were used to assess validity and intra-class correlation coefficients (ICC) were used to assess reliability.\n\nRESULTS: No significant differences were noted between Fitbit One step count outputs and observer counts, and concordance was substantial (0.97-1.00). Inter-device reliability of the step count was high for all walking speeds (ICC = 0.95). Percent relative error was less than 1.3%. The distance output of the Fitbit One activity monitors was significantly different from the criterion values for each monitor at all speeds (Ptextless0.001) and exhibited poor concordance (0.0-0.05). Inter-device reliability was excellent for all treadmill speeds (ICC = 0.90). Percent relative error was high (up to 39.6%).\n\nCONCLUSIONS: The Fitbit One activity monitors are valid and reliable devices for measuring step counts in healthy young adults. The distance output of the monitors is inaccurate and should be noted with caution.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1440244013004726", "newWindow": true } ] }, { "title": "Indoor activity monitoring system for elderly using RFID and Fitbit Flex wristband", "author": "Tan, T.-H., Gochoo, M., Chen, K.-H., Jean, F.-R., Chen, Y.-F., Shih, F.-J. and Ho, C.F.\t", "year": "2014", "journalProceedings": "IEEE-EMBS International Conference on Biomedical and Health Informatics (BHI)", "category": "Measurement", "devices": "Flex", "population": "Older Adults", "dataUsed": "Steps", "abstract": "An indoor activity monitoring system for the elderly is proposed in this paper by using a Fitbit Flex wristband (FFW) and an active RFID. Two methods have been presented for identification of an activity place and a best accuracy of 98.89% has been achieved. The activity level of the elderly is evaluated via dissimilarity measurement by employing an activity density map. The presented system has the advantages of avoiding invasion of one's privacy and monitoring the daily activity unobtrusively. Experimental results show the potential of the proposed system for practical application.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/lpdocs/epic03/wrapper.htm?arnumber=6864299", "newWindow": true } ] }, { "title": "\"Go4Life\" exercise counseling, accelerometer feedback, and activity levels in older people.", "author": "Thompson, W.G., Kuhle, C.L., Koepp, G.A., McCrady-Spitzer, S.K. and Levine, J.A.", "year": "2014", "journalProceedings": "Archives of Gerontology and Geriatrics", "category": "Intervention", "devices": "Classic", "population": "Older Adults", "dataUsed": "NA", "abstract": "Older people are more sedentary than other age groups. We sought to determine if providing an accelerometer with feedback about activity and counseling older subjects using Go4Life educational material would increase activity levels. Participants were recruited from independent living areas within assisted living facilities and the general public in the Rochester, MN area. 49 persons aged 65-95 (79.5±7.0 years) who were ambulatory but sedentary and overweight participated in this randomized controlled crossover trial for one year. After a baseline period of 2 weeks, group 1 received an accelerometer and counseling using Go4Life educational material (www.Go4Life.nia.nih.gov) for 24 weeks and accelerometer alone for the next 24 weeks. Group 2 had no intervention for the first 24 weeks and then received an accelerometer and Go4Life based counseling for 24 weeks. There were no significant baseline differences between the two groups. The intervention was not associated with a significant change in activity, body weight, % body fat, or blood parameters (p>0.05). Older (80-93) subjects were less active than younger (65-79) subjects (p=0.003). Over the course of the 48 week study, an increase in activity level was associated with a decline in % body fat (p=0.008). Increasing activity levels benefits older patients. However, providing an accelerometer and a Go4Life based exercise counseling program did not result in a 15% improvement in activity levels in this elderly population. Alternate approaches to exercise counseling may be needed in elderly people of this age range.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0167494314000053", "newWindow": true } ] }, { "title": "Activity monitor intervention to promote physical activity of physicians-in-training: randomized controlled trial.", "author": "Thorndike, A.N., Mills, S., Sonnenberg, L., Palakshappa, D., Gao, T., Pau, C.T. and Regan, S.", "year": "2014", "journalProceedings": "PloS ONE", "category": "Intervention", "devices": "Classic", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Physicians are expected to serve as role models for healthy lifestyles, but long work hours reduce time for healthy behaviors. A hospital-based physical activity intervention could improve physician health and increase counseling about exercise.\n\nMETHODS: We conducted a two-phase intervention among 104 medical residents at a large hospital in Boston, Massachusetts. Phase 1 was a 6-week randomized controlled trial comparing daily steps of residents assigned to an activity monitor displaying feedback about steps and energy consumed (intervention) or to a blinded monitor (control). Phase 2 immediately followed and was a 6-week non-randomized team steps competition in which all participants wore monitors with feedback. Phase 1 outcomes were: 1) median steps/day and 2) proportion of days activity monitor worn. The Phase 2 outcome was mean steps/day on days monitor worn (=500 steps/day). Physiologic measurements were collected at baseline and study end. Median steps/day were compared using Wilcoxon rank-sum tests. Mean steps were compared using repeated measures regression analyses.\n\nRESULTS: In Phase 1, intervention and control groups had similar activity (6369 vs. 6063 steps/day, p = 0.16) and compliance with wearing the monitor (77% vs. 77% of days, p = 0.73). In Phase 2 (team competition), residents recorded more steps/day than during Phase 1 (CONTROL: 7,971 vs. 7,567, p = 0.002; INTERVENTION: 7,832 vs. 7,739, p = 0.13). Mean compliance with wearing the activity monitor decreased for both groups during Phase 2 compared to Phase 1 (60% vs. 77%, p < 0.001). Mean systolic blood pressure decreased (p = 0.004) and HDL cholesterol increased (p < 0.001) among all participants at end of study compared to baseline.\n\nCONCLUSIONS: Although the activity monitor intervention did not have a major impact on activity or health, the high participation rates of busy residents and modest changes in steps, blood pressure, and HDL suggest that more intensive hospital-based wellness programs have potential for promoting healthier lifestyles among physicians.", "links": [ { "caption": "URL", "url": "http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0100251", "newWindow": true } ] }, { "title": "The validation of Fibit Zip™ physical activity monitor as a measure of free-living physical activity.", "author": "Tully, M.A., McBride, C., Heron, L. and Hunter, R.F.", "year": "2014", "journalProceedings": "BMC Research Notes", "category": "Usability,Validation", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: The new generation of activity monitors allow users to upload their data to the internet and review progress. The aim of this study is to validate the Fitbit Zip as a measure of free-living physical activity.\n\nFINDINGS: Participants wore a Fitbit Zip, ActiGraph GT3X accelerometer and a Yamax CW700 pedometer for seven days. Participants were asked their opinion on the utility of the Fitbit Zip. Validity was assessed by comparing the output using Spearman's rank correlation coefficients, Wilcoxon signed rank tests and Bland-Altman plots. 59.5% (25/47) of the cohort were female. There was a high correlation in steps/day between the Fitbit Zip and the two reference devices (r = 0.91, p < 0.001). No statistically significant difference between the Fitbit and Yamax steps/day was observed (Median (IQR) 7477 (3597) vs 6774 (3851); p = 0.11). The Fitbit measured significantly more steps/day than the Actigraph (7477 (3597) vs 6774 (3851); p textless 0.001). Bland-Altman plots revealed no systematic differences between the devices.\n\nCONCLUSIONS: Given the high level of correlation and no apparent systematic biases in the Bland Altman plots, the use of Fitbit Zip as a measure of physical activity. However the Fitbit Zip recorded a significantly higher number of steps per day than the Actigraph.", "links": [ { "caption": "URL", "url": "http://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-7-952", "newWindow": true } ] }, { "title": "Validity and usability of low-cost accelerometers for internet-based self-monitoring of physical activity in patients with chronic obstructive pulmonary disease.", "author": "Vooijs, M., Alpay, L.L., Snoeck-Stroband, J.B., Beerthuizen, T., Siemonsma, P.C., Abbink, J.J., Sont, J.K. and Rövekamp, T.A.", "year": "2014", "journalProceedings": "Interactive Journal of Medical Research", "category": "Usability,Validation", "devices": "Ultra", "population": "Patients,Adults", "dataUsed": "Steps,Energy Expenditure", "abstract": "BACKGROUND: The importance of regular physical activity for patients with chronic obstructive pulmonary disease (COPD) is well-established. However, many patients do not meet the recommended daily amount. Accelerometers might provide patients with the information needed to increase physical activity in daily life.\nOBJECTIVE: Our objective was to assess the validity and usability of low-cost Internet-connected accelerometers. Furthermore we explored patients' preferences with regards to the presentation of and feedback on monitored physical activity.\n\nMETHODS: To assess concurrent validity we conducted a field validation study with patients who wore two low-cost accelerometers, Fitbit and Physical Activity Monitor (PAM), at the same time along with a sophisticated multisensor accelerometer (SenseWear Armband) for 48 hours. Data on energy expenditure assessed from registrations from the two low-cost accelerometers were compared to the well validated SenseWear Armband which served as a reference criterion. Usability was examined in a cross-over study with patients who, in succession, wore the Fitbit and the PAM for 7 consecutive days and filled out a 16 item questionnaire with regards to the use of the corresponding device\n\nRESULTS: The agreement between energy expenditure (METs) from the SenseWear Armband with METs estimated by the Fitbit and PAM was good (r=.77) and moderate (r=.41), respectively. The regression model that was developed for the Fitbit explained 92% whereas the PAM-model could explain 89% of total variance in METs measured by the SenseWear. With regards to the usability, both the Fitbit and PAM were well rated on all items. There were no significant differences between the two devices.\n\nCONCLUSIONS: The low-cost Fitbit and PAM are valid and usable devices to measure physical activity in patients with COPD. These devices may be useful in long-term interventions aiming at increasing physical activity levels in these patients.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259960/", "newWindow": true } ] }, { "title": "StepCity: a preliminary investigation of a personal informatics-based social game on behavior change", "author": "Walsh, G. and Golbeck, J.", "year": "2014", "journalProceedings": "Proceedings of the extended abstracts of the 32nd annual ACM conference on Human factors in computing systems", "category": "Intervention", "devices": "Classic", "population": "Adults", "dataUsed": "Steps", "abstract": "Encouraging physical activity is an important public health issue. In this study, we set out to see if a game could be used to motivate people to be more active. We recruited 74 subjects to wear Fitbits – a personal activity monitoring device that tracked the number of steps taken in a day – and compared step totals in three experimental conditions: a control, a social interaction experience, and a social game we developed called StepCity. We found that for newer Fitbit users, the game led to users taking more steps than they did in a control condition. In this poster, we present the details of our system and the results of a controlled experiment.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?id=2559206.2581326", "newWindow": true } ] }, { "title": "Preliminary efficacy of prize-based contingency management to increase activity levels in healthy adults.", "author": "Washington, W.D., Banna, K.M. and Gibson, A.L.", "year": "2014", "journalProceedings": "Journal of Applied Behavior Analysis", "category": "Intervention", "devices": "Classic", "population": "Adults", "dataUsed": "Steps", "abstract": "An estimated 30% of Americans meet the criteria for obesity. Effective, low-cost interventions to increase physical activity are needed to prevent and treat obesity. In this study, 11 healthy adults wore Fitbit accelerometers for 3 weeks. During the initial baseline, subjects earned prize draws for wearing the Fitbit. During intervention, percentile schedules were used to calculate individual prize-draw criteria. The final week was a return to baseline. Four subjects increased step counts as a result of the intervention. A bout analysis of interresponse times revealed that subjects increased overall step counts by increasing daily minutes active and within-bout response rates and decreasing pauses between bouts of activity. Strategies to improve effectiveness are suggested, such as modification of reinforcement probability and amount and identification of the function of periods of inactivity.", "links": [ { "caption": "URL", "url": "http://onlinelibrary.wiley.com/doi/10.1002/jaba.119/abstract", "newWindow": true } ] }, { "title": "Decomposing activities of daily living to discover routine clusters", "author": "Yürüten, O., Zhang, J. and Pu, P.\t", "year": "2014", "journalProceedings": "Proceedings of the Twenty-Eighth AAAI Conference on Artificial Intelligence", "category": "Methods", "devices": "Ultra,One", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "The modern sensor technology helps us collect time series data for activities of daily living (ADLs), which in turn can be used to infer broad patterns, such as common daily routines. Most of the existing approaches either rely on a model trained by a preselected and manually labeled set of activities, or perform micro-pattern analysis with manually selected length and number of micro-patterns. Since real life ADL datasets are massive, such approaches would be too costly to apply. Thus, there is a need to formulate unsupervised methods that can be applied to different time scales. We propose a novel approach to discover clusters of daily activity routines. We use a matrix decomposition method to isolate routines and deviations to obtain two different sets of clusters.We obtain the final memberships via the cross product of these sets. We validate our approach using two real-life ADL datasets and a well-known artificial dataset. Based on average silhouette width scores, our approach can capture strong structures in the underlying data. Furthermore, results show that our approach improves on the accuracy of the baseline algorithms by 12% with a statistical significance (p textless0.05) using the Wilcoxon signed-rank comparison test.", "links": [] }, { "title": "Mobile Phone-Connected Wearable Motion Sensors to Assess Postoperative Mobilization", "author": "Appelboom, G., Taylor, B.E., Bruce, E., Bassile, C.C., Malakidis, C., Yang, A., Youngerman, B., D'Amico, R., Bruce, S., Bruyère, O., Reginster, J.-Y., Dumont, E.P. and Connolly Jr, E.S.\t", "year": "2015", "journalProceedings": "JMIR mHealth and uHealth", "category": "Usability,Validation", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background: Early mobilization after surgery reduces the incidence of a wide range of complications. Wearable motion sensors measure movements over time and transmit this data wirelessly, which has the potential to monitor patient recovery and encourages patients to engage in their own rehabilitation.\nObjective: We sought to determine the ability of off-the-shelf activity sensors to remotely monitor patient postoperative mobility.\n\nMethods: Consecutive subjects were recruited under the Department of Neurosurgery at Columbia University. Patients were enrolled during physical therapy sessions. The total number of steps counted by the two blinded researchers was compared to the steps recorded on four activity sensors positioned at different body locations.\n\nResults: A total of 148 motion data points were generated. The start time, end time, and duration of each walking session were accurately recorded by the devices and were remotely available for the researchers to analyze. The sensor accuracy was significantly greater when placed over the ankles than over the hips (P<.001). Our multivariate analysis showed that step length was an independent predictor of sensor accuracy. On linear regression, there was a modest positive correlation between increasing step length and increased ankle sensor accuracy (r=.640, r2=.397) that reached statistical significance on the multivariate model (P=.03). Increased gait speed also correlated with increased ankle sensor accuracy, although less strongly (r=.444, r2=.197). We did not note an effect of unilateral weakness on the accuracy of left- versus right-sided sensors. Accuracy was also affected by several specific measures of a patient’s level of physical assistance, for which we generated a model to mathematically adjust for systematic underestimation as well as disease severity.\n\nConclusions: We provide one of the first assessments of the accuracy and utility of widely available and wirelessly connected activity sensors in a postoperative patient population. Our results show that activity sensors are able to provide invaluable information about a patient’s mobility status and can transmit this data wirelessly, although there is a systematic underestimation bias in more debilitated patients.", "links": [ { "caption": "URL", "url": "http://mhealth.jmir.org/2015/3/e78/", "newWindow": true } ] }, { "title": "Promoting physical activity among women using wearable technology and online social connectivity: a feasibility study", "author": "Arigo, D.", "year": "2015", "journalProceedings": "Health Psychology and Behavioral Medicine", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "Wearable physical activity (PA) tracking technology, which has the capacity to connect users' PA data to online social networks, could address the need for cost-effective, scalable PA programs for women. It is not yet clear how to use wearable devices to maximize the effectiveness of evidence-based PA promotion techniques. There also is need to examine time-sensitive, within-person relationships between aspects of social networking and PA progress. The present study tested the feasibility, acceptability, and effectiveness of an online PA program that employed wearable technology, an associated social network, and the assignment of program partners. Sedentary women (n = 20, MAge = 50, MBMI = 30.9 kg/m2) used wearable devices and attended one face-to-face session that introduced evidence-based PA promotion skills (e.g. goal setting). The remainder of the six-week program emphasized online communication with PA partners and other group members. Participants completed online surveys about their social contact at the end of every week. The recruitment target (set at 20) was reached after three weeks, and retention over six weeks was 100%. Objectively verified daily device wear was high (97%) and participant program ratings were favorable (e.g. M = 3.85 of 5, SD = 1.04 for “effectiveness”). Participants showed large increases in daily steps (from 3796 [SE = 478] to 8190 [SE = 516]) and daily minutes of moderate-to-vigorous PA (from 12.68 [SE = 3.15] to 24.05 [SE = 3.48]). Multilevel models revealed meaningful within-person relationships between PA and social contact (ps textless .02); PA was highest at times when social contact was higher than a participant's average level. Findings support the feasibility, acceptability, and effectiveness of incorporating wearable technology and online social networking into an online PA program for women, and provide time-sensitive evidence that social networking is beneficial for PA. Consequently, larger, randomized trials of this approach are warranted.", "links": [ { "caption": "URL", "url": "http://www.tandfonline.com/doi/full/10.1080/21642850.2015.1118350", "newWindow": true } ] }, { "title": "Addressing barriers to physical activity among women: A feasibility study using social networking-enabled technology", "author": "Arigo, D., Schumacher, L.M., Pinkasavage, E. and Butryn, M.L.\t", "year": "2015", "journalProceedings": "Digital Health", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity,Goals", "abstract": "Objective: Automated physical activity (PA) monitoring technology and associated social networks have potential to address barriers to PA, but have rarely been tested for PA promotion. This technology may be especially beneficial for women, who experience particular barriers to health-based social networking. The present study tested the feasibility and acceptability of pairing women as PA partners via technology-connected social networking. Social comparison (i.e. tendency to make self-evaluations relative to others) was examined as a mechanism of interest.\nMethod: Overweight women (n?=?12, Mage?=?46, MBMI?=?32.60?kg/m2) used a PA sensor (daily wear?=?93%) and communicated with an assigned partner (introduced via technology-connected social networking) for four weeks. Partners did not know one another prior to study enrollment.\n\nResults: PA meaningfully increased during the program, and was highest among participants who endorsed stronger (vs. weaker) tendencies toward social comparisons (r?=?0.64). Participants identified several benefits of partner communication; however, some partners had difficulty initiating communication, and direct comparisons with partners were seen as unhelpful in this context. Most participants found the PA sensor beneficial, showed high compliance with daily wear recommendations, and reported an intent to continue using the PA sensor. Participants endorsed satisfaction with the program's approach and confidence in maintaining PA gains.\n\nConclusions: These findings support the use of automated PA sensors and facilitated partner communication via social networking to promote PA among women. Insights from participant feedback identify specific avenues for program improvement; specifically, with respect to the potential difficulties of negative social comparisons.", "links": [ { "caption": "URL", "url": "http://dhj.sagepub.com/lookup/doi/10.1177/2055207615583564", "newWindow": true } ] }, { "title": "“Not just another walking program”: Everyday Activity Supports You (EASY) model---a randomized pilot study for a parallel randomized controlled trial", "author": "Ashe, M.C., Winters, M., Hoppmann, C.A., Dawes, M.G., Gardiner, P.A., Giangregorio, L.M., Madden, K.M., McAllister, M.M., Wong, G., Puyat, J.H., Singer, J., Sims-Gould, J. and McKay, H.A.", "year": "2015", "journalProceedings": "Pilot and Feasibility Studies", "category": "Intervention", "devices": "One", "population": "Older Adults", "dataUsed": "Steps,Goals", "abstract": "Background: Maintaining physical activity is an important goal with positive health benefits, yet many people spend most of their day sitting. Our Everyday Activity Supports You (EASY) model aims to encourage movement through daily activities and utilitarian walking. The primary objective of this phase was to test study feasibility (recruitment and retention rates) for the EASY model.\nMethods: This 6-month study took place in Vancouver, Canada, from May to December 2013, with data analyses in February 2014. Participants were healthy, inactive, community-dwelling women aged 55--70 years. We recruited through advertisements in local community newspapers and randomized participants using a remote web service. The model included the following: group-based education and social support, individualized physical activity prescription (called Activity 4-1-1), and use of a Fitbit activity monitor. The control group received health-related information only. The main outcome measures were descriptions of study feasibility (recruitment and retention rates). We also collected information on activity patterns (ActiGraph GT3X+ accelerometers) and health-related outcomes such as body composition (height and weight using standard techniques), blood pressure (automatic blood pressure monitor), and psychosocial variables (questionnaires).\n\nResults: We advertised in local community newspapers to recruit participants. Over 3 weeks, 82 participants telephoned; following screening, 68% (56/82) met the inclusion criteria and 45% (25/56) were randomized by remote web-based allocation. This included 13 participants in the intervention group and 12 participants in the control group (education). At 6 months, 12/13 (92%) intervention and 8/12 (67%) control participants completed the final assessment. Controlling for baseline values, the intervention group had an average of 2,080 [95% confidence intervals (CIs) 704, 4,918] more steps/day at 6 months compared with the control group. There was an average between group difference in weight loss of -4.3 [95% CI -6.22, -2.40] kg and reduction in diastolic blood pressure of -8.54 [95% CI -16.89, -0.198] mmHg, in favor of EASY.\n\nConclusions: The EASY pilot study was feasible to deliver; there was an increase in physical activity and reduction in weight and blood pressure for intervention participants at 6 months. (Continued", "links": [ { "caption": "URL", "url": "https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/2055-5784-1-4", "newWindow": true } ] }, { "title": "An Evaluation of Commercial Pedometers for Monitoring Slow Walking Speed Populations.", "author": "Beevi, F.H.A., Miranda, J., Pedersen, C.F. and Wagner, S.", "year": "2015", "journalProceedings": "Telemedicine journal and e-health : the official journal of the American Telemedicine Association", "category": "Validation", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Pedometers are considered desirable devices for monitoring physical activity. Two population groups of interest include patients having undergone surgery in the lower extremities or who are otherwise weakened through disease, medical treatment, or surgery procedures, as well as the slow walking senior population. For these population groups, pedometers must be able to perform reliably and accurately at slow walking speeds. The objectives of this study were to evaluate the step count accuracy of three commercially available pedometers, the Yamax (Tokyo, Japan) Digi-Walker(®) SW-200 (YM), the Omron (Kyoto, Japan) HJ-720 (OM), and the Fitbit (San Francisco, CA) Zip (FB), at slow walking speeds, specifically at 1, 2, and 3 km/h, and to raise awareness of the necessity of focusing research on step-counting devices and algorithms for slow walking populations.\nMATERIALS AND METHODS: Fourteen participants 29.93 ±4.93 years of age were requested to walk on a treadmill at the three specified speeds, in four trials of 100 steps each. The devices were worn by the participants on the waist belt. The pedometer counts were recorded, and the error percentage was calculated.\n\nRESULTS: The error rate of all three evaluated pedometers decreased with the increase of speed: at 1 km/h the error rates varied from 87.11% (YM) to 95.98% (FB), at 2 km/h the error rates varied from 17.27% (FB) to 46.46% (YM), and at 3 km/h the error rates varied from 22.46% (YM) to a slight overcount of 0.70% (FB).\n\nCONCLUSIONS: It was observed that all the evaluated devices have high error rates at 1 km/h and mixed error rates at 2 km/h, and at 3 km/h the error rates are the smallest of the three assessed speeds, with the OM and the FB having a slight overcount. These results show that research on pedometers' software and hardware should focus more on accurate step detection at slow walking speeds.", "links": [ { "caption": "URL", "url": "http://online.liebertpub.com/doi/abs/10.1089/tmj.2015.0120", "newWindow": true } ] }, { "title": "Evaluating Low-cost Activity Trackers for Use in Large-scale Data Gathering of Forestry Workers", "author": "Bowen, J., Hinze, A., Cunningham, S.J. and Parker, R", "year": "2015", "journalProceedings": "Proceedings of the Annual Meeting of the Australian Special Interest Group for Computer Human Interaction - OzCHI '15", "category": "Usability,Validation", "devices": "One,Flex", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "The New Zealand forestry industry has the country's highest rate of workplace fatalities, the reasons for which are not welrichardl studied or understood. We believe the first step in identifying any successful solution is to develop a fine-grained understanding of the physical context of forestry work by performing large-scale data collection of the levels of physical activity the workers engage in as well as their sleep patterns over extended periods of time. Our goal is to use lightweight, wearable technology (so-called activity trackers) to collect this data. In order to do so we need a clear understanding of the capabilities and limitations of such devices, both in general and in the proposed use environment for forestry workers. In this paper we present the results of user studies and comparisons of six activity trackers and three mobile phone applications used to track activity and sleep. We also discuss our initial pilot study with forestry workers and discuss the problems encountered using the trackers in the environment.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=2838739.2838741", "newWindow": true } ] }, { "title": "Randomized Trial of a Fitbit-Based Physical Activity Intervention for Women.", "author": "Cadmus-Bertram, L.A., Marcus, B.H., Patterson, R.E., Parker, B.A. and Morey, B.L.", "year": "2015", "journalProceedings": "American Journal of Preventive Medicine", "category": "Intervention", "devices": "One", "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "INTRODUCTION: Direct-to-consumer mHealth devices are a potential asset to behavioral research but rarely tested as intervention tools. This trial examined the accelerometer-based Fitbit tracker and website as a low-touch physical activity intervention. The purpose of this study is to evaluate, within an RCT, the feasibility and preliminary efficacy of integrating the Fitbit tracker and website into a physical activity intervention for postmenopausal women.\nMETHODS: Fifty-one inactive, postmenopausal women with BMI =25.0 were randomized to a 16-week web-based self-monitoring intervention (n=25) or comparison group (n=26). The Web-Based Tracking Group received a Fitbit, instructional session, and follow-up call at 4 weeks. The comparison group received a standard pedometer. All were asked to perform 150 minutes/week of moderate to vigorous physical activity (MVPA). Physical activity outcomes were measured by the ActiGraph GT3X+ accelerometer.\n\nRESULTS: Data were collected and analyzed in 2013-2014. Participants were aged 60 (SD=7) years with BMI of 29.2 (3.5) kg/m(2). Relative to baseline, the Web-Based Tracking Group increased MVPA by 62 (108) minutes/week (ptextless0.01); 10-minute MVPA bouts by 38 (83) minutes/week (p=0.008); and steps by 789 (1,979) (p=0.01), compared to non-significant increases in the Pedometer Group (between-group p=0.11, 0.28, and 0.30, respectively). The Web-Based Tracking Group wore the tracker on 95% of intervention days; 96% reported liking the website and 100% liked the tracker.\n\nCONCLUSIONS: The Fitbit was well accepted in this sample of women and associated with increased physical activity at 16 weeks. Leveraging direct-to-consumer mHealth technologies aligned with behavior change theories can strengthen physical activity interventions.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0749379715000446", "newWindow": true } ] }, { "title": "Use of the Fitbit to Measure Adherence to a Physical Activity Intervention Among Overweight or Obese, Postmenopausal Women: Self-Monitoring Trajectory During 16 Weeks.", "author": "Cadmus-Bertram, L., Marcus, B.H., Patterson, R.E., Parker, B.A. and Morey, B.L.", "year": "2015", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "One", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND: Direct-to-consumer trackers and devices have potential to enhance theory-based physical activity interventions by offering a simple and pleasant way to help participants self-monitor their behavior. A secondary benefit of these devices is the opportunity for investigators to objectively track adherence to physical activity goals across weeks or even months, rather than relying on self-report or a small number of accelerometry wear periods. The use of consumer trackers for continuous monitoring of adherence has considerable potential to enhance physical activity research, but few studies have been published in this rapidly developing area.\n\nOBJECTIVE: The objective of the study was to assess the trajectory of physical activity adherence across a 16-week self-monitoring intervention, as measured by the Fitbit tracker.\nMETHODS: Participants were 25 overweight or obese, postmenopausal women enrolled in the intervention arm of a randomized controlled physical activity intervention trial. Each participant received a 16-week technology-based intervention that used the Fitbit physical activity tracker and website. The overall study goal was 150 minutes/week of moderate to vigorous intensity physical activity (MVPA) and 10,000 steps/day; however, goals were set individually for each participant and updated at Week 4 based on progress. Adherence data were collected by the Fitbit and aggregated by Fitabase. Participants also wore an ActiGraph GT3X+ accelerometer for 7 days prior to the intervention and again during Week 16.\n\nRESULTS: The median participant logged 10 hours or more/day of Fitbit wear on 95% of the 112 intervention days, with no significant decline in wear over the study period. Participants averaged 7540 (SD 2373) steps/day and 82 minutes/week (SD 43) of accumulated \"fairly active\" and \"very active\" minutes during the intervention. At Week 4, 80% (20/25) of women chose to maintain/increase their individual MVPA goal and 72% (18/25) of participants chose to maintain/increase their step goal. Physical activity levels were relatively stable after peaking at 3 weeks, with only small declines of 8% for steps (P=.06) and 14% for MVPA (P=.05) by 16 weeks.\n\nCONCLUSIONS: These data indicate that a sophisticated, direct-to-consumer activity tracker encouraged high levels of self-monitoring that were sustained over 16 weeks. Further study is needed to determine how to motivate additional gains in physical activity and evaluate the long-term utility of the Fitbit tracker as part of a strategy for chronic disease prevention.", "links": [ { "caption": "URL", "url": "http://mhealth.jmir.org/2015/4/e96/", "newWindow": true } ] }, { "title": "Accuracy of smartphone applications and wearable devices for tracking physical activity data.", "author": "Case, M.A., Burwick, H.A., Volpp, K.G. and Patel, M.S", "year": "2015", "journalProceedings": "JAMA", "category": "Validation", "devices": "One,Zip,Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Despite the potential of pedometers to increase physical activity and improve health, there is little evidence of broad adoption by the general population. In contrast, nearly two-thirds of adults in the United States own a smartphone and technology advancements have enabled these devices to track health behaviors such as physical activity and provide convenient feedback. New wearable devices that may have more consumer appeal have also been developed.\n\nEven though these devices and applications might better engage individuals in their health, for example through workplace wellness programs, there has been little evaluation of their use. The objective of this study was to evaluate the accuracy of smartphone applications and wearable devices compared with direct observation of step counts, a metric successfully used in interventions to improve clinical outcomes.", "links": [ { "caption": "URL", "url": "http://jama.jamanetwork.com/article.aspx?articleid=2108876", "newWindow": true } ] }, { "title": "mHealth Physical Activity Intervention: A Randomized Pilot Study in Physically Inactive Pregnant Women.", "author": "Choi, J., Lee, J.H., Vittinghoff, E. and Fukuoka, Y.", "year": "2015", "journalProceedings": "Maternal and Child Health Journal", "category": "Intervention", "devices": "Ultra", "population": "Adults", "dataUsed": "Steps", "abstract": "Introduction: Physical inactivity is prevalent in pregnant women, and innovative strategies to promote physical activity are strongly needed. The purpose of the study was to test a 12-week mobile health (mHealth) physical activity intervention for feasibility and potential efficacy.\nMethods: Participants were recruited between December 2012 and February 2014 using diverse recruitment methods. Thirty pregnant women between 10 and 20 weeks of gestation were randomized to an intervention (mobile phone app plus Fitbit) or a control (Fitbit) group. Both conditions targeted gradual increases in physical activity. The mHealth intervention included daily messages and a mobile phone activity diary with automated feedback and self-monitoring systems.\n\nResults: On monthly average, 4 women were screened for initial eligibility by telephone and 2.5 were randomized. Intervention participants had a 1096 ± 1898 step increase in daily steps compared to an increase of 259 ± 1604 steps in control participants at 12 weeks. The change between groups in weekly mean steps per day during the 12-week study period was not statistically significant (p = 0.38). The intervention group reported lower perceived barrier to being active, lack of energy, than the control group at 12-week visit (p = 0.02). The rates of responding to daily messages and using the daily diary through the mobile app declined during the 12 week study period.\n\nDiscussion: It was difficult to recruit and randomize inactive women who wanted to increase physical activity during pregnancy. Pregnant women who were motivated to increase physical activity might find using mobile technologies in assessing and promoting PA acceptable. Possible reasons for the non-significant treatment effect of the mHealth intervention on physical activity are discussed. Public awareness of safety and benefits of physical activity during pregnancy should be promoted.", "links": [ { "caption": "URL", "url": "http://link.springer.com/article/10.1007%2Fs10995-015-1895-7", "newWindow": true } ] }, { "title": "Feasibility and preliminary efficacy of a physical activity counseling intervention using Fitbit in people with knee osteoarthritis: the TRACK-OA study protocol", "author": "Clayton, C., Feehan, L., Goldsmith, C.H., Miller, W.C., Grewal, N., Ye, J., Yoo, J.Y. and Li, L.C.", "year": "2015", "journalProceedings": "Pilot and Feasibility Studies}", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "NA", "abstract": "Physical activity (PA) reduces pain and improves functioning in people with knee osteoarthritis (OA), but few people with the condition meet recommended PA guidelines. Successful intervention strategies to increase PA include goal setting, action planning, self-monitoring, and follow-up feedback from a healthcare professional. Recently developed consumer wearable activity trackers allow users to set activity goals, self-monitor daily goal-progress, and provide feedback on goal attainment. It is hypothesized that a multi-component physiotherapist-led intervention that includes a short (40-min) education module, guided goal-setting and action planning, the use of a wristband activity tracker, and weekly follow-up phone calls will lead to increased PA outcomes.", "links": [ { "caption": "URL", "url": "http://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-015-0027-x", "newWindow": true } ] }, { "title": "Validitiy and usability testing of the Fitbit pedometer in patients with COPD", "author": "De Sousa Sena, R., Bourbeau, J., Zhi Li, P. and Ahmed, S.", "year": "2015", "journalProceedings": "European Respiratory Journal", "category": "Usability,Validation", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Long-term physical activity self-monitoring in COPD patients requires the use of valid and user-friendly devices. We examined the validity and long-term usability of the Fitbit One Pedometer in COPD patients. In study A, COPD patients (n=11;FEV1%Pred 34.5 ±12;age, 69.6 ±6.5, 55% male) simultaneously wore the Fitbit one and the Actigraph GT3X activity monitor for 7 days. Study B, COPD patients (n=7;age, 63 ±6, FEV1%Pred 45±11) completed a usability questionnaire and participanted in qualitative interviews. Bland-Altman plots showed good agreement between daily step counts from the Fitbit One and the Actigraph, and intraclass correlations of 0.9 (CI: 07-0.9). Overall there was high usage, acceptability and satisfaction with the pedometer in terms of comfort and appearance and 60% of patients reported willingness to use it for longer than 12 months. Usability issues registered include replacement due to loss (n=02) and underestimation of daily stairs. Qualitative interviews revealed that COPD patients feel more empowered using a self-monitoring tool, but they have expectations to understand the accuracy of other physical activity outcomes including daily stairs, minutes active and calories. These results suggest that the Fitbit One is a valid device to count steps in COPD patients and feasible for long-term usability, but other activity outcomes from this pedometer requires further testing.", "links": [ { "caption": "URL", "url": "http://erj.ersjournals.com/content/46/suppl_59/PA2067", "newWindow": true } ] }, { "title": "Fitbit®: An accurate and reliable device for wireless physical activity tracking", "author": "Diaz, K.M., Krupka, D.J., Chang, M.J., Peacock, J., Ma, Y., Goldsmith, J., Schwartz, J.E. and Davidson, K.W.", "year": "2015", "journalProceedings": "International Journal of Cardiology", "category": "Validation", "devices": "One,Flex", "population": "Adults", "dataUsed": "Steps,Energy Expenditure", "abstract": "Although physicians recognize the importance of physical activity in the prevention and maintenance of chronic diseases [1], few incorporate physical activity counseling into routine clinic visits [2]. One major barrier has been the paucity of means to objectively assess patient's long-term physical activity patterns [3]. We investigated if the Fitbit®, one of the most common wireless physical activity trackers in the consumer market, met reasonable validity and reliability standards such that they could be used by primary care physicians to monitor their patient's physical activity objectively between clinic visits.", "links": [ { "caption": "URL", "url": "http://www.internationaljournalofcardiology.com/article/S0167-5273(15)00276-4/abstract", "newWindow": true } ] }, { "title": "Measuring steps with the Fitbit activity tracker: an inter-device reliability study", "author": "Dontje, M.L., de Groot, M., Lengton, R.R., van der Schans, C.P. and Krijnen, W.P.", "year": "2015", "journalProceedings": "Journal of Medical Engineering & Technology", "category": "Validation", "devices": "Ultra", "population": "Adults", "dataUsed": "Steps", "abstract": "Activity trackers like Fitbit are used for self-tracking of physical activity by an increasing number of individuals. Comparing physical activity scores with peers can contribute to the desired behavioural change. However, for meaningful social comparison a high inter-device reliability is paramount. This study aimed to determine the inter-device reliability of Fitbit activity trackers in measuring steps. Ten activity trackers (Fitbit Ultra) were worn by a single person (male, 46 years) during eight consecutive days. Inter-device reliability was assessed on three different levels of aggregation (minutes, hours, days) with various methods, including intra-class correlation coefficient (ICC), Bland-Altman plots, limits of agreement (LOA) and Mixed Model Analysis. Results showed that the inter-device reliability of the Fitbit in measuring steps is good at all levels of aggregation (minutes, hours, days), but especially when steps were measured per day. This implies that individuals can reliably compare their daily physical activity scores with peers.", "links": [ { "caption": "URL", "url": "http://www.tandfonline.com/doi/abs/10.3109/03091902.2015.1050125", "newWindow": true } ] }, { "title": "Are Currently Available Wearable Devices for Activity Tracking and Heart Rate Monitoring Accurate, Precise, and Medically Beneficial?", "author": "El-Amrawy, F. and Nounou, M.I.", "year": "2015", "journalProceedings": "Healthcare Informatics Research", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Objectives: The new wave of wireless technologies, fitness trackers, and body sensor devices can have great impact on healthcare systems and the quality of life. However, there have not been enough studies to prove the accuracy and precision of these trackers. The objective of this study was to evaluate the accuracy, precision, and overall performance of seventeen wearable devices currently available compared with direct observation of step counts and heart rate monitoring.\nMethods: Each participant in this study used three accelerometers at a time, running the three corresponding applications of each tracker on an Android or iOS device simultaneously. Each participant was instructed to walk 200, 500, and 1,000 steps. Each set was repeated 40 times. Data was recorded after each trial, and the mean step count, standard deviation, accuracy, and precision were estimated for each tracker. Heart rate was measured by all trackers (if applicable), which support heart rate monitoring, and compared to a positive control, the Onyx Vantage 9590 professional clinical pulse oximeter.\n\nResults: The accuracy of the tested products ranged between 79.8% and 99.1%, while the coefficient of variation (precision) ranged between 4% and 17.5%. MisFit Shine showed the highest accuracy and precision (along with Qualcomm Toq), while Samsung Gear 2 showed the lowest accuracy, and Jawbone UP showed the lowest precision. However, Xiaomi Mi band showed the best package compared to its price.\n\nConclusions: The accuracy and precision of the selected fitness trackers are reasonable and can indicate the average level of activity and thus average energy expenditure.", "links": [ { "caption": "URl", "url": "http://synapse.koreamed.org/DOIx.php?id=10.4258/hir.2015.21.4.315", "newWindow": true } ] }, { "title": "Systematic review of the validity and reliability of consumer-wearable activity trackers.", "author": "Evenson, K.R., Goto, M.M. and Furberg, R.D.", "year": "2015", "journalProceedings": "The International Journal of Behavioral Nutrition and Physical Activity", "category": "Validation,Systematic Review", "devices": "Classic,Ultra,One,Zip,Flex", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance,Sleep", "abstract": "BACKGROUND: Consumer-wearable activity trackers are electronic devices used for monitoring fitness- and other health-related metrics. The purpose of this systematic review was to summarize the evidence for validity and reliability of popular consumer-wearable activity trackers (Fitbit and Jawbone) and their ability to estimate steps, distance, physical activity, energy expenditure, and sleep.\nMETHODS: Searches included only full-length English language studies published in PubMed, Embase, SPORTDiscus, and Google Scholar through July 31, 2015. Two people reviewed and abstracted each included study.\n\nRESULTS: In total, 22 studies were included in the review (20 on adults, 2 on youth). For laboratory-based studies using step counting or accelerometer steps, the correlation with tracker-assessed steps was high for both Fitbit and Jawbone (Pearson or intraclass correlation coefficients (CC) textgreater =0.80). Only one study assessed distance for the Fitbit, finding an over-estimate at slower speeds and under-estimate at faster speeds. Two field-based studies compared accelerometry-assessed physical activity to the trackers, with one study finding higher correlation (Spearman CC 0.86, Fitbit) while another study found a wide range in correlation (intraclass CC 0.36-0.70, Fitbit and Jawbone). Using several different comparison measures (indirect and direct calorimetry, accelerometry, self-report), energy expenditure was more often under-estimated by either tracker. Total sleep time and sleep efficiency were over-estimated and wake after sleep onset was under-estimated comparing metrics from polysomnography to either tracker using a normal mode setting. No studies of intradevice reliability were found. Interdevice reliability was reported on seven studies using the Fitbit, but none for the Jawbone. Walking- and running-based Fitbit trials indicated consistently high interdevice reliability for steps (Pearson and intraclass CC 0.76-1.00), distance (intraclass CC 0.90-0.99), and energy expenditure (Pearson and intraclass CC 0.71-0.97). When wearing two Fitbits while sleeping, consistency between the devices was high.\n\nCONCLUSION: This systematic review indicated higher validity of steps, few studies on distance and physical activity, and lower validity for energy expenditure and sleep. The evidence reviewed indicated high interdevice reliability for steps, distance, energy expenditure, and sleep for certain Fitbit models. As new activity trackers and features are introduced to the market, documentation of the measurement properties can guide their use in research settings.", "links": [ { "caption": "URL", "url": "http://ijbnpa.biomedcentral.com/articles/10.1186/s12966-015-0314-1", "newWindow": true } ] }, { "title": "The validity of consumer-level, activity monitors in healthy adults worn in free-living conditions: a cross-sectional study.", "author": "Ferguson, T., Rowlands, A.V., Olds, T. and Maher, C.", "year": "2015", "journalProceedings": "The International Journal of Behavioral Nutrition and Physical Activity", "category": "Validation", "devices": "One,Zip", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Sleep", "abstract": "BACKGROUND: Technological advances have seen a burgeoning industry for accelerometer-based wearable activity monitors targeted at the consumer market. The purpose of this study was to determine the convergent validity of a selection of consumer-level accelerometer-based activity monitors.\n\nMETHODS: 21 healthy adults wore seven consumer-level activity monitors (Fitbit One, Fitbit Zip, Jawbone UP, Misfit Shine, Nike Fuelband, Striiv Smart Pedometer and Withings Pulse) and two research-grade accelerometers/multi-sensor devices (BodyMedia SenseWear, and ActiGraph GT3X+) for 48-hours. Participants went about their daily life in free-living conditions during data collection. The validity of the consumer-level activity monitors relative to the research devices for step count, moderate to vigorous physical activity (MVPA), sleep and total daily energy expenditure (TDEE) was quantified using Bland-Altman analysis, median absolute difference and Pearson's correlation.\n\nRESULTS: All consumer-level activity monitors correlated strongly (r > 0.8) with research-grade devices for step count and sleep time, but only moderately-to-strongly for TDEE (r = 0.74-0.81) and MVPA (r = 0.52-0.91). Median absolute differences were generally modest for sleep and steps (<10% of research device mean values for the majority of devices) moderate for TDEE (<30% of research device mean values), and large for MVPA (26-298%). Across the constructs examined, the Fitbit One, Fitbit Zip and Withings Pulse performed most strongly.\n\nCONCLUSIONS: In free-living conditions, the consumer-level activity monitors showed strong validity for the measurement of steps and sleep duration, and moderate valid for measurement of TDEE and MVPA. Validity for each construct ranged widely between devices, with the Fitbit One, Fitbit Zip and Withings Pulse being the strongest performers.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416251/", "newWindow": true } ] }, { "title": "Mobile App to Reduce Inactivity in Sedentary Overweight Women", "author": "Finkelstein, J., Bedra, M.K., Li, X., Wood, J. and Ouyang, P.", "year": "2015", "journalProceedings": "Studies in Health Technology and Informatics", "category": "Intervention", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "Recent studies demonstrated that the duration of inactivity (sedentary state) is independently associated with increased risk of cardiovascular disease. Our goal was to develop the technology that can measure the amount of inactivity in real time, remind a person that a preprogrammed period of inactivity has occurred and encourage a period of activity, and provide web-based feedback with tailored information to the participant and investigators. Once it was developed, we carried out a pilot study in a group of sedentary overweight women. The objective of the study was to assess potential of the mobile app to reduce inactivity in our target population. A randomized crossover design was employed with study subjects randomly assigned to a 4-week each \"message-on\" and \"message-off\" periods. Out of 30 enrolled subjects, 27 completed the study. The average age of participants was 52+/-12; BMI: 37+/-6; 47% were white and 47% were African American. Overall, inactivity was significantly lower (p<0.02) during \"message-on\" periods (24.6%) as compared to the \"message-off\" periods (30.4%). We concluded that mobile app monitoring inactivity and providing a real-time notification when inactivity period exceeds healthy limits was able to significantly reduce inactivity periods in overweight sedentary women.", "links": [ { "caption": "URL", "url": "http://ebooks.iospress.nl/volumearticle/40174", "newWindow": true } ] }, { "title": "Using Commercial Activity Monitors to Measure Gait in Patients with Suspected iNPH: Implications for Ambulatory Monitoring.", "author": "Gaglani, S., Moore, J., Haynes, M.R., Hoffberger, J.B. and Rigamonti, D.", "year": "2015", "journalProceedings": "Cure¯us", "category": "Validation", "devices": "Ultra", "population": "Adults", "dataUsed": "Steps", "abstract": "OBJECTIVES: This study seeks to validate the use of activity monitors to detect and record gait abnormalities, potentially identifying patients with idiopathic normal pressure hydrocephalus (iNPH) prior to the onset of cognitive or urinary symptoms.\n\nMETHODS: This study compared the step counts of four common activity monitors (Omron Step Counter HJ-113, New Lifestyles 2000, Nike Fuelband, and Fitbit Ultra) to an observed step count in 17 patients with confirmed iNPH.\n\nRESULTS: Of the four devices, the Fitbit Ultra (Fitbit, Inc., San Francisco, CA) provided the most accurate step count. The correlation with the observed step count was significantly higher (p < 0.009) for the Fitbit Ultra than for any of the other three devices.\n\nCONCLUSIONS: These preliminary findings suggest that existing activity monitors have variable efficacy in the iNPH patient population and that the MEMS tri-axial accelerometer and algorithm of the Fitbit Ultra provides the most accurate gait measurements of the four devices tested.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4689565/", "newWindow": true } ] }, { "title": "A televideo exercise and nutrition program for children with acute lymphoblastic leukemia in maintenance therapy: design and methods", "author": "Gibson, C., August, K., Greene, J.L., Herrmann, S.D., Lee, J., Harvey, S.P., Lambourne, K. and Debra, S.", "year": "2015", "journalProceedings": "Open Access Journal of Clinical Trials", "category": "Methods", "devices": "Zip", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Changes in nutrient intake and decreased exercise resulting from cancer therapies as well as their side effects may be contributing factors in the increased body weight and differences in physical fitness observed in survivors of childhood acute lymphoblastic leukemia (ALL). This article will describe the study protocol for an intervention program designed to improve the physical activity and nutrition behaviors of ALL survivors. Twenty-four children aged between 4 years and 12 years with ALL will be randomized to a 6-month technology-based exercise and nutrition program (TLC4ALLKids) or to enhanced usual care (eUC). The participants randomized to the TLC4ALLKids will participate in weekly, 1-hour coaching sessions on nutrition and physical activity and 1-hour physical activity classes delivered by group video conferencing. Participants will be provided with iPad tablets loaded with video conferencing software and the Healthy Lifestyle Tracking calendar to track daily nutrition and physical activity goals and weight. Both groups will be provided with Fitbit™ Zip to monitor physical activity. To assess feasibility, participant recruitment (achievement of proposed sample size), attendance (per weekly online sessions/assessment sessions), and adherence (number of families at 3 and 6 months) will be evaluated. Outcome measures to assess the intervention will include anthropometrics (weight, height, and waist circumference), physical activity (accelerometry), energy and macronutrient intake (food records), sleep habits (Children's Sleep Habits Questionnaire), and quality of life (Pediatric Quality of Life Inventory) will be obtained at baseline, 3 months, and 6 months. Semi-structured interviews will be used to gather information about ways to improve the program and overcome barriers to participation. If successful, the TLC4ALLKids intervention will provide a means to educate and improve the health behaviors of ALL survivors that can be delivered remotely and conveniently to participants.", "links": [ { "caption": "URL", "url": "http://www.dovepress.com/a-televideo-exercise-and-nutrition-program-for-children-with-acute-lym-peer-reviewed-article-OAJCT", "newWindow": true } ] }, { "title": "Impact of increasing physical activity on cognitive functioning in breast cancer survivors: Rationale and study design of Memory & Motion.", "author": "Hartman, S.J., Natarajan, L., Palmer, B.W., Parker, B., Patterson, R.E. and Sears, D.D.", "year": "2015", "journalProceedings": "Contemporary Clinical Trials", "category": "Methods", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "NTRODUCTION: Many breast cancer survivors experience problems with cognitive functioning that can persist years after treatment. Increasing physical activity has been shown to improve cognitive functioning in healthy and cognitively impaired adults, but has not yet been tested in cancer survivors. The primary aim of this randomized controlled trial is to examine the effects of a 3-month physical activity intervention compared to a waitlist Control arm on neuropsychological outcomes and subjective cognitive concerns in breast cancer survivors.\n\nMETHODS: Eighty sedentary breast cancer survivors, self-reporting difficulties with cognition, will be randomized into an Exercise arm or Control arm. The Exercise arm includes an activity tracker (i.e., a Fitbit), phone calls, plus tailored and non-tailored email content. The Control arm will receive emails on women's health topics on the same schedule as the Exercise arm. Assessments conducted at baseline and 3months include: neuropsychological testing, cognitive concerns and other aspects of quality of life, and 7days of a hip-worn accelerometer. Participants will also provide fasting blood draws to assess brain-derived neurotropic factor, Insulin-like growth factor 1, insulin resistance, and C-reactive protein. Primary and secondary outcomes are changes in neuropsychological testing and cognitive concerns. Biomarkers will be examined to further understand the underlying relationship between physical activity and cognition.\n\nCONCLUSION: The Memory & Motion study is designed to test whether increasing physical activity can improve cognitive functioning in breast cancer survivors. Results from this study could be used to guide development of interventions to improve cognitive functioning in breast cancer survivors.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1551714415300963", "newWindow": true } ] }, { "title": "Increasing physical activity of children during school recess.", "author": "Hayes, L.B. and Van Camp, C.M.", "year": "2015", "journalProceedings": "Journal of Applied Behavior Analysis", "category": "Intervention", "devices": "Classic", "population": "Children", "dataUsed": "Steps", "abstract": "Physical activity is crucial for children's health. Fitbit accelerometers were used to measure steps of 6 elementary students during recess. The intervention included reinforcement, self-monitoring, goal setting, and feedback. Steps taken during the intervention phase (M = 1,956 steps) were 47% higher than in baseline (M = 1,326 steps), and the percentage of recess spent in moderate-to-vigorous physical activity was higher during intervention (M = 25%) than in baseline (M = 4%). These methods successfully increased steps during recess and could be used to increase steps in other settings.", "links": [ { "caption": "URL", "url": "http://onlinelibrary.wiley.com/doi/10.1002/jaba.222/abstract", "newWindow": true } ] }, { "title": "The Walking Interventions Through Texting (WalkIT) Trial: Rationale, Design, and Protocol for a Factorial Randomized Controlled Trial of Adaptive Interventions for Overweight and Obese, Inactive Adults", "author": "Hurley, J.C., Hollingshead, K.E., Todd, M., Jarrett, C.L., Tucker, W.J., Angadi, S.S. and Adams, M.A.\t", "year": "2015", "journalProceedings": "JMIR Research Protocols", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Walking is a widely accepted and frequently targeted health promotion approach to increase physical activity (PA). Interventions to increase PA have produced only small improvements. Stronger and more potent behavioral intervention components are needed to increase time spent in PA, improve cardiometabolic risk markers, and optimize health.\n\nObjective: Our aim is to present the rationale and methods from the WalkIT Trial, a 4-month factorial randomized controlled trial (RCT) in inactive, overweight/obese adults. The main purpose of the study was to evaluate whether intensive adaptive components result in greater improvements to adults’ PA compared to the static intervention components.\n\nMethods: Participants enrolled in a 2x2 factorial RCT and were assigned to one of four semi-automated, text message–based walking interventions. Experimental components included adaptive versus static steps/day goals, and immediate versus delayed reinforcement. Principles of percentile shaping and behavioral economics were used to operationalize experimental components. A Fitbit Zip measured the main outcome: participants’ daily physical activity (steps and cadence) over the 4-month duration of the study. Secondary outcomes included self-reported PA, psychosocial outcomes, aerobic fitness, and cardiorespiratory risk factors assessed pre/post in a laboratory setting. Participants were recruited through email listservs and websites affiliated with the university campus, community businesses and local government, social groups, and social media advertising.\n\nResults: This study has completed data collection as of December 2014, but data cleaning and preliminary analyses are still in progress. We expect to complete analysis of the main outcomes in late 2015 to early 2016.\n\nConclusions: The Walking Interventions through Texting (WalkIT) Trial will further the understanding of theory-based intervention components to increase the PA of men and women who are healthy, insufficiently active and are overweight or obese. WalkIT is one of the first studies focusing on the individual components of combined goal setting and reward structures in a factorial design to increase walking. The trial is expected to produce results useful to future research interventions and perhaps industry initiatives, primarily focused on mHealth, goal setting, and those looking to promote behavior change through performance-based incentives.", "links": [ { "caption": "URL", "url": "http://www.researchprotocols.org/2015/3/e108/", "newWindow": true } ] }, { "title": "Encouraging regular physical activity for hormone-receptor positive breast cancer patients to improve mental and physical health during treatment and survivorship.", "author": "Jordan, C. and Klepsa, A.\t", "year": "2015", "journalProceedings": "Journal of Clinical Oncology", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background: Physical inactivity has direct effects on risk of chronic diseases, mental health, quality of life, and early mortality. Women that engage in physical activity after a breast cancer diagnosis may reduce the risk of recurrence and death from this disease. This study examines postmenopausal women with clinical stage I or II breast cancer using the Patient Reported Outcome Measurement Information System (PROMIS) 10 – Global Health Survey, Fitbit Flex, and regular Wellness Coaching. Methods: Our prospective study follows clinical stage I/II, postmenopausal, ER+, Her2- women with BMI textgreater or = to 25 beginning at their surgical consultation. Visits occur again post-operatively, six months after consultation, and again at one year. Each patient was given a Fitbit Flex with the expectation to complete 7,000 steps daily, and weekly Wellness Coaching. At each visit, a record of their activity was recorded including steps, heartrate, blood pressure, and body mass index. Quality of life was also assessed using PROMIS 10 - Global Health Survey. Results: 19 patients have enrolled. 100% of patients on study had BMI stay the same or decrease from initial consult to postop visit. 66% gained weight from initial postop visit to 6 months. 47% of patients met the daily goal of 7,000 steps. 80% showed significant increase in mental health scores and 60% increased physical health scores by PROMIS 10. Conclusions: Encouraging regular physical activity during treatment and survivorship for breast cancer can improve mental health and physical well-being during breast cancer treatment. Regular wellness coaching can support patients to reach their physical and mental health goals during treatment and survivorship.", "links": [] }, { "title": "Electronic activity trackers encourage family fun and fitness", "author": "Klein, D.", "year": "2015", "journalProceedings": "The Australasian Medical Journal", "category": "Case Study", "devices": "Charge", "population": "Children,Adolescents", "dataUsed": "NA", "abstract": "NA", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4496722/", "newWindow": true } ] }, { "title": "Reliability and validity of ten consumer activity trackers.", "author": "Kooiman, T.J.M., Dontje, M.L., Sprenger, S.R., Krijnen, W.P., van der Schans, C.P. and de Groot, M.", "year": "2015", "journalProceedings": "BMC Sports Science, Medicine and Rehabilitation", "category": "Validation", "devices": "One,Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Activity trackers can potentially stimulate users to increase their physical activity behavior. The aim of this study was to examine the reliability and validity of ten consumer activity trackers for measuring step count in both laboratory and free-living conditions.\nMETHOD: Healthy adult volunteers (n = 33) walked twice on a treadmill (4.8 km/h) for 30 min while wearing ten different activity trackers (i.e. Lumoback, Fitbit Flex, Jawbone Up, Nike+ Fuelband SE, Misfit Shine, Withings Pulse, Fitbit Zip, Omron HJ-203, Yamax Digiwalker SW-200 and Moves mobile application). In free-living conditions, 56 volunteers wore the same activity trackers for one working day. Test-retest reliability was analyzed with the Intraclass Correlation Coefficient (ICC). Validity was evaluated by comparing each tracker with the gold standard (Optogait system for laboratory and ActivPAL for free-living conditions), using paired samples t-tests, mean absolute percentage errors, correlations and Bland-Altman plots.\n\nRESULTS: Test-retest analysis revealed high reliability for most trackers except for the Omron (ICC .14), Moves app (ICC .37) and Nike+ Fuelband (ICC .53). The mean absolute percentage errors of the trackers in laboratory and free-living conditions respectively, were: Lumoback (-0.2, -0.4), Fibit Flex (-5.7, 3.7), Jawbone Up (-1.0, 1.4), Nike+ Fuelband (-18, -24), Misfit Shine (0.2, 1.1), Withings Pulse (-0.5, -7.9), Fitbit Zip (-0.3, 1.2), Omron (2.5, -0.4), Digiwalker (-1.2, -5.9), and Moves app (9.6, -37.6). Bland-Altman plots demonstrated that the limits of agreement varied from 46 steps (Fitbit Zip) to 2422 steps (Nike+ Fuelband) in the laboratory condition, and 866 steps (Fitbit Zip) to 5150 steps (Moves app) in the free-living condition.\n\nCONCLUSION: The reliability and validity of most trackers for measuring step count is good. The Fitbit Zip is the most valid whereas the reliability and validity of the Nike+ Fuelband is low.", "links": [ { "caption": "URL", "url": "http://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-015-0018-5", "newWindow": true } ] }, { "title": "Opportunistic uses of the traditional school day through student examination of Fitbit activity tracker data", "author": "Lee, V.R., Drake, J.R., Cain, R. and Thayne, J.\t", "year": "2015", "journalProceedings": "Proceedings of the 14th International Conference on Interaction Design and Children", "category": "Usability", "devices": "Ultra", "population": "Children", "dataUsed": "Steps", "abstract": "In large part due to the highly prescribed nature of the typical school day for children, efforts to design new interactions with technology have often focused on less-structured after-school clubs and other out-of-school environments. We argue that while the school day imposes serious restrictions, school routines can and should be opportunistically leveraged by designers and by youth. Specifically, wearable activity tracking devices open some new avenues for opportunistic collection of and reflection on data from the school day. To demonstrate this, we present two cases from an elementary statistics classroom unit we designed that intentionally integrated wearable activity trackers and child-created data visualizations. The first case involves a group of students comparing favored recess activities to determine which was more physically demanding. The second case is of a student who took advantage of her knowledge of teachers' school day routines to test the reliability of a Fitbit activity tracker against a commercial mobile app.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=2771839.2771861", "newWindow": true } ] }, { "title": "Let's Get Physical: K-12 Students Using Wearable Devices to Obtain and Learn About Data from Physical Activities", "author": "Lee, V.R., Drake, J. and Williamson, K.\t", "year": "2015", "journalProceedings": "TechTrends", "category": "Usability", "devices": "Ultra", "population": "Children", "dataUsed": "Steps", "abstract": "Accessibility to wearable technology has exploded in the last decade. As such, this technology has potential to be used in classrooms in uniquely interactive and personally meaningful ways. Seeing this as a possible future for schools, we have been exploring approaches for designing activities to incorporate wearable physical activity data tracking technologies to help students learn how to interpret data. This article describes four instances of designed learning activities in which wearable physical activity data tracking devices in use with K-12 students. Of special note is how the devices could be used to help students learn both content related to statistics and about physical activities in general. We also identify some of the challenges associated with the use of such devices that others who may use wearable technology in the classroom may wish to consider.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s11528-015-0870-x", "newWindow": true } ] }, { "title": "Effects of an Intervention using Movement Technology in a University Physical Activity Class", "author": "Mahar, M.T., Nanney, L.W., Das, B.M., Raedeke, T.D., Vick, G.A. and Rowe, D.A.\t", "year": "2015", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "The college-age population is insufficiently active and physical activity declines during the college years. Interventions in university settings are potential avenues for increasing physical activity in this population.\nPURPOSE: To examine the effect of movement technology on college students' physical activity levels, self-determined motivation for physical activity, physical activity enjoyment, and stage of change.\n\nMETHODS: Students (N = 75) wore pedometers for one week at baseline and at post-intervention to objectively assess physical activity. Volunteer participants in a university basic instruction course were randomly assigned to condition. The intervention group (n = 34) wore a Fitbit® Flex everyday throughout the 10-week intervention. The comparison group (n = 41) did not wear a Fitbit monitor. The Fitbit is a commercially available monitor that can be used to assess physical activity, provide feedback, self-monitor, and set goals. Intervention effectiveness was evaluated with a series of mixed model analyses of variance and effect size estimates via Cohen's delta (d).\n\nRESULTS: Across conditions, students showed decreases in objectively measured steps per day from baseline to post-intervention, possibly due to the time of the semester in which the pedometer assessment was conducted. However, students who wore a Fitbit had a lesser decrease in steps per day (decrease of 104 steps per day, d = -0.05) compared to students who did not wear a Fitbit (decrease of 461 steps per day, d = -0.18). The difference in changes in steps per day between conditions was small and not significant (p = .98; d = 0.16). From baseline to post-intervention, self-reported physical activity increased more in the students who wore a Fitbit than in students who did not (p = .07; d = 0.32). Changes in self-determined motivation for physical activity, physical activity enjoyment, and stage of change were similar for both groups (p textgreater .05, d textless 0.16). Intrinsic regulation was the only motivational variable that increased more among students who wore a Fitbit compared to students who did not wear a Fitbit (d = 0.33), although this difference was not significant (p = .11).\n\nCONCLUSIONS: Commercially available activity monitors, such as the Fitbit, can have a small positive impact on physical activity and intrinsic regulation for physical activity.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Citation/2015/05001/Effects_of_an_Intervention_using_Movement.1601.aspx", "newWindow": true } ] }, { "title": "Comparison of a Commercial Accelerometer with Polysomnography and Actigraphy in Children and Adolescents", "author": "Meltzer, L.J., Hiruma, L.S., Avis, K., Montgomery-Downs, H. and Valentin, J.\t", "year": "2015", "journalProceedings": "Sleep", "category": "Validation", "devices": "Ultra", "population": "Children,Adolescents", "dataUsed": "Sleep", "abstract": "Study Objectives:\nTo evaluate the reliability and validity of the commercially available Fitbit Ultra (2012) accelerometer compared to polysomnography (PSG) and two different actigraphs in a pediatric sample.\nDesign and Setting:\nAll subjects wore the Fitbit Ultra while undergoing overnight clinical polysomnography in a sleep laboratory; a randomly selected subset of participants also wore either the Ambulatory Monitoring Inc. Motionlogger Sleep Watch (AMI) or Phillips-Respironics Mini-Mitter Spectrum (PRMM).\nParticipants: 63 youth (32 females, 31 males), ages 3–17 years (mean 9.7 years, SD 4.6 years).\nMeasurements: Both “Normal” and “Sensitive” sleep-recording Fitbit Ultra modes were examined. Outcome variables included total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE). Primary analyses examined the differences between Fitbit Ultra and PSG using repeated-measures ANCOVA, with epoch-by-epoch comparisons between Fitbit Ultra and PSG used to determine sensitivity, specificity, and accuracy. Intra-device reliability, differences between Fitbit Ultra and actigraphy, and differences by both developmental age group and sleep disordered breathing (SDB) status were also examined.\nResults: Compared to PSG, the Normal Fitbit Ultra mode demonstrated good sensitivity (0.86) and accuracy (0.84), but poor specificity (0.52); conversely, the Sensitive Fitbit Ultra mode demonstrated adequate specificity (0.79), but inadequate sensitivity (0.70) and accuracy (0.71). Compared to PSG, the Fitbit Ultra significantly overestimated TST (41 min) and SE (8%) in Normal mode, and underestimated TST (105 min) and SE (21%) in Sensitive mode. Similar differences were found between Fitbit Ultra (both modes) and both brands of actigraphs.\nConclusions: Despite its low cost and ease of use for consumers, neither sleep-recording mode of the Fitbit Ultra accelerometer provided clinically comparable results to PSG. Further, pediatric sleep researchers and clinicians should be cautious about substituting these devices for validated actigraphs, with a significant risk of either overestimating or underestimating outcome data including total sleep time and sleep efficiency.", "links": [ { "caption": "URL", "url": "https://academic.oup.com/sleep/article-lookup/doi/10.5665/sleep.4918", "newWindow": true } ] }, { "title": "Smart Wristbands as Inexpensive and Reliable Non-dedicated Solution for Self-Managing Type 2 Diabetes", "author": "Militaru, A., Frandes, M. and Lungeanu, D.", "year": "2015", "journalProceedings": "2015 E-Health and Bioengineering Conference (EHB)", "category": "Case Study", "devices": "Charge HR", "population": "Older Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Sleep,Heart Rate", "abstract": "The paper presents the results of a pilot investigation we conducted to explore the suitability of non-dedicated smart gadgets for self-management and daily feed-back in type 2 diabetes. Data were collected with a fitness bracelet from a non-insulin dependent male subject aged 67, over a 14-day period. In parallel, the subject self-monitored his blood glucose with a home test strips glucometer, three measurements per day. The bracelet was from the upper scale of FitBit mobile wearables (i.e. Active fitness on professional scale), providing a fair large range of monitoring parameters. We further applied a multi-variable regression model with blood glucose level as the outcome and found reliable evidence regarding the predictive power of the data collected with the wearable gadget, on a daily basis. The novelty is that such affordable devices can be useful tools for a positive, non-invasive, and motivational approach in self-managing the illness.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/lpdocs/epic03/wrapper.htm?arnumber=7391558", "newWindow": true } ] }, { "title": "Effects of Public Commitments and Accountability in a Technology-Supported Physical Activity Intervention", "author": "Munson, S.A., Krupka, E., Richardson, C. and Resnick, P.\t", "year": "2015", "journalProceedings": "Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Walking and other forms of physical activity have many health benefits, but people often fail to follow through on their own goals of being more active. To address gaps in current understanding of how to design technology-supported physical activity interventions, we conducted a randomized field experiment of a commitment device: making public announcements. In a control condition, weekly commitments were kept private. In two treatment conditions, they were announced on Facebook and by email. In one of the two, the announcements also included results: whether the previous week's commitment was kept. We find that, with or without public results, these posts can elicit supportive replies from the poster's social networks. People in both public announcements conditions were less likely to make commitments. We conclude that the prospect of public accountability may suppress the making of commitments in a way that counteracts the benefits of that accountability. Designers will need to address this limitation in order to make effective use of public accountability as a commitment device.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=2702123.2702524", "newWindow": true } ] }, { "title": "Feasibility of popular m-health technologies for activity tracking among individuals with serious mental illness.", "author": "Naslund, J.A., Aschbrenner, K.A., Barre, L.K. and Bartels, S.J.", "year": "2015", "journalProceedings": "Telemedicine journal and e-health: the official journal of the American Telemedicine Association", "category": "Usability", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "NA", "abstract": "Obesity prevalence is nearly double among individuals with serious mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorder, or major depressive disorder, compared with the general population. Emerging mobile health (m-health) technologies are increasingly available and offer the potential to support lifestyle interventions targeting weight loss, yet the practical feasibility of using these technologies in this high-risk group has not been established. We evaluated the feasibility and acceptability of popular m-health technologies for activity tracking among overweight and obese individuals with SMI. We provided wearable activity monitoring devices (FitBit [San Francisco, CA] Zip™ or Nike Inc. [Beaverton, OR] FuelBand) and smartphones (Apple [Cupertino, CA] iPhone(®) 4S) for accessing the smartphone application for each device to participants with SMI enrolled in a weight loss program. Feasibility of these devices was measured by the frequency of use over time. Acceptability was measured through qualitative follow-up interviews with participants. Ten participants with SMI wore the devices for a mean of 89% (standard deviation=13%) of the days in the study. Five participants wore the devices 100% of the time. Participants reported high satisfaction, stating the devices were easy to use, helpful for setting goals, motivational, and useful for self-monitoring. Several participants liked the social connectivity feature of the devices where they could see each other's progress on the smartphone application, noting that \"friendly\" competition increased motivation to be more physically active. This study supports using popular m-health technologies for activity tracking among individuals with SMI. These findings can inform the design of weight loss interventions targeting this vulnerable patient population.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/25536190/", "newWindow": true } ] }, { "title": "Text Messaging to Reduce Inactivity Using Real-Time Step Count Monitoring in Sedentary Overweight Females", "author": "Ouyang, P., Stewart, K.J., Bedra, M.E., York, S., Valdiviezo, C. and Finkelstein, J.", "year": "2015", "journalProceedings": "Circulation", "category": "Intervention", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "Introduction: Prolonged periods of of inactivity are associated with higher CV morbidity independent of level of activity. Work and lifestyle choices today are associated with long periods of sitting, e.g. computer or screen watching. Wearable activity monitors such as pedometers have focused on increasing daily activity but not on reducing inactivity.\nHypothesis: Sedentary women will decrease inactivity if given a real time reminder of inactivity .\n\nMethod: We developed a program to monitor real-time activity levels generated by a wearable activity monitor (Fitbit). Fitbit communicated step counts to a smartphone which sent this information to a database every 15 minutes. When 10 or fewer steps had been recorded for a 60 min period of time, an inactivity reminder text message was sent to the participant to encourage them to move about. 30 obese women with self-reported > 3 hours of inactivity per day, were enrolled, provided with a Fitbit and smartphone, and monitored for 8 weeks. Women were randomized to two groups. Gp A received inactivity reminders (IR) for the first 4 weeks followed by 4 weeks without IR. Gp B received no IR during the first 4 weeks and IR was given during the second 4 weeks. We defined inactivity as = 20 steps in a 2 hr block. We compared the percent of 2-hr blocks between 8:00 and 24:00 hr where women were inactive during the 4 weeks with IR-on vs IR-off, for each of the 2 groups. The mean number of steps per day over each 4 week block was also compared.\n\nResults: Gps A and B were similar in age (51.8 + 12.2 y), BMI (37.1 + 6.9), self-reported hypertension (27% ), diabetes (23 %), and hyperlipidemia (23%). Fitbit data was available from 27 women. Gp A (n=15) self-reported 5.2 + 2.5 hr sitting/day at work during IR-off vs 3.9 + 2.7 with IR-on (p<0.004). Gp B (n=12), who had IR turned on in the second 4 week block, self-reported no change in hours sitting with or without IR. Activity monitoring data showed that Gp A were inactive for 32 + 23% of the 2-hr periods during the 4 weeks with IR-off vs 21 + 14% with IR-on (p < 0.004). However, Gp B had no difference in inactivity periods (28 + 12% with IR-off vs 28 + 14 % with IR-on). There were no differences in mean total daily steps walked during either 4 week block with IR-on or IR-off in either Gp.\n\nConclusion: The use of real-time text messaging to inform women that they had been inactive for more than 60 mins was associated with a reduction in number of inactive periods independent of the number of steps taken a day. However, this effect was seen only when the reminder was implemented soon after enrollment. The behavior change did not persist after the reminders stopped. This study demonstrates that automated real time reminders can reduce periods of inactivity though the timing of the intervention affected the results. Further work will explore the behavioral factors that could improve the effectiveness and sustainability of the intervention.", "links": [ { "caption": "URL", "url": "http://circ.ahajournals.org/content/131/Suppl_1/AMP10", "newWindow": true } ] }, { "title": "Validity of the Fitbit activity tracker for measuring steps in community-dwelling older adults", "author": "Paul, S.S., Tiedemann, A., Hassett, L.M., Ramsay, E., Kirkham, C., Chagpar, S. and Sherrington, C.", "year": "2015", "journalProceedings": "BMJ Open Sport & Exercise Medicine", "category": "Validation", "devices": "One,Zip", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Background: Commercially available activity monitors, such as the Fitbit, may encourage physical activity. However, the accuracy of the Fitbit in older adults remains unknown. This study aimed to determine (1) the criterion validity of Fitbit step counts compared to visual count and ActiGraph accelerometer step counts and (2) the accuracy of ActiGraph step counts compared to visual count in community-dwelling older people.\nMethods: Thirty-two community-dwelling adults aged over 60 wore Fitbit and ActiGraph devices simultaneously during a 2 min walk test (2MWT) and then during waking hours over a 7-day period. A physiotherapist counted the steps taken during the 2MWT.\n\nResults: There was excellent agreement between Fitbit and visually counted steps (intraclass correlation coefficient (ICC2,1)=0.88, 95% CI 0.76 to 0.94) from the 2MWT, and good agreement between Fitbit and ActiGraph (ICC2,1=0.66, 95% CI 0.41 to 0.82), and between ActiGraph and visually counted steps (ICC2,1=0.60, 95% CI 0.33 to 0.79). There was excellent agreement between the Fitbit and ActiGraph in average steps/day over 7 days (ICC2,1=0.94, 95% CI 0.88 to 0.97). Percentage agreement was closest for Fitbit steps compared to visual count (mean 0%, SD 4%) and least for Fitbit average steps/day compared to the ActiGraph (mean 13%, SD 25%).\n\nConclusions: The Fitbit accurately tracked steps during the 2MWT, but the ActiGraph appeared to underestimate steps. There was strong agreement between Fitbit and ActiGraph counted steps. The Fitbit tracker is sufficiently accurate to be used among community-dwelling older adults to monitor and give feedback on step counts.", "links": [ { "caption": "URL", "url": "http://bmjopensem.bmj.com/content/1/1/e000013.full", "newWindow": true } ] }, { "title": "Using A Facebook Group As An Adjunct To A Pilot mHealth Physical Activity Intervention: A Mixed Methods Approach.", "author": "Pumper, M.A., Mendoza, J.A., Arseniev-Koehler, A., Holm, M., Waite, A. and Moreno, M.A.\t", "year": "2015", "journalProceedings": "Studies in Health Technology and Informatics", "category": "Intervention", "devices": "Flex", "population": "Adolescents", "dataUsed": "Steps", "abstract": "In the United States, most adolescents do not obtain the recommended amounts of physical activity for optimal health. Around 80% of adolescents own a mobile device, and social media is frequently used by adolescents on mobile devices. Few studies have examined the use of social media as part of an intervention to promote physical activity. The purpose of this study was to evaluate the use of a Facebook group as part of a mHealth physical activity intervention trial. Adolescents, ages 14-18 years, were recruited for a four week physical activity intervention using the FitBit Flex. Participants were also given the option to join a private Facebook group where they could interact and were given badges for fitness accomplishments. The research assistant moderator posted on the Facebook group an average of 25.3 times (SD=7.2). Post-intervention, participants completed a phone interview about their experience. Of 30 intervention participants (avg age 16.0 (SD=1.1), 60.0% female), 17 opted to join the Facebook group (avg age 16.3 (SD=1.2), 47.0% female) of which 10 completed a qualitative interview. Participants averaged 4.9 interactions (SD=8.7) on the Facebook group wall throughout the intervention. From the interview responses, major themes included enjoying the badge feature of the Facebook group and wanting more content and interaction. In conclusion, participants used and enjoyed having the Facebook group, particularly the badge feature of the group, as an adjunct to the physical activity intervention.", "links": [ { "caption": "URL", "url": "http://ebooks.iospress.nl/publication/42131", "newWindow": true } ] }, { "title": "Exploring physical activity monitoring devices for diabetic and obese patients", "author": "Randriambelonoro, M., Chen, Y., Geissbuhler, A. and Pu, P.", "year": "2015", "journalProceedings": "Proceedings of the 2015 ACM International Joint Conference on Pervasive and Ubiquitous Computing and Proceedings of the 2015 ACM International Symposium on Wearable Computers", "category": "Usability", "devices": "One", "population": "Patients,Adults", "dataUsed": "NA", "abstract": "The World Health Organization highly recommends physical activities to control diabetes and obesity. Research on pervasive fitness devices is on the rise, but little attention has been given to how diabetic and obese patients use them to change their lifestyle. This paper reports the results of a one-month in-situ study with obese and diabetic patients. We interviewed 18 subjects using a set of carefully designed qualitative questions and let them use a fitness sensor called Fitbit for one month. Before the study, participants found it challenging to motivate themselves for physical exercise. One month later, they became aware of their sedentary lifestyles and started to perform more activities at a steady pace. Subsequently, patients reported rethinking of fitness and visible behavior changes.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=2800835.2800951", "newWindow": true } ] }, { "title": "Comparison of Three Inexpensive Commercially Available Activity Monitors to a Previously Validated Tri-Axial Accelerometer", "author": "Reid, R.E., Comptour, A.M., Insogna, J.A., Bewski, N.A., Sciortino, C.D. and Andersen, R.E.", "year": "2015", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "One,Force", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Inexpensive personal activity monitors have recently gained popularity with the general public. Given the current wide-spread use of these devices, it is important to ensure that users are attaining accurate information compared to previously validated measures.\nPURPOSE: To compare the accuracy of the Fitbit Force™ and One™ activity monitors in measuring steps per day and time spent in different intensities of activity with the ActiGraph GT3X™tri-axial accelerometer.\n\nMETHODS: Twenty-two women, 18-26y.o. with a BMI of 23.24 ± 3.26kg/m2 wore two Fitbit Ones TM (Bra and Waist respectively), a Fitbit Force TM (Wrist), and an ActiGraph GT3X™(Waist) for 7-consecutive days. ActiGraph™ data was processed using Actilife™ V5.1.1 and the Freedson equation activity cut points. Fitbit™ data was processed using their proprietary online software. A multivariate analysis of variance (MANOVA) was used to compare steps per day and time spent in light, moderate and vigorous intensity activities between the four devices. A post-hoc test of the least squared difference was used to determine where any differences occurred.\n\nRESULTS: The activity monitors differed in time spent in light F(3,19)= 3.16, ptextgreater.05) and vigorous (F(3,19)= 3.16, ptextgreater.05) intensity activities. Post-hoc comparisons revealed that the GT3X™ differed from all three Fitbit™ devices in the measurement of time spent in light (GT3X= 89.92±36 min, Force=419.97±129.22 min, Bra=379.93±122.2 min, Waist=392.75±114.78 min) and vigorous activities (GT3X=7.05±9.63 min, Force=36.91±27.7 min, Bra=31.29±18.53 min, Waist=30.45±18.3 min). There was no difference found in the number of steps per day or minutes of moderate intensity activity recorded between the four devices.\n\nCONCLUSIONS: Fitbit™ activity monitors compare well to other previously validated objective activity monitors in the measurement of steps per day and time spent in moderate intensity activities. However, Fitbit™ devices may not accurately quantify the time spent in light and vigorous intensity activities, and therefore may not be the ideal solution for individuals' personal activity monitoring needs.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Citation/2015/05001/Comparison_of_Three_Inexpensive_Commercially.42.aspx", "newWindow": true } ] }, { "title": "24 Hours of Sleep, Sedentary Behavior, and Physical Activity with Nine Wearable Devices", "author": "Rosenberger, M.E., Buman, M.P., Haskell, W.L., McConnell, M.V. and Carstensen, L.L.", "year": "2015", "journalProceedings": "Medicine and Science in Sports and Exercise", "category": "Validation", "devices": "One", "population": "Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "Getting enough sleep, exercising, and limiting sedentary activities can greatly contribute to disease prevention and overall health and longevity. Measuring the full 24-h activity cycle-sleep, sedentary behavior (SED), light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA)-may now be feasible using small wearable devices.\nPURPOSE: This study compared nine devices for accuracy in a 24-h activity measurement.\n\nMETHODS: Adults (n = 40, 47% male) wore nine devices for 24 h: ActiGraph GT3X+, activPAL, Fitbit One, GENEactiv, Jawbone Up, LUMOback, Nike Fuelband, Omron pedometer, and Z-Machine. Comparisons (with standards) were made for total sleep time (Z-machine), time spent in SED (activPAL), LPA (GT3X+), MVPA (GT3X+), and steps (Omron). Analysis included mean absolute percent error, equivalence testing, and Bland-Altman plots.\n\nRESULTS: Error rates ranged from 8.1% to 16.9% for sleep, 9.5% to 65.8% for SED, 19.7% to 28.0% for LPA, 51.8% to 92% for MVPA, and 14.1% to 29.9% for steps. Equivalence testing indicated that only two comparisons were significantly equivalent to standards: the LUMOback for SED and the GT3X+ for sleep. Bland-Altman plots indicated GT3X+ had the closest measurement for sleep, LUMOback for SED, GENEactiv for LPA, Fitbit for MVPA, and GT3X+ for steps.\n\nCONCLUSIONS: Currently, no device accurately captures activity data across the entire 24-h day, but the future of activity measurement should aim for accurate 24-h measurement as a goal. Researchers should continue to select measurement devices on the basis of their primary outcomes of interest.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/26484953", "newWindow": true } ] }, { "title": "Validation of the Fitbit wireless activity tracker for prediction of energy expenditure.", "author": "Sasaki, J.E., Hickey, A., Mavilia, M., Tedesco, J., John, D., Kozey Keadle, S. and Freedson, P.S.", "year": "2015", "journalProceedings": "Journal of Physical Activity & Health", "category": "Validation", "devices": "Classic", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "OBJECTIVE: The purpose of this study was to examine the accuracy of the Fitbit wireless activity tracker in assessing energy expenditure (EE) for different activities.\nMETHODS: Twenty participants (10 males, 10 females) wore the Fitbit Classic wireless activity tracker on the hip and the Oxycon Mobile portable metabolic system (criterion). Participants performed walking and running trials on a treadmill and a simulated free-living activity routine. Paired t tests were used to test for differences between estimated (Fitbit) and criterion (Oxycon) kcals for each of the activities.\n\nRESULTS: Mean bias for estimated energy expenditure for all activities was -4.5 ± 1.0 kcals/6 min (95% limits of agreement: -25.2 to 15.8 kcals/6 min). The Fitbit significantly underestimated EE for cycling, laundry, raking, treadmill (TM) 3 mph at 5% grade, ascent/descent stairs, and TM 4 mph at 5% grade, and significantly overestimated EE for carrying groceries. Energy expenditure estimated by the Fitbit was not significantly different than EE calculated from the Oxycon Mobile for 9 activities.\n\nCONCLUSION: The Fitbit worn on the hip significantly underestimates EE of activities. The variability in underestimation of EE for the different activities may be problematic for weight loss management applications since accurate EE estimates are important for tracking/monitoring energy deficit.", "links": [ { "caption": "URL", "url": "http://europepmc.org/abstract/med/24770438", "newWindow": true } ] }, { "title": "Capturing step counts at slow walking speeds in older adults: comparison of ankle and waist placement of measuring device.", "author": "Simpson, L.A., Eng, J.J., Klassen, T.D., Lim, S.B., Louie, D.R., Parappilly, B., Sakakibara, B.M. and Zbogar, D.", "year": "2015", "journalProceedings": "Journal of Rehabilitation Medicine", "category": "Validation", "devices": "One", "population": "Older Adults", "dataUsed": "Steps", "abstract": "OBJECTIVE: It is important for older adults to be physically active, but many older adults walk slowly. This study examined the accuracy of a commercially available step-count device (Fitbit One) at slow speeds and compared the accuracy of the device when worn at the ankle and waist in older adults.\nMETHODS: The Fitbit One was placed at the ankle and waist of participants (n=42; mean age 73 years) while they performed walking trials at 7 different speeds (0.3-0.9 m/s). Step counts obtained from video recordings were used as the gold standard comparison to determine the accuracy of the device.\n\nRESULTS: The ankle-worn device had significantly less error than the waist-worn device at all speeds. The percentage error of the ankle-worn device was less than 10% at speeds of 0.4-0.9 m/s and did not record zero steps at any speed. The percentage error of the waist-worn device was below 10% at only the 2 fastest speeds (0.8 and 0.9 m/s) and recorded zero steps for numerous participants at speeds of 0.3-0.5 m/s.\n\nCONCLUSION: The Fitbit One can accurately capture steps at slow speeds when placed at the ankle and thus may be appropriate for capturing physical activity in slow-walking older adults.", "links": [ { "caption": "URL", "url": "http://www.medicaljournals.se/jrm/content/?doi=10.2340/16501977-1993", "newWindow": true } ] }, { "title": "Accuracy of the FitBit at walking speeds and cadences relevant to clinical rehabilitation populations", "author": "Singh, A.K., Farmer, C., Van Den Berg, M.L., Killington, M. and Barr, C.J.", "year": "2015", "journalProceedings": "Disability and Health Journal", "category": "Validation", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Activity monitoring is used for motivation and assessing patients in the rehabilitation setting. Monitors available on the market have not been assessed for accuracy at walking patterns seen in the clinical setting.\nOBJECTIVES: To assess the accuracy of the Fitbit Zip device at different anatomical locations at walking speeds, step length, and cadence similar to those seen in clinical rehabilitation populations.\n\nMETHODS: Ten healthy participants completed 3 sets of 12 combinations of speed and cadence ranging from 0.2m/s at 48 steps per minute to 1.0 m/s at 120 steps per minute along a 20m walkway. Step length was controlled by ground markings and cadence was controlled by a metronome. Five Fitbit Zip devices were concurrently worn at the chest, hip, shin, ankle and forefoot. Percent accuracy for each location and walking condition combination were calculated.\n\nRESULTS: At the chest and hip the Fitbit has poor accuracy below 0.7m/s, however when worn distally, can be accurate to 5.5% at speeds as slow as 0.5m/s.\n\nCONCLUSIONS: For patient populations with slow walking speed, activity monitoring with the Fitbit can be achieved provided the device is located distally on the lower limb.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1936657415001740", "newWindow": true } ] }, { "title": "Intergenerational activity tracker program: Impact with health related outcomes on older adults", "author": "Sookhai, L., Coppola, J.F. and Gaur, C.", "year": "2015", "journalProceedings": "2015 Long Island Systems, Applications and Technology", "category": "Usability,Measurement", "devices": "Zip", "population": "Older Adults", "dataUsed": "Steps", "abstract": "As resilient as the human body may appear to be, the aging process is inevitable and takes a physical toll on all bodies, but getting older does not equate to neglecting healthy habits. If anything, as people age it is more important to be vigilant and lead proactive lifestyles. In an effort to increase health awareness and promote a healthier lifestyle Pace University conducted a 7 week pilot study using activity trackers and Telemedical Bluetooth devices. Most Senior citizens are intimidated and unaccepting when it comes to relying on technology but through the use of activity trackers senior citizens are able to measure their progress towards a healthier lifestyle. With the data gained from the activity trackers students will be able to monitor daily activity and assess whether or not it has encouraged a positive effect on senior vital data. This paper analyzes the impact of activity trackers on senior citizen biometric data including weight, blood pressure and pulse. By tracking the amount of steps the seniors have taken over the 7 week study. We will be able to determine if an increase in physical activity has a positive effect on the vital signs of older adults. Through the use of wireless technology, senior vital sings and step tracking data are synchronized wirelessly once a week by students at Pace University and measured for any significant changes. Prior to distributing activity trackers seniors were administered Pre assessment surveys and Post surveys, after receiving the trackers. Some of the collected data included preexisting health conditions, activity habits, and willingness to try new technology. By assessing the results, this paper explores whether the activity tracker had a significant effect on senior vital signs.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/lpdocs/epic03/wrapper.htm?arnumber=7160218", "newWindow": true } ] }, { "title": "A Mobile Health Driven Walking Program Improves Quality of Life but not Fitness or Fatness in Obese Sedentary Women", "author": "Stewart, K.J., Katz, J., Dobrosielski, M. and Ouyang, P.", "year": "2015", "journalProceedings": "Circulation", "category": "Intervention", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Many mHealth programs exist for increasing physical activity (PA) yet few have been tested for their effects on fitness, fatness, and health related quality of life (HRQOL).\nMethods: We conducted a 3-month randomized trial that examined 2 message formats that promoted the 10,000 steps/day walking program. Women (n=70), aged 48+/-12 years, BMI 35.0 +/-3.8, with self-report of no regular (PA), were given a FitBit and smartphone, which automatically sent daily step data to us daily. Daily messages with feedback about meeting step goals and motivation to add 500 more daily steps/week were sent to the subject's smartphone. We compared the Multimedia Messaging Service (MMS) consisting of audio, video and graphs versus the Short Message Service (SMS), or plain text messages. Message content was the same for both groups. Outcomes included the 6-minute walk test, weight, waist and hip circumferences, BMI, SF-36, and Profile of Mood States (POMS). We hypothesized that MMS subjects would be more engaged, walk more, and attain greater gains in study outcomes.\n\nResults: We delayed messaging for the first 2 weeks to establish a daily step baseline, which was 6665 +/-2270. There were no group differences in daily steps at baseline or at any time point in the study. Daily steps in Month 1 was 6926+/-2465; Month 2, 7327+/- 3310; and Month 3, 6642+/-2914. The increases from baseline to the full Month 1 (p=0.004) and Month 1 to 2 (p=0.025) were significant but not the decrease from Month 2 to 3. The FitBit was worn 91% of study days in both groups. There were no changes or group differences in any fitness or fatness measure. Both groups similarly improved SF-36 General Health (p=0.02) and Vitality (p=0.01); and POMS Fatigue (p=0.01), Vigor (p=0.001), Tension-Anxiety (p=0.03), and Total Mood Score, (p=0.02).\n\nConclusions: Baseline steps were about 2-3 times more than expected for sedentary women. It seems that the novelty of using a tracking device accelerated the planned progression for walking, with a much higher than expected step count initially and then a slight drop over time. An average of 10,000 steps/day was not met. There were no changes in physical measures though indicators of HRQOL improved. Contrary to our hypothesis, the different messaging formats did not affect outcomes.", "links": [ { "caption": "URL", "url": "http://circ.ahajournals.org/content/132/Suppl_3/A15928.short", "newWindow": true } ] }, { "title": "Step Detection and Activity Recognition Accuracy of Seven Physical Activity Monitors", "author": "Storm, F.A., Heller, B.W. and Mazzà, C.", "year": "2015", "journalProceedings": "PLOS ONE", "category": "Validation", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "The aim of this study was to compare the seven following commercially available activity monitors in terms of step count detection accuracy: Movemonitor (Mc Roberts), Up (Jawbone), One (Fitbit), ActivPAL (PAL Technologies Ltd.), Nike+ Fuelband (Nike Inc.), Tractivity (Kineteks Corp.) and Sensewear Armband Mini (Bodymedia). Sixteen healthy adults consented to take part in the study. The experimental protocol included walking along an indoor straight walkway, descending and ascending 24 steps, free outdoor walking and free indoor walking. These tasks were repeated at three self-selected walking speeds. Angular velocity signals collected at both shanks using two wireless inertial measurement units (OPAL, ADPM Inc) were used as a reference for the step count, computed using previously validated algorithms. Step detection accuracy was assessed using the mean absolute percentage error computed for each sensor. The Movemonitor and the ActivPAL were also tested within a nine-minute activity recognition protocol, during which the participants performed a set of complex tasks. Posture classifications were obtained from the two monitors and expressed as a percentage of the total task duration.\nThe Movemonitor, One, ActivPAL, Nike+ Fuelband and Sensewear Armband Mini underestimated the number of steps in all the observed walking speeds, whereas the Tractivity significantly overestimated step count. The Movemonitor was the best performing sensor, with an error lower than 2% at all speeds and the smallest error obtained in the outdoor walking. The activity recognition protocol showed that the Movemonitor performed best in the walking recognition, but had difficulty in discriminating between standing and sitting. Results of this study can be used to inform choice of a monitor for specific applications.", "links": [ { "caption": "URL", "url": "http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0118723", "newWindow": true } ] }, { "title": "The intervention composed of aerobic training and non-exercise physical activity (I-CAN) study: Rationale, design and methods", "author": "Swift, D.L., Dover, S.E., Nevels, T.R., Solar, C.A., Brophy, P.M., Hall, T.R., Houmard, J.A. and Lutes, L.D.\t", "year": "2015", "journalProceedings": "Contemporary Clinical Trials", "category": "Methods", "devices": "One", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Recent data has suggested that prolonged sedentary behavior is independent risk factor for cardiovascular and all-cause mortality independent of adequate amounts of moderate to vigorous physical activity. However, few studies have prospectively evaluated if exercise training and increasing non-exercise physical activity leads to greater reduction in cardiometabolic risk compared to aerobic training alone. The purpose of the Intervention Composed of Aerobic Training and Non-Exercise Physical Activity (I-CAN) study is to determine whether a physical activity program composed of both aerobic training (consistent with public health recommendations) and increasing non-exercise physical activity (3000 steps above baseline levels) leads to enhanced improvements in waist circumference, oral glucose tolerance, systemic inflammation, body composition, and fitness compared to aerobic training alone in obese adults (N=45). Commercially available accelerometers (Fitbits) will be used to monitor physical activity levels and behavioral coaching will be used to develop strategies of how to increase non-exercise physical activity levels. In this manuscript, we describe the design, rationale, and methodology associated with the I-CAN study.", "links": [ { "caption": "URL", "url": "http://linkinghub.elsevier.com/retrieve/pii/S1551714415301166", "newWindow": true } ] }, { "title": "Evaluating an Internet-based program and a behavioral coach for increasing physical activity.", "author": "Valbuena, D., Miltenberger, R. and Solley, E.\t", "year": "2015", "journalProceedings": "Behavior Analysis: Research & Practice", "category": "Intervention", "devices": "One,Aria", "population": "Adults", "dataUsed": "Steps,Weight", "abstract": "Obesity is a problem of vast social concern in the United States. One factor that has been linked to reduction in body fat and the health problems associated with obesity is increasing physical activity. Although in-person behavioral interventions have been shown effective at increasing physical activity, attention is now being placed on disseminating these interventions through the use of technology. Several internet-based interventions have been developed and are readily available. The purpose of this study was to evaluate \"Fitbit,\" a web-based behavioral intervention for increasing physical activity and losing weight. Additionally, this study examined if the addition of contact from a behavioral coach through videoconference and email enhanced the effectiveness of this program. Through a multiple-baseline design across seven participants this research project evaluated the effectiveness of the \"Fitbit\" program with and without a behavioral coach. Step counts were recorded by a Fitbit sensor as a measure of physical activity. The Fitbit program alone increased physical activity for some of the participants, and the addition of the behavioral coach resulted in further increases in mean step counts.", "links": [ { "caption": "URL", "url": "http://psycnet.apa.org/?&fa=main.doiLanding&doi=10.1037/bar0000013", "newWindow": true } ] }, { "title": "The Effect of Fitbit Technology on Physical Activity in Inactive Adults (50+ Years of Age)", "author": "Vasold, K.L., Groendal, E.G. and Knous, J.L.\t", "year": "2015", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Intervention", "devices": null, "population": "Older Adults", "dataUsed": "Steps", "abstract": "The Fitbit tracker is a wearable technology designed to motivate individuals to become physically active by increasing awareness of physical activity (PA) levels. The Fitbit tracks activity, sleep, nutrition, uploads wirelessly, and is tiny and discreet. Published data is limited concerning the effectiveness of Fitbit technology on increasing PA levels in inactive adult populations.\nPURPOSE: To study changes in PA as a result of wearing the Fitbit for 8 weeks in individuals 50+ years of age.\n\nMETHODS: Sixty university employees were stratified into two groups, intervention (n=29) and comparison (n=31), based on meeting PA recommendations of 150 minutes per week. Of these employees, 18 were ages 50 and over (7 intervention; 11 comparison). Intervention group participants (not meeting ACSM PA recommendations) were given a Fitbit to wear for 8 weeks, while comparison group participants were not and were encouraged to maintain their current PA habits. Demographic, anthropometric, and biometric data, body composition, flexibility, muscular strength/endurance, and cardiorespiratory fitness were assessed prior to and following the intervention. Self-reported PA was assessed via online survey. Independent sample T-tests were used to analyze differences between intervention and control groups. Paired sample T-tests were used to analyze differences pre- and post-Fitbit intervention.\n\nRESULTS: Mean age, weight, and BMI for the adult (50+) cohort of the sample was 58±5 years, 172±27 pounds, and 28.8±3.8 kg/m2, respectively. There were no significant differences between intervention and control groups at pre-test despite a large difference in self-reported PA (intervention: 70 minutes, comparison: 399 minutes). There was a positive change in self-reported PA in the intervention group from pre- to post-intervention that trended towards significance (p=0.08). Six out of seven of the intervention group participants were meeting PA recommendations post-intervention.\n\nCONCLUSIONS: Based on these results, wearing the Fitbit for 8 weeks increased PA in inactive adults (50+) to the point of meeting/exceeding PA recommendations. Further research is needed to determine the levels of improvement for this older adult population using this technology.", "links": [] }, { "title": "Wearable Sensor/Device (Fitbit One) and SMS Text-Messaging Prompts to Increase Physical Activity in Overweight and Obese Adults: A Randomized Controlled Trial.", "author": "Wang, J.B., Cadmus-Bertram, L.A., Natarajan, L., White, M.M., Madanat, H., Nichols, J.F., Ayala, G.X. and Pierce, J.P.", "year": "2015", "journalProceedings": "Telemedicine and e-Health", "category": "Intervention", "devices": "One", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND: Studies have shown self-monitoring can modify health behaviors, including physical activity (PA). This study tested the utility of a wearable sensor/device (Fitbit(®) One™; Fitbit Inc., San Francisco, CA) and short message service (SMS) text-messaging prompts to increase PA in overweight and obese adults.\nMATERIALS AND METHODS: Sixty-seven adults wore a Fitbit One tracker for 6 weeks; half were randomized to also receive three daily SMS-based PA prompts. The Fitbit One consisted of a wearable tracker for instant feedback on performance and a Web site/mobile application (app) for detailed summaries. Outcome measures were objectively measured steps and minutes of PA by intensity using two accelerometers: Actigraph™ (Pensacola, FL) GT3X+ (primary measure) at baseline and Week 6 and Fitbit One (secondary measure) at baseline and Weeks 1, 2, 3, 4, 5, and 6.\n\nRESULTS: Mixed-model repeated-measures analysis of primary measures indicated a significant within-group increase of +4.3 (standard error [SE]=2.0) min/week of moderate- to vigorous-intensity PA (MVPA) at 6-week follow-up (p=0.04) in the comparison group (Fitbit only), but no study group differences across PA levels. Secondary measures indicated the SMS text-messaging effect lasted for only 1 week: the intervention group increased by +1,266 steps (SE=491; p=0.01), +17.8 min/week MVPA (SE=8.5; p=0.04), and +38.3 min/week total PA (SE=15.9; p=0.02) compared with no changes in the comparison group, and these between-group differences were significant for steps (p=0.01), fairly/very active minutes (ptextless0.01), and total active minutes (p=0.02).\n\nCONCLUSIONS: These data suggest that the Fitbit One achieved a small increase in MVPA at follow-up and that the SMS-based PA prompts were insufficient in increasing PA beyond 1 week. Future studies can test this intervention in those requiring less help and/or test strategies to increase participants' engagement levels.", "links": [ { "caption": "URL", "url": "http://online.liebertpub.com/doi/abs/10.1089/tmj.2014.0176", "newWindow": true } ] }, { "title": "Validation of Fitbit-Flex as a measure of free-living physical activity in a community-based phase III cardiac rehabilitation population", "author": "Alharbi, M., Bauman, A., Neubeck, L. and Gallagher, R.", "year": "2016", "journalProceedings": "European Journal of Preventive Cardiology", "category": "Validation", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: Accurate physical activity monitoring is important for cardiac patients. Novel activity monitoring devices may enable precise measurement of physical activity. This study aimed to validate Fitbit-Flex against Actigraph accelerometer for monitoring physical activity.\nDesign: A validation study with a comparative design.\n\nMethods: Cardiac patients and family members participating in community-based exercise programs wore Fitbit-Flex and Actigraph simultaneously over four days to monitor daily step counts and minutes of moderate to vigorous physical activity (MVPA).\n\nResults: Participants (N?=?48) comprised 52.1% males, with a mean age of 65.6?±?6.9 years and 58.9% had a cardiac diagnosis. Fitbit-Flex and Actigraph were significantly correlated in males, females, total participants and cardiac patients for step counts (r?=?.96; r?=?.95; r?=?.95; r?=?.95), though less so for MVPA (r?=?.81; r?=?.65, r?=?.74; r?=?.71). As step counts increased the differences between Fitbit-Flex and Actigraph also increased. Fitbit-Flex over-estimated step counts in females (556 steps/day), males (1462 steps/day) and total participants (1038 steps/day) as well as for minutes of MVPA in females (4?min/day), males (15?min/day) and total participants (10?min/day). Fitbit-Flex had high sensitivity and specificity in classifying participants who achieved the recommended physical activity guidelines.\n\nConclusion: Fitbit-Flex is accurate in assessing attainment of physical activity guideline recommendations and is useful for monitoring physical activity in cardiac patients. The device does, however, slightly over-estimate step counts and MVPA.", "links": [ { "caption": "URL", "url": "http://cpr.sagepub.com/content/23/14/1476", "newWindow": true } ] }, { "title": "An experimental analysis of active living technologies to review device accuracy", "author": "Altamimi, R. and Skinner, G.\t", "year": "2016", "journalProceedings": "2016 IEEE Region 10 Conference (TENCON)", "category": "Validation", "devices": "One,Flex", "population": "Adults", "dataUsed": "Steps,Distance", "abstract": "Active living is a way of life that promotes health and active behavior. Technology in modern life can either act as a barrier for active living or facilitate this lifestyle, depending on which technology people choose to use in their everyday lives. Finding a technology that facilitates an individuals' physical workout while also motivating them and promoting physical activity levels, first requires investigation of the current technologies available. Physical activity monitoring technologies have a range of types, mechanisms and capabilities. Physical activity trackers are also varied in their way of attachment to individuals' bodies. For example, they can be little devices for attachment, such as waist-clips or wrist-bands, or they can be applications installed one a user's mobile or tablet device. This paper is a part of our ongoing research into active living technology adaption and use. The focus of our current work seeks to find the most applicable and accurate types of these devices. We aim through the work presented in this paper to examine some of the current available physical activity monitors including Fitbit One, Fitbit Flex, Jawbone UP and Health iPhone application. In short, our study has revealed important variation being observed in the physical activity data, based on where monitors are held by or attached to a user.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/document/7848017/", "newWindow": true } ] }, { "title": "Validation of Contemporary Physical Activity Tracking Technologies through Exercise in a Controlled Environment", "author": "Altamimi, R.I. and Skinner, G.D.\t", "year": "2016", "journalProceedings": "International Journal of Medical, Health, Biomedical, Bioengineering and Pharmaceutical Engineering", "category": "Validation", "devices": "One,Flex", "population": "Adults", "dataUsed": "Distance", "abstract": "Extended periods engaged in sedentary behavior increases the risk of becoming overweight and/or obese which is linked to other health problems. Adding technology to the term ‘active living' permits its inclusion in promoting and facilitating habitual physical activity. Technology can either act as a barrier to, or facilitate this lifestyle, depending on the chosen technology. Physical Activity Monitoring Technologies (PAMTs) are a popular example of such technologies. Different contemporary PAMTs have been evaluated based on customer reviews; however, there is a lack of published experimental research into the efficacy of PAMTs. This research aims to investigate the reliability of four PAMTs: two wristbands (Fitbit Flex and Jawbone UP), a waist-clip (Fitbit One), and a mobile application (iPhone Health Application) for recording a specific distance walked on a treadmill (1.5km) at constant speed. Physical activity tracking technologies are varied in their recordings, even while performing the same activity. This research demonstrates that Jawbone UP band recorded the most accurate distance compared to Fitbit One, Fitbit Flex, and iPhone Health Application.", "links": [ { "caption": "URL", "url": "http://www.waset.org/Publications/validation-of-contemporary-physical-activity-tracking-technologies-through-exercise-in-a-controlled-environment/10004033", "newWindow": true } ] }, { "title": "Integrating Mobile health and Physical Activity to reduce the burden of Chronic low back pain Trial (IMPACT): a pilot trial protocol", "author": "Amorim, A.B., Pappas, E., Simic, M., Ferreira, M.L., Tiedemann, A., Jennings, M. and Ferreira, P.H.", "year": "2016", "journalProceedings": "BMC Musculoskeletal Disorders", "category": "Methods", "devices": null, "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "It is well recognised that low back pain is a significant public health problem and engagement in moderate levels of physical activity is associated with positive outcomes. Conservative active care, such as exercise, is effective in reducing pain and disability associated with chronic low back pain. However, a rapid decline in clinical outcomes is commonly seen after discharge from treatment. We will conduct a randomised controlled trial to investigate the effectiveness of a mobile health supported physical activity intervention (compared to standard care) in care-seeking, pain and disability in people with chronic low back pain after discharge from treatment. We will recruit 68 patients with chronic low back pain following discharge from an outpatient hospital program, who will be randomly allocated to the physical activity intervention (n?=?34) or the standard care group (n?=?34) and monitored for 6 months. The physical activity intervention will involve a physical activity advice booklet, a face-to-face health coaching session and 12 fortnightly follow-up telephone-based health coaching sessions. This intervention will be supported by provision of a specifically designed web app and a physical activity monitoring device (FitBit). The standard care group will receive the physical activity advice booklet only. This pilot trial will investigate a new model to prevent clinical decline in people following conservative treatment for chronic low back pain. If proven to be effective, this approach will constitute a major advance in the management of low back pain. Chronic patients who experience recurrent pain and disability after treatment are prone to seek additional care in the form of physiotherapy, medication, emergency department attendance, specialist consultation or spinal surgery. This model aims to maintain functional levels and reduce care-seeking empowering patients to self-manage their low back pain by offering them a contemporary patient-centered physical activity program with the support of mobile health technology. The outcomes of this trial will have immediate implications for clinical practice.", "links": [ { "caption": "URL", "url": "http://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-015-0852-3", "newWindow": true } ] }, { "title": "How valid are wearable physical activity trackers for measuring steps?", "author": "An, H.-S., Jones, G.C., Kang, S.-K., Welk, G.J. and Lee, J.-M.\t", "year": "2016", "journalProceedings": "European Journal of Sport Science", "category": "Validation", "devices": "Zip,Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Wearable activity trackers have become popular for tracking individual's daily physical activity, but little information is available to substantiate the validity of these devices in step counts. Thirty-five healthy individuals completed three conditions of activity tracker measurement: walking/jogging on a treadmill, walking over-ground on an indoor track, and a 24-hour free-living condition. Participants wore 10 activity trackers at the same time for both treadmill and over-ground protocol. Of these 10 activity trackers three were randomly given for 24-hour free-living condition. Correlations of steps measured to steps observed were r?=?0.84 and r?=?0.67 on a treadmill and over-ground protocol, respectively. The mean MAPE (mean absolute percentage error) score for all devices and speeds on a treadmill was 8.2% against manually counted steps. The MAPE value was higher for over-ground walking (9.9%) and even higher for the 24-hour free-living period (18.48%) on step counts. Equivalence testing for...", "links": [ { "caption": "URL", "url": "https://www.tandfonline.com/doi/full/10.1080/17461391.2016.1255261", "newWindow": true } ] }, { "title": "Real-World Walking Performance of Individuals with Lower-Limb Amputation Classified as Medicare Functional Classification Level 2 and 3", "author": "Arch, E.S., Erol, O., Bortz, C., Madden, C., Galbraith, M., Rossi, A., Lewis, J., Higginson, J.S., Buckley, J.M. and Horne, J.\t", "year": "2016", "journalProceedings": "Journal of Prosthetics and Orthotics", "category": "Measurement", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Introduction: Lower-limb prostheses are prescribed based on each patient's individual needs. However, there is no standardized method to identify a patient's needs, which results in difficulty and variability in making prosthetic recommendations. Using measures of real-world walking performance in conjunction with clinical measures and the clinician's expertise may be an ideal way to ensure that patients receive the optimal prosthetic treatment. Currently, there is only limited understanding of the relationship among in-clinic performance-based measures, real-world walking performance, and K-level. Therefore, the purpose of this study was to investigate outcomes of in-clinic performance-based evaluations and real-world walking performance measures for individuals with unilateral lower-limb amputation classified as K2 and K3. Materials and Methods: Twenty-seven individuals with unilateral lower-limb amputation classified as K2 or K3 functional levels underwent a clinical assessment visit that included a 10-m walk test and a 6-minute walk test. After the assessment, the individuals were equipped with an activity monitor, which they wore for a 7-day observation period. From these data, participants' self-selected walking speed, total distance walked in 6 minutes, total number of steps taken during the observation period, total number of active minutes during the observation period, and percentage of time spent in low-, moderate-, and high-intensity activity during the observation period were calculated. Results: Individuals classified as K2 had, on average, a significantly slower self-selected walking speed, significantly shorter distance walked in 6 minutes, significantly lower total step count, and a significantly fewer number of active minutes when compared with those classified as K3. Although not significant, trends in activity intensity were seen with individuals classified as K2, spending a larger percentage of time in low-intensity activity and less percentage of time in high-intensity activity when compared with those classified as K3. Conclusions: This study quantified real-world walking performance, in conjunction with in-clinic performance-based data, for individuals classified as K2 and K3 and showed significant differences between the 2 groups. This study is a step forward toward developing an objective and standardized method to classify an individual's functional ability and make prosthetic recommendations.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/jpojournal/Fulltext/2016/04000/Real_World_Walking_Performance_of_Individuals_with.2.aspx", "newWindow": true } ] }, { "title": "The Electronic CardioMetabolic Program (eCMP) for Patients With Cardiometabolic Risk: A Randomized Controlled Trial.", "author": "Azar, K.M., Koliwad, S., Poon, T., Xiao, L., Lv, N., Griggs, R. and Ma, J.", "year": "2016", "journalProceedings": "Journal of Medical Internet Research", "category": "Intervention", "devices": null, "population": "Patients,Adults", "dataUsed": "NA", "abstract": "BACKGROUND Effective lifestyle interventions targeting high-risk adults that are both practical for use in ambulatory care settings and scalable at a population management level are needed.\nOBJECTIVE Our aim was to examine the potential effectiveness, feasibility, and acceptability of delivering an evidence-based Electronic Cardio-Metabolic Program (eCMP) for improving health-related quality of life, improving health behaviors, and reducing cardiometabolic risk factors in ambulatory care high-risk adults.\n\nMETHODS We conducted a randomized, wait-list controlled trial with 74 adults aged =18 years recruited from a large multispecialty health care organization. Inclusion criteria were (1) BMI =35 kg/m(2) and prediabetes, previous gestational diabetes and/or metabolic syndrome, or (2) BMI =30 kg/m(2) and type 2 diabetes and/or cardiovascular disease. Participants had a mean age of 59.7 years (SD 11.2), BMI 37.1 kg/m(2) (SD 5.4) and were 59.5% female, 82.4% white. Participants were randomized to participate in eCMP immediately (n=37) or 3 months later (n=37). eCMP is a 6-month program utilizing video conferencing, online tools, and pre-recorded didactic videos to deliver evidence-based curricula. Blinded outcome assessments were conducted at 3 and 6 months postbaseline. Data were collected and analyzed between 2014 and 2015. The primary outcome was health-related quality of life. Secondary outcomes included biometric cardiometabolic risk factors (eg, body weight), self-reported diet and physical activity, mental health status, retention, session attendance, and participant satisfaction.\n\nRESULTS Change in quality of life was not significant in both immediate and delayed participants. Both groups significantly lost weight and reduced waist circumference at 6 months, with some cardiometabolic factors trending accordingly. Significant reduction in self-reported anxiety and perceived stress was seen in the immediate intervention group at 6 months. Retention rate was 93% at 3 months and 86% at 6 months post-baseline. Overall eCMP attendance was high with 59.5-83.8% of immediate and delayed intervention participants attending 50% of the virtual stress management and behavioral lifestyle sessions and 37.8-62.2% attending at least 4 out of 7 in-person physical activity sessions. The intervention received high ratings for satisfaction.\n\nCONCLUSIONS The technology-assisted eCMP is a feasible and well-accepted intervention and may significantly decrease cardiometabolic risk among high-risk individuals.", "links": [ { "caption": "URL", "url": "http://www.jmir.org/2016/5/e134/", "newWindow": true } ] }, { "title": "Assessing the Correlation Between Physical Activity and Quality of Life in Advanced Lung Cancer", "author": "Bade, B.C., Brooks, M.C., Nietert, S.B., Ulmer, A., Thomas, D.D., Nietert, P.J., Scott, J.B. and Silvestri, G.A.\t", "year": "2016", "journalProceedings": "Integrative Cancer Therapies", "category": "Usability,Medical", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background and objective. Increasing physical activity (PA) is safe and beneficial in lung cancer (LC) patients. Advanced-stage LC patients are under-studied and have worse symptoms and quality of life (QoL). We evaluated the feasibility of monitoring step count in advanced LC as well as potential correlations between PA and QoL.\n\nMethods. This is a prospective, observational study of 39 consecutive patients with advanced-stage LC. Daily step count over 1 week (via Fitbit Zip), QoL, dyspnea, and depression scores were collected. Spearman rank testing was used to assess correlations. Correlation coefficients (?) >0.3 or <-0.3 (more and less correlated, respectively) were considered potentially clinically significant. \n\nResults. Most (83%) of the patients were interested in participating, and 67% of those enrolled were adherent with the device. Of those using the device (n = 30), the average daily step count was 4877 (range = 504-12 118) steps/d. Higher average daily step count correlated with higher QoL (? = 0.46), physical (? = 0.61), role (? = 0.48), and emotional functioning (? = 0.40) scores as well as lower depression (? = -0.40), dyspnea (? = -0.54), and pain (? = -0.37) scores. \n\nConclusion. Remote PA monitoring (Fitbit Zip) is feasible in advanced-stage LC patients. Interest in participating in this PA study was high with comparable adherence to other PA studies. In those utilizing the device, higher step count correlates with higher QoL as well as lower dyspnea, pain, and depression scores. PA monitoring with wearable devices in advanced-stage LC deserves further study.", "links": [ { "caption": "URL", "url": "http://journals.sagepub.com/doi/abs/10.1177/1534735416684016", "newWindow": true } ] }, { "title": "Using passively collected sedentary behavior to predict hospital readmission", "author": "Bae, S., Dey, A.K. and Low, C.A.\t", "year": "2016", "journalProceedings": "Proceedings of the 2016 ACM International Joint Conference on Pervasive and Ubiquitous Computing", "category": "Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Distance", "abstract": "Hospital readmissions are a major problem facing health care systems today, costing Medicare alone US$26 billion each year. Being readmitted is associated with significantly shorter survival, and is often preventable. Predictors of readmission are still not well understood, particularly those under the patient's control: behavioral risk factors. Our work evaluates the ability of behavioral risk factors, specifically Fitbit-assessed behavior, to predict readmission for 25 postsurgical cancer inpatients. Our results show that sum of steps, maximum sedentary bouts, frequency, and low breaks in sedentary times during waking hours are strong predictors of readmission. We built two models for predicting readmissions: Steps-only and Behavioral model that adds information about sedentary behaviors. The Behavioral model (88.3%) outperforms the Steps-only model (67.1%), illustrating the value of passively collected information about sedentary behaviors. Indeed, passive monitoring of behavior data, i.e., mobility, after major surgery creates an opportunity for early risk assessment and timely interventions.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=2971648.2971750", "newWindow": true } ] }, { "title": "Comparison of consumer and research monitors under semistructured settings", "author": "Bai, Y., Welk, G.J., Nam, Y.H., Lee, J.A., Lee, J.M., Kim, Y., Meier, N.F. and Dixon, P.M.", "year": "2016", "journalProceedings": "Medicine and Science in Sports and Exercise", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "PURPOSE: This study evaluated the relative validity of different consumer and research activity monitors during semi-structured periods of sedentary activity, aerobic exercise and resistance exercise.\nMETHODS: A total of 52 participants (28 males) ages 18-65 performed 20-minutes of self-selected sedentary activities, 25-minutes of aerobic exercise, and 25-minutes of resistance exercise, with 5-minutes rest between each activity. Each participant wore five wrist-worn consumer monitors [Fitbit Flex (FBF), Jawbone UP 24 (JU24), Misfit Shine (MS), Nike+Fuelband SE (NFS), Polar Loop (PL)] and two research monitors [Actigraph GT3X+ (GT3X+) on the waist, and BodyMedia Core (BMC) on the arm] while being concurrently monitored with the Oxycon Mobile (OM), a portable metabolic system. The energy expenditure (EE) from different activity sessions were measured by OM and estimated by all monitors.\n\nRESULTS: Mean absolute percent error (MAPE) values for the full 80-minute protocol ranged from 15.3% (BMC) to 30.4% (MS). The EE estimates from the GT3X+ was found to be equivalent to those from the OM (±10% equivalence zone: 285.1, 348.5). Correlations between OM and the various monitors were generally high (ranges between 0.71 and 0.90). Three monitors had MAPE values less than 20% for sedentary activity: BMC (15.7%), MS (18.2%), and NFS (20.0%). Two monitors had MAPE values less than 20% for aerobic: BMC (17.2%) and NFS (18.5%). None of the monitors had MAPE values less than 25% for resistance exercise.\n\nCONCLUSION: Overall, the research monitors and the FBF, JU24, and NFS provided reasonably accurate total EE estimates at the individual level. However, larger error was evident for individual activities, especially resistance exercise. Further research is needed to examine these monitors across various activities and intensities, and under real-world conditions.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/pages/articleviewer.aspx?year=2016&issue=01000&article=00020&type=abstract", "newWindow": true } ] }, { "title": "Impact of Digital Health Methods for Weight Management on Atherosclerotic Cardiovascular Disease Risk in “at-risk” Women", "author": "Ball, C., Carter, K., Yeung, C., Abdelmoneim, S., Bauman, J., Huang, R., Mankad, R., Iftikar, S., Jain, S., Lopez-Jimenez, F. and Mulvagh, S.\t", "year": "2016", "journalProceedings": "Canadian Journal of Cardiology", "category": "Intervention", "devices": null, "population": "Adults", "dataUsed": null, "abstract": "BACKGROUND: The LEARN (Lifestyle-Exercise-AttitudesRelationships-Nutrition) program is an established weight loss program that may have positive impact on atherosclerotic cardiovascular disease (ASCVD) risk, but can be limited in application due to requirement of weekly meetings. We examine the changes in lipid profiles and 10-year ASCVD risk score in a prospective study of a novel format of the LEARN program utilizing digital health (DH) tools compared to a traditional meeting format.\nMETHODS: Eighty-nine women (age: 55.59.3 years, BMI: 34.35.2 kg/m2) with 2 CVD risk factors were prospectively randomized to a 3-month duration LEARN program delivered either through a DH approach using internet-based podcasts with an online interactive message board and FitBit (San Francisco, CA) activity trackers (DH group), or traditional weekly meetings (Control group¼C). Lipids (total cholesterol, LDL, HDL, triglycerides, NMR lipoprofile patterns) were analyzed at baseline and 3 months (LabCorp, Burlington, NC). Statistical analysis was performed (ANOVA and matched pairs). S9 CWHHS Abstracts\n\nRESULTS: Fifty-eight women (DH¼30, C¼28) completed baseline and 3-month testing. At baseline there were no differences in hypertension (52%), fasting glucose impairment (29%), or smoking history (31%). However, DH women were younger than C (52 vs 59 years, p¼0.007), and had lower 10-year ASCVD risk scores (6.25.1% vs 3.73.7, p¼0.042). Upon LEARN program completion, mean weight loss (2.94.1 kg), was similar in both groups (p¼0.773), and there was no change in SBP or ASCVD risk scores for either group. Lipid profile parameters showed favorable trends for both groups. A significant reduction was seen only for triglycerides in DH group (11940 at baseline vs 9826 at 3 months, p¼0.0009). Similarly, NMR lipoprofile analysis showed a significant reduction in large VLDL particles for DH group (5.33.6 at baseline vs 3.42.2 at 3 months, p¼0.0188).\n\nCONCLUSION: In women with ASCVD risk completing a 3 month LEARN program, Digital Health administration resulted in similar decreases in weight loss as traditional methods, but more favorable cardiometabolic results. This study demonstrates the feasibility and effectiveness of novel Digital Health methods for a weight loss program with immediate beneficial impact on weight loss and triglyceride levels. 19 C", "links": [ { "caption": "URL", "url": "http://linkinghub.elsevier.com/retrieve/pii/S0828282X16001240", "newWindow": true } ] }, { "title": "Accuracy and precision of smartphone applications and commercially available motion sensors in multiple sclerosis", "author": "Balto, J.M., Kinnett-Hopkins, D.L. and Motl, R.W.", "year": "2016", "journalProceedings": "Multiple Sclerosis Journal - Experimental, Translational and Clinical", "category": "Validation", "devices": "One,Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background: There is increased interest in the application of smartphone applications and wearable motion sensors among multiple sclerosis (MS) patients.\nObjective: This study examined the accuracy and precision of common smartphone applications and motion sensors for measuring steps taken by MS patients while walking on a treadmill.\n\nMethods: Forty-five MS patients (Expanded Disability Status Scale (EDSS)?=?1.0–5.0) underwent two 500-step walking trials at comfortable walking speed on a treadmill. Participants wore five motion sensors: the Digi-Walker SW-200 pedometer (Yamax), the UP2 and UP Move (Jawbone), and the Flex and One (Fitbit). The smartphone applications were Health (Apple), Health Mate (Withings), and Moves (ProtoGeo Oy).\n\nResults: The Fitbit One had the best absolute (mean?=?490.6 steps, 95% confidence interval (CI)?=?485.6–495.5 steps) and relative accuracy (1.9% error), and absolute (SD?=?16.4) and relative precision (coefficient of variation (CV)?=?0.0), for the first 500-step walking trial; this was repeated with the second trial. Relative accuracy was correlated with slower walking speed for the first (rs?=?-.53) and second (rs?=?-.53) trials.\n\nConclusion: The results suggest that the waist-worn Fitbit One is the most precise and accurate sensor for measuring steps when walking on a treadmill, but future research is needed (testing the device across a broader range of disability, at different speeds, and in real-life walking conditions) before inclusion in clinical research and practice with MS patients.", "links": [ { "caption": "URL", "url": "http://mso.sagepub.com/content/2/2055217316634754.full", "newWindow": true } ] }, { "title": "Use of a Wearable Activity Device in Rural Older Obese Adults: A Pilot Study", "author": "Batsis, J.A., Naslund, J.A., Gill, L.E., Masutani, R.K., Agarwal, N. and Bartels, S.J.\t", "year": "2016", "journalProceedings": "Gerontology and Geriatric Medicine", "category": "Usability", "devices": "Zip", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Objective: Assess the feasibility and acceptability of Fitbit for supporting behavioral change in rural, older adults with obesity. \n\nMethod: Eight adults aged =65 with a body mass index (BMI) =30kg/m2 were recruited from a rural practice and provided a Fitbit Zip device for 30 days. Participants completed validated questionnaires/interviews. \n\nResults: Mean age was 73.4 ± 4.0 years (50% female) with a mean BMI of 34.5 ± 4.5kg/m2. We observed reductions in exercise confidence (sticking to it: 34.5 ± 3.3 to 30.9 ± 4.3, p = .04; making time: 18.9 ± 1.3 to 17.0 ± 2.6, p = .03) but no changes in patient activation (45.4 ± 4.3 vs. 45.0 ± 3.9). All reported high satisfaction, seven (87.5%) found Fitbit easy to use, and five (62.5%) found the feedback useful. The majority (n = 6 [75.0%]) were mostly/very satisfied with the intervention. Consistent themes emerged regarding the benefit of self-monitoring and participant motivation. Common concerns included finding time to exercise and lack of a peer group. \n\nConclusion: Use of Fitbit is feasible/acceptable for use among older rural obese adults but may lead to reduced confidence.", "links": [ { "caption": "URL", "url": "http://ggm.sagepub.com/lookup/doi/10.1177/2333721416678076", "newWindow": true } ] }, { "title": "Using a Community Wellness Program Pairing People with Shelter Dogs to Increase Physical Activity", "author": "Becofsky, K., Lynch, L., Evans, E.W. and Wing, R.", "year": "2016", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "FosterFit™ is a community wellness program centered on the pairing of people with shelter dogs (Savannah, GA). Participants are matched with a shelter dog for 10 weeks and encouraged to 1) walk with their dog for at least 30 min/d and 2) consume a plant-based diet. Participants meet regularly for group sessions and events.\nPURPOSE: We examined whether this community program led to change in objectively measured physical activity (PA). We also examined program acceptability and change in psychosocial outcomes.\n\nMETHODS: Steps/d and moderate-to-vigorous PA min/d were assessed via the FitBit Flex™ pre- and post-program. Participants rated their satisfaction (‘Overall, how would you rate the FosterFit wellness program?') and success with the exercise and diet components (‘Over the past 10 weeks, how much success have you had in following the exercise plan [healthy eating plan] set out by FosterFit?'). Surveys (stress, depressive symptoms, exercise self-efficacy) were also collected pre- and post-program.\n\nRESULTS: Nine participants (6 female, mean age 37 yrs, all non-Hispanic white or mixed race) joined the program and completed a baseline assessment. Program completion rate was 78% (7/9). Despite a small sample size, the program led to medium effect sizes for change in steps (d=0.41) and exercise self-efficacy (d=0.48), Average daily steps increased by 1,494, with increases in four of six participants with complete PA data. There were also small effect sizes for change in depressive symptoms (d=-0.20) and perceived stress (d=-0.19) and five of seven participants saw improvements in at least one psychosocial outcome. Of participants completing a program evaluation (n=8), 75% rated the program as ‘good' or ‘excellent', 86% reported ‘some success' or ‘a lot of success' following the exercise plan, and 75% reported ‘some success' or ‘a lot of success' following the healthy eating plan. and. Additionally, 6 participants permanently adopted their foster dog.\n\nCONCLUSION: These data demonstrate the feasibility of pairing people with shelter dogs for 10 weeks, and provide preliminary evidence that fostering a dog increases PA and mental wellbeing. Community-based interventions centered on dog fostering could be a novel approach to wellness promotion with added humanitarian benefits.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Citation/2016/05001/Using_a_Community_Wellness_Program_Pairing_People.393.aspx", "newWindow": true } ] }, { "title": "Comparative analysis of actigraphy performance in healthy young subjects", "author": "Bellone, G.J., Plano, S.A., Cardinali, D.P., Chada, D.P., Vigo, D.E. and Golombek, D.A.", "year": "2016", "journalProceedings": "Sleep Science", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Sleep-related health disorders are increasing worldwide; diagnosis and treatment of such sleep diseases are commonly invasive and sometimes unpractical or expensive. Actigraphy has been recently introduced as a tool for the study of sleep and circadian disorders; however, there are several devices that claim to be useful for research and have not been thoroughly tested. This comparative study provides activity, sleep and temperature information regarding several of the most commonly used actigraphers: Micro-Mini Motion Logger; Act Trust; Misfit Flash; Fitbit Flex & Thermochron.\nTwenty-two healthy young subjects were assessed with five different commercial actigraphs (Micro-Mini Motionlogger Watch, Condor Act Trust, MisFit Flash and Fitbit Flex) and a temperature recorder (Thermochron), and also completed a sleep diary for a week. There were not significant differences in the analysis of rest-activity pattern between devices. Temperature rhythm comparison between the Act Trust and the Thermochron showed significant differences in rhythm percentage (p<0.05) and mesor (p<0.0563) but not in amplitude or acrophase.\n\nAlthough data accessibility and ease of use was very different for the diverse devices, there were no significant differences for sleep onset, total sleep time and sleep efficiency recordings, where applicable. In conclusion, depending on the type of study and analysis desired (as well as cost and compliance of use), we propose some relative advantages for the different actigraphy/temperature recording devices.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1984006316300232", "newWindow": true } ] }, { "title": "Development of a Mobile Phone-Based Weight Loss Lifestyle Intervention for Filipino Americans with Type 2 Diabetes: Protocol and Early Results From the PilAm Go4Health Randomized Controlled Trial", "author": "Bender, M.S., Santos, G.-M., Villanueva, C. and Arai, S.\t", "year": "2016", "journalProceedings": "JMIR Research Protocols", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Weight,Food", "abstract": "Background: Filipino Americans are the second largest Asian subgroup in the United States, and were found to have the highest prevalence of obesity and type 2 diabetes (T2D) compared to all Asian subgroups and non-Hispanic whites. In addition to genetic factors, risk factors for Filipinos that contribute to this health disparity include high sedentary rates and high fat diets. However, Filipinos are seriously underrepresented in preventive health research. Research is needed to identify effective interventions to reduce Filipino diabetes risks, subsequent comorbidities, and premature death.\n\n Objective: The overall goal of this project is to assess the feasibility and potential efficacy of the Filipino Americans Go4Health Weight Loss Program (PilAm Go4Health). This program is a culturally adapted weight loss lifestyle intervention, using digital technology for Filipinos with T2D, to reduce their risk for metabolic syndrome. \n\nMethods: This study was a 3-month mobile phone-based pilot randomized controlled trial (RCT) weight loss intervention with a wait list active control, followed by a 3-month maintenance phase design for 45 overweight Filipinos with T2D. Participants were randomized to an intervention group (n=22) or active control group (n=23), and analyses of the results are underway. The primary outcome will be percent weight change of the participants, and secondary outcomes will include changes in waist circumference, fasting plasma glucose, glycated hemoglobin A1c, physical activity, fat intake, and sugar-sweetened beverage intake. Data analyses will include descriptive statistics to describe sample characteristics and a feasibility assessment based on recruitment, adherence, and retention. Chi-square, Fisher's exact tests, t-tests, and nonparametric rank tests will be used to assess characteristics of randomized groups. Primary analyses will use analysis of covariance and linear mixed models to compare primary and secondary outcomes at 3 months, compared by arm and controlled for baseline levels. \n\nResults: Recruitment was completed in January, 2016, and participant follow-up continued through June, 2016. At baseline, mean age was 57 years, 100% (45/45) of participants self-identified as Filipinos, and the cohort was comprised of 17 males and 28 females. Overall, participants were obese with a baseline mean body mass index of 30.2 kg/m2 (standard deviation 4.9). The majority of participants were immigrants (84%, 38/45), with 47% (21/45) living in the United States for more than 10 years. One third of all participants (33%, 15/45) had previously used a pedometer. \n\nConclusions: This study will provide preliminary evidence to determine if the PilAm Go4Health weight loss lifestyle intervention is feasible, and if the program demonstrates potential efficacy to reduce risks for metabolic syndrome in Filipinos with T2D. Positive results will lend support for a larger RCT to evaluate the effectiveness of the PilAm Go4Health intervention for Filipinos.", "links": [ { "caption": "URL", "url": "http://www.researchprotocols.org/2016/3/e178/", "newWindow": true } ] }, { "title": "Evaluation of pedometry as a patient-centered outcome in patients undergoing hematopoietic cell transplant (HCT): a comparison of pedometry and patient reports of symptoms, health, and quality of life", "author": "Bennett, A.V., Reeve, B.B., Basch, E.M., Mitchell, S.A., Meeneghan, M., Battaglini, C.L., Smith-Ryan, A.E., Phillips, B., Shea, T.C. and Wood, W.A.", "year": "2016", "journalProceedings": "Quality of Life Research", "category": "Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Aims: We evaluated pedometry as a novel patient-centered outcome because it enables passive continuous assessment of activity and may provide information about the consequences of symptomatic toxicity complementary to self-report.\n\nMethods: Adult patients undergoing hematopoietic cell transplant (HCT) wore pedometers and completed PRO assessments during transplant hospitalization (4 weeks) and 4 weeks post-discharge. Patient reports of symptomatic treatment toxicities (single items from PRO-CTCAE, http://healthcaredelivery.cancer.gov/pro-ctcae) and symptoms, physical health, mental health, and quality of life (PROMIS® Global-10, http://nih.promis.org), assessed weekly with 7-day recall on Likert scales, were compared individually with pedometry data, summarized as average daily steps per week, using linear mixed models.\n\nResults: Thirty-two patients [mean age 55 (SD = 14), 63 % male, 84 % white, 56 % autologous, 43 % allogeneic] completed a mean 4.6 (SD = 1.5, range 1–8) evaluable assessments. Regression model coefficients (ß) indicated within-person decrements in average daily steps were associated with increases in pain (ß = -852; 852 fewer steps per unit increase in pain score, p < 0.001), fatigue (ß = -886, p < 0.001), vomiting (ß = -518, p < 0.01), shaking/chills (ß = -587, p < 0.01), diarrhea (ß = -719, p < 0.001), shortness of breath (ß = -1018, p < 0.05), reduction in carrying out social activities (ß = 705, p < 0.01) or physical activities (ß = 618, p < 0.01), and global physical health (ß = 101, p < 0.001), but not global mental health or quality of life.\n\nConclusions: In this small sample of HCT recipients, more severe symptoms, impaired physical health, and restrictions in the performance of usual daily activities were associated with statistically significant decrements in objectively measured daily steps. Pedometry may be a valuable outcome measure and validation anchor in clinical research.", "links": [ { "caption": "URL", "url": "http://link.springer.com/article/10.1007%2Fs11136-015-1179-0", "newWindow": true } ] }, { "title": "Video and computer-based interactive exercises are safe and improve task-specific balance in geriatric and neurological rehabilitation: a randomised trial", "author": "van den Berg, M., Sherrington, C., Killington, M., Smith, S., Bongers, B., Hassett, L. and Crotty, M.", "year": "2016", "journalProceedings": "Journal of Physiotherapy", "category": "Intervention", "devices": "Zip", "population": "Older Adults,Patients", "dataUsed": "Steps,Energy Expenditure,Distance", "abstract": "Question: Does adding video/computer-based interactive exercises to inpatient geriatric and neurological rehabilitation improve mobility outcomes? Is it feasible and safe? Design: Randomised trial. Participants: Fifty-eight rehabilitation inpatients. Intervention: Physiotherapist-prescribed, tailored, video/computer-based interactive exercises for 1 hour on weekdays, mainly involving stepping and weight-shifting exercises. Outcome measures: The primary outcome was the Short Physical Performance Battery (0 to 3) at 2 weeks. Secondary outcomes were: Maximal Balance Range (mm); Step Test (step count); Rivermead Mobility Index (0 to 15); activity levels; Activity Measure for Post Acute Care Basic Mobility (18 to 72) and Daily Activity (15 to 60); Falls Efficacy Scale (10 to 40), ED5D utility score (0 to 1); Reintegration to Normal Living Index (0 to 100); System Usability Scale (0 to 100) and Physical Activity Enjoyment Scale (0 to 126). Safety was determined from adverse events during intervention. Results: At 2 weeks the between-group difference in the primary outcome (0.1, 95% CI –0.2 to 0.3) was not statistically significant. The intervention group performed significantly better than usual care for Maximal Balance Range (38mm difference after baseline adjustment, 95% CI 6 to 69). Other secondary outcomes were not statistically significant. Fifty-eight (55%) of the eligible patients agreed to participate, 25/29 (86%) completed the intervention and 10 (39%) attended textgreater 70% of sessions, with a mean of 5.6 sessions (SD 3.3) attended and overall average duration of 4.5hours (SD 3.1). Average scores were 62 (SD 21) for the System Usability Scale and 62 (SD 8) for the Physical Activity Enjoyment Scale. There were no adverse events. Conclusion: The addition of video/computer-based interactive exercises to usual rehabilitation is a safe and feasible way to increase exercise dose, but is not suitable for all. Adding the exercises to usual rehabilitation resulted in task-specific improvements in balance but not overall mobility. Registration: ACTRN12613000610730. [van den Berg M, Sherrington C, Killington M, Smith S, Bongers B, Hassett L, Crotty M (2016) Video and computer-based interactive exercises are safe and improve task-specific balance in geriatric and neurological rehabilitation: a randomised trial. Journal of Physiotherapy 62: 20–28]", "links": [ { "caption": "URL", "url": "http://www.journalofphysiotherapy.com/article/S1836-9553(15)00131-9/fulltext", "newWindow": true } ] }, { "title": "Comparison of three different physiological wristband sensor systems and their applicability for resilience- and work load monitoring", "author": "Binsch, O., Wabeke, T. and Valk, P.", "year": "2016", "journalProceedings": "2016 IEEE 13th International Conference on Wearable and Implantable Body Sensor Networks", "category": "Validation", "devices": "Surge", "population": "Adults", "dataUsed": "Steps,Distance,Heart Rate", "abstract": "Leveraging miniaturized sensor and monitoring technology integrated in easy-to-wear wristband wearables represents a great opportunity for advancing Resilience and Mental Health of e.g. employees that experience high workload. Therefore, it is important to gain insights into the reliability of such technology before far reaching conclusions can be drawn and interventions can be developed. To that aim, we tested three wearable wristband sensor systems (Apple Watch, Microsoft Band and Fitbit Surge) and compared the assessed sensor output with a reliable ground truth. The results showed that heart rate, steps and distance varies considerably around the ground truth during tasks that required body movement. However, during the rest condition (sitting on chair) the heart rate was considered more reliable. It is concluded that caution is warranted while using and interpreting physiological data assessed by the new technology, but, in rest (e.g. pauses, sleep) the wearable' sensors could be used to detect undesirable physiological patterns, indicative of threats to resilience or (mental) health.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/document/7516272/?arnumber=7516272", "newWindow": true } ] }, { "title": "Continuous daily assessment of multiple sclerosis disability using remote step count monitoring", "author": "Block, V.J., Lizée, A., Crabtree-Hartman, E., Bevan, C.J., Graves, J.S., Bove, R., Green, A.J., Nourbakhsh, B., Tremblay, M., Gourraud, P.-A., Ng, M.Y., Pletcher, M.J., Olgin, J.E., Marcus, G.M., Allen, D.D., Cree, B.A.C. and Gelfand, J.M.\t", "year": "2016", "journalProceedings": "Journal of Neurology", "category": "Usability,Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Disability measures in multiple sclerosis (MS) rely heavily on ambulatory function, and current metrics fail to capture potentially important variability in walking behavior. We sought to determine whether remote step count monitoring using a consumer-friendly accelerometer (Fitbit Flex) can enhance MS disability assessment. 99 adults with relapsing or progressive MS able to walk =2-min were prospectively recruited. At 4 weeks, study retention was 97% and median Fitbit use was 97% of days. Substudy validation resulted in high interclass correlations between Fitbit, ActiGraph and manual step count tally during a 2-minute walk test, and between Fitbit and ActiGraph (ICC = 0.76) during 7-day home monitoring. Over 4 weeks of continuous monitoring, daily steps were lower in progressive versus relapsing MS (mean difference 2546 steps, p textless 0.01). Lower average daily step count was associated with greater disability on the Expanded Disability Status Scale (EDSS) (p textless 0.001). Within each EDSS category, substantial variability in step count was apparent (i.e., EDSS = 6.0 range 1097–7152). Step count demonstrated moderate-strong correlations with other walking measures. Lower average daily step count is associated with greater MS disability and captures important variability in real-world walking activity otherwise masked by standard disability scales, including the EDSS. These results support remote step count monitoring as an exploratory outcome in MS trials.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s00415-016-8334-6", "newWindow": true } ] }, { "title": "Concurrent Validity of Wearable Activity Trackers 1 in Free-living Conditions.", "author": "Brooke, S., An, H.-S., Kang, S.-K., Noble, J., Berg, K. and Lee, J.-M.", "year": "2016", "journalProceedings": "Journal of Strength and Conditioning Research", "category": "Validation", "devices": "Flex,Charge HR", "population": "Adults", "dataUsed": "Energy Expenditure,Sleep", "abstract": "The purpose of this study is to evaluate the concurrent validity of wearable activity trackers in energy expenditure (EE) and sleep period time (SPT) under free-living conditions. Ninety-five (28.5 ± 9.8 years) healthy males (n=34) and females (n=61) participated in this study. The total EE and SPT were measured by eight monitors; Nike+ Fuel Band SE (NFB), Garmin VivoFit (VF), Misfit Shine (MF), Fitbit Flex (FF), Jawbone UP (JU), Polar Loop (PL), Fitbit Charge HR (FC), and SenseWear Armband (SWA) (Criterion measures: SWA for EE and a sleep-log for SPT). Mean absolute percent error (MAPE) for EE were 13.0%, 15.2%, 15.5%, 16.1%, 16.2%, 22.8%, and 24.5% for PL, MF, FF, NFB, FC, JU, and VF, respectively. MAPE were calculated for SPT to be 4.0%, 8.8%, 10.2%, 11.5%, 12.9%, 13.6%, 17.5%, and 21.61% for VF, FF, JU, FC, MF, SWA laying down, PL, and SWA, respectively. Concurrent validity was examined by using equivalence testing on EE (equivalence zone: 2889.7 - 3531.9 kcal), two trackers fell short of falling in the zone; PL (2714.4 - 3164.8 kcal) and FC (2473.8 - 3066.5 kcal). For SPT (equivalence zone: 420.6 - 514.0 min), several monitors fell in the zone PL (448.3 - 485.6 min), MS (442.8 - 492.2 min), and FF (427.7 - 486.7 min). The present study suggests that the PL and FC provide reasonable estimate of EE in the free-living conditions. The PL, FC, and MF were the most valid monitors for measuring SPT.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/nsca-jscr/pages/articleviewer.aspx?year=9000&issue=00000&article=96362&type=abstract", "newWindow": true } ] }, { "title": "Accuracy of the Fitbit for Measuring Preschoolers' Physical Activity", "author": "Byun, W., Barry, A. and Lee, J.-M.\t", "year": "2016", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Flex", "population": "Children", "dataUsed": "Intensity", "abstract": "Identifying an accurate and feasible measurement tool for assessing physical activity (PA) is a priority in epidemiologic research. Although wearable activity monitors yields high potentials for being utilized in research, little information is available on the accuracy of those monitors in young children.\nPURPOSE: To evaluate the accuracy of the Fitbit Flex (FF) activity monitor for assessing preschooler' PA and sedentary behavior (SED) in free-living conditions, using the previously validated accelerometer-based monitor, ActiGraph GT3X+ (AG), as a criterion measure.\n\nMETHODS: 27 preschool age children (Girl: 41%, Age: 4.9 ± 1.1 yrs, BMI: 16.5 ± 1.6 kgtextperiodcenteredm2) wore AG (on dominant hip) and FF (on the non-dominant wrist) simultaneously for 24 hours. Using age-appropriate cutpoints for AG (Pate's 2006) and manufacturer-specific algorithms for FF, data from AG (15-sec epoch) and FF (60-sec epoch) were reduced in terms of time spent (min/day) in SED, moderate-to-vigorous PA (MVPA), and Total PA (TPA). Pearson correlations was used examine agreement between the estimates from AG and FF. Mean absolute percent errors (MAPEs) were computed as measurement errors. Equivalence test using SAS PROC MIXED procedure was used to compare the 85% confidence intervals (CI) of the estimates from the FF with the respective equivalence zone (EZ; ± 15% of the mean estimates) from the AG.\n\nRESULTS: The FF yielded significantly equivalent estimates of SED (FF: Mean (M) = 673 min, 85% CI: 632-714 min vs. AG: M = 631, EZ: 537-726 min) and TPA (FF: M = 337 min, 85% CI: 309-365 min vs. AG: M = 379 min, EZ: 303-435 min) as the AG. However, the estimate of MVPA from the FF was not equivalent to that from the AG. Correlations between FF and AG were consistently high for SED (r = 0.86, P textless.01) and TPA (r = 0.70, P textless.01), but moderate for MVPA (r = 0.59, P textless.01). MAPEs were 9.2, 70.1, and 14.5% for SED, MVPA, and TPA, respectively.\n\nCONCLUSIONS: The accuracy of the FF for estimating SED and TPA was supported by the high correlations and significant equivalence to AG. However, relatively large MAPEs and results from equivalence test suggest that the MVPA estimates from the FF were not equivalent to those from AG. Future studies utilizing FF in preschool age children should be aware of these findings. Efforts to replicate our findings with longer monitoring in larger samples are warranted", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Citation/2016/05001/Accuracy_of_the_Fitbit_for_Measuring_Preschoolers_.2331.aspx", "newWindow": true } ] }, { "title": "Fitbit Provides Valid Measures of Sedentary and Physical Activity in Preschool Children", "author": "Byun, W., Barry, A., Lee, J.-M. and Kim, Y.", "year": "2016", "journalProceedings": "Circulation", "category": "Validation", "devices": "Flex", "population": "Children", "dataUsed": "Intensity", "abstract": "Introduction: Both monitoring and promoting PA in children, two important areas in epidemiologic research, require the use of accurate and feasible measurement tools. The Fitbit activity monitor is one of the most widely commercialized, consumer-based activity monitors and its validity and reliability has been determined in adults; however, little research has determined the validity of Fitbit activity monitor in measuring sedentary behavior and PA in preschool-age children.\nHypothesis: We hypothesized that, when comparing to the direct observation (DO), the Fitbit Flex (FF) activity monitor would accurately measure the time spent in sedentary, moderate-to-vigorous PA (MVPA), and Total (light-to-vigorous) PA in preschool-age children.\n\nMethods: A total of 28 preschool age children (Female: 46%, Age: 4.6 ± 1.0 yrs, BMI: 16.4 ± 1.5 kg·m2) wore the FF (on the wrist) and were directly observed while performing a set of unstructured and structured activities with varying intensity levels such as watching TV, drawing, playing with toys, playing soccer, and shooting basket. Breath-by-breath oxygen consumption were also measured using Oxycon Mobile indirect calorimetry (OM). Data from the FF (PA counts) and the OM (VO2 ml·kg·min-1) were summarized in terms of minute-by-minute basis. The validity of FF for measuring the time spent in sedentary behavior, MVPA, and Total PA against DO was examined using three ways: (1) Pearson correlation examining the relatively agreement between FF and DO; (2) Mean absolute percent error (MAPE) examining the measurement errors of FF; and (3) One-sided equivalence test examining the absolute agreement between FF and DO by comparing the 90% confidence intervals (CI) of the estimates from the FF with the respective equivalence zone (EZ; ± 10% of the mean estimates from the DO).\n\nResults: On average, oxygen consumptions for sedentary, light, MVPA were 9.0 ± 1.6, 14.9 ± 3.9, 23.5 ± 5.5, and 33.8 ± 5.6 ml·kg·min-1, respectively. Correlations between FF and DO were consistently high for sedentary (r = 0.81, P <.001), MVPA (r = 0.62, P <.001), and Total PA (r = 0.81, P <.001). MAPEs were 8.2%, 21.1%, and 8.2% for sedentary, MVPA, and Total PA, respectively. The estimates from the FF were not significantly equivalent to those from the DO; sedentary (FF: Mean (M) = 7.8 min, 90% CI: 7.3 - 8.3 min vs. DO: M = 6 min, EZ: 5.4 - 6.6 min), MVPA (FF: M = 7.2 min, 90% CI: 6.2 - 8.2 min vs. DO: M = 12 min, EZ: 10.8 - 13.2 min), and Total PA (FF: M = 14.0 min, 90% CI: 13.6 - 14.4 min vs. DO: M = 16 min, EZ: 14.4 - 17.6 min).\n\nConclusions: The validity of the FF was supported by the consistently high correlations with the criterion measure. However, inconsistent results from equivalence testing warrants subsequent assessment of the validity of the FF as it has a high potential for replacing research-based PA monitors in preschool-age children.", "links": [ { "caption": "URL", "url": "http://circ.ahajournals.org/content/133/Suppl_1/AMP85", "newWindow": true } ] }, { "title": "A Study to Determine the Most Popular Lifestyle Smartphone Applications and Willingness of the Public to Share Their Personal Data for Health Research.", "author": "Chen, J., Bauman, A. and Allman-Farinelli, M.", "year": "2016", "journalProceedings": "Telemedicine and e-Health", "category": "Survey Research", "devices": null, "population": "Adults", "dataUsed": "NA", "abstract": "INTRODUCTION: Smartphone lifestyle applications (apps) and wearable fitness-tracking devices collect a wealth of data that could provide research insights to support prevention and treatment of obesity and chronic diseases. The aim of this study was to pilot a survey to explore patterns of behavioral tracking using smartphone lifestyle apps and individuals' willingness to share their app-generated data.\n\nMETHODS: A cross-sectional Web-based survey was conducted within a university setting. The 35-item survey asked participants about their self-tracking patterns; use of lifestyle apps and wearable devices; how their self-tracked health data could be useful to them; and any restrictions they would impose on sharing personal data. Responses were tabulated and analyzed for trends.\n\nRESULTS: The survey was completed by 101 participants. On average, 3.1 (standard deviation [SD] ±1.9) health and fitness apps were installed by current app users (n?=?85), with MyFitnessPal, MapMyRun, Nike+, and Fitbit being most popular. Most participants were willing to share their personal health data for research (77%). Those who did not normally share their health-tracking data were more likely than sharers to be concerned about privacy (odds ratio [OR]?=?5.93; 95% confidence interval [95% CI]?=?2.09-16.78), as were those not identifying with the quantified-self movement compared with those who were (OR?=?5.04; 95% CI?=?1.64-15.50).\n\nDISCUSSION: Participants were generally willing to share personal data, thus increasing the potential for these data to inform public health research and for use in targeted personalized program and intervention development.\n\nCONCLUSIONS: Opportunities for partnerships between researchers and commercial app developers or industry could improve public health research and practice.", "links": [ { "caption": "URL", "url": "http://online.liebertpub.com/doi/10.1089/tmj.2015.0159", "newWindow": true } ] }, { "title": "Peer Influence on the Engagement of Fitness Tracker Usage: A Diabetic and Obesity Study", "author": "Chen, Y., Chen, Y., Randriambelonoro, M., Geissbuhler, A. and Pu, P.\t", "year": "2016", "journalProceedings": "IEEE International Conference on Healthcare Informatics (ICHI)", "category": "Intervention", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Maintaining a physically active lifestyle is important for diabetic and obese patients, but how to motivate them to exercise and engage them in the long run remains a challenging issue. We aim to motivate their activities using fitness trackers and prevent relapse using peer influence. We conducted a study with diabetic and obese patients who used an activity tracker for four months. The 16 patients participated either as an individual or with a buddy. During the first month, most participants reported that they were motivated to conduct moderate-intensity activities. In the following three months, their number of steps significantly dropped, but the decrease is higher in the Individual condition than the Peer condition. The frequency of activity tracking slightly increased for patients exercising with a buddy, but significantly decreased for those participating as individuals. Patients with a buddy reported that competition, working out together, and nudging each other motivated them to exercise and keep monitoring their physical activities.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/document/7776344/", "newWindow": true } ] }, { "title": "Accuracy of Wristband Activity Monitors during Ambulation and Activities.", "author": "Chen, M.-D., Kuo, C.-C., Pellegrini, C.A. and Hsu, M.-J.\t", "year": "2016", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "PURPOSE: The main purpose of this study was to examine the accuracy of wristband activity monitors on measuring step counts at prescribed speeds on a treadmill and under short-bouts of common daily activities.\n\nMETHODS: Thirty healthy young adults wore three wristband activity monitors on both wrists while walking or jogging on a treadmill at different speeds (54, 80, 107, and 134 m·min) and performing six different common daily activities for 5 minutes each. The monitors included the Fitbit Flex, Garmin Vivofit, and Jawbone UP. The common daily activity conditions included 2 sitting activities (playing a tablet computer game, folding laundry), 2 walking activities (pushing a stroller, carrying a bag), and 2 stair climbing activities (down, up). Absolute percentage error (APE) scores were computed to examine the accuracy between actual observed steps and monitor-detected steps.\n\nRESULTS: Under the treadmill condition, the APE ranged between 1.5% and 9.6%. Accuracy was improved at faster speeds (134 m·min) for all the monitors (APE < 2.5%). In the common daily activity conditions, substantial step counts were registered when folding laundry. All monitors significantly underestimated actual steps (all APE >33%) when pushing a stroller. Higher APE was observed when wore on the dominant wrist under the common daily activity conditions.\n\nCONCLUSIONS: The wristband activity monitors examined were more accurate for measuring step counts between 80 m·min to 134 m·min as compared to a slower speed. Accuracy under each common daily activity condition ranged widely between monitors and activity, with less error when worn on the nondominant wrist. These results will help to inform researchers on the use and accuracy of wristband activity monitors for future studies.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/pages/articleviewer.aspx?year=9000&issue=00000&article=97519&type=abstract", "newWindow": true } ] }, { "title": "Social Incentives in Pervasive Fitness Apps for Obese and Diabetic patients", "author": "Chen, Y., Randriambelonoro, M.E., Geissbuhler, A. and Pu, P.", "year": "2016", "journalProceedings": "Proceedings of the 19th ACM Conference on Computer Supported Cooperative Work and Social Computing Companion", "category": "Intervention", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Social incentives such as cooperation and competition are found to motivate users in pervasive fitness applications. This work investigates how social incentives work for individuals with obesity and diabetes. We used a mobile fitness application called HealthyTogether as an experimental platform, which allows dyads to achieve fitness goals together and compete in an online community. We conducted a four-week study with 16 obese and diabetic patients who used HealthyTogether to exercise with a buddy. Results show that participants exercised more with social incentives compared with their baseline. Collaborating with buddies to compete in a community was reported as motivating for dyads exercising with strong ties. Social interactions could be demotivating between dyads who did not know each other well. Finally, it is crucial to consider patientsâ technical literacy when designing behavior-changing technologies.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=2818052.2869093", "newWindow": true } ] }, { "title": "Validating The Latest Commercial Physical Activity Monitors", "author": "Chow, J.J., Ward, R.E., Thom, J.M. and Parmenter, B.J.", "year": "2016", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "One,Flex,Charge,Charge HR", "population": "Adults", "dataUsed": "Intensity", "abstract": "PURPOSE: Completing 10,000 steps per day is recommended by the World Health Organisation, the US Centre for Disease Control and the Australian National Heart Foundation. Physical activity monitors (PAM) are popular and have become increasingly available, marketed for their ability to count steps. However, limited data is available on the newer monitors (Fitbits/Jawbone) in comparison to the Actigraph, a validated research-based accelerometer, or a visual step counts, at multiple speeds and placement sites. This study aimed to compare these newer PAMs to the Actigraph and a visual count 1) across different speeds; and 2) at different placement sites in a lab based treadmill test.\nMETHODS: Participants wore an Actigraph wGT3X-BT and Fitbit One around the waist and each wrist, as well as a Fitbit Flex, Fitbit Charge HR and Jawbone UP24 on each wrist while performing 5 x 3 minute bouts on a treadmill at multiple speeds (5.0, 6.5, 8.0, 10.0 and 12.0km/h). A video of their lower limbs was recorded for a visual count (criterion measure) to be completed in duplicate. Paired sample t-tests to test for any significant differences and Spearman's correlations for associations, between the device and visual count were completed.\n\nRESULTS: 31 participants (61% male) aged 24.3±5.2yrs ranging in BMI (18.6kg/m2 to 29.9kg/m2) were recruited. Across all speeds the Actigraph (waist) and Fitbit One (waist) were accurate when compared to visual counts (p,0.001), with the Fitbit One (waist) being the most accurate PAM at slower speeds (5.0, 6.5km/h). All PAMs worn around the wrist became more accurate at the faster speeds with the strongest associations at 8.0km/h=Fitbit Charge (r=0.87, p,0.01); 10.0km/h=Fitbit One (r=0.91, p<0.01) and 12.0km/h=Jawbone (r=0.90, p<0.01). Most PAMS, excluding the Fitbit One significantly undercounted at 5.0 and 6.5km/h (p>0.05). At the higher speeds (10.0, 12.0kph) there were no significant differences (p<0.05) between step counts for all devices.\n\nCONCLUSION: The step count accuracy of PAMs was affected by speed and placement site. The Fitbit One (waist) was the most accurate PAM across all speeds. Other PAMs worn on the wrist were accurate at the faster speeds only. Future studies should look at the effect of body mass index and outdoor free living environments on the accuracy of these newer PAMs.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Citation/2016/05001/Validating_The_Latest_Commercial_Physical_Activity.988.aspx", "newWindow": true } ] }, { "title": "Integrating Population-based Patterns with Personal Routine to Re-engage Fitbit Usesh", "author": "Chung, C.-F. and Danis, C.", "year": "2016", "journalProceedings": "Proceedings of the 10th EAI International Conference on Pervasive Computing Technologies for Healthcare", "category": "Usability", "devices": null, "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "In this paper, we explore user reactions to prototypes that integrate population fitness data with personal practice to bolster motivation and help decrease pragmatic barriers to incorporating exercise in daily life. We conducted a study in a major United States based company that makes wearable devices available to their employees through its wellness program. We interviewed each of 26 employees to understand their exercise and tracking habits. Each expressed an interest in improving or maintaining his or her fitness level but was frustrated by not getting appropriate support from the current Fitbit application. Based on the interview findings, we designed four use cases and two prototypes to address the main problems revealed through analyses of the participants' interviews and their Fitbit data. In a second interview probing reactions to they prototype, the same group of users reported a desire for Fitbit to support their daily, dynamic routines and to help them make adaptive, weekly plans. In addition, the participants perceived benefits to leveraging at least one of three different types of personalized reference groups (self, friends, or a population of similar individuals) to increase their motivation and to help incorporate activities into their daily or weekly plans. We discuss design consideration for researchers and designers of personal informatics tools and organizational wellness plans.", "links": [ { "caption": "URL", "url": "http://eudl.eu/doi/10.4108/eai.16-5-2016.2263334", "newWindow": true } ] }, { "title": "Tweeting to Health: A Novel mHealth Intervention Using Fitbits and Twitter to Foster Healthy Lifestyles", "author": "Chung, A.E., Skinner, A.C., Hasty, S.E. and Perrin, E.M.", "year": "2016", "journalProceedings": "Clinical Pediatrics", "category": "Intervention", "devices": "Zip,Aria", "population": "Adults", "dataUsed": "Steps,Intensity,Weight", "abstract": "We developed and pilot tested a mHealth intervention, “Tweeting to Health,” which used Fitbits, Twitter, and gamification to facilitate support for healthy lifestyle changes in overweight/obese (OW) and healthy weight (HW) young adults. Participants tracked activity and diet using Fitbits and used Twitter for messaging for 2 months. Physical activity, dietary intake, and Tweets were tracked and participants completed surveys at enrollment, 1 month, and 2 months. Descriptive statistics were used to examine steps/day, physical activity intensity, lifestyle changes, and total Tweets. Participants were on average 19 to 20 years old and had familiarity with Twitter. OW participants had on average 11?222 daily steps versus 11?686 (HW). One-day challenges were successful in increasing steps. Participants increased fruit/vegetable intake (92%) and decreased their sugar-sweetened beverage intake (67%). Compliance with daily Fitbit wear (99% of all days OW vs 73% HW) and daily dietary logging (82% OW vs 73% HW) and satisfaction was high.", "links": [ { "caption": "URL", "url": "http://cpj.sagepub.com/content/early/2016/06/16/0009922816653385", "newWindow": true } ] }, { "title": "Gender Differences in Regional Brain Activity in Patients with Chronic Primary Insomnia: Evidence from a Resting-State fMRI Study", "author": "Dai, X.-J., Nie, X., Liu, X., Pei, L., Jiang, J., Peng, D.-c., Gong, H.-H., Zeng, X.-J., Wáng, Y.-X.J. and Zhan, Y.\t", "year": "2016", "journalProceedings": "Journal of Clinical Sleep Medicine", "category": "Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Sleep", "abstract": "Study Objectives: To explore the regional brain activities in patients with chronic primary insomnia (PCPIs) and their sex differences.\nMethods: Forty-two PCPIs (27 females, 15 males) and 42 good sleepers (GSs; 24 females, 18 males) were recruited. Six PCPIs (3 males, 3 females) were scanned twice by MRI to examine the test-retest reliability. Amplitude of low frequency fluctuation (ALFF) method was used to assess the local brain features. The mean signal values of the different ALFF areas were analyzed with a receiver operating characteristic (ROC) curve. Simple linear regression analysis was performed to investigate the relationships between clinical features and different brain areas.\n\nResults: Both female and male PCPIs showed higher ALFF in the temporal lobe and occipital lobe, especially in female PCPIs. Female PCPIs had lower ALFF in the bilateral cerebellum posterior lobe, left dorsolateral prefrontal cortex, and bilateral limbic lobe; however, male PCPIs showed lower ALFF in the left occipital gyrus. The mean signal value of the cerebellum in female PCPIs showed negative correlations with negative emotions. Compared with male PCPIs, female PCPIs showed higher ALFF in the bilateral middle temporal gyrus and lower ALFF in the left limbic lobe. The different areas showed high test-retest stability (Clusters of contiguous volumes = 1080 mm3 with an intraclass correlation coefficient = 0.80) and high degree of sensitivity and specificity.\n\nConclusions: Female PCPIs showed more regional brain differences with higher and lower ALFF responses than male PCPIs. However, they shared analogous excessive hyperarousal mechanism and wide variations in aberrant brain areas.", "links": [ { "caption": "URL", "url": "http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=30512", "newWindow": true } ] }, { "title": "Feasibility and acceptability of remotely monitored pedometer-guided physical activity.", "author": "Darvall, J.N., Parker, A. and Story, D.A.\t", "year": "2016", "journalProceedings": "Anaesthesia and Intensive Care", "category": "Usability", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Nearly 70% of the Australian adult population are either sedentary, or have low levels of physical activity. There has been interest in addressing this problem by the 'mHealth', or mobile Health, arena, which is concerned with the confluence of mobile technology and health promotion. The newer generation of activity pedometers has the ability to automatically upload information, to enable aggregation and meta-data analysis of individual patient data. We conducted a ten-week pilot trial of the Fitbit Zip® pedometer using a validated tool in ten volunteers, finding it highly acceptable to both participants and investigators. Data synching was ranked as 'very easy' or 'easy' by all participants, and investigators could successfully monitor activity levels remotely. Median (interquartile range) daily step counts of participants over the ten-week trial ranged from 5471 (4591-7026) to 18779 (15031-21505) steps. Sedentary time over the study period ranged from 1.4% to 33.3% of study days. Percentage of days reaching the target activity level of textgreater10,000 steps/day varied markedly between participants from 4.5% to 95.7%. This study demonstrates the feasibility and acceptability of a remotely monitored pedometer-guided physical activity intervention. This technology may be useful to encourage increased exercise as a form of 'prehabilitation' of adequately screened at-risk surgical or obstetric patients.", "links": [ { "caption": "URL", "url": "http://www.aaic.net.au/document/?D=20160047", "newWindow": false } ] }, { "title": "A Study Analyzing the Effect of Using Accelerometer in a Lifestyle Intervention Program", "author": "Das, S., Rouseff, M., Guzman, H.E., Pino, A., Agatston, A., Shafer, et al.", "year": "2016", "journalProceedings": "Circulation", "category": "Intervention", "devices": null, "population": "Adults", "dataUsed": "NA", "abstract": "Introduction: With about 59% of the entire US population currently in the work force, there is much more emphasis on worksite-based interventions to improve health. The present study aimed to verify the role of accelerometry in worksite wellness programs. This study will analyze the short term effectiveness of including an accelerometer into a worksite wellness program.\nMethods: Inclusion criteria for participation in My Unlimited Potential (MyUP), for employees of Baptist Health South Florida (BHSF), were the presence of 2 or more Cardio-metabolic risk factors. One group was provided a Fitbit accelerometer as an adjunct to multidisciplinary team interventions guided by an advanced registered nurse practitioner (ARNP), certified diabetic educator-RN (CDE), registered nurse (RN), a registered dietician (RD) and exercise physiologist (EP), and the other group was not provided a Fitbit.\n\nResults: Table 1 shows the comparison of two MyUp programs at the end of 12-weeks. Employees who were given a Fitbit Activity tracker were statistically more successful in improving blood pressure than the non-Fitbit group. However, improvements in lipids, BMI, Hemoglobin A1C% and HsCRP remained significant at the end of the 12-week period for participants in both programs.\n\nConclusions: A multi-component lifestyle intervention program incorporating wearable technology can result in significant improvements in weight loss and overall health metrics leading to a healthier healthcare workforce.", "links": [ { "caption": "URL", "url": "http://circ.ahajournals.org/content/134/Suppl_1/A15175", "newWindow": true } ] }, { "title": "Men on the Move-Nashville: Feasibility and Acceptability of a Technology-Enhanced Physical Activity Pilot Intervention for Overweight and Obese Middle and Older Age African American Men.", "author": "Dean, D.A.L., Griffith, D.M., McKissic, S.A., Cornish, E.K. and Johnson-Lawrence, V.\t", "year": "2016", "journalProceedings": "American Journal of Men's Health", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Men on the Move-Nashvillewas a quasi-experimental, 10-week pilot physical activity intervention. A total of 40 overweight or obese African American men ages 30 to 70 (mean age = 47) enrolled in the intervention. Participants attended 8 weekly, 90-minute small group sessions with a certified personal trainer. Each session consisted of discussions aimed to educate and motivate men to be more physically active, and an exercise component aimed to increase endurance, strength, and flexibility. Throughout each week, men used wearable activity trackers to promote self-monitoring and received informational and motivational SMS text messages. Of the 40 enrolled men, 85% completed the intervention, and 80% attended four or more small group sessions. Additionally, 70% of participants successfully used the activity tracker, but only 30% of men utilized their gym memberships. Participants benefited from both the small group discussions and activities through increasing social connection and guidance from their trainer and group members. These African American men reported being motivated to engage in physical activity through each of these technologies. Men reported that the activity trackers provided an important extension to their social network of physically active people. The intervention resulted in significant increases in men's self-reported levels of light, moderate, vigorous, and sports-related physical activities, and high-density lipoprotein cholesterol levels, and significant decreases in weight and body fat percentage with small, moderate and large effects shown. Including technology and didactic components in small group-based interventions holds promise in motivating African American men to increase their physical activity.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/27099346", "newWindow": true } ] }, { "title": "Assessment, Assurance, and Actuation: The Use of Activity Trackers to Monitor Physical Activity in a Pediatric Population with Congenital Heart Disease", "author": "Dean, P., Voss, C., De Souza, A. and Harris, K.\t", "year": "2016", "journalProceedings": "Canadian Journal of Cardiology", "category": "Medical,Intervention", "devices": "Charge HR", "population": "Adolescents", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND: Physical activity (PA) trackers have demonstrated the potential to improve the PA habits of pediatric patients with congenital heart disease (CHD). This study was designed to reach patients across the province of British Columbia in order to assess levels of PA in a pediatric CHD population, provide assurance to patients and families regarding exercise capacity, and actuate an increase in PA. \n\nMETHODS: Eligible patients (9-18 years old with a diagnosis of CHD) were recruited during their regular clinic appointments. Baseline testing involved PA measurement using an accelerometer (GT3X+ or GT9X ActiGraph LLC). Participants were then given an activity tracker (FitBit Charge HRTM) to wear for 16 weeks (late October-early February). Their activity was monitored during this intervention by an exercise physiologist who would interact with participants on a bi-weekly basis. Introduction to the exercise physiologist was carried out over SkypeTM; subsequent interaction was conducted by email in order to eliminate geography as a barrier to participation. PA was re-assessed after 16 weeks with an accelerometer. \n\nRESULTS: Sixty-six subjects are currently enrolled and 21 subjects (8M, 13F) have completed the intervention thus far; recruitment success rate is 97%. There were no significant changes between baseline and follow-up daily step count (8384`2544 vs. 7524`1908, respectively) or moderate-to- vigorous PA (54`21 vs. 48`15 mins respectively; all p>0.05). The mean temperature ranged from 6 C at the beginning of the study period to 0 C at the end of the study period; mean snow cover ranged from 0.0cm to 9.0cm over the same time points. Participant compliance with the activity tracker remained high throughout the intervention; wear-time averaged 5.7 days per week. Of those (n1/416) who completed a voluntary feedback survey 63% found the activity tracker useful as a motivational tool.\n\nCONCLUSION: It is difficult to comment on the motivational power of the intervention because changes in weather likely acted as a confounding variable in this cohort. However, use of an activity tracker inspired interest in PA over the winter months and may have blunted the seasonal decline in PA that has been previously established in this age group. Subjects currently enrolled will provide the opportunity to compare the efficacy of the intervention across various seasons. The success of recruitment and high rates of compliance indicate that pediatric patients (and their families) are aware of the importance of PA and are seeking assurance regarding current activity habits and, for some, actuation to improve upon them.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0828282X1630397X", "newWindow": true } ] }, { "title": "Validity and inter-device reliability of dominant and non-dominant wrist worn activity trackers in suburban walking", "author": "De Man, M., Vanderploeg, E., Aimers, N., MacMahon, C., Wise, L. and Parrington, L.\t", "year": "2016", "journalProceedings": "Sensoria: A Journal of Mind, Brain & Culture", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps", "abstract": "Wearable activity trackers have become a popular way for general and athletic populations to measure daily physical activity and rest patterns. The validity and reliability of step count is often unknown for these devices. The aims of this study were to evaluate the validity of the step count of the Fitbit Charge HR and the inter-device reliability between devices worn on the dominant and non-dominant wrists in an ecologically valid walking setting. A secondary aim was to compare these findings with data from an inertial measurement unit (IMU). Six participants were fitted with one Fitbit Charge HR on each wrist and an IMU positioned on the left and right hip. Data from the Fitbit Charge HRs and IMUs were compared against the participant's self-reported step count. Each participant walked the same suburban circuit whilst counting their steps. When assessed for validity, the Fitbit Charge HR was found to have a low correlation with the self-reported step count (dominant arm, ICC 2, 1 = .19; non-dominant arm, ICC 2, 1 =.21), underestimating the number of steps taken. In comparison, the inter-device reliability of the dominant and non-dominant wrist worn Fitbit Charge HRs was good ( ICC 2,1 = .81). Moderate validity was found between the self-reported step count and IMUs (dominant hip, ICC 2, 1 = .74; non-dominant hip, ICC 2, 1 = .72). The findings suggest that inter-device measurement from dominant and non-dominant hands is reasonably reliable, however less valid as compared to more robust research-grade devices.", "links": [ { "caption": "URL", "url": "http://sensoria.swinburne.edu.au/index.php/sensoria/article/view/442", "newWindow": true } ] }, { "title": "Accuracy of Wrist and Hip-worn Commercial Physical Activity Monitors In Free Living Conditions", "author": "Deyarmin, K.N., Snyder, K.M., Mihalik, A.G. and Hargens, T.A.\t", "year": "2016", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "One,Charge", "population": "Older Adults,Adolescents", "dataUsed": "Steps", "abstract": "It is recommended that individuals participate in 150 minutes of moderate intensity physical activity or 75 minutes of vigorous physical activity each week. Commercially-available PA monitors are becoming popular for everyday use. These PA monitors provide feedback on steps, energy expenditure, moderate-to-vigorous intensity physical activity (MVPA), and sleep quality, with new models introduced to the public at an increasing rate. Whether these devices provide the consumer with accurate information is not well understood.\nPURPOSE: To examine the accuracy of a wrist worn commercial device (Fitbit Charge) and a hip worn device (Fitbit One) in regard to steps and MVPA under free living conditions, compared to a research-grade accelerometer (Actigraph GT3X).\n\nMETHODS: Participants (n=17, Mean SD, Age: 27.8 9.0; BMI: 24.7 4.2) wore 3 devices (Actigraph GT3X, Fitbit Charge and Fitbit One) for 7 consecutive days. Participants were told to go about their regular daily activities while wearing all 3 devices at the same time. The GT3X was worn on the right hip.\n\nRESULTS: Paired t-tests showed that mean steps per day between the Actigraph (10510.6 2443.7) and the Fitbit Charge (12537.7 3936.2) differed significantly (P = 0.016). Mean steps per day between the Actigraph and the Fitbit One (11726.7 11726.7) also differed (P = 0.001). Steps between the Fitbit Charge and Fitbit One did not differ (P = 0.195). No significant differences were found in active minutes recorded between any of the devices (53.0 15.2, 52.0 42.9 and 52.8 28.9) for the Actigraph, Charge and One, respectively). Bland-Altman analysis concluded that the Actigraph and Charge (P = 0.02) and the Actigraph and One (P textless 0.01) did not agree for steps, whereas the Charge and the One did agree (P = 0.2). All three devices showed good agreement with regard to MVPA.\n\nCONCLUSION: Results showed that the 2 commercial devices did not agree with the Actigraph, a widely used PA monitor for research purposes, in mean step data. However, the devices did show good agreement with regard to MVPA, suggesting that these commercial devices may provide useful feedback for individuals seeking to achieve the current public health PA guidelines for MVPA.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Citation/2016/05001/Accuracy_of_Wrist_and_Hip_worn_Commercial_Physical.2338.aspx", "newWindow": true } ] }, { "title": "Shaffer, J.A., Ma, Y., Goldsmith, J., Schwartz, J.E. and Davidson, K.W.\tValidation of the Fitbit One® for physical activity measurement at an upper torso attachment site", "author": "Diaz, K.M., Krupka, D.J., Chang, M.J., Shaffer, J.A., Ma, Y., Goldsmith, J., Schwartz, J.E. and Davidson, K.W.\t", "year": "2016", "journalProceedings": "BMC Research Notes", "category": "Validation", "devices": "One,Flex", "population": "Adults", "dataUsed": "Steps,Energy Expenditure", "abstract": "Background: The upper torso is recommended as an attachment site for the Fitbit One®, one of the most common wireless physical activity trackers in the consumer market, and could represent a viable alternative to wrist- and hip-attachment sites. The objective of this study was to provide evidence concerning the validity of the Fitbit One® attached to the upper torso for measuring step counts and energy expenditure among female adults.\nResults: Thirteen female adults completed a four-phase treadmill exercise protocol (1.9, 3.0, 4.0, and 5.2 mph). Participants were fitted with three Fitbit® trackers (two Fitbit One® trackers: one on the upper torso, one on the hip; and a wrist-based Fitbit Flex®). Steps were assessed by manual counting of a video recording. Energy expenditure was measured by gas exchange indirect calorimetry. Concordance correlation coefficients of Fitbit-estimated step counts to observed step counts for the upper torso-attached Fitbit One®, hip-attached Fitbit One® and wrist-attached Fitbit Flex® were 0.98 (95 % CI 0.97–0.99), 0.99 (95 % CI 0.99–0.99), and 0.75 (95 % CI 0.70–0.79), respectively. The percent error for step count estimates from the upper torso attachment site was =3 % for all walking and running speeds. Upper torso step count estimates showed similar accuracy relative to hip attachment of the Fitbit One® and were more accurate than the wrist-based Fitbit Flex®. Similar results were obtained for energy expenditure estimates. Energy expenditure estimates for the upper torso attachment site yielded relative percent errors that ranged from 9 to 19 % and were more accurate than the wrist-based Fitbit Flex®, but less accurate than hip attachment of the Fitbit One®.\n\nConclusions: Our study shows that physical activity measures obtained from the upper torso attachment site of the Fitbit One® are accurate across different walking and running speeds in female adults. The upper torso attachment site of the Fitbit One® outperformed the wrist-based Fitbit Flex® and yielded similar step count estimates to hip-attachment. These data support the upper torso as an alternative attachment site for the Fitbit One®.", "links": [ { "caption": "URL", "url": "http://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-016-2020-8", "newWindow": true } ] }, { "title": "A practical validation study of a commercial accelerometer using good and poor sleepers", "author": "Dickinson, D.L., Cazier, J. and Cech, T.\t", "year": "2016", "journalProceedings": "Health Psychology Open", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "We validated a Fitbit sleep tracking device against typical research-use actigraphy across four nights on 38 young adults. Fitbit devices overestimated sleep and were less sensitive to differences compared to the Actiwatch, but nevertheless captured 88 (poor sleepers) to 98?percent (good sleepers) of Actiwatch estimated sleep time changes. Bland–Altman analysis shows that the average difference between device measurements can be sizable. We therefore do not recommend the Fitbit device when accurate point estimates are important. However, when qualitative impacts are of interest (e.g. the effect of an intervention), then the Fitbit device should at least correctly identify the effect's sign.", "links": [ { "caption": "URL", "url": "http://journals.sagepub.com/doi/10.1177/2055102916679012", "newWindow": true } ] }, { "title": "Physical Activity Assessment Between Consumer- and Research-Grade Accelerometers: A Comparative Study in Free-Living Conditions", "author": "Dominick, M.G., Winfree, N.K., Pohlig, T.R. and Papas, A.M.\t", "year": "2016", "journalProceedings": "JMIR Mhealth Uhealth", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity", "abstract": "Background: Wearable activity monitors such as Fitbit enable users to track various attributes of their physical activity (PA) over time and have the potential to be used in research to promote and measure PA behavior. However, the measurement accuracy of Fitbit in absolute free-living conditions is largely unknown. Objective: To examine the measurement congruence between Fitbit Flex and ActiGraph GT3X for quantifying steps, metabolic equivalent tasks (METs), and proportion of time in sedentary activity and light-, moderate-, and vigorous-intensity PA in healthy adults in free-living conditions.\n\nMethods: A convenience sample of 19 participants (4 men and 15 women), aged 18-37 years, concurrently wore the Fitbit Flex (wrist) and ActiGraph GT3X (waist) for 1- or 2-week observation periods (n=3 and n=16, respectively) that included self-reported bouts of daily exercise. Data were examined for daily activity, averaged over 14 days and for minutes of reported exercise. Average day-level data included steps, METs, and proportion of time in different intensity levels. Minute-level data included steps, METs, and mean intensity score (0 = sedentary, 3 = vigorous) for overall reported exercise bouts (N=120) and by exercise type (walking, n=16; run or sports, n=44; cardio machine, n=20).\n\nResults: Measures of steps were similar between devices for average day- and minute-level observations (all P values > .05). Fitbit significantly overestimated METs for average daily activity, for overall minutes of reported exercise bouts, and for walking and run or sports exercises (mean difference 0.70, 1.80, 3.16, and 2.00 METs, respectively; all P values < .001). For average daily activity, Fitbit significantly underestimated the proportion of time in sedentary and light intensity by 20% and 34 respectively, and overestimated time by 3% in both moderate and vigorous intensity (all P values < .001). Mean intensity scores were not different for overall minutes of exercise or for run or sports and cardio-machine exercises (all P values > .05).\n\nConclusions: Fitbit Flex provides accurate measures of steps for daily activity and minutes of reported exercise, regardless of exercise type. Although the proportion of time in different intensity levels varied between devices, examining the mean intensity score for minute-level bouts across different exercise types enabled interdevice comparisons that revealed similar measures of exercise intensity. Fitbit Flex is shown to have measurement limitations that may affect its potential utility and validity for measuring PA attributes in free-living conditions.", "links": [ { "caption": "URL", "url": "https://mhealth.jmir.org/2016/3/e110/", "newWindow": true } ] }, { "title": "Comparative accuracy of fitness tracking modalities in quantifying energy expenditure", "author": "Dondzila, C. and Garner, D.", "year": "2016", "journalProceedings": "Journal of Medical Engineering & Technology", "category": "Validation", "devices": "Charge", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "The purpose of this study is to compare the accuracy of wrist-worn, consumer-grade pedometers and earbud sensor technology in quantifying energy expenditure. Nineteen participants (24.6?±?3.1 years) performed 5?min exercise stages on a treadmill (80.5 m/min, 107.3 m/min, 134.1 m/min and 160.9 m/min) while measuring energy expenditure via the Fitbit Charge pedometer and Jabra Sport Pulse Wireless Earbuds, comparing with indirect calorimetry. Paired samples t-tests were used to calculate differences and Pearson correlations to examine associations between kcals measured from the Fitbit and Jabra earbuds from indirect calorimetry. Results indicate significant underestimations of kcals for both devices at all speeds except one (Jabra earbuds at 107.3 m/min). Moderate correlations were observed for the Fitbit at 107.3 m/min and 107.3 m/min, and 134.1 m/min for the Jabra earbuds. Both devices considerably underestimated kcals, suggesting that caution be used when incorporating such data into fitness/health goals.", "links": [ { "caption": "URL", "url": "http://www.tandfonline.com/doi/full/10.1080/03091902.2016.1197978", "newWindow": true } ] }, { "title": "Weight management for adolescents with intellectual and developmental disabilities: Rationale and design for an 18month randomized trial", "author": "Donnelly, J., Ptomey, L., Goetz, J., Sullivan, D., Gibson, C., Greene, J., Lee, R., Mayo, M., Honas, J. and Washburn, R.\t", "year": "2016", "journalProceedings": "Contemporary Clinical Trials", "category": "Methods", "devices": "Charge HR", "population": "Adolescents", "dataUsed": "Steps", "abstract": "Adolescents with intellectual and developmental disabilities (IDD) are an underserved group in need of weight management. However, information regarding effective weight management for this group is limited, and is based primarily on results from small, non-powered, non-randomized trials that were not conducted in accordance with current weight management guidelines. Additionally, the comparative effectiveness of emerging dietary approaches, such as portion-controlled meals (PCMs) or program delivery strategies such as video chat using tablet computers have not been evaluated. Therefore, we will conduct an 18month trial to compare weight loss (6months) and maintenance (7–18months) in 123 overweight/obese adolescents with mild to moderate IDD, and a parent, randomized to a weight management intervention delivered remotely using FaceTime™ on an iPad using either a conventional meal plan diet (RD/CD) or a Stop Light diet enhanced with PCMs (RD/eSLD), or conventional diet delivered during face-to-face home visits (FTF/CD). This design will provide an adequately powered comparison of both diet (CD vs. eSLD) and delivery strategy (FTF vs. RD). Exploratory analyses will examine the influence of behavioral session attendance, compliance with recommendations for diet (energy intake), physical activity (min/day), self-monitoring of diet and physical activity, medications, and parental variables including diet quality, physical activity, baseline weight, weight change, and beliefs and attitudes regarding diet and physical activity on both weight loss and maintenance. We will also complete a cost and contingent valuation analysis to compare costs between RD and FTF delivery.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1551714416301094", "newWindow": true } ] }, { "title": "Balanced: a randomised trial examining the efficacy of two self-monitoring methods for an app-based multi-behaviour intervention to improve physical activity, sitting and sleep in adults.", "author": "Duncan, M.J., Vandelanotte, C., Trost, S.G., Rebar, A.L., Rogers, N., Burton, N.W., Murawski, B., Rayward, A., Fenton, S. and Brown, W.J.", "year": "2016", "journalProceedings": "BMC Public Health", "category": "Methods", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "BACKGROUND: Many adults are insufficiently physically active, have prolonged sedentary behaviour and report poor sleep. These behaviours can be improved by interventions that include education, goal setting, self-monitoring, and feedback strategies. Few interventions have explicitly targeted these behaviours simultaneously or examined the relative efficacy of different self-monitoring methods.\n\nMETHODS/DESIGN: This study aims to compare the efficacy of two self-monitoring methods in an app-based multi-behaviour intervention to improve objectively measured physical activity, sedentary, and sleep behaviours, in a 9 week 2-arm randomised trial. Participants will be adults (n?=?64) who report being physically inactive, sitting textgreater8 h/day and frequent insufficient sleep (=14 days out of last 30). The \"Balanced\" intervention is delivered via a smartphone 'app', and includes education materials (guidelines, strategies to promote change in behaviour), goal setting, self-monitoring and feedback support. Participants will be randomly allocated to either a device-entered or user-entered self-monitoring method. The device-entered group will be provided with a activity tracker to self-monitor behaviours. The user-entered group will recall and manually record behaviours. Assessments will be conducted at 0, 3, 6, and 9 weeks. Physical activity, sedentary behaviour and sleep-wake behaviours will be measured using the wrist worn Geneactiv accelerometer. Linear mixed models will be used to examine differences between groups and over time using an alpha of 0.01.\n\nDISCUSSION: This study will evaluate an app-based multi-behavioural intervention to improve physical activity, sedentary behaviour and sleep; and the relative efficacy of two different approaches to self-monitoring these behaviours. Outcomes will provide information to inform future interventions and self-monitoring targeting these behaviours.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/27473327/", "newWindow": true } ] }, { "title": "Behaviour change techniques and physical activity using the fitbit flex", "author": "Dunn, E. and Robertson-Wilson, D.J.\t", "year": "2016", "journalProceedings": "Journal of Exercise, Movement, and Sport", "category": "Measurement,Survey Research", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "The availability of low-cost accelerometer technology has led to a surge in consumer-based physical activity monitors (Lee et al., 2014). A top leader in this market is Fitbit (Dolan, 2014). Fitbit's activity tracking devices allow for self-monitoring and other features related to behaviour change (e.g., goal setting) called behaviour change techniques (BCTs). It has been determined that one popular wrist-worn device, the Fitbit Flex®, incorporates 20 BCTs (Lyons et al., 2014). The purpose of this study was to explore user's experience with the Fitbit Flex® as it relates to physical activity behaviour and BCTs. Participants (n=28, 82.1% female, 18-71 years old) completed an online survey assessing: (1) demographics and Fitbit acquisition, (2) step volume (number of steps for the past week and the first week of use), and (3) user's perceived importance and/or frequency of use of the 20 BCTs. Participants had used the Fitbit for an average 5 months and there was a significant increase of almost 2000 steps (p = .003) from the first to the past week of use. The BCTs rated among the highest for perceived importance for physical activity behaviour (i.e., step volume) were feedback, self-monitoring, and goal setting. The BCTs related to feedback or reward of outcomes (i.e., weight loss) and social features (e.g., social support) were rated on the lower end of importance/frequency. Overall, the present study contributes to understanding the influence wearing a Fitbit Flex has on physical activity as well as the importance of certain BCTs, which has implications for future physical activity promotion and product development.", "links": [ { "caption": "URL", "url": "http://www.scapps.org/jems/index.php/1/article/view/1415", "newWindow": true } ] }, { "title": "Acceptability of mHealth Technology for Self-Monitoring Eating and Activity among Rural Men.", "author": "Eisenhauer, C.M., Hageman, P.A., Rowland, S., Becker, B.J., Barnason, S.A. and Pullen, C.H.\t", "year": "2016", "journalProceedings": "Public Health Nursing", "category": "Usability", "devices": "One", "population": "Adults", "dataUsed": "Steps,Food", "abstract": "OBJECTIVE: To examine rural men's use and perceptions of mobile and wireless devices to self-monitor eating and physical activity (mHealth). \n\nDESIGN AND SAMPLE: Men in this 3-week pilot study used FitBit One(®) to log daily food intake and monitor activity. A companion application (app) allowed activity monitoring of fellow participants. Health-related text messages were received 1-3 times daily. A purposive sample of 12 rural men (ages 40-67) was recruited by community leaders. \n\nMEASURES: (1) baseline heart rate, blood pressure, and BMI, (2) FitBit One(®) usage, (3) investigator-generated surveys on acceptability of mHealth, and (4) focus group on experience with mHealth. \n\nRESULTS: Men were overweight (n = 3) or obese (n = 9) and 9 of 12 were hypertensive. Nine of twelve wore FitBit One(®) all 21 days. Eleven of 12 men logged food, with 9 of 12 doing this at least 15 of 21 days. Self-monitoring and daily text messaging increased awareness of energy intake and output. Companion app's food log needed targeting for rural foods. Rotating seasons (occupational, religious, recreational) and weak cellular signals created contextual barriers to self-monitoring eating and activity. \n\nCONCLUSIONS: FitBit One(®) and text messaging were perceived as useful among the rural men, while the companion apps require adaptation to reflect dietary norms.", "links": [ { "caption": "URL", "url": "http://onlinelibrary.wiley.com/doi/10.1111/phn.12297/abstract", "newWindow": true } ] }, { "title": "Reconsidering the device in the drawer: lapses as a design opportunity in personal informatics", "author": "Epstein, D.A., Kang, J.H., Pina, L.R., Fogarty, J. and Munson, S.A.", "year": "2016", "journalProceedings": "Proceedings of the 2016 ACM International Joint Conference on Pervasive and Ubiquitous Computing", "category": "Usability", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "People stop using personal tracking tools over time, referred to as the lapsing stage of their tool use. We explore how designs can support people when they lapse in tracking, considering how to design data representations for a person who lapses in Fitbit use. Through a survey of 141 people who had lapsed in using Fitbit, we identified three use patterns and four perspectives on tracking. Participants then viewed seven visual representations of their Fitbit data and seven approaches to framing this data. Participant Fitbit use and perspective on tracking influenced their preference, which we surface in a series of contrasts. Specifically, our findings guide selecting appropriate aggregations from Fitbit use (e.g., aggregate more when someone has less data), choosing an appropriate framing technique from tracking perspective (e.g., ensure framing aligns with how the person feels about tracking), and creating appropriate social comparisons (e.g., portray the person positively compared to peers). We conclude by discussing how these contrasts suggest new designs and opportunities in other tracking domains.", "links": [ { "caption": "URL", "url": "http://http://dl.acm.org/citation.cfm?doid=2971648.2971656", "newWindow": true } ] }, { "title": "Use of Fitness Bands by Teachers in the Classroom", "author": "Ertzberger, J. and Martin, F.", "year": "2016", "journalProceedings": "TechTrends", "category": "Usability", "devices": "Flex", "population": "Adults", "dataUsed": "NA", "abstract": "Wearable technologies are increasingly gaining attention. Gadgets such as Smartwatch, Fitband, Google Glass, and similar healthcare devices can be worn by the consumer and have several benefits in various contexts. This study examined teachers perception on fitness bands and if they have any benefits to classroom teachers. 28 classroom teachers were each given a fitness band for 35 days. Prior to giving them the fitness band, a pre-survey was administered. At the end of the 35 day period a post-survey was administered. Ninety-three percent of the teachers completed both the post and pre-survey in which they responded to change in teacher motivation and teaching practices due to wearing the fitness band. There were also four open ended questions that addressed benefits and challenges of using the fitness band in educational contexts. This study has implications for those considering using fitness band in an educational setting.", "links": [ { "caption": "URL", "url": "http://link.springer.com/article/10.1007%2Fs11528-016-0079-7", "newWindow": true } ] }, { "title": "Quantifying pilot contribution to flight safety for normal and non-normal airline operations", "author": "Etherington, T.J., Kramer, L.J., Bailey, R.E., Kennedy, K.D. and Stephens, C.L.\t", "year": "2016", "journalProceedings": "2016 IEEE/AIAA 35th Digital Avionics Systems Conference (DASC)", "category": "Measurement", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Accident statistics cite the flight crew as a causal factor in over 60% of accidents involving transport category airplanes. Yet, a well-trained and well-qualified pilot is acknowledged as the critical center point of aircraft systems safety and an integral safety component of the entire commercial aviation system. No data currently exists that quantifies the contribution of the flight crew in this role. Neither does data exist for how often the flight crew handles non-normal procedures or system failures on a daily basis in the National Airspace System. A pilot-in-the-loop high fidelity motion simulation study was conducted by the NASA Langley Research Center in partnership with the Federal Aviation Administration (FAA) to evaluate the pilot's contribution to flight safety during normal flight and in response to aircraft system failures. Eighteen crews flew various normal and non-normal procedures over a two-day period and their actions were recorded in response to failures. To quantify the human's contribution, crew complement was used as the experiment independent variable in a between-subjects design. Pilot actions and performance when one of the flight crew was impaired were also recorded for comparison against the nominal two-crew operations. This paper details a portion of the results of this study.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/document/7778094/", "newWindow": true } ] }, { "title": "The Effect of a Fitbit Accelerometer on Physical Activity", "author": "Farnell, G. and Westrup, R.\t", "year": "2016", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Measurement", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "PURPOSE: The purpose of this research was to determine if the FITBIT accelerometer altered physical activity levels in those wearing the accelerometer versus those not wearing the device.\n\nMETHODS: There were 19 participants in this study, recruited from the University of Central Oklahoma employee wellness program. Each participant completed the Human Activity Profile (HAP) survey to measure physical activity levels pre- and post- experimentation. Ten participants received a FITBIT accelerometer to wear for six weeks, while the other nine participants made up a control group and did not use an accelerometer.\n\nRESULTS: There was no significant difference between the FITBIT and the control groups HAP maximum activity scores (MAS) (p = 0.16), and HAP adjusted activity scores (AAS)(p = 0.0.179). There was not a significant difference for the main effect for time (p = 0.367), main effect for group (p = 0.98), or interaction of time by group (p = 0.389). Steps did not significantly change across time for the FITBIT group (p = 0.41). The FITBIT group did have a smaller effect size than the control group for MAS (d = 0.325, d = 0.587) and for AAS (d = 0.054, d = 0.565).\n\nCONCLUSIONS: The FITBIT group did not have significantly different physical activity levels than the control group. Despite the nonsignificant results, the smaller effect size for the FITBIT group may suggest that the FITBIT made a smaller difference compared to the control group--meaning the physical activity levels decreased less than that of the control group's activity levels.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Citation/2016/05001/The_Effect_of_a_Fitbit_Accelerometer_on_Physical.394.aspx", "newWindow": true } ] }, { "title": "Effectiveness of activity trackers with and without incentives to increase physical activity (TRIPPA): a randomised controlled trial", "author": "Finkelstein, E.A., Haaland, B.A., Bilger, M., Sahasranaman, A., Sloan, R.A., Nang, E.E.K. and Evenson, K.R.\t", "year": "2016", "journalProceedings": "The Lancet Diabetes & Endocrinology", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Despite the increasing popularity of activity trackers, little evidence exists that they can improve health outcomes. We aimed to investigate whether use of activity trackers, alone or in combination with cash incentives or charitable donations, lead to increases in physical activity and improvements in health outcomes.\n\nMethods: In this randomised controlled trial, employees from 13 organisations in Singapore were randomly assigned (1:1:1:1) with a computer generated assignment schedule to control (no tracker or incentives), Fitbit Zip activity tracker, tracker plus charity incentives, or tracker plus cash incentives. Participants had to be English speaking, full-time employees, aged 21–65 years, able to walk at least ten steps continuously, and non-pregnant. Incentives were tied to weekly steps, and the primary outcome, moderate-to-vigorous physical activity (MVPA) bout min per week, was measured via a sealed accelerometer and assessed on an intention-to-treat basis at 6 months (end of intervention) and 12 months (after a 6 month post-intervention follow-up period). Other outcome measures included steps, participants meeting 70?000 steps per week target, and health-related outcomes including weight, blood pressure, and quality-of-life measures. This trial is registered at ClinicalTrials.gov, number NCT01855776.\n\nFindings: Between June 13, 2013, and Aug 15, 2014, 800 participants were recruited and randomly assigned to the control (n=201), Fitbit (n=203), charity (n=199), and cash (n=197) groups. At 6 months, compared with control, the cash group logged an additional 29 MVPA bout min per week (95% CI 10–47; p=0·0024) and the charity group an additional 21 MVPA bout min per week (2–39; p=0·0310); the difference between Fitbit only and control was not significant (16 MVPA bout min per week [–2 to 35; p=0·0854]). Increases in MVPA bout min per week in the cash and charity groups were not significantly greater than that of the Fitbit group. At 12 months, the Fitbit group logged an additional 37 MVPA bout min per week (19–56; p=0·0001) and the charity group an additional 32 MVPA bout min per week (12–51; p=0·0013) compared with control; the difference between cash and control was not significant (15 MVPA bout min per week [–5 to 34; p=0·1363]). A decrease in physical activity of -23 MVPA bout min per week (95% CI -42 to -4; p=0·0184) was seen when comparing the cash group with the Fitbit group. There were no improvements in any health outcomes (weight, blood pressure, etc) at either assessment.\n\nInterpretation: The cash incentive was most effective at increasing MVPA bout min per week at 6 months, but this effect was not sustained 6 months after the incentives were discontinued. At 12 months, the activity tracker with or without charity incentives were effective at stemming the reduction in MVPA bout min per week seen in the control group, but we identified no evidence of improvements in health outcomes, either with or without incentives, calling into question the value of these devices for health promotion. Although other incentive strategies might generate greater increases in step activity and improvements in health outcomes, incentives would probably need to be in place long term to avoid any potential decrease in physical activity resulting from discontinuation.", "links": [ { "caption": "URL", "url": "http://www.thelancet.com/journals/landia/article/PIIS2213-8587(16)30284-4/abstract", "newWindow": true } ] }, { "title": "Validation of Consumer-Based Hip and Wrist Activity Monitors in Older Adults With Varied Ambulatory Abilities.", "author": "Floegel, T.A., Florez-Pregonero, A., Hekler, E.B. and Buman, M.P.", "year": "2016", "journalProceedings": "The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences", "category": "Validation", "devices": "One,Flex", "population": "Older Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: The accuracy of step detection in consumer-based wearable activity monitors in older adults with varied ambulatory abilities is not known.\n\nMETHODS: We assessed the validity of two hip-worn (Fitbit One and Omron HJ-112) and two wrist-worn (Fitbit Flex and Jawbone UP) activity monitors in 99 older adults of varying ambulatory abilities and also included the validity results from the ankle-worn StepWatch as a comparison device. Nonimpaired, impaired (Short Physical Performance Battery Score < 9), cane-using, or walker-using older adults (62 and older) ambulated at a self-selected pace for 100 m wearing all activity monitors simultaneously. The criterion measure was directly observed steps. Intraclass correlation coefficients (ICC), mean percent error and mean absolute percent error, equivalency, and Bland-Altman plots were used to assess accuracy.\n\nRESULTS: Nonimpaired adults steps were underestimated by 4.4% for StepWatch (ICC = 0.87), 2.6% for Fitbit One (ICC = 0.80), 4.5% for Omron HJ-112 (ICC = 0.72), 26.9% for Fitbit Flex (ICC = 0.15), and 2.9% for Jawbone UP (ICC = 0.55). Impaired adults steps were underestimated by 3.5% for StepWatch (ICC = 0.91), 1.7% for Fitbit One (ICC = 0.96), 3.2% for Omron HJ-112 (ICC = 0.89), 16.3% for Fitbit Flex (ICC = 0.25), and 8.4% for Jawbone UP (ICC = 0.50). Cane-user and walker-user steps were underestimated by StepWatch by 1.8% (ICC = 0.98) and 1.3% (ICC = 0.99), respectively, where all other monitors underestimated steps by >11.5% (ICCs < 0.05).\n\nCONCLUSIONS: StepWatch, Omron HJ-112, Fitbit One, and Jawbone UP appeared accurate at measuring steps in older adults with nonimpaired and impaired ambulation during a self-paced walking test. StepWatch also appeared accurate at measuring steps in cane-users.", "links": [ { "caption": "URL", "url": "http://biomedgerontology.oxfordjournals.org/content/early/2016/06/02/gerona.glw098.long", "newWindow": true } ] }, { "title": "Program Design for Healthy Weight in Lesbian and Bisexual Women: A Ten-City Prevention Initiative", "author": "Fogel, S.C., McElroy, J.A., Garbers, S., McDonnell, C., Brooks, J., Eliason, M.J., Ingraham, N., Osborn, A., Rayyes, N., Redman, S.D., Wood, S.F. and Haynes, S.G.\t", "year": "2016", "journalProceedings": "Women's Health Issues", "category": "Methods", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "PURPOSE\nAdult lesbian and bisexual (LB) women are more likely to be obese than adult heterosexual women. To address weight- and fitness-related health disparities among older LB women using culturally appropriate interventions, the Office on Women's Health (OWH) provided funding for the program, Healthy Weight in Lesbian and Bisexual Women (HWLB): Striving for a Healthy Community. This paper provides a description of the interventions that were implemented.\nMETHODS\nFive research organizations partnered with lesbian, gay, bisexual, and transgender community organizations to implement healthy weight interventions addressing the needs of LB women 40 years and older. The interventions incorporated evidence-based recommendations related to physical activity and nutrition. Each group intervention developed site-specific primary objectives related to the overall goal of improving the health of LB women and included weight and waist circumference reduction as secondary objectives. A 57-item core health survey was administered across the five sites. At a minimum, each program obtained pre- and post-program assessments.\n\nRESULTS\nEach program included the OWH-required common elements of exercise, social support, and education on nutrition and physical activity, but adopted a unique approach to deliver intervention content.\n\nCONCLUSION\nThis is the first time a multisite intervention has been conducted to promote healthy weight in older LB women. Core measurements across the HWLB programs will allow for pooled analyses, and differences in study design will permit analysis of site-specific elements. The documentation and analysis of the effectiveness of these five projects will provide guidance for model programs and future research on LB populations.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1049386715001620", "newWindow": true } ] }, { "title": "Reliability and Validity of Ten Consumer Activity Trackers Depend on Walking Speed", "author": "Fokkema, T., Kooiman, T.J., Krijnen, W.P., van der Schans, C.P. and de Groot, M.\t", "year": "2016", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps", "abstract": "Purpose: To examine the test-retest reliability and validity of ten activity trackers for step counting at three different walking speeds.\nMethods: Thirty-one healthy participants walked twice on a treadmill for 30 minutes while wearing ten activity trackers (Polar Loop, Garmin Vivosmart, Fitbit Charge HR, Apple Watch Sport, Pebble Smartwatch, Samsung Gear S, Misfit Flash, Jawbone Up Move, Flyfit and Moves). Participants walked three walking speeds for ten minutes each; slow (3.2 km[middle dot]h-1), average (4.8 km[middle dot]h-1), and vigorous (6.4 km[middle dot]h-1). To measure test-retest reliability, intraclass correlations (ICCs) were determined between the first and second treadmill test. Validity was determined by comparing the trackers with the gold standard (hand counting), using mean differences, mean absolute percentage errors, and ICCs. Statistical differences were calculated by paired-sample t-tests, Wilcoxon signed-rank tests, and by constructing Bland-Altman plots.\n\nResults: Test-retest reliability varied with ICCs ranging from -0.02 to 0.97. Validity varied between trackers and different walking speeds with mean differences between the gold standard and activity trackers ranging from 0.0 to 26.4%. Most trackers showed relatively low ICCs and broad limits of agreement of the Bland-Altman plots at the different speeds. For the slow walking speed, the Garmin Vivosmart and Fitbit Charge HR showed the most accurate results. The Garmin Vivosmart and Apple Watch Sport demonstrated the best accuracy at an average walking speed. For vigorous walking, the Apple Watch Sport, Pebble Smartwatch, and Samsung Gear S exhibited the most accurate results.\n\nConclusion: Test-retest reliability and validity of activity trackers depends on walking speed. In general, consumer activity trackers perform better at an average and vigorous walking speed than at a slower walking speed.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/28319983", "newWindow": true } ] }, { "title": "Validation of the Fitbit Charge Heart Rate Device to Monitor Physical Activity in Children with Congenital Heart Disease", "author": "Gardner, R., Voss, C., Dean, P. and Harris, K.\t", "year": "2016", "journalProceedings": "Canadian Journal of Cardiology", "category": "Medical,Validation", "devices": "Charge HR", "population": "Patients,Children,Adolescents", "dataUsed": "Steps", "abstract": "Background: Commercial wearable activity trackers, like the FitBit™, may be useful to monitor and promote activity in children. However, these trackers are designed for adults and it is unclear whether they are valid for use in children. The aim of this study was to determine whether the FitBit Charge HR™ accurately estimates daily step counts in a pediatric population.\n\nMethods: Eligible participants (10-18yrs) were recruited from the Children's Heart Centre at BC Children's Hospital and partnership clinics across the province of British Columbia. Participants were fitted with an accelerometer positioned over the right hip (Actigraph LLC; ‘criterion') and a wrist-worn FitBit Charge HR™ (‘measure'). Participants were asked to wear both devices simultaneously for 7 consecutive days. We retrieved daily sums of step counts from valid accelerometry days, which was defined as monitor wear time of =600 minutes/day (Actilife LLC). We paired these days with corresponding daily step counts from the FitBit™ for analyses. A subset of participants underwent exercise tolerance testing while wearing the FitBit™ to validate its heart rate tracking feature. We calculated intra-class correlation coefficients (ICC) and mean bias (criterion-measure) with 95% limits of agreement (95%LoA) to estimate agreement between devices.\n\nResults: Twenty-one participants (13.4±2.0yrs, 57% female) provided 97 person-days of data. Overall, there was a strong association between the two devices for daily step counts across person-days (ICC=0.852, ptextless0.001). However, FitBit™ devices systematically recorded more steps than accelerometers (9,914±5,255 vs. 7,637±3,953 steps/day) with a mean bias of -2,277 steps/day (95%LoA= -7,587-3,034). We were unable to assess the validity of the FitBit™ heart rate tracking feature during exercise tolerance testing because of electromagnetic interference from clinical equipment, which temporarily impacted the data recording ability of the FitBit™.\n\nConclusion: FitBit Charge HR™ devices are a valid tool to assess patterns in daily step count in a pediatric population; however, caution is required when comparing FitBit Charge HR™ step counts to physical activity studies that are based on the more conservative criterion measure.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0828282X16303968", "newWindow": true } ] }, { "title": "Efficacy, feasibility, and acceptability of a novel technology-based intervention to support physical activity in cancer survivors", "author": "Gell, N.M., Grover, K.W., Humble, M., Sexton, M. and Dittus, K.\t", "year": "2016", "journalProceedings": "Supportive Care in Cancer", "category": "Intervention", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "Purpose: Physical activity is known to minimize the long-term side effects of cancer treatment. Yet, rates of physical activity participation by cancer survivors are significantly lower compared to the general population. The purpose of this pilot study was to examine the efficacy, feasibility, and acceptability of a technology-based intervention to promote maintenance of physical activity after completing an exercise-based oncology rehabilitation program.\n\nMethods: The pre-post 4-week intervention included support delivered through tailored text messages, Fitbit® self-monitoring, and brief health coaching sessions. The primary outcome measure was accelerometer-assessed physical activity levels. Self-efficacy, self-regulation, social support, fatigue, sleep disturbance, depression, and Fitbit® step counts were assessed as secondary outcomes.\n\nResults: Twenty-four participants (20 females; mean age = 57.9 years ± 10.4) completed the intervention. Mean daily step counts and weekly minutes of moderate-to-vigorous intensity physical activity were maintained after the intervention, as compared to baseline levels achieved at the end of 12 weeks of exercise-based oncology rehabilitation. Both self-regulation (goal setting, relapse prevention) and fatigue severity increased significantly post intervention as compared to baseline (p = 0.05 and p = 0.02, respectively). Qualitative responses demonstrated overall satisfaction with intervention components.\n\nConclusions: Results demonstrate efficacy of the intervention for maintenance of physical activity levels achieved during exercise-based oncology rehabilitation. Low attrition and high satisfaction provide evidence for both the acceptability and feasibility of the intervention components. Exercise interventions post oncology treatment provide multiple benefits for cancer survivors, yet continued maintenance after program completion is challenging. Technological options offer low-cost, accessible modes to deliver continued monitoring and support beyond traditional facility-based programs.", "links": [ { "caption": "URL", "url": "http://dx.doi.org/10.1007/s00520-016-3523-5", "newWindow": true } ] }, { "title": "Impact of a Digital Activity Tracker-Based Workplace Activity Program on Health and Wellbeing", "author": "Glance, D.G., Ooi, E., Berman, Y., Glance, C.F. and Barrett, H.R.", "year": "2016", "journalProceedings": "Proceedings of the 6th International Conference on Digital Health Conference", "category": "Measurement", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "Chronic disease is endemic within the Australian community. 3.6 million Australians have diabetes or pre-diabetes with the number increasing by 7% each year. Fifty three percent of Australians have one or more chronic diseases. Increasing levels of activity has proved relatively straightforward, especially through workplace physical activity interventions. What is still not certain are the short, and long-term, health benefits arising from these workplace activity challenges. Research into workplace activity challenges is beset with a number of methodological obstacles that may, in part, explain why consistent outcomes have not been found from studies of this type. The aim of this study was to assess whether participation in a 16-week activity challenge would result in measurable changes in lipid profile, blood glucose, renal function, blood pressure, weight and health and well being as measured using a health and wellbeing assessment. The study demonstrated that participants could increase their levels of activity and maintain at least 10,000 steps a day for a period of 16 weeks. The study also identified that participants in teams were significantly more active than those participating as individuals. Furthermore, attrition from the activity challenge was greater amongst participants not in a team. This demonstrated the importance of social interactions, support and possibly other factors that being part of a group brought to the experience of participating in the activity challenge. In addition to the above, the challenge resulted in reductions in non-HDL cholesterol, and triglyceride concentrations and health and well being score.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=2896338.2896345", "newWindow": true } ] }, { "title": "Estimating Physical Activity and Sedentary Behavior in a Free-Living Context: A Pragmatic Comparison of Consumer-Based Activity Trackers and ActiGraph Accelerometry", "author": "Gomersall, S.R., Ng, N., Burton, N.W., Pavey, T.G., Gilson, N.D. and Brown, W.J.\t", "year": "2016", "journalProceedings": "Journal of Medical Internet Research", "category": "Validation", "devices": "One", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: Activity trackers are increasingly popular with both consumers and researchers for monitoring activity and for promoting positive behavior change. However, there is a lack of research investigating the performance of these devices in free-living contexts, for which findings are likely to vary from studies conducted in well-controlled laboratory settings. Objective: The aim was to compare Fitbit One and Jawbone UP estimates of steps, moderate-to-vigorous physical activity (MVPA), and sedentary behavior with data from the ActiGraph GT3X+ accelerometer in a free-living context. \n\nMethods: Thirty-two participants were recruited using convenience sampling; 29 provided valid data for this study (female: 90%, 26/29; age: mean 39.6, SD 11.0 years). On two occasions for 7 days each, participants wore an ActiGraph GT3X+ accelerometer on their right hip and either a hip-worn Fitbit One (n=14) or wrist-worn Jawbone UP (n=15) activity tracker. Daily estimates of steps and very active minutes were derived from the Fitbit One (n=135 days) and steps, active time, and longest idle time from the Jawbone UP (n=154 days). Daily estimates of steps, MVPA, and longest sedentary bout were derived from the corresponding days of ActiGraph data. Correlation coefficients and Bland-Altman plots with examination of systematic bias were used to assess convergent validity and agreement between the devices and the ActiGraph. Cohen's kappa was used to assess the agreement between each device and the ActiGraph for classification of active versus inactive (=10,000 steps per day and =30 min/day of MVPA) comparable with public health guidelines. \n\nResults: Correlations with ActiGraph estimates of steps and MVPA ranged between .72 and .90 for Fitbit One and .56 and .75 for Jawbone UP. Compared with ActiGraph estimates, both devices overestimated daily steps by 8% (Fitbit One) and 14% (Jawbone UP). However, mean differences were larger for daily MVPA (Fitbit One: underestimated by 46%; Jawbone UP: overestimated by 50%). There was systematic bias across all outcomes for both devices. Correlations with ActiGraph data for longest idle time (Jawbone UP) ranged from .08 to .19. Agreement for classifying days as active or inactive using the =10,000 steps/day criterion was substantial (Fitbit One: ?=.68; Jawbone UP: ?=.52) and slight-fair using the criterion of =30 min/day of MVPA (Fitbit One: ?=.40; Jawbone UP: ?=.14). \n\nConclusions: There was moderate-strong agreement between the ActiGraph and both Fitbit One and Jawbone UP for the estimation of daily steps. However, due to modest accuracy and systematic bias, they are better suited for consumer-based self-monitoring (eg, for the public consumer or in behavior change interventions) rather than to evaluate research outcomes. The outcomes that relate to health-enhancing MVPA (eg, “very active minutes” for Fitbit One or “active time” for Jawbone UP) and sedentary behavior (“idle time” for Jawbone UP) should be used with caution by consumers and researchers alike.", "links": [ { "caption": "URL", "url": "http://www.jmir.org/2016/9/e239/", "newWindow": true } ] }, { "title": "Implementation of the physical activity guidelines in lung cancer: The CAPACITY study", "author": "Granger, C., Irving, L., Antippa, P., Edbrooke, L., Parry, S., Lin, K.-Y., Eriksen, A., Martin, J., Steinfort, D. and Denehy, L.", "year": "2016", "journalProceedings": "European Respiratory Journal", "category": "Intervention", "devices": null, "population": "Patients,Adults", "dataUsed": "Intensity", "abstract": "Introduction: Physical activity (PA) is important in lung cancer yet the majority of patients do not meet minimum recommended levels.\nAims: To determine if a PA self-management program is feasible and effective at preventing decline in PA, which commonly occurs after surgery.\n\nMethod: Prospective case series. 40 patients (55% male, mean age 66±10years) with newly diagnosed operable lung cancer. The intervention was a PA program based on the cancer PA guidelines, commenced pre-surgery (if recruitment occurred textgreater7days prior to surgery) or post-surgery if not and continued to 8weeks post-surgery. It included prescription of an unsupervised home exercise program, provision of a Fitbit (activity monitor), education and weekly telephone support. Outcomes: feasibility, self-reported PA, function, symptoms, self-efficacy and health-related quality of life (HRQoL) assessed pre-surgery and 2weeks, 8weeks and 6months post-surgery.\n\nResults: 16% of patients commenced the intervention pre-surgery and 84% commenced post-surgery. Median[IQR] number of intervention sessions (face-to-face or telephone) delivered was 4[3-6] per patient. There was no change in PA levels (total estimated mets/week pre-op=1543±1501, 8weeks=1748±2581, p=0.72), sedentary time (sitting hours/day pre-op= 6.1±3.6, 8-weeks=5.6±2.7, p=0.59), function (p=0.39) or dyspnoea (p=0.51) from pre to 8weeks post-surgery and global HRQoL improved (p=0.005) over this time. 63% and 67% met PA guidelines pre-op and 8weeks respectively.\n\nConclusion: The PA program was feasible when implemented in the post-surgical setting. Compared with published literature that shows decline, patients maintained their PA levels after surgery.", "links": [ { "caption": "URL", "url": "https://erj.ersjournals.com/content/48/suppl_60/OA1521.abstract", "newWindow": true } ] }, { "title": "Does Non-Running Physical Activity Contribute to the Risk of Developing a Running Related Overuse Injury?", "author": "Gruber, A.H., Murphy, S.P., Vollmar, J.E., Kennedy-Armbruster, C. and Chomistek, A.K.", "year": "2016", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Measurement", "devices": "Charge", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Running related overuse injury (RROI) affects a significant proportion of runners annually. To date, only running mileage has been considered when quantifying the amount of loading that may elicit tissue micro-damage and injury, while the loading that occurs from activities of daily living and non-running physical activity has been ignored. By ignoring non-running physical activity (PA), we may be severely underestimating the amount of loading that leads to RROI.\nPURPOSE: To determine the role of daily non-running PA on the risk of RROI development among recreational and competitive runners.\n\nMETHODS: As part of a larger prospective running injury pilot study, 50 recreational and competitive male and female runners will be enrolled and complete questionnaires regarding running history, injury history, and all forms of non-running daily PA. Participants will receive a FitBit Charge activity monitor to track PA for 24 hrs/day over 12 months. To date, questionnaires and a typical running gait analysis had been completed by 21 participants (9 male, 12 female; 27.5±6.3 years; BMI = 22.6±2.0 kg/mˆ2).\n\nRESULTS: Participants had mean±SD running experience of 8.6±5.6 years and run 24.1±15.2 mi/wk. Among n = 21 participants, RROI occurred within the past year in n = 4, within the past two years in n = 11, and in their lifetime in n = 16. Current mi/wk was 54% greater in those that had sustained a RROI in their lifetime compared with those that had not (No RROI = 15.3±4.5 mi/wk; Yes RROI 26.9±16.4 mi/wk, P=0.02). Total PA was not different between those who had and had not sustained a RROI in their lifetime or in the past 1-2 years (Ptextgreater0.05). Non-running PA was greater in those that did not sustain a RROI in each time period, but the differences were not significant with this initial sample size (No RROI vs Yes RROI: lifetime 11.8±8.3 vs 7.1±7.2 hrs/wk, Ptextgreater0.05; 1 yr: 8.7±8.2 vs 6.1±3.9 hrs/wk, Ptextgreater0.05; 2 yr: 9.2±8.6 vs 7.3±6.8 hrs/wk, Ptextgreater0.05).\n\nCONCLUSIONS: Results from the first 21 participants enrolled in this study support previous reports that running mi/wk may increase RROI risk. Given that total PA was the same between injured and non-injured runners in this sample, more hrs/wk spent in non-running PA vs running PA may reduce RROI risk. Continuous monitoring of PA collected in this 12 month study will provide evidence to support or reject this hypothesis.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Citation/2016/05001/Does_Non_Running_Physical_Activity_Contribute_to.3234.aspx", "newWindow": true } ] }, { "title": "A Leisure-Time Physical Activity Intervention for Adolescents With Visual Impairments", "author": "Haegele, J.A. and Porretta, D.\t", "year": "2016", "journalProceedings": "Research Quarterly for Exercise and Sport", "category": "Intervention", "devices": "Zip", "population": "Adolescents", "dataUsed": "Steps", "abstract": "Background/Purpose: School-aged individuals with visual impairments tend to be less physically active than their non-visually impaired peers (Kozub & Oh, 2004). However, a recent literature review revealed only 7 physical activity intervention studies targeting this population during a recent 30-year period (Haegele & Porretta, 2015). Of those studies, 1 utilized a theoretical framework. Therefore, the purpose of this study was to examine the effects of a social-cognitive theory-based physical education intervention on leisure-time physical activity of adolescents with visual impairments.\n\nMethod: Six adolescents with visual impairments attending a Midwestern residential school for the blind received a 9-lesson physical activity intervention during in-school physical education. Lessons were designed to assist participants in developing individual activity programs while addressing social-cognitive theory constructs. Each lesson included curricular concepts, in-class activities, and homework. A multiple-baseline across-participants design was used, and physical activity behavior was measured by steps taken using Fitbit Zips. Questionnaires were used to collect data (i.e., change scores) on the social-cognitive theory constructs of self-efficacy, self-regulation, social support, and outcome expectancy. Data were analyzed through visual analysis, effect size estimates (percentage of nonoverlapping data [PND]), and descriptive statistics. A treatment integrity checklist was developed, and 2 trained observers completed them independently (99.8% agreement).\n\nAnalysis/Results: Results did not demonstrate a functional relation between physical activity (i.e., number of steps taken) and the intervention. PND scores ranged from 0% to 48%. However, positive changes in mean steps per day for all participants were found from baseline to final intervention (Participant 1, 2,225–4,178 [87%]; Participant 2, 1,328–2,632 [98%]; Participant 3, 1,137– 2,111 [86%]; Participant 4, 1,151–1,740 [51%]; Participant 5, 521–588 [13%]; and Participant 6, 2,751–3,858 [40%]). Relative to the social-cognitive theory constructs, all 6 participants demonstrated positive changes in selfregulation (37%–203%), 5 demonstrated positive changes in outcome expectancy (6%–69%), and 4 demonstrated positive changes in social support (15%–42%). Three of 6 participants demonstrated increases in each of 2 selfefficacy questionnaires.\n\nConclusion: The intervention did not exert functional control of the participants' physical activity (i.e., steps taken). Results may have been directly influenced by several study limitations, such as seasonality and program truncation for 3 participants. Therefore, the results may not represent the full intervention effect. With the lack of physical activity intervention research related to adolescent-aged individuals with visual impairments (Haegele & Porretta, 2015) and the influence physical activity has on health-related outcomes (e.g., obesity), further research is needed.", "links": [ { "caption": "URL", "url": "http://search.proquest.com/openview/e1e94139646d164224809faee1a60f4c/1?pq-origsite=gscholar{\\&}cbl=40785", "newWindow": true } ] }, { "title": "Integrating physical activity data in videogames with user-centered dashboards", "author": "Hagood, D., Ching, C.C. and Schaefer, S.\t", "year": "2016", "journalProceedings": "Proceedings of the Sixth International Conference on Learning Analytics & Knowledge", "category": "Intervention", "devices": "Zip", "population": "Adolescents", "dataUsed": "Steps", "abstract": "To promote healthy awareness and activity learning, we gave 12-to 14-year-old youth activity monitors (Fitbits) to track their physical activity, which was then integrated into a videogame we created. The players' real-world steps transform into in-game resources needed for gameplay. In addition to requiring real-world steps for various in-game activities, a dashboard in this game presents visual representations of activity patterns, ostensibly informing students about patterns of their own activity. In this paper and poster, we discuss challenges in initial designs of our dashboard. We present findings and challenges in the process of creating a user-centered dashboard and conclude with our future design goals.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=2883851.2883958", "newWindow": true } ] }, { "title": "Quantifying Physical Activity Levels and Sleep in Hemodialysis Patients Using a Commercially Available Activity Tracker", "author": "Han, M., Williams, S., Mendoza, M., Ye, X., Zhang, H., Calice-Silva, V., Thijssen, S., Kotanko, P. and Meyring-Wösten, A.", "year": "2016", "journalProceedings": "Blood Purification", "category": "Intervention,Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps,Distance,Sleep", "abstract": "Background/Aims: Hemodialysis (HD) patients are less active than their healthy counterparts and frequently experience poor sleep. Our aims were to objectively quantify activity and sleep quality in HD patients of an urban population and to determine the effect of providing feedback on activity.\n\nMethods: Activity parameters and sleep parameters were collected by a commercially available activity tracker in 29 chronic HD patients. Patients in the feedback group were provided with their activity and sleep data during each HD treatment. Questionnaires were administered at the beginning and at the end of the study.\n\nResults: On average, patients walked 8,454 steps/day and slept 349 min/night. Only 28% of the patients were sedentary, defined as walking <5,000 steps/day. Providing feedback did not increase the activity in this urban population. Patients walked significantly less on Sundays compared to other days of the week: 7,024 steps on Sundays vs. 8,633 steps on HD days and 8,732 on non-HD days. It was also found that patients experienced poor sleep quality. HD treatments during shift 1 (6 a.m. to 10 a.m.) interfered with sleep patterns. Most patients reported that physical activity became more important to them after the 5-week period. The tracking device was very well accepted.\n\nConclusion: Interventions to increase physical activity on Sundays could improve physical activity levels overall. Prospective studies are necessary to further explore the use of tracking devices to identify patients at risk and to implement targeted interventions.", "links": [ { "caption": "URL", "url": "http://www.karger.com/Article/FullText/441314", "newWindow": true } ] }, { "title": "Accuracy of Commercial Activity Trackers to Measure Energy Expenditure During a Controlled Exercise Trial", "author": "Hargens, T.A., Deyarmin, K.N., Snyder, K.M., Mihalik, A.G. and Sharpe, L.E.\t", "year": "2016", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "One,Charge", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "Commercially available activity trackers are increasingly popular for the general public in measuring physical activity. Daily energy expenditure (EE) is one of the primary measures provided to the public by these devices. Whether these devices can accurately estimate EE is not clear.\nPURPOSE: To compare the EE values obtained from two commercially available devices (Fitbit Charge and Fitbit One) to that measured by the Actigraph GT3X and indirect calorimetry (IC).\n\nMETHODS: Seventeen men (n = 4) and women (n = 13) (Age: Mean ± SD = 27.8 ± 9.0; BMI = 24.7 ± 4.2 kg/m2) completed a submaximal treadmill exercise trial while wearing a Fitbit Charge, a Fitbit One, and an Actigraph GT3X. Oxygen consumption and EE (in kcals) was measured via breath-by-breath IC system. The exercise trial consisted of four, 5-minute stages (2.0 mph/0% grade; 2.0 mph/5%; 3.0 mph/0%; 3.0 mph/5%). To approximate the EE reported by the Fitbit devices, an estimated resting metabolic rate was added to the EE reported by the Actigraph. Repeated measures ANOVA was used to asses the main effects for measurement device and stage.\n\nRESULTS: There was a significant main effect for measurement device (P < 0.01) and stage (P < 0.01). Post-hoc analysis determined that the Fitbit Charge (P < 0.01), the Fitbit One (P textless 0.01), and the Actigraph (P < 0.01), all differed from IC in measuring EE. The Fitbit Charge (P < 0.01) overestimated EE across all stages (25.3 ± 4.7, 31.0 ± 3.7, 33.0 ± 5.8 and 34.2 ± 6.1 vs 13.2 ± 2.3, 18.8 ± 3.0, 20.5 ± 2.8 and 26.9 ± 5.0 for Fitbit One and IC, respectively). The Fitbit One (14.4 ± 2.7, 15.3 ± 2.7, 19.9 ± 3.4 and 21.1 ± 4.6; P < 0.01) and the Actigraph (6.7 ± 3.8, 7.4 ± 25.4 ± 8.5 and 26.4 ± 7.9; P textless 0.01) underestimated EE compared to IC across all stages. Significant interactions between IC and the Fitbit One (P < 0.01), and IC and the Actigraph (P < 0.01), however, indicate that they are less sensitive to grade changes than IC.\n\nCONCLUSION: Results show that the wrist-worn Fitbit Charge overestimates EE, which may negatively impact the fitness goals of the wearer, particularly as it relates to energy balance and weight loss. The hip worn devices appear to be closer to IC in EE measures, but do not accurately reflect changes in treadmill grade, impacting those who use this exercise mode.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Citation/2016/05001/Accuracy_of_Commercial_Activity_Trackers_to.2326.aspx", "newWindow": true } ] }, { "title": "Technology- and Phone-Based Weight Loss Intervention", "author": "Hartman, S.J., Nelson, S.H., Cadmus-Bertram, L.A., Patterson, R.E., Parker, B.A. and Pierce, J.P.", "year": "2016", "journalProceedings": "American Journal of Preventive Medicine", "category": "Intervention", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Introduction: For women with an increased breast cancer risk, reducing excess weight and increasing physical activity are believed to be important approaches for reducing their risk. This study tested a weight loss intervention that combined commercially available technology-based self-monitoring tools with individualized phone calls.\n\nDesign: Women were randomized to a weight loss intervention arm (n=36) or a usual care arm (n=18). Setting/Participants: Participants were women with a BMI = 27.5 kg/m2 and elevated breast cancer risk recruited from the mammography clinic at the Moores Cancer Center at the University of California San Diego. \n\nIntervention; Intervention participants used the MyFitnessPal website and phone app to monitor diet and a Fitbit to monitor physical activity. Participants received 12 standardized coaching calls with trained counselors over 6 months. Usual care participants received the U.S. Dietary Guidelines for Americans at baseline and two brief calls over the 6 months. Main outcome measures: Weight and accelerometer-measured physical activity were assessed at baseline and 6 months. Data were collected in San Diego, CA, from 2012 to 2014 and analyzed in 2015.\n\nResults: Participants (n=54) had a mean age of 59.5 (SD=5.6) years, BMI of 31.9 (SD=3.5), and a mean Gail Model score of 2.5 (SD=1.4). At 6 months, intervention participants had lost significantly more weight (4.4 kg vs 0.8 kg, p=0.004) and a greater percentage of starting weight (5.3% vs 1.0%, p=0.005) than usual care participants. Across arms, greater increases in moderate-to-vigorous physical activity resulted in greater weight loss (p=0.01).\n\nConclusions: Combining technology-based self-monitoring tools with phone counseling supported weight loss over 6 months in women at increased risk for breast cancer.", "links": [ { "caption": "URL", "url": "http://www.ajpmonline.org/article/S0749-3797(16)30277-X/abstract", "newWindow": true } ] }, { "title": "Effect of affordable technology on physical activity levels and mobility outcomes in rehabilitation: a protocol for the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial.", "author": "Hassett, L., van den Berg, M., Lindley, R.I., Crotty, M., McCluskey, A., van der Ploeg, H.P., Smith, S.T., Schurr, K., Killington, M., Bongers, B., Howard, K., Heritier, S., Togher, L., Hackett, M., Treacy, D., Dorsch, S., Wong, S., Scrivener, K., Chagpar, S., Weber, H., Pearson, R. and Sherrington, C.", "year": "2016", "journalProceedings": "BMJ Open", "category": "Methods", "devices": null, "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "NTRODUCTION People with mobility limitations can benefit from rehabilitation programmes that provide a high dose of exercise. However, since providing a high dose of exercise is logistically challenging and resource-intensive, people in rehabilitation spend most of the day inactive. This trial aims to evaluate the effect of the addition of affordable technology to usual care on physical activity and mobility in people with mobility limitations admitted to inpatient aged and neurological rehabilitation units compared to usual care alone.\nMETHODS AND ANALYSIS A pragmatic, assessor blinded, parallel-group randomised trial recruiting 300 consenting rehabilitation patients with reduced mobility will be conducted. Participants will be individually randomised to intervention or control groups. The intervention group will receive technology-based exercise to target mobility and physical activity problems for 6 months. The technology will include the use of video and computer games/exercises and tablet applications as well as activity monitors. The control group will not receive any additional intervention and both groups will receive usual inpatient and outpatient rehabilitation care over the 6-month study period. The coprimary outcomes will be objectively assessed physical activity (proportion of the day spent upright) and mobility (Short Physical Performance Battery) at 6 months after randomisation. Secondary outcomes will include: self-reported and objectively assessed physical activity, mobility, cognition, activity performance and participation, utility-based quality of life, balance confidence, technology self-efficacy, falls and service utilisation. Linear models will assess the effect of group allocation for each continuously scored outcome measure with baseline scores entered as a covariate. Fall rates between groups will be compared using negative binomial regression. Primary analyses will be preplanned, conducted while masked to group allocation and use an intention-to-treat approach.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908951/", "newWindow": true } ] }, { "title": "Utility of Consumer Physical Activity Trackers as an Intervention Tool in Cardiovascular Disease Prevention and Treatment", "author": "Hickey, A.M. and Freedson, P.S.", "year": "2016", "journalProceedings": "Progress in Cardiovascular Diseases", "category": "Review", "devices": "Classic,Ultra,One,Zip,Flex", "population": "NA", "dataUsed": "NA", "abstract": "Consumer activity trackers have grown in popularity over the last few years. These devices are typically worn on the hip or wrist and provide the user with information about physical activity (PA) measures such as steps taken, energy expenditure and time spent in moderate to vigorous PA. The consumer may also use the computer interface (e.g. device websites, smart phone applications) to monitor and track achievement of PA goals and compete with other users. This review will describe some of the most popular consumer devices and discuss the user feedback tools. We will also present the limited evidence available about the accuracy of these devices and highlight how they have been used in cardiovascular disease (CVD) management. We conclude with some recommendations for future research, focusing on how consumer devices might be used to assess effectiveness of various CVD treatments.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0033062016300160", "newWindow": true } ] }, { "title": "Individual Differences in Diurnal Preference and Time-of-Exercise Interact to Predict Exercise Frequency", "author": "Hisler, G.C., Phillips, A.L. and Krizan, Z.\t", "year": "2016", "journalProceedings": "Annals of Behavioral Medicine", "category": "Measurement", "devices": "Zip", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background\n\nDiurnal preference (and chronotype more generally) has been implicated in exercise behavior, but this relation has not been examined using objective exercise measurements nor have potential psychosocial mediators been examined. Furthermore, time-of-day often moderates diurnal preference’s influence on outcomes, and it is unknown whether time-of-exercise may influence the relation between chronotype and exercise frequency.\n\nPurpose: The current study examined whether individual differences in diurnal preference (“morningness-eveningness”) predict unique variance in exercise frequency and if commonly studied psychosocial variables mediate this relation (i.e., behavioral intentions, internal exercise control, external exercise control, and conscientiousness). Moreover, the study sought to test whether individuals’ typical time-of-exercise moderated the impact of diurnal preference on exercise frequency.\n\nMethods: One hundred twelve healthy adults (mean age = 25.4; SD = 11.6 years) completed baseline demographics and then wore Fitbit Zips® for 4 weeks to objectively measure exercise frequency and typical time-of-exercise. At the end of the study, participants also self-reported recent exercise.\n\nResults: Diurnal preference predicted both self-reported exercise and Fitbit-recorded exercise frequency. When evaluating mediators, only conscientiousness emerged as a partial mediator of the relation between diurnal preference and self-reported exercise. In addition, time-of-exercise moderated diurnal preference’s relation to both self-reported exercise and Fitbit-recorded exercise frequency such that diurnal preference predicted higher exercise frequency when exercise occurred at a time that was congruent with one’s diurnal preference.\n\nConclusion: Based on these findings, diurnal preference is valuable, above and beyond other psychological constructs, in predicting exercise frequency and represents an important variable to incorporate into interventions seeking to increase exercise.", "links": [ { "caption": "URL", "url": "http://link.springer.com/article/10.1007%2Fs12160-016-9862-0", "newWindow": true } ] }, { "title": "Promote Students’ Healthy Behavior Through Sensor and Game: A Randomized Controlled Trial", "author": "H-Jennings, F., Clément, M.-V., Brown, M., Leong, B., Shen, L. and Dong, C.", "year": "2016", "journalProceedings": "Medical Science Educator", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Objectives: The aim of the study was to assess the impact of using sensor technology to track steps and sleep with and without a game platform in motivating students to attain the recommended exercise level and sleep hours.\nMethods: Three hundred first-year medical students were randomly assigned to the control group, group 1 using a tracking device (FitBit Flex) and group 2 using FitBit Flex and a social media-based game. Stress, exercise, and sleep time and quality were assessed by validated instruments. Daily steps and sleep hours were monitored by FitBit Flex from week 1 to week 8 in group 1 and group 2. From week 9, all groups had access to FitBit Flex and the game platform, and students’ daily steps and sleep time were monitored until week 14 by FitBit Flex.\n\nResults: For exercise, 85% of students were active at the baseline, and the interventions did not significantly modify their exercise level except during recess and exam week where the incentive of the game mitigated the decrease of daily steps. For sleep, by week 14, all groups attained an average of daily sleep time close to 8 h compared to the baseline of 7.26 h. For stress, baseline survey showed that 57.7% of students experienced medium to high stress level, and this trend did not significantly change during the study.\n\nConclusion: It is more important to reinforce the benefit of staying active instead of motivating students to start doing exercise. Tracking sleep is critical to motivate a student to increase sleep time close to the recommended 8 h.", "links": [ { "caption": "URL", "url": "http://link.springer.com/article/10.1007%2Fs40670-016-0253-8", "newWindow": true } ] }, { "title": "Use of a Fitness Tracker to Promote Physical Activity in Children With Acute Lymphoblastic Leukemia", "author": "Hooke, M.C., Gilchrist, L., Tanner, L., Hart, N. and Withycombe, J.S.", "year": "2016", "journalProceedings": "Pediatric Blood & Cancer", "category": "Intervention", "devices": "One", "population": "Patients,Children", "dataUsed": "Steps", "abstract": "Background :Children with cancer identify fatigue as a pervasive symptom, which increases during the corticosteroid pulse in acute lymphoblastic leukemia (ALL) maintenance. The FitBit® is a fitness tracker that downloads activity measurements to the Internet in real time. In this feasibility study, we explored if children who received daily FitBit® coaching for 2 weeks before a maintenance steroid pulse had an increase in steps per day and determined the relationship between steps per day prepulse and fatigue postpulse.\nProcedure: Seventeen children in ALL maintenance, aged 6–15, wore the FitBit® for 3 days to establish a baseline. A tailored weekly step goal was then set with the child and parent. Daily emails with feedback and FitBit® screenshots were sent over the 2-week intervention. Self-report of fatigue was measured at baseline, after 2 weeks (i.e. before the steroid pulse), and after 5 days of steroids.\n\nResults: There was a trend toward increased steps per day from weeks 1–2 (P = 0.079); fatigue was low and did not increase during the corticosteroid pulse. A significant correlation (r = -0.66, P = 0.005) was found between the steps per day during week 2 and fatigue after the steroid pulse with higher steps associated with lower fatigue.\n\nConclusions: The intervention was feasible in this small sample. The average steps each time period (week 1, week 2, and during steroids) was over 10,000, demonstrating that children with ALL can be active during treatment. Physical activity may be protective of fatigue during a corticosteroid pulse.", "links": [ { "caption": "URL", "url": "http://onlinelibrary.wiley.com/doi/10.1002/pbc.25860/abstract;jsessionid=B7A4183E1182BCE5E23C07555336305B.f04t04", "newWindow": true } ] }, { "title": "Validity of FitBit, Jawbone UP, Nike+ and other wearable devices for level and stair walking", "author": "Huang, Y., Xu, J., Yu, B. and Shull, P.B.", "year": "2016", "journalProceedings": "Gait & Posture", "category": "Validation", "devices": "One,Zip,Flex", "population": "Adults", "dataUsed": "Steps,Distance", "abstract": "Background: Increased physical activity can provide numerous health benefits. The relationship between physical activity and health assumes reliable activity measurements including step count and distance traveled. This study assessed step count and distance accuracy for Nike+ FuelBand, Jawbone UP 24, Fitbit One, Fitbit Flex, Fitbit Zip, Garmin Vivofit, Yamax CW-701, and Omron HJ-321 during level, upstairs, and downstairs walking in healthy adults.\n\nMethods: Forty subjects walked on flat ground (400 m), upstairs (176 steps), and downstairs (176 steps), and a subset of 10 subjects performed treadmill walking trials to assess the influence of walking speed on accuracy. Activity monitor measured step count and distance values were compared with actual step count (determined from video recordings) and distance to determine accuracy.\n\nResults:For level walking, step count errors in Yamax CW-701, Fitbit Zip, Fitbit One, Omron HJ-321, and Jawbone UP 24 were within 1% and distance errors in Fitbit Zip and Yamax CW-701 were within 5%. Garmin Vivofit and Omron HJ-321 were the most accurate in estimating step count for stairs with errors less than 4%. An important finding is that all activity monitors overestimated distance for stair walking by at least 45%.\n\nConclusion: In general, there were not accuracy differences among activity monitors for stair walking. Accuracy did not change between moderate and fast walking speeds, though slow walking increased errors for some activity monitors. Nike+ FuelBand was the least accurate step count estimator during all walking tasks. Caution should be taken when interpreting step count and distance estimates for activities involving stairs.", "links": [ { "caption": "URL", "url": "http://linkinghub.elsevier.com/retrieve/pii/S096663621630042X", "newWindow": true } ] }, { "title": "Trajectories of objectively-measured physical activity and sedentary time over the course of pregnancy in women self-identified as inactive", "author": "Huberty, J.L., Buman, M.P., Leiferman, J.A., Bushar, J. and Adams, M.A.", "year": "2016", "journalProceedings": "Preventive Medicine Reports", "category": "Measurement", "devices": "Flex", "population": "Adults,Pregnant Women", "dataUsed": "Steps,Intensity", "abstract": "There is a need for investigations that document the daily course of pregnancy-related changes in PA and sedentary behavior. The purpose of this study was to describe the trajectory of PA and sedentary behavior and whether they differ among weight status in pregnant women self-identified as inactive. Eighty inactive pregnant women (8–16 weeks) were recruited from a nationwide text-message intervention. PA was measured using a Fitbit. Chi-square analyses and t-tests were used to analyze univariate demographic and PA variables. Mixed model-repeated measures ANOVA was used to analyze trajectory changes in daily PA and sedentary behavior. Light activity (beta [SE] = 2.79 [0.30], p < .001), active time (b [SE] = 1.62 [0.16], p < .001), and steps (b [SE] = 112.21 [10.66], p < .001) increased during the second trimester followed by a precipitous decline during the third trimester. Sedentary behavior followed an opposite pattern (b = - 9.88 [1.07], p < .001). Overweight and obese women took significantly fewer steps/day (b [SE] = - 742.37 [362.57], p < .05 and - 855.94 [381.25], p < .05, respectively) than normal weight women, and obese women had less “active” minutes/day (~> 3.0 metabolic equivalents; b [SE] = - 12.99 [5.89], p < .05) than normal weight women (P's < 0.05). Women who self-identify as inactive, become more sedentary and less physically active as pregnancy progresses. This study was among the first to describe the trajectory of daily PA and sedentary behavior throughout pregnancy. This study may help inform health care provider and patient communication related to PA, sedentary behavior, and the time in which to communicate about these behaviors.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S2211335516300237", "newWindow": true } ] }, { "title": "Dose and timing of text messages for increasing physical activity among pregnant women: a randomized controlled trial", "author": "Huberty, J.L., Buman, M.P., Leiferman, J.A., Bushar, J., Hekler, E.B. and Adams, M.A.", "year": "2016", "journalProceedings": "Translational Behavioral Medicine", "category": "Intervention", "devices": "Flex", "population": "Pregnant Women", "dataUsed": "Steps", "abstract": "ext4baby (T4b), a free nation-wide mobile health information service, delivers health-related text messages (SMS) to pregnant women. The objective of this study was to determine the effectiveness of physical activity (PA) specific SMS to improve PA in pregnant women (vs standard T4b) and the most effective dose/timing of PA-specific SMS to improve PA. Pregnant women (N?=?80) were randomized to one of four groups that differed in frequency and time of SMS. The Fitbit™ Flex measured PA. Data were analyzed using mixed model analyses. There were no increases in PA regardless of frequency or time. Those that received six PA SMS/week had greater decreases in activity and greater increases in sedentary time. SMS may not be a “potent” enough strategy to improve PA. Future studies should explore a modified focus on behavior change (e.g., decrease sedentary activity, increase light activity) and incorporate SMS as part of a multi-level approach with other evidence-based strategies.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s13142-016-0445-1", "newWindow": true } ] }, { "title": "Can a Home-based Cardiac Rehabilitation Program Improve the Physical Function Quality of Life in Children With Fontan Circulation?", "author": "Jacobsen, R.M., Danduran, M., Mussatto, K., Neubauer, J. and Ginde, S.", "year": "2016", "journalProceedings": "Congenital Heart Disease", "category": "Intervention,Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Distance", "abstract": "Objective: Patients after Fontan operation for complex congenital heart disease (CHD) have decreased exercise capacity and report reduced health-related quality of life (HRQOL). Studies suggest hospital-based cardiac physical activity programs can improve HRQOL and exercise capacity in patients with CHD; however, these programs have variable adherence rates. The impact of a home-based cardiac physical activity program in Fontan survivors is unclear. This pilot study evaluated the safety, feasibility, and benefits of an innovative home-based physical activity program on HRQOL in Fontan patients.\n\nMethods: A total of 14 children, 8–12 years, with Fontan circulation enrolled in a 12-week moderate/high intensity home-based cardiac physical activity program, which included a home exercise routine and 3 formalized in-person exercise sessions at 0, 6, and 12 weeks. Subjects and parents completed validated questionnaires to assess HRQOL. The Shuttle Test Run was used to measure exercise capacity. A Fitbit Flex Activity Monitor was used to assess adherence to the home activity program.\n\nResults: Of the 14 patients, 57% were male and 36% had a dominant left ventricle. Overall, 93% completed the program. There were no adverse events. Parents reported significant improvement in their child's overall HRQOL (P? 116 bpm, the BPk demonstrated an r = 0.77 and mean bias = -4.9 bpm (95% LoA 21.3, -31.0) while the FB demonstrated an r = 0.58 and mean bias = -12.7 bpm (95% LoA 28.6, -54.0). The BPk satisfied validity criteria for HR monitors, however showed a marginal decline in accuracy with increasing physical effort (ECG HR > 116 bpm). The FB failed to satisfy validity criteria and demonstrated a substantial decrease in accuracy during higher exercise intensities.", "links": [ { "caption": "URL", "url": "http://www.jssm.org/researchjssm-15-540.xml.xml", "newWindow": true } ] }, { "title": "Feasibility and preliminary results from utilizing a Fitbit device in a pediatric pain rehabilitation program", "author": "Junghans-Rutelonis, A., Gephardt, J., Skipper, R., Timm, W. and Weiss, K.\t", "year": "2016", "journalProceedings": "The Journal of Pain", "category": "Measurement", "devices": null, "population": "Children,Adolescents", "dataUsed": "Steps,Distance,Sleep", "abstract": "Personal informatics technologies including mobile electronic devices (e.g., Fitbit) facilitate objective measurement, communication between patients and medical teams, and sustainable personal management of physical activity (PA) and sleep. As PA and sleep are often problematic in youth with chronic pain, the current study presents feasibility and preliminary data from use of Fitbit devices in an interdisciplinary pediatric pain rehabilitation clinic (PPRC).\nParticipants are youth with chronic pain, between the ages of 12 and 18, who were scheduled to participate in a 3-week PPRC. 64 youth were identified as eligible and contacted regarding participation in the current study. Youth were asked to wear a Fitbit for 3 weeks prior to and during the PPRC. 47% agreed to participate. 25% of those contacted decided not to attend the PPRC. 22% did not respond and missed their window of eligibility. 6% were sent Fitbits but did not participate in the PPRC and did not return devices. Restructuring of staff responsibilities was helpful early in recruitment. Significant difficulties arose in collecting sleep data. Preliminary PA data shows significant increases in both steps taken and distance walked from pre-PPRC to during PRC (p < .001). Multiple challenges exist when initiating use of a Fitbit device in an interdisciplinary rehabilitation setting. Youth were more compliant with regular use during, as opposed to before, programming and when multiple disciplines were involved in checking compliance. Despite the difficulties, recruiting adjustments have improved feasibility and PA changes are significant and promising. Additional recruitment, program design, and implications for future research, as well as preliminary physical activity data, will be presented.", "links": [ { "caption": "URL", "url": "http://linkinghub.elsevier.com/retrieve/pii/S1526590016003734", "newWindow": true } ] }, { "title": "A comparison of wearable fitness devices.", "author": "Kaewkannate, K. and Kim, S.", "year": "2016", "journalProceedings": "BMC Public Health", "category": "Usability", "devices": "Flex", "population": "Adults", "dataUsed": "NA", "abstract": "BACKGROUND: Wearable trackers can help motivate you during workouts and provide information about your daily routine or fitness in combination with your smartphone without requiring potentially disruptive manual calculations or records. This paper summarizes and compares wearable fitness devices, also called \"fitness trackers\" or \"activity trackers.\" These devices are becoming increasingly popular in personal healthcare, motivating people to exercise more throughout the day without the need for lifestyle changes. The various choices in the market for wearable devices are also increasing, with customers searching for products that best suit their personal needs. Further, using a wearable device or fitness tracker can help people reach a fitness goal or finish line. Generally, companies display advertising for these kinds of products and depict them as beneficial, user friendly, and accurate. However, there are no objective research results to prove the veracity of their words. This research features subjective and objective experimental results, which reveal that some devices perform better than others.\nMETHODS: The four most popular wristband style wearable devices currently on the market (Withings Pulse, Misfit Shine, Jawbone Up24, and Fitbit Flex) are selected and compared. The accuracy of fitness tracking is one of the key components for fitness tracking, and some devices perform better than others. This research shows subjective and objective experimental results that are used to compare the accuracy of four wearable devices in conjunction with user friendliness and satisfaction of 7 real users. In addition, this research matches the opinions between reviewers on an Internet site and those of subjects when using the device.\n\nRESULTS: Withings Pulse is the most friendly and satisfactory from the users' viewpoint. It is the most accurate and repeatable for step and distance tracking, which is the most important measurement of fitness tracking, followed by Fitbit Flex, Jawbone Up24, and Misfit Shine. In contrast, Misfit Shine has the highest score for design and hardware, which is also appreciated by users.\n\nCONCLUSIONS: From the results of experiments on four wearable devices, it is determined that the most acceptable in terms of price and satisfaction levels is the Withings Pulse, followed by the Fitbit Flex, Jawbone Up24, and Misfit Shine.", "links": [ { "caption": "URl", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4877805/", "newWindow": true } ] }, { "title": "An Exercise Intervention for South Asian Mothers with Risk Factors for Diabetes", "author": "Kandula, Namratha R.; Dave, Swapna S.; De Chavez, Peter John D.; Marquez, David X.; Bharucha, Himali; Mammen, Shinu M.; Dunaif, Andrea; Ackermann, Ronald T.; Kumar, Santosh; Siddique, J.", "year": "2016", "journalProceedings": "Translational Journal of the American College of Sports Medicine", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "South Asians (Indians, Pakistanis, Bangladeshis, Sri Lankans, Nepalis, and Bhutanese) in the United States have a very high prevalence of type 2 diabetes mellitus (DM). This pilot study evaluated a culturally tailored exercise intervention among South Asian immigrant mothers with DM risk factors. Through an academic–community partnership, South Asian women with risk factors for DM and who had at least one child between 6 and 14 yr were enrolled into this single-arm study. The intervention for the mothers included 16 wk of twice weekly exercise classes, self-monitoring with activity trackers, goal setting, and classes on healthy eating. Based on prior community-based participatory research, children were offered exercise classes during the mothers' classes. The primary efficacy outcomes were change in mothers' moderate/vigorous physical activity and body weight pre- and postintervention (16 wk). Program adherence, clinical, and psychosocial outcomes were measured. A qualitative process evaluation was conducted to understand participant perspectives. Participants' (n = 30) average age was 40 yr (SD, 5), 57% had a high school education or less, and all were overweight/obese. At baseline, women were not meeting the recommended physical activity guidelines. Overall, participants attended 75% of exercise classes. Compared with baseline, participants' weight decreased by 3.2 lb (95% confidence interval, -5.5 to -1.0) postintervention. Among women who attended at least 80% of classes (n = 17), weight change was -4.8 lb (95% confidence interval, -7.7 to -1.9). Change in accelerometer-measured physical activity was not significant; however, exercise-related confidence increased from baseline (P textless 0.01). Women described multiple physical and psychosocial benefits from the intervention. In conclusion, this pilot study suggests that a culturally tailored exercise intervention that included exercise classes for children was feasible and had physical and psychosocial benefits in South Asian mothers with risk factors for DM.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-tj/Abstract/2016/06150/An_Exercise_Intervention_for_South_Asian_Mothers.1.aspx", "newWindow": true } ] }, { "title": "Wellbeing in the Making: Peoples' Experiences with Wearable Activity Trackers.", "author": "Karapanos, E., Gouveia, R., Hassenzahl, M. and Forlizzi, J.\t", "year": "2016", "journalProceedings": "Psychology of Well-being", "category": "Usability", "devices": "Flex", "population": "Adults", "dataUsed": "NA", "abstract": "BACKGROUND Wearable activity trackers have become a viable business opportunity. Nevertheless, research has raised concerns over their potentially detrimental effects on wellbeing. For example, a recent study found that while counting steps with a pedometer increased steps taken throughout the day, at the same time it decreased the enjoyment people derived from walking. This poses a serious threat to the incorporation of healthy routines into everyday life. Most studies aim at proving the effectiveness of activity trackers. In contrast, a wellbeing-oriented perspective calls for a deeper understanding of how trackers create and mediate meaningful experiences in everyday life.\n\nMETHODS We present a study of real life experiences with three wearable activity trackers: Fitbit, Jawbone Up and Nike + Fuelband. Using need fulfillment as a theoretical lens, we study recent, memorable experiences submitted by 133 users of activity trackers.\n\nRESULTS We reveal a two-dimensional structure of users' experience driven by the needs of physical thriving or relatedness. Our qualitative findings further show a nuanced picture of the adoption of activity trackers and their impact on wellbeing. For instance, while reflection about own exercising practices lost its relevance over time, users continued to wear the tracker to document and collect their runs. More than just supporting behavioral change, we find trackers to provide multiple psychological benefits. For instance, they enhance feelings of autonomy as people gain more control about their exercising regime. Others experience relatedness, when family members purchase a tracker for relatives and join them in their efforts towards a better, healthier self.\n\nCONCLUSIONS The study highlights that activity trackers can be more than \"tools\" to change behavior. Through incorporation in daily life, they offer new social experiences, new ways of boosting our self-esteem and getting closer to our ideal selves.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908170/", "newWindow": true } ] }, { "title": "Validity of Wearable Fitness Trackers on Sleep Measure", "author": "Keill, A.K., An, H.-S., Dinkel, D.M. and Lee, J.-M.\t", "year": "2016", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "PURPOSE: To examine the validity of wearable fitness trackers for estimating total sleep time (TST) with respect to a sleep log as a reference measure.\nMETHODS: Nineteen healthy individuals (mean ± SD; age = 29.5 ± 13.4 years; body mass index = 25.87 ± 5.03 kg textperiodcentered m2) participated in the study. Participants randomly assigned to one of two groups. Group 1 (n = 10) wore the BodyMedia SenseWear Mini Armband (SWA), Basis Peak (BP), and Fitbit Charge HR (FB). Group 2 (n = 9) wore the ActiGraph Sleep (AG), Jawbone UP3 (JU), and Garmin Vivosmart (GV). Trackers were worn on the non-dominant wrist for one night and a sleep log was completed. Two existing sleep algorithms for the AG (Sadeh and Cole-Kripke) and Fitbit sleep sensitive algorithm were also included for comparison. Pearson correlation was used to examine the linearity of mean TST minutes (TSTM) from each tracker compared to the log TSTM. Mean absolute percentage errors (MAPE) of TSTM from each tracker were calculated against the log TSTM. Lastly, mean differences in average TST between the trackers were examined by a general linear model for repeated measures.\n\nRESULTS: Pearson correlation coefficients were .32, .69, .24, and -.26 for the SWA, FB, and FBs with regard to log TSTM, respectively. Group 2 correlations between the log TSTM and Sadeh, Cole-Kripke, JU, and GV were .34, .65, .54, and .92, respectively. MAPE were 17.1%, 16.3%, 40.2%, and 32.9% for SWA, FB, FBs, and BP, respectively. MAPE of 17.0%, 11.5%, 14.9%, and 10% were observed for Sadeh, Cole-Kripke, JU, and GV, respectively. Bland-Altman Plots showed no systematic bias between all variables for TST compared with log TSTM. ANOVA and post-hoc analysis revealed a significant difference in the Fitbit sensitive TST (p = .001) in Group 1 (F (5, 51) = 8.06, p = .00) and no significant difference between Group 2 (F (4, 40) = 1.27, p = .296).\n\nCONCLUSION: The FB, Cole-Kripke, JU, and GV display the closest estimation of TST compared with log TST minutes. However, further research is needed to validate these monitors with polysomnography.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Citation/2016/05001/Validity_of_Wearable_Fitness_Trackers_on_Sleep.31.aspx", "newWindow": true } ] }, { "title": "An exercise in nostalgia: Nostalgia promotes health optimism and physical activity", "author": "Kersten, M., Cox, C.R. and Enkevort, E.A.V.\t", "year": "2016", "journalProceedings": "Psychology & Health", "category": "Measurement", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "Objective: Previous research has shown that nostalgia, a sentimental longing for the past, leads to greater feelings of optimism, with other work demonstrating that optimistic thinking (general & health-orientated) is associated with better physical and psychological health. Integrating these two lines of research, the current studies examined whether nostalgia-induced health optimism promotes attitudes and behaviours associated with better physical well-being.\n\nMethods: Participants, in three experiments, were randomly assigned to write about either a nostalgic or ordinary event. Following this, everyone completed a measure of health optimism (Studies 1–3), measures of health attitudes (Study 2) and had their physical activity monitored over the course of 2 weeks (Study 3).\n\nResults: The results revealed that, in comparison to control conditions, nostalgic reverie led to greater health optimism (Studies 1–3). Further, heightened health optimism following nostalgic reflection led to more positive health attitudes (Study 2), and increased physical activity over a two-week period (i.e. Fitbit activity trackers; Study 3).\n\nConclusions: These findings highlight the importance of nostalgia on health attitudes and behaviours. Specifically, this work suggests that nostalgia can be used as a mechanism to increase the importance, perceived efficacy and behaviour associated with better physical health.", "links": [ { "caption": "URL", "url": "http://www.tandfonline.com/doi/full/10.1080/08870446.2016.1185524", "newWindow": true } ] }, { "title": "SleepSight: a wearables-based relapse prevention system for schizophrenia", "author": "Kerz, M., Folarin, A., Meyer, N., Begale, M., MacCabe, J. and Dobson, R.J.\t", "year": "2016", "journalProceedings": "Proceedings of the 2016 ACM International Joint Conference on Pervasive and Ubiquitous Computing", "category": "Usability", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Sleep", "abstract": "SleepSight is a novel approach to detecting early signs of relapse in psychosis, thereby allowing targeted intervention for relapse prevention. The system uses a wireless-enabled wearable device and smartphone to collect longitudinal accelerometry, heart-rate, ambient light and smartphone usage patterns from patients living in their homes. These data are encrypted and sent via the mobile data network to a secure server for real-time analysis, using the Purple Robot mobile application.\n\nThis study tested feasibility and acceptability of the SleepSight system in 15 participants with a diagnosis of schizophrenia. Patient recruitment and data collection was completed in January 2016, at the South London and Maudsley NHS Foundation Trust (SLaM), the largest mental health service provider in the EU. The project is a unique multidisciplinary collaboration between the NIHR Biomedical Research Centre for Mental Health, the Institute of Psychiatry, Psychology and Neuroscience, and the National Health Service.", "links": [ { "caption": "UR", "url": "http://dl.acm.org/citation.cfm?doid=2968219.2971419", "newWindow": true } ] }, { "title": "MOVE MORE, SIT LESS, AND BE WELL: Behavioral Aspects of Activity Trackers", "author": "Kiessling, B.I.I. and Kennedy-Armbruster, C.", "year": "2016", "journalProceedings": "ACSM's Health & Fitness Journal", "category": "Usability", "devices": "Flex", "population": "Adults", "dataUsed": "NA", "abstract": "Learning Objectives1. Provide suggestions to help fitness professionals understand how wearable activity trackers (ATs) affect human movement patterns.2. Describe the role of ATs in physical activity programming3. Critique a programming case study using ATs in the workplace, including comments by participants", "links": [ { "caption": "URL", "url": "https://journals.lww.com/acsm-healthfitness/Fulltext/2016/11000/MOVE_MORE,_SIT_LESS,_AND_BE_WELL__Behavioral.8.aspx", "newWindow": true } ] }, { "title": "\"Stepping Up\" Activity poststroke: Ankle-Positioned Accelerometer Can Accurately Record Steps During Slow Walking", "author": "Klassen, T.D., Simpson, L.A., Lim, S.B., Louie, D.R., Parappilly, B., Sakakibara, B.M., Zbogar, D. and Eng, J.J.\t", "year": "2016", "journalProceedings": "Physical Therapy", "category": "Validation", "devices": "One", "population": "Older Adults,Patients", "dataUsed": "Steps", "abstract": "As physical activity in people poststroke is low, devices that monitor and provide feedback of walking activity provide motivation to engage in exercise and may assist rehabilitation professionals in auditing walking activity. However, most feedback devices are not accurate at slow walking speeds. This study assessed the accuracy of one accelerometer to measure walking steps of community-dwelling individuals poststroke. Two accelerometers were positioned on the nonparetic waist and ankle of participants, and walking steps from these devices were recorded at 7 speeds and compared with video recordings (gold standard). When positioned at the waist, the accelerometer had more than 10% error at all speeds, except 0.8 and 0.9 m/s, and numerous participants recorded zero steps at 0.3 to 0.5 m/s. The device had 10% or less error when positioned at the ankle for all speeds between 0.4 and 0.9 m/s. Some participants were unable to complete the faster walking speeds due to their walking impairments and inability to maintain the requested walking speed.", "links": [ { "caption": "URl", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4774387/", "newWindow": true } ] }, { "title": "The Volunteering-in-Place (VIP) Program: Providing meaningful volunteer activity to residents in assisted living with mild cognitive impairment", "author": "Klinedinst, N.J. and Resnick, B.\t", "year": "2016", "journalProceedings": "Geriatric Nursing", "category": "Measurement", "devices": "Flex", "population": "Older Adults", "dataUsed": "Steps", "abstract": "The Volunteering-in-Place (VIP) Program was developed to provide individualized meaningful volunteer activities matched to interests and capabilities for older adults with MCI in assisted living. The purposes of this single-site pre-test/post-test pilot study were to (1) establish feasibility of the VIP Program based on treatment fidelity (design, treatment, delivery, enactment); and (2) evaluate preliminary efficacy via improvement in psychological health (depressive symptoms, usefulness, purpose, resilience, and life satisfaction) and decreased sedentary activity (survey and Fitbit) at 3 and 6 months. Ten residents participated. The majority was white, female and educated, and on average 88 years old. The VIP Program was feasible and most participants continued to volunteer at 6 months. There were non-significant improvements in depressive symptoms, usefulness, purpose, resilience and recreational physical activity. The results of this study provide support for the feasibility of the VIP Program. Further study is necessary to examine efficacy.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0197457216000665", "newWindow": true } ] }, { "title": "Consumer sleep tracking devices: a review of mechanisms, validity and utility", "author": "Kolla, B.P., Mansukhani, S. and Mansukhani, M.P.\t", "year": "2016", "journalProceedings": "Expert Review of Medical Devices", "category": "Review", "devices": "Classic,Ultra", "population": "NA", "dataUsed": "Sleep", "abstract": "Consumer sleep tracking devices such as fitness trackers and smartphone apps have become increasingly popular. These devices claim to measure the sleep duration of their users and in some cases purport to measure sleep quality and awaken users from light sleep, potentially improving overall sleep. Most of these devices appear to utilize data generated from in-built accelerometers to determine sleep parameters but the exact mechanisms and algorithms are proprietary. The growing literature comparing these devices against polysomnography/actigraphy shows that they tend to underestimate sleep disruptions and overestimate total sleep times and sleep efficiency in normal subjects. In this review, we evaluate the current literature comparing the accuracy of consumer sleep tracking devices against more conventional methods used to measure sleep duration and quality. We discuss the current technology that these devices utilize as well as summarize the value of these devices in clinical evaluations and their potential limitations.", "links": [ { "caption": "URL", "url": "http://www.tandfonline.com/doi/full/10.1586/17434440.2016.1171708", "newWindow": true } ] }, { "title": "Effects of Charitable Versus Monetary Incentives on the Acceptance of and Adherence to a Pedometer-Based Health Intervention: Study Protocol and Baseline Characteristics of a Cluster-Randomized Controlled Trial", "author": "Kowatsch, T., Kramer, J.-N., Kehr, F., Wahle, F., Elser, N. and Fleisch, E.\t", "year": "2016", "journalProceedings": "JMIR Research Protocols", "category": "Methods", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Research has so far benefited from the use of pedometers in physical activity interventions. However, when public health institutions (eg, insurance companies) implement pedometer-based interventions in practice, people may refrain from participating due to privacy concerns. This might greatly limit the applicability of such interventions. Financial incentives have been successfully used to influence both health behavior and privacy concerns, and may thus have a beneficial effect on the acceptance of pedometer-based interventions. Objective: This paper presents the design and baseline characteristics of a cluster-randomized controlled trial that seeks to examine the effect of financial incentives on the acceptance of and adherence to a pedometer-based physical activity intervention offered by a health insurance company. \n\nMethods: More than 18,000 customers of a large Swiss health insurance company were allocated to a financial incentive, a charitable incentive, or a control group and invited to participate in a health prevention program. Participants used a pedometer to track their daily physical activity over the course of 6 months. A Web-based questionnaire was administered at the beginning and at the end of the intervention and additional data was provided by the insurance company. The primary outcome of the study will be the participation rate, secondary outcomes will be adherence to the prevention program, physical activity, and health status of the participants among others. \n\nResults: Baseline characteristics indicate that residence of participants, baseline physical activity, and subjective health should be used as covariates in the statistical analysis of the secondary outcomes of the study. \n\nConclusions: This is the first study in western cultures testing the effectiveness of financial incentives with regard to a pedometer-based health intervention offered by a large health insurer to their customers. Given that the incentives prove to be effective, this study provides the basis for powerful health prevention programs of public health institutions that are easy to implement and can reach large numbers of people in need.", "links": [ { "caption": "URL", "url": "https://www.researchprotocols.org/2016/3/e181/", "newWindow": true } ] }, { "title": "Accuracy of a Wrist-Worn Wearable Device for Monitoring Heart Rates in Hospital Inpatients: A Prospective Observational Study", "author": "Kroll, R.R., Boyd, G.J. and Maslove, M.D.\t", "year": "2016", "journalProceedings": "Journal of Medical Internet Research", "category": "Medical,Validation", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Heart Rate", "abstract": "Background: As the sensing capabilities of wearable devices improve, there is increasing interest in their application in medical settings. Capabilities such as heart rate monitoring may be useful in hospitalized patients as a means of enhancing routine monitoring or as part of an early warning system to detect clinical deterioration. Objective: To evaluate the accuracy of heart rate monitoring by a personal fitness tracker (PFT) among hospital inpatients.\n\nMethods: We conducted a prospective observational study of 50 stable patients in the intensive care unit who each completed 24 hours of heart rate monitoring using a wrist-worn PFT. Accuracy of heart rate recordings was compared with gold standard measurements derived from continuous electrocardiographic (cECG) monitoring. The accuracy of heart rates measured by pulse oximetry (Spo2.R) was also measured as a positive control.\n\nResults: On a per-patient basis, PFT-derived heart rate values were slightly lower than those derived from cECG monitoring (average bias of ?1.14 beats per minute [bpm], with limits of agreement of 24 bpm). By comparison, Spo2.R recordings produced more accurate values (average bias of +0.15 bpm, limits of agreement of 13 bpm, P<.001 as compared with PFT). Personal fitness tracker device performance was significantly better in patients in sinus rhythm than in those who were not (average bias ?0.99 bpm vs ?5.02 bpm, P=.02).\n\nConclusions: Personal fitness tracker--derived heart rates were slightly lower than those derived from cECG monitoring in real-world testing and not as accurate as Spo2.R-derived heart rates. Performance was worse among patients who were not in sinus rhythm. Further clinical evaluation is indicated to see if PFTs can augment early warning systems in hospitals.", "links": [ { "caption": "URL", "url": "https://www.jmir.org/2016/9/e253/", "newWindow": true } ] }, { "title": "Sedentary Behavior in the Workplace: A Potential Occupational Hazard for Radiologists", "author": "Lamar, D.L., Chou, S.-H.S., Medverd, J.R. and Swanson, J.O.\t", "year": "2016", "journalProceedings": "Current Problems in Diagnostic Radiology", "category": "Measurement", "devices": "One", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "In this study, we sought to quantify the sedentary worklife of the radiologist, a potential health risk. Radiologists of all training levels at our academic institution were surveyed to estimate the levels of at-work and out-of-work sitting. Fitbit One activity monitors were used to measure the at-work activity levels of radiology, pediatric, and internal medicine (IM) residents. Correlation between awareness and utilization of dynamic (sitting or standing, walking, or biking) picture archiving and communication system (PACS) workstations among radiology residents was assessed. Among surveyed radiologists (n = 89), 78% estimated sitting for at least 6 hours per workday. Estimated workplace sitting accounted for most of the total sitting for 81% of respondents. As measured by activity monitors, radiology residents (n = 27) took fewer steps per day (2683 vs 4602 vs 4967) and per hour (294 vs 419 vs 444) and experienced more sedentary time per hour (40.3 vs 36.2 vs 34.9min/h) than IM (n = 15) and pediatric (n = 9) residents. Activity experienced during reading room–based work and interventional work was compared by studying 4 additional radiology residents during both types of rotations. Reading-room activity was low, whereas activity on interventional rotations surpassed average levels for the pediatric and IM residents in our study. Radiology residents' (n = 28) awareness and utilization of dynamic PACS workstations varied among reading rooms, but were generally low—75% reported never or rarely using them. Resident utilization correlated with awareness of dynamic workstations available at our institution (R2 = 0.64; P = 0.013). In conclusion, radiology residents in our study led more sedentary worklives compared with residents from other specialties and took minimal advantage of available tools to mitigate this. Potential health risks of inactivity justify individual and departmental efforts to limit workplace inactivity among radiologists.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0363018815300359", "newWindow": true } ] }, { "title": "A home-based physical activity intervention using activity trackers in survivors of childhood cancer: A pilot study", "author": "Le, A., Mitchell, H.-R., Zheng, D.J., Rotatori, J., Fahey, J.T., Ness, K.K. and Kadan-Lottick, N.S.\t", "year": "2016", "journalProceedings": "Pediatric Blood & Cancer", "category": "Intervention", "devices": "One", "population": "Patients,Adults,Adolescents", "dataUsed": "NA", "abstract": "Background: Over 70% of childhood cancer survivors develop late complications from therapy, many of which can be mitigated by physical activity. Survivors engage in exercise at similar or lower rates than their sedentary healthy peers. We piloted a novel home-based exercise intervention with a motivational activity tracker. We evaluated (i) feasibility, (ii) impact on activity levels and physical fitness, and (iii) barriers, preferences, and beliefs regarding physical activity.\n\nMethods: Childhood cancer survivors currently 15 years or older and not meeting the Centers for Disease Control and Prevention physical activity guidelines were enrolled and instructed to wear the Fitbit One, a 4.8 cm × 1.8 cm motivational activity tracker, daily for 6 months. Baseline and follow-up evaluations included self-report surveys, an Actigraph accelerometer for 7 days, and a VO2 maximum test by cardiac stress test.\n\nResults: Nineteen participants were enrolled (13.4% participation rate) with a mean age of 24.3 ± 5.8 years (range 15–35). Four participants withdrew with a 79% retention rate. Participants wore the Fitbit an average of 19.0 ± 4.7 days per month during months 1–3 and 15.0 ± 7.9 days per month during months 4–6. Total weekly moderate to vigorous physical activity increased from 265.6 ± 117.0 to 301.4 ± 135.4 min and VO2 maximum increased from 25.7 ± 7.7 to 27.2 ± 7.4 ml/kg/min. These changes were not statistically significant (P = 0.47 and 0.30, respectively). Survey responses indicated no change in barriers, preferences, and beliefs regarding physical activity.\n\nConclusions: This pilot study of a motivational activity tracker demonstrated feasibility as measured by participant retention, receptivity, and belief of utility. Future studies with a large sample size are needed to demonstrate the efficacy and sustainability of this intervention.", "links": [ { "caption": "URL", "url": "http://onlinelibrary.wiley.com/doi/10.1002/pbc.26235/abstract", "newWindow": true } ] }, { "title": "Examining The Validity Of Fitbit Charge HR For Measuring Heart Rate In Free-living Conditions", "author": "Lee, J.-M.M., An, H., Kang, S.-k., Kim, Y. and Dinkel, D.\t", "year": "2016", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Optical blood flow sensors (i.e. photoplethysmographic techniques) have recently been utilized in wearable activity trackers. The Fitbit Charge HRTM (FBHR) is one of the widely recognized wearable activity trackers that utilizes Fitbit's proprietary PurePulse optical heart rate (HR) technology to automatically measure wrist-based HR. Despite its increasing popularity, however, no study to date has addressed the validity of FBHR for measuring HR in free-living conditions.\nPURPOSE: The purpose of this study was to examine the validity of FBHR for measuring HR using a chest strap Polar HR monitor (PHR) as a reference measure in free-living conditions.\n\nMETHODS: Ten healthy college students (8 males; mean age = 26.5 ± 5.4 years; mean body mass index (BMI) = 24.5 ± 3.23 kgtextperiodcenteredm2) participated in the study. The participants were asked to perform normal daily activities for 8 hours in a day while wearing the PHR (model RS400) on their chest and two FBHRs on their dominant and non-dominant wrists, respectively. HR was recorded every minute and the minute-by-minute HR data from each monitor were synchronized by time of day. Pearson correlation was used to examine the linearity of average beats-per-minute (bpm) estimated from FBHRs with respect to the PHR. Mean differences in average bpm between the monitors were examined by a general linear model for repeated measures. Lastly, mean absolute percentage error (MAPE) of minute-by-minute bpm estimated from the FBHRs were calculated against the PHR.\n\nRESULTS: Average HRs (mean ± SD) for PHR, FBHR non-dominant, and FBHR dominant were 75.6 ± 18.5 bpm, 72.8 ± 16.7 bpm, and 73.9 ± 17.06 bpm, respectively. Pearson correlation coefficients (r) between the PHR and FBHR non-dominant and dominant were r=.805 and r=.793, respectively. MAPE were 9.17 ± 10.9% for FBHR non-dominant and 9.71 ± 12.4% for FBHR HR dominant. ANOVA and post-hoc analyses with Bonferroni revealed significant differences in estimating HR from FBHR non-dominant wrist (p=.001) and FBHR dominant wrist (p=.001) compared to PHR monitor.\n\nCONCLUSION: The results indicated that the wrist-oriented Fitbit Charge HRTM device does not provide an accurate measurement of HR during free-living condition in this study. However, further research is needed to validate these monitors with a larger sample with different population groups.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Citation/2016/05001/Examining_The_Validity_Of_Fitbit_Charge_HR_For.2355.aspx", "newWindow": true } ] }, { "title": "Evidence of Convergent Validity for Measuring Free-Living Walking Using Wearable Devices", "author": "Lee, M., Choi, J.-Y., Lee, K., Min, J., Kim, J. and Choi, M.C.\t", "year": "2016", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "One,Charge", "population": "Adults", "dataUsed": "Steps", "abstract": "PURPOSE: To determine the convergent validity of consumer-based wearable devices for assessing walking during free-living activities.\nMETHODS: A total of 48 healthy adults (10 males, 50.3±10.6 yrs & BMI 24.9±2.5; 38 females, 53.3±7.4 yrs & BMI 24.4±2.9) participated. The consumer-based wearable devices included Actigraph GT3X+(AT), BodyMedia Armband (BM), Fitbit Charge (FC), Fitbit One (FO), Jawbone up (JB), Misfit (MF), and the Nike Fuelband (NF) worn on wrist, waist, or upper arm. The Omron HJ720IT pedometer served as the reference measure. While simultaneously wearing all devices, walking time (6.64±.80min), steps (13.28±1.22), and speed (1.43±.20m/sec) were assessed (10 m walk). Participants also completed selected free-living activities including moving boxes, cleaning desks, mopping, walking up & down stairs, and outdoor walking on hills. On average these activities took 40min to complete. Descriptive statistics, correlation coefficients (r) and paired t-test among the wearable devices and the Omron pedometer were calculated using SPSS 20.\n\nRESULTS: It was unable to examine the accuracy of the JB due to constant synchronizing errors. Walking Time, Steps, and Speed showed moderate correlations with the Omron (r = .39, .55, & .43, respectively); but low correlations with wearable devices r = .11 to .23(Time), -.10 to .37(Steps), and -.08 to -.23(Speed). Step counts measured by the devices during free-living were as follows: FC=178±238, NF=1595±156, MF=1628±283, BM=1667±191, FO=1735±174, and AT=1778±180. The Omron (reference) recorded 1749±169 steps. The correlation coefficients between the step counts from the wearable devices and the Omron during free-living were AT=.91, FO=.91, NF =.61, FC=.59, BM=.44, and MF=-.15. All wearable devices showed statistically significant differences when compared to the Omron (t = -2.2 to -14.3, p textless0.05).\n\nCONCLUSIONS: : Of the devices examined, AT and FO were the most valid for measuring walking steps during free-living activities. On the other hand, quality control and measurement error associated with JB and MF suggest they should not be used.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Citation/2016/05001/Evidence_of_Convergent_Validity_for_Measuring.2336.aspx", "newWindow": true } ] }, { "title": "Appropriating Quantified Self Technologies to Support Elementary Statistical Teaching and Learning", "author": "Lee, V., Drake, J. and Thayne, J.\t", "year": "2016", "journalProceedings": "IEEE Transactions on Learning Technologies", "category": "Usability,Measurement", "devices": "Ultra,One", "population": "Children", "dataUsed": "Steps", "abstract": "Wearable activity tracking devices associated with the Quantified Self movement may have potential benefit for educational settings because they produce authentic and granular data about activities and experiences already familiar to youth. This article explores how that potential could be realized through explicit acknowledgment of and response to tacit design assumptions about how such technologies will be used in practice and strategic design of a classroom unit. We argue that particular practical adaptations that we have identified serve to ensure that the classroom and educational use cases are appropriately considered. As an example of how those adaptations are realized in actual elementary classrooms, we describe an effort to provide fifth-grade students each with their own Fitbit activity trackers in the context of a multi-week unit exploring core ideas in elementary statistics. Observational descriptions and transcript excerpts of students and teachers discussing their own Fitbit data are presented to illustrate what opportunities exist to leverage youth familiarity with daily activities in a way that targets development of statistical thinking. Quantitative written test results showing learning gains and differences between traditional and wearable device-enhanced instruction are also presented. Improvement on several statistical thinking constructs is identified, including in the areas of data display, conceptions of statistics, modeling variability, and informal inference.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/document/7529181/?arnumber=7529181", "newWindow": true } ] }, { "title": "Validation and Accuracy of FITBIT Charge: A Pilot Study in a University Worksite Walking Program", "author": "Leininger, L.J., Cook, B.J. and Adams, K.J.\t", "year": "2016", "journalProceedings": "Journal of Fitness Research", "category": "Validation", "devices": "Charge", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "PURPOSE: Wearable activity monitors (e.g., Fitbit®) have become increasingly popular for both researchers and lay people alike. Recent studies have reported several Fitbit® models correlate with research grade monitors; however none to date have examined the Fitbit® Charge model. Furthermore, none have reported on the accuracy of Fitbit® devices. The primary purpose of this study was to compare step counts assessed by Fitbit® Charge and a research grade accelerometer (i.e., Actigraph®). The secondary purpose of this study was to compare the Fitbit® Charge algorithms for physical activity intensity with an algorithm validated for research purposes.\n\nMETHODS: Participants (n=8) wore Fitbit® Charge and Actigraph® monitors for 7 days. First, correlations were run to examine the concordance of step counts and physical activity intensity levels derived from Fitbit® Charge and Actigraph® algorithms. Next, accuracy was investigated by paired sample t-tests comparing each device’s assessment of step counts and minutes spent in light, moderate and vigorous intensity activity.\n\nRESULTS: Significant correlations were found for all study outcomes (p’s < .05). Significant differences were observed for step counts on all days and weekly total step count (p’s < .05). Analyses of each intensity level revealed significant differences on most days for light and moderate intensity (p’s <.05). For vigorous intensity, only day 6 (p = .007) and accumulated weekly total of minutes were different (p = .014).\n\nCONCLUSIONS: Our correlation results were similar to previous research examining validity of other Fitbit® models. However, Fitbit® Charge devices may overestimate step counts. Moreover, the algorithm used by Fitbit® may overestimate light and vigorous physical activity, while underestimating minutes in moderate physical activity. Further research is needed to determine reliability of Fitbit® Charge to assess activity and intensity that reflects current health recommendations. Therefore, researchers should use discretion if considering use of Fitbit® Charge for research purposes.", "links": [ { "caption": "URl", "url": "http://fitnessresearch.edu.au/journal-view/validation-and-accuracy-of-fitbit-charge-a-pilot-182", "newWindow": true } ] }, { "title": "Validation And Accuracy Of Fitbit Charge", "author": "Leininger, L.J., Cook, B.J., Jones, V., Bellumori, M. and Adams, K.J.\t", "year": "2016", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "URPOSE: Wearable activity monitors (e.g., Fitbit®) have become increasingly popular for both researchers and lay people alike. Recent studies have reported several Fitbit® models correlate with research grade monitors; however none to date have examined the Fitbit® Charge model. Furthermore, none have reported on the accuracy of Fitbit® devices. The primary purpose of this study was to compare step counts assessed by Fitbit® Charge and a research grade accelerometer (i.e., Actigraph®). The secondary purpose of this study was to compare the Fitbit® Charge algorithms for physical activity intensity with an algorithm validated for research purposes.\nMETHODS: Participants (n=8) wore Fitbit® Charge and Actigraph® monitors for 7 days. First, correlations were run to examine the concordance of step counts and physical activity intensity levels derived from Fitbit® Charge and Actigraph® algorithms. Next, accuracy was investigated by paired sample t-tests comparing each device's assessment of step counts and minutes spent in light, moderate and vigorous intensity activity.\n\nRESULTS: Significant correlations were found for all study outcomes (p's textless .05). Significant differences were observed for step counts on all days and weekly total step count (p's textless .05). Analyses of each intensity level revealed significant differences on most days for light and moderate intensity (p's textless.05). For vigorous intensity, only day 6 (p = .007) and accumulated weekly total of minutes were different (p = .014).\n\nCONCLUSIONS: Our correlation results were similar to previous research examining validity of other Fitbit® models. However, Fitbit® Charge devices may overestimate step counts. Moreover, the algorithm used by Fitbit® may overestimate light and vigorous physical activity, while underestimating minutes in moderate physical activity. Further research is needed to determine reliability of Fitbit® Charge to assess activity and intensity that reflects current health recommendations. Therefore, researchers should use discretion if considering use of Fitbit® Charge for research purposes.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Citation/2016/05001/Validation_And_Accuracy_Of_Fitbit_Charge___A_Pilot.287.aspx", "newWindow": true } ] }, { "title": "A Personalized Approach for Detecting Unusual Sleep from Time Series Sleep-Tracking Data", "author": "Liang, Z.,Martell, M.A.C., and Nishimura T. ", "year": "2016", "journalProceedings": "2016 IEEE International Conference on Healthcare Informatics (ICHI)", "category": "Methods", "devices": "Charge HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "Nowadays emerging sleep-tracking technologies such as Fibit make it possible for individuals to collect personal sleep data. However, people find it difficult to gain insights from these data without proper analysis. The objective of this study was to investigate the possibility of establishing a sleep analysis approach that helps people detect their unusual sleep pattern by considering their own sleep baselines instead of the population average. The proposed approach was consisted of two steps. In the first step, the dimension of time series sleep data was reduced using permutation entropy. Following that, univariate outlier detection techniques were applied to detect unusual sleep patterns. We tested our approach on a real sleep tracking data set consisting of 35 days of time series data tracked using a Fitbit Charge HR. Depending on the univariate outlier detection technique used, the identified unusual sleep differed. We found that permutation entropy of a sleep time series was strongly correlated to the time that the user went to bed and weekly correlated to minutes asleep, but was not correlated to minutes awake, awakening count and sleep efficiency. Based on the analysis results, we pointed out the directions for future study on personal sleep data analysis.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/document/7776322/", "newWindow": true } ] }, { "title": "Sleep Tracking in the Real World: A Qualitative Study into Barriers for Improving Sleep", "author": "Liang, Z. and Ploderer, B.\t", "year": "2016", "journalProceedings": "Proceedings of the 28th Australian Conference on Computer-Human Interaction", "category": "Usability", "devices": null, "population": "Adults", "dataUsed": "Sleep", "abstract": "Wearable devices like Fitbit and Apple Watch provide convenient access to personal information about sleep habits. However, it is unclear if awareness of one's sleep habits also translates into improved sleep. Hence, we conducted an interview study with 12 people who track their sleep with Fitbit devices to investigate if they have managed to improve their sleep and to examine potential barriers for improving sleep. The participants reported increased awareness of sleep habits, but none of the participants managed to improve their sleep. They faced three barriers in improving their sleep: (1) not knowing what is normal sleep, (2) not being able to diagnose the reasons for a lack of sleep, and (3) not knowing how to act. This paper discusses how to address these barriers, both conceptually as well through design considerations - reference points, connections to lifestyle data, and personalized recommendations - to help users gain improvements in wellbeing from their personal data.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=3010915.3010988", "newWindow": true } ] }, { "title": "SleepExplorer: a visualization tool to make sense of correlations between personal sleep data and contextual factors", "author": "Liang, Z., Ploderer, B., Liu, W., Nagata, Y., Bailey, J., Kulik, L. and Li, Y.\t", "year": "2016", "journalProceedings": "Personal and Ubiquitous Computing", "category": "Usability,Case Study", "devices": "Flex,Charge,Charge HR", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance,Sleep", "abstract": "Getting enough quality sleep is a key part of a healthy lifestyle. Many people are tracking their sleep through mobile and wearable technology, together with contextual information that may influence sleep quality, like exercise, diet, and stress. However, there is limited support to help people make sense of this wealth of data, i.e., to explore the relationship between sleep data and contextual data. We strive to bridge this gap between sleep-tracking and sense-making through the design of SleepExplorer, a web-based tool that helps individuals understand sleep quality through multi-dimensional sleep structure and explore correlations between sleep data and contextual information. Based on a two-week field study with 12 participants, this paper offers a rich understanding on how technology can support sense-making on personal sleep data: SleepExplorer organizes a flux of sleep data into sleep structure, guides sleep-tracking activities, highlights connections between sleep and contributing factors, and supports individuals in taking actions. We discuss challenges and opportunities to inform the work of researchers and designers creating data-driven health and well-being applications.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s00779-016-0960-6", "newWindow": true } ] }, { "title": "Use of Fitbit Charge HR for Management of Post-Concussive Syndrome: A Case Report", "author": "Lindsay, L.R. and Chae, H.\t", "year": "2016", "journalProceedings": "PM&R", "category": "Medical,Case Study", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Sleep,Heart Rate", "abstract": "Case/Program Description: A 43-year-old woman with Hashimoto’s thyroiditis presented to outpatient clinic with diagnosis of post-concussive syndrome for the past 1.5 years. She had had a short course of physical and cognitive therapy but returned to work and had full decompensation and resumption of concussive symptoms. She continued to experience significant headaches, sleep disturbance, decreased processing speed, and concentration deficits. Additionally, she had labile blood pressures, tachycardia, and intermittent sweating episodes. Despite normal TSH, free T4 levels, and a negative tilt table test, these symptoms persisted. She purchased a Fitbit Charge HR and began a sub-aerobic workout regimen. Clonidine 0.1 mg was prescribed to be taken twice a day to treat suspected dysautonomia and results were obtained via the Fitbit software.\n\nSetting: Academic outpatient practice.\n\nResults\nUsing the Fitbit Charge HR we were able to visualize and quantify the effect of clonidine on her suspected dysautonomia symptoms. The heart rate and heart rate variability response were graphically represented. Additionally, we objectively measured hours of sleep increase, and noted fewer episodes of restlessness.\n\nDiscussion: This is the first documented use of the Fitbit Charge HR in this capacity. This technology allows us to collect larger amounts of data that helps us more objectively measure response to interventions. While Fitbit data is not the gold standard, the information gathered is likely more detailed and objective than the self reporting.\n\nConclusions: Fitbit Charge HR is a novel and affordable technology that may have a significant role in informing patient-physician interaction. More specifically, the technology transforms what was originally a patient’s subjective and static measurement of response to an objective and dynamic assessment, empowering both patients and physicians with immediate and easily accessible data.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1934148216305688", "newWindow": true } ] }, { "title": "Pedometry to Prevent Cardiorespiratory Fitness Decline—Is it Effective?", "author": "Lystrup, R.M., West, G.F., Olsen, C., Ward, M. and Stephens, M.B.\t", "year": "2016", "journalProceedings": "Military Medicine", "category": "Measurement", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Introduction: Physically active providers are more likely to prescribe exercise. Unfortunately, many become sedentary during their training. We examined pedometry as an incentive to promote physical activity in a cohort of medical students. \n\nMethods: This was a prospective, unblinded clinical trial of pedometry. 107 preclinical medical students volunteered. 50 students received Fitbit pedometers and 57 served as controls. All students ran 1.5- or 2-mile timed runs before pedometer issue, and again 1 year after. Change in run times were the primary outcome measure. Step counts, body composition, and exercise frequency were secondary outcomes.\n\nResults: 76% of students with pedometers reported increased motivation to exercise and 57% reported changing daily routines as a result of pedometry. Active pedometry participants declined from 48/50 initially to 22/50 over 13 months. Run times slowed an average of 5.0 seconds for pedometry users vs. 12.3 seconds for the control group. This difference was not statistically significant (p = 0.48). \n\nConclusions: A subset of future physicians reported increased motivation to exercise after a trial of pedometry. However, adherence over the long term was poor and it seems to have a limited impact on aerobic exercise performance in this population.", "links": [ { "caption": "URL", "url": "http://publications.amsus.org/doi/10.7205/MILMED-D-15-00540", "newWindow": true } ] }, { "title": "Mission Possible: Using Ubiquitous Social Goal Sharing Technology to Promote Physical Activity in Children", "author": "Mackintosh, K.\t", "year": "2016", "journalProceedings": "Movement, Health & Exercise", "category": "Intervention", "devices": "Zip", "population": "Children", "dataUsed": "Steps,Intensity", "abstract": "The present study investigated the acceptability of a novel ubiquitous social goal-sharing intervention aimed at promoting physical activity (PA) in schoolchildren. Methods: Thirty children (18 boys; 10.1±0.3 years; 1.39±0.06 m; 19.85±4.03 kgtextperiodcenteredm-2) were randomly assigned to ten groups and provided with Fitbit monitors. Video-clips describing mission-based activities were shown on iPads each week, for four consecutive weeks. An LED lighting-strip provided visual feedback on daily group PA levels. Three semistructured group interviews were conducted with 10 children (4 boys, 6 girls; n=2) and two teachers (n=1). Additionally, at baseline and post-intervention, seven-day accelerometry, cardiorespiratory fitness (CRF; 20m shuttle run test), anthropometrics and physical selfperceptions were assessed. Data were analysed using a mixed “between-within\" analysis of variance (ANOVA). Results: Children stated that peers were positive role models and provided encouragement to accomplish the missions. Teachers felt that children's fitness, teamwork and problem-solving skills considerably improved. Statistical analyses revealed no significant intervention effect (ptextgreater0.05), though BMI and waist circumference, and CRF, decreased and increased, respectively. Conclusion: The integration of ubiquitous social goal-sharing technology in schools was well received by teachers and pupils. However, further studies integrating a larger sample size encompassing numerous schools, comparison groups and a longer intervention period with associated follow-up measurements, are warranted to ascertain the feasibility as a low-cost intervention to promote children's PA levels.", "links": [ { "caption": "URL", "url": "http://mohejournal.com/index.php/mohe/article/view/115", "newWindow": true } ] }, { "title": "Toward Accessible Health and Fitness Tracking for People with Mobility Impairments", "author": "Malu, M. and Findlater, L.\t", "year": "2016", "journalProceedings": "Proceedings of the 10th EAI International Conference on Pervasive Computing Technologies for Healthcare", "category": "Usability", "devices": "One", "population": "Patients,Adults", "dataUsed": "NA", "abstract": "Electronic health and fitness trackers have received substantial attention over the past decade, from new mobile and wearable technologies to evaluations of potential health impacts. These trackers, however, may not be accessible to people with mobility impairments, for whom activities such as running, walking, or climbing stairs can be difficult or impossible. To investigate the accessibility of wearable tracking devices and mobile apps, we conducted a study with 14 participants with a range of mobility impairments. The study included an in-person interview, evaluation of two off-the-shelf wearable devices, and a participatory design activity, followed by an optional week-long field evaluation of a mobile fitness app (to which 8 participants opted in). Our findings highlight widespread accessibility challenges with existing tracking technologies and provide implications for designing more inclusive solutions.", "links": [ { "caption": "URL", "url": "http://eudl.eu/doi/10.4108/eai.16-5-2016.2263329", "newWindow": true } ] }, { "title": "Reliability of Sleep Measures from Four Personal Health Monitoring Devices Compared to Research-Based Actigraphy and Polysomnography", "author": "Mantua, J., Gravel, N. and Spencer, R.\t", "year": "2016", "journalProceedings": "Sensors", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Sleep", "abstract": "Polysomnography (PSG) is the “gold standard” for monitoring sleep. Alternatives to PSG are of interest for clinical, research, and personal use. Wrist-worn actigraph devices have been utilized in research settings for measures of sleep for over two decades. Whether sleep measures from commercially available devices are similarly valid is unknown. We sought to determine the validity of five wearable devices: Basis Health Tracker, Misfit Shine, Fitbit Flex, Withings Pulse O2, and a research-based actigraph, Actiwatch Spectrum. We used Wilcoxon Signed Rank tests to assess differences between devices relative to PSG and correlational analysis to assess the strength of the relationship. Data loss was greatest for Fitbit and Misfit. For all devices, we found no difference and strong correlation of total sleep time with PSG. Sleep efficiency differed from PSG for Withings, Misfit, Fitbit, and Basis, while Actiwatch mean values did not differ from that of PSG. Only mean values of sleep efficiency (time asleep/time in bed) from Actiwatch correlated with PSG, yet this correlation was weak. Light sleep time differed from PSG (nREM1 + nREM2) for all devices. Measures of Deep sleep time did not differ from PSG (SWS + REM) for Basis. These results reveal the current strengths and limitations in sleep estimates produced by personal health monitoring devices and point to a need for future development.", "links": [ { "caption": "URL", "url": "http://www.mdpi.com/1424-8220/16/5/646", "newWindow": true } ] }, { "title": " Workplace Indicators of Mood: Behavioral and Cognitive Correlates of Mood Among Information Workers", "author": "Mark, G., Czerwinski, M., Iqbal, S. and Johns, P.\t", "year": "2016", "journalProceedings": "Proceedings of the 6th International Conference on Digital Health Conference", "category": "Measurement", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Positive wellbeing in the workplace is tied to better health. However, lack of wellbeing in the workplace is a serious problem in the U.S, is rising continually, and can lead to poor health conditions. In this study we investigate factors that might be associated with workplace wellbeing. We report on an in situ study in the workplace of 40 information workers whose mood was tracked for 12 days. We used a mixed-methods study using Fitbit actigraphs to measure sleep and physical activity, computer logging, and repeated daily surveys. We found that sleep and perceived productivity are positively correlated with affect balance (the balance of positive and negative affect), whereas concentration difficulty, and amount of time on workplace email, are negatively correlated with affect balance. Our model explains 48% of the variance of workplace mood. We discuss the value and challenges of multi-faceted measures of health as we move towards designing interdisciplinary digital health research.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=2896338.2896360", "newWindow": true } ] }, { "title": "Older Adults' Experiences Using a Commercially Available Monitor to Self-Track Their Physical Activity.", "author": "McMahon, S.K., Lewis, B., Oakes, M., Guan, W., Wyman, J.F. and Rothman, A.J.\t", "year": "2016", "journalProceedings": "JMIR mHealth and uHealth", "category": "Usability", "devices": "One", "population": "Older Adults", "dataUsed": "NA", "abstract": "BACKGROUND: Physical activity contributes to older adults' autonomy, mobility, and quality of life as they age, yet fewer than 1 in 5 engage in activities as recommended. Many older adults track their exercise using pencil and paper, or their memory. Commercially available physical activity monitors (PAM) have the potential to facilitate these tracking practices and, in turn, physical activity. An assessment of older adults' long-term experiences with PAM is needed to understand this potential.\nOBJECTIVE: To assess short and long-term experiences of adults textgreater70 years old using a PAM (Fitbit One) in terms of acceptance, ease-of-use, and usefulness: domains in the technology acceptance model.\n\nMETHODS: This prospective study included 95 community-dwelling older adults, all of whom received a PAM as part of randomized controlled trial piloting a fall-reducing physical activity promotion intervention. Ten-item surveys were administered 10 weeks and 8 months after the study started. Survey ratings are described and analyzed over time, and compared by sex, education, and age.\n\nRESULTS: Participants were mostly women (71/95, 75%), 70 to 96 years old, and had some college education (68/95, 72%). Most participants (86/95, 91%) agreed or strongly agreed that the PAM was easy to use, useful, and acceptable both 10 weeks and 8 months after enrolling in the study. Ratings dropped between these time points in all survey domains: ease-of-use (median difference 0.66 points, P=.001); usefulness (median difference 0.16 points, P=.193); and acceptance (median difference 0.17 points, P=.032). Differences in ratings by sex or educational attainment were not statistically significant at either time point. Most participants 80+ years of age (28/37, 76%) agreed or strongly agreed with survey items at long-term follow-up, however their ratings were significantly lower than participants in younger age groups at both time points.\n\nCONCLUSIONS: Study results indicate it is feasible for older adults (70-90+ years of age) to use PAMs when self-tracking their physical activity, and provide a basis for developing recommendations to integrate PAMs into promotional efforts.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848389/", "newWindow": true } ] }, { "title": "Acceptance of Commercially Available Wearable Activity Trackers Among Adults Aged Over 50 and With Chronic Illness: A Mixed-Methods Evaluation.", "author": "Mercer, K., Giangregorio, L., Schneider, E., Chilana, P., Li, M. and Grindrod, K.\t", "year": "2016", "journalProceedings": "JMIR mHealth and uHealth", "category": "Usability", "devices": "Zip", "population": "Older Adults,Patients", "dataUsed": "NA", "abstract": "BACKGROUND: Physical inactivity and sedentary behavior increase the risk of chronic illness and death. The newest generation of \"wearable\" activity trackers offers potential as a multifaceted intervention to help people become more active. \n\nOBJECTIVE: To examine the usability and usefulness of wearable activity trackers for older adults living with chronic illness.\n\nMETHODS: We recruited a purposive sample of 32 participants over the age of 50, who had been previously diagnosed with a chronic illness, including vascular disease, diabetes, arthritis, and osteoporosis. Participants were between 52 and 84 years of age (mean 64); among the study participants, 23 (72%) were women and the mean body mass index was 31 kg/m(2). Participants tested 5 trackers, including a simple pedometer (Sportline or Mio) followed by 4 wearable activity trackers (Fitbit Zip, Misfit Shine, Jawbone Up 24, and Withings Pulse) in random order. Selected devices represented the range of wearable products and features available on the Canadian market in 2014. Participants wore each device for at least 3 days and evaluated it using a questionnaire developed from the Technology Acceptance Model. We used focus groups to explore participant experiences and a thematic analysis approach to data collection and analysis.\n\nRESULTS: Our study resulted in 4 themes: (1) adoption within a comfort zone; (2) self-awareness and goal setting; (3) purposes of data tracking; and (4) future of wearable activity trackers as health care devices. Prior to enrolling, few participants were aware of wearable activity trackers. Most also had been asked by a physician to exercise more and cited this as a motivation for testing the devices. None of the participants planned to purchase the simple pedometer after the study, citing poor accuracy and data loss, whereas 73% (N=32) planned to purchase a wearable activity tracker. Preferences varied but 50% felt they would buy a Fitbit and 42% felt they would buy a Misfit, Jawbone, or Withings. The simple pedometer had a mean acceptance score of 56/95 compared with 63 for the Withings, 65 for the Misfit and Jawbone, and 68 for the Fitbit. To improve usability, older users may benefit from devices that have better compatibility with personal computers or less-expensive Android mobile phones and tablets, and have comprehensive paper-based user manuals and apps that interpret user data.\n\nCONCLUSIONS: For older adults living with chronic illness, wearable activity trackers are perceived as useful and acceptable. New users may need support to both set up the device and learn how to interpret their data.", "links": [ { "caption": "URL", "url": "http://mhealth.jmir.org/2016/1/e7/", "newWindow": true } ] }, { "title": "Behavior Change Techniques Present in Wearable Activity Trackers: A Critical Analysis", "author": "Mercer, K., Li, M., Giangregorio, L., Burns, C. and Grindrod, K.\t", "year": "2016", "journalProceedings": "JMIR mHealth and uHealth", "category": "Review", "devices": "Flex", "population": "NA", "dataUsed": "NA", "abstract": "Background: Wearable activity trackers are promising as interventions that offer guidance and support for increasing physical activity and health-focused tracking. Most adults do not meet their recommended daily activity guidelines, and wearable fitness trackers are increasingly cited as having great potential to improve the physical activity levels of adults. Objective: The objective of this study was to use the Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy to examine if the design of wearable activity trackers incorporates behavior change techniques (BCTs). A secondary objective was to critically analyze whether the BCTs present relate to known drivers of behavior change, such as self-efficacy, with the intention of extending applicability to older adults in addition to the overall population. Methods: Wearing each device for a period of 1 week, two independent raters used CALO-RE taxonomy to code the BCTs of the seven wearable activity trackers available in Canada as of March 2014. These included Fitbit Flex, Misfit Shine, Withings Pulse, Jawbone UP24, Spark Activity Tracker by SparkPeople, Nike+ FuelBand SE, and Polar Loop. We calculated interrater reliability using Cohen's kappa. Results: The average number of BCTs identified was 16.3/40. Withings Pulse had the highest number of BCTs and Misfit Shine had the lowest. Most techniques centered around self-monitoring and self-regulation, all of which have been associated with improved physical activity in older adults. Techniques related to planning and providing instructions were scarce. Conclusions: Overall, wearable activity trackers contain several BCTs that have been shown to increase physical activity in older adults. Although more research and development must be done to fully understand the potential of wearables as health interventions, the current wearable trackers offer significant potential with regard to BCTs relevant to uptake by all populations, including older adults.", "links": [ { "caption": "URL", "url": "http://mhealth.jmir.org/2016/2/e40/", "newWindow": true } ] }, { "title": "Statistical methods for detecting groups of patterns in daily step count activity profiles", "author": "Meyer, E., Tran, T. and Greenwood, M.\t", "year": "2016", "journalProceedings": "Skyline - The Big Sky Undergraduate Journal", "category": "Methods", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "In recent years, “step counting” has become a constant pre-occupation for some people as a way of trying to tie activity to fitness goals. This has been spurred on by inexpensive digital devices that provide a suite of information on how and how much you move during the day. Many of the consumer interfaces to these data provide summary information that often focuses on daily totals and visual displays of patterns of activity if the user dives a little deeper. This suggests that when you move throughout the day is just as much of a story as how much you move in total. The purpose of this research is to explore cluster analysis of daily step count profiles using a novel dissimilarity measure that allows days that are similar but are slightly offset in timing to be grouped together. We illustrate the method with self-recorded step count activity data from a Fitbit activity tracker band over a 70 day span. The results show days that may be similar in total step counts that are separated in this analysis by looking more closely at the daily count profiles. This provides an alternative way to understand patterns in daily activity profiles that goes beyond just comparing daily totals.", "links": [ { "caption": "URL", "url": "http://skyline.bigskyconf.com/journal/vol4/iss1/6/", "newWindow": true } ] }, { "title": "Physical Activity Measured with Accelerometer and Self-Rated Disability in Lumbar Spine Surgery: A Prospective Study.", "author": "Mobbs, R.J., Phan, K., Maharaj, M. and Rao, P.J.\t", "year": "2016", "journalProceedings": "Global Spine Journal", "category": "Measurement", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps,Energy Expenditure,Distance", "abstract": "OBJECTIVE: Patient-based subjective ratings of symptoms and function have traditionally been used to gauge the success and extent of recovery following spine surgery. The main drawback of this type of assessment is the inherent subjectivity involved in patient scoring. We aimed to objectively measure functional outcome in patients having lumbar spine surgery using quantitative physical activity measurements derived from accelerometers.\n\nMETHODS: A prospective study of 30 patients undergoing spine surgery was conducted with subjective outcome scores (visual analog scale [VAS], Oswestry Disability Index [ODI] and Short Form 12 [SF-12]) recorded; patients were given a Fitbit accelerometer (Fitbit Inc., San Francisco, California, United States) at least 7 days in advance of surgery to record physical activity (step count, distance traveled, calories burned) per day. Following surgery, postoperative activity levels were reported at 1-, 2-, and 3-month follow-up.\n\nRESULTS: Of the 28 compliant patients who completed the full trial period, mean steps taken per day increased 58.2% (p?=?0.008) and mean distance traveled per day increased 63% (p?=?0.0004) at 3-month follow-up. Significant improvements were noted for mean changes in VAS back pain, VAS leg pain, ODI, and SF-12 Physical Component Summary (PCS) scores. There was no significant correlation between the improvement in steps or distance traveled per day with improvements in VAS back or leg pain, ODI, or PCS scores at follow-up.\n\nCONCLUSIONS: High compliance and statistically significant improvement in physical activity were demonstrated in patients who had lumbar decompression and lumbar fusion. There was no significant correlation between improvements in subjective clinical outcome scores with changes in physical activity measurements at follow-up. Limitations of the present study include its small sample size, and the validity of objective physical activity measurements should be assessed in future larger, prospective studies.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947409/", "newWindow": true } ] }, { "title": "Consumer-based Physical Activity Monitors and Research-grade Accelerometers Underestimate Physical Activity in a Semi-structured Setting", "author": "Montoye, A.H., Tuttle, M.S., Nelson, M.B., Steeves, J.A. and Kaminsky, L.A.\t", "year": "2016", "journalProceedings": "Circulation", "category": "Validation", "devices": "One,Zip,Flex", "population": "Adults", "dataUsed": "Steps,Energy Expenditure", "abstract": "Introduction: Consumer-based physical activity (PA) monitors have become popular tools to track PA (steps and energy expenditure [EE]), but little is known about their accuracy and comparability to research-grade PA monitors.\nHypothesis: We hypothesized that consumer-based PA monitors would have lower PA measurement accuracy than a research-grade PA monitor.\n\nMethods: Healthy adults (n=30 [n=15 male], aged 18-79 years) were fitted with three Fitbit PA monitors (One and Zip, left hip; Flex, non-dominant wrist), one Jawbone PA monitor (UP24, non-dominant wrist), and one research-grade, accelerometer-based PA monitor (ActiGraph Link; right hip). Subjects performed =12 activities from a list of 21 sedentary, household, and ambulatory activities during an 80-minute, semi-structured protocol while wearing all five monitors and a portable metabolic analyzer. Steps and EE were recorded from PA monitors at the beginning and end of the protocol. A previously validated EE prediction equation (Freedson) was used to estimate EE from PA (PAEE) using ActiGraph data. A previous lab visit by subjects was used to estimate resting EE; resting EE was added to PAEE to estimate total EE from the ActiGraph. Criterion measures included a trained research assistant counting total steps (with a hand tally counter) and the metabolic analyzer for measurement of total EE and PAEE (total EE - resting EE). Repeated measures analysis of variance was used to assess step, total EE, and PAEE measures among the consumer-based PA monitors, ActiGraph, and criterion methods.\n\nResults: Participants averaged 3,231±104 steps, 294±10 kcals for total EE, and 235±9 kcals for PAEE according to criterion measures. Consumer-based PA monitors and the ActiGraph significantly underestimated steps (mean difference [MD]: 714-1,047 steps [22.1-32.4%], p<0.01), total EE (MD: 37-109 kcals [12.6-37.1%], p<0.05), and PAEE (MD: 35-107 kcals [14.9-45.5%], p<0.05) compared to criterion measures. The Fitbit One, Zip, and Flex monitors estimated significantly higher steps than the ActiGraph (MD: 199-302 steps [9.1-13.8%], p<0.05), but there was no significant difference in steps estimated by the UP24 compared to the ActiGraph (MD: 144 steps [6.6%], p=0.21). All consumer-based monitors estimated significantly higher total EE and PAEE than the ActiGraph (MD: 23-60 kcals [12.6-32.7%] and 22-53 kcals [17.3.0-41.2%], respectively; p<0.05).\n\nConclusions: All PA monitors underestimated steps, total EE, and PAEE compared to the criterion measures. Large variability existed in the step and EE estimates from the PA monitors tested. Contrary to our hypothesis, the research-grade ActiGraph monitor (using Freedson EE prediction equation) had more severe PA underestimates than the consumer-based PA monitors. In conclusion, estimates of PA between studies using consumer-based vs. research-grade PA monitors should be interpreted with caution.", "links": [ { "caption": "URL", "url": "http://circ.ahajournals.org/content/133/Suppl_1/AP121.short", "newWindow": true } ] }, { "title": "Accuracy of Wearable Devices for Estimating Total Energy Expenditure", "author": "Murakami, H., Kawakami, R., Nakae, S., Nakata, Y., Ishikawa-Takata, K., Tanaka, S. and Miyachi, M.\t", "year": "2016", "journalProceedings": "JAMA Internal Medicine", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "Accurate estimation of energy expenditure is a key element in determining the relationships between aspects of human behavior, physical activity, and overall health. Although wearable devices for estimating energy expenditure are becoming increasingly popular, there is little evidence regarding their validity. This study was performed to examine the validity of total energy expenditure estimates made by several wearable devices compared with gold standard measurements for a standardized day (metabolic chamber method) and free-living days (doubly labeled water [DLW] method).", "links": [ { "caption": "URL", "url": "http://archinte.jamanetwork.com/article.aspx?articleID=2500062", "newWindow": true } ] }, { "title": "Wearable Devices and Smartphones for Activity Tracking Among People with Serious Mental Illness.", "author": "Naslund, J.A., Aschbrenner, K.A. and Bartels, S.J.\t", "year": "2016", "journalProceedings": "Mental Health and Physical Activity", "category": "Usability", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "NA", "abstract": "INTRODUCTION: People with serious mental illness, including schizophrenia spectrum and mood disorders, are more physically inactive than people from the general population. Emerging wearable devices and smartphone applications afford opportunities for promoting physical activity in this group. This exploratory mixed methods study obtained feedback from participants with serious mental illness to assess the acceptability of using wearable devices and smartphones to support a lifestyle intervention targeting weight loss.\n\nMETHODS: Participants with serious mental illness and obesity enrolled in a 6-month lifestyle intervention were given Fitbit activity tracking devices and smartphones to use for the study. Participants completed quantitative post-intervention usability and satisfaction surveys, and provided qualitative feedback regarding acceptability of using these devices and recommendations for improvement through in-depth interviews.\n\nRESULTS: Eleven participants wore Fitbits for an average of 84.7% (SD=18.1%) of the days enrolled in the study (median=93.8% of the days enrolled, interquartile range=83.6-94.3%). Participants were highly satisfied, stating that the devices encouraged them to be more physically active and were useful for self-monitoring physical activity and reaching daily step goals. Some participants experienced challenges using the companion mobile application on the smartphone, and recommended greater technical support, more detailed training, and group tutorials prior to using the devices.\n\nDISCUSSION: Participants' perspectives highlight the feasibility and acceptability of using commercially available mHealth technologies to support health promotion efforts targeting people with serious mental illness. This study offers valuable insights for informing future research to assess the effectiveness of these devices for improving health outcomes in this high-risk group.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1755296615300223", "newWindow": true } ] }, { "title": "Wearable devices and mobile technologies for supporting behavioral weight loss among people with serious mental illness", "author": "Naslund, J.A., Aschbrenner, K.A., Scherer, E.A., McHugo, G.J., Marsch, L.A. and Bartels, S.J.\t", "year": "2016", "journalProceedings": "Psychiatry Research", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Promoting physical activity is essential for addressing elevated cardiovascular risk and high obesity rates affecting people with serious mental illness. Numerous challenges interfere with exercise participation in this high-risk group including mental health symptoms, low motivation, and limited access to safe and affordable options for physical activity. Wearable devices and mobile health technologies may afford new opportunities for promoting physical activity and supporting behavioral weight loss efforts. This exploratory study examined whether daily step count measured using Fitbit wearable devices was associated with weight loss and improved fitness among individuals with serious mental illness enrolled in a 6-month lifestyle program. Participants (n=34) had a schizophrenia spectrum disorder (23.5%), major depression (50.0%), or bipolar disorder (26.5%), and wore Fitbits most of the days (M=86.2%; SD=18.4%) they were enrolled in the study. At 6-months, higher average daily step count was associated with greater weight loss (F=5.07; df=1,32; p=0.0314), but not improved fitness (F=1.92; df=1,31; p=0.176). These findings demonstrate that encouraging participants with serious mental illness enrolled in lifestyle interventions to collect more steps may contribute to greater weight loss. This suggests that wearable devices may offer a feasible and potentially effective strategy for supporting behavioral weight loss in community mental health settings.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0165178116304322", "newWindow": true } ] }, { "title": "Validity of Consumer-Based Physical Activity Monitors for Specific Activity Types.", "author": "Nelson, M.B., Kaminsky, L.A., Dickin, D.C. and Montoye, A.H.K.\t", "year": "2016", "journalProceedings": "Medicine and Science in Sports and Exercise", "category": "Validation", "devices": "One,Zip,Flex", "population": "Adults", "dataUsed": "Steps,Energy Expenditure", "abstract": "PURPOSE: Consumer-based physical activity (PA) monitors are popular for individual tracking of PA variables. However, current research has not examined how these monitors track energy expenditure (EE) and steps in distinct activities. This study examined the accuracy of the Fitbits One, Zip, and Flex and Jawbone UP24 for estimating EE and steps for specific activities and activity categories.\n\nMETHODS: Thirty subjects completed a structured protocol consisting of three sedentary, four household, and four ambulatory/exercise activities. All subjects began by lying on a bed for 10 min; 10 other activities were performed for 5 min each. Indirect calorimetry (COSMED) and researcher-counted steps were criterion measures for EE and step counts, respectively. The Omron HJ-720IT pedometer was used as a comparison of step count accuracy. EE and steps were compared with criterion measures using the Friedman repeated-measures nonparametric test and mean absolute percent error (MAPE).\n\nRESULTS: All PA monitors predicted EE within 8% of COSMED for sedentary activity but overestimated EE by 16%-40% during ambulatory activity. All monitors except the Fitbit Flex (within 8% of criterion) underestimated EE by 27%-34% during household activity. EE predictions were accompanied with MAPE textgreater10%. For household activity, the Fitbit Flex estimated steps within 10% of researcher-counted steps; all other monitors underestimated steps by 35%-64%. All monitors estimated steps within 4% of researcher-counted steps and displayed MAPE textless10% during ambulatory activity. The Omron underestimated household steps by 74% but was within 1% for ambulatory steps. All monitors severely underestimated EE and steps during cycling.\n\nCONCLUSION: Consumer-based PA monitors should be used cautiously for estimating EE, although they provide accurate measures of steps for structured ambulatory activity, similar to validated pedometers.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2016/08000/Validity_of_Consumer_Based_Physical_Activity.23.aspx", "newWindow": true } ] }, { "title": "Physical activity in acute ischemic stroke patients during hospitalization", "author": "Nozoe, M., Kitamura, Y., Kanai, M., Kubo, H., Mase, K. and Shimada, S.\t", "year": "2016", "journalProceedings": "International Journal of Cardiology", "category": "Measurement", "devices": "One", "population": "Adults", "dataUsed": "Steps,Intensity,Distance", "abstract": "NA", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0167527315305192", "newWindow": true } ] }, { "title": "Evaluating a community-based exercise intervention with adults living with HIV: protocol for an interrupted time series study", "author": "O'Brien, K.K., Bayoumi, A.M., Solomon, P., Tang, A., Murzin, K., Chan Carusone, S., Zobeiry, M., Nayar, A. and Davis, A.M.", "year": "2016", "journalProceedings": "BMJ Open", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance", "abstract": "Introduction: Our aim was to evaluate a community-based exercise (CBE) intervention with the goal of reducing disability and enhancing health for community-dwelling people living with HIV (PLWH).\nMethods and analysis: We will use a mixed-methods implementation science study design, including a prospective longitudinal interrupted time series study, to evaluate a CBE intervention with PLWH in Toronto, Canada. We will recruit PLWH who consider themselves medically stable and safe to participate in exercise. In the baseline phase (0-8 months), participants will be monitored bimonthly. In the intervention phase (8-14 months), participants will take part in a 24-week CBE intervention that includes aerobic, resistance, balance and flexibility exercise at the YMCA 3 times per week, with weekly supervision by a fitness instructor, and monthly educational sessions. In the follow-up phase (14-22 months), participants will be encouraged to continue to engage in unsupervised exercise 3 times per week. Quantitative assessment: We will assess cardiopulmonary fitness, strength, weight, body composition and flexibility outcomes followed by the administration of self-reported questionnaires to assess disability and contextual factor outcomes (coping, mastery, stigma, social support) bimonthly. We will use time series regression analysis to determine the level and trend of outcomes across each phase in relation to the intervention. Qualitative assessment: We will conduct a series of face-to-face interviews with a subsample of participants and recreation providers at initiation, midpoint and completion of the 24-week CBE intervention. We will explore experiences and anticipated benefits with exercise, perceived impact of CBE for PLWH and the strengths and challenges of implementing a CBE intervention. Interviews will be audio recorded and analysed thematically.", "links": [ { "caption": "URL", "url": "http://bmjopen.bmj.com/content/6/10/e013618.abstract", "newWindow": true } ] }, { "title": "These Shoes Are Made for Walking: Sensitivity Performance Evaluation of Commercial Activity Monitors under the Expected Conditions and Circumstances Required to Achieve the International Daily Step Goal of 10,000 Steps.", "author": "O'Connell, S., ÓLaighin, G., Kelly, L., Murphy, E., Beirne, S., Burke, N., Kilgannon, O. and Quinlan, L.R.\t", "year": "2016", "journalProceedings": "PLOS ONE", "category": "Validation", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "INTRODUCTION: Physical activity is a vitally important part of a healthy lifestyle, and is of major benefit to both physical and mental health. A daily step count of 10,000 steps is recommended globally to achieve an appropriate level of physical activity. Accurate quantification of physical activity during conditions reflecting those needed to achieve the recommended daily step count of 10,000 steps is essential. As such, we aimed to assess four commercial activity monitors for their sensitivity/accuracy in a prescribed walking route that reflects a range of surfaces that would typically be used to achieve the recommended daily step count, in two types of footwear expected to be used throughout the day when aiming to achieve the recommended daily step count, and in a timeframe required to do so.\n\nMETHODS: Four commercial activity monitors were worn simultaneously by participants (n = 15) during a prescribed walking route reflective of surfaces typically encountered while achieving the daily recommended 10,000 steps. Activity monitors tested were the Garmin Vivofit ™, New Lifestyles' NL-2000 ™ pedometer, Withings Smart Activity Monitor Tracker (Pulse O2) ™, and Fitbit One ™.\n\nRESULTS: All activity monitors tested were accurate in their step detection over the variety of different surfaces tested (natural lawn grass, gravel, ceramic tile, tarmacadam/asphalt, linoleum), when wearing both running shoes and hard-soled dress shoes.\n\nCONCLUSION: All activity monitors tested were accurate in their step detection sensitivity and are valid monitors for physical activity quantification over the variety of different surfaces tested, when wearing both running shoes and hard-soled dress shoes, and over a timeframe necessary for accumulating the recommended daily step count of 10,000 steps. However, it is important to consider the accuracy of activity monitors, particularly when physical activity in the form of stepping activities is prescribed as an intervention in the treatment or prevention of a disease state.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864247/", "newWindow": true } ] }, { "title": "Workstations To Increase Workplace Physical Activity And Reduce Sitting Time", "author": "Olenick, A., Jason, C., Schafer, M.A., Battogtokh, Z., Lyons, S.T., Brown, J. and Falls, D.\t", "year": "2016", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Intervention", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "There is growing evidence prolonged workplace sitting is associated with multiple health risks. Utilizing static and active workstations may increase daily workplace physical activity and reduce workplace-sitting time.\nPURPOSE: The purpose of study was to determine if access to both static and active workstations could increase workplace physical activity and decrease sitting time.\n\nMETHODS: Participants (N=15) were assigned to an experimental (sit-stand workstation and shared treadmill desk; n=8) or control group (n=7) for seven weeks. The International Physical Activity Questionnaire long form was administered at baseline and at the end of the study to assess workplace physical activity and sitting time. Participants wore an activity tracker (Fitbit One) to objectively assess daily footsteps and physically active hours. A mixed between-within subject analysis of variance was used to compare the groups (alpha: p textless .05).\n\nRESULTS: There were no statistically significant between group differences in the dependent variables.\n\nCONCLUSIONS: This is the first study to examine the use of static and active workstations to increase workplace physical activity and reduce sitting time. Workday sitting decreased 61% in the experimental group, while increasing 8.3% in the control group. Although only half of the experimental group participants used the shared treadmill desk, the mean number of footsteps taken (8897.25) was well above the recommended 5000 steps/day. Because no attempt was made to motivate or promote use of the equipment in any way, a health education component may be needed, along with a larger sample size to attain more significant increases in workplace physical activity and reductions in sitting time.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Citation/2016/05001/Workstations_To_Increase_Workplace_Physical.403.aspx", "newWindow": true } ] }, { "title": "ActiviTeen: A Protocol for Deployment of a Consumer Wearable Device in an Academic Setting", "author": "Ortiz, A.M., Tueller, S.J., Cook, S.L. and Furberg, R.D.\t", "year": "2016", "journalProceedings": "JMIR Research Protocols", "category": "Methods", "devices": "Zip", "population": "Adolescents", "dataUsed": "Steps,Intensity", "abstract": "Background: Regular physical activity (PA) can be an important indicator of health across an individual's life span. Consumer wearables, such as Fitbit or Jawbone, are becoming increasingly popular to track PA. With the increased adoption of activity trackers comes the increased generation of valuable individual-based data. Generated data has the potential to provide detailed insights into the user's behavior and lifestyle.\nObjective: The primary objective of the described study is to evaluate the feasibility of individual data collection from the selected consumer wearable device (the Fitbit Zip). The rate of user attrition and barriers preventing the use of consumer wearable devices will also be evaluated as secondary objectives.\n\nMethods: The pilot study will occur in two stages and employs a long-term review and analysis with a convenience sample of 30 students attending Research Triangle High School. For the first stage, students will initially be asked to wear the Fitbit Zip over the course of 4 weeks. During which time, their activity data and step count will be collected. Students will also be asked to complete a self-administered survey at the beginning and conclusion of the first stage. The second stage will continue to collect students' activity data and step count over an additional 3-month period. Results: We are anticipating results for this study by the end of 2016.\n\nConclusion: This study will provide insight into the data collection procedures surrounding consumer wearable devices and could serve as the future foundation for other studies deploying consumer wearable devices in educational settings.", "links": [ { "caption": "URL", "url": "http://www.researchprotocols.org/2016/3/e153/", "newWindow": true } ] }, { "title": "A Comparison Study Of The Fitbit Activity Monitor And PSG For Assessing Sleep Patterns And Movement In Children", "author": "Osterbauer, B., Koempel, J.A., Davidson Ward, S.L., Fisher, L.M. and Don, D.M.", "year": "2016", "journalProceedings": "Journal of Otolaryngology Advances", "category": "Validation", "devices": "Flex", "population": "Children", "dataUsed": "Sleep", "abstract": "BACKGROUND: Despite its expense, labor and intrusiveness, polysomnography (PSG) is the gold standard for diagnosing obstructive sleep apnea (OSA). Recently, commercially available electronic activity monitors, such as Fitbit, have become widely accepted and can provide an estimate of sleep patterns for screening children with possible OSA. A previous study demonstrated Fitbit to be valid compared to PSG in adults. To date, these devices have not been extensively utilized for research in children with sleep disordered breathing (SDB). \n\nOBJECTIVE: To evaluate the validity of the Fitbit activity monitor compared to PSG in children and adolescents with SDB.\n\nMETHODS: Data was collected from 14 children, ages 3 through 11, who were scheduled for a PSG during the study period. Fitbit was worn concurrently during the night of the PSG. Analyses were performed by comparing total sleep time, number of awakenings, sleep efficiency and wake after sleep onset (WASO) Fitbit parameters with the corresponding parameters measured by PSG using Spearman’s rho. Fitbit movement epochs were also compared to PSG epochs showing movement behavior.\n\nRESULTS: Pilot data suggest that Fitbit demonstrates a high sensitivity for sleep, a low specificity for wake and a trend suggesting good association of movement measurements.\n\nCONCLUSION: Although Fitbit is not as accurate as PSG for determining wakefulness, it may be a useful screening device to assess gross sleep quality in children. Further studies are indicated to validate these findings.", "links": [ { "caption": "URL", "url": "http://www.openaccesspub.org/journals/joa/view-article.php?art_id=251&jid=64", "newWindow": true } ] }, { "title": "Using High-Tech and High-Touch Methods for Effective Population Health Management", "author": "Padarthy, S., Crespo, C., Rich, K. and Srivatsan, N.\t", "year": "2016", "journalProceedings": "Iproceedings", "category": "Medical,Measurement", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Healthcare consumers today are more engaged and empowered than ever before. Social, mobile, and in-home self-monitoring tools now enable health consumers to manage their health conditions and receive advice, support, and care without leaving home. Consumers are increasingly buying biometric devices such the Fitbit and Apple Watch to monitor their health. Many payers and employers are providing fitness devices to encourage consumers to be healthy, often offering discounts to their healthcare premiums. These devices create a sense of euphoria initially, but they do not yield sustainable health results and necessary behavioral changes in consumers to sustain it in the long-term. According to BJ Fogg, Stanford professor, sustainable behavior change (B) is a function of the motivation of the individual (M) × ability of the individual to do the task (A) × Trigger (T); B=MAT. Objective: Our hypothesis was that self-managed digital triggers alone would not yield sustainable change, but a combination of digital biometrics devices that automatically monitor health supplemented by weekly contact with a health coach would deliver sustainable changes to consumer behavior. Methods: During the 6-month pilot in 2014 and 12-month program in 2015, Cognizant wanted to test this hypothesis by providing appropriate triggers to motivate individuals to achieve their goals and ensure sustainable change in behavior. We provided Fitbit devices to participants and shared their digital information with our health coach. The coach worked with the individuals in setting individual goals, reviewed their progress, and helped with better food and exercise choices. The coach also used gamification to motivate the group into friendly competitions. Results: At the end of the pilot, participants averaged 70,000 steps per week. This was well above the average US baseline of 36,000 steps and Fitbit average of 42,000 steps. Pilot participants also lost over an average of 10 pounds each. However, during the pilot we determined coaching needed more focus on incremental, sustainable goals to lead toward long-term behavior changes. During a 6 month period between the pilot ending and the 2015 program initiation where pilot participants did not have access to a coach, participants' activity level decreased, and weight lost during the pilot was gained back. During the 2015 program, participants sustained on average 66,000 steps per week (well above both the US and Fitbit average). Obese 1 participants normalized steps at 70,000 per week and increased activity from baseline almost 30%. This group started at the very bottom of “Somewhat Active” and transitioned into the “Active” category. Obese 2 participants normalized steps at 60,000 per week and increased activity from baseline almost 33%, which transitioned them from “Low Active” to “Somewhat Active.” This was the largest increase by any group from baseline. Our control group, who did not have access to coaches, averaged only 43,000 steps per week. Conclusions: Coach influence and participant change is most effective in the first 6 months. After that, coaches concentrate on incrementally increasing activity in a sustainable manner. Effective population health management and high value personalized services can be achieved by weight loss from increasing physical activity and better food choices brought about by direct consumer engagement that combines “high tech” with “high touch.” [iproc 2016;2(1):e17]", "links": [ { "caption": "URL", "url": "http://www.iproc.org/2016/1/e17/", "newWindow": true } ] }, { "title": "Retrofit Weight-Loss Outcomes at 6, 12, and 24 Months and Characteristics of 12-Month High Performers: A Retrospective Analysis", "author": "Painter, S., Ditsch, G., Ahmed, R., Hanson, N.B., Kachin, K. and Berger, J.\t", "year": "2016", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "One,Aria", "population": "Adults", "dataUsed": "Weight", "abstract": "Background: Obesity is the leading cause of preventable death costing the health care system billions of dollars. Combining self-monitoring technology with personalized behavior change strategies results in clinically significant weight loss. However, there is a lack of real-world outcomes in commercial weight-loss program research.\n\nObjective: Retrofit is a personalized weight management and disease-prevention solution. This study aimed to report Retrofit’s weight-loss outcomes at 6, 12, and 24 months and characterize behaviors, age, and sex of high-performing participants who achieved weight loss of 10% or greater at 12 months.\n\nMethods: A retrospective analysis was performed from 2011 to 2014 using 2720 participants enrolled in a Retrofit weight-loss program. Participants had a starting body mass index (BMI) of >25 kg/m² and were at least 18 years of age. Weight measurements were assessed at 6, 12, and 24 months in the program to evaluate change in body weight, BMI, and percentage of participants who achieved 5% or greater weight loss. A secondary analysis characterized high-performing participants who lost =10% of their starting weight (n=238). Characterized behaviors were evaluated, including self-monitoring through weigh-ins, number of days wearing an activity tracker, daily step count average, and engagement through coaching conversations via Web-based messages, and number of coaching sessions attended.\n\nResults: Average weight loss at 6 months was -5.55% for male and -4.86% for female participants. Male and female participants had an average weight loss of -6.28% and -5.37% at 12 months, respectively. Average weight loss at 24 months was -5.03% and -3.15% for males and females, respectively. Behaviors of high-performing participants were assessed at 12 months. Number of weigh-ins were greater in high-performing male (197.3 times vs 165.4 times, P=.001) and female participants (222 times vs 167 times, P<.001) compared with remaining participants. Total activity tracker days and average steps per day were greater in high-performing females (304.7 vs 266.6 days, P<.001; 8380.9 vs 7059.7 steps, P<.001, respectively) and males (297.1 vs 255.3 days, P<.001; 9099.3 vs 8251.4 steps, P=.008, respectively). High-performing female participants had significantly more coaching conversations via Web-based messages than remaining female participants (341.4 vs 301.1, P=.03), as well as more days with at least one such electronic message (118 vs 108 days, P=.03). High-performing male participants displayed similar behavior.\n\nConclusions: Participants on the Retrofit program lost an average of -5.21% at 6 months, -5.83% at 12 months, and -4.09% at 24 months. High-performing participants show greater adherence to self-monitoring behaviors of weighing in, number of days wearing an activity tracker, and average number of steps per day. Female high performers have higher coaching engagement through conversation days and total number of coaching conversations.", "links": [ { "caption": "URL", "url": "http://mhealth.jmir.org/2016/3/e101/", "newWindow": true } ] }, { "title": "Smartwomantm: Feasibility of a Mobile Application to Improve Cardiovascular Risk Factors in Indigent Diabetic Women", "author": "Parashar, S., Williams, O. and Wenger, N.\t", "year": "2016", "journalProceedings": "Circulation: Cardiovascular Quality and Outcomes", "category": "Usability", "devices": null, "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Introduction: Cardiovascular disease disparately affects women with diabetes mellitus. Among women with diabetes, cardiovascular disease prevention, including risk factor monitoring and lifestyle modification is important but underutilized. Mobile health strategies are emerging communication technologies to improve self management and health behaviours. However, the feasibility of mobile health technology (m-health) to enhance health behaviors in an indigent population is unknown. We developed and examined the feasibility of m-health to improve health behaviors and self-management regarding coronary risk factors in indigent women with diabetes. \n\nMethods: We developed a smartphone application based on the AHA's “Life's Simple 7” prevention module. Mobile technology was integrated into the overall program, with communication enabled devices (weight scales, glucometers, and sphygmomanometers) synchronized to the smartphone. FitBit was used to monitor activity level. We tested the feasibility of the mobile application in the SMARTWOMANTM project which enrolled women with diabetes, without known CVD at an inner city hospital;,these women had suboptimal access to care, limited transportation and resources, and limited health literacy. \n\nResults: Fourteen women, all African-American were enrolled in SMARTWOMANTM (mean age 52 yrs, 86% with hypertension, hypercholesterolemia and obesity). The overall weekly mobile-application reporting was 85% for blood glucose, 83% for daily steps, and 77% for systolic blood pressure. The majority reported the text messages to be useful (92%) and appropriate in frequency (92%). Participants found positive text messages as a strong reinforcement to healthy behaviors. They indicated that study participation increased their motivation in taking charge of their health, and increased understanding of their health condition and self-management. \n\nConclusions: Among indigent African-American women with diabetes and no known CVD, the development and use of mobile health application was feasible and resulted in increased patient satisfaction and positive reinforcement to healthy behaviors.", "links": [ { "caption": "URL", "url": "http://circoutcomes.ahajournals.org/content/9/Suppl_2/A245.short", "newWindow": true } ] }, { "title": "Long-Term Objective Physical Activity Measurements using a Wireless Accelerometer Following Minimally Invasive Transforaminal Interbody Fusion Surgery", "author": "Phan, K., Phan, K. and Mobbs, R.J.\t", "year": "2016", "journalProceedings": "Asian Spine Journal", "category": "Case Study", "devices": null, "population": "Patients,Adults", "dataUsed": "Steps,Distance", "abstract": "We report on a case of a patient who underwent minimally invasive transforaminal lumbar interbody fusion (mi-TLIF) with objective physical activity measurements performed preoperatively and postoperatively at up to 12-months using wireless accelerometer technology. In the first postoperative month following surgery, the patient had reduced mobility, taking 2,397 steps over a distance of 1.8 km per day. However, the number of steps taken and distance travelled per day had returned to baseline levels by the second postoperative month. At one-year follow-up, the patient averaged 5,095 steps per day in the month over a distance of 3.8 km; this was a 60% improvement in both steps taken and distance travelled compared to the preoperative status. The use of wireless accelerometers is feasible in obtaining objective physical activity measurements before and after lumbar interbody fusion and may be applicable to other related spinal surgeries as well.", "links": [ { "caption": "URL", "url": "http://synapse.koreamed.org/DOIx.php?id=10.4184/asj.2016.10.2.366", "newWindow": true } ] }, { "title": "Intrinsic rewards predict exercise via behavioral intentions for initiators but via habit strength for maintainers", "author": "Phillips, L.A., Chamberland, P.-É., Hekler, E.B., Abrams, J. and Eisenberg, M.H.\t", "year": "2016", "journalProceedings": "Sport, Exercise, and Performance Psychology", "category": "Measurement", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Regular exercise is thought to involve both reflective (e.g., intention) and automatic (e.g., habit) mechanisms. Intrinsic motivation is a reflective factor in exercise initiation; we propose that the experience of intrinsic exercise rewards (enjoyment; stress reduction) may come to function as a factor in exercise automaticity, or habit, and therefore of exercise maintenance. The current studies evaluate whether the relationship between intrinsic exercise rewards and exercise is mediated by behavioral intention for those newer to exercise (initiators) but mediated by behavioral habit strength for longer term exercisers (maintainers). In 2 studies, self-reported exercise stage (initiation vs. maintenance), intrinsic exercise rewards, intentions, and habit strength were measured at baseline. For outcomes, Study 1 concurrently assessed self-reported exercise in a large sample of U.S. college students (n = 463), and Study 2 prospectively assessed objective activity using accelerometers for 1 month in a U.S. college student and staff population (n = 114). Moderated mediation analyses resulted in support of the hypotheses: Habit strength significantly mediated the relationship between intrinsic rewards and exercise for maintainers in Studies 1 and 2 (unstandardized indirect effect = 7.66 and 0.04, respectively; p < .05) but less strongly for initiators in Study 1 and not at all for initiators in Study 2. Intentions mediated the relationship for initiators (unstandardized indirect effect = 0.94 and 0.02, respectively; p < .05) but not for maintainers, as expected. We concluded that intrinsic rewards may promote exercise repetition via intentional or reflective means in initiation but via habit strength in maintenance. Interventions that foster intrinsic exercise rewards may promote exercise maintenance through habitual action. (PsycINFO Database Record (c) 2016 APA, all rights reserved)", "links": [ { "caption": "URL", "url": "http://psycnet.apa.org/?&fa=main.doiLanding&doi=10.1037/spy0000071", "newWindow": true } ] }, { "title": "Self-management of chronic illness: the role of 'habit' versus reflective factors in exercise and medication adherence.", "author": "Phillips, L.A., Cohen, J., Burns, E., Abrams, J. and Renninger, S.\t", "year": "2016", "journalProceedings": "Journal of Behavioral Medicine", "category": "Measurement", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Non-adherence to health behaviors required for chronic illness self-management is pervasive. Advancing health-behavior theory to include behavioral initiation and maintenance factors, including reflective (e.g., belief- and feedback-based) and automatic (e.g., habit-based) mechanisms of adherence to different treatment-related behaviors could improve non-adherence prediction and intervention efforts. To test behavioral initiation and maintenance factors from an extended common sense self-regulation theoretical framework for predicting medication adherence and physical activity among patients with Type 2 diabetes. Patients (n = 133) in an in-person (n = 80) or online (n = 53) version of the study reported treatment-related (1) barriers, (2) beliefs and experiential feedback (reflective mechanisms of treatment-initiation and short-term repetition), and (3) habit strength (automatic mechanism of treatment-maintenance) for taking medication and engaging in regular physical activity at baseline. Behaviors were assessed via self-reports (n = 133) and objectively (electronic monitoring pill bottles, accelerometers; n = 80) in the subsequent month. Treatment-specific barriers and habit strength predicted self-reported and objective adherence for both behaviors. Beliefs were inconsistently related to behavior, even when habits were \"weak\". Experiential feedback from behavior was not related to adherence. Among patients with Type 2 diabetes diagnosis, medication and physical activity adherence were better predicted by their degree of automatic behavioral repetition than their beliefs/experiences with the treatment-actions. Habit strength should be an intervention target for chronic illness self-management; assessing it in practice settings may effectively detect non-adherence to existing treatment-regimens. However, future research and further refining of CS-SRM theory regarding the processes required for such habit development are needed.", "links": [ { "caption": "URL", "url": "http://link.springer.com/article/10.1007%2Fs10865-016-9732-z", "newWindow": true } ] }, { "title": "Exploring Path Models of Disablement in Residential Care and Assisted Living Residents", "author": "Phillips, L.J., Petroski, G.F., Conn, V.S., Brown, M., Leary, E., Teri, L. and Zimmerman, S.\t", "year": "2016", "journalProceedings": "Journal of Applied Gerontology", "category": "Measurement", "devices": "Classic", "population": "Older Adults", "dataUsed": "Steps", "abstract": "This study examined the relationships between individual and environmental factors and physical activity, and between physical activity and functional limitations and disability in residential care/assisted living (RC/AL) residents. Participants completed questionnaires and physical performance tests, and wore the Fitbit Motion Tracker® to capture physical activity. Model fit was analyzed using two-level path models with residents nested within RC/AL settings. Model parameters were estimated using the MPlus robust maximum likelihood method. A multilevel model with good fit (root mean square error of approximation = 0.07, comparative fit index [CFI] = 0.91) showed that persons with greater exercise self-efficacy were more physically active, and persons who were more physically active had better physical function and less disability. Setting-level factors did not significantly correlate with physical activity or disability. Although environmental factors may influence physical activity behavior, only individual factors were associated with physical activity in this sample of RC/AL residents.", "links": [] }, { "title": "Adherent Use of Digital Health Trackers Is Associated with Weight Loss", "author": "Pourzanjani, A., Quisel, T. and Foschini, L.\t", "year": "2016", "journalProceedings": "PLOS ONE", "category": "Measurement", "devices": null, "population": "Adults", "dataUsed": "Steps,Weight,Food", "abstract": "We study the association between weight fluctuation and activity tracking in an on-line population of thousands of individuals using digital health trackers (1,749 = N = 14,411, depending on the activity tracker considered) with millions of recorded activities (119,292 = N = 2,221,382) over the years 2013–2015. In a first between-subject analysis, we found a positive association between activity tracking frequency and weight loss. Users who log food with moderate frequency lost an additional 0.63% (CI [0.55, 0.72]; p < .001) of their body weight per month relative to low frequency loggers. Frequent workout loggers lost an additional 0.38% (CI [0.20, 0.56]; p < .001) and frequent weight loggers lost an additional 0.40% (CI [0.33, 0.47]; p < .001) as compared to infrequent loggers. In a subsequent within-subject analysis on a subset of the population (799 = N = 6,052) with sufficient longitudinal data, we used fixed effect models to explore the temporal relationship between a change in tracking adherence and weight change. We found that for the same individual, weight loss is significantly higher during periods of high adherence to tracking vs. periods of low adherence: +2.74% of body weight lost per month (CI [2.68, 2.81]; p < .001) during adherent weight tracking, +1.35% per month (CI [1.26, 1.43]; p < .001) during adherent food tracking, and +0.60% per month (CI [0.44, 0.76]; p < .001) during adherent workout tracking. The findings suggest that adherence to activity tracking can be utilized as a convenient real-time predictor of weight fluctuations, enabling large-scale, personalized intervention strategies.", "links": [ { "caption": "URL", "url": "http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152504", "newWindow": true } ] }, { "title": "Validation of the Fitbit One, Garmin Vivofit and Jawbone UP activity tracker in estimation of energy expenditure during treadmill walking and running", "author": "Price, K., Bird, S.R., Lythgo, N., Raj, I.S., Wong, J.Y.L. and Lynch, C.\t", "year": "2016", "journalProceedings": "Journal of Medical Engineering & Technology", "category": "Validation", "devices": "One", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "Objectives: To determine the validity of energy expenditure estimation made by the Fitbit One, Garmin Vivofit and Jawbone UP activity trackers during treadmill walking and running. Determining validity of such trackers will inform the interpretation of the data they generate.\n\nDesign: Cross-sectional study.\n\nMethod: Fourteen adults walked at 0.70, 1.25, 1.80?ms-1 and ran at 2.22, 2.78, 3.33?ms-1 on a treadmill wearing a Fitbit One, Garmin Vivofit and Jawbone UP. Estimation of energy expenditure from each tracker was compared to measurement from indirect calorimetry (criterion). Paired t-tests, correlation coefficients and Bland–Altman plots assessed agreement and proportional bias. Mean percentage difference assessed magnitude of difference between estimated and criterion energy expenditure for each speed.\n\nResults: Energy expenditure estimates from the Fitbit One and Garmin Vivofit correlated significantly (p7h). Taste perception measures included sweet and salt detection thresholds (ascending 3-alternative, forced-choice method), as well as sweet preference (Monell 2-series, forced-choice, paired-comparison, tracking method). Steps and sleep were tracked via FitBit, an activity monitoring device. Dietary intake was assessed using 24-hour recalls and analyzed using Nutritionist Pro. Habitual long-sleepers had a higher sweet taste preference (p=0.042) and took fewer steps (p=0.036) following sleep curtailment compared to the night where they slept >7h but did not experience changes in dietary intake or detection thresholds. Habitual short-sleepers did not experience changes in taste perception, activity, or dietary intake following sleep alteration. Habitual long-sleepers may be at greater risk of gaining weight when typical sleep patterns are disrupted.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0031938416302141", "newWindow": true } ] }, { "title": "Incorporation of a Physical Education and Nutrition Program Into Neurosurgery: A Proof of Concept Pilot Program.", "author": "Spiotta, A.M., Fargen, K.M., Denham, S.L., Fulton, M.E., Kellogg, R., Young, E., Patel, S. and Turner, R.D.\t", "year": "2016", "journalProceedings": "Neurosurgery", "category": "Measurement", "devices": "Surge", "population": "Adults", "dataUsed": "Sleep,Heart Rate", "abstract": "BACKGROUND: Balancing the demands of a busy medical career with personal wellness can be daunting, and there is little education on these principles available to physicians in training.\n\nOBJECTIVE: To implement a voluntary wellness initiative in our neurosurgery department to promote healthy lifestyle choices. This report details the baseline data collected as part of this quality improvement initiative.\n\nMETHODS: The wellness initiative was implemented in July 2015 and available to all faculty and resident physicians in the Department of Neurological Surgery in collaboration with the Medical University of South Carolina Wellness Center. All participants were provided a Fitbit Surge HR wrist monitor (Fitbit, Boston, Massachusetts) and underwent baseline physical and psychological testing.\n\nRESULTS: Six faculty physicians and 9 residents participated. Overall physical fitness levels varied widely between subjects. Health screening demonstrated abnormalities in 80% of participants (elevated systolic blood pressure in 60%, elevated diastolic in 47%, elevated serum low-density lipoprotein in 53%). Body composition analysis demonstrated body weight higher than ideal in 69% (47% overweight; 13% obese). Recommended average body fat mass reduction was 25.4 pounds. Seventy-nine percent reported below-average quality of life compared with the average healthy adult. All subjects reported wanting more time for personal health.\n\nCONCLUSION: Baseline health and psychological screenings in our department demonstrated alarmingly prevalent, previously undiagnosed abnormalities on cardiovascular and body weight screenings. Obstacles to leading a healthier lifestyle have been identified and solutions have been incorporated into the program. This quality improvement initiative may serve as a template for other programs seeking to improve physician physical and mental well-being.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/neurosurgery/pages/articleviewer.aspx?year=9000&issue=00000&article=97299&type=abstract", "newWindow": true } ] }, { "title": "Piece it Together: Comprehensive Wellness for Teens and Young Adults with Autism and Neurodevelopment Disorders", "author": "Spratt, E.G., Flynn, K., Newton, J., Papa, C., Harris, K., Serpe, A., O'Connor, A., Blackmon, L. and Eckert, M.\t", "year": "2016", "journalProceedings": "Journal of the American Academy of Child & Adolescent Psychiatry", "category": "Intervention,Measurement", "devices": "Charge", "population": "Adults,Adolescents", "dataUsed": "Steps", "abstract": "Objectives: Adults and youth with neurodevelopmental disabilities are at increased risk of poor health and obesity as a result of restricted diets, sensory deficits, limited interests, sedentary lifestyles, and medications. Traditional fitness programs do not address socialization and stress reduction strategies that help to promote the likelihood of success with individualized goals for this unique population.\n\nMethods: A 6-week summer Piece it Together (PIT) Wellness program (2015) brought together teenagers and young adults with ASD and other mild neurodevelopmental disabilities for a comprehensive wellness program to improve fitness, nutritional habits, and socialization; reduce stress; and encourage individuals to get out of their comfort zone. Classes included opportunities for socialization, fitness activities, group exercise, stress reduction, yoga, mindfulness, and discussion groups on lessons learned. Assessments were completed before and after session for 12 youth (ages 15–27) via Patient Health Questionnaire-9 depression scale, nutrition and lifestyle questionnaires, a self-satisfaction scale, and InBody 570 Analyzer©2014.\n\nResults: Appropriate individualized goals were made, new friendships were made, a Facebook group was established, and most became online Fitbit buddies. Average PHQ-9 depression scores decreased from 7.67 to 3.42 (from mild to minimal depression; P = 0.000063). Self-report data revealed more fruits and veggies in the diet at time 2 (t = 2.39, P = 0.038) and modest improvement in self-efficacy-related questions (e.g., I like the way I look/I am a good worker/I have good friends; t = 2.46, P = 0.032). There was a small decrease in body fat, an increase in skeletal muscle mass, and a decrease in carbonated drink consumption (P = not significant). Volunteers have included health professional students, and this has enhanced their knowledge about youth with ASD. Results of the 2016 summer program, which includes twice the number of participants, pre- and post behavioral markers, and biological markers, as well as the success of technology supports, will be shared.\n\nConclusions: Comprehensive wellness programs with a multidisciplinary team can help to address the unique fitness, nutrition, socialization, and stress reduction needs of this population and are needed to help prevent obesity. Components of this program have been individualized and adapted as a model to promote overall brain health.", "links": [ { "caption": "URL", "url": "http://www.jaacap.com/article/S0890-8567(16)31265-5/fulltext", "newWindow": true } ] }, { "title": "Unsupervised Detection and Analysis of Changes in Everyday Physical Activity Data", "author": "Sprint, G., Cook, D.J. and Schmitter-Edgecombe, M.\t", "year": "2016", "journalProceedings": "Journal of Biomedical Informatics", "category": "Methods", "devices": "Flex", "population": "NA", "dataUsed": "Steps", "abstract": "Sensor-based time series data can be utilized to monitor changes in human behavior as a person makes a significant lifestyle change, such as progress toward a fitness goal. Recently, wearable sensors have increased in popularity as people aspire to be more conscientious of their physical health. Automatically detecting and tracking behavior changes from wearable sensor-collected physical activity data can provide a valuable monitoring and motivating tool. In this paper, we formalize the problem of unsupervised physical activity change detection and address the problem with our Physical Activity Change Detection (PACD) approach. PACD is a framework that detects changes between time periods, determines significance of the detected changes, and analyzes the nature of the changes. We compare the abilities of three change detection algorithms from the literature and one proposed algorithm to capture different types of changes as part of PACD. We illustrate and evaluate PACD on synthetic data and using Fitbit data collected from older adults who participated in a health intervention study. Results indicate PACD detects several changes in both datasets. The proposed change algorithms and analysis methods are useful data mining techniques for unsupervised, window-based change detection with potential to track users' physical activity and motivate progress toward their health goals.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1532046416300740", "newWindow": true } ] }, { "title": "The Effects of Spacing, Naps, and Fatigue on the Acquisition and Retention of Laparoscopic Skills.", "author": "Spruit, E.N., Band, G.P.H., van der Heijden, K.B., and Hamming, J.F.", "year": "2016", "journalProceedings": "Journal of Surgical Education", "category": "Measurement", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND Earlier research has shown that laparoscopic skills are trained more efficiently on a spaced schedule compared to a massed schedule. The aim of the study was to estimate to what extent the spacing interval, naps, and fatigue influenced the effectiveness of spacing laparoscopy training. \n\nMETHODS Overall 4 groups of trainees (aged 17-41y; 72% female; Nmassed = 40; Nbreak = 35; Nbreak-nap = 37; Nspaced = 37) without prior experience were trained in 3 laparoscopic tasks using a physical box trainer with different scheduling interventions. The first (massed) group received three 100-minute training sessions consecutively on a single day. The second (break) group received the sessions interrupted with two 45-minute breaks. The third (break-nap) group had the same schedule as the second group, but had two 35-minute powernap intervals during the breaks. The fourth (spaced) group had the 3 sessions on 3 consecutive days. A retention session was organized approximately 3 months after training. \n\nRESULTS The results showed an overall pattern of superior performance at the end of training and at retention for the spaced group, followed by the break-nap, break, and massed group, respectively. The spaced and break-nap group significantly outperformed the break and massed group, with effect sizes ranging from 0.20 to 0.37. \n\nCONCLUSIONS Spacing laparoscopic training over 3 consecutive days or weeks is superior to massed training, even if the massed training contains breaks. Breaks with sleep opportunity (i.e., lying, inactive, and muted sensory input) enhance performance over training with regular breaks and traditional massed training.", "links": [ { "caption": "URL", "url": "http://www.jsurged.org/article/S1931-7204(16)30293-8/abstract", "newWindow": true } ] }, { "title": "How accurate are the wrist-based heart rate monitors during walking and running activities? Are they accurate enough?", "author": "Stahl, S.E., An, H.-S., Dinkel, D.M., Noble, J.M. and Lee, J.-M.\t", "year": "2016", "journalProceedings": "BMJ Open Sport & Exercise Medicine", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Background: Heart rate (HR) monitors are valuable devices for fitness-orientated individuals. There has been a vast influx of optical sensing blood flow monitors claiming to provide accurate HR during physical activities. These monitors are worn on the arm and wrist to detect HR with photoplethysmography (PPG) techniques. Little is known about the validity of these wearable activity trackers.\n\nAim: Validate the Scosche Rhythm (SR), Mio Alpha (MA), Fitbit Charge HR (FH), Basis Peak (BP), Microsoft Band (MB), and TomTom Runner Cardio (TT) wireless HR monitors.\nMethods: 50 volunteers (males: n=32, age 19–43 years; females: n=18, age 19–38 years) participated. All monitors were worn simultaneously in a randomised configuration. The Polar RS400 HR chest strap was the criterion measure. A treadmill protocol of one 30 min bout of continuous walking and running at 3.2, 4.8, 6.4, 8.0, and 9.6 km/h (5 min at each protocol speed) with HR manually recorded every minute was completed.\n\nResults: For group comparisons, the mean absolute percentage error values were: 3.3%, 3.6%, 4.0%, 4.6%, 4.8% and 6.2% for TT, BP, RH, MA, MB and FH, respectively. Pearson product-moment correlation coefficient (r) was observed: r=0.959 (TT), r=0.956 (MB), r=0.954 (BP), r=0.933 (FH), r=0.930 (RH) and r=0.929 (MA). Results from 95% equivalency testing showed monitors were found to be equivalent to those of the criterion HR (±10% equivalence zone: 98.15–119.96).\n\nConclusions: The results demonstrate that the wearable activity trackers provide an accurate measurement of HR during walking and running activities.", "links": [ { "caption": "URL", "url": "http://bmjopensem.bmj.com/content/2/1/e000106.full", "newWindow": true } ] }, { "title": "Validity and Reliability of Fitbit Flex for Step Count, Moderate to Vigorous Physical Activity and Activity Energy Expenditure", "author": "Sushames, A., Edwards, A., Thompson, F., McDermott, R. and Gebel, K.\t", "year": "2016", "journalProceedings": "PLOS ONE", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity", "abstract": "Objectives: To examine the validity and reliability of the Fitbit Flex against direct observation for measuring steps in the laboratory and against the Actigraph for step counts in free-living conditions and for moderate-to-vigorous physical activity (MVPA) and activity energy expenditure (AEE) overall.\n\nMethods: Twenty-five adults (12 females, 13 males) wore a Fitbit Flex and an Actigraph GT3X+ during a laboratory based protocol (including walking, incline walking, running and stepping) and free-living conditions during a single day period to examine measurement of steps, AEE and MVPA. Twenty-four of the participants attended a second session using the same protocol.\n\nResults: Intraclass correlations (ICC) for test-retest reliability of the Fitbit Flex were strong for walking (ICC = 0.57), moderate for stair stepping (ICC = 0.34), and weak for incline walking (ICC = 0.22) and jogging (ICC = 0.26). The Fitbit significantly undercounted walking steps in the laboratory (absolute proportional difference: 21.2%, 95%CI 13.0–29.4%), but it was more accurate, despite slightly over counting, for both jogging (6.4%, 95%CI 3.7–9.0%) and stair stepping (15.5%, 95%CI 10.1–20.9%). The Fitbit had higher coefficients of variation (Cv) for step counts compared to direct observation and the Actigraph. In free-living conditions, the average MVPA minutes were lower in the Fitbit (35.4 minutes) compared to the Actigraph (54.6 minutes), but AEE was greater from the Fitbit (808.1 calories) versus the Actigraph (538.9 calories). The coefficients of variation were similar for AEE for the Actigraph (Cv = 36.0) and Fitbit (Cv = 35.0), but lower in the Actigraph (Cv = 25.5) for MVPA against the Fitbit (Cv = 32.7).\n\nConclusion: The Fitbit Flex has moderate validity for measuring physical activity relative to direct observation and the Actigraph. Test-rest reliability of the Fitbit was dependant on activity type and had greater variation between sessions compared to the Actigraph. Physical activity surveillance studies using the Fitbit Flex should consider the potential effect of measurement reactivity and undercounting of steps.", "links": [ { "caption": "URL", "url": "http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161224", "newWindow": true } ] }, { "title": "Daily & Hourly Adherence: Towards Understanding Activity Tracker Accuracy", "author": "Tang, L.M., Day, M., Engelen, L., Poronnik, P., Bauman, A. and Kay, J.\t", "year": "2016", "journalProceedings": "Proceedings of the 2016 CHI Conference Extended Abstracts on Human Factors in Computing Systems", "category": "Measurement", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "We tackle the important problem of understanding the accuracy of activity tracker data. To do this, we introduce the notions of daily and hourly adherence, key aspects of how consistently people wear trackers. We hypothesise that these measures provide a valuable means to address accuracy problems in population level activity tracking data. To test this, we conducted a semester-long study of 237 University students: 88 Information Technology, 149 Medical Science. We illustrate how our adherence measures provide new ways to interpret data and valuable insights that take account of tracker data accuracy. Finally, we discuss broader roles for daily and hourly adherence measures in activity tracker data.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=2851581.2892438", "newWindow": true } ] }, { "title": "Cardiac Patients' Walking Activity Determined by a Step Counter in Cardiac Telerehabilitation: Data From the Intervention Arm of a Randomized Controlled Trial.", "author": "Thorup, C., Hansen, J., Grønkjær, M., Andreasen, J.J., Nielsen, G., Sørensen, E.E. and Dinesen, B.I.\t", "year": "2016", "journalProceedings": "Journal of Medical Internet Research", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Walking represents a large part of daily physical activity. It reduces both overall and cardiovascular diseases and mortality and is suitable for cardiac patients. A step counter measures walking activity and might be a motivational tool to increase and maintain physical activity. There is a lack of knowledge about both cardiac patients' adherence to step counter use in a cardiac telerehabilitation program and how many steps cardiac patients walk up to 1 year after a cardiac event.\n\nOBJECTIVE: The purpose of this substudy was to explore cardiac patients' walking activity. The walking activity was analyzed in relation to duration of pedometer use to determine correlations between walking activity, demographics, and medical and rehabilitation data.\n\nMETHODS: A total of 64 patients from a randomized controlled telerehabilitation trial (Teledi@log) from Aalborg University Hospital and Hjoerring Hospital, Denmark, from December 2012 to March 2014 were included in this study. Inclusion criteria were patients hospitalized with acute coronary syndrome, heart failure, and coronary artery bypass grafting or valve surgery. In Teledi@log, the patients received telerehabilitation technology and selected one of three telerehabilitation settings: a call center, a community health care center, or a hospital. Monitoring of steps continued for 12 months and a step counter (Fitbit Zip) was used to monitor daily steps.\n\nRESULTS: Cardiac patients walked a mean 5899 (SD 3274) steps per day, increasing from mean 5191 (SD 3198) steps per day in the first week to mean 7890 (SD 2629) steps per day after 1 year. Adherence to step counter use lasted for a mean 160 (SD 100) days. The patients who walked significantly more were younger (P=.01) and continued to use the pedometer for a longer period (P=.04). Furthermore, less physically active patients weighed more. There were no significant differences in mean steps per day for patients in the three rehabilitation settings or in the disease groups.\n\nCONCLUSIONS: This study indicates that cardiac telerehabilitation at a call center can support walking activity just as effectively as telerehabilitation at either a hospital or a health care center. In this study, the patients tended to walk fewer steps per day than cardiac patients in comparable studies, but our study may represent a more realistic picture of walking activity due to the continuation of step counter use. Qualitative studies on patients' behavior and motivation regarding step counter use are needed to shed light on adherence to and motivation to use step counters.", "links": [ { "caption": "URL", "url": "http://www.jmir.org/2016/4/e69/", "newWindow": true } ] }, { "title": "Pedometer use and self-determined motivation for walking in a cardiac telerehabilitation program: a qualitative study", "author": "Thorup, C.B., Grønkjær, M., Spindler, H., Andreasen, J.J., Hansen, J., Dinesen, B.I., Nielsen, G. and Sørensen, E.E.\t", "year": "2016", "journalProceedings": "BMC Sports Science, Medicine and Rehabilitation", "category": "Measurement", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Exercise-based cardiac rehabilitation reduces morbidity and mortality. Walking is a convenient activity suitable for people with cardiac disease. Pedometers count steps, measure walking activity and motivate people to increase physical activity. In this study, patients participating in cardiac telerehabilitation were provided with a pedometer to support motivation for physical activity with the purpose of exploring pedometer use and self-determined motivation for walking experienced by patients and health professionals during a cardiac telerehabilitation program. A qualitative research design consisting of observations, individual interviews and patient documents made the basis for a content analysis. Data was analysed deductively using Self Determination Theory as a frame for analysis and discussion, focusing on the psychological needs of autonomy, competence and relatedness. Twelve cardiac patients, 11 health professionals, 6 physiotherapists and 5 registered nurses were included. The pedometer offered independence from standardised rehabilitation since the pedometer supported tailoring, individualised walking activity based on the patient's choice. This led to an increased autonomy. The patients felt consciously aware of health benefits of walking, and the pedometer provided feedback on walking activity leading to an increased competence to achieve goals for steps. Finally, the pedometer supported relatedness with others. The health professionals' surveillance of patients' steps, made the patients feel observed, yet supported, furthermore, their next of kin appeared to be supportive as walking partners. Cardiac patients' motivation for walking was evident due to pedometer use. Even though not all aspects of motivation were autonomous and self determined, the patients felt motivated for walking. The visible steps and continuous monitoring of own walking activity made it possible for each individual patient to choose their desired kind of activity and perform ongoing adjustments of walking activity. The immediate feedback on step activity and the expectations of health benefits resulted in motivation for walking. Finally, pedometer supported walking made surveillance possible, giving the patients a feeling of being looked after and supported. Current study is a part of The Teledi@log project.", "links": [ { "caption": "URL", "url": "http://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-016-0048-7", "newWindow": true } ] }, { "title": "Health coaching and pedometers to enhance physical activity and prevent falls in community-dwelling people aged 60 years and over: study protocol for the Coaching for Healthy AGEing (CHAnGE) cluster randomised controlled trial", "author": "Tiedemann, A., Rissel, C., Howard, K., Tong, A., Merom, D., Smith, S., Wickham, J., Bauman, A., Lord, S.R., Vogler, C., Lindley, R.I., Simpson, J.M., Allman-Farinelli, M. and Sherrington, C.\t", "year": "2016", "journalProceedings": "BMJ Open", "category": "Methods", "devices": null, "population": "Older Adults", "dataUsed": "Steps", "abstract": "INTRODUCTION Prevention of falls and promotion of physical activity are essential for maximising well-being in older age. However, there is evidence that promoting physical activity among older people without providing fall prevention advice may increase fall rates. This trial aims to establish the impact of a physical activity and fall prevention programme compared with a healthy eating programme on physical activity and falls among people aged 60+ years.\nMETHODS AND ANALYSIS This cluster randomised controlled trial will involve 60 groups of community-dwelling people aged 60+ years. Participating groups will be randomised to: (1) a physical activity and fall prevention intervention (30 groups), involving written information, fall risk assessment and prevention advice, a pedometer-based physical activity tracker and telephone-based health coaching; or (2) a healthy eating intervention (30 groups) involving written information and telephone-based dietary coaching. Primary outcomes will be objectively measured physical activity at 12 months post-randomisation and self-reported falls throughout the 12-month trial period. Secondary outcomes include: the proportion of fallers, the proportion of people meeting the Australian physical activity guidelines, body mass index, eating habits, mobility goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being, self-reported physical activity, disability, and health and community service use. The between-group difference in the number of falls per person-year will be analysed using negative binomial regression models. For the continuously scored primary and secondary outcome measures, linear regression adjusted for corresponding baseline scores will assess the effect of group allocation. Analyses will be preplanned, conducted while masked to group allocation, will take into account cluster randomisation, and will use an intention-to-treat approach.", "links": [ { "caption": "URL", "url": "http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2016-012277", "newWindow": true } ] }, { "title": "The monitoring of activity at home after total hip arthroplasty", "author": "Toogood, P.A., Abdel, M.P., Spear, J.A., Cook, S.M., Cook, D.J. and Taunton, M.J.", "year": "2016", "journalProceedings": "The Bone & Joint Journal", "category": "Measurement", "devices": null, "population": "Older Adults,Patients", "dataUsed": "Steps", "abstract": "Aims: Total hip arthroplasty (THA) has well known subjective benefits, but little is known objectively about the recovery of mobility in the early post-operative period.\n\nPatients and Methods: A total of 33 patients aged textgreater 60 years who underwent elective primary THA had their activity monitored for 30 days post-operatively using an at-home (Fitbit) ankle accelerometer. Their mean age was 70.7 years (61 to 86); 15 (45.5%) were female. The rate of compliance and the mean level of activity were determined. Comparisons between subgroups based on age, body mass index (BMI), surgical approach, and the destination of the patients when discharged were also performed. \n\nResults: The mean compliance over the 30 days was 26.7 days (16 to 30; 89%) of use. The mean number of steps increased from 235 (5 to 1152) to 2563 (87 to 7280) (p textless 0.001) between the first and the 30th post-operative day. Age textless 70 years and an anterior surgical approach were significantly associated with higher levels of activity (1600 to 2400 (p = 0.016 to 0.031) and 1000 to 1800 (p = 0.017 to 0.037) more steps per day, respectively) between the second and the fourth week post-operatively. There was also a trend towards higher levels of activity in those who were discharged to their home rather than to a nursing facility (a mean of 1500 more steps per day, p = 0.02). BMI greater or less than 30 kg/m2 was not predictive of activity (p = 0.45 to 0.98). \n\nConclusion: At-home remote mobility monitoring using existing commercially available technology is feasible in patients who have undergone THA. It showed a clear trend towards increased activity with the passage of time. Additionally, the remote device was able to detect differences in levels of activity clearly between patients in relation to variables of interest including age, BMI, surgical approach, and the destination of the patient at the time of discharge from hospital. Such monitoring may allow for the early identification and targeted intervention in patients who recover slowly.", "links": [ { "caption": "URL", "url": "http://www.bjj.boneandjoint.org.uk/content/98-B/11/1450.long", "newWindow": true } ] }, { "title": "Health Outcomes of Information System Use Lifestyles among Adolescents: Videogame Addiction, Sleep Curtailment and Cardio-Metabolic Deficiencies.", "author": "Turel, O., Romashkin, A. and Morrison, K.M.\t", "year": "2016", "journalProceedings": "PLOS ONE", "category": "Measurement", "devices": "Ultra,One", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "BACKGROUND AND OBJECTIVE: Obesity is a rising problem among adolescents in modern societies; it results in long-term cardio-metabolic problems. Possible overlooked drivers of obesity and its consequent cardio-metabolic deficits include videogame addiction and the resulting curtailed sleep; both are growing problems among adolescents. The objective of this study is to examine possible associations among these concepts in adolescents, as a means to point to plausible interventions.\n\nMETHODS: Data were collected from 94 adolescents who play videogames and are enrolled in outpatient clinics, using surveys, wearable sleep monitors (FitBit), physical exams, and blood tests at three points in time. These data were subjected to structural equation modeling (SEM) analyses and bootstrapping-based mediation testing procedures.\n\nRESULTS: Videogame addiction among adolescents was negatively associated with sleep duration (ß = -0.24). Sleep duration was negatively associated with obesity (ß = -0.30), which in turn was associated with elevated blood pressure (ß = 0.26), low high-density lipoprotein cholesterol (ß = -0.18), high triglycerides (ß = 0.61), and high insulin resistance (ß = 0.39). The model explained 36.2% of the variation in sleep duration, 32.7% of the variation in obesity, and between 12.8% and 28.1% of the variation in cardio-metabolic indicators. Post-hoc analyses indicated that curtailed sleep is a possible full mediator of the association between videogame addiction, abdominal obesity and the associated cardio-metabolic deficits.\n\nCONCLUSION: The findings point to possible information systems use lifestyle-health links, which behooves researchers and practitioners to pay closer attention to possible adverse health outcomes of technology-related addictions. Interventions that target problematic video-gaming and sleep should be devised as a possible means for improving adolescents' long-term cardio-metabolic health.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4858285/", "newWindow": true } ] }, { "title": "Association between activity limitations and pain in patients scheduled for total knee arthroplasty", "author": "Usiskin, I.M., Yang, H.Y., Deshpande, B.R., Collins, J.E., Michl, G.L., Smith, S.R., Klara, K.M., Selzer, F., Katz, J.N. and Losina, E.\t", "year": "2016", "journalProceedings": "BMC Musculoskeletal Disorders", "category": "Measurement", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background: Historically, persons scheduled for total knee arthroplasty (TKA) have reported severe pain with low demand activities such as walking, but recent data suggests that TKA recipients may have less preoperative pain. Little is known about people who elect TKA with low levels of preoperative pain. To better understand current TKA utilization, we evaluated the association between preoperative pain and difficulty performing high demand activities, such as kneeling and squatting, among TKA recipients.\n\nMethods: We used baseline data from a randomized control trial designed to improve physical activity following TKA. Prior to TKA, participants were categorized according to Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain scores: Low (0–25), Medium (26–40), and High (41–100). Within each group, limitations in both low demand and high demand activities were assessed.\n\nResults: The sample consisted of 202 persons with a mean age of 65 (SD 8) years; 21 %, 34 %, and 45 % were categorized in the Low, Medium, and High Pain groups, respectively. Of the Low Pain group, 60 % reported at least one of the following functional limitations: limited flexion, limp, limited walking distance, and limitations in work or housework. While only 12 % of the Low Pain group reported at least moderate pain with walking on a flat surface, nearly all endorsed at least moderate difficulty with squatting and kneeling.\n\nConclusions: A substantial number of persons scheduled for TKA report Low WOMAC Pain (=25) prior to surgery. Persons with Low WOMAC Pain scheduled for TKA frequently report substantial difficulty with high demand activities such as kneeling and squatting. Studies of TKA appropriateness and effectiveness for patients with low WOMAC Pain should include measures of these activities.", "links": [ { "caption": "URL", "url": "http://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1233-2", "newWindow": true } ] }, { "title": "Feasibility of a Memory Clinic-Based Physical Activity Prescription Program", "author": "Vidoni, E.D., Watts, A.S., Burns, J.M., Greer, C.S., Graves, R.S., Van Sciver, A., Black, J.R., Cooper, S.K., Nagely, A.C., Uphoff, E., Volmer, J.M. and Bieberle, N.A.\t", "year": "2016", "journalProceedings": "Journal of Alzheimer's Disease", "category": "Intervention", "devices": "Zip", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Background: Effective programs for promoting physical activity are needed for those with cognitive impairment.\nObjective: To test the feasibility of mobile Health (mHealth) technology-supported physical activity prescription from a tertiary care memory clinic.\n\nMethods: This feasibility study was designed as a 16-week randomized, crossover trial of a physical activity prescription: 8 weeks of intervention, 8 weeks of baseline or maintenance phase data collection. We recruited 2 cohorts: 21 individuals with Alzheimer-related cognitive impairment (mean age 72.3 (5.2), 9 females), and 9 individuals with normal cognition (mean age 69.6 (5.8), 8 females). We gave each cohort an mHealth accelerometer-based physical activity prescription to double number of steps taken. Our primary outcomes were feasibility and safety. Our secondary outcomes were change in weekly steps taken, Dementia Quality of Life Scale, Self-efficacy Scale, 6-minute Walk, and mini-Physical Performance Test.\n\nResults: Set-up and use of the device was not a barrier to participation. However, only 62% of participants with cognitive impairment completed the intervention. The cohort with cognitive impairment did not change their weekly step count above Week 1. All participants in the cohort with normal cognition were able to set up and use their device and increased their weekly step count above Week 1. There were no differences between Week 1 and Week 8 for any secondary measures in either cohort.\n\nConclusions: Setup and daily use of mHealth technology appears to be feasible for a person with cognitive impairment with the help of a partner, but increasing daily step counts over 8 weeks was not achieved. Future work needs to assess alternative activity prescription goals or additional support for patients and their partners.", "links": [ { "caption": "URL", "url": "http://content.iospress.com/articles/journal-of-alzheimers-disease/jad160158", "newWindow": true } ] }, { "title": "Validity of commercial activity trackers in children with congenital heart disease", "author": "Voss, C., Gardner, R.F., Dean, P.H. and Harris, K.C.\t", "year": "2016", "journalProceedings": "Canadian Journal of Cardiology", "category": "Validation", "devices": "Charge HR", "population": "Adolescents", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND\nIncreasing physical activity levels is a high priority to optimize long-term health in children with congenital heart disease (CHD). Commercial activity trackers have been validated in adults and are increasingly used to measure and promote physical activity in pediatric populations, but they have not been validated in children.\nMETHODS\nIn 30 children with CHD aged 10-18yrs, we assessed the validity of physical activity form the wrist-based Fitbit Charge HRTM against hip-based ActiGraph accelerometers under free living conditions for 7 days. We assessed the association between devices by intra-class correlation coefficients and Bland-Altman plots. Receiver-operating curves were used to identify Fitbit step cut-points.\n\nRESULTS\nThere was a strong association between the two devices for daily steps across 138 analysed person-days (ICC=0.855, ptextless0.001), but poorer agreement for time spent in physical activity intensities (ICCstextless0.7). Daily Fitbit steps of =12,500 identified meeting physical activity guidelines defined as =60 min MVPA/day. Fitbit devices recorded more steps than accelerometers (-2,242 steps/d, 95%LoA of -7,738 to 3,253). Between-device differences were greater in boys vs. girls. Fitbit devices were worn for longer than accelerometers (-36 min/d, 95%LoA -334 to 261), but overall differences in wear time explained little of the variance in step differences (7%, p=0.048).\n\nCONCLUSIONS\nCommercial activity trackers provide opportunities to remotely monitor physical activity in children with CHD, but absolute values may differ from accelerometers. These findings are important given the increasing emphasis on physical activity promotion and monitoring in children with cardiovascular risk factors.", "links": [ { "caption": "URL", "url": "http://www.onlinecjc.ca/article/S0828-282X(16)31147-3/abstract", "newWindow": true } ] }, { "title": "Is There an Association of Physical Activity with Brain Volume, Behavior, and Day-to-day Functioning? A Cross Sectional Design in Prodromal and Early Huntington Disease.", "author": "Wallace, M., Downing, N., Lourens, S., Mills, J., Kim, J.-I., Long, J., Paulsen, J. and Predict-Hd Investigators And Coordinators Of The Huntington Study Group", "year": "2016", "journalProceedings": "PLoS Currents", "category": "Measurement", "devices": "Ultra", "population": "Patients,Adults", "dataUsed": "Steps,Distance", "abstract": "BACKGROUND: Huntington disease (HD) is a genetic neurodegenerative disease leading to progressive motor, cognitive, and behavioral decline. Subtle changes in these domains are detectable up to 15 years before a definitive motor diagnosis is made. This period, called prodromal HD, provides an opportunity to examine lifestyle behaviors that may impact disease progression.\nTHEORETICAL FRAMEWORK: Physical activity relates to decreased rates of brain atrophy and improved cognitive and day-to-day functioning in Alzheimer disease and healthy aging populations. Previous research has yielded mixed results regarding the impact of physical activity on disease progression in HD and paid little attention to the prodromal phase.\n\nMETHODS: We conducted analyses of associations among current physical activity level, current and retrospective rate of change for hippocampus and striatum volume, and cognitive, motor, and day-to-day functioning variables. Participants were 48 gene-expanded cases with prodromal and early-diagnosed HD and 27 nongene-expanded control participants. Participants wore Fitbit Ultra activity monitors for three days and completed the self-reported International Physical Activity Questionnaire (IPAQ). Hippocampal and striatal white matter volumes were measured using magnetic resonance imaging. Cognitive tests included the Stroop Color and Word Test, and the Symbol Digit Modalities Test (SDMT). Motor function was assessed using the Unified Huntington's Disease Rating Scale total motor score (TMS). Day-to-day functioning was measured using the World Health Organization Disability Assessment Schedule (WHODAS) version 2.0.\n\nRESULTS: Higher Fitbit activity scores were significantly related to better scores on the SDMT and WHODAS in case participants but not in controls. Fitbit activity scores tracked better with TMS scores in the group as a whole, though the association did not reach statistical significance in the case participants. Higher Fitbit activity scores related to less day-to-day functioning decline in retrospective slope analyses. Fitbit activity scores did not differ significantly between cases and controls.\n\nCONCLUSIONS: This is the first known study examining the associations between activity level and imaging, motor, cognitive, and day-to-day functioning outcomes in prodromal and early HD. Preliminary results suggest physical activity positively correlates with improved cognitive and day-to-day functioning and possibly motor function in individuals in the prodromal and early phase of the condition.", "links": [ { "caption": "URL", "url": "http://currents.plos.org/hd/article/hd-15-0010r1-is-there-an-association-of-physical-activity-with-brain-volume-behavior-and-day-to-day-functioning-a-cross-sectional-design-in-prodromal-and-early-huntington-disease/", "newWindow": true } ] }, { "title": "Accuracy of Heart Rate Watches: Implications for Weight Management", "author": "Wallen, M.P., Gomersall, S.R., Keating, S.E., Wisløff, U. and Coombes, J.S.\t", "year": "2016", "journalProceedings": "PLOS ONE", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Heart Rate", "abstract": "Background: Wrist-worn monitors claim to provide accurate measures of heart rate and energy expenditure. People wishing to lose weight use these devices to monitor energy balance, however the accuracy of these devices to measure such parameters has not been established.\n\nAim: To determine the accuracy of four wrist-worn devices (Apple Watch, Fitbit Charge HR, Samsung Gear S and Mio Alpha) to measure heart rate and energy expenditure at rest and during exercise.\n\nMethods: Twenty-two healthy volunteers (50% female; aged 24 ± 5.6 years) completed 1-hr protocols involving supine and seated rest, walking and running on a treadmill and cycling on an ergometer. Data from the devices collected during the protocol were compared with reference methods: electrocardiography (heart rate) and indirect calorimetry (energy expenditure).\n\nResults: None of the devices performed significantly better overall, however heart rate was consistently more accurate than energy expenditure across all four devices. Correlations between the devices and reference methods were moderate to strong for heart rate (0.67–0.95 [0.35 to 0.98]) and weak to strong for energy expenditure (0.16–0.86 [-0.25 to 0.95]). All devices underestimated both outcomes compared to reference methods. The percentage error for heart rate was small across the devices (range: 1–9%) but greater for energy expenditure (9–43%). Similarly, limits of agreement were considerably narrower for heart rate (ranging from -27.3 to 13.1 bpm) than energy expenditure (ranging from -266.7 to 65.7 kcals) across devices.\n\nConclusion: These devices accurately measure heart rate. However, estimates of energy expenditure are poor and would have implications for people using these devices for weight loss.", "links": [ { "caption": "URL", "url": "http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0154420", "newWindow": true } ] }, { "title": "Mobile and Wearable Device Features that Matter in Promoting Physical Activity", "author": "Wang, J.B., Cataldo, J.K., Ayala, G.X., Natarajan, L., Cadmus-Bertram, L.A., White, M.M., Madanat, H., Nichols, J.F. and Pierce, J.P.\t", "year": "2016", "journalProceedings": "Journal of Mobile Technology in Medicine", "category": "Usability", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: As wearable sensors/devices become increasingly popular to promote physical activity (PA), research is needed to examine how and which components of these devices people use to increase their PA levels. AIMS (1) To assess usability and level of engagement with the Fitbit One and daily SMS-based prompts in a 6-week PA intervention, and (2) to examine whether use/ level of engagement with specific intervention components were associated with PA change.\n\nMETHODS: Data were analyzed from a randomized controlled trial that compared (1) a wearable sensor/ device (Fitbit One) plus SMS-based PA prompts, and (2) Fitbit One only, among overweight/ obese adults (N = 67). We calculated average scores from Likert-type response items that assessed usability and level of engagement with device features (e.g., tracker, website, mobile app, and SMS-based prompts), and assessed whether such factors were associated with change in steps/day (using Actigraph GT3X+).\n\nRESULTS: Participants reported the Fitbit One was easy to use and the tracker helped to be more active. Those who used the Fitbit mobile app (36%) vs. those who did not (64%) had an increase in steps at 6-week follow-up, even after adjusting for previous web/app use: +545 steps/ day (SE = 265) vs. -28 steps/ day (SE = 242) (p = .04).\n\nCONCLUSIONS: Level of engagement with the Fitbit One, particularly the mobile app, was associated with increased steps. Mobile apps can instantly display summaries of PA performance and could optimize self-regulation to activate change. More research is needed to determine whether such modalities might be cost-effective in future intervention research and practice.", "links": [ { "caption": "URL", "url": "http://www.journalmtm.com/2016/mobile-and-wearable-device-features-that-matter-in-promoting-physical-activity/", "newWindow": true } ] }, { "title": "Accuracy of wrist-worn heart rate monitors", "author": "Wang, R., Blackburn, G., Desai, M. and et al\t", "year": "2016", "journalProceedings": "JAMA Cardiology", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Wrist-worn fitness and heart rate (HR) monitors are popular.1,2 While the accuracy of chest strap, electrode-based HR monitors has been confirmed,3,4 the accuracy of wrist-worn, optically based HR monitors is uncertain.5,6 Assessment of the monitors’ accuracy is important for individuals who use them to guide their physical activity and for physicians to whom these individuals report HR readings. The objective of this study was to assess the accuracy of 4 popular wrist-worn HR monitors under conditions of varying physical exertion.", "links": [ { "caption": "URL", "url": "http://jamanetwork.com/journals/jamacardiology/article-abstract/2566167", "newWindow": true } ] }, { "title": "Sleep quality, but not quantity, is associated with self-perceived minor error rates among emergency department nurses", "author": "Weaver, A.L., Stutzman, S.E., Supnet, C. and Olson, D.M.\t", "year": "2016", "journalProceedings": "International Emergency Nursing", "category": "Measurement", "devices": null, "population": "Adults", "dataUsed": "Sleep", "abstract": "INTRODUCTION\nThe emergency department (ED) is demanding and high risk. The impact of sleep quantity has been hypothesized to impact patient care. This study investigated the hypothesis that fatigue and impaired mentation, due to sleep disturbance and shortened overall sleeping hours, would lead to increased nursing errors.\nMETHODS\nThis is a prospective observational study of 30 ED nurses using self-administered survey and sleep architecture measured by wrist actigraphy as predictors of self-reported error rates. An actigraphy device was worn prior to working a 12-hour shift and nurses completed the Pittsburgh Sleep Quality Index (PSQI). Error rates were reported on a visual analog scale at the end of a 12-hour shift.\n\nRESULTS\nThe PSQI responses indicated that 73.3% of subjects had poor sleep quality. Lower sleep quality measured by actigraphy (hours asleep/hours in bed) was associated with higher self-perceived minor errors. Sleep quantity (total hours slept) was not associated with minor, moderate, nor severe errors.\n\nDISCUSSION\nOur study found that ED nurses' sleep quality, immediately prior to a working 12-hour shift, is more predictive of error than sleep quantity. These results present evidence that a “good night's sleep” prior to working a nursing shift in the ED is beneficial for reducing minor errors.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1755599X15000865", "newWindow": true } ] }, { "title": "A Technology-Mediated Behavioral Weight Gain Prevention Intervention for College Students: Controlled, Quasi-Experimental Study.", "author": "West, D.S., Monroe, C.M., Turner-McGrievy, G., Sundstrom, B., Larsen, C., Magradey, K., Wilcox, S. and Brandt, H.M.\t", "year": "2016", "journalProceedings": "Journal of Medical Internet Research", "category": "Intervention", "devices": "Zip,Aria", "population": "Adults", "dataUsed": "Steps,Weight", "abstract": "BACKGROUND: Both men and women are vulnerable to weight gain during the college years, and this phenomenon is linked to an increased risk of several chronic diseases and mortality. Technology represents an attractive medium for the delivery of weight control interventions focused on college students, given its reach and appeal among this population. However, few technology-mediated weight gain prevention interventions have been evaluated for college students.\n\nOBJECTIVE: This study examined a new technology-based, social media-facilitated weight gain prevention intervention for college students.\n\nMETHODS: Undergraduates (n =58) in two sections of a public university course were allocated to either a behavioral weight gain prevention intervention (Healthy Weight, HW; N=29) or a human papillomavirus (HPV) vaccination awareness intervention (control; N=29). All students were enrolled, regardless of initial body weight or expressed interest in weight management. The interventions delivered 8 lessons via electronic newsletters and Facebook postings over 9 weeks, which were designed to foster social support and introduce relevant educational content. The HW intervention targeted behavioral strategies to prevent weight gain and provided participants with a Wi-Fi-enabled scale and an electronic physical activity tracker to facilitate weight regulation. A repeated-measures analysis of variance was conducted to examine within- and between-group differences in measures of self-reported weight control practices and objectively measured weight. Use of each intervention medium and device was objectively tracked, and intervention satisfaction measures were obtained.\n\nRESULTS: Students remained weight stable (HW: -0.48+1.9 kg; control: -0.45+1.4 kg), with no significant difference between groups over 9 weeks (P =.94). However, HW students reported a significantly greater increase in the number of appropriate weight control strategies than did controls (2.1+4.5 vs -1.1+3.4, respectively; P =.003) and there was no increase in inappropriate weight control behaviors (P =.11). More than 90% of students in the HW arm opened the electronic newsletters each week, and the average number of Facebook interactions (comments and likes) per student each week was 3.3+1.4. Each self-monitoring device was initialized by 90% of HW students. On average, they used their physical activity tracker for 23.7+15.2 days and their Wi-Fi scale for 14.1+13.1 days over the 9 weeks. HW students rated the intervention favorably.\n\nCONCLUSIONS: The short-term effect of this technology-based weight gain prevention intervention for college students is promising and merits evaluation over a longer duration to determine whether engagement and behavioral improvements positively affect weight outcomes and can be maintained.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923588/", "newWindow": true } ] }, { "title": "Distance Learning Strategies for Weight Management Utilizing Online Social Networks versus Group Phone Conference Call", "author": "Willis, E.A., Szabo-Reed, A.N., Ptomey, L.T., Steger, F.L., Honas, J.J., Al-Hihi, E.M., Lee, R., Lee, J., Oh, Y., Washburn, R.A. and Donnelly, J.E.\t", "year": "2016", "journalProceedings": "Obesity Science & Practice", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Objective\n\nThe increase in technology and online social networks (OSNs) may present healthcare providers with an innovative modality for delivering weight management programs that could have an impact on health care at the population level. The objective of this study was to evaluate the feasibility and efficacy of using an OSN to deliver a weight loss program to inform future, large scale trials.\nMethods\n\nSeventy individuals (age?=?47?±?12.4, minority?=?24.3%) with obesity (BMI?=?36.2?±?4.0) completed a six-month weight loss intervention and were randomized to either a conference call or OSN delivery group. Weight loss was achieved by reducing energy intake by 500-700?kcal/day below estimated total daily energy expenditure and progressing physical activity to 300?minutes/week. Behavioral weight loss strategies were delivered weekly throughout the intervention.\nResults\n\nConference call and OSN groups produced clinically meaningful weight loss of =5% from baseline to six months (phone?=?-6.3?±?6.4%, OSN?=?-5.8?±?6.7%). There was no significant difference in weight change between groups (p?=?0.765).\nConclusion\n\nThe phone and OSN groups met American Heart Association/American College of Cardiology/The Obesity Society's Guidelines by reducing baseline weight by 5-10% within six months. OSNs appear to be a viable delivery platform for weight loss interventions, however, larger scale adequately powered trials are needed.", "links": [ { "caption": "URL", "url": "http://onlinelibrary.wiley.com/doi/10.1002/osp4.96/abstract", "newWindow": true } ] }, { "title": "Measures of sleep and cardiac functioning during sleep using a multi-sensory commercially-available wristband in adolescents", "author": "de Zambotti, M., Baker, F.C., Willoughby, A.R., Godino, J.G., Wing, D., Patrick, K. and Colrain, I.M", "year": "2016", "journalProceedings": "Physiology & Behavior", "category": "Validation", "devices": "Charge HR", "population": "Adolescents", "dataUsed": "Sleep,Heart Rate", "abstract": "To validate measures of sleep and heart rate (HR) during sleep generated by a commercially-available activity tracker against those derived from polysomnography (PSG) in healthy adolescents. Sleep data were concurrently recorded using FitbitChargeHR™ and PSG, including electrocardiography (ECG), during an overnight laboratory sleep recording in 32 healthy adolescents (15 females; age, mean ± SD: 17.3 ± 2.5 years). Sleep and HR measures were compared between FitbitChargeHR™ and PSG using paired t-tests and Bland-Altman plots. Epoch-by-epoch analysis showed that FitbitChargeHR™ had high overall accuracy (91%), high sensitivity (97%) in detecting sleep, and poor specificity (42%) in detecting wake on a min-to-min basis. On average, FitbitChargeHR™ significantly but negligibly overestimated total sleep time by 8 min and sleep efficiency by 1.8%, and underestimated wake after sleep onset by 5.6 min (p < 0.05). Within FitbitChargeHR™ epochs of sleep, the average HR was 59.3 ± 7.5 bpm, which was significantly but negligibly lower than that calculated from ECG (60.2 ± 7.6 bpm, p < 0.001), with no change in mean discrepancies throughout the night. FitbitChargeHR™ showed good agreement with PSG and ECG in measuring sleep and HR during sleep, supporting its use in assessing sleep and cardiac function in healthy adolescents. Further validation is needed to assess its reliability over prolonged periods of time in ecological settings and in clinical populations.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0031938416300932", "newWindow": true } ] }, { "title": "A hospital and home-based exercise program to address functional decline in people following allogeneic stem cell transplantation", "author": "Abo, S., Ritchie, D., Denehy, L., Panek-Hudson, Y., Irving, L. and Granger, C.L.\t", "year": "2017", "journalProceedings": "Supportive Care in Cancer", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Purpose\nThe aims of this study are to investigate the feasibility of an exercise program commencing 60 days following allogeneic stem cell transplantation (alloSCT), to investigate changes in physical function and health-related quality of life (HRQoL) in patients from pre- to post-alloSCT and to explore changes in patient outcomes before and after the program.\n\nMethods\nThis study is a single site, prospective case series including 43 adults undergoing alloSCT. The intervention was an 8-week outpatient and home-based exercise and education program. Outcomes included feasibility (consent, attendance, compliance and completion rates), functional exercise capacity (incremental shuttle walk test), muscle strength (hand-held dynamometry), self-efficacy for physical activity (Physical Activity Assessment Inventory) and HRQoL (Functional Assessment of Cancer Therapy-Bone Marrow Transplant). Outcomes were measured pre-alloSCT, 60 days post-alloSCT (pre-intervention) and 100 days post-alloSCT (post-intervention).\n\nResults\nThe consent rate was 93%. From baseline to 60 days post-alloSCT, there was significant decline in functional exercise capacity (mean difference 224 m, 95% CI 153–295, p < 0.0005), self-efficacy for physical activity (294 points, 95% CI 136–452, p = 0.001) and HRQoL (15 points, 95% CI 8–21, p < 0.0005). Ten participants did not commence the exercise program due to death (n = 5), illness (n = 1) or cancellation of alloSCT (n = 4). The intervention was feasible in those not affected by major medical complications or death. No adverse events occurred. From pre- to post-intervention, there was significant improvement in functional exercise capacity (p = 0.001) and HRQoL (p = 0.001).\n\nConclusions\nAlloSCT results in significant decline in functional exercise capacity, self-efficacy for physical activity and HRQoL, which may be improved through an exercise program. This pilot demonstrated safety, feasibility and high patient interest. Further randomised research is required.", "links": [] }, { "title": "Developing a Fitbit-supported lifestyle physical activity intervention for depressed alcohol dependent women", "author": "Abrantes, A.M., Blevins, C., Battle, C.L., Read, J.P., Gordon, A. and Stein, M.\t", "year": "2017", "journalProceedings": "Journal of Substance Abuse Treatment", "category": "Intervention", "devices": "Charge", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Purpose\nWomen in alcohol treatment are more likely to relapse when in unpleasant, negative emotional states. Given the demonstrated benefits of exercise for decreasing depression, negative affect, and urges to drink, helping women engage in a lifestyle physical activity (LPA) intervention in early recovery may provide them a tool they can utilize “in the moment” in order to cope with negative emotional states and alcohol craving when relapse risk is highest. New digital fitness technologies (e.g., Fitbit activity monitor with web and mobile applications) may facilitate increases in physical activity (PA) through goal setting and self-monitoring.\n\nMethod\nWe piloted a 12-week LPA + Fitbit intervention focused on strategically using bouts of PA to cope with affect and alcohol cravings to prevent relapse in 20 depressed women (mean age = 39.5 years) in alcohol treatment.\n\nResults\nParticipants wore their Fitbit on 73% of days during the intervention period. An average of 9174 steps/day were taken on the days the Fitbit was worn. Participants completed 4.7 of the 6 scheduled phone PA counseling sessions (78%). Among women who completed the intervention (n = 15), 44% remained abstinent throughout the entire course of treatment. On average, women were abstinent on 95% of days during the 12-week intervention. Participants reported an increase in using PA to cope with either negative affect or urges to drink from baseline to end of treatment (p textless 0.05). Further, participants reported high satisfaction with the LPA + Fitbit intervention and with the Fitbit tracker.\n\nConclusions\nFurther research is needed to evaluate the LPA + Fitbit intervention in a more rigorous randomized controlled trial. If the LPA + Fitbit intervention proves to be helpful during early recovery, this simple, low-cost and easily transported intervention can provide a much-needed alternate coping strategy to help reduce relapse risk among women in alcohol treatment.", "links": [ { "caption": "URL", "url": "http://linkinghub.elsevier.com/retrieve/pii/S0740547217301083", "newWindow": true } ] }, { "title": "Adaptive goal setting and financial incentives: a 2 × 2 factorial randomized controlled trial to increase adults' physical activity", "author": "Adams, M.A., Hurley, J.C., Todd, M., Bhuiyan, N., Jarrett, C.L., Tucker, W.J., Hollingshead, K.E. and Angadi, S.S.\t", "year": "2017", "journalProceedings": "BMC Public Health", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Emerging interventions that rely on and harness variability in behavior to adapt to individual performance over time may outperform interventions that prescribe static goals (e.g., 10,000 steps/day). The purpose of this factorial trial was to compare adaptive vs. static goal setting and immediate vs. delayed, non-contingent financial rewards for increasing free-living physical activity (PA).\nMethods: A 4-month 2 × 2 factorial randomized controlled trial tested main effects for goal setting (adaptive vs. static goals) and rewards (immediate vs. delayed) and interactions between factors to increase steps/day as measured by a Fitbit Zip. Moderate-to-vigorous PA (MVPA) minutes/day was examined as a secondary outcome.\n\nResults: Participants (N = 96) were mainly female (77%), aged 41 ± 9.5 years, and all were insufficiently active and overweight/obese (mean BMI = 34.1 ± 6.2). Participants across all groups increased by 2389 steps/day on average from baseline to intervention phase (p textless .001). Participants receiving static goals showed a stronger increase in steps per day from baseline phase to intervention phase (2630 steps/day) than those receiving adaptive goals (2149 steps/day; difference = 482 steps/day, p = .095). Participants receiving immediate rewards showed stronger improvement (2762 step/day increase) from baseline to intervention phase than those receiving delayed rewards (2016 steps/day increase; difference = 746 steps/day, p = .009). However, the adaptive goals group showed a slower decrease in steps/day from the beginning of the intervention phase to the end of the intervention phase (i.e. less than half the rate) compared to the static goals group (-7.7 steps vs. -18.3 steps each day; difference = 10.7 steps/day, p textless .001) resulting in better improvements for the adaptive goals group by study end. Rate of change over the intervention phase did not differ between reward groups. Significant goal phase x goal setting x reward interactions were observed.\n\nConclusions: Adaptive goals outperformed static goals (i.e., 10,000 steps) over a 4-month period. Small immediate rewards outperformed larger, delayed rewards. Adaptive goals with either immediate or delayed rewards should be preferred for promoting PA.", "links": [ { "caption": "URL", "url": "http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4197-8", "newWindow": true } ] }, { "title": "The Physical Activity Patterns of Cardiac Rehabilitation Program Participants Using Three Different Measures: Exercise Capacity, Functional Activity, and Habitual Physical Activity", "author": "Alharbi, M., Bauman, A., Neubeck, L., Naismith, S., Tofler, Yun-Hee, J., Mitchell, J., Kirkness, A., Gallagher, P., Woolaston, A. and Gallagher, R.\t", "year": "2017", "journalProceedings": "Heart, Lung and Circulation", "category": "Measurement", "devices": "Flex", "population": "Older Adults,Patients", "dataUsed": "Steps,Intensity", "abstract": "Background: Understanding physical activity (PA) patterns and precise PA assessments are essential in cardiac rehabilitation (CR) settings to promote PA and to evaluate interventions.\nPurpose: Report the comprehensive patterns of PA and determine whether Fitbit-Flex, Physical Activity Scale for the Elderly (PASE), and six-minute walk test (6MWT) provided similar PA outcomes.\n\nMethods: 40 patients attending CR programs completed PASE and 6MWT following assessment at baseline and 8 weeks. Participants also wore Fitbit-Flex for four consecutive days including two weekend days.\n\nResults: Participants' mean age was 66 years, 67% were male. Significant increases occurred from baseline to 8 weeks in: PASE score (114–158; p = .04); mean 6MWT-distance (477–516; p = .01) and average steps (8024–9818; p = .01). A greater increase in average weekday steps (8923 steps/day) than weekend steps (7317 steps/day; p = .01) occurred at baseline. Non-significant increase in average moderate-to-vigorous-physical-activity (MVPA) occurred from baseline to 8 weeks measured by Fitbit-Flex and PASE (33–41; p = .14, and 49–64; p = .15, respectively). Average Fitbit-Flex steps at baseline and 8 weeks was weakly correlated with PASE score (r = .24; r = 16, respectively); and moderately-weakly correlated with 6MWT (r = .33; r = .23, respectively). Significant moderate correlations occurred at baseline between 6MWT and Fitbit-Flex for weekend steps, weekend MVPA, and overall average MVPA, with coefficients between .35 and .42. 6MWT correlated weakly with PASE score (r = .30) at week 8, but reasonably well (r = .57) at baseline.\n\nConclusion: CR patients' PA patterns changed over time. Fitbit-Flex is the best at capturing and differentiating habitual PA from exercise capacity and functional activity.", "links": [ { "caption": "URL", "url": "http://linkinghub.elsevier.com/retrieve/pii/S1443950617305541", "newWindow": true } ] }, { "title": "Harnessing the Potential of Wearable Activity Trackers for Heart Failure Self-Care", "author": "Alharbi, M., Straiton, N. and Gallagher, R.\t", "year": "2017", "journalProceedings": "Current Heart Failure Reports", "category": "Review", "devices": "One,Flex", "population": "Patients,Adults", "dataUsed": "NA", "abstract": "Purpose of review: The purpose of this study was to explore the potential of wearable activity trackers to promote self-care management for physical activity in heart failure (HF).\nRecent findings: Exercise participation decreases hospital admissions and improves quality of life in HF, and activity tracking devices provide more precise means to assess free-living physical activity and thus enable tailored exercise instruction. Use of activity trackers by cardiac patients for self-monitoring and motivational purposes is associated with increased levels of physical activity and is predictive of disease severity. However, more research is required to establish the feasibility and validity of these devices in HF patients. It is also critical that the devices can be easily used to collect, process and utilise relevant data.\n\nSummary: Activity trackers have the potential to promote HF self-care because they provide monitoring of physical activity behaviours and the potential to generate habit formation and goal reinforcement, all of which foster physical activity.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s11897-017-0318-z", "newWindow": true } ] }, { "title": "How Accurate Is Your Activity Tracker? A Comparative Study of Step Counts in Low-Intensity Physical Activities", "author": "Alinia, P., Cain, C., Fallahzadeh, R., Shahrokni, A., Cook, D. and Ghasemzadeh, H.\t", "year": "2017", "journalProceedings": "JMIR Mhealth and Uhealth", "category": "Validation", "devices": "One,Zip,Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: As commercially available activity trackers are being utilized in clinical trials, the research community remains uncertain about reliability of the trackers, particularly in studies that involve walking aids and low-intensity activities. While these trackers have been tested for reliability during walking and running activities, there has been limited research on validating them during low-intensity activities and walking with assistive tools. Objective: The aim of this study was to (1) determine the accuracy of 3 Fitbit devices (ie, Zip, One, and Flex) at different wearing positions (ie, pants pocket, chest, and wrist) during walking at 3 different speeds, 2.5, 5, and 8 km/h, performed by healthy adults on a treadmill; (2) determine the accuracy of the mentioned trackers worn at different sites during activities of daily living; and (3) examine whether intensity of physical activity (PA) impacts the choice of optimal wearing site of the tracker. Methods: We recruited 15 healthy young adults to perform 6 PAs while wearing 3 Fitbit devices (ie, Zip, One, and Flex) on their chest, pants pocket, and wrist. The activities include walking at 2.5, 5, and 8 km/h, pushing a shopping cart, walking with aid of a walker, and eating while sitting. We compared the number of steps counted by each tracker with gold standard numbers. We performed multiple statistical analyses to compute descriptive statistics (ie, ANOVA test), intraclass correlation coefficient (ICC), mean absolute error rate, and correlation by comparing the tracker-recorded data with that of the gold standard. Results: All the 3 trackers demonstrated good-to-excellent (ICC>0.75) correlation with the gold standard step counts during treadmill experiments. The correlation was poor (ICC<0.60), and the error rate was significantly higher in walker experiment compared to other activities. There was no significant difference between the trackers and the gold standard in the shopping cart experiment. The wrist worn tracker, Flex, counted several steps when eating (P<.01). The chest tracker was identified as the most promising site to capture steps in more intense activities, while the wrist was the optimal wearing site in less intense activities. Conclusions: This feasibility study focused on 6 PAs and demonstrated that Fitbit trackers were most accurate when walking on a treadmill and least accurate during walking with a walking aid and for low-intensity activities. This may suggest excluding participants with assistive devices from studies that focus on PA interventions using commercially available trackers. This study also indicates that the wearing site of the tracker is an important factor impacting the accuracy performance. A larger scale study with a more diverse population, various activity tracker vendors, and a larger activity set are warranted to generalize our results.", "links": [ { "caption": "URL", "url": "http://mhealth.jmir.org/2017/8/e106/", "newWindow": true } ] }, { "title": "FitBit Garden: A Mobile Game Designed to Increase Physical Activity in Children", "author": "Amresh, A., Lyles, A., Small, L. and Gary, K.\t", "year": "2017", "journalProceedings": "Proceedings of the 2017 International Conference on Digital Health", "category": "Usability", "devices": null, "population": "Children", "dataUsed": null, "abstract": "In this paper, we present the design and deployment of a mobile game titled \"FitBit Garden\" that encourages children to be physically active by representing the activity levels tracked via a FitBit pedometer in a garden ecosystem. The garden flourishes and grows as children and their parents take positive actions in the real world to improve the child's physical activity. These actions are then manifested into the virtual world via the mobile app. The paper presents the design of the intervention, the methods developed to collect and analyze data and the results of the usability study to determine form, function and acceptability of the intervention.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=3079452.3079457", "newWindow": true } ] }, { "title": "Step Count Accuracy of the Stepwatch and FitBit One Among Individuals with a Unilateral Transtibial Amputation", "author": "Arch, E.S., Sions, J.M. and Horne, J.R.\t", "year": "2017", "journalProceedings": "American Academy of Orthotists & Prosthetists", "category": "Validation", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Daily step counts, as obtained via activity monitors, provide insight into real-world activity level (Albert, 2013). For persons with lower-limb amputations, the StepWatch (Modus Health LLC) has historically been the most widely used monitor. The StepWatch is costly, though, making its use prohibitive for many clinicians (Albert, 2013; Fulk, 2014). The Fitbit One (Fitbit Inc.) is a lower cost option. However, accuracy assessments of both monitors are limited among individuals with lower-limb amputations. This study's purpose was to (1) evaluate the step count accuracy of both monitors during forward, linear walking and more complex walking and (2) compare monitor step counts during real-world walking.", "links": [ { "caption": "URL", "url": "http://media.mycrowdwisdom.com.s3.amazonaws.com/aaop/Resources/JOP/2017/2017-F51.pdf", "newWindow": true } ] }, { "title": "Facilitating Partner Support for Lifestyle Change Among Adults with Serious Mental Illness: A Feasibility Pilot Study", "author": "Aschbrenner, K.A., Mueser, K.T., Naslund, J.A., Gorin, A.A., Zawacki, S.A., Pratt, S.I., Kinney, A. and Bartels, S.\t", "year": "2017", "journalProceedings": "Community Mental Health Journal", "category": "Usability,Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps,Distance", "abstract": "The purpose of this pilot study was to explore the feasibility of an intervention designed to facilitate partner support for lifestyle change among overweight and obese adults with serious mental illness (SMI). Fifteen adults with SMI enrolled in a lifestyle intervention at community mental health centers participated with a self-selected partner in an additional 12-week intervention component designed to facilitate social support for health behavior change. Participants reported that the program was useful, convenient, and helped them reach their goals. Approximately two-thirds (66%) of participants were below their baseline weight at follow-up, including 27% achieving clinically significant weight loss. Participants reported significant increases in partner support for exercise and use of persuasive social support strategies. Partner support interventions that promote exercising together and positive communication may be effective for helping individuals with SMI initiate and sustain health behavior change necessary to reduce cardiovascular risk.", "links": [ { "caption": "URL", "url": "https://link.springer.com/article/10.1007%2Fs10597-017-0100-4", "newWindow": true } ] }, { "title": "Assessing the Benefits and Use of Gain-Framed Text Messaging to Improve Physical Activity in Advanced Stage Lung Cancer", "author": "Bade, B., Pastis, A., Owens, L., Hyer, J. and Silvestri, G.\t", "year": "2017", "journalProceedings": "Chest", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "PURPOSE: Physical activity (PA) is a potential therapy to improve quality of life (QoL) in patients with advanced stage lung cancer (LC). Many regimens have been studied, but no PA regimen has been shown to be both beneficial and sustainable. We have previously used weekly phone calls to deliver PA goals. We hypothesize that a walking-based PA regimen using gain-framed text messaging will improve PA levels more effectively than weekly phone calls.\nMETHODS: In patients with advanced stage LC, we implemented a Patient-Centered Activity Regimen (PCAR) utilizing a FitBit Flex® (San Francisco, CA) accelerometer, an educational session at enrollment, individualized walking goals, and twice daily gain-framed text messages. Feedback surveys were collected at the end of the intervention. Over a 4 week period, activity levels were compared between the PCAR group (n=15) and prior efforts using weekly phone calls (n=29). Data collection and likelihood of increasing PA were compared, and a repeated measures, mixed-effects model was constructed.\n\nRESULTS: Compared to those receiving weekly phone calls, subjects receiving twice daily gain-framed text messages more frequently used the device (100% vs 76%), increased their step count (67% vs 34%), and less frequently had missing data (12% vs 37%). Scatterplots revealed “more active” and “less active” groups. Participants were grouped into “more active” and “less active” groups based on above- or below-average step counts at baseline. The “less active” group improved their PA level whereas the “more active” group became less active. Most subjects (92%) found the intervention helpful and would participate in another activity study. Most subjects would prefer individualized (rather than group) PA interventions (83%) and to be motivated via daily text messages (55%) that are sent at noon (55%).\n\nCONCLUSIONS: In this small cohort, compared to weekly phone calls, twice daily gain-framed text messaging (1) improves data collection, (2) is more likely than weekly phone calls to improve PA (especially in “less active” subjects), and (3) has high patient satisfaction scores. Gain-framed text messaging appears to be an effective way to motivate patients with advanced stage LC to exercise. Future studies should further evaluate the benefits of walking-based PA in this group as well as the differences between the “more active” and “less active” groups.\n\nCLINICAL IMPLICATIONS: This study will help inform future efforts to motivate patients with advanced stage lung cancer toward exercise.", "links": [ { "caption": "URl", "url": "http://www.sciencedirect.com/science/article/pii/S0012369217322845", "newWindow": true } ] }, { "title": "The Validity of Fitbit Charge in Free Living Conditions", "author": "Bai, Y., Ellingson, L. and Welk, G.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "PURPOSE: Research is accumulating regarding the accuracy of wrist-worn consumer activity monitors in controlled lab settings. However, there is a lack of evidence of validity under free living conditions. The study investigated the accuracy of Fitbit Charge (FBC) for estimating minutes of moderate and vigorous physical activity (MVPA) compared to research grade accelerometers. A secondary purpose was to evaluate the accuracy of steps/day.\nMETHODS: Ninety-four healthy men and women (mean age 41 ± 9 years) wore a FBC as part of a 12-week intervention. The participants were also asked to wear research grade accelerometers concurrently as the criterion physical activity measure during the last week of intervention. A minimal of 10 hours/day wear-time was applied to both methods. Estimated daily MVPA and steps taken from the FBC were compared against the criterion using indicators of Pearson correlation, mean absolute percent errors, mean percent errors, and equivalence testing. The activity classification agreement of MVPA at the minute level was evaluated with Kappa, sensitivity and specificity.\n\nRESULTS: Complete data were collected on 61 individuals with an average of 5.5 days of wear-time. The average daily MVPA measured by accelerometer was 76.3 minutes compared to a higher value, 118.7 minutes, estimated by the FBC. The correlation between the two methods was 0.8 (ptextless0.0001). The mean absolute percent errors and mean percent errors were 68.2% and -64.2% indicating a consistent overestimating MVPA by the FBC. The average daily steps were 8,897 and 7,716 measured by FBC and accelerometer, respectively, with a correlation of 0.76 (ptextless0.0001). The mean absolute percent errors and mean percent errors of steps estimated by FBC were 30.0% and -20.1%. Neither of the MVPA and steps measured by FBC fell into the ±10% equivalence zone set up by the accelerometer. The Kappa statistics of the classification agreement between the two methods was 0.32 with a low the sensitivity of 30.1% but a high specificity of 96.7%.\n\nCONCLUSIONS: This FBC estimated substantially higher minutes of MVPA in free living conditions among healthy adults and significantly higher steps compared to research grade accelerometer. The researchers who use FBC to track physical activity need to interpret their results with caution.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/The_Validity_of_Fitbit_Charge_in_Free_Living.1559.aspx", "newWindow": false } ] }, { "title": "Comparative evaluation of heart rate-based monitors: Apple Watch vs Fitbit Charge HR", "author": "Bai, Y., Hibbing, P., Mantis, C. and Welk, G.J.\t", "year": "2017", "journalProceedings": "Journal of Sports Sciences", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Heart Rate", "abstract": "The purpose of this investigation was to examine the validity of energy expenditure (EE), steps, and heart rate measured with the Apple Watch 1 and Fitbit Charge HR. Thirty-nine healthy adults wore the two monitors while completing a semi-structured activity protocol consisting of 20 minutes of sedentary activity, 25 minutes of aerobic exercise, and 25 minutes of light intensity physical activity. Criterion measures were obtained from an Oxycon Mobile for EE, a pedometer for steps, and a Polar heart rate strap worn on the chest for heart rate. For estimating whole-trial EE, the mean absolute percent error (MAPE) from Fitbit Charge HR (32.9%) was more than twice that of Apple Watch 1 (15.2%). This trend was consistent for the individual conditions. Both monitors accurately assessed steps during aerobic activity (MAPEApple: 6.2%; MAPEFitbit: 9.4%) but overestimated steps in light physical activity. For heart rate, Fitbit Charge HR produced its smallest MAPE in sedentary behaviors (7.2%), followed by aerobic exercise (8.4%), and light activity (10.1%). The Apple Watch 1 had stronger validity than the Fitbit Charge HR for assessing overall EE and steps during aerobic exercise. The Fitbit Charge HR provided heart rate estimates that were statistically equivalent to Polar monitor.", "links": [] }, { "title": "The Effects of a Campus Forest-Walking Program on Undergraduate and Graduate Students' Physical and Psychological Health", "author": "Bang, K.-S., Lee, I., Kim, S., Lim, C.S., Joh, H.-K., Park, B.-J. and Song, M.K.\t", "year": "2017", "journalProceedings": "International Journal of Environmental Research and Public Health", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "We conducted a campus forest-walking program targeting university and graduate students during their lunchtime and examined the physical and psychological effects of the program. We utilized a quasi-experimental design with a control group and a pretest–posttest design. Forty-seven men (M = 25.5 ± 3.8 years) and 52 women (M = 23.3 ± 4.3 years) volunteered to participate (experimental group n = 51, control group n = 48). The intervention group participated in campus forest-walking program once a week for six weeks; they were also asked to walk once a week additionally on an individual basis. Additionally, participants received one lecture on stress management. Post-tests were conducted both just after the program ended and three months after. A chi-square test, t-test, and repeated measures analysis of variance were used to evaluate the effects of the program. Health promoting behaviors (F = 7.27, p = 0.001, ES = 0.27) and parasympathetic nerve activity (F = 3.69, p = 0.027, ES = 0.20) significantly increased and depression (F = 3.15, p = 0.045, ES = 0.18) significantly decreased in the experimental group after the intervention compared to the control group. In conclusion, using the campus walking program to target students during their lunchtime is an efficient strategy to promote their physical and psychological health.", "links": [ { "caption": "URL", "url": "http://www.mdpi.com/1660-4601/14/7/728", "newWindow": true } ] }, { "title": "Assessing bouts of activity using modeled clinically validated physical activity on commodity hardware", "author": "Barrett, C., Dominick, G. and Winfree, K.N.", "year": "2017", "journalProceedings": "2017 IEEE EMBS International Conference on Biomedical & Health Informatics", "category": "Methods", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Human activity can be measured through identification of bouts of activity. The Freedson cut point method used by ActiGraph has become one very common and well accepted standard for estimating times of continuous moderate to vigorous physical activity (MVPA). However, such methods do not directly apply to other data sources such as the Fitbit Flex, a wrist worn wireless pedometer. In previous research by the authors, a model was presented to improve the estimates of physical activity (PA) level in the Fitbit devices. This paper considers the estimates of activity bouts, building on the modeled PA level from the Fitbit Flex as compared to the results from the ActiGraph GT3X. The purpose of this paper is to compare the “gold standard” ActiGraph to modeled Fitbit Freedson methods and to establish normative values of expected errors in bout detection between the two devices and methods, both of which are proxy methods aimed at measuring actual physical activity levels. Here we compare bout identification using three measures, the ActiGraph Freedson method, Fitbit Intensity Score, and the modeled Fitbit Freedson using three different outcomes. First, we compare a baseline of per subject per day number and duration of bouts from an ActiGraph GT3X to the results found from using the same methods on the Intensity Score reported by Fitbit and the modeled Fitbit Freedson method. Next, we compare the difference in duration of bouts identified in each data source matched according to similar start and end times. Finally, we compare the bouts found from the three methods to bouts identified in a self report diary.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/document/7897257/", "newWindow": true } ] }, { "title": "The Accuracy of Personal Activity Monitoring Devices", "author": "Battenberg, A.K., Donohoe, S., Robertson, N. and Schmalzried, T.P.\t", "year": "2017", "journalProceedings": "Seminars in Arthroplasty", "category": "Validation", "devices": "One,Force", "population": "Adults", "dataUsed": "Steps", "abstract": "Activity monitoring has important applications in orthopedic and medical research. There is a paucity of information on device accuracy. Thirty adults tested the accuracy of 10 devices in 5 activities: walk 400-M, run 400-M, walk 10-M, ascend and descend 10 steps. A second protocol tested slow walking speeds at 1.0, 1.5, 1.8, and 2.0MPH. The waist-based devices FitBit One™ and Omron HJ-321 were > 90% accurate for all activities. The wristband devices and Smartphone Apps were textless90% accurate for most activities. The StepWatch™ Activity Monitor was > 95% accurate at lower cadence activities, but undercounted running by ˜25%. Waist-based, dedicated activity monitors are highly accurate in a variety of activities.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1045452717300585", "newWindow": true } ] }, { "title": "Does supplementation with carnosine improve cardiometabolic health and cognitive function in patients with pre-diabetes and type 2 diabetes? study protocol for a randomised, double-blind, placebo-controlled trial", "author": "Baye, E., Menon, K., de Courten, M.P., Earnest, A., Cameron, J. and de Courten, B.\t", "year": "2017", "journalProceedings": "BMJ Open", "category": "Methods", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Heart Rate", "abstract": "Introduction: Carnosine, an over-the-counter food supplement, has a promising potential for the prevention and treatment of chronic diseases such as type 2 diabetes (T2DM), cardiovascular and neurodegenerative diseases through its anti-inflammatory, antiglycation, antioxidative and chelating effects. We have previously shown that supplementation with carnosine preserves insulin sensitivity and secretion in non-diabetic overweight and obese individuals. The effect of carnosine on cardiometabolic risk and related cognitive outcomes in patients with pre-diabetes and T2DM has thus far not been studied. We therefore aim to investigate whether supplementation with carnosine improves cardiometabolic health and cognitive function in patients with pre-diabetes and T2DM.\n\nMethods and analysis: We will employ a parallel design randomised controlled trial. Fifty participants with pre-diabetes (impaired fasting glycaemia and impaired glucose tolerance) and T2DM (with HbA1c level textless 8%) aged between 18 to 70 years will be randomly assigned to the intervention or control group. At baseline, participants will undergo a medical review and series of tests including anthropometric measurements (body mass index, a dual X-ray absorptiometry and peripheral quantitative computed tomography scan), an oral glucose tolerance test, cardiovascular measurements (central blood pressure, endothelial function and arterial stiffness), cognitive function, physical activity measurement, heart rate variability and liver fibroscan as well as questionnaires to assess dietary habits, sleep quality, depression and quality of life. The intervention group will receive 2?g of carnosine daily in two divided doses while the control group will receive identical placebo capsules for 14 weeks. All baseline measurements will be repeated at the end of the intervention. The change in glycaemic, cardiovascular and cognitive parameters as well as other measures will be compared between the groups.\n\nEthics and dissemination: This study is approved by the Human Research Ethics Committee of Monash Health and Monash University, Australia. The findings will be disseminated via peer-reviewed publications and conference presentations.", "links": [ { "caption": "URL", "url": "http://bmjopen.bmj.com/content/7/9/e017691", "newWindow": true } ] }, { "title": "Estimation of sleep stages in a healthy adult population from optical plethysmography and accelerometer signals", "author": "Beattie, Z., Oyang, Y., Statan, A., Ghoreyshi, A., Pantelopoulos, A., Russell, A. and Heneghan, C.\t", "year": "2017", "journalProceedings": "Physiological Measurement", "category": "Validation", "devices": "Surge", "population": "Adults", "dataUsed": "Sleep", "abstract": "Objective: This paper aims to report on the accuracy of estimating sleep stages using a wrist-worn device that measures movement using a 3D accelerometer and an optical pulse photoplethysmograph (PPG). Approach: Overnight recordings were obtained from 60 adult participants wearing these devices on their left and right wrist, simultaneously with a Type III home sleep testing device (Embletta MPR) which included EEG channels for sleep staging. The 60 participants were self-reported normal sleepers (36 M: 24 F, age  =  34  ±  10, BMI  =  28  ±  6). The Embletta recordings were scored for sleep stages using AASM guidelines and were used to develop and validate an automated sleep stage estimation algorithm, which labeled sleep stages as one of Wake, Light (N1 or N2), Deep (N3) and REM (REM). Features were extracted from the accelerometer and PPG sensors, which reflected movement, breathing and heart rate variability. Main results: Based on leave-one-out validation, the overall per-epoch accuracy of the automated algorithm was 69%, with a Cohen's kappa of 0.52  ±  0.14. There was no observable bias to under- or over-estimate wake, light, or deep sleep durations. REM sleep duration was slightly over-estimated by the system. The most common misclassifications were light/REM and light/wake mislabeling. Significance: The results indicate that a reasonable degree of sleep staging accuracy can be achieved using a wrist-worn device, which may be of utility in longitudinal studies of sleep habits.", "links": [ { "caption": "URL", "url": "http://stacks.iop.org/0967-3334/38/i=11/a=1968?key=crossref.9d3836004c84123c742c124648581e02", "newWindow": true } ] }, { "title": "Estimation of Sleep Stages Using Cardias and Accelerometer Data from a Wrist-Worn Device", "author": "Beattie, Z., Pantelopoulos, A., Ghoreyshi, A., Oyang, Y., Statan, A. and Heneghan, C.\t", "year": "2017", "journalProceedings": "Sleep", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "Introduction: We investigated the ability of a wrist-worn tracker to estimate sleep stages in normal adult sleepers. Such a device could be useful in simplifying sleep research and in increasing public knowledge of sleep.\nMethods: Movement and cardiac data was collected from 60 adult subjects (36 M: 24 F, ages 34?±?10 yrs) wearing two wrist worn devices (left and right hand) containing a 3D-accelerometer and an optical photoplethysmogram (PPG), while undergoing a sleep stage study using a Type III home sleep testing device. The accelerometer was used to generate various features of movement; the PPG records cardiac peaks generated by each heartbeat, and can be used to determine heart rate and heart rate variability metrics. The sleep study was scored independently by two registered PSG technicians, using consensus AASM scoring rules. Using these labels, an automated classifier and post-processing rule was developed to label 30-second epochs as one of Wake/Light/Deep/REM (note that Stages N1 and N2 were combined into a single “Light” classification). The estimated performance of this automated classifier system was calculated using a leave-one out validation method. The performance metrics were Cohen's kappa (measures the level of agreement greater than chance) and per-epoch accuracy (percent of epochs correctly labeled).\n\nResults: The estimated Cohen's kappa was 0.52?±?0.14 for left hand wear, and 0.53?±?0.14 (right hand). The per-epoch accuracy was 69%. Across the population, there was no statistically significant bias in the estimated durations of the wake, light, deep and REM stages versus the gold standard measurements.\n\nConclusion: These results suggest that a wrist worn device with movement and cardiac sensors can be used to determine sleep stages with a reasonable degree of accuracy in normal adult sleepers, but without the cost and artificial sleep environment of a sleep laboratory. The reported performance figures are similar or better than previously reported results from non-EEG based sleep staging using combinations of cardiac, respiratory and movement information.", "links": [ { "caption": "URL", "url": "https://academic.oup.com/sleep/article-lookup/doi/10.1093/sleepj/zsx050.067", "newWindow": false } ] }, { "title": "Validity, reliability and feasibility of commercially available activity trackers in physical therapy for people with a chronic disease: a study protocol of a mixed methods research", "author": "Beekman, E., Braun, S.M., Ummels, D., van Vijven, K., Moser, A. and Beurskens, A.J.\t", "year": "2017", "journalProceedings": "Pilot and Feasibility Studies", "category": "Methods", "devices": "One,Flex", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "For older people and people with a chronic disease, physical activity provides health benefits. Patients and healthcare professionals can use commercially available activity trackers to objectively monitor (alterations in) activity levels and patterns and to support physical activity. However, insight in the validity, reliability, and feasibility of these trackers in people with a chronic disease is needed. In this article, a study protocol is described in which the validity, reliability (part A), and feasibility from a patient and therapist's point of view (part B) of commercially available activity trackers in daily life and health care is investigated. In part A, a quantitative cross-sectional study, an activity protocol that simulates everyday life activities will be used to determine the validity and reliability of nine commercially available activity trackers. Video recordings will act as the gold standard. In part B, a qualitative participatory action research study will be performed to gain insight in the use of activity trackers in peoples' daily life and therapy settings. Objective feasibility of the activity trackers will be measured with questionnaires, and subjective feasibility (experiences) will be explored in a community of practice. Physical therapists (n = 8) will regularly meet during 6 months to learn from each other regarding the actual use of activity trackers in therapy. Therapists and patients (n = 48) will decide together which tracker will be used in therapy and for which purpose (e.g., monitoring, goal setting). Data from the therapist' and patients' experiences will be collected by interviews (individual and focus groups) and analyzed by a directed content analysis. At the time of submission, selection of activity trackers, development of the activity protocol, and the ethical approval process are finished. Data collection and data processing are ongoing. The relevance of the study as well as the advantages and disadvantages of several aspects of the chosen design are discussed. The results acquired from both study parts can be used to create decision aids that may assist therapists and people with a chronic disease in choosing a suitable activity tracker, and to facilitate use of these activity trackers in health care settings. Ethical approval has been obtained from two medical-ethical committees (nr. 15-N-109, 15-N-48 and MEC-15-07).", "links": [ { "caption": "URL", "url": "https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-017-0200-5", "newWindow": true } ] }, { "title": "A Feasible and Efficacious Mobile-Phone Based Lifestyle Intervention for Filipino Americans with Type 2 Diabetes: Randomized Controlled Trial", "author": "Bender, M.S., Cooper, B.A., Park, L.G., Padash, S. and Arai, S.\t", "year": "2017", "journalProceedings": "JMIR Diabetes", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps,Weight,Food", "abstract": "Background: Filipino Americans have a high prevalence of obesity, type 2 diabetes (T2D), and cardiovascular disease compared with other Asian American subgroups and non-Hispanic whites. Mobile health (mHealth) weight loss interventions can reduce chronic disease risks, but these are untested in Filipino Americans with T2D. Objective: The objective of this study was to assess feasibility and potential efficacy of a pilot, randomized controlled trial (RCT) of a culturally adapted mHealth weight loss lifestyle intervention (Pilipino Americans Go4Health [PilAm Go4Health]) for overweight Filipino Americans with T2D. Methods: This was a 2-arm pilot RCT of the 3-month PilAm Go4Health intervention (phase 1) with an active waitlist control and 3-month follow-up (phase 2). The waitlist control received the PilAm Go4Health in phase 2, whereas the intervention group transitioned to the 3-month follow-up. PilAm Go4Health incorporated a Fitbit accelerometer, mobile app with diary for health behavior tracking (steps, food/calories, and weight), and social media (Facebook) for virtual social support, including 7 in-person monthly meetings. Filipino American adults ≥18 years with T2D were recruited from Northern California. Feasibility was measured by rates of recruitment, engagement, and retention. Multilevel regression analyses assessed within and between group differences for the secondary outcome of percent weight change and other outcomes of weight (kg), body mass index (BMI), waist circumference, fasting plasma glucose, HbA1c, and steps. Results: A total of 45 Filipino American adults were enrolled and randomized. Mean age was 58 (SD 10) years, 62% (28/45) were women, and mean BMI was 30.1 (SD 4.6). Participant retention and study completion were 100%, with both the intervention and waitlist group achieving near-perfect attendance at all 7 intervention office visits. Groups receiving the PilAm Go4Health in phase 1 (intervention group) and phase 2 (waitlist group) had significantly greater weight loss, −2.6% (−3.9 to −1.4) and −3.3% (−1.8 to −4.8), respectively, compared with the nonintervention group, resulting in a moderate to small effect sizes (d=0.53 and 0.37, respectively). In phase 1, 18% (4/22) of the intervention group achieved a 5% weight loss, whereas 82% (18/22) maintained or lost 2% to 5% of their weight and continued to maintain this weight loss in the 3-month follow-up. Other health outcomes, including waist circumference, BMI, and step counts, improved when each arm received the PilAm Go4Health, but the fasting glucose and HbA1c outcomes were mixed. Conclusions: The PilAm Go4Health was feasible and demonstrated potential efficacy in reducing diabetes risks in overweight Filipino Americans with T2D. This study supports the use of mHealth and other promising intervention strategies to reduce obesity and diabetes risks in Filipino Americans. Further testing in a full-scale RCT is warranted. These findings may support intervention translation to reduce diabetes risks in other at-risk diverse populations. Trial Registration: Clinicaltrials.gov NCT02290184; https://clinicaltrials.gov/ct2/show/NCT02290184 (Archived by WebCite at http://www.webcitation.org/6vDfrvIPp) [JMIR Diabetes 2017;2(2):e30]", "links": [] }, { "title": "A Feasible and Effective Mobile Health Weight Loss Lifestyle Intervention for Filipinos With Type 2 Diabetes", "author": "Bender, M.S., Cooper, B. and Arai, S.\t", "year": "2017", "journalProceedings": "Circulation", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Introduction: Filipino Americans have the highest prevalence of obesity and type 2 diabetes (T2D) compared to Asian American subgroups placing them at high risk for cardiometabolic disease. Effective interventions are needed to reduce these health disparities. Mobile health (mHealth) weight loss lifestyle interventions have been effective in reducing cardiometabolic risks, but are untested among Filipinos, particularly with T2D. As prolific users of digital technology, Filipinos are ideal candidates for mHealth lifestyle interventions. Therefore, we conducted the PilAm Go4Health intervention study - a culturally adapted weight loss lifestyle intervention using mobile technology to reduce cardiometabolic risks among Filipinos with T2D.\nObjective: To demonstrate intervention feasibility and potential efficacy.\n\nHypothesis: 1) participant retention rate will be greater than 80%; 2) Compared to the control, intervention group will have significantly greater reduction in: % weight loss, waist circumference, fasting plasma glucose, and HbA1; and greater increase in step-counts.\n\nMethods: Two-arm (intervention +active control groups) RCT compared a 3-month intervention (Fitbit accelerometer +mHealth app/diary +Facebook group) and control (Fitbit accelerometer). N=45 overweight Filipino adults with T2D were recruited from Northern California communities. Between group differences from baseline to 3-months were analyzed using: 1) multilevel regression for within-person change in weight and step-counts using a nonparametric bias-corrected bootstrapped 95% CI for the multilevel models, and 2) T-tests, ANOVA for waist circumference, fasting plasma glucose, and HbA1c (significance =ptextless0.05, 2-sided). Cohen's d was used for effect size analyses.\n\nResults: Randomized N=45 Filipinos (intervention =22 and control =23). Mean age was 58±10 years, 62% women, and retention rate=100%. There was significantly greater reduction in the intervention group compared to the control for: % weight (2.3% greater decrease, d=0.46); waist circumference (-2.68cm; d= 0.88); and fasting plasma glucose (-18.52mg/dl; d= -0.86). HbA1c group difference was not significant (-0.34%; ptextless 0.19). Step-counts significantly increased in the intervention group compared to control (3432 steps at endpoint; d=1.44).\n\nConclusion: PilAm Go4Health intervention demonstrated excellent feasibility in recruitment and retention, and potential efficacy for reducing cardiometabolic risks in Filipinos with T2D. Results warrant further testing of this lifestyle intervention that may support translation to other at-risk diverse populations living with T2D.", "links": [ { "caption": "URL", "url": "http://circ.ahajournals.org/content/135/Suppl_1/AMP006", "newWindow": true } ] }, { "title": "Exploring the Association Between Self-Reported Asthma Impact and Fitbit-Derived Sleep Quality and Physical Activity Measures in Adolescents", "author": "Bian, J., Guo, Y., Xie, M., Parish, A.E., Wardlaw, I., Brown, R., Modave, F., Zheng, D. and Perry, T.T.\t", "year": "2017", "journalProceedings": "JMIR mHealth and uHealth", "category": "Measurement", "devices": "Charge HR", "population": "Patients,Children", "dataUsed": "Steps,Intensity,Sleep", "abstract": "BACKGROUND Smart wearables such as the Fitbit wristband provide the opportunity to monitor patients more comprehensively, to track patients in a fashion that more closely follows the contours of their lives, and to derive a more complete dataset that enables precision medicine. However, the utility and efficacy of using wearable devices to monitor adolescent patients' asthma outcomes have not been established. OBJECTIVE The objective of this study was to explore the association between self-reported sleep data, Fitbit sleep and physical activity data, and pediatric asthma impact (PAI). METHODS We conducted an 8-week pilot study with 22 adolescent asthma patients to collect: (1) weekly or biweekly patient-reported data using the Patient-Reported Outcomes Measurement Information System (PROMIS) measures of PAI, sleep disturbance (SD), and sleep-related impairment (SRI) and (2) real-time Fitbit (ie, Fitbit Charge HR) data on physical activity (F-AM) and sleep quality (F-SQ). To explore the relationship among the self-reported and Fitbit measures, we computed weekly Pearson correlations among these variables of interest. RESULTS We have shown that the Fitbit-derived sleep quality F-SQ measure has a moderate correlation with the PROMIS SD score (average r=-.31, P=.01) and a weak but significant correlation with the PROMIS PAI score (average r=-.18, P=.02). The Fitbit physical activity measure has a negligible correlation with PAI (average r=.04, P=.62). CONCLUSIONS Our findings support the potential of using wrist-worn devices to continuously monitor two important factors-physical activity and sleep-associated with patients' asthma outcomes and to develop a personalized asthma management platform.", "links": [ { "caption": "URL", "url": "http://mhealth.jmir.org/2017/7/e105/", "newWindow": true } ] }, { "title": "Trial to Incentivise Adherence for Diabetes (TRIAD): study protocol for a randomised controlled trial", "author": "Bilger, M., Shah, M., Tan, N.C., Howard, K.L., Xu, H.Y., Lamoureux, E.L. and Finkelstein, E.A.\t", "year": "2017", "journalProceedings": "Trials", "category": "Methods", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Many people with diabetes have suboptimal glycaemic control due to not being adherent to their treatment regimen. Behavioural economic theory suggests that the lack of adherence results from the disconnect between the timing of when costs and benefits accrue. One strategy to address this discontinuity is to offer patients a near-term benefit, such as a financial reward. Whereas there is evidence that rewards can improve treatment adherence and sometimes health outcomes, further research is needed to determine whether rewards are more effective when targeting processes or intermediary health outcomes. In the Trial to Incentivise Adherence for Diabetes (TRIAD) we test whether adding financial incentives to usual care can improve HbA1c levels among people with diabetes and whether the financial incentives work better when targeting processes (adherence to blood glucose testing, medication, and daily physical activity) or the primary intermediary health outcome of self-monitored blood glucose within an acceptable range. TRIAD is a randomised, controlled, open-label, single-centre superiority trial with three parallel arms. A total of 240 patients with suboptimally controlled diabetes (HbA1c ≥ 8%) from a polyclinic in Singapore are block-randomised (blocking factor: current vs. new glucometer users) into three arms, namely (1) usual care (UC) only, (2) UC with process incentive and (3) UC with outcome incentive, in a 2:3:3 ratio. Masking the arm allocation will be precluded by the behavioural nature of the intervention but blocking size will not be disclosed to protect concealment. The primary outcome (change in HbA1c level at month 6) will be measured by a laboratory that is independent from the study team. Secondary outcomes (at month 6) include the number of blood glucose testing days, glucose readings within the normal range (between 4 to 7 mmol/L), medication-adherent days, physically active days, and average incentives earned and time spent administrating the incentives. This study will provide evidence on whether financial incentives can cost-effectively improve glycaemic control. It will also provide evidence on the benefit incidence of interventions involving financial incentives. By comparing process to outcome incentives, this study will inform the design of future incentive strategies in chronic disease management and beyond.", "links": [ { "caption": "URL", "url": "https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-2288-6", "newWindow": true } ] }, { "title": "Daily Activity Measured With Wearable Technology as a Novel Measurement of Treatment Effect in Patients With Coronary Microvascular Dysfunction: Substudy of a Randomized Controlled Crossover Trial", "author": "Birkeland, K., Khandwalla, R.M., Kedan, I., Shufelt, C.L., Mehta, P.K., Minissian, M.B., Wei, J., Handberg, E.M., Thomson, L.E., Berman, D.S., Petersen, J.W., Anderson, R.D., Cook-Wiens, G., Pepine, C.J. and Bairey Merz, C.N.\t", "year": "2017", "journalProceedings": "JMIR Research Protocols", "category": "Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background: Digital wearable devices provide a “real-world” assessment of physical activity and quantify intervention-related changes in clinical trials. However, the value of digital wearable device-recorded physical activity as a clinical trial outcome is unknown. Objective: Because late sodium channel inhibition (ranolazine) improves stress laboratory exercise duration among angina patients, we proposed that this benefit could be quantified and translated during daily life by measuring digital wearable device-determined step count in a clinical trial. Methods: We conducted a substudy in a randomized, double-blinded, placebo-controlled, crossover trial of participants with angina and coronary microvascular dysfunction (CMD) with no obstructive coronary artery disease to evaluate the value of digital wearable device monitoring. Ranolazine or placebo were administered (500-1000 mg twice a day) for 2 weeks with a subsequent 2-week washout followed by crossover to ranolazine or placebo (500-1000 mg twice a day) for an additional 2 weeks. The outcome of interest was within-subject difference in Fitbit Flex daily step count during week 2 of ranolazine versus placebo during each treatment period. Secondary outcomes included within-subject differences in angina, quality of life, myocardial perfusion reserve, and diastolic function. Results: A total of 43 participants were enrolled in the substudy and 30 successfully completed the substudy for analysis. Overall, late sodium channel inhibition reduced within-subject daily step count versus placebo (mean 5757 [SD 3076] vs mean 6593 [SD 339], P=.01) but did not improve angina (Seattle Angina Questionnaire-7 [SAQ-7]) (P=.83). Among the subgroup with improved angina (SAQ-7), a direct correlation with increased step count (r=.42, P=.02) was observed. Conclusions: We report one of the first studies to use digital wearable device-determined step count as an outcome variable in a placebo-controlled crossover trial of late sodium channel inhibition in participants with CMD. Our substudy demonstrates that late sodium channel inhibition was associated with a decreased step count overall, although the subgroup with angina improvement had a step count increase. Our findings suggest digital wearable device technology may provide new insights in clinical trial research. Trial Registration: Clinicaltrials.gov NCT01342029; https://clinicaltrials.gov/ct2/show/NCT01342029 (Archived by WebCite at http://www.webcitation.org/6uyd6B2PO) [JMIR Res Protoc 2017;6(12):e255]", "links": [] }, { "title": "Impact of a Wireless \"Wearable\" Device to Measure Daily Activity in Patients With Coronary Microvascular Disease Treated With Late Na Channel Inhibition (ranolazine): a Substudy of the RWISE Clinical Trial", "author": "Birkeland, K., Khandwalla, R.M., Kedan, I., Shufelt, C.L., Mehta, P.K., Minissian, M.B., Wei, J., Handberg, E.M., Thomson, L.E., Berman, D.S., Petersen, J.W., Anderson, R.D., Cook-Wiens, G., Pepine, C.J. and Bairey Merz, C.N.\t", "year": "2017", "journalProceedings": "Circulation: Cardiovascular Quality and Outcomes", "category": "Clinical Care,Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background: Since late Na channel inhibition (ranolazine) improves exercise duration in the stress laboratory among angina patients, we questioned if this benefit would translate to impact step-count during daily life assessed by a \"wearable\" device.\nMethods: We conducted a pilot substudy within a randomized, double-blinded, placebo-controlled, cross-over trial of subjects with angina, non-obstructive coronary artery disease and coronary microvascular dysfunction. Ranolazine was administered (500-1000mg BID for 2 weeks). The outcome of interest was difference in Fitbit Flex daily step-count during weeks 2 of ranolazine or placebo treatment. Other outcomes included angina, quality of life, ischemia, diastolic function.\n\nResults: 30 subjects were analyzed. Overall, late Na channel inhibition reduced daily step-count vs. placebo (5757 +/- 3076 vs. 6593 +/- 3393, p=0.01) and did not improve angina. However, among those with improved angina (SAQ-7 improvement), a direct correlation with increased step-count (0.42, p=0.02) was observed, most due to typical angina (0.57, p=0.05) (Fig).\n\nConclusions: We report the \"first\" data set from a wearable monitor to measure step-count in a controlled late Na channel inhibition trial. Our results suggest short-term late Na channel inhibition (ranolazine) does not increase step-count during daily life.", "links": [ { "caption": "URL", "url": "http://circoutcomes.ahajournals.org/content/10/Suppl_3/A108", "newWindow": true } ] }, { "title": "Determining the Reliability of Several Consumer-Based Physical Activity Monitors", "author": "Bock, J., Kaminsky, L., Harber, M. and Montoye, A.\t", "year": "2017", "journalProceedings": "Technologies", "category": "Validation", "devices": "One,Zip,Flex", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity", "abstract": "Limited research exists on the reliability of consumer-based physical activity monitors (CPAMs) despite numerous studies on their validity. Consumers often purchase CPAMs to assess their physical activity (PA) habits over time, emphasizing CPAM reliability more so than their validity; therefore, the purpose of this study was to investigate the reliability of several CPAMs. In this study, 30 participants wore a pair of four CPAM models (Fitbit One, Zip, Flex, and Jawbone Up24) for a total of eight monitors, while completing seven activities in the laboratory. Activities were completed in two consecutive five-minute bouts. Participants then wore either all wrist- or hip-mounted CPAMs in a free-living setting for the remainder of the day. Intra-monitor reliability for steps (0.88–0.99) was higher than kcals (0.77–0.94), and was higher for hip-worn CPAMs than for wrist-worn CPAMs (p textless 0.001 for both). Inter-monitor reliability in the laboratory for steps (0.81–0.99) was higher than kcals (0.64–0.91) and higher for hip-worn CPAMs than for wrist-worn CPAMs (p textless 0.001 for both). Free-living correlations were 0.61–0.98, 0.35–0.96, and 0.97–0.98 for steps, kcals, and active minutes, respectively. These findings illustrate that all CPAMs assessed yield reliable estimations of PA. Additionally, all CPAMs tested can provide reliable estimations of physical activity within the laboratory but appear less reliable in a free-living setting.", "links": [ { "caption": "URL", "url": "http://www.mdpi.com/2227-7080/5/3/47", "newWindow": true } ] }, { "title": "Accuracy of Wearable Devices for Determining Physiological Measures during Different Physical Activities", "author": "Boudreaux, B.D., Cormier, C.L., Williams, B.M., Hebert, E.P. and Kraemer, R.R.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Heart Rate", "abstract": "PURPOSE: Wearable technology is ACSM's number one 2016-2017 fitness trend. The accuracy of these devices has yet to be firmly established. The objective of the study was to determine the validity of wearable devices' assessment of step count, heart rate (HR) and caloric expenditure (KCAL) during various physical activities.\nMETHODS: Thirty college students (19 female, 11 male) engaged in 3 activity sessions (sweeping with a broom and dustpan, climbing stairs, and walking 1/4 mile) while wearing an Apple Watch Sport, Fitbit Charge HR, Accusplit Hip Pedometer, and iPhone 6 Plus. Step counts from devices were compared to those objectively recorded using a tally counter. Subjects also completed a treadmill graded exercise test during which HR and KCAL were reported by an Apple Watch Sport, Fitbit Charge HR, and Polar T-31. Values were compared to those from a six-lead ECG and metabolic analyzer. HR was recorded at rest and during each stage. KCAL was determined at the end of the protocol.\n\nRESULTS: Correlations between objective step counts and from the devices were: walking (.08 to .84), stair climbing (.12 to .90), and sweeping (.12 to .70). No device was accurate across all activities. The most accurate devices for activities were: walking (Apple Watch, r=.84); stair climbing (iPhone, r=.90); sweeping (Fitbit, r=.70). During the treadmill test, correlations between HR assessed via ECG and devices were: Apple Watch (.76 to .99), Polar T-31 (.72 to .94), and Fitbit (.19 to .98). Heart rate accuracy across the session was highest in the Apple Watch. KCAL from neither the Apple Watch (r=.63) nor Fitbit (r=.48) had a high correlational value to that from the metabolic analyzer.\n\nCONCLUSIONS: Fitness-related values provided by wearable devices had varying levels of accuracy when compared to objective step counts, HR and KCAL assessed by calibrated scientific equipment. Accuracy of step counts varied by activity and was higher across activities in the iPhone. HR reported from wearable devices, similarly, had varying levels of accuracy, with the Apple Watch being most accurate across a graded exercise test. Fitness-related information from wearables that are not medical devices and should be considered as estimates and used for motivation. Further validation of these devices should include a variety of physical activity modalities.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Accuracy_of_Wearable_Devices_for_Determining.2222.aspx", "newWindow": true } ] }, { "title": "Validity of Wearable Activity Monitors during Cycling and Resistance Exercise", "author": "Boudreaux, B.D., Hebert, E.P., Hollander, D.B., Williams, B.M., Cormier, C.L., Naquin, M.R., Gillan, W.W., Gusew, E.E. and Kraemer, R.R.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge 2,Blaze", "population": "Adults", "dataUsed": "Energy Expenditure,Heart Rate", "abstract": "The use of wearable activity monitors has seen rapid growth; however, the mode and intensity of exercise could affect validity of heart rate (HR) and caloric (energy) expenditure (EE) readings. There is a lack of data regarding the validity of wearable activity monitors during graded cycling regimen and a standard resistance exercise. The present study determined the validity of eight monitors for HR compared to an ECG and seven monitors for EE compared to a metabolic analyzer during graded cycling and resistance exercise. Fifty subjects (28 women, 22 men) completed separate trials of graded cycling and three sets of four resistance exercises at a 10-repetition maximum (RM) load. Monitors included: Apple Watch Series 2 (AWS2), Fitbit Blaze, Fitbit Charge 2, Polar H7 (PH7), Polar A360, Garmin Vivosmart HR, TomTom Touch, and Bose SoundSport Headphones (BSP). HR was recorded after each cycling intensity and following each resistance exercise set. EE was recorded following both protocols. Validity was established as having a mean absolute percent error (MAPE) value of textless10%. The PH7 and BSP were valid during both exercise modes (Cycling: MAPE=6.87%, R=0.79; Resistance Exercise: MAPE=6.31%, R=0.83). During cycling, the AWS2 revealed the greatest HR validity (MAPE=4.14%, R=0.80). The BSP revealed the greatest HR accuracy during resistance exercise (MAPE=6.24%, R=0.86). Across all devices, as exercise intensity increased, there was greater underestimation of HR. No device was valid for EE during cycling or resistance exercise. HR from wearable devices differed at different exercise intensities; EE estimates from wearable devices were inaccurate. Wearable devices are not medical devices and users should employ caution when utilizing these devices for monitoring physiological responses to exercise.", "links": [ { "caption": "URL", "url": "https://insights.ovid.com/crossref?an=00005768-900000000-97049", "newWindow": true } ] }, { "title": "Validity of Fitbit's active minutes as compared with a research-grade accelerometer and self-reported measures", "author": "Brewer, W., Swanson, B.T. and Ortiz, A.\t", "year": "2017", "journalProceedings": "BMJ Open Sport & Exercise Medicine", "category": "Validation", "devices": null, "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "OBJECTIVES The main purpose of the study was to assess the validity between the Fitbit and ActiGraph GT3X+ accelerometer. The specific aims were to determine the: (1) concurrent validity between the various models of the Fitbit and the GTX3+ accelerometer as the criterion measure for: number of steps and active minutes averaged over a single-day and 7-day period; (2) validity of the two devices with the International Physical Activity Questionnaire (IPAQ) for the number of daily active minutes performed. METHODS Fifty-three subjects wore a Fitbit and ActiGraph concurrently for 7 days. Data were analysed using correlation coefficients, t-tests to assess mean comparisons and Bland-Altman plots to determine agreement between the Fitbit and the ActiGraph. RESULTS The correlations between the Fitbit and ActiGraph for steps per day and per 7 days were r=0.862 and 0.820, respectively with significant mean differences between both devices. Bland-Altman analyses revealed agreement between the Fitbit and the ActiGraph for 7-day active minutes only. The correlations between the Fitbit and ActiGraph for active minutes per day and per 7 days were r=0.695 and r=0.658, respectively, with no significant mean differences between both devices. No significant correlations were found between the IPAQ and the other two devices. CONCLUSIONS The data produced by the Fitbit were consistent with the ActiGraph when the means of each device were compared over the 1-day and 7-day time periods. However, Bland-Altman analyses revealed that the Fitbit agreed with the ActiGraph when used to measure physical activity levels over a 7-day span only.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/29018543", "newWindow": true } ] }, { "title": "Establishing Linkages Between Distributed Survey Responses and Consumer Wearable Device Datasets: A Pilot Protocol", "author": "Brinton, J.E., Keating, M.D., Ortiz, A.M., Evenson, K.R. and Furberg, R.D.\t", "year": "2017", "journalProceedings": "JMIR Research Protocols", "category": "Measurement", "devices": null, "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance,Sleep,Heart Rate", "abstract": "Background: As technology increasingly becomes an integral part of everyday life, many individuals are choosing to use wearable technology such as activity trackers to monitor their daily physical activity and other health-related goals. Researchers would benefit from learning more about the health of these individuals remotely, without meeting face-to-face with participants and avoiding the high cost of providing consumer wearables to participants for the study duration. Objective: The present study seeks to develop the methods to collect data remotely and establish a linkage between self-reported survey responses and consumer wearable device biometric data, ultimately producing a de-identified and linked dataset. Establishing an effective protocol will allow for future studies of large-scale deployment and participant management. Methods: A total of 30 participants who use a Fitbit will be recruited on Mechanical Turk Prime and asked to complete a short online self-administered questionnaire. They will also be asked to connect their personal Fitbit activity tracker to an online third-party software system, called Fitabase, which will allow access to 1 month's retrospective data and 1 month's prospective data, both from the date of consent. Results: The protocol will be used to create and refine methods to establish linkages between remotely sourced and de-identified survey responses on health status and consumer wearable device data. Conclusions: The refinement of the protocol will inform collection and linkage of similar datasets at scale, enabling the integration of consumer wearable device data collection in cross-sectional and prospective cohort studies.", "links": [ { "caption": "URL", "url": "http://www.researchprotocols.org/2017/4/e66/", "newWindow": true } ] }, { "title": "Randomized trial of a clinic-based weight loss intervention in cancer survivors", "author": "Brown, J.C., Yung, R.L., Gobbie-Hurder, A., Shockro, L., O'Connor, K., Campbell, N., Kasper, J., Mayer, E.L., Tolaney, S.M., Partridge, A.H. and Ligibel, J.A.\t", "year": "2017", "journalProceedings": "Journal of Cancer Survivorship", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background\nThis trial examined the efficacy of a clinic-based weight loss intervention in cancer survivors.\nMethods\nThis single-center phase II trial randomized survivors of solid tumors and hematologic malignancies to a 15-week group-based weight loss intervention that included caloric restriction and physical activity (n = 30) or a wait-list control intervention (n = 30). The primary study outcome was body mass. Secondary study outcomes included body composition using dual-energy X-ray absorptiometry, physical fitness using the 6-min walk test (6MWT), and concentrations of serum biomarkers.\n\nResults\nParticipants in the intervention group lost 5.6 ± 4.4% of baseline weight (4.6 ± 3.9 kg), whereas participants in the control group gained 0.2 ± 2.4% of baseline weight (0.2 ± 2.0 kg); intervention effect − 5.8% (95% CI − 7.8, − 3.8); − 4.8 kg (95% CI − 6.6, − 3.0); P = 0.0001. A larger proportion of participants in the intervention group lost ≥ 5% of baseline weight compared to the control group (43 vs 0%; P textless 0.0001). The intervention led to reductions in fat mass (− 3.2 ± 0.7 kg; P textless 0.0001), improvements in physical fitness (an increase of 22.6 ± 10.8 m on 6MWT; P = 0.03), and reductions in concentrations of insulin (− 7.7 ± 3.5 μU/mL; P = 0.004) and leptin (− 7.3 ± 4.0 ng/mL; P = 0.04).\n\nConclusion\nA 15-week clinic-based weight loss intervention resulted in significant weight loss and improvements in body composition, physical fitness, and concentrations of serum biomarkers in cancer survivors.\n\nImplications for cancer survivors\nWeight loss programs provide a number of benefits for cancer survivors; survivors should inquire about the availability of lifestyle programs offered at their cancer center and within their local communities.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s11764-017-0657-5", "newWindow": true } ] }, { "title": "Does Stress Result in You Exercising Less? Or Does Exercising Result in You Being Less Stressed? Or Is It Both? Testing the Bi-directional Stress-Exercise Association at the Group and Person (N of 1) Level", "author": "Burg, M.M., Schwartz, J.E., Kronish, I.M., Diaz, K.M., Alcantara, C., Duer-Hefele, J. and Davidson, K.W.\t", "year": "2017", "journalProceedings": "Annals of Behavioral Medicine", "category": "Measurement", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: Psychosocial stress contributes to heart disease in part by adversely affecting maintenance of health behaviors, while exercise can reduce stress. Assessing the bi-directional relationship between stress and exercise has been limited by lack of real-time data and theoretical and statistical models. This lack may hinder efforts to promote exercise maintenance.\n\nPurpose: We test the bi-directional relationship between stress and exercise using real-time data for the average person and the variability—individual differences—in this relationship.\n\nMethods: An observational study was conducted within a single cohort randomized controlled experiment. Healthy young adults, (n = 79) who reported only intermittent exercise, completed 12 months of stress monitoring by ecological momentary assessment (at the beginning of, end of, and during the day) and continuous activity monitoring by Fitbit. A random coefficients linear mixed model was used to predict end-of-day stress from the occurrence/non-occurrence of exercise that day; a logistic mixed model was used to predict the occurrence/non-occurrence of exercise from ratings of anticipated stress. Separate regression analyses were also performed for each participant. Sensitivity analysis tested all models, restricted to the first 180 days of observation (prior to randomization).\n\nResults: We found a significant average inverse (i.e., negative) effect of exercise on stress and of stress on exercise. There was significant between-person variability. Of N = 69, exercise was associated with a stress reduction for 15, a stress increase for 2, and no change for the remainder. We also found that an increase in anticipated stress reported the previous night or that morning was associated with a significant 20–22% decrease (OR = 0.78–0.80) in the odds of exercising that day. Of N = 69, this increase in stress reduced the likelihood of exercise for 17, increased the odds for 1, and had no effect for the remainder. We were unable to identify psychosocial factors that moderate the individual differences in these effects.\n\nConclusions: The relationship of stress to exercise can be uni- or bi-directional and varies from person to person. A precision medicine approach may improve exercise uptake.", "links": [ { "caption": "URL", "url": "https://link.springer.com/article/10.1007%2Fs12160-017-9902-4", "newWindow": true } ] }, { "title": "Mobile Technology to Monitor Physical Activity and Wellbeing in Daily Life - Objective and Subjective Experiences of Older Adults", "author": "Cabrita, M., Tabak, M. and Vollenbroek-Hutten, M.M.\t", "year": "2017", "journalProceedings": "Proceedings of the 3rd International Conference on Information and Communication Technologies for Aging Well and e-Health", "category": "Usability", "devices": "Zip", "population": "Older Adults", "dataUsed": "Steps,Intensity,Distance", "abstract": "Older adults are not reaching the recommended guidelines for physical activity. There is growing evidence that physical activity and positive emotions reinforce each other. However, the development of interventions leveraging this knowledge faces several challenges, such as the limited knowledge on the assessment of emotional wellbeing in daily life using technology. In this study, we investigate the experience of older adults regarding the use of mobile technology to coach physical activity and monitor emotional wellbeing during one month. Our results show that the participants became more aware of their daily physical activity and perceived an added value in using the technology in daily life. However, only limited added-value was perceived on monitoring positive emotions in daily life in the way we performed it. The most common argument concerned repetitiveness of the questions being asked every day. Moreover, participants also reported that they were not used to think about their emotions, what affected the way they answered the questions regarding their emotional wellbeing. Our results suggest that, to ensure reliability of the data, it is extremely important to hear the experience of the participants after performing studies in daily life.", "links": [ { "caption": "URL", "url": "http://www.scitepress.org/DigitalLibrary/Link.aspx?doi=10.5220/0006321101640171", "newWindow": true } ] }, { "title": "The Accuracy of Heart Rate Monitoring by Some Wrist-Worn Activity Trackers", "author": "Cadmus-Bertram, L., Gangnon, R., Wirkus, E.J., Thraen-Borowski, K.M. and Gorzelitz-Liebhauser, J.\t", "year": "2017", "journalProceedings": "Annals of Internal Medicine", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "No abstract available.", "links": [ { "caption": "URL", "url": "http://annals.org/aim/article/2618339/accuracy-heart-rate-monitoring-some-wrist-worn-activity-trackers", "newWindow": true } ] }, { "title": "A novel stepped-care approach to weight loss: The role of self-monitoring and health literacy in treatment outcomes", "author": "Carels, R.A., Selensky, J.C., Rossi, J., Solar, C. and Hlavka, R.\t", "year": "2017", "journalProceedings": "Eating Behaviors", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps,Food", "abstract": "OBJECTIVES\nThe aims of the current study were twofold: 1) examine the effectiveness of an innovative three-step, stepped-care behavioral weight loss treatment, and 2) examine factors that contribute to poor weight loss outcomes and the need for more intensive treatment.\nMETHODS\nThe total sample for the study consisted of 53 individuals (87% female) with MBMI=35.6, SDBMI=6.4. A three-step, stepped-care treatment approach was implemented over six months. Step 1 included the Diabetes Prevention Program manual adapted for self-administration augmented with monitoring technology shown to facilitate weight loss and participant accountability and engagement. Participants who were unsuccessful at achieving established weight loss goals received stepped-up treatments in 2-month increments beginning at month 2. The stepped progression included the addition of meal replacement at Step 2 and individual counseling concurrent with meal replacement at Step 3.\n\nRESULTS\nUn-stepped and once stepped participants lost a clinically significant amount of weight (i.e., textgreater5%), while twice stepped participants lost an insignificant amount of weight. Twice stepped participants were significantly lower in health literacy and self-monitoring frequency.\n\nCONCLUSIONS\nIn this investigation, approximately 60% of the participants were able to lose a clinically significant amount of weight utilizing a minimally intensive intervention with little additional support. Regular self-monitoring and high health literacy proved to be significant correlates of success.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1471015316303373", "newWindow": true } ] }, { "title": "The efficacy of wearable activity tracking technology as part of a weight loss program: a systematic review.", "author": "Cheatham, S.W., Stull, K.R., Fantigrassi, M. and Motel, I.\t", "year": "2017", "journalProceedings": "The Journal of sports medicine and physical fitness", "category": "Review", "devices": null, "population": "Adults", "dataUsed": null, "abstract": "INTRODUCTION The world obesity rate has increased over the past two decades. This problem has been linked to inactivity and lack of exercise among individuals which prompted the development of wearable activity tracking technology. This technology is commonly offered as a bracelet, watch, or pendent that provides feedback of daily activity such as total step count, heart rate, and energy expenditure. Despite the popularity of these devices, their efficacy to assist in behavior change and weight loss is still being studied. The purpose of this systematic review was to appraise the current evidence on the efficacy of wearable activity devices when used in a comprehensive weigh loss program. EVIDENCE ACQUISITION A systematic review was conducted according the PRISMA guidelines. A search of electronic databases was conducted through December, 2016 using the following keywords: activity monitor, consumer, wearable, technology, Fitbit®, Garmin®, Jawbone®, physical, activity, tracker, weight loss, walking, pedometer, accelerometer, step count, calories, obesity, digital, self-monitoring, and mobile health (mHealth). The grading of studies was conducted using the PEDro scale. EVIDENCE SYNTHESIS We identified 7184 citations, 25 met the inclusion criteria. Twenty-one studies scored a 6 or higher and four studies scored a 5 on the PEDro scale. All subjects had a body mass index (BMI) of = 25 and were mostly women. CONCLUSIONS The results suggests that short-term (textless6 months) weight loss interventions using activity trackers may be a better option than a standard weight loss program in middle age or older adults. Younger adults may not benefit from such technology.", "links": [] }, { "title": "Short-Term Efficacy of an Innovative Mobile Phone Technology-Based Intervention for Weight Management for Overweight and Obese Adolescents: Pilot Study.", "author": "Chen, J.-L., Guedes, C.M., Cooper, B.A. and Lung, A.E.\t", "year": "2017", "journalProceedings": "Interactive Journal of Medical Research", "category": "Intervention", "devices": "Flex", "population": "Adolescents", "dataUsed": "Steps", "abstract": "BACKGROUND In the United States, approximately one-third of adolescents are now overweight or obese, and one in six is obese. This financial cost and the larger nonfinancial costs of obesity make obesity prevention and management for adolescents imperative for the health of the nation. However, primary care visits are typically brief, and primary care providers may lack adequate resources to help overweight or obese adolescents to manage weight issues. To augment the efficacy of primary care visits for adolescent weight management, mobile phone technology can be used as an adjunct treatment that provides additional opportunities for encouraging improvement in lifestyle, attainment, and maintenance of healthy weight. OBJECTIVE The purposes of this study were to (1) measure effects of an innovative mobile phone technology-based intervention for overweight and obese adolescents and to (2) examine the intervention's feasibility for use in primary care clinics. METHODS The mobile phone-based intervention had three components: use of the Fitbit Flex, participation in an online educational program, and receipt of biweekly text messages during the maintenance phase. A randomized controlled study design was utilized. Data regarding anthropometrics (body mass index [BMI] and waist-to-hip ratio), blood pressure, levels of physical and sedentary activity, diet, and self-efficacy regarding physical activity and diet were collected at baseline and at 3 and 6 months after the baseline assessment. RESULTS A total of 40 adolescents participated in the study. At the 6-month follow-up visit, compared to participants in the control group, the mobile phone-based intervention participants had significant improvement in BMI (z=-4.37, P=.001), diastolic blood pressure (z=-3.23, P=.001), physical activity days per week (z=2.58, P=.01), TV and computer time (z=-3.34, P=.001), servings of fruits and vegetables per day (z=2.74, P=.006), servings of soda and sweetened drinks (z=-3.19, P=.001), physical activity self-efficacy (z=2.75, P=.006), and dietary self-efficacy (z=5.05, P=.001). Medium to large effect sizes were found in these outcome variables. CONCLUSIONS The use of mobile technologies may offer a practical, reliable adjunct to weight management for overweight and obese adolescents in busy primary care clinics serving adolescents.", "links": [ { "caption": "URL", "url": "http://www.i-jmr.org/2017/2/e12/", "newWindow": true } ] }, { "title": "Explainable sleep quality evaluation model using machine learning approach", "author": "Choi, R.-H., Kang, W.-S. and Son, C.-S.", "year": "2017", "journalProceedings": "2017 IEEE International Conference on Multisensor Fusion and Integration for Intelligent Systems (MFI)", "category": "Methods", "devices": "Charge HR", "population": "Adults", "dataUsed": "Sleep,Heart Rate", "abstract": "This research presents a scheme for explainable sleep quality evaluation utilizing the heart rate based sleep index. In the proposed model, the global covering rule induction of LERS (Learning from Examples based on Rough Sets) is used to generate rules associated with sleep quality status, such as `Bad,' `Normal,' and `Good.' These rules are used to interpret the three sleep statuses. To show the applicability of the proposed scheme, we construct a sleep quality evaluation model based on sleep intraday time-series data collected from 280 factory and office workers with Fitbit fitness trackers. An evaluation of the proposed model was provided through statistical cross validation experiments.", "links": [ { "caption": "URL", "url": "https://ieeexplore.ieee.org/document/8170377/", "newWindow": true } ] }, { "title": "Accuracy of step count measured by physical activity monitors: the effect of gait speed and anatomical placement site.", "author": "Chow, J.J., Thom., J.M., Wewege, M.A., Ward, R.E. and Parmenter, B.J.\t", "year": "2017", "journalProceedings": "Gait & Posture", "category": "Validation", "devices": "One,Flex,Charge HR", "population": "Adults", "dataUsed": "Steps", "abstract": "INTRODUCTION\nConsumer-based physical activity monitors (PAMs) are becoming increasingly popular, with multiple global organizations recommending physical activity levels that equate to 10,000 steps per day for optimal health. We therefore aimed to compare the step count of five PAMs to a visual step count to identify the most accurate monitors at varying gait speeds, along with the optimal anatomical placement site.\nMETHODS\nParticipants completed 3minutes on a treadmill for five speeds (5.0kmh-1, 6.5kmh-1, 8.0kmh-1, 10kmh-1, 12kmh-1). An Actigraph wGT3XBT-BT and Fitbit One the waist and both wrists, as well as a Fitbit Flex, Fitbit Charge HR and Jawbone UP24 on both wrists. A video of participant's lower limbs was recorded for visual count. Analyses of variance (ANOVAs) were conducted to examine the effects of gait speed and device placement site on step count accuracy.\n\nRESULTS\nThirty-one participants (mean age 24.3±5.2yrs) took part. Step count error ranged from 41.3±13.8% for the wrist-worn Actigraph to only 0.04±4.3% and -0.3±4.0% for the waist-worn Fitbit One and Actigraph, respectively. Across all gait speeds, waist-worn devices achieved better accuracy than those on the wrist (p t< 0.001). The Jawbone was the most accurate wrist-worn consumer-based device at slower speeds (p=0.026), with the Fitbit Flex, and Fitbit Charge HR increasing in accuracy to match the Jawbone at higher speeds.\n\nCONCLUSION\nThe accuracy and reliability of consumer-based PAMs and the Actigraph is affected by anatomical placement site and walking speed. The Fitbit One and Actigraph on the waist were the strongest performers across all speeds.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0966636217302357", "newWindow": true } ] }, { "title": "Accuracy of Accelerometer (Fitbit® ChargeHR™) Measured Distance and Heart Rate in Patients with Pulmonary Arterial Hypertension", "author": "Chowdhury, A., Sehgal, S., Rabih, F., Gadre, A. and Highland, K.B.\t", "year": "2017", "journalProceedings": "American Journal of Respiratory and Critical Care Medicine", "category": "Validation", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Distance,Heart Rate", "abstract": "Journal of Respiratory and Critical Care MedicineRationale: Functional capacity assessment in patients with pulmonary arterial hypertension (PAH) is used to establish treatment goals and prognoses. Higher resting heart rate and poor heart rate recovery after activity has been associated with worse outcomes. Devices that can accurately monitor heart rate and activity can thus be valuable to monitor patients with PAH. Accelerometers measure movement using a piezo-electric crystal and can quantify activity as steps. Several accelerometers can monitor heart rate using optical blood flow sensing by photoplethysmography. Accelerometers have been validated to measure step count in healthy adults and patients with COPD. Studies validating distance and heart rate (HR) measured by activity monitors are discrepant. Validity in patients with PAH has not been studied. The Fitbit® ChargeHR™ is a “watch” type activity monitor that can continuously measure step count and heart rate. It uses height to estimate gait length and calculates distance walked. We examined the accuracy of this device in measuring distance walked and HR at rest and after exercise in patients with PAH. Methods: Thirty patients with WHO Group I PAH were enrolled. Subjects wore a Fitbit® ChargeHR™ during a 6 minute walk test (6MWT). Distance and HR as determined by the Fitbit® and 6MWT were recorded. HR measured using pulse oximetry was used at the reference. The Fitbit® failed to record steps if patients used a walker (n = 6), and these data were not analyzed. The concordance correlation coefficient (CCC) was used to compare the accelerometer with reference values. Results: 30 patients with WHO Group I PAH (23 idiopathic and 7 connective tissue disease), with a mean age 50.49 ± 12.97 were enrolled in the study. Mean six minute walk distance was 368.6 ± 144 m, WHO functional class was I - 0%, II - 56%, III - 34.9 %, and IV - 8.7% The distance walked as determined by the accelerometer did not correlate with distance measured in the 6MWT (CCC 0.52, 95% CI [0.19, 0.74]). Heart rate measured by the Fitbit® did not correlate with HR measured by pulse oximetry at rest or after exertion (CCC and [95% CI] were 0.57 [0.28, 0.76] and 0.24 [-0.03, 0.47]. Conclusions: We demonstrate that the Fitbit® ChargeHR™ did not accurately determine walk distance or resting heart rate in a controlled test environment in patients with WHO Group I PAH. Reported HR and distance walked should be interpreted with caution in patients with PAH.", "links": [ { "caption": "URL", "url": "http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A3116", "newWindow": false } ] }, { "title": "Assessment of laboratory and daily energy expenditure estimates from consumer multi-sensor physical activity monitors", "author": "Chowdhury, E.A., Western, M.J., Nightingale, T.E., Peacock, O.J. and Thompson, D.\t", "year": "2017", "journalProceedings": "PLOS ONE", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "Wearable physical activity monitors are growing in popularity and provide the opportunity for large numbers of the public to self-monitor physical activity behaviours. The latest generation of these devices feature multiple sensors, ostensibly similar or even superior to advanced research instruments. However, little is known about the accuracy of their energy expenditure estimates. Here, we assessed their performance against criterion measurements in both controlled laboratory conditions (simulated activities of daily living and structured exercise) and over a 24 hour period in free-living conditions. Thirty men (n = 15) and women (n = 15) wore three multi-sensor consumer monitors (Microsoft Band, Apple Watch and Fitbit Charge HR), an accelerometry-only device as a comparison (Jawbone UP24) and validated research-grade multi-sensor devices (BodyMedia Core and individually calibrated Actiheart™). During discrete laboratory activities when compared against indirect calorimetry, the Apple Watch performed similarly to criterion measures. The Fitbit Charge HR was less consistent at measurement of discrete activities, but produced similar free-living estimates to the Apple Watch. Both these devices underestimated free-living energy expenditure (-394 kcal/d and -405 kcal/d, respectively; Ptextless0.01). The multi-sensor Microsoft Band and accelerometry-only Jawbone UP24 devices underestimated most laboratory activities and substantially underestimated free-living expenditure (-1128 kcal/d and -998 kcal/d, respectively; Ptextless0.01). None of the consumer devices were deemed equivalent to the reference method for daily energy expenditure. For all devices, there was a tendency for negative bias with greater daily energy expenditure. No consumer monitors performed as well as the research-grade devices although in some (but not all) cases, estimates were close to criterion measurements. Thus, whilst industry-led innovation has improved the accuracy of consumer monitors, these devices are not yet equivalent to the best research-grade devices or indeed equivalent to each other. We propose independent quality standards and/or accuracy ratings for consumer devices are required.", "links": [ { "caption": "URL", "url": "http://dx.plos.org/10.1371/journal.pone.0171720", "newWindow": true } ] }, { "title": "Comparison of wrist-worn Fitbit Flex and waist-worn ActiGraph for measuring steps in free-living adults", "author": "Chu, A.H.Y., Ng, S.H.X., Paknezhad, M., Gauterin, A., Koh, D., Brown, M.S. and Müller-Riemenschneider, F.\t", "year": "2017", "journalProceedings": "PLOS ONE", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Introduction: Accelerometers are commonly used to assess physical activity. Consumer activity trackers have become increasingly popular today, such as the Fitbit. This study aimed to compare the average number of steps per day using the wrist-worn Fitbit Flex and waist-worn ActiGraph (wGT3X-BT) in free-living conditions.\n\nMethods: 104 adult participants (n = 35 males; n = 69 females) were asked to wear a Fitbit Flex and an ActiGraph concurrently for 7 days. Daily step counts were used to classify inactive (textless10,000 steps) and active (=10,000 steps) days, which is one of the commonly used physical activity guidelines to maintain health. Proportion of agreement between physical activity categorizations from ActiGraph and Fitbit Flex was assessed. Statistical analyses included Spearman's rho, intraclass correlation (ICC), median absolute percentage error (MAPE), Kappa statistics, and Bland-Altman plots. Analyses were performed among all participants, by each step-defined daily physical activity category and gender.\n\nResults: The median average steps/day recorded by Fitbit Flex and ActiGraph were 10193 and 8812, respectively. Strong positive correlations and agreement were found for all participants, both genders, as well as daily physical activity categories (Spearman's rho: 0.76–0.91; ICC: 0.73–0.87). The MAPE was: 15.5% (95% confidence interval [CI]: 5.8–28.1%) for overall steps, 16.9% (6.8–30.3%) vs. 15.1% (4.5–27.3%) in males and females, and 20.4% (8.7–35.9%) vs. 9.6% (1.0–18.4%) during inactive days and active days. Bland-Altman plot indicated a median overestimation of 1300 steps/day by the Fitbit Flex in all participants. Fitbit Flex and ActiGraph respectively classified 51.5% and 37.5% of the days as active (Kappa: 0.66).\n\nConclusions: There were high correlations and agreement in steps between Fitbit Flex and ActiGraph. However, findings suggested discrepancies in steps between devices. This imposed a challenge that needs to be considered when using Fitbit Flex in research and health promotion programs.", "links": [ { "caption": "URL", "url": "http://dx.plos.org/10.1371/journal.pone.0172535", "newWindow": true } ] }, { "title": "Pulmonary exposure to metal fume particulate matter cause sleep disturbances in shipyard welders", "author": "Chuang, H.-C., Su, T.-Y., Chuang, K.-J., Hsiao, T.-C., Lin, H.-L., Hsu, Y.-T., Pan, C.-H., Lee, K.-Y., Ho, S.-C. and Lai, C.-H.\t", "year": "2017", "journalProceedings": "Environmental Pollution", "category": "Measurement", "devices": "Charge HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "Sleep disorders may pose a risk to workers in the workplace. We aimed to investigate the associations between metal fume fine particulate matter (PM2.5) and sleep quality in workers. We assessed the effects of personal exposure to metal fume PM2.5 on lung functions, urinary biomarkers, and sleep quality in shipyard welding workers. In total, 96 welding workers and 54 office workers were recruited in the present study; office workers were exposed to 82.1 ± 94.1 μg/m3 PM2.5 and welding workers were exposed to 2166.5 ± 3149.1 μg/m3. Welding workers had significantly lower levels of FEV25-75 than office workers (p textless 0.05). An increase in 1 μg/m3 PM2.5 was associated with a decrease of 0.003 ng/mL in urinary serotonin (95% CI = −0.007–0.000, p textless 0.05) in all workers and with a decrease of 0.001 ng/mL in serotonin (95% CI = −0.004–0.002, p textless 0.05) in welding workers, but these were not observed in office workers. There was no significant association of PM2.5 with urinary cortisol observed in any workers. Urinary serotonin was associated with urinary Cu, Mn, Co, Ni, Cd, and Pb. Urinary cortisol was associated with Cu, Mn, Co, Ni, Cd, and Pb. Sixteen subjects were randomly selected from each of the office and welding workers for personal monitoring of sleep quality using a wearable device. We observed that welding workers had greater awake times than did office workers (p textless 0.05). Our study observed that exposure to heavy metals in metal fume PM2.5 may disrupt sleep quality in welding workers.", "links": [] }, { "title": "Acceptability of the Fitbit in behavioural activation therapy for depression: a qualitative study.", "author": "Chum, J., Kim, M.S., Zielinski, L., Bhatt, M., Chung, D., Yeung, S., Litke, K., McCabe, K., Whattam, J., Garrick, L., O'Neill, L., Goyert, S., Merrifield, C., Patel, Y. and Samaan, Z.\t", "year": "2017", "journalProceedings": "Evidence-based Mental Health", "category": "Usability", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "INTRODUCTION Major depressive disorder is characterised by low mood and poor motivation. Literature suggests that increased physical activity has positive effects on alleviating depression. Fitness-tracking devices may complement behavioural activation (BA) therapy to improve physical activity and mental health in patients with depression. OBJECTIVES To understand patients' perceived benefit from the Fitbit and explore themes associated with patient experiences. To compare perceived benefit, patient factors, Fitbit usage and Beck's Depression Inventory (BDI) scores. METHODS Semistructured interviews were conducted with patients (n=36) who completed a 28-week BA group programme in a mood disorders outpatient clinic. All patients were asked to carry a Fitbit One device. We conducted thematic analyses on the interviews and exploratory quantitative analyses on patient characteristics, Fitbit usage, steps recorded, perceived benefit and BDI scores. FINDINGS Twenty-three patients found the Fitbit helpful for their physical activity. Themes of positive experiences included self-awareness, peer motivation and goal-setting opportunities. Negative themes included inconvenience, inaccuracies and disinterest. Age, baseline and change in BDI scores, prior physical activity goals and familiarity with technology were not associated with perceived benefit from the Fitbit or usage. Perceived benefit was significantly (p<0.01) associated with usage. CONCLUSIONS Overall, the Fitbit is an acceptable tool to complement BA therapy for patients with depression. Many positive themes were concordant with current literature; however, patients also reported negative aspects that may affect use. CLINICAL IMPLICATIONS Clinicians and researchers should consider both strengths and limitations of activity trackers when implementing them to motivate patients with depression. TRIAL REGISTRATION NUMBER NCT02045771; Pre-results.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/29056608", "newWindow": true } ] }, { "title": "A 30-month worksite-based lifestyle program to promote cardiovascular health in middle-aged bank employees: Design of the TANSNIP-PESA randomized controlled trial", "author": "Coffeng, J.K., van der Ploeg, H.P., Castellano, J.M., Fernández-Alvira, J.M., Ibáñez, B., García-Lunar, I., van der Beek, A.J., Fernández-Ortiz, A., Mocoroa, A., García-Leal, L., Cárdenas, E., Rojas, C., Martínez-Castro, M.I., Santiago-Sacristán, S., Fernández-Gallardo, M., Mendiguren, J.M., Bansilal, S., van Mechelen, W. and Fuster, V.\t", "year": "2017", "journalProceedings": "American Heart Journal", "category": "Methods", "devices": "Flex", "population": "Adults", "dataUsed": null, "abstract": "Background\nCardiovascular disease (CVD) is the leading cause of death worldwide. With atherosclerosis as the underlying cause for many CVD events, prevention or reduction of subclinical atherosclerotic plaque burden (SAPB) through a healthier lifestyle may have substantial public health benefits.\nObjective\nThe objective was to describe the protocol of a randomized controlled trial investigating the effectiveness of a 30-month worksite-based lifestyle program aimed to promote cardiovascular health in participants having a high or a low degree of SAPB compared with standard care.\n\nMethods\nWe will conduct a randomized controlled trial including middle-aged bank employees from the Progression of Early Subclinical Atherosclerosis cohort, stratified by SAPB (high SAPB n = 260, low SAPB n = 590). Within each stratum, participants will be randomized 1:1 to receive a lifestyle program or standard care. The program consists of 3 elements: (a) 12 personalized lifestyle counseling sessions using Motivational Interviewing over a 30-month period, (b) a wrist-worn physical activity tracker, and (c) a sit-stand workstation. Primary outcome measure is a composite score of blood pressure, physical activity, sedentary time, body weight, diet, and smoking (ie, adapted Fuster-BEWAT score) measured at baseline and at 1-, 2-, and 3-year follow-up.\n\nConclusions\nThe study will provide insights into the effectiveness of a 30-month worksite-based lifestyle program to promote cardiovascular health compared with standard care in participants with a high or low degree of SAPB.", "links": [ { "caption": "URL", "url": "http://www.ahjonline.com/article/S0002-8703(16)30258-7/fulltext", "newWindow": true } ] }, { "title": "Applicability of consumer activity monitor data in marathon events: an exploratory study", "author": "Constantinou, V., Felber, A.E. and Chan, J.L.\t", "year": "2017", "journalProceedings": "Journal of Medical Engineering & Technology", "category": "Validation", "devices": null, "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Distance", "abstract": "Emerging opportunities to measure individual and population-level health data with activity monitors during recreational running activities may set the stage for new research possibilities in mass participation running events and marathon medicine. This study explores the applicability of consumer activity monitor data in a preliminary study for future marathon health research with a cohort of 12 (n = 12) participants completing a 3.379 km walking or running course. This study explored the feasibility of collecting pace and distance data from Fitbit brand consumer activity monitors, from access to user data to reporting of data characteristics and data analysis. We show that a large percentage of participant data can be successfully retrieved from Fitbit consumer activity monitor devices for analysis in marathon health research, and that identifying variations in pace across participants is a practical possibility. We note a mean absolute percentage error of 13% over the true distance of 3.379 km, a higher error than that reported by other studies. We also observe a Pearson correlation coefficient between participant variation in pace and absolute distance error of 0.61. This study provides preliminary evidence to support the applicability of consumer activity monitor data in marathon health research.", "links": [ { "caption": "URL", "url": "https://www.tandfonline.com/doi/full/10.1080/03091902.2017.1366560", "newWindow": true } ] }, { "title": "Utility of the Fitbit Flex to Evaluate Sleep in Major Depressive Disorder: A comparison against polysomnography and wrist-worn actigraphy", "author": "Cook, J.D., Prairie, M.L., Plante, D.T., Finn, L., Benca, R., Nielsen, G., Straume, S., Nordhus, I., Coleman, J., Lee-Chiong, T., Pancer, J., Swick, T., Committee, S. and Medicine, A.\t", "year": "2017", "journalProceedings": "Journal of Affective Disorders", "category": "Validation", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Sleep", "abstract": "Background\nSleep disturbance is a common and important component of affective illness. Fitness activity trackers are emerging as alternative means to estimate sleep in psychiatric patients; however, their ability to quantify sleep in mood disorders has not been empirically evaluated. Thus, this study sought to evaluate the utility of the Fitbit Flex (FBF) to estimate sleep in patients with major depressive disorder (MDD) relative to gold standard polysomnography (PSG) and a widely-used actigraph (Actiwatch-2; AW-2).\n\nMethods\nTwenty-one patients with unipolar MDD wore the FBF and AW-2 during in-laboratory PSG. Bland-Altman analysis compared sleep variables among devices. Epoch-by-epoch analysis further evaluated sensitivity, specificity, and accuracy for the FBF and AW-2 relative to PSG.\n\nResults\nThe FBF demonstrated significant limitations in quantifying sleep and wake, relative to PSG. In the normal setting, the FBF significantly overestimated sleep time and efficiency, and displayed poor ability to correctly identify wake epochs (i.e. low specificity). In the sensitive setting, the FBF significantly underestimated sleep time and efficiency relative to PSG. Performance characteristics of the FBF were more similar to the AW-2 in the normal compared to sensitive setting.\n\nLimitations\nParticipants were young to middle aged and predominantly female, which may limit generalizability of findings. Study design also precluded ability to assess longitudinal performance of FBF.\n\nConclusions\nThe FBF is not an adequate substitute for PSG when quantifying sleep in MDD, and the settings of the device sizably impact its performance relative to PSG and other standard actigraphs. The limitations and capabilities of the FBF should be carefully considered prior to clinical and research implementation.", "links": [ { "caption": "URL", "url": "http://www.jad-journal.com/article/S0165-0327(16)31770-0/fulltext", "newWindow": true } ] }, { "title": "Development of the Physical activity and Your Nutrition for Cancer (PYNC) smartphone app for preventing breast cancer in women", "author": "Coughlin, S.S., Besenyi, G.M., Bowen, D. and De Leo, G.\t", "year": "2017", "journalProceedings": "mHealth", "category": "Methods", "devices": null, "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "Background: In the U.S., breast cancer accounts for more cancer deaths in women than any site other than lung cancer. Based upon attributable risks, about 30–35% of breast cancers could potentially be prevented by addressing obesity, physical inactivity, increased alcohol consumption, and carcinogenic exposures such as hormone replacement therapy (HRT). We need methods of reducing women's risks of this disease that are attractive and easy to use, widely accessible to diverse women, and able to be easily amended to account for new research.\nMethods: The overall objective of this 12-month project is to develop and test a smartphone app to provide women with information about how they can reduce their risk of breast cancer through healthy behaviors such as physical activity, weight management, restricting caloric intake, consuming a healthy diet and proper nutrition, engaging in regular physical activity, and avoiding carcinogenic exposures such as HRT and alcohol. The specific aims are: (I) to develop a smartphone app for breast cancer prevention using a behavioral framework; (II) to ensure interconnectivity with commercially available products (Fitbit device for monitoring physical activity and the LoseIt! smartphone app for monitoring and tracking diet and nutrition); and (III) to ensure that the mHealth intervention is suitable for women with varying levels of health literacy and eHealth literacy.\n\nResults: The app, referred to as Physical activity and Your Nutrition for Cancer (PYNC), is being coded on an iOS platform. Users will be able to access the breast cancer prevention app using their smartphone or tablet. The app's design will ensure interconnectivity with commercially available products for monitoring and tracking physical activity, caloric intake, diet and nutrition. Using the app, it will be feasible for users to connect and sync their Fitbit and LoseIt! accounts so that information collected about physical activity, caloric intake, diet, and nutrition can be conveniently assessed from one portal. The Fitbit device and app provides reminders and allows users to set physical activity goals. Users will be able to access health education information about breast cancer risk-reduction with attractive graphics and visual displays.\n\nConclusions: Future directions will include testing the efficacy of the mHealth intervention in increasing physical activity, improving diet and nutrition, and weight management through a randomized controlled trial, and widespread dissemination and implementation research.", "links": [ { "caption": "URL", "url": "http://mhealth.amegroups.com/article/view/13647/13952", "newWindow": true } ] }, { "title": "Healthy lifestyle intervention for adult clinic patients with type 2 diabetes mellitus", "author": "Coughlin, S.S., Hatzigeorgiou, C., Anglin, J., Xie, D., Besenyi, G.M., De Leo, G., Stewart, J. and Wilkins, T.\t", "year": "2017", "journalProceedings": "Diabetes Management", "category": "Methods", "devices": "Blaze", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Sleep,Heart Rate", "abstract": "Background: Diet and exercise therapy have been reported to be effective in improving blood glucose control and are an important part of treatment of type 2 diabetes mellitus. Objective: The goal of this study is to examine the efficacy of a healthy lifestyle intervention for adult clinic patients with type 2 diabetes mellitus, as measured by Hgb-A1c, cardiovascular indicators, physical activity, weight, and BMI. Also of interest are optimal strategies for subject recruitment, the number of intervention sessions attended, and participant use of the Fitbit watch to monitor their physical activity and track food and beverage consumption. Methods: A pre/post-test design will be used in this pilot study. Non-institutionalized adult patients (n=50) aged 18-65 years who have been seen at the Augusta Health outpatient clinics (General Internal Medicine or Family Medicine) for type 2 diabetes in the past 12 months, and who are interested in reducing their risk of disease recurrence through healthy lifestyle behaviors, will be eligible to participate. At orientation visit, eligible individuals will be asked to provide written informed consent. Consenting volunteers (n=50) will be asked to complete the baseline and 6-month follow-up questionnaire and to participate in 12 weekly group sessions of 90 min duration, involving physical activity and to meet with a dietitian (baseline, one month, 90 days) to receive individualized advice on diet and nutrition. The technology–based intervention will use wrist-worn Fitbit Blaze physical activity monitoring devices. Conclusions: This pilot study will provide important information about the feasibility and preliminary efficacy of a healthy lifestyle intervention for adult clinic patients with type 2 diabetes mellitus. The use of consumer-facing devices such as the Fitbit watch has the potential advantage over the use of research accelerometers, pedometers, or actigraphs in increasing the likelihood that the intervention will be sustainable after the study ends.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545882/", "newWindow": true } ] }, { "title": "A pragmatic, phase III, multisite, double-blind, placebo-controlled, parallel-arm, dose increment randomised trial of regular, low-dose extended-release morphine for chronic breathlessness: Breathlessness, Exertion And Morphine Sulfate (BEAMS) study protocol", "author": "Currow, D., Watts, G.J., Johnson, M., McDonald, C.F., Miners, J.O., Somogyi, A.A., Denehy, L., McCaffrey, N., Eckert, D.J., McCloud, P., Louw, S., Lam, L., Greene, A., Fazekas, B., Clark, K.C., Fong, K., Agar, M.R., Joshi, R., Kilbreath, S., Ferreira, D. and Ekström, M.\t", "year": "2017", "journalProceedings": "BMJ Open", "category": "Methods", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "Introduction: Chronic breathlessness is highly prevalent and distressing to patients and families. No medication is registered for its symptomatic reduction. The strongest evidence is for regular, low-dose, extended- release (ER) oral morphine. A recent large phase III study suggests the subgroup most likely to benefit have chronic obstructive pulmonary disease (COPD) and modified Medical Research Council breathlessness scores of 3 or 4. This protocol is for an adequately powered, parallel-arm, placebo-controlled, multisite, factorial, block-randomised study evaluating regular ER morphine for chronic breathlessness in people with COPD.\nMethods and analysis: The primary question is what effect regular ER morphine has on worst breathlessness, measured daily on a 0–10 numerical rating scale. Uniquely, the coprimary outcome will use a FitBit to measure habitual physical activity. Secondary questions include safety and, whether upward titration after initial benefit delivers greater net symptom reduction. Substudies include longitudinal driving simulation, sleep, caregiver, health economic and pharmacogenetic studies. Seventeen centres will recruit 171 participants from respiratory and palliative care. The study has five phases including three randomisation phases to increasing doses of ER morphine. All participants will receive placebo or active laxatives as appropriate. Appropriate statistical analysis of primary and secondary outcomes will be used.\n\nEthics and dissemination: Ethics approval has been obtained. Results of the study will be submitted for publication in peer-reviewed journals, findings presented at relevant conferences and potentially used to inform registration of ER morphine for chronic breathlessness.", "links": [ { "caption": "URL", "url": "http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2017-018100", "newWindow": true } ] }, { "title": "Using Wrist-Worn Sensors to Measure and Compare Physical Activity Changes for Patients Undergoing Rehabilitation", "author": "Dahmne, J., Fleur, A.L., Sprint, G., Cook, D. and Weeks, D.L.\t", "year": "2017", "journalProceedings": "The Third IEEE International Workshop on Sensing Systems and Applications Using Wrist Worn Smart Devices", "category": "Methods", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Wrist-worn sensors have increased in popularity in health care settings. As the use of wrist-worn sensors increases, a better understanding is needed of how to detect changes in behavior as well as an ability to quantify such changes. We introduce a statistical method to address this need. In this study, we used Fitbit Charge Heart Rate devices with two separate populations to continuously record data. There were eight participants in the healthy control group and nine in the hospitalized inpatient rehabilitation group. We performed comparisons both within the groups and between groups on the gathered step count and heart rate data. The inpatient rehabilitation group showed improved step count changes between the first half of the study participation and the second half. Heart rate did not show significant changes for either the healthy control group or inpatient rehabilitation group across time. We conclude that our statistical change analysis applied to wrist-worn sensors can effectively detect changes in physical activity that provides valuable information to patients as well as their healthcare care providers.", "links": [ { "caption": "URL", "url": "http://userpages.umbc.edu/~nroy/courses/shhasp17/papers/p667-dahmen.pdf", "newWindow": true } ] }, { "title": "Using Wrist-Worn Actigraphic Devices to Measure Sleep in People with Huntington's Disease", "author": "Dao, P., Maskevich, S., Jumabhoy, R., Drummond, S. and Stout, J.\t", "year": "2017", "journalProceedings": "Sleep", "category": "Validation", "devices": "One", "population": "Patients,Adults", "dataUsed": "Sleep", "abstract": "Introduction:\nSleep disturbances are an early symptom of Huntington's disease (HD), and may be linked to the cognitive, motor and psychiatric symptoms of HD. Long-term collection of HD ambulatory sleep data can show the impact of sleep disturbances as HD symptoms progress. Actigraphy provides an objective measure of sleep well suited to long-term ambulatory data collection, but is cost prohibitive for large-scale studies. Commercial actigraphy devices may be a good alternative. This study aimed to validate research and commercial actigrapy in people with HD.\nMethods:\nSeven people with the gene for Huntington's disease (Age=54.1?±?6.4, 6F) completed an overnight sleep study using polysomnography, research-grade (Actiwatch Spectrum Pro), and consumer-grade (Fitbit One) actigraphy to measure sleep. For each actigraph, sensitivity and specificity compared to polysomnography were calculated. Intraclass correlations (ICCs) and Bland-Altman analyses (BAA) were used to compare the actigraphs to polysomnography on total sleep time (TST), sleep efficiency (SE), sleep latency (SL), and wake after sleep onset (WASO).\nResults:\nThe sensitivity of the research-grade and consumer-grade actigraphs were 97.13% and 98.90% respectively, and specificities were 31.32% and 27.05% respectively. The only significant ICC was the correspondence between the consumer-grade actigraph and polysomnography for TST (r=0.52, p=.03). Using BAA, both actigraphs overestimated TST (Research-grade - Avg.dif=74.3?±?54.1min; Consumer-grade - Avg.dif=94.3?±?50.2min) and SE (Research-grade - Avg.dif=14.8?±?11.0%; Consumer-grade - Avg.dif=17.5?±?9.8%), and showed good agreement for SL (Research-grade - Avg.dif=-27.9?±?28.0min; Consumer-grade - Avg.dif=-22.0?±?24.7?min). The research-grade actigraph showed good agreement with polysomnography on WASO (Avg.dif=-20.0?±?32.2min), whilst the consumer-grade actigraph underestimated WASO (Avg.dif=-39.0?±?29.1min).\nConclusion:\nIn people with HD, neither actigraph showed sufficient agreement with polysomnography to be a suitable replacement for ambulatory sleep measurement, particularly considering the very low specificity values. Our research-grade actigraphy performed notably worse than what is typically seen in patient populations. The development of a HD specific actigraphy algorithm would greatly improve the agreement between actigraphy and polysomnography.", "links": [ { "caption": "URL", "url": "https://academic.oup.com/sleep/article-lookup/doi/10.1093/sleepj/zsx050.1162", "newWindow": true } ] }, { "title": "Nurses’ Physical Activity Study: Caring For You So You Can Care For Others", "author": "Das, B.M., Clemmons, B.S., Kemble, C.D., Schreier, A.M. and Mahar, M.T.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Nurses face multiple negative stressors and report the greatest stress of all health care workers. The stress can have a negative effect on the health of nurses (e.g., obesity, fatigue, decrease in quality of life and satisfaction with life, and burnout). Stress is common among nurses with negative impacts on a nurse’s health as well as the quality of care patients receive. It is important for nurses to implement self-care strategies techniques (e.g., physical activity) to lower feelings of stress.\nPURPOSE: To examine the relationship between physical activity levels and measures of health among nurses in eastern NC.\n\nMETHODS: Nurses (n = 62, 94% females; 85% White; age = 42.2 ± 11.7) were assessed for physical activity via the Fitbit Flex activity tracker over a 7 day period and the International Physical Activity Questionnaire. Nurses reported burnout, stress, and fatigue using self-reported questionnaires. Body mass index was measured by dividing weight (kg) by the participant’s squared height (m).\n\nRESULTS: BMI was significantly correlated with moderate-to-vigorous physical activity (r = -.28), steps (r = -0.29), and vigorous intensity physical activity (r = -.32). Fatigue was significantly correlated with moderate-to-vigorous physical activity (r = -.27). Stress was significantly correlated with steps (r = -.27), moderate intensity physical activity (r = -.25), and light intensity physical activity (r = -.40). Significant associations were also found between quality of life and light intensity physical activity (r = .40), moderate intensity physical activity (r = .30), and steps (r = .29). A relationship was found between high intensity physical activity and burnout (r = .23, p < .001) and between steps and compassion fatigue (r = -.26, p < .05).\n\nCONCLUSIONS: Findings demonstrated that stress, fatigue, and burnout were lowly correlated with physical activity among nurses. Thus, a physical activity intervention among nurses may be needed to fully see the effects of physical activity on nurses’ health, and ultimately patient health and safety.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Nurses__Physical_Activity_Study___Caring_For_You.677.aspx", "newWindow": true } ] }, { "title": "Performance of an Artificial Pancreas System for Young Children with Type 1 Diabetes", "author": "DeBoer, M.D., Breton, M.D., Wakeman, C., Schertz, E.M., Emory, E.G., Robic, J.L., Kollar, L.L., Kovatchev, B.P. and Cherñavvsky, D.R.\t", "year": "2017", "journalProceedings": "Diabetes Technology & Therapeutics", "category": "Measurement", "devices": "Charge HR", "population": "Patients,Children", "dataUsed": "Steps,Heart Rate", "abstract": "BACKGROUND Young children 5-8 years old with type 1 diabetes (T1D) exhibit clear needs for improved glycemic control but may be limited in their ability to safely interact with an artificial pancreas system. Our goal was to evaluate the safety and performance of an artificial pancreas (AP) system among young children with T1D. RESEARCH DESIGN AND METHODS In a randomized, crossover trial, children with T1D age 5-8 years were enrolled to receive on separate study periods (in random order) either the UVa AP using the DiAs Control Platform software with child-resistant lock-out screens (followed as an out-patient admission) or their usual insulin pump+continuous glucose monitor (CGM) care at home. Hypoglycemic events and CGM tracings were compared between the two 68-h study periods. All analyses were adjusted for level of physical activity as tracked using Fitbit devices. RESULTS Twelve participants (median age 7 years, n?=?6 males) completed the trial. Compared to home care, the AP admission resulted in increased time with blood glucose (BG) 70-180?mg/dL (73% vs. 47%) and lower mean BG (152?mg/dL vs. 190?mg/dL), both P?textless?0.001 after adjustment for activity. Occurrence of hypoglycemia was similar between sessions without differences in time textless70?mg/dL (AP 1.1%?±?1.1%; home 1.6%?±?1.2%). There were no adverse events during the AP or home study periods. CONCLUSIONS Use of an AP in young children was safe and resulted in improved mean BG without increased hypoglycemia. This suggests that AP use in young children is safe and improves overall diabetes control. ClinicalTrials.gov registration number: NCT02750267.", "links": [ { "caption": "URL", "url": "http://online.liebertpub.com/doi/10.1089/dia.2016.0424", "newWindow": true } ] }, { "title": "Does Wearable Technology Provide Accurate Heart Rate Measures While Playing Pickleball Doubles?", "author": "Denning, M., Smith, M., Zagrodnik, J. and Ruden, T.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "The sport of pickleball is increasing in popularity throughout the United States, especially in middle-aged, and older adults. Research investigating the physiological demands of pickleball is limited. The use of wearable technology is also gaining popularity, however, the accuracy of such devices is under question.\nPURPOSE: The purpose of this study was to determine if wearable technology provide valid heart rate (HR) measures during pickleball doubles in middle aged adults.\n\nMETHODS: 8 female, intermediate level pickleball players (IFP = 3.0 ± 0.8; age = 47 ± 11 years; mass = 72.5 ± 12.8 kg; height = 1.70 ± 0.08 m) participated in this study. All subjects played pickleball doubles for 30 minutes. HR was measured using two devices (Fitbit HR, worn on the dominate writs, and Polar HR monitor, worn at the xiphoid process level). Peak and mean HR were determined for each device. A paired sample t-tests was used to determine differences in HR between devices for each dependent variable (HR max and HR mean). A Pearson product-moment correlation coefficient was used to evaluate the concurrent validity between the gold standard (Polar HR system) and the wearable technology (Fitbit HR).\n\nRESULTS: Peak HR measured by the Polar system (151.9 ± 15.9 beats/min) was not significantly different from the peak HR measured by the Fitbit HR (149.6 ± 18.0 beats/min; p = 0.69). Similarly, mean HR measured by the Polar system (127.9 ± 17.9 beats/min) was not significantly different from the mean HR measured by the Fitbit HR (121.0 ± 18.2 beats/min; p = 0.23). Concurrent validity between the Polar HR system and the Fitbit HR for both peak (r = 0.6) and mean HR (r = 0.66) was also nonsignificant (p textgreater 0.05).\n\nCONCLUSIONS: On average, peak and mean HR was similar between the two devices. These results support the validity of wearable technology; the Fitbit HR was moderately valid in peak and mean HR compared to the Polar HR system. These results are promising for those who own wearable technology and are using it to monitor HR during physical activities such as pickleball doubles. We acknowledge our small sample size and admit that further investigation of the validity of wearable technology on physiological measures during pickleball and other racket sports is warranted.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Does_Wearable_Technology_Provide_Accurate_Heart.1082.aspx", "newWindow": true } ] }, { "title": "Learning pulse: a machine learning approach for predicting performance in self-regulated learning using multimodal data", "author": "Di Mitri, D., Scheffel, M., Drachsler, H., Börner, D., Ternier, S. and Specht, M.\t", "year": "2017", "journalProceedings": "Proceedings of the Seventh International Learning Analytics & Knowledge Conference", "category": "Methods", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Learning Pulse explores whether using a machine learning approach on multimodal data such as heart rate, step count, weather condition and learning activity can be used to predict learning performance in self-regulated learning settings. An experiment was carried out lasting eight weeks involving PhD students as participants, each of them wearing a Fitbit HR wristband and having their application on their computer recorded during their learning and working activities throughout the day. A software infrastructure for collecting multimodal learning experiences was implemented. As part of this infrastructure a Data Processing Application was developed to pre-process, analyse and generate predictions to provide feedback to the users about their learning performance. Data from different sources were stored using the xAPI standard into a cloud-based Learning Record Store. The participants of the experiment were asked to rate their learning experience through an Activity Rating Tool indicating their perceived level of productivity, stress, challenge and abilities. These self-reported performance indicators were used as markers to train a Linear Mixed Effect Model to generate learner-specific predictions of the learning performance. We discuss the advantages and the limitations of the used approach, highlighting further development points.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=3027385.3027447", "newWindow": true } ] }, { "title": "An Examination of Body Mass Index Influence on Activity Tracker Accuracy", "author": "Dondzila, C., Johnson, H. and Steckel, M.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "One,Charge HR", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "A variety of activity trackers with evolving technology are commercially available, yet it remains uncertain the influence body size has on these devices' accuracy (as previous activity trackers have been), which would compromise their generalizability.\nPURPOSE: To examine the accuracy of consumer-grade activity trackers in quantifying steps and moderate-vigorous physical activity (MVPA) engagement in free-living conditions in a diverse sample of body mass index (BMI) categories.\n\nMETHODS: Sixty individuals (21.1 ± 1.5 years, 2.3 ± 0.2 ft stride length) across three BMI categories (“Normal” [n=25]: 20-24.9 kg/m2; “Overweight” [n=22]: 25-29.9 kg/m2; “Obese” [n=13]: =30 kg/m2) wore four activity trackers during one 24-hour day (wear time 12.7 ± 1.9 hours). On the non-dominant side of the body, the Fitbit Charge HR (Charge) and Jawbone UP3 (UP3) were worn on the wrist and the Fitbit One (ONE) on the waist, with the NL1000 activity tracker (NL; serving as the criterion device) worn on the dominant side of the waist. Mixed between-within ANOVA analyses were performed to examine differences in steps and MVPA for the activity trackers across three BMI categories.\n\nRESULTS: There were no differences in steps or MVPA for the individual devices across BMI categories. In the Normal group, the UP3 (6667 ± 3366 steps) and ONE (7400 ± 8135 steps) underestimated steps (p=.000), compared to the NL (8135 ± 3562 steps). Similarly, in the Overweight group, the UP3 (8799 ± 3986 steps) and ONE (9019 ± 3841 steps) underestimated steps (NL 9312 ± 3986 steps, both < .05). In the Obese group the Charge overestimated steps (8847 ± 4168, < .05) and the ONE underestimated steps (7726 ± 3791, < .05), compared to the NL (8224 ± 4264 steps). The UP3 overestimated MVPA in the Normal group (67.7 ± 44.3 minutes), compared to the NL (27.6 ± 16.3, p=.000). In both the Overweight and Obese groups, the UP3 overestimated MVPA (Overweight: 81.5 ± 44.3 minutes, Obese: 77.5 ± 39.4 minutes, both p=.000), whereas the ONE underestimated MVPA (Overweight: 25.9 ± 26.5 minutes, Obese: 19.5 ± 25.3 minutes, both < .05), compared to the NL (Overweight: 36.6 ± 19.2 minutes, Obese: 31.6 ± 27.3 minutes).\n\nCONCLUSION: Within BMI groups, The UP3 underestimated steps and overestimated MVPA, the ONE underestimated steps and MVPA, whereas the Charge performed relatively well for both measures.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/An_Examination_of_Body_Mass_Index_Influence_on.2218.aspx", "newWindow": true } ] }, { "title": "Estimating Accuracy at Exercise Intensities: A Comparative Study of Self-Monitoring Heart Rate and Physical Activity Wearable Devices", "author": "Dooley, E.E., Golaszewski, N.M. and Bartholomew, J.B.\t", "year": "2017", "journalProceedings": "JMIR mHealth and uHealth", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Energy Expenditure,Heart Rate", "abstract": "Background: Physical activity tracking wearable devices have emerged as an increasingly popular method for consumers to assess their daily activity and calories expended. However, whether these wearable devices are valid at different levels of exercise intensity is unknown. Objective: The objective of this study was to examine heart rate (HR) and energy expenditure (EE) validity of 3 popular wrist-worn activity monitors at different exercise intensities. Methods: A total of 62 participants (females: 58%, 36/62; nonwhite: 47% [13/62 Hispanic, 8/62 Asian, 7/62 black/ African American, 1/62 other]) wore the Apple Watch, Fitbit Charge HR, and Garmin Forerunner 225. Validity was assessed using 2 criterion devices: HR chest strap and a metabolic cart. Participants completed a 10-minute seated baseline assessment; separate 4-minute stages of light-, moderate-, and vigorous-intensity treadmill exercises; and a 10-minute seated recovery period. Data from devices were compared with each criterion via two-way repeated-measures analysis of variance and Bland-Altman analysis. Differences are expressed in mean absolute percentage error (MAPE). Results: For the Apple Watch, HR MAPE was between 1.14% and 6.70%. HR was not significantly different at the start (P=.78), during baseline (P=.76), or vigorous intensity (P=.84); lower HR readings were measured during light intensity (P=.03), moderate intensity (P=.001), and recovery (P=.004). EE MAPE was between 14.07% and 210.84%. The device measured higher EE at all stages (Ptextless.01). For the Fitbit device, the HR MAPE was between 2.38% and 16.99%. HR was not significantly different at the start (P=.67) or during moderate intensity (P=.34); lower HR readings were measured during baseline, vigorous intensity, and recovery (Ptextless.001) and higher HR during light intensity (Ptextless.001). EE MAPE was between 16.85% and 84.98%. The device measured higher EE at baseline (P=.003), light intensity (Ptextless.001), and moderate intensity (P=.001). EE was not significantly different at vigorous (P=.70) or recovery (P=.10). For Garmin Forerunner 225, HR MAPE was between 7.87% and 24.38%. HR was not significantly different at vigorous intensity (P=.35). The device measured higher HR readings at start, baseline, light intensity, moderate intensity (Ptextless.001), and recovery (P=.04). EE MAPE was between 30.77% and 155.05%. The device measured higher EE at all stages (Ptextless.001). Conclusions: This study provides one of the first validation assessments for the Fitbit Charge HR, Apple Watch, and Garmin Forerunner 225. An advantage and novel approach of the study is the examination of HR and EE at specific physical activity intensities. Establishing validity of wearable devices is of particular interest as these devices are being used in weight loss interventions and could impact findings. Future research should investigate why differences between exercise intensities and the devices exist. [JMIR Mhealth Uhealth 2017;5(3):e34]", "links": [ { "caption": "URL", "url": "http://mhealth.jmir.org/2017/3/e34/", "newWindow": true } ] }, { "title": "Varying Exercise Intensities: The Accuracy of Three Self-Monitoring Heart Rate and Physical Activity Wearable Devices", "author": "Dooley, E.E., Golaszewski, N.M. and Bartholomew, J.B.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Energy Expenditure,Heart Rate", "abstract": "Physical activity tracking wearables have emerged as a popular method for consumers to assess their daily activity, calories expended and heart rate. However, less is known if these health measures are valid at various levels of exercise intensity.\nPURPOSE: To examine heart rate (HR) and energy expenditure (EE) validity of three popular wrist-worn activity monitors at different exercise intensities.\n\nMETHODS: 62 participants (36 females, 46.8% non-white) wore the Apple Watch (AW), Fitbit Charge HR (FCHR) and Garmin Forerunner 225 (GF). Validity was assessed by 2 criterion devices: HR chest strap and a metabolic cart. Participants completed a 10-min seated baseline; separate 4-min stages of light, moderate and vigorous-intensity treadmill exercises; and a 10-min seated recovery. Data from devices were compared to each criterion via two-way RM-ANOVA and Bland-Altman analysis. Differences were expressed in mean absolute percentage error values (MAPE).\n\nRESULTS: AW - HR MAPE between 1.14-6.70%. HR not significantly different at the start (p = .13), baseline (p = .76) or vigorous intensity (p = .84). Lower HR readings during light (p textless .05), moderate (p < .01) and recovery (p textless .01). EE MAPE between 14.07-210.84%. Measured higher EE at all stages (p textless .01). FCHR - HR MAPE between 2.38-16.99%. HR not significantly different at start (p = .43) or moderate intensity (p = .34). Lower HR readings during baseline, vigorous and recovery (p textless .001) and higher HR in light (p textless .001). EE MAPE between 16.85-84.98%. Measured higher EE at baseline (p textless .05), light (p textless .001) and moderate (p < .001). GF - HR MAPE between 7.87-24.38%. HR not significantly different at vigorous intensity (p = .35). Measured higher HR readings start, baseline, light, moderate (p textless .001) and recovery (p < .05). EE MAPE between 30.77-155.05%. Measured higher EE at all stages (p < .001).\n\nCONCLUSION: This study provides one of the first validation assessments for the Fitbit Charge HR, Apple Watch and Garmin Forerunner 225. An advantage and novel approach of the study is the examination of HR and EE at specific PA intensities. Establishing validity of wearables is of particular interest as these devices are being used in weight loss interventions and could impact findings. Future research should investigate why differences between exercise intensities and the devices exist.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Varying_Exercise_Intensities___The_Accuracy_of.2214.aspx", "newWindow": true } ] }, { "title": "Accelerometer-based sleep behavior and activity levels in student athletes in comparison to student non-athletes", "author": "Driller, M.W., Dixon, Z.T. and Clark, M.I.", "year": "2017", "journalProceedings": "Sport Sciences for Health", "category": "Measurement", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance,Sleep", "abstract": "Purpose\nThe comparison between athletes and non-athletes for sleep, sedentary time or incidental daily activity is yet to be examined in a student population. Therefore, the purpose of the current study was to measure sleep and activity levels using accelerometry in athlete and non-athlete university students.\n\nMethods\n\n19 students on university athletic scholarships (11 female/8 male, age 20 ± 2, body mass index 24 ± 3) and 21 student non-athletes (11 female/10 male, age 21 ± 3, body mass index 25 ± 4) volunteered to wear an activity monitor over a 7-day period to measure general daily activity levels and sleep. All general daily activity, excluding time spent exercise training, was monitored and minutes spent at different activity zones as well as step count, distance covered and calories burnt were used for analysis between groups. Measures of sleep quality and quantity were also compared between groups.\n\nResults\n\nSignificant differences were found between groups for step count and distance covered (p textless 0.05); however, all activity variables were associated with small to moderate effect sizes, with the athlete group being more physically active than the non-athlete group. There was a small effect size associated with longer sleep time in the non-athlete group (476 vs 456 min, d = 0.39) and also poorer sleep behavior scores in the athlete group (d = -0.39).\n\nConclusion\n\nStudent athletes exhibit more incidental activity and less sedentary time than student non-athletes. There was a trend for student athletes to sleep less and display poorer sleep behavior than student non-athletes.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s11332-017-0373-6", "newWindow": true } ] }, { "title": "Quantitative and qualitative measures of poststroke walking activity with inertial technologies", "author": "Duclos, N., Tavares, L.A., Parent, G., Aissaoui, R., Nadeau, S. and Duclos, C.\t", "year": "2017", "journalProceedings": "Annals of Physical and Rehabilitation Medicine", "category": "Validation", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "OBJECTIVE\nInertial technologies (activity monitors, inertial sensors) allow the evaluation of the number of steps and spatial-temporal parameters (STP) in daily life environments. However, activity monitors, generally worn at the hip, are not accurate for quantifying steps at slow walking speed (textless0.8m/s). Moreover, current models behind inertial sensors measurements estimate STP supposing symmetry between limbs. The current use of these tools decreases the accuracy of outdoor walking assessment in individuals poststroke since they generally walk slowly and have an asymmetrical gait pattern. The aim of this study was to assess the accuracy of: (1) an activity monitor placed at the ankle to count the number of steps and (2) an algorithm developed to estimate asymmetric STP in individuals poststroke.\nMATERIAL/PATIENTS AND METHODS\nUp to now, eight poststroke individuals who were independent walkers (with or without walking aid) were recruited. Study 1: an activity monitor (Fitbit® One) placed at the non-paretic ankle (not at the hip as recommended) was tested during a walk in a commercial center. The number of steps measured was compared to the one measured by video recording. Study 2: four inertial sensors (OPAL, APDM inc.) were placed bilaterally at the ankle and thigh of the participants and used to assess a new algorithm developed to estimate the right and left STP independently. The estimated STP was compared to those measured simultaneously by a GAITRite® walking mat. For each study, the agreement between data provided by the tools was estimated using Altman-Bland charts.\n\nRESULTS\nAmong participants, the range of walking speed (0.4–1.2m/s) and STP asymmetry was large. In study 1, the Fitbit® One error for the number of steps was acceptable (0.14–4.60%), for participants walking faster than 0.4m/s. In study 2, the stride times were precisely estimated but the support times were underestimated (−13 [6.2]%) and the oscillation times overestimated (+30.1 [11.3]%). Spatial parameter estimation was inconsistent.\n\nDISCUSSION, CONCLUSION\nPlacing the Fitbit® One at the non-paretic ankle is a suitable method for evaluating the amount of poststroke walking, except for very slow walkers. The algorithm for estimating STP from inertial sensors needs further work before being used in the community.", "links": [ { "caption": "URL", "url": "http://linkinghub.elsevier.com/retrieve/pii/S1877065717303044", "newWindow": true } ] }, { "title": "Activity Trackers Implement Different Behavior Change Techniques for Activity, Sleep, and Sedentary Behaviors.", "author": "Duncan, M., Murawski, B., Short, C.E., Rebar, A.L., Schoeppe, S., Alley, S., Vandelanotte, C. and Kirwan, M.\t", "year": "2017", "journalProceedings": "Interactive Journal of Medical Research", "category": "Review", "devices": null, "population": "NA", "dataUsed": "NA", "abstract": "BACKGROUND: Several studies have examined how the implementation of behavior change techniques (BCTs) varies between different activity trackers. However, activity trackers frequently allow tracking of activity, sleep, and sedentary behaviors; yet, it is unknown how the implementation of BCTs differs between these behaviors. \n\nOBJECTIVE: The aim of this study was to assess the number and type of BCTs that are implemented by wearable activity trackers (self-monitoring systems) in relation to activity, sleep, and sedentary behaviors and to determine whether the number and type of BCTs differ between behaviors. \n\nMETHODS: Three self-monitoring systems (Fitbit [Charge HR], Garmin [Vivosmart], and Jawbone [UP3]) were each used for a 1-week period in August 2015. Each self-monitoring system was used by two of the authors (MJD and BM) concurrently. The Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy was used to assess the implementation of 40 BCTs in relation to activity, sleep, and sedentary behaviors. Discrepancies in ratings were resolved by discussion, and interrater agreement in the number of BCTs implemented was assessed using kappa statistics. \n\nRESULTS: Interrater agreement ranged from 0.64 to 1.00. From a possible range of 40 BCTs, the number of BCTs present for activity ranged from 19 (Garmin) to 33 (Jawbone), from 4 (Garmin) to 29 (Jawbone) for sleep, and 0 (Fitbit) to 10 (Garmin) for sedentary behavior. The average number of BCTs implemented was greatest for activity (n=26) and smaller for sleep (n=14) and sedentary behavior (n=6). \n\nCONCLUSIONS: The number and type of BCTs implemented varied between each of the systems and between activity, sleep, and sedentary behaviors. This provides an indication of the potential of these systems to change these behaviors, but the long-term effectiveness of these systems to change activity, sleep, and sedentary behaviors remains unknown.", "links": [ { "caption": "URL", "url": "http://www.i-jmr.org/2017/2/e13/", "newWindow": true } ] }, { "title": "Feasibility study protocol to examine the role of mantra meditation at reducing psychological distress in emergency department staff", "author": "Dunne, P.J., O'Leary, C., Prihodova, L., Breen, R., Walsh, C., Freeman, L., Carroll, A., McMahon, G. and White, B.\t", "year": "2017", "journalProceedings": "International Journal of Clinical Trials", "category": "Methods", "devices": "Charge 2", "population": "Adults", "dataUsed": "Sleep,Heart Rate", "abstract": "Background: Work in a healthcare setting can affect the psychological wellbeing of healthcare professionals (HCPs). Emotional exhaustion among HCPs can have a significant negative impact on the quality of healthcare provided to patients in terms of increased medical errors and decreased patient satisfaction. There is a need for an effective stress-reducing intervention, such as mantra meditation. This feasibility study will examine the suitability of random controlled trial (RCT) methodology to assess the efficacy of mantra meditation at reducing emotional exhaustion among emergency department (ED) staff.\nMethods: This is a mixed methods, stratified feasibility study with intent-to-treat protocol, using two study arms (passive control and intervention), the purpose of which is to examine (1) recruitment, retention, and adherence; (2) outcome measures (psychological wellbeing and stress-related biological parameters such as blood pressure, heart rate variability and salivary cortisol); and (3) data management, control, and dissemination prior to conducting a full RCT.\n\nResults Eligible ED staff allocated to the intervention group (n = 30) will be taught mantra meditation and discuss prescribed texts (4 x 4 hour session over 6 weeks), as well as engage in 20 minutes of twice-daily mantra meditation practice. Participants in the passive control group (n = 30) will work as usual. Data will be collected pre (T1), post (week 11; T2) and at follow-up (week 19; T3).\n\nConclusions: This study will pave the way for a larger RCT that will investigate mantra meditation as a definitive intervention to reduce emotional exhaustion among ED staff.", "links": [ { "caption": "URL", "url": "http://www.ijclinicaltrials.com/index.php/ijct/article/view/145", "newWindow": true } ] }, { "title": "Restoring effective sleep tranquility (REST): A feasibility and pilot study", "author": "Eakman, A.M., Schmid, A.A., Henry, K.L., Rolle, N.R., Schelly, C., Pott, C.E. and Burns, J.E.\t", "year": "2017", "journalProceedings": "British Journal of Occupational Therapy", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Sleep", "abstract": "IntroductionThe purpose of this pilot study was to establish the feasibility of completing a future controlled trial of a multi-component cognitive behavioral therapy for insomnia program for military veterans with sleep disturbance.MethodThis was a single-arm feasibility and pilot study. Participants were United States post-9/11 veterans with service-connected injuries, university students, and had self-reported sleep disturbances. Restoring Effective Sleep Tranquility was a multi-component cognitive behavioral therapy for insomnia intervention consisting of seven sessions of group therapy and eight 1:1 sessions delivered by occupational therapists. Feasibility and pilot indicators were process, resources, management, and scientific, including pre–post-assessments of sleep difficulties, dysfunctional sleep beliefs, participation, and pain interference.FindingsIndicators were supportive of feasibility, including reduced sleep difficulties (for example Medical Outcomes Study Sleep Measure [t?=?3.29, p?=?.0...", "links": [ { "caption": "URL", "url": "http://journals.sagepub.com/doi/10.1177/0308022617691538", "newWindow": true } ] }, { "title": "The impact of E-diaries and accelerometers on young adults' perceived and objectively assessed physical activity", "author": "Eisenberg, M.H., Phillips, L.A., Fowler, L. and Moore, P.J.\t", "year": "2017", "journalProceedings": "Psychology of Sport and Exercise", "category": "Measurement", "devices": "Zip", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "OBJECTIVE\nE-diaries and accelerometers promise more objective, real-time measurements of health behavior. However, social-psychological theory suggests that using electronic behavioral monitoring may influence rather than just record physical activity (PA), especially when a device is novel.\nDESIGN\nParticipants (n = 146) were randomly assigned to either an accelerometer-only, e-diary-only, accelerometer + e-diary, or a no-technology control group for one week to assess how these technologies influenced PA, both perceived and actual, in young adults.\n\nMETHOD\nParticipants reported their PA, overall and number of discrete exercise sessions (DES) at baseline and follow-up; accelerometers provided daily step counts and e-diaries captured daily reports of PA for the active week of the study.\n\nRESULTS\nAverage daily steps in the accelerometer-only and accelerometer + e-diary groups did not differ nor did daily reports of PA via e-diary compared to accelerometer + e-diary group, showing that neither technology affected actual PA. ANCOVAS tested group differences in perceived PA; The accelerometer-only group had increased perceived overall PA but not DES compared to no-technology control.\n\nCONCLUSIONS\nAccelerometers may increase perceived overall PA, but the tested technologies did not increase DES or actual PA, suggesting that they may be viable unbiased measures of PA.", "links": [] }, { "title": "Use of a Fitness Tracking Device to Monitor Physical Activity and Sleep Patterns during Hospitalization for Hematopoietic Stem Cell Transplant. Results of a Prospective Observational Study", "author": "El Jurdi, N.H., Cotton, M.J., Pinto, R., Galloway, E., Kolke, S., Cooper, B.W., Tomlinson, B.K., Metheny, L., Malek, E., Nock, N., Kolk, M., Lee, R., De Lima, M. and Caimi, P.\t", "year": "2017", "journalProceedings": "Blood", "category": "Measurement", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Sleep,Heart Rate", "abstract": "Background The prolonged hospitalization often associated with hematopoietic stem cell transplant (HSCT) increases risk of immobility and inactivity-associated complications. There is limited information on the daily activity and sleep patterns of patients undergoing HSCT and their effect on transplant related outcomes, functional recovery and length of hospital stay. We conducted a prospective observational study to determine the feasibility of using a fitness tracking device to monitor the physical activity and sleep patterns of patients undergoing HSCT.\nMethods Patients undergoing autologous (autoHSCT) or allogeneic (alloHSCT) were consented to wear a Fitbit HR ® activity tracking device. The device was placed on the patients' wrist within 48 hours of admission and was removed on discharge. Patients were followed for 100 days post-HCT. Daily activity parameters measured by the Fitbit HR® device included steps, distance, time spent in physical activity, active calories burned, minimum and maximum heart rate. Sleep parameters included: total sleep duration and number of times patients were awake or restless. All patients were evaluated by a Physical Therapist upon admission. Comparisons between groups were done using the Mann-Whitney test for continuous variables and Fisher's exact test for qualitative variables; correlations were evaluated with Pearson's and Spearman's correlation tests; modeling was done with linear regression for quantitative variable pairs and one-way ANOVA for qualitative and quantitative variable pairs.\n\nResults 31 patients were consented, 4 were removed from the study (2 patients withdrew consent; 2 patients were not compliant). The baseline characteristics of 27 subjects with available activity and sleep data are summarized in table 1. There were no statistically significant differences in baseline characteristics between subjects receiving autoHSCT and alloHSCT. All patients undergoing alloHSCT received reduced intensity conditioning regimens. Transplant outcomes and results from activity and sleep pattern measurements are presented in table 2. As expected, longer length of hospitalization, longer time to neutrophil engraftment, infectious complications and readmissions were more common in subjects undergoing alloHSCT.\n\nWhile the number of steps at admission was comparable between both groups, alloHCT subjects had a more intense decrease in their physical activity, manifested by a lower number of steps at nadir (249 vs 697, p=0.03) as well as by a larger percentage decrease in physical activity from admission (89% vs 68%, p=0.02) and a decrease compared to their peak performance during admission (92% vs 82%, p =0.02). Among baseline characteristics, age and presence of cardiovascular risk factors correlated with number of steps at admission (Pearson R =-0.43, p=0.03 and biserial correlation R=0.39, p=0.04, respectively); BMI showed a positive correlation with the decrease in activity from peak to nadir (Pearson R=0.54, p=0.005) and ECOG PS of 1 (vs 0) correlated with the absolute decrease in steps from admission to discharge (Spearman R -0.47, p=0.02). ANOVA showed that infectious complications were associated with changes in activity from peak to nadir (R2=0.18, p=0.03), while linear regression identified an association between time from transplant to discharge and both the decrease in activity from admission and peak to nadir (R2=0.15, p=0.05 and R2=0.16,p=0.04).\n\nConclusions This study demonstrates the feasibility of monitoring activity and sleep patterns in HSCT patients with a commercially available fitness tracking device. Approximately 90% of patients remained compliant with the use of the device. The fitness data obtained showed correlation with known transplant outcomes, and the patterns observed highlighted differences within the patient population. Use of a fitness tracking device in patients undergoing HCT represents an objective method for measuring physical activity during hospitalization, and potentially identifies patients in which interventions such as intensified physical therapy could improve outcomes. Studies comparing the quality of data of Fitbit HR® devices with other instruments such as Actigraph® are underway at our institution. Future studies evaluating the effect physical activity devices have on patient's activity during hospitalization and in the post-transplant recovery period are planned.", "links": [] }, { "title": "Effect of personal activity trackers on weight loss in families enrolled in a comprehensive behavioral family-lifestyle intervention program in the federally qualified health center setting: A randomized controlled trial", "author": "Espinoza, J., Chen, A., Orozco, J., Deavenport-Saman, A. and Yin, L.\t", "year": "2017", "journalProceedings": "Contemporary Clinical Trials Communications", "category": "Methods", "devices": "Flex", "population": "Patients,Children", "dataUsed": "Steps", "abstract": "BACKGROUND\nChildhood obesity continues to be a substantial problem despite major public health efforts, and disproportionately impacts children from low-income families. Digital health tools and consumer technology offer promising opportunities for interventions, but few studies have evaluated how they might be incorporated into existing interventions or used to create new types of interventions. It remains unclear which approaches would be most beneficial for underserved pediatric populations.\nPURPOSE\nTo describe the design and rationale of a single-center randomized, controlled trial evaluating the effects of personal activity tracker (PAT) use by parents on weight-status improvement in both parents and overweight children enrolled in BodyWorks (BW), a comprehensive behavioral family-lifestyle intervention program (CBFLI), in a primary-care clinic serving a predominantly low-income Latino population.\n\nMETHODS\nThis study is being conducted in the AltaMed general pediatrics clinic at Children's Hospital Los Angeles. Eligible participants are families (child and adult caregiver) in which the child is between 7 and 18 years of age, has a BMI =85th percentile for age and sex, and has been referred to BW by their AltaMed pediatrician. BW consists of one weekly, two-hour session for 7 weeks. In a given cycle, the program is offered on two separate nights: Monday (Spanish) and Wednesday (English). Families self sort into one of two groups based on language preference. To ensure balanced allocation of language preference groups and prevent in-group cross contamination, block randomization is used to assign whole groups to either the intervention or control arms of the study. The control arm consists of usual care, while the intervention arm adds assigning a Fitbit PAT to the parents and training them in its proper use. Study personnel are blinded to group assignment during the analysis phase. Study outcomes include attendance rate, program completion rate, and changes in weight-status improvement, defined as change in weight and BMI for adults and change in BMI z-score for children. We hypothesize that the intervention arm will have better weight-related outcomes than the control arm. Study completion is anticipated in 2017, after the enrollment of approximately 150 families.\n\nCONCLUSIONS\nThe study aim is to evaluate the effects of PATs on weight-related outcomes in overweight children and parents participating in a CBFLI. The results will be important for determining whether wearable devices are an effective addition to weight loss interventions for overweight and obese children.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S2451865416301284", "newWindow": true } ] }, { "title": "Using Novel Technology within a School-Based Setting to Increase Physical Activity: A Pilot Study in School-Age Children from a Low-Income, Urban Community", "author": "Evans, E.W., Abrantes, A.M., Chen, E. and Jelalian, E.\t", "year": "2017", "journalProceedings": "BioMed Research International", "category": "Intervention", "devices": "Zip,Charge", "population": "Children", "dataUsed": "Steps", "abstract": "Background. Less than half of American children meet national physical activity (PA) recommendations. This study tested the feasibility, acceptability, and preliminary effectiveness of using wearable PA monitors to increase PA in school-age children. Methods. In Phase 1 of this study, conducted in 2014, 32 fifth-grade students enrolled in a low-resource middle school were given a waist-worn Fitbit Zip monitor for 4 weeks to test its feasibility (adherence) and acceptability. Adherence, wear time of ≥8 hours per day, was examined. Feedback was solicited from parents through structured interviews. In Phase 2, conducted in 2015, 42 sixth-grade students were assigned, by classroom, to one of three conditions (Fitbit + goal and incentive-based intervention, Fitbit only, or control) to test the feasibility of the wrist-worn Fitbit Charge and its preliminary effectiveness in increasing PA over 6 weeks. Results. In Phase 1, average adherence was 64.1%. In Phase 2, it was 73.4% and 80.2% for participants in the Fitbit + intervention and Fitbit only groups, respectively (). After controlling for baseline values, weight status, and sex, there were no significant group differences in changes in MVPA or steps from baseline to follow-up. Conclusions. While moderately acceptable, wearable PA monitors did not increase PA levels in this sample. They may be more effective within a coordinated school-based physical activity program.", "links": [] }, { "title": "Assessing Validity of the Fitbit Indicators for U.S. Public Health Surveillance", "author": "Evenson, K.R., Wen, F. and Furberg, R.D.\t", "year": "2017", "journalProceedings": "American Journal of Preventive Medicine", "category": "Methods", "devices": null, "population": "Adults", "dataUsed": null, "abstract": "NA", "links": [ { "caption": "URL", "url": "http://linkinghub.elsevier.com/retrieve/pii/S0749379717303045", "newWindow": true } ] }, { "title": "The Validity of Consumer-Level Activity Monitors in Healthy Older Adults in Free-Living Conditions", "author": "Farina, N. and Lowry, R.G.\t", "year": "2017", "journalProceedings": "Journal of Aging and Physical Activity", "category": "Validation", "devices": "Charge HR", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Consumer-level activity monitors, such as Fitbit and Misfit devices, are a popular and low-cost means of measuring physical activity. This study aims to compare the accuracy of step counts from two consumer-level activity monitors against two reference devices in healthy, community dwelling older adults in free-living conditions. Twenty-five older adults (aged 65-84) simultaneously wore 5 devices (e.g. Misfit Shine and Fitbit Charge HR) over 7 consecutive days. All consumer-level activity monitors positively correlated with reference devices (p<0.001). There was also substantial to near perfect agreement between all consumer-level activity monitors and reference devices. Compared to the Actigraph GT3X+, the waist worn Misfit Shine displayed the highest agreement amongst the devices worn (ICC=0.96, 95% 0.91 to 0.99). The wrist worn devices showed poorer agreement to reference devices. Future research needs to consider that not all consumer-level activity monitors are equal in terms of accuracy, design and function.", "links": [ { "caption": "URL", "url": "http://journals.humankinetics.com/doi/10.1123/japa.2016-0344", "newWindow": true } ] }, { "title": "The effect of a wearable physical activity monitor ( Fitbit One ) on physical activity behaviour in women : A pilot study. ", "author": "Farnell, G. and Barkley, J.\t", "year": "2017", "journalProceedings": "Journal of Human Sport and Exercise", "category": "Intervention", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "Introduction. With wearable technology topping both the 2016 and 2017 American College of Sports Medicine (ACSM) Fitness Trends survey, research in this area is needed to help determine the importance of such devices. Purpose. To determine the effect of wearing a popular, commercially-available wearable activity monitor (i.e., Fitbit One) upon physical activity behaviour relative to a group who was not utilizing such a monitor. Methods. A sample of 19 healthy adult women completed the Human Activity Profile survey to assess physical activity behaviour pre – and post – intervention. For the intervention, nine participants received a Fitbit One accelerometer to wear for six weeks, while the remaining participants (control group) did not receive an accelerometer. Results. There were no significant differences (p ≥ 0.16) in physical activity. However, the control group reduced physical activity by ≥20% from pre to post intervention whereas the Fitbit One group was largely unchanged (0.5% - 2.4% decrease). Conclusion. While wearing a physical activity monitor did not increase physical activity behaviour it may help maintain it.", "links": [] }, { "title": "Exploring Compliance: Observations from a Large Scale Fitbit Study", "author": "Faust, L., Purta, R., Hachen, D., Striegel, A., Poellabauer, C., Lizardo, O. and Chawla, N.V.\t", "year": "2017", "journalProceedings": "Proceedings of the 2nd International Workshop on Social Sensing - SocialSens'17", "category": "Measurement,Methods", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Universities often draw from their student body when conducting human subject studies. Unfortunately, as with any longitudinal human studies project, data quality problems arise from student's waning compliance to the study. While incentive mechanisms may be employed to boost student compliance, such systems may not encourage all participants in the same manner. This paper coupled student's compliance rates with other personal data collected via Fitbits, smartphones, and surveys. Machine learning algorithms were then employed to explore factors that influence compliance. With such insight, universities may target groups in their studies who are more likely to become non-compliant and implement preventative strategies such as tailoring their incentive mechanisms to accommodate a diverse population. In doing so, data quality problems stemming from failing compliance can be minimized.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=3055601.3055608", "newWindow": true } ] }, { "title": "Virtual weight loss program for African-American breast cancer survivors: Preliminary results.", "author": "Ferrante, J.M., Doose, M., Bator, A., Devine, K., Ohman Strickland, P., Angelino, A., Lee, J., Koransky, A., Hwang, K. and Bandera, E.\t", "year": "2017", "journalProceedings": "Journal of Clinical Oncology", "category": "Intervention", "devices": null, "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background: Obesity is associated with higher breast cancer recurrence and death, and poorer health and quality of life. African-American (AA) women have the highest prevalence of obesity, obesity-related comorbidities, and breast cancer mortality compared with other racial/ethnic groups. Weight loss after breast cancer diagnosis may lower rates of recurrence and improve fitness, fatigue, and quality of life. Methods: This 6-month randomized controlled trial pilot-tests the use of a Fitbit activity tracker (Fitbit only group) versus Fitbit plus SparkPeople, a free web-based weight loss program (combined group) among 70 AA breast cancer survivors. Paired t-tests assess changes from baseline to 6-months among each participant in primary (weight, body mass index [BMI], percent body fat) and secondary (24-hour caloric intake, daily number of steps, quality of life, self-monitoring strategies, self-efficacy) outcomes. Two-group t-tests assess differences in outcomes between the two groups. Results: Currently, 36 of 46 (78.3%) eligible participants have enrolled and completed baseline assessments. Mean age of participants is 61.7 years (SD 8.7) and mean BMI is 36.9 (SD 7.0). Analyses of the first 25 participants who completed 3-month assessments (Fitbit only N = 12; combined group N = 13) show significant weight loss in both groups; Fitbit only: mean weight change -6.73 pounds, SD 4.61, p textless 0.001; mean BMI change -0.96 kg/m2, SD 0.84, p = 0.002; combined group: mean weight change -5.95 pounds, SD 5.84, p = 0.003; mean BMI change -1.03 kg/m2, SD 0.77, p textless 0.001. All participants significantly increased tracking of diet (Fitbit only p = 0.016; combined group p textless 0.001) and physical activity (Fitbit only p textless 0.001; combined group p = 0.001). Though not significant, combined group participants showed greater increases in self-efficacy for eating healthy and reducing fat and calories, and increases in daily steps (+1308 vs. +285 for Fitbit only group). Preliminary analyses show no statistically significant difference in changes in outcomes from baseline to 3 months between the two groups. Conclusions: Both programs show potential as convenient and efficient weight loss methods for African-American breast cancer survivors. Clinical trial information: NCT02699983.", "links": [ { "caption": "URL", "url": "http://ascopubs.org/doi/10.1200/JCO.2017.35.5_suppl.163", "newWindow": true } ] }, { "title": "Caloric Expenditure Using Indirect Calorimetry, Apple Watch Sport, and Fitbit Zip", "author": "Ferrara CM, Smyth S, Mullan E and Burke C\t", "year": "2017", "journalProceedings": "Journal of Exercise Physiology", "category": "Validation", "devices": "Zip", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "The aim of this study was to compare caloric expenditure values during exercise using Apple Watch Sport, Fitbit Zip, and indirect calorimetry. The study included 7 healthy subjects (3 men and 4 women). The subjects completed six 6-min bouts of sitting, treadmill walking, and jogging (sitting, 4.0, 5.6, 6.8, and 8.9 km·hr-1, followed by 4.0 km·hr-1 cool-down) while wearing an Apple Watch Sport and a Fitbit Zip. Oxygen consumption (VO2) was measured using the Cosmed Quark CPET. The data were analyzed using ANOVA (P<0.05). The results are presented as means ± SD. Caloric expenditure values for the Fitbit Zip were significantly higher than values calculated from VO2 for all walking and jogging speeds (P<0.05). In contrast, caloric expenditure values for Apple Watch Sport were not significantly different than values calculated from VO2 (P>0.05). Total caloric expenditure values were also significantly higher for the Fitbit Zip (296.3 ± 33.0 kcals) compared to values calculated using VO2 (195.8 ± 30.4 kcals) and the Apple Watch Sport (201.1 ± 41.5 kcals) (P<0.05). The results of this study suggest that the Fitbit Zip may overestimate caloric expenditure compared to indirect calorimetry. In contrast, caloric expenditure values from the Apple Watch are not different from the indirect calorimetry values. This information may be important for exercise professionals to consider when recommending physical activity trackers to clients.", "links": [ { "caption": "URL", "url": "http://www.asep.org/asep/asep/JEPonlineJUNE2017_Ferrara.docx", "newWindow": true } ] }, { "title": "Day2day: investigating daily variability of magnetic resonance imaging measures over half a year.", "author": "Filevich, E., Lisofsky, N., Becker, M., Butler, O., Lochstet, M., Martensson, J., Wenger, E., Lindenberger, U. and Kühn, S.\t", "year": "2017", "journalProceedings": "BMC Neuroscience", "category": "Measurement", "devices": "One", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "BACKGROUND Most studies of brain structure and function, and their relationships to cognitive ability, have relied on inter-individual variability in magnetic resonance (MR) images. Intra-individual variability is often ignored or implicitly assumed to be equivalent to the former. Testing this assumption empirically by collecting enough data on single individuals is cumbersome and costly. We collected a dataset of multiple MR sequences and behavioural covariates to quantify and characterize intra-individual variability in MR images for multiple individuals. METHODS AND DESIGN Eight participants volunteered to undergo brain scanning 40-50 times over the course of 6 months. Six participants completed the full set of sessions. T1-weighted, T2*-weighted during rest, T2-weighted high-resolution hippocampus, diffusion-tensor imaging (DTI), and proton magnetic resonance spectroscopy sequences were collected, along with a rich set of stable and time-varying physical, behavioural and physiological variables. Participants did not change their lifestyle or participated in any training programs during the period of data collection. CONCLUSION This imaging dataset provides a large number of MRI scans in different modalities for six participants. It enables the analysis of the time course and correlates of intra-individual variability in structural, chemical, and functional aspects of the human brain.", "links": [ { "caption": "URL", "url": "https://bmcneurosci.biomedcentral.com/articles/10.1186/s12868-017-0383-y", "newWindow": true } ] }, { "title": "Fitbit and Fitabase Technology: Tracking and Evaluating Youth Physical Activity", "author": "Franzen-Castle, L., Dunker, T., Chai, W. and Krehbiel, M.\t", "year": "2017", "journalProceedings": "Journal of Extension", "category": "Methods", "devices": "Charge", "population": "Adolescents", "dataUsed": "Steps", "abstract": "With the health of today's youth a national priority, professionals need tools for accurately assessing activity patterns and motivating behavior change. Fitness technology may be a promising tool for promoting positive behavior change. The afterschool program WeCook: Fun with Food and Fitness focused on improving food preparation skills, nutrition knowledge, and physical activity levels of youths. As part of the program assessment, each participant wore a Fitbit near the beginning and end of the program. Fitabase, an online research platform, was used for aggregating and analyzing data. We discuss a model for incorporating these technologies.", "links": [ { "caption": "URL", "url": "https://www.joe.org/joe/2017april/tt5.php", "newWindow": true } ] }, { "title": "System identification of Just Walk: A behavioral mHealth intervention for promoting physical activity", "author": "Freigoun, M.T., Martin, C.A., Magann, A.B., Rivera, D.E., Phatak, S.S., Korinek, E.V. and Hekler, E.B.\t", "year": "2017", "journalProceedings": "2017 American Control Conference", "category": "Methods", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "There is significant evidence to show that physical activity reduces the risk of many chronic diseases. With the rise of mobile health (mHealth) technologies, one promising approach is to design interventions that are responsive to an individual's changing needs. This is the overarching goal of Just Walk, an intensively adaptive physical activity intervention that has been designed on the basis of system identification and control engineering principles. Features of this intervention include the use of multisine signals as pseudo-random inputs for providing daily step goals and reward targets for participants, and an unconventional ARX estimation-validation procedure applied to judiciously-selected data segments that seeks to balance predictive ability over validation data segments with overall goodness of fit. Analysis of the estimated models provides important clues to individual participant characteristics that influence physical activity. The insights gained from black-box modeling are critical to building semi-physical models based on a dynamic extension of Social Cognitive Theory.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/document/7962940/", "newWindow": true } ] }, { "title": "Comparison Between SenseWear and FitBit Physical Activity Monitors in Chronic Obstructive Pulmonary Disease", "author": "Fuhr, D., Michaelchuk, W. and Stickland, M.\t", "year": "2017", "journalProceedings": "American Journal of Respiratory and Critical Care Medicine", "category": "Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps,Energy Expenditure", "abstract": "Introduction: Higher physical activity levels have been shown to reduce the likelihood of hospital readmission in chronic obstructive pulmonary disease (COPD). Improving physical activity levels may be an effective disease management strategy, thus accurate physical activity monitors (PAMs) are needed.The Sensewear Mini armband (SWM), a relatively expensive PAM, has been shown to provide accurate estimations of energy expenditure,but underestimate step count in patients with COPD. The Fitbit Flex (FB), a relatively inexpensive and more accessible PAM, has been shown to give accurate estimations of step count at a variety of walking speeds, but underestimate energy expenditure in other clinical conditions. The aim of this study was to compare the step count and energy expenditure calculated for FB and SWM in individuals with COPD. Methods: 39 individuals with COPD (mean±SD; Age (yrs): 68±10; FEV (% predicted): 63.2±28.2) wore SWM and FB devices during 1 unrestricted physical activity over a period of five days and an average five day step count and energy expenditure was determined. Results: While a significant correlation between FB and SWM daily step count was observed (R =0.89, p<0.05), SWM daily step count was 2 significantly lower than FB step count (FB (steps/day): 3704±2325 vs. SWM (steps/day): 2486±1895; p<0.01). In spite of this, SWM calculated a significantly higher daily energy expenditure as compared to the FB (FB (kcal): 919±229 vs. SWM (kcal): 1220±471; p<0.01). Conclusions: A strong correlation between FB and SWM devices was found in individuals with COPD, however, caution must be taken when interpreting absolute results for step count and energy expenditure. Slower walking speeds in patients with COPD may affect the algorithms used to calculate step count and energy expenditure in both PAMs. Future work should include a criterion measure for step count and energy expenditure between these PAMs in order to more accurately assess their validity.", "links": [ { "caption": "URL", "url": "http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A6248", "newWindow": true } ] }, { "title": "Subjective Age and Physical Activity: A Daily-Dieary Study with Commercially Available Wearables", "author": "Gabrian, M.\t", "year": "2017", "journalProceedings": "Innovation in Aging", "category": "Measurement", "devices": null, "population": "Older Adults", "dataUsed": "Steps", "abstract": "Emerging intervention studies suggest that positive self-perceptions of aging (SPA) promote physical activity (PA) in older adults. Short-term intra-individual variation in both PA and SPA calls for an investigation of the day-to-day dynamics. 40 individuals (60–74 years) wore a FitbitTM device to assess PA and reported subjective ages for a 2-week diary period. Domain-specific SPA were assessed at the outset of this pilot-like study. Multilevel model analyses revealed that individuals felt younger on physically more active days (ß = -0.12; p <.05). Domain-specific associations were found at the between-person level, with physically active participants tending to perceive their own aging more in terms of physical decline (ß = .34; p < .10) and less in terms of social loss (ß = .42; p < .05). Findings suggest that, despite making individuals more aware of age-related physical limitations, PA exertion is paralleled by a positive perception of one's own age.", "links": [ { "caption": "URL", "url": "https://academic.oup.com/innovateage/article-lookup/doi/10.1093/geroni/igx004.3367", "newWindow": true } ] }, { "title": "Accuracy of Fitbit Activity Trackers During Walking in a Controlled Setting", "author": "Gamez, J.L., Gonzalez, J., Leyva, P., Figueroa, I.A., Lucio, N., Salazar, V.E., Salazar, C., Garcia, M. and Funk, M.D.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "One,Zip,Flex,Charge HR,Blaze", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Activity trackers are widely used to measure daily physical activity. Many devices have been shown to measure steps more accurately at higher intensities, however, it is also important to determine accuracy at a walking pace.\nPURPOSE: To assess 6 popular activity trackers at measuring steps while walking on a treadmill.\n\nMETHODS: Twenty-six college students (Mean±SD; 22.1±3.7yrs; 25.1±4.0kg/m2; 13 male) walked 500 steps at 3mph on a treadmill while wearing 6 different activity trackers (Pedometer, Fitbit Blaze, Charge HR, Alta, Flex, Zip, One). The Charge HR was placed two fingers above the right wrist while the Flex was next to the wrist bone. The Blaze was placed two fingers above the left wrist while the Alta was next to the wrist bone. The Fitbit Zip and the One were aligned with the hip bone on the left and right waistband respectively. A trained researcher using a hand tally counter counted the steps. Missing values were replaced with the mean value for that device. Step counts were correlated between Fitbit devices and the pedometer and tally counter using Pearson correlations. Significance was set at ptextless0.05. Mean bias scores were calculated between the step counts for each device and the tally counter. Mean Absolute Percent Error (MAPE) values were also calculated for each device relative to the tally counter.\n\nRESULTS: Fitbit Zip and One were significantly correlated with the tally counter (r=0.50, ptextless0.05; r=0.68, ptextless0.01, respectively) while the other devices were not significantly correlated. Mean bias and MAPE values were as follows:\n\nFitbit Zip and One were within one half percent of actual steps while wrist-worn Fitbits ranged from 7.0-19.7% from actual step counts.\n\nCONCLUSION: Consistent with previous research, activity trackers worn at the waist provide the most accurate step counts compared to wrist-worn models. Differences found in wrist-worn models may result in significant over- or underestimation of activity levels when worn for long periods of time.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Accuracy_of_Fitbit_Activity_Trackers_During.1069.aspx", "newWindow": true } ] }, { "title": "Accuracy of Smartwatches in Assessing College Students’ Energy Expenditure in Exercise with Different Intensities", "author": "Gao, Z., Li, X., Zeng, N., Pope, Z., Yang, H., Liu, W., Xiong, H., Chen, Y., Li, J. and He, W.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Surge", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "PURPOSE: Despite the recent prevalence of health wearable devices (e.g., smartwatches), the validity and reliability of smartwatches’ physiological outcomes remain largely unexplored. This study was designed to examine the accuracy of the Microsoft Band (MS), Fitbit Surge HR (FB), TomTom Cardio Watch (TT) and Apple Watch (AW) in assessing energy expenditure (EE) during three exercise sessions with different intensities.\nMETHODS: Participants were 25 college students (12 males; Mage= 23.52, SD = ± 1.04) from Southcenter region in China. They completed three separate 10-minute exercise sessions at light physical activity (LPA, walking at 3.0 km/h), moderate PA (MPA, running at 5.0 km/h), and vigorous PA (VPA, running at 7.0 km/h) conditions on the Hpcosmos treadmill at a highly controlled laboratory. In this study, the AW and TT were placed on the right wrist while the FB and MS were worn on the left wrist. All demographic information (i.e., height, weight, age, gender) was loaded onto each smartwatch prior to testing. EEs of smartwatches were then validated against EE data from a Actigraph wGT3X accelerometer worn on the right side of waist.\n\nRESULTS: ANOVAs with repeated measures revealed significant differences between smartwatches for EE, F(9, 16)=45.73, p<0.01, ?2=0.98. When validated against accelerometer, post-hoc comparisons suggested significantly different EE assessments for the FB at LPA and MPA conditions (p<0.01), and for MS and FB at the VPA (p<0.01). Interclass correlations between the accelerometer and smartwatches revealed reliability for EE for the TT at LPA (r=0.65, p<0.01), for the FB, TT and AW at MPA (r=0.53-0.59, p<0.01), and for MS, FB and TT at VPA (r=0.59-0.65, p<0.01). However, only the TT demonstrated excellent agreement with the accelerometer at LPA with coefficient of variation of 2.0%. Additionally, Bland-Altman plots yielded satisfactory precision/no bias for FB and TT measurements against the accelerometers at all conditions (p<0.05), for MS at LPA and VPA (p<0.05), and for AW at VPA (p < 0.05).\n\nCONCLUSIONS: Findings suggested EE measurements of smartwatches are far from ideal in terms of validity and reliability. In this study the most valid and reliable measurements were from the TT. Future study may investigate the validity and reliability of smartwatch measurements in everyday life.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Accuracy_of_Smartwatches_in_Assessing_College.1385.aspx", "newWindow": true } ] }, { "title": "A Bit of Fit: Minimalist Intervention in Adolescents Based on a Physical Activity Tracker.", "author": "Gaudet, J., Gallant, F. and Bélanger, M.\t", "year": "2017", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "Charge HR", "population": "Adolescents", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "BACKGROUND Only 5% of Canadian youth meet the recommended 60 minutes of moderate to vigorous physical activity (MVPA) per day, with leisure time being increasingly allocated to technology usage. Direct-to-consumer mHealth devices that promote physical activity, such as wrist-worn physical activity trackers, have features with potential appeal to youth. \n\nOBJECTIVE The primary purpose of this study was to determine whether a minimalist physical activity tracker-based intervention would lead to an increase in physical activity in young adolescents. A secondary aim of this study was to assess change in physical activity across a 7-week intervention, as measured by the tracker. \n\nMETHODS Using a quasi-experimental crossover design, two groups of 23 young adolescents (aged 13-14 years) were randomly assigned to immediate intervention or delayed intervention. The intervention consisted of wearing a Fitbit-Charge-HR physical activity tracker over a 7-week period. Actical accelerometers were used to measure participants' levels of MVPA before and at the end of intervention periods for each group. Covariates such as age, sex, stage of change for physical activity behavior, and goal commitment were also measured. \n\nRESULTS There was an increase in physical activity over the course of the study period, though it was not related to overall physical activity tracker use. An intervention response did, however, occur in a subset of participants. Specifically, exposure to the physical activity tracker was associated with an average daily increase in MVPA by more than 15 minutes (P=.01) among participants who reported being in the action and maintenance stages of behavior change in relation to participation in physical activity. Participants in the precontemplation, contemplation, and preparation stages of behavior change had no change in their level of MVPA (P=.81). \n\nCONCLUSIONS These results suggest that physical activity trackers may elicit improved physical activity related behavior in young adolescents demonstrating a readiness to be active. Future studies should seek to investigate if integrating physical activity trackers as part of more intensive interventions leads to greater increases in physical activity across different levels of stages of behavior change and if these changes can be sustained over longer periods of time.", "links": [ { "caption": "URL", "url": "http://mhealth.jmir.org/2017/7/e92/", "newWindow": true } ] }, { "title": "Home-Based Trials in Adolescent Migraine", "author": "Gelfand, A.A., Qubty, W., Patniyot, I., Grimes, B., Pletcher, M.J., Goadsby, P.J. and Cummings, S.R.\t", "year": "2017", "journalProceedings": "JAMA Neurology", "category": "Intervention", "devices": null, "population": "Adolescents", "dataUsed": "Sleep", "abstract": "Randomized trials are needed to identify safe and effective migraine preventive treatments for children. Conventional trials typically require frequent in-person study visits. Many families decline study participation, citing time and distance. Home-based trials are a novel, participant-centered design innovation wherein most or all study procedures are completed remotely using technology. Melatonin is safe and effective for migraine prevention in adults. In this pilot study, we assessed the feasibility of a home-based trial of melatonin for adolescent migraine prevention.", "links": [ { "caption": "URL", "url": "http://jamanetwork.com/journals/jamaneurology/article-abstract/2622651", "newWindow": true } ] }, { "title": "The Role of Fitbits in Corporate Wellness Programs: Does Step Count Matter?", "author": "Giddens, L., Leidner, D. and Gonzalez, E.\t", "year": "2017", "journalProceedings": "Hawaii International Conference on System Sciences (HICSS) 2017", "category": "Measurement", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Striving to promote the health and well-being of their workforce and decrease insurance expenditures, many organizations are incorporating wearable fitness trackers into their corporate wellness programs. Research suggests that these devices encourage individuals to make healthier choices; however, little is known about the drivers and impact of fitness trackers on employee health and well-being. We seek to fill this knowledge gap by investigating the following research questions: (1) what is the impact of wearable fitness device use on employee health and well-being? (2) what is the impact of wearable fitness device use on step count? Our results indicate that extended use has a positive impact on employee well-being and step count, which fully mediates the relationship between feature use and health. These findings have implications for research into wearable fitness trackers and, more specifically, for research on the uses of wearable fitness devices in corporate wellness programs.", "links": [ { "caption": "URL", "url": "http://hdl.handle.net/10125/41596", "newWindow": true } ] }, { "title": "Variable Accuracy of Wearable Heart Rate Monitors during Aerobic Exercise", "author": "Gillinov, S., Etiwy, M., Wang, R., Blackburn, G., Phelan, D., Gillinov, A.M., Houghtaling, P., Javadikasgari, H. and Desai, M.Y.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Blaze", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Purpose: Athletes and members of the public increasingly rely upon wearable heart rate (HR) monitors to guide physical activity and training. The accuracy of newer, optically based monitors is unconfirmed. We sought to assess the accuracy of 5 optically based HR monitors during various types of aerobic exercise.\nMethods: Fifty healthy adult volunteers (mean age 38+12 years, 54% female) completed exercise protocols on a treadmill, stationary bicycle and an elliptical trainer (+/- arm movement). Each participant underwent HR monitoring with an electrocardiogaphic, chest strap monitor (Polar H7), forearm monitor (Scosche Rhythm+), and two randomly assigned wrist-worn HR monitors (Apple Watch, Fitbit Blaze, Garmin Forerunner 235, TomTom Spark Cardio), one on each wrist. For each exercise type, HR was recorded at rest, light, moderate and vigorous intensity. Agreement between HR measurements was assessed using Lin's concordance correlation coefficient (rc).\n\nResults: Across all exercise conditions, the chest strap monitor (Polar H7) had the best agreement with ECG (rc=.996) followed by the Apple Watch (rc=.92), the TomTom Spark (rc=.83) and Garmin Forerunner (rc=.81). The Scosche Rhythm+ and Fitbit Blaze were less accurate (rc=.75 and rc=.67, respectively). On treadmill, all devices performed well (rc=.88-.93) except the Fitbit Blaze (rc=.76). While bicycling, only the Garmin, Apple Watch and Scosche Rhythm+ had acceptable agreement (rctextgreater.80). On the elliptical trainer without arm levers, only the Apple Watch was accurate (rc=.94). None of the devices was accurate during elliptical trainer use with arm levers (all rc textless .80).\n\nConclusion: The accuracy of wearable, optically based HR monitors varies with exercise type and is greatest on the treadmill and lowest on elliptical trainer. Electrode-containing chest monitors should be used when accurate HR measurement is imperative.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Abstract/publishahead/Variable_Accuracy_of_Wearable_Heart_Rate_Monitors.97240.aspx", "newWindow": true } ] }, { "title": "Personalized Mobile Health Intervention for Health and Weight Loss in Postpartum Women Receiving Women, Infants, and Children Benefit: A Randomized Controlled Pilot Study", "author": "Gilmore, L.A., Klempel, M.C., Martin, C.K., Myers, C.A., Burton, J.H., Sutton, E.F. and Redman, L.M.\t", "year": "2017", "journalProceedings": "Journal of Women's Health", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Prepregnancy maternal obesity and excessive weight gain during pregnancy lead to significant morbidities in mothers and their children. Mothers who never return to their prepregnancy weight begin subsequent pregnancies at a greater weight and have a larger propensity for excess gestational weight gain and postpartum weight retention.\n\nMethods: In this pilot study, 40 postpartum women credentialed to receive postpartum women, infants, and children (WIC) service were randomized to usual care (“WIC Moms”) or a personalized health intervention delivered via a SmartPhone (“E-Moms”). Assessments, including body weight, vital signs, circumferences, and body composition, were completed at week 0 (6–8 weeks postpartum), week 8, and week 16.\n\nResults: Results are presented as change from week 0 at 16. As per the completers analysis, body weight change was not different between the groups (WIC Moms vs. E-Moms; 1.8?±?0.9 vs. -0.1?±?0.9?kg; p?=?0.10), neither was the change in percent body fat (1.7?±?0.6 vs. 0.1%?±?0.6%; p?=?0.90) or waist/hip ratio (-0.01?±?0.01 vs. -0.02?±?0.01?cm; p?=?0.60). However, due to notable variability in intervention adherence as the study progressed, participants were classified post hoc as having low (<40% adherence), medium (40%–70% adherence), or high adherence (>70% adherence). Participants with high intervention adherence (n?=?5) had a significant reduction in body weight (-3.6?±?1.6 vs. 1.8?±?0.9?kg; p?=?0.005) and percent body fat (-2.5?±?1.0 vs. 1.7%?±?0.6%; p?=?0.001) when compared to WIC Moms.\n\nConclusions: Overall, the E-Moms intervention was not able to decrease postpartum weight retention in women receiving WIC benefits compared to usual care received through the current WIC program. However, there is some evidence to suggest improved adherence to the intervention would improve weight management.", "links": [ { "caption": "URL", "url": "http://online.liebertpub.com/doi/10.1089/jwh.2016.5947", "newWindow": true } ] }, { "title": "Enhancing mHealth Technology in the Patient-Centered Medical Home Environment to Activate Patients With Type 2 Diabetes: A Multisite Feasibility Study Protocol.", "author": "Gimbel, R., Shi, L., Williams, J.E., Dye, C.J., Chen, L., Crawford, P., Shry, E.A., Griffin, S.F., Jones, K.O., Sherrill, W.W., Truong, K., Little, J.R., Edwards, K.W., Hing, M. and Moss, J.B.\t", "year": "2017", "journalProceedings": "JMIR Research Protocols", "category": "Methods", "devices": "Charge", "population": "Patients,Adults", "dataUsed": "Steps,Sleep", "abstract": "BACKGROUND The potential of mHealth technologies in the care of patients with diabetes and other chronic conditions has captured the attention of clinicians and researchers. Efforts to date have incorporated a variety of tools and techniques, including Web-based portals, short message service (SMS) text messaging, remote collection of biometric data, electronic coaching, electronic-based health education, secure email communication between visits, and electronic collection of lifestyle and quality-of-life surveys. Each of these tools, used alone or in combination, have demonstrated varying degrees of effectiveness. Some of the more promising results have been demonstrated using regular collection of biometric devices, SMS text messaging, secure email communication with clinical teams, and regular reporting of quality-of-life variables. In this study, we seek to incorporate several of the most promising mHealth capabilities in a patient-centered medical home (PCMH) workflow. OBJECTIVE We aim to address underlying technology needs and gaps related to the use of mHealth technology and the activation of patients living with type 2 diabetes. Stated differently, we enable supporting technologies while seeking to influence patient activation and self-care activities. METHODS This is a multisite phased study, conducted within the US Military Health System, that includes a user-centered design phase and a PCMH-based feasibility trial. In phase 1, we will assess both patient and provider preferences regarding the enhancement of the enabling technology capabilities for type 2 diabetes chronic care management. Phase 2 research will be a single-blinded 12-month feasibility study that incorporates randomization principles. Phase 2 research will seek to improve patient activation and self-care activities through the use of the Mobile Health Care Environment with tailored behavioral messaging. The primary outcome measure is the Patient Activation Measure scores. Secondary outcome measures are Summary of Diabetes Self-care Activities Measure scores, clinical measures, comorbid conditions, health services resource consumption, and technology system usage statistics. RESULTS We have completed phase 1 data collection. Formal analysis of phase 1 data has not been completed. We have obtained institutional review board approval and began phase 1 research in late fall 2016. CONCLUSIONS The study hypotheses suggest that patients can, and will, improve their activation in chronic care management. Improved activation should translate into improved diabetes self-care. Expected benefits of this research to the scientific community and health care services include improved understanding of how to leverage mHealth technology to activate patients living with type 2 diabetes in self-management behaviors. The research will shed light on implementation strategies in integrating mHealth into the clinical workflow of the PCMH setting. TRIAL REGISTRATION ClinicalTrials.gov NCT02949037. https://clinicaltrials.gov/ct2/show/NCT02949037.", "links": [ { "caption": "URL", "url": "http://www.researchprotocols.org/2017/3/e38/", "newWindow": true } ] }, { "title": "OPREVENT2: Design of a multi-institutional intervention for obesity control and prevention for American Indian adults.", "author": "Gittelsohn, J., Jock, B., Redmond, L., Fleischhacker, S., Eckmann, T., Bleich, S.N., Loh, H., Ogburn, E., Gadhoke, P., Swartz, J., Pardilla, M. and Caballero, B.\t", "year": "2017", "journalProceedings": "BMC Public Health", "category": "Methods", "devices": null, "population": "Adults", "dataUsed": null, "abstract": "BACKGROUND: Obesity and other nutrition-related chronic disease rates are high in American Indian (AI) populations, and an urgent need exists to identify evidence-based strategies for prevention and treatment. Multi-level, multi-component (MLMC) interventions are needed, but there are significant knowledge gaps on how to deliver these types of interventions in low-income rural AI communities. \n\nMETHODS: OPREVENT2 is a MLMC intervention targeting AI adults living in six rural reservations in New Mexico and Wisconsin. Aiming to prevent and reduce obesity in adults by working at multiple levels of the food and physical activity (PA) environments, OPREVENT2 focuses on evidence-based strategies known to increase access to, demand for, and consumption of healthier foods and beverages, and increase worksite and home-based opportunities for PA. OPREVENT2 works to create systems-level change by partnering with tribal stakeholders, multiple levels of the food and PA environment (food stores, worksites, schools), and the social environment (children as change agents, families, social media). Extensive evaluation will be conducted at each level of the intervention to assess effectiveness via process and impact measures. \n\nDISCUSSION: Novel aspects of OPREVENT2 include: active engagement with stakeholders at many levels (policy, institutional, and at multiple levels of the food and PA system); use of community-based strategies to engage policymakers and other key stakeholders (community workshops, action committees); emphasis on both the built environment (intervening with retail food sources) and the social environment. This paper describes the design of the intervention and the evaluation plan of the OPREVENT2.", "links": [ { "caption": "URL", "url": "http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5260044", "newWindow": true } ] }, { "title": "Physical activity levels in individuals with and without patellofemoral pain", "author": "Glaviano, N.R., Baellow, A. and Saliba, S.\t", "year": "2017", "journalProceedings": "Physical Therapy in Sport", "category": "Measurement", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "OBJECTIVES\nPatellofemoral pain (PFP) is a chronic condition that results in long-term subjective and objective impairments. PFP has been identified to result in modification in activity levels, however it is unknown the extent of activity levels in individuals with and without PFP.\nDESIGN\nCase-control study.\n\nPARTICIPANTS\n20 individuals with PFP and 20 healthy individuals.\n\nMAIN OUTCOME MEASURES\nPhysical activity was assessed by steps per day, minutes of mild, moderate, and high activity over 14 consecutive days. Anterior Knee Pain Scale (AKPS), worst pain in last week (WVAS), and Fear Avoidance Belief Questionnaire (FABQ) were also collected. Paired t-tests were used to compare variables between groups. Pearson r correlations were conducted to evaluate relationships between subjective function and activity level.\n\nRESULTS\nIndividuals with PFP took less steps per day (p = 0.004) and completed less daily minutes of mild activity (p = 0.007) and high activity (p = 0.012). Significant correlations were seen between steps per day and subjective function: AKPS (p = 0.002), WVAS (p = 0.016), and FABQ (p = 0.002) in the PFP population.\n\nCONCLUSION\nIndividuals with PFP are less physically active than their healthy counterparts in both steps per day and minutes spent conducting physical activity. A relationship between subjective function and physical activity exists in individuals with PFP.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1466853X17301530", "newWindow": true } ] }, { "title": "Influence of the Fitbit Charge HR on physical activity, aerobic fitness and disability in non-specific back pain participants.", "author": "Gordon, R. and Bloxham, S.\t", "year": "2017", "journalProceedings": "The Journal of Sports Medicine and Physical Fitness", "category": "Intervention", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Increasing levels of physical activity (PA) and aerobic fitness can reduce non-specific chronic low back pain (NSCLBP) yet patient's physical activity 1 and aerobic fitness 2 have been shown to be lower than healthy counterparts. Pedometers are effective at promoting PA 3, yet more 'advanced consumer level activity monitors' (AAMs) can provide greater feedback to the user. The aim of this study was to determine the effect of new advances in commercially available wearable technology on PA, aerobic fitness and disability of low back pain participants. \n\nMETHODS: Seventeen participants volunteered and were provided with Fitbit Charge HR (FIT n=9) or pedometer (PED n=8). Participants completed a 6- week, multi-component, physical activity programme lasting two hours per week. All activities were designed to be relevant to activities of daily living. \n\nRESULTS: Non-significant (Ptextgreater0.05) increases in step count were identified from pre to post intervention in both FIT, (23%) and PED (29%) groups. At one month follow up, aerobic fitness significantly (Ptextless0.05) increased by 33% in the FIT but not PED group. Non-significant reductions in both FIT (19%) and PED (13%) disability scores were identified and remained stable at one-month follow-up. No significant change in body composition were reported for either group (Ptextgreater0.05). \n\nCONCLUSIONS: Our data suggest feedback on user exercise intensity provided by AAMs, may show promise in improving aerobic fitness. AAMs were not more effective than pedometers at increasing the volume of PA, or reducing disability in NSCLP participants.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/28181773", "newWindow": true } ] }, { "title": "Fitbit Charge HR Wireless Heart Rate Monitor: Validation Study Conducted Under Free-Living Conditions", "author": "Gorny, A.W., Liew, S.J., Tan, C.S. and Müller-Riemenschneider, F.\t", "year": "2017", "journalProceedings": "JMIR mHealth and uHealth", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Background: Many modern smart watches and activity trackers feature an optical sensor that estimates the wearer's heart rate. Recent studies have evaluated the performance of these consumer devices in the laboratory. Objective: The objective of our study was to examine the accuracy and sensitivity of a common wrist-worn tracker device in measuring heart rates and detecting 1-min bouts of moderate to vigorous physical activity (MVPA) under free-living conditions. Methods: Ten healthy volunteers were recruited from a large university in Singapore to participate in a limited field test, followed by a month of continuous data collection. During the field test, each participant would wear one Fitbit Charge HR activity tracker and one Polar H6 heart rate monitor. Fitbit measures were accessed at 1-min intervals, while Polar readings were available for 10-s intervals. We derived intraclass correlation coefficients (ICCs) for individual participants comparing heart rate estimates. We applied Centers for Disease Control and Prevention heart rate zone cut-offs to ascertain the sensitivity and specificity of Fitbit in identifying 1-min epochs falling into MVPA heart rate zone. Results: We collected paired heart rate data for 2509 1-min epochs in 10 individuals under free-living conditions of 3 to 6 hours. The overall ICC comparing 1-min Fitbit measures with average 10-s Polar H6 measures for the same epoch was .83 (95% CI .63-.91). On average, the Fitbit tracker underestimated heart rate measures by −5.96 bpm (standard error, SE=0.18). At the low intensity heart rate zone, the underestimate was smaller at −4.22 bpm (SE=0.15). This underestimate grew to −16.2 bpm (SE=0.74) in the MVPA heart rate zone. Fitbit devices detected 52.9% (192/363) of MVPA heart rate zone epochs correctly. Positive and negative predictive values were 86.1% (192/223) and 92.52% (2115/2286), respectively. During subsequent 1 month of continuous data collection (270 person-days), only 3.9% of 1-min epochs could be categorized as MVPA according to heart rate zones. This measure was affected by decreasing wear time and adherence over the period of follow-up. Conclusions: Under free-living conditions, Fitbit trackers are affected by significant systematic errors. Improvements in tracker accuracy and sensitivity when measuring MVPA are required before they can be considered for use in the context of exercise prescription to promote better health. [JMIR Mhealth Uhealth 2017;5(10):e157]", "links": [ { "caption": "URL", "url": "http://mhealth.jmir.org/2017/10/e157/", "newWindow": true } ] }, { "title": "Reversal of type 2 diabetes in youth who adhere to a very-low-energy diet: a pilot study", "author": "Gow, M.L., Baur, L.A., Johnson, N.A., Cowell, C.T. and Garnett, S.P.\t", "year": "2017", "journalProceedings": "Diabetologia", "category": "Intervention", "devices": "One", "population": "Children,Adolescents", "dataUsed": "Steps", "abstract": "Aims/hypothesis: The aim of the study was to investigate whether a very-low-energy diet (VLED) is a feasible and acceptable treatment option for type 2 diabetes in children and adolescents, and whether adherence can lead to rapid weight loss, reversal of type 2 diabetes and reduced liver fat as seen in adult studies.\nMethods: Eight participants with type 2 diabetes and obesity, aged 7–16 years, non-medicated (n?=?1) or treated with metformin (n?=?7) and in some cases insulin (n?=?3), followed a VLED (textless3360 kJ/day) for 8 weeks, then transitioned to a hypocaloric diet (~6300 kJ/day) that they followed to 34 weeks. HbA1c, fasting glucose and 2 h post-glucose load plasma glucose (2hG) were determined from fasting blood and an OGTT. Liver fat concentration was quantified using proton magnetic resonance spectroscopy. Adherence was defined as =5% weight loss during the 8 week VLED.\n\nResults: Adherers (n?=?5) and non-adherers (n?=?3) had median weight loss of 7.5% and 0.5%, respectively, at 8 weeks. Overall, HbA1c (mean [SE] 8.1% [0.7%] to 6.6% [0.5%]; p?=?0.004) and 2hG (15.6 [1.6] mmol/l to 11.3 [1.0] mmol/l; p?=?0.009) were significantly reduced at 8 weeks compared with baseline. Liver fat was also significantly reduced from baseline (14.7% [2.2%]) to 8 weeks (5.8% [1.7%]; p?=?0.001). Only three out of eight participants met non-alcoholic fatty liver disease (NAFLD) criteria (=5.5%) at 8 weeks, compared with eight out of eight at baseline. The three participants on insulin therapy at baseline were able to cease therapy during the 8 week VLED. At 34 weeks, adherers (n?=?5) achieved 12.3% weight loss, none met NAFLD criteria and four did not meet American Diabetes Association criteria for type 2 diabetes.\n\nConclusions/interpretation: A VLED appears to be a feasible treatment option for some youth with type 2 diabetes on metformin therapy. Youth who agree to participate and adhere to a VLED achieve rapid weight loss, dramatic reductions in liver fat and reversal of type 2 diabetes. This highlights the capacity of a VLED to be used as a first-line treatment option in newly diagnosed youth. A larger trial with a control group and longer follow-up will be required to encourage a change in standard treatment.", "links": [ { "caption": "URL", "url": "https://link.springer.com/article/10.1007%2Fs00125-016-4163-5", "newWindow": true } ] }, { "title": "Meaningful weight loss in obese postmenopausal women: A pilot study of high-intensity interval training and wearable technology.", "author": "Grossman, J.A., Arigo, D. and Bachman, J.L.\t", "year": "2017", "journalProceedings": "Menopause", "category": "Intervention", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "OBJECTIVE Postmenopausal women cite lack of time as their primary barrier to exercise and related weight control behaviors. The purpose of this study was to address this barrier via testing the feasibility and initial outcomes of a short-duration/high-intensity interval training (HIIT)-based weight loss program among obese postmenopausal women, with descriptive comparison to an endurance-focused exercise program. METHODS A 16-week behavioral program incorporated (1) HIIT to limit time necessary to produce health benefits of exercise, and (2) wearable activity sensors to facilitate self-monitoring exercise. Participants (n = 11; MAge = 59 ± 5.33; MBMI = 32.0 ± 2.53 kg/m) were randomly assigned to HIIT or endurance exercise. Both groups followed a calorie-restricted diet, attended monthly in-person meetings, weekly weigh-ins and electronic check-ins to review behavioral skills, and monitored their exercise with a Fitbit ChargeHR. Adherence to exercise programs, assessed with the Fitbit sensor, was used to determine feasibility. RESULTS Participants in the HIIT group (6/6) adhered to their program, whereas 3 of 5 adhered to the Endurance program. Participants in the HIIT group lost twice as much weight as those in the Endurance group (8.7% vs 4.3% of initial body weight), and lost an additional 6 in. of body mass. In addition, only the HIIT group significantly changed fat mass, body mass index, and fat-free mass (Ps textless 0.04). CONCLUSIONS These findings support the feasibility and potential effectiveness of HIIT for weight loss and body composition changes in obese postmenopausal women, and indicate that additional investigation of this approach is warranted to reduce postmenopausal chronic disease risk.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/29088015", "newWindow": true } ] }, { "title": "Fitbit Activity Trackers Interrupt Workplace Sedentary Behavior: A New Application", "author": "Guitar, N.A., MacDougall, A., Connelly, D.M. and Knight, E.\t", "year": "2017", "journalProceedings": "Workplace Health & Safety", "category": "Intervention", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "This study investigated whether Fitbit devices can reduce sedentary behavior among employees in the workplace. Participants were asked to wear Fitbits during 8-hour work shifts, 5 days per week, for 8 weeks. They were instructed to stand at least once every 30 minutes throughout the workday. The goal of the study was to determine whether standing once every 30 minutes was a feasible strategy for reducing sedentary workplace behavior. On average, participants completed 36 of 40 workdays using Fitbits. The number of times participants stood during an 8-hour workday averaged 12 stands per day (maximum 16 stands per day). These results indicate that Fitbit technology is effective for recording and tracking interruptions in sitting time; however, to reduce sitting behavior, alternate approaches are required to motivate larger numbers of workers to participate.", "links": [ { "caption": "URL", "url": "http://journals.sagepub.com/doi/10.1177/2165079917738264", "newWindow": true } ] }, { "title": "Can a Made-for-Consumer Activity Monitor Assess Physical Activity in Adolescents and Young Adults After Lower Extremity Limb Salvage for Osseous Tumors?", "author": "Gundle, K.R., Punt, S.E., Mattioli-Lewis, T. and Conrad, E.U.\t", "year": "2017", "journalProceedings": "Journal of Pediatric Orthopaedics", "category": "Measurement", "devices": "One", "population": "Adolescents", "dataUsed": "Steps", "abstract": "Background: The purpose of this study was to test the validity of a consumer-oriented activity monitor in adolescents and young adults undergoing limb salvage for primary bone malignancies.\n\nMethods: A cross-sectional population of participants with an average age of 16 (range 12 to 22) years produced 472 days of activity monitoring during 25 evaluations periods alongside patient-reported outcome measures.\n\nResults: Average daily steps ranged from 557 to 12,756 (mean=4711) and was moderately associated with the short-form (SF) 36 physical component subscale (r=0.46, P=0.04) as well as the SF6D health state utility measure (r=0.48, P=0.04), but not the SF36 mental component subscale (P=0.66) or Toronto extremity salvage score (P=0.07). Time from surgery was strongly correlated with average daily steps (r=0.7, P<0.001).\n\nConclusions: A made-for-consumer activity monitor provided real-world data regarding the outcome of adolescent and young adult limb salvage, and evidence of validity in this population. Such lower cost, user-friendly devices may facilitate assessment of free-living activity and allow novel comparisons of treatment strategies.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/pedorthopaedics/Abstract/2017/04000/Can_a_Made_for_Consumer_Activity_Monitor_Assess.16.aspx", "newWindow": true } ] }, { "title": "FitViz: A Personal Informatics Tool for Self-management of Rheumatoid Arthritis", "author": "Gupta, A., Tong, X., Shaw, C., Li, L. and Feehan, L.\t", "year": "2017", "journalProceedings": "2017 International Conference on Human-Computer Interaction", "category": "Usability,Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "Rheumatoid arthritis (RA) affects 1 in 100 adults in Canada. Self-management of this disease requires that the patients maintain an adequate level of daily physical activity, while not overdoing it; excessive physical activity can be harmful to RA patients. The RA patients receive regular physical activity recommendations from their clinicians, based on the condition of their disease. Current solutions for physical activity monitor do not satisfy the needs of the arthritis patients and their clinicians, as they do not allow the patients and the clinicians to know if the patients did the physical activity as recommended by the clinicians. Therefore, we developed a web application which monitors patient's daily physical activity, and generates visualizations to help the patients in the self-management of the disease. In this paper, we present the design of the application and the interim results of an ongoing pilot study that we are conducting to evaluate our prototype.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/978-3-319-58753-0_35", "newWindow": true } ] }, { "title": "Accuracy of the Fitbit Zip for Measuring Steps for Adolescents With Visual Impairments", "author": "Haegele, J.A., Brian, A.S. and Wolf, D.\t", "year": "2017", "journalProceedings": "Adapted Physical Activity Quarterly", "category": "Validation", "devices": "Zip", "population": "Patients,Adolescents", "dataUsed": "Steps", "abstract": "Our purpose in this study was to document the criterion validity of the Fitbit Zip for measuring steps taken by youth with visual impairments (VI). A secondary purpose was to determine whether walking pace, mounting position, or relative position to the user's mobility device impacted the criterion validity of the device. Fourteen adolescent-aged individuals (Mage = 15.4; 13 male and 1 female) with VI participated in this study. Participants wore four Fitbit Zips at different mounting positions and completed two, 2-min walking trials while the lead investigator hand tallied steps. Measurement validity was analyzed using absolute percent error (APE), intraclass correlation coefficients estimated level of conformity, and paired samples t tests and Cohen's d effect sizes assessed APE relative to mounting positions. Results supported the use of the Fitbit Zip during regular-paced walking; however, caution must be used during activities exceeding regular walking speeds, as devices consistently underestimated s...", "links": [ { "caption": "URL", "url": "http://journals.humankinetics.com/doi/10.1123/apaq.2016-0055", "newWindow": true } ] }, { "title": "Regular exercise improves the well-being of parents of children with cancer", "author": "Halliday, G.C., Miles, G.C.P., Marsh, J.A., Kotecha, R.S. and Alessandri, A.J.\t", "year": "2017", "journalProceedings": "Pediatric Blood & Cancer", "category": "Intervention", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "Aim: Parents of children with cancer describe impaired physical and social functioning, sleep disturbance and poor mental health. Exercise-related interventions impact positively on these quality of life domains, but have not been examined in this population. The aim of this longitudinal pilot study was to explore the feasibility of a 12-week pedometer-monitored walking intervention among parents of children with cancer, assessing adherence to a set activity target of 70,000 steps per week, and to explore the benefits of physical activity on mental and physical health.\nMethods: Parents were provided with a pedometer and requested to achieve a daily step count of 10,000 steps per day for 12 weeks. Mood, well-being and psychological distress were examined using validated questionnaires (Profile of Mood States 2nd edition [POMS-2], Distress Thermometer for Parents [DT-P] and Depression Anxiety Stress Scales [DASS-42]) at baseline, midpoint (6 weeks) and endpoint (12 weeks) to identify changes in these domains with increased activity.\nResults: Fifteen parents were recruited. The majority increased their counts during the first 4 weeks of the study and maintained this to week 8 (n = 12). Time-dependent improvements were identified in the following psychometric test outcomes at week 12: DT-P score (likelihood ratio test [LRT] P = 0.02), POMS-2 total mood disturbance (LRT P = 0.03), fatigue inertia (LRT P = 0.009), tension anxiety (LRT P = 0.007) and vigour activity (LRT P = 0.001).\nConclusions: Mental health benefits of a pedometer-based exercise intervention for parents of children with cancer were identified. Such programs should be included in a holistic approach to improve the psychological outcomes of parents whose children are receiving treatment for cancer.", "links": [ { "caption": "URL", "url": "http://doi.wiley.com/10.1002/pbc.26668", "newWindow": true } ] }, { "title": "Physical activity among children: objective measurements using Fitbit One® and ActiGraph", "author": "Hamari, L., Kullberg, T., Ruohonen, J., Heinonen, O.J., Díaz-Rodríguez, N., Lilius, J., Pakarinen, A., Myllymäki, A., Leppänen, V. and Salanterä, S.\t", "year": "2017", "journalProceedings": "BMC Research Notes", "category": "Validation", "devices": "One", "population": "Children", "dataUsed": "Steps", "abstract": "BACKGROUND Self-quantification of health parameters is becoming more popular; thus, the validity of the devices requires assessments. The aim of this study was to evaluate the validity of Fitbit One step counts (Fitbit Inc., San Francisco, CA, USA) against Actigraph wActisleep-BT step counts (ActiGraph, LLC, Pensacola, FL, USA) for measuring habitual physical activity among children. DESIGN The study was implemented as a cross-sectional experimental design in which participants carried two waist-worn activity monitors for five consecutive days. METHODS The participants were chosen with a purposive sampling from three fourth grade classes (9-10 year olds) in two comprehensive schools. Altogether, there were 34 participants in the study. From these, eight participants were excluded from the analysis due to erroneous data. Primary outcome measures for step counts were Fitbit One and Actigraph wActisleep-BT. The supporting outcome measures were based on activity diaries and initial information sheets. Classical Bland-Altman plots were used for reporting the results. RESULTS The average per-participant daily difference between the step counts from the two devices was 1937. The range was [116, 5052]. Fitbit One gave higher step counts for all but the least active participant. According to a Bland-Altman plot, the hourly step counts had a relative large mean bias across participants (161 step counts). The differences were partially explained by activity intensity: higher intensity denoted higher differences, and light intensity denoted lower differences. CONCLUSIONS Fitbit One step counts are comparable to Actigraph step counts in a sample of 9-10-year-old children engaged in habitual physical activity in sedentary and light physical activity intensities. However, in moderate-to-vigorous physical activity, Fitbit One gives higher step counts when compared to Actigraph.", "links": [ { "caption": "URL", "url": "http://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-017-2476-1", "newWindow": true } ] }, { "title": "Zero Cadence as a Proxy Indicator of Sitting Behaviors in Objective Monitoring", "author": "Han, H., Aguiar, E.J., Ducharme, S., Lim, J., Moore, C., Busa, M.A., Sirard, J.R., Chipkin, S.R., Staudenmayer, J. and Tudor-Locke, C.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Methods", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "Consistent evidence has been presented regarding the potentially deleterious health consequences of prolonged sitting time independent of physical activity level. Zero cadence (0 steps/min) determined using accelerometers may be a suitable proxy measure of sitting behaviors since theoretically no steps should be registered in this position.\nPURPOSE: The purpose of the current study was to determine the capability of accelerometer-determined zero cadence to predict seated activities of daily living.\n\nMETHODS: A total of 80 young adults (mean age 29.8±6.7 years), 10 men and 10 women representing each 5-year age-group category between 21-40 years (21-25, 26-30, 31-35, 36-40) performed lab-based simulated daily living activities (i.e., seated rest, watching a movie, computer work, folding laundry while standing, vacuuming, stair stepping and a self-paced over-ground walk) while concurrently wearing multiple (n=7) research-grade (e.g., ActiGraph, ActivPAL, ActiCal and StepWatch) and consumer-grade (e.g., Fitbit One and Vivofit2) accelerometers on manufacturer-indicated locations (i.e., hip, wrist, thigh or ankle). Receiver Operating Characteristic (ROC) analyses were conducted to examine the accuracy of zero cadence for classifying sitting behaviors (e.g., seated rest, watching a movie and computer work) among the performed activities. Sensitivity, specificity, accuracy and area under the ROC curve (AUC) values were compared for each device.\n\nRESULTS: All devices demonstrated the capability of using zero cadence to determine sitting activities with high combined sensitivity and specificity (e.g., ranges between 75-98%). AUC values of all devices were above 0.8 (p<.001) indicating good or excellent discrimination ability of zero cadence. Vivofit2 and wrist-worn ActiGraph provided the highest (93%) and lowest (75%) accuracy, respectively.\n\nCONCLUSION: In agreement with zero cadence, both research- and consumer-grade activity monitors provided valid capacity for discriminating seated activities from common daily living activities. Based on this preliminary analysis it appears that accumulated time spent at zero cadence obtained by activity monitors can be used as a proxy indicator of time spent sitting.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Zero_Cadence_as_a_Proxy_Indicator_of_Sitting.1887.aspx", "newWindow": true } ] }, { "title": "Validity Of The Diagnostix 2100 And Fitbit Charge HR In Assessing Heart Rate", "author": "Hardekopf, P. and Fountaine, C.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "The importance of exercise intensity is an important factor when maximizing the health benefits that result from exercise. New innovations in consumer based activity trackers and electronic healthcare monitoring devices have been able to quantify the level of exercise intensity based on heart rate (HR) values. However, there is limited research assessing the validity of these devices.\n\nPURPOSE: To assess the validity of the Fitbit Charge HR (FB) and ACSC Diagnostix 2100 Fingertip Pulse Oximeter (PO) in assessing heart rate during exercise in comparison to the heart rate from an electrocardiogram (EKG).\n\nMETHODS: Healthy college students (n=30, 18 females) performed 1 min of standing rest, 10 min of the standard Bruce Protocol test on a treadmill, and a 2 min cool-down walk. Each participant simultaneously wore the FB on the right wrist, the PO on the right index finger, and had 10 electrodes placed on their chest for the 12-lead EKG. HR was recorded from each device every minute. Absolute differences between the 3 HR monitors were compared using repeated measures ANOVA. Pearson r correlation coefficients and Standard Error of Estimate (SEE) were calculated to determine the relationships between each HR monitor vs. EKG.\n\nRESULTS: Repeated measures ANOVA indicated a significant difference in HR between the 3 monitors, F(2,58)=16.876, p<0.001. Post hoc tests indicated a significant difference between EKG and FB (132.1 ± 13 vs. 120.5 ± 13.7 bpm, p<0.001), and EKG and PO (132.1 ± 13 vs. 121.9 ± 15.5 bpm, p<0.001). The correlation between the EKG and FB was r=0.64, p<0.001, SEE 10.2 bpm, whereas the correlation between EKG and PO was r=0.63, p<0.001, SEE 10.27 bpm.\n\nCONCLUSIONS: Large absolute differences and modest correlation values do not indicate a strong agreement between the FB or PO vs. EKG. Therefore, the extent of each device’s validity to monitor HR is questionable when compared to the gold standard EKG.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Validity_Of_The_DiagnostixTM_2100_And_Fitbit.2223.aspx", "newWindow": true } ] }, { "title": "A Trial of Financial and Social Incentives to Increase Older Adults' Walking", "author": "Harkins, K.A., Kullgren, J.T., Bellamy, S.L., Karlawish, J. and Glanz, K.\t", "year": "2017", "journalProceedings": "American Journal of Preventive Medicine", "category": "Intervention", "devices": "Ultra", "population": "Older Adults", "dataUsed": "Steps", "abstract": "INTRODUCTION\nDespite evidence that regular physical activity confers health benefits, physical activity rates among older adults remain low. Both personal and social goals may enhance older adults' motivation to become active. This study tested the effects of financial incentives, donations to charity, and the combined effects of both interventions on older adults' uptake and retention of increased levels of walking.\nSTUDY DESIGN\nRCT comparing three interventions to control. Data collection occurred from 2012 to 2013. Analyses were conducted in 2013–2016.\n\nPARTICIPANTS\nNinety-four adults aged =65 years from Philadelphia-area retirement communities.\n\nINTERVENTION\nAll participants received digital pedometers, walking goals of a 50% increase in daily steps, and weekly feedback on goal attainment. Participants were randomized to one of four groups: (1) Control: received weekly feedback only; (2) Financial Incentives: received payment of $20 each week walking goals were met; (3) Social Goals: received donation of $20 to a charity of choice each week walking goals were met; and (4) Combined: received $20 each week walking goals were met that could be received by participant, donated to a charity of choice, or divided between the participant and charity.\n\nMAIN OUTCOME MEASURES\nMean proportion of days walking goals were met during the 16-week intervention and 4-week follow-up period.\n\nRESULTS\nAfter adjusting for baseline walking, the proportion of days step goals were met during the 16-week intervention period was higher in all intervention groups versus controls (relative risk, 3.71; 95% CI=1.37, 10.01). During the 4-week follow up period, the proportion of days step goals were met did not differ in intervention groups compared to control (relative risk, 2.91; 95% CI=0.62, 13.64).\n\nCONCLUSIONS\nIncentive schemes that use donations to a charity of choice, personal financial incentives, or a combination of the two can each increase older adults' initial uptake of increased levels of walking.", "links": [ { "caption": "URL", "url": "http://www.ajpmonline.org/article/S0749-3797(16)30612-2/abstract", "newWindow": true } ] }, { "title": "Randomized controlled trial of increasing physical activity on objectively measured and self-reported cognitive functioning among breast cancer survivors: The memory & motion study", "author": "Hartman, S.J., Nelson, S.H., Myers, E., Natarajan, L., Sears, D.D., Palmer, B.W., Weiner, L.S., Parker, B.A. and Patterson, R.E.\t", "year": "2017", "journalProceedings": "Cancer", "category": "Intervention", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND\nIncreasing physical activity can improve cognition in healthy and cognitively impaired adults; however, the benefits for cancer survivors are unknown. The current study examined a 12-week physical activity intervention, compared with a control condition, on objective and self-reported cognition among breast cancer survivors.\n\nMETHODS\nSedentary breast cancer survivors were randomized to an exercise arm (n = 43) or a control arm (n = 44). At baseline and at 12 weeks, objective cognition was measured with the National Institutes of Health Cognitive Toolbox, and self-reported cognition using the Patient-Reported Outcomes Measurement Information System scales. Linear mixed-effects regression models tested intervention effects for changes in cognition scores.\n\nRESULTS\nOn average, participants (n = 87) were aged 57 years (standard deviation, 10.4 years) and were 2.5 years (standard deviation, 1.3 years) post surgery. Scores on the Oral Symbol Digit subscale (a measure of processing speed) evidenced differential improvement in the exercise arm versus the control arm (b = 2.01; P < .05). The between-group differences in improvement on self-reported cognition were not statistically significant but were suggestive of potential group differences. Time since surgery moderated the correlation, and participants who were ≤2 years post surgery had a significantly greater improvement in Oral Symbol Digit score (exercise vs control (b = 4.00; P < .01), but no significant improvement was observed in patients who were >2 years postsurgery (b = −1.19; P = .40). A significant dose response was observed with greater increased physical activity associated with objective and self-reported cognition in the exercise arm.\n\nCONCLUSIONS\nThe exercise intervention significantly improved processing speed, but only among those who had been diagnosed with breast cancer within the past 2 years. Slowed processing speed can have substantial implications for independent functioning, supporting the potential importance of early implementation of an exercise intervention among patients with breast cancer. Cancer 2017. © 2017 American Cancer Society.", "links": [ { "caption": "URL", "url": "http://doi.wiley.com/10.1002/cncr.30987", "newWindow": true } ] }, { "title": "Tea, talk and technology: patient and public involvement to improve connected health ‘wearables' research in dementia", "author": "Hassan, L., Swarbrick, C., Sanders, C., Parker, A., Machin, M., Tully, M.P. and Ainsworth, J.\t", "year": "2017", "journalProceedings": "Research Involvement and Engagement", "category": "Usability", "devices": "Charge HR", "population": "Older Adults", "dataUsed": "NA", "abstract": "Background\nIncreasingly, researchers are recognising the potential for connected health devices, including smartphones and smartwatches, to generate high resolution data about patterns of daily activity and health outcomes. One aim of the Dementias Platform UK (DPUK) project is to provide researchers with a secure means to collect, collate and link data generated by such devices, thereby accelerating this type of research in the field of dementia. We aimed to involve members of the public in discussions about the acceptability and feasibility of different devices and research designs to inform the development of a device pool, software platform and written guidance to support future studies.\n\nMethods\n\nOver 30 people attended a series of interactive workshops, drop-in sessions and meetings in Greater Manchester. This included people living with dementia and cognitive impairments, carers and people without memory problems. Discussions were tailored to suit different audiences and focused on the feasibility and acceptability of a range of different wearable devices and research designs. We also invited volunteers to borrow a device to test at home, enabling further insights from hands-on interactions with devices.\n\nResults\n\nDiscussions revealed that people were supportive of connected health dementia research in principle, provided they gave informed consent and that devices were discreet, comfortable and easy to use. Moreover, they recommended technical support and regular feedback on study progress to encourage ongoing participation.\n\nConclusion\n\nBy using a range of discussion-based and practical activities, we found it was feasible to involve people affected by dementia and use their insights to shape the development of a software platform and device pool to support future connected health dementia research. We recommend that researchers planning such studies in future pay adequate attention to designing suitable participant information, technical support and mechanisms of providing study progress updates to support sustained engagement from participants.", "links": [ { "caption": "URL", "url": "http://researchinvolvement.biomedcentral.com/articles/10.1186/s40900-017-0063-1", "newWindow": true } ] }, { "title": "Determinants for Sustained Use of an Activity Tracker: Observational Study", "author": "Hermsen, S., Moons, J., Kerkhof, P., Wiekens, C. and De Groot, M.\t", "year": "2017", "journalProceedings": "JMIR mHealth and uHealth", "category": "Measurement", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: A lack of physical activity is considered to cause 6% of deaths globally. Feedback from wearables such as activity trackers has the potential to encourage daily physical activity. To date, little research is available on the natural development of adherence to activity trackers or on potential factors that predict which users manage to keep using their activity tracker during the first year (and thereby increasing the chance of healthy behavior change) and which users discontinue using their trackers after a short time. Objective: The aim of this study was to identify the determinants for sustained use in the first year after purchase. Specifically, we look at the relative importance of demographic and socioeconomic, psychological, health-related, goal-related, technological, user experience–related, and social predictors of feedback device use. Furthermore, this study tests the effect of these predictors on physical activity. Methods: A total of 711 participants from four urban areas in France received an activity tracker (Fitbit Zip) and gave permission to use their logged data. Participants filled out three Web-based questionnaires: at start, after 98 days, and after 232 days to measure the aforementioned determinants. Furthermore, for each participant, we collected activity data tracked by their Fitbit tracker for 320 days. We determined the relative importance of all included predictors by using Random Forest, a machine learning analysis technique. Results: The data showed a slow exponential decay in Fitbit use, with 73.9% (526/711) of participants still tracking after 100 days and 16.0% (114/711) of participants tracking after 320 days. On average, participants used the tracker for 129 days. Most important reasons to quit tracking were technical issues such as empty batteries and broken trackers or lost trackers (21.5% of all Q3 respondents, 130/601). Random Forest analysis of predictors revealed that the most influential determinants were age, user experience–related factors, mobile phone type, household type, perceived effect of the Fitbit tracker, and goal-related factors. We explore the role of those predictors that show meaningful differences in the number of days the tracker was worn. Conclusions: This study offers an overview of the natural development of the use of an activity tracker, as well as the relative importance of a range of determinants from literature. Decay is exponential but slower than may be expected from existing literature. Many factors have a small contribution to sustained use. The most important determinants are technical condition, age, user experience, and goal-related factors. This finding suggests that activity tracking is potentially beneficial for a broad range of target groups, but more attention should be paid to technical and user experience–related aspects of activity trackers. [JMIR Mhealth Uhealth 2017;5(10):e164]", "links": [ { "caption": "URL", "url": "http://mhealth.jmir.org/2017/10/e164/", "newWindow": true } ] }, { "title": "Using mobile technologies with psychiatric patients: Assessing the potential to reduce risk of developing diseases related to inactivity ", "author": "Holubova, A., Schlenker, J., Socha, V., Muzik, J., Gillar, D., Doksansky, M., Polacek, M., Hana, K., Kaspar, J., Smrcka, P., Cendelinova, M. and Gojda, J.\t", "year": "2017", "journalProceedings": "2017 IEEE 15th International Symposium on Applied Machine Intelligence and Informatics (SAMI),", "category": "Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Mental disorders, such as schizophrenia, are accompanied by increased morbidity and mortality rates, potentially reducing the lifespan of patients by up to 10 years. Premature deaths in schizophrenia sufferers are caused mainly by cardiovascular diseases and complications related to excessive weight gain and type 2 diabetes mellitus. Gaining weight is, furthermore, often a side effect of medicine prescribed for the treatment of schizophrenia. This is why treatment protocols are putting a greater emphasis on healthy lifestyle and exercise for patients, which may support both weight loss and suppress feelings of anxiety. It is, therefore, important for a doctor to monitor the exercise habits of their patients. This article focuses on telemonitoring of physical activity and other biological parameters in patients with mental disorders, such as schizophrenia, using the recent m-Health technology in the form of a Fitbit Flex activity tracker. The Soma web portal has been created to continuously monitor, visualize and analyse the data measured on patients within the scope of research activities.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/abstract/document/7880310/?part=1", "newWindow": true } ] }, { "title": "A Multi-Level, Mobile-Enabled Intervention to Promote Physical Activity in Older Adults in the Primary Care Setting (iCanFit 2.0): Protocol for a Cluster Randomized Controlled Trial", "author": "Hong, Y.A., Forjuoh, S.N., Ory, M.G., Reis, M.D. and Sang, H.\t", "year": "2017", "journalProceedings": "JMIR Research Protocols", "category": "Methods", "devices": "Flex 2", "population": "Older Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "Background: Most older adults do not adhere to the US Centers for Disease Control physical activity guidelines; their physical inactivity contributes to overweight and multiple chronic conditions. An urgent need exists for effective physical activity-promotion programs for the large number of older adults in the United States. Objective: This study presents the development of the intervention and trial protocol of iCanFit 2.0, a multi-level, mobile-enabled, physical activity-promotion program developed for overweight older adults in primary care settings. Methods: The iCanFit 2.0 program was developed based on our prior mHealth intervention programs, qualitative interviews with older patients in a primary care clinic, and iterative discussions with key stakeholders. We will test the efficacy of iCanFit 2.0 through a cluster randomized controlled trial in six pairs of primary care clinics. Results: The proposed protocol received a high score in a National Institutes of Health review, but was not funded due to limited funding sources. We are seeking other funding sources to conduct the project. Conclusions: The iCanFit 2.0 program is one of the first multi-level, mobile-enabled, physical activity-promotion programs for older adults in a primary care setting. The development process has actively involved older patients and other key stakeholders. The patients, primary care providers, health coaches, and family and friends were engaged in the program using a low-cost, off-the-shelf mobile tool. Such low-cost, multi-level programs can potentially address the high prevalence of physical inactivity in older adults. [JMIR Res Protoc 2017;6(9):e183]", "links": [ { "caption": "URL", "url": "http://www.researchprotocols.org/2017/9/e183/", "newWindow": true } ] }, { "title": "MyAirCoach: the use of home-monitoring and mHealth systems to predict deterioration in asthma control and the occurrence of asthma exacerbations; study protocol of an observational study.", "author": "Honkoop, P.J., Simpson, A., Bonini, M., Snoeck-Stroband, J.B., Meah, S., Fan Chung, K., Usmani, O.S., Fowler, S. and Sont, J.K.\t", "year": "2017", "journalProceedings": "BMJ Open", "category": "Methods", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "INTRODUCTION Asthma is a variable lung condition whereby patients experience periods of controlled and uncontrolled asthma symptoms. Patients who experience prolonged periods of uncontrolled asthma have a higher incidence of exacerbations and increased morbidity and mortality rates. The ability to determine and to predict levels of asthma control and the occurrence of exacerbations is crucial in asthma management. Therefore, we aimed to determine to what extent physiological, behavioural and environmental data, obtained by mobile healthcare (mHealth) and home-monitoring sensors, as well as patient characteristics, can be used to predict episodes of uncontrolled asthma and the onset of asthma exacerbations. METHODS AND ANALYSIS In an 1-year observational study, patients will be provided with mHealth and home-monitoring systems to record daily measurements for the first-month (phase I) and weekly measurements during a follow-up period of 11 months (phase II). Our study population consists of 150 patients, aged =18 years, with a clinician's diagnosis of asthma, currently on controller medication, with uncontrolled asthma and/or minimally one exacerbation in the past 12 months. They will be enrolled over three participating centres, including Leiden, London and Manchester. Our main outcomes are the association between physiological, behavioural and environmental data and (1) the loss of asthma control and (2) the occurrence of asthma exacerbations. ETHICS This study was approved by the Medical Ethics Committee of the Leiden University Medical Center in the Netherlands and by the NHS ethics service in the UK. TRIAL REGISTRATION NUMBER NCT02774772.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278295/", "newWindow": true } ] }, { "title": "The Accuracy of Wrist-worn Heart Rate Monitors across a Range of Exercise Intensities", "author": "Hough, P., Glaister, M. and Pledger, A.\t", "year": "2017", "journalProceedings": "Journal of Physical Activity Research", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Commercially available wrist-worn heart rate (HR) monitors have become increasingly popular. However, the accuracy of the devices across a range of exercise intensities is largely unknown. This study investigated the accuracy of four wrist-worn HR monitors (Apple Watch Series 1, Fitbit Charge, TomTom Touch, and Mio Fuse). Eighteen adults completed three trials on a cycle ergometer wearing a chest-worn HR monitor (Polar). Trial 1 established the HR-power output relationship, and resting and maximum HR. In trials 2 and 3, participants were fitted to an electrocardiogram (ECG) and completed a step test consisting of 5 x 3 minute stages at 40 - 80% of HR reserve (determined in trial 1) whilst wearing two wrist-worn HR monitors. Relative to ECG, there were no differences in HR between the devices during exercise (p = 0.239), and no device × exercise intensity interaction (p = 0.370). There were no instances where ECG and Polar data differed by ≥ 5 btextperiodcenteredmin-1. Conversely, there were two instances (2.2%) with the Apple, four (4.4%) with the Mio, 10 (11.1%) with the TomTom, and 19 (21.1%) with the Fitbit. A chest-worn HR monitor offers greater accuracy compared to wrist-worn devices.", "links": [] }, { "title": "Elderly People Living Alone: Detecting Home Visits with Ambient and Wearable Sensing", "author": "Hu, R., Pham, H., Buluschek, P. and Gatica-Perez, D.\t", "year": "2017", "journalProceedings": "Proceedings of the 2nd International Workshop on Multimedia for Personal Health and Health Care - MMHealth '17", "category": "Measurement,Methods", "devices": "Charge HR", "population": "Older Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "Ubiquitous computing techniques are enabling the possibility to provide remote health care services to elderly citizens. In such systems, daily activities are extracted from raw sensor signals, based on which users? health status can be inferred. Due to the ambiguity of raw sensor signals, it is challenging to distinguish the number of people in the ambient, and most such systems assume user live alone. We present an algorithm to automatically detect home visits to elderly people living alone, using an ambient and wearable sensing network. We use visiting reports from caregivers as partially labeled positive data, and conduct statistical analysis to gain insights of visit events in terms of raw sensor data, based on which a set of features are extracted. A one-class support vector machine is trained on a small set of positive data from one user, and tested on five installations. Experimental results show that our algorithm can correctly detect 58%-83% of the labeled visits using only the ambient sensors. The detection rate is improved by incorporating the activity data from Fitbit activity tracker, i.e., with which 75%-87% visiting events are detected. Our system is implemented and tested in the context of a real life health care system.", "links": [ { "caption": "URl", "url": "http://dl.acm.org/citation.cfm?doid=3132635.3132649", "newWindow": true } ] }, { "title": "A First Step Towards Behavioral Coaching for Managing Stress: A Case Study on Optimal Policy Estimation with Multi-stage Threshold Q-learning.", "author": "Hu, X., Hsueh, P.-Y.S., Chen, C.-H., Diaz, K.M., Cheung, Y.-K.K. and Qian, M.", "year": "2017", "journalProceedings": "AMIA Annual Symposium proceedings.", "category": "Measurement", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Psychological stress is a major contributor to the adoption of unhealthy behaviors, which in turn accounts for 41% of global cardiovascular disease burden. While the proliferation of mobile health apps has offered promise to stress management, these apps do not provide micro-level feedback with regard to how to adjust one's behaviors to achieve a desired health outcome. In this paper, we formulate the task of multi-stage stress management as a sequential decision-making problem and explore the application of reinforcement learning to provide micro-level feedback for stress reduction. Specifically, we incorporate a multi-stage threshold selection into Q-learning to derive an interpretable form of a recommendation policy for behavioral coaching. We apply this method on an observational dataset that contains Fitbit ActiGraph measurements and self-reported stress levels. The estimated policy is then used to understand how exercise patterns may affect users' psychological stress levels and to perform coaching more effectively.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977571/", "newWindow": false } ] }, { "title": "Validity of the Fitbit One for Measuring Activity in Community-Dwelling Stroke Survivors", "author": "Hui, J., Heyden, R., Bao, T., Accettone, N., McBay, C., Richardson, J. and Tang, A.\t", "year": "2017", "journalProceedings": "Physiotherapy Canada", "category": "Validation", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Purpose: We determined the correlation between the Fitbit One and Actical accelerometer for quantifying the 3-day step count and activity levels in community-dwelling individuals with stroke. Method: Twelve participants with a mean age of 62.6 (SD 9.3) years wore both the Fitbit One and the Actical on the non-paretic ankle for 3 days. Regression analyses were performed to examine concurrent validity between the devices for step counts and sedentary, light, moderate, and vigorous activity. The relative error of the Fitbit One compared with the Actical in measuring step count was calculated. Results: Participants spent about 80% of their days being sedentary. The associations between the Fitbit One and the Actical were r>0.80 for step count and light-intensity activity across the 3 days of free-living activity. The overall relative error in measuring step count was 3.8%, with differences between those with walking speeds of less than 0.58 metres per second and 0.58 metres per second or more (27.4% [SD 34.2] vs. –8.0% [SD 10.7], p<0.001). Conclusions: The Fitbit One was associated with the Actical accelerometer in measuring step count and light-intensity activity during free-living activity after stroke, but had lower error in capturing step count for those with faster walking speeds. The Fitbit One may not be valid for capturing higher intensity activity after stroke.", "links": [ { "caption": "URL", "url": "http://utpjournals.press/doi/10.3138/ptc.2016-40.ep", "newWindow": true } ] }, { "title": "The Accuracy of Pedometers in Measuring Walking Steps on a Treadmill in College Students", "author": "Husted, H. and Llewellyn, T.\t", "year": "2017", "journalProceedings": "International Journal of Exercise Science", "category": "Validation", "devices": "Charge", "population": "Adults", "dataUsed": "Steps", "abstract": "Pedometers are a popular way for people to track if they have reached the recommended 10,000 daily steps. Therefore, the purpose of this study was to determine the accuracy of four brands of pedometers at measuring steps, and to determine if a relationship exists between pedometer cost and accuracy. The hypothesis was that the more expensive brands of pedometers (the Fitbit Charge™ and Omron HJ-303™) would yield more accurate step counts than less expensive brands (the SmartHealth – Walking FIT™ and Sportline™). While wearing all pedometers at once, one male and eleven female college students (mean ± SD; age = 20.8 ± 0.94 years) walked 400 meters on a treadmill for 5 minutes at 3.5 miles per hour. The pedometer step counts were recorded at the end. Video analysis of the participants' feet was later completed to count the number of steps actually taken (actual steps). When compared to the actual steps, the Sportline™ brand (-3.83 ± 22.05) was the only pedometer that was significantly similar. The other three brands significantly under-estimated steps (Fitbit™ 55.00 ± 42.58, SmartHealth™ 43.50 ± 49.71, and Omron™ 28.58 ± 33.86), with the Fitbit being the least accurate. These results suggest an inverse relationship between cost and accuracy for the four specific brands tested, and that waist pedometers are more accurate than wrist pedometers. The results concerning the Fitbit are striking considering its high cost and popularity among consumers today. Further research should be conducted to improve the accuracy of pedometers.", "links": [ { "caption": "URL", "url": "http://digitalcommons.wku.edu/ijes/vol10/iss1/15", "newWindow": true } ] }, { "title": "Comparison of four Fitbit and Jawbone activity monitors with a research-grade ActiGraph accelerometer for estimating physical activity and energy expenditure", "author": "Imboden, M.T., Nelson, M.B., Kaminsky, L.A. and Montoye, A.H.\t", "year": "2017", "journalProceedings": "British Journal of Sports Medicine", "category": "Validation", "devices": "One,Zip,Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background/aim Consumer-based physical activity (PA) monitors have become popular tools to track PA behaviours. Currently, little is known about the validity of the measurements provided by consumer monitors. We aimed to compare measures of steps, energy expenditure (EE) and active minutes of four consumer monitors with one research-grade accelerometer within a semistructured protocol.\nMethods Thirty men and women (18–80 years old) wore Fitbit One (worn at the waist), Fitbit Zip (waist), Fitbit Flex (wrist), Jawbone UP24 (wrist) and one waist-worn research-grade accelerometer (ActiGraph) while participating in an 80?min protocol. A validated EE prediction equation and active minute cut-points were applied to ActiGraph data. Criterion measures were assessed using direct observation (step count) and portable metabolic analyser (EE, active minutes). A repeated measures analysis of variance (ANOVA) was used to compare differences between consumer monitors, ActiGraph, and criterion measures. Similarly, a repeated measures ANOVA was applied to a subgroup of subjects who didn't cycle.\n\nResults Participants took 3321±571 steps, had 28±6?active min and expended 294±56 kcal based on criterion measures. Comparatively, all monitors underestimated steps and EE by 13%–32% (ptextless0.01); additionally the Fitbit Flex, UP24, and ActiGraph underestimated active minutes by 35%–65% (ptextless0.05). Underestimations of PA and EE variables were found to be similar in the subgroup analysis.\n\nConclusion Consumer monitors had similar accuracy for PA assessment as the ActiGraph, which suggests that consumer monitors may serve to track personal PA behaviours and EE. However, due to discrepancies among monitors, individuals should be cautious when comparing relative and absolute differences in PA values obtained using different monitors.", "links": [ { "caption": "URL", "url": "http://bjsm.bmj.com/lookup/doi/10.1136/bjsports-2016-096990", "newWindow": true } ] }, { "title": "Activity trackers, prior motivation, and perceived informational and motivational affordances", "author": "Jarrahi, M.H., Gafinowitz, N. and Shin, G.\t", "year": "2017", "journalProceedings": "Personal and Ubiquitous Computing", "category": "Survey Research", "devices": null, "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "A large number of activity-tracking devices have recently dominated the fitness world. These devices typically track different forms of activities and are argued to encourage more active lifestyles. The devices encourage and incentivize change in behavior through mechanisms including personal goals, gratifying representations, and social features. However, both current research and anecdotal evidence about the real impacts of these devices point to mixed outcomes. Many users enjoy positive experiences, while others are reported to have abandoned these devices without generating lasting value for themselves. Through a qualitative study of 29 users of Fitbit activity-tracking devices, we explore how different types of pre-existing motivation shaped people's perception and adoption of the device. Building from the affordance perspective, our findings suggest that users' pre-existing motivations, derived from unique life priorities, personal situations, and personalities, may interact with different aspects of the tool, and result in disparate outcomes. Two primary conclusions of this research are (1) the motivational features of activity-tracking devices may only complement already existing motivations of the users but do not create incentive for more physical activities on their own. (2) The value of informational affordances of activity trackers diminishes over time for most users (except the quantified selfers), and without motivational affordances, informational affordances do not sustain long-term use of the device.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s00779-017-1099-9", "newWindow": true } ] }, { "title": "Wrist-Worn Activity Monitoring Devices Overestimate Sleep Duration and Efficiency in Healthy Adults", "author": "Jumabhoy, R., Dao, P., Maskevich, S., Stout, J. and Drummond, S.\t", "year": "2017", "journalProceedings": "Sleep", "category": "Validation", "devices": "One", "population": "Adults", "dataUsed": "Sleep", "abstract": "ntroduction:\nThe use of activity monitors for sleep measurement purposes has increased in research and consumer settings. However, validation of such monitors is lacking. This study examined agreement on total sleep time (TST) and sleep efficiency (SE) between polysomnography and three activity monitors - Actiwatch Spectrum Pro (ACT), Fitbit One (FB) and Jawbone UP2 (JB). Differences between polysomnography and each activity monitor, and differences between research-grade ACT and commercial devices FB and JB, were examined.\nMethods:\nTwenty-two healthy adults (Mage =29.3, SDage=11.4) had one night of sleep measured by polysomnography and each activity monitor simultaneously in a laboratory. Minute-by-minute data were extracted and compared. Wilcoxon signed-ranks tests assessed statistical differences between measures, and Bland-Altman analyses examined clinically meaningful differences between measures, using cut-offs of ±30 minutes for TST and ±5% for SE.\nResults:\nCompared to polysomnography, all activity monitors significantly overestimated TST and SE. Differences between polysomnography and each monitor were also clinically meaningful, as Bland-Altman upper and lower limits of agreement for TST exceeded clinical cut-offs for ACT (-64.7min-+166.1min), FB (-66.1min-+189.2min), and JB (-103.6min-+186.2min). Similarly, upper and lower limits of agreement for SE exceeded clinical cut-offs for ACT (-13.0%-+34.0%), FB (-13.1%-+38.5%), and JB (-20.7%-+37.9%). Compared to ACT, only FB significantly overestimated TST and SE. However, differences between ACT and each of FB and JB were clinically meaningful. For FB, Bland-Altman upper limits of agreement exceeded clinical cut-offs for TST (-18.7min-+40.2min) and SE (-3.8%-+8.1%). For JB, upper and lower limits of agreement exceeded clinical cut-offs for TST (-100.4min-+79.3min) and SE (-20.1%-+16.0%). Agreement between devices decreased as TST and SE decreased. All monitors demonstrated poor specificity (18.8–35.6%), but high sensitivity (94.2–99.2%).\nConclusion:\nResults suggest these models of ACT, FB, and JB cannot be used interchangeably with polysomnography. When activity monitors must be used, such as in field settings, FB and JB cannot replace research-grade ACT. Overall, users should account for each monitor's potential to overestimate or underestimate TST and SE to an unacceptable degree. Future research should examine within-subject variability over time to determine whether monitors can be used to track long-term sleep patterns.", "links": [ { "caption": "URL", "url": "https://academic.oup.com/sleep/article-lookup/doi/10.1093/sleepj/zsx050.778", "newWindow": true } ] }, { "title": "Ka-HOLO Project: a protocol for a randomized controlled trial of a native cultural dance program for cardiovascular disease prevention in Native Hawaiians", "author": "Kaholokula, J.K., Look, M.A., Wills, T.A., de Silva, M., Mabellos, T., Seto, T.B., Ahn, H.J., Sinclair, K.A. and Buchwald, D.\t", "year": "2017", "journalProceedings": "BMC Public Health", "category": "Methods", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance", "abstract": "Background\nAs a major risk factor for cardiovascular and cerebrovascular disease (CVD), hypertension affects 33% of U.S. adults. Relative to other US races and ethnicities, Native Hawaiians have a high prevalence of hypertension and are 3 to 4 times more likely to have CVD. Effective, culturally-relevant interventions are needed to address CVD risk in this population. Investigators of the Ka-HOLO Project developed a study design to test the efficacy of an intervention that uses hula, a traditional Hawaiian dance, to increase physical activity and reduce CVD risk.\nMethods\nA 2-arm randomized controlled trial with a wait-list control design will be implemented to test a 6-month intervention based on hula to manage blood pressure and reduce CVD risk in 250 adult Native Hawaiians with diagnosed hypertension. Half of the sample will be randomized to each arm, stratified across multiple study sites. Primary outcomes are reduction in systolic blood pressure and improvement in CVD risk as measured by the Framingham Risk Score. Other psychosocial and sociocultural measures will be included to determine mediators of intervention effects on primary outcomes. Assessments will be conducted at baseline, 3 months, and 6 months for all participants, and at 12 months for intervention participants only.\n\nDiscussion\nThis trial will elucidate the efficacy of a novel hypertension management program designed to reduce CVD risk in an indigenous population by using a cultural dance form as its physical activity component. The results of this culturally-based intervention will have implications for other indigenous populations globally and will offer a sustainable, culturally-relevant means of addressing CVD disparities.", "links": [ { "caption": "URL", "url": "http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4246-3", "newWindow": true } ] }, { "title": "Validity of a commercial wearable sleep tracker in adult insomnia disorder patients and good sleepers", "author": "Kang, S.-G., Kang, J.M., Ko, K.-P., Park, S.-C., Mariani, S. and Weng, J.\t", "year": "2017", "journalProceedings": "Journal of Psychosomatic Research", "category": "Validation", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Sleep", "abstract": "OBJECTIVES\nTo compare the accuracy of the commercial Fitbit Flex device (FF) with polysomnography (PSG; the gold-standard method) in insomnia disorder patients and good sleepers.\nMETHODS\nParticipants wore an FF and actigraph while undergoing overnight PSG. Primary outcomes were intraclass correlation coefficients (ICCs) of the total sleep time (TST) and sleep efficiency (SE), and the frequency of clinically acceptable agreement between the FF in normal mode (FFN) and PSG. The sensitivity, specificity, and accuracy of detecting sleep epochs were compared among FFN, actigraphy, and PSG.\n\nRESULTS\nThe ICCs of the TST between FFN and PSG in the insomnia (ICC=0.886) and good-sleepers (ICC=0.974) groups were excellent, but the ICC of SE was only fair in both groups. The TST and SE were overestimated for FFN by 6.5min and 1.75%, respectively, in good sleepers, and by 32.9min and 7.9% in the insomnia group with respect to PSG. The frequency of acceptable agreement of FFN and PSG was significantly lower (p=0.006) for the insomnia group (39.4%) than for the good-sleepers group (82.4%). The sensitivity and accuracy of FFN in an epoch-by-epoch comparison with PSG was good and comparable to those of actigraphy, but the specificity was poor in both groups.\n\nCONCLUSIONS\nThe ICC of TST in the FFN–PSG comparison was excellent in both groups, and the frequency of agreement was high in good sleepers but significantly lower in insomnia patients. These limitations need to be considered when applying commercial sleep trackers for clinical and research purposes in insomnia.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S002239991630561X", "newWindow": true } ] }, { "title": "Blood Glucose Control and Related Factors at a Camp for Korean Children and Adolescents with Type 1 Diabetes", "author": "Kang, N., Lee, J., Park, D.-H., Lee, S.-K., Nam, S.-Y., Lee, S., Kim, M., Kang, H., Kim, E., Kim, M. and Sohn, M.\t", "year": "2017", "journalProceedings": "Comprehensive Child and Adolescent Nursing", "category": "Measurement", "devices": "Flex", "population": "Patients,Children,Adolescents", "dataUsed": "Steps", "abstract": "Data about Asian children and adolescents with type 1 diabetes are sparse. This study's objectives were to describe blood glucose (BG) levels and related factors at a camp for Korean children and adolescents with type 1 diabetes. This descriptive study was conducted January 8–10, 2015. The participants, 24 children and adolescents, were recruited for a 3-day residential diabetes camp. Data on 24 campers were analyzed. Their mean age was 13.4 (± 1.7) years; 44.4% were boys, and mean HgbA1c was 8.5% (± 1.4%). Results revealed that BG levels were maintained safely: The mean BG level during the 3-day stay was 171.1 (± 33.3) mg/dl. Multiple regression analysis showed that insulin adjustment for hyperglycemia (standardized ß = .426; t = 2.431; p = .030) and snacks for hypoglycemia (standardized ß = –.719; t = –3.723; p = .003) at the camp were the only independent contributors to mean BG levels during the 3-day study period. No demographic or clinical factor was found to be associated with the mean BG level. This is the first study of its kind to be conducted in an Asian population, presumably because the prevalence of type 1 diabetes in Asia is low and diabetes camps are a novel concept. Further research is recommended to assess the characteristics of campers (e.g., diet, activity levels, and cultural background) and to determine how the health outcomes of children and adolescents with type 1 diabetes are affected by camp programs.", "links": [ { "caption": "URL", "url": "https://www.tandfonline.com/doi/full/10.1080/24694193.2017.1316792", "newWindow": true } ] }, { "title": "Examination of a Wearable Activity Tracker to Assess Children’s Physical Activity", "author": "Kang, S.-K., An, H.-S., Hong, S. and Lee, J-M.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge HR", "population": "Children", "dataUsed": "Intensity", "abstract": "ewer wearable activity monitors have the capability to measure heart rate (HR) from the user’s wrist using an optical blood flow sensor (i.e., photoplethysmography techniques), and none of the previous studies examining children’s free-living activity utilizing a newly developed wearable activity tracker which includes built-in HR sensor.\nPURPOSE: To examine PA intensity using the wearable HR monitor.\n\nMETHODS: a total of 43 children (girls = 18, boys = 25), aged 8 - 12 years, participated in the study. Participants were asked to wear the Fitbit Charge HR (FHR) on their left (FHRL), right wrist (FHRR) and Polar HR (PHR) monitor on their chest, while completing 11 different activities lasted 48 mins, monitoring their HR. Oxygen consumption was measured throughout the routine with the Cosmed K4B2 metabolic analyzer. 10 min average values of the resting metabolic rate were used as one metabolic equivalent of task (MET) to categorize children’s PA intensity. Activity intensities using HR from the FHR were classified by calculating children’s target HR between 50 and 75% of their maximum HR as moderate intensity activity and greater than 75% of their maximum HR as a vigorous intensity activity. An estimate of children’s maximum age-related HR was obtained from the 208 - 0.7 (age) equation. Each intensity classified by the MET determined by HR was compared to the intensity classified by the MET determined by resting metabolic rate (i.e., criterion measure) to examine the measurement agreement. McNemar’s test was used to examine the measurement agreement for paired intensity frequency.\n\nRESULTS: After setting PA intensity classification with 50% and 75% of HR, the frequency determined by measured MET from the Cosmed K4B2 were 1002, 407, and 120 for light, moderate, and vigorous intensity. The frequency determined by HR monitor and FHR were as follow: 1076, 394, and 58 by PHR, 1393, 127, and 9 by FHRL, 1393, 129, and 7 by FHRR. The values of weighted Kappa statistics from the McNemar’s test were 0.40 (95% CL: 0.36-0.44) for the intensity by PHR, 0.21 (95% CL: 0.18-0.25) for the intensity by FHRL, 0.19 (95% CL: 0.16-0.23) for the intensity by FHRR.\n\nCONCLUSIONS: The agreement of PA intensity classified by the wearable activity tracker to the intensity classified the metabolic analyzer showed fair agreement.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Examination_of_a_Wearable_Activity_Tracker_to.1071.aspx", "newWindow": true } ] }, { "title": "Physical Activities in Patients with β-Thalassemia As Measured By Fitbit in Association with Patient-Reported Outcomes", "author": "Kattamis, A., Sutcharitchan, P., Taher, A., Cappellini, M.D., Mahmoud, D., Pariseau, J., Laadem, A., Khan, A., Hu, X.H. and Viprakasit, V.\t", "year": "2017", "journalProceedings": "Blood", "category": "Measurement", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background: Tiredness, weakness, and shortness of breath are the most commonly reported symptoms in patients with β-thalassemia, and they may also adversely affect the quality of life (QoL) of patients. We aimed to explore the associations between β-thalassemia symptom severity and QoL in relation to physical activities, as tracked by Fitbit wearable electronic devices (Fitbit, Inc., San Francisco, CA).\nMethod: Adult patients with β-thalassemia under routine clinical care were enrolled in a prospective observational study. All patients completed Short Form 36 Health Survey version 2 (SF-36v2) and Functional Assessment of Cancer Therapy (FACT)-Anemia (An) questionnaires at baseline and then once every 3 weeks using a hand-held electronic device. Patients with transfusion-dependent (TD) β-thalassemia also completed the Transfusion-dependent QoL (TranQoL) questionnaire, a disease-specific QoL instrument developed for TD patients, with the same scheduling. Transfusion dependent was defined as receiving ≥ 6 red blood cell units in the 24 weeks prior to study entry and no transfusion-free period for ≥ 35 days during that period. Patients with non-transfusion-dependent (NTD) β-thalassemia were instructed to complete the NTDT-PROtextcopyright daily, a symptom diary developed specifically for patients with NTD β-thalassemia with 2 domains: tiredness/weakness (T/W; score range: 0-40) and shortness of breath (SoB; score range: 0-20) with higher scores indicating more severe symptoms. Physical activities were passively tracked by a Fitbit wearable electronic device in terms of steps taken and floors climbed. This analysis examined the association between physical activities at week 1 of the study with QoL measurements and β-thalassemia symptom severity at baseline. For this analysis, average daily steps taken and floors climbed were grouped into quartile categories for those patients who had 4 or more days of Fitbit data during week 1.\n\nResults: A total of 102 patients with β-thalassemia (52 TD and 50 NTD) were enrolled; the mean age of patients was 31.2 years and 70 (68.6%) were females. A total of 91 patients had Fitbit data and, on average, they took 10,811 steps (median: 9,656) and climbed 16.0 floors (median: 10.0) daily. There were no associations observed between the number of steps taken and QoL measurements and β-thalassemia symptom severity. The floors climbed, however, were associated with SF-36v2 Physical Functioning and General Health domains. Patients in the lowest quartile for floors climbed had statistically significant lower Physical Functioning and General Health scores compared with patients in the highest quartile for floors climbed (47.0 vs 52.3; P textless 0.01; and 42.1 vs 46.3; P= 0.01, respectively). Floors climbed were also associated with the NTDT-PROtextcopyright symptom severity scores for T/W and SoB domains. Patients in the lowest quartile for floors climbed had T/W and SoB domain scores of 12.8 and 4.6, respectively, compared with those patients in the highest quartile for floors climbed who had scores of 4.9 and 0.8 (P textless 0.01 and P= 0.02).\n\nConclusions: Steps taken tracked by Fitbit did not appear to be associated with QoL and symptom severity in patients with β-thalassemia. Floors climbed, however, were associated with SF-36v2 Physical Functioning and General Health domains, and β-thalassemia symptom severity. Floors climbed is likely to be a more sensitive endpoint as a measurement for physical activities in clinical studies.", "links": [] }, { "title": "Physical Activity to Reduce Fatigue in Rheumatoid Arthritis: A Randomized, Controlled Trial", "author": "Katz, P., Margaretten, M., Gregorich, S. and Trupin, L.\t", "year": "2017", "journalProceedings": "Arthritis Care & Research", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Objective: Effective treatments for rheumatoid arthritis (RA) fatigue are limited. We tested the effect of a pedometer-based intervention on increasing physical activity and decreasing fatigue among individuals with RA.\nMethods: Participants completed baseline questionnaires; had one week of activity monitoring; were randomized to control (education; EDUC), pedometer and step-monitoring diary (PED), or pedometer and diary plus step targets (PED+) groups; and followed for 21 weeks. At week 10, questionnaires were administered by phone to all participants. During the final week, all participants again had one week of activity monitoring. Primary outcomes were changes in average weekly steps and fatigue (PROMIS 7-item questionnaire) from baseline to week 21. Secondary outcomes were self-reported disease activity, physical function, pain interference, and depressive symptoms. Changes in steps were tested using a linear mixed model. Changes in fatigue were tested with repeated measures models including baseline, week-10, and week-21 scores.\n\nResults: 96 individuals participated. Eight did not complete 21-week assessments. Both intervention groups significantly increased steps (PED: +1441, p=0.004; PED+: +1656, p=0.001); EDUC decreased steps (-747, p=0.14) (Group-by-time interaction p=0.0025). Between group changes in fatigue were not significantly different (interaction p=.21). Mean changes in fatigue scores from baseline to week 21 were -1.6 (with-group p=.26), -3.2 (p=.02), and -4.8 (p=.0002) for EDUC, PED, and PED+ groups, respectively. Function and self-reported disease activity also improved in PED and PED+.\n\nConclusion: Provision of pedometers, with and without providing step targets, was successful in increasing activity levels and decreasing fatigue in this sample of individuals with RA.", "links": [ { "caption": "URL", "url": "http://doi.wiley.com/10.1002/acr.23230", "newWindow": true } ] }, { "title": "The Motivational Impact of Wearable Healthy Lifestyle Technologies: A Self-determination Perspective on Fitbits With Adolescents", "author": "Kerner, C. and Goodyear, V.A.\t", "year": "2017", "journalProceedings": "American Journal of Health Education", "category": "Measurement", "devices": "Charge", "population": "Adolescents", "dataUsed": "NA", "abstract": "Background: Considerable numbers of young people are not meeting physical activity guidelines. Wearable fitness devices can provide opportunities for physical activity promotion. Purpose: The aim of the study was to explore whether wearable healthy lifestyle technologies impacted on adolescents’ (13- to 14-year-olds) motivation for physical activity. Methods: The study was a mixed method sequential design. Participants were 84 adolescents (44 girls, 40 boys) from 6 physical education classes. Pupils were issued with a Fitbit to wear for 8 weeks and completed pre-/posttest questionnaires that assessed motivational regulation and psychological need satisfaction. Adolescents also engaged in focus group interviews after wearing the Fitbit for 8 weeks. Quantitative data were analyzed using a repeated measures multivariate analysis of variance (MANOVA) to explore differences between gender and time. Qualitative data analysis was conducted deductively using self-determination theory. Results: The quantitative findings identified significant reductions in need satisfaction and autonomous motivation and significant increases in amotivation after 8 weeks. Qualitative evidence suggested short-term increases in motivation through feelings of competition, guilt, and internal pressure. Discussion: Findings suggest that healthy lifestyle technology may have negative motivational consequences. Translation to Health Education Practice: Certified Health Education Specialists should support young people to personalize health targets in order to critically engage with normalized health targets.", "links": [ { "caption": "URL", "url": "http://www.tandfonline.com/doi/full/10.1080/19325037.2017.1343161", "newWindow": true } ] }, { "title": "Development of an innovative mHealth platform for remote physical activity monitoring and health coaching of cardiac rehabilitation patients", "author": "Kitsiou, S., Thomas, M., Marai, G.E., Maglaveras, N., Kondos, G., Arena, R. and Gerber, B.\t", "year": "2017", "journalProceedings": "2017 IEEE EMBS International Conference on Biomedical & Health Informatics (BHI)", "category": "Usability", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Physical activity (PA) is a central component of cardiac rehabilitation (CR) programs [1] and one of the four health behaviors targeted by the American Heart Association's (AHA) 2020 Strategic Impact Goals for improving cardiovascular health [2]. A substantial body of evidence shows that increases in PA are associated with a marked decrease in cardiovascular mortality and significant improvements in many well-known Coronary Heart Disease (CHD) risk factors [3], [4]. The amount of PA currently recommended by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) for people with CHD is 30 to 60 minutes of moderate-intensity PA per day (e.g. brisk walking) [1]. One of the key aims of outpatient center-based CR is to provide patients with advice, support, and consistent encouragement to achieve these recommended levels. However, prior studies have shown that many patients who attend CR programs fail to reach the target levels, mainly because of lack of PA on non-CR days [5]–[8]. Non-adherence to this basic lifestyle measure leads to a larger proportion of the CHD population at greater risk for poor health outcomes with substantial economic implications [9]. Innovative, alternative approaches are needed to enhance patient engagement and improve adherence to PA.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/document/7897223/", "newWindow": true } ] }, { "title": "Consumer-Based Physical Activity Monitor as a Practical Way to Measure Walking Intensity During Inpatient Stroke Rehabilitation", "author": "Klassen, T.D., Semrau, J.A., Dukelow, S.P., Bayley, M.T., Hill, M.D. and Eng, J.J.\t", "year": "2017", "journalProceedings": "Stroke", "category": "Validation", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND AND PURPOSE Identifying practical ways to accurately measure exercise intensity and dose in clinical environments is essential to advancing stroke rehabilitation. This is especially relevant in monitoring walking activity during inpatient rehabilitation where recovery is greatest. This study evaluated the accuracy of a readily available consumer-based physical activity monitor during daily inpatient stroke rehabilitation physical therapy sessions. METHODS Twenty-one individuals admitted to inpatient rehabilitation were monitored for a total of 471 one-hour physical therapy sessions which consisted of walking and nonwalking therapeutic activities. Participants wore a consumer-based physical activity monitor (Fitbit One) and the gold standard for assessing step count (StepWatch Activity Monitor) during physical therapy sessions. Linear mixed modeling was used to assess the relationship of the step count of the Fitbit to the StepWatch Activity Monitor. Device accuracy is reported as the percent error of the Fitbit compared with the StepWatch Activity Monitor. RESULTS A strong relationship (slope=0.99; 95% confidence interval, 0.97-1.01) was found between the number of steps captured by the Fitbit One and the StepWatch Activity Monitor. The Fitbit One had a mean error of 10.9% (5.3) for participants with walking velocities textless0.4 m/s, 6.8% (3.0) for walking velocities between 0.4 and 0.8 m/s, and 4.4% (2.8) for walking velocities textgreater0.8 m/s. CONCLUSIONS This study provides preliminary evidence that the Fitbit One, when positioned on the nonparetic ankle, can accurately measure walking steps early after stroke during inpatient rehabilitation physical therapy sessions. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01915368.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/28784922%20http://stroke.ahajournals.org/lookup/doi/10.1161/STROKEAHA.117.018175", "newWindow": true } ] }, { "title": "Active2Gether: A Personalized m-Health Intervention to Encourage Physical Activity", "author": "Klein, M., Manzoor, A. and Mollee, J.\t", "year": "2017", "journalProceedings": "Sensors", "category": "Methods", "devices": "One", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Lack of physical activity is an increasingly important health risk. Modern mobile technology, such as smartphones and digital measurement devices, provides new opportunities to tackle physical inactivity. This paper describes the design of a system that aims to encourage young adults to be more physically active. The system monitors the user's behavior, uses social comparison and provides tailored and personalized feedback based on intelligent reasoning mechanisms. As the name suggests, social processes play an important role in the Active2Gether system. The design choices and functioning of the system are described in detail. Based on the experiences with the development and deployment of the system, a number of lessons learnt are provided and suggestions are proposed for improvements in future developments.", "links": [ { "caption": "URL", "url": "http://www.mdpi.com/1424-8220/17/6/1436", "newWindow": true } ] }, { "title": "The Volunteering-in-Place Program: Meaningful Volunteer Activity for Assisted Living Residents", "author": "Klinedinst, J.\t", "year": "2017", "journalProceedings": "Innovation in Aging", "category": "Intervention", "devices": null, "population": "Older Adults", "dataUsed": null, "abstract": "The Volunteering-in-Place (VIP) Program was developed to provide individualized meaningful volunteer activities matched to interests and capabilities for older adults in assisted living (AL). The purposes of this study were to (1) establish feasibility of the VIP Program based on treatment fidelity (design, treatment, delivery, enactment); and (2) evaluate preliminary efficacy via improvement in psychological health (depressive symptoms, usefulness, purpose, resilience, and life satisfaction) and decreased sedentary activity (survey and Fitbit) at 3 and 6 months.\nGuided by the Social Ecological Model and Social Cognitive Theory, the VIP Program addressed barriers to volunteering through innovative motivational techniques and making volunteer opportunities accessible to residents. A Volunteer Coordinator facilitated the VIP Program using a four step approach: 1) Environmental Scan and Staff Education; 2) Assessment of Residents Abilities and Interests; 3) Ongoing Implementation of the VIP Program; and 4) Individualized Reassessment of the Volunteer Activity.\nThis was a single group, single-site, repeated measures study. Residents were eligible if they were = 65years old, scored = 2 on the three-item recall, and could sign consent. Survey and Fitbit data were collected at baseline, three and six months post volunteering.\nTen residents participated. The majority was white, female, educated, and on average 88 years. The VIP Program was feasible and most participants continued to volunteer at 6 months. There were non-significant improvements in depressive symptoms, usefulness, purpose, resilience and recreational physical activity.\nThe results of this study provide support for the feasibility of the VIP Program. Further study is necessary to examine efficacy.", "links": [ { "caption": "URL", "url": "https://academic.oup.com/innovateage/article-lookup/doi/10.1093/geroni/igx004.4602", "newWindow": true } ] }, { "title": "Implementation of a Home Monitoring System for Heart Failure Patients: A Feasibility Study.", "author": "Kohn, M.S., Haggard, J., Kreindler, J., Birkeland, K., Kedan, I., Zimmer, R. and Khandwalla, R.\t", "year": "2017", "journalProceedings": "JMIR Research Protocols", "category": "Methods", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND Improving the management of patients with complex chronic disease is a substantial undertaking with the simultaneous goals of improving patient outcomes and controlling costs. Reducing avoidable hospitalization for such patients is a step toward both objectives. Some of the deterioration experienced in chronic disease patients occurs outside the view of their clinicians, and before the patient becomes overtly symptomatic. Home monitoring has been used for more than 20 years to detect deterioration earlier so that the patients could be treated before they became ill enough to require hospitalization. Patient participation is an important requirement for successful home monitoring. There has been some concern that patients would be unwilling or unable to engage in a program that collected multiple measurements. The Cedars-Sinai Cardiology Center provides a high-touch, intense management program for patients with congestive heart failure (CHF). A group of their patients were chosen to join a complex, multidevice home monitoring system to see whether such patients would find value in the additional effort. OBJECTIVE The objective of our study was to determine whether patients already actively engaged in a high-touch intensive management program for CHF would take on the additional burden of a complex home monitoring effort. METHODS A total of 20 patients from the Cedars-Sinai group were enrolled in a monitoring program utilizing 5 different devices. Anonymous surveys were collected from the patients to assess their satisfaction with the program. RESULTS In total, 90% (18/20) completed the program, and 61% (11/20) submitted the survey. Among the 18 patients, overall compliance with the requested measurements was 70%. It was found that 73% (8/11) felt better about their health as a result of the program, whereas another 73% (8/11) believed that the care team now had a better picture of their health. CONCLUSIONS Substantial patient compliance and satisfaction can be achieved in a sophisticated home monitoring program.", "links": [ { "caption": "URL", "url": "http://www.researchprotocols.org/2017/3/e46/", "newWindow": true } ] }, { "title": "Heart Rate Assessment by Smart Watch: Utility or Futility?", "author": "Koshy, A., Sajeev, J., Zureik, M., Rajakariar, K., Street, M., Cosgrave, N., Wong, M., Hamer, A., Cooke, J., Roberts, L. and Teh, A.\t", "year": "2017", "journalProceedings": "Heart, Lung and Circulation", "category": "Validation", "devices": "Blaze", "population": "Patients,Adults", "dataUsed": "Heart Rate", "abstract": "Background: Smart watches that estimate heart rate (HR) via photoplethysmography are increasingly popular and show strong correlation with electrocardiography (ECG) among healthy controls. Although not marketed for medical use, presentations to the emergency department due to device-detected heart rate abnormalities are increasing, without data on their validity in cardiac arrhythmias.\nMethods: 112 inpatients (atrial fibrillation, AF [n = 32], atrial flutter [n = 20], complete heart block [n = 7], ventricular tachycardia [n = 1] and sinus rhythm [Controls] n = 52) were prospectively recruited from a single centre (65% male; age 68 ± 15.5 years, BMI 28.9 ± 6.2). Each patient was monitored with a 5-lead ECG, while simultaneously wearing a Fitbit Blaze and Apple Watch with HR estimation, for thirty minutes.\n\nResults: Across all devices, 54,030 HR values were recorded. When compared with the ECG-HR, smart watch accuracy varied based on type of arrhythmia, brand of device and ventricular rate (Pearson's correlation r value: Table).\n\nConclusions: The Apple Watch demonstrated the strongest correlation to the ECG in HR estimation in both arrhythmias and controls. Both devices were robust in identifying HR during brady-arrhythmias but underestimated HR during tachycardia, with the exception of atrial flutter.", "links": [ { "caption": "URL", "url": "http://dx.doi.org/10.1016/j.hlc.2017.06.548", "newWindow": true } ] }, { "title": "Wearable technology to reduce sedentary behavior and CVD risk in older adults: Design of a randomized controlled trial", "author": "Krehbiel, L.M., Layne, A.S., Sandesara, B., Manini, T.M., Anton, S.D. and Buford, T.W.\t", "year": "2017", "journalProceedings": "Contemporary Clinical Trials Communications", "category": "Methods", "devices": "Zip", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Persons aged over 65 years account for over the vast majority of healthcare expenditures and deaths attributable to cardiovascular disease (CVD). Accordingly, reducing CVD risk among older adults is an important public health priority. Structured physical activity (i.e. exercise) is a well-documented method of decreasing CVD risk, but recent large-scale trials suggest that exercise alone is insufficient to reduce CVD events in high-risk populations of older adults. Thus adjuvant strategies appear necessary to reduce CVD risk. Accumulating evidence indicates that prolonged sedentary behavior (e.g. sitting) has detrimental health effects that are independent of engagement in recommended levels of moderate-intensity exercise. Yet clinical trials in this area are lacking. We hypothesize that exercise, when combined with a novel technology based intervention specifically designed to reduce sedentary behavior will reduce CVD risk among sedentary older adults. The purpose of this study is to evaluate the feasibility and efficacy of combining a traditional, structured exercise intervention with an innovative intervention designed to decrease sedentary behavior and increase non-exercise physical activity (NEPA). This study will provide us with critical data necessary to design and implement a full-scale trial to test our central hypothesis. Participants aged =60 years with moderate to high risk of coronary heart disease (CHD) events are randomly assigned to either the exercise and technology intervention (EX + NEPA) or exercise alone (EX) groups. Study dependent outcomes include changes in 1) daily activity patterns, 2) blood pressure, 3) exercise capacity, 4) waist circumference, and 5) circulating indices of cardiovascular function. This study will provide critical information for designing a fully-powered clinical trial, which could have health implications for the ever increasing population of older adults.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S2451865416301363", "newWindow": true } ] }, { "title": "Use of wearable devices for post-discharge monitoring of ICU patients: a feasibility study", "author": "Kroll, R.R., McKenzie, E.D., Boyd, J.G., Sheth, P., Howes, D., Wood, M. and Maslove, D.M.\t", "year": "2017", "journalProceedings": "Journal of Intensive Care", "category": "Usability", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Wearable devices generate signals detecting activity, sleep, and heart rate, all of which could enable detailed and near-continuous characterization of recovery following critical illness. To determine the feasibility of using a wrist-worn personal fitness tracker among patients recovering from critical illness, we conducted a prospective observational study of a convenience sample of 50 stable ICU patients. We assessed device wearability, the extent of data capture, sensitivity and specificity for detecting heart rate excursions, and correlations with questionnaire-derived sleep quality measures. Wearable devices were worn over a 24-h period, with excellent capture of data. While specificity for the detection of tachycardia was high (98.8%), sensitivity was low to moderate (69.5%). There was a moderate correlation between wearable-derived sleep duration and questionnaire-derived sleep quality (r = 0.33, P = 0.03). Devices were well-tolerated and demonstrated no degradation in quality of data acquisition over time. We found that wearable devices could be worn by patients recovering from critical illness and could generate useful data for the majority of patients with little adverse effect. Further development and study are needed to better define and enhance the role of wearables in the monitoring of post-ICU recovery.", "links": [ { "caption": "URL", "url": "https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-017-0261-9", "newWindow": true } ] }, { "title": "N-of-1 study of weight loss maintenance assessing predictors of physical activity, adherence to weight loss plan and weight change", "author": "Kwasnicka, D., Dombrowski, S.U., White, M. and Sniehotta, F.F.\t", "year": "2017", "journalProceedings": "Psychology & Health", "category": "Measurement", "devices": "One,Aria", "population": "Adults", "dataUsed": "Steps,Weight", "abstract": "Objective: Behaviour change interventions are effective in supporting individuals to achieve clinically significant weight loss, but weight loss maintenance (WLM) is less often attained. This study examined predictive variables associated with WLM.\n\nDesign: N-of-1 study with daily ecological momentary assessment combined with objective measurement of weight and physical activity, collected with wireless devices (Fitbit™) for six months. Eight previously obese adults who had lost over 5% of their body weight in the past year took part. Data were analysed using time series methods.\n\nMain outcomes measures: Predictor variables were based on five theoretical themes: maintenance motives, self-regulation, personal resources, habits, and environmental influences. Dependent variables were: objectively estimated step count and weight, and self-reported WLM plan adherence.\n\nResults: For all participants, daily fluctuations in self-reported adherence to their WLM plan were significantly associated with most of the explanatory variables, including maintenance motivation and satisfaction with outcomes, self-regulation, habit, and stable environment. Personal resources were not a consistent predictor of plan adherence.\n\nConclusion: This is the first study to assess theoretical predictions of WLM within individuals. WLM is a dynamic process including the interplay of motivation, self-regulation, habit, resources, and perceptions of environmental context. Individuals maintaining their weight have unique psychological profiles which could be accounted for in interventions.", "links": [ { "caption": "URL", "url": "http://www.tandfonline.com/doi/full/10.1080/08870446.2017.1293057", "newWindow": true } ] }, { "title": "Use of a mobile social networking intervention for weight management: a mixed-methods study protocol", "author": "Laranjo, L., Lau, A.Y.S., Martin, P., Tong, H.L. and Coiera, E.\t", "year": "2017", "journalProceedings": "BMJ Open", "category": "Methods", "devices": "Flex 2", "population": "Adults", "dataUsed": "Steps,Weight", "abstract": "Introduction Obesity and physical inactivity are major societal challenges and significant contributors to the global burden of disease and healthcare costs. Information and communication technologies are increasingly being used in interventions to promote behaviour change in diet and physical activity. In particular, social networking platforms seem promising for the delivery of weight control interventions.\nWe intend to pilot test an intervention involving the use of a social networking mobile application and tracking devices (Fitbit Flex 2 and Fitbit Aria scale) to promote the social comparison of weight and physical activity, in order to evaluate whether mechanisms of social influence lead to changes in those outcomes over the course of the study.\n\nMethods and analysis Mixed-methods study involving semi-structured interviews and a pre–post quasi-experimental pilot with one arm, where healthy participants in different body mass index (BMI) categories, aged between 19 and 35 years old, will be subjected to a social networking intervention over a 6-month period. The primary outcome is the average difference in weight before and after the intervention. Secondary outcomes include BMI, number of steps per day, engagement with the intervention, social support and system usability. Semi-structured interviews will assess participants' expectations and perceptions regarding the intervention.\n\nEthics and dissemination Ethics approval was granted by Macquarie University's Human Research Ethics Committee for Medical Sciences on 3 November 2016 (ethics reference number 5201600716).\n\nThe social network will be moderated by a researcher with clinical expertise, who will monitor and respond to concerns raised by participants. Monitoring will involve daily observation of measures collected by the fitness tracker and the wireless scale, as well as continuous supervision of forum interactions and posts. Additionally, a protocol is in place to monitor for participant misbehaviour and direct participants-in-need to appropriate sources of help.", "links": [ { "caption": "URL", "url": "http://bmjopen.bmj.com/content/7/7/e016665", "newWindow": true } ] }, { "title": "Use It And Lose It: Fitbit Use, Daily Steps, And Weight Change Among Overweight Adults", "author": "Larsen, C.A., Monroe, C.M. and West, D.S.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Despite the increasing proliferation of advanced wearable physical activity tracking devices (e.g., Fitbit Zip), their value as tools for physical activity promotion and weight loss remains unclear.\nPURPOSE: As part of a pilot intervention trial that examined the efficacy of a novel social support approach for enhancing weight loss, participants were provided with a Fitbit Zip to monitor their physical activity. The current study examined the relationships between Fitbit use and change in weight and daily steps over 4 months.\n\nMETHODS: Overweight adults (N=36) were randomized to either a standard or social support-enhanced, 16-week behavioral weight loss intervention. In addition to a Fitbit Zip, both groups received weekly, in-person group counseling sessions and digital body weight scales. Participants in the social-support enhanced group received two extra Fitbits and scales to share with up to two persons in their social circle. There were no significant differences between conditions, so analyses collapsed groups and examined the full sample. Paired t-tests were used to evaluate changes in weight and daily steps from baseline to post-treatment. Spearman rank correlation coefficients were calculated to test the associations between the total number of days the Fitbit was used (out of 112 days) and changes in daily steps and weight. Fitbit use was objectively established by weekly monitoring of synced data from the Fitbit website.\n\nRESULTS: At baseline, participants were obese (M BMI= 36.1 + 7.3 kg/m2) and low active (M=5546 + 2390 steps/d). Weight losses averaged -3.5+4.3 kg (p<.0001) and daily steps increased an average of 1101+2395 (p=.009) over baseline. Participants used the Fitbit an average of 5.9+2.5 days/wk. A significant correlation between total number of days the Fitbit was used and weight loss such that there was greater use of Fitbit was associated with greater weight loss (rs = -.60, p<.0001). A significant, positive correlation was found between the change in daily steps and the number of days the Fitbit was used (rs=.43, p=.008).\n\nCONCLUSION: These preliminary findings suggest that advanced wearable physical activity trackers hold promise as tools for assisting with physical activity promotion and weight loss in adults within the context of a multi-component behavioral weight loss program.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Use_It_And_Lose_It___Fitbit_Use,_Daily_Steps,_And.98.aspx", "newWindow": true } ] }, { "title": "Comparison of Wearable Activity Tracker with Actigraphy for Sleep Evaluation and Circadian Rest-Activity Rhythm Measurement in Healthy Young Adults", "author": "Lee, H.-A., Lee, H.-J., Moon, J.-H., Lee, T., Kim, M.-G., In, H., Cho, C.-H. and Kim, L.\t", "year": "2017", "journalProceedings": "Psychiatry Investigation", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Objective: The purpose of this study was to evaluate the applicability of data obtained from a wearable activity tracker (Fitbit Charge HR) to medical research. This was performed by comparing the wearable activity tracker (Fitbit Charge HR) with actigraphy (Actiwatch 2) for sleep evaluation and circadian rest-activity rhythm measurement.\nMethods: Sixteen healthy young adults (female participants, 62.5%; mean age, 22.8 years) wore the Fitbit Charge HR and the Actiwatch 2 on the same wrist; a sleep log was recorded over a 14-day period. We compared the sleep variables and circadian rest-activity rhythm measures with Wilcoxon signed-rank tests and Spearman's correlations.\n\nResults: The periods and acrophases of the circadian rest-activity rhythms and the sleep start times did not differ and correlated significantly between the Fitbit Charge HR and the Actiwatch 2. The Fitbit Charge HR tended to overestimate the sleep durations compared with the Actiwatch 2. However, the sleep durations showed high correlation between the two devices for all days.\n\nConclusion: We found that the Fitbit Charge HR showed high accuracy in sleep evaluation and circadian rest-activity rhythm measurement when compared with actigraphy for healthy young adults. The results suggest that the Fitbit Charge HR could be applicable on medical research as an alternative tool to actigraphy for sleep evaluation and measurement of the circadian rest-activity rhythm.", "links": [ { "caption": "URL", "url": "https://synapse.koreamed.org/DOIx.php?id=10.4306/pi.2017.14.2.179", "newWindow": true } ] }, { "title": "Evaluation of Commercial Self-Monitoring Devices for Clinical Purposes: Results from the Future Patient Trial, Phase I.", "author": "Leth, S., Hansen, J., Nielsen, O.W. and Dinesen, B.\t", "year": "2017", "journalProceedings": "Sensors", "category": "Validation", "devices": "One,Zip,Charge HR", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Commercial self-monitoring devices are becoming increasingly popular, and over the last decade, the use of self-monitoring technology has spread widely in both consumer and medical markets. The purpose of this study was to evaluate five commercially available self-monitoring devices for further testing in clinical applications. Four activity trackers and one sleep tracker were evaluated based on step count validity and heart rate validity. \n\nMETHODS: The study enrolled 22 healthy volunteers in a walking test. Volunteers walked a 100 m track at 2 km/h and 3.5 km/h. Steps were measured by four activity trackers and compared to gyroscope readings. Two trackers were also tested on nine subjects by comparing pulse readings to Holter monitoring. \n\nRESULTS: The lowest average systematic error in the walking tests was -0.2%, recorded on the Garmin Vivofit 2 at 3.5 km/h; the highest error was the Fitbit Charge HR at 2 km/h with an error margin of 26.8%. Comparisons of pulse measurements from the Fitbit Charge HR revealed a margin error of -3.42% ± 7.99% compared to the electrocardiogram. The Beddit sleep tracker measured a systematic error of -3.27% ± 4.60%. \n\nCONCLUSION: The measured results revealed the current functionality and limitations of the five self-tracking devices, and point towards a need for future research in this area.", "links": [ { "caption": "URL", "url": "http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5298782", "newWindow": true } ] }, { "title": "A technology-enabled Counselling program versus a delayed treatment control to support physical activity participation in people with inflammatory arthritis: study protocol for the OPAM-IA randomized controlled trial", "author": "Li, L.C., Feehan, L.M., Shaw, C., Xie, H., Sayre, E.C., Aviña-Zubeita, A., Grewal, N., Townsend, A.F., Gromala, D., Noonan, G. and Backman, C.L.\t", "year": "2017", "journalProceedings": "BMC Rheumatology", "category": "Methods", "devices": "Flex 2", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "Being physically active is an essential component of successful self-management for people with inflammatory arthritis; however, the vast majority of patients are inactive. This study aims to determine whether a technology-enabled counselling intervention can improve physical activity participation and patient outcomes. The Effectiveness of Online Physical Activity Monitoring in Inflammatory Arthritis (OPAM-IA) project is a community-based randomized controlled trial with a delayed control design. We will recruit 130 people with rheumatoid arthritis or systemic lupus erythematosus, who can be physically active without health professional supervision. Randomization will be stratified by diagnosis. In Weeks 1–8, participants in the Immediate Group will: 1) receive education and counselling by a physical therapist (PT), 2) use a Fitbit and a new web-based application, FitViz, to track and obtain feedback about their physical activity, 3) receive 4 biweekly follow-up calls from the PT. Those in the Delayed Group will receive the same program in Week 10. We will interview a sample of participants about their experiences with the intervention. Participants will be assessed at baseline, and Weeks 9, 18 and 27. The primary outcome measure is time spent in moderate/vigorous physical activity in bouts of ≥ 10 min, measured with a portable multi-sensor device in the free-living environment. Secondary outcomes include step count, time in sedentary behaviour, pain, fatigue, mood, self-management capacity, and habitual behaviour. A limitation of this study is that participants, who also administer the outcome measures, will not be blinded. Nonetheless, by customizing existing self-monitoring technologies in a patient-centered manner, individuals can be coached to engage in an active lifestyle and monitor their performance. The results will determine if this intervention improves physical activity participation. The qualitative interviews will also provide insight into a paradigm to integrate this program to support self-management. Date of last update in ClinicalTrials.gov: September 18, 2015. ClinicalTrials.gov Identifier: NCT02554474 .", "links": [ { "caption": "URL", "url": "https://bmcrheumatol.biomedcentral.com/articles/10.1186/s41927-017-0005-4", "newWindow": true } ] }, { "title": "A Community-Based Physical Activity Counselling Program for People With Knee Osteoarthritis: Feasibility and Preliminary Efficacy of the Track-OA Study", "author": "Li, L.C., Sayre, E.C., Xie, H., Clayton, C. and Feehan, L.M.\t", "year": "2017", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background: Physical activity can improve health outcomes in people with knee osteoarthritis (OA); however, participation in physical activity is very low in this population. Objective: The objective of our study was to assess the feasibility and preliminary efficacy of the use of wearables (Fitbit Flex) and telephone counselling by a physical therapist (PT) for improving physical activity in people with a physician-confirmed diagnosis of knee OA, or who have passed 2 validated criteria for early OA. Methods: We conducted a community-based feasibility randomized controlled trial. The immediate group (n=17) received a brief education session by a physical therapist, a Fitbit Flex activity tracker, and a weekly telephone call for activity counselling with the physical therapist. The delayed group (n=17) received the same intervention 1 month later. All participants were assessed at baseline (T0), and the end of 1 month (T1) and 2 months (T2). Outcomes were (1) mean moderate to vigorous physical activity time, (2) mean time spent on sedentary behavior, (3) Knee Injury and Osteoarthritis Outcome Score (KOOS), and (4) Partners in Health Scale. Feasibility data were summarized with descriptive statistics. We used analysis of covariance to evaluate the effect of the group type on the outcome measures at T1 and T2, after adjusting for blocking and T0. We assessed planned contrasts of changes in outcome measures over measurement periods. Results: We identified 46 eligible individuals; of those, 34 (74%) enrolled and no one dropped out. All but 1 participant adhered to the intervention protocol. We found a significant effect, with the immediate intervention group having improved in the moderate to vigorous physical activity time and in the Partners in Health Scale at T0 to T1 compared with the delayed intervention group. The planned contrast of the immediate intervention group at T0 to T1 versus the delayed group at T1 to T2 showed a significant effect in the sedentary time and the KOOS symptoms subscale, favoring the delayed group. Conclusions: This study demonstrated the feasibility of a behavioral intervention, supported by the use of a wearable device, to promote physical activity among people with knee OA.", "links": [ { "caption": "URL", "url": "http://mhealth.jmir.org/2017/6/e86/", "newWindow": true } ] }, { "title": "Considering interpersonal differences in validating wearable sleep-tracking technologies", "author": "Liang, Z. and Martell, M.A.C.\t", "year": "2017", "journalProceedings": "2017 Tenth International Conference on Mobile Computing and Ubiquitous Network", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "This study investigated an important yet usually neglected question in validating consumer sleep tracking devices: does interpersonal difference play a role in the validity of consumer sleep trackers? Most existing validation studies assume that the accuracy of these devices is consistent cross individuals, ignoring the fact that human sleep demonstrates significant interpersonal differences. This study aimed to test this assumption through validating two newest gadgets of home sleep tracking technologies, i.e. Fitbit Charge 2 (wearable wristband) and Neuroon (wearable EEG eye mask), in comparison to a clinical device. Two participants were recruited to track their sleep using a Fitbit, a Neuroon, and a clinical device SLEEP SCOPE simultaneously for approximately 40 nights. Data analysis was conducted for each participant separately. The results showed that the Fitbit measurements completely deviated from the clinical measurements for one participant, but agreed very well for another participant, especially in the dimension of total sleep time. Neuroon measurements agreed well but were uncorrelated to clinical measurements for one participant, and were correlated significantly but agreed poorly for another participant. This study suggested that interpersonal differences should be considered in future validation studies and in designing better consumer sleep-tracking technologies.", "links": [] }, { "title": "Are wearable EEG devices more accurate than fitness wristbands for home sleep Tracking? Comparison of consumer sleep trackers with clinical devices", "author": "Liang, Z. and Nishimura, T.\t", "year": "2017", "journalProceedings": "2017 IEEE 6th Global Conference on Consumer Electronics", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "This study aimed to compare two off-the-shelf sleep tracking devices, Fitbit (wearable fitness wristband) and Neuroon (wearable EEG eye mask), for measuring sleep under free living conditions. Taking the measurements of a clinical sleep monitor as the ground truth, we compared the measurements of Fitbit and Neuroon on total sleep time (TST), wake after sleep onset (WASO), the number of awakenings (NAWK), sleep onset latency (SOL), and sleep efficiency (SE). Although the users of home sleep tracking technologies generally assume that the measurements by EEG-based sleep trackers are more accurate than movement-based wristbands, our study showed that compared to Neuroon EEG eye mask, the measurements by Fitbit wristband agreed better to those of the clinical device.", "links": [] }, { "title": "Metformin to Augment Strength Training Effective Response in Seniors (MASTERS): study protocol for a randomized controlled trial", "author": "Long, D.E., Peck, B.D., Martz, J.L., Tuggle, S.C., Bush, H.M., McGwin, G., Kern, P.A., Bamman, M.M. and Peterson, C.A.\t", "year": "2017", "journalProceedings": "Trials", "category": "Intervention", "devices": "Flex", "population": "Older Adults,Patients", "dataUsed": "Steps,Intensity", "abstract": "Background\nMuscle mass and strength are strong determinants of a person's quality of life and functional independence with advancing age. While resistance training is the most effective intervention to combat age-associated muscle atrophy (sarcopenia), the ability of older adults to increase muscle mass and strength in response to training is blunted and highly variable. Thus, finding novel ways to complement resistance training to improve muscle response and ultimately quality of life among older individuals is critical. The purpose of this study is to determine whether a commonly prescribed medication called metformin can be repurposed to improve the response to resistance exercise training by altering the muscle tissue inflammatory environment.\nMethods/design\nIndividuals aged 65 and older are participating in a two-site, randomized, double-blind, placebo-controlled trial testing the effects of metformin or placebo on muscle size, strength, and physical function when combined with a progressive resistance training program. Participants consume 1700 mg of metformin per day or placebo for 2 weeks before engaging in a 14-week progressive resistance training regimen, with continued metformin or placebo. Participants are then monitored post-training to determine if the group taking metformin derived greater overall benefit from training in terms of muscle mass and strength gains than those on placebo. Muscle biopsies are taken from the vastus lateralis at three time points to assess individual cellular and molecular adaptations to resistance training and also changes in response to metformin.\n\nDiscussion\nThe response of aged muscles to a resistance training program does not always result in a positive outcome; some individuals even experience a loss in muscle mass following resistance training. Thus, adjuvant therapies, including pharmacological ones, are required to optimize response to training in those who do not respond and may be at increased risk of frailty. This is the first known metformin repurposing trial in non-diseased individuals, aimed specifically at the resistance exercise “non-responder” phenotype present in the aging population. The overall goal of this trial is to determine if combined exercise-metformin intervention therapy will benefit older individuals by promoting muscle hypertrophy and strength gains, thereby maintaining functional independence.", "links": [ { "caption": "URL", "url": "http://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-1932-5", "newWindow": true } ] }, { "title": "Financial incentives and health coaching to improve physical activity following total knee replacement: a randomized controlled trial", "author": "Losina, E., Collins, J.E., Deshpande, B.R., Smith, S.R., Michl, G.L., Usiskin, I.M., Klara, K.M., Winter, A.R., Yang, H.Y., Selzer, F. and Katz, J.N.\t", "year": "2017", "journalProceedings": "Arthritis Care & Research", "category": "Intervention", "devices": "Zip", "population": "Older Adults,Patients", "dataUsed": "Steps", "abstract": "OBJECTIVE Most persons who undergo total knee replacement (TKR) do not increase their physical activity following surgery. We assessed whether financial incentives and health coaching would improve physical activity in persons undergoing TKR. METHODS We designed a factorial randomized controlled trial among persons undergoing TKR for osteoarthritis. Subjects underwent normal perioperative procedures, including post-operative physical therapy, and were assigned to one of four arms: attention control, telephonic health coaching (THC), financial incentives (FI), or THC+FI. We objectively measured step counts and minutes of physical activity with a commercial accelerometer (Fitbit Zip) and compared the changes from pre-TKR to 6 months post-TKR across the four study arms. RESULTS Of the 202 randomized subjects, 150 (74%) provided both pre-TKR and 6 months post-TKR accelerometer data. Among completers, the average daily step count at 6 months ranged from 5619 (SD 381) in the THC arm to 7152 (SD 407) in the THC+FI arm (adjusting for baseline values). Daily step count 6 months post-TKR increased by 680 (95% CI: -94 - 1,454) in the control arm, 274 (95% CI: -473 - 1021) in the THC arm, 826 (95% CI: 89 - 1563) in the FI arm, and 1808 (95% CI: 1010 - 2606) in the THC+FI arm. Physical activity increased by 14 (SD 10), 14 (SD 10), 16 (SD 10), and 39 (SD 11) minutes in the control, THC, FI, and THC+FI arms, respectively. CONCLUSIONS A dual THC+FI intervention led to substantial improvements in step count and physical activity following TKR. This article is protected by copyright. All rights reserved.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/28732147%20http://doi.wiley.com/10.1002/acr.23324", "newWindow": true } ] }, { "title": "Implementation of a workplace intervention using financial rewards to promote adherence to physical activity guidelines: a feasibility study", "author": "Losina, E., Smith, S.R., Usiskin, I.M., Klara, K.M., Michl, G.L., Deshpande, B.R., Yang, H.Y., Smith, K.C., Collins, J.E. and Katz, J.N.\t", "year": "2017", "journalProceedings": "BMC Public Health", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Intensity", "abstract": "We designed and implemented the Brigham and Women's Wellness Initiative (B-Well), a single-arm study to examine the feasibility of a workplace program that used individual and team-based financial incentives to increase physical activity among sedentary hospital employees. We enrolled sedentary, non-clinician employees of a tertiary medical center who self-reported low physical activity. Eligible participants formed or joined teams of three members and wore Fitbit Flex activity monitors for two pre-intervention weeks followed by 24 weeks during which they could earn monetary rewards. Participants were rewarded for increasing their moderate-to-vigorous physical activity (MVPA) by 10% from the previous week or for meeting the Centers for Disease Control and Prevention (CDC) physical activity guidelines (150 min of MVPA per week). Our primary outcome was the proportion of participants meeting weekly MVPA goals and CDC physical activity guidelines. Secondary outcomes included Fitbit-wear adherence and factors associated with meeting CDC guidelines more consistently. B-Well included 292 hospital employees. Participants had a mean age of 38 years (SD 11), 83% were female, 38% were obese, and 62% were non-Hispanic White. Sixty-three percent of participants wore the Fitbit ≥4 days per week for ≥20 weeks. Two-thirds were satisfied with the B-Well program, with 79% indicating that they would participate again. Eighty-six percent met either their personal weekly goal or CDC physical activity guidelines for at least 6 out of 24 weeks, and 52% met their goals or CDC physical activity guidelines for at least 12 weeks. African Americans, non-obese subjects, and those with lower impulsivity scores reached CDC guidelines more consistently. Our data suggest that a financial incentives-based workplace wellness program can increase MVPA among sedentary employees. These results should be reproduced in a randomized controlled trial. Clinicaltrials.gov, NCT02850094 . Registered July 27, 2016 [retrospectively registered].", "links": [ { "caption": "URL", "url": "https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4931-2", "newWindow": true } ] }, { "title": "Estimation of Symptom Severity During Chemotherapy From Passively Sensed Data: Exploratory Study.", "author": "Low, C.A., Dey, A.K., Ferreira, D., Kamarck, T., Sun, W., Bae, S. and Doryab, A.\t", "year": "2017", "journalProceedings": "Journal of Medical Internet Research", "category": "Measurement,Methods", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Heart Rate", "abstract": "BACKGROUND Physical and psychological symptoms are common during chemotherapy in cancer patients, and real-time monitoring of these symptoms can improve patient outcomes. Sensors embedded in mobile phones and wearable activity trackers could be potentially useful in monitoring symptoms passively, with minimal patient burden. OBJECTIVE The aim of this study was to explore whether passively sensed mobile phone and Fitbit data could be used to estimate daily symptom burden during chemotherapy. METHODS A total of 14 patients undergoing chemotherapy for gastrointestinal cancer participated in the 4-week study. Participants carried an Android phone and wore a Fitbit device for the duration of the study and also completed daily severity ratings of 12 common symptoms. Symptom severity ratings were summed to create a total symptom burden score for each day, and ratings were centered on individual patient means and categorized into low, average, and high symptom burden days. Day-level features were extracted from raw mobile phone sensor and Fitbit data and included features reflecting mobility and activity, sleep, phone usage (eg, duration of interaction with phone and apps), and communication (eg, number of incoming and outgoing calls and messages). We used a rotation random forests classifier with cross-validation and resampling with replacement to evaluate population and individual model performance and correlation-based feature subset selection to select nonredundant features with the best predictive ability. RESULTS Across 295 days of data with both symptom and sensor data, a number of mobile phone and Fitbit features were correlated with patient-reported symptom burden scores. We achieved an accuracy of 88.1% for our population model. The subset of features with the best accuracy included sedentary behavior as the most frequent activity, fewer minutes in light physical activity, less variable and average acceleration of the phone, and longer screen-on time and interactions with apps on the phone. Mobile phone features had better predictive ability than Fitbit features. Accuracy of individual models ranged from 78.1% to 100% (mean 88.4%), and subsets of relevant features varied across participants. CONCLUSIONS Passive sensor data, including mobile phone accelerometer and usage and Fitbit-assessed activity and sleep, were related to daily symptom burden during chemotherapy. These findings highlight opportunities for long-term monitoring of cancer patients during chemotherapy with minimal patient burden as well as real-time adaptive interventions aimed at early management of worsening or severe symptoms.", "links": [] }, { "title": "Fitness band accuracy in older community dwelling adults", "author": "Madigan, E.A.\t", "year": "2017", "journalProceedings": "Health Informatics Journal", "category": "Validation", "devices": "Flex", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Fitness bands are widely available and assist with tracking the number of steps taken. However, for older people with slow gaits, shorter step widths and/or use of ambulatory devices, the accuracy of fitness bands for step counting has not been well studied. Using four commercially available fitness bands (Garmin Vivofit2™, Fitbit Flex™, Up3™ and Microsoft Band™), we studied 30 older people with varying ambulatory abilities. We videotaped participants walking and compared the videotaped step count with the fitness band counts. Only 5 of the 30 participants had accurate readings within a ±20?percent accuracy for all four bands. There was no relationship between the step speed and accuracy of the fitness bands. Participants using walkers and walking sticks had none of the bands that met the ±20?percent accuracy. Canes were more variable with accuracy. Fitness band manufacturers may need to tune their algorithms for use by older people.", "links": [ { "caption": "URL", "url": "http://journals.sagepub.com/doi/10.1177/1460458217720399", "newWindow": true } ] }, { "title": "Step Count Accuracy and Reliability from Activity Monitors Worn by Mobility-Intact Older Adults", "author": "Maganja, S., Donaldson, M. and Mackey, D.\t", "year": "2017", "journalProceedings": "Innovation in Aging", "category": "Validation", "devices": "One,Charge", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Accurate and reliable measurement of physical activity is necessary to assess adherence to and effects of physical activity interventions within a growing population of physically inactive older adults. The STRIDES Study was designed to determine accuracy (criterion=tally counter) and reliability (test-retest) of step counting in mobility-intact older adults from six wearable activity monitors (Fitbit Charge, Fitbit One, Garmin Vivofit2, Jawbone UP2, Misfit Shine, and New-Lifestyles 1000 pedometer). Participants (n=10, 69–80 years) completed a continuous 400-meter walk (average speed 1.3m/s), a non-continuous 400-meter walk (1.1m/s) designed to mimic daily walking patterns incorporating small disturbances, and two 100-step reliability walks. For the continuous walk, five monitors had small mean errors less than +/-5% (One -0.3%,95%CI=-0.4to-0.2%; Vivofit2 -0.6%,CI=-1.4to0.2%; UP2 -3.2%,CI=-5.7to-0.6%; Shine 0.5%,CI=-6.3to7.4%; New-Lifestyles -0.7%,CI=-1.1to-0.3%) while error for the Charge was larger (-7.7%;CI=-17.1to1.6%). Step counts from the One, Vivofit2 and New-Lifestyles were strongly correlated with criterion (r=0.95). For the non-continuous walk, the One, Vivofit2, and Shine had small errors less than +/-5% (-4.4%,CI=-5.4to-3.5%; -4.2%,CI=-8.1to-0.2%; -1.4%,CI=-5.6to2.8%), while errors for the Charge, UP2 and New-Lifestyles were larger (-8.1%,CI=-15.5to-0.6%; -6.3%,CI=-10.6to-2.1%; -6.2%,CI=-11.4to-0.9%). Only step counts from the One were strongly correlated with criterion (r=0.95). The Charge, One, Vivofit2, and New-Lifestyles were reliable with no significant differences in step counts between trials, while the Shine and UP2 were unreliable (mean differences between trials of 25.6 and 14.6%, p<0.05). In summary, we found that most activity monitors were reliable and accurate for step counting in older adults during continuous walking, while accuracy of some monitors was compromised during non-continuous walking.", "links": [ { "caption": "URL", "url": "https://academic.oup.com/innovateage/article-lookup/doi/10.1093/geroni/igx004.1450", "newWindow": true } ] }, { "title": "Users' experiences of wearable activity trackers: a cross-sectional study", "author": "Maher, C., Ryan, J., Ambrosi, C. and Edney, S.\t", "year": "2017", "journalProceedings": "BMC Public Health", "category": "Survey Research", "devices": null, "population": "Adults", "dataUsed": null, "abstract": "Wearable activity trackers offer considerable promise for helping users to adopt healthier lifestyles. This study aimed to explore users' experience of activity trackers, including usage patterns, sharing of data to social media, perceived behaviour change (physical activity, diet and sleep), and technical issues/barriers to use. A cross-sectional online survey was developed and administered to Australian adults who were current or former activity tracker users. Results were analysed descriptively, with differences between current and former users and wearable brands explored using independent samples t-tests, Mann-Whitney, and chi square tests. Participants included 200 current and 37 former activity tracker users (total N = 237) with a mean age of 33.1 years (SD 12.4, range 18–74 years). Fitbit (67.5%) and Garmin devices (16.5%) were most commonly reported. Participants typically used their trackers for sustained periods (5–7 months) and most intended to continue usage. Participants reported they had improved their physical activity (51–81%) more commonly than they had their diet (14–40%) or sleep (11–24%), and slightly more participants reported to value the real time feedback (89%) compared to the long-term monitoring (78%). Most users (70%) reported they had experienced functionality issues with their devices, most commonly related to battery life and technical difficulties. Results suggest users find activity trackers appealing and useful tools for increasing perceived physical activity levels over a sustained period.", "links": [ { "caption": "URL", "url": "https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4888-1", "newWindow": true } ] }, { "title": "Aerobic exercise training in children and adolescents with inflammatory bowel disease: Influence on psychological functioning, sleep and physical performance – An exploratory trial", "author": "Mählmanna, L., Gerber, M., Furlano, R.I., Legeret, C., Kalak, N., Holsboer-Trachsler, E. and Brand, S.\t", "year": "2017", "journalProceedings": "Mental Health and Physical Activity", "category": "Intervention", "devices": "Flex", "population": "Children,Adolescents", "dataUsed": "Steps", "abstract": "People with Inflammatory Bowel Disease (IBD) are at risk for mental health issues, poor sleep quality and limited engagement in physical activity (PA). Standard treatment consists of immune modulating pharmaceuticals though evidence is growing that aerobic exercise training (AET) could serve as an adjuvant option to reduce disease symptoms and improve mental health. The aim of the present exploratory trial was to investigate possible AET effects on psychological functioning, symptoms of depression, sleep and physical activity in paediatric patients with IBD.\nTwenty-one paediatric patients with IBD and 23 gender- and age-matched healthy controls (HC) were assessed. The IBD group was further split into a “remission-group” (IBD-RE; n = 14) and an “active disease group” (IBD-AD; n = 7). All participants completed an 8-week AET exergame intervention reaching 60–80% of maximum heart rate for 5 days per week. At baseline and after 8 weeks, psychological functioning, depressive symptoms, objective sleep EEG, subjective sleep and objective and subjective PA were assessed.\nAET improved the exercise capacity of all participants. Self-reported fitness and daily physical activity increased in IBD-AD, but not in IBD-RE and HC. No improvements were observed for psychological functioning, depressive symptoms or subjective sleep. Objective sleep improved, deep sleep increased, light sleep decreased, and in the IBD-AD group the number of arousals after sleep onset decreased. Descriptively, the IBD-AD group reported lower psychological functioning and poorer subjective sleep quality.\n\nAmong paediatric patients with IBD and healthy controls, an exergaming intervention has the potential to improve exercise capacity, self-reported fitness, daily physical activity, and aspects of objective sleep. Results suggest that children and adolescents in an active state of IBD are at increased risk of poor psychological functioning and poor sleep quality.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1755296617300364?via{\\%}3Dihub", "newWindow": true } ] }, { "title": "Promoting Optimal Physical Exercise for Life (PROPEL): aerobic exercise and self-management early after stroke to increase daily physical activity-study protocol for a stepped-wedge randomised trial.", "author": "Mansfield, A., Brooks, D., Tang, A., Taylor, D., Inness, E.L., Kiss, A., Middleton, L., Biasin, L., Fleck, R., French, E., LeBlanc, K., Aqui, A. and Danells, C.\t", "year": "2017", "journalProceedings": "BMJ Open", "category": "Methods", "devices": "One,Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Heart Rate", "abstract": "INTRODUCTION Physical exercise after stroke is essential for improving recovery and general health, and reducing future stroke risk. However, people with stroke are not sufficiently active on return to the community after rehabilitation. We developed the Promoting Optimal Physical Exercise for Life (PROPEL) programme, which combines exercise with self-management strategies within rehabilitation to promote ongoing physical activity in the community after rehabilitation. This study aims to evaluate the effect of PROPEL on long-term participation in exercise after discharge from stroke rehabilitation. We hypothesise that individuals who complete PROPEL will be more likely to meet recommended frequency, duration and intensity of exercise compared with individuals who do not complete the programme up to 6 months post discharge from stroke rehabilitation. METHODS AND ANALYSIS Individuals undergoing outpatient stroke rehabilitation at one of six hospitals will be recruited (target n=192 total). A stepped-wedge design will be employed; that is, the PROPEL intervention (group exercise plus self-management) will be 'rolled out' to each site at a random time within the study period. Prior to roll-out of the PROPEL intervention, sites will complete the control intervention (group aerobic exercise only). Participation in physical activity for 6 months post discharge will be measured via activity and heart rate monitors, and standardised physical activity questionnaire. Adherence to exercise guidelines will be evaluated by (1) number of 'active minutes' per week (from the activity monitor), (2) amount of time per week when heart rate is within a target range (ie, 55%-80% of age-predicted maximum) and (3) amount of time per week completing 'moderate' or 'strenuous' physical activities (from the questionnaire). We will compare the proportion of active and inactive individuals at 6 months post intervention using mixed-model logistic regression, with fixed effects of time and phase and random effect of cluster (site). ETHICS AND DISSEMINATION To date, research ethics approval has been received from five of the six sites, with conditional approval granted by the sixth site. Results will be disseminated directly to study participants at the end of the trial, and to other stake holders via publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02951338; Pre-results.", "links": [] }, { "title": "Validity of the Fitbit? Distance Traveled Feature Among Multiple Speed Trials", "author": "Marton, C.J.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge", "population": "Adults", "dataUsed": "Distance", "abstract": "A science review by Delago (2014) suggested that the distance-traveled feature on Fitbit® was an accurate measurement. However, as speed increased the accuracy of the Fitbit® decreased, meaning the faster the pace, the greater the error for distance measured. Whereas a systematic review conducted by Evenson et al. (2015) reported only one study that measured the distance-traveled feature. This study concluded that the Fitbit® over-estimated at lower speeds and underestimated at faster speeds.\nPURPOSE: To examine whether the fitness device, Fitbit® Charge, provides an accurate measurement of the distance-traveled feature at various speeds and to expand on the research regarding the distance-traveled feature.\n\nMETHODS: Twenty-eight healthy students from a Division III college participated in this study. A repeated measure ANVOA experimental design compared the Fitbit® distance-traveled output under three dependent variable speeds of 2.5mph (76.1m/min), 4.5mph (120.7m/min), and 6mph (160.9m/min) to a Quinton MedTrack ST55 treadmill distance-traveled measurement. All participants completed a six-minute trial for each of three different speeds on a treadmill while wearing the Fitbit® Charge. Following each six-minute trial, the distance-traveled was compared between the treadmill and the Fitbit® output. A repeated measure ANOVA analysis was used to test for significant differences (p < .05) among the three speeds between the Fitbit® and the treadmill.\n\nRESULTS: Results did not detect significant differences in distance-traveled between the Fitbit® Charge compared to the treadmill at 2.5mph (F(1,27) = 0.67, p = .42), 4.5mph (F(1,27) = 2.45, p = .13), or 6mph (F(1,24) = .66, p = .43) speeds.\n\nCONCULSION: It seems reasonable to conclude that the distance-traveled feature on the Fitbit® Charge is valid when compared to treadmill output at these three speeds. Future research could look at a wider range of speeds to ensure further accuracy.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Validity_of_the_Fitbit__Distance_Traveled_Feature.2224.aspx", "newWindow": true } ] }, { "title": "Pilot Validation of Ambulatory Activity Monitors for Sleep Measurement in Huntington's Disease Gene Carriers", "author": "Maskevich, S., Jumabhoy, R., Dao, P.D., Stout, J.C. and Drummond, S.P.\t", "year": "2017", "journalProceedings": "Journal of Huntington's Disease", "category": "Validation", "devices": "One", "population": "Patients,Adults", "dataUsed": "Sleep", "abstract": "Sleep disturbance occurs early in Huntington's disease (HD). Consumer- and research-grade activity monitors may enable routine assessment of sleep disturbances in HD. We compared Actiwatch Spectrum Pro, Jawbone UP2 and Fitbit One to the gold standard, polysomnography, in four late presymptomatic and three early HD participants. Compared to polysomnography, all ambulatory monitors overestimated total sleep time by textgreater60 minutes and sleep efficiency by ∼15%. Thus, for assessment of specific sleep parameters in HD, none of the activity monitors are sufficiently accurate to replace polysomnography, although they may be sufficient for estimating overall sleep-wake patterns. Larger sample replication is required.", "links": [ { "caption": "URL", "url": "https://content.iospress.com/articles/journal-of-huntingtons-disease/jhd170251", "newWindow": true } ] }, { "title": "Explaining System Missing: Missing Data and Experience Sampling Method", "author": "McLean, D.C., Nakamura, J. and Csikszentmihalyi, M.\t", "year": "2017", "journalProceedings": "Social Psychological and Personality Science", "category": "Measurement", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Missing values are nearly inescapable within social science research. The problem of missing data is especially troubling in longitudinal and intensive longitudinal studies when participants miss an entire collection cycle compared to item nonresponse. The present study examines some of the contextual influences of missed study participation using unobtrusive measures of experience in conjunction with the experience sampling method (ESM). A sample of 66 participants generated 2,940 observations across a 7-day study, yielding a missing response rate of 34%. Multilevel binary logistic regression was used to estimate the probability of missing the study participation signal based upon study time and physical activity states. Results indicate that the probability of missing collection signals increases throughout the duration of the study and with high levels of physical activity. The strongest predictor of missed participation occurred when participants' activity monitors were set to “asleep” mode. Implications of these findings and recommendations for future ESM studies are discussed.", "links": [ { "caption": "URL", "url": "http://journals.sagepub.com/doi/10.1177/1948550617708015", "newWindow": true } ] }, { "title": "Assessing the Effects of Interpersonal and Intrapersonal Behavior Change Strategies on Physical Activity in Older Adults: a Factorial Experiment", "author": "McMahon, S.K., Lewis, B., Oakes, J.M., Wyman, J.F., Guan, W. and Rothman, A.J.\t", "year": "2017", "journalProceedings": "Annals of Behavioral Medicine", "category": "Intervention", "devices": "One", "population": "Older Adults", "dataUsed": "Steps,Intensity,Distance", "abstract": "Background: Little is known about which behavior change strategies motivate older adults to increase their physical activity. Purpose: The purpose of this study was to assess the relative effects of two sets of behavior change strategies to motivate increased physical activity among older adults: interpersonal and intrapersonal. Methods: Community-dwelling older adults (N = 102, mean age = 79) were randomized in a 2 × 2 factorial experiment to receive interpersonal (e.g., social support, friendly social comparison; no, yes) and /or intrapersonal (e.g., goal setting, barriers management; no, yes) behavior change strategies, combined with an evidence-based, physical activity protocol (Otago exercise program) and a physical activity monitor (Fitbit One™). Results: Based on monitor data, participants who received interpersonal strategies, compared to those who did not, increased their average minutes of total physical activity (light, moderate, vigorous) per week, immediately (p = .006) and 6 months (p = .048) post-intervention. Similar, increases were observed on measures of functional strength and balance, immediately (p = .012) and 6 months (p = .003) post-intervention. The intrapersonal strategies did not elicit a significant increase in physical activity or functional strength and balance. Conclusions: Findings suggest a set of interpersonally oriented behavior change strategies combined with an evidencebased physical activity protocol can elicit modest, but statistically and clinically significant, increases in older adults' physical activity and functional strength and balance. Future research should replicate these findings and investigate the sustained quantity of physical activity elicited by these strategies and their impact on older adults' quality of life and falls.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s12160-016-9863-z", "newWindow": true } ] }, { "title": "Impact of work-hours and sleep on well-being and burnout for physicians-in-training: the prospective RATE Study", "author": "Mendelsohn, D., Despot, I., Gooderham, P., Singhal, A., Redekop, G. and Toyota, B.\t", "year": "2017", "journalProceedings": "Canadian Journal of Neurological Sciences", "category": "Measurement", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Wearable activity trackers are an innovative tool for measuring sleep and physical activity. The Resident Activity Tracker Evaluation (RATE) is a prospective observational study evaluating the impact of work-hours, sleep, and physical activity on resident well-being, burnout, and job satisfaction. Methods: Residents were recruited from: 1. general surgery and orthopedics (SURG), 2. internal medicine and neurology (MED) and 3. anesthesia and radiology (RCD). Groups 1 and 2 do not enforce on-call duration restrictions and group 3 had 12-hour restricted-call durations (RCD). Participants wore FitBit activity trackers for 14 days and completed four validated surveys assessing self-reported health, sleepiness, burnout, and job satisfaction. Results: Fifty-nine residents completed the study. 778 days of activity and 244 on-call periods were tracked. Surgical residents worked 24 more hours per week than non-surgical residents (84.3 vs 60.7). Surgical residents had 7 less hours of sleep per week and reported significantly higher Epworth Sleepiness scores. Nearly two-thirds of participants (61%) scored high burnout on the Maslach depersonalization subscore. Total steps per day and self-reported well-being, burnout, and job satisfaction were comparable between the groups. Conclusions: Despite a positive correlation between work-hours and sleepiness, burnout and well-being were similar among residents. Physical activity did not prevent burnout. These findings are relevant to work-hours policies.", "links": [ { "caption": "URL", "url": "https://www.cambridge.org/core/journals/canadian-journal-of-neurological-sciences/article/b01-impact-of-workhours-and-sleep-on-wellbeing-and-burnout-for-physiciansintraining-the-prospective-rate-study/30AA302CF5DFE32FF74FFA5020756211", "newWindow": true } ] }, { "title": "Data driven multi-agent m-health system to characterize the daily activities of elderly people", "author": "Mendes, S., Queiroz, J. and Leitao, P.\t", "year": "2017", "journalProceedings": "2017 12th Iberian Conference on Information Systems and Technologies", "category": "Measurement,Methods", "devices": "Charge HR", "population": "Older Adults", "dataUsed": "Steps,Intensity,Sleep,Heart Rate", "abstract": "With the continuous growing of aging population, the society is facing new challenges, namely the implementation of healthcare services for older people, as well as the promotion of the active aging and well-being. These challenges imply the optimization of these services through biomedical, physical, psychological and socio-environmental interventions. ICT technologies can support the implementation of these healthcare services, e.g., the use of wearable devices to collect the physiological data, cloud technology to store big amounts of data and advanced data analytics algorithms to extract valuable conclusions and actionable knowledge. This work proposes a multi-agent system driven data analysis approach to characterize the daily physiological conditions of a group of elderly people institutionalized in a nursing home, supporting the healthcare professionals to monitor their behavior and promote an active aging. The individual's data were collected by a set of Fitbit Charge HR wristbands and analyzed by clustering algorithms, running in the distributed autonomous agents, allowing to identify and characterize the individuals' daily habits and physiological conditions.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/document/7975725/", "newWindow": true } ] }, { "title": "A Fitbit and Facebook mHealth intervention for promoting physical activity among adolescent and young adult childhood cancer survivors: A pilot study", "author": "Mendoza, J.A., Baker, K.S., Moreno, M.A., Whitlock, K., Abbey-Lambertz, M., Waite, A., Colburn, T. and Chow, E.J.\t", "year": "2017", "journalProceedings": "Pediatric Blood & Cancer", "category": "Intervention", "devices": "Flex", "population": "Adolescents", "dataUsed": "Steps", "abstract": "Background\nPhysical activity (PA) may be important for preventing chronic diseases for adolescent and young adult (AYA) childhood cancer survivors. Randomized controlled trials (RCTs) of PA interventions for AYA survivors are sparse, but necessary to determine effective programs for increasing PA among this population. Thus, we conducted a pilot RCT, testing the feasibility of a mobile health (mHealth) intervention to promote PA among AYA survivors.\nProcedure\n\nWe recruited 14– to 18–year–olds who were =1-year post cancer therapy from Seattle Children's Hospital. The 10-week intervention consisted of a wearable PA-tracking device (Fitbit Flex) and a peer-based virtual support group (Facebook group). Research staff helped set step goals and awarded badges weekly. Controls received usual care. Baseline assessments occurred before randomization and follow-up assessments occurred during weeks 8–10 of the intervention period. Feasibility criteria are defined below. Qualitative interviews assessed acceptability. Exploratory outcomes included PA, quality of life, and motivation for PA.\nResults\n\nAll feasibility criteria were met: we recruited 60 survivors, intervention participants wore the Fitbit on the majority (71.5%) of intervention days, and =90% of all participants completed questionnaires. Qualitative data confirmed intervention acceptability. Exploratory analyses found no significant adjusted group differences for change in moderate-to-vigorous PA (4.4 vs. 5.0 min/day; P = 0.92) or sedentary time (-4.5 vs. 1.0 min/day; P = 0.73), comparing intervention subjects to controls. Some modest differences were found for select subscales of quality of life and motivation for PA.\nConclusions\n\nThis mHealth PA intervention was feasible and acceptable to AYA childhood cancer survivors and warrants a fully powered RCT.", "links": [ { "caption": "URL", "url": "http://doi.wiley.com/10.1002/pbc.26660", "newWindow": true } ] }, { "title": "Crafting a View of Self-Tracking Data in the Clinical Visit", "author": "Mentis, H.M., Komlodi, A., Schrader, K., Phipps, M., Gruber-Baldini, A., Yarbrough, K. and Shulman, L.\t", "year": "2017", "journalProceedings": "Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems", "category": "Usability", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "When self-tracking encounters clinical practices, the data is reshaped by goals and expertise that exist within a healthcare framework. To uncover these shaping practices, we provided a Fitbit Zip step-count sensor to nine patients with Parkinson's disease. Each patient wore the sensor for four weeks and then returned for a clinical visit with their neurologist. Our analysis focuses on this first clinical visit after four weeks of data had been collected. Our use of conversation analysis of both talk and action makes visible the practices engaged in by both collaborative members to 'craft a view' of the data toward shared decision making. Our findings reveal the deliberate guiding of attention to specific interpretations of the data through both talk and actions and we explain how our systematic analysis has uncovered tools for the mutually beneficial crafting practices of the clinician and patient.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=3025453.3025589", "newWindow": true } ] }, { "title": "Adolescent girls' reactions to nutrition and physical activity assessment tools and insight into lifestyle habits", "author": "Metos, J., Gren, L., Brusseau, T., Moric, E., O'Toole, K., Mokhtari, T., Buys, S. and Frost, C.\t", "year": "2017", "journalProceedings": "Health Education Journal", "category": "Usability", "devices": "Flex", "population": "Adolescents", "dataUsed": "Steps,Energy Expenditure", "abstract": "Objective:The objective of this study was to understand adolescent girls' experiences using practical diet and physical activity measurement tools and to explore the food and physical activity settings that influence their lifestyle habits.Design:Mixed methods study using quantitative and qualitative methods.Setting:Large city in the western USA. Participants were recruited from a larger study of girls and families.Methods:A total of 10 girls aged 13–17 years completed a 3-day food diary, a Food Frequency Questionnaire and wore a Fitbit wrist bracelet to measure physical activity for 30 days. Following the data collection period, a structured focus group using a phenomenological approach was held to understand girls' experiences with the collection tools and to understand the internal and external environments in which they make eating and physical activity decisions.Results:Participants completed an average of 8,459 steps/day. Girls had an average Healthy Eating Index score of 37 (out of 100), with diets...", "links": [ { "caption": "URL", "url": "http://journals.sagepub.com/doi/10.1177/0017896917734575", "newWindow": true } ] }, { "title": "Identification and Classification of Usage Patterns in Long-Term Activity Tracking", "author": "Meyer, J., Wasmann, M., Heuten, W., El Ali, A. and Boll, S.C.\t", "year": "2017", "journalProceedings": "Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems", "category": "Review,Methods", "devices": "Ultra,One,Zip,Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Activity trackers are frequently used in health and well-being, but their application in effective interventions is challenging. While research for reasons of use and non-use is ongoing, little is known about the way activity trackers are used in everyday life and over longer periods. We analyzed data of 104 individuals over 14,413 use days, and in total over 2.5 years. We describe general tracker use, periodic changes and overall changes over time, and identify characteristic patterns. While the use of trackers shows large individual heterogeneity, from our findings we could identify and classify general patterns for activity tracker use such as try-and-drop, slow-starter, experimenter, hop-on hop-off, intermittent and power user. Our findings contribute to the body of knowledge towards the successful design of effective health technologies, health interventions, and long-term health applications.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=3025453.3025690", "newWindow": true } ] }, { "title": "A Validation Study of the Fitbit One in Daily Life Using Different Time Intervals", "author": "Middelweerd, A., Van der Ploeg, H.P., Van Halteren, A., Twisk, J., Brug, J. and Te Velde, S.J.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "One", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Purpose: Accelerometer-based wearables can provide the user with real-time feedback through the device's interface and the mobile platforms. Few studies have focused on the minute-by-minute validity of wearables, which is essential for high-quality real-time feedback. This study aims to assess the validity of the Fitbit One compared with the ActiGraph GT3x + for assessing physical activity (i.e., steps, time spent in moderate, vigorous, and moderate–vigorous physical activity) in young adults using traditional time intervals (i.e., days) and smaller time intervals (i.e., minutes and hours).\nMethods: Healthy young adults (N = 34) wore the ActiGraph GT3x+ and a Fitbit One for 1 wk. Three aggregation levels were used: minute, hour, and day. Mixed models analyses, intraclass correlation coefficients, Bland–Altman analyses, and absolute error percentage for steps per day were conducted to analyze the validity for steps and minutes spent in moderate, vigorous, and moderate–vigorous physical activity.\n\nResults: As compared with ActiGraph (mean = 9 steps per minute, 509 steps per hour and 7636 steps per day), the Fitbit One systematically overestimated physical activity for all aggregation levels: on average 0.82 steps per minute, 45 steps per hour, and 677 steps per day. Strong and significant associations were found between ActiGraph and Fitbit results for steps taken (B = 0.72–0.89). Weaker but statistically significant associations were found for minutes spent in moderate, vigorous, and moderate–vigorous physical activity for all time intervals (B = 0.39–0.57).\n\nConclusions: Although the Fitbit One overestimates the step activity compared with the ActiGraph, it can be considered a valid device to assess step activity, including for real-time minute-by-minute self-monitoring. However, agreement and correlation between ActiGraph and Fitbit One regarding time spent in moderate, vigorous, and moderate–vigorous physical activity were lower.", "links": [ { "caption": "URL", "url": "http://insights.ovid.com/crossref?an=00005768-201706000-00025", "newWindow": true } ] }, { "title": "Increasing physical activity through an Internet-based motivational intervention supported by pedometers in a sample of sedentary students: A randomised controlled trial", "author": "Miragall, M., Domínguez-Rodríguez, A., Navarro, J., Cebolla, A. and Baños, R.M.\t", "year": "2017", "journalProceedings": "Psychology & Health", "category": "Intervention", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "Objective: The aim of this study was to analyse the effect of an Internet-based motivational intervention (IMI) supported by pedometers (in comparison with IMI alone and non-intervention) on increasing daily steps and changing constructs related to physical activity (PA) in a sample of sedentary students.\nDesign: A randomised-controlled trial was conducted with 76 sedentary or low-active college students. The purpose of the IMI was to deliver information to increase motivation and set individualised PA goals. It involved a 3-week intervention and a 3-months follow-up.\n\nOutcome measures: Objective measures were used to measure daily steps, and self-report questionnaires to assess different constructs related to PA.\n\nResults: Results revealed that IMI supported by pedometers condition increased significantly more the daily steps (post-intervention: M = 2069; SD = 1827; follow-up: M = 2227; SD = 2477) and enjoyment than non-intervention condition at both points in time. Moreover, results showed that IMI alone condition increased more the scores in variables involved in PA behaviour than non-intervention condition.\n\nConclusions: This study shows the effectiveness of a self-administered IMI using pedometers in increasing PA and enjoyment, and the effectiveness of the IMI alone in changing different theoretical constructs related to the PA behaviour.", "links": [ { "caption": "URL", "url": "https://www.tandfonline.com/doi/full/10.1080/08870446.2017.1368511", "newWindow": true } ] }, { "title": "Assessing the Use of Wrist-Worn Devices in Patients With Heart Failure: Feasibility Study", "author": "Moayedi, Y., Abdulmajeed, R., Duero Posada, J., Foroutan, F., Alba, A.C., Cafazzo, J. and Ross, H.J.\t", "year": "2017", "journalProceedings": "JMIR Cardio", "category": "Validation", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Background: Exercise capacity and raised heart rate (HR) are important prognostic markers in patients with heart failure (HF). There has been significant interest in wrist-worn devices that track activity and HR. Objective: We aimed to assess the feasibility and accuracy of HR and activity tracking of the Fitbit and Apple Watch. Methods: We conducted a two-phase study assessing the accuracy of HR by Apple Watch and Fitbit in healthy participants. In Phase 1, 10 healthy individuals wore a Fitbit, an Apple Watch, and a GE SEER Light 5-electrode Holter monitor while exercising on a cycle ergometer with a 10-watt step ramp protocol from 0-100 watts. In Phase 2, 10 patients with HF and New York Heart Association (NYHA) Class II-III symptoms wore wrist devices for 14 days to capture overall step count/exercise levels. Results: Recorded HR by both wrist-worn devices had the best agreement with Holter readings at a workload of 60-100 watts when the rate of change of HR is less dynamic. Fitbit recorded a mean 8866 steps/day for NYHA II patients versus 4845 steps/day for NYHA III patients (P=.04). In contrast, Apple Watch recorded a mean 7027 steps/day for NYHA II patients and 4187 steps/day for NYHA III patients (P=.08). Conclusions: Both wrist-based devices are best suited for static HR rate measurements. In an outpatient setting, these devices may be adequate for average HR in patients with HF. When assessing exercise capacity, the Fitbit better differentiated patients with NYHA II versus NYHA III by the total number of steps recorded. This exploratory study indicates that these wrist-worn devices show promise in prognostication of HF in the continuous monitoring of outpatients. [JMIR Cardio 2017;1(2):e8]", "links": [] }, { "title": "Mobile Device Accuracy for Step Counting Across Age Groups.", "author": "Modave, F., Guo, Y., Bian, J., Gurka, M.J., Parish, A., Smith, M.D., Lee, A.M. and Buford, T.W.\t", "year": "2017", "journalProceedings": "JMIR mHealth and uHealth", "category": "Validation", "devices": "Surge", "population": "Older Adults,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND Only one in five American meets the physical activity recommendations of the Department of Health and Human Services. The proliferation of wearable devices and smartphones for physical activity tracking has led to an increasing number of interventions designed to facilitate regular physical activity, in particular to address the obesity epidemic, but also for cardiovascular disease patients, cancer survivors, and older adults. However, the inconsistent findings pertaining to the accuracy of wearable devices for step counting needs to be addressed, as well as factors known to affect gait (and thus potentially impact accuracy) such as age, body mass index (BMI), or leading arm. \n\nOBJECTIVE We aim to assess the accuracy of recent mobile devices for counting steps, across three different age groups. \n\nMETHODS We recruited 60 participants in three age groups: 18-39 years, 40-64 years, and 65-84 years, who completed two separate 1000 step walks on a treadmill at a self-selected speed between 2 and 3 miles per hour. We tested two smartphones attached on each side of the waist, and five wrist-based devices worn on both wrists (2 devices on one wrist and 3 devices on the other), as well as the Actigraph wGT3X-BT, and swapped sides between each walk. All devices were swapped dominant-to-nondominant side and vice-versa between the two 1000 step walks. The number of steps was recorded with a tally counter. Age, sex, height, weight, and dominant hand were self-reported by each participant. \n\nRESULTS Among the 60 participants, 36 were female (60%) and 54 were right-handed (90%). Median age was 53 years (min=19, max=83), median BMI was 24.1 (min=18.4, max=39.6). There was no significant difference in left- and right-hand step counts by device. Our analyses show that the Fitbit Surge significantly undercounted steps across all age groups. Samsung Gear S2 significantly undercounted steps only for participants among the 40-64 year age group. Finally, the Nexus 6P significantly undercounted steps for the group ranging from 65-84 years. \n\nCONCLUSIONS Our analysis shows that apart from the Fitbit Surge, most of the recent mobile devices we tested do not overcount or undercount steps in the 18-39-year-old age group, however some devices undercount steps in older age groups. This finding suggests that accuracy in step counting may be an issue with some popular wearable devices, and that age may be a factor in undercounting. These results are particularly important for clinical interventions using such devices and other activity trackers, in particular to balance energy requirements with energy expenditure in the context of a weight loss intervention program.", "links": [ { "caption": "URL", "url": "https://mhealth.jmir.org/2017/6/e88/", "newWindow": true } ] }, { "title": "Types of Social Support and Weight Change among Overweight Adults", "author": "Monroe, C.M., Larsen, C. and West, D.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Intervention", "devices": "Zip,Aria", "population": "Adults", "dataUsed": "Weight", "abstract": "Engaging social support has been found to be an effective strategy to promote weight loss. Yet, little is known about the specific types of social support that may be the most influential.\n\nPURPOSE: The aim of this study was to examine the association between weight change and the types of social support adults participating in a behavioral weight loss intervention identified as the most helpful for their weight loss efforts.\n\nMETHODS: Overweight adults (N=36) were randomized to one of two, 16-week behavioral weight loss interventions. Both treatments consisted of weekly, in-person group counseling sessions, Fitbit Zips for monitoring physical activity, and scales for monitoring body weight. One group also received two extra Fitbit Zips and scales to share with up to two persons in their social circle. There were no significant differences between conditions, so analyses collapsed groups and examined those who started the intervention (N=35). Participants completed an online survey at the end of each intervention week, which asked them to select the most helpful type of social support they received (informational; tangible; network; emotional; esteem). The support type identified the most frequently as the most helpful type over time was determined for each participant and used in Fisher’s exact tests to measure the frequencies with which each type of support was reported between those who lost > 5% of their initial body weight and those who did not.\n\nRESULTS: Participants were obese at baseline (M BMI = 36.1 + 7.3 kg/m2), and 43% lost > 5% of their initial weight by 16 weeks. Only emotional, esteem, and tangible support emerged as the most frequently reported most helpful types of support among all participants across the intervention period. A greater proportion of those who lost > 5% of their baseline weight identified esteem support as the most helpful type of support versus those who lost < 5% of their initial weight (47% vs 10%, p = .02). No significant differences between weight change groups were found for other support types (ps > .05).\n\nCONCLUSION: These findings suggest that esteem support may be especially influential for fostering weight loss. However, future studies should employ designs that allow for the direct comparison and more robust evaluation of the effectiveness of different types of support on weight loss in adults.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Types_of_Social_Support_and_Weight_Change_among.114.aspx", "newWindow": true } ] }, { "title": "Energy Expenditure and Step Count Analysis of the Fitbit Flex Activity Tracker", "author": "Montes, J. and Navalta, J.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Energy Expenditure", "abstract": "PURPOSE: To investigate energy expenditure (EE) and step count (SC) measurements of the Fitbit Flex (FF) activity tracker during two walking protocols.\n\nMETHODS: 49 volunteers (male, N=26, female N=23; age (years) 23.43±6.57; height (m) 1.72±0.11; mass (kg) 76.15±18.46 walked protocol one and 46 (male, N=24, female N=22; age (years) 23.39±6.69; height (m) 1.72±0.11; mass (kg) 76.52±18.73 walked protocol two. 31 (male, N=18, female N=13; age (years) 24.39±7.59; height (m) 1.73±0.10; mass (kg) 77.95±21.52 were used for reliability. Subjects walked for 3 minutes at 1.5, 2.5, and 3.5mph at 0% grade for each protocol. EE and SC values for each speed were compared to a MOXUS respiratory cart and a manual count of steps respectively.\n\nRESULTS: EE@1.5mph (r=0.52, p<0.01; a=0.56; FF:19.43±7.12 Kcal, MOXUS:11.9±3.09 Kcal, p<.01), 2.5mph (r=0.53, p<0.01; a=0.72; FF:25.0±7.3 Kcal, MOXUS:14.43±3.67 Kcal, p<.01), 3.5mph (r=0.61, p<.01; a=0.67; FF:27.2±7.55 Kcal, MOXUS:19.43±4.76 Kcal, p<.01). SC@1.5mph (r=0.4, p<.01; a=0.55; FF:231.05±58.75 steps, Observed:268.95±25.17 steps, p<.01), 2.5mph (r=0.37, p<.01, a=0.50; FF:322.64±42.74 steps, Observed:331.6±21.22 steps, p=.03), 3.5mph (r=0.53, p<.01; a=0.66; FF:366.02±31.35 steps, Observed:379.83±21.58 steps, p<.01).\n\nCONCLUSIONS: Because of the popularity of activity trackers such as the Fitbit Flex, it is important to evaluate their accuracy and consistency. By underestimating steps taken and overestimating the caloric cost associated with it, the Fitbit Flex may be hindering people from reaching the recommended levels of daily exercise that have shown to provide minimum health benefits.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Energy_Expenditure_and_Step_Count_Analysis_of_the.1068.aspx", "newWindow": true } ] }, { "title": "Comparative Accuracy of a Wrist-Worn Activity Tracker and a Smart Shirt for Physical Activity Assessment", "author": "Montoye, A.H.K., Mitrzyk, J.R. and Molesky, M.J.\t", "year": "2017", "journalProceedings": "Measurement in Physical Education and Exercise", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Heart Rate", "abstract": "The purpose of the current study was to determine the accuracy of the Fitbit Charge HR and Hexoskin smart shirt. Participants (n = 32, age: 23.5 ± 1.3 years) wore a Fitbit and Hexoskin while performing 14 activities in a laboratory and on a track (lying, sitting, standing, walking various speeds and inclines, jogging, and cycling). Steps, kcals, heart rate, breathing rate, depth, and volume were measured by the Fitbit and Hexoskin and compared to criterion measures. The Fitbit and Hexoskin had low mean absolute percent error for steps (9.7%, 9.4%). The mean absolute percent error was low for heart rate (6.6% and 2.4%), with the Fitbit underestimating heart rate at higher intensities. Both devices had high mean absolute percent error for kcals (43.7% and 27.9%, respectively), and the Hexoskin had high mean absolute percent error for breathing rate, depth, and volume (19.4%, 35.6%, and 33.6%, respectively). The Fitbit and Hexoskin have utility for measurement of some, but not all, physical activity ...", "links": [ { "caption": "URL", "url": "https://www.tandfonline.com/doi/full/10.1080/1091367X.2017.1331166", "newWindow": true } ] }, { "title": "Determining Resident Sleep during and after Call with Commercial Sleep Monitoring Devices.", "author": "Morhardt, D.R., Luckenbaugh, A., Goldstein, C. and Faerber, G.J.\t", "year": "2017", "journalProceedings": "Urology", "category": "Measurement", "devices": "Flex", "population": "Adults", "dataUsed": "Sleep", "abstract": "OBJECTIVE To demonstrate that CAMDs are practical for monitoring resident sleep while on call. Studies that have directly monitored resident sleep are limited, likely due to both cost and difficulty in study interpretation. The advent of wearable commercial activity monitoring devices (CAMDs) that estimate sleep presents the opportunity to more readily evaluate resident sleep in physically active settings and \"home call,\" an coverage arrangement familiar to urology programs. \n\nMETHODS Twelve urology residents were outfitted with Fitbit® Flex devices during \"home call\" for a total of 57 (of 64, or 89%) call/post-call night pairs. Residents were surveyed with the Stanford Sleepiness Scale (SSS), a single-question alertness survey. Time in bed (TIB) was \"time to bed\" to \"rise for day\". Fitbit® accelerometers register activity as: 1) not moving; 2) minimal movement/restless; or 3) above threshold for accelerometer to register steps. Total sleep time (TST) was the number of minutes in level 1 activity during TIB. Sleep efficiency (SE) was defined as TST/TIB. \n\nRESULTS While on call, ten responding (of 12 available, 83%) residents on average reported TIB as 347 minutes, TST was 165 minutes, and had a SE of 47%. Interestingly, SSS responses did not correlate with sleep parameters. Post-call sleep demonstrated increases in TIB, SE, and TST (+23%, +15%, and +44% respectively) while sleepiness was reduced by 22%. \n\nCONCLUSIONS We demonstrate that urologic residents can consistently wear CAMDs while on home call. SSS did not correlate with Fitbit estimated sleep duration. Further study with such devices may enhance sleep deprivation recognition to improve resident sleep.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/28502597", "newWindow": true } ] }, { "title": "Reduction of Health Disparities in Appalachians With Multiple Cardiovascular Disease Risk Factors: A Randomized Controlled Trial", "author": "Moser, D.K., Feltner, F., Biddle, M.J., Chung, M.L. and Lennie, T.A.\t", "year": "2017", "journalProceedings": "Circulation", "category": "Intervention", "devices": null, "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Introduction: Appalachia is a socioeconomically austere environment with marked health disparities. People living in Appalachian Kentucky represent the top 1% for cardiovascular disease (CVD) risk, morbidity and mortality in the US.\nHypothesis: We hypothesized that compared to control (referral of patients to a primary care provider), a culturally appropriate, self-care CVD risk reduction intervention (HeartHealth) would be superior in promoting improvement of these risk factors: tobacco use (urinary cotinine), blood pressure (BP), lipid profile (point-of-care device), body mass index, depressive symptoms (PHQ-9), and physical activity levels (Fitbit).\n\nMethods: The study was developed with a community advisory board of lay community members, business owners, church leaders, and healthcare providers. In this randomized trial, we enrolled 352 individuals living in Appalachian Kentucky who were at risk for CVD by virtue of having two or more CVD risk factors. The intervention was delivered in person to groups of 10 or less over 6 weeks. The HeartHealth intervention was designed to provide participants with self-care skills appropriate to CVD risk reduction while reducing barriers to risk reduction found in austere environments. The targeted CVD risk factors were measured at baseline, then 4 and 12 months post-intervention. Linear mixed models analysis was used to compare outcomes between the groups across time.\n\nResults: The intervention produced improvement in systolic and diastolic BP (p=0.002 and p=0.001 for group X time interaction [GXT])), total cholesterol (p=0.026 GXT), high density lipoprotein (p=0.026 GXT), body mass index (p=0.017 GXT), smoking status (p=0.001 GXT), physical activity (p=0.001 GXT) and depressive symptoms (p=0.019 GTX) compared to the control group, and these improvements were maintained through 12 months. There were no differences seen across time by group in low density lipoprotein or triglyceride levels.Conclusion: Interventions like HeartHealth that focus on self-care of CVD risk factors and that are derived from collaboration with the community of interest are highly appropriate and effective in underserved, socioeconomically distressed areas.", "links": [ { "caption": "URL", "url": "http://circ.ahajournals.org/content/136/Suppl_1/A20502", "newWindow": true } ] }, { "title": "Development and evaluation of two web-based interventions for the promotion of physical activity in older adults: study protocol for a community-based controlled intervention trial", "author": "Muellmann, S., Bragina, I., Voelcker-Rehage, C., Rost, E., Lippke, S., Meyer, J., Schnauber, J., Wasmann, M., Toborg, M., Koppelin, F., Brand, T., Zeeb, H. and Pischke, C.R.\t", "year": "2017", "journalProceedings": "BMC Public Health", "category": "Methods", "devices": "Zip", "population": "Older Adults", "dataUsed": "Steps", "abstract": "BACKGROUND Regular physical activity (PA) is a key contributor to healthy ageing. However, despite known health benefits, only one third of older adults in Germany reach the PA levels recommended for persons aged 65 years and above by the World Health Organization. The aim of the current study is to evaluate the effectiveness of two web-based interventions for the initiation and maintenance of regular PA (i.e., intervention groups 1 and 2) compared to a delayed intervention control group of older adults aged 65 to 75 years. METHODS/DESIGN Study participants will be randomly assigned to one of three study arms in five communities in the Bremen-Oldenburg metropolitan region: a) Participants in the first arm will receive access to a web-based intervention for 10 weeks allowing them to track their weekly PA (subjective self-monitoring, intervention group 1); b) participants in the second arm will receive access to the web-based intervention for 10 weeks and, in addition, track PA using Fitbit Zips (objective self-monitoring, intervention group 2); c) participants in the delayed intervention control group will receive access to the intervention implemented in the first study arm after completion of the 12-week follow-up in the other two groups within each community. In addition, weekly group meetings in the communities will be offered to study participants in the intervention groups providing the opportunity to address questions related to the use of the website and to practice PA in groups (e.g., neighborhood walks, strength and balance exercises). To evaluate short-term effects of the intervention on physical and psychological health, PA, physical fitness, and cognitive and psychological variables will be assessed at baseline and 12-week follow-up. DISCUSSION This study will provide answers regarding acceptance and effectiveness of web-based interventions promoting uptake and maintenance of regular PA in persons aged 65-75 years. Study findings will contribute to a growing body of evidence in Germany concerning the role of community-based interventions for the promotion of PA and healthy ageing in older adults. T", "links": [ { "caption": "URL", "url": "http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4446-x", "newWindow": true } ] }, { "title": "Minimal Detectable Change Thresholds and Responsiveness of Zephyr Bioharness & Fitbit Charge Devices.", "author": "Nazari, G. and MacDermid, J.C.\t", "year": "2017", "journalProceedings": "Journal of Strength and Conditioning Research", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "The aim of the current study was to define the MDC thresholds for Zephyr Bioharness (ZB) and Fitbit Charge (FC-HR) heart rate variables, and to establish the internal responsiveness of ZB and FC-HR devices in terms of their heart rate, respiratory rate variables and number of steps taken variables, in a healthy sample of males and females at resting, sub-maximal activity and throughout recovery phases. A total of sixty participants (30 females, 48 ± 15) and (30 males, 48 ± 15) were recruited using stratified convenience and snowball sampling approaches from our university student, staff and faculty population. At rest, MDC90 values of ± 4.89 and ± 5.15 were noted for ZB and FC-HR devices respectively. Throughout the recovery, thresholds of ±8.14 for ZB and ± 8.74 for FC-HR were reported. During the sub-maximal phases, scores of ± 8.18 and ± 9.35 were established for ZB and FC-HR respectively. From a resting to a sub-maximal state, the Standardized Response Means for ZB and FC-HR heart rate variables exhibited large responsiveness of SRMZB-HR=4.42; SRMFC-HR=4.04. In addition, the ZB respiratory rate variable showed the largest effect size of SRMZB-RR= 2.55. Similarly, large effect size of SRMFC-ST=1.76 were reported for the FC-HR steps taken variable. From a sub-maximal to a recovery state, he Standardized Response Means for ZB and FC-HR heart rate variables demonstrated effect sizes of SRMZBHR= -3.10; SRMFC-HR= -3.12). Furthermore, the ZB respiratory rate variable displayed similar internal responsiveness measures of SRMZB-RR= -2.45. To conclude, Similar MDC heart rate thresholds can be expected using the ZB and FC-HR devices, and that the two devices demonstrated large internal responsiveness in our healthy male and female cohort when transitioning from resting to submaximal states and vice-versa. Our findings suggest that the ZB and FC-HR devices can be used in monitoring performance improvements or deterioration over time, and would allow qualified personnel in assessing the effectiveness of exercise programs in healthy individuals.", "links": [ { "caption": "URL", "url": "http://insights.ovid.com/crossref?an=00124278-900000000-95853", "newWindow": true } ] }, { "title": "Feasibility of a telephone and web-based physical activity intervention for women shift workers", "author": "Neil-Sztramko, S.E., Gotay, C.C., Sabiston, C.M., Demers, P.A. and Campbell, K.C.\t", "year": "2017", "journalProceedings": "Translational Behavioral Medicine", "category": "Usability,Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity,Distance", "abstract": "Policy: Workplaces with large numbers of shift workers may consider implementing strategies to help their workers become more active.\n\nResearch: Based on feasibility and preliminary efficacy, similar interventions should be evaluated using a randomised controlled trial to determine efficacy.\n\nPractice: Targeted interventions aimed at increasing physical activity in shift workers are feasible to implement.", "links": [ { "caption": "URL", "url": "https://link.springer.com/article/10.1007%2Fs13142-017-0471-7", "newWindow": true } ] }, { "title": "A qualitative evaluation of breast cancer survivors' acceptance of and preferences for consumer wearable technology activity trackers", "author": "Nguyen, N.H., Hadgraft, N.T., Moore, M.M., Rosenberg, D.E., Lynch, C., Reeves, M.M. and Lynch, B.M.\t", "year": "2017", "journalProceedings": "Supportive Care in Cancer", "category": "Usability", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background: Physical inactivity and sedentary behaviour are common amongst breast cancer survivors. These behaviours are associated with an increased risk of comorbidities such as heart disease, diabetes and other cancers. Commercially available, wearable activity trackers (WATs) have potential utility as behavioural interventions to increase physical activity and reduce sedentary behaviour within this population.\nPurpose: The purpose of the study is to explore the acceptability and usability of consumer WAT amongst postmenopausal breast cancer survivors.\n\nMethods: Fourteen participants tested two to three randomly assigned trackers from six available models (Fitbit One, Jawbone Up 24, Garmin Vivofit 2, Garmin Vivosmart, Garmin Vivoactive and Polar A300). Participants wore each device for 2 weeks, followed by a 1-week washout period before wearing the next device. Four focus groups employing a semi-structured interview guide explored user perceptions and experiences. We used a thematic analysis approach to analyse focus group transcripts.\n\nResults: Five themes emerged from our data: (1) trackers' increased self-awareness and motivation, (2) breast cancer survivors' confidence and comfort with wearable technology, (3) preferred and disliked features of WAT, (4) concerns related to the disease and (5) peer support and doctor monitoring were possible strategies for WAT application.\n\nConclusions: WATs are perceived as useful and acceptable interventions by postmenopausal breast cancer survivors. Effective WAT interventions may benefit from taking advantage of the simple features of the trackers paired with other behavioural change techniques, such as specialist counselling, doctor monitoring and peer support, along with simple manual instructions.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s00520-017-3756-y", "newWindow": true } ] }, { "title": "Cognitive Behavior Therapy to Treat Sleep Disturbance and Fatigue After Traumatic Brain Injury: A Pilot Randomized Controlled Trial", "author": "Nguyen, S., McKay, A., Wong, D., Rajaratnam, S.M., Spitz, G., Williams, G., Mansfield, D. and Ponsford, J.L.\t", "year": "2017", "journalProceedings": "Archives of Physical Medicine and Rehabilitation", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "OBJECTIVE\nTo evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance and fatigue in individuals with traumatic brain injury (TBI).\nDESIGN\nParallel 2-group randomized controlled trial.\n\nSETTING\nOutpatient therapy.\n\nPARTICIPANTS\nAdults (N=24) with history of TBI and clinically significant sleep and/or fatigue complaints were randomly allocated to an 8-session adapted CBT intervention or a treatment as usual (TAU) condition.\n\nINTERVENTIONS\nCognitive behavior therapy.\n\nMAIN OUTCOME MEASURES\nThe primary outcome was the Pittsburgh Sleep Quality Index (PSQI) posttreatment and at 2-month follow-up. Secondary measures included the Insomnia Severity Index, Fatigue Severity Scale, Brief Fatigue Inventory (BFI), Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale.\n\nRESULTS\nAt follow-up, CBT recipients reported better sleep quality than those receiving TAU (PSQI mean difference, 4.85; 95% confidence interval [CI], 2.56–7.14). Daily fatigue levels were significantly reduced in the CBT group (BFI difference, 1.54; 95% CI, 0.66–2.42). Secondary improvements were significant for depression. Large within-group effect sizes were evident across measures (Hedges g=1.14–1.93), with maintenance of gains 2 months after therapy cessation.\n\nCONCLUSIONS\nAdapted CBT produced greater and sustained improvements in sleep, daily fatigue levels, and depression compared with TAU. These pilot findings suggest that CBT is a promising treatment for sleep disturbance and fatigue after TBI.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0003999317302277", "newWindow": true } ] }, { "title": "Determining the role of Maternal Leptin and Activity in Pregnancy Outcomes", "author": "Nishimura, T.E., Polgreen, P.M., Polgreen, L.A., Brandt, D.S., Thomas, K.M., Scroggins, S.M., Evans, N.J., Alexander, L.B., Santillan, M.K. and Santillan, D.A.\t", "year": "2017", "journalProceedings": "The FASEB Journal", "category": "Measurement", "devices": "Zip", "population": "Adults,Pregnant Women", "dataUsed": "Steps", "abstract": "Leptin, an adipocytokine with an important role in energy homeostasis and other neuroendocrine functions, is found in higher levels in obese individuals. Maternal obesity is associated with numerous adverse pregnancy outcomes, such as miscarriage, gestational diabetes, gestational hypertension, and preeclampsia. However, the relationship between leptin, activity, and pregnancy outcomes is unclear. Some studies have found reduced leptin with physical activity and leptin is known to have direct effects on the cardiovascular system. Therefore, we hypothesized that women who have higher activity during pregnancy will have lower plasma leptin levels and experience fewer adverse outcomes during their pregnancy.\nIn a cross-sectional study, 100 pregnant women were co-enrolled into the Maternal Fetal Tissue Bank (IRB200901784) and this study (IRB201502767). Pregnant women received triaxial accelerometers (Fitbit Zip) to wear throughout gestation. Maternal blood samples from each trimester were assayed in duplicate for plasma leptin concentration using an enzyme-linked immunosorbent assay (ELISA). Pregnancy outcomes including maternal development of gestational diseases such as preeclampsia as well as mode of delivery, birthweight, fetal gender, and APGAR scores were extracted from the electronic health record (EPIC). Additionally, maternal demographics (age, race, and ethnicity) and health characteristics such as body mass index and any chronic health conditions at the beginning of pregnancy were recorded.\n\nAverage step counts were obtained for the first (5523.77 ± 3720.33), second (5667.62 ± 4029.63), and third (4979.32 ± 3138.37) trimesters. In addition, no significant differences in average plasma leptin concentrations were obtained for the first (19839.8 ± 2390.9 pg/mL), second (11319.0 ± 2000.9 pg/mL), and third (26468.3 ± 5918.5 pg/mL) trimesters (P = 0.08). Leptin was only inversely correlated with activity in the first trimester (R2 =-0.32, P = 0.02), whereas no associations were detected in the 2nd and 3rd trimester. As an adverse outcome, we examined activity and leptin in patients with and without preeclampsia. The preeclamptic cohort took significantly fewer steps than the control group (5656.59 vs. 3586.72, P textless 0.05) during the first trimester. The preeclamptic cohort also had a significantly higher average BMI (39 ± 6 vs. 27 ± 7, P = 0.02) and rates of chronic hypertension (67% vs. 6%, P textless 0.001) than controls. Leptin was also significantly higher in the preeclamptic cohort than controls (52476.1 ± 10456.0 pg/mL vs. 16777.1 ± 1395.0 pg/mL, P textless0.001).\n\nIn conclusion, significant differences exist between the activity levels, leptin, and pregnancy outcomes of the preeclamptic and control groups.", "links": [ { "caption": "URL", "url": "http://www.fasebj.org/content/31/1_Supplement/692.2.short", "newWindow": true } ] }, { "title": "The utility of personal activity trackers (Fitbit Charge 2) on exercise capacity in patients post acute coronary syndrome [UP-STEP ACS Trial]: a randomised controlled trial protocol", "author": "Nogic, J., Thein, P.M., Cameron, J., Mirzaee, S., Ihdayhid, A. and Nasis, A.\t", "year": "2017", "journalProceedings": "BMC Cardiovascular Disorders", "category": "Methods", "devices": "Charge 2", "population": "Patients,Adults", "dataUsed": "Steps,Heart Rate", "abstract": "The benefits of physical activity and cardiovascular rehabilitation on the reduction of cardiovascular risk are well documented. Despite this, significant barriers and challenges remain in optimizing patient risk factors post acute coronary syndromes (ACS) and ensuring patient compliance. Consumer wearable personal activity trackers represent a cost effective and readily available technology that may aid in this endeavour. UP-STEP ACS is a prospective single-blinded, two-arm, parallel, randomized control trial with an aim to enrol 200 patients all undertaking cardiac rehabilitation. It will assess the affect that personal activity monitors have on change in exercise capacity in patients post acute coronary syndromes primarily measured by a six-minute walk test (6MWT). Secondary end points will be the improvement in other cardiovascular risk factors, namely; blood lipid and glucose levels, weight, waist circumference, along with mood, quality of life and cardiac rehabilitation adherence. Patients will be randomized to either receive a personal activity tracker or standard post hospital care during their index event. After the 8- week intervention period, patients will return for a clinical review and repeat of baseline assessments including the 6MWT. The utility and impact on exercise capacity of personal activity trackers in patient's post-acute coronary syndrome has not been assessed. This study aims to add to the scientific evidence emerging regarding the clinical utility and validity of these devices in different patient population groups. If proven to be of benefit, these devices represent a cost effective, easily accessible technology that could aid in the reduction of cardiovascular events.", "links": [] }, { "title": "Accuracy of Consumer Monitors for Measuring Sleep Across Seven Nights", "author": "Nowakowski, S., Grandner, M., Stout-Aguilar, J., Meers, J., Lewis-Powell, Z., Swartz, M., Choi, H. and Lyons, E.\t", "year": "2017", "journalProceedings": "Sleep", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Sleep", "abstract": "Introduction:\nSleep and fitness trackers available to the consumer market show promise for measuring sleep. However, there are few published studies examining their accuracy compared with well-validated actigraphy devices for multiple nights outside the sleep laboratory. The purpose of this study was to evaluate the reliability and validity of several commercially-available devices compared to a well-validated actigraphy device.\nMethods:\nHealthy adults (N=40, mean age= 42?±?14, 50% female) wore a Fitbit Flex, Jawbone Up24, Misfit Shine, and Actiwatch-2 (AW-2) on the same wrist for seven consecutive 24-hour periods. Outcome variables included total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE) averaged over 7 nights. Both “Normal” and “Sensitive” sleep-recording Fitbit modes were examined. Each commercial monitor was compared with AW-2 using paired t-test and Bland-Altman concordance analyses. Clinical acceptance was defined a priori as =60 minutes difference between devices for TST and WASO, and =10% difference for SE.\nResults:\nFitbit (normal), Jawbone, and Misfit were in the clinically acceptable range for TST, with Fitbit (normal) and Misfit overestimating by 2 minutes and 60 minutes, respectively; and Jawbone underestimating by 15 minutes compared with AW-2 (m=406?±?47 minutes). Fitbit (sensitive) overestimated by 160 minutes. All devices met clinically acceptable criteria but underestimated WASO by 13 minutes (Jawbone), 21 minutes (Fitbit sensitive), 23 minutes (Fitbit normal), and 25 minutes (Misfit) compared to AW-2 (m=38?±?15 minutes). Jawbone and Fitbit (normal) met clinically acceptable criteria for SE, with both devices overestimating by 4% and 5%, respectively compared to AW-2 (m=85?±?6%). Misfit overestimated by 12% and Fitbit (sensitive) underestimated by 30%.\nConclusion:\nFitbit (normal) and Jawbone accelerometers provided clinically comparable result for TST, WASO, and SE when compared to AW-2. Misfit met criteria for TST and WASO but not SE. Fitbit (sensitive) performed poorest. Further research is needed to reevaluate these findings with newer models.", "links": [ { "caption": "URL", "url": "https://academic.oup.com/sleep/article-lookup/doi/10.1093/sleepj/zsx050.761", "newWindow": true } ] }, { "title": "Measuring and understanding adherence in a home-based exercise intervention during chemotherapy for early breast cancer", "author": "Nyrop, K.A., Deal, A.M., Choi, S.K., Wagoner, C.W., Lee, J.T., Wood, A., Anders, C., Carey, L.A., Dees, E.C., Jolly, T.A., Reeder-Hayes, K.E. and Muss, H.B.\t", "year": "2017", "journalProceedings": "Breast Cancer Research and Treatment", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "PURPOSE Ensuring and measuring adherence to prescribed exercise regimens are fundamental challenges in intervention studies to promote exercise in adults with cancer. This study reports exercise adherence in women who were asked to walk 150 min/week throughout chemotherapy treatment for early breast cancer. Participants were asked to wear a Fitbit(TM) throughout their waking hours, and Fitbit steps were uploaded directly into study computers. \n\nMETHODS Descriptive statistics are reported, and both unadjusted and multivariable linear regression models were used to assess associations between participant characteristics, breast cancer diagnosis, treatment, chemotherapy toxicities, and patient-reported symptoms with average Fitbit steps/week.\n\nRESULTS Of 127 women consented to the study, 100 had analyzable Fitbit data (79%); mean age was 48 and 31% were non-white. Mean walking steps were 3956 per day. Nineteen percent were fully adherent with the target of 6686 steps/day and an additional 24% were moderately adherent. In unadjusted analysis, baseline variables associated with fewer Fitbit steps were: non-white race (p = 0.012), high school education or less (p = 0.0005), higher body mass index (p = 0.0024), and never/almost never drinking alcohol (p = 0.0048). Physical activity variables associated with greater Fitbit steps were: pre-chemotherapy history of vigorous physical activity (p = 0.0091) and higher self-reported walking minutes/week (p textless 0.001), and higher outcome expectations from exercise (p = 0.014). Higher baseline anxiety (p = 0.03) and higher number of chemotherapy-related symptoms rates \"severe/very severe\" (p = 0.012) were associated with fewer steps. In multivariable analysis, white race was associated with 12,146 greater Fitbit steps per week (p = 0.004), as was self-reported walking minutes prior to start of chemotherapy (p < 0.0001). \n\nCONCLUSIONS Inexpensive commercial-grade activity trackers, with data uploaded directly into research computers, enable objective monitoring of home-based exercise interventions in adults diagnosed with cancer. Analysis of the association of walking steps with participant characteristics at baseline and toxicities during chemotherapy can identify reasons for low/non-adherence with prescribed exercise regimens.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s10549-017-4565-1", "newWindow": true } ] }, { "title": "When a Step Is Not a Step! Specificity Analysis of Five Physical Activity Monitors", "author": "O’Connell, S., ÓLaighin, G. and Quinlan, L.R.\t", "year": "2017", "journalProceedings": "PLOS ONE", "category": "Validation", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "Introduction: Physical activity is an essential aspect of a healthy lifestyle for both physical and mental health states. As step count is one of the most utilized measures for quantifying physical activity it is important that activity-monitoring devices be both sensitive and specific in recording actual steps taken and disregard non-stepping body movements. The objective of this study was to assess the specificity of five activity monitors during a variety of prescribed non-stepping activities. \n\nMethods: Participants wore five activity monitors simultaneously for a variety of prescribed activities including deskwork, taking an elevator, taking a bus journey, automobile driving, washing and drying dishes; functional reaching task; indoor cycling; outdoor cycling; and indoor rowing. Each task was carried out for either a specific duration of time or over a specific distance. Activity monitors tested were the ActivPAL micro™, NL-2000™ pedometer, Withings Smart Activity Monitor Tracker (Pulse O2)™, Fitbit One™ and Jawbone UP™. Participants were video-recorded while carrying out the prescribed activities and the false positive step count registered on each activity monitor was obtained and compared to the video. \n\nResults: All activity monitors registered a significant number of false positive steps per minute during one or more of the prescribed activities. The Withings™ activity performed best, registering a significant number of false positive steps per minute during the outdoor cycling activity only (P = 0.025). The Jawbone™ registered a significant number of false positive steps during the functional reaching task and while washing and drying dishes, which involved arm and hand movement (P < 0.01 for both). The ActivPAL™ registered a significant number of false positive steps during the cycling exercises (P < 0.001 for both). \n\nConclusion: As a number of false positive steps were registered on the activity monitors during the non-stepping activities, the authors conclude that non-stepping physical activities can result in the false detection of steps. This can negatively affect the quantification of physical activity with regard to step count as an output. The Withings™ activity monitor performed best with regard to specificity during the activities of daily living tested.", "links": [ { "caption": "URL", "url": "http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0169616", "newWindow": true } ] }, { "title": "What Matters in Weight Loss? An In-Depth Analysis of Self-Monitoring.", "author": "Painter, S.L., Ahmed, R., Hill, J.O., Kushner, R.F., Lindquist, R., Brunning, S. and Margulies, A.\t", "year": "2017", "journalProceedings": "Journal of Medical Internet Research", "category": "Intervention", "devices": "One,Aria", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Weight", "abstract": "BACKGROUND Using technology to self-monitor body weight, dietary intake, and physical activity is a common practice used by consumers and health companies to increase awareness of current and desired behaviors in weight loss. Understanding how to best use the information gathered by these relatively new methods needs to be further explored. OBJECTIVE The purpose of this study was to analyze the contribution of self-monitoring to weight loss in participants in a 6-month commercial weight-loss intervention administered by Retrofit and to specifically identify the significant contributors to weight loss that are associated with behavior and outcomes. \n\nMETHODS A retrospective analysis was performed using 2113 participants enrolled from 2011 to 2015 in a Retrofit weight-loss program. Participants were males and females aged 18 years or older with a starting body mass index of =25 kg/m2, who also provided a weight measurement at the sixth month of the program. Multiple regression analysis was performed using all measures of self-monitoring behaviors involving weight measurements, dietary intake, and physical activity to predict weight loss at 6 months. Each significant predictor was analyzed in depth to reveal the impact on outcome. \n\nRESULTS Participants in the Retrofit Program lost a mean -5.58% (SE 0.12) of their baseline weight with 51.87% (1096/2113) of participants losing at least 5% of their baseline weight. Multiple regression model (R(2)=.197, P<0.001) identified the following measures as significant predictors of weight loss at 6 months: number of weigh-ins per week (P<.001), number of steps per day (P=.02), highly active minutes per week (P,.001), number of food log days per week (P<.001), and the percentage of weeks with five or more food logs (P<.001). Weighing in at least three times per week, having a minimum of 60 highly active minutes per week, food logging at least three days per week, and having 64% (16.6/26) or more weeks with at least five food logs were associated with clinically significant weight loss for both male and female participants. \n\nCONCLUSIONS The self-monitoring behaviors of self-weigh-in, daily steps, high-intensity activity, and persistent food logging were significant predictors of weight loss during a 6-month intervention.", "links": [ { "caption": "URL", "url": "http://www.jmir.org/2017/5/e160/", "newWindow": true } ] }, { "title": "Screening of Atrial Fibrillation Using Wrist Photoplethysmography from a Fitbit Tracker", "author": "Pantelopoulos, A., Faranesh, A., Milescu, A., Hosking, P., Venkatraman, S. and Heneghan, C.\t", "year": "2017", "journalProceedings": "Iproceedings", "category": "Validation,Methods", "devices": null, "population": "Patients,Adults", "dataUsed": "Heart Rate", "abstract": "Background: Atrial Fibrillation is the most common clinically significant cardiac arrhythmia, estimated to affect between 2% ( 65 years of age) of the U.S. population. Screening and early detection of AF can help prevent associated stroke and cardiovascular disease. Commonly used monitoring devices are limited to short periods (textless 4 weeks) and are usually employed in symptomatic subjects. Wrist-worn wearables equipped with photoplethysmography (PPG) could potentially aid in AF screening, as they can be easily worn by most people for extended periods of time. Objective: This study aimed to investigate the ability of wrist-based PPG to detect the presence of AF in subjects while at rest. Methods: This study was conducted with the approval of local institutional review boards, and all patients provided written, informed consent. The first dataset consisted of 9 patients with persistent AF and 13 subjects with normal sinus rhythm. For these 22 subjects, PPG and ECG data were collected while sitting stationary for 15 minutes (awake dataset). A second dataset consisted of 10 patients with persistent AF and 27 subjects with no known diagnosis of AF. These subjects were asked to wear a Fitbit wrist-band which recorded PPG and accelerometry data during sleep (sleep dataset, 73 total nights). There was no overlap between subjects in the awake and sleep datasets. Results: Data were analyzed in overlapping 1 or 5-minute windows. Pulse Rate Variability (PRV) features, PPG morphology features and accelerometer features were extracted for each window. An algorithm was trained on the awake dataset and was validated on the sleep dataset. The performance was 95.7% (98%) sensitivity (Se) and 0.8% (0.8%) False Positive Rate (FPR) for 1 min (5 min) windows. We also investigated the shortest duration of an AF episode that could be detected by using synthesized data. With 1 minute analysis windows, the algorithm was sensitive down to 40-second episodes. Using 5-minute intervals, episodes down to 3 minutes could be reliably detected. Conclusions: Wrist-bands equipped with PPG sensors can be used to detect atrial fibrillation during sleep or during awake, stationary periods. While reliable detection of short AF episodes can be challenging due to the noisy nature of PPG signals, we have demonstrated that select PPG features can enable accurate detection of AF down to 40 second periods. These findings suggest that wrist-worn devices equipped with a PPG sensor could be used to screen for AF in high-risk subjects or monitor patients post treatment, but are limited to cases where users are not moving or exercising. Additional, larger clinical studies are planned for the future to validate these promising early results and to validate the algorithm's specificity against other forms of arrhythmia. [iproc 2017;3(1):e17]", "links": [ { "caption": "URL", "url": "http://www.iproc.org/2017/1/e17/", "newWindow": true } ] }, { "title": "Sources of Error with Wearable Step Counters", "author": "Park, S., Toth, L.P., Morton, A.L., Pittman, W.L., Sarasaltik, D. and Bassett, D.R.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Zip,Charge", "population": "Adults", "dataUsed": "Steps", "abstract": "PURPOSE: To investigate sources of error with 11 wearable step counting devices, during common types of physical activities.\nMETHODS: 20 participants performed 15 activities for 2 min each, while wearing 11 step counters on the waist, ankle, or non-dominant wrist. Arm activities included: snacking, brushing hair, folding laundry, sweeping, brushing teeth, and meal preparation. Overground activities included: walking holding onto backpack strap, walking with umbrella, walking with hands in pockets, and pushing stroller. Treadmill activities included: walking at 1 mph, walking at 2 mph, walking at 3 mph, walking at 3 mph holding onto bars, and jogging at 6 mph. Wrist-worn devices included: Garmin Vivofit 2, Fitbit Charge, Polar A360, Withings Pulse Ox, and ActiGraph GT3X. Waist-worn devices included: Yamax Digi-Walker SW-200, Fitbit Zip, Omron HJ-322U, and ActiGraph GT3X (without low-frequency extension). Ankle-worn devices included: two StepWatch 3 devices, one with preprogrammed, default settings and one with modified cadence and sensitivity settings. A researcher hand-counted steps during each activity; this served as the criterion. The step counts reported from each device compared to the hand count using a 1-way (1x12) repeated measured ANOVA. If the overall effect for an activity was significant, the outputs from individual devices and the criterion were analyzed using planned contrasts. Devices with significant contrasts (p = 0.05) and observed power greater than 0.8 were considered to be significantly different than the criterion.\n\nRESULTS: During arm activities, the wrist-worn devices overcounted steps while hip-worn devices slightly undercounted steps. The ActiGraph GT3X on the wrist greatly overcounted steps during arm activities, while other devices had smaller errors. During treadmill walking at 1 mph, all wrist and hip-worn devices undercounted steps. The ankle-worn device (StepWatch 3) had the smallest error across all activities, especially when programmed with the modified setting.\n\nCONCLUSIONS: Individuals using step counting devices should be aware of sources of error in step counts. Contributing factors to error are the wear location, the algorithms used to count steps, and the activities performed.", "links": [ { "caption": "URL", "url": "http://insights.ovid.com/crossref?an=00005768-201705001-01079", "newWindow": true } ] }, { "title": "Effect of a Game-Based Intervention Designed to Enhance Social Incentives to Increase Physical Activity Among Families: The BE FIT Randomized Clinical Trial", "author": "Patel, M.S., Benjamin, E.J., Volpp, K.G., Fox, C.S., Small, D.S., Massaro, J.M., Lee, J.J., Hilbert, V., Valentino, M., Taylor, D.H., Manders, E.S., Mutalik, K., Zhu, J., Wang, W. and Murabito, J.M.\t", "year": "2017", "journalProceedings": "AMA Internal Medicine", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "mportance Gamification, the application of game design elements such as points and levels in nongame contexts, is often used in digital health interventions, but evidence on its effectiveness is limited.\nObjective To test the effectiveness of a gamification intervention designed using insights from behavioral economics to enhance social incentives within families to increase physical activity.\n\nDesign, Setting, and Participants The Behavioral Economics Framingham Incentive Trial (BE FIT) was a randomized clinical trial with a 12-week intervention period and a 12-week follow-up period. The investigation was a community-based study between December 7, 2015, and August 14, 2016. Participants in the modified intent-to-treat analysis were adults enrolled in the Framingham Heart Study, a long-standing cohort of families.\n\nInterventions All participants tracked daily step counts using a wearable device or a smartphone, established a baseline, selected a step goal increase, and received daily individual feedback on goal performance by text message or email for 24 weeks. Families in the gamification arm could earn points and progress through levels based on physical activity goal achievement during the 12-week intervention. The game design was meant to enhance collaboration, accountability, and peer support.\n\nMain Outcomes and Measures The primary outcome was the proportion of participant-days that step goals were achieved during the intervention period. Secondary outcomes included the proportion of participant-days that step goals were achieved during the follow-up period and the change in the mean daily steps during the intervention and follow-up periods.\n\nResults Among 200 adults comprising 94 families, the mean age was 55.4 years, and 56.0% (n = 112) were female. During the intervention period, participants in the gamification arm achieved step goals on a significantly greater proportion of participant-days (0.53 vs 0.32; adjusted difference, 0.27; 95% CI, 0.20-0.33; P < .001) and had a significantly greater increase in the mean daily steps compared with baseline (1661 vs 636; adjusted difference, 953; 95% CI, 505-1401; P < .001) than the control arm. During the follow-up period, physical activity in the gamification arm declined but remained significantly greater than that in the control arm for the proportion of participant-days achieving step goals (0.44 vs 0.33; adjusted difference, 0.12; 95% CI, 0.05-0.19; P < .001) and the mean daily steps compared with baseline (1385 vs 798; adjusted difference, 494; 95% CI, 170-818; P < .01).\n\nConclusions and Relevance Gamification designed to leverage insights from behavioral economics to enhance social incentives significantly increased physical activity among families in the community.", "links": [ { "caption": "URL", "url": "http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655242", "newWindow": true } ] }, { "title": "Using Wearable Devices and Smartphones to Track Physical Activity: Initial Activation, Sustained Use, and Step Counts Across Sociodemographic Characteristics in a National Sample", "author": "Patel, M.S., Foschini, L., Kurtzman, G.W., Zhu, J., Wang, W., Rareshide, C.A. and Zbikowski, S.M.\t", "year": "2017", "journalProceedings": "Annals of Internal Medicine", "category": "Measurement,Methods", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Interest in using wearable devices and smartphones to monitor daily health behaviors, such as physical activity, is growing (1, 2). Many large employers are using these technologies in workplace wellness programs (3). The precision medicine initiative has described how data collected by these technologies can be used to better target interventions. However, the characteristics of persons who use these devices are poorly understood.", "links": [ { "caption": "URL", "url": "http://annals.org/aim/article/2654953/using-wearable-devices-smartphones-track-physical-activity-initial-activation-sustained", "newWindow": true } ] }, { "title": "A Feasibility Study for Improved Physical Activity After Total Knee Arthroplasty", "author": "Paxton, R.J., Forster, J.E., Miller, M.J., Gerron, K.L., Stevens-Lapsley, J.E. and Christiansen, C.L.\t", "year": "2017", "journalProceedings": "Journal of Aging and Physical Activity", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background:\nPhysical activity outcomes are poor following total knee arthroplasty (TKA). The purpose was to evaluate feasibility of a physical activity feedback intervention for patients after TKA.\n\nMethods:\nParticipants completing conventional TKA rehabilitation were randomized to a physical activity feedback (PAF; n=22) or control (CTL; n=23) group. The PAF intervention included real-time activity feedback, weekly action planning, and monthly group support meetings (12-weeks). The CTL group received attention control education. Feasibility was assessed using retention, adherence, dose goal attainment, and responsiveness with pre- and post-intervention testing.\n\nResults:\nThe PAF group had 100% retention, 92% adherence (frequency of feedback use), and 65% dose goal attainment (frequency of meeting goals). PAF group average daily step count increased from 5754 (2714) (pre) to 6917 (3445) steps/day (post).\n\nConclusion:\nThis study describes a feasible intervention to use as an adjunct to conventional rehabilitation for people with TKA.", "links": [ { "caption": "URL", "url": "http://journals.humankinetics.com/doi/10.1123/japa.2016-0268", "newWindow": true } ] }, { "title": "Physical Activity Trackers in Combination with Motivational Interviewing to Increase Activity", "author": "Perez, M., Ellingson, L., Bai, Y., Peyer, K. and Welk, G.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Intervention", "devices": "Charge", "population": "Adults", "dataUsed": "Steps", "abstract": "Evidence is equivocal regarding the benefits of wearable technology for increasing physical activity. Use of these devices in combination with health coaching strategies like motivational interviewing (MI) may be more effective.\nPURPOSE: The study examined if physical activity trackers increase activity levels in healthy adults and if the addition of MI results in greater benefits. A secondary purpose was to examine characteristics of those who were successful in increasing physical activity versus those who were not in order to determine who is more likely to benefit from this type of intervention.\n\nMETHODS: Ninety-four healthy men and women (mean age 41 ± 9 years) were randomly assigned to one of two groups for a 12-week intervention. Groups received either 1) a physical activity tracker (PAT) alone, or 2) a physical activity tracker and three sessions of MI (PAT+MI). Physical activity was assessed pre and post-intervention with accelerometers. Average steps per day were compared within and between groups pre- and post-intervention using paired and independent sample t-tests. Participants were then split into two groups based on whether they increased their mean daily step count from baseline. These post-hoc groups were then compared on demographic and baseline physical activity characteristics.\n\nRESULTS: Complete data were collected on 84 individuals. Physical activity measured in average steps per day did not increase significantly for either group (PAT+MI – pre: 7496 ± 2895 steps/day, post: 7624 ± 3557 steps/day; PAT – pre: 7519 ± 2259 steps/day, post: 7097 ± 2179 steps/day; p>0.05); further, no group differences were observed (p>0.05). When comparing those who improved over the intervention to those who did not, there were no differences in demographic characteristics including age, gender, income, or education level. However, those who improved over the intervention accumulated significantly fewer steps at baseline (6650 ± 2056 vs. 8522 ± 2871, p < 0.0001).\n\nCONCLUSION: The provision of a physical activity tracker (with or without brief MI sessions) was not sufficient to increase physical activity in this sample; however, individuals with low baseline activity achieved more significant benefits.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Physical_Activity_Trackers_in_Combination_with.1451.aspx", "newWindow": true } ] }, { "title": "Quantification of physical activity in adult patients with haemophilic arthropathy in prophylaxis treatment using a fitness tracker", "author": "Pérez-Alenda, S., Carrasco, J.J., Megías-Vericat, J.E., Poveda, J.L., Bonanad, S. and Querol, F.\t", "year": "2017", "journalProceedings": "Haemophilia", "category": "Measurement", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Distance", "abstract": "Not available", "links": [] }, { "title": "Interdependent Effects of Autonomous and Controlled Regulation on Exercise Behavior", "author": "Phillips, L.A. and Johnson, M.A.\t", "year": "2017", "journalProceedings": "Personality and Social Psychology Bulletin", "category": "Measurement", "devices": "Zip", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Self-determination theory (SDT) is used to predict individual differences in goal-directed behavior. A fundamental tenet of SDT is that autonomously regulated behavior is more likely to be engaged in and sustained than externally controlled behavior. Unidimensional treatment of regulation is suboptimal. The current study utilizes a multidimensional approach—polynomial regression—to evaluate the interdependent effects of autonomous and controlled regulation on physical activity. Results from three samples of healthy, younger adults demonstrate a mostly positive influence of autonomous regulation but a curvilinear effect of controlled regulation on behavior such that greater activity was associated with moderate levels of controlled regulation—an effect that cannot be identified with “unidimensional” methods. Results from Sample 3 showed that autonomous regulation was associated with greater exercise levels only when controlled regulation was moderate or high. Results suggest that controlled regulation is not wholly detrimental to behavioral promotion.", "links": [ { "caption": "URL", "url": "http://journals.sagepub.com/doi/10.1177/0146167217733068", "newWindow": true } ] }, { "title": "Wellness, sleep and exercise in emergency medicine residents: an observational study", "author": "Poonja, Z., O'Brien, P., Cross, E., Desrochers, C., Jaggi, P., Dance, E., Krentz, J. and Thoma, B.\t", "year": "2017", "journalProceedings": "Canadian Journal of Emergency Medicine", "category": "Measurement", "devices": "Charge", "population": "Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "Introduction: Burnout is well documented in residents and emergency physicians. Wellness initiatives are becoming increasingly prevalent, but there is a lack of data supporting their efficacy. In some populations, a relationship between sleep, exercise and wellness has been documented, but this relationship has not been established in emergency medicine (EM) residents or physicians. We aim to determine whether exercise and sleep quality and quantity as measured by a Fitbit are associated with greater perceived wellness in EM residents. Methods: Fifteen EM residents from two training sites wore a Fitbit during a 4-week EM rotation. The Fitbit recorded data on sleep quantity (minutes sleeping)/quality (sleep disruptions) and exercise quantity (daily step count)/quality (daily active minutes performing activity of 3-6 and >6 metabolic equivalents). Participants completed an end-of-rotation Perceived Wellness Survey (PWS) which provided information on six domains of personal wellness (psychological, emotional, social, physical, spiritual and intellectual). Associations between PWS scores and the Fitbit markers were evaluated using a Mann-Whitney-U statistical analysis. Results: Preliminary results indicate that residents who scored =50th percentile for sleep quantity had significantly higher PWS scores than those who scored =50th percentile (median PWS 17.0 vs 13.0 respectively, p=0.04). There was no significant correlation between PWS scores, sleep interruptions, daily step count and average daily active minutes. Postgraduate Year PGY1 and PGY2-5 report median PWS scores of 13.9 and 17.2 respectively. Conclusion: To our knowledge, this is the first study to objectively measure the quality and quantity of sleep as well as exercise habits of EM residents using a Fitbit device. Our data indicates a significant relationship between better sleep quantity and higher wellness scores in this population. We aim to enroll 30 residents in order to obtain a more robust data set. A larger sample size will increase statistical power and allow us to more extensively evaluate the use of exercise and sleep monitoring devices in the efficacy assessment of wellness initiatives.", "links": [ { "caption": "URL", "url": "https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/p095-wellness-sleep-and-exercise-in-emergency-medicine-residents-an-observational-study/5DC4C9A470AA496E3A44D53AFBE1246A", "newWindow": true } ] }, { "title": "Step It Up: Higher Step Count Is Significantly Correlated with Better Exercise Capacity in Individuals with Cystic Fibrosis", "author": "Powers, K., Herzog, T., Loosen, H., Berg, K.V., Weir, B., Riekert, K.A. and Mogayzel, P.J.\t", "year": "2017", "journalProceedings": "American Journal of Respiratory and Critical Care Medicine", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Rationale: The positive health benefits of physical activity (PA) have been extensively studied and commonly accepted. The CDC and the American College of Sports Medicine have recommended regular PA to reduce risk factors for chronic disease including physical functioning, aerobic fitness and quality of life. PA in individuals with cystic fibrosis (CF) improves exercise capacity, slows decline in lung function, increases mucus clearance and improves health-related quality of life. Hypothesis: Increased daily PA as measured by step count in participants with CF will be associated with greater exercise capacity as measured by the Modified Shuttle Walk Test (MSWT). \n\nMethods: We completed the MSWT and spirometry in 22 participants at enrollment into the Do More, B’More, Live Fit trial. This randomized control trial is a 6-month fitness training program designed to optimize exercise habits of 12-21 year-olds. Participants received a FitBit Flex (Fitbit© Boston, MA). Daily step count was assessed over 7 consecutive days within the enrollment period prior to any intervention. The step count variables assessed included mean, median and highest daily step count. Lung function was measured via spirometry and was compared to both FitBit step count and the number of MSWT shuttles completed using multiple linear regression analysis and Spearman Rho correlation. \n\nResults: MWST shuttles were significantly correlated with better lung function as measured by FEV1pp, Rho=0.58 (p=0.005). FitBit step count (mean and maximum) was significantly correlated to performance on MSWT, Rho=0.53 (p=0.01) and Rho=0.58 (p=0.005) respectively. The association between mean FitBit step count with MSWT performance remained significant after controlling for FEV1pp, [overall model R2=0.67; step count B=0.006 (p=0.001)]. Similar results were found using the median step count and highest daily value step count values. \n\nConclusions: Measuring FitBit daily step count provides a novel approach to assessing effects of PA on exercise capacity in individuals with CF. More daily steps significantly correlated with better MSWT performance. Based on these data, it is suggested that daily fitness as reflected in FitBit step count may be a significant predictor for exercise capacity even after accounting for disease severity as measured by lung function. Within the context of the Do More, B’More, Live Fit trial, the value of step counts as a real-world measure of changes in exercise capacity may be further elucidated.", "links": [ { "caption": "URL", "url": "http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A6135", "newWindow": true } ] }, { "title": "Accuracy And Reliability Of The Fitbit Charge? Activity Tracker Among Older Adults", "author": "Powers, M., Smith, M., Henderson, O. and Bodman, T.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Wearable technology, including activity trackers, remains a top fitness trend world-wide; however, the ability of individual activity trackers to accurately and consistently record physical activity remains unknown.\nPURPOSE: To evaluate the accuracy and reliability of step counts from the Fitbit Charge™ among older adults.\n\nMETHODS: Thirteen participants with a mean age of 70.38 ±4.27 years volunteered to participate and completed all testing. Participants completed a 96 meter walk around a gymnasium while wearing the Fitbit Charge™ activity tracker. Step counts on the activity tracker were recorded before and after the walk to determine the step count. The walk was also video recorded to determine the actual number of steps taken during the walk. Step counts from video analysis were confirmed by two researchers. The same procedures were repeated on a second, non-consecutive day of testing to determine the reliability of the activity tracker. Accuracy of the activity tracker was determined by comparing step counts to the observed step counts from each testing session. The reliability of the activity tracker was determined by correlation analysis and comparison of step counts from the first testing session to the second testing session.\n\nRESULTS: The activity tracker significantly underestimated observed steps at both testing sessions by 21.31 steps and 22.62 steps, respectively (p < .05). No difference in step count from the activity tracker was seen from session one to session two (151.85 steps vs. 152.54 steps, p > .05); however, the correlation between the two sessions was only moderate, r = .55, p = .05.\n\nCONCLUSION: Among older adults, the Fitbit Charge™ appears to underestimate steps taken even over a short distance. The reliability of the Fitbit Charge™ is questionable given only a moderate correlation between sessions. While preliminary, these results call into question the accuracy and reliability of daily step counts from the Fitbit Charge™. It is suggested that all new activity trackers to hit the market are given careful study to determine their ability to accurately measure daily activity.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Accuracy_And_Reliability_Of_The_Fitbit_Charge_.1070.aspx", "newWindow": true } ] }, { "title": "Validation of a self-monitoring tool for use in exercise therapy.", "author": "Powierza, C.S., Clark, M.D., Hughes, J.M., Carneiro, K.A. and Mihalik, J.P.\t", "year": "2017", "journalProceedings": "PM&R", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Aerobic exercise at a sub-symptom heart rate has been recommended as therapy for Post-Concussion Syndrome (PCS). Assessing adherence with an accurate heart rate monitoring instrument is difficult limiting the proliferation of large-scale randomized controlled trials. \nOBJECTIVE: To evaluate the validity of the Fitbit Charge HR against electrocardiogram (EKG) to monitor heart rate during a treadmill-based exercise protocol. \nDESIGN: A methods comparison study. \nSETTING: Sports medicine research center within a tertiary care institution. \nPARTICIPANTS: A convenience sample of 22 healthy participants (12 female) aged 18-26 years (mean age: 22 ± 2 years). \nMETHODS: Fitbit Charge HR heart rate measurements were compared to EKG data concurrently collected while participants completed the Buffalo Concussion Treadmill Test (BCTT). \nMAIN OUTCOME MEASURES: Agreement between Fitbit Charge HR and EKG was assessed by intraclass correlation coefficients (ICC3,1), Bland-Altman limits of agreement, and percent error. RESULTS: We observed a strong single-measure absolute agreement between Fitbit Charge HR and EKG (ICC3,1 = 0.83; 95% CI: 0.67 - 0.90). Fitbit Charge HR underestimated heart rate compared to EKG (mean difference = -6.04 beats per min (bpm); SD = 10.40 bpm; Bland-Altman 95% limits of agreement = -26.42 to 14.35 bpm). 69.9% of Fitbit heart rate measurements were within 10% error compared to EKG, and 91.5% of all heart rate measurements were within 20% error. \nCONCLUSIONS: While the mean bias in measuring heart rate was relatively small, the limits of agreement between the Fitbit Charge HR and EKG were broad. Thus, the Fitbit Charge HR would not be a suitable option for monitoring heart rate within a narrow range. For the purposes of post-concussion exercise therapy, the relatively inexpensive cost, easy implementation, and low maintenance make Fitbit Charge HR a viable option for assessing adherence to an exercise program when expensive clinical equipment is unavailable.", "links": [ { "caption": "URL", "url": "http://www.pmrjournal.org/article/S1934-1482(17)30425-2/abstract", "newWindow": true } ] }, { "title": " A Six-Week Supervised Exercise and Educational Intervention After Total Hip Arthroplasty: A Case Series", "author": "Pozzi, F., Madara, K. and Zeni Jr, J.A.\t", "year": "2017", "journalProceedings": "The International Journal of Sports Physical Therapy", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background and Purpose: Most rehabilitation interventions after total hip arthroplasty (THA) are not designed to return patients to high-levels of physical activity and, thus, low levels of physical activity and residual weakness are common. The purpose of this case series was to describe the feasibility and preliminary efficacy of an exercise and education intervention for patients after THA who have already completed formal outpatient physical therapy. Study Design: Case series Case Description: Two participants underwent unilateral THA seven (case A) or eight (case B) months prior to the intervention. Individuals participated in 18 treatment sessions that included progressive aerobic and strengthening exercises and meetings with a health coach. Change in function, strength, and self-reported physical activity were measured. Outcomes 12 months after surgery were compared to a historical cohort of patients after THA. Outcome: There were no adverse events during the intervention. At the end of the intervention, hip and knee strength on the surgical side increased approximately 30% compared to baseline in both cases. Activity level, and recreational performance, including walking up stairs and hiking uphill (case A), and running and golfing (case B), improved by the end of the intervention. Most changes were maintained at follow-up, although hip strength for case B decreased 27% after discharge from the intervention. Outcomes for both cases exceeded historical averages for patients 12 months after THA, with the exception of strength in case B. Discussion: The exercise intervention was well tolerated and without negative effects in two participants. Both par-ticipants increased their ability to complete demanding recreational and sports-related activities, physical activity, and demonstrated improved hip abductor and knee extensor strength. Further research is needed to evaluate the implementation and effectiveness of similar interventions after THA. Acknowledgements: We would like to acknowledge Alan Jette, PT, PhD, FAPTA and Stefano Zaffagnini, MD for critically reviewing our work; Tara Leonard, MS who carried out the health coach portion of the intervention; and Michael Brian, PhD for performing the graded exercise tests.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380869/", "newWindow": true } ] }, { "title": "Monitoring-Based Model for Personalizing the Clinical Process of Crohn's Disease", "author": "de Ramón-Fernández, A., Ruiz-Fernández, D., Marcos-Jorquera, D., Gilart-Iglesias, V. and Vives-Boix, V.\t", "year": "2017", "journalProceedings": "Sensors", "category": "Methods", "devices": "Flex", "population": "Patients", "dataUsed": "Steps", "abstract": "Crohn's disease is a chronic pathology belonging to the group of inflammatory bowel diseases. Patients suffering from Crohn's disease must be supervised by a medical specialist for the rest of their lives; furthermore, each patient has its own characteristics and is affected by the disease in a different way, so health recommendations and treatments cannot be generalized and should be individualized for a specific patient. To achieve this personalization in a cost-effective way using technology, we propose a model based on different information flows: control, personalization, and monitoring. As a result of the model and to perform a functional validation, an architecture based on services and a prototype of the system has been defined. In this prototype, a set of different devices and technologies to monitor variables from patients and their environment has been integrated. Artificial intelligence algorithms are also included to reduce the workload related to the review and analysis of the information gathered. Due to the continuous and automated monitoring of the Crohn's patient, this proposal can help in the personalization of the Crohn's disease clinical process.", "links": [ { "caption": "URL", "url": "http://www.mdpi.com/1424-8220/17/7/1570", "newWindow": true } ] }, { "title": "Can Fitness Trackers Help Diabetic and Obese Users Make and Sustain Lifestyle Changes?", "author": "Randriambelonoro, M., Chen, Y. and Pu, P.\t", "year": "2017", "journalProceedings": "Computer", "category": "Usability,Measurement", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Diabetic and obese users given a Fitbit fitness tracker for seven months identified the device's playfulness, practicality, persuasiveness, personalization, and privacy as the top motivators for its use. These results provide insights into designing wearable health monitors that are engaging enough to effect long-term change.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/document/7888406/", "newWindow": true } ] }, { "title": "Effectiveness of SmartMoms, a Novel eHealth Intervention for Management of Gestational Weight Gain: Randomized Controlled Pilot Trial", "author": "Redman, L.M., Gilmore, L.A., Breaux, J., Thomas, D.M., Elkind-Hirsch, K., Stewart, T., Hsia, D.S., Burton, J., Apolzan, J.W., Cain, L.E., Altazan, A.D., Ragusa, S., Brady, H., Davis, A., Tilford, J.M., Sutton, E.F. and Martin, C.K.\t", "year": "2017", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "Zip", "population": "Adults,Pregnant Women", "dataUsed": "Steps", "abstract": "Background: Two-thirds of pregnant women exceed gestational weight gain (GWG) recommendations. Because excess GWG is associated with adverse outcomes for mother and child, development of scalable and cost-effective approaches to deliver intensive lifestyle programs during pregnancy is urgent. Objective: The aim of this study was to decrease the proportion of women who exceed the Institute of Medicine (IOM) 2009 GWG guidelines. Methods: In a parallel-arm randomized controlled trial, 54 pregnant women (age 18-40 years) who were overweight (n=25) or obese (n=29) were enrolled to test whether an intensive lifestyle intervention (called SmartMoms) decreased the proportion of women with excess GWG, defined as exceeding the 2009 IOM guidelines, compared to no intervention (usual care group). The SmartMoms intervention was delivered through mobile phone (remote group) or in a traditional in-person, clinic-based setting (in-person group), and included a personalized dietary intake prescription, self-monitoring weight against a personalized weight graph, activity tracking with a pedometer, receipt of health information, and continuous personalized feedback from counselors. Results: A significantly smaller proportion of women exceeded the IOM 2009 GWG guidelines in the SmartMoms intervention groups (in-person: 56%, 10/18; remote: 58%, 11/19) compared to usual care (85%, 11/13; P=.02). The remote intervention was a lower cost to participants (mean US $97, SD $6 vs mean US $347, SD $40 per participant; Ptextless.001) and clinics (US $215 vs US $419 per participant) and with increased intervention adherence (76.5% vs 60.8%; P=.049). Conclusions: An intensive lifestyle intervention for GWG can be effectively delivered via a mobile phone, which is both cost-effective and scalable. Trial Registration: Clinicaltrials.gov NCT01610752; https://clinicaltrials.gov/ct2/show/NCT01610752 (Archived by WebCite at http://www.webcitation.org/6sarNB4iW) [JMIR Mhealth Uhealth 2017;5(9):e133]", "links": [ { "caption": "URL", "url": "http://mhealth.jmir.org/2017/9/e133/", "newWindow": true } ] }, { "title": "A Feasibility Study Examining Use of the FitBit Zip™ vs. the Accusplit Eagle AC 120 XL Pedometer to Increase Physical Activity for Persons with Mild Cognitive Disorder", "author": "Richeson, N.E. and Croteau, K.A.\t", "year": "2017", "journalProceedings": "Activities, Adaptation & Aging", "category": "Usability", "devices": "Zip", "population": "Older Adults", "dataUsed": "Steps", "abstract": "A feasibility study examined the use of the FitBit Zip™ (Figure 1) vs. the Accusplit Eagle AE 120 XL (Figure 2) on daily physical activity for older adults with mild cognitive impairment (MCI). The study used descriptive and inferential statistics in addition to post-test interviews. Ten participants with multiple chronic health conditions, ages ranging from 57 to 84, participated in the 2-week intervention. The descriptive data reported the range of daily steps to be 2,632 to 8,323. No significant correlations were found between the number of steps on age, device, education, gender, and location. Correlations between age and device (r = .732, n = 10, p = .016) and education and device (r = .860, n = 10, p = .001) were noted, suggesting the older and less educated participants used the pedometer rather than the FitBit™. The post-test interview data revealed four major themes: (a) motivation, (b) strategies, (c) constraints, and (d) benefits. Overall, older adults with MCI felt the wearable monitoring tools were useful in increasing physical activity.", "links": [ { "caption": "URL", "url": "https://www.tandfonline.com/doi/full/10.1080/01924788.2017.1385367", "newWindow": true } ] }, { "title": "A cluster-randomised controlled trial to promote physical activity in adolescents: the Raising Awareness of Physical Activity (RAW-PA) Study.", "author": "Ridgers, N.D., Timperio, A., Brown, H., Ball, K., Macfarlane, S., Lai, S.K., Richards, K., Ngan, W. and Salmon, J.\t", "year": "2017", "journalProceedings": "BMC Public Health", "category": "Methods", "devices": "Flex", "population": "Adolescents", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND Recent technological advances provide an alternative yet underutilised opportunity for promoting physical activity in youth. The primary aim of the Raising Awareness of Physical Activity (RAW-PA) Study is to examine the short- and longer-term impact of a wearable activity monitor combined with digital behaviour change resources on adolescents' daily physical activity levels. \n\nMETHODS/DESIGN RAW-PA is a 12 week, multicomponent physical activity intervention that utilises a popular activity tracker (Fitbit® Flex) and supporting digital materials that will be delivered online via social media. The resources target key behaviour change techniques. The intervention structure and components have been informed by participatory research principles. RAW-PA will be evaluated using a cluster randomised controlled trial design with schools as the unit of randomisation. Twelve schools located in Melbourne, Australia, will allocated to either the intervention or wait-list control group. The target sample size is 300 Year 8 adolescents (aged 13-14 years). Participants' moderate- to vigorous-intensity physical activity will be the primary outcome. Survey measures will be completed. Process factors (e.g. feasibility, acceptability/appeal, fidelity) will also be collected.\n\nDISCUSSION To our knowledge, this study will provide some of the first evidence concerning the effect of wearable activity trackers and digital behaviour change resources on adolescents' physical activity levels. This study will provide insights into the use of such technologies for physical activity promotion, which may have a significant impact on health education, promotion, practice and policy. Tregistration: July 7, 2016.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5209805/", "newWindow": true } ] }, { "title": "Smartphone-Enabled Health Coaching Intervention (iMOVE) to Promote Long-Term Maintenance of Physical Activity in Breast Cancer Survivors: Protocol for a Feasibility Pilot Randomized Controlled Trial", "author": "Ritvo, P., Obadia, M., Santa Mina, D., Alibhai, S., Sabiston, C., Oh, P., Campbell, K., McCready, D., Auger, L. and Jones, J.M.\t", "year": "2017", "journalProceedings": "JMIR Research Protocols", "category": "Methods", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "Background: Although physical activity has been shown to contribute to long-term disease control and health in breast cancer survivors, a majority of breast cancer survivors do not meet physical activity guidelines. Past research has focused on promoting physical activity components for short-term breast cancer survivor benefits, but insufficient attention has been devoted to long-term outcomes and sustained exercise adherence. We are assessing a health coach intervention (iMOVE) that uses mobile technology to increase and sustain physical activity maintenance in initially inactive breast cancer survivors. Objective: This pilot randomized controlled trial (RCT) is an initial step in evaluating the iMOVE intervention and will inform development of a full-scale pragmatic RCT. Methods: We will enroll 107 physically inactive breast cancer survivors and randomly assign them to intervention or control groups at the University Health Network, a tertiary cancer care center in Toronto, Canada. Participants will be women (age 18 to 74 years) stratified by age (55 years and older/younger than 55 years) and adjuvant hormone therapy (AHT) exposure (AHT vs no AHT) following breast cancer treatment with no metastases or recurrence who report less than 60 minutes of preplanned physical activity per week. Both intervention and control groups receive the 12-week physical activity program with weekly group sessions and an individualized, progressive, home-based exercise program. The intervention group will additionally receive (1) 10 telephone-based health coaching sessions, (2) smartphone with data plan, if needed, (3) supportive health tracking software (Connected Wellness, NexJ Health Inc), and (4) a wearable step-counting device linked to a smartphone program. Results: We will be assessing recruitment rates; acceptability reflected in selective, semistructured interviews; and enrollment, retention, and adherence quantitative intervention markers as pilot outcome measures. The primary clinical outcome will be directly measured peak oxygen consumption. Secondary clinical outcomes include health-related quality of life and anthropometric measures. All outcome measures are administered at baseline, after exercise program (month 3), and 6 months after program (month 9). Conclusions: This pilot RCT will inform full-scale RCT planning. We will assess pilot procedures and interventions and collect preliminary effect estimates. Clinical Trial: ClinicalTrials.gov NCT02620735; https://clinicaltrials.gov/ct2/show/NCT02620735 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02620735) [JMIR Res Protoc 2017;6(8):e165]", "links": [ { "caption": "URL", "url": "http://www.researchprotocols.org/2017/8/e165/", "newWindow": true } ] }, { "title": "An Acceptance and Commitment Therapy (ACT) intervention for Chronic Fatigue Syndrome (CFS): A case series approach", "author": "Roche, L., Dawson, D.L., Moghaddam, N.G. and Abey, A.\t", "year": "2017", "journalProceedings": "Journal of Contextual Behavioral Science", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "OBJECTIVE\nAcceptance and Commitment Therapy (ACT) has been shown to improve the psychological well-being of individuals suffering from a range of chronic health conditions, and aims to increase psychological flexibility in order to foster greater engagement in personally meaningful behavior. We aimed to assess whether the approach (delivered via guided bibliotherapy) may have utility for individuals experiencing the debilitating effects of Chronic Fatigue Syndrome (CFS).\nMETHODS\nWe used a mixed-methods multiple single-case design to explore the effects of a six week self-help ACT intervention for six participants diagnosed with CFS.\n\nRESULTS\nSignificant increases in ratings of valued living were replicated and maintained in four participants, with qualitative data further highlighting the importance of the values component of the intervention. Acceptance scores improved in four participants but were not maintained at follow-up, whereas improvements in psychological flexibility were observed and maintained for three participants. All participants wearing an activity monitor evinced increased physical activity postintervention, which was maintained at follow up in half of the participants.\n\nCONCLUSION\nThe ACT self-help intervention appeared to benefit most participants on at least one assessed metric, particularly in terms of the promotion and pursuit of individual values, and increased physical activity. However, the results suggest these benefits may be difficult to maintain longer term without further input.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S2212144717300315", "newWindow": true } ] }, { "title": "A telehealth intervention to promote healthy lifestyles after stroke: The Stroke Coach protocol", "author": "Sakakibara, B.M., Lear, S.A., Barr, S.I., Benavente, O., Goldsmith, C.H., Silverberg, N.D., Yao, J. and Eng, J.J.\t", "year": "2017", "journalProceedings": "International Journal of Stroke", "category": "Methods", "devices": "Zip", "population": "Older Adults,Patients", "dataUsed": "Steps", "abstract": "Rationale: Recurrent stroke is prevalent and associated with high mortality rates, disability, and social and economic costs. Adequate management of risk factors may reduce recurrent stroke; however, many stroke survivors have poor control of risk factors. We have developed a theoretically sound and evidence-based lifestyle modification program called the Stroke Coach, a telephone-based self-management program to improve control of risk factors.\nHypothesis: Individuals who participate in Stroke Coach will achieve more lifestyle improvements than individuals in an attention controlled Memory Training Program.\n\nDesign: In this single blind randomized controlled trial, 126 community-living stroke survivors will be randomized to Stroke Coach or the attention control group. Participants randomized to the six-month Stroke Coach will receive seven telephone lifestyle coaching sessions, self-management education and practice, and a self-monitoring kit, comprised of a health report card, with blood pressure and activity monitors.\n\nStudy Outcomes: The primary outcome will be measured using the Health Promoting Lifestyle Profile II. Secondary outcomes include behavioral and physiological risk factors, quality of life, cognitive status, health and social service use. Measurements will be taken at baseline, immediately after the intervention and six-month post-intervention.\n\nSummary: The results of this trial will add to our understanding of the use of self-management to improve control of risk factors, and may facilitate the development of a larger trial evaluating the effect of Stroke Coach on endpoints such as recurrent stroke or cardiac events as the primary outcome.", "links": [ { "caption": "URL", "url": "http://journals.sagepub.com/doi/10.1177/1747493017729266", "newWindow": true } ] }, { "title": "Heart rate and sentiment experimental data with common timeline", "author": "Salamon, J. and Moucek, R.\t", "year": "2017", "journalProceedings": "Data in Brief", "category": "Measurement", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Sentiment extraction and analysis using spoken utterances or written corpora as well as collection and analysis of human heart rate data using sensors are commonly used techniques and methods. On the other hand, these have been not combined yet. The collected data can be used e.g. to investigate the mutual dependence of human physical and emotional activity.\nThe paper describes the procedure of parallel acquisition of heart rate sensor data and tweets expressing sentiment and difficulties related to this procedure. The obtained datasets are described in detail and further discussed to provide as much information as possible for subsequent analyses and conclusions. Analyses and conclusions are not included in this paper.\n\nThe presented experiment and provided datasets serve as the first basis for further studies where all four presented data sources can be used independently, combined in a reasonable way or used all together. For instance, when the data is used all together, performing studies comparing human sensor data, acquired noninvasively from the surface of the human body and considered as more objective, and human written data expressing the sentiment, which is at least partly cognitively interpreted and thus considered as more subjective, could be beneficial.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S2352340917305577", "newWindow": true } ] }, { "title": "Accuracy of Fitbit Charge 2 Worn at Different Wrist Locations During Exercise", "author": "Salazar, V.E., Lucio, N.D. and Funk, M.D.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Many newly released activity monitors use heart rate measured at the wrist to estimate exercise intensity, however, where the device is placed on the wrist may affect accuracy of the measurement.\nPURPOSE: To determine whether the Pure Pulse technology on the Fitbit Charge 2 will show different heart rate readings when placed on the recommended exercise position compared to the all-day wear position at various exercise intensities.\n\nMETHODS: Thirty five participants (MEAN ± SD; 22.0 ± 2.9yrs; 23.9 ± 2.6kg/m2; 18 male) consented to participate in a single visit where two Fitbit Charge 2 devices were placed on the non-dominant wrist. Fitbit A was placed 2-3 fingers above the wrist bone. Fitbit B was placed directly above the wrist bone. The treadmill was set at 3 mph with 0% grade. Participants remained at this speed for 4 minutes. Heart rate measurements were taken at the last 10 seconds of each stage from both Fitbits and a polar heart rate monitor (chest strap). The same procedure was followed for 5 and 6 mph. Statistical analyses were performed using IBM SPSS 23.0. A Two-way (speed x location) Repeated Measures ANOVA was used to examine mean differences. Pairwise comparisons with Bonferroni correction were used in post-hoc analysis. Pearson correlations and mean bias between polar heart rate monitor and activity monitors were also calculated for each speed.\n\nRESULTS: Repeated Measures ANOVA found significant differences between speeds (ptextless0.01) and location (ptextless0.01), but not for the interaction (p=0.234). Pairwise comparisons indicated significant differences between each speed (ptextless0.01) and between the polar monitor and Fitbit B (ptextless0.05), but not between the polar monitor and Fitbit A (p=0.608). Pearson correlations indicated strong correlations between each Fitbit and the polar monitor (r= .58-.91; all ptextless0.01). Mean bias decreased as speed increased for Fitbit A (mean bias bpm ± SD; -1.1 ± 5.4; -1.9 ± 9.5; -0.4 ± 6.9; -0.3 ± 7.3 for resting, 3mph, 5mph, 6mph respectively) while mean bias for Fitbit B increased as speed increased (-2.8 ± 8.8; -3.1 ± 11.1; -3.9 ± 14.6; -6.7 ± 14.3 for resting, 3mph, 5mph, 6mph respectively).\n\nCONCLUSION: Wrist-worn heart rate monitors appear to provide values adequate for recreational use, however, following recommended guidelines on wear-position may impact heart rate readings.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Accuracy_of_Fitbit_Charge_2_Worn_at_Different.1085.aspx", "newWindow": true } ] }, { "title": "Step count accuracy and reliability of two activity tracking devices in people after stroke", "author": "Schaffer, S.D., Holzapfel, S.D., Fulk, G. and Bosch, P.R.\t", "year": "2017", "journalProceedings": "Physiotherapy Theory and Practice", "category": "Validation", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background/Purpose: The increasing popularity of activity tracking devices presents an opportunity to monitor physical activity in patients after stroke. We sought to determine the reliability and accuracy of the Garmin Vivofit and Fitbit Zip for adults after stroke. Methods: Twenty-four participants with stroke-induced hemiparesis wore a Fitbit Zip on the nonparetic hip and Garmin Vivofits on both wrists during a 6-minute walk test to determine the accuracy of the devices against video-determined step counts. Participants also wore the devices during two trials of exactly 50 steps to determine the reliability of the devices. Results: Fitbit Zip showed excellent reliability (ICC2,1 = 0.974) and accuracy (4.2% error) for participants who walked faster than 0.35 m/s. Garmin Vivofit (nonparetic side) had excellent reliability (ICC2,1 = 0.964) but poor accuracy (=-16.0%) for all participants. Garmin Vivofit (paretic side) had excellent reliability (ICC2,1 = 0.858) and accuracy (-4.0% error) for faster walkers (> 0.48 m/s) but poor accuracy (-68.2%) for slower walkers. Conclusion: Fitbit Zip was more accurate and reliable for persons with stroke than Garmin Vivofit, but slower walking speeds were associated with greater undercounting of steps for both devices. The Fitbit Zip is appropriate for counting steps in adults poststroke who range from household to community ambulators.", "links": [ { "caption": "URL", "url": "https://www.tandfonline.com/doi/full/10.1080/09593985.2017.1354412", "newWindow": true } ] }, { "title": "Piloting a mobile health intervention to increase physical activity for adolescents with ADHD", "author": "Schoenfelder, E., Moreno, M., Wilner, M., Whitlock, K.B. and Mendoza, J.A.\t", "year": "2017", "journalProceedings": "Preventive Medicine Reports", "category": "Intervention", "devices": "Flex", "population": "Patients,Adolescents", "dataUsed": "Steps", "abstract": "Physical activity (PA) reduces symptoms of Attention Deficit Hyperactivity Disorder (ADHD); interventions to increase PA may improve functioning and health for adolescents with ADHD. Mobile health (mHealth) technology and social media constitute promising interactive modalities for engaging adolescents—who are at highest risk for ADHD treatment drop-out—in interventions to increase PA. The current pilot study evaluated feasibility and acceptability of an innovative intervention incorporating an mHealth-linked wearable activity tracker (Fitbit Flex) and a Facebook group to increase PA among adolescents with ADHD. 11 adolescents diagnosed with ADHD (age 14–18, m=15.5; 54% female) participated in a 4-week trial utilizing the Fitbit Flex in conjunction with (1) weekly personalized step count goals (2) social support through a Facebook group and (3) daily text messages about PA. The study took place in the greater Seattle, Washington area in the fall of 2015. Adolescents completed online surveys twice per week to rate their ADHD symptoms and positive and negative mood states, and parents rated adolescent ADHD symptoms weekly. Participants were adherent to the study protocol and acceptability of the intervention was high. Linear mixed models indicated that participants significantly increased their average weekly steps over the course of the study and demonstrated improvements in both adolescent and parent-reported ADHD Inattentive symptoms. Results indicate that this mHealth intervention is engaging and promising for increasing PA among adolescents with ADHD, and warrant further study. Implications for improving ADHD symptoms and overall functioning for this undertreated population are discussed.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S2211335517300451", "newWindow": true } ] }, { "title": "What factors predict Fitbit adherence in Stroke and Parkinson disease?", "author": "Schrader, K., Mentis, H., Phipps, M., Barr, E., Gruber-Baldini, A., Yarbrough, K., Coelln, F.R.V. and Shulman, L.\t", "year": "2017", "journalProceedings": "Neurology", "category": "Usability", "devices": "Charge HR", "population": "Patients,Children", "dataUsed": "Heart Rate", "abstract": "Objective: To investigate predictors of adherence to wearing the Fitbit activity monitor in patients with Parkinson disease (PD) and stroke.\nBackground: Exercise and activity improve symptoms of PD and stroke, and aid in primary and secondary stroke prevention. However, adherence to physical activity programs is low and little is known about adherence to daily activity monitoring.\n\nDesign/Methods: Patients (n=19, age=58.8+/-11, range 37–83Y) with PD (n=12) and stroke (n=8) participated in a pilot study to investigate feasibility and adherence of Fitbit monitoring to track activity between clinical office visits.\n\nResults: Comparing PD and stroke, PD patients were more disabled (Rankin; p= .004) but more likely to be employed (p= .03). Stroke patients were more depressed (PROMIS; p=.045), more cognitively impaired (MoCA; p=.02) and had lower numeracy (Subjective Numeracy Scale; p=.03). Fitbit data was collected for 28–53 days (mean=32.9). Patients used the Fitbit for 86% of days and 13.5 hours/day on average. Average steps/day were 6041+/-2797. The only significant predictor of adherence to the Fitbit (% of days used) was medical co-morbidity (r=-.46, p=.047) such that those with greater comorbidity (Cumulative Illness Rating Scale) wore the Fitbit less. Other high correlations with adherence (but nonsignificant) were: PROMIS Self-Efficacy for Managing Medications (r=.57), Self-Efficacy for Managing Social Interactions (r=.46), greater e-Health Literacy (eHEALs; r=.39), and less pain (r=-.37). Adherence showed low correlation (rtextless.2) with disease severity, disability, cognition, depression, age and socioeconomic status.\n\nConclusions: The strongest predictor of adherence to daily activity monitoring was level of medical co-morbidity. Other determinants of adherence were self-efficacy for managing conditions, e-Health literacy and pain. Age and level of disability did not affect daily use of small wireless monitors to track activity in stroke and PD.", "links": [ { "caption": "URL", "url": "http://www.neurology.org/content/88/16_Supplement/P6.029.short", "newWindow": true } ] }, { "title": "Assessing the Influence of a Fitbit Physical Activity Monitor on the Exercise Practices of Emergency Medicine Residents: A Pilot Study", "author": "Schrager, J.D., Shayne, P., Wolf, S., Das, S., Patzer, R.E., White, M. and Heron, S.\t", "year": "2017", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: Targeted interventions have improved physical activity and wellness of medical residents. However, no exercise interventions have focused on emergency medicine residents. Objective: This study aimed to measure the effectiveness of a wearable device for tracking physical activity on the exercise habits and wellness of this population, while also measuring barriers to adoption and continued use. Methods: This pre-post cohort study enrolled 30 emergency medicine residents. Study duration was 6 months. Statistical comparisons were conducted for the primary end point and secondary exercise end points with nonparametric tests. Descriptive statistics were provided for subjective responses. Results: The physical activity tracker did not increase the overall self-reported median number of days of physical activity per week within this population: baseline 2.5 days (interquartile range, IQR, 1.9) versus 2.8 days (IQR 1.5) at 1 month (P=.36). There was a significant increase in physical activity from baseline to 1 month among residents with median weekly physical activity level below that recommended by the Centers for Disease Control and Prevention at study start, that is, 1.5 days (IQR 0.9) versus 2.4 days (IQR 1.2; P=.04), to 2.0 days (IQR 2.0; P=.04) at 6 months. More than half (60%, 18/30) of participants reported a benefit to their overall wellness, and 53% (16/30) reported a benefit to their physical activity. Overall continued use of the device was 67% (20/30) at 1 month and 33% (10/30) at 6 months. Conclusions: The wearable physical activity tracker did not change the overall physical activity levels among this population of emergency medicine residents. However, there was an improvement in physical activity among the residents with the lowest preintervention physical activity. Subjective improvements in overall wellness and physical activity were noted among the entire study population. [JMIR Mhealth Uhealth 2017;5(1):e2]", "links": [ { "caption": "URL", "url": "http://mhealth.jmir.org/2017/1/e2/", "newWindow": true } ] }, { "title": "Understanding physical activity lapses among women: responses to lapses and the potential buffering effect of social support", "author": "Schumacher, L.M., Arigo, D. and Thomas, C.\t", "year": "2017", "journalProceedings": "Journal of Behavioral Medicine", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Many women fail to meet recommended levels of physical activity (PA). Limited research has examined women's barriers to PA adoption during attempts to increase PA—in particular, how often they experience PA lapses (i.e., failure to meet PA goals), their cognitive–affective responses to lapses, and the role of social support in preventing or responding to lapses. The present study assessed weekly variability in PA lapses, cognitive–affective responses to lapses, and social support related to PA among women participating in a partner-based PA program (n = 20). Multilevel modeling showed that greater PA self-efficacy and more frequent partner communication predicted fewer lapses during the concurrent or subsequent week (ps textless 0.02). Interestingly, greater self-forgiveness for lapsing also predicted more lapses the subsequent week (p = 0.04), though greater perceived partner support appeared to buffer the negative effect of self-forgiveness on future lapses (p = 0.04). These findings demonstrate the importance of cognitive–affective responses to PA lapses for future PA, as well as the potential benefit of social support for preventing PA lapses among women.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s10865-017-9846-y", "newWindow": true } ] }, { "title": "Fitbit Vs Six Minute Walk in PAH", "author": "Sehgal, S., Chowdhury, A., Rabih, F., Gadre, A. and Highland, K.B.\t", "year": "2017", "journalProceedings": "American Journal of Respiratory and Critical Care Medicine", "category": "Measurement", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Rationale: The six minute walk test is a widely used instrument for monitoring and prognostication in patients with pulmonary arterial hypertension (PAH). It is a valid measure of exercise capacity and has been used as an endpoint in clinical trials. Limitations include a ‘ceiling effect’ in patients with minimal functional limitation and confounding factors affecting mobility. Accelerometers measure an individual's activity in step counts. A piezo-electric crystal measures acceleration, which is quantified as steps. Accelerometers have been validated as a measure of step count in patients with chronic lung disease. In patients with PAH, activity measured by an accelerometer has correlated with WHO functional class, six minute walk distance and survival. We prospectively studied the use of a wrist worn accelerometer (Fitbit ChargeHR) as a monitoring tool in patients with PAH. We present initial data from the first two weeks of patient monitoring. Methods: 30 ambulatory patients with WHO group one PAH were enrolled. A Fitbit ChargeHR was worn by the patient on the wrist until their next follow up visit. Six minute walk test, physical exam and WHO functional class stratification were done during the visits. Serum biomarkers and ECHO were done if clinically indicated. Pearson correlation test was used for continuous variables. ANOVA was performed for categorical variables. Results: 30 patients with WHO group one PAH (23- idiopathic, 7- connective tissue disease) with a mean age 50.49 ± 12.97 were enrolled. Mean six minute walk distance (6MWD) was 368.6 ± 144 m, WHO functional class classification was FC I- 10%, II-46%, III-36 %, IV- 2% The mean daily step count (r 0.55, p 0.004) and peak daily six minute step counts (r 0.44, p 0.01) in the first two weeks, correlated with the baseline 6MWD. Mean daily step count correlated with ability to self-care, but not with mobility, usual care, anxiety or pain. Both the daily step count and 6MWD did not correlate with NTproBNP levels and ECHO parameters (RA dilatation, LA dilatation, RV function, RVSP). Correlation of Step count with six minute walk distance – Pearson correlation Mean step count (two weeks) R=0.55 P=0.004 Peak daily six minute walk step count R=0.46 P=0.01 Conclusions: We demonstrate that daily step count measured by a wrist worn accelerometer (Fitbit ChargeHR) correlates with the 6MWD and ability to self-care in patients with PAH. 6MWD and daily step counts in our patients did not correlate with other PAH parameters measured. The Fitbit ChargeHR can be used to measure activity and a change over time may be useful monitoring tool.", "links": [ { "caption": "URL", "url": "http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A3110", "newWindow": true } ] }, { "title": "Validity and reliability of the Fitbit Zip as a measure of preschool children's step count", "author": "Sharp, C.A., Mackintosh, K.A., Erjavec, M., Pascoe, D.M. and Horne, P.J.\t", "year": "2017", "journalProceedings": "BMJ Open Sport & Exercise Medicine", "category": "Validation", "devices": "Zip", "population": "Children", "dataUsed": "Steps", "abstract": "Objectives Validation of physical activity measurement tools is essential to determine the relationship between physical activity and health in preschool children, but research to date has not focused on this priority. The aims of this study were to ascertain inter-rater reliability of observer step count, and interdevice reliability and validity of Fitbit Zip accelerometer step counts in preschool children.\nMethods Fifty-six children aged 3–4 years (29 girls) recruited from 10 nurseries in North Wales, UK, wore two Fitbit Zip accelerometers while performing a timed walking task in their childcare settings. Accelerometers were worn in secure pockets inside a custom-made tabard. Video recordings enabled two observers to independently code the number of steps performed in 3 min by each child during the walking task. Intraclass correlations (ICCs), concordance correlation coefficients, Bland-Altman plots and absolute per cent error were calculated to assess the reliability and validity of the consumer-grade device.\n\nResults An excellent ICC was found between the two observer codings (ICC=1.00) and the two Fitbit Zips (ICC=0.91). Concordance between the Fitbit Zips and observer counts was also high (r=0.77), with an acceptable absolute per cent error (6%–7%). Bland-Altman analyses identified a bias for Fitbit 1 of 22.8±19.1 steps with limits of agreement between −14.7 and 60.2 steps, and a bias for Fitbit 2 of 25.2±23.2 steps with limits of agreement between −20.2 and 70.5 steps.\n\nConclusions Fitbit Zip accelerometers are a reliable and valid method of recording preschool children's step count in a childcare setting.", "links": [ { "caption": "URL", "url": "http://bmjopensem.bmj.com/lookup/doi/10.1136/bmjsem-2017-000272", "newWindow": true } ] }, { "title": "Accuracy in Wrist-Worn, Sensor-Based Measurements of Heart Rate and Energy Expenditure in a Diverse Cohort", "author": "Shcherbina, A., Mattsson, C., Waggott, D., Salisbury, H., Christle, J., Hastie, T., Wheeler, M. and Ashley, E.\t", "year": "2017", "journalProceedings": "Journal of Personalized Medicine", "category": "Validation", "devices": "Surge", "population": "Adults", "dataUsed": "Energy Expenditure,Heart Rate", "abstract": "The ability to measure physical activity through wrist-worn devices provides an opportunity for cardiovascular medicine. However, the accuracy of commercial devices is largely unknown. The aim of this work is to assess the accuracy of seven commercially available wrist-worn devices in estimating heart rate (HR) and energy expenditure (EE) and to propose a wearable sensor evaluation framework. We evaluated the Apple Watch, Basis Peak, Fitbit Surge, Microsoft Band, Mio Alpha 2, PulseOn, and Samsung Gear S2. Participants wore devices while being simultaneously assessed with continuous telemetry and indirect calorimetry while sitting, walking, running, and cycling. Sixty volunteers (29 male, 31 female, age 38 ± 11 years) of diverse age, height, weight, skin tone, and fitness level were selected. Error in HR and EE was computed for each subject/device/activity combination. Devices reported the lowest error for cycling and the highest for walking. Device error was higher for males, greater body mass index, darker skin tone, and walking. Six of the devices achieved a median error for HR below 5% during cycling. No device achieved an error in EE below 20 percent. The Apple Watch achieved the lowest overall error in both HR and EE, while the Samsung Gear S2 reported the highest. In conclusion, most wrist-worn devices adequately measure HR in laboratory-based activities, but poorly estimate EE, suggesting caution in the use of EE measurements as part of health improvement programs. We propose reference standards for the validation of consumer health devices (http://precision.stanford.edu/).", "links": [] }, { "title": "Exercise- and Psychosocial-Based Interventions to Improve Daily Activity in Heart Failure: A Pilot Study", "author": "Shoemaker, M.J., Oberholtzer, N.L., Jongekrijg, L.E., Bowen, T.E., Cartwright, K., Hanson, K., Serba, D., Dickinson, M.G. and Kowalk, A.\t", "year": "2017", "journalProceedings": "Home Health Care Management & Practice", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "In individuals with heart failure (HF), low daily activity is associated with a poorer prognosis. The purpose of this pilot study was to investigate the effects of two home-based interventions on the primary HF-related outcome of daily activity and secondary outcomes of exercise tolerance, HF-related health status, and lower extremity functional strength in 16 patients with HF and implanted Medtronic implantable cardioverter defibrillator and cardiac resynchronization devices using a single-blind, randomized controlled pilot trial. Interventions were either daily activity feedback and encouragement or health coaching and home-based exercise. There were no significant differences in primary or secondary outcomes either between or within groups. Three subjects in each treatment group improved in two or more secondary outcomes, and only one improved in daily activity. Although the present pilot study incorporated both exercise and psychosocial components in the intervention, there was no effect on daily activity, perhaps because readiness for behavioral change was not accounted for either in group stratification/allocation or inclusion criteria.", "links": [ { "caption": "URL", "url": "http://journals.sagepub.com/doi/10.1177/1084822316683660", "newWindow": true } ] }, { "title": "\"Pre-Habilitation\" of Frail Candidates for Lung Transplantation Using a Mobile Health Enabled Home-Based Intervention Is Feasible and Safe", "author": "Singer, J., Soong, A., Bruun, A., Hays, S., Kukreja, J., Bracha, A., Chin, G., Wolters, P.J., Peters, M. and Garvey, C.M.\t", "year": "2017", "journalProceedings": "American Journal of Respiratory and Critical Care Medicine", "category": "Intervention", "devices": null, "population": "Patients,Adults", "dataUsed": null, "abstract": "Rationale: Frailty is prevalent in lung transplant candidates and is associated delisting or death on the waiting list. Studies in community dwelling older adults suggest that frailty may be reversible through exercise-based intervention. It is unknown whether such an intervention in advanced lung disease is safe. Herein, we report early feasibility and safety data on a pilot intervention to treat frailty in lung transplant candidates using novel mobile health technologies. Methods: In March 2016, we launched a pilot, home-based combined exercise and nutrition intervention in lung transplant candidates diagnosed with COPD or pulmonary fibrosis. We customized a commercially available telehealth platform (AidCube) originally designed for home-based pulmonary rehabilitation (PR). The platform features a participant-facing app and a web-based provider interface, allowing for real-time interaction and communication between participants and study personnel. In our protocol, an in-person assessment and training is performed and measures of frailty (Short Physical Performance Battery), disability, and health-related quality of life collected. Subjects are provided tablets loaded with the customized app and can choose from a tailored menu of exercises based on ATS/ERS PR recommendations. Subjects are taught how to safely perform the exercises in person and are provided Fitbit activity trackers. Once home, adherence, safety, and progress is assessed in real-time through AidCube, Fitbit and weekly phone check-ins. Based on participant feedback, exercises are progressed via the provider interface. After 8-weeks, measures of frailty, disability, HRQL, are reassessed. Results: To date, we have enrolled 15 participants (target n=24). Participants to date are 31% female with a mean age of 62 years (standard deviation [SD]=5), FEV1% predicted 48 (SD=27), and median LAS 35 (25, 75%: 33, 37). Over 209 participant-weeks of the intervention, we have observed no adverse events (i.e., falls/injuries, desaturations <85%, respiratory complications). Qualitatively, participants report the “app” platform is easy to use and that the embedded gamification features and Fitbit trackers help in motivation. Early adherence appears reasonable. Participants have completed a median of 44 exercises per week (95% confidence interval: 27, 55). Of the eight subjects who have completed the intervention, six adhered; of these, four demonstrated improvement in SPPB frailty by at least 1 point on a 12-point scale. Conclusions: Preliminarily, a home-based pre-habilitation program to treat frailty in lung transplant candidates using a novel mobile health technology appears feasible and safe. Also, our very early data support that frailty is modifiable in a population of adults with end-stage lung disease.", "links": [ { "caption": "URL", "url": "http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A2342", "newWindow": true } ] }, { "title": "Accuracy Of Steps, Energy Expenditure, And Distance In Nine Activity Trackers", "author": "Smith, M.A.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge,Charge HR,Surge", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Distance", "abstract": "PURPOSE: To evaluate the accuracy of the step counts, energy expenditure (EE), and distance measured from 9 consumer grade activity trackers.\nMETHODS: Twenty participants completed 1 mile of walking followed by 1 mile of running on a treadmill in the lab. Participants completed 3 sessions of exercise while wearing as many as 4 devices set up for their height, weight, and age in addition to an Actigraph GT3X (GT3X) accelerometer. Devices included in the study were (1) the Fitbit Surge (FBS), Charge (FBC), and Charge HR (FBH); (2) the Garmin Vivoactive (GVA) and Vivosmart HR (GVS); (3) the Jawbone UP2 and UP3; (4) the Polar Loop and; (5) the Microsoft Band 2 (MSB). Data from the devices were compared to the GT3X for steps and American College of Sports Medicine metabolic equations (ACSMME) for estimated EE. Distance recorded by the devices was compared to the 1-mile treadmill completed distance.\n\nRESULTS: The GVA and GVS performed best with accurate measures for running steps counted, walking EE, running EE, and walking distance (p < .05). The FBH and UP3 performed worst with only accurate step counts for running (p < .05). The FBH and FBS underestimated walking steps by 370 steps (p < .000) and 318 steps (p = .002) respectively. Only the PL and UP2 were accurate for steps counted at a walking pace; however, both devices underestimated steps at 48 steps (p = .227) and 86 steps (p = .06) respectively.\n\nCONCLUSION: Few devices accurately measured steps at speeds lower than 4.5mph when compared to a validated accelerometer; however, most devices may accurately measure steps taken at speeds greater than 4.5mph. Few devices accurately measured EE for a 1-mile walk or run when compared to ACSMME. Few devices accurately measured distance for a walk, and none of the devices accurately measured distance for a run. It is recommended that accuracy should be considered when using activity tracking devices for the measurement of daily physical activity.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Accuracy_Of_Steps,_Energy_Expenditure,_And.1066.aspx", "newWindow": true } ] }, { "title": "Maintained Physical Activity Induced Changes in Delay Discounting", "author": "Sofis, M.J., Carrillo, A. and Jarmolowicz, D.P.\t", "year": "2017", "journalProceedings": "Behavior Modification", "category": "Intervention", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps", "abstract": "Those who discount the subjective value of delayed rewards less steeply are more likely to engage in physical activity. There is limited research, however, showing whether physical activity can change rates of delay discounting. In a two-experiment series, treatment and maintenance effects of a novel, effort-paced physical activity intervention on delay discounting were evaluated with multiple baseline designs. Using a lap-based method, participants were instructed to exercise at individualized high and low effort levels and to track their own perceived effort. The results suggest that treatment-induced changes in discounting were maintained at follow-up for 13 of 16 participants. In Experiment 2, there were statistically significant group-level improvements in physical activity and delay discounting when comparing baseline with both treatment and maintenance phases. Percentage change in delay discounting was significantly correlated with session attendance and relative pace (min/mile) improvement over the course of the 7-week treatment. Implications for future research are discussed.", "links": [ { "caption": "URL", "url": "http://journals.sagepub.com/doi/full/10.1177/0145445516685047", "newWindow": true } ] }, { "title": "Analyzing Sensor-Based Time Series Data to Track Changes in Physical Activity during Inpatient Rehabilitation", "author": "Sprint, G., Cook, D., Weeks, D., Dahmen, J. and La Fleur, A.\t", "year": "2017", "journalProceedings": "Sensors", "category": "Methods", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Time series data collected from sensors can be analyzed to monitor changes in physical activity as an individual makes a substantial lifestyle change, such as recovering from an injury or illness. In an inpatient rehabilitation setting, approaches to detect and explain changes in longitudinal physical activity data collected from wearable sensors can provide value as a monitoring, research, and motivating tool. We adapt and expand our Physical Activity Change Detection (PACD) approach to analyze changes in patient activity in such a setting. We use Fitbit Charge Heart Rate devices with two separate populations to continuously record data to evaluate PACD, nine participants in a hospitalized inpatient rehabilitation group and eight in a healthy control group. We apply PACD to minute-by-minute Fitbit data to quantify changes within and between the groups. The inpatient rehabilitation group exhibited greater variability in change throughout inpatient rehabilitation for both step count and heart rate, with the greatest change occurring at the end of the inpatient hospital stay, which exceeded day-to-day changes of the control group. Our additions to PACD support effective change analysis of wearable sensor data collected in an inpatient rehabilitation setting and provide insight to patients, clinicians, and researchers.", "links": [ { "caption": "URL", "url": "http://www.mdpi.com/1424-8220/17/10/2219", "newWindow": true } ] }, { "title": "Activity-tracking devices for older adults: comparison and preferences", "author": "Steinert, A., Haesner, M. and Steinhagen-Thiessen, E.\t", "year": "2017", "journalProceedings": "Universal Access in the Information Society", "category": "Usability", "devices": "Flex", "population": "Older Adults", "dataUsed": null, "abstract": "Research demonstrates that physical activity beneficially influences brain function, quality of life and reduces cardiovascular diseases. Therefore, many projects and technical developments aim to promote physical activity. As a result of the “quantified self”-movement, a great number of wearable technologies, which are mainly developed for a younger target group, emerged on the market. However, there is a lack of scientific studies to establish which systems are suitable for older adults and there is still little known about seniors' needs and preferences regarding fitness trackers. In this crossover-designed usability study, 20 older adults aged over 60 took part. In the study, all participants were requested to rate the usability of five of the most widely used fitness trackers (Nike FuelBand, Jawbone Up, Fitbit Flex, Garmin vivofit, Sony SmartBand) and were asked about their preferences. Participants had to rate its ergonomic features such as handling, material and design. Overall, the fitness trackers differ a lot in tracking features, design, usability and acceptance of the seniors. We present an aggregated list of requirements for the “ideal” activity tracker for older adults. The results seem to be of high interest for developers, but also for scientists to choose appropriate sensors for technology-based interventions that may promote physical activity.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s10209-017-0539-7", "newWindow": true } ] }, { "title": "Healthy lifestyle intervention for African American uterine cancer survivors: Study protocol", "author": "Stewart, J.L., Besenyi, G.B., Williams, L.B., Burt, V., Anglin, J.C., Ghamande, S.A. and Coughlin, S.S.\t", "year": "2017", "journalProceedings": "Contemporary Clinical Trials Communications", "category": "Methods", "devices": "Blaze", "population": "Patients,Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance,Sleep,Heart Rate", "abstract": "BACKGROUND\nCancer of the uterine corpus is the most common gynecologic malignancy and the fourth most common cancer in U.S. women. There is a racial disparity in the survival from endometrial cancer and this may be addressed by culturally-tailored lifestyle interventions to help African American (AA) endometrial cancer survivors lose weight or maintain a healthy weight.\nOBJECTIVE\nThe overall purpose of this pilot study is to develop and evaluate a culturally-tailored lifestyle intervention to help AA uterine cancer survivors reduce their risk of cancer recurrence and improve their quality of life through healthy eating, physical activity, and weight management. While many interventions have been evaluated to assist cancer survivors through diet and physical activity, few have focused on AA women with a uterine cancer diagnosis.\n\nMETHODS\nCommunity-engaged research principles are being followed. This study was developed with input from the Augusta University (AU) College of Nursing Community Advisory Board (CAB) and the Division of Gynecologic Oncology at the Georgia Cancer Center at AU. Weekly sessions throughout a 12-week intervention will include physical activity and lectures on improving nutritional status. The pre/post-test design includes baseline and 6-month follow-up, where participants will complete a questionnaire that assesses knowledge and attitudes about physical activity, nutrition, uterine cancer, social support, and quality of life.\n\nCONCLUSIONS\nFrom this pilot study, we will learn more about the feasibility and integration of healthy lifestyle interventions in this patient population, and the results can provide an opportunity for a larger-scale, multi-center study with a randomized controlled design.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S245186541730039X", "newWindow": true } ] }, { "title": "Virtual Games and Real- World Communities: Environments that Constrain and Enable Physical Activity in Games for Health", "author": "Stewart, M.K., Hagood, D. and Ching, C.C.\t", "year": "2017", "journalProceedings": "International Journal of Game-Based Learning", "category": "Usability", "devices": null, "population": "Children,Adolescents", "dataUsed": null, "abstract": "This article examines two communities of youth who play an online game that integrates physical activity into virtual game play. Participating youth from two research sites—an urban middle school and a suburban junior high school—wore FitBits that tracked their physical activity and then integrated their real-world energy into game-world resource boosts. This incorporation of daily life as a mechanic of the video game creates a tangible connection between players' physical and virtual experiences. To better understand that connection, this article presents survey, GIS, and mapping data to detail the two communities as multi-domain ecologies, and then presents interview and focus group data to illustrate the players' perceptions of the affordances and limitations of their physical environments. Ultimately, the authors argue that a multi-layered analysis of real world communities is essential for designing games for health and for effectively facilitating game-based learning within players' complex ecologies.", "links": [ { "caption": "URL", "url": "http://www.igi-global.com/gateway/article/171665", "newWindow": true } ] }, { "title": "A multicenter controlled study for dementia prevention through physical, cognitive and social activities - GESTALT-kompakt.", "author": "Streber, A., Abu-Omar, K., Hentschke, C. and Rütten, A.\t", "year": "2017", "journalProceedings": "Clinical Interventions in Aging", "category": "Intervention", "devices": "Zip", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Prevention of dementia is a public health priority. Physical activity (PA) can reduce the risk of dementia, but the majority of people remain sedentary. We conducted a multicenter controlled study with older adults (60+ years). We hypothesized that an evidence-based PA intervention - GEhen, Spielen und Tanzen Als Lebenslange Tätigkeiten - kompakt [walking, playing and dancing as lifelong activities-compact] (GESTALT-kompakt) - would lead to significantly larger improvements in PA levels (step counts/Fitbit Zip™), cognitive functions (DemTect) and social activities (Social Activity Log), compared to an active control group. Data were collected at baseline and after 3 and 12 months. The intervention group received a 12-week (1/week) multimodal and multicomponent PA program, which combined PA with cognitive and social activities. The control group received either regular gymnastics or cognitive training (1/week). A mixed linear model was chosen for analysis. A total of 87 older individuals were recruited in the GESTALT-kompakt study (68 females, average age =76.0 years, SD ±9.2, range 52-95 years). Marginally significant differences were observed in the intervention group (n=57) in comparison to the control group (n=30), regarding improvements in PA (difference of mean changes =866.4 steps,p=0.055) after 3 months. However, their PA decreased to the baseline score value after 12 months (-866.0 steps,p=0.061). GESTALT-kompakt did not cause significant differences in cognitive functioning (-0.8620,p=0.074) and social activities (-0.2428,p=0.288) in comparison to the control intervention from T0 to T1. Sixteen (24.2%) study participants who finished T2 reported a negative life event during the follow-up period, which severely influenced their PA behavior. GESTALT-kompakt might be effective in increasing PA in the short term, but did not have a long-term impact on the PA levels, cognitive functions or social activities of the participants. We recommend PA programs with longer duration to change behavior in the long term.", "links": [] }, { "title": "The Spread of Physical Activity Through Social Networks", "author": "Stück, D., Hallgrímsson, H.T., Ver Steeg, G., Epasto, A. and Foschini, L.\t", "year": "2017", "journalProceedings": "Proceedings of the 26th International Conference on World Wide Web - WWW '17", "category": "Measurement,Methods", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "Many behaviors that lead to worsened health outcomes are modifiable, social, and visible. Social influence has thus the potential to foster adoption of habits that promote health and improve disease management. In this study, we consider the evolution of the physical activity of 44.5 thousand Fitbit users as they interact on the Fitbit social network, in relation to their health status. The users collectively recorded 9.3 million days of steps over the period of a year through a Fitbit device. 7,515 of the users also self-reported whether they were diagnosed with a major chronic condition. A time-aggregated analysis shows that ego net size, average alter physical activity, gender, and body mass index (BMI) are significantly predictive of ego physical activity. For users who self-reported chronic conditions, the direction and effect size of associations varied depending on the condition, with diabetic users specifically showing almost a 6-fold increase in additional daily steps for each additional social tie. Subsequently, we consider the co-evolution of activity and friendship longitudinally on a month by month basis. We show that the fluctuations in average alter activity significantly predict fluctuations in ego activity. By leveraging a class of novel non-parametric statistical tests we investigate the causal factors in these fluctuations. We find that under certain stationarity assumptions, non-null causal dependence exists between ego and alter's activity, even in the presence of unobserved stationary individual traits. We believe that our findings provide evidence that the study of online social networks have the potential to improve our understanding of factors affecting adoption of positive habits, especially in the context of chronic condition management.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=3038912.3052688", "newWindow": true } ] }, { "title": "A Mobile Health Application to Track Patients After Gastrointestinal Surgery: Results from a Pilot Study", "author": "Symer, M.M., Abelson, J.S., Milsom, J., McClure, B. and Yeo, H.L.\t", "year": "2017", "journalProceedings": "Journal of Gastrointestinal Surgery", "category": "Usability", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Introduction: Many surgical readmissions are preventable. Mobile health technology can identify nascent complications and potentially prevent readmission.\nMethods: We performed a pilot study of a new mobile health application in adults undergoing major abdominal surgery. Patients reported their pain, answered surveys, photographed their wound, were reminded to stay hydrated, and used a Fitbit™ device. Abnormal responses triggered alerts for further evaluation. Patients were followed postoperatively for 30 days and compliance with app use was tracked.\n\nResults: Thirty-one patients participated. Most were female (58%) and white (61%). Six (19%) had an ostomy as part of their surgery. 83.9% of patients completed an app-related task at least 70% of the time and 89% said using the app was easy to use. Patients generated an average of 1.1 alerts. One patient was readmitted and generated seven alerts prior to readmission. Patients participated most in collecting Fitbit data (84.8% of days) and completing a single-item photoaffective meter, but had more difficulty uploading photographs (51.4% completed). Eighty-nine percent of patients found the application easy to use.\n\nConclusions: A novel mobile health app can track patient recovery from major abdominal surgery, is easy to use, and has potential to improve outcomes. Further studies using the app are planned.", "links": [ { "caption": "URL", "url": "https://link.springer.com/article/10.1007%2Fs11605-017-3482-2", "newWindow": true } ] }, { "title": "Fitbit And Actigraph: A Comparison Of Physical Activity And Sedentary Time In Overweight/obese Adults", "author": "Szabo-Reed, A.N., Willis, E., Ptomey, L., Washburn, R. and Donnelly, J.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "here is limited information regarding the validity of consumer targeted wearable physical activity (PA) trackers, such as the Fitbit, to assess PA in free-living adults.\nPURPOSE: To compare daily minutes of sedentary time, and moderate-to-vigorous (MVPA) colleted using two types of activity trackers, in a sample of overweight and obese adults (n = 12, BMI= 37±4 kg/m2, age = 48±12 yrs.) who completed a 6-mo. weight loss intervention (diet + self-directed PA) delivered using Facebook.\n\nMETHODS: Participants wore a Fitbit FlexTM on their non-dominant wrist continuously over 6 mos. They were also asked to wear an ActiGraph GTX1TM on their non-dominant hip for 7 consecutive days at both baseline and 6 mos. Fitbit and ActiGraph data for a minimum of one 10-hr. day at baseline and 6 mos. was required for inclusion in this analysis. Categorization of sedentary time and MVPA was derived from the Fitbit algorithm or using NHANES Actigraph cut-points (Troiano, 2008).\n\nRESULTS: Sedentary time was significantly lower and MVPA was significantly higher when assessed with the Fitbit compared with the ActiGraph at both baseline (sedentary time: Fitbit = 427 ±168, ActiGraph = 639 ±132 min/d, p< 0.001; MPVA: Fitbit= 128 ±49, ActiGraph = 18 ±19 min/d, p <0.0001) or 6 mos. (sedentary time: Fitbit = 459 ±168, ActiGraph = 613 ±103 min/d, p= 0.001; MPVA: Fitbit= 123±53, ActiGraph= 14 ±10 min/d, p<0.0001). Change in both sedentary time and MVPA from baseline to 6 mos. was not statistically significant measured either with the Fitbit (sedentary time = +63 ±46, p =0.16; MVPA = -8±13 min/d, p = 0.72) or the ActiGraph (sedentary time = - 49±52, p =0.39; MVPA = -2±13 min/d, p = 0.48).\n\nCONCLUSIONS: The Fitbit significantly underestimated sedentary time and overestimated MVPA when compared with the ActiGraph in a small sample. Changes in sedentary time and MVPA over 6 mos. were non-significant when assessed by either the Fitbit or ActiGraph. These observations suggest that the Fitbit, which is relatively inexpensive when compared with the ActiGraph, may be useful for assessing changes in sedentary time and MVPA in response to an intervention. However, the absolute values for sedentary time and MVPA assessed by the Fitbit are questionable, and worthy of additional investigation in larger samples of free-living adults.Funded by Kansas City Life Sciences Institute", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Fitbit_And_Actigraph___A_Comparison_Of_Physical.1078.aspx", "newWindow": true } ] }, { "title": "Effect of sleep curtailment on dietary behavior and physical activity: A randomized crossover trial", "author": "Tajiri, E., Yoshimura, E., Hatamoto, Y., Tanaka, H. and Shimoda, S.\t", "year": "2017", "journalProceedings": "Physiology & Behavior", "category": "Measurement", "devices": "Charge HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "Our objective was to clarify the effect of sleep curtailment on energy intake (EI) and physical activity under free-living conditions. Participants were 16 healthy women aged 21–22 years. A randomized crossover trial design was used to compare a short sleep condition (SS): 4 h/night (2:00–6:00) and a control sleep condition (CS): 7 h/night (23:00–6:00). Each condition comprised 3 consecutive nights. Sleep duration was assessed using a wristwatch-type accelerometer at home. All living activities except sleeping were free-living. Physical activity was assessed using a tri-axial accelerometer, and was categorized by intensity level (sedentary; sedentary to light; moderate to vigorous). Participants were asked to purchase and consume meals with visible nutrient information. EI was evaluated by adding values from these food labels. Mean sleep duration in the two conditions was significantly different (4.3 ± 0.3 vs. 7.1 ± 0.4 h, p < 0.01). For the shared wakefulness period in the two conditions (6:00–23:00), step counts and physical activity were not significantly different. Sedentary time (878 ± 61 vs. 727 ± 40 min, p < 0.01), and sedentary to light-intensity activity time (1122 ± 18 vs. 932 ± 63 min, p textless 0.01) were significantly increased in SS (waking time, 06:00–02:00) compared with CS (waking time, 06:00–23:00). However, these significant effects were clearly attenuated after adjustment for awake time (p ≥ 0.05). Total EI was not significantly different between conditions (8.64 ± 0.82 vs. 8.46 ± 1.28 MJ, p = 0.05), nor were leptin levels (p > 0.05), but insulin and cortisol levels after SS were significantly higher than after CS (p < 0.05). In this study, physical activity was increased in the SS condition and attributed to differences in awake time between conditions. However, there were no differences in EI. Further studies to investigate the effect of sleep curtailment on weight gain through stress and insulin resistance are necessary.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S0031938417303992", "newWindow": false } ] }, { "title": "Harnessing Long Term Physical Activity Data—How Long-term Trackers Use Data and How an Adherence-based Interface Supports New Insights", "author": "Tang, L.M. and Kay, J.\t", "year": "2017", "journalProceedings": "Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies", "category": "Usability", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "Increasingly, people are amassing long term physical activity data which could play an important role for reflection. However, it is not clear if and how existing trackers use their long term data and incomplete data is a potential challenge. We introduced the notion of adherence to design iStuckWithIt, a custom calendar display that integrates and embeds daily adherence (days with data and days without), hourly adherence (hours of wear each day) and goal adherence (days people achieved their activity goals). Our study of 21 long term FitBit users (average: 23 months, 17 over 1 year) began with an interview about their use and knowledge of long term physical activity data followed by a think-aloud use of iStuckWithIt and a post-interview. Our participants gained new insights about their wearing patterns and they could then use this to overcome problems of missing data, to gain insights about their physical activity and goal achievement. This work makes two main contributions: new understanding of the ways that long term trackers have used and understand their data; the design and evaluation of iStuckWithIt demonstrating that people can gain new insights through designs that embed daily, hourly adherence data with goal adherence.", "links": [ { "caption": "URL", "url": "http://dl.acm.org/citation.cfm?doid=3120957.3090091", "newWindow": true } ] }, { "title": "Study protocol for the FITR Heart Study: Feasibility, safety, adherence, and efficacy of high intensity interval training in a hospital-initiated rehabilitation program for coronary heart disease", "author": "Taylor, J., Keating, S.E., Leveritt, M.D., Holland, D.J., Gomersall, S.R. and Coombes, J.S.\t", "year": "2017", "journalProceedings": "Contemporary Clinical Trials Communications", "category": "Methods", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND\nFor decades, moderate intensity continuous training (MICT) has been the cornerstone of exercise prescription for cardiac rehabilitation (CR). High intensity interval training (HIIT) is now recognized in CR exercise guidelines as an appropriate and efficient modality for improving cardiorespiratory fitness, a strong predictor of mortality. However, the clinical application of HIIT in a real world CR setting, in terms of feasibility, safety, and long-term adherence, needs further investigation to address ongoing reservations. Furthermore, studies using objective measures of exercise intensity (such as heart rate; HR) have produced variable outcomes. Therefore we propose investigating the use of subjective measures (such as rating of perceived exertion (RPE)) for prescribing exercise intensity.\nMETHODS\nOne hundred adults with coronary artery disease (CAD) attending a hospital-initiated CR program will be randomized to 1) HIIT: 4 × 4 min high intensity intervals at 15–18 RPE interspersed with 3-min active recovery periods or 2) MICT: usual care exercise including 40 min continuous exercise at a moderate intensity corresponding to 11–13 RPE. Primary outcome is change in exercise capacity (peak VO2) following 4 weeks of exercise training. Secondary outcome measures are: feasibility, safety, exercise adherence, body composition, vascular function, inflammatory markers, intrahepatic lipid, energy intake, and dietary behavior over 12-months; and visceral adipose tissue (VAT) following 12 weeks of exercise training.\n\nCONCLUSIONS\nThis study aims to address the ongoing concerns regarding the practicality and safety of HIIT in CR programs. We anticipate study findings will lead to the development of a standardized protocol to facilitate CR programs to incorporate HIIT as a standard exercise option for appropriate patients.", "links": [ { "caption": "URL", "url": "http://linkinghub.elsevier.com/retrieve/pii/S2451865417300571", "newWindow": true } ] }, { "title": "Accuracy of a step counter during treadmill and daily life walking by healthy adults and patients with cardiac disease", "author": "Thorup, C.B., Andreasen, J.J., Sørensen, E.E., Grønkjær, M., Dinesen, B.I. and Hansen, J.\t", "year": "2017", "journalProceedings": "BMJ Open", "category": "Validation", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND Step counters have been used to observe activity and support physical activity, but there is limited evidence on their accuracy. OBJECTIVE The purpose was to investigate the step accuracy of the Fitbit Zip (Zip) in healthy adults during treadmill walking and in patients with cardiac disease while hospitalised at home. METHODS Twenty healthy adults aged 39±13.79 (mean ±SD) wore four Zips while walking on a treadmill at different speeds (1.7-6.1 km/hour), and 24 patients with cardiac disease (age 67±10.03) wore a Zip for 24 hours during hospitalisation and for 4 weeks thereafter at home. A Shimmer3 device was used as a criterion standard. RESULTS At a treadmill speed of 3.6 km/hour, the relative error (±SD) for the Zips on the upper body was -0.02±0.67 on the right side and -0.09 (0.67) on the left side. For the Zips on the waist, this was 0.08±0.71 for the right side and -0.08 (0.47) on the left side. At a treadmill speed of 3.6 km/hour and higher, the average per cent of relative error was textless3%. The 24-hour test for the hospitalised patients showed a relative error of -47.15±24.11 (interclass correlation coefficient (ICC): 0.60), and for the 24-hour test at home, the relative error was -27.51±28.78 (ICC: 0.87). Thus, none of the 24-hour tests had less than the expected 20% error. In time periods of evident walking during the 24 h test, the Zip had an average per cent relative error of textless3% at 3.6 km/hour and higher speeds. CONCLUSIONS A speed of 3.6 km/hour or higher is required to expect acceptable accuracy in step measurement using a Zip, on a treadmill and in real life. Inaccuracies are directly related to slow speeds, which might be a problem for patients with cardiac disease who walk at a slow pace.", "links": [ { "caption": "URL", "url": "http://bmjopen.bmj.com/content/7/3/e011742", "newWindow": true } ] }, { "title": "Step Count Filters in Wearable Step Counters", "author": "Toth, L., Park, S., Pittman, W., Sarasaltik, D., Morton, A.L. and Bassett, D.R.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation,Methods", "devices": "Zip,Charge", "population": "Adults", "dataUsed": "Steps", "abstract": "Manufacturers of step counting devices apply filters to their step counting algorithms to prevent accumulation of steps when none are taken (i.e. false positives). However because filters prevent steps from being recorded during short, intermittent walking bouts, it is possible that these filters may be a source of error. Since few manufacturers disclose the type of filter they use, we decided to investigate this topic.\nPURPOSE: To determine whether the devices used in this study have a filter, and to describe the effects of the filter on short, intermittent walking bouts with varied walk and pause durations.\n\nMETHODS: In Parts A and B, 20 participants performed intermittent walking bouts for 2 min, at a cadence of 100 steps/min. In Part A participants were instructed to walk a certain number of steps (i.e. 4, 6, 8, 10, and 12) followed by a 10-sec pause and repeat this until the trial ended. In Part B participants were instructed to walk four steps followed by various pause intervals (i.e. 8, 6, 4, 2, and 1 sec) and repeat this. A researcher counted steps using a hand-tally device (criterion). “Percent of actual steps taken” was used for statistical analysis. A one-way repeated measures ANOVA was completed for both parts. In the case of significant overall effects (p textless 0.05), the results were further examined using planned contrasts to see which conditions differed from the criterion.\n\nRESULTS: In Parts A and B the multivariate results for ActiGraph GT3X (AG) (without low frequency extension) worn at the wrist, StepWatch 3, and Yamax Digi-Walker SW-200 were not significantly different from the criterion, indicating absence of a step count filter. Walking bouts shorter than 4 steps (AG at the hip), 6 steps (Withings), 8 steps (Omron and Garmin Vivofit 2), and 12 steps (Polar A360), resulted in a significant decrease in the number of steps counted, indicating presence of a filter. The minimum pause needed to break up a walking bout was 1 sec (Fitbit Charge, Fitbit Zip, and Withings), and textless 1 sec (Omron HJ-322U). For both the Polar and Garmin, the longer the pause, the less likely they were to record steps.\n\nCONCLUSIONS: Devices with step count filters will contribute to error in daily step counts because steps taken during short, intermittent walking bouts (e.g., meal preparation, and housework) are not registered.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/acsm-msse/Fulltext/2017/05001/Step_Count_Filters_in_Wearable_Step_Counters__1355.1080.aspx", "newWindow": true } ] }, { "title": "Validity of Different Activity Monitors to Count Steps in an Inpatient Rehabilitation Setting.", "author": "Treacy, D., Hassett, L., Schurr, K., Chagpar, S., Paul, S.S. and Sherrington, C.\t", "year": "2017", "journalProceedings": "Physical Therapy", "category": "Validation", "devices": "One,Charge", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background Commonly used activity monitors have been shown to be accurate in counting steps in active people, however, further validation is needed in slower walking populations. Objectives To determine the validity of activity monitors for measuring step counts in rehabilitation inpatients compared to visually-observed step counts. To explore the influence of gait parameters, activity monitor position and use of walkers on activity monitor accuracy. Methods 166 inpatients admitted to a rehabilitation unit with an average walking speed of 0.4 m/s (SD 0.2) wore 16 activity monitors (seven different devices in different positions) simultaneously during 6-minute and 6-metre walks. The number of steps taken during the tests was also counted by a physiotherapist. Gait parameters were assessed using the GAITRite system. To analyse the influence of different gait parameters, the percentage accuracy for each monitor was graphed against various gait parameters for each activity monitor. Results The StepWatch , Fitbit One worn on the ankle and the ActivPAL showed excellent agreement with observed step count (ICC 2,1 0.98; 0.92; 0.78 respectively). Other devices ( Fitbit Charge , Fitbit One worn on hip, G-Sensor , Garmin Vivofit , Actigraph ) showed poor agreement with the observed step count (ICC 2,1 0.12-0.40). Percentage agreement with observed step count was highest for the StepWatch (mean 98%). The StepWatch and the Fitbit One worn on the ankle maintained accuracy in individuals who walked more slowly and with shorter strides but other devices were less accurate in these individuals. Limitations There were small numbers of participants for some gait parameters. Conclusions The StepWatch showed the highest accuracy and closest agreement with observed step count. This device can be confidently used by researchers for accurate measurement of step counts in inpatient rehabilitation in individuals who walk slowly. If immediate feedback is desired, the Fitbit One when worn on the ankle would be the best choice for this population.", "links": [ { "caption": "URL", "url": "https://academic.oup.com/ptj/article-abstract/doi/10.1093/ptj/pzx010/3059635/Validity-of-Different-Activity-Monitors-to-Count?redirectedFrom=fulltext", "newWindow": true } ] }, { "title": "A model linking video gaming, sleep quality, sweet drinks consumption and obesity among children and youth", "author": "Turel, O., Romashkin, A. and Morrison, K.M.\t", "year": "2017", "journalProceedings": "Clinical Obesity", "category": "Measurement", "devices": null, "population": "Children", "dataUsed": "Steps", "abstract": "There is a growing need to curb paediatric obesity. The aim of this study is to untangle associations between video-game-use attributes and obesity as a first step towards identifying and examining possible interventions. Cross-sectional time-lagged cohort study was employed using parent–child surveys (t1) and objective physical activity and physiological measures (t2) from 125 children/adolescents (mean age?=?13.06, 9–17-year-olds) who play video games, recruited from two clinics at a Canadian academic children's hospital. Structural equation modelling and analysis of covariance were employed for inference. The results of the study are as follows: (i) self-reported video-game play duration in the 4-h window before bedtime is related to greater abdominal adiposity (waist-to-height ratio) and this association may be mediated through reduced sleep quality (measured with the Pittsburgh Sleep Quality Index); and (ii) self-reported average video-game session duration is associated with greater abdominal adiposity and this association may be mediated through higher self-reported sweet drinks consumption while playing video games and reduced sleep quality. Video-game play duration in the 4-h window before bedtime, typical video-game session duration, sweet drinks consumption while playing video games and poor sleep quality have aversive associations with abdominal adiposity. Paediatricians and researchers should further explore how these factors can be altered through behavioural or pharmacological interventions as a means to reduce paediatric obesity.", "links": [ { "caption": "URL", "url": "http://onlinelibrary.wiley.com/doi/10.1111/cob.12191/abstract", "newWindow": true } ] }, { "title": "Building research in diet and cognition: The BRIDGE randomized controlled trial.", "author": "Tussing-Humphreys, L., Lamar, M., Blumenthal, J.A., Babyak, M., Fantuzzi, G., Blumstein, L., Schiffer, L. and Fitzgibbon, M.L.\t", "year": "2017", "journalProceedings": "Contemporary clinical trials", "category": "Methods", "devices": null, "population": "Older Adults,Patients", "dataUsed": "Steps,Intensity,Distance", "abstract": "Obesity has been linked to cognitive impairment, cognitive decline and dementia. Given that 38.5% of U.S. adults 60years and older are obese and these numbers are rapidly increasing, strategies to decouple obesity from cognitive decline are needed. Innovative lifestyle strategies that may postpone the onset of subclinical symptoms or even arrest the transition to overt dementia in at-risk individuals are critically needed. Poor diet is central to the development of obesity and diet may affect cognition. Adherence to a Mediterranean Diet (MedDiet) is associated with reduced risk of cognitive impairment and dementia. Furthermore, weight loss through caloric restriction improves cognitive function. This paper describes the Building Research in Diet and CoGnition (BRIDGE) study, a randomized trial examining the effect of the MedDiet, with and without weight loss, on cognitive functioning in obese older adults. Obese (BMI=30 and =50kg/m(2)) older adults (=55years) (n=180) will be randomized in a 2:2:1 allocation scheme to: Typical Diet Control; MedDiet alone, without weight loss; or MedDiet lifestyle intervention to promote weight loss and weight loss maintenance. Both MedDiet intervention groups will meet for one individual session and 27 group sessions over an 8-month period. Individuals in the control group will be asked to maintain their current lifestyle. Outcomes will be assessed at baseline, 8 and 14months. The primary outcome is cognitive functioning; secondary outcomes will include changes in body weight, diet, cardiovascular, metabolic, and inflammatory biomarkers.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/28600159", "newWindow": true } ] }, { "title": "Patient-Specific Activity Level Benchmarks During Recovery for Total Knee Arthoplasty", "author": "Twiggs, J., Roe, J., Salmon, L., Miles, B. and Theodore, W.\t", "year": "2017", "journalProceedings": "Orthopaedic Proceedings", "category": "Measurement", "devices": null, "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Introduction: Ambulation in the postoperative period following TKR is a marker of speed of recovery and, potentially longer term outcomes. However, patient lifestyle factors are a major confounder. This study sought to develop a model of expected patient step count taking into account preoperative condition and demographics in order to benchmark recovery at a patient specific level.\nMethod: 94 patients were recruited to the study. BMI, demographics, the Short Form 12 (SF-12) and the Knee injury and Osteoarthritis Outcome Score (KOOS) were all captured preoperatively. Step count was measured using commercially available Fitbit devices preoperatively, immediately postoperatively and at 6 weeks postoperatively. Stepwise multiple linear regression models were developed using the preoperative information to define a predictive model of the postoperative step count levels. Spearman's Rho correlations for all relevant data series were also calculated.\n\nResults: Of the personal and clinical characteristics, BMI and the SF-12 physical component score had the strongest correlations with outcome. Prior step count periods all had significant correlations with later step count periods. The most significant correlations occurred between the 6 week postoperative step count period and the preoperative period (0.709), while correlations with the period immediately following surgery were weaker (0.389 and 0.536 for preoperative and 6 week postoperative step counts respectively.) All are significantly different from 0 (to p textless 0.01.) Likewise, BMI had a significantly negative relationship with step count (-0.526, -0.346 and -0.553 for the preoperative, immediate postoperative and 6 week postoperative periods, see Figure 2), as did the KOOS activities of daily living score and the SF-12 physical health component score. Males were significantly less mobile than females during recovery.\n\nA multiple linear regression model of 6 week step count using prior data had an adjusted R2 of 0.754, explaining much of the variation, but the immediate postoperative period performed poorly. Predictors in the 6 week model were gender, preoperative SF-12 score, preoperative and immediate postoperative step count.\n\nConclusions: Patient specific factors, including but not limited to that from prior step count periods need to be considered if using step count as a means of benchmarking patient recovery after surgery. The variation in recovery at 6 weeks is more readily explained with the data collected than in the immediate postoperative period, where variations in specific care received, anaesthetic response or surgical outcomes might be more expected to have an impact. Reporting patient performance against customised goals on an individual patient basis could provide a means to drive greater patient mobility and appropriate activity levels during postoperative recovery.", "links": [ { "caption": "URL", "url": "http://www.bjjprocs.boneandjoint.org.uk/content/99-B/SUPP_6/55", "newWindow": true } ] }, { "title": "Measurement of physical activity in the pre- and early post-operative period after total knee arthroplasty for Osteoarthritis using a Fitbit Flex device.", "author": "Twiggs, J., Salmon, L., Kolos, E., Bogue, E., Miles, B. and Roe, J.\t", "year": "2017", "journalProceedings": "Medical Engineering &Physics", "category": "Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Total knee arthroplasty (TKA) is a standard treatment for patients with end stage knee Osteoarthritis (OA) to reduce pain and restore function. The aim of this study was to assess pre- and early post-operative physical activity (PA) with Fitbit Flex devices for patients with OA undergoing TKA and determine any benchmarks for expected post-operative activity. Significant correlations of pre-operative step count, post-operative step count, Body Mass Index (BMI) and Short Form 12 Physical Component Summaries (SF-12 PCS) were found. Mean step counts varied by 3,203 steps per day between obese and healthy weight patients, and 3,786 steps per day between those with higher and lower SF-12 PCS scores, suggesting the need for benchmarks for recovery that vary by patient pre-operative factors. A backwards stepwise regression model developed to provide patient specific step count predictions at 6 weeks had an R(2) of 0.754, providing a robust patient specific benchmark for post-operative recovery, while population means from BMI and SF-12 subgroups provide a clinically practical alternative.", "links": [ { "caption": "URL", "url": "http://www.medengphys.com/article/S1350-4533(17)30262-X/fulltext", "newWindow": true } ] }, { "title": "Data presentation options to manage variability in physical activity research", "author": "Valbuena, D., Miller, B.G., Samaha, A.L. and Miltenberger, R.G.\t", "year": "2017", "journalProceedings": "Journal of Applied Behavior Analysis", "category": "Methods", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "This paper presents seven tactics for managing the variability evident in some physical activity data. High levels of variability in daily step-count data from pedometers or accelerometers can make typical visual inspection difficult. Therefore, the purpose of the current paper is to discuss several strategies that might facilitate the visual interpretation of highly variable data. The seven strategies discussed in this paper are phase mean and median lines, daily average per week, weekly cumulative, proportion of baseline, 7-day moving average, change point detection, and confidence intervals. We apply each strategy to a data set and discuss the advantages and disadvantages.", "links": [ { "caption": "URL", "url": "http://doi.wiley.com/10.1002/jaba.397", "newWindow": true } ] }, { "title": "Self-monitoring and reminder texts to increase physical activity after colorectal cancer (Smart Pace): A pilot trial.", "author": "Van Blarigan, E., Van Loon, K., Kenfield, S.A., Chan, J.M., Fukuoka, Y., Laffan, A., Mitchell, E., Chan, H., Rodriguez-Jaquez, D., Meyerhardt, J.A. and Venook, A.P.\t", "year": "2017", "journalProceedings": "Journal of Clinical Oncology", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background: Colorectal cancer (CRC) survivors can improve their quality-of-life (QOL), and potentially survival, by engaging in physical activity. The aim of this pilot randomized controlled trial (RCT) is to determine the feasibility of a technology-based physical activity intervention for CRC survivors. Methods: 40 CRC survivors will be randomized (1:1) to a 12-week physical activity intervention (Fitbit Flex, daily text messages) or usual care. Eligible individuals must: 1) have stage I-III colon or rectal adenocarcinoma; 2) have completed therapy; 3) be considered cancer-free; 4) be English speaking; 5) have no contraindications to moderate physical activity; 6) engage in < 150 min/week of moderate physical activity; and 7) have Internet and a phone that can receive text messages. Our primary outcomes are adherence (e.g., Fitbit wear time, text response rate) and acceptability assessed via survey. Secondary outcomes include change in physical activity via 7-days of ActiGraph GT3X+ accelerometers and QOL. Results: We have screened 350 individuals with stage I-III CRC at the University of California, San Francisco (UCSF) for eligibility. Of these, 181 (52%) were not eligible [non-English speaking (46%), = 150 min/week of physical activity (22%), contraindications to physical activity (22%), not cancer-free (7%), did not own a mobile phone (2%)]. We invited the remaining 169 eligible CRC survivors to participate by mail, e-mail, phone, or in clinic; 76 (45%) actively declined and 59 (35%) did not respond after up to 3 contact efforts. As of October 2016, 34 CRC survivors have been randomized to intervention (n = 16) or control (n = 18). These individuals are: 55% female; 64% Non-Hispanic White; 73% have a 4-y college degree; and 64% work full-time. The median (IQR) age and BMI are: 56 (50, 65) y and 26.4 (23.2, 32.4) kg/m2, respectively. Conclusions: The results of this pilot study will inform a definitive RCT to determine whether a technology-based physical activity intervention improves QOL and survival after CRC diagnosis. Funding: This research was supported by the NIH (K07CA197077, KL2TR000143), Mt. Zion Health Fund and UCSF Helen Diller Family Comprehensive Cancer Center.", "links": [ { "caption": "URL", "url": "http://ascopubs.org/doi/10.1200/JCO.2017.35.5_suppl.166", "newWindow": true } ] }, { "title": "The Fitbit One Physical Activity Tracker in Men With Prostate Cancer: Validation Study", "author": "Van Blarigan, E.L., Kenfield, S.A., Tantum, L., Cadmus-Bertram, L.A., Carroll, P.R. and Chan, J.M.\t", "year": "2017", "journalProceedings": "JMIR Cancer", "category": "Validation", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND Physical activity after cancer diagnosis improves quality of life and may lengthen survival. However, objective data in cancer survivors are limited and no physical activity tracker has been validated for use in this population. \nOBJECTIVE The aim of this study was to validate the Fitbit One's measures of physical activity over 7 days in free-living men with localized prostate cancer. \nMETHODS We validated the Fitbit One against the gold-standard ActiGraph GT3X+ accelerometer in 22 prostate cancer survivors under free-living conditions for 7 days. We also compared these devices with the HJ-322U Tri-axis USB Omron pedometer and a physical activity diary. We used descriptive statistics (eg, mean, standard deviation, median, interquartile range) and boxplots to examine the distribution of average daily light, moderate, and vigorous physical activity and steps measured by each device and the diary. We used Pearson and Spearman rank correlation coefficients to compare measures of physical activity and steps between the devices and the diary. \nRESULTS On average, the men wore the devices for 5.8 days. The mean (SD) moderate-to-vigorous physical activity (MVPA; minutes/day) measured was 100 (48) via Fitbit, 51 (29) via ActiGraph, and 110 (78) via diary. The mean (SD) steps/day was 8724 (3535) via Fitbit, 8024 (3231) via ActiGraph, and 6399 (3476) via pedometer. Activity measures were well correlated between the Fitbit and ActiGraph: 0.85 for MPVA and 0.94 for steps (all p < 001). The Fitbit's step measurements were well correlated with the pedometer (0.67, P=.001), and the Fitbit's measure of MVPA was well correlated with self-reported activity in the diary (0.84; p < .001).\nCONCLUSIONS Among prostate cancer survivors, the Fitbit One's activity and step measurements were well correlated with the ActiGraph GT3X+ and Omron pedometer. However, the Fitbit One measured two times more MVPA on average compared with the ActiGraph.", "links": [ { "caption": "URL", "url": "http://cancer.jmir.org/2017/1/e5/", "newWindow": true } ] }, { "title": "Identifying Beneficial Physical Activity During School Recess: Utility and Feasibility of the Fitbit", "author": "Van Camp, C.M. and Hayes, L.B.\t", "year": "2017", "journalProceedings": "Journal of Behavioral Education", "category": "Usability,Validation", "devices": "Classic", "population": "Children", "dataUsed": "Steps", "abstract": "The purpose of the current study was to assess the utility, feasibility, and reliability of Fitbit accelerometers to measure physical activity (via steps) of 15 young children simultaneously during recess. Fitbit-recorded steps per minute (SPM) were used as the primary measure to assess levels of activity in children playing in various structured (i.e., instructed) and unstructured (i.e., free play) recess activities. The results suggested that the number of steps measured by two Fitbits resulted in high levels of agreement, and the Fitbits were successful at identifying differential levels of activity across multiple types of play activities. Across all children, running or walking was associated with the most SPM (M = 89) and highest percentage of moderate-to-vigorous physical activity (MVPA; M = 47%), followed by soccer (M = 58 SPM; M = 12% MVPA), free play (M = 53 SPM; 3% MVPA), and tag (M = 43 SPM; 7% MVPA). The utility of the Fitbit's minute-by-minute data records was demonstrated, with the use of additional third-party software by Python, as differential levels of physical activity associated with various play behaviors were detected, and all 15 participants were assessed simultaneously with very few observers.", "links": [ { "caption": "URL", "url": "http://link.springer.com/10.1007/s10864-017-9276-5", "newWindow": true } ] }, { "title": "TEEN HEED: Design of a clinical-community youth diabetes prevention intervention", "author": "Vangeepuram, N., Williams, N., Constable, J., Waldman, L., Lopez-Belin, P., Phelps-Waldropt, L. and Horowitz, C.R.\t", "year": "2017", "journalProceedings": "Contemporary Clinical Trials", "category": "Methods", "devices": "One", "population": "Adolescents", "dataUsed": "Steps", "abstract": "No abstract available.", "links": [ { "caption": "URL", "url": "http://www.sciencedirect.com/science/article/pii/S1551714416301288", "newWindow": true } ] }, { "title": "Virtual Environment for Diabetes Self-Management Education and Support: Preliminary RCT Outcomes", "author": "Vorderstrasse, A., Melkus, G.D., Feinglos, M., Pan, W., Chang, J., Pereira, K., Reagan, L., Kreider, K., Totten, S., Burd, A., Nowlin, S., Birdsall, S. and Johnson, C.M.\t", "year": "2017", "journalProceedings": "Circulation", "category": "Intervention", "devices": null, "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "Introduction: Internet interventions are vital to reaching the growing population with type 2 diabetes.\nMethods: Based on our promising pilot study, we are conducting an RCT to test the efficacy of this virtual environment (LIVE) as compared to a traditional website format for providing education and support. The LIVE community is a gaming platform for adults with type 2 diabetes. Platform functionality allows for group information sharing and social networking, individual learning and behavior modification strategies. Participants attend synchronous diabetes education classes with educators and peers in the site; play games based on diabetes knowledge and scenarios; or visit locations (i.e., grocery store, bookstore) for advice and information to support adult learning and health behaviors.\n\nResults: 208 participants enrolled with mean age of 59 and diabetes duration of 10.9 years; 38% male; 56.5% White. Outcomes at six months reveal significant improvement in self-report physical activity (est 0.28;p=0.046) for those with the highest engagement in the LIVE site; and decrease in sedentary time (Fitbit™ data) for the LIVE group as compared to control (est -12.17;p=0.048). Those in the top quartile of time spent in the sites also had a significantly greater decrease in fat intake over 6 months in the LIVE group versus control (est -0.65;p=0.025). A1c did not decrease significantly overall; however, among those with A1c ≥10% at baseline there was a significant decrease (mean 11.42 [1.53] to 8.77 [1.49]; p=0.018).\n\nConclusions: These early RCT outcomes indicate that among those who are active participants, a virtual environment creates more positive behavioral changes than a traditional website for DSMT/S.", "links": [ { "caption": "URL", "url": "http://circ.ahajournals.org/content/136/Suppl_1/A17519", "newWindow": true } ] }, { "title": "Criterion-Validity of Commercially Available Physical Activity Tracker to Estimate Step Count, Covered Distance and Energy Expenditure during Sports Conditions", "author": "Wahl, Y., Düking, P., Droszez, A., Wahl, P. and Mester, J.\t", "year": "2017", "journalProceedings": "Frontiers in Physiology", "category": "Validation", "devices": "Charge,Charge HR", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Distance", "abstract": "Background: In the past years, there was an increasing development of physical activity tracker (Wearables). For recreational people, testing of these devices under walking or light jogging conditions might be sufficient. For (elite) athletes, however, scientific trustworthiness needs to be given for a broad spectrum of velocities or even fast changes in velocities reflecting the demands of the sport. Therefore, the aim was to evaluate the validity of eleven Wearables for monitoring step count, covered distance and energy expenditure (EE) under laboratory conditions with different constant and varying velocities.\n\nMethods: Twenty healthy sport students (10 men, 10 women) performed a running protocol consisting of four 5 min stages of different constant velocities (4.3; 7.2; 10.1; 13.0 km·h−1), a 5 min period of intermittent velocity, and a 2.4 km outdoor run (10.1 km·h−1) while wearing eleven different Wearables (Bodymedia Sensewear, Beurer AS 80, Polar Loop, Garmin Vivofit, Garmin Vivosmart, Garmin Vivoactive, Garmin Forerunner 920XT, Fitbit Charge, Fitbit Charge HR, Xaomi MiBand, Withings Pulse Ox). Step count, covered distance, and EE were evaluated by comparing each Wearable with a criterion method (Optogait system and manual counting for step count, treadmill for covered distance and indirect calorimetry for EE).\n\nResults: All Wearables, except Bodymedia Sensewear, Polar Loop, and Beurer AS80, revealed good validity (small MAPE, good ICC) for all constant and varying velocities for monitoring step count. For covered distance, all Wearables showed a very low ICC (<0.1) and high MAPE (up to 50%), revealing no good validity. The measurement of EE was acceptable for the Garmin, Fitbit and Withings Wearables (small to moderate MAPE), while Bodymedia Sensewear, Polar Loop, and Beurer AS80 showed a high MAPE up to 56% for all test conditions.\n\nConclusion: In our study, most Wearables provide an acceptable level of validity for step counts at different constant and intermittent running velocities reflecting sports conditions. However, the covered distance, as well as the EE could not be assessed validly with the investigated Wearables. Consequently, covered distance and EE should not be monitored with the presented Wearables, in sport specific conditions.", "links": [ { "caption": "URL", "url": "http://journal.frontiersin.org/article/10.3389/fphys.2017.00725/full", "newWindow": true } ] }, { "title": "Evaluation on Step Counting Performance of Wristband Activity Monitors in Daily Living Environment", "author": "Wang, L., Liu, T., Wang, Y., Li, Q., Yi, J. and Inoue, Y.\t", "year": "2017", "journalProceedings": "IEEE Access", "category": "Validation", "devices": "Charge", "population": "Adults", "dataUsed": "Steps", "abstract": "Wristband-placed physical activity monitors, as a convenient means for counting walking steps, assessing movement, and estimating energy expenditure, are widely used in daily life. There are many consumer-based wristband monitors on the market, but there is not an unified method to compare their performance. In this paper, we designed a series of experiments testing step counting performance under different walking conditions to evaluate these wristband activity monitors. Seven popular brands, including Huawei B1, Mi Band, Fitbit Charge, Polar Loop, Garmin Vivofit2, Misfit Shine, and Jawbone Up, were selected and evaluated with the proposed experiment method in this paper. These experiments include four parts, which are walking in a field at a different walking speed with and without arm swing, walking along a specified complex path, walking on a treadmill, and walking up and down stairs. Experiment results and analysis with nine healthy subjects were reported to show the step counting performance of these seven monitors.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/document/7967642/", "newWindow": true } ] }, { "title": "Polysomnography vs Consumer Devices: Comparing Common Sleep Indices", "author": "Wedderburn-Bisshop, J., Kharatishvili-Bredt, I., Martin, I. and Tolhurst, S.\t", "year": "2017", "journalProceedings": "Sleep", "category": "Validation", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Sleep", "abstract": "Introduction:\nAs public interest in health tracking technology increases, so too does the prevalence of commercially available consumer activity devices and apps utilising actigraphy. With the increase of the population's ability to access this technology, and limited research available on the concordance of these devices with polysomnography (PSG), the accuracy, specificity and sensitivity of the FitbitCharge HR device's common sleep indices were compared and evaluated against those of Level 1 PSG in participants with a diagnosis of respiration within normal limits and those with varying degrees of sleep-disordered breathing (SDB).\nMethods:\nAnalysis was performed on 41 participants (age, mean ± SD: 55?±?14 years; BMI ± SD: 32?±?6?kg/m2). The different categories of SDB were classified upon AASM PSG guidelines and consequently broken up into normal respiration (AHI = 5); mild OSA (AHI = 5 but = 14.99); moderate OSA (AHI = 15 but = 29.99); severe OSA (AHI = 30.0). Full overnight PSG was performed (in accordance with AASM guidelines) in a laboratory setting and recorded concurrently with the consumer device. Primary outcome measures were limited to sleep-onset latency (SOL), total sleep time (TST), wake after sleep-onset (WASO) and sleep-efficiency (SE). Exclusion criteria were applied.\nResults:\nThese common sleep indices of Fitbit Charge HR were compared to similar indices of PSG using paired t-tests and Bland-Altman plots. Significant differences were seen in SOL for the participants within the category of respiration within normal limits, moderate OSA and severe OSA; WASO was significantly different in all categories; SE was significantly different in the category of moderate OSA; there were no significant differences in TST at any category.\nConclusion:\nPrevious research has shown that actigraphy has high sensitivity in detecting sleep, but poor specificity in detecting wake in persons with respiration within normal limits. This poster shows that there was a significant difference in the participants with SDB in their SOL, SE and WASO but no difference in TST when comparing the FitbitCharge HR to PSG.", "links": [ { "caption": "URL", "url": "https://academic.oup.com/sleep/article-lookup/doi/10.1093/sleepj/zsx050.621", "newWindow": true } ] }, { "title": "Wearable Heart Rate Monitor Technology Accuracy in Research: A Comparative Study Between PPG and ECG Technology", "author": "Weiler, D.T., Villajuan, S.O., Edkins, L., Cleary, S. and Saleem, J.J.\t", "year": "2017", "journalProceedings": "Proceedings of the Human Factors and Ergonomics Society Annual Meeting", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Wearable heart rate (HR) monitors typically implement photoplethysmography (PPG) technology and are used in research as an alternative to electrocardiogram (ECG). However, questions surrounding the accuracy of PPG technology exist. To provide an answer regarding the question of accuracy, we conducted a study to compare average HR readings of two different HR technologies (PPG vs. ECG) after an interval style cardio-based workout. A total of 30 trials were conducted and average HR readings from the two HR technologies were compared using an ANOVA. Results revealed no significant difference between the two technologies. However, when HR reached around 155-160 beats per minute, a difference of +/− 5 beats per minute was observed between the two technologies with PPG HR readings being less than ECG. As a result, future research could consider the wearable PPG HR technology as accurate, but with certain experimental design implications.", "links": [ { "caption": "URl", "url": "http://journals.sagepub.com/doi/10.1177/1541931213601804", "newWindow": true } ] }, { "title": "Evaluating the Consistency of Current Mainstream Wearable Devices in Health Monitoring: A Comparison Under Free-Living Conditions", "author": "Wen, D., Zhang, X., Liu, X. and Lei, J.\t", "year": "2017", "journalProceedings": "Journal of Medical Internet Research", "category": "Validation", "devices": "Surge", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance,Sleep", "abstract": "Background: Wearable devices are gaining increasing market attention; however, the monitoring accuracy and consistency of the devices remains unknown. Objective: The purpose of this study was to assess the consistency of the monitoring measurements of the latest wearable devices in the state of normal activities to provide advice to the industry and support to consumers in making purchasing choices. Methods: Ten pieces of representative wearable devices (2 smart watches, 4 smart bracelets of Chinese brands or foreign brands, and 4 mobile phone apps) were selected, and 5 subjects were employed to simultaneously use all the devices and the apps. From these devices, intact health monitoring data were acquired for 5 consecutive days and analyzed on the degree of differences and the relationships of the monitoring measurements ??by the different devices. Results: The daily measurements by the different devices fluctuated greatly, and the coefficient of variation (CV) fluctuated in the range of 2-38% for the number of steps, 5-30% for distance, 19-112% for activity duration, .1-17% for total energy expenditure (EE), 22-100% for activity EE, 2-44% for sleep duration, and 35-117% for deep sleep duration. After integrating the measurement data of 25 days among the devices, the measurements of the number of steps (intraclass correlation coefficient, ICC=.89) and distance (ICC=.84) displayed excellent consistencies, followed by those of activity duration (ICC=.59) and the total EE (ICC=.59) and activity EE (ICC=.57). However, the measurements for sleep duration (ICC=.30) and deep sleep duration (ICC=.27) were poor. For most devices, there was a strong correlation between the number of steps and distance measurements (R2 >.95), and for some devices, there was a strong correlation between activity duration measurements and EE measurements (R2 > .7). A strong correlation was observed in the measurements of steps, distance and EE from smart watches and mobile phones of the same brand, Apple or Samsung (R2 > 88). Conclusions: Although wearable devices are developing rapidly, the current mainstream devices are only reliable in measuring the number of steps and distance, which can be used as health assessment indicators. However, the measurement consistencies of activity duration, EE, sleep quality, and so on, are still inadequate, which require further investigation and improved algorithms. [J Med Internet Res 2017;19(3):e68]", "links": [ { "caption": "URL", "url": "http://www.jmir.org/2017/3/e68/", "newWindow": true } ] }, { "title": "Sensing interstitial glucose to nudge active lifestyles (SIGNAL): feasibility of combining novel self-monitoring technologies for persuasive behaviour change.", "author": "Whelan, M.E., Kingsnorth, A.P., Orme, M.W., Sherar, L.B. and Esliger, D.W.\t", "year": "2017", "journalProceedings": "BMJ Open", "category": "Methods", "devices": "Charge 2", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "INTRODUCTION Increasing physical activity (PA) reduces the risk of developing diabetes, highlighting the role of preventive medicine approaches. Changing lifestyle behaviours is difficult and is often predicated on the assumption that individuals are willing to change their lifestyles today to reduce the risk of developing disease years or even decades later. The self-monitoring technologies tested in this study will present PA feedback in real time, parallel with acute physiological data. Presenting the immediate health benefits of being more physically active may help enact change by observing the immediate consequences of that behaviour. The present study aims to assess user engagement with the self-monitoring technologies in individuals at moderate-to-high risk of developing type 2 diabetes. METHODS AND ANALYSIS 45 individuals with a moderate-to-high risk, aged ≥40 years old and using a compatible smartphone, will be invited to take part in a 7-week protocol. Following 1 week of baseline measurements, participants will be randomised into one of three groups: group 1- glucose feedback followed by biobehavioural feedback (glucose plus PA); group 2-PA feedback followed by biobehavioural feedback; group 3-biobehavioural feedback. A PA monitor and a flash glucose monitor will be deployed during the intervention. Participants will wear both devices throughout the intervention but blinded to feedback depending on group allocation. The primary outcome is the level of participant engagement and will be assessed by device use and smartphone usage. Feasibility will be assessed by the practicality of the technology and screening for diabetes risk. Semistructured interviews will be conducted to explore participant experiences using the technologies. TRIAL REGISTRATION NUMBER ISRCTN17545949. Registered on 15/05/2017.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/28993396", "newWindow": true } ] }, { "title": "Physical Activity and Sleep Patterns in Hemodialysis Patients in a Suburban Environment.", "author": "Williams, S., Han, M., Ye, X., Zhang, H., Meyring-Wösten, A., Bonner, M., Young, C., Thijssen, S., Marsh, D. and Kotanko, P.\t", "year": "2017", "journalProceedings": "Blood Purification", "category": "Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps,Sleep", "abstract": "BACKGROUND/AIMS: Hemodialysis (HD) patients are less active than their healthy counterparts. They are often plagued with sleep disorders that affect the quality of their sleep. Our aim was to objectively quantify activity and sleep quality among HD patients in a suburban HD population. \n\nMETHODS: Activity and sleep parameters were measured using a commercially available activity tracker in 29 HD patients from Baton Rouge, LA, USA. Patients in the feedback group received their activity and sleep data at each dialysis treatment. In addition, questionnaires were administered at the beginning and end of the study period. Patients were stratified based on activity levels and sleep quality. \n\nRESULTS: Patients walked an average of 5,281 steps/day and slept 370.5 min/night. Informing patients about their daily number of steps taken, did not increase activity. Only 3% of the population followed were active, defined as walking more than 10,000 steps per day. Patients walked significantly less on dialysis days compared to the other days of the week. Many of the patients experienced poor sleep quality, with patients in the first shift experiencing the greatest disturbance to their sleep/wake cycle. \n\nCONCLUSION: Patients in a suburban environment walked much less than those in a previously studied urban population. They rarely met the recommended goal of 10,000 steps/day, even on non-dialysis days. Interventions to increase physical activity may target any day of the week, particularly HD days. Prospective, long-term studies are needed to evaluate the use of activity trackers in dialysis patients and their impact on physical activity.", "links": [ { "caption": "URL", "url": "https://www.karger.com/Article/FullText/452751", "newWindow": true } ] }, { "title": "Modeling clinically validated physical activity using commodity hardware", "author": "Winfree, K.N. and Dominick, G.\t", "year": "2017", "journalProceedings": "2017 IEEE EMBS International Conference on Biomedical & Health Informatics (BHI)", "category": "Methods", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Fitbit devices are one of the most popular wearable activity monitors in the consumer market. They are considerably cheaper than many of their clinical grade counterparts. However, they utilize proprietary algorithms for estimation of physical activity (PA). This study aims to model the measures of PA as reported by the ActiGraph GT3X using Fitbit measures of steps, METs, and intensity level. Such a model relating the Fitbit to what would have been reported by the ActiGraph could enable researchers to use the Fitbit instead of the ActiGraph in some applications, thus reducing cost or increasing the number of subjects involved in a study. This paper describes a study in which a model of the Freedson VM3 physical activity classification was constructed that uses measures from the Fitbit device instead of the typically provided ActiGraph vector magnitude. The data from 19 subjects, who concurrently wore both the ActiGraph and Fitbit devices for an average of 1.8 weeks, was used to generate the minute level based model. Several modeling methods were tested; a nai¨ve Bayes classifier was chosen based on the lowest achieved error rate. That model reduces overall Fitbit to Acti-Graph errors from 19.97% to 16.32%, a notable improvement. More importantly, it reduces the errors in moderate to vigorous physical activity levels by 40%, eliminating a statistically significant difference between MVPA estimates provided by the Freedson VM3 and Fitbit Intensity scores. This justifies use of the Fitbit device in place of an ActiGraph device in some large scale studies, especially those where MVPA estimates are of importance.", "links": [ { "caption": "URL", "url": "http://ieeexplore.ieee.org/document/7897229/", "newWindow": true } ] }, { "title": "Improved Mental Acuity Forecasting with an Individualized Quantitative Sleep Model.", "author": "Winslow, B.D., Nguyen, N. and Venta, K.E.\t", "year": "2017", "journalProceedings": "Frontiers in Neurology", "category": "Methods", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "Sleep impairment significantly alters human brain structure and cognitive function, but available evidence suggests that adults in developed nations are sleeping less. A growing body of research has sought to use sleep to forecast cognitive performance by modeling the relationship between the two, but has generally focused on vigilance rather than other cognitive constructs affected by sleep, such as reaction time, executive function, and working memory. Previous modeling efforts have also utilized subjective, self-reported sleep durations and were restricted to laboratory environments. In the current effort, we addressed these limitations by employing wearable systems and mobile applications to gather objective sleep information, assess multi-construct cognitive performance, and model/predict changes to mental acuity. Thirty participants were recruited for participation in the study, which lasted 1?week. Using the Fitbit Charge HR and a mobile version of the automated neuropsychological assessment metric called CogGauge, we gathered a series of features and utilized the unified model of performance to predict mental acuity based on sleep records. Our results suggest that individuals poorly rate their sleep duration, supporting the need for objective sleep metrics to model circadian changes to mental acuity. Participant compliance in using the wearable throughout the week and responding to the CogGauge assessments was 80%. Specific biases were identified in temporal metrics across mobile devices and operating systems and were excluded from the mental acuity metric development. Individualized prediction of mental acuity consistently outperformed group modeling. This effort indicates the feasibility of creating an individualized, mobile assessment and prediction of mental acuity, compatible with the majority of current mobile devices.", "links": [ { "caption": "URL", "url": "http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5403829", "newWindow": true } ] }, { "title": "Validation of Three Wearable Fitness Trackers for Measuring Physical Activity in College Students", "author": "Witmer, C., Zhang, P., Godin, S. and Che, D.\t", "year": "2017", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "Many wearable fitness trackers have a function measuring physical activity such as energy expenditure but the accuracy of the measures is unclear.\nPURPOSE: The aim of the study was to validate the energy expenditure estimation of three fitness trackers: LT, FB, and AW for treadmill walking and running.\n\nMETHODS: The participants of the study were 30 college students (17 males and 13 females) from a public university in Pennsylvania. All participants completed six trials of 10-minute walking and running activities on a treadmill at speeds of 54, 80, 107, 134, 161, & 188 m•min-. Participants were wearing all the fitness trackers and connected to indirect calorimetry during the exercise protocol. All devices provided caloric expenditure while the indirect calorimetry was used as a criterion measure. Resting Metabolic Rate was collected along with a familiarization trial prior to the execution of the exercise protocol. Two-way ANOVA with repeated measures and Pearson Correlation were used to compare the caloric expenditure estimates between the criterion and three fitness trackers.\n\nRESULTS: There were no significant differences in energy expenditure estimates between the criterion and AW (mean difference 4.6 kcal, p textgreater 0.05), nor criterion and LT (mean difference 0.8 kcal, p textgreater 0.05). However there was a significant difference between the criterion measure and FB (mean difference 18.2 kcal, p = 0.001). Pearson correlation coefficients (r): the criterion of indirect calorimetry-derived activity energy expenditure yielded the strongest positive correlations with activity energy expenditure estimated from the AW at all speed levels (range from .55 to .85, all ps textless0.01). FB was positively correlated to the criterion measure at five speed levels (range from .46 to .67, ps textless0.05). No positive correlation was found between the criterion and LT measures (range from -.40 to .26).\n\nCONCLUSION: AW and FB demonstrated a moderate to high level of validity on measuring physical activity while LT had a low level of validity.", "links": [ { "caption": "URL", "url": "http://insights.ovid.com/crossref?an=00005768-201705001-02227", "newWindow": true } ] }, { "title": "An analysis of how consumer physical activity monitors are used in biomedical research", "author": "Wright, S.P., Collier, S.R., Brown, T.S. and Sandberg, K.\t", "year": "2017", "journalProceedings": "The FASEB Journal", "category": "Review", "devices": null, "population": "NA", "dataUsed": "NA", "abstract": "BACKGROUND Biomedical researchers are very interested in measuring physical activity because sedentary lifestyle and lack of physical activity are well-established risk factors for chronic disease and adverse health outcomes. Many consumer physical activity monitors have accuracies similar to research-grade monitors for measuring steps and offer a relatively new tool for measuring physical activity in an ecological setting.\nAIM To analyze how consumer physical activity monitors are currently used in biomedical research.\n\nMETHOD Searches were conducted in Ovid Medline, PubMed Medline, clinicaltrials.gov, and NIH RePorter using search terms including Fitbit, Jawbone, Apple watch, Garmin, Polar, Microsoftband, Misfit, Nike, Withings, and Xiaomi. Results were quantitated by category: condition/topic, intervention, enrollment status, study type and design, participant age, funding mechanism, and primary outcome.\n\nRESULTS Fitbit devices were the most common consumer physical activity monitors used in published work (89%), clinical trials (83%), and NIH-funded research (95%). Validity studies represented the plurality (19/40) of published studies involving consumer physical activity monitors. The design of the majority of clinical trials (116/127) and unique NIH-funded grants (20/25) involving Fitbit are interventional. The most common primary outcome measure reported in clinical trials using Fitbit is physical activity (50/127), with biomarkers of health (e.g., blood pressure, HbA1c, fasting glucose) being the second most prominent. The most common clinical conditions studied in clinical trials are mental and brain related (74/127), second most being body weight related (62/127).\n\nCONCLUSION The current state and potential growth of the consumer monitor technology is transforming biomedical research, and is enabling us to ask new and more granular questions about physical activity in health and disease.", "links": [ { "caption": "URL", "url": "http://www.fasebj.org/content/31/1_Supplement/1020.24.short", "newWindow": true } ] }, { "title": "How consumer physical activity monitors could transform human physiology research", "author": "Wright, S.P., Hall Brown, T.S., Collier, S.R. and Sandberg, K.\t", "year": "2017", "journalProceedings": "American Journal of Physiology - Regulatory, Integrative and Comparative Physiology", "category": "Review", "devices": null, "population": "NA", "dataUsed": "NA", "abstract": "Sedentary lifestyle and lack of physical activity are well-established risk factors for chronic disease and adverse health outcomes. Thus there is enormous interest in measuring physical activity in biomedical research. Many consumer physical activity monitors, including Basis® Health Tracker, BodyMedia® Fit, DirectLife®, Fitbit® Flex, Fitbit One, Fitbit Zip, Garmin® Vivofit, Jawbone® UP, MisFit® Shine, Nike® FuelBand, Polar® Loop, Withings® Pulse O2, and others have accuracies similar to that of research-grade physical activity monitors for measuring steps. This review focuses on the unprecedented opportunities consumer physical activity monitors offer for human physiology and pathophysiology research because of their ability to measure activity continuously under real life conditions and because they are already widely used by consumers. We examine current and potential uses of consumer physical activity monitors as a measuring or monitoring device, or as an intervention in strategies to change behavior and predict health outcomes. The accuracy, reliability, reproducibility, and validity of consumer physical activity monitors is reviewed, as are limitations and challenges associated with using these devices in research. Other topics covered include how smartphone apps and platforms such as the Apple ResearchKit can be used in conjunction with consumer physical activity monitors for research. Lastly, the future of consumer physical activity monitors and related technology is considered: pattern recognition, integration of sleep monitors, and other biosensors in combination with new forms of information processing.", "links": [ { "caption": "URL", "url": "http://ajpregu.physiology.org/content/early/2017/01/04/ajpregu.00349.2016", "newWindow": true } ] }, { "title": "Using Wireless Pedometers to Measure Children's Physical Activity: How Reliable is the Fitbit Zip?", "author": "Xu, T., Byker, E.J. and Gonzales, M.R.\t", "year": "2017", "journalProceedings": "Movement, Health & Exercise", "category": "Validation", "devices": "Zip", "population": "Children", "dataUsed": "Steps", "abstract": "he purpose of this study is to examine the reliability of wireless pedometers in measuring elementary school children's physical activity. Activity measurement using a wireless pedometer Fitbit Zip was compared to activity measurement using Yamax Digital-Walker SW701 for a group of randomly selected 25 children in Grades 3, 4, and 5 (n =25). Fitbit Zip wireless pedometers were found to have an appropriate degree (Nunnally & Bernstein, 1994) of accuracy and reliability compared to the Yamax SW701 pedometer. The Fitbit Zip wireless pedometer collected more step counts than the Yamax SW701 pedometer; however, the difference was not statistically significant. Participants reported that they preferred wearing the Fitbit Zip to the Yamax SW701 because the Fitbit Zip was more comfortable to wear and less likely to fall off. Participants also reported being more motivated to move while wearing the Fitbit Zip.", "links": [ { "caption": "URL", "url": "http://mohejournal.com/index.php/mohe/article/view/MoHE%20Vol6%7B/%%7D282%7B/%%7D29%7B/_%7D1", "newWindow": true } ] }, { "title": "Habitual sleep duration and sleep duration variation are independently associated with body mass index", "author": "Xu, X., Conomos, M.P., Manor, O., Rohwer, J.E., Magis, A.T. and Lovejoy, J.C.\t", "year": "2017", "journalProceedings": "International Journal of Obesity", "category": "Measurement", "devices": "Charge HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "BACKGROUND: Sleep plays a vital role in maintaining homeostasis and promoting health. Previous studies show that shorter sleep duration is associated with elevated body mass index (BMI) and other cardiovascular risk factors. The goal of this study was to investigate the effects of habitual sleep duration and nightly sleep duration variation based on daily device-recorded data on BMI and obesity-related biomarkers.\nMETHOD: 748 individuals (50.6% females, 85.4% European-Americans, average age: 49.7 years old) participated in a commercial lifestyle coaching program beginning in July 2015. Daily sleep data were recorded by Fitbit Charge HRTM wristbands. Clinical laboratory blood tests were measured up to 3 times over a 12-month period. Linear regression models were used for cross-sectional analyses, and generalized estimating equations for longitudinal analyses. All models were adjusted for age, sex, geographic location, season, genetic ancestry inferred from whole genome sequencing data, and BMI (if applicable). Multiple testing issues were corrected by False Discovery Rate (FDR).\n\nRESULTS: We calculated habitual sleep duration and nightly sleep duration variation. In general, females slept 15-minutes longer on average than males. A negative correlation was found between habitual sleep duration and BMI (ß=-1.12, standard error=0.25, Ptextless0.001). Moreover, we identified a positive correlation between sleep duration variation and BMI (ß=2.97, standard error=0.79, Ptextless0.001) while controlling for sleep duration, indicating that larger sleep duration variation is significantly and independently associated with increased BMI.\n\nCONCLUSION: We explored the impact of habitual sleep duration and sleep duration variation, and identified that shorter habitual sleep duration and larger duration variation were independently associated with increased BMI.", "links": [ { "caption": "URL", "url": "http://www.nature.com/doifinder/10.1038/ijo.2017.223", "newWindow": true } ] }, { "title": "Impact of Electronic Feedback and Peer Comparisons on Residents' Physical Activity Level", "author": "Yeung, J., Mazloomdoost, D., Crisp, C.C., Kleeman, S. and Pauls, R.N.\t", "year": "2017", "journalProceedings": "Journal of Graduate Medical Education", "category": "Intervention,Measurement", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Activity tracking devices can reinforce physical fitness and may be beneficial to resident physicians. To date, their use has not been evaluated.\nObjective: To determine if use of an activity tracking device increases residents' activity, measured as steps per day.\n\nMethods: A prospective, crossover study involved residents at 1 academic hospital system. Participants were weighed and completed a baseline survey. All participants were asked to wear an activity tracking device for 8 weeks. Residents were blinded to feedback from the device on activity level during the first 4 weeks. During the second 4-week period, participants were given access to data on activity level and were invited to join a voluntary activity tracking group.\n\nResults: Of 104 residents invited to participate, 86 enrolled. The majority of participants were female and did not have experience using activity trackers. Almost half (49%; 51 of 104) had a body mass index greater than 25 kg/m2. The median steps per day of all participants during the blinded period was 7260. This increased to 8266 steps per day during the unblinded period. Surgical residents recorded significantly more steps than nonsurgical specialties (7938 versus 6724; P?=?.018). The 26 residents who joined the voluntary activity tracking group registered higher median steps per day, and wore their activity tracker more consistently.\n\nConclusions: Providing residents with activity trackers, increasing feedback, and providing comparisons to peers may enhance residents' physical activity levels.", "links": [ { "caption": "URL", "url": "http://www.jgme.org/doi/10.4300/JGME-D-16-00425.1", "newWindow": true } ] }, { "title": "Stress moderation impacting lupus with exercise (S.M.I.L.E.): influence of daily moderate exercise and stress modification on autoimmune-mediated inflammation in mice and humans with lupus", "author": "Young, N., Thomas, E., Snoad, B., Sharma, J., Mobeen, M., Yedimenko, J., Steigelman, H., Meara, A., Valiente, G., Ardoin, S., Powell, N., Sheridan, J. and Jarjour, W.\t", "year": "2017", "journalProceedings": "Annals of the Rheumatic Diseases", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps,Energy Expenditure,Distance,Sleep", "abstract": "Background Despite numerous studies indicating the positive effects of exercise and psychological stress reduction in patients with autoimmune disease, these therapeutic modalities are currently underemphasized due to the absence of comprehensive immunological characterization and regimen standardization.\nObjectives In order to examine the influence on the immune system at the cellular and tissue level, disease pathology was analyzed in the NZM2410 mouse model of lupus nephritis. To translate these results and begin to characterize a consensus treatment regimen, a pilot cohort of systemic lupus erythematosus (SLE) patients with active disease was enrolled into a daily Tai Chi program, which emphasized moderate exercise levels with meditative breathing to provide daily physical activity and stress reduction.\n\nMethods Mice were exercised daily by treadmill walking at moderate intensity. Social disruption stress was induced in mice by disturbing the social order within an established hierarchy. All mice were removed from the study when experimental removal criteria was reached [blood urea nitrogen (BUN)textgreater50 mg/dL; weight losstextgreater20%]. Kidney tissue and serum were collected from mice at experimental endpoint. SLE patients completed daily Tai Chi exercises and data was collected at baseline and throughout the study via questionnaires to access physical activity and stress levels, activity trackers (Fitbit), and serum sample analysis.\n\nResults Histopathological analysis of NZM2410 mice demonstrated that psychosocial stress induction significantly exacerbated and daily moderate exercise significantly reduced lupus nephritis disease pathology, as measured by BUN levels, complement component 3 and IgG complex deposition in glomeruli, pathological grading of H&E-stained kidney sections, and renal macrophage infiltration. Furthermore, stressors induced levels of IL-6, TNF-a, and IL-1ß, while exercise suppressed IL-6, TNF-a, IL-10, and CXCL1 in mice. Compared to baseline data, questionnaires confirmed a significant reduction in perceived social stress and an increase in combined metabolic equivalent of task (MET) and overall physical activity in SLE patients. Moreover, fitness activity tracker data showed a significant increase in steps, distance, and activity calories with no changes in body mass index or vigorous activity levels. Interestingly, this correlated with an increased average time in bed each night. Analysis of pro-inflammatory serum cytokine expression revealed suppression in the relative fold change of IL-6 by 23%, IL-8 by 30%, TNF-a by 11%, and IFN-? by 21% with Tai Chi.\n\nConclusions These data suggest that moderate exercise and stress management can have potent immunoregulatory effects on the chronic, systemic inflammation associated with SLE and identify daily Tai Chi exercise as a viable adjunct therapy to compliment current pharmacological interventions.", "links": [ { "caption": "URL", "url": "http://ard.bmj.com/content/76/Suppl_2/1099.2", "newWindow": true } ] }, { "title": "A validation study of Fitbit Charge 2™ compared with polysomnography in adults", "author": "de Zambotti, M., Goldstone, A., Claudatos, S., Colrain, I.M. and Baker, F.C.\t", "year": "2017", "journalProceedings": "Chronobiology International", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "We evaluated the performance of a consumer multi-sensory wristband (Fitbit Charge 2™), against polysomnography (PSG) in measuring sleep/wake state and sleep stage composition in healthy adults.\n\nIn-lab PSG and Fitbit Charge 2™ data were obtained from a single overnight recording at the SRI Human Sleep Research Laboratory in 44 adults (19—61 years; 26 women; 25 Caucasian). Participants were screened to be free from mental and medical conditions. Presence of sleep disorders was evaluated with clinical PSG. PSG findings indicated periodic limb movement of sleep (PLMS, > 15/h) in nine participants, who were analyzed separately from the main group (n = 35). PSG and Fitbit Charge 2™ sleep data were compared using paired t-tests, Bland–Altman plots, and epoch-by-epoch (EBE) analysis.\n\nIn the main group, Fitbit Charge 2™ showed 0.96 sensitivity (accuracy to detect sleep), 0.61 specificity (accuracy to detect wake), 0.81 accuracy in detecting N1+N2 sleep (“light sleep”), 0.49 accuracy in detecting N3 sleep (“deep sleep”), and 0.74 accuracy in detecting rapid-eye-movement (REM) sleep. Fitbit Charge 2™ significantly (p < 0.05) overestimated PSG TST by 9 min, N1+N2 sleep by 34 min, and underestimated PSG SOL by 4 min and N3 sleep by 24 min. PSG and Fitbit Charge 2™ outcomes did not differ for WASO and time spent in REM sleep. No more than two participants fell outside the Bland–Altman agreement limits for all sleep measures. Fitbit Charge 2™ correctly identified 82% of PSG-defined non-REM–REM sleep cycles across the night. Similar outcomes were found for the PLMS group.\n\nFitbit Charge 2™ shows promise in detecting sleep-wake states and sleep stage composition relative to gold standard PSG, particularly in the estimation of REM sleep, but with limitations in N3 detection. Fitbit Charge 2™ accuracy and reliability need to be further investigated in different settings (at-home, multiple nights) and in different populations in which sleep composition is known to vary (adolescents, elderly, patients with sleep disorders).", "links": [] }, { "title": "A Pilot Study to Assess the Feasibility and Impact of a Home Exercise Program on Heart Rate and Heart Rate Variability in Children with Muscular Dystrophy (P4.163)", "author": "Zelikovich, A.S., Oswald, T. and Kuntz, N.L.\t", "year": "2017", "journalProceedings": "Neurology", "category": "Usability", "devices": null, "population": "Older Adults,Patients,Adults", "dataUsed": "Steps", "abstract": "Objective: To determine if a home exercise program is feasible and beneficial in a pediatric muscular dystrophy (MD) population.\nBackground: Research has shown that children with MD exhibit tachycardia and decreased heart rate variability (HRV), sometimes reversible with aerobic exercise. Whether aerobic exercise will improve long-term clinical outcomes in children with MD is unknown. Feasibility and barriers with respect to a voluntary, aerobic home exercise program are poorly studied.\n\nDesign/Methods: A 4-week voluntary game-based home exercise program was created and trialed by 12 children (3–11 yrs) with MD. Fitbit Charge HR bands were worn to track heart rate (HR). Satisfaction surveys and Pediatric Quality of Life Neuromuscular Module (Peds QOL:NM) were submitted weekly by parents. 24-hour Holter monitoring was performed concurrently with Fitbit in a subset of subjects.\n\nResults: 12 games were created to provide exercise at a mean of 25 minutes three times weekly (with 95% rate of positive feedback). 75% of the participants completed participation with 82% of total surveys returned. Peds QOL: NM demonstrated a high baseline quality of life without interval change. 60% of the HR recordings during exercise were adequate. These demonstrated tachycardia for age at baseline (mean 113 BPM) with a mean increase during exercise of 7 BPM. 24-hour Holter monitoring was performed on 3 subjects simultaneously wearing a Fitbit. Holter HR and Fitbit HR were comparable with Holter mean HR consistently higher than Fitbit mean HR (+2.0% to +8.4%). The average cost per exercise kit was $3.88.\n\nConclusions: A novel, inexpensive aerobic exercise program was trialed allowing children with MD to exercise at home in an enjoyable, cost-effective manner. Fitbit Charge HR is an inexpensive, long term HR monitor that recorded values comparable to Holter HR monitoring. Fitbit HR averages are slightly lower than Holter monitoring likely due to inability to capture short bursts of tachycardia.", "links": [ { "caption": "URL", "url": "http://www.neurology.org/content/88/16_Supplement/P4.163.short", "newWindow": true } ] }, { "title": "Exercise Among Women With Ovarian Cancer: A Feasibility and Pre-/Post-Test Exploratory Pilot Study.", "author": "Zhang, X., McClean, D., Ko, E., Morgan, M.A. and Schmitz, K.\t", "year": "2017", "journalProceedings": "Oncology Nursing Forum", "category": "Intervention", "devices": null, "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "PURPOSE/OBJECTIVES:\nTo establish the feasibility and acceptability of completing a higher dose of the planned physical activity volume among women with ovarian cancer, including those undergoing active treatment. \u2029.\nDESIGN:\nA pre-/post-test exercise intervention. All participants were asked to complete 225 minutes per week of physical activity for 26 weeks. Multiple supports were provided, including exercise DVDs, self-reported logs, and an objective physical activity tracker (Fitbit®).\u2029.\nSETTING:\nHome-based exercise intervention with in-person training and telephone follow-ups.\u2029.\nSAMPLE:\n10 women with ovarian cancer who were treated within Penn Medicine in Philadelphia, Pennsylvania.\u2029.\nMETHODS:\nHome-based, in-person exercise counseling was provided by an exercise trainer weekly for the first six weeks and then monthly for a total of 26 weeks. Weekly follow-up telephone calls were used to assess exercise adherence and barriers to completing exercise, review symptom changes, and provide behavioral support. \u2029.\nMAIN RESEARCH VARIABLES:\nFeasibility and acceptability.\u2029.\nFINDINGS:\nEight participants completed the study and achieved at least 80% of the prescribed exercise dose. Five participants were undergoing chemotherapy simultaneously. Participants experienced no adverse events during the 26-week intervention. Compared to baseline, average steps increased by 1,593 per day and moderate-intensity physical activity increased by 15 minutes per day. \u2029.\nCONCLUSIONS:\nA 225-minutes-per-week exercise program is feasible and acceptable in a population of patients with ovarian cancer. Participants significantly improved their physical activity during the 26-week intervention.\u2029.\nIMPLICATIONS FOR NURSING:\nThe findings suggest that nursing professionals could recommend that women with ovarian cancer exercise 225 minutes per week regardless of cancer and/or treatment trajectory. For those experiencing aches and pains, behavioral supports and suggestions of a lower exercise dose are needed to maintain physical activity.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/28635971", "newWindow": true } ] }, { "title": "Effects of Brief Fitbit Use on Physical Activity & Cardiometabolic Risk ", "author": "Adams, M.M. and Freleng, C.", "year": "2018", "journalProceedings": "Journal of Physical Activity Research", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Energy Expenditure,Intensity,Heart Rate", "abstract": "Wrist-worn fitness trackers are popular consumer products, but few studies have documented their use as a stand-alone intervention tool. This study examined the effect of wearing the Fitbit Flex on moderate to vigorous physical activity (MVPA), sedentary behavior (SB), self-efficacy (SE), and cardiometabolic risk factors. Participants (n=28, m age = 50.5 yrs) wore the Fitbit for 3 weeks, then were randomly assigned to continue for 3 more weeks (6-week group) or discontinue use (3-week group). Participants were not physically active prior to the study. Accelerometers recorded weekly, work-week and weekend MVPA and SB at baseline and post. BMI, waist circumference, and blood pressure were measured baseline and post. A self-efficacy questionnaire was administered baseline, mid-point, and post. MVPA significantly increased in both groups. The 6-week group performed better on weekend MVPA. SB did not change. Waist circumference decreased significantly in both groups. Overall, there was no change in SE. However, the hypothesized pattern between groups was found. The 6-week group had a small increase in SE while the 3-week group declined non-significantly. Fitbit fitness trackers are effective at increasing MVPA and impact waist circumference, in as little as 6 weeks. However, the mechanism for behavior change is unclear and needs further study. This research is challenging as the features of fitness trackers are constantly changing.", "links": [ { "caption": "URL", "url": "http://pubs.sciepub.com/jpar/3/2/4/", "newWindow": true } ] }, { "title": "Step count accuracy of StepWatch and FitBit One™ among individuals with a unilateral transtibial amputation", "author": "Arch, E.S., Sions, J.M., Horne, J. and Bodt, B.A.\t", "year": "2018", "journalProceedings": "Prosthetics and Orthotics International", "category": "Validation", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background:Step counts, obtained via activity monitors, provide insight into activity level in the free-living environment. Accuracy assessments of activity monitors are limited among individuals with lower-limb amputations.Objectives:(1) To evaluate the step count accuracy of both monitors during forward-linear and complex walking and (2) compare monitor step counts in the free-living environment.Study design:Cross-sectional study.Methods:Adult prosthetic users with a unilateral transtibial amputation were equipped with StepWatch and FitBit One™. Participants completed an in-clinic evaluation to evaluate each monitor's step count accuracy during forward linear and complex walking followed by a 7-day step count evaluation in the free-living environment.Results:Both monitors showed excellent accuracy during forward, linear walking (intraclass correlation coefficients = 0.97–0.99, 95% confidence interval = 0.93–0.99; percentage error = 4.3%–6.2%). During complex walking, percentage errors were higher (13.0%...", "links": [] }, { "title": "Assessing and enhancing the utility of low-cost activity and location sensors for exposure studies", "author": "Asimina, S., Chapizanis, D., Karakitsios, S., Kontoroupis, P., Asimakopoulos, D.N., Maggos, T. and Sarigiannis, D.\t", "year": "2018", "journalProceedings": "Environmental Monitoring and Assessment", "category": "Methods", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Nowadays, the advancement of mobile technology in conjunction with the introduction of the concept of exposome has provided new dynamics to the exposure studies. Since the addressing of health outcomes related to environmental stressors is crucial, the improvement of exposure assessment methodology is of paramount importance. Towards this aim, a pilot study was carried out in the two major cities of Greece (Athens, Thessaloniki), investigating the applicability of commercially available fitness monitors and the Moves App for tracking people's location and activities, as well as for predicting the type of the encountered location, using advanced modeling techniques. Within the frame of the study, 21 individuals were using the Fitbit Flex activity tracker, a temperature logger, and the application Moves App on their smartphones. For the validation of the above equipment, participants were also carrying an Actigraph (activity sensor) and a GPS device. The data collected from Fitbit Flex, the temperature logger, and the GPS (speed) were used as input parameters in an Artificial Neural Network (ANN) model for predicting the type of location. Analysis of the data showed that the Moves App tends to underestimate the daily steps counts in comparison with Fitbit Flex and Actigraph, respectively, while Moves App predicted the movement trajectory of an individual with reasonable accuracy, compared to a dedicated GPS. Finally, the encountered location was successfully predicted by the ANN in most of the cases.", "links": [] }, { "title": "Assessing personal exposure to PM using data from an integrated indoor-outdoor experiment in Athens-Greece", "author": "Assimakopoulos, V.D., Bekiari, T., Pateraki, S., Maggos, T., Stamatis, P., Nicolopoulou, P. and Assimakopoulos, M.N.", "year": "2018", "journalProceedings": "Science of The Total Environment", "category": "Measurement", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "An integrated indoor-outdoor 15-day PM sampling campaign in a general area close to the centre of Athens, targeted to examine personal exposure. All microenvironments (MEs) (second and fourth floor flats, cafes, cars, restaurants, underground metro, outdoor etc.) frequented by the residents were included in the study. The instrumentation used was both stationary (low volume samplers) and portable/wearable to be able to measure continuously PM10, PM2.5, PM1 and analyze chemically PM2.5 and PM1 samples. The study showed that the residences' air quality was determined by the type and intensity of outdoor sources and their vertical distance from the street. Indoor activities such as cooking, cleaning further increased PM levels and formulated the air quality, while particulate accumulation was evident. In general, PM2.5 concentrations were higher outdoors, 11-43 μg/m3, than in the second floor flat as well as on days within different MEs, 13-33 μg/m3 and 8-35 μg/m3, respectively and finally in the fourth floor 10-18 μg/m3. PM2.5 chemical composition was typical of a Mediterranean urban area predominantly composed on average of OC/EC (33%), sulfate (13%), ammonium (9%), nitrate (5%) and crustal material (Cl−, Na+, K+, Mg2+ and Ca2+) (5%). On days when other MEs were visited crustal material increased on average to 16%. The PM levels measured with the portable instrumentation at all mEs showed that the persons were exposed to higher PM10 concentrations in the subway (avg. 218 μg/m3) due to the resuspension of crustal material, while maximum PM2.5 and PM1 were experienced in cafes where smoking was allowed (avg. 126 and 108 μg/m3, respectively). Using the car resulted to the lowest PM10, PM2.5 and PM1 exposure (58, 10 and 6 μg/m3, respectively). Total exposure to particulates depended both on the time spent in each ME and on the mixture of MEs visited in 24 h.", "links": [ { "caption": "URL", "url": "https://www.sciencedirect.com/science/article/pii/S0048969718314268", "newWindow": true } ] }, { "title": "Clinical response to treatment in inpatients with depression correlates with changes in activity levels and psychomotor speed", "author": "Averill, I.R., Crowe, M., Frampton, C.M., Beaglehole, B., Lacey, C.J., Jordan, J., Wilson, L.D., Douglas, K.M. and Porter, R.J.\t", "year": "2018", "journalProceedings": "Australian & New Zealand Journal of Psychiatry", "category": "Intervention", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Intensity", "abstract": "Background:Monitoring clinical response to treatment in depressed inpatients, particularly identifying early improvement, may be sub-optimal. This may impact adversely on patients through longer admissions and sub-optimal pharmacotherapy. Psychomotor speed is a prominent neuropsychological function which changes as recovery occurs. This study examines simple techniques used to quantify psychomotor change and their potential to contribute to monitoring recovery.Methods:Activity levels were continuously monitored in patients diagnosed with a major depressive episode from four acute psychiatric wards using two actigraphs (commercial and scientific) for 3 weeks and linear regression used to calculate a gradient to express rate of change. Psychomotor speed was assessed using the simple Coin Rotation Task. Mood and functioning were rated using the Quick Inventory of Depressive Symptoms, Clinical Global Impression Scale and Functioning Assessment Short Test. The assessments were completed at baseline and follow-...", "links": [] }, { "title": "A Patient-Centered Activity Regimen Improves Participation in Physical Activity Interventions in Advanced-Stage Lung Cancer ", "author": "Bade, B.C., Hyer, J.M., Bevill, B.T., Pastis, A., Rojewski, A.M., Toll, B.A. and Silvestri, G.A", "year": "2018", "journalProceedings": "Integrative Cancer Therapies", "category": "Intervention", "devices": "Zip,Flex", "population": "Patients", "dataUsed": "Steps", "abstract": "Introduction: Physical activity (PA) is a potential therapy to improve quality of life in patients with advanced-stage lung cancer (LC), but no PA regimen has been shown to be beneficial, clinically practical, and sustainable. We sought to test the hypothesis that a patient-centered activity regimen (PCAR) will improve patient participation and PA more effectively than weekly phone calls. Methods: In patients with advanced-stage LC, we implemented a walking-based activity regimen and motivated patients via either weekly phone calls (n = 29; FitBit Zip accelerometer) or PCAR (n = 15; FitBit Flex, an educational session, and twice-daily gain-framed text messages). Data collection over a 4-week period was compared, and a repeated-measures, mixed-effects model for activity level was constructed. Results: Subjects receiving PCAR more frequently used the device (100% vs 79%) and less frequently had missing data (11% vs 38%). “More active” and “less active” groups were created based on mean step count in the fir...", "links": [] }, { "title": "Current, future and potential use of mobile and wearable technologies and social media data in the ABCD study to increase understanding of contributors to child health", "author": "Bagot, K., Matthews, S., Mason, M., Squeglia, L.M., Fowler, J., Gray, K., Herting, M., May, A., Colrain, I., Godino, J., Tapert, S., Brown, S. and Patrick, K.\t", "year": "2018", "journalProceedings": "Developmental Cognitive Neuroscience", "category": "Review", "devices": "Charge HR,Charge 2", "population": "Adolescents", "dataUsed": "Sleep,Heart Rate", "abstract": "Mobile and wearable technologies and novel methods of data collection are innovating health-related research. These technologies and methods allow for multi-system level capture of data across environmental, physiological, behavioral, and psychological domains. In the Adolescent Brain Cognitive Development (ABCD) Study, there is great potential for harnessing the acceptability, accessibility, and functionality of mobile and social technologies for in-vivo data capture to precisely measure factors, and interactions between factors, that contribute to childhood and adolescent neurodevelopment and psychosocial and health outcomes. Here we discuss advances in mobile and wearable technologies and methods of analysis of geospatial, ecologic, social network and behavioral data. Incorporating these technologies into the ABCD study will allow for interdisciplinary research on the effects of place, social interactions, environment, and substance use on health and developmental outcomes in children and adolescents.", "links": [] }, { "title": "Feeling validated yet? A scoping review of the use of consumer-targeted wearable and mobile technology to measure and improve sleep ", "author": "Baron, K.G., Duffecy, J., Berendsen, M.A., Cheung Mason, I., Lattie, E.G. and Manalo, N.C.", "year": "2018", "journalProceedings": "Sleep Medicine Reviews", "category": "Review", "devices": "One,Flex,Charge,Charge HR", "population": "NA", "dataUsed": "Sleep", "abstract": "The objectives of this review were to evaluate the use of consumer-targeted wearable and mobile sleep monitoring technology, identify gaps in the literature and determine the potential for use in behavioral interventions. We undertook a scoping review of studies conducted in adult populations using consumer-targeted wearable technology or mobile devices designed to measure and/or improve sleep. After screening for inclusion/exclusion criteria, data were extracted from the articles by two co-authors. Articles included in the search were using wearable or mobile technology to estimate or evaluate sleep, published in English and conducted in adult populations. Our search returned 3897 articles and 43 met our inclusion criteria. Results indicated that the majority of studies focused on validating technology to measure sleep (n = 23) or were observational studies (n = 10). Few studies were used to identify sleep disorders (n = 2), evaluate response to interventions (n = 3) or deliver interventions (n = 5). In conclusion, the use of consumer-targeted wearable and mobile sleep monitoring technology has largely focused on validation of devices and applications compared with polysomnography (PSG) but opportunities exist for observational research and for delivery of behavioral interventions. Multidisciplinary research is needed to determine the uses of these technologies in interventions as well as the use in more diverse populations including sleep disorders and other patient populations.", "links": [] }, { "title": "Technology-Assisted Behavioral Intervention to Extend Sleep Duration: Development and Design of the Sleep Bunny Mobile App.", "author": "Baron, K.G., Duffecy, J., Reid, K., Begale, M. and Caccamo, L.\t", "year": "2018", "journalProceedings": "JMIR Mental Health", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Sleep", "abstract": "BACKGROUND Despite the high prevalence of short sleep duration (29.2% of adults sleep textless6 hours on weekdays), there are no existing theory-based behavioral interventions to extend sleep duration. The popularity of wearable sleep trackers provides an opportunity to engage users in interventions. OBJECTIVE The objective of this study was to outline the theoretical foundation and iterative process of designing the \"Sleep Bunny,\" a technology-assisted sleep extension intervention including a mobile phone app, wearable sleep tracker, and brief telephone coaching. We conducted a two-step process in the development of this intervention, which was as follows: (1) user testing of the app and (2) a field trial that was completed by 2 participants with short sleep duration and a cardiovascular disease risk factor linked to short sleep duration (body mass index [BMI] textgreater25). METHODS All participants had habitual sleep duration textless6.5 hours verified by 7 days of actigraphy. A total of 6 individuals completed initial user testing in the development phase, and 2 participants completed field testing. Participants in the user testing and field testing responded to open-ended surveys about the design and utility of the app. Participants in the field testing completed the Epworth Sleepiness Scale and also wore an actigraph for a 1-week baseline period and during the 4-week intervention period. RESULTS The feedback suggests that users enjoyed the wearable sleep tracker and found the app visually pleasing, but they suggested improvements to the notification and reminder features of the app. The 2 participants who completed the field test demonstrated significant improvements in sleep duration and daytime sleepiness. CONCLUSIONS Further testing is needed to determine effects of this intervention in populations at risk for the mental and physical consequences of sleep loss.", "links": [] }, { "title": "Assessment of the Fitbit Charge 2 for monitoring heart rate", "author": "Benedetto, S., Caldato, C., Bazzan, E., Greenwood, D.C., Pensabene, V. and Actis, P.\t", "year": "2018", "journalProceedings": "PLOS ONE", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Fitness trackers are devices or applications for monitoring and tracking fitness-related metrics such as distance walked or run, calorie consumption, quality of sleep and heart rate. Since accurate heart rate monitoring is essential in fitness training, the objective of this study was to assess the accuracy and precision of the Fitbit Charge 2 for measuring heart rate with respect to a gold standard electrocardiograph. Fifteen healthy participants were asked to ride a stationary bike for 10 minutes and their heart rate was simultaneously recorded from each device. Results showed that the Fitbit Charge 2 underestimates the heart rate. Although the mean bias in measuring heart rate was a modest -5.9 bpm (95% CI: -6.1 to -5.6 bpm), the limits of agreement, which indicate the precision of individual measurements, between the Fitbit Charge 2 and criterion measure were wide (+16.8 to -28.5 bpm) indicating that an individual heart rate measure could plausibly be underestimated by almost 30 bpm.", "links": [] }, { "title": "We12BFit!-Improving lifestyle physical activity in children aged 7-12 years with developmental coordination disorder: protocol of a multicentre single-arm mixed-method study. ", "author": "Braaksma, P., Stuive, I., Boomsma, H., van der Sluis, C.K., Schoemaker, M.M. and Dekker, R.", "year": "2018", "journalProceedings": "BMJ open", "category": "Usability", "devices": "Zip", "population": "Children", "dataUsed": "Steps", "abstract": "INTRODUCTION Children with developmental coordination disorder (DCD) are less physically active than their typically developing peers. No substantiated interventions are available to address this issue. Therefore, this study aims to describe the design and rationale of (1) a family-focused intervention to increase motivation for physical activity (PA) and, indirectly, lifestyle PA in children aged 7-12 years with DCD and (2) the methods to examine its preliminary effectiveness and feasibility. METHODS AND ANALYSIS This intervention is the second part of a more comprehensive, multidisciplinary treatment called We12BFit! The intervention was developed using the steps of treatment theory which includes the concept of targets, mechanism of action and essential ingredients. The content of the intervention is based on the transtheoretical model of change (TTM). In the intervention, the motivation for PA will be targeted through application of behaviour change strategies that fit the stages of the TTM. The modes of delivery include: pedometer, poster, parent meeting, booklet and coaching. At least 19 children with DCD, aged 7-12 years, will be included from two schools for special education and two rehabilitation centres. The intervention will be evaluated using a single-arm mixed-method design. Effectiveness will be assessed at three instances by using ActiGraph accelerometers accompanied by an activity log. Feasibility will be assessed using interviews with the participants and coaches. This evaluation may add to our understanding of motivation for PA in children with DCD and may eventually improve the rehabilitation programme of children with DCD. ETHICS AND DISSEMINATION The study has been approved by the Medical Ethics Committee of the University Medical Center of Groningen (METc 2015.216). We will disseminate the final results to the public through journal publications and presentations for practice providers and scientists. A final study report will also be provided to funding organisations. PROTOCOL VERSION 4, 12 April 2018. TRIAL REGISTRATION NUMBER NTR6334; Pre-results.", "links": [] }, { "title": "Reliability and validity of two fitness tracker devices in the laboratory and home environment for older community-dwelling people", "author": "Burton, E., Hill, K.D., Lautenschlager, N.T., Thøgersen-Ntoumani, C., Lewin, G., Boyle, E. and Howie, E.\t", "year": "2018", "journalProceedings": "BMC Geriatrics", "category": "Validation", "devices": "Flex,Charge HR", "population": "Older Adults", "dataUsed": "Steps,Intensity,Distance,Sleep", "abstract": "Two-thirds of older Australians are sedentary. Fitness trackers have been popular with younger people and may encourage older adults to become more active. Older adults may have different gait patterns and as such it is important to establish whether fitness trackers are valid and reliable for this population. The aim of the study was to test the reliability and validity of two fitness trackers (Fitbit Flex and ChargeHR) by step count when worn by older adults. Reliability and validity were tested in two conditions: 1) in the laboratory using a two-minute-walk-test (2MWT) and 2) in a free-living environment. Two 2MWTs were completed while wearing the fitness trackers. Participants were videoed during each test. Participants were then given one fitness tracker and a GENEactiv accelerometer to wear at home for 14-days. Thirty-one participants completed two 2MWTs and 30 completed the free-living procedure. Intra Class Correlation’s of the fitness trackers with direct observation of steps (criterion validity) was high (ICC:0.86,95%CI:0.76,0.93). However, both fitness trackers underestimated steps. Excellent test-retest reliability (ICC ≥ 0.75) was found between the two 2MWTs for each device, particularly the ChargeHR devices. Good strength of agreement was found for total distance and steps (fitness tracker) and moderate-to-vigorous physical activity (GENEactiv) for the free-living environment (Spearman Rho’s 0.78 and 0.74 respectively). Reliability and validity of the Flex and ChargeHR when worn by older adults is good, however both devices underestimated step count within the laboratory environment. These fitness trackers appear suitable for consumer use and promoting physical activity for older adults.", "links": [] }, { "title": "Impact of Coordinated-Bilateral Physical Activities on Attention and Concentration in School-Aged Children ", "author": "Buchele Harris, H., Cortina, K.S., Templin, T., Colabianchi, N. and Chen, W.", "year": "2018", "journalProceedings": "BioMed Research International", "category": "Intervention", "devices": "Charge HR", "population": "Children", "dataUsed": "Steps,Intensity", "abstract": "Purpose. This study examined the effects of 4-week, daily 6-minute coordinated-bilateral physical activity (CBPA) breaks in classroom on attention and concentration in school-aged children. Methods. Participants (n=116) in fifth grade from two elementary schools were assigned to three groups: two intervention groups (n= 60) and one control group (n = 56). All three groups were pre- and post-tested with the d2 Test of Attention (d2 test). One intervention group (n = 31) took part in six minutes of daily classroom-based coordinated-bilateral physical activity (CBPA) break for four weeks. Another intervention group (n = 29), the Fitbit Only (Fitbit-O), wore Fitbits per day during a school, five days per week for four weeks without CBPA breaks. A 2 × 3 ANOVA was conducted, followed by the post hoc comparisons. Results. The CBPA showed significant increases in processing speed ( = 6.876, p = .010), focused attention ( = 10.688, p = .002), concentration performance ( = 26.46, p = .000), and attention span ( = 14.090, p = .000) over the control, but not in accuracy (Error %). The CBPA showed significant improvement in concentration performance ( = 24.162, p = .000) and attention span ( = 6.891, p = .011), compared to the Fitbit-O. No significant changes in all five attention parameters were found between the Fitbit-O and the control. Conclusion. It was concluded that daily brief coordinated-bilateral activities can improve attention and concentration in fifth-grade students over the course of four weeks.", "links": [] }, { "title": "Technology-Enhanced Classroom Activity Breaks Impacting Children’s Physical Activity and Fitness ", "author": "Buchele Harris, H. and Chen, W.", "year": "2018", "journalProceedings": "Journal of Clinical Medicine", "category": "Intervention", "devices": "Charge HR", "population": "Children", "dataUsed": "Steps,Intensity", "abstract": "Background: This study examined the effects of a 4-week technology-enhanced physical activity (PA) interventions on students’ real-time daily PA and aerobic fitness levels. Methods: 116 fifth-graders were assigned to one intervention group (n = 31) participating in daily physical activity engaging the brain with Fitbit Challenge (PAEB-C), another intervention group (n = 29) wearing Fitbits only (Fitbit-O) daily, five days per week, or the comparison group (n = 56). Four-week real-time PA data were collected from the intervention students via Fitbase. Three groups were pre- and post-tested aerobic fitness. Results: The PAEB-C students showed significantly higher steps and minutes of being very active and fairly active (F = 7.999, p = 0.014, ŋ = 0.121; F = 5.667, p = 0.021, ŋ = 0.089; F = 10.572, p = 0.002, ŋ = 0.154) and lower minutes of being sedentary daily (F = 4.639, p = 0.035, ŋ = 0.074) than the Fitbit-O group. Both Fitbit groups exhibited significantly greater increases in aerobic fitness scores than the comparison group over time (F = 21.946, p = 0.001, ŋ = 0.303). Boys were more physically active and fit than girls. Conclusions: Technology-enhanced PA intervention was effective for improving real-time PA and aerobic fitness.", "links": [] }, { "title": "Assessment of step accuracy using the Consumer Technology Association standard ", "author": "Bunn, J.A., Jones, C., Oliviera, A. and Webster, M.J.", "year": "2018", "journalProceedings": "Journal of Sports Sciences", "category": "Review", "devices": "Surge", "population": "Adults", "dataUsed": "Steps", "abstract": "The purpose of this study was to compare the accuracy of commercially-available physical activity devices when walking and running at various treadmill speeds using CTA 2056: Physical Activity Monitoring for Fitness Wearables: Step Counting, standard by the Consumer Technology Association (CTA). Twenty participants (10 males and 10 females) completed self-paced walking and running protocols on the treadmill for five minutes each. Eight devices (Apple iWatch series 1, Fitbit Surge, Garmin 235, Moto 360, Polar A360, Suunto Spartan Sport, Suunto Spartan Trainer, and TomTom Spark 3) were tested two at a time, one per wrist. Manual step counts were obtained from video to serve as the benchmark. The mean absolute percent error (MAPE) was calculated during walking and running. During walking, three devices: Fitbit Surge (11.20%), Suunto Sport (22.93%), and TomTom (10.11%) and during running, one device, Polar (10.66%), exceeded the CTA suggestion of a MAPE < 10%. The Moto 360 had the lowest MAPE of all d...", "links": [] }, { "title": "Classification Accuracy of a Wearable Activity Tracker for Assessing Sedentary Behavior and Physical Activity in 3–5-Year-Old Children", "author": "Byun, W., Lee, J.-M., Kim, Y. and Brusseau, T.\t", "year": "2018", "journalProceedings": "International Journal of Environmental Research and Public Health", "category": "Validation", "devices": "Flex", "population": "Children", "dataUsed": "Intensity", "abstract": "This study examined the accuracy of the Fitbit activity tracker (FF) for quantifying sedentary behavior (SB) and varying intensities of physical activity (PA) in 3–5-year-old children. Twenty-eight healthy preschool-aged children (Girls: 46%, Mean age: 4.8 ± 1.0 years) wore the FF and were directly observed while performing a set of various unstructured and structured free-living activities from sedentary to vigorous intensity. The classification accuracy of the FF for measuring SB, light PA (LPA), moderate-to-vigorous PA (MVPA), and total PA (TPA) was examined calculating Pearson correlation coefficients (r), mean absolute percent error (MAPE), Cohen's kappa (k), sensitivity (Se), specificity (Sp), and area under the receiver operating curve (ROC-AUC). The classification accuracies of the FF (ROC-AUC) were 0.92, 0.63, 0.77 and 0.92 for SB, LPA, MVPA and TPA, respectively. Similarly, values of kappa, Se, Sp and percentage of correct classification were consistently high for SB and TPA, but low for LPA and MVPA. The FF demonstrated excellent classification accuracy for assessing SB and TPA, but lower accuracy for classifying LPA and MVPA. Our findings suggest that the FF should be considered as a valid instrument for assessing time spent sedentary and overall physical activity in preschool-aged children.", "links": [] }, { "title": "\tThe Use of a Fitbit Device for Assessing Physical Activity and Sedentary Behavior in Preschoolers.", "author": "Byun, W., Kim, Y. and Brusseau, T.A.", "year": "2018", "journalProceedings": "The Journal of pediatrics", "category": "Validation", "devices": "Flex", "population": "Children", "dataUsed": "Intensity,Sleep", "abstract": "OBJECTIVE To determine the accuracy of the Fitbit Flex (FF) activity monitor for assessing preschoolers' physical activity (PA) and sedentary behavior (SED) in free-living conditions. STUDY DESIGN This is a cross-sectional study of 27 preschoolers (41% girls; age, 4.9 years) who each wore the FF and ActiGraph GT3X+ (AG) simultaneously for 24 hours. Raw data from each device were temporally matched and summarized into estimates of SED, moderate-to-vigorous PA, and total PA after removing sleep and nonwear time periods. Equivalence testing was performed to compare the 90% CIs of the estimates from the FF with the respective equivalence zone (±15% of the mean estimates) from the AG. RESULTS The FF yielded equivalent estimates of SED (mean difference, 42-71 minutes/day) and total PA (mean difference, 42-70 minutes/day), but lower moderate-to-vigorous PA (mean difference, 29-67 minutes/day) than the AG, on average. The FF showed strong correlations and relatively low mean absolute percent errors (MAPEs) in relation to the AG for SED (r = 0.87; MAPE = 9.1%) and total PA (r = 0.71; MAPE = 14.3%), but a moderate correlation and high MAPE for moderate-to-vigorous PA (r = 0.59; MAPE = 70.1%). CONCLUSIONS The FF activity monitor accurately estimated the amount of time spent in SED and overall PA in preschool-aged children, but with an underestimation of moderate-to-vigorous PA. Our findings support the use of the FF as a feasible and a relatively accurate PA monitoring tool in clinical and research settings.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pubmed/29754862", "newWindow": true } ] }, { "title": "Exercise combined with Acceptance and Commitment Therapy (ExACT) compared to a supervised exercise programme for adults with chronic pain: study protocol for a randomised controlled trial", "author": "Casey, M.-B., Smart, K., Segurado, R., Hearty, C., Gopal, H., Lowry, D., Flanagan, D., McCracken, L. and Doody, C.\t", "year": "2018", "journalProceedings": "Trials", "category": "Methods", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Acceptance and Commitment Therapy (ACT) is a form of cognitive behavioural therapy, which may be beneficial for people with chronic pain. The approach aims to enhance daily functioning through increased psychological flexibility. Whilst the therapeutic model behind ACT appears well suited to chronic pain, there is a need for further research to test its effectiveness in clinical practice, particularly with regards to combining ACT with physical exercise. This prospective, two-armed, parallel-group, single-centre randomised controlled trial (RCT) will assess the effectiveness of a combined Exercise and ACT programme, in comparison to supervised exercise for chronic pain. One hundred and sixty patients, aged 18 years and over, who have been diagnosed with a chronic pain condition by a physician will be recruited to the trial. Participants will be individually randomised to one of two 8-week, group interventions. The combined group will take part in weekly psychology sessions based on the ACT approach, in addition to supervised exercise classes led by a physiotherapist. The control group will attend weekly supervised exercise classes but will not take part in an ACT programme. The primary outcome will be pain interference at 12-week follow-up, measured using the Brief Pain Inventory-Interference Scale. Secondary outcomes will include self-reported pain severity, self-perception of change, patient satisfaction, quality of life, depression, anxiety and healthcare utilisation. Treatment process measures will include self-efficacy, pain catastrophising, fear avoidance, pain acceptance and committed action. Physical activity will be measured using Fitbit ZipTM activity trackers. Both groups will be followed up post intervention and again after 12 weeks. Estimates of treatment effects at follow-up will be based on an intention-to-treat framework, implemented using a linear mixed-effects model. Individual and focus group qualitative interviews will be undertaken with a purposeful sample of participants to explore patient experiences of both treatments. To our knowledge, this will be the first RCT to examine whether combining exercise with ACT produces greater benefit for patients with chronic pain, compared to a standalone supervised exercise programme.", "links": [] }, { "title": "Validation of Fitness Tracker for Sleep Measures in Women with Asthma ", "author": "Castner, J., Mammen, M.J., Jungquist, C., Licata, O., Pender, J.J., Wilding, G.E. and Sethi, S.", "year": "2018", "journalProceedings": "Journal of Asthma", "category": "Validation", "devices": "Charge", "population": "Adults", "dataUsed": "Sleep", "abstract": "AbstractObjective: Night-time wakening with asthma symptoms is key to assessment and therapy decisions, with no gold standard objective measure. The study aims were to 1) determine the feasibility, 2) explore equivalence, and 3) test concordance of a consumer-based accelerometer with standard actigraphy for measurement of sleep patterns in women with asthma as an adjunct to self-report.Methods: Panel study design of women with poorly controlled asthma from a university-affiliated primary care clinic system was used. We assessed sensitivity and specificity, equivalence and concordance of sleep time, sleep efficiency, and wake counts between the consumer-based accelerometer Fitbit Charge™ and Actigraph wGT3X+. We linked data between devices for comparison both automatically by 24-hour period and manually by sleep segment.Results: Analysis included 424 938 minutes, 738 nights, and 833 unique sleep segments from 47 women. The fitness tracker demonstrated 97% sensitivity and 40% specificity to identify sleep. ...", "links": [] }, { "title": "Effect of physical activity trackers and daily text messages on quality-of-life in colorectal survivors (Smart Pace): A pilot randomized controlled trial.", "author": "Chan, H., Van Loon, K., Kenfield, S.A., Chan, J.M., Mitchell, E., Zhang, L., Paciorek, A., Joseph, G., Laffan, A., Fukuoka, Y., Miaskowski, C., Meyerhardt, J.A., Venook, A.P. and Van Blarigan, E.", "year": "2018", "journalProceedings": "JCO", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "559Background: There are over 1.3 million colorectal cancer (CRC) survivors in the United States, and many of whom suffer from lower health-related quality-of-life (HRQoL) years after diagnosis and treatment. Physical activity may improve survival outcomes and HRQoL for CRC survivors. Feasible interventions to support physical activity after CRC diagnosis are needed. Methods: We conducted a two-arm randomized controlled trial of 41 men and women who had completed treatment for CRC. Participants in the intervention arm were given a Fitbit Flex? and received daily text messages for 12 weeks. HRQoL was assessed in both arms at baseline and 12 weeks using the RAND Short Form Survey (SF-36) and the Functional Assessment of Cancer Therapy ? Colorectal (FACT-C). Survey score changes from baseline to 12 weeks were compared between the two arms using independent t-tests, and scores at baseline and 12 weeks were compared using paired t-tests. SAS was used for analysis, and statistical significance was declared at p < 0.05. Results: We observed a statistically significant increase in the FACT-C functional well-being sub-scale in individuals in the intervention arm pre- and post- intervention (mean ? 1.81 ± 2.76; p: 0.02). There was no change in functional well-being in the control arm (mean ? -0.35 ± 4.12; p: 0.71). The between-arm comparison of change from baseline to 12 weeks was not statistically significantly (p: 0.08). There was a statistically significant increase in the FACT-C emotional well-being sub-scale in the control arm (mean ? 1.20 ± 2.48; p: 0.04) and in the SF-36 role physical sub-scale in the control arm (mean ? 22.5 ± 38.8; p: 0.02). No other measures of HRQoL were statistically significantly different within groups, across time points, or between groups. Conclusions: A 12-week physical activity intervention using a Fitbit Flex? and daily text messages may improve functional well-being among CRC survivors. Larger randomized studies are needed to definitively determine if a digital physical activity intervention improves functional well-being among CRC survivors, and if the improvement can be sustained over time. Clinical trial information: NCT02966054.\n559Background: There are over 1.3 million colorectal cancer (CRC) survivors in the United States, and many of whom suffer from lower health-related quality-of-life (HRQoL) years after diagnosis and treatment. Physical activity may improve survival outcomes and HRQoL for CRC survivors. Feasible interventions to support physical activity after CRC diagnosis are needed. Methods: We conducted a two-arm randomized controlled trial of 41 men and women who had completed treatment for CRC. Participants in the intervention arm were given a Fitbit Flex? and received daily text messages for 12 weeks. HRQoL was assessed in both arms at baseline and 12 weeks using the RAND Short Form Survey (SF-36) and the Functional Assessment of Cancer Therapy ? Colorectal (FACT-C). Survey score changes from baseline to 12 weeks were compared between the two arms using independent t-tests, and scores at baseline and 12 weeks were compared using paired t-tests. SAS was used for analysis, and statistical significance was declared at p < 0.05. Results: We observed a statistically significant increase in the FACT-C functional well-being sub-scale in individuals in the intervention arm pre- and post- intervention (mean ? 1.81 ± 2.76; p: 0.02). There was no change in functional well-being in the control arm (mean ? -0.35 ± 4.12; p: 0.71). The between-arm comparison of change from baseline to 12 weeks was not statistically significantly (p: 0.08). There was a statistically significant increase in the FACT-C emotional well-being sub-scale in the control arm (mean ? 1.20 ± 2.48; p: 0.04) and in the SF-36 role physical sub-scale in the control arm (mean ? 22.5 ± 38.8; p: 0.02). No other measures of HRQoL were statistically significantly different within groups, across time points, or between groups. Conclusions: A 12-week physical activity intervention using a Fitbit Flex? and daily text messages may improve functional well-being among CRC survivors. Larger randomized studies are needed to definitively determine if a digital physical activity intervention improves functional well-being among CRC survivors, and if the improvement can be sustained over time. Clinical trial information: NCT02966054.", "links": [ { "caption": "URL", "url": "http://ascopubs.org/doi/abs/10.1200/JCO.2018.36.4_suppl.559", "newWindow": true } ] }, { "title": "Preliminary concurrent validity of the Fitbit-Zip and ActiGraph activity monitors for measuring steps in people with polymyalgia rheumatica.", "author": "Chandrasekar, A., Hensor, E.M.A., Mackie, S.L., Backhouse, M.R. and Harris, E.\t", "year": "2018", "journalProceedings": "Gait & posture", "category": "Validation", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND Activity monitors provide objective measurements of physical activity, however, the accuracy of these devices in people with polymyalgia rheumatica (PMR) is unknown. Therefore, this study aimed to obtain preliminary evidence of the accuracy of two activity monitors and explore if clinical and gait-related factors altered device accuracy in people with PMR. METHODS The ActiGraph with low frequency extension (+LFE) and standard (-LFE) algorithms, Fitbit-Zip (waist) and Fitbit-Zip (shirt) were concurrently tested using a two-minute walk test (2MWT) and stairs test in 27 people with PMR currently treated with prednisolone. To determine accuracy, activity monitor step-count was compared to a gold-standard step-count (GSSC; calculated from video recording) using Bland-Altman plots. RESULTS The Fitbit-Zip (waist) achieved closest agreement to the GSSC for the 2MWT (mean bias (95%CI): 10 (-3, 23); 95%LOA: -55, 74). The ActiGraph (+LFE) achieved closest agreement to the GSSC for the stairs test (mean bias (95%CI): 0 (-1, 1); 95%LOA: -5, 5). The ActiGraph (-LFE) performed poorly in both tests. All devices demonstrated reduced accuracy in participants with lower gait velocity, reduced stride length, longer double-limb support phase and greater self-reported functional impairment. CONCLUSION Our preliminary results suggest that in controlled conditions, the Fitbit-Zip fairly accurately measures step-count during walking in people with PMR receiving treatment. However, device error was greater than data published in healthy people. The ActiGraph may not be recommended without activation of the LFE. We identified clinical and gait-related factors associated with higher levels of functional impairment that reduced device accuracy. Further work is required to evaluate the validity of the activity monitors in field conditions.", "links": [] }, { "title": "A Physical Therapist–Administered Physical Activity Intervention After Total Knee Replacement: Protocol for a Randomized Controlled Trial", "author": "Christiansen, M.B., Thoma, L.M., Master, H., Schmitt, L.A., Pohlig, R. and White, D.K.\t", "year": "2018", "journalProceedings": "Physical Therapy", "category": "Methods", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background\nThe definitive treatment for knee osteoarthritis is a total knee replacement, which results in a clinically meaningful improvement in pain and physical function. However, evidence suggests that physical activity (PA) remains unchanged after total knee replacement (TKR).\nObjective\nThe objective of this study is to investigate the efficacy, fidelity, and safety of a physical therapist–administered PA intervention for people after TKR.\n\nDesign\nThis study is a protocol for a randomized controlled trial.\n\nSetting\nThe setting is an outpatient physical therapy clinic.\n\nParticipants\nThe participants are 125 individuals who are over the age of 45 and are seeking outpatient physical therapy following a unilateral TKR.\n\nIntervention\nIn addition to standardized physical therapy after TKR, the intervention group will receive, during physical therapy, a weekly PA intervention that includes a wearable activity tracking device, individualized step goals, and face-to-face feedback provided by a physical therapist.\n\nControl\nThe control group will receive standardized physical therapy alone after TKR.\n\nMeasurements\nThe efficacy of the intervention will be measured as minutes per week spent in moderate to vigorous PA at enrollment, at discharge, and at 6 months and 12 months after discharge from physical therapy. The fidelity and safety of the intervention will be assessed throughout the study.\n\nLimitations\nParticipants will not be masked, PA data will be collected after randomization, and the trial will be conducted at a single site.\n\nConclusions\nThe goal of this study is to increase PA after TKR. A protocol for investigating the efficacy, fidelity, and safety of a physical therapist–administered PA intervention for people after total knee replacement is presented. The findings will be used to support a large multisite clinical trial to test the effectiveness, implementation, and cost of this intervention.", "links": [] }, { "title": "The role of sleep in adolescents' daily stress recovery: Negative affect spillover and positive affect bounce-back effects", "author": "Chue, A.E., Gunthert, K.C., Kim, R.W., Alfano, C.A. and Ruggiero, A.R.\t", "year": "2018", "journalProceedings": "Journal of Adolescence", "category": "Measurement", "devices": "Flex", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "The present study examined the role of sleep in daily affective stress recovery processes in adolescents. Eighty-nine American adolescents recorded their emotions and stress through daily surveys and sleep with Fitbit devices for two weeks. Results show that objectively measured sleep (sleep onset latency and sleep debt) moderated negative affective responses to previous-day stress, such that stress-related negative affect spillover effects became more pronounced as amount of sleep decreased. Total sleep time and sleep debt moderated cross-day positive affect “bounce-back” effects. With more sleep, morning positive affect on days following high stress tended to bounce back to the levels that were common following low stress days. Conversely, if sleep was short following high stress days, positive affect remained low the next morning. No evidence for subjective sleep quality as a moderator of spillover/bounce-back effects was found. This research suggests that sleep quantity could relate to overnight affective stress recovery.", "links": [ { "caption": "URL", "url": "https://www.sciencedirect.com/science/article/pii/S0140197118300782", "newWindow": true } ] }, { "title": "Engagement Strategies for Self-Monitoring Symptoms of Bipolar Disorder With Mobile and Wearable Technology: Protocol for a Randomized Controlled Trial", "author": "Cochran, A., Belman-Wells, L. and McInnis, M.\t", "year": "2018", "journalProceedings": "JMIR Research Protocols", "category": "Methods", "devices": null, "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Sleep,Heart Rate", "abstract": "Background: Monitoring signs and symptoms in bipolar disorder (BP) is typically based on regular assessments from patient-clinician interactions. Mobile and wearable technology promises to make monitoring symptoms in BP easier, but little is known about how best to engage individuals with BP in monitoring symptoms. Objective: The objective of this study was to provide the rationale and protocol for a randomized controlled trial that investigates engagement strategies for monitoring symptoms of BP, including the strategies of using activity trackers compared with self-reports and reviewing recorded symptoms weekly with an interviewer. Methods: A total of 50 individuals with BP will be recruited from the Prechter Longitudinal Study of Bipolar Disorder at the University of Michigan to participate in a 6-week study. Participants will monitor their symptoms through an activity tracker (Fitbit Alta HR) and a mobile phone app designed for this study. In addition to monitoring symptoms, participants have a 50-50 chance of being assigned to an arm that reviews self-reports and activity information weekly. Statistical tests will be performed to test hypotheses that participants adhere to activity tracking significantly more than self-reporting, prefer activity tracking significantly more than self-reporting, and better adhere to both activity tracking and self-reporting when reviewing collected information weekly. Results: Recruitment commenced in November 2017. The first group of participants began the study in January 2018. Conclusions: This study aims to establish strategies to engage individuals with BP in monitoring their symptoms with mobile and wearable technology. Better engagement strategies are expected to aid current efforts in bipolar research and clinical care, from the development of new mobile phone apps to providing the right intervention to the right individual at the right moment. Trial Registration: ClinicalTrials.gov NCT03358238; https://clinicaltrials.gov/ct2/show/NCT03358238 (Archived by WebCite at http://www.webcitation.org/6yebuNfz5) Registered Report Identifier: RR1-10.2196/9899 [JMIR Res Protoc 2018;7(5):e130]", "links": [] }, { "title": "Peer Coaching Through mHealth Targeting Physical Activity in People With Parkinson Disease: Feasibility Study.", "author": "Colón-Semenza, C., Latham, N.K., Quintiliani, L.M. and Ellis, T.D.\t", "year": "2018", "journalProceedings": "JMIR mHealth and uHealth", "category": "Usability", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND Long-term engagement in exercise and physical activity mitigates the progression of disability and increases quality of life in people with Parkinson disease (PD). Despite this, the vast majority of individuals with PD are sedentary. There is a critical need for a feasible, safe, acceptable, and effective method to assist those with PD to engage in active lifestyles. Peer coaching through mobile health (mHealth) may be a viable approach. OBJECTIVE The purpose of this study was to develop a PD-specific peer coach training program and a remote peer-mentored walking program using mHealth technology with the goal of increasing physical activity in persons with PD. We set out to examine the feasibility, safety, and acceptability of the programs along with preliminary evidence of individual-level changes in walking activity, self-efficacy, and disability in the peer mentees. METHODS A peer coach training program and a remote peer-mentored walking program using mHealth was developed and tested in 10 individuals with PD. We matched physically active persons with PD (peer coaches) with sedentary persons with PD (peer mentees), resulting in 5 dyads. Using both Web-based and in-person delivery methods, we trained the peer coaches in basic knowledge of PD, exercise, active listening, and motivational interviewing. Peer coaches and mentees wore FitBit Zip activity trackers and participated in daily walking over 8 weeks. Peer dyads interacted daily via the FitBit friends mobile app and weekly via telephone calls. Feasibility was determined by examining recruitment, participation, and retention rates. Safety was assessed by monitoring adverse events during the study period. Acceptability was assessed via satisfaction surveys. Individual-level changes in physical activity were examined relative to clinically important differences. RESULTS Four out of the 5 peer pairs used the FitBit activity tracker and friends function without difficulty. A total of 4 of the 5 pairs completed the 8 weekly phone conversations. There were no adverse events over the course of the study. All peer coaches were \"satisfied\" or \"very satisfied\" with the training program, and all participants were \"satisfied\" or \"very satisfied\" with the peer-mentored walking program. All participants would recommend this program to others with PD. Increases in average steps per day exceeding the clinically important difference occurred in 4 out of the 5 mentees. CONCLUSIONS Remote peer coaching using mHealth is feasible, safe, and acceptable for persons with PD. Peer coaching using mHealth technology may be a viable method to increase physical activity in individuals with PD. Larger controlled trials are necessary to examine the effectiveness of this approach.", "links": [] }, { "title": "Validation of the Fitbit Flex in an Acute Post-Cardiac Surgery Patient Population ", "author": "Daligadu, J., Pollock, C.L., Carlaw, K., Chin, M., Haynes, A., Thevaraajah Kopal, T., Tahsinul, A., Walters, K. and Colella, T.J.F.", "year": "2018", "journalProceedings": "Physiotherapy Canada", "category": "Validation", "devices": "Flex", "population": "Patients", "dataUsed": "Steps,Distance", "abstract": "Purpose: This study examined the validity of the Fitbit Flex activity monitor for step count and distance walked among post-cardiac surgery patients. Method: Participants (N=20) from a major urban cardiac surgery centre were recruited 1-2 days before hospital discharge. The Fitbit Flex step count and distance walked outputs and video recording of each participant performing the 6-minute walk test were collected. Fitbit Flex output was compared with criterion measures of manual step count obtained from the video recording and manual measurement of distance walked. Statistical analysis compared the output and criterion measures using paired sample t-tests, Pearson correlation coefficients, Lin's concordance correlations, and Bland-Altman plots. Sub-analysis compared slower walking (<0.8 m/s; n=11) and faster walking (≥0.8 m/s; n=8) group speeds (1 participant was excluded from analysis). Results: Steps counted and distance walked were significantly different between the Fitbit Flex outputs and criterion mea...", "links": [] }, { "title": "Free-Living Physical Activity Monitoring in Adult US Patients with Multiple Sclerosis Using a Consumer Wearable Device", "author": "DasMahapatra, P., Chiauzzi, E., Bhalerao, R. and Rhodes, J.\t", "year": "2018", "journalProceedings": "Digital Biomarkers", "category": "Usability,Measurement", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Introduction: Wearable devices have been used to characterize physical activity in multiple sclerosis (MS). The objectives of this study were to advance the literature on the utility of free-living physical activity tracking from secondary analyses of a pilot study in MS patients. Method: The original observational study was conducted in participants with MS at PatientsLikeMe (www.PatientsLikeMe.com), an online network of patients with chronic diseases. Participants completed a baseline self-assessment, and received a Fitbit OneTM wearable device with instructions to upload data. Eligible participants (1) self-reported MS, (2) logged on to the PatientsLikeMe website 90 days prior to enrollment, and (3) consented to participate electronically. Participants (1) textless 18 years, (2) living outside the United States, and (3) requiring wheelchair assistance for most daily activities were excluded. The secondary analyses were limited to participants with complete data on MS type, disease duration, and Multiple Sclerosis Rating Scale (MSRS) and at least 7 days of wearable data. Step count was used as a measure of physical activity. Results: The analysis cohort of 114 participants uploaded a mean of 20.1 days of wearable data over the 23-day study (87% adherence); participants averaged 4,393 steps per day. The mean age of participants was 52 years, predominantly female (75%), relapsing-remitting type (79%), with mean disease duration of 16 years. Mean MSRS score within 30-day of baseline was 32; 72% reported mild-moderate walking disability. The reliability of step count measured by intraclass correlation was 0.55 for a single day, ≥0.7 for 2-day average, and ≥0.9 for 7-day average. After controlling for covariates, self-reported disease severity (MSRS quartile) was an independent predictor of step count (p textless 0.001). Least square means (LS means) for participants that were least disabled (lowest quartile) was 5,937 steps, which was significantly higher than participants in the second, third, and fourth quartiles (4,570, 3,490, and 3,272, respectively). Similarly, LS means of participants with no ambulatory disability (measured by MSRS walk component) was 6,931 steps, significantly higher than participants with greater disability (4,743, 4,394, 2,727 steps for symptomatic, mild, and moderate disability, respectively, p textless 0.001). Discussion: Using an interactive platform, this study captured free-living mobility data in MS patients. Important metrics such as the use of a minimum of 2-day estimates and self-reported disability were found to be robust indicators and correlates, respectively, of participant activity levels. Further triangulation of such metrics may reduce the burden on patients, clinicians, and researchers when monitoring clinical status.", "links": [] }, { "title": "Feasibility of using the Fitbit Charge HR in validating self-reported exercise diaries in a community setting in patients with heart failure", "author": "Deka, P., Pozehl, B., Norman, J.F. and Khazanchi, D.\t", "year": "2018", "journalProceedings": "European Journal of Cardiovascular Nursing", "category": "Usability", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Intensity", "abstract": "Background:\nUse of wrist-worn activity monitors has increased over the past few years; however, the use of the Fitbit® Charge HR (FCHR) in a community setting in patients with heart failure has not been tested.\n\nPurpose:\nThe purpose of the study was to assess the feasibility, practicality and acceptability of utilizing the FCHR to validate self-reported exercise diaries and monitor exercise in community dwelling patients with heart failure. Methods: Thirty heart failure patients (12 females and 18 males) aged 64.7 ± 11.5 years were provided with a FCHR. Participants were provided with an exercise routine and for eight weeks, recorded their exercise sessions in self-reported exercise diaries and used the FCHR to record those exercise sessions.\n\nResults:\nExercise data from the self-reported exercise diaries were validated with data from the FCHR. Participants’ perception and acceptance of using the FCHR was positive. Validation of exercise and physical activity interventions using the FCHR appears feasible and acceptable in patients with heart failure.\n\nConclusion:\nWrist-worn activity monitors can be useful for objective measurement of exercise adherence and monitoring of physical activity in patients with heart failure in a community setting.", "links": [] }, { "title": "Utilizing wearable technology to increase physical activity in future physicians: A randomized trial ", "author": "DiFrancisco-Donoghue, J., Jung, M.-K., Stangle, A., Werner, W.G., Zwibel, H., Happel, P. and Balentine, J.", "year": "2018", "journalProceedings": "Preventive Medicine Reports", "category": "Intervention", "devices": null, "population": "Adults", "dataUsed": "Steps,Weight", "abstract": "This study examined the use of activity trackers alone or combined with weekly communication through email to improve activity and body composition over one academic year in medical students. This randomized clinical trial conducted at the New York Institute of Technology from July 7, 2016 through June 4, 2017 enrolled 120 medical students. The first group (Fitbit-Plus) wore activity trackers and received weekly emails offering fitness challenges and lifestyle modification challenges. The second group (Fitbit-Only) received only activity trackers and did not receive weekly emails. The third group (Control) was asked not to purchase an activity tracker of any kind throughout the study. All groups had a body composition analysis prior to the start of the academic year and at the end of the first academic year. Outcome measures included step count and body composition (body fat percentage and lean body mass). The results showed the overall mean daily steps were greater in the Fitbit-Plus group than the Fitbit-Only group for the academic year (7429 ± 2833 vs. 6483 ± 2359) with only months April and May showing a significant difference between the groups (p = 0.011; p = 0.044). Body fat percentage decreased in the Fitbit-Plus overweight women (2.1 ± 1.6%) lean body mass increased in the Fitbit-Plus group in overweight men (2.4 ± 4.6 lbs.). A subsequent finding of this study showed improved body composition in a small sub-group of over-weight students. Weekly behavioral challenges combined with an activity tracker increased step count in medical students compared to an activity tracker alone. Clinicaltrials.gov Identifier: NCT02778009.", "links": [] }, { "title": "Personalized Physical Activity Coaching: A Machine Learning Approach", "author": "Dijkhuis, T.B., Blaauw, F.J., van Ittersum, M.W., Velthuijsen, H. and Aiello, M.\t", "year": "2018", "journalProceedings": "Sensors", "category": "Methods", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Living a sedentary lifestyle is one of the major causes of numerous health problems. To encourage employees to lead a less sedentary life, the Hanze University started a health promotion program. One of the interventions in the program was the use of an activity tracker to record participants' daily step count. The daily step count served as input for a fortnightly coaching session. In this paper, we investigate the possibility of automating part of the coaching procedure on physical activity by providing personalized feedback throughout the day on a participant's progress in achieving a personal step goal. The gathered step count data was used to train eight different machine learning algorithms to make hourly estimations of the probability of achieving a personalized, daily steps threshold. In 80% of the individual cases, the Random Forest algorithm was the best performing algorithm (mean accuracy = 0.93, range = 0.88–0.99, and mean F1-score = 0.90, range = 0.87–0.94). To demonstrate the practical usefulness of these models, we developed a proof-of-concept Web application that provides personalized feedback about whether a participant is expected to reach his or her daily threshold. We argue that the use of machine learning could become an invaluable asset in the process of automated personalized coaching. The individualized algorithms allow for predicting physical activity during the day and provides the possibility to intervene in time.", "links": [] }, { "title": "Validation of PiezoRx Pedometer Derived Sedentary Time", "author": "Donahoe, K., MacDonald, D., Tremblay, M. and Saunders, T.\t", "year": "2018", "journalProceedings": "International Journal of Exercise Science", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Intensity", "abstract": "International Journal of Exercise Science 11(7): 552-560, 2018. Although pedometers are valid tools for measuring physical activity, to date they have not been used to assess sedentary time. The primary purpose of this study was to determine if the PiezoRx pedometer is a valid and reliable measure of sedentary time compared to the hip-worn Actical accelerometer. A secondary purpose was to compare sedentary time derived via the Fitbit Flex with that of the Actical. Finally, a third purpose was to compare sedentary time derived from the above devices, with that of the ActivPAL inclinometer. Thirty-five participants ages 11-69 years (Mage= 23.3; 21 Female) wore five devices for up to one week: two PiezoRx pedometers, an Actical, an ActivPAL and a Fitbit Flex. Participants recorded daily wear-time of each device using a log sheet. The average sedentary time calculated from the PiezoRx (716±137.68 min/day) was not different from the Actical (694 ±136.11 min/day, p>0.05), although it was higher than the ActivPAL (475±171.52 min/day) and Fitbit Flex (530±149.94 min/day, all p<0.001). Sedentary time from all devices were significantly correlated with each other, with the strongest relationship seen between the Actical and PiezoRx (R2=0.93, p<0.001). In comparison to the ActivPAL, error in PiezoRx- (R2=0.96), Actical- (R2=0.96) and Fitbit Flex- (R2=0.34) determined sedentary time was strongly associated with standing time (all p<0.001). Sedentary time derived using the PiezoRx pedometer may be statistically equivalent to the Actical accelerometer, but not the ActivPAL inclinometer or Fitbit Flex.", "links": [] }, { "title": "Congruent Accuracy of Wrist-worn Activity Trackers during Controlled and Free-living Conditions", "author": "Dondzilla, C.J., Lewis, C., Lopez, J. and Parker, T.\t", "year": "2018", "journalProceedings": "International Journal of Exercise Science", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Heart Rate", "abstract": "To examine activity tracker accuracy for measuring steps, energy expenditure, and heart rate in controlled and free-living conditions. Forty participants performed four, five-minute stages (walking: 53.7 m∙min-1, 80.5 m∙min-1; running: 134.1 m∙min-1, 160.9 m∙min-1) while wearing the Fitbit Charge HR (FB) and the Mio FUSE (MF) activity trackers. Measurements included steps, energy expenditure (kcals), and heart rate (beats∙min-1). In addition to the FB and MF, participants wore the NL-1000 (NL) activity tracker during waking hours of the subsequent day. One way ANOVAs with Tukey's post hoc analyses were performed to compare mean values for steps, kcals, and mean heart rate between the FB, MF, and criterion measures. Levels of agreement for heart rate with 95% confidence intervals were examined with Bland-Altman plots. Compared to criterion measures, the FB and MF underestimated steps and overestimated kcals at 53.7 m∙min-1 (FB: 12.7% for steps, 89.2% for kcals; MF: 15.8% for steps, 44.9% for kcals, ptextless.001) and 80.5 m∙min-1 (FB: 9.7% for steps, 69.9% for kcals; MF: 13.4% for steps, 32.0% for kcals, ptextless.001). During free-living conditions, the MF significantly underestimated steps by 30.0% (ptextless.05). Increasing exercise intensity is indicative of heightened accuracy for step detection and kcal estimation for the FB and MF, while decreasing heart rate accuracy for the FB. However, the MF performed poorly for estimating total daily activity.", "links": [] }, { "title": "Individual differences in regulatory mode moderate the effectiveness of a pilot mHealth trial for diabetes management among older veterans", "author": "Dugas, M., Crowley, K., Gao, G.G., Xu, T., Agarwal, R., Kruglanski, A.W. and Steinle, N.\t", "year": "2018", "journalProceedings": "PLOS ONE", "category": "Intervention", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "mHealth tools to help people manage chronic illnesses have surged in popularity, but evidence of their effectiveness remains mixed. The aim of this study was to address a gap in the mHealth and health psychology literatures by investigating how individual differences in psychological traits are associated with mHealth effectiveness. Drawing from regulatory mode theory, we tested the role of locomotion and assessment in explaining why mHealth tools are effective for some but not everyone. A 13-week pilot study investigated the effectiveness of an mHealth app in improving health behaviors among older veterans (n = 27) with poorly controlled Type 2 diabetes. We developed a gamified mHealth tool (DiaSocial) aimed at encouraging tracking of glucose control, exercise, nutrition, and medication adherence. Important individual differences in longitudinal trends of adherence, operationalized as points earned for healthy behavior, over the course of the 13-week study period were found. Specifically, low locomotion was associated with unchanging levels of adherence during the course of the study. In contrast, high locomotion was associated with generally stronger adherence although it exhibited a quadratic longitudinal trend. In addition, high assessment was associated with a marginal, positive trend in adherence over time while low assessment was associated with a marginal, negative trend. Next, we examined the relationship between greater adherence and improved clinical outcomes, finding that greater adherence was associated with greater reductions in glycated hemoglobin (HbA1c) levels. Findings from the pilot study suggest that mHealth technologies can help older adults improve their diabetes management, but a “one size fits all” approach may yield suboptimal outcomes.", "links": [] }, { "title": "Behavior Change Techniques and Physical Activity Using the Fitbit Flex®", "author": "Dunn, E.E. and Robertson-Wilson, J.\t", "year": "2018", "journalProceedings": "International Journal of Exercise Science", "category": "Survey Research", "devices": "Flex", "population": "Adults", "dataUsed": "NA", "abstract": "International Journal of Exercise Science 11(7): 561-574, 2018. Due to the availability of low-cost accelerometers, there has been an increase in the adoption of physical activity monitors (e.g., Fitbit®) (14) accompanied by a desire to understand the behavior change techniques (BCTs; 15) present in such monitors. One specific Fitbit® monitor incorporates 20 BCTs (15), but how users experience these BCTs has yet to be explored. The purpose of this study was to explore user's experience with the Fitbit Flex® regarding physical activity behavior and BCTs. The specific research objectives were to: 1) describe Fitbit Flex® users and 2) explore user's engagement with the 20 BCTs. Participants (n=28) completed an online survey composed of questions about demographics, step volume, and perceived importance and/or frequency of use of the BCTs. Participants were mostly female (82.1%), between the ages of 18-71 years, and had used the Fitbit® for an average of 5 months. There was a significant increase of almost 2000 steps per day (p=0.003) from participants' first week to their past week (i.e., last 7 days) of monitor use. The BCTs rated among the highest for perceived importance for physical activity behavior (i.e., step volume) were “feedback on behavior”, “self-monitoring of behavior”, and “goal setting (behavior)”. In brief, Fitbit® devices have the potential for increased step-based physical activity. As well, the present study contributes to understanding how user's experience BCTs in the Fitbit Flex® which can inform future physical activity promotion and interventions.", "links": [] }, { "title": "Effects of a 12 Week mHealth Program on Peak VO2 and Physical Activity Patterns after Completing Cardiac Rehabilitation: A Randomized Controlled Trial", "author": "Duscha, B.D., Piner, L.W., Patel, M.P., Craig, K.P., Brady, M., McGarrah, R.W., Chen, C. and Kraus, W.E.\t", "year": "2018", "journalProceedings": "American Heart Journal", "category": "Intervention", "devices": "Charge", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND\nSite-based cardiac rehabilitation (CR) provides supervised exercise, education and motivation for patients. Graduates of CR have improved exercise tolerance. However, when participation in CR ceases, adherence to regular physical activity often decline consequently leading to worsening risk factors and clinical events. Therefore, the purpose of this pilot study was to evaluate if a mHealth program could sustain the fitness and physical activity levels gained during CR.\nMETHODS AND RESULTS\nA 12-week mHealth program was implemented using physical activity trackers and health coaching. Twenty-five patients were randomized into mHealth or usual care after completing CR. The combination of a 4.7 ± 13.8% increase in the mHealth and a 8.5 ± 11.5% decrease in the usual care group resulted in a difference between groups (p ≤ 0.05) for absolute peak VO2. Usual care decreased the amount of moderate-low physical activity minutes per week (117 ± 78 vs 50 ± 53; p textless 0.05) as well as moderate-high (111 ±87 vs 65 ± 64; p textless 0.05). mHealth increased moderate-high physical activity (138 ± 113 vs 159 ± 156; NS). The divergent changes between mHealth and usual care in moderate-high physical activity minutes/week resulted in a difference between groups (21 ± 103 vs – 46 ± 36; p textless 0.05).\n\nCONCLUSIONS\nA 12-week mHealth program of physical activity trackers and health coaching following CR graduation can sustain the gains in peak VO2 and physical activity achieved by site-based CR.", "links": [] }, { "title": "Chronic Health Risks in Commercial Fishermen: A Cross-Sectional Analysis from a Small Rural Fishing Village in Alaska", "author": "Eckert, C., Baker, T. and Cherry, D.\t", "year": "2018", "journalProceedings": "Journal of Agromedicine", "category": "Measurement", "devices": "One", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "ABSTRACTObjectives: The purpose of this study is to evaluate chronic health risks before and during the fishing season in a sample of commercial fishermen, addressing the NIOSH priority of Total Worker HealthTM.Methods: Gillnet license holders in Cordova, Alaska (n = 607) were contacted to participate in a preseason survey (March 2015) assessing health behaviors. A mid-season survey (July 2015) was also conducted. Physical exams and additional assessments were performed on a subset of these fishermen.Results: Sixty-six fishermen participated in the preseason survey and 38 participated in the mid-season survey. The study population was overwhelmingly white males with an average age of 49. The average BMI was 27 with 70% of the participants overweight or obese. Nearly 80% of the sample considered their health good or better. Participants reported longer working hours, less sleep, and less aerobic exercise during the fishing season (P textless .05). FitBitTM monitoring (n = 8) confirmed less sleep and fewer steps d...", "links": [] }, { "title": "Steps per Day Measured by Consumer Activity Trackers Worn at the Non-Dominant and Dominant Wrist Relative to a Waist-Worn Pedometer", "author": "Edwardson, C.L., Davies, M., Khunti, K., Yates, T. and Rowlands, A.V.\t", "year": "2018", "journalProceedings": "Journal for the Measurement of Physical Behaviour", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Purpose: To compare steps counts recorded by consumer activity trackers when worn on the non-dominant and dominant wrist against a waist-worn pedometer during free-living. Methods: 30 participants wore six consumer wrist-worn physical activity trackers and a pedometer. On day 1, three trackers were worn on the non-dominant wrist (ND) and three on the dominant (D) wrist. On day 2 trackers were worn on the opposite wrist. On both days, a pedometer (New-Lifestyles NL-800) was worn at the waist. Mean absolute percent error (MAPE) and the Bland-Altman method assessed tracker agreement with the pedometer. Repeated measures ANOVA examined whether MAPEs were significantly different between wrist trackers (i.e., brand comparison) and between wrist location (i.e., non-dominant vs. dominant). Results: MAPEs were higher for the D wrist trackers. Five out of six trackers on the D wrist over-counted, while four out of six trackers on the ND wrist under-counted. MAPE errors were significant (p ≤ .001) between trackers b...", "links": [] }, { "title": "A modified activity protocol for claudication.", "author": "Endicott, K.M., Hynes, C.F., Amdur, R. and Macsata, R.\t", "year": "2018", "journalProceedings": "The Journal of Cardiovascular Surgery", "category": "Intervention", "devices": "One,Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND We propose the use of a monitored step tracking device, the FitBit® to supplant supervised exercise therapy (SET) programs to facilitate improvement in walking distance in Veteran claudicators. METHODS In this prospective study, we enrolled fortynine patients with clinical evidence of lower extremity claudication in a six month walking program. Each patient was given a FitBit® device to track daily number of steps. Patients were seen in clinic monthly to collect data and discuss walking goals. Surveys at the beginning and end of each study assessed patient perception of changes in walking distance as well as symptoms. The primary outcome was monthly distance walked. Changes over time in each outcome variables were examined using a random effects mixed model. RESULTS In the first month, the adjusted mean number of steps per day was 3492 (95% CI 2661 4322). By month 5, this had increased to 4502 (36365367) (p=.0007). 28 patients used the tracker at least for 1 month, while 21 (43%) did not. Being bothered by symptoms was the only patient variable that was significantly associated with use of the FitBit®. Those who used the tracker tended to be younger, heavier, more active, and were more likely to have diabetes. CONCLUSIONS In the Veteran population, the use of a monitored step tracking device such as the FitBit® is a potentially effective strategy to improve walking distance in claudicators particularly in those with mild symptoms. Additional investigation is needed to determine which patients will benefit most from this walking protocol.", "links": [] }, { "title": "Buying time: a proof-of-concept randomized controlled trial to improve sleep quality and cognitive function among older adults with mild cognitive impairment ", "author": "Falck, R.S., Davis, J.C., Best, J.R., Li, L.C., Chan, P.C.Y., Wyrough, A.B., Landry, G.J. and Liu-Ambrose, T.", "year": "2018", "journalProceedings": "Trials", "category": "Intervention", "devices": "Flex", "population": "Older Adults", "dataUsed": "Sleep", "abstract": "Current evidence suggests that good quality sleep is associated with preserved cognitive function and reduced dementia risk in older adults. Sleep complaints are especially common among older adults with mild cognitive impairment (MCI), and this may contribute to their increased risk for progression to dementia. Thus, improving their sleep may be important for maintaining their cognitive health. Chronotherapy is a set of intervention strategies that can improve sleep quality through strengthening the entrainment of the biological clock to the solar light-dark cycle, and includes strategies such as (1) bright light therapy (BLT); (2) physical activity (PA); and (3) good sleep hygiene. Of these strategies, BLT is the most potent and is based on providing individualized timing to entrain circadian rhythms. Thus, a personalized chronotherapy intervention of individually timed BLT and individually tailored PA promotion, in conjunction with general sleep hygiene education may promote older adult sleep quality. We therefore aim to carry out a proof-of-concept randomized controlled trial (RCT) to examine the efficacy of such a personalized chronotherapy intervention to improve sleep quality among older adults with MCI. This was a 24-week RCT of a personalized chronotherapy intervention aimed to primarily improve sleep quality as measured by the MotionWatch8©. Participants in the personalized chronotherapy group (INT) will receive four once-weekly, general sleep hygiene education classes, followed by 20 weeks of (1) individually timed BLT and (2) bi-weekly, individually tailored PA counseling phone calls in conjunction with receiving a consumer-available PA tracker--the Fitbit® Flex™. Ninety-six adults (aged 65-85 years) classified as having MCI (i.e., Mini-Mental State Exam (MMSE) ≥ 24; Montreal Cognitive Assessment (MoCA) ≤ 26; without dementia or significant functional impairment) will be randomized to either INT or a waitlist control group (CON). The results of this trial will help determine if a personalized chronotherapy intervention that includes individually timed BLT and individually tailored PA promotion, along with general sleep hygiene education can promote sleep quality among older adults at increased risk for dementia. Our results will help inform best practices for promoting sleep quality among older adults with MCI. ClinicalTrials.gov , NCT02926157 . Registered on 6 October 2016.", "links": [] }, { "title": "A Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) in Older Adults With Obesity: Protocol for the MORPH Trial.", "author": "Fanning, J., Brooks, A.K., Ip, E., Nicklas, B.J. and Rejeski, W.J.\t", "year": "2018", "journalProceedings": "JMIR research protocols", "category": "Methods", "devices": "Aria,Alta", "population": "Older Adults", "dataUsed": "Steps,Intensity,Weight", "abstract": "BACKGROUND Chronic pain is a complex, age-related health issue that affects both physical functioning and quality of life. Because the impact of chronic pain is worsened by obesity and inactivity, nonpharmacological interventions that promote movement, reduce sitting, and aid in weight loss are needed to help manage pain symptoms among older adults with chronic pain. OBJECTIVE The Mobile Intervention to Reduce Pain and Improve Health (MORPH) pilot trial aims to develop and test the feasibility and acceptability of a novel, patient-centered intervention to reduce chronic pain and improve physical functioning in older adults, leveraging the combination of telecoaching and individually adaptive mHealth tools to decrease both body mass and sedentary behavior. METHODS MORPH comprises 2 phases, including a 1-year iterative development phase, and a 1-year pilot randomized controlled trial (RCT). During the development phase, representative participants will engage in one-on-one structured interviews and a 1-week field test. The resulting feedback will be used to guide the development of the finalized MORPH intervention package. During the second phase, the finalized intervention will be tested in a pilot RCT (N=30) in which older adult participants with chronic pain and obesity will be assigned to receive the 12-week MORPH intervention or to a waitlist control. Primary outcomes include self-reported pain symptoms and physical function. RESULTS Phase 1 recruitment is ongoing as of December 2017. CONCLUSIONS The MORPH intervention brings together a strong body of evidence using group-based behavioral intervention designs with contemporary mHealth principles, allowing for intervention when and where it matters the most. Given the ubiquity of smartphone devices and the popularity of consumer activity and weight monitors, the results of this study may serve to inform the development of scalable, socially driven behavioral pain management interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03377634; https://clinicaltrials.gov/ct2/show/NCT03377634 (Archived by WebCite at http://www.webcitation.org/6yj0J5Pan). REGISTERED REPORT IDENTIFIER RR1-10.2196/9712.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pubmed/29759957", "newWindow": true } ] }, { "title": "Quantifying Subjective Well-Being Using Trends in Weekend Activity ", "author": "Faust, L., Hachen, D., Lizardo, O. and Chawla, N.V.", "year": "2018", "journalProceedings": "2018 IEEE International Conference on Healthcare Informatics (ICHI)", "category": "Usability", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps", "abstract": null, "links": [] }, { "title": "Acceptability and feasibility of wearable fitness technology for endometrial cancer survivors ", "author": "Frechette, L., Miller, D.T., Rossi, A., Miller, E.M., Van Arsdale, A.R., Viswanathan, S. and Nevadunsky, N.S.", "year": "2018", "journalProceedings": "Gynecologic Oncology", "category": "Intervention", "devices": null, "population": "Older Adults", "dataUsed": "Steps", "abstract": null, "links": [] }, { "title": "A weight loss intervention using a commercial mobile application in Latino Americans—Adelgaza Trial", "author": "Fukuoka, Y., Vittinghoff, E. and Hooper, J.\t", "year": "2018", "journalProceedings": "Translational Behavioral Medicine", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps,Food", "abstract": "More than half of Latino adults living in the USA are expected to develop type 2 diabetes in their lifetime. Despite the growing interest in smartphone use for weight loss and diabetes prevention, relatively few clinical trials have evaluated the efficacy of mobile app-based interventions in Latino populations. The aim of this study was to evaluate the potential efficacy of an in-person weight loss intervention in conjunction with a commercially available Fitbit app in a Latino sample at risk for type 2 diabetes and explore significant predictors associated with weight loss. After the run-in period, 54 self-identified Latinos with body mass index (BMI) > 24.9 kg/m2 were enrolled in an 8-week uncontrolled pilot study, and received a Fitbit Zip, its app, and two in-person weight loss sessions adapted from the Diabetes Prevention Program. Mean age was 45.3 (SD ± 10.8) years, 61.1% were born in the USA, and mean BMI was 31.4 (SD ± 4.1) kg/m2. Participants lost an average of 3.3 (SD ± 3.4) % of their body weight (p < .0005). We also observed statistically significant reductions in hip and waist circumferences, and systolic and diastolic blood pressure (p < .001). After controlling for demographic factors, use of the mobile app weight diary at least twice a week (p = .01) and change in the International Physical Activity Questionnaire score (p = .03) were associated with change in percent body weight. The intervention showed the potential efficacy of this intervention, which should be formally evaluated in a randomized controlled trial.", "links": [] }, { "title": "Accuracy of Fitbit Surge and Smartphone Apps at Measuring Cycling Distance and Speed ", "author": "Gamez, J.L., Figueroa, I.A. and Funk, M.D.", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Surge", "population": "Adults", "dataUsed": "Distance", "abstract": "PURPOSE: To determine the accuracy of Fitbit Surge and two smartphone applications at measuring distance and speed while cycling outside. METHODS: Thirteen college-aged students (Mean±SD; BMI: 25.2±3.0kg/m2; 10 males, 3 females) consented to participate in one measurement session. A 0.75 mile trail along a sidewalk around the university campus was used for 3 separate trials using a mountain bike, Android smartphone running Google-Fit (G-Fit) and S-Health (SH), and Fitbit (FB) provided to each participant. A researcher rode along with each participant the entire study using a cycle computer as the standard for speed and distance. The first lap consisted of walking 0.25 miles, cycling 0.15 miles at a slow speed, cycling 0.20 miles at a fast speed, and cycling 0.15 miles at a moderate speed. The second lap consisted of 1 lap at a moderate speed. The third lap consisted in 1 lap at a slow speed. After every lap a researcher recorded the data from the phone and the Fitbit. Mean bias and mean absolute percent error (MAPE) were calculated to describe speeds and distances recorded on each device compared to the cycle computer. RESULTS: Thirteen participants completed all 3 trials though 2 were excluded due to a malfunction with the smartphone apps causing partial data to be collected, leaving 11 included in this analysis. Results are as follows: CONCLUSION: The Fitbit Surge was most accurate at measuring speed and distance for cycling followed by the S-Health app and lastly the Google-Fit app.", "links": [] }, { "title": "Intensive remote monitoring versus conventional care in type 1 diabetes: A randomized controlled trial", "author": "Gandrud, L., Altan, A., Buzinec, P., Hemphill, J., Chatterton, J., Kelley, T. and Vojta, D.\t", "year": "2018", "journalProceedings": "Pediatric Diabetes", "category": "Intervention", "devices": null, "population": "Adolescents", "dataUsed": "Steps", "abstract": "Objective\nWhile frequent contact with diabetes care providers may improve glycemic control among patients with type 1 diabetes (T1D), in-person visits are labor-intensive and costly. This study was conducted to assess the impact of an intensive remote therapy (IRT) intervention for pediatric patients with T1D.\nMethods\nPediatric patients with T1D were randomized to IRT or conventional care (CC) for 6 months. Both cohorts continued routine quarterly clinic visits and uploaded device data; for the IRT cohort, data were reviewed and patients were contacted if regimen adjustments were indicated. Glycated hemoglobin (HbA1c) change from baseline was assessed at 6 and 9 months. Diabetes-related quality of life (QoL), healthcare services utilization, and hypoglycemic events were also tracked.\n\nResults\nAmong 117 enrollees (60 IRT, 57 CC), mean (SD) 6-month %HbA1c change for IRT vs CC was −0.34 (0.85) (−3.7 mmol/mol) vs −0.05 (0.74) (−0.5 mmol/mol) overall (P = .071); −0.15 (0.67) (1.6 mmol/mol) vs −0.02 (0.66) (0.2 mmol/mol) for ages 8 to 12 (P = .541); and −0.50 (0.95) (−5.5 mmol/mol) vs −0.06 (0.80) (−0.7 mmol/mol) for ages 13 to 17 (P = .056). Diabetes-related QoL increased by 6.5 and 1.3 points for IRT and CC, respectively (P = .062). Three months after intervention cessation, %HbA1c changed minimally among treated children aged 8 to 12 but increased by 0.22 (0.89) (2.4 mmol/mol) among those aged 13 to 17.\n\nConclusions\nIRT substantially affected diabetes metrics and improved QoL among pediatric patients with T1D. Adolescents experienced a stronger treatment effect, but had difficulty in sustaining improved control after intervention cessation.", "links": [] }, { "title": "The Feasibility of a Gender- and Culturally-Sensitive Weight Loss Intervention Plus Mobile Health Technology for Hispanic Males ", "author": "Garcia, D.O., Valdez, L.A., Aceves, B., Campas, D., Loya, J., Hingle, M., Humphrey, K., Bell, M.L., McEwen, M. and Hooker, S.P.", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Usability", "devices": "Charge 2,Aria", "population": "Adults", "dataUsed": "Intensity", "abstract": "BACKGROUND: Hispanic males suffer disproportionate rates of overweight and obesity compared to other racial/ethnic groups. However, few weight loss interventions have been developed for this high-risk group. Further, the use of mobile health (mHealth) technologies to support lifestyle behavior changes in weight loss interventions for Hispanic men are untested. PURPOSE: This pilot study examined the feasibility and acceptability of integrating mHealth technology into a 12-week gender- and culturally- sensitive weight loss intervention (GCSWLI) for sedentary, overweight/obese Hispanic males. METHODS: Eighteen Hispanic males (age: 38 ± 11 years; BMI: 34 ± 5 kg/m2; 56% Spanish monolingual) received a GCSWLI including weekly in-person individual sessions, a daily calorie goal, and prescription of ≥225 minutes of moderate-intensity physical activity/week. mHealth technology support included tailored text messaging and behavior and weight self-monitoring support using the Fitbit Charge 2, a consumer- wearable physical activity tracker, and a Fitbit Aria Wi-Fi Smart Scale. Participants were encouraged to use the Fitbit tracker during all waking hours and weigh themselves daily using the provided scale. Participants received biweekly SMS customized to address self-reported barriers to behavior change and in response to objective data collected via tracking tools. Changes in weight from baseline to 12-weeks were estimated using a paired t-test. Descriptive analyses characterized use of the Fitbit and the smart scale. RESULTS: Sixteen of 18 participants completed 12-week assessments; overall attrition rate was 11.1%. Mean weight loss at week 12 was 4.7 kg (95% CI [-7.1, -2.3], p < 0.001). Participants wore the Fitbit 71.6% of intervention days and logged body weight using the smart scale 30.5% of intervention days. Participants identified barriers for use of the technology, including strenuous work activities prohibiting them from wearing the Fitbit. In addition, reliable internet access was cited as a barrier to using the smart scale. CONCLUSIONS: While significant weight loss was achieved integrating mHealth technology into a GCSWLI, the use of technology was modest. Addressing barriers identified in our work may help to refine an mHealth intervention approach for Hispanic men.", "links": [] }, { "title": "Determining the Validity and Accuracy of Multiple Activity-Tracking Devices in Controlled and Free-Walking Conditions", "author": "Gaz, D.V., Rieck, T.M., Peterson, N.W., Ferguson, J.A., Schroeder, D.R., Dunfee, H.A., Henderzahs-Mason, J.M. and Hagen, P.T.\t", "year": "2018", "journalProceedings": "American Journal of Health Promotion", "category": "Validation", "devices": "One,Zip,Charge HR", "population": "Adults", "dataUsed": "Steps,Distance", "abstract": "Purpose:\nClinicians and fitness professionals are increasingly recommending the use of activity trackers. This study compares commercially available activity tracking devices for step and distance accuracy in common exercise settings.\n\nDesign:\nCross sectional.\n\nSetting:\nRochester, Minnesota.\n\nParticipants:\nThirty-two men (n = 10) and women (n = 22) participated in the study.\n\nMeasures:\nResearchers manually counted steps and measured distance for all trials, while participants wore 6 activity tracking devices that measured steps and distance.\n\nAnalysis:\nWe computed the difference between the number of steps measured by the device and the actual number of steps recorded by the observers, as well as the distance displayed by the device and the actual distance measured.\n\nResults:\nThe analyses showed that both the device and walking trials affected the accuracy of the results (steps or distance, P < .001). Hip-based devices were more accurate and consistent for measuring step count. No significant differences were found among devices or locations for the distance measured.\n\nConclusions:\nHip-based activity tracking devices varied in accuracy but performed better than their wrist-based counterparts for step accuracy. Distance measurements for both types of devices were more consistent but lacked accuracy.", "links": [] }, { "title": "Feasibility and effects of a home-based intervention using activity trackers on achievement of individual goals, quality of life and motor performance in patients with paediatric cancer", "author": "Götte, M., Kesting, S.V., Gerss, J., Rosenbaum, D. and Boos, J.\t", "year": "2018", "journalProceedings": "BMJ Open Sport & Exercise Medicine", "category": "Intervention", "devices": "One,Flex", "population": "Patients,Adults,Adolescents", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance", "abstract": "Objectives Supervised exercise interventions during inpatient care are feasible. The objective was to evaluate the usability of activity trackers and centralised monitoring to conduct a home-based exercise intervention during cancer treatment. The primary endpoint and confirmatory analysis was achievement of individual goals for daily steps, compared (A) in the intervention group (IG) over time and (B) between the IG and control group (CG). Secondary endpoints included achievement of goals for active minutes and effects on motor performance and health-related quality of life (hrQoL).", "links": [ { "caption": "URL", "url": "http://bmjopensem.bmj.com/content/4/1/e000322", "newWindow": true } ] }, { "title": "Gamifying Accelerometer Use Increases Physical Activity Levels of Sedentary Office Workers. ", "author": "Gremaud, A.L., Carr, L.J., Simmering, J.E., Evans, N.J., Cremer, J.F., Segre, A.M., Polgreen, L.A. and Polgreen, P.M.", "year": "2018", "journalProceedings": "Journal of the American Heart Association", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND Sedentary work is hazardous. Over 80% of all US jobs are predominantly sedentary, placing full-time office workers at increased risk for cardiovascular and metabolic morbidity and mortality. Thus, there is a critical need for effective workplace physical activity interventions. MapTrek is a mobile health platform that gamifies Fitbit use for the purpose of promoting physical activity. The purpose of this study was to test the efficacy of MapTrek for increasing daily steps and moderate-intensity steps over 10 weeks in a sample of sedentary office workers. METHODS AND RESULTS Participants included 146 full-time sedentary office workers aged 21 to 65 who reported sitting at least 75% of their workday. Each participant received a Fitbit Zip to wear daily throughout the intervention. Participants were randomized to either a: (1) Fitbit-only group or 2) Fitbit + MapTrek group. Physical activity outcomes and intervention compliance were measured with the Fitbit activity monitor. The Fitbit + MapTrek group significantly increased daily steps (+2092 steps per day) and active minutes (+11.2 min/day) compared to the Fitbit-only arm, but, on average, participants' steps declined during the study period. CONCLUSIONS MapTrek is an effective approach for increasing physical activity at a clinically meaningful level in sedentary office workers, but as with accelerometer use alone, the effect decreases over time. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03109535.", "links": [] }, { "title": "Wearable activity monitors to assess performance status and predict clinical outcomes in advanced cancer patients ", "author": "Gresham, G., Hendifar, A.E., Spiegel, B., Neeman, E., Tuli, R., Rimel, B.J., Figlin, R.A., Meinert, C.L., Piantadosi, S. and Shinde, A.M.", "year": "2018", "journalProceedings": "npj Digital Medicine", "category": "Usability", "devices": "Charge HR", "population": "Patients", "dataUsed": "Steps,Intensity,Sleep,Heart Rate", "abstract": "An objective evaluation of patient performance status (PS) is difficult because patients spend the majority of their time outside of the clinic, self-report to providers, and undergo dynamic changes throughout their treatment experience. Real-time, objective activity data may allow for a more accurate assessment of PS and physical function, while reducing the subjectivity and bias associated with current assessments. Consenting patients with advanced cancer wore a wearble activity monitor for three consecutive visits in a prospective, single-cohort clinical trial. Provider-assessed PS (ECOG/Karnofsky) and NIH PROMIS® patient-reported outcomes (PROs) were assessed at each visit. Associations between wearable activity monitor metrics (steps, distance, stairs) and PS, clinical outcomes (adverse events, hospitalizations, survival), and PROs were assessed using correlation statistics and in multivariable logistic regression models. Thirty-seven patients were evaluated (54% male, median 62 years). Patients averaged 3700 steps, 1.7 miles, and 3 flights of stairs per day. Highest correlations were observed between average daily steps and ECOG-PS and KPS (r = 0.63 and r = 0.69, respectively p < 0.01). Each 1000 steps/day increase was associated with reduced odds for adverse events (OR: 0.34, 95% CI 0.13, 0.94), hospitalizations (OR: 0.21 95% CI 0.56, 0.79), and hazard for death (HR: 0.48 95% CI 0.28-0.83). Significant correlations were also observed between activity metrics and PROs. Our trial demonstrates the feasibility of using wearable activity monitors to assess PS in advanced cancer patients and suggests their potential use to predict clinical and patient-reported outcomes. These findings should be validated in larger, randomized trials.", "links": [] }, { "title": "A mobile phone-based program to promote healthy behaviors among adults with prediabetes: study protocol for a pilot randomized controlled trial", "author": "Griauzde, D.H., Kullgren, J.T., Liestenfeltz, B., Richardson, C. and Heisler, M.\t", "year": "2018", "journalProceedings": "Pilot and Feasibility Studies", "category": "Methods", "devices": "Aria", "population": "Patients,Adults", "dataUsed": "Steps,Weight", "abstract": "Rates of participation in Diabetes Prevention Programs (DPPs) are low. This may be due, in part, to low levels of autonomous motivation (i.e., motivation that arises from internal sources and sustains healthy behaviors over time) to prevent type 2 diabetes (T2DM) among many individuals with prediabetes. Mobile health (mHealth) technologies that incorporate principles from the Self-Determination Theory offer an effective and scalable approach to increase autonomous motivation levels. One promising mobile phone-based application is JOOL Health, which aims to help users connect certain health behaviors (e.g., sleep and diet) with personal values in specific life domains (e.g., family and work). The first aim of this study is to estimate whether JOOL Health can increase autonomous motivation to prevent T2DM among individuals with prediabetes who declined DPP participation. The second aim of this pilot study is to examine the intervention's feasibility and acceptability. This is a 12-week, three-arm pilot randomized controlled trial. We will recruit 105 individuals with prediabetes who did not engage in a DPP despite invitation from their health plan to participate in face-to-face or web-based programs at no out-of-pocket-cost. Participants will be randomized to one of three study arms: (1) a group that receives information on prediabetes, evidence-based strategies to decrease progression to T2DM, and a list of resources for mHealth tools for monitoring diet, physical activity, and weight (comparison group); (2) a group that receives the JOOL Health application; and (3) a group that receives the JOOL Health application as well as a Fitbit activity tracker and wireless-enabled scale. Our primary outcome is change in autonomous motivation to prevent T2DM (measured using the Treatment Self-Regulation Questionnaire). We will also collect data related to the intervention's feasibility (recruitment and retention rates) and acceptability (adherence and qualitative experience) as well as changes in psychosocial outcomes, hemoglobin A1c, and weight. To our knowledge, this is the first study that aims to promote positive health behaviors among individuals with prediabetes who previously declined to participate in a DPP. Our results will inform a larger trial to test the effect of JOOL Health on clinically relevant outcomes, including weight loss, physical activity, and DPP engagement.", "links": [] }, { "title": "Assessment of the accuracy of nutrient calculations of five popular nutrition tracking applications", "author": "Griffiths, C., Harnack, L. and Pereira, M.A.\t", "year": "2018", "journalProceedings": "Public Health Nutrition", "category": "Validation", "devices": null, "population": "Adults", "dataUsed": "Food", "abstract": "Objective\nTo assess the accuracy of nutrient intake calculations from leading nutrition tracking applications (apps).\nDesign\nNutrient intake estimates from thirty 24 h dietary recalls collected using Nutrition Data System for Research (NDSR) were compared with intake calculations from these recalls entered by the researcher into five free nutrition tracking apps. Apps were selected from the Apple App Store based on consumer popularity from the list of free ‘Health and Fitness' apps classified as a nutrition tracking apps.\n\nSubjects\nDietary recall data collected from thirty lower-income adults.\n\nResults\nCorrelations between nutrient intake calculations from NDSR and the nutrition tracking apps ranged from 0textperiodcentered73 to 0textperiodcentered96 for energy and macronutrients. Correlations for the other nutrients examined (Na, total sugars, fibre, cholesterol, saturated fat) ranged from 0textperiodcentered57 to 0textperiodcentered93. For each app, one or more mean nutrient intake calculations were significantly lower than those from NDSR. These differences included total protein (P=0textperiodcentered03), total fat (P=0textperiodcentered005), Na (P=0textperiodcentered02) and cholesterol (P=0textperiodcentered005) for MyFitnessPal; dietary fibre (P=0textperiodcentered04) for Fitbit; total protein (P=0textperiodcentered0004), total fat (P=0textperiodcentered008), Na (P=0textperiodcentered002), sugars (P=0textperiodcentered007), cholesterol (P=0textperiodcentered0006) and saturated fat (P=0textperiodcentered005) for Lose It!; Na (P=0textperiodcentered03) and dietary fibre (P=0textperiodcentered005) for MyPlate; and total fat (P=0textperiodcentered03) for Lifesum.\n\nConclusions\nFindings suggest that nutrient calculations from leading nutrition tracking apps tend to be lower than those from NDSR, a dietary analysis software developed for research purposes. Further research is needed to evaluate the validity of the apps when foods consumed are entered by consumers.", "links": [] }, { "title": "Feasibility of Wearable Physical Activity Monitors in Patients With Cancer", "author": "Gupta, A., Stewart, T., Bhulani, N., Dong, Y., Rahimi, Z., Crane, K., Rethorst, C. and Beg, M.S.\t", "year": "2018", "journalProceedings": "JCO Clinical Cancer Informatics", "category": "Usability", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Purpose\nThe feasibility of using physical activity monitors (PAMs) to measure functional status in patients with cancer is unclear. We aimed to determine the feasibility of using PAMs to longitudinally assess physical activity and performance status (PS) in patients with cancer.\n\nMethods\nPatients with cancer who had Eastern Cooperative Oncology Group (ECOG) PS of 0 to 2 and were receiving systemic therapy were enrolled in a prospective pilot trial of PAM use. Feasibility was defined as patients using the PAM for > 50% of the observation period. We correlated PAM-reported measures with scores from ECOG PS and quality-of-life tools (Functional Assessment of Cancer Therapy–General [FACT-G], Quick Inventory of Depressive Symptoms–Self-Rated 16 [QIDS-SR16], and Brief Fatigue Inventory [BFI]) using Pearson’s correlation test. Patients were surveyed regarding their experience with PAMs at study completion.\n\nResults\nIn all, 24 patients were enrolled; mean age was 54 years, 16 (67%) were women, and 19 (79%) were white. Twenty-three patients (96%) met the primary end point of feasibility. The median duration of follow-up was 69 days. Mean PAM-measured steps for ECOG PS of 0, 1, and 2 were 5,911, 1,890, and 845 steps per day, respectively (P = .002). Minimum steps per day correlated with BFI (r = –0.53; P < .01), FACT-G (r = 0.45; P = .02), and QIDS-SR16 (r = –0.57; P < .01). Eighteen patients (75%) reported a positive experience with the PAM.\n\nConclusion\nPAMs are a feasible tool for measuring long-term physical activity in patients with cancer who are receiving systemic therapy. PAM-derived measures correlated with clinician-assessed PS.", "links": [] }, { "title": "Enhancing Lifestyle Change in Cardiac Patients Through the Do CHANGE System (\"Do Cardiac Health: Advanced New Generation Ecosystem\"): Randomized Controlled Trial Protocol.", "author": "Habibović, M., Broers, E., Piera-Jimenez, J., Wetzels, M., Ayoola, I., Denollet, J. and Widdershoven, J.\t", "year": "2018", "journalProceedings": "JMIR Research Protocols", "category": "Methods", "devices": null, "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND Promoting a healthy lifestyle (eg, physical activity, healthy diet) is crucial for the primary and secondary prevention of cardiac disease in order to decrease disease burden and mortality. OBJECTIVE The current trial aims to evaluate the effectiveness of the Do Cardiac Health: Advanced New Generation Ecosystem (Do CHANGE) service, which is developed to assist cardiac patients in adopting a healthy lifestyle and improving their quality of life. METHODS Cardiac patients (ie, people who have been diagnosed with heart failure, coronary artery disease, and/or hypertension) will be recruited at three pilot sites (Badalona Serveis Assistencials, Badalona, Spain [N=75]; Buddhist Tzu Chi Dalin General Hospital, Dalin, Taiwan [N=100] and Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands [N=75]). Patients will be assisted by the Do Something Different (DSD) program to change their unhealthy habits and/or lifestyle. DSD has been developed to increase behavioral flexibility and subsequently adopt new (healthier) habits. In addition, patients' progress will be monitored with a number of (newly developed) devices (eg, Fitbit, Beddit, COOKiT, FLUiT), which will be integrated in one application. RESULTS The Do CHANGE trial will provide us with new insights regarding the effectiveness of the proposed intervention in different cultural settings. In addition, it will give insight into what works for whom and why. CONCLUSIONS The Do CHANGE service integrates new technologies into a behavior change intervention in order to change the unhealthy lifestyles of cardiac patients. The program is expected to facilitate long-term, sustainable behavioral change. TRIAL REGISTRATION Clinicaltrials.gov NCT03178305; https://clinicaltrials.gov/ct2/show/NCT03178305 (Archived by WebCite at http://www.webcitation.org/6wfWHvuyU).", "links": [] }, { "title": "Relationships between Neighborhood Walkability and Objectively Measured Physical Activity Levels in Hemodialysis Patients.", "author": "Han, M., Ye, X., Preciado, P., Williams, S., Campos, I., Bonner, M., Young, C., Marsh, D., Larkin, J.W., Usvyat, L.A., Maddux, F.W., Pecoits-Filho, R. and Kotanko, P.\t", "year": "2018", "journalProceedings": "Blood Purification", "category": "Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND/AIMS Neighborhood walkability is associated with indicators of health in the general population. We explored the association between neighborhood walkability and daily steps in hemodialysis (HD) patients. METHODS We measured daily steps over 5 weeks using Fitbit Flex (Fitbit, San Francisco, CA, USA) and retrieved Walk Score® (WS) data by patient's home ZIP code (www.walkscore.com; 0 = poorest walkability; 100 = greatest walkability). RESULTS HD patients took a mean of 6,393 ± 3,550 steps/day (n = 46). Median WS of the neighborhood where they resided was 28. Patients in an above-median WS (n = 27) neighborhood took significantly more daily steps compared to those (n = 19) in a below-median WS neighborhood (7,514 ± 3,900 vs. 4,800 ± 2,228 steps/day; p textless 0.001, t test). Daily steps and WS were directly correlated (R = 0.425; p = 0.0032, parametric test; R = 0.359, p = 0.0143, non-parametric test). CONCLUSION This is the first study conducted among HD patients to indicate a direct relationship between neighborhood walkability and the actual steps taken. These results should be considered when designing initiatives to increase and improvise exercise routines in HD populations.", "links": [] }, { "title": "Impact of Coordinated-Bilateral Physical Activities on Attention and Concentration in School-Aged Children", "author": "Buchele Harris, Heidi; Cortina, Kai Schnabel; Templin, Thomas; Colabianchi, Natalie; Chen, Weiyun", "year": "2018", "journalProceedings": "BioMed Research International", "category": "Intervention", "devices": "Charge HR", "population": "Children", "dataUsed": "Steps,Energy Expenditure,Distance,Heart Rate", "abstract": "{\\textless}p{\\textgreater} {\\textless}italic{\\textgreater}Purpose.{\\textless}/italic{\\textgreater} This study examined the effects of 4-week, daily 6-minute coordinated-bilateral physical activity (CBPA) breaks in classroom on attention and concentration in school-aged children. {\\textless}italic{\\textgreater}Methods.{\\textless}/italic{\\textgreater} Participants (n=116) in fifth grade from two elementary schools were assigned to three groups: two intervention groups (n= 60) and one control group (n = 56). All three groups were pre- and post-tested with the d2 Test of Attention (d2 test). One intervention group (n = 31) took part in six minutes of daily classroom-based coordinated-bilateral physical activity (CBPA) break for four weeks. Another intervention group (n = 29), the Fitbit Only (Fitbit-O), wore Fitbits per day during a school, five days per week for four weeks without CBPA breaks. A 2 × 3 ANOVA was conducted, followed by the post hoc comparisons. {\\textless}italic{\\textgreater}Results.{\\textless}/italic{\\textgreater} The CBPA showed significant increases in processing speed ( {\\textless}math id=M1\"{\\textgreater} {\\textless}mrow{\\textgreater} {\\textless}msub{\\textgreater} {\\textless}mrow{\\textgreater} {\\textless}mi{\\textgreater}F{\\textless}/mi{\\textgreater} {\\textless}/mrow{\\textgreater} {\\textless}mrow{\\textgreater} {\\textless}mn fontstyle=\"italic\"{\\textgreater}1{\\textless}/mn{\\textgreater} {\\textless}/mrow{\\textgreater} {\\textless}/msub{\\textgreater} {\\textless}/mrow{\\textgreater} {\\textless}/math{\\textgreater} = 6.876", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/29998131", "newWindow": true }, { "caption": "URL", "url": "http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5994583", "newWindow": true }, { "caption": "URL", "url": "https://www.hindawi.com/journals/bmri/2018/2539748/", "newWindow": true } ] }, { "title": "Patterns of Fitbit Use and Activity Levels Throughout a Physical Activity Intervention: Exploratory Analysis from a Randomized Controlled Trial", "author": "Hartman, S.J., Nelson, S.H. and Weiner, L.S.\t", "year": "2018", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND There has been a rapid increase in the use of technology-based activity trackers to promote behavior change. However, little is known about how individuals use these trackers on a day-to-day basis or how tracker use relates to increasing physical activity. OBJECTIVE The aims were to use minute level data collected from a Fitbit tracker throughout a physical activity intervention to examine patterns of Fitbit use and activity and their relationships with success in the intervention based on ActiGraph-measured moderate to vigorous physical activity (MVPA). METHODS Participants included 42 female breast cancer survivors randomized to the physical activity intervention arm of a 12-week randomized controlled trial. The Fitbit One was worn daily throughout the 12-week intervention. ActiGraph GT3X+ accelerometer was worn for 7 days at baseline (prerandomization) and end of intervention (week 12). Self-reported frequency of looking at activity data on the Fitbit tracker and app or website was collected at week 12. RESULTS Adherence to wearing the Fitbit was high and stable, with a mean of 88.13% of valid days over 12 weeks (SD 14.49%). Greater adherence to wearing the Fitbit was associated with greater increases in ActiGraph-measured MVPA (binteraction=0.35, Ptextless.001). Participants averaged 182.6 minutes/week (SD 143.9) of MVPA on the Fitbit, with significant variation in MVPA over the 12 weeks (F=1.91, P=.04). The majority (68%, 27/40) of participants reported looking at their tracker or looking at the Fitbit app or website once a day or more. Changes in Actigraph-measured MVPA were associated with frequency of looking at one's data on the tracker (b=-1.36, P=.07) but not significantly associated with frequency of looking at one's data on the app or website (P=.36). CONCLUSIONS This is one of the first studies to explore the relationship between use of a commercially available activity tracker and success in a physical activity intervention. A deeper understanding of how individuals engage with technology-based trackers may enable us to more effectively use these types of trackers to promote behavior change. TRIAL REGISTRATION ClinicalTrials.gov NCT02332876; https://clinicaltrials.gov/ct2/show/NCT02332876?term=NCT02332876 &rank=1 (Archived by WebCite at http://www.webcitation.org/6wplEeg8i).", "links": [] }, { "title": "Predicting Future Glucose Fluctuations Using Machine Learning and Wearable Sensor Data ", "author": "HAYERI, A.M.I.R.", "year": "2018", "journalProceedings": "Diabetes", "category": "Validation", "devices": null, "population": "Children", "dataUsed": "Steps,Heart Rate", "abstract": "Predicting blood glucose values (BG) using machine learning (ML) algorithms and data fusion techniques. There has been a recent explosion of interest in BG prediction due to its application in the development of insulin regulating algorithms for the Artificial Pancreas Project. During this study, we measured the predictive accuracy of a software system designed to predict glucose behaviour using step-count and heart-rate data in addition to BG-insulin dynamics. The software was tested in a blinded pilot study at BC Children's Hospital for 9 type 1 diabetic children. Using continuous glucose monitors (CGM) and fitness wearables (Fitbit), the software aggregated 60-days of continuous data from each participant. The data from the first 30-days of the study was used to train the algorithem. The trained algorithm was then used to make predictions every 5mins for the next 30days. On average, the software was able to predict user's future glucose values with 93% accuracy rate for 60-mins ahead of time. Although encouraging, the algorithm required further testing. We have since released the app under the commercial name \"DiaBits\" for more testing and further data collection.", "links": [] }, { "title": "Using Fitness Trackers and Smartwatches to Measure Physical Activity in Research: Analysis of Consumer Wrist-Worn Wearables.", "author": "Henriksen, A., Haugen Mikalsen, M., Woldaregay, A.Z., Muzny, M., Hartvigsen, G., Hopstock, L.A. and Grimsgaard, S.\t", "year": "2018", "journalProceedings": "Journal of Medical Internet Research", "category": "Review", "devices": null, "population": null, "dataUsed": "NA", "abstract": "BACKGROUND New fitness trackers and smartwatches are released to the consumer market every year. These devices are equipped with different sensors, algorithms, and accompanying mobile apps. With recent advances in mobile sensor technology, privately collected physical activity data can be used as an addition to existing methods for health data collection in research. Furthermore, data collected from these devices have possible applications in patient diagnostics and treatment. With an increasing number of diverse brands, there is a need for an overview of device sensor support, as well as device applicability in research projects. OBJECTIVE The objective of this study was to examine the availability of wrist-worn fitness wearables and analyze availability of relevant fitness sensors from 2011 to 2017. Furthermore, the study was designed to assess brand usage in research projects, compare common brands in terms of developer access to collected health data, and features to consider when deciding which brand to use in future research. METHODS We searched for devices and brand names in six wearable device databases. For each brand, we identified additional devices on official brand websites. The search was limited to wrist-worn fitness wearables with accelerometers, for which we mapped brand, release year, and supported sensors relevant for fitness tracking. In addition, we conducted a Medical Literature Analysis and Retrieval System Online (MEDLINE) and ClinicalTrials search to determine brand usage in research projects. Finally, we investigated developer accessibility to the health data collected by identified brands. RESULTS We identified 423 unique devices from 132 different brands. Forty-seven percent of brands released only one device. Introduction of new brands peaked in 2014, and the highest number of new devices was introduced in 2015. Sensor support increased every year, and in addition to the accelerometer, a photoplethysmograph, for estimating heart rate, was the most common sensor. Out of the brands currently available, the five most often used in research projects are Fitbit, Garmin, Misfit, Apple, and Polar. Fitbit is used in twice as many validation studies as any other brands and is registered in ClinicalTrials studies 10 times as often as other brands. CONCLUSIONS The wearable landscape is in constant change. New devices and brands are released every year, promising improved measurements and user experience. At the same time, other brands disappear from the consumer market for various reasons. Advances in device quality offer new opportunities for research. However, only a few well-established brands are frequently used in research projects, and even less are thoroughly validated.", "links": [] }, { "title": "Protocol for Moving On: a randomized controlled trial to increase outcome expectations and exercise among breast cancer survivors", "author": "Hirschey, R., Kimmick, G., Hockenberry, M., Shaw, R., Pan, W. and Lipkus, I.\t", "year": "2018", "journalProceedings": "Nursing Open", "category": "Methods", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "The aim of this study was to test the feasibility and fidelity of an intervention, Moving On, aimed to increase outcome expectations OEs (i.e. what one expects to obtain or avoid as a result of a behaviour) and exercise among breast cancer survivors.\nDesign\nRandomized controlled trial\n\nMethods\nIntervention arm participants will be given a theory‐guided booklet that was co‐created by the research team and three physically active breast cancer survivors who exercise to manage late and long‐term treatment effects. Attention control arm participants will be given a similar booklet focused on diet. Participants will have 1 week to complete reading, writing and reflecting activities in the booklets. Study outcomes will be measured through online surveys; exercise will also be measured objectively with a Fitbit®. Four weeks postintervention, participants' thoughts about the usefulness, strengths and weakness of the intervention booklet will be assessed. OEs and exercise will be measured at baseline, 4‐, 8‐ and 12‐week postintervention.", "links": [] }, { "title": "The Accuracy of Wrist-Worn Heart Rate Monitors Across a Range of Exercise Intensities ", "author": "Hough, P.", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "PURPOSE: This study investigated the accuracy of four wrist-worn HR monitors (Apple Watch Series 1, Fitbit Charge, TomTom Touch, and Mio Fuse). METHODS: Eighteen adults completed three trials on a cycle ergometer wearing a chest-worn HR monitor (Polar). Trial 1 established the HR-power output relationship, and resting and maximum HR. In trials 2 and 3, participants were fitted to an electrocardiogram (ECG) and completed a step test consisting of 5 x 3 minute stages at 40 - 80% of HR reserve (determined in trial 1) whilst wearing two wrist-worn HR monitors. RESULTS: Relative to ECG, there were no differences in HR between the devices during exercise (p = 0.239), and no device × exercise intensity interaction (p = 0.370). There were no instances where ECG and Polar data differed by ≥ 5 b·min-1. Conversely, there were two instances (2.2%) with the Apple, four (4.4%) with the Mio, 10 (11.1%) with the TomTom, and 19 (21.1%) with the Fitbit. CONCLUSIONS: A chest-worn HR monitor offers greater accuracy compared to wrist-worn devices.", "links": [] }, { "title": "A Reimbursable Counseling Intervention Improves Physical Activity and Function for Primary Care Patients with Type 2 Diabetes ", "author": "HUEBSCHMANN, A.M.Y.G., LEAVITT, I.A.N.M., GLASGOW, R.U.S.S.E.L.L., REGENSTEINER, J.U.D.I.T.H.G. and ANDREA L., D.U.N.N.", "year": "2018", "journalProceedings": "Diabetes", "category": "Intervention", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "Physical activity (PA) is a cornerstone of treatment for type 2 diabetes mellitus (T2D). Among other benefits, regular PA improves physical function which can prevent institutionalization. However, effective PA interventions are not widely adopted in primary care. Our recent systematic review identified an effective PA intervention for adults with T2D that was nearly pragmatic enough for use in primary care. However, it still required adaptation to fit clinic work flows and to be reimbursed by insurance. After adapting the intervention (Be ACTIVE) to address these issues, we hypothesized Be ACTIVE would improve PA and physical function relative to randomized controls. This pragmatic pilot trial randomized adults with T2D to 12 weeks of Be ACTIVE (6 telephone behavioral counseling sessions + PA tracking (FitBit©); 3 primary care visits to teach strength exercises + monitor safety) vs. enhanced usual care (3 self-management mailings). At baseline and post-intervention, we assessed PA with Actigraph© accelerometers (steps/week) and physical function by a timed 400-meter walk (sec) and the Short Physical Performance Battery (SPPB, 0-12 scale). To date, we have completed assessments for 15 participants (n=8 Be ACTIVE, n=7 controls). Pre-post PA increased by 19.8% in the Be ACTIVE group (+5122 ± 10steps/week; data shown as mean ± SE ) and decreased by 15.9% in controls (-3122 ± 1233 steps/week). SPPB scores increased by a clinically important >1-point difference in the Be ACTIVE group (+1.1 ± 0.2), and were stable in controls (+0.3 ± 0.1). The 400-meter walk time improved by 10.3% in Be ACTIVE participants (-38.3 ± 6.6 sec) and declined by 5.4% in controls (+17.3 ± 6.4 sec). Be ACTIVE is a reimbursable intervention delivered by primary care staff. Strong pilot data support that Be ACTIVE improves PA/physical function. If our data remain promising at trial completion, the next step towards broader dissemination will be to test Be ACTIVE in multiple clinical settings.", "links": [] }, { "title": "VALIDITY AND RELIABILITY OF THE FITBIT FLEX™ AND ACTIGRAPH GT3X+ AT JOGGING AND RUNNING SPEEDS. ", "author": "Jones, D., Crossley, K., Dascombe, B., Hart, H.F. and Kemp, J.", "year": "2018", "journalProceedings": "International journal of sports physical therapy", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Background Monitoring levels of physical activity, as an outcome or in guiding rehabilitation, is challenging for clinicians. Personal activity monitors are increasing in popularity and provide potential to enhance rehabilitation protocols. However, research to support the validity and reliability of these devices at jogging and running speeds is limited. Purpose The purpose of this study was to evaluate the validity of the Fitbit Flex™ and ActiGraph GT3X + for measuring step count at jogging and running speeds. A secondary purpose was to examine inter-device reliability of the Fitbit Flex™. Study Design Cross-sectional study. Methods Thirty healthy participants aged between 19 and 50 years, completed a treadmill protocol at jogging and running speeds (8 km/h to 16 km/h). Treadmill speed was progressively increased by intervals of 2 km/h. Each interval was four minutes in duration with a two minute rest period between stages. Participants were encouraged to continue through the graded exercise test until they reached the maximum running speed that they felt they could maintain for four minutes. Step count data was collected for Fitbit Flex™ devices and the ActiGraph GT3X+. Video analysis of step count was used as the criterion measure. Results At speeds of 8 to 14 km/h Mean Absolute Percentage Errors were ≤1% for the Fitbit Flex™ and the ActiGraph GT3X + when compared to step count via video analysis. Standard Error of Measurement between the three Fitbit Flex™ devices was ≤ 7 steps for speeds of 8 to 14 km/h and varied between 9 to 19 steps at 16 km/h. Fitbit Flex™ devices showed good to excellent between device reliability at speeds of 8 to14 km/h (ICC 0.723 to 0.999; p ≤ 0.001). Greater variability was evident with the low participant numbers at 16 km/h (ICC 0.527 to 0.896; p ≥ 0.02). Conclusion Both the Fitbit Flex™ and the ActiGraph GT3X + provide a valid account of steps taken at jogging and running speeds up to 14 km/hr, attainable by non-elite runners on a treadmill. Fitbit Flex™ devices provide equivalent step count output to each other, enabling comparison between devices during treadmill jogging and running. Level of evidence 2b.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159488/", "newWindow": true } ] }, { "title": "Relationship between subjective fatigue, physical activity, and sleep indices in nurses working 16-hour night shifts in a rotating two-shift system ", "author": "Kagamiyama, H. and Yano, R.", "year": "2018", "journalProceedings": "Journal of Rural Medicine", "category": "Case Study", "devices": "One", "population": "Adults", "dataUsed": "Energy Expenditure,Sleep", "abstract": "Objective: We clarified the relationship between the degree of subjective fatigue, sleep, and physical activity among nurses working 16-hour night shifts in a rotating two-shift system.", "links": [] }, { "title": "Effects of Sleep, Physical Activity, and Shift Work on Daily Mood: a Prospective Mobile Monitoring Study of Medical Interns ", "author": "Kalmbach, D.A., Fang, Y., Arnedt, J.T., Cochran, A.L., Deldin, P.J., Kaplin, A.I. and Sen, S.", "year": "2018", "journalProceedings": "Journal of General Internal Medicine", "category": "Measurement", "devices": "One,Charge", "population": "Adults", "dataUsed": "Sleep", "abstract": "Although short sleep, shift work, and physical inactivity are endemic to residency, a lack of objective, real-time information has limited our understanding of how these problems impact physician mental health.", "links": [ { "caption": "URL", "url": "https://link.springer.com/article/10.1007%2Fs11606-018-4373-2", "newWindow": true } ] }, { "title": "Effect of accelerometer-based feedback on physical activity in hospitalized patients with ischemic stroke: a randomized controlled trial", "author": "Kanai, M., Izawa, K.P., Kobayashi, M., Onishi, A., Kubo, H., Nozoe, M., Mase, K. and Shimada, S.\t", "year": "2018", "journalProceedings": "Clinical Rehabilitation", "category": "Intervention", "devices": "One", "population": "Older Adults,Patients", "dataUsed": "Steps", "abstract": "Objective:\nTo evaluate the effect of accelerometer-based feedback on physical activity in hospitalized patients with ischemic stroke.\nDesign:\nRandomized controlled trial.\n\nSetting:\nAcute care hospital.\n\nSubjects:\nA total of 55 patients with ischemic stroke who could walk without assistance were randomly assigned to the intervention group (n = 27) or the control group (n = 28).\n\nInterventions:\nAt the baseline measurement, patients did not receive accelerometer-based feedback. At follow-up, a physical therapist provided instruction on accelerometer-based feedback, discussed physical activity targets and encouraged the patients to walk more until discharge.\n\nMain measures:\nThe average daily number of steps taken was used as the index of daily hospitalized physical activity.\n\nResults:\nThe study sample consisted of 48 patients, of whom 23 patients comprised the intervention group and 25 patients comprised the control group. Although there were no significant differences in physical activity values between the two groups at the baseline measurement, the values in the intervention group at follow-up were significantly higher than those in the control group (5180.5 ± 2314.9 vs. 3113.6 ± 1150.9 steps/day, P = 0.0003). The effect size of physical activity values (Cohen's d = 1.15) at follow-up was large between the two groups.\n\nConclusion:\nExercise training combined with accelerometer-based feedback effectively increased physical activity in hospitalized patients with ischemic stroke.", "links": [] }, { "title": "Impact Of Placement Of Wrist-worn Activity Monitors During The Lab And Free-living Settings ", "author": "Kang, M., Lee, N.H., Jung, H.C., Jeon, S. and Lee, S.", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": null, "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Heart Rate", "abstract": "Wrist-worn activity monitors have been widely used to measure heart rates, step counts, and/or calories. While the versatility of altering the wearing locations (i.e., left vs. right; distal vs. proximal) may prove appealing, the influence of monitor placement on the outcome measurements needs to be examined. PURPOSE: This study was to examine the difference in measurements of heart rates, step counts, and calories estimated from the Fitbit monitors worn at different locations. METHODS: Thirty-two healthy male and female, aged 26.03 ± 6.59 years, participated in this study. Participants wore Fitbit monitors at four different locations [Right Proximal (RP), Right Distal (RD), Left Proximal (LP), Left Distal (LD)]. Lab testing consisted of four 5-min phases: slow and brisk walking and jogging at 53.6, 107.3, 160.9 m/min on a treadmill and a recovery. Free living activities involved ten 5-min activities with different intensity levels (e.g., stretching, climbing stairs, jogging). Heart rates, step counts, and calories were recorded during various activities. Repeated measures ANOVAs were performed with a monitor placement as a within-subjects factor on 14 lab and free-living activities for each outcome measurement. Bonferroni technique was used to adjust the alpha level of .004 (.05/14). The Greenhouse-Geisser (G-G) adjusted F and degrees of freedom were reported. RESULTS: Overall, there were no significant differences in measurements of heart rates, step counts, and calories estimated from the four Fitbit monitors during the lab activities. In free-living activities, step counts were significantly different during climbing stairs, F(2.86, 88.76) = 5.16, G-G p = .003 and sports, F(1.24, 38.40) = 27.93, G-G p < .001. Step counts estimated from LD (446 ± 49) were significantly higher than Fitbit monitors worn at RP (413 ± 61) and RD (417 ± 49) when climbing stairs. Fitbit monitors worn at LP (649 ± 64) and LD (642 ± 70) estimated significantly higher step counts than Fitbit monitors worn at RP (587 ± 75) and RD (565 ± 73) as participated in sports. CONCLUSION: This study revealed that monitor placement does not make a significant influence on the measurements of heart rates and calories during the lab and free- living settings. Further studies on the impact of monitor placement against criterion measures are warranted.", "links": [] }, { "title": "Use of Consumer Monitors for Estimating Energy Expenditure in Youth ", "author": "Kaplan, A.S., Lamunion, S.R., Hibbing, P.R. and Crouter, S.E.", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge 2", "population": "Children", "dataUsed": "Energy Expenditure,Intensity", "abstract": "Consumer-grade physical activity monitors (PAMs) have been extensively examined for estimating energy expenditure (EE) in adults; however, few studies have examined their ability to estimate EE in youth. PURPOSE: The purpose of this study was to examine equivalence between predicted EE (consumer-grade PAMs) and measured EE (indirect calorimetry) in youth. METHODS: Ninety-five youth (mean(SD); age, 12.2(3.5) yr; 49% male) performed 30 min of supine rest and 16 structured activities ranging from sedentary behaviors to vigorous intensities. Each structured activity was performed twice: once for 60-90 s and once for 4-5 min. During all testing, participants wore an Apple Watch 2 (AW, left wrist) and Mymo Activity Tracker (MT, right hip). Subsamples wore two Misfit Shine 2 devices (MSH, right hip; MSS, right shoe, n = 27), a Samsung Gear Fit 2 (SG, right wrist, n = 44), and/or a Fitbit Charge 2 (FC, right wrist, n = 53). A Cosmed K4b2 was used as the criterion measure of EE. Oxygen consumption was converted to EE in kilocalories (kcal), then summed over the whole trial to obtain gross EE. Net EE was calculated by subtracting the estimated basal EE (Schofield’s equation) from the measured gross EE. For all PAMS, EE was recorded at the start and end of the trial, and the difference was used for analysis. 95% equivalence testing with ±10% equivalence zone was used to assess equivalence between the estimated (PAM) and measured (K4b2) EE. All PAMs estimated gross EE, except for AW which estimated net EE, thus separate equivalence test was performed for the AW. Mean absolute percent error (MAPE) was used to assess individual-level error. RESULTS: Equivalence testing results and MAPE are summarized in Table 1. CONCLUSION: Only the MT was equivalent to the K4b2, however it also had the largest individual error. Caution is warranted when using consumer-grade PAMs in youth for tracking EE as there is a high degree of variability in device output.", "links": [] }, { "title": "Detecting short-duration ambulatory episodes in Fitbit® data", "author": "van Kasteren, Y.F., Perimal-Lewis, L. and Maeder, A.\t", "year": "2018", "journalProceedings": "Proceedings of the Australasian Computer Science Week Multiconference on - ACSW '18", "category": "Methods", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps", "abstract": "Wearable consumer physical activity tracking devices (such as Fitbit®) which generate logs of step count data for users offer a simple and relatively inexpensive way to monitor ambulatory behaviour. However, for researchers, the time granularity with which incremental step count data can typically be obtained using these devices, limits their usefulness particularly for short duration events. This prevents wider use of consumer wearables for non-fitness related purposes, such as using step counts to describe specific activities of daily living. This paper describes a method to overcome this limitation by classifying movements based on patterns in the data. We propose a simple model for analysing adjacent step count data values to achieve this using pilot data on physical activity in an office setting.", "links": [] }, { "title": "Validity of wearable activity monitors for tracking steps and estimating energy expenditure during a graded maximal treadmill test ", "author": "Kendall, B., Bellovary, B. and Gothe, N.P.", "year": "2018", "journalProceedings": "Journal of Sports Sciences", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Energy Expenditure", "abstract": "The purpose of this study was to assess the accuracy of energy expenditure (EE) estimation and step tracking abilities of six activity monitors (AMs) in relation to indirect calorimetry and hand counted steps and assess the accuracy of the AMs between high and low fit individuals in order to assess the impact of exercise intensity. Fifty participants wore the Basis watch, Fitbit Flex, Polar FT7, Jawbone, Omron pedometer, and Actigraph during a maximal graded treadmill test. Correlations, intra-class correlations, and t-tests determined accuracy and agreement between AMs and criterions. The results indicate that the Omron, Fitbit, and Actigraph were accurate for measuring steps while the Basis and Jawbone significantly underestimated steps. All AMs were significantly correlated with indirect calorimetry, however, no devices showed agreement (p < .05). When comparing low and high fit groups, correlations between AMs and indirect calorimetry improved for the low fit group, suggesting AMs may be better", "links": [ { "caption": "URL", "url": "https://www.tandfonline.com/doi/full/10.1080/02640414.2018.1481723", "newWindow": true } ] }, { "title": "Commonly available activity tracker apps and wearables as a mental health outcome indicator: A prospective observational cohort study among young adults with psychological distress", "author": "Knight, A. and Bidargaddi, N.\t", "year": "2018", "journalProceedings": "Journal of Affective Disorders", "category": "Measurement", "devices": null, "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND\nMonitoring is integral to adequately recognise and track mental health indicators of symptoms and functioning. Early identification of warning signs from digital footprints could facilitate adaptive and dynamic just in-time monitoring and care for individuals with common mental disorders.\nMETHODS\nSelf-report data on mental health and lifestyle behaviour from 120 male and female Australian young adults experiencing psychological distress were collected online. API software was used to download participant's daily activity duration measurements over eight months from linked commercial activity tracker apps and wearables in real time. An independent samples t-test was conducted to compare the differences in daily durations of recorded physical activity between wearable devises and smartphone apps. Entropy techniques using R interpol package were used to analyse volatility in daily activity duration.\n\nRESULTS\nDASS-21 depression, stress and anxiety sub-scale scores indicated the study sample on average, had a moderate level of psychological distress. Daily activity duration was significantly greater from wearable devices when compared with smartphone apps (t-test = 25.4, p textless 0.001). Entropy indices were not related with any of the DASS-21 measures. However, significant correlation between DASS-21 anxiety subscale scores and entropy of those with over 45 days measurements (r = 0.58, p = 0.02) was observed.\n\nLIMITATIONS\nThe observational nature of this study prohibits causal inference. As a convenience sample was used, the results may lack generalisability to the wider population.\n\nCONCLUSIONS\nContinuous monitoring using commercial apps and wearables as a resource to help clinicians augment clinical care for common mental disorders appears viable.", "links": [] }, { "title": "Self-tracking of Physical Activity in People With Type 2 Diabetes", "author": "Kooiman, T.J.M., de Groot, M., Hoogenberg, K., Krijnen, W.P., van der Schans, C.P. and Kooy, A.\t", "year": "2018", "journalProceedings": "CIN: Computers, Informatics, Nursing", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "The purpose of this study was to determine the efficacy of an online self-tracking program on physical activity, glycated hemoglobin, and other health measures in patients with type 2 diabetes. Seventy-two patients with type 2 diabetes were randomly assigned to an intervention or control group. All participants received usual care. The intervention group received an activity tracker (Fitbit Zip) connected to an online lifestyle program. Physical activity was analyzed in average steps per day from week 0 until 12. Health outcome measurements occurred in both groups at baseline and after 13 weeks. Results indicated that the intervention group significantly increased physical activity with 1.5 ± 3 days per week of engagement in 30 minutes of moderate-vigorous physical activity versus no increase in the control group (P = .047). Intervention participants increased activity with 1255 ± 1500 steps per day compared to their baseline (P < .010). No significant differences were found in glycated hemoglobin A1c, with the intervention group decreasing −0.28% ± 1.03% and the control group showing −0.0% ± 0.69% (P = .206). Responders (56%, increasing minimally 1000 steps/d) had significantly decreased glycated hemoglobin compared with nonresponders (−0.69% ± 1.18% vs 0.22% ± 0.47%, respectively; P = .007). To improve effectiveness of eHealth programs, additional strategies are needed.", "links": [] }, { "title": "Text messaging and activity tracker motivation program to increase physical activity in cancer survivors. ", "author": "Koontz, B.F., Levine, E., McSherry, F., Dale, T., Streicher, M., Chino, J.P., Kelsey, C.R., Ward, K., Little, K., Owen, L., Bennett, G., Kraus, W., Peterson, B., Pollak, K.I. and Sutton, L.", "year": "2018", "journalProceedings": "Journal of Clinical Oncology", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Cancer survivors have high rates of sedentary behavior leading to obesity and cardiovascular disease. Physical activity improves quality of life (QOL) and reduces morbidity and mortality. However, cancer survivors commonly cite motivation as a barrier to increasing physical activity. We hypothesized that a motivational text-messaging feedback system linked to a Fitbit Flex activity tracker would increase the activity level of survivors and those undergoing cancer treatment. Methods: 29 participants were enrolled in an IRB-approved single-institution study. Eligibility allowed any cancer/stage, ≤2 days of exercise per week, life expectancy of 12+ months, and smartphone access. After baseline fitness/QOL testing, participants were provided a Fitbit Flex activity tracker. A text-messaging program automatically uploaded data from the tracker via an application programming interface and provided personalized text message feedback to subject’s smartphone daily for 3 months. Primary endpoint was ch...", "links": [ { "caption": "URL", "url": "http://ascopubs.org/doi/10.1200/JCO.2018.36.7_suppl.92", "newWindow": true } ] }, { "title": "Accuracy and precision of consumer-level activity monitors for stroke detection during wheelchair propulsion and arm ergometry", "author": "Kressler, J., Koeplin-Day, J., Muendle, B., Rosby, B., Santo, E. and Domingo, A.\t", "year": "2018", "journalProceedings": "PLOS ONE", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "The purpose of this study was to evaluate whether consumer-level activity trackers can estimate wheelchair strokes and arm ergometer revolutions. Thirty able-bodied participants wore three consumer-level activity trackers (Garmin VivoFit, FitBit Flex, and Jawbone UP24) on the wrist. Participants propelled a wheelchair at fixed frequencies (30, 45 and 60 strokes per minute (spm)) three minutes each and at pre-determined varied frequencies, (30–80 spm) for two minutes. Participants also freely wheeled through an obstacle course. 10 other participants performed arm-ergometry at 40, 60 and 80 revolutions per minute (rpm), for three minutes each. Mean percentage error (MPE(SD)) for 30 spm were ≥46(26)% for all monitors, and declined to 3-6(2–7)% at 60 spm. For the obstacle course, MPE ranged from 12-17(7–13)% for all trackers. For arm-ergometry, MPE was at 1-96(0–37)% with the best measurement for the Fitbit at 60 and 80 rpm, and the Garmin at 80rpm, with MPE = 1(0–1)%. The consumer-level wrist-worn activity trackers we tested have higher accuracy/precision at higher movement frequencies but perform poorly at lower frequencies.", "links": [] }, { "title": "The Physical Activity Daily (PAD) Trial: The rationale and design of a randomized controlled trial evaluating an internet walking program to improve maximal walking distance among patients with peripheral arterial disease ", "author": "Kumar, A.M., Lyden, A.K., Carlozzi, N.E., Sen, A., Richardson, C.R. and Jackson, E.A.", "year": "2018", "journalProceedings": "Contemporary Clinical Trials", "category": "Intervention", "devices": null, "population": "Patients", "dataUsed": "Steps,Distance", "abstract": "BACKGROUND Despite established guidelines for regular walking as a first line therapy for adults with peripheral arterial disease (PAD), most patients do not walk routinely. This paper presents the design specifications for a randomized clinical trial to examine the effectiveness of an internet-based walking program compared to a telephone intervention, or the combination (internet-based with telephone counseling) for promotion of regular walking in patients with PAD.", "links": [] }, { "title": "Accuracy of wearable physical activity trackers in people with Parkinson's disease", "author": "Lamont, R.M., Daniel, H.L., Payne, C.L. and Brauer, S.G.\t", "year": "2018", "journalProceedings": "Gait & Posture", "category": "Validation", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "Introduction\nThe purpose of this study was to determine the accuracy of the Fitbit Charge HR™ and Garmin vívosmart® HR in measuring steps and reflecting intensity of activity in people with Parkinson's disease (PD).\nMethods\nThirty-three people with mild-moderate PD performed six, two-minute indoor walks at their self-selected walking pace, and at target cadences of 60, 80, 100, 120 and 140 beats/minute. A 500 m outdoor walk with terrain challenges was also performed. Step count was recorded by the two wrist-worn activity trackers (Fitbit Charge HR™ and Garmin vívosmart® HR) and compared to an accelerometer (ActivPAL3™). Intensity was recorded by a portable breath-by-breath gas analyser (VO2), heart rate and Borg scale.\n\nResults\nBoth commercial activity trackers had low error (textless3%) and moderate to high consistency at self-selected pace both indoors and outdoors (ICC 0.88–0.97; p textless 0.05) compared to the ActivPAL3™. The Garmin recorded low error (textless5%) and high agreement (ICCs textgreater 0.68; p textless 0.001) for all target cadences ≥80steps/minute. The Fitbit had higher error was less consistent for all target cadences ≥80steps/minute. Cadence measured by the Fitbit and Garmin weakly reflected increases in heart rate (ICCs 0.27–0.28; p textless 0.05), and did not reflect VO2 or Borg (ICCs 0.08–0.15, p textgreater 0.05).\n\nConclusion\nThe Garmin device was more accurate at reflecting step count across a broader range of walking cadences than the Fitbit, but neither strongly reflected intensity of activity. While not intended to replace research grade devices, these wrist-worn devices may be a clinically useful adjunct to exercise therapy to increase physical activity in people with PD.", "links": [] }, { "title": "The effectiveness, reproducibility, and durability of tailored mobile coaching on diabetes management in policyholders: A randomized, controlled, open-label study", "author": "Lee, D.Y., Park, J., Choi, D., Ahn, H.-Y., Park, S.-W. and Park, C.-Y.\t", "year": "2018", "journalProceedings": "Scientific Reports", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "This randomized, controlled, open-label study conducted in Kangbuk Samsung Hospital evaluated the effectiveness, reproducibility, and durability of tailored mobile coaching (TMC) on diabetes management. The participants included 148 Korean adult policyholders with type 2 diabetes divided into the Intervention-Maintenance (I-M) group (n = 74) and Control-Intervention (C-I) group (n = 74). Intervention was the addition of TMC to typical diabetes care. In the 6-month phase 1, the I-M group received TMC, and the C-I group received their usual diabetes care. During the second 6-month phase 2, the C-I group received TMC, and the I-M group received only regular information messages. After the 6-month phase 1, a significant decrease (0.6%) in HbA1c levels compared with baseline values was observed in only the I-M group (from 8.1 ± 1.4% to 7.5 ± 1.1%, P textless 0.001 based on a paired t-test). At the end of phase 2, HbA1c levels in the C-I group decreased by 0.6% compared with the value at 6 months (from 7.9 ± 1.5 to 7.3 ± 1.0, P textless 0.001 based on a paired t-test). In the I-M group, no changes were observed. Both groups showed significant improvements in frequency of blood-glucose testing and exercise. In conclusion, addition of TMC to conventional treatment for diabetes improved glycemic control, and this effect was maintained without individualized message feedback.", "links": [] }, { "title": "Clinical Feasibility of Continuously Monitored Data for Heart Rate, Physical Activity, and Sleeping by Wearable Activity Trackers in Patients with Thyrotoxicosis: Protocol for a Prospective Longitudinal Observational Study.", "author": "Lee, J.-E., Lee, D.H., Oh, T.J., Kim, K.M., Choi, S.H., Lim, S., Park, Y.J., Park, D.J., Jang, H.C. and Moon, J.H.\t", "year": "2018", "journalProceedings": "JMIR Research Protocols", "category": "Methods", "devices": "Charge HR,Charge 2", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Distance,Sleep,Heart Rate", "abstract": "BACKGROUND Thyrotoxicosis is a common disease caused by an excess of thyroid hormones. The prevalence of thyrotoxicosis about 2% and 70-90% of thyrotoxicosis cases are caused by Graves' disease, an autoimmune disease, which has a high recurrence rate when treated with antithyroid drugs such as methimazole or propylthiouracil. The clinical symptoms and signs of thyrotoxicosis include palpitation, weight loss, restlessness, and difficulty sleeping. Although these clinical changes in thyrotoxicosis can be detected by currently available wearable activity trackers, there have been few trials of the clinical application of wearable devices in patients with thyrotoxicosis. OBJECTIVE The aim of this study is to investigate the clinical applicability of wearable device-generated data to the management of thyrotoxicosis. We are analyzing continuously monitored data for heart rate, physical activity, and sleep in patients with thyrotoxicosis during their clinical course after treatment. METHODS Thirty thyrotoxic patients and 10 control subjects were enrolled in this study at Seoul National University Bundang Hospital. Heart rate, physical activity, and sleep are being monitored using a Fitbit Charge HR or Fitbit Charge 2. Clinical data including anthropometric measures, thyroid function test, and hyperthyroidism symptom scale are recorded. RESULTS Study enrollment began in December 2016, and the intervention and follow-up phases are ongoing. The results of the data analysis are expected to be available by September 2017. CONCLUSIONS This study will provide a foundational feasibility trial of the clinical applications of biosignal measurements to the differential diagnosis, prediction of clinical course, early detection of recurrence, and treatment in patients with thyrotoxicosis.", "links": [] }, { "title": "Comparison of Wearable Trackers’ Ability to Estimate Sleep ", "author": "Lee, J.-M., Byun, W., Keill, A., Dinkel, D. and Seo, Y.", "year": "2018", "journalProceedings": "International Journal of Environmental Research and Public Health", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "Tracking physical activity and sleep patterns using wearable trackers has become a current trend. However, little information exists about the comparability of wearable trackers measuring sleep. This study examined the comparability of wearable trackers for estimating sleep measurement with a sleep diary (SD) for three full nights. A convenience sample of 78 adults were recruited in this research with a mean age of 27.6 ± 11.0 years. Comparisons between wearable trackers and sleep outcomes were analyzed using the mean absolute percentage errors, Pearson correlations, Bland–Altman Plots, and equivalent testing. Trackers that showed the greatest equivalence with the SD for total sleep time were the Jawbone UP3 and Fitbit Charge Heart Rate (effect size = 0.09 and 0.23, respectively). The greatest equivalence with the SD for time in bed was seen with the SenseWear Armband, Garmin Vivosmart, and Jawbone UP3 (effect size = 0.09, 0.16, and 0.07, respectively). Some of the wearable trackers resulted in closer approximations to self-reported sleep outcomes than a previously sleep research-grade device, these trackers offer a lower-cost alternative to tracking sleep in healthy populations.", "links": [] }, { "title": "Lifelog-based classification of mild cognitive impairment using artificial neural networks", "author": "Lee, S.-h., Kang, W.-s. and Moon, C.\t", "year": "2018", "journalProceedings": "2018 International Conference on Electronics, Information, and Communication (ICEIC)", "category": "Methods", "devices": "Charge 2", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "The swift diagnosis and treatment of mild cognitive impairment (MCI), as a prestage of dementia, are important to reduce the enormous costs of dementia treatment. The aim of this paper is to investigate the potential features in human behavior to facilitate the early diagnosis of MCI. In order to extract specific features from lifelogs, we collected data of activity and sleep using Fitbit's wrist band worn day and night from 12 subjects, for 12 week each. These data were analyzed using the SPSS (Statistical Package for Social Science) for verification and 12 total numbers of the significant features are extracted, further these features used for classification based on artificial neural networks (ANNs). ANNs with 8 input neurons (extracted features), 4 hidden neurons, and output neurons (diagnosis) were used to classify the patients. The results indicate that lifelog-based classifier have a good capacity (AUC=0.81 ±0.08) to discriminate MCI patients from healthy controls.", "links": [] }, { "title": "Validation of Overall Energy Expenditure Measurements in the Fitbit Charge HR 2 and Apple Watch ", "author": "Li, K., Nuss, K., Thomson, E.A., Comstock, A., Blake, S., Reinwald, S., Pimentel, R.E. and Tracy, B.", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "PURPOSE: To determine the validity of the energy expenditure (EE) estimation for the Fitbit Charge HR 2 and the Apple Watch devices. METHODS: Thirty young adults (15 females, 15 males, aged 23.5±3.0 years) completed the Bruce Protocol. Gross EE of participants was measured by PARVO metabolic cart and estimated by Fitbit Charge HR 2 and Apple Watch devices. A concordance correlation coefficient (CCC, rc) was conducted to examine the strength of the relationship of PARVO measured EE with EE estimated by each device. Relative error rates (RER) were calculated to indicate the difference between each device and PARVO. RESULTS: For the Apple Watch, the relative error was 24.25% for overall, 18.58% for males, and 29.93% for females. For the Fitbit, the relative error was 20.07% for overall, 24.17% for males, and 16.72% for females. Moderate Concordance correlations between estimated EEs and PARVO measured EEs were found for both Apple Watch (rc = 0.65, 0.43, and 0.39 for overall, males and female) and Fitbit Charge HR 2 (rc = 0.53, 0.39, and 0.21 for overall, males and females). In addition, stronger relationships were found between PARVO EE and Apple Watch EE than those between PARVO EE and Fitbit Chare HR 2 EE for overall, males and females. CONCLUSIONS: This was one of the first studies to examine the accuracy of overall energy expenditure estimated by Apple Watch and Fitbit Charge HR 2. Neither of the two devices showed accurate results compared to the measured EE by the standard approach. The Apple Watch revealed overestimated EE for females but underestimated EE for males. The Fitbit underestimated EE for both males and females. Researchers, practitioners and personal users should consider these results when designing programs or personal training plans targeting physical activity related EE with a wearable device.", "links": [] }, { "title": "Efficacy of a Community-Based Technology-Enabled Physical Activity Counseling Program for People With Knee Osteoarthritis: Proof-of-Concept Study", "author": "Li, L.C., Sayre, E.C., Xie, H., Falck, R.S., Best, J.R., Liu-Ambrose, T., Grewal, N., Hoens, A.M., Noonan, G. and Feehan, L.M.\t", "year": "2018", "journalProceedings": "Journal of Medical Internet Research", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background: Current practice guidelines emphasize the use of physical activity as the first-line treatment of knee osteoarthritis; however, up to 90% of people with osteoarthritis are inactive. Objective: We aimed to assess the efficacy of a technology-enabled counseling intervention for improving physical activity in people with either a physician-confirmed diagnosis of knee osteoarthritis or having passed two validated criteria for early osteoarthritis. Methods: We conducted a proof-of-concept randomized controlled trial. The immediate group received a brief education session by a physical therapist, a Fitbit Flex, and four biweekly phone calls for activity counseling. The delayed group received the same intervention 2 months later. Participants were assessed at baseline (T0) and at the end of 2 months (T1), 4 months (T2), and 6 months (T3). Outcomes included (1) mean time on moderate-to-vigorous physical activity (MVPA ≥3 metabolic equivalents [METs], primary outcome), (2) mean time on MVPA ≥4 METs, (3) mean daily steps, (4) mean time on sedentary activities, (5) Knee Injury and Osteoarthritis Outcome Score (KOOS), and (6) Partners in Health scale. Mixed-effects repeated measures analysis of variance was used to assess five planned contrasts of changes in outcome measures over measurement periods. The five contrasts were (1) immediate T1-T0 vs delayed T1-T0, (2) delayed T2-T1 vs delayed T1-T0, (3) mean of contrast 1 and contrast 2, (4) immediate T1-T0 vs delayed T2-T1, and (5) mean of immediate T2-T1 and delayed T3-T2. The first three contrasts estimate the between-group effects. The latter two contrasts estimate the effect of the 2-month intervention delay on outcomes. Results: We recruited 61 participants (immediate: n=30; delayed: n=31). Both groups were similar in age (immediate: mean 61.3, SD 9.4 years; delayed: mean 62.1, SD 8.5 years) and body mass index (immediate: mean 29.2, SD 5.5 kg/m2; delayed: mean 29.2, SD 4.8 kg/m2). Contrast analyses revealed significant between-group effects in MVPA ≥3 METs (contrast 1 coefficient: 26.6, 95% CI 4.0-49.1, P=.02; contrast 3 coefficient: 26.0, 95% CI 3.1-49.0, P=.03), daily steps (contrast 1 coefficient: 1699.2, 95% CI 349.0-3049.4, P=.02; contrast 2 coefficient: 1601.8, 95% CI 38.7-3164.9, P=.045; contrast 3 coefficient: 1650.5, 95% CI 332.3-2968.7; P=.02), KOOS activity of daily living subscale (contrast 1 coefficient: 6.9, 95% CI 0.1-13.7, P=.047; contrast 3 coefficient: 7.2, 95% CI 0.8-13.6, P=.03), and KOOS quality of life subscale (contrast 1 coefficient: 7.4, 95% CI 0.0-14.7, P=.049; contrast 3 coefficient: 7.3, 95% CI 0.1-14.6, P=.048). We found no significant effect in any outcome measures due to the 2-month delay of the intervention. Conclusions: Our counseling program improved MVPA ≥3 METs, daily steps, activity of daily living, and quality of life in people with knee osteoarthritis. These findings are important because an active lifestyle is an important component of successful self-management. Trial Registration: ClinicalTrials.gov NCT02315664; https://clinicaltrials.gov/ct2/show/NCT02315664 (Archived by WebCite at http://www.webcitation.org/6ynSgUyUC) [J Med Internet Res 2018;20(4):e159]", "links": [] }, { "title": "Validity of Consumer Activity Wristbands and Wearable EEG for Measuring Overall Sleep Parameters and Sleep Structure in Free-Living Conditions", "author": "Liang, Z. and Chapa Martell, M.A.\t", "year": "2018", "journalProceedings": "Journal of Healthcare Informatics Research", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "Consumer sleep tracking technologies offer an unobtrusive and cost-efficient way to monitor sleep in free-living conditions. Technological advances in hardware and software have significantly improved the functionality of the new gadgets that recently appeared in the market. However, whether the latest gadgets can provide valid measurements on overall sleep parameters and sleep structure such as deep and REM sleep has not been examined. In this study, we aimed to investigate the validity of the latest consumer sleep tracking devices including an activity wristband Fitbit Charge 2 and a wearable EEG-based eye mask Neuroon in comparison to a medical sleep monitor. First, we confirmed that Fitbit Charge 2 can automatically detect the onset and offset of sleep with reasonable accuracy. Second, analysis found that both consumer devices produced comparable results in measuring total sleep duration and sleep efficiency compared to the medical device. In addition, Fitbit accurately measured the number of awakenings, while Neuroon with good signal quality had satisfactory performance on total awake time and sleep onset latency. However, measuring sleep structure including light, deep, and REM sleep remains to be challenging for both consumer devices. Third, greater discrepancies were observed between Neuroon and the medical device in nights with more disrupted sleep and when the signal quality was poor, but no trend was observed in Fitbit Charge 2. This study suggests that current consumer sleep tracking technologies may be immature for diagnosing sleep disorders, but they are reasonably satisfactory for general purpose and non-clinical use.", "links": [] }, { "title": "Internet Gaming Disorder: the interplay between physical activity and user-avatar relationship", "author": "Liew, L.W.L., Stavropoulos, V., Adams, B.L.M., Burleigh, T.L. and Griffiths, M.D.\t", "year": "2018", "journalProceedings": "Behaviour & Information Technology", "category": "Measurement", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Understanding both the risk and protective factors associated with Internet Gaming Disorder (IGD) has been viewed by many in the gaming studies field as an area of research priority. The present study focused on the potential risk and protective effects of user–avatar (game figure) relationship and physical activity (PA), respectively. To address these aims, a cross-sectional and a longitudinal mixed-methods design were combined (comprising both psychological and physiological assessments). A sample of 121 emerging adult gamers (18–29 years) residing in Australia, who played massively multiplayer online games, were assessed in relation to their IGD behaviours using the nine-item Internet Gaming Disorder Scale – Short Form. Additionally, the Proto-Self-Presence (PSP) scale was used to evaluate the extent to which gamers identified with the body of their avatar. Finally, a PA monitor (Fitbit Flex) measured levels of energy consumed during real-world daily activities (active minutes). A number of linear regressions and moderation analyses were conducted. Findings confirmed that PSP functioned as an IGD risk factor and that PA acted protectively, weakening the association between PSP and IGD behaviours. Implications of these findings are discussed in relation to IGD treatment and gaming development aspects.", "links": [] }, { "title": "Beyond fitness tracking: The use of consumer-grade wearable data from normal volunteers in cardiovascular and lipidomics research", "author": "Lim, W.K., Davila, S., Teo, J.X., Yang, C., Pua, C.J., Blöcker, C., Lim, J.Q., Ching, J., Yap, J.J.L., Tan, S.Y., Sahlén, A., Chin, C.W.-L., Teh, B.T., Rozen, S.G., Cook, S.A., Yeo, K.K. and Tan, P.\t", "year": "2018", "journalProceedings": "PLOS Biology", "category": "Measurement", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "The use of consumer-grade wearables for purposes beyond fitness tracking has not been comprehensively explored. We generated and analyzed multidimensional data from 233 normal volunteers, integrating wearable data, lifestyle questionnaires, cardiac imaging, sphingolipid profiling, and multiple clinical-grade cardiovascular and metabolic disease markers. We show that subjects can be stratified into distinct clusters based on daily activity patterns and that these clusters are marked by distinct demographic and behavioral patterns. While resting heart rates (RHRs) performed better than step counts in being associated with cardiovascular and metabolic disease markers, step counts identified relationships between physical activity and cardiac remodeling, suggesting that wearable data may play a role in reducing overdiagnosis of cardiac hypertrophy or dilatation in active individuals. Wearable-derived activity levels can be used to identify known and novel activity-modulated sphingolipids that are in turn associated with insulin sensitivity. Our findings demonstrate the potential for wearables in biomedical research and personalized health.", "links": [] }, { "title": "Altered connection properties of important network hubs may be neural risk factors for individuals with primary insomnia", "author": "Liu, X., Zheng, J., Liu, B.-X. and Dai, X.-J.\t", "year": "2018", "journalProceedings": "Scientific Reports", "category": "Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Sleep", "abstract": "Primary insomnia (PIs) is highly prevalent and can lead to adverse socioeconomic impacts, but the underlying mechanism of its complex brain network impairment remains largely unknown. Functional studies are too few and diverse in methodology, which makes it difficult to glean general conclusions. To answer this question, we first used graph theory-based network analyse, together with seed-based functional connectivity approach, to characterize the topology architecture of whole-brain functional networks associated with PIs. Forty-eight subjects with PIs and 48 age/sex/education-matched good sleepers were recruited. We found PIs is associated with altered connection properties of intra-networks within the executive control network, default mode network and salience network, and inter-network between auditory language comprehension center and executive control network. These complex networks were correlated with negative emotions and insomnia severity in the PIs group. Altered connection properties of these network hubs appeared to be neural risk factors for neuropsychological changes of PIs, and might be used as potential neuroimaging markers to distinguish the PIs from the good sleepers. These findings highlight the role of functional connectivity in the pathophysiology of PIs, and may underlie the neural mechanisms of etiology of PIs.", "links": [] }, { "title": "Fitbit step counts during inpatient recovery from cancer surgery as a predictor of readmission", "author": "Low, C.A., Bovbjerg, D.H., Ahrendt, S., Choudry, M.H., Holtzman, M., Jones, H.L., Pingpank, J.F., Ramalingam, L., Zeh, H.J., Zureikat, A.H. and Bartlett, D.L.\t", "year": "2018", "journalProceedings": "Annals of Behavioral Medicine", "category": "Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background\nPostoperative ambulation is encouraged to promote timely recovery but is rarely monitored objectively or examined as a predictor of clinical outcomes, despite growing availability of wearable devices that allow passive quantification and remote real-time monitoring of the number of steps taken during recovery.\nPurpose\nTo determine whether the number of steps taken during inpatient recovery predicts 30- and 60-day readmission risk after metastatic cancer surgery.\n\nMethods\nPatients diagnosed with metastatic peritoneal cancer and scheduled for surgical resection were enrolled in this observational cohort study at their preoperative clinic visit. Fitbits were placed on patients’ wrists upon transfer from the ICU following surgery and worn for the duration of their inpatient stay. Information about hospital readmission was extracted from electronic medical records.\n\nResults\nSeventy-one patients participated in the study (mean age = 57.14, range = 31–80 years; 42% female; 51% diagnosed with appendiceal cancer). Mean steps per day were calculated for each participant over the entire inpatient recovery period (mean stay = 12.12 days, 4–37 days). Readmission within 30 and 60 days was medically indicated for 34% and 39% of patients, respectively. After statistically adjusting for age, body mass index, comorbidity, and length of postoperative stay, higher mean steps per day predicted lower 30-day and 60-day readmission risk.\n\nConclusions\nHigher Fitbit step counts during inpatient recovery predicted lower risk of 30- and 60-day readmission after surgery for metastatic peritoneal cancer. Results suggest that passively monitoring perioperative ambulation may identify patients at risk for readmission and highlight opportunities for behavioral intervention.", "links": [] }, { "title": "Joint Modeling of Heterogeneous Sensing Data for Depression Assessment via Multi-task Learning", "author": "Lu, J., Bi, J., Shang, C., Yue, C., Morillo, R., Ware, S., Kamath, J., Bamis, A., Russell, A. and Wang, B.\t", "year": "2018", "journalProceedings": "Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies", "category": "Methods", "devices": "Charge HR", "population": "Adults", "dataUsed": "Intensity,Distance,Sleep,Heart Rate", "abstract": "Depression is a common mood disorder that causes severe medical problems and interferes negatively with daily life. Identifying human behavior patterns that are predictive or indicative of depressive disorder is important. Clinical diagnosis of depression relies on costly clinician assessment using survey instruments which may not objectively reflect the fluctuation of daily behavior. Self-administered surveys, such as the Quick Inventory of Depressive Symptomatology (QIDS) commonly used to monitor depression, may show disparities from clinical decision. Smartphones provide easy access to many behavioral parameters, and Fitbit wrist bands are becoming another important tool to assess variables such as heart rates and sleep efficiency that are complementary to smartphone sensors. However, data used to identify depression indicators have been limited to a single platform either iPhone, or Android, or Fitbit alone due to the variation in their methods of data collection. The present work represents a large-scale effort to collect and integrate data from mobile phones, wearable devices, and self reports in depression analysis by designing a new machine learning approach. This approach constructs sparse mappings from sensing variables collected by various tools to two separate targets: self-reported QIDS scores and clinical assessment of depression severity. We propose a so-called heterogeneous multi-task feature learning method that jointly builds inference models for related tasks but of different types including classification and regression tasks. The proposed method was evaluated using data collected from 103 college students and could predict the QIDS score with an R2 reaching 0.44 and depression severity with an F1-score as high as 0.77. By imposing appropriate regularizers, our approach identified strong depression indicators such as time staying at home and total time asleep.", "links": [] }, { "title": "Findings from a Diabetes Support Group--A Pilot Study ", "author": "MALONEY, L.O.R.I.M.C.L.E.E.R., FLOOD, J.E.R.E.M.Y., ALAMUDDIN, N.A.J.I. and MUKADDAM, M.O.N.A.A.L.", "year": "2018", "journalProceedings": "Diabetes", "category": "Intervention", "devices": null, "population": "Adults", "dataUsed": "Steps,Food", "abstract": "Purpose: Diabetes Self-Management Education (DSME) is a crucial aspect of treating type 2 diabetes mellitus (T2DM). Daily individual decisions affect patient health, well-being, and long term outcomes. This pilot study evaluated what best educates and motivates patients to improve glucose control.", "links": [] }, { "title": "Increasing physical activity in cancer survivors at cardiovascular risk using Fitbits: Randomized controlled trial. ", "author": "Maxwell-Smith, C.M., Cohen, P.A., Platell, C., Tan, P., Tan, J., Salama, P., Levitt, M., Makin, G.B., Salfinger, S., Kader Ali Mohan, G.R., Kane, R., Hince, D. and Hardcastle, S.J.", "year": "2018", "journalProceedings": "Journal of Clinical Oncology", "category": "Methods", "devices": "Alta", "population": "Patients,Adults", "dataUsed": "NA", "abstract": "Efforts to increase physical activity in cancer survivors have typically been facility-based, and results have generally not been durable. Home-based interventions provide a more feasible option, and are likely to produce longer-lasting benefits. Wearable trackers present a novel opportunity for monitoring physical activity in a practical way. The Health Action Process Approach model suggests that strategies such as action-planning and overcoming barriers may be effective for transitioning individuals from intention to behavioural change. This trial aims to increase physical activity in cancer survivors at cardiovascular risk, by implementing a 24-week self-monitoring and action-planning intervention using Fitbits. Methods: Sixty-eight cancer survivors were recruited to participate in the trial. Eligibility criteria included: insufficiently physically active, presence of cardiovascular risk factors, and completion of active cancer treatment in the five years prior to recruitment. Trial asses...", "links": [ { "caption": "URL", "url": "http://ascopubs.org/doi/10.1200/JCO.2018.36.7_suppl.93", "newWindow": true } ] }, { "title": "Wearable Activity Technology And Action-Planning (WATAAP) to promote physical activity in cancer survivors: Randomised controlled trial protocol", "author": "Maxwell-Smith, C., Cohen, P.A., Platell, C., Tan, P., Levitt, M., Salama, P., Makin, G.B., Tan, J., Salfinger, S., Kader Ali Mohan, G.R., Kane, R.T., Hince, D., Jiménez-Castuera, R. and Hardcastle, S.J.\t", "year": "2018", "journalProceedings": "International Journal of Clinical and Health Psychology", "category": "Methods", "devices": null, "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "Background/Objective: Colorectal and gynecologic cancer survivors are at cardiovascular risk due to comorbidities and sedentary behaviour, warranting a feasible intervention to increase physical activity. The Health Action Process Approach (HAPA) is a promising theoretical framework for health behaviour change, and wearable physical activity trackers offer a novel means of self-monitoring physical activity for cancer survivors. Method: Sixty-eight survivors of colorectal and gynecologic cancer will be randomised into 12-week intervention and control groups. Intervention group participants will receive: a Fitbit Alta™ to monitor physical activity, HAPA-based group sessions, booklet, and support phone-call. Participants in the control group will only receive the HAPA-based booklet. Physical activity (using accelerometers), blood pressure, BMI, and HAPA constructs will be assessed at baseline, 12-weeks (post-intervention) and 24-weeks (follow-up). Data analysis will use the Group x Time interaction from a General Linear Mixed Model analysis. Conclusions: Physical activity interventions that are acceptable and have robust theoretical underpinnings show promise for improving the health of cancer survivors.", "links": [] }, { "title": "Effect of a Home-Based Exercise Intervention of Wearable Technology and Telephone Coaching on Walking Performance in Peripheral Artery Disease", "author": "McDermott, M.M., Spring, B., Berger, J.S., Treat-Jacobson, D., Conte, M.S., Creager, M.A., Criqui, M.H., Ferrucci, L., Gornik, H.L., Guralnik, J.M., Hahn, E.A., Henke, P., Kibbe, M.R., Kohlman-Trighoff, D., Li, L., Lloyd-Jones, D., McCarthy, W., Polonsky, T.S., Skelly, C., Tian, L., Zhao, L., Zhang, D. and Rejeski, W.J.\t", "year": "2018", "journalProceedings": "JAMA", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "Importance Clinical practice guidelines support home-based exercise for patients with peripheral artery disease (PAD), but no randomized trials have tested whether an exercise intervention without periodic medical center visits improves walking performance.\nObjective To determine whether a home-based exercise intervention consisting of a wearable activity monitor and telephone coaching improves walking ability over 9 months in patients with PAD.\n\nDesign, Setting, and Participants Randomized clinical trial conducted at 3 US medical centers. Patients with PAD were randomized between June 18, 2015, and April 4, 2017, to home-based exercise vs usual care for 9 months. Final follow-up was on December 5, 2017.\n\nInterventions The exercise intervention group (n = 99) received 4 weekly medical center visits during the first month followed by 8 months of a wearable activity monitor and telephone coaching. The usual care group (n = 101) received no onsite sessions, active exercise, or coaching intervention.\n\nMain Outcomes and Measures The primary outcome was change in 6-minute walk distance at 9-month follow-up (minimal clinically important difference [MCID], 20 m). Secondary outcomes included 9-month change in subcomponents of the Walking Impairment Questionnaire (WIQ) (0-100 score; 100, best), SF-36 physical functioning score, Patient-Reported Outcomes Measurement Information System (PROMIS) mobility questionnaire (higher = better; MCID, 2 points), PROMIS satisfaction with social roles questionnaire, PROMIS pain interference questionnaire (lower = better; MCID range, 3.5-4.5 points), and objectively measured physical activity.\n\nResults Among 200 randomized participants (mean [SD] age, 70.2 [10.4] years; 105 [52.5%] women), 182 (91%) completed 9-month follow-up. The mean change from baseline to 9-month follow-up in the 6-minute walk distance was 5.5 m in the intervention group vs 14.4 m in the usual care group (difference, −8.9 m; 95% CI, −26.0 to 8.2 m; P = .31). The exercise intervention worsened the PROMIS pain interference score, mean change from baseline to 9 months was 0.7 in the intervention group vs −2.8 in the usual care group (difference, 3.5; 95% CI, 1.3 to 5.8; P = .002). There were no significant between-group differences in the WIQ score, the SF-36 physical functioning score, or the PROMIS mobility or satisfaction with social roles scores.\n\nConclusions and Relevance Among patients with PAD, a home-based exercise intervention consisting of a wearable activity monitor and telephone coaching, compared with usual care, did not improve walking performance at 9-month follow-up. These results do not support home-based exercise interventions of wearable devices and telephone counseling without periodic onsite visits to improve walking performance in patients with PAD.\n\nTrial Registration clinicaltrials.gov Identifier: NCT02462824", "links": [] }, { "title": "Sleep and BMI: Do (Fitbit) bands aid? [version 1; referees: 2 approved with reservations] ", "author": "McDonald, L., Mehmud, F. and Ramagopalan, S.V.", "year": "2018", "journalProceedings": "PLOS Biology", "category": "Usability", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps", "abstract": "Recent studies have used mainstream consumer devices (Fitbit) to assess sleep objectively and test the well documented association between sleep and body mass index (BMI). In order to further investigate the applicability of Fitbit data for biomedical research across the globe, we analysed openly available Fitbit data from a largely Chinese population. We found that after adjusting for age, gender, race, and average number of steps taken per day, average hours of sleep per day was negatively associated with BMI (p=0.02), further demonstrating the significant potential for wearables in international scientific research.", "links": [ { "caption": "URL", "url": "https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.2004285", "newWindow": true } ] }, { "title": "Simultaneous Aerobic Exercise and Memory Training Program in Older Adults with Subjective Memory Impairments", "author": "McEwen, S.C., Siddarth, P., Abedelsater, B., Kim, Y., Mui, W., Wu, P., Emerson, N.D., Lee, J., Greenberg, S., Shelton, T., Kaiser, S., Small, G.W. and Merrill, D.A.\t", "year": "2018", "journalProceedings": "Journal of Alzheimer's Disease", "category": "Intervention", "devices": "Charge HR", "population": "Older Adults", "dataUsed": "Heart Rate", "abstract": "Abstract: Background:Several modifiable lifestyle factors have been shown to have potential beneficial effects in slowing cognitive decline. Two such factors that may affect cognitive performance and slow the progression of memory loss into dementia in older adults are cognitive training and physical activity. There are currently no effective treatments for dementia; therefore, preventative strategies to delay or prevent the onset of dementia are of critical importance. Objective:The aim of this study was to determine the relative effectiveness of simultaneous performance of memory training and aerobic exercise to a sequential performance intervention on memory functioning in older adults. Methods:55 older adults (aged 60– 75) with subjective memory impairments (non-demented and non-MCI) completed the intervention that consisted of 90-minute small group classes held twice weekly. Participants were randomized to either 4-weeks of supervised strategy-based memory training done simultaneously while stationary cycling (SIM) or sequentially after the stationary cycling (SEQ). Standardized neurocognitive measures of memory, executive functioning, speed of processing, attention, and cognitive flexibility were assessed at baseline and post-intervention. Results:The SIM group, but not the SEQ group, had a significant improvement on composite memory following the intervention (t(51) = 2.7, p = 0.01, effect size (ES) = 0.42) and transfer to non-trained reasoning abilities (t(51) = 6.0, ES = 0.49) and complex attention (t(51) = 3.1, p = 0.003, ES = 0.70). Conversely, the SEQ group, but not the SIM, showed significant improvement in executive functioning (t(51) = 5.0, p = 0.0001, ES = 0.96). Conclusion:These findings indicate that a 4-week simultaneous memory training and aerobic exercise program is sufficient to improve memory, attention, and reasoning abilities in older adults.", "links": [] }, { "title": "Reconsidering the experience machine: Self-reported versus objective measures of physical activity to increase positive affect ", "author": "McLean, D.C., Nakamura, J. and Csikszentmihalyi, M.", "year": "2018", "journalProceedings": "Journal of Health Psychology", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Intensity", "abstract": "This article tests the utility of self-report and objective assessment of physical activity to predict increased positive affect. Participants wore Fitbit activity trackers and responded to single-item assessments of momentary affect and self-reported physical activity following an experience sampling method protocol. A test of the within-person mediation indicated that, on average, 63 percent of the relationship between objective physical activity and affect was accounted for by self-reported physical activity. This research adds to the body of literature demonstrating the benefits of physical activity and discusses the utility of perceived over actual assessments of physical activity in naturalistic settings.", "links": [] }, { "title": "Promoting Healthy Diet, Physical Activity, and Life-Skills in High School Athletes: Results from the WAVE Ripples for Change Childhood Obesity Prevention Two-Year Intervention ", "author": "Meng, Y., Manore, M., Schuna, J., Patton-Lopez, M., Branscum, A. and Wong, S", "year": "2018", "journalProceedings": "Nutrients", "category": "Intervention", "devices": "Zip", "population": "Adolescents", "dataUsed": "Intensity,Food", "abstract": "The purpose of this study was to compare changes in diet and daily physical activity (PA) in high school (HS) soccer players who participated in either a two-year obesity prevention intervention or comparison group, while controlling for sex, race/ethnicity, and socioeconomic status. Participants (n = 388; females = 58%; Latino = 38%; 15.3 ± 1.1 years, 38% National School Breakfast/Lunch Program) were assigned to either an intervention (n = 278; 9 schools) or comparison group (n = 110; 4 schools) based on geographical location. Pre/post intervention assessment of diet was done using Block Fat/Sugar/Fruit/Vegetable Screener, and daily steps was done using the Fitbit-Zip. Groups were compared over-time for mean changes (post-pre) in fruit/vegetables (FV), saturated fat (SF), added sugar, and PA (daily steps, moderate-to-vigorous PA) using analysis of covariance. The two-year intervention decreased mean added sugar intake (−12.1 g/day, CI (7.4, 16.8), p = 0.02); there were no differences in groups for FV or SF intake (p = 0.89). For both groups, PA was significantly higher in-soccer (9937 steps/day) vs. out-of-soccer season (8117 steps/day), emphasizing the contribution of organized sports to youth daily PA. At baseline, Latino youth had significantly higher added sugar intake (+14 g/day, p < 0.01) than non-Latinos. Targeting active youth in a diet/PA intervention improves diet, but out of soccer season youth need engagement to maintain PA (200).", "links": [] }, { "title": "Validating Fitbit Zip for monitoring physical activity of children in school: a cross-sectional study ", "author": "Mooses, K., Oja, M., Reisberg, S., Vilo, J. and Kull, M.", "year": "2018", "journalProceedings": "BMC Public Health", "category": "Validation", "devices": "Zip", "population": "Children", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND Modern activity trackers, including the Fitbit Zip, enable the measurement of both the step count as well as physical activity (PA) intensities. However, there is a need for field-based validation studies in a variety of populations before using trackers for research. Therefore, the purpose of the current study was to investigate the validity of Fitbit Zip step count, moderate to vigorous physical activity (MVPA) and sedentary minutes, in different school segments in 3rd grade students. METHODS Third grade students (N = 147, aged 9-10 years) wore a Fitbit Zip and an ActiGraph GT3x-BT accelerometer simultaneously on a belt for five days during school hours. The number of steps, minutes of MVPA and sedentary time during class time, physical education lessons and recess were extracted from both devices using time filters, based on the information from school time tables obtained from class teachers. The validity of the Fitbit Zip in different school segments was assessed using Bland-Altman analysis and Spearman's correlation. RESULTS There was a strong correlation in the number of steps in all in-school segments between the two devices (r = 0.85-0.96, P < 0.001). The Fitbit Zip overestimated the number of steps in all segments, with the greatest overestimation being present in physical education lessons (345 steps). As for PA intensities, the agreement between the two devices in physical education and recess was moderate for MVPA minutes (r = 0.56 and r = 0.72, P < 0.001, respectively) and strong for sedentary time (r = 0.85 and r = 0.87, P < 0.001, respectively). During class time, the correlation was weak for MVPA minutes (r = 0.24, P < 0.001) and moderate for sedentary time (r = 0.57, P < 0.001). For total in-school time, the correlation between the two devices was strong for steps (r = 0.98, P < 0.001), MVPA (r = 0.80, P < 0.001) and sedentary time (r = 0.94, P < 0.001). CONCLUSION In general, the Fitbit Zip can be considered a relatively accurate device for measuring the number of steps, MVPA and sedentary time in students in a school-setting. However, in segments where sedentary time dominates (e.g. academic classes), a research-grade accelerometer should be preferred.", "links": [] }, { "title": "Heart Rate Alters, But Does Not Improve, Calorie Predictions in Fitbit Activity Monitors", "author": "Montoye, A.H., Vusich, J., Mitrzyk, J. and Wiersma, M.\t", "year": "2018", "journalProceedings": "Journal for the Measurement of Physical Behaviour", "category": "Validation", "devices": "Charge HR,Flex 2,Charge 2,Blaze", "population": "Adults", "dataUsed": "Energy Expenditure,Heart Rate", "abstract": "Background: Consumer-based activity monitors use accelerometers to estimate Calories (kcals), but it is unknown if monitors measuring heart rate (HR) use HR in kcal prediction. Purpose: Determine if there is a difference in kcal estimations in Fitbits measuring HR compared to those not measuring HR. Methods: Participants (n = 23) wore five Fitbits and performed nine activities for five minutes each, split into four groupings (G1: sitting, standing, cycling 50–150W; G2: level (0%) and inclined (10%) walking at 1.1 m/s; G3: level (0%) and inclined (10%) walking at 1.4 m/s; G4: level (0%) and inclined (3%) jogging at 2.2–4.5 m/s) in the laboratory. Three Fitbits (Blaze, Charge HR, Alta HR) assessed steps, HR, and kcals, and two Fitbits (Alta, Flex2) assessed steps and kcals. Steps, HR, and kcals data from the Fitbits were compared to criterion measures and between Fitbits measuring HR and Fitbits without HR. Results: Fitbits with HR had significantly higher kcal predictions (10.5–23.8% higher, p < .05) during inclined compared to level activities in G2–G4, whereas Fitbits without HR had similar kcal estimates between level and inclined activities. Mean absolute percent errors for kcal predictions were similar for Fitbits measuring HR (33.7–38.3%) and Fitbits without HR (32.4–36.6%). Conclusion: Fitbits measuring HR appear to use HR when predicting kcals. However, kcal prediction accuracies were similarly poor compared to Fitbits without HR compared to criterion measures.", "links": [] }, { "title": "Reliability of Zephyr Bioharness and Fitbit Charge Measures of Heart Rate and Activity at Rest, During the Modified Canadian Aerobic Fitness Test and Recovery", "author": "Nazari, G., Macdermid, J.C., Kin., K.E.S.R., Richardson, J. and Tang, A.\t", "year": "2018", "journalProceedings": "Journal of Strength and Conditioning Research", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "The purpose of current study was to determine the intra-session and inter-session reliability of Zephyr Bioharness and Fitbit Charge variables in both healthy men and women at rest, during the Modified Canadian Aerobic Fitness Test (mCAFT) and throughout recovery. Stratified convenience and snowball sampling were used to recruit sixty participants (30 females, 48 ± 15) and (30 males, 48 ± 15) from McMaster University student, staff and faculty population. At rest, intra-session average heart rate (beats/min.) Intra-class correlation coefficients (ICCs) and Standard Error of Measurement [SEM] for Zephyr ranged from (0.94 to 0.97) [1.17 - 1.70] and (0.92 - 0.97) [1.45 - 2.10] for Fitbit Charge. During the mCAFT, the Zephyr ICCs and (SEM) ranged from 0.31 - 0.99 (1.28 - 8.10) and 0.45 - 0.99 (1.45 - 8.71) for the Fitbit Charge. Throughout the recovery, the ICCs and (SEM) ranged from 0.44 - 0.98 (1.26 - 10.47) and 0.45 - 0.98 (1.15 - 11.90) for Zephyr and Fitbit devices respectively. At rest, intersession ICCs (SEM) for Zephyr and Fitbit ranged from 0.90 - 0.94 (1.73 - 2.37) and 0.88 - 0.94 (1.83 - 2.67) respectively. At mCAFT, the Zephyr ICCs (SEM) ranged from 0.91 - 0.97 (3.12 - 4.64) and 0.85 - 0.98 (3.28 - 4.88) for the Fitbit. Throughout the recovery, the ICCs (SEM) ranged from 0.93 - 0.97 (2.65 - 4.66) and 0.76 -0.91 (3.17 - 4.67) for Zephyr and Fitbit devices respectively. To conclude both the Zephyr Bioharness and Fitbit Charge devices demonstrated excellent reliability measures throughout the three phases. The findings from our study adds to the existing pool of literature regarding the reliability parameters of wearable devices and suggests that stable and consistent measures of heart rate and physical activity can be obtained using Zephyr Bioharness and Fitbit Charge devices among healthy male and female participants at rest, during a standardized sub-maximal fitness test (mCAFT) and throughout recovery.", "links": [] }, { "title": "Veterans’ Perspectives on Fitbit Use in Treatment for Post-Traumatic Stress Disorder: An Interview Study ", "author": "Ng, A., Reddy, M., Zalta, A.K. and Schueller, S.M.", "year": "2018", "journalProceedings": "JMIR Mental Health", "category": "Validation", "devices": "Charge HR", "population": "Patients", "dataUsed": "Steps,Sleep", "abstract": "Background: The increase in availability of patient data through consumer health wearable devices and mobile phone sensors provides opportunities for mental health treatment beyond traditional self-report measurements. Previous studies have suggested that wearables can be effectively used to benefit the physical health of people with mental health issues, but little research has explored the integration of wearable devices into mental health care. As such, early research is still necessary to address factors that might impact integration including patients' motivations to use wearables and their subsequent data. Objective: The aim of this study was to gain an understanding of patients’ motivations to use or not to use wearables devices during an intensive treatment program for post-traumatic stress disorder (PTSD). During this treatment, they received a complementary Fitbit. We investigated the following research questions: How did the veterans in the intensive treatment program use their Fitbit? What are contributing motivators for the use and nonuse of the Fitbit? Methods: We conducted semistructured interviews with 13 veterans who completed an intensive treatment program for PTSD. We transcribed and analyzed interviews using thematic analysis. Results: We identified three major motivations for veterans to use the Fitbit during their time in the program: increase self-awareness, support social interactions, and give back to other veterans. We also identified three major reasons certain features of the Fitbit were not used: lack of clarity around the purpose of the Fitbit, lack of meaning in the Fitbit data, and challenges in the veteran-provider relationship. Conclusions: To integrate wearable data into mental health treatment programs, it is important to understand the patient’s perspectives and motivations in using wearables. We also discuss how the military culture and PTSD may have contributed to our participants' behaviors and attitudes toward Fitbit usage. We conclude with possible approaches for integrating patient-generated data into mental health treatment settings that may address the challenges we identified. [JMIR Ment Health 2018;5(2):e10415]", "links": [] }, { "title": "Early enforced mobilization after liver resection: A prospective randomized controlled trial ", "author": "Ni, C.-y., Wang, Z.-h., Huang, Z.-p., Zhou, H., Fu, L.-j., Cai, H., Huang, X.-x., Yang, Y., Li, H.-f. and Zhou, W.-p.", "year": "2018", "journalProceedings": "International Journal of Surgery", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps,Distance,Sleep", "abstract": "This randomized controlled study investigated the feasibility of early ambulation after liver resection and the effect of the amount of activity on postoperative recovery.", "links": [ { "caption": "URL", "url": "https://www.sciencedirect.com/science/article/pii/S1743919118307489", "newWindow": true } ] }, { "title": "Patient Experiences and Opinions of a Behavioral Activation Group Intervention for Depression", "author": "O'Neill, L., Samaan, Z., McCabe, K., Tabak, T.A., Key, B., Litke, K., Whattam, J., Garrick, L., Chalmers, S., Xie, F., Thabane, L., Patel, Y., Shahid, H., Zielinski, L. and Vanstone, M.\t", "year": "2018", "journalProceedings": "Research on Social Work Practice", "category": "Usability", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Purpose:\nMajor depressive disorder is the leading cause of disability worldwide. This study is part of a mixed methods pilot trial, exploring the effectiveness, acceptability, and feasibility of providing behavioral activation (BA) treatment in a group format.\n\nMethods:\nUsing an applied, descriptive approach, qualitative data were collected from individual interviews (18) and focus groups (5) at multiple data points throughout the trial and feedback given to group facilitators, who adapted the program accordingly.\n\nResults:\nGroup BA is an effective and acceptable treatment format when a client-centered, flexible approach is utilized. This contrasted with findings from the comparison intervention, a peer support group, from which participants reported no benefit.\n\nConclusions:\nGroup BA is beneficial in a fiscally responsible evidenced-based health-care culture. Comparator groups need to be carefully selected. Engaging patient and clinician perspectives when designing and implementing new clinical interventions is vital in informing future research and social work practice.", "links": [] }, { "title": "The efficacy of a multimodal physical activity intervention with supervised exercises, health coaching and an activity monitor on physical activity levels of patients with chronic, nonspecific low back pain (Physical Activity for Back Pain (PAyBACK) trial): study protocol for a randomised controlled trial", "author": "Oliveira, C.B., Franco, M.R., Maher, C.G., Tiedemann, A., Silva, F.G., Damato, T.M., Nicholas, M.K., Christofaro, D.G.D. and Pinto, R.Z.\t", "year": "2018", "journalProceedings": "Trials", "category": "Methods", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "Physical activity plays an important role in the management of chronic low back pain (LBP). Engaging in an active lifestyle is associated with a better prognosis. Nevertheless, there is evidence to suggest that patients with chronic LBP are less likely to meet recommended physical activity levels. Furthermore, while exercise therapy has been endorsed by recent clinical practice guidelines, evidence from systematic reviews suggests that its effect on pain and disability are at best moderate and not sustained over time. A limitation of current exercises programmes for chronic LBP is that these programmes are not designed to change patients' behaviour toward an active lifestyle. Therefore, we will investigate the short- and long-term efficacy of a multimodal intervention, consisting of supervised exercises, health coaching and use of an activity monitor (i.e. Fitbit Flex) compared to supervised exercises plus sham coaching and a sham activity monitor on physical activity levels, pain intensity and disability, in patients with chronic, nonspecific LBP. This study will be a two-group, single-blind, randomised controlled trial. One hundred and sixty adults with chronic, nonspecific LBP will be recruited. Participants allocated to both groups will receive a group exercise programme. In addition, the intervention group will receive health coaching sessions (i.e. assisting the participants to achieve their physical activity goals) and an activity monitor (i.e. Fitbit Flex). The participants allocated to the control group will receive sham health coaching (i.e. encouraged to talk about their LBP or other problems, but without any therapeutic advice from the physiotherapist) and a sham activity monitor. Outcome measures will be assessed at baseline and at 3, 6 and 12 months post randomisation. The primary outcomes will be physical activity, measured objectively with an accelerometer, as well as pain intensity and disability at 3 months post randomisation. Secondary outcomes will be physical activity, pain intensity and disability at 6 and 12 months post randomisation as well as other self-report measures of physical activity and sedentary behaviour, depression, quality of life, pain self-efficacy and weight-related outcomes at 3, 6, and 12 months post randomisation. This study is significant as it will be the first study to investigate whether a multimodal intervention designed to increase physical activity levels reduces pain and disability, and increases physical activity levels compared to a control intervention in patients with chronic LBP.", "links": [] }, { "title": "Physical Activity in Patients With Type 2 Diabetes: The Case for Objective Measurement in Routine Clinical Care.", "author": "Oosterom, N., Gant, C.M., Ruiterkamp, N., van Beijnum, B.-J.F., Hermens, H., Bakker, S.J.L., Navis, G., Vollenbroek-Hutten, M.M.R. and Laverman, G.D.\t", "year": "2018", "journalProceedings": "Diabetes Care", "category": "Measurement", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "To perform at least 150 min of moderate-to-vigorous physical activity (MVPA) per week is a major aim in type 2 diabetes treatment (1), but actual measurements are not routinely performed in clinical practice. We questioned whether subjective assessment of physical activity is accurate to guide lifestyle advice.\n\nWe compared the results of the Short Questionnaire to Assess Health–Enhancing Physical Activity (SQUASH) (2) and the Fitbit Flex accelerometer (3) in 50 patients with type 2 diabetes included in the DIAbetes and LifEstyle Cohort Twente (DIALECT) trial, which was approved by the local institutional review board METC-Twente (NL57219.044.16) (4).\n\nPatients wore the Fitbit for 7 consecutive days and were instructed to maintain their usual activities. Raw Fitbit data (steps/min) were organized into ready variables by an algorithm written in MATLAB (MathWorks, Natick, MA). MVPA was defined as ≥95 steps/min (5). Patients maintained a diary regarding activities not detected by the Fitbit (i.e., cycling, swimming, and fitness). Data are presented as median (interquartile range). The association between log-transformed measured minutes of MVPA was tested using linear regression analyses and the difference between MVPA with the Wilcoxon test for paired nonparametric data.\n\nMedian age was 70 (63–76) years, median diabetes duration was 16 (10–21) years, 74% of the patients were male, 82% used insulin, and 84% had microvascular and 42% had macrovascular complications. According to SQUASH, patients had 165 (0–645) min of MVPA/week, and 20 participants (40%) adhered to the American Diabetes Association (ADA) recommendation of ≥150 min of MVPA/week (1) (Fig. 1). Fitbit data of >5 days were available in all patients. Median total steps per day were 4,277 (2,588–6,407), and 86% were able to reach ≥95 steps/min at some point during the measurement period. Based on the Fitbit data, patients had 23 (5–41) min of MVPA/week, and 1 (2%) participant adhered to the ADA guideline. When nonregistered activity was added, the figures increased to 31 (5–72) min of MVPA/week and 7 (14%) patients fulfilling the guideline. There was an association between SQUASH-assessed minutes of MVPA/week and Fitbit-assessed minutes of MVPA/week (β = 0.54, P < 0.001) (Fig. 1); however, the number of SQUASH-assessed minutes of MVPA/week was significantly and substantially higher (P < 0.001).\n\nMinutes of MVPA measured with SQUASH vs. minutes of MVPA measured with Fitbit. There was a correlation between measured minutes of MVPA between the two methods. However, in the majority of patients, the absolute number of weekly minutes of MVPA was substantially higher using the SQUASH results.\n\nSubjective assessment grossly overestimated weekly MVPA compared with objective assessment. When self-reporting, roughly half of the patients seem to meet the MVPA recommendations, whereas objective measurements indicate this number is 14%, at best. A limitation is that the Fitbit Flex, while validated for measuring steps, does not register other activities. Currently, several types of activity trackers with additional functionalities have become available, and future research should evaluate which tracker is most appropriate for clinical use. Although it has not been tested as to whether overestimation of activity occurs in a wider array of patients with diabetes, the findings presented here clearly point out the importance of using objective measurements of activity. We propose to incorporate objective measurements of physical activity in the standard care for patients with type 2 diabetes. Such measurements can not only identify individuals at risk but also increase patient awareness of physical inactivity and help to evaluate interventions.", "links": [] }, { "title": "Using the Habit App for Weight Loss Problem Solving: Development and Feasibility Study ", "author": "Pagoto, S., Tulu, B., Agu, E., Waring, M.E., Oleski, J.L. and Jake-Schoffman, D.E.", "year": "2018", "journalProceedings": "JMIR mHealth and uHealth", "category": "Usability", "devices": null, "population": "Adults", "dataUsed": "Weight", "abstract": "Background: Reviews of weight loss mobile apps have revealed they include very few evidence-based features, relying mostly on self-monitoring. Unfortunately, adherence to self-monitoring is often low, especially among patients with motivational challenges. One behavioral strategy that is leveraged in virtually every visit of behavioral weight loss interventions and is specifically used to deal with adherence and motivational issues is problem solving. Problem solving has been successfully implemented in depression mobile apps, but not yet in weight loss apps. Objective: This study describes the development and feasibility testing of the Habit app, which was designed to automate problem-solving therapy for weight loss. Methods: Two iterative single-arm pilot studies were conducted to evaluate the feasibility and acceptability of the Habit app. In each pilot study, adults who were overweight or obese were enrolled in an 8-week intervention that included the Habit app plus support via a private Facebook group. Feasibility outcomes included retention, app usage, usability, and acceptability. Changes in problem-solving skills and weight over 8 weeks are described, as well as app usage and weight change at 16 weeks. Results: Results from both pilots show acceptable use of the Habit app over 8 weeks with on average two to three uses per week, the recommended rate of use. Acceptability ratings were mixed such that 54% (13/24) and 73% (11/15) of participants found the diet solutions helpful and 71% (17/24) and 80% (12/15) found setting reminders for habits helpful in pilots 1 and 2, respectively. In both pilots, participants lost significant weight (P=.005 and P=.03, respectively). In neither pilot was an effect on problem-solving skills observed (P=.62 and P=.27, respectively). Conclusions: Problem-solving therapy for weight loss is feasible to implement in a mobile app environment; however, automated delivery may not impact problem-solving skills as has been observed previously via human delivery. Trial Registration: ClinicalTrials.gov NCT02192905; https://clinicaltrials.gov/ct2/show/NCT02192905 (Archived by WebCite at http://www.webcitation.org/6zPQmvOF2) [JMIR Mhealth Uhealth 2018;6(6):e145]", "links": [] }, { "title": "Exercise monitoring of young adults using a Facebook application ", "author": "Pagkalos, I., Kokkinopoulou, A., Weal, M., Petrou, L. and Hassapidou, M.", "year": "2017", "journalProceedings": "DIGITAL HEALTH", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Facebook, with a record 1.7+ billion monthly active users, is increasingly the platform of choice for a multitude of e-health applications. This work presents our experience in exercise monitoring using a custom-built Facebook application for activity self-reporting. A group of young adults (n = 49, age = 24 ± 7 years, body mass index (BMI) = 22.5 ± 3) took part in a 5-week pilot study, part of the NutriHeAl intervention project. Participants reported their daily exercise activities for an average of 33 ± 5 days and were also equipped with digital pedometers (Fibit Zips) for the full duration, allowing the evaluation of their activity reporting accuracy by comparing steps/min to a ‘truth ceiling’ value for two pre-defined exercise categories (2 + and 3+ metabolic equivalent of task (MET) intensity). We found that users not only reported their exercise consistently for an extended period of time but also achieved an average accuracy score of 71 ± 21% (82 ± 18% for 2+ MET exercises), making this novel exerc...", "links": [] }, { "title": "Dominant Vs Non-dominant Wrist ", "author": "Park, S.", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Charge", "population": "Adults", "dataUsed": "Steps", "abstract": null, "links": [] }, { "title": "Accuracy of a Wrist-Worn Heart Rate Sensing Device during Elective Pediatric Surgical Procedures", "author": "Pelizzo, G., Guddo, A., Puglisi, A., De Silvestri, A., Comparato, C., Valenza, M., Bordonaro, E. and Calcaterra, V.\t", "year": "2018", "journalProceedings": "Children", "category": "Validation", "devices": "Charge HR", "population": "Children,Adults", "dataUsed": "Heart Rate", "abstract": "The reliability of wearable photoplethysmography (PPG) sensors to measure heart rate (HR) in hospitalized patients has only been demonstrated in adults. We evaluated the accuracy of HR monitoring with a personal fitness tracker (PFT) in children undergoing surgery. HR monitoring was performed using a wrist-worn PFT (Fitbit Charge HR) in 30 children (8.21 ± 3.09 years) undergoing laparoscopy (n = 8) or open surgery (n = 22). HR values were analyzed preoperatively and during surgery. The accuracy of HR recordings was compared with measurements recorded during continuous electrocardiographic (cECG) monitoring; HRs derived from continuous monitoring with pulse oximetry (SpO2R) were used as a positive control. PFT-derived HR values were in agreement with those recorded during cECG (r = 0.99) and SpO2R (r = 0.99) monitoring. PFT performance remained high in children textless 8 years (r = 0.99), with a weight textless 30 kg (r = 0.99) and when the HR was textless 70 beats per minute (bpm) (r = 0.91) or textgreater 140 bpm (r = 0.99). PFT accuracy was similar during laparoscopy and open surgery, as well as preoperatively and during the intervention (r textgreater 0.9). PFT–derived HR showed excellent accuracy compared with HRs measured by cECG and SpO2R during pediatric surgical procedures. Further clinical evaluation is needed to define whether PFTs can be used in different health care settings.", "links": [] }, { "title": "Changes in Physical Activity during a Pilot Weight Loss Program Before and After Knee Replacement ", "author": "Pellegrini, C.A., Chang, R.W., Dunlop, D.D., Conroy, D.E., Lee, J. and Cameron, K.A.", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Intervention", "devices": null, "population": "Patients", "dataUsed": "Steps,Intensity", "abstract": "PURPOSE: Although knee replacement (KR) surgery typically results in pain reductions and functional improvement, most patients do not increase their physical activity. This study examined changes in objectively measured physical activity in KR patients who were participating in a weight loss program that started either before or after surgery. METHODS: Consented patients scheduled for KR were randomized to a 14 session pilot weight loss program starting ≤6 weeks before surgery (PACE) or 12 weeks post-op (Delayed PACE). Participants were encouraged to increase activity, set weekly activity goals, and self-monitor using paper, website, app, or Fitbit. Coaching sessions took place weekly or biweekly based on patient preference. Activity (moderate-to-vigorous activity [MVPA] bouts of ≥10 min of ≥2020 cpm and daily steps) was assessed using Actigraph GT3X monitors. PROMIS was used to assess pain intensity and function. Assessments were completed at baseline (pre-op), 12, and 26 weeks after surgery. Intent-to-treat was used with the last observation carried forward. Repeated measures ANOVAs examined changes in activity across time and group. RESULTS: Thirteen participants (mean±SD 63.5±7.9 years, 69% female, 69% White, BMI 35.7±5.1 kg/m2) provided physical activity data at baseline. Physical activity data was obtained for 77% of the sample at 12 and 26 weeks. Pain intensity decreased (P≤0.001) and function improved (P≤0.001) significantly, but no significant changes were observed in physical activity (Table 1). CONCLUSIONS: On average, KR patients participating in a weight loss program did not increase physical activity (weekly bouted MVPA and daily steps) after surgery. The lack of changes in activity, even in the presence of an intensive behavioral intervention and improvements in pain and function, highlight the challenges of altering behavior in this population. Future studies are needed to explore methods to increase activity after knee replacement.", "links": [] }, { "title": "Modeling Individual Differences: A Case Study of the Application of System Identification for Personalizing a Physical Activity Intervention", "author": "Phatak, S.S., Freigoun, M.T., Martín, C.A., Rivera, D.E., Korinek, E.V., Adams, M.A., Buman, M.P., Klasnja, P. and Hekler, E.B.\t", "year": "2018", "journalProceedings": "Journal of Biomedical Informatics", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND\nControl systems engineering methods, particularly, system identification (system ID), offer an idiographic (i.e., person-specific) approach to develop dynamic models of physical activity (PA) that can be used to personalize interventions in a systematic, scalable way. The purpose of this work is to: 1) apply system ID to develop individual dynamical models of PA (steps/day measured using Fitbit Zip) in the context of a goal setting and positive reinforcement intervention informed by Social Cognitive Theory; and 2) compare insights on potential tailoring variables (i.e., predictors expected to influence steps and thus moderate the suggested step goal and points for goal achievement) selected using the idiographic models to those selected via a nomothetic (i.e., aggregated across individuals) approach.\nMETHOD\nA personalized goal setting and positive reinforcement intervention was deployed for 14 weeks. Baseline PA measured in weeks 1-2 was used to inform personalized daily step goals delivered in weeks 3-14. Goals and expected reward points (granted upon goal achievement) were pseudo-randomly assigned using techniques from system ID, with goals ranging from their baseline median steps/day up to 2.5x baseline median steps/day, and points ranging from 100-500 (i.e., $0.20 - $1.00). Participants completed a series of daily self-report measures. Auto Regressive with eXogenous Input (ARX) modeling and multilevel modeling (MLM) were used as the idiographic and nomothetic approaches, respectively.\n\nRESULTS\nParticipants (N=20, mean age = 47.25 ± 6.16 years, 90% female) were insufficiently active, overweight (mean BMI = 33.79 ± 6.82 kg/m2) adults. Results from ARX modeling suggest that individuals differ in the factors (e.g., perceived stress, weekday/weekend) that influence their observed steps/day. In contrast, the nomothetic model from MLM suggested that goals and weekday/weekend were the key variables that were predictive of steps. Assuming the ARX models are more personalized, the obtained nomothetic model would have led to the identification of the same predictors for 5 of the 20 participants, suggesting a mismatch of plausible tailoring variables to use for 75% of the sample.\n\nCONCLUSION\nThe idiographic approach revealed person-specific predictors beyond traditional MLM analyses and unpacked the inherent complexity of PA; namely that people are different and context matters. System ID provides a feasible approach to develop personalized dynamical models of PA and inform person-specific tailoring variable selection for use in adaptive behavioral interventions.", "links": [] }, { "title": "Optimization of a technology-supported physical activity intervention for breast cancer survivors: Fit2Thrive study protocol.", "author": "Phillips, S.M., Collins, L.M., Penedo, F.J., Courneya, K.S., Welch, W., Cottrell, A., Lloyd, G.R., Gavin, K., Cella, D., Ackermann, R.T., Siddique, J. and Spring, B.\t", "year": "2018", "journalProceedings": "Contemporary Clinical Trials", "category": "Methods", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "Fit2Thrive is a theory-guided physical activity promotion trial using the Multiphase Optimization Strategy (MOST) to test efficacy for improving physical activity of five technology-supported physical activity promotion intervention components among breast cancer survivors. This trial will recruit 256 inactive breast cancer survivors nationwide. All participants will receive the core intervention which includes a Fitbit and standard self-monitoring Fit2Thrive smartphone application which will be downloaded to their personal phone. Women will be randomized to one of 32 conditions in a factorial design involving five factors with two levels: support calls (No vs. Yes), app type (standard vs. deluxe), text messaging (No vs. Yes), online gym (No vs. Yes) and Fitbit Buddy (No vs. Yes). The proposed trial examines the effects of the components on physical activity at 12 and 24weeks. Results will support the selection of a final package of intervention components that has been optimized to maximize physical activity and is subject to an upper limit of cost. The optimized intervention will be tested in a future trial. Fit2Thrive is the first trial to use the MOST framework to develop and test a physical activity promotion intervention in breast cancer survivors and will lead to an improved understanding of how to effectively change survivors' physical activity. These findings could result in more scalable, effective physical activity interventions for breast cancer survivors, and, ultimately, improve health and disease outcomes.", "links": [] }, { "title": "The effect of automated text messaging and goal setting on pedometer adherence and physical activity in patients with diabetes: A randomized controlled trial", "author": "Polgreen, L.A., Anthony, C., Carr, L., Simmering, J.E., Evans, N.J., Foster, E.D., Segre, A.M., Cremer, J.F. and Polgreen, P.M.\t", "year": "2018", "journalProceedings": "PLOS ONE", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Introduction Activity-monitoring devices may increase activity, but their effectiveness in sedentary, diseased, and less-motivated populations is unknown. Methods Subjects with diabetes or pre-diabetes were given a Fitbit and randomized into three groups: Fitbit only, Fitbit with reminders, and Fitbit with both reminders and goal setting. Subjects in the reminders group were sent text-message reminders to wear their Fitbit. The goal-setting group was sent a daily text message asking for a step goal. All subjects had three in-person visits (baseline, 3 and 6 months). We modelled daily steps and goal setting using linear mixed-effects models. Results 138 subjects participated with 48 in the Fitbit-only, 44 in the reminders, and 46 in the goal-setting groups. Daily steps decreased for all groups during the study. Average daily steps were 7123, 6906, and 6854 for the Fitbit-only, the goal-setting, and the reminders groups, respectively. The reminders group was 17.2 percentage points more likely to wear their Fitbit than the Fitbit-only group. Setting a goal was associated with a significant increase of 791 daily steps, but setting more goals did not lead to step increases. Conclusion In a population of patients with diabetes or pre-diabetes, individualized reminders to wear their Fitbit and elicit personal step goals did not lead to increases in daily steps, although daily steps were higher on days when goals were set. Our intervention improved engagement and data collection, important goals for activity surveillance. This study demonstrates that new, more-effective interventions for increasing activity in patients with pre-diabetes and diabetes are needed.", "links": [] }, { "title": "Lessons Learned Through the Implementation of an eHealth Physical Activity Gaming Intervention with High School Youth", "author": "Pope, L., Garnett, B. and Dibble, M.\t", "year": "2018", "journalProceedings": "Games for Health Journal", "category": "Intervention", "devices": "Flex", "population": "Adolescents", "dataUsed": "Steps", "abstract": "Objective: To encourage high school students to meet physical activity goals using a newly developed game, and to document the feasibility, benefits, and challenges of using an electronic gaming application to promote physical activity in high school students.\n\nMaterials and Methods: Working with youth and game designers an electronic game, Camp Conquer, was developed to motivate high school students to meet physical activity goals. One-hundred-five high school students were recruited to participate in a 12-week pilot test of the game and randomly assigned to a Game Condition or Control Condition. Students in both conditions received a FitBit to track their activity, and participants in the Game Condition received access to Camp Conquer. Number of steps and active minutes each day were tracked for all participants. FitBit use, game logins, and qualitative feedback from researchers, school personnel, and participants were used to determine intervention engagement.\n\nResults: The majority of study participants did not consistently wear their FitBit or engage with the gaming intervention. Numerous design challenges and barriers to successful implementation such as the randomized design, absence of a true school-based champion, ease of use, and game glitches were identified.\n\nConclusion: Developing games is an exciting technique for motivating the completion of a variety of health behaviors. Although the present intervention was not successful in increasing physical activity in high school students, important lessons were learned regarding how to best structure a gaming intervention for the high school population.", "links": [] }, { "title": "Comparison Of Daily Energy Expenditure And Weekly Physical Activity Exposure Estimated Using Consumer And Research-grade Physical Activity Monitors During Officer Cadet Initial Military Training ", "author": "Powell, S.D., Siddall, A.G., S Thompson, J.E., Edwards, V.C., Jackson, S., Greeves, J.P., Wardle, S., Blacker, S.D. and Myers, S.D.", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Surge", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "PURPOSE: Wearable physical activity monitors provide the capability to estimate the physical demands of military training and to potentially inform training practices. This study aimed to compare both the daily energy expenditure (EE) and weekly physical activity (PA) measured from two wrist-worn activity monitoring devices in Officer Cadets (OC) during initial military training. METHODS: Forty (26 male, 14 female) OC’s (mean ± SD: age 24 ± 2, height 1.76 ± 0.08 m, body mass 79.21 ± 9.97 kg) wore a consumer (“CN”; Fitbit Surge, San Francisco, USA) and a research-grade (“RG”; GENEActiv Original, Activinsights, Cambridge, UK) activity monitor during the second 14-week term of British Army OC training. A filtering process was implemented to exclude training days that did not fulfil wear-time criteria. Bivariate Pearsons correlations and limits of agreement (LoA) were used to compare EE measurement and duration of sedentary, light, moderate and vigorous PA between devices. RESULTS: Mean daily estimated EE from the CN and RG were 13.9 ± 2.5 and 15.7 ± 1.8 MJ.day-1, respectively. Estimated daily EE ranged from 8.6 ± 2.8 (day 35) to 22.4 ± 6.7 MJ.day-1 (day 49) in CN and from 10.7 ± 4.5 (day 55) to 21.3 ± 8.1 MJ.day-1 (day 49) in RG. There was a strong correlation between EE in CN and RG over 14 weeks (r = 0.761, p<0.001). However, the LoA indicated that CN underestimated EE (mean bias [95% CI] by -1.4 [-16 - 3.2] MJ.day-1, p<0.001) compared to the RG. Mean daily estimates from CN were 1069 ± 86 sedentary minutes, 221 ± 44 light minutes, 40 ± 14 moderate minutes and 56 ± 16 vigorous minutes. RG estimated 543 ± 53 sedentary minutes, 90 ± 16 light minutes, 249 ± 52 moderate minutes and 33 ± 14 vigorous minutes. All intensities were significantly different between CN and RG (p<0.05). The CN overestimated on sedentary minutes (526 mins.day-1 [319 - 734] mins.day-1), light minutes (131 [39 - 224] mins.day-1) and vigorous minutes (24 [-15 - 62] mins.day-1), but underestimated moderate minutes -208 [-295 - -122] mins.day-1). CONCLUSION: Consumer grade physical activity monitors provide an easily accessible tool for monitoring military training but more research is required to improve their accuracy before they can be used to inform training practices.", "links": [] }, { "title": "Impact of EPOC adjustment on estimation of energy expenditure using activity monitors ", "author": "Pribyslavska, V., Caputo, J.L., Coons, J.M. and Barry, V.W.", "year": "2018", "journalProceedings": "Journal of Medical Engineering & Technology", "category": "Validation", "devices": "Surge", "population": "Adults", "dataUsed": "Energy Expenditure,Intensity", "abstract": "AbstractPurpose: To examine the accuracy of activity monitors in estimating energy expenditure (EE) during activities of varying mode and intensity and to evaluate the impact of including energy expended during recovery from activity (EPOC) on the EE estimate. EE estimates obtained from the Fitbit Surge (FBS), Garmin Vívofit (GV) and SenseWear Armband Mini (SWA) were compared to criterion EE with and without EPOC adjustments during moderate- and vigorous-intensity treadmill and cycling activities.Methods: Participants (N = 34; 23 males) completed counterbalanced treadmill or cycling conditions, comprised of a resting metabolic rate measurement, 10-min bouts of moderate- and vigorous-intensity activity and an EPOC measurement. Participants simultaneously wore the three activity monitors and a portable metabolic analyser.Results: The FBS provided lowest percent error (PE) during treadmill walking (4.4%) and the GV during moderate (6.4%) and vigorous (−0.1%) cycling bouts. EPOC-adjusted PE was higher than no...", "links": [] }, { "title": "Changes in cognitive function after a 12-week exercise intervention in adults with Down syndrome.", "author": "Ptomey, L.T., Szabo, A.N., Willis, E.A., Gorczyca, A.M., Greene, J.L., Danon, J.C. and Donnelly, J.E.\t", "year": "2018", "journalProceedings": "Disability and Health Journal", "category": "Intervention", "devices": "Charge HR", "population": "Adults", "dataUsed": "Intensity,Heart Rate", "abstract": "BACKGROUND Between 250,000 and 400,000 individuals in the United States are diagnosed with Down syndrome (DS). Nearly all adults with DS will develop Alzheimer's disease pathology starting in their thirties. Recent studies suggest that increased physical activity (PA) may be important for maintaining components of cognition, including memory. OBJECTIVE The purpose of this study was to evaluate changes in cognitive function after completion of a 12-week exercise intervention in adults with DS. METHODS Participants were randomized to attend 30-minute group exercise sessions 1 or 2 times a week for 12 weeks. The exercise sessions were delivered via video conferencing on a tablet computer to groups of 5-8 participants. Sessions consisted of aerobic based exercises such as walking and jogging to music, dancing, as well as strength based exercises such as vertical jumps, bicep curls, and squats. Cognitive function was measured at baseline and end of study using the Cantab Dementia Battery for iPads, which assessed the cognitive domains of memory, attention, and reaction time. RESULTS Twenty-seven participants (27.9 ± 7.1 years of age, 40.7% female) enrolled and completed the 12-week intervention. Participants randomized to 1 session/week averaged 26.6 ± 3.0 min/week of PA from the group exercise session. Participants randomized to 2 sessions/week averaged 57.7 ± 15.3 min/week of PA from the group exercise sessions. Participants improved their performance on the two memory variables (p = 0.048 and p = 0.069). CONCLUSION Increased exercise may have positive changes on memory and other cognitive functions.", "links": [] }, { "title": "Remote Exercise for Adults with Down Syndrome", "author": "Ptomey, L.T., Szabo, A.N., Willis, E.A., Greene, J.L., Danon, J.C., Washburn, R.A., Forsha, D.E. and Donnelly, J.E.\t", "year": "2018", "journalProceedings": "Translational Journal of the American College of Sports Medicine", "category": "Intervention", "devices": "Charge HR", "population": "Adults", "dataUsed": "Intensity,Heart Rate", "abstract": "Adults with Down syndrome are less physically active than their typically developed peers. The purpose of this study was to assess the feasibility of delivering moderate-to-vigorous exercise sessions, led by a trained health educator using real-time video conferencing, to groups of young adults with Down syndrome in their homes. Participants were randomized to 30-min group exercise sessions either one or two times a week delivered on an iPad mini tablet computer using the Zoom video conferencing application, and were asked to attend individual support/education sessions once a week using FaceTime® on the iPad, for 12 wk. Minutes of moderate-to-vigorous physical activity (MVPA) during all group sessions were assessed using a Fitbit Charge HR activity/heart rate monitor. Participants were also asked to complete weekly homework assignments involving MVPA. Twenty-seven participants (n = 14, one session per week; n = 13, two sessions per week) with a mean age of 27.9 ± 7.1 yr ( 41% female) enrolled in and completed the 12-wk intervention. Attendance at group exercise and individual support/education sessions did not differ significantly between those randomized to one session per week (exercise sessions, 89.9% ± 8.8%; support/education sessions, 81.2% ± 18.7%) or two sessions per week (exercise sessions, 88.8% ± 7.7% (P = 0.79); support/education sessions, 86.0% ± 20.9% (P = 0.87)). Participants averaged 27.7 ± 5.7 min per session of MVPA with no significant difference between the one- (26.6 ± 3.0 min per session) and two-session-per-week groups (28.8 ± 7.7 min per session, P = 0.16). The completion rate for homework assignments did not differ significantly between the one- (21.4% ± 26.3%) and two-session-per-week groups (37.7% ± 21.7%, P = 0.28). Exercise delivered by group video conferencing may be a feasible and potentially effective approach for increasing MVPA in adults with Down syndrome.", "links": [] }, { "title": "Development of a Just-in-Time Adaptive mHealth Intervention for Insomnia: Usability Study ", "author": "Pulantara, I.W., Parmanto, B. and Germain, A.", "year": "2018", "journalProceedings": "JMIR Human Factors", "category": "Methods", "devices": "Charge", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background: Healthy sleep is a fundamental component of physical and brain health. Insomnia, however, is a prevalent sleep disorder that compromises functioning, productivity, and health. Therefore, developing efficient treatment delivery methods for insomnia can have significant societal and personal health impacts. Cognitive behavioral therapy for insomnia (CBTI) is the recommended first-line treatment of insomnia but access is currently limited for patients, since treatment must occur in specialty sleep clinics, which suffer from an insufficient number of trained clinicians. Smartphone-based interventions offer a promising means for improving the delivery of CBTI. Furthermore, novel features such as real-time monitoring and assessment, personalization, dynamic adaptations of the intervention, and context awareness can enhance treatment personalization and effectiveness, and reduce associated costs. Ultimately, this “Just in Time Adaptive Intervention” for insomnia--an intervention approach that is acceptable to patients and clinicians, and is based on mobile health (mHealth) platform and tools--can significantly improve patient access and clinician delivery of evidence-based insomnia treatments. Objective: This study aims to develop and assess the usability of a Just in Time Adaptive Intervention application platform called iREST (“interactive Resilience Enhancing Sleep Tactics”) for use in behavioral insomnia interventions. iREST can be used by both patients and clinicians. Methods: The development of iREST was based on the Iterative and Incremental Development software development model. Requirement analysis was based on the case study’s description, workflow and needs, clinician inputs, and a previously conducted BBTI military study/implementation of the Just in Time Adaptive Intervention architecture. To evaluate the usability of the iREST mHealth tool, a pilot usability study was conducted. Additionally, this study explores the feasibility of using an off-the-shelf wearable device to supplement the subjective assessment of patient sleep patterns. Results: The iREST app was developed from the mobile logical architecture of Just in Time Adaptive Intervention. It consists of a cross-platform smartphone app, a clinician portal, and secure 2-way communications platform between the app and the portal. The usability study comprised 19 Active Duty Service Members and Veterans between the ages of 18 and 60. Descriptive statistics based on in-app questionnaires indicate that on average, 12 (mean 12.23, SD 8.96) unique devices accessed the clinician portal per day for more than two years, while the app was rated as “highly usable”, achieving a mean System Usability Score score of 85.74 (SD 12.37), which translates to an adjective rating of “Excellent”. The participants also gave high scores on “ease of use and learnability” with an average score of 4.33 (SD 0.65) on a scale of 1 to 5. Conclusions: iREST provides a feasible platform for the implementation of Just in Time Adaptive Intervention in mHealth-based and remote intervention settings. The system was rated highly usable and its cross-platformness made it readily implemented within the heavily segregated smartphone market. The use of wearables to track sleep is promising; yet the accuracy of this technology needs further improvement. Ultimately, iREST demonstrates that mHealth-based Just in Time Adaptive Intervention is not only feasible, but also works effectively. [JMIR Hum Factors 2018;5(2):e21]", "links": [ { "caption": "URL", "url": "http://humanfactors.jmir.org/2018/2/e21/", "newWindow": true } ] }, { "title": "Examination of the association of physical activity during pregnancy after cesarean delivery and vaginal birth among Chinese women ", "author": "Qi, X.-Y., Xing, Y.-P., Wang, X.-Z. and Yang, F.-Z.", "year": "2018", "journalProceedings": "Reproductive Health", "category": "Measurement", "devices": "Flex", "population": "Adults,Pregnant Women", "dataUsed": "Steps,Intensity", "abstract": "The goal was to study whether higher physical activity can increase the success rate of Vaginal Birth after Cesarean Delivery (VBAC). We enrolled 823 patients with previous cesarean section delivery history (between January 2015 and December 2017) and measured their physical activity during pregnancy. A final number of 519 patients were included for the trial of labor after cesarean delivery (TOLAC). All patients signed informed consent forms. We conducted bivariate analyses and identified that several variables were associated with successful VBAC: Prior history of vaginal birth (odds ratio [OR] 2.4, 95% CI 1.8-3.9); previous indication for primary cesarean delivery (OR 2.2, 95% CI 1.5-3.0); age younger than 40 years (OR 2.1, 95% CI 1.3-3.4); Weight gain less than 20 kg (OR 1.5, 95% CI 1.3-2.4); high pelvic/birth weight score (OR 1.4, 95% CI 1.1-2.0); no induction of labor (OR 1.9, 95% CI 1.4-2.8); and estimated prenatal fetal weight (OR 1.4, 95% CI 1.2-1.5). We also found that the bivariate association between physical activity and VBAC was significant (p = 0.002). In addition, there was higher odds of VBAC in women who had active physical activity of more than 150 min/week (adjusted OR 1.86, 95% CI 1.69-2.07). Lower odds of VBAC was associated with older age, weight gain during pregnancy, induction of labor, and having estimated prenatal fetal weight more than 3500 g. Physical activity during pregnancy may influence the success rate of VBAC in Chinese women. Future studies will be needed to prove the robustness of this association using more detailed exposure and outcome definitions.", "links": [ { "caption": "URL", "url": "https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-018-0544-1", "newWindow": true } ] }, { "title": "Pilot Trial of an Acceptance-Based Behavioral Intervention to Promote Physical Activity Among Adolescents ", "author": "Remmert, J.E., Woodworth, A., Chau, L., Schumacher, L.M., Butryn, M.L. and Schneider, M.", "year": "2018", "journalProceedings": "The Journal of School Nursing", "category": "Intervention", "devices": "Flex 2", "population": "Adolescents", "dataUsed": "Steps,Intensity", "abstract": "Prior interventions have shown limited efficacy in increasing the number of adolescents engaging in adequate physical activity (PA). Preliminary evidence suggests acceptance-based behavioral treatments (ABTs) may increase PA; however, this approach has not been tested in adolescents. This was a nonrandomized experimental pilot study that examined feasibility, acceptability, and treatment outcomes of a school-based, acceptance-based behavioral intervention for PA. Adolescents (n = 20) with low activity received a PA tracking device and were allocated to device use only or device use plus 10-weeks of ABT. PA, cardiovascular fitness, and physiological outcomes were measured pre- and postintervention. The intervention was found to be feasible and acceptable. PA, cardiovascular fitness, and physiological outcomes improved over time in the intervention group, but not in the comparison condition. This study demonstrated feasibility, acceptability, and preliminary treatment efficacy based on effect sizes for an a...", "links": [] }, { "title": "Physical Activity during Pregnancy Alters Gene Expression in Neonatal Tissue ", "author": "Reynolds, L.J., Chavan, N.R., Rice, B.B., Maddox, H.F., Preston, J.D., DeHoff, L.B. and Pearson, K.J.", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Offspring born to mothers who exercise during pregnancy have been shown to have reduced birth weight and body weight during adolescence; however, mechanisms to explain this phenomenon are lacking. PURPOSE: This study examined whether male infants born to mothers with low levels of naturally occurring physical activity during pregnancy (<6,000 steps/day; <6K) had altered expression of genes related to glucose metabolism and adipogenesis compared to infants born to mothers with greater than 6,000 steps/day (>6K). METHODS: Physical activity levels were assessed via Fitbit Flex during the second and third trimester of pregnancy. The dartos layer of the foreskin was collected following circumcision in full term, singleton, male neonates (n = 6 per group). Tissue was homogenized, RNA isolated, and a NanoString code set run to quantify a panel of genes related to glucose metabolism and adipogenesis, as well as housekeeping genes. RESULTS: Peroxisome proliferator-activated receptor alpha (<6K: 86.4±9.2 vs. >6K: 59.4±5.0) and cAMP responsive element binding protein 1 (<6K: 285.7±36.8 vs. >6K: 197.4±12.1), genes encoding proteins that are involved in partially regulating adipogenesis, and DNA methyltransferase 1 (DNMT1) (<6K: 132.2±6.4 vs. >6K: 112.5±3.7), a gene coding an enzyme involved in the regulation of DNA methylation patterns, were significantly decreased in the infants born to mothers with higher levels of physical activity during pregnancy (p<0.05). Adiponectin receptor 1 (<6K: 490.1±38.1 vs. >6K: 743.3±99.7), a receptor that is downregulated in obese, insulin resistant populations, and glucose transporter 1 (<6K: 88.0±15.7 vs. >6K: 153.3±13.0), a glucose transporter responsible for basal levels of glucose uptake in most cells, were significantly increased in the tissue of neonates born to mothers with higher levels of physical activity (p<0.05). CONCLUSION: These preliminary data suggest that low levels of physical activity during pregnancy are associated with increased gene expression of markers of adipogenesis and decreased markers involved in insulin sensitivity and glucose uptake. Further, these adaptations or other gene expression changes may be epigenetically regulated as DNMT1 levels were significantly lower in the lower physical activity group.", "links": [] }, { "title": "Wearable Activity Tracker Use Among Australian Adolescents: Usability and Acceptability Study.", "author": "Ridgers, N.D., Timperio, A., Brown, H., Ball, K., Macfarlane, S., Lai, S.K., Richards, K., Mackintosh, K.A., McNarry, M.A., Foster, M. and Salmon, J.\t", "year": "2018", "journalProceedings": "JMIR mHealth and uHealth", "category": "Usability", "devices": "Flex", "population": "Adolescents", "dataUsed": "Steps,Goals,Sleep", "abstract": "BACKGROUND Wearable activity trackers have the potential to be integrated into physical activity interventions, yet little is known about how adolescents use these devices or perceive their acceptability. OBJECTIVE The aim of this study was to examine the usability and acceptability of a wearable activity tracker among adolescents. A secondary aim was to determine adolescents' awareness and use of the different functions and features in the wearable activity tracker and accompanying app. METHODS Sixty adolescents (aged 13-14 years) in year 8 from 3 secondary schools in Melbourne, Australia, were provided with a wrist-worn Fitbit Flex and accompanying app, and were asked to use it for 6 weeks. Demographic data (age, sex) were collected via a Web-based survey completed during week 1 of the study. At the conclusion of the 6-week period, all adolescents participated in focus groups that explored their perceptions of the usability and acceptability of the Fitbit Flex, accompanying app, and Web-based Fitbit profile. Qualitative data were analyzed using pen profiles, which were constructed from verbatim transcripts. RESULTS Adolescents typically found the Fitbit Flex easy to use for activity tracking, though greater difficulties were reported for monitoring sleep. The Fitbit Flex was perceived to be useful for tracking daily activities, and adolescents used a range of features and functions available through the device and the app. Barriers to use included the comfort and design of the Fitbit Flex, a lack of specific feedback about activity levels, and the inability to wear the wearable activity tracker for water-based sports. CONCLUSIONS Adolescents reported that the Fitbit Flex was easy to use and that it was a useful tool for tracking daily activities. A number of functions and features were used, including the device's visual display to track and self-monitor activity, goal-setting in the accompanying app, and undertaking challenges against friends. However, several barriers to use were identified, which may impact on sustained use over time. Overall, wearable activity trackers have the potential to be integrated into physical activity interventions targeted at adolescents, but both the functionality and wearability of the monitor should be considered.", "links": [] }, { "title": "A Latino Patient-Centered, Evidence-Based Approach to Diabetes Prevention. ", "author": "Rosas, L.G., Lv, N., Lewis, M.A., Venditti, E.M., Zavella, P., Luna, V. and Ma, J.", "year": "2018", "journalProceedings": "Journal of the American Board of Family Medicine : JABFM", "category": "Usability", "devices": null, "population": "Adults", "dataUsed": "NA", "abstract": "INTRODUCTION Cultural tailoring of evidence-based diabetes prevention program (DPP) interventions is needed to effectively address obesity and its related chronic diseases among Latinos in primary care. This article describes the patient-centered process used to adapt the DPP and reports cultural adaptations. METHODS We used a 2-stage formative research process to culturally adapt an evidence-based DPP intervention in the context of primary care. The first stage involved 5 focus groups of Latino patients and interviews with 5 stakeholders (3 with primary care physicians and 2 with medical directors) to inform a first round of adaptations. The second stage included pretesting the stage I-adapted intervention with a Latino patient advisory board to complete a second round of adaptations. RESULTS Key stakeholders involved in this 2-stage adaptation process included 34 Latino patients who participated in 5 focus groups and 5 physicians and medical directors who participated in key informant interviews during stage I and 11 patients who attended the 16 advisory board meetings and their family members who attended 1 of the meetings during stage II. Using this patient-centered stakeholder-engaged approach, we found the original intervention was largely congruent with the cultural values of the study population. To further strengthen the cultural relevance of the intervention, salient cultural values emphasized by patients and stakeholders underscored the importance of family and community support for behavior change. Accordingly, key adaptations were made to (1) invite family members to the orientation session and at 2 other key timepoints to facilitate family support, (2) provide participants support from the coach and each other via smartphone applications, and (3) provide healthy, easy, low-cost culturally appropriate meals at each group session. CONCLUSIONS The 2-stage approach actively engaging patients, family members, providers, and health care system leaders reinforced the cultural congruence of the existing intervention while further strengthening it with adaptations promoting Latino family and community support.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pubmed/29743220", "newWindow": true } ] }, { "title": "Acceptability and feasibility of a Fitbit physical activity monitor for endometrial cancer survivors.", "author": "Rossi, A., Frechette, L., Miller, D., Miller, E., Friel, C., Van Arsdale, A., Lin, J., Shankar, V., Kuo, D.Y.S. and Nevadunsky, N.S.\t", "year": "2018", "journalProceedings": "Gynecologic Oncology", "category": "Usability", "devices": null, "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "OBJECTIVE Endometrial cancer survivors are the least physically active of all cancer survivor groups and exhibit up to 70% obesity. While studies suggest lifestyle interventions result in improved health outcomes, recruitment and availability of these programs are limited. The purpose was to evaluate the acceptability and validity of the Fitbit Alta™ physical activity monitor (Fitbit) for socioculturally diverse endometrial cancer survivors. METHODS Thirty endometrial cancer survivors were given wrist-worn Fitbits to wear for 30 days. Participants then returned the Fitbits, completed the Godin Leisure-Time Exercise Questionnaire (GLTEQ), Technology Acceptance Questionnaire, and answered qualitative prompts. Correlations between daily Fitbit step counts, demographic factors, body mass index (BMI), and GLTEQ Index, were analyzed using Stata 13.0. Concordance Correlation Coefficient using U statistics was used to examine convergent validity. RESULTS Twenty-five participants completed the study. Mean age was 62 ± 9 years. Mean BMI was 32 ± 9 kgtextperiodcenteredm-2. Self-identified race/ethnicity was 36% Hispanic, 36% non-Hispanic white, 16% non-Hispanic black and 12% Asian. Participants wore the Fitbits a median of 93% of possible days. Median daily Fitbit step count was 5325 (IQR: 3761-8753). Mean Technology Acceptance score was 2.8 ± 0.5 out of 4.0. Younger (textless65 years) and employed participants were more likely to achieve at least 6000 daily steps (p textless 0.05). There was no correlation (CCC = 0.00, p = 0.99) between step count and GLTEQ Index. Most free responses reflected positive experiences. CONCLUSIONS The Fitbits were well accepted in this sample. Self-reported physical activity was not associated with steps recorded. The physical activity data indicate an insufficiently active population.", "links": [] }, { "title": "Consumer Wearable Devices for Activity Monitoring Among Individuals After a Stroke: A Prospective Comparison", "author": "Rozanski, G.M., Aqui, A., Sivakumaran, S. and Mansfield, A.\t", "year": "2018", "journalProceedings": "JMIR Cardio", "category": "Validation", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Background: Activity monitoring is necessary to investigate sedentary behavior after a stroke. Consumer wearable devices are an attractive alternative to research-grade technology, but measurement properties have not been established. Objective: The purpose of this study was to determine the accuracy of 2 wrist-worn fitness trackers: Fitbit Charge HR (FBT) and Garmin Vivosmart (GAR). Methods: Adults attending in- or outpatient therapy for stroke (n=37) wore FBT and GAR each on 2 separate days, in addition to an X6 accelerometer and Actigraph chest strap monitor. Step counts and heart rate data were extracted, and the agreement between devices was determined using Pearson or Spearman correlation and paired t or Wilcoxon signed rank tests (one- and two-sided). Subgroup analyses were conducted. Results: Step counts from FBT and GAR positively correlated with the X6 accelerometer (ρ=.78 and ρ=.65, Ptextless.001, respectively) but were significantly lower (Ptextless.01). For individuals using a rollator, there was no significant correlation between step counts from the X6 accelerometer and either FBT (ρ=.42, P=.12) or GAR (ρ=.30, P=.27). Heart rate from Actigraph, FBT, and GAR demonstrated responsiveness to changes in activity. Both FBT and GAR positively correlated with Actigraph for average heart rate (r=.53 and .75, Ptextless.01, respectively) and time in target zone (ρ=.49 and .74, Ptextless.01, respectively); these measures were not significantly different, but nonequivalence was found. Conclusions: FBT and GAR had moderate to strong correlation with best available reference measures of walking activity in individuals with subacute stroke. Accuracy appears to be lower among rollator users and varies according to heart rhythm. Consumer wearables may be a viable option for large-scale studies of physical activity. [JMIR Cardio 2018;2(1):e1]", "links": [] }, { "title": "How well does a commercially available wearable device measure sleep in young athletes?", "author": "Sargent, C., Lastella, M., Romyn, G., Versey, N., Miller, D.J. and Roach, G.D.\t", "year": "2018", "journalProceedings": "Chronobiology International", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "The validity of a commercially available wearable device for measuring total sleep time was examined in a sample of well-trained young athletes during night-time sleep periods and daytime naps. Participants wore a FitBit HR Charge on their non-dominant wrist and had electrodes attached to their face and scalp to enable polysomnographic recordings of sleep in the laboratory. The FitBit automatically detected 24/30 night-time sleep periods but only 6/20 daytime naps. Compared with polysomnography, the FitBit overestimated total sleep time by an average of 52 ± 152 min for night-time sleep periods, and by 4 ± 8 min for daytime naps. It is important for athletes and practitioners to be aware of the limitations of wearable devices that automatically detect sleep duration.", "links": [] }, { "title": "Use and physiological responses of portable dynamic office workstations in an occupational setting - A field study ", "author": "Schellewald, V., Kleinert, J. and Ellegast, R.", "year": "2018", "journalProceedings": "Applied Ergonomics", "category": "Usability", "devices": "Charge HR", "population": "Adults", "dataUsed": "Energy Expenditure,Heart Rate", "abstract": "The aim of this study was to investigate the use of two types of dynamic workstations (Deskbike, activeLife Trainer) and their effects on physiological activation in an occupational setting.", "links": [ { "caption": "URL", "url": "https://www.sciencedirect.com/science/article/pii/S0003687018300887?via%3Dihub", "newWindow": true } ] }, { "title": "Validation of Activity Tracking Procedures in Elderly Patients after Operative Treatment of Proximal Femur Fractures ", "author": "Schmal, H., Holsgaard-Larsen, A., Izadpanah, K., Brønd, J.C., Madsen, C.F. and Lauritsen, J.", "year": "2018", "journalProceedings": "Rehabilitation Research and Practice", "category": "Validation", "devices": "Flex", "population": "Patients", "dataUsed": "Steps", "abstract": "Background. Early postoperative physical activity in elderly patients suffering from proximal femoral fractures may reduce mortality. We hypothesized that activity trackers can reliably and objectively monitor the in-hospital mobilization, correlating with functional independence and quality of life. Methods. Three different tracker types (Fitbit™ flex, Misfit™ Shine, and Axivity AX3) at three locations (wrist, ankle, and femur) recorded steps and signal vector magnitudes (SVM) in 22 patients. They were years old, were equally distributed between the sexes, and had an ASA score of . Single protocoled activity events () were clinically categorized into 4 levels and correlated with the monitored signals. Additionally, and days after the operation, the EuroQol-5D and the Barthel-20 index supplemented this data. Results. All measurements at the wrist (Fitbit, Misfit) resulted in unacceptable accuracy; however, sensitivity and specificity reached around 90% using the Misfit at the ankle. Applying this combination, the correlation between real and measured steps ( = 0.99) and the category discrimination were statistically significant (). A discriminant analysis featured the calculation of four activity levels based on SVM measurements using the Axivity tracker at the femur. A cluster analysis showed a 100% agreement between the clinically observed and the calculated activity levels. The amount of active minutes or periods and both the EuroQol-5D and the Barthel-20 indices significantly increased between the analyzed time points after the operation. However, only the Barthel-20 was associated with the measured activity levels (). Conclusion. The Misfit and the Axivity trackers can reliably monitor activity in elderly patients after operative treatment of proximal femur fractures. However, the wear location is decisive. Objectively measured activity correlated with functional independence and quality of life.", "links": [] }, { "title": "Extending research on self-regulation of physical activity in older age: Role of views on aging within an intensive ambulatory assessment scheme ", "author": "Schmidt, L.I., Gabrian, M., Jansen, C.-P., Wahl, H.-W. and Sieverding, M.", "year": "2018", "journalProceedings": "Journal of Self-Regulation and Regulation", "category": "Intervention", "devices": "Charge HR", "population": "Older Adults", "dataUsed": "Intensity", "abstract": "Objective : Despite the well-known beneficial effects of physical activity (PA), many individuals lead a sedentary lifestyle in older age. This study aimed to examine the self-regulative role of individual views on aging for planning and implementing PA goals among retired, healthy older adults. We hypothesized that aging-related cognitions (regarding physical decline, social loss, and continuous growth), as well as subjective age, are relevant predictors of PA. We furthermore explored their predictive value over and above the intention to be active, an established predictor derived from the “Theory of Planned Behavior”. Method: N=40 retired participants aged 60 to 74 years wore commercially available activity monitors (Fitbit Charge HR) that tracked daily steps and moderate to vigorous PA on 14 consecutive days. Social-cognitive variables, views on aging and health complaints were assessed during home visits. Associations between variables were analyzed using hierarchical regression analyses. Results: Even after accounting for the intention to be active, views on aging explained additional variance of PA, indicating that participants who viewed aging as a process of social loss walked fewer steps per day. Against expectations, individuals who regarded aging as an inevitable process of physical decline and who felt older than their chronological age showed higher PA levels. Conclusion : Our findings underline that beliefs about the aging process affect the ability to self-regulate actions related to PA in older adults. We even found evidence for possible paradoxical effects. Further research on long-term effects and underlying mechanisms that relate views on aging to PA is needed.", "links": [] }, { "title": "'Wow! You're Wearing a Fitbit, You're a Young Boy Now!\"", "author": "Sharma, S., Achary, K., Kaur, H., Linna, J., Turunen, M., Varkey, B., Hakulinen, J. and Daeeyya, S.", "year": "2018", "journalProceedings": "Proceedings of the 20th International ACM SIGACCESS Conference on Computers and Accessibility - ASSETS '18", "category": "Usability", "devices": "Flex", "population": "Children", "dataUsed": "Steps,Energy Expenditure,Sleep", "abstract": "In this paper, we build a case for incorporating socio-technical aspirations of different stakeholders, e.g. parents, care-givers, and therapists, to motivate technology acceptance and adoption for children with autism. We base this on findings from two studies at a special school in New Delhi. First, with six children with autism, their parents and therapists we explored whether fitness bands motivate children with autism in India to increase their physical activity. Second, with five parents and specialists at the same school, we conducted interviews to understand their expectations from and current usage of technology. Previous work defines a culture-based framework for assistive technology design with three dimensions: lifestyle, socio-technical infrastructure, and monetary and informational resources. To this framework we propose a fourth dimension of socio-technical aspirations. We discuss the implications of the proposed fourth dimension to the existing framework.", "links": [] }, { "title": "Feasibility Of Recording Sleep Quality And Sleep Duration Using Fitbit In Children With Asthma", "author": "Sheth, A., Yip, H., Jaimini, U., Sridharan, V., Venkataramanan, R., Thirunarayam, K., Banerjee, T. and Kalra, M.\t", "year": "2018", "journalProceedings": "Sleep", "category": "Usability", "devices": "Flex", "population": "Children,Adolescents", "dataUsed": "Sleep", "abstract": "Introduction\nSleep disorders are common in children with asthma and have been implicated in poor asthma control. Smart wearables such as the Fitbit wristband allow monitoring patients sleep duration and quality in their natural surroundings. However, the utility and efficacy of using wearable devices to monitor sleep quality and sleep duration in pediatric patients with asthma has not been established.\nMethods\nChildren, ages 5 yrs. to 18 yrs., participating in kHealth Asthma research study at Dayton Children's Hospital were included. The kHealth kit includes an android tablet with a mobile health application that asks contextually relevant questions as well as collects personalized data from bluetooth connected Fitbit Charge 2, Peak flow meter, and Foobot, an indoor air quality monitor. Fitbit software calculated time in bed, sleep time and time in REM sleep, light sleep and deep sleep was downloaded on all subjects. Sleep efficiency was calculated as sleep time/time in bed and proportion of time in each sleep stage was calculated.\n\nResults\nPreliminary data from 14 children was analyzed. The average time in bed was 534 ± 77 minutes and average sleep time was 476 ± 70 minutes. The average time in REM sleep was 88 ± 25 minutes and average time in light sleep was 287 ± 37 minutes and in deep sleep was 92.5 ± 27.8 minutes. Sleep efficiency was 89%. Proportion of sleep time spent in REM sleep was 20 % and in light sleep was 60.5% and in deep sleep was 18.5 %. These correlate well with polysomnographic based normative data in children.\n\nConclusion\nOur findings support the potential of using wrist-worn devices to continuously monitor sleep duration and quality in children with asthma.\n\nFuture work seeks to evaluate the effect of sleep on asthma outcomes in children.", "links": [] }, { "title": "Using financial incentives to promote physical activity in American Indian adolescents: A randomized controlled trial ", "author": "Short, K.R., Chadwick, J.Q., Cannady, T.K., Branam, D.E., Wharton, D.F., Tullier, M.A., Thompson, D.M. and Copeland, K.C.", "year": "2018", "journalProceedings": "PLOS ONE", "category": "Intervention", "devices": "Zip", "population": "Adolescents", "dataUsed": "Steps", "abstract": "American Indians (AI) have high prevalence of diabetes in youth and may benefit from increasing physical activity as a strategy to improve metabolic health. We tested whether financial incentives would elicit greater frequency and/or duration of exercise in AI youth at high risk for developing diabetes. Overweight/obese AI boys and girls, 11-20 years old, were instructed to exercise on 3 days/week for 48 weeks at a tribal wellness center. The program was divided into three, 16-week-long phases to test different financial incentive strategies. Within each phase participants were randomly assigned to one of two groups that received different payments for exercise. Phase 1 was designed to test whether the size of the incentive would affect exercise frequency. In Phase 1, the number of exercise sessions did not differ between the group receiving a modest fixed-value payment per exercise session and the group receiving enhanced incentives to exercise more frequently (26 ± 3 versus 28 ± 2 sessions, respectively, p = 0.568). In Phase 2, the provision of an enhanced financial incentive to increase exercise duration resulted longer sessions, as the incentivized and standard payment groups exercised 38 ± 2 versus 29 ± 1 minutes per session (p = 0.002), respectively. In Phase 3, the effect of reducing the incentives on maintenance of exercise behaviors was inconclusive due to high participant withdrawal. Aerobic fitness increased 10% during Phase 1 but was unchanged thereafter. Insulin sensitivity and body composition were unchanged during the study. In conclusion, enhanced financial incentives increased the duration of exercise sessions, but had minimal effects on exercise participation. These results indicate that financial incentives hold promise in motivating previously sedentary, overweight/obese adolescents to exercise longer, but motivating them to sustain an exercise program remains the major challenge. Trial Registration: ClinicalTrials.gov NCT01848353.", "links": [ { "caption": "URL", "url": "http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198390", "newWindow": true } ] }, { "title": "Comparison of Research- and Consumer-grade Energy Expenditure Estimation Methods during 10 Days of Military Training ", "author": "Siddall, A.G., Thompson, J.E.S., Powell, S.D., Edwards, V.C., Kefyalew, S.S., Singh, P.A., Orford, E.R., Venables, M.C., Jackson, S., Greeves, J.P., Blacker, S.D. and Myers, S.D.", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Surge", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "PURPOSE: Wearable physical activity monitoring devices have improved the ability to estimate free-living total energy expenditure (TEE) but their application during arduous military training alongside more well-established techniques has not been widely documented. This study aimed to assess the validity of two wrist-worn activity monitors to estimate TEE by evaluating performance against doubly labelled water (DLW) during British Army Officer Cadet (OC) training. METHODS: Twenty (10 male and 10 female) OCs (mean ± SD: age 22 ± 1 years, height 1.73 ± 0.08 m, body mass 77.0 ± 9.3 kg) wore one research-grade accelerometer (GENEActiv, Cambridge, UK; “RES”) on the dominant wrist and one commercially available (FITBIT SURGE, USA; “COM”) monitor on the non-dominant wrist for 10 days of training. Immediately prior to this 10-day period, participants consumed a bolus of DLW and provided daily urine samples, which were analysed by mass spectrometry to determine TEE. Bivariate correlations and limits of agreement were calculated to compare the 10-day mean TEE from DLW with both activity monitors to evaluate device performance. RESULTS: TEE (mean ± SD) from DLW, RES and COM were 17.2 ± 2.7 MJ.day-1 (4112 ± 652 kcal.day-1), 17.3 ± 2.8 MJ.day-1 (4129 ± 677 kcal.day-1) and 15.1 ± 3.7 MJ.day-1 (3607 ± 888 kcal.day-1), respectively. TEE from DLW was linearly correlated with both RES (r=0.786, p<0.001) and COM (r=0.888, p<0.001). Despite a stronger association with DLW however, COM tended to underestimate TEE (mean bias [95% CI]) by -2.1 [-5.6-1.4] MJ.day-1 (-505 [-1348-339] kcal.day-1; p<0.05). In contrast, mean TEE from RES was similar to DLW (-0.05 [-3.6-3.5] MJ.day-1; -11 [-867-845] kcal.day-1; p>0.05). CONCLUSION: Wearable physical activity monitors provides a cheaper and more practical method for estimating free-living TEE than DLW, and could be useful for military populations. However, this study suggests a consumer monitor may underperform, by underestimating TEE, during physically demanding training in comparison to a research- grade device.", "links": [] }, { "title": "mActive-Smoke: A Prospective Observational Study Using Mobile Health Tools to Assess the Association of Physical Activity With Smoking Urges", "author": "Silverman-Lloyd, L.G., Kianoush, S., Blaha, M.J., Sabina, A.B., Graham, G.N. and Martin, S.S.\t", "year": "2018", "journalProceedings": "JMIR mHealth and uHealth", "category": "Measurement", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Background: Evidence that physical activity can curb smoking urges is limited in scope to acute effects and largely reliant on retrospective self-reported measures. Mobile health technologies offer novel mechanisms for capturing real-time data of behaviors in the natural environment. Objective: This study aimed to explore this in a real-world longitudinal setting by leveraging mobile health tools to assess the association between objectively measured physical activity and concurrent smoking urges in a 12-week prospective observational study. Methods: We enrolled 60 active smokers (≥3 cigarettes per day) and recorded baseline demographics, physical activity, and smoking behaviors using a Web-based questionnaire. Step counts were measured continuously using the Fitbit Charge HR. Participants reported instantaneous smoking urges via text message using a Likert scale ranging from 1 to 9. On study completion, participants reported follow-up smoking behaviors in an online exit survey. Results: A total of 53 participants (aged 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite) recorded at least 6 weeks of data and were thus included in the analysis. We recorded 15,365 urge messages throughout the study, with a mean of 290 (SD 62) messages per participant. Mean urge over the course of the study was positively associated with daily cigarette consumption at follow-up (Pearson r=.33; P=.02). No association existed between daily steps and mean daily urge (beta=−6.95×10−3 per 1000 steps; P=.30). Regression models of acute effects, however, did reveal modest inverse associations between steps within 30-, 60-, and 120-min time windows of a reported urge (beta=−.0191 per 100 steps, P<.001). Moreover, 6 individuals (approximately 10% of the study population) exhibited a stronger and consistent inverse association between steps and urge at both the day level (mean individualized beta=−.153 per 1000 steps) and 30-min level (mean individualized beta=−1.66 per 1000 steps). Conclusions: Although there was no association between objectively measured daily physical activity and concurrently self-reported smoking urges, there was a modest inverse relationship between recent step counts (30-120 min) and urge. Approximately 10% of the individuals appeared to have a stronger and consistent inverse association between physical activity and urge, a provocative finding warranting further study. [JMIR Mhealth Uhealth 2018;6(5):e121]", "links": [] }, { "title": "A Smartphone App to Promote an Active Lifestyle in Lower-Educated Working Young Adults: Development, Usability, Acceptability, and Feasibility Study.", "author": "Simons, D., De Bourdeaudhuij, I., Clarys, P., De Cocker, K., Vandelanotte, C. and Deforche, B.\t", "year": "2018", "journalProceedings": "JMIR mHealth and uHealth", "category": "Usability", "devices": "Charge", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND Physical activity (PA) levels are problematic in lower-educated working young adults (18-26 years). To promote PA, smartphone apps have great potential, but there is no evidence for their effectiveness in this population. To increase the likelihood that a newly developed app will be effective, formative research and user testing are required. OBJECTIVE The aim of this study was to describe the development, usability, acceptability, and feasibility of a new theory- and evidence-based smartphone app to promote an active lifestyle in lower-educated working young adults. METHODS The new app was developed by applying 4 steps. First, determinants important to promote an active lifestyle in this population were selected. Second, evidence-based behavior change techniques were selected to convert the determinants into practical applications. Third, a new smartphone app was developed. Fourth, volunteers (n=11, both lower and higher educated) tested the app on usability, and lower-educated working young adults (n=16) tested its acceptability and feasibility via (think aloud) interviews, a questionnaire, and Google Analytics. The app was accordingly adapted for the final version. RESULTS A new Android app, Active Coach, was developed that focused on knowledge, attitude, social support, and self-efficacy (based on outcomes from step 1), and that applied self-regulation techniques (based on outcomes from step 2). The app consists of a 9-week program with personal goals, practical tips, and scientific facts to encourage an active lifestyle. To ensure all-day and automatic self-monitoring of the activity behavior, the Active Coach app works in combination with a wearable activity tracker, the Fitbit Charge. Issues detected by the usability test (eg, text errors, wrong messages) were all fixed. The acceptability and feasibility test showed that participants found the app clear, understandable, and motivating, although some aspects needed to be more personal. CONCLUSIONS By applying a stepwise, user-centered approach that regularly consulted the target group, the new app is adapted to their specific needs and preferences. The Active Coach app was overall positively evaluated by the lower-educated working young adults at the end of the development process.", "links": [] }, { "title": "The influence of a consumer-wearable activity tracker on sedentary time and prolonged sedentary bouts: secondary analysis of a randomized controlled trial", "author": "Sloan, R.A., Kim, Y., Sahasranaman, A., Müller-Riemenschneider, F., Biddle, S.J.H. and Finkelstein, E.A.\t", "year": "2018", "journalProceedings": "BMC Research Notes", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "A recent meta-analysis surmised pedometers were a useful panacea to independently reduce sedentary time (ST). To further test and expand on this deduction, we analyzed the ability of a consumer-wearable activity tracker to reduce ST and prolonged sedentary bouts (PSB). We originally conducted a 12-month randomized control trial where 800 employees from 13 organizations were assigned to control, activity tracker, or one of two activity tracker plus incentive groups designed to increase step count. The primary outcome was accelerometer measured moderate-to-vigorous physical activity. We conducted a secondary analysis on accelerometer measured daily ST and PSB bouts. A general linear mixed model was used to examine changes in ST and prolonged sedentary bouts, followed by between-group pairwise comparisons. Regression analyses were conducted to examine the association of changes in step counts with ST and PSB. The changes in ST and PSB were not statistically significant and not different between the groups (P textless 0.05). Increases in step counts were concomitantly associated with decreases in ST and PSB, regardless of intervention (P textless 0.05). Caution should be taken when considering consumer-wearable activity trackers as a means to reduce sedentary behavior. Trial registration NCT01855776 Registered: August 8, 2012", "links": [] }, { "title": "Lessons Learned From a Feasibility Study Delivered in 2 WIC Sites to Promote Physical Activity Among Pregnant Latinas ", "author": "Soto, S.H., Sanz, S., Merchant, K.M., Nichols, J.F. and Arredondo, E.M.", "year": "2018", "journalProceedings": "Journal of Nutrition Education and Behavior", "category": "Usability", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "OBJECTIVE To assess the feasibility, including demand for and acceptability of a physical activity (PA) intervention among pregnant Latinas recruited at the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).", "links": [] }, { "title": "Water intake reverses dehydration associated impaired executive function in healthy young women", "author": "Stachenfeld, N.S., Leone, C.A., Mitchell, E.S., Freese, E. and Harkness, L.\t", "year": "2018", "journalProceedings": "Physiology & Behavior", "category": "Intervention", "devices": null, "population": "Adults", "dataUsed": "Steps,Sleep,Food", "abstract": "INTRODUCTION\nHealthy women do not always consume Recommended Daily Levels of fluid intake ad libitum. We hypothesized that 1) women lose≥1.0% BW during daily activities, 2) that mild body water loss impairs memory and executive function, 3) water intake to recommended daily levels will improve cognitive function.\nMETHODS\nWe tested 12 women (26±5yr, 22.5±2.6kg/m2 BMI). Session 1 was a control (CON) session, during which subjects monitored their food and fluid intake (diary) and activity (Fitbit®). The next two sessions were applied in balanced order: dehydration (DEH) session, where subjects minimized drinking, and a euhydration (EUH) session, where subjects drank Recommended Daily Levels of fluid for their age and sex, or 2500ml/24h. We compared emotion, sensory perception and cognition with computer based visual analog tests and computer based cognitive tasks (Cogstate) at 5PM, i.e. baseline (BL) on the evening prior to the session, and at 7AM, 12PM, and 5PM during the session.\n\nRESULTS\nUrine specific gravity (USG) was similar at BL across conditions (CON 1.013±0.002, DEH 1.015±0.002, EUH 1.014±0.002) and increased with dehydration (CON 1.011±0.003, DEH 1.021±0.002, EUH 1.010±0.002, Ptextless0.05) by 5PM of the session. Uncontrolled fluid intake and physical activity were similar across sessions. The water challenges did not impact Detection, Identification, One-Card Learning, but EUH improved visual and working memory (Groton Maze Learning Test) errors: CON 40.1±11.1, DEH 40.5±10.1, EUH 33.9±10.9, Ptextless0.05. Executive function [Set Shifting (SETS)] also improved under EUH, errors: BL 22.5±12.7 vs. 5PM 17.8±6.2, Ptextless0.05.\n\nCONCLUSIONS\nMild dehydration caused deficits in visual and working memory and executive function in healthy young women. These deficits were reversed by drinking water to the European Food Safety Authority and Institute of Medicine requirements of 2.5l/day for adult women.", "links": [] }, { "title": "Bouldering psychotherapy reduces depressive symptoms even when general physical activity is controlled for: A randomized controlled trial", "author": "Stelzer, E.-M., Book, S., Graessel, E., Hofner, B., Kornhuber, J. and Luttenberger, K.\t", "year": "2018", "journalProceedings": "Heliyon", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Background\nBouldering psychotherapy (BPT) combines psychotherapeutic elements with physical activity (PA). It might be effective for reducing symptoms of depression, but so far, no study has assessed individuals' levels of PA to control for whether positive effects on depression can also be found when adjusting for participants' levels of PA. This is important because PA itself has been proven effective in reducing depression and therefore might be an important variable to account for – especially in therapies using sport as one therapeutic mechanism.\nMethods\nUsing a waitlist control group design, outpatients with depression were assessed at baseline and after eight, 16, and 24 weeks. The intervention group took part in an eight-week bouldering psychotherapy which met once a week for three hours. Self-report measures before and after the intervention included the Symptom Checklist-90-R (SCL-90-R), the Beck Depression Inventory (BDI-II), and the questionnaire on resources and self-management skills (FERUS). PA was assessed during the first 16-week period via FitBit Zip accelerometers.\n\nResults\nAltogether, 47 complete cases (20 men and 27 women) were included in the final analyses. Depression scores dropped by up to 6.74 (CI 2.80–10.67) points on the SCL-90-R depression scale and by up to 8.26 (CI 4.21–12.31) points on the BDI-II during the BPT intervention, the control group remained stable (SCL-90-R Cohen's d = 0.60; BDI-II: Cohen's d = .50). All Participants accrued an average of 6,515 steps per day, which is considered “low-active.” Participants of the BPT intervention were significantly more likely to reduce their depressive symptoms (p = .025) than participants of the control group, even when PA was controlled for in a regression analysis.\n\nLimitations\nLimitations of the study are the relatively small number of patients and the assessment of outcome scores via self-report.\n\nConclusions\nThis study provides evidence that short-term BPT can be effective for reducing symptoms of depression even if controlled for other therapeutically active confounders including antidepressant medication, psychotherapy and general level of PA.", "links": [] }, { "title": "Heart Rate Equivalency of the Fitbit Charge HR During Continuous Aerobic Exercise ", "author": "Stock, J.M., Pohlig, R.T., Botieri, M.J., Edwards, D.G. and Dominick, G.M.", "year": "2018", "journalProceedings": "Journal for the Measurement of Physical Behaviour", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Purpose: Consumer-grade wrist-worn activity monitors frequently include photoplethysmography (PPG) sensors for estimating heart rate (HR). The Fitbit Charge HR is marketed specifically for tracking fitness; therefore, HR accuracy is critical, especially during exercise. This study examined HR equivalency of the Fitbit Charge HR during continuous aerobic exercise. Method: Participants (N = 19) concurrently wore a Polar H1 and Fitbit Charge HR during a measurement visit that included seated rest (5 minutes), warm-up (5 minutes), continuous treadmill exercise (30 minutes), and cool-down (5-10 minutes). Mean HR differences were examined by protocol phase, total activity (i.e., warm-up, exercise, and cool-down combined), and the first, middle, and last 5 minutes of continuous exercise. Mean absolute percent error (MAPE), Bland-Altman plots, and 95% equivalence testing explained overall and individual HR agreement between devices. Results: The Fitbit Charge HR significantly underestimated HR for all measurement...", "links": [] }, { "title": "The validity and reliability of consumer-grade activity trackers in older, community-dwelling adults: A systematic review", "author": "Straiton, N., Alharbi, M., Bauman, A., Neubeck, L., Gullick, J., Bhindi, R. and Gallagher, R.\t", "year": "2018", "journalProceedings": "Maturitas", "category": "Review", "devices": "One,Zip,Charge HR", "population": "Older Adults", "dataUsed": "Steps,Intensity", "abstract": "OBJECTIVE To understand the validity and reliability of consumer-grade activity trackers (consumer wearables) in older, community-dwelling adults. METHODS A systematic review of studies involving adults aged over 65 years who underwent physical activity monitoring with consumer wearables. A total of 7 observational studies qualified, identified from electronic databases: MEDLINE, EMBASE, Cochrane Library and others (2014-2018). Validity was interpreted using correlation coefficients (CC) and percentage error for agreement between reference devices or gold-standard validation methods Reliability was compared using mean differences or ranges (under- or overestimation) of step count and activity time. RESULTS Total sample size was 290 adults, mean age of 70.2 ± 4.8 years and females constituting 46.7 ± 26.1%. The studies evaluated eight different consumer wearables used by community-dwelling adults with a range of co-morbidities. Daily step count for all consumer wearables correlated highly with validation criterion, especially the ActiGraph device: intraclass correlation coefficients (ICC) were 0.94 for Fitbit One, 0.94 for Zip, 0.86 for Charge HR and 0.96 for Misfit Shine. Slower walking pace and impaired ambulation reduced the levels of agreement. Daily step count captured by Fitbit Zip was on average 7117 (±5,880.6), which was overestimated by five of the eight consumer wearables compared with reference devices (range 167.6-2,690.3 steps/day). Measurement of activity duration was accurate compared with reference devices, yet less so than step count. CONCLUSION In older, community-dwelling adults, consumer wearables accurately measure step count and activity duration, as confirmed by reference devices and validation methods Further research is required to understand how co-morbidities, gait and activity levels interact with monitoring in free-living environments.", "links": [] }, { "title": "The Influence Of Non-exercise Physical Activity During Aerobic Exercise On Cardiometabolic Risk Factors ", "author": "Swift, D.L., McGee, J.E., Barefoot, S.G., Brophy, P., Solar, C.A., Houmard, J.A. and Lutes, L.D.", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Intervention", "devices": "One", "population": "Adults", "dataUsed": "Intensity", "abstract": "PURPOSE: To determine the impact of changes in non-exercise physical activity on changes in cardiometabolic risk factors in participants performing aerobic exercise training. METHODS: Obese adults (N=25) were randomized to an aerobic training group or an aerobic training and increasing non-exercise physical activity group. Both groups performed supervised aerobic training (50%-75% VO2 max) for 24 weeks at a dose of 12 kcals per kg per week. Non-exercise physical activity (total steps, minutes in low, moderate to vigorous [MVPA] physical activity) was quantified during the entire intervention using Fitbit One accelerometers (removed during supervised exercise sessions). Cardiometabolic assessments included lipids, glucose, insulin, 2-hour glucose/insulin from an oral glucose tolerance test, fitness, and body composition measures (% body fat, weight, and waist circumference). Linear regression models were run with change in the cardiometabolic variable as the dependent variable and baseline value, age, race, sex, supervised exercise time, adherence to exercise dose, change in non-exercise physical activity variables (change in total steps, minutes in light intensity and minutes in MVPA) as predictor variables. RESULTS: Change in total steps was a significant predictor for change in weight (r2= 0.17, p=0.04), percent weight loss (r2= 0.18, p=0.03, waist circumference (r2=0.31, p=0.004), triglycerides (r2= 0.30, p=0.01) and relative fitness (r2= 0.19, p=0.03). Change in total steps approached significance as a predictor for absolute fitness (p=0.052) and body fat (p=0.059). Change in minutes in low intensity was a significant predictor of the change in 2-hour glucose (r2= 0.20, p=0.03). Change in MVPA was not associated with change in any cardiometabolic variables (all ps>0.05). Change in non-exercise physical activity did not predict changes in glucose, insulin, 2-hour insulin, low density lipoprotein, high density lipoprotein, total cholesterol, or lean mass levels (all ps>0.05). CONCLUSIONS: Change in non-exercise physical activity outside of aerobic training was associated with changes in several cardiometabolic variables. Increasing total steps or minutes in low intensity may represent a clinical target to maximize the health benefits of aerobic exercise training in obese adults.", "links": [] }, { "title": "Effect of carbohydrate restriction-induced weight loss on aortic pulse wave velocity in overweight men and women ", "author": "Syed-Abdul, M.M., Hu, Q., Jacome-Sosa, M., Padilla, J., Manrique-Acevedo, C., Heimowitz, C. and Parks, E.J.", "year": "2018", "journalProceedings": "Applied Physiology, Nutrition, and Metabolism", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Increased aortic stiffness, measured by carotid-to-femoral pulse wave velocity (PWV), is an independent predictor of cardiovascular disease (CVD) and past data have shown that low-fat and low-energy diets, fed for 8-24 wks lower PWV. The purpose of this study was to determine whether a reduction in PWV would be achieved by dietary carbohydrate (CHO) restriction, shown to bring about weight loss over a shorter timeframe. Men [n=10, age: 41.8 ± 3.2 y, BMI: 34.2 ± 1.0 kg/m2 (mean±SE)] and women (n=10, age: 38.6 ± 1.9 y, BMI: 33.5 ± 1.2 kg/m2) with characteristics of insulin resistance and the metabolic syndrome, consumed a structured, CHO-restricted diet (CRD) for 4 wks (energy deficit, 645 kcal/d). For the whole group, subjects lost 5.4 ± 0.5 % (P<0.001) of body weight and experienced significant reductions in blood pressure (6-8%), plasma insulin (34%) and triglycerides (34%). PWV was reduced by 6 ± 2% (7.1 ± 0.2 m/s to 6.7 ± 0.2 m/s, P=0.008) and surprisingly, in women, it fell significantly (from 7.2 ± 0.3 m/s to 6.3 ± 0.3 m/s, P=0.028), while no changes were observed in men (7.2 ± 0.3 vs 7.0 ± 0.3 m/s, P=0.144). This is the first study to demonstrate that weight loss can improve PWV in as little as 4 wks and that dietary CHO restriction may be an effective treatment for reducing aortic stiffness in women. Future studies are needed to establish the mechanisms by which dietary CHO restriction may confer more cardiovascular benefits to women compared to men.", "links": [ { "caption": "URL", "url": "http://www.nrcresearchpress.com/doi/10.1139/apnm-2018-0113#.Wx7AK_ZFxQk", "newWindow": true } ] }, { "title": "Validation of Electronic Activity Monitor Devices During Treadmill Walking", "author": "Tam, K.M. and Cheung, S.Y.\t", "year": "2018", "journalProceedings": "Telemedicine and e-Health", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps", "abstract": "Introduction:The purpose of this study was to assess the validity of the step count measurement of commercial electronic activity monitor devices. Two popular models, Fitbit Charge HR and Mi Band 2, were selected for treadmill walking in a single session.\n\nMaterials and Methods:Thirty healthy volunteers walked at five predetermined speeds (0.90, 1.12, 1.33, 1.54, and 1.78 m/s) on a treadmill with both Fitbit Charge HR and Mi Band 2 worn on their dominant hand's wrist. Observers counted the steps, with the aid of taped video, which was taken as the criterion measure for steps. The validity of the electronic activity devices was assessed by (1) Paired sample t test with the criterion measures and (2) Pearson's correlation coefficients and the corresponding p-values were calculated to compare the output of devices with manual step count. In addition, Bland-Altman plots were constructed to visually inspect the data and to assess agreement with the criterion measures.\n\nResults:There were no significant differences in step measurement between Fitbit Charge HR and Mi Band 2 with the criterion measures. Besides, there was a very strong agreement between step count measurements obtained using the Fitbit Charge HR (r = 0.99) and the Mi Band 2 (r = 0.99), at five predetermined speeds while comparing with the observed step counts.\n\nConclusion:Both Fitbit Charge HR and Mi Band 2 provided accurate step count measurement in the treadmill walking test.", "links": [] }, { "title": "Validity of wrist-worn consumer products to measure heart rate and energy expenditure", "author": "Thiebaud, R.S., Funk, M.D., Patton, J.C., Massey, B.L., Shay, T.E., Schmidt, M.G. and Giovannitti, N.\t", "year": "2018", "journalProceedings": "Digital Health", "category": "Validation", "devices": "Surge", "population": "Adults", "dataUsed": "Energy Expenditure,Heart Rate", "abstract": "Introduction\nThe ability to monitor physical activity throughout the day and during various activities continues to improve with the development of wrist-worn monitors. However, the accuracy of wrist-worn monitors to measure both heart rate and energy expenditure during physical activity is still unclear. The purpose of this study was to determine the accuracy of several popular wrist-worn monitors at measuring heart rate and energy expenditure.\nMethods\nParticipants wore the TomTom Cardio, Microsoft Band and Fitbit Surge on randomly assigned locations on each wrist. The maximum number of monitors per wrist was two. The criteria used for heart rate and energy expenditure were a three-lead electrocardiogram and indirect calorimetry using a metabolic cart. Participants exercised on a treadmill at 3.2, 4.8, 6.4, 8 and 9.7 km/h for 3 minutes at each speed, with no rest between speeds. Heart rate and energy expenditure were manually recorded every minute throughout the protocol.\n\nResults\nMean absolute percentage error for heart rate varied from 2.17 to 8.06% for the Fitbit Surge, from 1.01 to 7.49% for the TomTom Cardio and from 1.31 to 7.37% for the Microsoft Band. The mean absolute percentage error for energy expenditure varied from 25.4 to 61.8% for the Fitbit Surge, from 0.4 to 26.6% for the TomTom Cardio and from 1.8 to 9.4% for the Microsoft Band.\n\nConclusion\nData from these devices may be useful in obtaining an estimate of heart rate for everyday activities and general exercise, but energy expenditure from these devices may be significantly over- or underestimated.", "links": [] }, { "title": "SIT LESS: A prototype home-based system for monitoring older adults sedentary behavior ", "author": "Tirkel, T., Edan, Y., Khvorostyanov, N. and Bar-Haim, S.", "year": "2018", "journalProceedings": "Assistive Technology", "category": "Usability", "devices": "Charge HR", "population": "Older Adults", "dataUsed": "Steps", "abstract": "ABSTRACTThis paper presents the overall design of a prototype home-based system aimed to reduce sedentary behavior of older adults. Quantitative performance indicators were developed to measure the sedentary behavior and daily activities of an older adult. The sedentary behavior is monitored by identifying individual positions (standing, sitting, and lying) within the field of view of a Microsoft Kinect sensor, using a custom designed algorithm. The physical activity of the older adult when outside the field of view of the Microsoft Kinect sensor, is monitored by counting the number of steps using a Fitbit Charge HR watch, which the older adult is equipped with. A user interface was developed on a PC platform to interact with the older adult. The user interface is automatically operated and includes several modules. It displays the activity level, and provides feedbacks, alerts, and reminders to reduce sedentary behavior. Evaluations using a mixed methods approach that included a focus group, interviews, ...", "links": [] }, { "title": "Video-Recorded Validation of Wearable Step Counters under Free-living Conditions", "author": "Toth, L.P., Park, S., Springer, C.M., Feyerabend, M.D., Steeves, J.A. and Bassett, D.R.\t", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Zip,Charge", "population": "Adults", "dataUsed": "Steps", "abstract": "Purpose\nThe purpose of this study was to determine the accuracy of 14 step counting methods under free-living conditions. Methods\n\nPurpose\nTwelve adults (mean±SD, age: 35±13 yr) wore a chest harness that held a GoPro camera pointed down at the feet during all waking hours for one day. The GoPro continuously recorded video of all steps taken throughout the day. Simultaneously, participants wore two StepWatch [SW] devices on each ankle (all programmed with different settings), one activPAL [AP] on each thigh, four devices at the waist (Fitbit Zip [FZ], Yamax Digi-Walker SW-200 [DW], New Lifestyles NL-2000 [NL], and ActiGraph GT9X [AG]), and two devices on the dominant and non-dominant wrists (Fitbit Charge [FC] and AG). The GoPro videos were downloaded to a computer and researchers counted steps using a hand tally device, which served as the criterion method.\n\nResults\nThe SW devices recorded between 95.3% to 102.8% of actual steps taken throughout the day (P>0.05). Eleven step counting methods estimated less than 100% of actual steps; FZ, DW, and AG with the Moving Average Vector Magnitude algorithm (MAVM) on both wrists recorded 71% to 91% of steps (P>0.05), while the AP, NL, AG (without Low Frequency Extension [no-LFE], MAVM) worn on the hip, and FC recorded 69% to 84% of steps (P<0.05). Five methods estimated more than 100% of actual steps; AG (no-LFE) on both wrists recorded 109% to 122% of steps (P>0.05), while the AG (LFE) on both wrists and the hip recorded 128% to 220% of steps (P<0.05).\n\nConclusion\nAcross all waking hours of one day, step counts differ between devices. The SW, regardless of settings, was the most accurate method of counting steps.", "links": [] }, { "title": "Sleeping Well Trial: Increasing the effectiveness of treatment with continuous positive airway pressure using a weight management program in overweight adults with obstructive sleep apnoea-A stepped wedge randomised trial protocol ", "author": "Truby, H., Edwards, B.A., O'Driscoll, D.M., Young, A., Ghazi, L., Bristow, C., Roem, K., Bonham, M.P., Murgia, C., Day, K., Haines, T.P. and Hamilton, G.S.", "year": "2018", "journalProceedings": "Nutrition & Dietetics", "category": "Methods", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Sleep", "abstract": "Background The majority of adults diagnosed with obstructive sleep apnoea (OSA) are overweight or obese. Continuous positive airway pressure (CPAP) is the most common effective therapy for OSA. However, adherence declines over time with only 50% of patients prescribed CPAP continuing to use it long term. Furthermore, a recent prospective analysis indicated that those more adherent with CPAP therapy have enhanced weight gain trajectories which in turn may negatively impact their OSA.", "links": [ { "caption": "URL", "url": "https://onlinelibrary.wiley.com/doi/abs/10.1111/1747-0080.12435", "newWindow": true } ] }, { "title": "Parenting Intervention to Improve Nutrition and Physical Activity for Preschoolers with Type 1 Diabetes: A Feasibility Study ", "author": "Tully, C., Mackey, E., Aronow, L., Monaghan, M., Henderson, C., Cogen, F., Wang, J. and Streisand, R.", "year": "2018", "journalProceedings": "Journal of Pediatric Health Care", "category": "Usability", "devices": "One", "population": "Children,Adults", "dataUsed": "NA", "abstract": "OBJECTIVE This study reports the feasibility and acceptability of a healthy eating and physical-activity-focused behavioral intervention for parents of young children with type 1 diabetes (T1D).", "links": [] }, { "title": "Using Commercial Physical Activity Trackers for Health Promotion Research: Four Case Studies", "author": "Turner-McGrievy, G., Jake-Schoffman, D.E., Singletary, C., Wright, M., Crimarco, A., Wirth, M.D., Shivappa, N., Mandes, T., West, D.S., Wilcox, S., Drenowatz, C., Hester, A. and McGrievy, M.J.\t", "year": "2018", "journalProceedings": "Health Promotion Practice", "category": "Review", "devices": "Zip,Flex,Aria", "population": "Children,Adults", "dataUsed": "Steps,Weight", "abstract": "Background. Wearable physical activity (PA) trackers are becoming increasingly popular for intervention and assessment in health promotion research and practice. The purpose of this article is to present lessons learned from four studies that used commercial PA tracking devices for PA intervention or assessment, present issues encountered with their use, and provide guidelines for determining which tools to use. Method. Four case studies are presented that used PA tracking devices (iBitz, Zamzee, FitBit Flex and Zip, Omron Digital Pedometer, Sensewear Armband, and MisFit Flash) in the field—two used the tools for intervention and two used the tools as assessment methods. Results. The four studies presented had varying levels of success with using PA devices and experienced several issues that impacted their studies, such as companies that went out of business, missing data, and lost devices. Percentage ranges for devices that were lost were 0% to 29% and was 0% to 87% for those devices that malfunctioned or lost data. Conclusions. There is a need for low-cost, easy-to-use, accurate PA tracking devices to use as both intervention and assessment tools in health promotion research related to PA.", "links": [] }, { "title": "Counting Steps in Activities of Daily Living in People With a Chronic Disease Using Nine Commercially Available Fitness Trackers: Cross-Sectional Validity Study.", "author": "Ummels, D., Beekman, E., Theunissen, K., Braun, S. and Beurskens, A.J.\t", "year": "2018", "journalProceedings": "JMIR mHealth and uHealth", "category": "Validation", "devices": "One,Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND Measuring physical activity with commercially available activity trackers is gaining popularity. People with a chronic disease can especially benefit from knowledge about their physical activity pattern in everyday life since sufficient physical activity can contribute to wellbeing and quality of life. However, no validity data are available for this population during activities of daily living. OBJECTIVE The aim of this study was to investigate the validity of 9 commercially available activity trackers for measuring step count during activities of daily living in people with a chronic disease receiving physiotherapy. METHODS The selected activity trackers were Accupedo (Corusen LLC), Activ8 (Remedy Distribution Ltd), Digi-Walker CW-700 (Yamax), Fitbit Flex (Fitbit inc), Lumoback (Lumo Bodytech), Moves (ProtoGeo Oy), Fitbit One (Fitbit inc), UP24 (Jawbone), and Walking Style X (Omron Healthcare Europe BV). In total, 130 persons with chronic diseases performed standardized activity protocols based on activities of daily living that were recorded on video camera and analyzed for step count (gold standard). The validity of the trackers' step count was assessed by correlation coefficients, t tests, scatterplots, and Bland-Altman plots. RESULTS The correlations between the number of steps counted by the activity trackers and the gold standard were low (range: -.02 to .33). For all activity trackers except for Fitbit One, a significant systematic difference with the gold standard was found for step count. Plots showed a wide range in scores for all activity trackers; Activ8 showed an average overestimation and the other 8 trackers showed underestimations. CONCLUSIONS This study showed that the validity of 9 commercially available activity trackers is low measuring steps while individuals with chronic diseases receiving physiotherapy engage in activities of daily living.", "links": [] }, { "title": "The Wearable Technological Device as a Means of Physical Activity Monitoring ", "author": "Underhill, A.", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "PURPOSE: To assess the use of a wearable technological device for the increase in attainment of physical activity (PA) with the goal of preventing Type II Diabetes Mellitus (T2DM) through weight loss. The Fitbit offers an advantage to other activity trackers when used for study purposes, in that it can provide continuous measurement of PA across the entire study period. METHODS: Men and women over the age of 40, and at risk for prediabetes, were recruited. The study period was four months in length, with an initial four weeks of baseline PA testing, followed by 12 weeks of lifestyle intervention. Individualized PA goals were set. PA monitoring was very successful. Participants averaged 72 days of PA tracking with 46% of participants reaching the maximal number of days (77). The Fitbit Flex measures steps, minutes sedentary, minutes lightly active, minutes fairly active, minutes very active, and total active minutes. RESULTS: Participants (N = 13) were aged 65.03 (SD = 8.3) years. At baseline, participants were performing 220.8 (SD = 249.0) minutes per week of moderate intensity PA. Participants increased moderate intensity PA to 243.3 (SD = 198.8) minutes per week. At baseline, participants were accumulating 7511.6 steps/day (SD = 3271.2) increasing to 8177.6 steps/day (SD = 3078.9) taken during the three month intervention. No statistical significance was found. A Pearson CC (0.598) showed there was a positive trend with minutes of moderate-to-vigorous activity and weight loss. 36% of the variants of weight loss was influenced by minutes of PA. Compliance to wearing the Fitbit was very good with 93.1% of the weeks having data tracked for at least ≥ 6 days/week. Wear time was corroborated by Fitbit data, which showed of the 1415 tracked days, only 9.3% days recorded were of less than 2000 steps. Barriers to technology were low and 100% of participants strongly agreed that continuous monitoring of weight and PA encouraged them to make healthy lifestyle changes. CONCLUSIONS: Of particular importance was that 46% of participants initially self-reported that they were physically active for more than 150 minutes per week, which shows many people underestimate their actual PA. Continuous monitoring of PA through wearable technology can be a useful modality aiding in weight loss.", "links": [] }, { "title": "Self-monitoring and reminder text messages to increase physical activity after colorectal cancer (CRC): A pilot randomized controlled trial. ", "author": "Van Blarigan, E., Van Loon, K., Kenfield, S.A., Chan, J.M., Mitchell, E., Chan, H., Zhang, L., Paciorek, A., Joseph, G., Laffan, A., Fukuoka, Y., Miaskowski, C., Meyerhardt, J.A. and Venook, A.P.", "year": "2018", "journalProceedings": "JCO", "category": "Intervention", "devices": "Flex", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "615Background: Over 1.3 million people in the US are living with CRC. Physical activity is associated with lower risk of CRC mortality. Interventions are needed to increase physical activity after CRC diagnosis. Methods: We conducted a pilot RCT to determine the feasibility (adherence, attrition) and acceptability of a 12-wk intervention using a Fitbit Flex? and daily text messages to increase physical activity after CRC. Eligible patients had to have colon or rectal cancer of any stage, be disease free or have stable disease, able to speak and read English, and access to Internet and a mobile phone. Individuals with contraindications to moderate-to-vigorous physical activity (MVPA) or exercising ≥30 min ≥5 d/wk were excluded. We explored the impact of the intervention (n = 20) vs. usual care (n = 21) on MVPA via ActiGraph GT3X+ accelerometers pre-/post-intervention. Results: The intervention was feasible and acceptable. On average, participants were 54 y, BMI 28 kg/m2 and enrolled 1.5 y after diagnosis; 59% were women, 73% were White, and 61% were stage III. The intervention arm wore their Fitbits a median of 74 d (89% of study days, IQR: 23-83 d) and responded to 74% (34) of the 46 text messages that asked for a reply (IQR: 28-82%). Older participants were more likely to wear the Fitbit (r: 0.72; p < 0.001). Married participants were more likely to wear the Fitbit and respond to texts compared to unmarried (96% vs. 32% wear time, p: 0.02 and 85% vs. 46% response rate, p: 0.006). Most patients (88%) reported that the intervention motivated them to exercise and that they were satisfied with their experience. On average, the intervention arm increased MVPA by 14 min/d, while the control arm increased by only 1 min/d, but there was no statistically significant difference in change in MVPA between groups (mean difference comparing change in MVPA in the intervention vs. control: 13 min/d; 95% CI: -14, 40; p: 0.33). Conclusions: A 12-wk physical activity intervention with a Fitbit and text messages is feasible and acceptable among CRC patients after treatment. Larger studies are needed to determine whether the intervention increases physical activity. Clinical trial information: NCT02966054.", "links": [ { "caption": "URL", "url": "http://ascopubs.org/doi/abs/10.1200/JCO.2018.36.4_suppl.615", "newWindow": true } ] }, { "title": "Self-Reported Physical Activity at Breast Cancer Diagnosis is Associated with Greater Physical Activity During Chemotherapy ", "author": "Wagoner, C.W., Deal, A.M., Choi, S.K., Lee, J.T., Muss, H.B. and Nyrop, K.A.", "year": "2018", "journalProceedings": "Medicine & Science in Sports & Exercise", "category": "Intervention", "devices": "Zip", "population": "Patients", "dataUsed": "Steps,Intensity", "abstract": "PURPOSE: Examine the associations among self-reported physical activity levels at breast cancer diagnosis to physical activity levels during chemotherapy. METHODS: Prior to beginning chemotherapy, patients were approached by research staff to participate in a walking intervention. 100 early stage (I-III) breast cancer patients participated in the intervention, and were asked to walk 150 minutes per week during chemotherapy. Patient characteristics and physical activity levels were assessed via questionnaire at baseline. Physical activity during treatment was monitored via weekly step totals obtained from a Fitbit Zip and uploaded directly into research computers. A linear regression analysis of self-reported physical activity prior to chemotherapy with mean Fitbit steps per week during chemotherapy was conducted. RESULTS: Breast cancer patients (age 48 + 8 years) who reported higher self-reported walking minutes/week at baseline (79.9 + 16.7; p < 0.0001) and a history of self-reported vigorous physical activity (55% vs 45%; p < 0.01) at baseline exhibited greater weekly Fitbit step totals during chemotherapy. CONCLUSIONS: In this sample, early stage breast cancer patients with a history of greater physical activity prior to chemotherapy are more apt to remain physically active during chemotherapy. Funding: Breast Cancer Research Foundation, New York, NY.", "links": [] }, { "title": "Increasing At-Risk Youth Self-Reported and Objectively Measured Physical Activity in an Afterschool Program", "author": "Walther, A., Dunker, T., Franzen-Castle, L. and Krehbiel, M.\t", "year": "2018", "journalProceedings": "Journal of Family & Consumer Sciences", "category": "Intervention", "devices": "Charge", "population": "Children", "dataUsed": "Steps", "abstract": "Physical activity is essential for youth's health, growth, and development; however, only 42% of children in the United States meet physical activity recommendations. Piloted in spring 2016, \"WeCook: Fun with Food and Fitness\" engaged at-risk youth in physical activity, food preparation, and nutrition education. The objective was to determine if the program increased self-reported and objectively measured physical activity from pre- to post-assessment. The secondary aim was to test the feasibility of Fitbits as an objective measure. Results demonstrated a trend toward increased self-reported physical activity and a significant difference in average steps taken pre- to post-assessment, according to Fitbit data.", "links": [] }, { "title": "A Paradoxical Relationship between Physical Activity and HbA1c in Pediatric T1D Patients ", "author": "WATSON, D.A.V.I.D.A., BARNES, T.I.M.O.T.H.Y.L. and GANDRUD, L.A.U.R.A.M.", "year": "2018", "journalProceedings": "Diabetes", "category": "Intervention", "devices": null, "population": "Patients", "dataUsed": "Steps,Intensity", "abstract": "Regular physical activity (PA) has been found to contribute to lower HbA1c in T1D pediatric populations, but this relationship is not conclusive.", "links": [] }, { "title": "Sleep Tracking and Exercise in Patients With Type 2 Diabetes Mellitus (Step-D): Pilot Study to Determine Correlations Between Fitbit Data and Patient-Reported Outcomes. ", "author": "Weatherall, J., Paprocki, Y., Meyer, T.M., Kudel, I. and Witt, E.A.", "year": "2018", "journalProceedings": "JMIR mHealth and uHealth", "category": "Measurement", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps,Sleep", "abstract": "BACKGROUND Few studies assessing the correlation between patient-reported outcomes and patient-generated health data from wearable devices exist. OBJECTIVE The aim of this study was to determine the direction and magnitude of associations between patient-generated health data (from the Fitbit Charge HR) and patient-reported outcomes for sleep patterns and physical activity in patients with type 2 diabetes mellitus (T2DM). METHODS This was a pilot study conducted with adults diagnosed with T2DM (n=86). All participants wore a Fitbit Charge HR for 14 consecutive days and completed internet-based surveys at 3 time points: day 1, day 7, and day 14. Patient-generated health data included minutes asleep and number of steps taken. Questionnaires assessed the number of days of exercise and nights of sleep problems per week. Means and SDs were calculated for all data, and Pearson correlations were used to examine associations between patient-reported outcomes and patient-generated health data. All respondents provided informed consent before participating. RESULTS The participants were predominantly middle-aged (mean 54.3, SD 13.3 years), white (80/86, 93%), and female (50/86, 58%). Use of oral T2DM medication correlated with the number of mean steps taken (r=.35, P=.001), whereas being unaware of the glycated hemoglobin level correlated with the number of minutes asleep (r=-.24, P=.04). On the basis of the Fitbit data, participants walked an average of 4955 steps and slept 6.7 hours per day. They self-reported an average of 2.0 days of exercise and 2.3 nights of sleep problems per week. The association between the number of days exercised and steps walked was strong (r=.60, P<.001), whereas the association between the number of troubled sleep nights and minutes asleep was weaker (r=.28, P=.02). CONCLUSIONS Fitbit and patient-reported data were positively associated for physical activity as well as sleep, with the former more strongly correlated than the latter. As extensive patient monitoring can guide clinical decisions regarding T2DM therapy, passive, objective data collection through wearables could potentially enhance patient care, resulting in better patient-reported outcomes.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pubmed/29871856", "newWindow": true } ] }, { "title": "Accuracy of Activity Trackers in Parkinson Disease: Should We Prescribe Them?", "author": "Wendel, N., Macpherson, C.E., Webber, K., Hendron, K., Tamara, D., Cristina, C.-S. and Ellis, T.\t", "year": "2018", "journalProceedings": "Physical Therapy", "category": "Validation", "devices": "Zip,Surge", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background\nWearable, consumer-grade activity trackers have become widely available as a means of monitoring physical activity in the form of step counts. However, step counts may not be accurate in persons with Parkinson disease (PD) due to atypical gait characteristics.\nObjective\nThis study aimed to investigate the accuracy of 4 consumer-grade activity trackers in individuals with PD while ambulating during continuous and discontinuous walking tasks.\n\nDesign\nThis study used a cross-sectional design.\n\nMethods\nThirty-three persons with PD (Hoehn & Yahr stages 1–3) donned 4 models of activity trackers on the less affected side of their bodies. Participants performed 2 continuous walking tasks (2-minute walk tests at comfortable and fast speeds) and 2 discontinuous walking tasks (a simulated household course and an obstacle negotiation course) in an outpatient setting. Bland-Altman plots and intraclass correlation coefficients [ICC(2,1)] were computed as a measure of agreement between actual steps taken (reference standard: video recording) and steps recorded by each tracker.\n\nResults\nThe accuracy of the activity trackers varied widely, with ICCs ranging from − 0.03 to 0.98. Overall, the most accurate device across all tasks was the Fitbit Zip, and the least accurate was the Jawbone Up Move during the simulated household course. All activity trackers were more accurate for continuous compared walking tasks compared with discontinuous walking tasks. Waist-mounted devices were more accurate then wrist-mounted devices with continuous tasks. Bland-Altman plots revealed that all activity trackers underestimated step counts.\n\nLimitations\nAll walking tasks were measured over relatively short distances.\n\nConclusion\nIn persons with mild-to-moderate PD, waist-worn activity trackers may be prescribed to monitor bouts of continuous walking with reasonable accuracy; however, activity trackers have little utility in monitoring discontinuous walking common in household settings.", "links": [] }, { "title": "Modeling Clinically Validated Physical Activity Assessments Using Commodity Hardware", "author": "Winfree, K.N. and Dominick, G.\t", "year": "2018", "journalProceedings": "IEEE Journal of Biomedical and Health Informatics", "category": "Methods", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Consumer-grade wearable activity devices such as Fitbits are increasingly being used in research settings to promote physical activity (PA) due to their low-cost and widespread popularity. However, Fitbit-derived measures of activity intensity are consistently reported to be less accurate than intensity estimates obtained from research-grade accelerometers (i.e., ActiGraph). As such, the potential for using a Fitbit to measure PA intensity within research contexts remains limited. This study aims to model ActiGraph-based intensity estimates from the validated Freedson vector magnitude (VM3) algorithm using measures of steps, metabolic equivalents, and intensity levels obtained from Fitbit. Minute-level data collected from 19 subjects, who concurrently wore the ActiGraph GT3X and Fitbit Flex devices for an average of 1.8 weeks, were used to generate the model. After testing several modeling methods, a naïve Bayes classifier was chosen based on the lowest achieved error rate. Overall, the model reduced Fitbit to ActiGraph errors from 19.97% to 16.32%. Moreover, the model reduced misclassification of Fitbit-based estimates of moderate-to-vigorous physical activity (MVPA) by 40%, eliminating a statistically significant difference between MVPA estimates derived from ActiGraph and Fitbit. Study findings support the general utility of the model for measuring MVPA with the Fitbit Flex in place of the more costly ActiGraph GT3X accelerometer for young healthy adults.", "links": [] }, { "title": "The bit doesn't fit: Evaluation of a commercial activity-tracker at slower walking speeds. ", "author": "Wong, C.K., Mentis, H.M. and Kuber, R.\t", "year": "2018", "journalProceedings": "Gait & Posture", "category": "Validation", "devices": "Ultra", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Accelerometer-based commercial activity trackers are a low-cost and convenient method for monitoring and assessing health measures such as gait. However, the accuracy of these activity trackers in slow walking conditions on a minute-by-minute basis is largely unknown. In this study, the accuracy of a hip-worn commercial activity tracker (FitBit Ultra) was examined through step counts. Accuracy was evaluated through four minute trials of treadmill walking at speeds representative of older adults (0.9, 1.1, and 1.3m/s). Minute-by-minute step count was extracted through the FitBit API and compared it to observer counted steps through video recordings. Results highlighted a significant over-reporting of steps at the highest speed, and a significant under-reporting of steps at the slowest speed, with the FitBit Ultra failing to count steps for one or more minutes at the slowest speed for 11 participants. This study highlights problems with using the FitBit Ultra by slow-walking populations, and recommends that researchers and clinicians should carefully consider the trade-off between accuracy and convenience when using commercial activity trackers with slow-walking populations.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/29049964", "newWindow": true } ] }, { "title": "A randomized controlled trial testing a social network intervention to promote physical activity among adolescents", "author": "van Woudenberg, T.J., Bevelander, K.E., Burk, W.J., Smit, C.R., Buijs, L. and Buijzen, M.\t", "year": "2018", "journalProceedings": "BMC Public Health", "category": "Intervention", "devices": "Flex", "population": "Adolescents", "dataUsed": "Steps", "abstract": "The current study examined the effectiveness of a social network intervention to promote physical activity among adolescents. Social network interventions utilize peer influence to change behavior by identifying the most influential individuals within social networks (i.e., influence agents), and training them to promote the target behavior. A total of 190 adolescents (46.32% boys; M age = 12.17, age range: 11–14 years) were randomly allocated to either the intervention or control condition. In the intervention condition, the most influential adolescents (based on peer nominations of classmates) in each classroom were trained to promote physical activity among their classmates. Participants received a research smartphone to complete questionnaires and an accelerometer to measure physical activity (steps per day) at baseline, and during the intervention one month later. A multilevel model tested the effectiveness of the intervention, controlling for clustering of data within participants and days. No intervention effect was observed, b = .04, SE = .10, p = .66. This was one of the first studies to test whether physical activity in adolescents could be promoted via influence agents, and the first social network intervention to use smartphones to do so. Important lessons and implications are discussed concerning the selection criterion of the influence agents, the use of smartphones in social network intervention, and the rigorous analyses used to control for confounding factors.", "links": [] }, { "title": "Protocol for promoting recovery optimization of walking activity in stroke (PROWALKS): a randomized controlled trial", "author": "Wright, H., Wright, T., Pohlig, R.T., Kasner, S.E., Raser-Schramm, J. and Reisman, D.\t", "year": "2018", "journalProceedings": "BMC Neurology", "category": "Methods", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Stroke survivors are more physically inactive than even the most sedentary older adults, and low activity is associated with increased risk of recurrent stroke, medical complications, and mortality. We hypothesize that the combination of a fast walking intervention that improves walking capacity, with a step activity monitoring program that facilitates translation of gains from the clinic to the “real-world”, would generate greater improvements in real world walking activity than with either intervention alone. Using a single-blind randomized controlled experimental design, 225 chronic (textgreater 6 months) stroke survivors complete 12 weeks of fast walking training, a step activity monitoring program or a fast walking training + step activity monitoring program. Main eligibility criteria include: chronic ischemic or hemorrhagic stroke (textgreater 6 months post), no evidence of cerebellar stroke, baseline walking speed between 0.3 m/s and 1.0 m/s, and baseline average steps / day textless 8000. The primary (steps per day), secondary (self-selected and fastest walking speed, walking endurance, oxygen consumption) and exploratory (vascular events, blood lipids, glucose, blood pressure) outcomes are assessed prior to initiating treatment, after the last treatment and at a 6 and 12-month follow-up. Moderation of the changes in outcomes by baseline characteristics are evaluated to determine for whom the interventions are effective. Following completion of this study, we will not only understand the efficacy of the interventions and the individuals for which they are effective, we will have the necessary information to design a study investigating the secondary prevention benefits of improved physical activity post-stroke. This study is, therefore, an important step in the development of both rehabilitative and secondary prevention guidelines for persons with stroke.", "links": [] }, { "title": "Evaluating the Validity of Current Mainstream Wearable Devices in Fitness Tracking Under Various Physical Activities: Comparative Study", "author": "Xie, J., Wen, D., Liang, L., Jia, Y., Gao, L. and Lei, J.\t", "year": "2018", "journalProceedings": "JMIR Mhealth Uhealth", "category": "Validation", "devices": "Surge", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Distance,Sleep,Heart Rate", "abstract": "Background: Wearable devices have attracted much attention from the market in recent years for their fitness monitoring and other health-related metrics; however, the accuracy of fitness tracking results still plays a major role in health promotion. Objective: The aim of this study was to evaluate the accuracy of a host of latest wearable devices in measuring fitness-related indicators under various seminatural activities. Methods: A total of 44 healthy subjects were recruited, and each subject was asked to simultaneously wear 6 devices (Apple Watch 2, Samsung Gear S3, Jawbone Up3, Fitbit Surge, Huawei Talk Band B3, and Xiaomi Mi Band 2) and 2 smartphone apps (Dongdong and Ledongli) to measure five major health indicators (heart rate, number of steps, distance, energy consumption, and sleep duration) under various activity states (resting, walking, running, cycling, and sleeping), which were then compared with the gold standard (manual measurements of the heart rate, number of steps, distance, and sleep, and energy consumption through oxygen consumption) and calculated to determine their respective mean absolute percentage errors (MAPEs). Results: Wearable devices had a rather high measurement accuracy with respect to heart rate, number of steps, distance, and sleep duration, with a MAPE of approximately 0.10, whereas poor measurement accuracy was observed for energy consumption (calories), indicated by a MAPE of up to 0.44. The measurements varied for the same indicator measured by different fitness trackers. The variation in measurement of the number of steps was the highest (Apple Watch 2: 0.42; Dongdong: 0.01), whereas it was the lowest for heart rate (Samsung Gear S3: 0.34; Xiaomi Mi Band 2: 0.12). Measurements differed insignificantly for the same indicator measured under different states of activity; the MAPE of distance and energy measurements were in the range of 0.08 to 0.17 and 0.41 to 0.48, respectively. Overall, the Samsung Gear S3 performed the best for the measurement of heart rate under the resting state (MAPE of 0.04), whereas Dongdong performed the best for the measurement of the number of steps under the walking state (MAPE of 0.01). Fitbit Surge performed the best for distance measurement under the cycling state (MAPE of 0.04), and Huawei Talk Band B3 performed the best for energy consumption measurement under the walking state (MAPE of 0.17). Conclusions: At present, mainstream devices are able to reliably measure heart rate, number of steps, distance, and sleep duration, which can be used as effective health evaluation indicators, but the measurement accuracy of energy consumption is still inadequate. Fitness trackers of different brands vary with regard to measurement of indicators and are all affected by the activity state, which indicates that manufacturers of fitness trackers need to improve their algorithms for different activity states. [JMIR Mhealth Uhealth 2018;6(4):e94]", "links": [] }, { "title": "Successful adherence and retention to daily monitoring of physical activity: Lessons learned ", "author": "Xu, X., Tupy, S., Robertson, S., Miller, A.L., Correll, D., Tivis, R. and Nigg, C.R.", "year": "2018", "journalProceedings": "PLOS ONE", "category": "Usability", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "Research utilizing repeated-measures such as daily assessments with self-report and/or objective measures [e.g., physical activity (PA) monitors] are important in understanding health behaviors and informing practice and policy. However, studies that utilize daily assessment often encounter issues with attrition and non-compliance. The current research yielded high levels of retention and adherence with both self-report and objective daily measures. The purpose of this paper is to highlight and discuss strategies utilized in maximizing retention, minimizing missing data, and some lessons learned from the research experience. Fifty community participants took part in a 4-week study utilizing both daily self-report questionnaires and daily use of PA monitors (Fitbit One™). This study focused on typical daily PA and was not an intervention study (e.g., participants were not randomized nor asked to change their PA behavior). Participants completed the study in two waves (wave 1 n = 10, wave 2 n = 40). The research team utilized several retention strategies including automating the data collection process, a prorated incentive structure, having a dedicated and responsive study staff, and utilizing the 2-wave process to optimize data collection during the 2nd wave. The study had 100% retention and generally positive anonymous feedback post-study. Overall, participants completed the vast majority of daily surveys (97%) and wore their Fitbits (for at least part of the day) on almost all days (99.57%) of the study, although there were individual differences. The strategies discussed and lessons learned may be useful to other researchers using daily measurements for whom adherence and retention are important issues. Future research employing these strategies in different populations, with different measurements, and for longer durations is warranted to determine generalizability.", "links": [] }, { "title": "Using Behavioral Analytics to Increase Exercise: A Randomized N-of-1 Study.", "author": "Yoon, S., Schwartz, J.E., Burg, M.M., Kronish, I.M., Alcantara, C., Julian, J., Parsons, F., Davidson, K.W. and Diaz, K.M.\t", "year": "2018", "journalProceedings": "American Journal of Preventive Medicine", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "INTRODUCTION This intervention study used mobile technologies to investigate whether those randomized to receive a personalized \"activity fingerprint\" (i.e., a one-time tailored message about personal predictors of exercise developed from 6 months of observational data) increased their physical activity levels relative to those not receiving the fingerprint. STUDY DESIGN A 12-month randomized intervention study. SETTING/PARTICIPANTS From 2014 to 2015, 79 intermittent exercisers had their daily physical activity assessed by accelerometry (Fitbit Flex) and daily stress experience, a potential predictor of exercise behavior, was assessed by smartphone. INTERVENTION Data collected during the first 6 months of observation were used to develop a person-specific \"activity fingerprint\" (i.e., N-of-1) that was subsequently sent via email on a single occasion to randomized participants. MAIN OUTCOME MEASURES Pre-post changes in the percentage of days exercised were analyzed within and between control and intervention groups. RESULTS The control group significantly decreased their proportion of days exercised (10.5% decrease, ptextless0.0001) following randomization. By contrast, the intervention group showed a nonsignificant decrease in the proportion of days exercised (4.0% decrease, p=0.14). Relative to the decrease observed in the control group, receipt of the activity fingerprint significantly increased the likelihood of exercising in the intervention group (6.5%, p=0.04). CONCLUSIONS This N-of-1 intervention study demonstrates that a one-time brief message conveying personalized exercise predictors had a beneficial effect on exercise behavior among urban adults.", "links": [] }, { "title": "Forecasting of heart rate variability using wrist-worn heart rate monitor based on hidden Markov model", "author": "Yun, S., Son, C.-S., Lee, S.-H. and Kang, W.-S.\t", "year": "2018", "journalProceedings": "2018 International Conference on Electronics, Information, and Communication (ICEIC)", "category": "Methods", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "In this paper, we present Hidden Markov Models (HMM) approach for forecasting the changes of heart rate. Heart rate is an important indicator of the state of our body. Forecasting changes of heart rate is equivalent to forecasting changes of the body state. We use numerous HMM models that is trained by datasets clustered on similarity basis. We find the optimal models with best probabilities in various learned HMM models and use this model to predict next heart rate variability. The heart rate data are collected by Fitbit-HR from 190 healthy persons. The prediction performance was accuracy = 91.87% and recall = 91.67%.", "links": [] }, { "title": "Effect of Fitbit and iPad Wearable Technology in Health-Related Quality of Life in Adolescent and Young Adult Cancer Patients ", "author": "Yurkiewicz, I.R., Simon, P., Liedtke, M., Dahl, G. and Dunn, T.", "year": "2018", "journalProceedings": "Journal of Adolescent and Young Adult Oncology", "category": "Intervention", "devices": null, "population": "Adults,Adolescents", "dataUsed": "Steps,Sleep", "abstract": "Purpose: Adolescent and young adult (AYA) patients with cancer face significant challenges with regard to fatigue, reduced physical activity, and social isolation, which may negatively impact quality of life. This study investigated whether the use of digital wearable technology (Fitbits, along with synced iPads) can affect health-related quality of life (HRQOL) in AYA aged patients with cancer. Materials and Methods: This was a prospective cohort study that offered Fitbits and iPads to all AYA patients aged 15 to 29 at an academic medical center at the time of cancer diagnosis. Patients completed the Short Form Health Survey developed by RAND (RAND-36) assessing eight dimensions of HRQOL on entering the study and at the time of their 6-month follow-up or the end of treatment, whichever occurred first. At the time of follow-up, patients also completed a questionnaire that assessed user experience, including frequency of wearable device use, enjoyment, challenges, and participation, in online communities. ...", "links": [] }, { "title": "Acceptability of a Self-Regulation Theory-Based mHealth Behavior Intervention for Older Adults with Type 2 Diabetes and Obesity ", "author": "ZHENG, Y.A.G.U.A.N.G., WEINGER, K.A.T.I.E., GREGAS, M.A.T.T.C., GREENBERG, J.O.R.D.A.N., ZHUOXIN, L.I., BURKE, L.O.R.A.E., CHENFANG, Q.I., SLYNE, C.H.R.I.S.T.I.N.E., GREAVES, T.O.R.I. and MUNSHI, M.E.D.H.A.", "year": "2018", "journalProceedings": "Diabetes", "category": "Intervention", "devices": null, "population": "Older Adults", "dataUsed": "Weight", "abstract": "The successful use of mobile health (mHealth) in lifestyle changes for older adults with type 2 diabetes is unknown. We report here acceptability of a mHealth intervention for older adults.\nWe used a one-group pre-posttest design. Participants received an 8-week theory-based mHealth intervention, using the Lose It! App for daily self-monitoring of food intake, a Fitbit, and Bluetooth-enabled glucometers and weighing scales. Linear mixed models were used for analysis.", "links": [] }, { "title": "Personalized effect of health behavior on blood pressure: Machine learning based prediction and recommendation", "author": "Chiang, Po Han; Dey, Sujit", "year": "2018", "journalProceedings": "2018 IEEE 20th International Conference on e-Health Networking, Applications and Services (Healthcom)", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps", "abstract": "Blood pressure (BP) is one of the most important indicator of human health. In this paper, we investigate the relationship between BP and health behavior (e.g. sleep and exercise). Using the data collected from off-the-shelf wearable devices and wireless home BP monitors, we propose a data driven personalized model to predict daily BP level and provide actionable insight into health behavior and daily BP. In the proposed machine learning model using Random Forest (RF), trend and periodicity features of BP time-series are extracted to improve prediction. To further enhance the performance of the prediction model, we propose RF with Feature Selection (RFFS), which performs RF-based feature selection to filter out unnecessary features. Our experimental results demonstrate that the proposed approach is robust to different individuals and has smaller prediction error than existing methods. We also validate the effectiveness of personalized recommendation of health behavior generated by RFFS model.", "links": [] }, { "title": "The Go-VAR (Veterans Active Recovery): An Adjunctive, Exercise-Based Intervention for Veterans Recovering from Substance Use Disorders", "author": "Linke, Sarah E.; Hovsepians, Rita; Schnebly, Brittany; Godfrey, Kathryn; Noble, Madison; Strong, David R.; Isgro, Melodie; Lindamer, Laurie A.", "year": "2019", "journalProceedings": "Journal of Psychoactive Drugs", "category": "Intervention", "devices": "Charge HR", "population": "Adults", "dataUsed": "Intensity", "abstract": "Substance use disorders (SUD) are prevalent among veterans, and the relapse rate is estimated at ≥60{\\%} within one year of treatment. Exercise's broad health benefits make it an appealing adjunctive component to interventions preventing relapse among individuals with SUDs. After conducting formative research, we designed and conducted the Go-VAR! (Veterans Active Recovery) pilot study to examine the feasibility and acceptability of a multi-component exercise-based intervention for veterans seeking SUD treatment through the outpatient Alcohol {\\&} Drug Treatment Program (ADTP) at the VA San Diego Healthcare System (VASDHS). Participants (N = 15; mean age = 45 [SD = 9.7]; 13{\\%} Hispanic, 60{\\%} White) from the La Jolla VASDHS outpatient ADTP were enrolled in this 12-week one-arm pilot study. Feasibility and acceptability were established: 70{\\%} of participants attended weekly psychoeducation groups, wore their Fitbit Charge HR, increased their weekly physical activity, and used their study-provided YMCA memberships, group exercise training sessions, and Fit4Me personal training program. Lower use of both alcohol and drugs were reported at the end of the study (p {\\textless} .0001). Significant increases in daily steps as measured by the Fitbit HR and improvements in measures of physical fitness were also achieved (p {\\textless} .05). Future work should focus on potential integration within the VA system.", "links": [] }, { "title": "Night Stepping: Fitbit Cracks the Case", "author": "Somboon, Thapanee; Grigg-Damberger, Madeleine M.; Foldvary-Schaefer, Nancy", "year": "2019", "journalProceedings": "Journal of Clinical Sleep Medicine", "category": "Case Study", "devices": "Charge", "population": "Adults", "dataUsed": "Steps", "abstract": "The most common sleep disorders that can result in injurious or violent behaviors include REM sleep behavioral disorder, sleepwalking, comorbid parasomnias, sleep-related dissociative disorder, and obstructive sleep apnea. Video polysomnography is usually indicated to evaluate recurring sleeprelated injury in adults. Only one-third of patients with complex paroxysmal nocturnal events will have one of their habitual events on a single night of in-laboratory video polysomnography, most often those who have prominent, high-frequency motor features. We report evidence of sleep walking induced by sodium oxybate identifed by steps recorded on a consumer wearable device coinciding with clinical history and evidence of injury.", "links": [ { "caption": "URL", "url": "http://jcsm.aasm.org/doi/10.5664/jcsm.7646", "newWindow": true } ] }, { "title": "Accuracy of PurePulse photoplethysmography technology of Fitbit Charge 2 for assessment of heart rate during sleep", "author": "Haghayegh, Shahab; Khoshnevis, Sepideh; Smolensky, Michael H.; Diller, Kenneth R.", "year": "2019", "journalProceedings": "Chronobiology International", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Elevated asleep heart rate (HR) is a risk factor for cardiovascular disease and other-cause morbidity and mortality. We assessed the accuracy of Fitbit Inc. PurePulse{\\textregistered} photoplethysmography with reference to three-lead electrocardiography (ECG) in determining HR during sleep. HR of 35 (17 female) healthy adults 25.1 ± 10.6 years of age (mean ± SD) was continuously recorded throughout a single night of sleep. There was no significant difference in asleep HR mean (0.09 beats per minute [bpm], P = 0.426) between Fitbit photoplethysmography and ECG; plus, there was excellent intraclass correlation (0.998) and narrow Bland–Altman agreement range (2.67 bpm). The regression analysis of Bland–Altman plot of mean asleep HR indicates Fitbit tends to slightly overestimate reference values in the lower range of HR (HR {\\textless} 50 bpm) by 0.51 bpm and slightly underestimate reference values in the higher range of HR (HR {\\textgreater} 80 bpm) by 0.63 bpm. Mixed model analysis of epoch-by-epoch (5-min epochs) asleep HR showed significant “U” shape trend (P {\\textless} 0.001) in amount of Fitbit error (absolute amount of difference between ECG and Fitbit values regardless of overestimation or underestimation) in regard to HR, i.e. smaller error in the medium range of HR (60–80 bpm) and slightly larger error for lower ({\\textless}60 bpm) and higher ({\\textgreater}80 bpm) ranges of HR. However, effect of age, body mass index, gender, and subjective sleep quality measured by Pittsburgh sleep quality index (good/poor sleepers) on error in estimating HR by the Fitbit method was not significant. It is concluded that Fitbit photoplethysmography suitably tracks HR during sleep in healthy young adults.", "links": [ { "caption": "URL", "url": "https://www.tandfonline.com/doi/abs/10.1080/07420528.2019.1596947", "newWindow": true } ] }, { "title": "Heart rate measures from the Apple Watch, Fitbit Charge HR 2, and electrocardiogram across different exercise intensities", "author": "Thomson, Elizabeth A.; Nuss, Kayla; Comstock, Ashley; Reinwald, Steven; Blake, Sophie; Pimentel, Richard E.; Tracy, Brian L.; Li, Kaigang", "year": "2019", "journalProceedings": "Journal of Sports Sciences", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "This study compared heart rate (HR) measurements for the Fitbit Charge HR 2 (Fitbit) and the Apple Watch devices with HR measurements for electrocardiogram (ECG). Thirty young adults (15/15 females/males, age 23.5 ± 3.0 years) completed the Bruce Protocol. HR measurements were recorded from the ECG and both devices every minute. Average HR for each participant was calculated for very light, light, moderate, vigorous and very vigorous intensities based on ECG-measured HR. A concordance correlation coefficient (CCC) was calculated to examine the strength of the relationship between ECG measured HR and HR measured by each device. Relative error rates (RER) were also calculated to indicate the difference between each device and ECG. An equivalence test was conducted to examine the equivalence of HRs measured by devices and ECG. The Apple Watch showed lower RER (2.4–5.1{\\%}) compared with the Fitbit (3.9–13.5{\\%}) for all exercise intensities. For both devices, the strongest relationship with ECG-measured HR was found for very light PA with very high CCC ({\\textgreater}.90) and equivalence. The strength of the relationship declined as exercise intensity increased for both devices. These findings indicate that the accuracy of real-time HR monitoring by the Apple Watch and Fitbit Charge HR2 is reduced as exercise intensity increases.", "links": [ { "caption": "URL", "url": "https://www.tandfonline.com/doi/abs/10.1080/02640414.2018.1560644", "newWindow": true } ] }, { "title": "Accuracy of wristband fitbit models in assessing sleep: Systematic review and meta-analysis", "author": "Haghayegh, Shahab; Khoshnevis, Sepideh; Smolensky, Michael H.; Diller, Kenneth R.; Castriotta, Richard J.", "year": "2019", "journalProceedings": "Journal of Medical Internet Research", "category": "Systematic Review", "devices": null, "population": "NA", "dataUsed": "NA", "abstract": "Background: Wearable sleep monitors are of high interest to consumers and researchers because of their ability to provide estimation of sleep patterns in free-living conditions in a cost-efficient way. Objective: We conducted a systematic review of publications reporting on the performance of wristband Fitbit models in assessing sleep parameters and stages. Methods: In adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we comprehensively searched the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, MEDLINE, PubMed, PsycINFO, and Web of Science databases using the keyword Fitbit to identify relevant publications meeting predefined inclusion and exclusion criteria. Results: The search yielded 3085 candidate articles. After eliminating duplicates and in compliance with inclusion and exclusion criteria, 22 articles qualified for systematic review, with 8 providing quantitative data for meta-analysis. In reference to polysomnography (PSG), nonsleep-staging Fitbit models tended to overestimate total sleep time (TST; range from approximately 7 to 67 mins; effect size=-0.51, P{\\textless}.001; heterogenicity: I2=8.8{\\%}, P=.36) and sleep efficiency (SE; range from approximately 2{\\%} to 15{\\%}; effect size=-0.74, P{\\textless}.001; heterogenicity: I2=24.0{\\%}, P=.25), and underestimate wake after sleep onset (WASO; range from approximately 6 to 44 mins; effect size=0.60, P{\\textless}.001; heterogenicity: I2=0{\\%}, P=.92) and there was no significant difference in sleep onset latency (SOL; P=.37; heterogenicity: I2=0{\\%}, P=.92). In reference to PSG, nonsleep-staging Fitbit models correctly identified sleep epochs with accuracy values between 0.81 and 0.91, sensitivity values between 0.87 and 0.99, and specificity values between 0.10 and 0.52. Recent-generation Fitbit models that collectively utilize heart rate variability and body movement to assess sleep stages performed better than early-generation nonsleep-staging ones that utilize only body movement. Sleep-staging Fitbit models, in comparison to PSG, showed no significant difference in measured values of WASO (P=.25; heterogenicity: I2=0{\\%}, P=.92), TST (P=.29; heterogenicity: I2=0{\\%}, P=.98), and SE (P=.19) but they underestimated SOL (P=.03; heterogenicity: I2=0{\\%}, P=.66). Sleep-staging Fitbit models showed higher sensitivity (0.95-0.96) and specificity (0.58-0.69) values in detecting sleep epochs than nonsleep-staging models and those reported in the literature for regular wrist actigraphy. Conclusions: Sleep-staging Fitbit models showed promising performance, especially in differentiating wake from sleep. However, although these models are a convenient and economical means for consumers to obtain gross estimates of sleep parameters and time spent in sleep stages, they are of limited specificity and are not a substitute for PSG.", "links": [ { "caption": "URL", "url": "https://www.jmir.org/2019/11/e16273/", "newWindow": true } ] }, { "title": "Validation of Fitbit Charge 2 and Fitbit Alta HR Against Polysomnography for Assessing Sleep in Adults With Obstructive Sleep Apnea", "author": "Moreno-Pino, Fernando; Porras-Segovia, Alejandro; L{\\'{o}}pez-Esteban, Pilar; Art{\\'{e}}s, Antonio; Baca-Garc{\\'{i}}a, Enrique", "year": "2019", "journalProceedings": "Journal of Clinical Sleep Medicine", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "Study Objectives: Consumer wearable devices may be a helpful method of assessing sleep, but validation is required for their use in clinical practice. Our aim was to validate two models of Fitbit sleep trackers that rely on both accelerometer and heart rate sensors against polysomnography in participants with obstructive sleep apnea (OSA). Methods: Participants were adults presenting with symptoms of OSA and attending our outpatient sleep clinic. A polysomnography (PSG) was applied to all participants at the same time they were wearing a Fitbit sleep tracker. Using paired t tests and Bland-Altman plots, we compared the sleep measures provided by the wearable devices with those obtained by PSG. Since Fitbit devices' automatic detection of sleep start time can cause bias, we performed a correction using Huber loss function-based linear regression and a leave-one-out strategy. Results: Our sample consisted of 65 patients. Diagnosis of OSA was confirmed on 55 (84.6{\\%}). There were statistically significant differences between PSG and Fitbit measures for all sleep outcomes but rapid eye movement sleep. Fitbit devices overestimated total sleep time, and underestimated wake after sleep onset and sleep onset latency. After correction of bias, Fitbit-delivered measures of sleep onset latency did not significantly differ of those provided by PSG. Conclusions: Fitbit wearable devices showed an acceptable sensitivity but poor specificity. Consumer sleep trackers still have insufficient accuracy for clinical settings, especially in clinical populations. Solving technical issues and optimizing clinically-oriented features couldmake themapt for their use in clinical practice in a nondistant future.", "links": [ { "caption": "URL", "url": "http://jcsm.aasm.org/doi/10.5664/jcsm.8032", "newWindow": true } ] }, { "title": "Ability of the Fitbit Alta HR to quantify and classify sleep in patients with suspected central disorders of hypersomnolence: A comparison against polysomnography", "author": "Cook, Jesse D.; Eftekari, Sahand C.; Dallmann, Erika; Sippy, Megan; Plante, David T.", "year": "2019", "journalProceedings": "Journal of Sleep Research", "category": "Usability", "devices": "Alta HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "Measuring sleep duration and early onset rapid eye movement sleep (REMS) is critical in the assessment of suspected central disorders of hypersomnolence (CDH). Current multi-sensor activity trackers that integrate accelerometry and heart rate are purported to accurately quantify sleep time and REMS; however, their utility in suspected CDH has not been established. This investigation aimed to determine the ability of a current, multi-sensor tracker, Fitbit Alta HR (FBA-HR), to quantify and classify sleep in patients with suspected CDH relative to polysomnography (PSG). Forty-nine patients (46 female; mean age, 30.3 ± 9.84 years) underwent ad libitum PSG with concurrent use of the FBA-HR. FBA-HR sleep variable quantification was assessed using Bland-Altman analysis. FBA-HR all sleep (AS), light sleep (LS; PSG N1 + N2), deep sleep (DS; PSG N3) and REMS classification was evaluated using epoch-by-epoch comparisons. FBA-HR-detected sleep-onset rapid eye movement periods (SOREMPs) were compared against PSG SOMREMPs. FBA-HR displayed significant overestimation of total sleep time (11.6 min), sleep efficiency (1.98{\\%}) and duration of deep sleep (18.2 min). FBA-HR sensitivity and specificity were as follows: AS, 0.96, 0.58; LS, 0.73, 0.72;DS, 0.67, 0.92; REMS, 0.74, 0.93. The device failed to detect any nocturnal SOREMPs. Device performance did not differ appreciably among diagnostic subgroups. These results suggest FBA-HR cannot replace EEG-based measurements of sleep and wake in the diagnostic assessment of suspected CDH, and that improvements in device performance are required prior to adoption in clinical or research settings.", "links": [ { "caption": "URL", "url": "http://doi.wiley.com/10.1111/jsr.12789", "newWindow": true } ] }, { "title": "Validation of the Fitbit Charge 2 compared to the ActiGraph GT3X+ in older adults with knee osteoarthritis in free-living conditions", "author": "Collins, Jamie E.; Yang, Heidi Y.; Trentadue, Taylor P.; Gong, Yusi; Losina, Elena", "year": "2019", "journalProceedings": "PLOS ONE", "category": null, "devices": "Charge 2", "population": "Older Adults", "dataUsed": "Intensity", "abstract": "Objective To evaluate physical activity (PA) and sedentary time in subjects with knee osteoarthritis (OA) measured by the Fitbit Charge 2 (Fitbit) and a wrist-worn ActiGraph GT3X+ (AGW) compared to the hip-worn ActiGraph (AGH). Design We recruited a cohort of subjects with knee OA from rheumatology clinics. Subjects wore the AGH for four weeks, AGW for two weeks, and Fitbit for two weeks over a four-week study period. We collected accelerometer counts (ActiGraphs) and steps (ActiGraphs, Fitbit) and calculated time spent in sedentary, light, and moderate-to-vigorous activity. We used triaxial PA intensity count cut-points from the literature for ActiGraph and a stride length-based cadence algorithm to categorize Fitbit PA. We compared Fitbit wear times calculated from a step-based algorithm and a novel algorithm that incorporates steps and heart rate (HR). Results We enrolled 15 subjects (67{\\%} female, mean age 68 years). Relative to AGH, Fitbit, on average, overestimated steps by 39{\\%} and sedentary time by 37{\\%} and underestimated MVPA by 5 minutes. Relative to AGH, AGW overestimated steps 116{\\%}, underestimated sedentary time by 66{\\%}, and captured 281 additional MVPA minutes. The step-based wear time Fitbit algorithm captured 14{\\%} less wear time than the HR-based algorithm. Conclusions Fitbit overestimates steps and underestimates MVPA in knee OA subjects. Cut-offs validated for AGW should be developed to support the use of AGW for PA assessment. The HR-based Fitbit algorithm captured more wear time than the step-based algorithm. These data provide critical insight for researchers planning to use commercially-available accelerometers in pragmatic studies.", "links": [ { "caption": "URL", "url": "https://dx.plos.org/10.1371/journal.pone.0211231", "newWindow": true } ] }, { "title": "Identifying behavioral phenotypes of loneliness and social isolation with passive sensing: Statistical analysis, data mining and machine learning of smartphone and fitbit data", "author": "Doryab, Afsaneh; Villalba, Daniella K.; Chikersal, Prerna; Dutcher, Janine M.; Tumminia, Michael; Liu, Xinwen; Cohen, Sheldon; Creswell, Kasey; Mankoff, Jennifer; Creswell, John D.; Dey, Anind K.", "year": "2019", "journalProceedings": "JMIR mHealth and uHealth", "category": "Measurement", "devices": "Flex 2", "population": "Adults", "dataUsed": "Intensity", "abstract": "Background: Feelings of loneliness are associated with poor physical and mental health. Detection of loneliness through passive sensing on personal devices can lead to the development of interventions aimed at decreasing rates of loneliness. Objective: The aim of this study was to explore the potential of using passive sensing to infer levels of loneliness and to identify the corresponding behavioral patterns. Methods: Data were collected from smartphones and Fitbits (Flex 2) of 160 college students over a semester. The participants completed the University of California, Los Angeles (UCLA) loneliness questionnaire at the beginning and end of the semester. For a classification purpose, the scores were categorized into high (questionnaire score{\\textgreater}40) and low (≤40) levels of loneliness. Daily features were extracted from both devices to capture activity and mobility, communication and phone usage, and sleep behaviors. The features were then averaged to generate semester-level features. We used 3 analytic methods: (1) statistical analysis to provide an overview of loneliness in college students, (2) data mining using the Apriori algorithm to extract behavior patterns associated with loneliness, and (3) machine learning classification to infer the level of loneliness and the change in levels of loneliness using an ensemble of gradient boosting and logistic regression algorithms with feature selection in a leave-one-student-out cross-validation manner. Results: The average loneliness score from the presurveys and postsurveys was above 43 (presurvey SD 9.4 and postsurvey SD 10.4), and the majority of participants fell into the high loneliness category (scores above 40) with 63.8{\\%} (102/160) in the presurvey and 58.8{\\%} (94/160) in the postsurvey. Scores greater than 1 standard deviation above the mean were observed in 12.5{\\%} (20/160) of the participants in both pre- and postsurvey scores. The majority of scores, however, fell between 1 standard deviation below and above the mean (pre=66.9{\\%} [107/160] and post=73.1{\\%} [117/160]). Our machine learning pipeline achieved an accuracy of 80.2{\\%} in detecting the binary level of loneliness and an 88.4{\\%} accuracy in detecting change in the loneliness level. The mining of associations between classifier-selected behavioral features and loneliness indicated that compared with students with low loneliness, students with high levels of loneliness were spending less time outside of campus during evening hours on weekends and spending less time in places for social events in the evening on weekdays (support=17{\\%} and confidence=92{\\%}). The analysis also indicated that more activity and less sedentary behavior, especially in the evening, was associated with a decrease in levels of loneliness from the beginning of the semester to the end of it (support=31{\\%} and confidence=92{\\%}). Conclusions: Passive sensing has the potential for detecting loneliness in college students and identifying the associated behavioral patterns. These findings highlight intervention opportunities through mobile technology to reduce the impact of loneliness on individuals' health and well-being.", "links": [ { "caption": "URL", "url": "https://mhealth.jmir.org/2019/7/e13209/", "newWindow": true } ] }, { "title": "Is There a Benefit to Patients Using Wearable Devices Such as Fitbit or Health Apps on Mobiles? A Systematic Review", "author": "Jo, Ara; Coronel, Bryan D.; Coakes, Courtney E.; Mainous, Arch G.", "year": "2019", "journalProceedings": "American Journal of Medicine", "category": "Systematic Review", "devices": null, "population": "NA", "dataUsed": "NA", "abstract": "Wearable devices have become a standard health care intervention with emerging health care technologies. These devices are designed to promote healthy behaviors and decrease risk for chronic disease like cardiovascular disease and diabetes. The purpose of this study was to provide evidence of the benefit of wearable devices in chronic disease outcomes among adults. Systematic search of PubMed, Web of Science, World Health Organization international clinical trials registry platform, BMC ISRCTN registry, and the Institute of Electrical and Electronics Engineers was performed based upon the PRISMA guideline. Included articles were randomized controlled trials or quasi-experimental studies with health outcomes published in English up to October 2018. Studies focusing on adults were selected. Three investigators reviewed the selected publications and made agreement on final selection. Of a total of 550 publications extracted, 6 studies met the final criteria. There was little indication that wearable devices provide a benefit for health outcomes. Of the 6 studies examined, only one study showed a significant reduction for weight loss among participants who used wearable devices. No significant reduction was discovered in cholesterol or blood pressure. Among the 6 studies, only one study examined hemoglobin A1c, and it showed a significant reduction in older patients with type 2 diabetes. The current literature evaluating wearable devices indicates little benefit of the devices on chronic disease health outcomes. Wearable devices play a role as a facilitator in motivating and accelerating physical activity, but current data do not suggest other consistent health benefits.", "links": [ { "caption": "URL", "url": "https://www.amjmed.com/article/S0002-9343(19)30553-4/fulltext", "newWindow": true } ] }, { "title": "The Effects of a Mobile Wellness Intervention with Fitbit Use and Goal Setting for Workers", "author": "Lee, Sang-Ho; Ha, Yeongmi; Jung, Mira; Yang, Seungkyoung; Kang, Won-Seok", "year": "2019", "journalProceedings": "Telemedicine and e-Health", "category": "Intervention", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps", "abstract": "Background and Introduction: There is strong evidence that worksite wellness programs can significantly improve the health profile of participating workers. To date, little is known about research on the effects of mobile wellness interventions in worksite settings. Furthermore, no studies have been conducted to evaluate mobile wellness interventions with activity trackers and tailoring strategies for physically inactive workers in manufacturing companies. This study aimed to examine the effects of a mobile wellness intervention with Fitbit and goal setting using brief counseling and text messaging among workers. Materials and Methods: A total of 79 (n = 79) workers from large manufacturing companies were allocated into an experimental group (n = 41) and a control group (n = 38). All participants were asked to wear an activity tracker (Fitbit Charger HR) during all waking hours for 5 weekdays. Participants in the experimental group received Fitbit, daily motivational text messaging, and biweekly counseling with a specifically designed workbook for 12 weeks, whereas Fitbit was only provided to the control group. Results: At the 12-week measurement, there were significant differences between the experimental group and control group on wellness (p {\\textless} 0.001), physical activity behavior (p {\\textless} 0.001), daily walking steps (p {\\textless} 0.001), and physical activity self-efficacy (p {\\textless} 0.001). Discussion and Conclusions: Although Fitbit facilitates an individual's activities by providing information about daily steps, the tracker itself, without additional goal-setting techniques, may be insufficient to encourage behavior change. These findings indicate that the mobile wellness intervention with Fitbit and goal setting using brief counseling and tailored text messaging is more effective for physically inactive workers.", "links": [ { "caption": "URL", "url": "https://www.liebertpub.com/doi/10.1089/tmj.2018.0185", "newWindow": true } ] }, { "title": "Validity Evaluation of the Fitbit Charge2 and the Garmin vivosmart HR+ in Free-Living Environments in an Older Adult Cohort.", "author": "Tedesco, Salvatore; Sica, Marco; Ancillao, Andrea; Timmons, Suzanne; Barton, John; O'Flynn, Brendan", "year": "2019", "journalProceedings": "JMIR mHealth and uHealth", "category": "Validation", "devices": "Charge 2", "population": "Older Adults", "dataUsed": "Steps", "abstract": "BACKGROUND Few studies have investigated the validity of mainstream wrist-based activity trackers in healthy older adults in real life, as opposed to laboratory settings. OBJECTIVE This study explored the performance of two wrist-worn trackers (Fitbit Charge 2 and Garmin vivosmart HR+) in estimating steps, energy expenditure, moderate-to-vigorous physical activity (MVPA) levels, and sleep parameters (total sleep time [TST] and wake after sleep onset [WASO]) against gold-standard technologies in a cohort of healthy older adults in a free-living environment. METHODS Overall, 20 participants ({\\textgreater}65 years) took part in the study. The devices were worn by the participants for 24 hours, and the results were compared against validated technology (ActiGraph and New-Lifestyles NL-2000i). Mean error, mean percentage error (MPE), mean absolute percentage error (MAPE), intraclass correlation (ICC), and Bland-Altman plots were computed for all the parameters considered. RESULTS For step counting, all trackers were highly correlated with one another (ICCs{\\textgreater}0.89). Although the Fitbit tended to overcount steps (MPE=12.36{\\%}), the Garmin and ActiGraph undercounted (MPE 9.36{\\%} and 11.53{\\%}, respectively). The Garmin had poor ICC values when energy expenditure was compared against the criterion. The Fitbit had moderate-to-good ICCs in comparison to the other activity trackers, and showed the best results (MAPE=12.25{\\%}), although it underestimated calories burned. For MVPA levels estimation, the wristband trackers were highly correlated (ICC=0.96); however, they were moderately correlated against the criterion and they overestimated MVPA activity minutes. For the sleep parameters, the ICCs were poor for all cases, except when comparing the Fitbit with the criterion, which showed moderate agreement. The TST was slightly overestimated with the Fitbit, although it provided good results with an average MAPE equal to 10.13{\\%}. Conversely, WASO estimation was poorer and was overestimated by the Fitbit but underestimated by the Garmin. Again, the Fitbit was the most accurate, with an average MAPE of 49.7{\\%}. CONCLUSIONS The tested well-known devices could be adopted to estimate steps, energy expenditure, and sleep duration with an acceptable level of accuracy in the population of interest, although clinicians should be cautious in considering other parameters for clinical and research purposes.", "links": [ { "caption": "URL", "url": "http://www.ncbi.nlm.nih.gov/pubmed/31219048", "newWindow": true } ] }, { "title": "Accuracy of fitbit wristbands in measuring sleep stage transitions and the effect of user-specific factors", "author": "Liang, Zilu; Chapa-Martell, Mario Alberto", "year": "2019", "journalProceedings": "Journal of Medical Internet Research", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background: It has become possible for the new generation of consumer wristbands to classify sleep stages based on multisensory data. Several studies have validated the accuracy of one of the latest models, that is, Fitbit Charge 2, in measuring polysomnographic parameters, including total sleep time, wake time, sleep efficiency (SE), and the ratio of each sleep stage. Nevertheless, its accuracy in measuring sleep stage transitions remains unknown. Objective: This study aimed to examine the accuracy of Fitbit Charge 2 in measuring transition probabilities among wake, light sleep, deep sleep, and rapid eye movement (REM) sleep under free-living conditions. The secondary goal was to investigate the effect of user-specific factors, including demographic information and sleep pattern on measurement accuracy. Methods: A Fitbit Charge 2 and a medical device were used concurrently to measure a whole night's sleep in participants' homes. Sleep stage transition probabilities were derived from sleep hypnograms. Measurement errors were obtained by comparing the data obtained by Fitbit with those obtained by the medical device. Paired 2-tailed t test and Bland-Altman plots were used to examine the agreement of Fitbit to the medical device. Wilcoxon signed-rank test was performed to investigate the effect of user-specific factors. Results: Sleep data were collected from 23 participants. Sleep stage transition probabilities measured by Fitbit Charge 2 significantly deviated from those measured by the medical device, except for the transition probability from deep sleep to wake, from light sleep to REM sleep, and the probability of staying in REM sleep. Bland-Altman plots demonstrated that systematic bias ranged from 0{\\%} to 60{\\%}. Fitbit had the tendency of overestimating the probability of staying in a sleep stage while underestimating the probability of transiting to another stage. SE{\\textgreater}90{\\%} (P=.047) was associated with significant increase in measurement error. Pittsburgh sleep quality index (PSQI){\\textless}5 and wake after sleep onset (WASO){\\textless}30 min could be associated to significantly decreased or increased errors, depending on the outcome sleep metrics. Conclusions: Our analysis shows that Fitbit Charge 2 underestimated sleep stage transition dynamics compared with the medical device. Device accuracy may be significantly affected by perceived sleep quality (PSQI), WASO, and SE.", "links": [ { "caption": "URL", "url": "https://mhealth.jmir.org/2019/6/e13384/", "newWindow": true } ] }, { "title": "Reliability of Zephyr Bioharness and Fitbit Charge Measures of Heart Rate and Activity at Rest, During the Modified Canadian Aerobic Fitness Test, and Recovery", "author": "Nazari, Goris; MacDermid, Joy C.; Sinden, Kathryn E.; Richardson, Julie; Tang, Ada", "year": "2019", "journalProceedings": "Journal of Strength and Conditioning Research", "category": "Validation", "devices": "Charge", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "The purpose of this study was to determine the intrasession and intersession reliability of Zephyr Bioharness (ZB) and Fitbit Charge variables in both healthy men and women at rest, during the Modified Canadian Aerobic Fitness Test (mCAFT), and throughout recovery. Stratified convenience and snowball sampling were used to recruit 60 participants (30 women, 48 ± 15 years) and (30 men, 48 ± 15 years) from McMaster University student, staff, and faculty population. At rest, intrasession average heart rate (b{\\textperiodcentered}min -1 ). Intraclass correlation coefficients (ICCs) and Standard Error of Measurement [SEM] for Zephyr ranged from (0.94-0.97) [1.17-1.70] to (0.92-0.97) [1.45-2.10] for Fitbit Charge. During the mCAFT, the Zephyr ICCs and (SEM) ranged from 0.31-0.99 (1.28-8.10) to 0.45-0.99 (1.45-8.71) for the Fitbit Charge. Throughout the recovery, the ICCs and (SEM) ranged from 0.44-0.98 (1.26-10.47) to 0.45-0.98 (1.15-11.90) for Zephyr and Fitbit devices, respectively. At rest, intersession ICCs (SEM) for Zephyr and Fitbit ranged from 0.90-0.94 (1.73-2.37) to 0.88-0.94 (1.83-2.67), respectively. At mCAFT, the Zephyr ICCs (SEM) ranged from 0.91-0.97 (3.12-4.64) to 0.85-0.98 (3.28-4.88) for the Fitbit. Throughout the recovery, the ICCs (SEM) ranged from 0.93-0.97 (2.65-4.66) to 0.76-0.91 (3.17-4.67) for Zephyr and Fitbit devices, respectively. To conclude, both the ZB and Fitbit Charge devices demonstrated excellent reliability measures throughout the 3 phases. The findings from our study add to the existing pool of literature regarding the reliability parameters of wearable devices and suggest that stable and consistent measures of heart rate and physical activity can be obtained using ZB and Fitbit Charge devices among healthy male and female participants at rest, during a standardized submaximal fitness test (mCAFT), and throughout recovery.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/00124278-201902000-00032", "newWindow": true } ] }, { "title": "Concurrent validity of the Fitbit for assessing sedentary behavior and moderate-to-vigorous physical activity", "author": "Redenius, Nicklaus; Kim, Youngwon; Byun, Wonwoo", "year": "2019", "journalProceedings": "BMC Medical Research Methodology", "category": "Validation", "devices": "Flex", "population": "Adults", "dataUsed": "Intensity", "abstract": "Background: Recent advances in sensor technologies have promoted the use of consumer-based accelerometers such as Fitbit Flex in epidemiological and clinical research; however, the validity of the Fitbit Flex in measuring sedentary behavior (SED) and physical activity (PA) has not been fully determined against previously validated research-grade accelerometers such as ActiGraph GT3X+. Therefore, the purpose of this study was to examine the concurrent validity of the Fitbit Flex against ActiGraph GT3X+ in a free-living condition. Methods: A total of 65 participants (age: M = 42, SD = 14 years, female: 72{\\%}) each wore a Fitbit Flex and GT3X+ for seven consecutive days. After excluding sleep and non-wear time, time spent (min/day) in SED and moderate-to-vigorous PA (MVPA) were estimated using various cut-points for GT3X+ and brand-specific algorithms for Fitbit, respectively. Repeated measures one-way ANOVA and mean absolute percent errors (MAPE) served to examine differences and measurement errors in SED and MVPA estimates between Fitbit Flex and GT3X+, respectively. Pearson and Spearman correlations and Bland-Altman (BA) plots were used to evaluate the association and potential systematic bias between Fitbit Flex and GT3X+. PROC MIXED procedure in SAS was used to examine the equivalence (i.e., the 90{\\%} confidence interval with ±10{\\%} equivalence zone) between the devices. Results: Fitbit Flex produced similar SED and low MAPE (mean difference [MD] = 37 min/day, P =.21, MAPE = 6.8{\\%}), but significantly higher MVPA and relatively large MAPE (MD = 59-77 min/day, P {\\textless}.0001, MAPE = 56.6-74.3{\\%}) compared with the estimates from GT3X+ using three different cut-points. The correlations between Fitbit Flex and GT3X+ were consistently higher for SED (r = 0.90, $\\rho$ = 0.86, P {\\textless}.01), but weaker for MVPA (r = 0.65-0.76, $\\rho$ = 0.69-0.79, P {\\textless}.01). BA plots revealed that there is no apparent bias in estimating SED. Conclusion: In comparison with the GT3X+ accelerometer, the Fitbit Flex provided comparatively accurate estimates of SED, but the Fitbit Flex overestimated MVPA under free-living conditions. Future investigations using the Fitbit Flex should be aware of present findings.", "links": [ { "caption": "URL", "url": "https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-019-0668-1", "newWindow": true } ] }, { "title": "Fitbit Usage in Patients With Breast Cancer Undergoing Chemotherapy", "author": "Dreher, Nickolas; Hadeler, Edward Kenji; Hartman, Sheri J.; Wong, Emily C.; Acerbi, Irene; Rugo, Hope S.; Majure, Melanie Catherine; Chien, Amy Jo; Esserman, Laura J.; Melisko, Michelle E.", "year": "2019", "journalProceedings": "Clinical Breast Cancer", "category": "Usability", "devices": "Charge HR", "population": "Patients", "dataUsed": null, "abstract": "Fitbits may be useful in tracking changes in physical activity during chemotherapy. Sixty-five patients with breast cancer were given Fitbits at the start of chemotherapy, but adherence to wearing the Fitbit was low, with mean number of valid days across the 9-month study period of 44.5{\\%}. Interventions to increase wear are likely necessary in the active treatment setting.", "links": [] }, { "title": "Validity of Cardiorespiratory Fitness Measured with Fitbit Compared to V˙O2max", "author": "Klepin, Katharine; Wing, David; Higgins, Michael; Nichols, Jeanne; Godino, Job G.", "year": "2019", "journalProceedings": "Medicine and science in sports and exercise", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "PURPOSE: Cardiorespiratory fitness (CRF), broadly defined as the body's ability to utilize oxygen, is a well-established prognostic marker of health, but it is not routinely measured. This may be due to the difficulty of acquiring high-quality CRF measures. The purpose of this study was to independently determine the validity of the Fitbit Charge 2's measure of CRF (Fitbit CRF). METHODS: Sixty-five healthy adults between the ages of 18 and 45 yr (55{\\%} female, 45{\\%} male) were recruited to undergo gold standard V˙O2max testing and wear a Fitbit Charge 2 continuously for 1 wk during which they were instructed to complete a qualifying outdoor run to derive the Fitbit CRF (units: mL{\\textperiodcentered}kg{\\textperiodcentered}min). This measure was compared with V˙O2max measures (units: mL{\\textperiodcentered}kg{\\textperiodcentered}min) epoched at 15 and 60 s. RESULTS: Bland-Altman analyses revealed that Fitbit CRF had a positive bias of 1.59 mL{\\textperiodcentered}kg{\\textperiodcentered}min compared with laboratory data epoched at 15 s and 0.30 mL{\\textperiodcentered}kg{\\textperiodcentered}min compared with data epoched at 60 s (n = 60). F statistics (2.09; 0.08) and P values (0.133; 0.926) from Bradley-Blackwood tests for the concordance of Fitbit CRF with 15- and 60-s laboratory data, respectively, support the null hypothesis of equal means and variances, indicating there is concordance between the two measures. Mean absolute percentage error was less than 10{\\%} for each comparison. CONCLUSIONS: The Fitbit Charge 2 provides an acceptable level of validity when measuring CRF in young, healthy, and fit adults who are able to run. Further research is required to determine if it is a potentially useful tool in clinical practice and epidemiological research to quantify, categorize, and longitudinally track risk for adverse outcomes.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028477/", "newWindow": true } ] }, { "title": "Preliminary Agreement on Tracking Sleep Between a Wrist-Worn Device Fitbit Alta and Consensus Sleep Diary", "author": "Liu, Jiaxing; Wong, Wing To; Zwetsloot, Inez Maria; Hsu, Yu Cheng; Tsui, Kwok Leung", "year": "2019", "journalProceedings": "Telemedicine and e-Health", "category": "Validation", "devices": "Alta", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background: Sleep is related to various kinds of health outcomes. Many studies traditionally collect data on sleep using questionnaires or sleep diaries. An increasing popular alternative is a wrist-worn device. The accuracy of these devices is uncertain, and assessment of this accuracy is important. Introduction: The purpose of this study is to compare consensus sleep diary (CSD) and an actigraphy-based wrist-worn device (Fitbit Alta™ [Fitbit, San Francisco, CA]) measurements of total sleep time (TST), sleep onset latency, wake time after sleep onset, number of awakenings, and sleep efficiency. Materials and Methods: Ten healthy young adults (50{\\%} female, 100{\\%} Asian) in the age range between 20 to 24 years old wore a Fitbit Alta around their nondominated hand during seven consecutive nights. The participants also filled in a CSD every day. Results: On average, the wrist-worn device (Fitbit Alta) recorded a TST per night of 437.15 min, which is 5.46 min shorter on average than the CSD recorded (442.61 min). Bland-Altman plots indicate that there is large variance in the sleep recorded between Fitbit™ (Fitbit, San Francisco, CA) and CSD. For example, Fitbit recorded 2.15 more awakenings per night than CSD, which is equal to 13.09 min on average longer wake time after sleep onset. Conclusion: Fitbit and CSD show significant differences in recording sleep. We find that for most sleep metrics, the level of disagreement is small enough for the devices to be interchangeably used except for recording wakes during the night.", "links": [ { "caption": "URL", "url": "https://www.liebertpub.com/doi/10.1089/tmj.2018.0202", "newWindow": true } ] }, { "title": "Evaluation of Knee Cartilage Diurnal, Activity, and BMI-Related Variations Using Quantitative T2 Mapping MRI and Fitbit Activity Tracking", "author": "Matcuk, George R.; Jones, Ian A.; McIntyre, J. Alex; Burt, Robert; Hwang, Darryl; Cen, Steven; Schein, Aaron J.; Vangsness, C. Thomas", "year": "2019", "journalProceedings": "The Journal of Knee Surgery", "category": "Measurement", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "The aim of this study is to evaluate diurnal variation in knee cartilage 3 Tesla magnetic resonance imaging (MRI) T2 mapping relaxation times, as well as activity- and body mass index (BMI)-dependent variability, using quantitative analysis of T2 values from segmented regions of the weight-bearing articular surfaces of the medial and lateral femoral condyles and tibial plateaus. Ten healthy volunteers' daily activity (steps) were tracked with Fitbit pedometers. Sagittal MRI T2 maps were obtained in the morning and afternoon on days 2 and 3. Mean T2 values were analyzed for variation related to the number of steps taken (activity), time of day (diurnal variation), and BMI using mixed effect model. Significant (albeit small) differences in the medial femoral and medial tibial cartilage regions were identified between morning and afternoon scans (diurnal variation). Daily activity did not result in significant changes and increasing BMI only demonstrated a slight increase in T2 values for the lateral tibial plateau. These findings suggest that it may be necessary to control diurnal variation when using quantitative MRI T2 mapping to assess articular cartilage longitudinally in healthy participants. Further investigation is needed to confirm these findings and determine if they also apply to symptomatic patients.", "links": [ { "caption": "URL", "url": "http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1695000", "newWindow": true } ] }, { "title": "Assessment of Accuracy of Overall Energy Expenditure Measurements for the Fitbit Charge HR 2 and Apple Watch", "author": "Nuss, Kayla J.; Thomson, Elizabeth A.; Courtney, Jimikaye B.; Comstock, Ashley; Reinwald, Steven; Blake, Sophie; Richard, E.; Tracy, Brian L.; Li, Kaigang", "year": "2019", "journalProceedings": "American Journal of Health Behavior", "category": "Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "Objectives: In this study, we sought to determine the accuracy of energy expenditure (EE) esti- mation for the Fitbit Charge HR 2 (Fitbit) and the Apple Watch. Design: An observational study. Methods: Thirty young adults (15 men and 15 women, aged 23.5 ± 2.96 years) completed the Bruce treadmill protocol. We measured gross EE by a PARVO metabolic cart (MetCart) and concurrently estimated by the Fitbit and Apple Watch. We calculated concordance correlation coefficients (CCC, rc) and relative error rates to indicate the difference between each device and the MetCart system. Results: For the Apple Watch and Fitbit, the relative error rate was 24.3{\\%}, 20.1{\\%} for the pooled sample, 18.6{\\%}, 24.2{\\%} for men, and 29.9{\\%}, 16.7{\\%} for women, respectively. The Apple Watch overestimated EE for women and underestimated EE for men; the Fitbit underestimated EE for both. Moderate CCCs between estimated EEs and MetCart measured EEs were found for both Apple Watch (rc =0.65, 0.43, and 0.39 overall, men and women, respectively) and Fitbit (rc =0.53, 0.39, and 0.21 overall, men and women, respectively). Conclusion: Neither device showed accurate results compared with EE measured by a MetCart. Users should consider these results when designing programs or personal training plans where physical activity EE is a key outcome assessed with a wearable device.", "links": [] }, { "title": "Potential benefits of Fitbit device in managing a patient with mucopolysaccharidosis", "author": "Oldham, Andrew; Stepien, Karolina M.; Hendriksz, Christian J.", "year": "2019", "journalProceedings": "Molecular Genetics and Metabolism", "category": "Case Study", "devices": null, "population": "NA", "dataUsed": "Heart Rate", "abstract": "Mucopolysaccharidosis (MPS) IVa is a lysosomal storage disorder resulting from a deficiency of N-acetylgalactosamine-6-sulfatase leading to progressive accumulation of glycosaminoglycans (GAGs) in musculoskeletal system, patients manifest with an impaired gait pattern, reduced levels of physical endurance, muscular weakness, arrhythmias and upper airways abnormalities. Wearable life style technology is available and used in managing health issues. We describe the application of a FitBit device as part of physiotherapy assessment of one MPS IVa patient.", "links": [] }, { "title": "Validating Fitbit for Evaluation of Physical Activity in Patients with Knee Osteoarthritis: Do Thresholds Matter?", "author": "Silva, Genevieve S.; Yang, Heidi; Collins, Jamie E.; Losina, Elena", "year": "2019", "journalProceedings": "ACR Open Rheumatology", "category": "Validation", "devices": "Charge 2", "population": "Patients", "dataUsed": "Intensity", "abstract": "Objective: We sought to evaluate the performance of Fitbit in estimating ActiGraph-derived moderate-to-vigorous physical activity (MVPA) and sedentary time in the knee osteoarthritis (OA) population. Methods: We used data from two weeks of Fitbit and ActiGraph wear among knee OA subjects. In primary analyses, we used literature-based ActiGraph thresholds of 200 and 1924 counts/min (triaxial vector magnitude) for sedentary and MVPA time as the gold standard to which we compared three sets of Fitbit thresholds informed by literature and data (Youden index). We also considered personalized, stride length-based Fitbit thresholds. In sensitivity analyses, we used uniaxial, vertical axis-based as well as personalized, BMI-based ActiGraph thresholds. We calculated agreement, sensitivity, and specificity of Fitbit in classifying sedentary and MVPA time. Results: In the primary analysis (vector magnitude thresholds), maximum agreement for sedentary and MVPA time was 67.0{\\%} from the Youden index-based and 91.1{\\%} from the stride length-based Fitbit thresholds. For sedentary time, the 20 strides/min threshold had the highest sensitivity (97.6{\\%}), and Youden-derived 1 stride/min had the highest specificity (51.6{\\%}). For MVPA, Youden-derived 14 strides/min yielded 72.8{\\%} sensitivity, and using stride length yielded 98.6{\\%} specificity. MVPA time ranged from 49-323 min/d, depending on threshold used, with literature-based and personalized thresholds leading to more conservative estimates of MVPA than Youden-derived thresholds. Conclusion: Using Fitbit for MVPA and sedentary time assessment may lead to inaccurate estimates of both. Fitbit MVPA estimates were generally more conservative than ActiGraph estimates. Incorporating individuals' characteristics did not meaningfully improve Fitbit performance. Caution should be exercised when measuring activity using Fitbit.", "links": [ { "caption": "URL", "url": "https://onlinelibrary.wiley.com/doi/abs/10.1002/acr2.11080", "newWindow": true } ] }, { "title": "Offline and Online Learning Techniques for Personalized Blood Pressure Prediction and Health Behavior Recommendations", "author": "Chiang, Po Han; Dey, Sujit", "year": "2019", "journalProceedings": "IEEE Access", "category": "Usability", "devices": "Charge HR", "population": "Adults", "dataUsed": "Sleep,Heart Rate", "abstract": "Blood pressure (BP) is one of the essential indicators of human health and highly correlated to health behavior (e.g., exercise and sleep). However, the degree of impact of each health behavior on BP is unknown and may vary significantly between individuals. In this paper, we investigate the relationship between BP and health behavior using data collected from off-the-shelf wearable devices and wireless home BP monitors. We propose a personalized BP model based on random forest (RF), which can predict individual's BP using health behavior and historical BP, and identify the most important factors in predicting an individual's BP. The latter can be used to provide personalized health behavior recommendations to improve and manage BP. We propose RF with Feature Selection (RFFS), which performs RF-based feature selection to enhance the prediction. Furthermore, since BP and health behavior data are collected and learned sequentially, the performance of prediction is prone to the existence of concept drifts and anomaly points. To solve this problem, we propose an Online Weighted-Resampling (OWR) technique to enhance RFFS in an online learning scenario. To show the effectiveness of RFFS and OWR, we use existing machine learning methods on the proposed dataset as a comparison. Our experimental results show that the proposed approach achieves the lowest prediction error. We also validate the effectiveness of personalized recommendations based on feature importance, which influences the user to change lifestyle to improve his/her BP.", "links": [] }, { "title": "Goal-directed versus outcome-based financial incentives for weight loss among low-income patients with obesity: Rationale and design of the Financial Incentives for Weight Reduction (FIReWoRk) randomised controlled trial", "author": "Jay, Melanie; Orstad, Stephanie L.; Wali, Soma; Wylie-Rosett, Judith; Tseng, Chi Hong; Sweat, Victoria; Wittleder, Sandra; Shu, Suzanne B.; Goldstein, Noah J.; Ladapo, Joseph A.", "year": "2019", "journalProceedings": "BMJ Open", "category": "Intervention", "devices": "Alta HR", "population": "Adults", "dataUsed": "Intensity", "abstract": "Introduction Obesity is a major public health challenge and exacerbates economic disparities through employment discrimination and increased personal health expenditures. Financial incentives for weight management may intensify individuals' utilisation of evidence-based behavioural strategies while addressing obesity-related economic disparities in low-income populations. Trials have focused on testing incentives contingent on achieving weight loss outcomes. However, based on social cognitive and self-determination theories, providing incentives for achieving intermediate behavioural goals may be more sustainable than incentivising outcomes if they enhance an individual's skills and self-efficacy for maintaining long-Term weight loss. The objective of this paper is to describe the rationale and design of the Financial Incentives foR Weight Reduction study, a randomised controlled trial to test the comparative effectiveness and cost-effectiveness of two financial incentive strategies for weight loss (goal directed vs outcome based) among low-income adults with obesity, as well as compared with the provision of health behaviour change resources alone. Methods and analysis We are recruiting 795 adults, aged 18-70 years with a body mass index ≥30 kg/m 2, from three primary care clinics serving residents of socioeconomically disadvantaged neighbourhoods in New York City and Los Angeles. All participants receive a 1-year commercial weight loss programme membership, self-monitoring tools (bathroom scale, food journal and Fitbit Alta HR), health education and monthly check-in visits. In addition to these resources, those in the two intervention groups can earn up to 750 over 6 months for: (1) participating in an intensive weight management programme, self-monitoring weight and diet and meeting physical activity guidelines (goal-directed arm); or (2) a ≥1.5{\\%} to ≥5{\\%} reduction in baseline weight (outcome-based arm). To maximise incentive efficacy, we incorporate concepts from behavioural economics, including immediacy of payments and framing feedback to elicit regret aversion. We will use generalised mixed effect models for repeated measures to examine intervention effects on weight at 6, 9 and 12 months. Ethics and dissemination Human research protection committees at New York University School of Medicine, University of California Los Angeles (UCLA) David Geffen School of Medicine and Olive-View-UCLA Medical Center granted ethics approval. We will disseminate the results of this research via peer-reviewed publications, conference presentations and meetings with stakeholders. Trial registration number NCT03157713.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/30962231/", "newWindow": true } ] }, { "title": "What is the Agreement Between Two Generations of Commercial Accelerometer in a Free-Living Environment for Young to Middle-Aged Adults?", "author": "Jones, Denise M.; Hart, Harvi F.; Crossley, Kay M.; Ackerman, Ilana N.; Kemp, Joanne L.", "year": "2019", "journalProceedings": "Journal for the Measurement of Physical Behaviour", "category": "Validation", "devices": "Flex,Flex 2", "population": "Adults", "dataUsed": "Steps", "abstract": "To determine the level of agreement between two generations of Fitbit™ device for step count and activity level in a free-living environment.", "links": [ { "caption": "URL", "url": "https://journals.humankinetics.com/view/journals/jmpb/2/2/article-p49.xml", "newWindow": true } ] }, { "title": "The feasibility of using real-time, objective measurements of physiological stress among law enforcement officers in Dallas, Texas", "author": "Reingle Gonzalez, Jennifer M.; Jetelina, Katelyn K.; Bishopp, Stephen A.; Livingston, Melvin D.; Perez, Rodolfo A.; Gabriel, Kelley Pettee", "year": "2019", "journalProceedings": "Policing", "category": "Usability", "devices": "Charge 2", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Purpose: Law enforcement officers (LEOs) suffer from premature mortality, intentional and unintentional injury, suicide and are at an increased risk for several non-communicable disease outcomes including cardiovascular disease and several cancers, compared to those employed in other occupations. Repeated exposure to stressful and traumatic stimuli is a possible mechanism driving these adverse health outcomes among LEOs. To better identify the sources of these health problems, the purpose of this paper is to determine the feasibility of conducting a cohort study using physiological measures of stress (e.g. heart rate) with LEOs; perceptions of the FitBit device, including LEO buy-in and attitudes associated with the protocol. Design/methodology/approach: Data were collected from ten recent graduates of the Dallas Police Training Academy. Findings: Results suggest that officer buy-in and protocol compliance was high. Officers were eager to participate in this study, and completion of weekly surveys was 100 percent. Minute-level missing data from wearable devices was relatively low (25 percent), and 90 percent of participants wore the FitBit devices on more than 90 percent of study days. Originality/value: Results from this study suggest that wearable physiological devices can be effectively used in law enforcement populations to measure stress.", "links": [ { "caption": "URL", "url": "https://www.emerald.com/insight/content/doi/10.1108/PIJPSM-12-2018-0184/full/html", "newWindow": true } ] }, { "title": "Free-Living Comparison of Physical Activity and Sleep Data from Fitbit Activity Trackers Worn on the Dominant and Nondominant Wrists", "author": "Clevenger, Kimberly A.; Molesky, Monroe J.; Vusich, John; Montoye, Alexander H. K.", "year": "2019", "journalProceedings": "Measurement in Physical Education and Exercise Science", "category": "Validation", "devices": "Flex,Flex 2", "population": "Adults", "dataUsed": "Steps,Intensity,Distance,Sleep", "abstract": "Despite proprietary algorithms to account for differences, output from activity trackers worn on different wrists may not be comparable because individuals vary in their reliance on each hand during free-living activities. Participants (n = 48) wore Fitbit Flex or Flex2 monitors on each wrist for three days. T tests, equivalence tests, and correlations were used to compare steps, Calories, distance, active minutes, and sleep duration recorded by dominant and nondominant wrist-worn monitors and effect sizes and mean absolute and percent difference were calculated. The nondominant Flex2 monitor was not equivalent to the dominant wrist-worn monitor and recorded significantly more steps/day (absolute difference = 708), miles/day (0.3), and active minutes/day (7.9) than the dominant Flex2 monitor. For all variables, nondominant and dominant output was correlated (r{\\textgreater}0.75). Nondominant and dominant Flex2 monitors are significantly different, but there were small differences for Flex monitors. Research should investigate effects on behavior and replicate findings using other monitors.", "links": [ { "caption": "URL", "url": "https://shapeamerica.tandfonline.com/doi/abs/10.1080/1091367X.2019.1577737", "newWindow": true } ] }, { "title": "Validity of Heart Rate Measurements in a Fitbit Charge 2 and Apple iWatch in a Free-Living Setting", "author": "Dione, Dakota", "year": "2019", "journalProceedings": "UVM Honors College Senior Theses", "category": "Validation,Dissertation / Thesis", "devices": "Charge 2", "population": "Adults", "dataUsed": "Heart Rate", "abstract": null, "links": [ { "caption": "URL", "url": "https://scholarworks.uvm.edu/hcoltheses/281", "newWindow": true } ] }, { "title": "Agreement between the Apple Series 1, LifeTrak Core C200, and Fitbit Charge HR with Indirect Calorimetry for Assessing Treadmill Energy Expenditure", "author": "Zhang, Peng; Burns, Ryan Donald; Fu, You; Godin, Steven; Byun, Wonwoo", "year": "2019", "journalProceedings": "International Journal of Environmental Research and Public Health", "category": "Usability", "devices": "Charge HR", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "The purpose of this study was to examine agreement in energy expenditure between the Apple Series 1 Watch, LifeTrak Core C200, and Fitbit Charge HR with indirect calorimetry during various treadmill speeds in young adults. Participants were a sample of college-aged students (mean age = 20.1 (1.7) years; 13 females, 17 males). Participants completed six structured 10-minute exercise sessions on a treadmill with speeds ranging from 53.6 m{\\textperiodcentered}min−1 to 187.7 m{\\textperiodcentered}min−1. Indirect calorimetry was used as the criterion. Participants wore the Apple Watch, LifeTrak, and Fitbit activity monitors on their wrists. Group-level agreement was examined using equivalence testing, relative agreement was examined using Spearman's rho, and individual-level agreement was examined using Mean Absolute Percent Error (MAPE) and Bland-Altman Plots. Activity monitor agreement with indirect calorimetry was supported using the Apple Watch at 160.9 m{\\textperiodcentered}min−1 (Mean difference = −2.7 kcals, 90{\\%} C.I.: −8.3 kcals, 2.8 kcals; MAPE = 11.9{\\%}; rs = 0.64) and 187.7 m{\\textperiodcentered}min−1 (Mean difference = 3.7 kcals, 90{\\%} C.I.: −2.2 kcals, 9.7 kcals; MAPE = 10.7{\\%}; rs = 0.72) and the Fitbit at 187.7 m{\\textperiodcentered}min−1 (Mean difference = −0.2 kcals, 90{\\%} C.I.: −8.8 kcals, 8.5 kcals; MAPE = 20.1{\\%}; rs = 0.44). No evidence for statistical equivalence was seen for the LifeTrak at any speed. Bland-Altman Plot Limits of Agreement were narrower for the Apple Series 1 Watch compared to other monitors, especially at slower treadmill speeds. The results support the utility of the Apple Series 1 Watch and Fitbit Charge HR for assessing energy expenditure during specific treadmill running speeds in young adults.{\\textless}/p{\\textgreater}", "links": [ { "caption": "URL", "url": "https://www.mdpi.com/1660-4601/16/20/3812", "newWindow": true } ] }, { "title": "The Influence of Wearing a fitbit on Eating Behaviors While Stressed", "author": "Sparacino, Maria", "year": "2019", "journalProceedings": "Coastal Carolina University Digital Commons", "category": "Measurement", "devices": "Flex", "population": "Adults", "dataUsed": "Heart Rate", "abstract": null, "links": [ { "caption": "URL", "url": "https://digitalcommons.coastal.edu/honors-theses/346", "newWindow": true } ] }, { "title": "Comparing Methods to Identify Wear-Time Intervals for Physical Activity With the Fitbit Charge 2", "author": "Claudel, Sophie E.; Tamura, Kosuke; Troendle, James; Andrews, Marcus R.; Ceasar, Joniqua N.; Mitchell, Valerie M.; Vijayakumar, Nithya; Powell-Wiley, Tiffany M.", "year": "2020", "journalProceedings": "Journal of Aging and Physical Activity", "category": "Methods", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps", "abstract": " There is no established method for processing data from commercially available physical activity trackers. This study aims to develop a standardized approach to defining valid wear time for use in future interventions and analyses. Sixteen African American women (mean age = 62.1 years and mean body mass index = 35.5 kg/m 2 ) wore the Fitbit Charge 2 for 20 days. Method 1 defined a valid day as ≥10-hr wear time with heart rate data. Method 2 removed minutes without heart rate data, minutes with heart rate ≤ mean − 2 SD s below mean and ≤2 steps, and nighttime. Linear regression modeled steps per day per week change. Using Method 1 ( n = 292 person-days), participants had 20.5 ( SD = 4.3) hr wear time per day compared with 16.3 ( SD = 2.2) hr using Method 2 ( n = 282) ( p {\\textless} .0001). With Method 1, participants took 7,436 ( SD = 3,543) steps per day compared with 7,298 ( SD = 3,501) steps per day with Method 2 ( p = .64). The proposed algorithm represents a novel approach to standardizing data generated by physical activity trackers. Future studies are needed to improve the accuracy of physical activity data sets. ", "links": [ { "caption": "URL", "url": "https://journals.humankinetics.com/view/journals/japa/aop/article-10.1123-japa.2020-0059/article-10.1123-japa.2020-0059.xml", "newWindow": true } ] }, { "title": "Fitbit for learning: Towards capturing the learning experience using wearable sensing", "author": "Giannakos, Michail N.; Sharma, Kshitij; Papavlasopoulou, Sofia; Pappas, Ilias O.; Kostakos, Vassilis", "year": "2020", "journalProceedings": "International Journal of Human Computer Studies", "category": "Usability", "devices": null, "population": "Adolescents", "dataUsed": "Heart Rate", "abstract": "The assessment of learning during class activities mostly relies on standardized questionnaires to evaluate the efficacy of the learning design elements. However, standardized questionnaires pose additional strain on students, do not provide “temporal” information during the learning experience, require considerable effort and language competence, and sometimes are not appropriate. To overcome these challenges, we propose using wearable devices, which allow for continuous and unobtrusive monitoring of physiological parameters during learning. In this paper we set out to quantify how well we can infer students' learning experience from wrist-worn devices capturing physiological data. We collected data from 31 students in 93 class sessions (3 class sessions per student), and our analysis shows that wrist data can predict the learning experience with 11{\\%} error. We also show that 6.25 min (SD = 3.1 min) of data are needed to achieve a reliable estimate (i.e., 13.8{\\%} error). Our work highlights the benefits and limitations of utilizing wearable devices to assess learning experiences. Our findings help shape the future of quantified-self technologies in learning by pointing out the substantial benefits of physiological sensing for self-monitoring, evaluation, and metacognitive reflection in learning.", "links": [ { "caption": "URL", "url": "https://www.sciencedirect.com/science/article/pii/S1071581919301508", "newWindow": true } ] }, { "title": "Performance assessment of new-generation Fitbit technology in deriving sleep parameters and stages", "author": "Haghayegh, Shahab; Khoshnevis, Sepideh; Smolensky, Michael H.; Diller, Kenneth R.; Castriotta, Richard J.", "year": "2020", "journalProceedings": "Chronobiology International", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "We compared performance in deriving sleep variables by both Fitbit Charge 2™, which couples body movement (accelerometry) and heart rate variability (HRV) in combination with its proprietary interpretative algorithm (IA), and standard actigraphy (Motionlogger{\\textregistered} Micro Watch Actigraph: MMWA), which relies solely on accelerometry in combination with its best performing ‘Sadeh' IA, to electroencephalography (EEG: Zmachine{\\textregistered} Insight+ and its proprietary IA) used as reference. We conducted home sleep studies on 35 healthy adults, 33 of whom provided complete datasets of the three simultaneously assessed technologies. Relative to the Zmachine EEG method, Fitbit showed an overall Kappa agreement of 54{\\%} in distinguishing wake/sleep epochs and sensitivity of 95{\\%} and specificity of 57{\\%} in detecting sleep epochs. Fitbit, relative to EEG, underestimated sleep onset latency (SOL) by {\\~{}}11 min and overestimated sleep efficiency (SE) by {\\~{}}4{\\%}. There was no statistically significant difference between Fitbit and EEG methods in measuring wake after sleep onset (WASO) and total sleep time (TST). Fitbit showed substantial agreement with EEG in detecting rapid eye movement and deep sleep, but only moderate agreement in detecting light sleep. The MMWA method showed 51{\\%} overall Kappa agreement with the EEG one in detecting wake/sleep epochs, with sensitivity of 94{\\%} and specificity of 53{\\%} in detecting sleep epochs. MMWA, relative to EEG, underestimated SOL by {\\~{}}10 min. There was no significant difference between Fitbit and MMWA methods in amount of bias in estimating SOL, WASO, TST, and SE; however, the minimum detectable change (MDC) per sleep variable with Fitbit was better (smaller) than with MMWA, respectively, by {\\~{}}10 min, {\\~{}}16 min, {\\~{}}22 min, and {\\~{}}8{\\%}. Overall, performance of Fitbit accelerometry and HRV technology in conjunction with its proprietary IA to detect sleep vs. wake episodes is slightly better than wrist actigraphy that relies solely on accelerometry and best performing Sadeh IA. Moreover, the smaller MDC of Fitbit technology in deriving sleep parameters in comparison to wrist actigraphy makes it a suitable option for assessing changes in sleep quality over time, longitudinally, and/or in response to interventions.", "links": [ { "caption": "URL", "url": "https://www.tandfonline.com/doi/abs/10.1080/07420528.2019.1682006", "newWindow": true } ] }, { "title": "Fitbit wear-time and patterns of activity in cancer survivors throughout a physical activity intervention and follow-up: Exploratory analysis from a randomised controlled trial", "author": "Hardcastle, Sarah J.; Jim{\\'{e}}nez-Castuera, Ruth; Maxwell-Smith, Chlo{\\'{e}}; Bulsara, Max K.; Hince, Dana", "year": "2020", "journalProceedings": "PLOS ONE", "category": "Intervention", "devices": "Alta", "population": "Patients", "dataUsed": "Intensity", "abstract": "Objective There has been growing interest in the use of smart wearable technology to promote physical activity (PA) behaviour change. However, little is known concerning PA patterns throughout an intervention or engagement with trackers. The objective of the study was to explore patterns of Fitbit-measured PA and wear-time over 24-weeks and their relationship to changes in Actigraph-derived moderate-to-vigorous PA (MVPA). Methods Twenty-nine intervention participants (88{\\%}) from the wearable activity technology and action-planning (WATAAP) trial in colorectal and endometrial cancer survivors accepted a Fitbit friend request from the research team to permit monitoring of Fitbit activity. Daily steps and active minutes were recorded for each participant over the 12-week intervention and throughout the follow-up period to 24-weeks. Accelerometer (GT9X) derived MVPA was assessed at end of intervention (12-weeks) and end of follow-up (24-weeks). Results Fitbit wear-time over the 24-weeks of data was remarkably consistent, with median adherence score of 100{\\%} for all weeks. During the intervention, participants recorded a median 8006 steps/day. Daily step count was slightly increased through week-13 to week-24 with a median of 8191 steps/day (p = 0.039). Actigraph and Fitbit derived measures were highly correlated but demonstrated poor agreement overall. Fitbit measured activity was closest to MVPA measured using Freedson cut-points as no bias was observed. Conclusions Step count was maintained throughout the trial displaying promise for the effectiveness of smart-wearable interventions to reduce sedentary behaviour beyond the intervention period. Further worthwhile work should compare more advanced smart-wearable technology with accelerometers in order to improve agreement and explore less resource-intensive methods to assess PA that could be scalable. Copyright:", "links": [ { "caption": "URL", "url": "https://dx.plos.org/10.1371/journal.pone.0240967", "newWindow": true } ] }, { "title": "Estimating physical activity and sedentary behaviour in a free-living environment: A comparative study between Fitbit Charge 2 and Actigraph GT3X", "author": "Mikkelsen, Marie-Louise K.; Berg-Beckhoff, Gabriele; Frederiksen, Peder; Horgan, Graham; O'Driscoll, Ruairi; Palmeira, Ant{\\'{o}}nio L.; Scott, Sarah E.; Stubbs, James; Heitmann, Berit L.; Larsen, Sofus C.", "year": "2020", "journalProceedings": "PLOS ONE", "category": "Measurement", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps", "abstract": "Background Activity trackers such as the Fitbit Charge 2 enable users and researchers to monitor physical activity in daily life, which could be beneficial for changing behaviour. However, the accuracy of the Fitbit Charge 2 in a free-living environment is largely unknown. Objective To investigate the agreement between Fitbit Charge 2 and ActiGraph GT3X for the estimation of steps, energy expenditure, time in sedentary behaviour, and light and moderate-to-vigorous physical activity under free-living conditions, and further examine to what extent placing the ActiGraph on the wrist as opposed to the hip would affect the findings. Methods 41 adults (n = 10 males, n = 31 females) were asked to wear a Fitbit Charge 2 device and two ActiGraph GT3X devices (one on the hip and one on the wrist) for seven consecutive days and fill out a log of wear times. Agreement was assessed through Bland-Altman plots combined with multilevel analysis. Results The Fitbit measured 1,492 steps/day more than the hip-worn ActiGraph (limits of agreement [LoA] = -2,250; 5,234), while for sedentary time, it measured 25 min/day less (LoA = -137; 87). Both Bland-Altman plots showed fixed bias. For time in light physical activity, the Fitbit measured 59 min/day more (LoA = -52;169). For time in moderate-to-vigorous physical activity, the Fitbit measured 31 min/day less (LoA = -132; 71) and for activity energy expenditure it measured 408 kcal/day more than the hip-worn ActiGraph (LoA = -385; 1,200). For the two latter outputs, the plots indicated proportional bias. Similar or more pronounced discrepancies, mostly in opposite direction, appeared when comparing to the wrist-worn ActiGraph. Conclusion Moderate to substantial differences between devices were found for most outputs, which could be due to differences in algorithms. Caution should be taken if replacing one device with another and when comparing results.", "links": [ { "caption": "URL", "url": "https://dx.plos.org/10.1371/journal.pone.0234426", "newWindow": true } ] }, { "title": "Participant Perceptions on a Fitbit and Facebook Intervention for Young Adult Cancer Survivors: A Qualitative Study", "author": "Miropolsky, Evelina M.; Scott Baker, Kevin; Abbey-Lambertz, Mark; Syrjala, Karen; Chow, Eric J.; Ceballos, Rachel; Mendoza, Jason A.", "year": "2020", "journalProceedings": "Journal of Adolescent and Young Adult Oncology", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Among cancer survivors, physical activity (PA) is associated with reductions in cancer recurrence, morbidity, and mortality. Most young adult (YA) survivors do not attain adequate PA. Digital modalities, specifically wearable activity monitors with a paired mobile application and private social media group for support offer a promising approach for promoting PA among YAs. We conducted a pilot randomized controlled trial of this intervention. To evaluate its acceptability and perceptions of the intervention components, we conducted qualitative interviews with those in the intervention. The results of our interviews serve to refine future interventions to better serve this population. Methods: Semistructured qualitative interviews with 13 YA cancer survivors ages 20-39 who participated in the intervention assessed perceptions of the digital components of the study and buddy system of nominating a friend to participate in PA with the survivor. Analyses included a qualitative thematic analysis of the interview transcripts and coded interview segments into three predetermined categories: facilitators, limitations, and suggestions. Results: Participants described wide-ranging benefits of the intervention, citing the Fitbit device and buddy system as major motivators to engage in PA and reach goals. Most participants noted feelings of increased physical and emotional wellness. The most-cited limitation of the intervention was the automated text messages, which participants found impersonal. Suggestions for improvement included integrating more elements of competition and group challenges. Conclusion: This digital PA intervention was perceived as feasible and acceptable to YA cancer survivors and appears promising for promoting PA and improving long-term health and quality of life. Clinicaltrial.gov identifier number: NCT03233581; Date of registration: July 28, 2017.", "links": [ { "caption": "URL", "url": "https://www.liebertpub.com/doi/10.1089/jayao.2019.0072", "newWindow": true } ] }, { "title": "Fitbit-Based Interventions for Healthy Lifestyle Outcomes: Systematic Review and Meta-Analysis", "author": "Ringeval, Mickael; Wagner, Gerit; Denford, James; Par{\\'{e}}, Guy; Kitsiou, Spyros", "year": "2020", "journalProceedings": "Journal of Medical Internet Research", "category": "Systematic Review", "devices": null, "population": null, "dataUsed": "Steps", "abstract": "Background: Unhealthy behaviors, such as physical inactivity, sedentary lifestyle, and unhealthful eating, remain highly prevalent, posing formidable challenges in efforts to improve cardiovascular health. While traditional interventions to promote healthy lifestyles are both costly and effective, wearable trackers, especially Fitbit devices, can provide a low-cost alternative that may effectively help large numbers of individuals become more physically fit and thereby maintain a good health status. Objective: The objectives of this meta-analysis are (1) to assess the effectiveness of interventions that incorporate a Fitbit device for healthy lifestyle outcomes (eg, steps, moderate-to-vigorous physical activity, and weight) and (2) to identify which additional intervention components or study characteristics are the most effective at improving healthy lifestyle outcomes. Methods: A systematic review was conducted, searching the following databases from 2007 to 2019: MEDLINE, EMBASE, CINAHL, and CENTRAL (Cochrane). Studies were included if (1) they were randomized controlled trials, (2) the intervention involved the use of a Fitbit device, and (3) the reported outcomes were related to healthy lifestyles. The main outcome measures were related to physical activity, sedentary behavior, and weight. All the studies were assessed for risk of bias using Cochrane criteria. A random-effects meta-analysis was conducted to estimate the treatment effect of interventions that included a Fitbit device compared with a control group. We also conducted subgroup analysis and fuzzy-set qualitative comparative analysis (fsQCA) to further disentangle the effects of intervention components. Results: Our final sample comprised 41 articles reporting the results of 37 studies. For Fitbit-based interventions, we found a statistically significant increase in daily step count (mean difference [MD] 950.54, 95{\\%} CI 475.89-1425.18; P{\\textless}.001) and moderate-to-vigorous physical activity (MD 6.16, 95{\\%} CI 2.80-9.51; P{\\textless}.001), a significant decrease in weight (MD −1.48, 95{\\%} CI −2.81 to −0.14; P=.03), and a nonsignificant decrease in objectively assessed and self-reported sedentary behavior (MD −10.62, 95{\\%} CI −35.50 to 14.27; P=.40 and standardized MD −0.11, 95{\\%} CI −0.48 to 0.26; P=.56, respectively). In general, the included studies were at low risk for bias, except for performance bias. Subgroup analysis and fsQCA demonstrated that, in addition to the effects of the Fitbit devices, setting activity goals was the most important intervention component. Conclusions: The use of Fitbit devices in interventions has the potential to promote healthy lifestyles in terms of physical activity and weight. Fitbit devices may be useful to health professionals for patient monitoring and support.", "links": [ { "caption": "URL", "url": "https://www.jmir.org/2020/10/e23954/", "newWindow": true } ] }, { "title": "Outcomes of a text message, Fitbit, and coaching intervention on physical activity maintenance among cancer survivors: a randomized control pilot trial", "author": "Gell, Nancy M.; Grover, Kristin W.; Savard, Liliane; Dittus, Kim", "year": "2020", "journalProceedings": "Journal of Cancer Survivorship", "category": "Intervention", "devices": "One", "population": "Adults", "dataUsed": "Intensity", "abstract": "Purpose: We aimed to determine the effect of a health coach, text message, and Fitbit intervention on moderate-to-vigorous physical activity (MVPA) maintenance in cancer survivors following a supervised exercise program compared to provision of a Fitbit alone. Methods: Participants were recruited during the last month of an exercise-based oncology rehabilitation program and randomly assigned to the full intervention (n = 34) or Fitbit-only control groups (n = 32). In total, 59 cancer survivors completed the program (81{\\%} female; mean age 61.4 ± 9.0). Group by time differences in accelerometer-measured MVPA was assessed using linear mixed models. Additionally, we examined mean weekly Fitbit-derived MVPA levels. Results: Intervention participants maintained weekly MVPA from pre- (295.7 ± 139.6) to post-intervention (322.0 ± 199.4; p = 0.37), whereas those in the Fitbit-only group had a significant decrease in MVPA (305.5 ± 181.1 pre vs 250.7 ± 166.5 post; p = 0.03, effect size 0.57). The intervention participants maintained recommended levels of MPVA for health benefits during the 8-week intervention, whereas the Fitbit-only control group did not. Conclusions: The findings demonstrate that a remote intervention delivered through health coaching, text messages, and Fitbit can promote maintenance of MVPA after a structured program for cancer survivors. However, use of a Fitbit alone was not sufficient to prevent expected decline in MVPA. Additional research is warranted to examine long-term impacts and efficacy in a more diverse population of cancer survivors. Implications for Cancer Survivors: Use of a wearable tracker alone may not be sufficient for exercise maintenance among cancer survivors after transition to an independent program. Additional planning for relapse prevention is recommended.", "links": [ { "caption": "URL", "url": "https://link.springer.com/article/10.1007/s11764-019-00831-4", "newWindow": true } ] }, { "title": "Performance of a commercial multi-sensor wearable (Fitbit Charge HR) in measuring physical activity and sleep in healthy children", "author": "Godino, Job G.; Wing, David; de Zambotti, Massimiliano; Baker, Fiona C.; Bagot, Kara; Inkelis, Sarah; Pautz, Carina; Higgins, Michael; Nichols, Jeanne; Brumback, Ty; Chevance, Guillaume; Colrain, Ian M.; Patrick, Kevin; Tapert, Susan F.", "year": "2020", "journalProceedings": "PLOS ONE", "category": "Validation", "devices": "Charge HR", "population": "Children", "dataUsed": "Sleep", "abstract": "Purpose This study sought to assess the performance of the Fitbit Charge HR, a consumer-level multi-sensor activity tracker, to measure physical activity and sleep in children. Methods 59 healthy boys and girls aged 9–11 years old wore a Fitbit Charge HR, and accuracy of physical activity measures were evaluated relative to research-grade measures taken during a combination of 14 standardized laboratory- and field-based assessments of sitting, stationary cycling, treadmill walking or jogging, stair walking, outdoor walking, and agility drills. Accuracy of sleep measures were evaluated relative to polysomnography (PSG) in 26 boys and girls during an at-home unattended PSG overnight recording. The primary analyses included assessment of the agreement (biases) between measures using the Bland-Altman method, and epoch-by-epoch (EBE) analyses on a minute-by-minute basis. Results Fitbit Charge HR underestimated steps ({\\~{}}11.8 steps per minute), heart rate ({\\~{}}3.58 bpm), and metabolic equivalents ({\\~{}}0.55 METs per minute) and overestimated energy expenditure ({\\~{}}0.34 kcal per minute) relative to research-grade measures (p{\\textless} 0.05). The device showed an overall accuracy of 84.8{\\%} for classifying moderate and vigorous physical activity (MVPA) and sedentary and light physical activity (SLPA) (sensitivity MVPA: 85.4{\\%}; specificity SLPA: 83.1{\\%}). Mean estimates of bias for measuring total sleep time, wake after sleep onset, and heart rate during sleep were 14 min, 9 min, and 1.06 bpm, respectively, with 95.8{\\%} sensitivity in classifying sleep and 56.3{\\%} specificity in classifying wake epochs.", "links": [ { "caption": "URL", "url": "https://dx.plos.org/10.1371/journal.pone.0237719", "newWindow": true } ] }, { "title": "Use of Fitbit Technology Does Not Impact Health Biometrics in a Community of Older Adults", "author": "Hong, Estee; Jakacic, Alexa N.; Sahoo, Arpan; Breyman, Erica; Ukegbu, Gabriel; Tabacof, Laura; Sachs, David; Migliaccio, John; Phipps, Colette; Schwartz, Jennifer; Capasso, Marikay; Carpenter, Mae; Putrino, David", "year": "2020", "journalProceedings": "Telemedicine and e-Health", "category": "Intervention", "devices": "Zip", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Introduction: To evaluate if the offering of Fitbit technology led to changes in cardiovascular health metrics in a cohort of older adults. Methods: A retrospective cohort study was developed in two community-embedded health monitoring sites, located in aggregate housing communities for older adults in Westchester County, NY. Participants included older adults (55 years or older) enrolled in the Telehealth Intervention Programs for Seniors (TIPS) initiative, a community-embedded remote patient monitoring initiative. Weekly blood pressure, heart rate, weight, and blood oxygenation were taken on all participants. For participants who accepted a Fitbit Zip device, a weekly step count was also collected. Results: Ninety-four TIPS participants were offered Fitbit technology. Thirty participants accepted the technology and used it for a minimum of 6 months. No significant differences in any of the regularly acquired biometrics were noted between Fitbit users and non-Fitbit users. Across all participants, regardless of Fitbit use, there was a significant decrease in systolic blood pressure (SBP) over time. Conclusions: Neither Fitbit Zip ownership or compliance to Fitbit Zip usage influenced any of the biometrics taken as part of the TIPS. However, participation in the TIPS initiative may have an overall positive effect on SBP in older adults.", "links": [ { "caption": "URL", "url": "https://www.liebertpub.com/doi/10.1089/tmj.2020.0060", "newWindow": true } ] }, { "title": "Investigating the within-person relationships between activity levels and sleep duration using Fitbit data", "author": "Liao, Yue; Robertson, Michael C.; Winne, Andrea; Wu, Ivan H. C.; Le, Thuan A.; Balachandran, Diwakar D.; Basen-Engquist, Karen M.", "year": "2020", "journalProceedings": "Translational Behavioral Medicine", "category": "Intervention", "devices": "Flex 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "The advancement of wearable technologies provides opportunities to continuously track individuals' daily activity levels and sleep patterns over extended periods of time. These data are useful in examining the reciprocal relationships between physical activity and sleep at the intrapersonal level. The purpose of this study is to test the bidirectional relationships between daily activity levels and sleep duration. The current study analyzed activity and sleep data collected from a Fitbit device as part of a 6 month employer-sponsored weight loss program. A total of 105 overweight/obese adults were included (92{\\%} female, 70{\\%} obese, and 44{\\%} Hispanic). Multilevel models were used to examine (a) whether daily active and sedentary minutes predicted that night's sleep duration and (b) whether sleep duration predicted active and sedentary minutes the following day. Potential extended effects were explored by using a 2 day average of the activity minutes/sleep duration as the predictor. No significant relationships between active minutes and sleep duration were found on a daily basis. However, having less sleep over two nights than one's usual level was associated with an increased likelihood of engaging in some physical activity the following day. There was a significant bidirectional negative association between sedentary minutes and sleep duration for both the daily and 2 day models. Data from wearable trackers, such as Fitbit, can be used to investigate the daily within-person relationship between activity levels and sleep duration. Future studies should investigate other sleep metrics that may be obtained from wearable trackers, as well as potential moderators and mediators of daily activity levels and sleep.", "links": [ { "caption": "URL", "url": "https://academic.oup.com/tbm/advance-article/doi/10.1093/tbm/ibaa071/5871745", "newWindow": true } ] }, { "title": "Towards a Functional Approach to the Assessment of Daily Life Physical Activity in Children: Are the PAQ-C and Fitbit Flex-2 Technically Adequate?", "author": "Venetsanou, Fotini; Emmanouilidou, Kyriaki; Soutos, Konstantinos; Sotiriou, Sofoklis A.; Bastida, Leire; Moya, Ana; Kambas, Antonis", "year": "2020", "journalProceedings": "International Journal of Environmental Research and Public Health", "category": "Usability", "devices": "Flex 2", "population": "Children", "dataUsed": "Intensity", "abstract": "{\\textless}p{\\textgreater}Considering the need for functional physical activity (PA) measures in PA settings, this study sought to determine the technical adequacy of the Physical Activity Questionnaire for Older Children (PAQ-C) and the Fitbit Flex-2, two instruments with promising features for wide use, using the Actigraph GT3X+ accelerometer as the criterion reference. A total of 218 Greek children (94 boys, 124 girls; mean age = 10.99 ± 1.52 years) volunteered to join in. Participants wore the PA trackers for seven days and completed the PAQ-C. Moreover, a sub-group (n = 60) recompleted the PAQ-C after a week. Results revealed acceptable internal consistency and excellent test–retest reliability for the PAQ-C. Regarding concurrent validity, weak to moderate correlations with PA parameters recorded by the GT3X+ were revealed for the total PAQ-C and were excellent for the Flex-2, while a Bland–Altman plot indicated good agreement. Finally, in alignment with relevant literature, significant gender, but no age, differences were found in participants' PA records in all the tools applied. The above results support the use of the PAQ-C and the Fitbit Flex-2 in children. Considering that they shed light into different parameters of children's habitual PA, their combined utilisation, providing comprehensive information, is strongly recommended.{\\textless}/p{\\textgreater}", "links": [ { "caption": "URL", "url": "https://www.mdpi.com/1660-4601/17/22/8503", "newWindow": true } ] }, { "title": "Minimal Detectable Change Thresholds and Responsiveness of Zephyr Bioharness and Fitbit Charge Devices", "author": "Nazari, Goris; MacDermid, Joy C.", "year": "2020", "journalProceedings": "Journal of Strength and Conditioning Research", "category": "Validation", "devices": "Charge", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Nazari, G and MacDermid, JC. Minimal detectable change thresholds and responsiveness of zephyr bioharness and Fitbit Charge devices. J Strength Cond Res 34(1): 257-263, 2020-The aim of the current study was to define the minimal detectable change (MDC) thresholds for Zephyr Bioharness (ZB) and Fitbit Charge Heart Rate (FC-HR) variables and to establish the internal responsiveness of ZB and FC-HR devices in terms of their HR, respiratory rate variables, and number of steps taken variables, in a healthy sample of men and women at resting, submaximal activity and throughout recovery phases. A total of sixty participants (30 women, 48 ± 15) and (30 men, 48 ± 15) were recruited using stratified convenience and snowball sampling approaches from our university student, staff, and faculty population. At rest, MDC90 values of ±4.89 and ±5.15 were noted for ZB and FC-HR devices, respectively. Throughout the recovery, thresholds of ±8.14 for ZB and 8.74 for FC-HR were reported. During the submaximal phases, scores of ±8.18 and ±9.35 were established for ZB and FC-HR, respectively. From a resting to a submaximal state, the standardized response means (SRMs) for ZB and FC-HR variables exhibited large responsiveness of SRMZB-HR = 4.42; SRMFC-HR = 4.04. In addition, the ZB respiratory rate variable showed the largest effect size of SRMZB-RR = 2.55. Similarly, the large effect size of SRMFC-ST = 1.76 was reported for the FC-HR steps taken variable. From a submaximal to a recovery state, the SRMs for ZB and FC-HR variables demonstrated effect sizes of SRMZB-HR = -3.10; SRMFC-HR = -3.12. Furthermore, the ZB respiratory rate variable displayed similar internal responsiveness measures of SRMZB-RR = -2.45. To conclude, Similar MDC HR thresholds can be expected using the ZB and FC-HR devices and that the two devices demonstrated large internal responsiveness in our healthy male and female cohort when transitioning from resting to submaximal states and vice-versa. Our findings suggest that the ZB and FC-HR devices can be used in monitoring performance improvements or deterioration over time and would allow qualified personnel in assessing the effectiveness of exercise programs in healthy individuals.", "links": [ { "caption": "URL", "url": "http://journals.lww.com/10.1519/JSC.0000000000002136", "newWindow": true } ] }, { "title": "Twitter-Based Social Support Added to Fitbit Self-Monitoring for Decreasing Sedentary Behavior: Protocol for a Randomized Controlled Pilot Trial With Female Patients From a Women's Heart Clinic", "author": "Oppezzo, Marily; Tremmel, Jennifer; Desai, Manisha; Baiocchi, Michael; Ramo, Danielle; Cullen, Mark; Prochaska, Judith J.", "year": "2020", "journalProceedings": "JMIR Research Protocols", "category": "Usability", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Prolonged sitting is an independent risk behavior for the development of chronic disease. With most interventions focusing on physical activity and exercise, there is a separate need for investigation into innovative and accessible interventions to decrease sedentary behavior throughout the day. Twitter is a social media platform with application for health communications and fostering of social support for health behavior change. Objective: This pilot study aims to test the feasibility, acceptability, and preliminary efficacy of delivering daily behavior change strategies within private Twitter groups to foster peer-to-peer support and decrease sedentary behavior throughout the day in women. The Twitter group was combined with a Fitbit for self-monitoring activity and compared to a Fitbit-only control group. Methods: In a 2-group design, participants were randomized to a Twitter + Fitbit treatment group or a Fitbit-only control group. Participants were recruited via the Stanford Research Repository System, screened for eligibility, and then invited to an orientation session. After providing informed consent, they were randomized. All participants received 13 weeks of tailored weekly step goals and a Fitbit. The treatment group participants, placed in a private Twitter support group, received daily automated behavior change “tweets” informed by theory and regular automated encouragement via text to communicate with the group. Fitbit data were collected daily throughout the treatment and follow-up period. Web-based surveys and accelerometer data were collected at baseline, treatment end (13 weeks), and at 8.5 weeks after the treatment. Results: The initial study design funding was obtained from the Women's Heart Clinic and the Stanford Clayman Institute. Funding to run this pilot study was received from the National Institutes of Health's National Heart, Lung, and Blood Institute under Award Number K01HL136702. All procedures were approved by Stanford University's Institutional Review Board, {\\#}32127 in 2018, prior to beginning data collection. Recruitment for this study was conducted in May 2019. Of the 858 people screened, 113 met the eligibility criteria, 68 came to an information session, and 45 consented to participate in this pilot study. One participant dropped out of the intervention, and complete follow-up data were obtained from 39 of the 45 participants (87{\\%} of the sample). Data were collected over 6 months from June to December 2019. Feasibility, acceptability, and preliminary efficacy results are being analyzed and will be reported in the winter of 2021. Conclusions: This pilot study is assessing the feasibility, acceptability, and preliminary efficacy of delivering behavior change strategies in a Twitter social support group to decrease sedentary behavior in women. These findings will inform a larger evaluation. With an accessible, tailorable, and flexible platform, Twitter-delivered interventions offer potential for many treatment variations and titrations, thereby testing the effects of different behavior change strategies, peer-group makeups, and health behaviors of interest.", "links": [ { "caption": "URL", "url": "https://www.researchprotocols.org/2020/12/e20926", "newWindow": true } ] }, { "title": "Impact of placement of fitbit HR under laboratory and free-living conditions", "author": "Jung, Hyun Chul; Kang, Minsoo; Lee, Nan Hee; Jeon, Soeun; Lee, Sukho", "year": "2020", "journalProceedings": "Sustainability (Switzerland)", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Wrist-worn activity monitors have become accessible for measuring physical activities, but an activity monitor's accuracy worn at different placements is not well understood. This study aimed to examine the differences in measurements of heart rates, step counts, and calories estimated from the fitness tracker worn at different locations and the accuracy of Fitbit HR against criterion measures. Thirty-two healthy adults participated in this study. Participants wore Fitbit HR at four different locations (right proximal, distal, and left proximal, distal). Treadmill exercise consisted of five 5-min phases including slow walking and jogging. Free-living activities involved ten 5-min activities with four different intensities. We found that the placement of Fitbit HR has no significant influence on the measurement outcomes overall. However, significant differences were observed in the step counts between left and right while climbing stairs (p = 0.003) and sports activities (p {\\textless} 0.001). The accuracy of Fitbit HR measurements against the criterion measure was moderate. However, we found out that Fitbit HR overestimated the calories regardless of their positions and activity types. In conclusion, the different placements of Fitbit HR do not have a significant influence on the measurements and Fitbit HR was moderately associated with criterion reference devices for measures of heart rate and steps.", "links": [ { "caption": "URL", "url": "https://www.mdpi.com/2071-1050/12/16/6306", "newWindow": true } ] }, { "title": "Using Fitbit Competitions to Increase Physical Activity in College Students", "author": "Ramirez, Omar; Bernhardt, Vipa", "year": "2020", "journalProceedings": "The Macksey Journal", "category": "Intervention", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "According to the World Health Organization (2018), physical inactivity is a leading risk factors for global mortality. Only one in four college students meet the current federal Physical Activity Guidelines for Americans of engaging in ≥150 minutes per week of exercise (Raynor and Jankowiak, 2010). The advancement of technology, especially in the acquisition of physical activity data, combined with the desire for virtual social interaction, has not been studied in college students. It is unknown if physical activity trackers and accompanying mobile apps, such as Fitbit, could motivate college students to be more physically active. It was hypothesized that wearing a Fitbit watch and participating in weekly competitions via the app will increase weekly step counts in college students as compared with a simple pedometer.", "links": [ { "caption": "URL", "url": "https://www.mackseyjournal.org/publications/vol1/iss1/77", "newWindow": true } ] }, { "title": "Self-efficacy and physical activity in overweight and obese adults participating in a worksite weight loss intervention: Multistate modeling of wearable device data", "author": "Robertson, Michael C.; Green, Charles E.; Liao, Yue; Durand, Casey P.; Basen-Engquist, Karen M.", "year": "2020", "journalProceedings": "Cancer Epidemiology Biomarkers and Prevention", "category": "Intervention", "devices": "Flex 2", "population": "Adults", "dataUsed": "Intensity", "abstract": "Background: Physical activity is associated with a reduced risk of numerous types of cancer and plays an important role in maintaining a healthy weight. Wearable physical activity trackers may supplement behavioral intervention and enable researchers to study how determinants like self-efficacy predict physical activity patterns over time. Methods: We used multistate models to evaluate how selfefficacy predicted physical activity states among overweight and obese individuals participating in a 26-week weight loss program (N = 96). We specified five states to capture physical activity patterns: (i) active (i.e., meeting recommendations for 2 weeks), (ii) insufficiently active, (iii) nonvalid wear, (iv) favorable transition (i.e., improvement in physical activity over 2 weeks), and (v) unfavorable transition.We calculated HRs of transition probabilities by self-efficacy, body mass index, age, and time. Results: The average prevalence of individuals in the active, insufficiently active, and nonvalid wear states was 13{\\%}, 44{\\%}, and 16{\\%}, respectively. Low self-efficacy negatively predicted entering an active state [HR, 0.51; 95{\\%} confidence interval (CI), 0.29- 0.88]. Obesity negatively predicted making a favorable transition out of an insufficiently active state (HR, 0.61; 95{\\%} CI, 0.40-0.91). Older participants were less likely to transition to the nonvalid wear state (HR, 0.53; 95{\\%} CI, 0.30-0.93). Device nonwear increased in the second half of the intervention (HR, 1.73; 95{\\%} CI, 1.07-2.81). Conclusions: Self-efficacy is an important predictor for clinically relevant physical activity change in overweight and obese individuals. Multistate modeling is useful for analyzing longitudinal physical activity data. Impact: Multistate modeling can be used for statistical inference of covariates and allow for explicit modeling of nonvalid wear.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/31871110/", "newWindow": true } ] }, { "title": "Comparison of Physical Activity Measures Derived From the Fitbit Flex and the ActiGraph GT3X+ in an Employee Population With Chronic Knee Symptoms", "author": "Semanik, Pamela; Lee, Jungwha; Pellegrini, Christine A.; Song, Jing; Dunlop, Dorothy D.; Chang, Rowland W.", "year": "2020", "journalProceedings": "ACR Open Rheumatology", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Intensity", "abstract": "Background/Purpose: There is increasing public health interest in the objective measurement of free-living physical activity in persons with arthritis, but research grade wearable monitors can be expensive. We therefore sought to examine the accuracy of the affordable personal monitor (Fitbit Flex) by comparing that output with data from the GT3X+ accelerometer (amount of time spent in light, moderate, and vigorous PA) worn simultaneously for 7 days; high accuracy would support substitution with this less expensive personal activity monitor in future arthritis research. Methods: Subjects (n=35) with chronic knee symptoms were recruited for a pilot intervention study using Fitbits to increase physical activity in employees with chronic knee symptoms at an urban insurance corporation. Subjects simultaneously wore for 7 days a Fitbit Flex (wrist-worn)and ActiGraph GT3x+ (waist-worn) as part of 12-week postintervention follow-upevaluation. Fitbit Flex data was regularly stored on a research storage service (Fitabase)by participants. Correlation tables were constructed to examine the association between the amount of time spent in activity intensity categories(Light, Moderate, Vigorous, and Moderate/Vigorous - the last three categories in bouts of 10 min or more). Due to discrepancy in wear time (Fitbit worn for 24hours/day, ActiGraph unit was not), sedentary minutes were not included for comparison. Comparisons were calculated by matching Fitabase data from calendar days Fitbit was worn with data from valid monitoring days (≥10hours wear time) of the ActiGraph. Results: Participants at baseline were primarily female (69{\\%}), Caucasian (57{\\%}), with mean age 52 years, BMI 32 kg/m2. Table I provides an overview of the definitions and distinctions of each measured activity intensity level. Table 2 provides the comparison of data from Fitbit Flex and ActiGraph GT3x+, including Spearman correlations, within each of the activity intensity categories. Conclusion: The individual intensity category correlations for the two devices are not strong. However, the bouted Moderate-Vigorous activity categories are moderately well correlated. One potential confounder includes the wrist vs waist location of the monitoring device during data collection. This moderate correlation of moderate/vigorous intensity between devices is reassuring to consumers/researchers using the Fitbit to track bouted higher intensity activities, but may not support substitution of the ActiGraph with the Fitbit in population studies that seek to accurately measure all levels of activity and sedentary time.", "links": [ { "caption": "URL", "url": "https://onlinelibrary.wiley.com/doi/abs/10.1002/acr2.11099", "newWindow": true } ] }, { "title": "Participant perceptions on a Fitbit and Facebook intervention for adolescent and young adult cancer survivors: A qualitative study", "author": "Miropolsky, Evelina", "year": "2020", "journalProceedings": "University of Washington", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Among cancer survivors, physical activity (PA) is associated with reductions in cancer\r\nrecurrence, morbidity, and mortality. Most adolescent and young adult (AYA) survivors do not\r\nattain adequate PA. Digital modalities, specifically wearable activity monitors with a paired\r\nmobile application (app) and private social media group for support offer a promising approach\r\nfor promoting PA among AYAs. We conducted a pilot randomized controlled trial of this\r\nintervention. To evaluate its acceptability and perceptions of the intervention components, we\r\nconducted qualitative interviews with those in the intervention.", "links": [ { "caption": "URL", "url": "https://digital.lib.washington.edu:443/researchworks/handle/1773/46526", "newWindow": true } ] }, { "title": "Physical activity pattern and Fitbit use in working patients with hip and/or knee osteoarthritis throughout an intervention: an exploratory descriptive study - Osteoarthritis and Cartilage", "author": "E. Östlind, A. Sant'Anna, F. Eek, K. Stigmar, E. Ekvall Hansson", "year": "2020", "journalProceedings": "Osteoarthritis and Cartilage", "category": "Intervention", "devices": "Flex 2", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Osteoarthritis (OA) is the most common joint disorder in the world, causing pain and reduced function as well as an increased risk of comorbidities. Physical activity (PA) is the standard treatment but a majority does not meet the recommended levels. Monitoring PA with a commercial accelerometer could promote PA but increased knowledge on PA pattern and usage of a commercial activity tracker is needed. The aims were to describe PA pattern in patients with hip/knee OA, measured with a Fitbit and also to describe the use of the Fitbit.\r\n", "links": [ { "caption": "URL", "url": "https://www.oarsijournal.com/article/S1063-4584(20)30339-3/abstract", "newWindow": true } ] }, { "title": "Fitbit\\textregistered-derived evidence of enhanced mobility of patients with knee osteoarthritis treated with triamcinolone acetonide extended release: Results from a phase 3B, single-ARM, open-label study", "author": "Huffman, K. M.; Spitzer, A.; Richmond, J. C.; Gomoll, A.; Kraus, V. B.; Jones, D. G.; Concoff, A.; Cinar, A.; Kelley, S.", "year": "2020", "journalProceedings": "Osteoarthritis and Cartilage", "category": null, "devices": null, "population": null, "dataUsed": null, "abstract": "Purpose: Repeated treatment with intra-articular corticosteroid is often used to manage recurrent osteoarthritis (OA) symptoms. Triamcinolone acetonide extended-release (TA-ER) is an intra-articular injection approved for the treatment of pain in patients with knee OA. We conducted a Phase 3b, single-arm, open-label study and assessed safety and exploratory efficacy endpoints in patients with knee OA treated with repeat administration of TA-ER (NCT03046446). This analysis assessed the clinical benefit of treatment based on patient mobility defined as numbers of steps per day. Method(s): Enrolled patients were aged {\\textgreater}=40 years with symptomatic knee OA for {\\textgreater}=6 months, ACR clinical and radiological diagnosis, Kellgren-Lawrence Grade 2-4, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain total sum score {\\textgreater}=6, and index-knee pain for {\\textgreater}15 days during the past month. Patients received the 1st injection of TA-ER on Day 1 and the 2nd injection at either Week 12, 16, 20, or 24. This analysis collected patient mobility data within the 1st injection period only. Patient movements were analyzed with a measured function device [Fitbit] that was worn beginning at least 7 days prior to Day 1 and continuing to the end of Week 12. Weekly average step values were recorded if 3 out of 7 daily values were obtained with a lower threshold of 1000 steps per day. Exploratory efficacy endpoints included WOMAC A (pain) assessed every 4 weeks. A mixed effects model was generated to assess an outcome of change from baseline in steps per day using data from Weeks 4, 8, and 12. The primary independent variable of interest was change from baseline in WOMAC-A average pain scale. Other covariates examined were age, sex, baseline body mass index (BMI), region, month of the start of trial (categorical), visit (continuous, indicating time in weeks from receiving 1st injection), baseline global physical activity questionnaire (GPAQ) values (average MET-minutes of moderate or vigorous physical activity per day), baseline steps per day, and baseline average pain scale. Result(s): 208 patients were enrolled, most patients were female (55.8{\\%}), and 67.8{\\%} had radiographic OA severity of Kellgren-Lawrence Grade 3 or 4 at baseline. Mean age was 60.8 years and mean BMI was 31.4 kg/m2. The baseline mean WOMAC pain score was 2.17. Patients treated with TA-ER exhibited an immediate improvement in mobility as shown by increases in weekly mean steps per day (Figure 1) and mean change from baseline in weekly mean steps per day (Figure 2). Treatment with TA-ER was effective with mean changes from baseline in WOMAC-A scores of -1.4, -1.2, and -0.8 at Weeks 4, 8, and 12, respectively. A statistically significant greater change in step count from baseline was observed in association with larger decreases in WOMAC pain scores, male gender, lower BMI, lower baseline GPAQ average MET, and lower baseline steps per day. For every 1-unit decrease (from baseline) in mean WOMAC pain scale, the mean step count per day increased by 339 steps (95{\\%} confidence limits, 58 and 620 steps) (Figure 3). [Formula presented] [Formula presented] [Formula presented] Conclusion(s): Patients with knee OA treated with TA-ER exhibited a decrease in pain and increased mobility as measured by their Fitbit. Limitations to this study include incomplete patient adherence to usage of the Fitbit device and that this was an open-label study with no control arm for comparison. Furthermore, it is unclear why the patient population had a relatively high mean number of steps per day at baseline. This study shows the feasibility of using personal fitness monitors to assess the effectiveness of treatments for OA. Sponsor: This study was funded by Flexion Therapeutics (Burlington, MA, USA).Copyright {\\textcopyright} 2020", "links": [ { "caption": "URL", "url": "http://www.oarsijournal.com/article/S1063458420308451/fulltext", "newWindow": true }, { "caption": "URL", "url": "http://www.oarsijournal.com/article/S1063458420308451/abstract", "newWindow": true }, { "caption": "URL", "url": "https://www.oarsijournal.com/article/S1063-4584(20)30845-1/abstract", "newWindow": true } ] }, { "title": "Accuracy and precision of three consumer-grade motion sensors during overground and treadmill walking in people with parkinson disease: Cross-sectional comparative study", "author": "Lai, Byron; Sasaki, Jeffer E.; Jeng, Brenda; Cederberg, Katie L.; Bamman, Marcas M.; Motl, Robert W.", "year": "2020", "journalProceedings": "JMIR Rehabilitation and Assistive Technologies", "category": null, "devices": null, "population": null, "dataUsed": null, "abstract": "Background: Wearable motion sensors are gaining popularity for monitoring free-living physical activity among people with Parkinson disease (PD), but more evidence supporting the accuracy and precision of motion sensors for capturing step counts is required in people with PD. Objective: This study aimed to examine the accuracy and precision of 3 common consumer-grade motion sensors for measuring actual steps taken during prolonged periods of overground and treadmill walking in people with PD. Methods: A total of 31 ambulatory participants with PD underwent 6-min bouts of overground and treadmill walking at a comfortable speed. Participants wore 3 devices (Garmin Vivosmart 3, Fitbit One, and Fitbit Charge 2 HR), and a single researcher manually counted the actual steps taken. Accuracy and precision were based on absolute and relative metrics, including intraclass correlation coefficients (ICCs) and Bland-Altman plots. Results: Participants walked 628 steps over ground based on manual counting, and Garmin Vivosmart, Fitbit One, and Fitbit Charge 2 HR devices had absolute (relative) error values of 6 (6/628, 1.0{\\%}), 8 (8/628, 1.3{\\%}), and 30 (30/628, 4.8{\\%}) steps, respectively. ICC values demonstrated excellent agreement between manually counted steps and steps counted by both Garmin Vivosmart (0.97) and Fitbit One (0.98) but poor agreement for Fitbit Charge 2 HR (0.47). The absolute (relative) precision values for Garmin Vivosmart, Fitbit One, and Fitbit Charge 2 HR were 11.1 (11.1/625, 1.8{\\%}), 14.7 (14.7/620, 2.4{\\%}), and 74.4 (74.4/598, 12.4{\\%}) steps, respectively. ICC confidence intervals demonstrated low variability for Garmin Vivosmart (0.96 to 0.99) and Fitbit One (0.93 to 0.99) but high variability for Fitbit Charge 2 HR (–0.57 to 0.74). The Fitbit One device maintained high accuracy and precision values for treadmill walking, but both Garmin Vivosmart and Fitbit Charge 2 HR (the wrist-worn devices) had worse accuracy and precision for treadmill walking. Conclusions: The waist-worn sensor (Fitbit One) was accurate and precise in measuring steps with overground and treadmill walking. The wrist-worn sensors were accurate and precise only during overground walking. Similar research should inform the application of these devices in clinical research and practice involving patients with PD.", "links": [ { "caption": "URL", "url": "https://rehab.jmir.org/2020/1/e14059", "newWindow": true } ] }, { "title": "A SECONDARY DATA ANALYSIS ON THE RELATIONSHIP BETWEEN BREAST CANCER SURVIVORS' SYMPTOMS AND PHYSICAL ACTIVITY LEVELS MEASURED BY FITBIT (STEPS/DAY)", "author": "Merritt, Alexis", "year": "2020", "journalProceedings": "East Carolina University ", "category": null, "devices": null, "population": null, "dataUsed": null, "abstract": null, "links": [ { "caption": "URL", "url": "https://thescholarship.ecu.edu/handle/10342/8696", "newWindow": true } ] }, { "title": "The Physical Activity Wearables in the Police Force (PAW-Force) study: acceptability and impact", "author": "Buckingham, Sarah Ann; Morrissey, Karyn; Williams, Andrew James; Price, Lisa; Harrison, John", "year": "2020", "journalProceedings": "BMC Public Health", "category": "Intervention", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "Background: Policing is a highly stressful and increasingly sedentary occupation. The study aim was to assess the acceptability and impact of a mobile health (mHealth) technology intervention (Fitbit{\\textregistered} activity monitor and ‘Bupa Boost' smartphone app) to promote physical activity (PA) and reduce sedentary time in the police force. Methods: Single-group, pre-post, mixed methods pilot study. Police officers and staff (n = 180) were recruited from two police forces in South West England. Participants used the technology for 12 weeks (an ‘individual' then ‘social' phase) followed by 5 months of optional use. Data sources included Fitbit{\\textregistered}-recorded objective step count, questionnaire surveys and semi-structured interviews (n = 32). Outcome assessment points were baseline (week 0), mid-intervention (week 6), post-intervention (week 12) and follow-up (month 8). Paired t-tests were used to investigate changes in quantitative outcomes. Qualitative analysis involved framework and thematic analysis. Results: Changes in mean daily step count were non-significant (p {\\textgreater} 0.05), but self-reported PA increased in the short term (e.g. + 465.4 MET-minutes/week total PA baseline to week 12, p = 0.011) and longer term (e.g. + 420.5 MET-minutes/week moderate-to-vigorous PA baseline to month 8, p = 0.024). The greatest impact on behaviour was perceived by less active officers and staff. There were no significant changes in sedentary time; the qualitative findings highlighted the importance of context and external influences on behaviour. There were no statistically significant changes (all p-values {\\textgreater} 0.05) in any secondary outcomes (physical and mental health-related quality of life, perceived stress and perceived productivity), with the exception of an improvement in mental health-related quality of life (SF-12 mental component score + 1.75 points, p = 0.020) from baseline to month 8. Engagement with and perceived acceptability of the intervention was high overall, but a small number of participants reported negative physical (skin irritation) and psychological (feelings of guilt and anxiety) consequences of technology use. Individual app features (such as goal-setting and self-monitoring) were generally preferred to social components (social comparison, competitions and support). Conclusions: mHealth technology is an acceptable and potentially impactful intervention for increasing PA in the police force. The intervention was less useful for reducing sedentary time and the impact on secondary outcomes is unclear. Trial registration: NCT03169179 (registered 30th May 2017).", "links": [ { "caption": "URL", "url": "https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09776-1", "newWindow": true } ] }, { "title": "Examining the Effects of a Fitbit Treatment Package on the Physical Activity for Adults with Intellectual Disabilities", "author": "Peck, Kimberly", "year": "2020", "journalProceedings": "Western Michigan University", "category": null, "devices": null, "population": null, "dataUsed": null, "abstract": null, "links": [ { "caption": "URL", "url": "https://scholarworks.wmich.edu/dissertations/3600", "newWindow": true } ] }, { "title": "Harnessing wearable device data to improve state-level real-time surveillance of influenza-like illness in the USA: a population-based study", "author": "Radin, Jennifer M.; Wineinger, Nathan E.; Topol, Eric J.; Steinhubl, Steven R.", "year": "2020", "journalProceedings": "The Lancet Digital Health", "category": null, "devices": null, "population": null, "dataUsed": null, "abstract": "Background: Acute infections can cause an individual to have an elevated resting heart rate (RHR) and change their routine daily activities due to the physiological response to the inflammatory insult. Consequently, we aimed to evaluate if population trends of seasonal respiratory infections, such as influenza, could be identified through wearable sensors that collect RHR and sleep data. Methods: We obtained de-identified sensor data from 200 000 individuals who used a Fitbit wearable device from March 1, 2016, to March 1, 2018, in the USA. We included users who wore a Fitbit for at least 60 days and used the same wearable throughout the entire period, and focused on the top five states with the most Fitbit users in the dataset: California, Texas, New York, Illinois, and Pennsylvania. Inclusion criteria included having a self-reported birth year between 1930 and 2004, height greater than 1 m, and weight greater than 20 kg. We excluded daily measurements with missing RHR, missing wear time, and wear time less than 1000 min per day. We compared sensor data with weekly estimates of influenza-like illness (ILI) rates at the state level, as reported by the US Centers for Disease Control and Prevention (CDC), by identifying weeks in which Fitbit users displayed elevated RHRs and increased sleep levels. For each state, we modelled ILI case counts with a negative binomial model that included 3-week lagged CDC ILI rate data (null model) and the proportion of weekly Fitbit users with elevated RHR and increased sleep duration above a specified threshold (full model). We also evaluated weekly change in ILI rate by linear regression using change in proportion of elevated Fitbit data. Pearson correlation was used to compare predicted versus CDC reported ILI rates. Findings: We identified 47 249 users in the top five states who wore a Fitbit consistently during the study period, including more than 13{\\textperiodcentered}3 million total RHR and sleep measures. We found the Fitbit data significantly improved ILI predictions in all five states, with an average increase in Pearson correlation of 0{\\textperiodcentered}12 (SD 0{\\textperiodcentered}07) over baseline models, corresponding to an improvement of 6{\\textperiodcentered}3–32{\\textperiodcentered}9{\\%}. Correlations of the final models with the CDC ILI rates ranged from 0{\\textperiodcentered}84 to 0{\\textperiodcentered}97. Week-to-week changes in the proportion of Fitbit users with abnormal data were associated with week-to-week changes in ILI rates in most cases. Interpretation: Activity and physiological trackers are increasingly used in the USA and globally to monitor individual health. By accessing these data, it could be possible to improve real-time and geographically refined influenza surveillance. This information could be vital to enact timely outbreak response measures to prevent further transmission of influenza cases during outbreaks. Funding: Partly supported by the US National Institutes of Health National Center for Advancing Translational Sciences.", "links": [ { "caption": "URL", "url": "https://www.thelancet.com/journals/landig/article/PIIS2589-7500(19)30222-5/fulltext", "newWindow": true } ] }, { "title": "Evaluation of an Activity Tracker to Detect Seizures Using Machine Learning", "author": "Mittlesteadt, Jackson; Bambach, Sven; Dawes, Alex; Wentzel, Evelynne; Debs, Andrea; Sezgin, Emre; Digby, Dan; Huang, Yungui; Ganger, Andrea; Bhatnagar, Shivani; Ehrenberg, Lori; Nunley, Sunjay; Glynn, Peter; Lin, Simon; Rust, Steve; Patel, Anup D.", "year": "2020", "journalProceedings": "Journal of Child Neurology", "category": "Usability", "devices": "Charge 2", "population": "Children,Adolescents", "dataUsed": "Heart Rate", "abstract": "Currently, the tracking of seizures is highly subjective, dependent on qualitative information provided by the patient and family instead of quantifiable seizure data. Usage of a seizure detection device to potentially detect seizure events in a population of epilepsy patients has been previously done. Therefore, we chose the Fitbit Charge 2 smart watch to determine if it could detect seizure events in patients when compared to continuous electroencephalographic (EEG) monitoring for those admitted to an epilepsy monitoring unit. A total of 40 patients were enrolled in the study that met the criteria between 2015 and 2016. All seizure types were recorded. Twelve patients had a total of 53 epileptic seizures. The patient-aggregated receiver operating characteristic curve had an area under the curve of 0.58 [0.56, 0.60], indicating that the neural network models were generally able to detect seizure events at an above-chance level. However, the overall low specificity implied a false alarm rate that would likely make the model unsuitable in practice. Overall, the use of the Fitbit Charge 2 activity tracker does not appear well suited in its current form to detect epileptic seizures in patients with seizure activity when compared to data recorded from the continuous EEG.", "links": [ { "caption": "URL", "url": "http://journals.sagepub.com/doi/10.1177/0883073820937515", "newWindow": true } ] }, { "title": "Using Fitbit data to examine factors that affect daily activity levels of college students", "author": "Wang, Cheng; Lizardo, Omar; Hachen, David S.", "year": "2021", "journalProceedings": "PLOS ONE", "category": "Measurement", "devices": "Charge HR", "population": "Adults", "dataUsed": "Intensity", "abstract": "To date, the effect of both fixed and time-varying individual, social, psychological, environmental, and behavioral characteristics on temporal growth trends in physical activity (PA) among younger individuals remains an under-studied topic. In this paper, we address this gap in previous work by examining how temporal growth trends in PA respond to changing social, environmental, and behavioral characteristics using a large sample of college students (N = 692) who participated in the NetHealth project at the University of Notre Dame and from which fine-grained longitudinal data on physical activity and social interaction were collected unobtrusively via the use of wearables for 637 days (August 16, 2015 to May 13, 2017). These data are augmented by periodic survey data on fixed sociodemographic and psychological variables. We estimate latent growth-curve models for daily activity status, steps, active minutes, and activity calories. We find evidence of both a generalized friendship paradox and a peer effect for PA, with the average PA level of study participants' contacts being on average larger than their own, and with this average level exerting a statistically significant effect on individual PA levels. Notably, there was limited evidence of temporal growth in PA across the 637 days of observation with null temporal effects for three out of the four PA indicators, except for daily steps taken. Finally, we find that social, psychological, and behavioral factors (e.g., large network size, high extroversion levels, and more courses taken) are systematically associated with higher PA levels in this sample. Overall, our findings highlight the importance of social, environmental, and behavioral factors (such as peer networks and daily sociability) in modulating the dynamics of PA levels among college students.", "links": [ { "caption": "URL", "url": "https://dx.plos.org/10.1371/journal.pone.0244747", "newWindow": true } ] }, { "title": "Feasibility and acceptability of a technology-based, rural weight management intervention in older adults with obesity", "author": "Batsis, John A.; Petersen, Curtis L.; Clark, Matthew M.; Cook, Summer B.; Kotz, David; Gooding, Tyler L.; Roderka, Meredith N.; Al-Nimr, Rima I.; Pidgeon, Dawna; Haedrich, Ann; Wright, K. C.; Aquila, Christina; Mackenzie, Todd A.", "year": "2021", "journalProceedings": "BMC Geriatrics", "category": "Intervention", "devices": "Alta", "population": "Older Adults", "dataUsed": "Intensity", "abstract": "Background: Older adults with obesity residing in rural areas have reduced access to weight management programs. We determined the feasibility, acceptability and preliminary outcomes of an integrated technology-based health promotion intervention in rural-living, older adults using remote monitoring and synchronous video-based technology. Methods: A 6-month, non-randomized, non-blinded, single-arm study was conducted from October 2018 to May 2020 at a community-based aging center of adults aged ≥65 years with a body mass index (BMI) ≥30 kg/m2. Weekly dietitian visits focusing on behavior therapy and caloric restriction and twice-weekly physical therapist-led group strength, flexibility and balance training classes were delivered using video-conferencing to participants in their homes. Participants used a Fitbit Alta HR for remote monitoring with data feedback provided by the interventionists. An aerobic activity prescription was provided and monitored. Results: Mean age was 72.9±3.9 years (82{\\%} female). Baseline anthropometric measures of weight, BMI, and waist circumference were 97.8±16.3 kg, 36.5±5.2 kg/m2, and 115.5±13.0 cm, respectively. A total of 142 participants were screened (n=27 ineligible), and 53 consented. There were nine dropouts (17{\\%}). Overall satisfaction with the trial (4.7+ 0.6, scale: 1 (low) to 5 (high)) and with Fitbit (4.2+ 0.9) were high. Fitbit was worn an average of 81.7±19.3{\\%} of intervention days. In completers, mean weight loss was 4.6±3.5 kg or 4.7±3.5{\\%} (p{\\textless} 0.001). Physical function measures of 30-s sit-to-stand repetitions increased from 13.5±5.7 to 16.7±5.9 (p{\\textless} 0.001), 6-min walk improved by 42.0±77.3 m (p=0.005) but no differences were observed in gait speed or grip strength. Subjective measures of late-life function improved (3.4±4.7 points, p{\\textless} 0.001). Conclusions: A technology-based obesity intervention is feasible and acceptable to older adults with obesity and may lead to weight loss and improved physical function. Clinical trial registration: Registered on Clinicaltrials.gov {\\#}NCT03104205. Registered on April 7, 2017. First participant enrolled on October 1st, 2018.", "links": [ { "caption": "URL", "url": "https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-020-01978-x", "newWindow": true } ] }, { "title": "Annual rhythms in adults' lifestyle and health (ARIA): protocol for a 12-month longitudinal study examining temporal patterns in weight, activity, diet, and wellbeing in Australian adults", "author": "Curtis, Rachel G.; Olds, Timothy; Fraysse, Fran{\\c{c}}ois; Dumuid, Dorothea; Hendrie, Gilly A.; Esterman, Adrian; Brown, Wendy J.; Ferguson, Ty; Lagiseti, Rajini; Maher, Carol A.", "year": "2021", "journalProceedings": "BMC Public Health", "category": "Intervention", "devices": null, "population": "Adults", "dataUsed": "Intensity", "abstract": "Background: Almost one in three Australian adults are now obese, and the rate continues to rise. The causes of obesity are multifaceted and include environmental, cultural and lifestyle factors. Emerging evidence suggests there may be temporal patterns in weight gain related, for example, to season and major festivals such as Christmas, potentially due to changes in diet, daily activity patterns or both. The aim of this study is to track the annual rhythm in body weight, 24 h activity patterns, dietary patterns, and wellbeing in a cohort of Australian adults. In addition, through data linkage with a concurrent children's cohort study, we aim to examine whether changes in children's body mass index, activity and diet are related to those of their parents. Methods: A community-based sample of 375 parents aged 18 to 65 years old, residing in or near Adelaide, Australia, and who have access to a Bluetooth-enabled mobile device or a computer and home internet, will be recruited. Across a full year, daily activities (minutes of moderate to vigorous physical activity, light physical activity, sedentary behaviour and sleep) will be measured using wrist-worn accelerometry (Fitbit Charge 3). Body weight will be measured daily using Fitbit wifi scales. Self-reported dietary intake (Dietary Questionnaire for Epidemiological Studies V3.2), and psychological wellbeing (WHOQOL-BREF and DASS-21) will be assessed eight times throughout the 12-month period. Annual patterns in weight will be examined using Lowess curves. Associations between changes in weight and changes in activity and diet compositions will be examined using repeated measures multi-level models. The associations between parent's and children's weight, activity and diet will be investigated using multi-level models. Discussion: Temporal factors, such as day type (weekday or weekend day), cultural celebrations and season, may play a key role in weight gain. The aim is to identify critical opportunities for intervention to assist the prevention of weight gain. Family-based interventions may be an important intervention strategy. Trial registration: Australia New Zealand Clinical Trials Registry, identifier ACTRN12619001430123. Prospectively registered on 16 October 2019.", "links": [ { "caption": "URL", "url": "https://link.springer.com/article/10.1186/s12889-020-10054-3", "newWindow": true } ] }, { "title": "A digital lifestyle behaviour change intervention for the prevention of type 2 diabetes: a qualitative study exploring intuitive engagement with real-time glucose and physical activity feedback", "author": "Whelan, Maxine E.; Denton, Francesca; Bourne, Claire L. A.; Kingsnorth, Andrew P.; Sherar, Lauren B.; Orme, Mark W.; Esliger, Dale W.", "year": "2021", "journalProceedings": "BMC Public Health", "category": "Intervention", "devices": "Charge 2", "population": "Adults", "dataUsed": "Intensity", "abstract": "Mobile health technologies have advanced to now allow monitoring of the acute physiological responses to lifestyle behaviours. Our aim was to explore how people engaged with real-time feedback on their physical activity and glucose levels over several weeks. Semi-structured interviews with 26 participants (61.5{\\%} female, 56.6 years) at moderate-to-high risk of developing type 2 diabetes were conducted. Interviews were completed after participants took part in an intervention comprising a flash glucose monitor (Freestyle Libre) and a physical activity monitor (Fitbit Charge 2). Purposive sampling ensured representation of ages, genders and group allocations. Inductive thematic analysis revealed how individuals intuitively used, interpreted and acted on feedback from wearable technologies. Six key themes emerged: triggers of engagement with the technologies, links between behaviour and health, lack of confidence, changes to movement behaviours, changes to diet and barriers to lifestyle behaviour change. Our findings demonstrate that accessing behavioural and physiological feedback can increase self-awareness of how lifestyle impacts short-term health. Some participants noticed a link between the feedback presented by the two devices and changed their behaviour but many did not. Training and educational support, as well as efforts to optimize how feedback is presented to users, are needed to sustain engagement and behaviour change. Extensions of this work to involve people with diabetes are also warranted to explore whether behavioural and physiological feedback in parallel can encourage better diabetes self-management. ISRCTN Registry, ISRCTN17545949 , 12/05/2017, prospectively registered.", "links": [ { "caption": "URL", "url": "https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09740-z", "newWindow": true } ] }, { "title": "Measuring Daily Compliance with Physical Activity Tracking in Ambulatory Surgery Patients: Comparative Analysis of Five Compliance Criteria (Preprint)", "author": "Kelly, Ryan; Jones, Simon; Price, Blaine; Katz, Dmitri; McCormick, Ciaran; Pearce, Oliver", "year": "2021", "journalProceedings": "JMIR mHealth and uHealth", "category": null, "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Physical activity trackers such as the Fitbit can allow clinicians to monitor the recovery of their patients following surgery. An important issue when analyzing activity tracker data is to determine patients' daily compliance with wearing their assigned device, using an appropriate criterion to determine a valid day of wear. However, it is currently unclear as to how different criteria can affect the reported compliance of patients recovering from ambulatory surgery. Investigating this issue can help to inform the use of activity data by revealing factors that may impact compliance calculations. Objective: This study aimed to understand how using different criteria can affect the reported compliance with activity tracking in ambulatory surgery patients. It also aimed to investigate factors that explain variation between the outcomes of different compliance criteria. Methods: A total of 62 patients who were scheduled to undergo total knee arthroplasty (TKA, ie, knee replacement) volunteered to wear a commercial Fitbit Zip activity tracker over an 8-week perioperative period. Patients were asked to wear the Fitbit Zip daily, beginning 2 weeks prior to their surgery and ending 6 weeks after surgery. Of the 62 patients who enrolled in the study, 20 provided Fitbit data and underwent successful surgery. The Fitbit data were analyzed using 5 different daily compliance criteria, which consider patients as compliant with daily tracking if they either register {\\textgreater}0 steps in a day, register {\\textgreater}500 steps in a day, register at least one step in 10 different hours of the day, register {\\textgreater}0 steps in 3 distinct time windows, or register {\\textgreater}0 steps in 3 out of 4 six-hour time windows. The criteria were compared in terms of compliance outcomes produced for each patient. Data were explored using heatmaps and line graphs. Linear mixed models were used to identify factors that lead to variation between compliance outcomes across the sample. Results: The 5 compliance criteria produce different outcomes when applied to the patients' data, with an average 24{\\%} difference in reported compliance between the most lenient and strictest criteria. However, the extent to which each patient's reported compliance was impacted by different criteria was not uniform. Some individuals were relatively unaffected, whereas others varied by up to 72{\\%}. Wearing the activity tracker as a clip-on device, rather than on the wrist, was associated with greater differences between compliance outcomes at the individual level (P=.004, r=.616). This effect was statistically significant (P{\\textless}.001) in the first 2 weeks after surgery. There was also a small but significant main effect of age on compliance in the first 2 weeks after surgery (P=.040). Gender and BMI were not associated with differences in individual compliance outcomes. Finally, the analysis revealed that surgery has an impact on patients' compliance, with noticeable reductions in activity following surgery. These reductions affect compliance calculations by discarding greater amounts of data under strict criteria. Conclusions: This study suggests that different compliance criteria cannot be used interchangeably to analyze activity data provided by TKA patients. Surgery leads to a temporary reduction in patients' mobility, which affects their reported compliance when strict thresholds are used. Reductions in mobility suggest that the use of lenient compliance criteria, such as {\\textgreater}0 steps or windowed approaches, can avoid unnecessary data exclusion over the perioperative period. Encouraging patients to wear the device at their wrist may improve data quality by increasing the likelihood of patients wearing their tracker and ensuring that activity is registered in the 2 weeks after surgery. Trial Registration: ClinicalTrials.gov NCT03518866; https://clinicaltrials.gov/ct2/show/NCT03518866", "links": [ { "caption": "URL", "url": "https://mhealth.jmir.org/2021/1/e22846", "newWindow": true } ] }, { "title": "A Prospective Observational Study Comparing Effects of Call Schedules on Surgical Resident Sleep and Physical Activity Using the Fitbit", "author": "Kelly-Schuette, Kathrine; Shaker, Tamer; Carroll, Joseph; Davis, Alan T.; Wright, G. Paul; Chung, Mathew", "year": "2021", "journalProceedings": "Journal of Graduate Medical Education", "category": "Measurement", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Background Surgical residency training has an extended tradition of long hours. Residency programs use a variety of call schedules to combat resident fatigue and sleep deprivation while maintaining adherence to duty hour restrictions. Nonetheless, there is a paucity of data regarding objective measurements of sleep during the different call schedules included in general surgery training.", "links": [ { "caption": "URL", "url": "http://dx.doi.org/10.4300/JGME-D-20-00304.1", "newWindow": true } ] }, { "title": "Phase II trial evaluating efficacy of a Fitbit program for improving the health of endometrial cancer survivors", "author": "Rahimy, Elham; Usoz, Melissa; von Eyben, Rie; Fujimoto, Dylann; Watanabe, Darla; Karam, Amer; Jairam-Thodla, Arati; Mills, Margaret; Dorigo, Oliver; Diver, Elisabeth Jenefer; Teng, Nelson; English, Diana; Kidd, Elizabeth", "year": "2021", "journalProceedings": "Gynecologic Oncology", "category": "Usability,Intervention", "devices": "Alta", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Goals", "abstract": "Background: Despite the favorable prognosis of early stage endometrial cancer, mortality from cardiovascular disease is high. We aimed to evaluate the efficacy of a Fitbit program to improve physical activity in endometrial cancer survivors. Methods: Eligible patients were diagnosed with stage IA-IIIA endometrial adenocarcinoma, ≥3 months out from treatment. Participants received a Fitbit Alta and were randomized to receive communication via telephone or electronic methods (email/text). Communication was every two weeks for two months, then once during months four and five. Average daily steps were assessed weekly for nine months. Results: The 46 analyzable patients demonstrated a baseline of 5641 median daily average steps. Average steps increased by 22{\\%} at 6 months but decreased to baseline by nine months. Baseline activity level (daily steps and walks per week) was the greatest predictor of activity level. Only the telephone intervention participants demonstrated increased activity level at several timepoints, although not maintained by nine months. BMI was unchanged. There was mild improvement in physical and social well-being in those with low baseline well-being (p = 0.009 and 0.014, respectively), regardless of intervention group. Emotional well-being correlated with step count (p = 0.005). Conclusions: Activity level was low and mildly improved on the Fitbit program with the telephone intervention, but effects did not persist by study completion. The program had the greatest impact on a select group of telephone intervention patients with high baseline walking frequency and low baseline step count. Others may require more intense intervention to promote more robust/persistent lifestyle changes.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33551199/", "newWindow": true } ] }, { "title": "Performance of Fitbit Charge 3 against polysomnography in measuring sleep in adolescent boys and girls", "author": "Menghini, Luca; Yuksel, Dilara; Goldstone, Aimee; Baker, Fiona C.; de Zambotti, Massimiliano", "year": "2021", "journalProceedings": "Chronobiology International", "category": "Validation", "devices": "Charge 3", "population": "Adolescents", "dataUsed": "Sleep,Heart Rate", "abstract": "We evaluated the performance of Fitbit Charge 3™ (FC3), a multi-sensor commercial sleep-tracker, for measuring sleep in adolescents against gold-standard laboratory polysomnography (PSG). Single-night PSG and FC3 sleep outcomes were compared in thirty-nine adolescents (22 girls; 16–19 years), 12 of whom presented with clinical/subclinical DSM-5 insomnia symptoms (7 girls). Discrepancy analysis, Bland–Altman plots, and epoch-by-epoch analyses were used to evaluate FC3 performance. The influence of several factors potentially affecting FC3 performance (e.g., sex, age, body mass index, firmware version, and magnitude of heart rate changes between consecutive PSG epochs) was also tested. In the sample of healthy adolescents, FC3 systematically underestimated PSG total sleep time by about 11 min and sleep efficiency by 2.5%, and overestimated wake after sleep onset by 9 min. Proportional biases were detected for “light” and “deep” sleep duration, resulting in significant underestimation of these parameters for those participants having longer PSG N1+ N2 and N3 durations, respectively. No significant systematic bias was detected for sleep efficiency and sleep onset latency. Epoch-by-epoch analysis showed sleep-stage sensitivity (average proportion of PSG epochs correctly classified by the device for a given sleep stage) of 68% for wake, 78% for “light” sleep, 59% for “deep” sleep, and 69% for rapid eye movement (REM) sleep in healthy sleepers. Similar results were found in the sample of adolescents with insomnia symptoms. Body mass index was positively associated with FC3-PSG discrepancies in wake after sleep onset (R2 = .16, p = .048). The magnitude of the heart rate acceleration/deceleration between consecutive PSG epochs was an important factor affecting FC3 classifications of sleep stages. Our results are in line with a general trend in the literature, suggesting better performance for the recently introduced multi-sensor devices compared to motion-only devices, although further developments are needed to improve accuracy in sleep stage classification and wake detection. Further insight is needed to determine factors potentially affecting device performance, such as accuracy and reliability (consistency of performance over time), in different samples and conditions.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33792456/", "newWindow": true } ] }, { "title": "A standardized framework for testing the performance of sleep-tracking technology: step-by-step guidelines and open-source code", "author": "Menghini, Luca; Cellini, Nicola; Goldstone, Aimee; Baker, Fiona C.; de Zambotti, Massimiliano", "year": "2021", "journalProceedings": "Sleep", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "Sleep-tracking devices, particularly within the consumer sleep technology (CST) space, are increasingly used in both research and clinical settings, providing new opportunities for large-scale data collection in highly ecological conditions. Due to the fast pace of the CST industry combined with the lack of a standardized framework to evaluate the performance of sleep trackers, their accuracy and reliability in measuring sleep remains largely unknown. Here, we provide a step-by-step analytical framework for evaluating the performance of sleep trackers (including standard actigraphy), as compared with gold-standard polysomnography (PSG) or other reference methods. The analytical guidelines are based on recent recommendations for evaluating and using CST from our group and others (de Zambotti and colleagues; Depner and colleagues), and include raw data organization as well as critical analytical procedures, including discrepancy analysis, Bland-Altman plots, and epoch-by-epoch analysis. Analytical steps are accompanied by open-source R functions (depicted at https://sri-human-sleep.github.io/sleep-trackers-performance/AnalyticalPipeline_v1.0.0.html). In addition, an empirical sample dataset is used to describe and discuss the main outcomes of the proposed pipeline. The guidelines and the accompanying functions are aimed at standardizing the testing of CSTs performance, to not only increase the replicability of validation studies, but also to provide ready-to-use tools to researchers and clinicians. All in all, this work can help to increase the efficiency, interpretation, and quality of validation studies, and to improve the informed adoption of CST in research and clinical settings.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/32882005/", "newWindow": true } ] }, { "title": "Comparing the accuracy of sleep staging data from a new wearable sleep electroencephalography device versus the Fitbit Charge 3 with polysomnography as reference", "author": "Suzuki, Yoko; Abe, Takashi; Kawana, Fusae; Okabe, Satomi; Kokubo, Toshio; Hoshino, Kazuya; Baba, Misao; Fujiwara, Masaaki; Yanagisawa, Masashi", "year": "2021", "journalProceedings": "Clinical Neurophysiology", "category": "Validation", "devices": "Charge 3", "population": "Adults", "dataUsed": "Sleep", "abstract": "Although sleep disorders are a common social problem, polysomnography (PSG), the gold standard in sleep diagnostics, can be burdensome and may interfere with natural sleep. We have developed a high-precision wearable electroencephalography (EEG) device for objectively measuring sleep at home. Actigraphy devices with the capability of measuring heart rate variability can also be used to evaluate sleep stages at home (e.g., Fitbit Charge 3). However, the accuracy of these inhome devices has not yet been compared. We hypothesized that the accuracy of our wearable sleep EEG device would be higher than that of the Fitbit Charge 3.", "links": [ { "caption": "URL", "url": "https://linkinghub.elsevier.com/retrieve/pii/S1388245721002005", "newWindow": true } ] }, { "title": "Monitoring Beliefs and Physiological Measures Using Wearable Sensors and Smartphone Technology Among Students at Risk of COVID-19: Protocol for a mHealth Study", "author": "Christine; Clingan, Caroline; Gilley, Kristen; Rozwadowski, Michelle; Gainsburg, Izzy; Bradley, Christina; Barabas, Jenny; Sandford, Erin; Olesnavich, Mary; Tyler, Jonathan; Mayer, Caleb; DeMoss, Matthew; Flora, Christopher; Forger, Daniel B.; Cunningham, Julia Lee; Tewari, Muneesh; Choi, Sung Won", "year": "2021", "journalProceedings": "JMIR Res Protoc 2021;10(6):e29561 https://www.researchprotocols.org/2021/6/e29561", "category": "Usability", "devices": "Charge 3", "population": "Adults", "dataUsed": "Energy Expenditure,Sleep,Heart Rate", "abstract": "Background: The COVID-19 pandemic has significantly impacted lives and greatly affected the mental health and public safety of an already vulnerable population—college students. Social distancing and isolation measures have presented challenges to students' mental health. mHealth apps and wearable sensors may help monitor students at risk of COVID-19 and support their mental well-being. Objective: This study aimed to monitor students at risk of COVID-19 by using a wearable sensor and a smartphone-based survey. Methods: We conducted a prospective study on undergraduate and graduate students at a public university in the Midwest United States. Students were instructed to download the Fitbit, Social Rhythms, and Roadmap 2.0 apps onto their personal smartphone devices (Android or iOS). Subjects consented to provide up to 10 saliva samples during the study period. Surveys were administered through the Roadmap 2.0 app at five timepoints: at baseline, 1 month later, 2 months later, 3 months later, and at study completion. The surveys gathered information regarding demographics, COVID-19 diagnoses and symptoms, and mental health resilience, with the aim of documenting the impact of COVID-19 on the college student population. Results: This study enrolled 2158 college students between September 2020 and January 2021. Subjects are currently being followed-up for 1 academic year. Data collection and analysis are currently underway. Conclusions: This study examined student health and well-being during the COVID-19 pandemic and assessed the feasibility of using a wearable sensor and a survey in a college student population, which may inform the role of our mHealth tools in assessing student health and well-being. Finally, using data derived from a wearable sensor, biospecimen collection, and self-reported COVID-19 diagnosis, our results may provide key data toward the development of a model for the early prediction and detection of COVID-19. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788", "links": [ { "caption": "URL", "url": "https://www.researchprotocols.org/2021/6/e29561", "newWindow": true } ] }, { "title": "Co-occurrence of pain and dyspnea in Veterans with COPD: Relationship to functional status and a pilot study of neural correlates using structural and functional magnetic resonance imaging", "author": "Moy, Marilyn L.; Daniel, Rinu A.; Rivera, Paola N. Cruz; Mongiardo, Maria A.; Goldstein, Rebekah L.; Higgins, Diana M.; Salat, David H.", "year": "2021", "journalProceedings": "PLOS ONE", "category": "Medical", "devices": "Zip", "population": "Older Adults", "dataUsed": "Steps,Intensity", "abstract": "Persons with COPD experience co-occurring dyspnea and pain. Little is known about the relationship between symptom co-occurrence with physical activity (PA) and exercise. Novel diagnostic tools are needed for accurate symptom discrimination. In this secondary analysis, we examined relationships between baseline assessments of pain, dyspnea, objectively measured PA, and exercise capacity in persons with COPD who previously enrolled in three PA studies. Pain was assessed with the bodily pain domain of the Veterans RAND-36 (VR-36), and dyspnea with the modified Medical Research Council (mMRC) scale. Average daily step count was assessed with the Omron HJ-720ITC or FitBit Zip pedometer, and exercise capacity with 6-minute walk test (6MWT). We also conducted a pilot neuroimaging study. Neuroimaging data were acquired on a Siemens 3-Tesla Magnetom Prismafit whole-body scanner. Analysis of variance assessed trends in daily step count and 6MWT distance across categories of co-occurring pain and dyspnea. General linear models examined relationships between cortical thickness and resting state functional connectivity (fc) with symptoms and functional status. In 373 Veterans, 98% were male with mean age 70.5± 8.3 years and FEV1% predicted 59 ± 21%. Compared to those with no co-occurrence of pain and dyspnea, those with co-occurrence walked 1,291–1,444 fewer steps per day and had an 80–85 m lower 6MWT distance. Ten males participated in the pilot neuroimaging study. Predominant findings were that lower cortical thickness and greater fc were associated with higher pain and dyspnea, p<0.05. Greater cortical thickness and lower fc were associated with higher daily step count and 6MWT distance, p<0.05. Regional patterns of associations differed for pain and dyspnea, suggesting that cortical thickness and fc may discriminate symptoms. Co-occurring dyspnea and pain in COPD are associated with significant reductions in PA and exercise capacity. It may be feasible for neuroimaging markers to discriminate between pain and dyspnea.", "links": [ { "caption": "URL", "url": "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254653", "newWindow": true } ] }, { "title": "Feasibility, preliminary efficacy, and accessibility of a twitter-based social support group vs Fitbit only to decrease sedentary behavior in women", "author": "Oppezzo, M. A.; Tremmel, J. A.; Kapphahn, K.; Desai, M.; Baiocchi, M.; Sanders, M.; Prochaska, J. J.", "year": "2021", "journalProceedings": "Internet Interventions", "category": "Usability,Intervention", "devices": "Inspire", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background\nHealth behavior change interventions delivered by social media allow for real-time, dynamic interaction, peer social support, and experimenter-provided content.\n\nAims\nWe tested the feasibility, acceptability, and preliminary efficacy of a novel Twitter-based walking break intervention with daily behavior change strategies and prompts for social support, combined with a Fitbit, vs. Fitbit alone.\n\nMethods\nIn a 2-group pilot, 45 sedentary women from a heart clinic were randomized to Twitter + Fitbit activity tracker (Tweet4Wellness, n = 23) or Fitbit-only (control, n = 22). All received a Fitbit Inspire and 13 weeks of tailored weekly step goals. Tweet4Wellness consisted of a private Twitter support group, with daily automated behavior change “tweets” informed by behavior change theory, and encouragement to communicate within the group. Feasibility outcomes included recruitment and enrollment numbers, implementation challenges, and number and type of help requests from participants throughout the study period. Preliminary efficacy outcomes provided by Fitbit data were sedentary minutes, number of hours with >250 steps, maximum sitting bout, weighted sedentary median bout length, total steps, intensity minutes (>3.0 METS), and ratio of time spent sitting-to-moving. Acceptability outcomes included level of Twitter participation within Tweet4Wellness, and Likert scale plus open-ended survey questions on enjoyment and perceived effectiveness of intervention components. Survey data on acceptability of the features of the intervention were collected at 13 weeks (end-of-treatment [EOT]) and 22 weeks (follow-up).\n\nResults\nThe study was feasible, with addressable implementation challenges. Tweet4Wellness participants changed significantly from baseline to EOT relative to control participants on number of active hours p = .018, total steps p = .028, and ratio of sitting-to-moving, p = .014. Only sitting-to-moving was significant at follow-up (p = .047). Among Tweet4Wellness participants, each tweet sent during treatment was associated with a 0.11 increase in active hours per day (p = .04) and a 292-step increase per day (p < .001). Tweet4Wellness participants averaged 54.8 (SD = 35.4) tweets, totaling 1304 tweets, and reported liking the accountability and peer support provided by the intervention.\n\nConclusion\nA Twitter-delivered intervention for promoting physical activity among inactive women from a heart clinic was feasible, acceptable, and demonstrated preliminary efficacy in increasing daily active hours, daily total steps, and the ratio of sitting-to-moving from pre to post for the intervention compared with the control. Lessons learned from this pilot suggest that the next study should expand the recruitment pool, refine the intervention to increase group engagement, and select active hours, total steps, and ratio of sitting-to-movement as primary sedentary behavior measures.", "links": [ { "caption": "URL", "url": "https://linkinghub.elsevier.com/retrieve/pii/S221478292100066X", "newWindow": true } ] }, { "title": "Using fitbit as an mHealth intervention tool to promote physical activity: Potential challenges and solutions", "author": "Balbim, Guilherme M.; Marques, Isabela G.; Marquez, David X.; Patel, Darshilmukesh; Sharp, Lisa K.; Kitsiou, Spyros; Nyenhuis, Sharmilee M.", "year": "2021", "journalProceedings": "JMIR mHealth and uHealth", "category": "Review", "devices": "Charge HR", "population": "Older Adults,Adults", "dataUsed": "Steps,Intensity", "abstract": "Consumer-based physical activity (PA) trackers, also known as wearables, are increasingly being used in research studies as intervention or measurement tools. One of the most popular and widely used brands of PA trackers is Fitbit. Since the release of the first Fitbit in 2009, hundreds of experimental studies have used Fitbit devices to facilitate PA self-monitoring and behavior change via goal setting and feedback tools. Fitbit's ability to capture large volumes of PA and physiological data in real time creates enormous opportunities for researchers. At the same time, however, it introduces a number of challenges (eg, technological, operational, logistical), most of which are not sufficiently described in study publications. Currently, there are no technical reports, guidelines, nor other types of publications discussing some of these challenges and offering guidance to researchers on how to best incorporate Fitbit devices in their study design and intervention to achieve their research goals. As a result, researchers are often left alone to discover and address some of these issues during the study through “trial and error.” This paper aims to address this gap. Drawing on our cumulative experience of conducting multiple studies with various Fitbit PA trackers over the years, we present and discuss various key challenges associated with the use of Fitbit PA trackers in research studies. Difficulties with the use of Fitbit PA trackers are encountered throughout the entire research process. Challenges and solutions are categorized in 4 main categories: study preparation, intervention delivery, data collection and analysis, and study closeout. Subsequently, we describe a number of empirically tested strategies used in 4 of our interventional studies involving participants from a broad range of demographic characteristics, racial/ethnic backgrounds, and literacy levels. Researchers should be prepared to address challenges and issues in a timely fashion to ensure that the Fitbit effectively assists participants and researchers in achieving research and outcome goals.", "links": [] }, { "title": "Implementation of a school-based Fitbit program for youth with Autism Spectrum Disorder: A feasibility study", "author": "Garcia, J. M.; Leahy, N.; Brazendale, K.; Quelly, S.; Lawrence, S.", "year": "2021", "journalProceedings": "Disability and health journal", "category": "Usability,Survey Research", "devices": "Inspire", "population": "Adolescents", "dataUsed": "Steps,Energy Expenditure,Distance,Sleep", "abstract": "Background: School settings may be optimal for physical activity interventions for youth with Autism Spectrum Disorder (ASD). Additionally, consumer-based fitness trackers may encourage youth with ASD to increase their physical activity levels, however, no studies have examined whether a fitness tracker program would be feasible in youth with ASD. Objective: To examine the feasibility of a 12-week school-based Fitbit{\\textcopyright} program for youth with ASD. Methods: Six classroom teachers and their students (n = 45) were provided with Fitbit fitness trackers to wear over 12-weeks. Classroom teachers monitored student tracker use and completed open-ended surveys to describe both their experience and their students' experience with the fitness trackers. Results: Out of the 45 eligible students, 42 (94%) opted to participate in the study. All six teachers and 32 (76%) of the 42 students wore the fitness tracker daily over 12 weeks. Teachers reported that students were most interested in tracking their daily steps, and the short batter life, and account set-up were the biggest challenges to students. All six teachers felt that this program could have long-term sustainability, especially if tracker use could be incorporated into school curriculum and classroom activities. Conclusions: A school-based Fitbit program appears to be both feasible, and well-accepted by students with ASD. Future work should evaluate the preliminary efficacy of this type of program.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33011113/", "newWindow": true } ] }, { "title": "Use of Fitbit Devices in Physical Activity Intervention Studies Across the Life Course: Narrative Review", "author": "St Fleur, R. G.; St George, S. M.; Leite, R.; Kobayashi, M.; Agosto, Y.; Jake-Schoffman, D. E.", "year": "2021", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention,Review,Measurement", "devices": "Classic,Ultra,One,Zip,Flex,Charge,Charge HR,Flex 2,Alta", "population": "Older Adults,Children,Adults,Adolescents", "dataUsed": "Steps,Intensity,Goals,Sleep,Heart Rate,Food", "abstract": "Background: Commercial off-the-shelf activity trackers (eg, Fitbit) allow users to self-monitor their daily physical activity (PA), including the number of steps, type of PA, amount of sleep, and other features. Fitbits have been used as both measurement and intervention tools. However, it is not clear how they are being incorporated into PA intervention studies, and their use in specific age groups across the life course is not well understood. Objective: This narrative review aims to characterize how PA intervention studies across the life course use Fitbit devices by synthesizing and summarizing information on device selection, intended use (intervention vs measurement tool), participant wear instructions, rates of adherence to device wear, strategies used to boost adherence, and the complementary use of other PA measures. This review provides intervention scientists with a synthesis of information that may inform future trials involving Fitbit devices. Methods: We conducted a search of the Fitabase Fitbit Research Library, a database of studies published between 2012 and 2018. Of the 682 studies available on the Fitabase research library, 60 interventions met the eligibility criteria and were included in this review. A supplemental search in PubMed resulted in the inclusion of 15 additional articles published between 2019 and 2020. A total of 75 articles were reviewed, which represented interventions conducted in childhood; adolescence; and early, middle, and older adulthood. Results: There was considerable heterogeneity in the use of Fitbit within and between developmental stages. Interventions for adults typically required longer wear periods, whereas studies on children and adolescents tended to have more limited device wear periods. Most studies used developmentally appropriate behavior change techniques and device wear instructions. Regardless of the developmental stage and intended Fitbit use (ie, measurement vs intervention tool), the most common strategies used to enhance wear time included sending participants reminders through texts or emails and asking participants to log their steps or synchronize their Fitbit data daily. The rates of adherence to the wear time criteria were reported using varying metrics. Most studies supplemented the use of Fitbit with additional objective or self-reported measures for PA. Conclusions: Overall, the heterogeneity in Fitbit use across PA intervention studies reflects its relative novelty in the field of research. As the use of monitoring devices continues to expand in PA research, the lack of uniformity in study protocols and metrics of reported measures represents a major issue for comparability purposes. There is a need for increased transparency in the prospective registration of PA intervention studies. Researchers need to provide a clear rationale for the use of several PA measures and specify the source of their main PA outcome and how additional measures will be used in the context of Fitbit-based interventions.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34047705/", "newWindow": true } ] }, { "title": "Feasibility of a Latin Dance Program with mHealth for Middle-Aged and Older Latinxs (BAILA TECH)", "author": "Marques, Isabela G.; Kitsiou, Spyros; Gerber, Ben S.; Buchholz, Susan W.; Bustamante, Eduardo E.; Marquez, David X.", "year": "2021", "journalProceedings": "Translational Journal of the American College of Sports Medicine", "category": "Intervention", "devices": "Charge 2", "population": "Older Adults", "dataUsed": "Steps,Intensity,Goals,Sleep,Heart Rate", "abstract": "ABSTRACT\nLatinxs have low levels of leisure-time physical activity. Mobile health (mHealth) interventions incorporating smartphone apps and wearable PA tracking devices represent a promising solution for promoting leisure-time physical activity. This study aimed to assess the feasibility of the BAILA TECH intervention for middle-aged and older Latinxs. A single-group feasibility trial was conducted for 16 wk, with 2-h in-person sessions twice a week. The Fitbit® Charge 2TM, its mo- bile application, and text messages (TM) were added to the BAILAMOSTM Latin dance program. In-person sessions comprised Fitbit instructional sessions, the BAILAMOSTM program, and technology Q&A sessions. Participants wore Fitbits for 19 wk (16 wk of BAILAMOSTM + two baseline and one posttest week) and re- ceived TM for the last 12 wk. Feasibility was assessed by recruitment capability (e.g., recruitment rates), acceptability and suitability (e.g., enjoyment), and re- sources (e.g., monetary requirements). Feasibility metrics were tracked and interviews were conducted, descriptive statistics and themes are presented. Fifty-one middle- aged and older Latinxs were screened, 28 (55%) were eligible, and 20 (39%) started the intervention (female n = 15, M age = 67 yr old, SD = 7.1). All 20 participants wore their wearable PA tracker for 19 wk, and 3 participants (15%) dropped out of the in-person sessions. Participants reported enjoyment of learning and wearing the Fitbit, dancing, and receiving TM. Total intervention costs were $9572, not includ- ing personnel costs. A Latin dance program with mHealth components appears feasible for middle-aged and older Latinxs.", "links": [] }, { "title": "The Association Between Logging Steps Using a Website, App, or Fitbit and Engaging With the 10,000 Steps Physical Activity Program: Observational Study", "author": "Rayward, A. T.; Vandelanotte, C.; Van Itallie, A.; Duncan, M. J.", "year": "2021", "journalProceedings": "Journal of medical Internet research", "category": "Usability,Intervention,Measurement", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Engagement is positively associated with the effectiveness of digital health interventions. It is unclear whether tracking devices that automatically synchronize data (eg, Fitbit) produce different engagement levels compared with manually entering data. Objective: This study examines how different step logging methods in the freely available 10,000 Steps physical activity program differ according to age and gender and are associated with program engagement. Methods: A subsample of users (n=22,142) of the free 10,000 Steps physical activity program were classified into one of the following user groups based on the step-logging method: Website Only (14,617/22,142, 66.01%), App Only (2100/22,142, 9.48%), Fitbit Only (1705/22,142, 7.7%), Web and App (2057/22,142, 9.29%), and Fitbit Combination (combination of web, app, and Fitbit; 1663/22,142, 7.51%). Generalized linear regression and binary logistic regression were used to examine differences between user groups' engagement and participation parameters. The time to nonusage attrition was assessed using Cox proportional hazards regression. Results: App Only users were significantly younger and Fitbit user groups had higher proportions of women compared with other groups. The following outcomes were significant and relative to the Website Only group. The App Only group had fewer website sessions (odds ratio [OR] −6.9, 95% CI −7.6 to −6.2), whereas the Fitbit Only (OR 10.6, 95% CI 8.8-12.3), Web and App (OR 1.5, 95% CI 0.4-2.6), and Fitbit Combination (OR 8.0; 95% CI 6.2-9.7) groups had more sessions. The App Only (OR −0.7, 95% CI −0.9 to −0.4) and Fitbit Only (OR −0.5, 95% CI −0.7 to −0.2) groups spent fewer minutes on the website per session, whereas the Fitbit Combination group (OR 0.2, 95% CI 0.0-0.5) spent more minutes. All groups, except the Fitbit Combination group, viewed fewer website pages per session. The mean daily step count was lower for the App Only (OR −201.9, 95% CI −387.7 to −116.0) and Fitbit Only (OR −492.9, 95% CI −679.9 to −305.8) groups but higher for the Web and App group (OR 258.0, 95% CI 76.9-439.2). The Fitbit Only (OR 5.0, 95% CI 3.4-6.6), Web and App (OR 7.2, 95% CI 5.9-8.6), and Fitbit Combination (OR 15.6, 95% CI 13.7-17.5) groups logged a greater number of step entries. The App Only group was less likely (OR 0.65, 95% CI 0.46-0.94) and other groups were more likely to participate in Challenges. The mean time to nonusage attrition was 35 (SD 26) days and was lower than average in the Website Only and App Only groups and higher than average in the Web and App and Fitbit Combination groups. Conclusions: Using a Fitbit in combination with the 10,000 Steps app or website enhanced engagement with a real-world physical activity program. Integrating tracking devices that synchronize data automatically into real-world physical activity interventions is one strategy for improving engagement.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34142966/", "newWindow": true } ] }, { "title": "A Comparison of Sedentary Behavior as Measured by the Fitbit and ActivPAL in College Students", "author": "Carpenter, C.; Yang, C. H.; West, D.", "year": "2021", "journalProceedings": "International journal of environmental research and public health", "category": "Validation,Measurement", "devices": "Charge 3", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Sleep,Heart Rate", "abstract": "Previous studies have examined the ability of the Fitbit to measure physical activity compared to research-grade accelerometers. However, few have examined whether Fitbits accurately measure sedentary behavior. This study examined whether the Fitbit Charge 3 adequately quantifies sedentary behavior compared to the gold standard in objectively measured sedentary behavior assessment, the activPAL. Eleven adults wore a Fitbit Charge 3 and activPAL device for 14 days and self-reported their sedentary behavior each week. ActivPAL epoch data were summed into minute-by-minute data and processed with two cutpoints (activPAL_Half and activPAL_Full) to compare to Fitbit data. Paired t-tests were used to examine differences between the two devices for sedentary behavior variables. Intraclass correlations were used to examine device agreement. There was no significant difference in sedentary time between activPAL_Half and Fitbit data, but activPAL_Full estimated significantly lower sedentary time than Fitbit. Intraclass correlations showed high agreement. We suggest that Fitbit could replace activPAL when measuring total sedentary time.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33917879/", "newWindow": true } ] }, { "title": "Physical Activity Monitoring Using a Fitbit Device in Ischemic Stroke Patients: Prospective Cohort Feasibility Study", "author": "Katzan, I.; Schuster, A.; Kinzy, T.", "year": "2021", "journalProceedings": "JMIR mHealth and uHealth", "category": "Medical,Clinical Care", "devices": "Charge HR", "population": "Older Adults,Patients,Adults", "dataUsed": "Steps", "abstract": "Background: Continuous tracking of ambulatory activity in real-world settings using step activity monitors has many potential uses. However, feasibility, accuracy, and correlation with performance measures in stroke patients have not been well-established. Objective: The primary study objective was to determine adherence with wearing a consumer-grade step activity monitor, the Fitbit Charge HR, in home-going ischemic stroke patients during the first 90 days after hospital discharge. Secondary objectives were to (1) determine accuracy of step counts of the Fitbit Charge HR compared with a manual tally; (2) calculate correlations between the Fitbit step counts and the mobility performance scores at discharge and 30 days after stroke; (3) determine variability and change in weekly step counts over 90 days; and (4) evaluate patient experience with using the Fitbit Charge HR poststroke. Methods: A total of 15 participants with recent mild ischemic stroke wore a Fitbit Charge HR for 90 days after discharge and completed 3 mobility performance tests from the National Institutes of Health Toolbox at discharge and Day 30: (1) Standing Balance Test, (2) 2-Minute Walk Endurance Test, and (3) 4-Meter Walk Gait Speed Test. Accuracy of step activity monitors was assessed by calculating differences in steps recorded on the step activity monitor and a manual tally during 2-minute walk tests. Results: Participants had a mean age of 54 years and a median modified Rankin scale score of 1. Mean daily adherence with step activity monitor use was 83.6%. Mean daily step count in the first week after discharge was 4376. Daily step counts increased slightly during the first 30 days after discharge (average increase of 52.5 steps/day; 95% CI 32.2-71.8) and remained stable during the 30-90 day period after discharge. Mean step count difference between step activity monitor and manual tally was –4.8 steps (–1.8%). Intraclass correlation coefficients for step counts and 2-minute walk, standing balance, and 4-meter gait speed at discharge were 0.41 (95% CI –0.14 to 0.75), –0.12 (95% CI –0.67 to 0.64), and 0.17 (95% CI –0.46 to 0.66), respectively. Values were similarly poor at 30 days. Conclusions: The use of consumer-grade Fitbit Charge HR in patients with recent mild stroke is feasible with reasonable adherence and accuracy. There was poor correlation between step counts and gait speed, balance, and endurance. Further research is needed to evaluate the association between step counts and other outcomes relevant to patients, including patient-reported outcomes and measures of physical function.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33464213/", "newWindow": true } ] }, { "title": "Assessing acceptability and patient experience of a behavioral lifestyle intervention using fitbit technology in older adults to manage type 2 diabetes amid COVID-19 pandemic: A focus group study", "author": "Jiwani, R.; Dennis, B.; Bess, C.; Monk, S.; Meyer, K.; Wang, J.; Espinoza, S.", "year": "2021", "journalProceedings": "Geriatric nursing (New York, N.Y.)", "category": "Intervention", "devices": null, "population": "Older Adults", "dataUsed": "Steps,Energy Expenditure,Distance,Weight,Food", "abstract": "Type 2 diabetes (T2D) contributes to reduced quality of life in older adults, especially in those with comorbidities such as being overweight or obese. Personal fitness technology (Fitbit {\\textregistered}) has the potential to improve the management of T2D. Using a semi-structured interview guide, focus groups were conducted to explore participants' acceptability and experiences following a behavioral lifestyle intervention that integrated Fitbit in overweight/obese older adults with T2D amid the COVID-19 pandemic which began during the time of this study. Focus group transcripts were transcribed and analyzed using thematic analysis. Eighteen (18) of the 20 participants completed the program and focus group interviews. Overall, we observed high acceptability of the program, and participants reported favorable experiences such as increased knowledge of health behaviors, improved diabetes management, and improved quality of life following the behavioral lifestyle intervention, even under stressful life circumstances from COVID-19.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33248357/", "newWindow": true } ] }, { "title": "Validity Evaluation of the Fitbit Charge2 and the Garmin vivosmart HR+ in Free-Living Environments in an Older Adult Cohort", "author": "Tedesco, S.; Sica, M.; Ancillao, A.; Timmons, S.; Barton, J.; O'Flynn, B.", "year": "2019", "journalProceedings": "JMIR mHealth and uHealth", "category": "Usability,Validation", "devices": "Charge 2", "population": "Older Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Sleep", "abstract": "Background: Few studies have investigated the validity of mainstream wrist-based activity trackers in healthy older adults in real life, as opposed to laboratory settings. Objective: This study explored the performance of two wrist-worn trackers (Fitbit Charge 2 and Garmin vivosmart HR+) in estimating steps, energy expenditure, moderate-to-vigorous physical activity (MVPA) levels, and sleep parameters (total sleep time [TST] and wake after sleep onset [WASO]) against gold-standard technologies in a cohort of healthy older adults in a free-living environment. Methods: Overall, 20 participants (>65 years) took part in the study. The devices were worn by the participants for 24 hours, and the results were compared against validated technology (ActiGraph and New-Lifestyles NL-2000i). Mean error, mean percentage error (MPE), mean absolute percentage error (MAPE), intraclass correlation (ICC), and Bland-Altman plots were computed for all the parameters considered. Results: For step counting, all trackers were highly correlated with one another (ICCs>0.89). Although the Fitbit tended to overcount steps (MPE=12.36%), the Garmin and ActiGraph undercounted (MPE 9.36% and 11.53%, respectively). The Garmin had poor ICC values when energy expenditure was compared against the criterion. The Fitbit had moderate-to-good ICCs in comparison to the other activity trackers, and showed the best results (MAPE=12.25%), although it underestimated calories burned. For MVPA levels estimation, the wristband trackers were highly correlated (ICC=0.96); however, they were moderately correlated against the criterion and they overestimated MVPA activity minutes. For the sleep parameters, the ICCs were poor for all cases, except when comparing the Fitbit with the criterion, which showed moderate agreement. The TST was slightly overestimated with the Fitbit, although it provided good results with an average MAPE equal to 10.13%. Conversely, WASO estimation was poorer and was overestimated by the Fitbit but underestimated by the Garmin. Again, the Fitbit was the most accurate, with an average MAPE of 49.7%. Conclusions: The tested well-known devices could be adopted to estimate steps, energy expenditure, and sleep duration with an acceptable level of accuracy in the population of interest, although clinicians should be cautious in considering other parameters for clinical and research purposes.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/31219048/", "newWindow": true } ] }, { "title": "Physician Monitoring of FitBit Use for Patient Health", "author": "Shannahan Md, A.; Shah Md, A.; Wright PhD, K.; Clements Md, D. S.", "year": "2021", "journalProceedings": "Global advances in health and medicine", "category": null, "devices": null, "population": null, "dataUsed": null, "abstract": "BackgroundPhysical activity is a critical component of health.ObjectiveWe implemented a pilot project to determine feasibility of embedding activity tracker data within routine primary care visits ...", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34104577/", "newWindow": true } ] }, { "title": "A study of the accuracy of the Fitbit Zip in measuring steps both indoors and outdoors in a mixed rehabilitation population", "author": "Farmer, C.; van den Berg, M. E.; Vuu, S.; Barr, C. J.", "year": "2021", "journalProceedings": "Clinical rehabilitation", "category": "Usability,Validation,Measurement", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Objective: To assess (1) step count accuracy of the Fitbit Zip, compared to manual step count, in people receiving outpatient rehabilitation, in indoor and outdoor conditions, and (2) impact of slow walking speed on Fitbit accuracy. Design: Observational study. Setting: A metropolitan rehabilitation hospital. Subjects: Adults (n = 88) attending a subacute rehabilitation outpatient clinic with walking speeds of between 0.4 and 1.0 m/s. Interventions: Two 2-minute walk tests, one indoors and one outdoors, completed in random order. Main measures: Step count recorded manually by observation and by a Fitbit Zip, attached to the shoe on the dominant or non-affected side. Subgroup analysis included assessment accuracy for those considered limited community walkers (slower than 0.8 m/s) and those considered community walkers (faster than 0.8 m/s). Results: The Fitbit significantly (P < 0.05) undercounted steps compared to manual step count, indoors and outdoors, with percentage agreement slightly higher outdoors (mean 92.4%) than indoors (90.1%). Overall, there was excellent consistent agreement between the Fitbit and manual step count for both indoor (ICC 0.83) and outdoor (ICC 0.88) walks. The accuracy of the Fitbit was significantly (P < 0.05) reduced in those who walked slower than 0.8 m/s outdoors (ICC 0.80) compared to those who walk faster than 0.8 m/s (ICC 0.90). Conclusions: The Fitbit Zip shows high step count accuracy with manual step count in a mixed subacute rehabilitation population. However, accuracy is affected by walking speed, with decreased accuracy in limited community walkers.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34313149/", "newWindow": true } ] }, { "title": "Predicting lying, sitting, walking and running using Apple Watch and Fitbit data", "author": "Fuller, D.; Anaraki, J. R.; Simango, B.; Rayner, M.; Dorani, F.; Bozorgi, A.; Luan, H.; A Basset, F.", "year": "2021", "journalProceedings": "BMJ open sport & exercise medicine", "category": "Validation,Measurement", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance,Heart Rate", "abstract": "Objectives This study's objective was to examine whether commercial wearable devices could accurately predict lying, sitting and varying intensities of walking and running. Methods We recruited a convenience sample of 49 participants (23 men and 26 women) to wear three devices, an Apple Watch Series 2, a Fitbit Charge HR2 and iPhone 6S. Participants completed a 65 min protocol consisting of 40 min of total treadmill time and 25 min of sitting or lying time. The study's outcome variables were six movement types: lying, sitting, walking self-paced and walking/running at 3 metabolic equivalents of task (METs), 5 METs and 7 METs. All analyses were conducted at the minute level with heart rate, steps, distance and calories from Apple Watch and Fitbit. These included three different machine learning models: support vector machines, Random Forest and Rotation forest. Results Our dataset included 3656 and 2608 min of Apple Watch and Fitbit data, respectively. Rotation Forest models had the highest classification accuracies for Apple Watch at 82.6%, and Random Forest models had the highest accuracy for Fitbit at 90.8%. Classification accuracies for Apple Watch data ranged from 72.6% for sitting to 89.0% for 7 METs. For Fitbit, accuracies varied between 86.2% for sitting to 92.6% for 7 METs. Conclusion This preliminary study demonstrated that data from commercial wearable devices could predict movement types with reasonable accuracy. More research is needed, but these methods are a proof of concept for movement type classification at the population level using commercial wearable device data.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33907628/", "newWindow": true } ] }, { "title": "Measurement of Heart Rate Using the Polar OH1 and Fitbit Charge 3 Wearable Devices in Healthy Adults During Light, Moderate, Vigorous, and Sprint-Based Exercise: Validation Study", "author": "Muggeridge, D. J.; Hickson, K.; Davies, A. V.; Giggins, O. M.; Megson, I. L.; Gorely, T.; Crabtree, D. R.", "year": "2021", "journalProceedings": "JMIR mHealth and uHealth", "category": "Validation", "devices": "Charge 3", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Background: Accurate, continuous heart rate measurements are important for health assessment, physical activity, and sporting performance, and the integration of heart rate measurements into wearable devices has extended its accessibility. Although the use of photoplethysmography technology is not new, the available data relating to the validity of measurement are limited, and the range of activities being performed is often restricted to one exercise domain and/or limited intensities. Objective: The primary objective of this study was to assess the validity of the Polar OH1 and Fitbit Charge 3 devices for measuring heart rate during rest, light, moderate, vigorous, and sprint-type exercise. Methods: A total of 20 healthy adults (9 female; height: mean 1.73 [SD 0.1] m; body mass: mean 71.6 [SD 11.0] kg; and age: mean 40 [SD 10] years) volunteered and provided written informed consent to participate in the study consisting of 2 trials. Trial 1 was split into 3 components: 15-minute sedentary activities, 10-minute cycling on a bicycle ergometer, and incremental exercise test to exhaustion on a motorized treadmill (18-42 minutes). Trial 2 was split into 2 components: 4 × 15-second maximal sprints on a cycle ergometer and 4 × 30- to 50-m sprints on a nonmotorized resistance treadmill. Data from the 3 devices were time-aligned, and the validity of Polar OH1 and Fitbit Charge 3 was assessed against Polar H10 (criterion device). Validity was evaluated using the Bland and Altman analysis, Pearson moment correlation coefficient, and mean absolute percentage error. Results: Overall, there was a very good correlation between the Polar OH1 and Polar H10 devices (r=0.95), with a mean bias of −1 beats{\\textperiodcentered}min-1 and limits of agreement of −20 to 19 beats{\\textperiodcentered}min-1. The Fitbit Charge 3 device underestimated heart rate by 7 beats{\\textperiodcentered}min-1 compared with Polar H10, with a limit of agreement of −46 to 33 beats{\\textperiodcentered}min-1 and poor correlation (r=0.8). The mean absolute percentage error for both devices was deemed acceptable (<5%). Polar OH1 performed well across each phase of trial 1; however, validity was worse for trial 2 activities. Fitbit Charge 3 performed well only during rest and nonsprint-based treadmill activities. Conclusions: Compared with our criterion device, Polar OH1 was accurate at assessing heart rate, but the accuracy of Fitbit Charge 3 was generally poor. Polar OH1 performed worse during trial 2 compared with the activities in trial 1, and the validity of the Fitbit Charge 3 device was particularly poor during our cycling exercises.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33764310/", "newWindow": true } ] }, { "title": "Comparison of the Wrist-Worn Fitbit Charge 2 and the Waist-Worn Actigraph GTX3 for Measuring Steps Taken in Occupational Settings", "author": "Garza, J. L.; Wu, Z. H.; Singh, M.; Cherniack, M. G.", "year": "2021", "journalProceedings": "Annals of work exposures and health", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps", "abstract": null, "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34383020/", "newWindow": true } ] }, { "title": "Accuracy of the ActivPAL and Fitbit Charge 2 in measuring step count in Cystic Fibrosis", "author": "Curran, M.; Tierney, A.; Collins, L.; Kennedy, L.; McDonnell, C.; Sheikhi, A.; Walsh, C.; Casserly, B.; Cahalan, R.", "year": "2021", "journalProceedings": "Physiotherapy theory and practice", "category": "Validation", "devices": "Charge 2", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background: Physical activity (PA) is important in Cystic Fibrosis (CF) management. Fitness wearables are becoming increasingly popular as measurement tools of PA; however, the accuracy of these devices should first be evaluated. Objective: The purpose of this study was to assess the accuracy of the ActivPAL and Fitbit Charge 2 as a measure of step count in Cystic Fibrosis. Methods: Twenty-one participants were recruited from an adult CF Center in Ireland for a single session of testing. Participants walked for 5 min at five pre-determined speeds in a controlled testing environment (2, 2.5, 3, 3.5 and 4 miles per hour on a treadmill) and at three self-selected speeds in a corridor (slow, medium, and fast). They concurrently wore an accelerometer (ActivPAL) and fitness wearable (Fitbit Charge 2), and both were compared to visual observations. Step count is the outcome being assessed. Results: The ActivPAL under-estimated step count by 0.63% across treadmill speeds and 1.1% across self-selected walking speeds. The Fitbit Charge 2 underestimated the step count by 2.97% across treadmill speeds and by 6.3% across self-selected walking speeds. Very strong correlations were found between the ActivPAL and visual observations (r: 0.93 to 0.99), while the Fitbit Charge 2 ranged from weak to very strong correlations when compared to visual observations (r: 0.34 to 0.84). Conclusion: The ActivPAL and Fitbit Charge 2 demonstrated acceptable validity for step count measurement in CF. These devices can be used for tracking PA during interventions in people with CF.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34369283/", "newWindow": true } ] }, { "title": "Comparison of free-living physical activity data obtained from a Fitbit Zip, the Apple iPhone Health app and a modified Bouchard Activity Record", "author": "Reynolds, R. C.; Smith, V. M.; Macniven, R.", "year": "2021", "journalProceedings": "Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals", "category": "Validation", "devices": "Zip", "population": "Adults", "dataUsed": "Steps,Distance", "abstract": "Issue addressed: Physical activity tracking devices have potential to improve public health, but their data needs to be reliable. No study has compared movement data between the Fitbit Zip, Apple iPhone Health app and physical activity records in a community setting over 10 days. Methods: University students aged 18+ years wore both a Fitbit Zip and an iPhone at/near their right waist and completed a modified Bouchard Activity Record (BAR) for 10 days in a free-living setting. Comparisons were made between the Fitbit Zip and iPhone for the number of steps and the distance travelled and between the Fitbit Zip and BAR for the minutes of activity in three different intensities. Results: Eighteen students provided sufficient data for inclusion. There were strong correlations between steps per day (r =.87) and distance travelled (r =.88) between the Fitbit Zips and iPhones. However, the Fitbit Zip measured significantly more steps per day (mean 8437 vs 7303; P ≤.001) and greater distances (mean 5.9 vs 4.9; P ≤.001) than the iPhone. Correlations between the Fitbit Zips and the BARs were moderate for minutes of total (r =.51) and light (r =.40) activity and weak for moderate/fairly active (r =.20) and vigorous/very active (r =.25). Conclusions: There were strong correlations between the physical activity data measured by Fitbit Zips and iPhones, but the iPhone Health app significantly underestimated the number of steps per day taken and the distance travelled when compared to the Fitbit Zip. So what?: Understanding the comparability of accelerometer devices provides useful information for future pragmatic physical activity measurement.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33864306/", "newWindow": true } ] }, { "title": "Does a physical therapist-administered physical activity intervention reduce sedentary time after total knee replacement: An exploratory study?", "author": "Coleman, Grace; White, Daniel K.; Thoma, Louise M.; Mathews, Dana; Christiansen, Meredith B.; Schmitt, Laura A.; Jakiela, Jason T.; Master, Hiral", "year": "2021", "journalProceedings": "Musculoskeletal Care", "category": "Intervention", "devices": "Zip", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Goals", "abstract": "Abstract\nDesign:: Exploratory secondary data analysis of a pilot randomized control trial conducted between 2015 and 2017.\n\nSetting:: Outpatient physical therapy clinic in an academic setting.\n\nParticipants:: 43 participants were randomized to the intervention or control group. Both groups received standard physical therapy (PT) after total knee replacement (TKR).\n\nInterventions:: Participants in the intervention group received a Fitbit, weekly step goals from their physical therapist, and up to six monthly phone calls after their discharge from PT (DC).\n\nMain Outcome Measures:: The outcome, change in sedentary time (∆SED), was measured using a triaxial accelerometer (Actigraph GT3X) from initial evaluation (IE) to DC (short-term), and IE to 12 months (12M) after DC (long-term). Positive values represent a reduction in SED. We compared the short- and long-term ∆SED between the intervention and control groups using independent t-tests.\n\nResults:: Of the 43 participants [mean(SD) age 67.0 (7.0) years, BMI 31.5 (5.9) kg/m2, 53% female], 36 participants had data at IE and DC (18 intervention, 18 control) and 27 had data at IE and 12M (12 intervention, 15 control). The between group difference in short-term ∆SED was [mean(95%CI)] 32.9 (−14.4, 80.1) minutes/day. The between group difference in long-term ∆SED was 59.2 (8.6, 109.7) minutes/day.\n\nConclusion:: Our preliminary results indicate that a physical therapist-administered physical activity intervention may reduce SED in adults after TKR. However, a full-clinical trial is needed to establish the effect on SED.", "links": [] }, { "title": "Management of fatigue with physical activity and behavioural change support in vasculitis: a feasibility study", "author": "Harper, L.; Hewitt, C. A.; Litchfield, I.; Morgan, M. D.; Chanouzas, D.; Caulfield, H. K.; Coughlan, L.; Dean, C.; Fletcher, K.; Cramp, F.; Greenfield, S.; Ives, N. J.; Jowett, S.; Kodabuckus, S.; Tearne, S.; Sehmi, S.; Edwardson, C.; Dawkins, N. P.; Daley, A. J.", "year": "2021", "journalProceedings": "Rheumatology (Oxford, England)", "category": "Intervention", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Goals", "abstract": "OBJECTIVE: Patients with ANCA associated vasculitis (AAV) experience high levels of fatigue, despite disease remission. This study assessed the feasibility and acceptability of a definitive randomised controlled trial of a behavioural-based physical activity intervention to support fatigue self-management in AAV patients. METHODS: AAV patients in disease remission with fatigue (Multidimensional Fatigue Inventory-20 general fatigue domain ≥) were randomly allocated to intervention or standard care in this single-centre open-label randomised controlled feasibility study. The intervention lasted 12 weeks and comprised eight face-to-face physical activity sessions with a facilitator and 12 weekly telephone calls. Participants were encouraged to monitor their physical activity using a tracker device (Fitbit). Standard care involved sign-posting to fatigue websites. The primary outcome was feasibility of a phase III trial assessed against three stop-go traffic light criteria, (recruitment, intervention adherence and study withdrawal). A qualitative study assessed participant views about the intervention. RESULTS: 248 patients were screened and 134 were eligible to participate (54%). Stop-go criteria were amber for recruitment; 43/134 (32%, 95% CI 24-40) eligible participants randomised, amber for adherence; 73% of participants attended all eight physical activity sessions, but only 11/22 (50%, 95% CI 29-71%) completed the intervention as per the intended schedule, and green for study withdrawal; 2/43 participants withdrew before 24 weeks (5%, 95% CI 0-11). Qualitative results suggested the intervention was acceptable. CONCLUSION: This study suggests a behavioural-based physical activity intervention targeting fatigue self-management was acceptable to patients with AAV, although recruitment and protocol adherence will need modification prior to a definitive trial. Clinical Trial Registration Number ISRCTN11929227.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33369680/", "newWindow": true } ] }, { "title": "Effect and feasibility of wearable physical activity trackers and pedometers for increasing physical activity and improving health outcomes in cancer survivors: A systematic review and meta-analysis", "author": "Singh, B.; Zopf, E. M.; Howden, E. J.", "year": "2021", "journalProceedings": "Journal of sport and health science", "category": "Systematic Review", "devices": "One", "population": "Adults", "dataUsed": "Steps,Intensity,Distance", "abstract": "Background: The purpose of this systematic review and meta-analysis was to evaluate the effect of wearable devices for improving physical activity and health-related outcomes in cancer survivors. Methods: CINAHL, Cochrane, Ebscohost, MEDLINE, Pubmed, ProQuest Health and Medical Complete, ProQuest Nursing and Allied Health Source, ScienceDirect, and SPORTDiscus databases were searched for randomized controlled trials published before September 1, 2020, that evaluated interventions involving wearable devices in cancer survivors. Standardized mean differences (SMDs) were calculated to assess effects on physical activity and health-related outcomes. Subgroup analyses were conducted to assess whether the effects differed by intervention and cancer characteristics. Risk of bias was assessed using the Cochrane risk of bias tool. Results: Thirty-five trials were included (breast cancer, n = 15, 43%). Intervention durations ranged between 4 weeks and 1 year. Most trials (n = 25, 71%) involved pedometer-based physical activity interventions. Seven (20%) involved Fitbit-based interventions, and three (9%) involved other wearable physical activity trackers (e.g., Polar, Garmin). Compared to usual care, wearable devices had moderate-to-large effects (SMD range = 0.54−0.87, p < 0.001) on moderate-intensity physical activity, moderate-to-vigorous-intensity physical activity, total physical activity, and daily steps. Compared to usual care, those in the intervention had higher quality of life, aerobic fitness, physical function, and reduced fatigue (SMD range = 0.18−0.66, all p < 0.05). Conclusion: Wearable physical activity trackers and pedometers are effective tools that increase physical activity and improve health-related outcomes in individuals with cancer. Identifying how these devices can be implemented for longer-term use with other intervention components remains an area for future research.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34314878/", "newWindow": true } ] }, { "title": "Consumer-based activity trackers in evaluation of physical activity in myositis patients", "author": "Saygin, D.; Rockette-Wagner, B.; Oddis, C.; Neiman, N.; Koontz, D.; Moghadam-Kia, S.; Aggarwal, R.", "year": "2021", "journalProceedings": "Rheumatology (Oxford, England)", "category": "Validation,Intervention", "devices": "One", "population": "Patients,Adults", "dataUsed": "Steps,Intensity", "abstract": "Abstract\nObjectives\nInflammatory myopathies are characterized by muscle weakness that limit activities of daily living. Daily step count is an accepted metric of physical activity. Wearable technologies such as Fitbit® enable tracking of daily step counts. We assessed psychometric properties of Fitbit® and compared the accuracy of Fitbit® step counts to ActiGraph®.\n\nMethods\nThis was a pilot, proof of concept, prospective observational study with 4 visits at 0, 1-, 3-, and 6-months in polymyositis (PM), dermatomyositis (DM), necrotizing myopathy (NM) or anti-synthetase syndrome (AS) subjects. Six core set measures [manual muscle testing, physician (MD-GDA), patient (PT-GDA), and extra-muscular disease activity, HAQ-DI and creatine kinase], 3 functional tests [six-minute walk, timed up-and-go, sit-to-stand tests] and SF-36 physical function-10 (PF10) were collected at each visit. Patients wore waist-worn Fitbit® One and ActiGraph® T3X-BT concurrently for 7 days/month for 6-months.\n\nResults\nTwenty-four (10 DM, 8 PM/NM, 6 AS) patients (17 females/7 males; 91% Caucasian) were enrolled. Test-retest reliability of daily steps was strong in 1-month follow-up (ICC 0.89). Daily steps and peak 1-min cadence showed moderate-strong correlations with MD-GDA, PT-GDA, HAQ-DI, SF-36 PF10 and all three functional tests. Fitbit® and ActiGraph® step counts demonstrated good agreement and strong correlation (ICC 0.96).\n\nConclusion\nFitbit® daily steps and peak 1-min cadence are reliable and valid measures of physical activity in a cohort of myositis patients. This pilot data suggests that Fitbit® has a potential for use in clinical practice and trials to monitor physical activity in myositis patients, but larger studies are needed for further validation.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34528065/", "newWindow": true } ] }, { "title": "Inter-Device Agreement between Fitbit Flex 1 and 2 for Assessing Sedentary Behavior and Physical Activity", "author": "Kwon, S.; Burns, R. D.; Kim, Y.; Bai, Y.; Byun, W.", "year": "2021", "journalProceedings": "International journal of environmental research and public health", "category": "Validation", "devices": "Flex,Flex 2", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "This study examined the inter-model agreement between the Fitbit Flex (FF) and FF2 in estimating sedentary behavior (SED) and physical activity (PA) during a free-living condition. 33 healthy adults wore the FF and FF2 on non-dominant wrist for 14 consecutive days. After excluding sleep and non-wear time, data from the FF and FF2 was converted to the time spent (min/day) in SED and PA using a proprietary algorithm. Pearson's correlation was used to evaluate the association between the estimates from FF and FF2. Mean absolute percent errors (MAPE) were used to examine differences and measurement agreement in SED and PA estimates between FF and FF2. Bland-Altman (BA) plots were used to examine systematic bias between two devices. Equivalence testing was conducted to examine the equivalence between the FF and FF2. The FF2 had strong correlations with the FF in estimating SED and PA times. Compared to the FF, the FF2 yielded sim-ilar SED and PA estimates along with relatively low measurement discords and did not have significant systematic biases for SED and Moderate-to-vigorous PA estimates. Our findings suggest that researchers may choose FF2 as a measurement of SED and PA when FF is not available in the market during the longitudinal PA research.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33800254/", "newWindow": true } ] }, { "title": "Objective Measurement of Physical Activity Attributed to a Park-Based Afterschool Program", "author": "Booth, J. V.; Messiah, S. E.; Hansen, E.; Nardi, M. I.; Hawver, E.; Patel, H. H.; Kling, H.; Okeke, D.; D'Agostino, E. M.", "year": "2021", "journalProceedings": "Journal of physical activity & health", "category": "Intervention", "devices": "Charge 2", "population": "Adolescents", "dataUsed": "Steps,Intensity", "abstract": "Background: Only 24% of US youth meet physical activity recommendations set by the Centers for Disease Control and Prevention. Research demonstrates that community-based programs provide underresourced minority youth with opportunities for routine physical activity, although limited work draws from accelerometry data. This study objectively assessed youth physical activity attributable to participation (vs nonparticipation) days in a park-based afterschool program in Miami-Dade County, Miami, FL. Methods: Participants' (n = 66; 60% male; 57% white Hispanic, 25% non-Hispanic black, 14% Black Hispanic, mean age = 10.2 y) physical activity was assessed April to May 2019 over 10 days across 7 park sites using Fitbit (Charge 2) devices. Separate repeated-measures multilevel models were developed to assess the relationship between program daily attendance and total (1) moderate to vigorous physical activity minutes and (2) step counts per day. Results: Models adjusted for individual-level age, sex, race/ethnicity, poverty, and clustering by park showed significantly higher moderate to vigorous physical activity minutes ($\\beta$ = 25.33 more minutes per day; 95% confidence interval, 7.0 to 43.7, P < .01) and step counts ($\\beta$ = 4067.8 more steps per day; 95% confidence interval, 3171.8 to 4963.8, P < .001) on days when youth did versus did not attend the program. Conclusions: Study findings suggest that park-based programs may support underserved youth in achieving daily physical activity recommendations.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33524953/", "newWindow": true } ] }, { "title": "Multilevel mHealth Intervention Increases Physical Activity of Older Adults Living in Retirement Community", "author": "Hosteng, K. R.; Simmering, J. E.; Polgreen, L. A.; Cremer, J. F.; Segre, A. M.; Francis, S. L.; Whitaker, K. M.; Polgreen, P. M.; Carr, L. J.", "year": "2021", "journalProceedings": "Journal of physical activity & health", "category": "Intervention", "devices": "Zip", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Background: Regular physical activity is crucial for healthy aging, but older adults are the least active age group. This study explored the feasibility, acceptability, and efficacy of a multilevel mHealth intervention for increasing physical activity of older adults living in a retirement community. Methods: Participants included 54 older adults (mean age = 81.2 y, 77.8% female, 98.1% white) living in a retirement community. Participants received a Fitbit Zip and access to a multilevel mHealth physical activity intervention (MapTrek Residential) for 8 weeks. Physical activity (in steps per day) and intervention compliance (days worn) were measured objectively with the Fitbit for 12 weeks (8-wk intervention plus 4-wk follow-up). Psychosocial outcomes (social support, self-efficacy, and outcome expectations) were assessed at baseline and 8 weeks. Acceptability outcomes were assessed with an open-ended process evaluation survey and focus groups. Descriptive statistics and linear mixed models were used to examine intervention effects. Results: Participants increased daily steps from 5438 steps per day at baseline (95% CI, 4620 to 6256) to 6201 steps per day (95% CI, 5359 to 7042) at week 8 (P < .0001) but this was not maintained at 12 weeks (P = .92). Conclusions: Our multilevel mHealth physical activity intervention was effective for increasing physical activity older adults over 8 weeks. Additional research focused on maintaining physical activity gains with this approach is warranted.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34039774/", "newWindow": true } ] }, { "title": "Physical Activity and Sleep Measures Using a Fitness Tracking Device during Hematopoietic Cell Transplantation: A Pilot Study", "author": "Jurdi, N. E.; Nock, N.; Fu, P.; Cao, S.; Cotton, J. M.; Ali, N.; Ravi, G.; Pinto, R.; Galloway, E.; Kolke, S.; Cooper, B.; Tomlinson, B.; Malek, E.; Lance, C.; Kolk, M. J.; Ferrari, N.; Lee, R.; de Lima, M.; Caimi, P. F.; Metheny, L.", "year": "2021", "journalProceedings": "Transplantation and cellular therapy", "category": "Intervention", "devices": "Charge HR", "population": "Patients", "dataUsed": "Steps,Intensity,Distance,Sleep,Heart Rate", "abstract": "Patients undergoing hematopoietic cell transplantation (HCT) experience decline in their physical activity during their transplant admission. There is limited experience with prospective monitoring of transplant recipients. We therefore measured physical activity and sleep patterns of subjects undergoing autologous and allogeneic HCT. Eighty-three patients were consented for this study. Sixty-three patients competed the study and had their physical activity prospectively assessed using the fitness-tracking device Fitbit HR. Outcomes included adherence, physical activity, readmission, hematopoietic engraftment, and 100-day survival. Sixty percent of patients (n = 37) underwent autologous HCT, and 40% (n = 26) underwent allogenic HCT. Both groups had a comparable number of steps at admission to the hospital. The number of daily steps during the study period was lower in the allogeneic group (2159 versus 3008, P = .07), as was the minimum number of steps recorded over the transplant admission (allogeneic HCT = 395 versus autologous HCT = 848, P = .01). Patients undergoing allogeneic HCT were less active on the day before discharge (1956 steps versus 3183 steps, P = .08). In multivariate analysis, physical activity was not associated with HCT-related outcomes. Patients undergoing HCT experience significant decline in their physical activity during their transplant admission that does not recover by the time of discharge. This effect can be objectively measured using fitness tracking devices.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33827757/", "newWindow": true } ] }, { "title": "Consumer-Based Activity Trackers as a Tool for Physical Activity Monitoring in Epidemiological Studies During the COVID-19 Pandemic: Development and Usability Study", "author": "Henriksen, A.; Johannessen, E.; Hartvigsen, G.; Grimsgaard, S.; Hopstock, L. A.", "year": "2021", "journalProceedings": "JMIR public health and surveillance", "category": "Usability", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Sleep", "abstract": "Background: Consumer-based physical activity trackers have increased in popularity. The widespread use of these devices and the long-term nature of the recorded data provides a valuable source of physical activity data for epidemiological research. The challenges include the large heterogeneity between activity tracker models in terms of available data types, the accuracy of recorded data, and how this data can be shared between different providers and third-party systems. Objective: The aim of this study is to develop a system to record data on physical activity from different providers of consumer-based activity trackers and to examine its usability as a tool for physical activity monitoring in epidemiological research. The longitudinal nature of the data and the concurrent pandemic outbreak allowed us to show how the system can be used for surveillance of physical activity levels before, during, and after a COVID-19 lockdown. Methods: We developed a system (mSpider) for automatic recording of data on physical activity from participants wearing activity trackers from Apple, Fitbit, Garmin, Oura, Polar, Samsung, and Withings, as well as trackers storing data in Google Fit and Apple Health. To test the system throughout development, we recruited 35 volunteers to wear a provided activity tracker from early 2019 and onward. In addition, we recruited 113 participants with privately owned activity trackers worn before, during, and after the COVID-19 lockdown in Norway. We examined monthly changes in the number of steps, minutes of moderate-to-vigorous physical activity, and activity energy expenditure between 2019 and 2020 using bar plots and two-sided paired sample t tests and Wilcoxon signed-rank tests. Results: Compared to March 2019, there was a significant reduction in mean step count and mean activity energy expenditure during the March 2020 lockdown period. The reduction in steps and activity energy expenditure was temporary, and the following monthly comparisons showed no significant change between 2019 and 2020. A small significant increase in moderate-to-vigorous physical activity was observed for several monthly comparisons after the lockdown period and when comparing March-December 2019 with March-December 2020. Conclusions: mSpider is a working prototype currently able to record physical activity data from providers of consumer-based activity trackers. The system was successfully used to examine changes in physical activity levels during the COVID-19 period.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33843598/", "newWindow": true } ] }, { "title": "Characterizing rates of physical activity in individuals with binge eating disorder using wearable sensor technologies and clinical interviews", "author": "Wons, O. B.; Michael, M. L.; Lin, M.; Juarascio, A. S.", "year": "2021", "journalProceedings": "European eating disorders review : the journal of the Eating Disorders Association", "category": "Intervention", "devices": "Flex 2", "population": "Adults", "dataUsed": "Steps,Intensity,Weight", "abstract": "Objective: Research suggests physical activity (PA) improves behavioural, psychological and behavioural symptoms in individuals with binge eating disorder (BED), yet self-reported PA is notably low. Little remains known about objective rates of PA and subclinical levels of maladaptive PA (i.e., compensatory or driven PA), and few studies have attempted to understand the role that dissatisfaction and overvaluation with shape and weight plays in promoting PA in individuals with BED. We sought to characterize PA and investigate whether elevated rates of shape and weight concerns contribute to rates of PA in individuals with BED. Method: Individuals meeting DSM-5 diagnosis of BED (N = 56) completed the Eating Disorder Examination and wore a Fitbit Flex 2 for 1 week. Results: On average, participants recorded 7621.12 (SD = 3034.20) daily steps and 194.30 (SD = 161.45) weekly moderate-to-vigorous PA minutes. About 21% of participants reported subclinical levels of maladaptive PA. Greater shape and weight overvaluation predicted lower duration of compensatory PA. Conclusion: A small percentage of individuals with BED are engaging in subclinical levels of maladaptive PA, and there is a need to identify factors that influence rates of PA in individuals with BED.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33247869/", "newWindow": true } ] }, { "title": "Physical activity in hemodialysis patients on nondialysis and dialysis days: Prospective observational study", "author": "Malhotra, R.; Kumar, U.; Virgen, P.; Magallon, B.; Garimella, P. S.; Chopra, T.; Kotanko, P.; Ikizler, T. A.; Trzebinska, D.; Cadmus-Bertram, L.; Ix, J. H.", "year": "2021", "journalProceedings": "Hemodialysis international. International Symposium on Home Hemodialysis", "category": "Medical,Intervention", "devices": "Charge 2", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Introduction: The physical decline in patients with end-stage kidney disease (ESKD) is associated with morbidity and mortality. Prior studies have attempted to promote physical activity at the time of dialysis; however, physical activity patterns on the nondialysis days are unknown. This study aimed to quantify physical activity on dialysis and nondialysis days in hemodialysis patients using a wearable actigraph. Methods: In this prospective study, subjects receiving hemodialysis were recruited from two outpatient dialysis units in urban San Diego and rural Imperial County, CA, between March 2018 and April 2019. Key inclusion criteria included: (1) receiving thrice weekly hemodialysis for ≥3 months, (2) age ≥ 18 years, and (3) able to walk with or without assistive devices. All participants wore a Fitbit Charge 2 tracker for a minimum of 4 weeks. The primary outcome was the number of steps per day. Each participant completed the Physical Activity Questionnaire, the Patient Health Questionnaire (PHQ)-9, the PROMIS Short form Fatigue Questionnaire at baseline, and the Participant Technology Experience Questionnaire at day 7 after study enrolment. Findings: Of the 52 recruited, 45 participants (urban = 25; rural = 20) completed the study. The mean age was 61 ± 15 years, 42% were women, 64% were Hispanic, and the mean dialysis vintage was 4.4 ± 3.0 years. For those with valid Fitbit data (defined as ≥10 hours of wear per day) for 28 days (n = 45), participants walked an average of 3688 steps per day, and 73% of participants were sedentary (<5000 steps/day). Participants aged >80 years were less active than younger (age < 65 years) participants (1232 vs. 4529 steps, P = 0.01). There were no statistical differences between the groups when stratified by gender (women vs. men [2817 vs. 4324 steps, respectively]), urbanicity (rural vs. urban dialysis unit [3141 vs. 4123 steps, respectively]), and dialysis/nondialysis day (3177 vs. 4133 steps, respectively). Due to the small sample size, we also calculated effect sizes. The effect size was medium for the gender differences (cohen's d = 0.57) and small to medium for urbanicity and dialysis/nondialysis day (d = 0.37 and d = 0.33, respectively). We found no association between physical activity and self-reported depression and fatigue scale. The majority of participants (62%, 28/45) found the Fitbit tracker easy to wear and comfortable. Discussion: ESKD participants receiving hemodialysis are frequently sedentary, and differences appear more pronounced in older patients. These findings may assist in designing patient-centered interventions to increase physical activity among hemodialysis patients.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33650200/", "newWindow": true } ] }, { "title": "Dynamics of sleep, sedentary behavior, and moderate-to-vigorous physical activity on school versus nonschool days", "author": "Armstrong, Bridget; Beets, Michael W.; Starrett, Angela; Brazendale, Keith; Turner-McGrievy, Gabrielle; Saelens, Brian E.; Pate, Russell R.; Youngstedt, Shawn D.; Maydeu-Olivares, Alberto; Weaver, R. Glenn", "year": "2021", "journalProceedings": "Sleep", "category": "Case Study", "devices": "Charge 2", "population": "Children,Adolescents", "dataUsed": "Steps,Intensity,Sleep,Heart Rate", "abstract": "STUDY OBJECTIVES: Studies examining time-use activity behaviors (sleep, sedentary behavior, and physical activity) on school days compared with nonschool days have examined these behaviors independently, ignoring their interrelated nature, limiting our ability to optimize the health benefits of these behaviors. This study examines the associations of school-day (vs. nonschool day) with time-use activity behaviors. METHODS: Time series data (6,642 days) from Fitbits (Charge-2) were collected (n = 196, 53% female, 5-10 years). We used a variable-centered dynamic structural equation modeling approach to estimate day-to-day associations of time-use activity behaviors on school days for each child. We then used person-centered cluster analyses to group individuals based on these estimates. RESULTS: Within-participant analysis showed that on school days (vs. nonschool days), children (1) slept less (β = -0.17, 95% CI = -0.21, -0.13), (2) were less sedentary (β = -0.05, 95% CI = -0.09, -0.02), and (3) had comparable moderate-to-vigorous physical activity (MVPA; β = -0.05, 95% CI = -0.11, 0.00). Between-participant analysis showed that, on school days, children with higher sleep carryover experienced greater decreases in sleep (β = 0.44, 95% CI = 0.08, 0.71), children with higher body mass index z-score decreased sedentary behavior more (β = -0.41, 95% CI = -0.64, -0.13), and children with lower MVPA increased MVPA more (β = -0.41, 95% CI -0.64, -0.13). Cluster analysis demonstrated four distinct patterns of connections between time-use activity behaviors and school (High Activity, Sleep Resilient, High Sedentary, and Dysregulated Sleep). CONCLUSIONS: Using a combination of person-centered and more traditional variable-centered approaches, we identified patterns of interrelated behaviors that differed on school, and nonschool days. Findings can inform targeted intervention strategies tailored to children's specific behavior patterns.", "links": [ { "caption": "URL", "url": "https://academic.oup.com/sleep/article/44/2/zsaa174/5902294", "newWindow": true } ] }, { "title": "Physical activity patterns, adherence to using a wearable activity tracker during a 12-week period and correlation between self-reported function and physical activity in working age individuals with hip and/or knee osteoarthritis", "author": "Östlind, Elin; Sant’Anna, Anita; Eek, Frida; Stigmar, Kjerstin; Hansson, Eva Ekvall", "year": "2021", "journalProceedings": "BMC Musculoskeletal Disorders 2021 22:1", "category": "Intervention", "devices": "Flex 2", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "A majority of individuals with osteoarthritis (OA) are insufficiently physically active. Self-monitoring with wearable activity trackers (WAT) could promote physical activity (PA), and increased knowledge of PA patterns and adherence to using a WAT is needed. The aim of this study was to describe PA patterns and adherence to WAT-use during an intervention among participants of working age with hip and/or knee OA. The study further explores the correlation between self-reported joint function and PA. Individuals of working age with hip and/or knee OA who used a WAT, Fitbit Flex 2, for 12 weeks were included. Participants monitored their PA in the Fitbit-app. An activity goal of 7,000 steps/day was set. Steps and minutes in light (L), moderate and vigorous (MV) PA were collected from the Fitbit. Self-reported joint function (HOOS/KOOS) was completed. Data was analyzed with linear mixed models and Spearman’s rank correlation. Seventy-five participants (45–66 years) walked on average 10 593 (SD 3431) steps/day, spent 248.5 (SD 42.2) minutes in LPA/day, 48.1 (SD 35.5) minutes in MVPA/day, 336.0 (SD 249.9) minutes in MVPA/week and used the Fitbit for an average of 88.4 % (SD 11.6) of the 12-week period. 86.7 % took > 7,000 steps/day and 77.3 % spent > 150 min in MVPA/week. Mean daily steps/week decreased significantly over the 12 weeks (β-coefficient − 117, 95 % CI -166 to -68, p = < 0.001) as well as mean daily minutes in LPA/week (β-coefficient − 2.3, 95 % CI -3.3 to -1.4, p = < 0.001), mean daily minutes in MVPA/week (β-coefficient − 0.58, 95 % CI -1.01 to -0.16, p = 0.008) and mean adherence to Fitbit-use per week (β-coefficient − 1.3, 95 % CI -1.8 to -0.8, p = < 0.001). There were no significant correlations between function (HOOS/KOOS) and PA. The majority of participants reached 7,000 steps/day and the recommended 150 min in MVPA per week. However, PA decreased slightly but gradually over time. Adherence to using the Fitbit was high but also decreased during the intervention. Understanding PA patterns and the use of a Fitbit to promote PA could be beneficial in tailoring interventions for individuals with hip and/or knee OA.", "links": [ { "caption": "URL", "url": "https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04338-x", "newWindow": true } ] }, { "title": "Does Education Close the Black-White Physical Activity and Obesity Gaps?", "author": "Blackshear, T. B.; Seyfried, L.", "year": "2021", "journalProceedings": "Journal of American college health : J of ACH", "category": "Case Study", "devices": "Zip", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Objective: The purpose of the study was to investigate physical activity patterns and body mass index (BMI) among black and white women in college to determine if attending college acts as a catalyst for sustaining physical activity and for closing the black-white physical activity and obesity gaps. Participants/Methods: 111 undergraduate women (black N = 42; white N = 69) aged 18–25 volunteered to wear Fitbit ZipTM activity trackers for 7 days. Height and weight measurements were used to compute BMI. Results: White women had higher levels of physical activity, lower weight status, and lower BMIs than black women. Conclusions: Racial disparities were evident; however, both groups had low to moderate levels of physical activity. Required physical education programing that targets women in college could lead to sustained physical activity.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/31765289/", "newWindow": true } ] }, { "title": "Applying Mobile Technology to Sustain Physical Activity After Completion of Cardiac Rehabilitation: Acceptability Study", "author": "Elnaggar, A.; von Oppenfeld, J.; Whooley, M. A.; Merek, S.; Park, L. G.", "year": "2021", "journalProceedings": "JMIR human factors", "category": "Intervention", "devices": "Charge 2", "population": "Patients", "dataUsed": "Steps", "abstract": "Background: Many patients do not meet the recommended levels of physical activity after completing a cardiac rehabilitation (CR) program. Wearable activity trackers and mobile phone apps are promising potential self-management tools for maintaining physical activity after CR completion. Objective: This study aims to evaluate the acceptability of a wearable device, mobile app, and push messages to facilitate physical activity following CR completion. Methods: We used semistructured interviews to assess the acceptability of various mobile technologies after participation in a pilot randomized controlled trial. Intervention patients in the randomized controlled trial wore the Fitbit Charge 2, used the Movn mobile app, and received push messages on cardiovascular disease prevention and physical activity for over 2 months. We asked 26 intervention group participants for feedback about their experience with the technology and conducted semistructured individual interviews with 7 representative participants. We used thematic analysis to create the main themes from individual interviews. Results: Our sample included participants with a mean age of 66.7 (SD 8.6) years; 23% (6/26) were female. Overall, there were varying levels of satisfaction with different technology components. There were 7 participants who completed the satisfaction questionnaires and participated in the interviews. The Fitbit and Movn mobile app received high satisfaction scores of 4.86 and 4.5, respectively, whereas push messages had a score of 3.14 out of 5. We identified four main themes through the interviews: technology use increased motivation to be physically active, technology use served as a reminder to be physically active, recommendations for technology to improve user experience, and desire for personal feedback. Conclusions: By applying a wearable activity tracker, mobile phone app, and push messages, our study showed strong potential for the adoption of new technologies by older adults to maintain physical activity after CR completion. Future research should include a larger sample over a longer period using a mixed methods approach to assess the efficacy of technology use for promoting long-term physical activity behavior in older adults.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34473064/", "newWindow": true } ] }, { "title": "A Pilot Randomized Controlled Trial of a Fitbit- and Facebook-Based Physical Activity Intervention for Young Adult Cancer Survivors", "author": "Johnson, A. M.; Baker, K. S.; Haviland, M. J.; Syrjala, K. L.; Abbey-Lambertz, M.; Chow, E. J.; Mendoza, J. A.", "year": "2021", "journalProceedings": "Journal of adolescent and young adult oncology", "category": "Intervention", "devices": "Device unspecified", "population": "Patients,Adults", "dataUsed": "Steps,Goals", "abstract": "Purpose: Most young adult cancer survivors (YACS) do not meet physical activity (PA) guidelines. Although PA can improve health and quality of life (QOL), few randomized controlled trials (RCTs) of PA interventions for YACS exist. We conducted a pilot RCT to test feasibility of a PA intervention among YACS. Methods: We recruited 18-39-year-olds (≥1 and <5 years postcancer therapy) from Seattle Cancer Care Alliance. The 12-week intervention involved a wrist-worn PA-tracking device (Fitbit), a peer-based Facebook support group, step count goal setting, and a self-selected support \"buddy.\" Controls received Fitbit only. Baseline assessments occurred before randomization; follow-up assessments occurred during intervention weeks 10-12. Feasibility criteria are listed below. Exploratory outcomes included PA, sedentary time (ST), QOL measures (e.g., fatigue), and self-determination theory (SDT) construct measures. Results: All feasibility criteria were met: We recruited 50 YACS, intervention participants wore the Fitbit on the majority of intervention days (82.9%), ≥75% of participants completed questionnaires at baseline (100%) and follow-up (93.9%). Exploratory analyses, adjusted for wave, accelerometer wear time, race, and income, showed significant group differences for change in ST (-52.4 vs. 2.5 minutes/day; p = 0.002) but no change in moderate-to-vigorous intensity PA (0.0 vs. -0.2 minutes/day; p = 0.40), comparing intervention participants to controls. The intervention (vs. control) group had a greater increase in fatigue interference (p = 0.03). No other significant differences in SDT or QOL measures were found. Conclusion: This Fitbit and Facebook-based PA intervention was feasible to YACS, with promising effects on reducing ST, and warrants a fully powered RCT. Clinical Trial Registration no.: NCT03233581.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34677081/", "newWindow": true } ] }, { "title": "Greater time in bed and less physical activity associate with poorer cognitive functioning performance in Huntington's disease", "author": "McLaren, B.; Drummond, S. P. A.; Glikmann-Johnston, Y.; Loy, C.; Bellgrove, M. A.; Stout, J. C.; Andrews, S. C.", "year": "2021", "journalProceedings": "Neuropsychology", "category": "Case Study,Measurement", "devices": "One", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Objective: This study aimed to investigate how sleep and physical activity habits related to cognitive functioning, in naturalistic settings, in early Huntington's disease (HD). Method: Forty-two participants with the expanded HD repeat (20 manifest, 22 premanifest) and 29 healthy controls wore Fitbit One sleep and activity monitors for 7 days and 7 nights. They used a smartphone application to complete daily sleep and activity diaries, sleep and mood inventories, and a brief battery of cognitive tests, which were completed on Day 8 of the study. All data were collected in naturalistic home and community settings. Results: Amongst participants with the expanded HD repeat, greater time spent in bed, measured by Fitbit, was associated with poorer accuracy and response speed on a test of visual memory, whereas lower levels of physical activity, measured by Fitbit, were associated with poorer accuracy on a test involving a working memory component. Neither time in bed nor physical activity is associated with a test of psychomotor speed. Groups were mostly similar across a range of Fitbit and self-report measures of sleep and physical activity, although the Manifest-HD group spent more time in bed than the Premanifest-HD and Healthy Control groups and had better self-reported sleep quality and more self-reported time spent sitting than the Healthy Control group and the Premanifest-HD group, respectively. Conclusions: Sleep timing and physical activity relate to cognitive functioning in HD and may be important targets for management in behavioral intervention studies aimed at improving cognition in HD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34292025/", "newWindow": true } ] }, { "title": "Patterns of Fitbit Use and Activity Levels Among African American Breast Cancer Survivors During an eHealth Weight Loss Randomized Controlled Trial", "author": "Ferrante, J. M.; Lulla, A.; Williamson, J. D.; Devine, K. A.; Ohman-Strickland, P.; Bandera, E. V.", "year": "2021", "journalProceedings": "American journal of health promotion : AJHP", "category": "Usability", "devices": "Charge,Alta", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Goals", "abstract": "Purpose: This study examined adherence with a physical activity tracker and patterns of activity among different subgroups of African American/Black breast cancer survivors (AABCS). Design: Secondary analysis of weight loss trial that used an activity tracker (FitBit) with or without a commercial eHealth program (SparkPeople) over 12 months. Setting and Subjects: AABCS (N = 44) in New Jersey. Measures and Analysis: Adherence with tracker use, steps per day, and active minutes per week were compared by demographic and clinical characteristics using nonparametric statistics. Results: Median adherence was over 6 days per week throughout the 12-months. Adherence was significantly correlated with steps and active minutes (p < 0.015). Groups with lower adherence included: those with 5 or more conditions (p = 0.039), had higher number of household members (p = 0.008), and younger than 60 years (p = 0.044). Median number of steps per day remained consistently around 7000 throughout 12 months. Factors associated with lower activity included: age > 60; retirement; higher number of household members, comorbidity, or baseline BMI; and those in the SparkPeople + Fitbit group. Self-monitoring, goal setting, and self-efficacy were significantly correlated with activity levels (p < 0.05). Conclusion: Use of a physical activity tracker may help increase activity levels in AABCS. Certain subgroups, e.g. those older than age 60 years, retired, with BMI over 40, higher number of comorbidities or more household members, may require additional interventions.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34344171/", "newWindow": true } ] }, { "title": "Targeting self-control as a behavior change mechanism to increase physical activity: Study protocol of a randomized controlled trial", "author": "Stieger, M.; Allemand, M.; Lachman, M. E.", "year": "2021", "journalProceedings": "Contemporary clinical trials", "category": "Intervention", "devices": "Charge 4", "population": "Adults", "dataUsed": "Steps", "abstract": "Despite the highly publicized beneficial effects of physical activity, 51.1% of middle-aged US adults do not achieve the recommended minimum of aerobic physical activity needed to maintain health. A sedentary lifestyle can be attributed in part to a lack of self-control and there is some evidence that self-control strategies can be improved with targeted interventions. The overall aim of this study is to test self-control as a behavior change mechanism for physical activity and to investigate whether a smartphone-based self-control intervention can increase physical activity among sedentary middle-aged adults. This protocol describes the design of a randomized controlled trial with two experimental conditions: The self-control treatment group and the control group. Both groups track their daily physical activity using a Fitbit step counter for eight weeks. Additionally, the self-control intervention group receives a 7-week smartphone-based self-control intervention to learn strategies how to potentiate desirable impulses or weaken undesirable ones. It is expected that the self-control treatment group will show greater increases in physical activity and that changes last longer compared to the control group. All participants will be assessed at pretest (baseline), at the end of each week (weeks 1–7), at posttest (week 8), and at follow-up (week 12). If this self-control intervention proves effective, this digital approach would represent a low-threshold and cost-effective approach to increasing physical activity. Such an intervention could be delivered to a large number of people to improve their health outcomes in the long run. Trial Registration: ClinicalTrials.gov: NCT04522141", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33276145/", "newWindow": true } ] }, { "title": "Effect of Wearable Technology-Based Physical Activity Interventions on Breast Cancer Survivors' Physiological, Cognitive, and Emotional Outcomes: A Systematic Review", "author": "Blount, Daphne S.; McDonough, Daniel J.; Gao, Zan", "year": "2021", "journalProceedings": "Journal of Clinical Medicine", "category": "Systematic Review", "devices": "One", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "This systematic review synthesized all randomized controlled trials (RCTs) and controlled trials examining the effects of wearable health technology-based physical activity interventions on physiological, cognitive, and emotional outcomes in breast cancer survivors (BCS). We searched NCBI, Academic Search Premier, EMBASE, Web of Science, PubMed, and Medline from inception to March 2021. We included studies which: (1) were RCTs or controlled trials ≥8 weeks in duration; (2) were peer-reviewed and published in English; (3) sampled BCS in full remission and had not received treatment for at least six months; (4) utilized wearable health technology (e.g., Fitbit, Garmin xGC30); and (5) examined physiological, emotional, and/or cognitive outcomes. Sixty-six studies were identified and 14 were included in the review. Most of the observed effects were statistically significant and those which employed multi-component interventions generally yielded greater effects. Overall, the use of wearable health technology reduced sedentary behavior and increased moderate-to-vigorous intensity physical activity. Further, increased moderate-to-vigorous intensity physical activity was observed to be associated with increased perceived cognition and higher cognitive performance. Multiple studies also observed significant improvements in attitude, worry, and anxiety. Overall, findings suggested wearable health technology-based physical activity interventions to be effective for improving physical activity, attitude, and cognitive functions and for reducing sedentary behavior, anxiety, and worry in BCS.", "links": [ { "caption": "URL", "url": "/pmc/articles/PMC8125804/", "newWindow": true }, { "caption": "URL", "url": "/pmc/articles/PMC8125804/?report=abstract", "newWindow": true }, { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125804/", "newWindow": true } ] }, { "title": "Examining physical activity and quality of life in adults with autism spectrum disorder and intellectual disability", "author": "Tomaszewski, B.; Savage, M. N.; Hume, K.", "year": "2021", "journalProceedings": "Journal of intellectual disabilities : JOID", "category": "Intervention", "devices": "Flex 2", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity", "abstract": "Adults with autism and co-occurring intellectual disability engage in low levels of physical activity and are at increased risk of developing secondary health conditions attributed to physical inactivity compared to adults in the general population. Few studies have examined the use of objective measures to characterize physical activity levels for adults with autism and intellectual disability. The current study aimed to examine the relationship between physical activity, using an activity tracker, and quality of life in adults with autism and intellectual disability. In the current study, 38 adults with autism and intellectual disability, ages 18–55, wore a Fitbit Flex 2{\\textregistered} activity tracker for 1 week, and completed the Quality of Life Questionnaire. The relationship between average daily step count quality of life was examined. Most adults in the sample were overweight and taking fewer daily steps than recommended guidelines. Increased average daily step count was significantly associated with quality of life.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34514893/", "newWindow": true } ] }, { "title": "A Mind-Body Physical Activity Program for Chronic Pain With or Without a Digital Monitoring Device: Proof-of-Concept Feasibility Randomized Controlled Trial", "author": "Greenberg, Jonathan; Popok, Paula J.; Lin, Ann; Kulich, Ronald J.; James, Peter; Macklin, Eric A.; Millstein, Rachel A.; Edwards, Robert R.; Vranceanu, Ana Maria", "year": "2020", "journalProceedings": "JMIR formative research", "category": "Intervention", "devices": null, "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "Background: Chronic pain is associated with poor physical and emotional functioning. Nonpharmacological interventions can help, but improvements are small and not sustained. Previous clinical trials do not follow recommendations to comprehensively target objectively measured and performance-based physical function in addition to self-reported physical function. Objective: This study aimed to establish feasibility benchmarks and explore improvements in physical (self-reported, performance based, and objectively measured) and emotional function, pain outcomes, and coping through a pilot randomized controlled trial of a mind-body physical activity program (GetActive) with and without a digital monitoring device (GetActive-Fitbit), which were iteratively refined through mixed methods. Methods: Patients with chronic pain were randomized to the GetActive (n=41) or GetActive-Fitbit (n=41) programs, which combine relaxation, cognitive behavioral, and physical restoration skills and were delivered in person. They completed in-person assessments before and after the intervention. Performance-based function was assessed with the 6-min walk test, and step count was measured with an ActiGraph. Results: Feasibility benchmarks (eg, recruitment, acceptability, credibility, therapist adherence, adherence to practice at home, ActiGraph wear, and client satisfaction) were good to excellent and similar in both programs. Within each program, we observed improvement in the 6-min walk test (mean increase=+41 m, SD 41.15; P<.001; effect size of 0.99 SD units for the GetActive group and mean increase=+50 m, SD 58.63; P<.001; effect size of 0.85 SD units for the GetActive-Fitbit group) and self-reported physical function (P=.001; effect size of 0.62 SD units for the GetActive group and P=.02; effect size of 0.38 SD units for the GetActive-Fitbit group). The mean step count increased only among sedentary patients (mean increase=+874 steps for the GetActive group and +867 steps for the GetActive-Fitbit group). Emotional function, pain intensity, pain coping, and mindfulness also improved in both groups. Participants rated themselves as much improved at the end of the program, and those in the GetActive-Fitbit group noted that Fitbit greatly helped with increasing their activity. Conclusions: These preliminary findings support a fully powered efficacy trial of the two programs against an education control group. We present a model for successfully using the Initiative on the Methods, Measurement, and Pain Assessment in Clinical Trials criteria for a comprehensive assessment of physical function and following evidence-based models to maximize feasibility before formal efficacy testing.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/32348281/", "newWindow": true } ] }, { "title": "Experiences of Wearable Technology by Persons with Knee Osteoarthritis Participating in a Physical Activity Counseling Intervention: Qualitative Study Using a Relational Ethics Lens", "author": "Leese, Jenny; MacDonald, Graham; Backman, Catherine L.; Townsend, Anne; Nimmon, Laura; Li, Linda C.", "year": "2021", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "Flex", "population": "Older Adults,Adults", "dataUsed": "Steps,Goals", "abstract": null, "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34766912/", "newWindow": true } ] }, { "title": "A Mental Health-Informed Physical Activity Intervention for First Responders and Their Partners Delivered Using Facebook: Mixed Methods Pilot Study", "author": "McKeon, Grace; Steel, Zachary; Wells, Ruth; Newby, Jill; Hadzi-Pavlovic, Dusan; Vancampfort, Davy; Rosenbaum, Simon", "year": "2021", "journalProceedings": "JMIR formative research", "category": "Measurement", "devices": "Flex 2", "population": "Adults", "dataUsed": "Steps,Intensity,Goals", "abstract": "Background: First responders (eg, police, firefighters, and paramedics) are at high risk of experiencing poor mental health. Physical activity interventions can help reduce symptoms and improve mental health in this group. More research is needed to evaluate accessible, low-cost methods of delivering programs. Social media may be a potential platform for delivering group-based physical activity interventions. Objective: This study aims to examine the feasibility and acceptability of delivering a mental health–informed physical activity program for first responders and their self-nominated support partners. This study also aims to assess the feasibility of applying a novel multiple time series design and to explore the impact of the intervention on mental health symptoms, sleep quality, quality of life, and physical activity levels. Methods: We co-designed a 10-week web-based physical activity program delivered via a private Facebook group. We provided education and motivation around different topics weekly (eg, goal setting, overcoming barriers to exercise, and reducing sedentary behavior) and provided participants with a Fitbit. A multiple time series design was applied to assess psychological distress levels, with participants acting as their own control before the intervention. Results: In total, 24 participants (12 first responders and 12 nominated support partners) were recruited, and 21 (88%) completed the postassessment questionnaires. High acceptability was observed in the qualitative interviews. Exploratory analyses revealed significant reductions in psychological distress during the intervention. Preintervention and postintervention analysis showed significant improvements in quality of life (P=.001; Cohen d=0.60); total depression, anxiety, and stress scores (P=.047; Cohen d=0.35); and minutes of walking (P=.04; Cohen d=0.55). Changes in perceived social support from family (P=.07; Cohen d=0.37), friends (P=.10; Cohen d=0.38), and sleep quality (P=.28; Cohen d=0.19) were not significant. Conclusions: The results provide preliminary support for the use of social media and a multiple time series design to deliver mental health–informed physical activity interventions for first responders and their support partners. Therefore, an adequately powered trial is required.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33885376/", "newWindow": true } ] }, { "title": "Validity of Fitbit activity monitoring for adults with progressive muscle diseases", "author": "Roberts-Lewis, Sarah F.; White, Claire M.; Ashworth, Mark; Rose, Michael R.", "year": "2021", "journalProceedings": "Disability and rehabilitation", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Heart Rate", "abstract": null, "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34719329/", "newWindow": true } ] }, { "title": "Using Ecological Momentary Assessments and Fitbit Data to Examine Daily Associations Between Physical Activity, Affect and Alcohol Cravings in Patients with Alcohol Use Disorder", "author": "Stevenson, Brittany L.; Kunicki, Zachary J.; Brick, Leslie; Blevins, Claire E.; Stein, Michael; Abrantes, Ana M.", "year": "2021", "journalProceedings": "International journal of behavioral medicine", "category": "Intervention,Measurement", "devices": "Charge 3", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": null, "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34750719/", "newWindow": true } ] }, { "title": "The Feasibility and Acceptability of the Developing Real Incentives and Volition for Exercise (DRIVE) Program: A Pilot Study for Promoting Physical Activity in African American Women", "author": "Sweeney, Allison M.; Wilson, Dawn K.; Zarrett, Nicole; Van Horn, M. Lee; Resnicow, Kenneth", "year": "2021", "journalProceedings": "Health promotion practice", "category": "Intervention,Measurement", "devices": "Flex 2", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background. The purpose of the current article is to demonstrate how formative process evaluation was used in a pilot study to optimize the design and implementation of two motivationally targeted community-based physical activity (PA) interventions for inactive African American women. Method. Fifteen African American women (M age: 41.6 years) were randomized to a challenge-focused program targeted toward high autonomous motivation or a rewards-focused program targeted toward low autonomous motivation. The challenge-focused program targeted enjoyment and valuation of PA and a team-based positive social climate through competitive intergroup activities and team-based goals, whereas the rewards-focused program targeted PA interest, competency, and partner-based social support through a walking program, individual-based goals with financial incentives, and partner-based action-plans. Results. Feedback from participants revealed high levels of acceptability of essential elements. Average weekly attendance exceeded the a priori goal of ≥75% of members in attendance each week. External systematic observation demonstrated that session content dose was ≥93% in both programs. Facilitator-level fidelity exceeded the a priori goal of averaging ≥3 on a 4-point scale for behavioral skills, communication, autonomy support, and session content. The process evaluation also revealed areas for improvement, including facilitator-level social support and behavioral skills at the group-level. Process data collected through FitBits revealed that participants were engaged in self-monitoring PA during the 6-week programs. Conclusions. The formative process evaluation demonstrated adequate levels of feasibility and acceptability and also provided key insights into adjustments needed before proceeding with implementing the motivationally targeted group-based programs in a larger randomized study.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/32639170/", "newWindow": true } ] }, { "title": "Physical Activity Can Enhance Life (PACE-Life): results from a 10-week walking intervention for individuals with schizophrenia spectrum disorders", "author": "Orleans-Pobee, Maku; Browne, Julia; Ludwig, Kelsey; Merritt, Carrington; Battaglini, Claudio L.; Jarskog, L. Fredrik; Sheeran, Paschal; Penn, David L.", "year": "2021", "journalProceedings": "Journal of mental health (Abingdon, England)", "category": "Intervention,Measurement", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Background: Premature mortality in individuals with schizophrenia spectrum disorders (SSDs) is largely due to high rates of chronic health conditions. Although exercise has been shown to improve health in this population, scalable and accessible interventions are limited. Aim: To examine the impact of Physical Activity Can Enhance Life (PACE-Life), a novel walking intervention, on physical activity, and on secondary outcomes of cardiorespiratory fitness (CRF), physical health, autonomous motivation, social support, and quality of life. Method: Sixteen individuals with SSDs were enrolled in a 10-week open trial. The intervention included walking groups, home-based walks, Fitbit use, and goal-setting and if-then plans. Within-group effect sizes were calculated to represent changes from baseline to post-test and 1-month follow-up. Results: Participants increased self-reported weekly walking minutes and decreased daily hours spent sitting; however, Fitbit-recorded exercise behavior changed only minimally. There were also improvements in secondary outcomes including autonomous motivation and hip circumference. CRF improved only minimally, and findings were relatively unchanged with outliers removed from the full sample. Conclusions: This open trial demonstrates modest improvements in key parameters of exercise behavior and physical health from participating in PACE-Life. Future research should assess the efficacy of this intervention in a randomized controlled trial.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33527859/", "newWindow": true } ] }, { "title": "A Feasibility Study of a Peer-Facilitated Physical Activity Intervention in Methadone Maintenance", "author": "Abrantes, Ana M.; Van Noppen, Donnell; Bailey, Genie; Uebelacker, Lisa A.; Buman, Matthew; Stein, Michael D.", "year": "2021", "journalProceedings": "Mental health and physical activity", "category": "Intervention", "devices": null, "population": "Adults", "dataUsed": "Steps", "abstract": "Purpose: While methadone maintenance treatment (MMT) has been effective in improving opioid use outcomes, most patients continue to engage in unhealthy lifestyles that lead to significant mental and physical health consequences. Interventions targeting increases in physical activity (PA) in MMT patients could have a significant impact on reducing the overall morbidity in these individuals. The purpose of this study was to assess acceptability and feasibility of a 12-week peer-facilitated PA intervention for MMT patients called TREC (Transforming Recovery with Exercise and Community). Method: We developed and then pilot-tested TREC in 26 low-active MMT clients (73% female; mean age = 41.2 years). TREC included: 1) an orientation session and intervention materials, 2) weekly PA discussion groups led by trained MMT clients, 3) peer-led walking groups and 4) a Fitbit activity tracker to facilitate self-monitoring of PA. Results: Participants attended 63% of eligible TREC sessions. Sixty-nine percent of the sample wore the Fitbit for at least 6 weeks (of the 12-week intervention). Participants reported that they enjoyed the group walks and that it was helpful to have a peer-facilitated PA group. There were small-to-moderate effect sizes for increases in PA, positive affect, and benefits of PA, and decreases in illicit opioid use and barriers to PA. No changes in depression, anxiety, and negative affect were observed from baseline to the end of the 12-week intervention. Conclusion: Indicators of feasibility and acceptability suggest that a peer-facilitated PA intervention can be incorporated in the context of MMT. Low active, opioid dependent clients showed increases in PA during the 12-week intervention. A future randomized clinical trial is necessary to determine the efficacy of TREC on long-term maintenance of PA and ancillary mental health and substance use outcomes.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34552664/", "newWindow": true } ] }, { "title": "Feasibility of a behavioral intervention using mobile health applications to reduce cardiovascular risk factors in cancer survivors: a pilot randomized controlled trial", "author": "Chow, Eric J.; Doody, David R.; Di, Chongzhi; Armenian, Saro H.; Baker, K. Scott; Bricker, Jonathan B.; Gopal, Ajay K.; Hagen, Anna M.; Ketterl, Tyler G.; Lee, Stephanie J.; Reding, Kerryn W.; Schenk, Jeannette M.; Syrjala, Karen L.; Taylor, Sarah A.; Wang, Guangxing; Neuhouser, Marian L.; Mendoza, Jason A.", "year": "2021", "journalProceedings": "Journal of cancer survivorship : research and practice", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "Purpose: Determine the feasibility of a remotely delivered mobile health (mHealth)-supported intervention to improve diet and physical activity in hematologic malignancy survivors. Methods: Pilot randomized controlled trial of a 16-week intervention for improving diet and physical activity: individualized goal-setting (daily steps, sodium, saturated fat, added sugar intake) per feedback from mHealth trackers (Fitbit for activity; Healthwatch360 for diet), supplemented by a Facebook peer support group. Controls accessed the trackers without goal-setting or peer support. Everyone received standardized survivorship counseling with tailored advice from a clinician. Actigraphy and food frequency questionnaires assessed activity and diet at baseline and follow-up. Results: Forty-one participants (51.2% male; median age 45.1 years; 7.0 years from treatment) were randomized (24 intervention; 17 control). Fitbit and Healthwatch360 use were more common among intervention versus control participants (75.0% versus 70.6% and 50.0% versus 17.7% of eligible days, respectively). Most intervention participants (66.7%) engaged with Facebook; overall, 91.7% interacted with the study's mHealth applications. While no comparisons in activity or dietary outcomes between intervention versus control group met statistical significance, the intervention was associated with greater reductions in the targeted dietary factors and improvements in Healthy Eating Index-2015 score, moderate-vigorous physical activity time, and daily steps. Participant retention at 6 months was 90.2%. Conclusions: An intervention for cardiovascular risk reduction based on individualized goal-setting enhanced by mHealth and social media peer support was feasible and acceptable among cancer survivors. Implications for Cancer Survivors: Effective and easily disseminated strategies that improve diet and physical activity in this population are needed. Trial registration: Registered in ClinicalTrials.gov (NCT03574012) on June 29, 2018.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33037989/", "newWindow": true } ] }, { "title": "A qualitative study on participants' experiences with a community-based mindful walking intervention and mobile device activity measurement", "author": "Jones, Karyn O.; Lopes, Snehal S.; Kelly, Claire; Welsh, Ralph S.; Chen, Liwei; Wilson, Mark; Jindal, Meenu; Zinzow, Heidi; Zhang, Lingling; Shi, Lu", "year": "2021", "journalProceedings": "Complementary therapies in medicine", "category": "Intervention", "devices": null, "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "Background: Mindful walking (MW) interventions employ mindfulness training combined with physical activity. Wearable mobile devices have been increasingly used to measure outcomes of physical activity interventions. The purpose of this study was to understand MW participants' attitudes towards MW and the use of mobile devices in health promotion interventions, including barriers and facilitators of intervention engagement and adherence. Few qualitative studies have documented participant experience with these two types of interventions. Method: The pilot study involved a randomized MW intervention including 38 participants with self-reported inadequate physical activity. Half of them were randomized to receive MW intervention plus a FitBit device and the other received the FitBit device only. We used a qualitative thematic analysis of the narrative data collected through open-ended survey questions at three time points. Participants in the MW intervention were asked to describe their experiences with MW, while all participants were asked to describe their experience with wearing the FitBit to track their step counts. Results: Participants reported a broad range of perceived benefits and challenges related to adopting the MW intervention and using the mobile device. Participants were generally willing to try to adopt the recommended MW practice and to see value of MW in increasing physical activity and improving overall health. Participants reported using a variety of additional device features beyond goal setting and step counts, indicating using the devices may have been effective in providing additional motivation for participants in meeting physical activity goals in both the control and intervention groups. While most of the feedback about MW (in the intervention group) and the device (all participants) was overwhelmingly positive, a minority of participants reported barriers such as lack of patience with meditation and discomfort with wearing the device. Conclusion: Most participants in the MW intervention see the health benefits of this program and most participants using the wearable physical activity tracking device reported the motivational benefits of this device. Issues with the MW intervention (e.g., lack of patience) and the wearable device (e.g., discomfort with wearing) need to be addressed in future interventions.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33388390/", "newWindow": true } ] }, { "title": "Measuring Daily Compliance With Physical Activity Tracking in Ambulatory Surgery Patients: Comparative Analysis of Five Compliance Criteria", "author": "Kelly, Ryan; Jones, Simon; Price, Blaine; Katz, Dmitri; McCormick, Ciaran; Pearce, Oliver", "year": "2021", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": null, "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "Background: Physical activity trackers such as the Fitbit can allow clinicians to monitor the recovery of their patients following surgery. An important issue when analyzing activity tracker data is to determine patients' daily compliance with wearing their assigned device, using an appropriate criterion to determine a valid day of wear. However, it is currently unclear as to how different criteria can affect the reported compliance of patients recovering from ambulatory surgery. Investigating this issue can help to inform the use of activity data by revealing factors that may impact compliance calculations. Objective: This study aimed to understand how using different criteria can affect the reported compliance with activity tracking in ambulatory surgery patients. It also aimed to investigate factors that explain variation between the outcomes of different compliance criteria. Methods: A total of 62 patients who were scheduled to undergo total knee arthroplasty (TKA, ie, knee replacement) volunteered to wear a commercial Fitbit Zip activity tracker over an 8-week perioperative period. Patients were asked to wear the Fitbit Zip daily, beginning 2 weeks prior to their surgery and ending 6 weeks after surgery. Of the 62 patients who enrolled in the study, 20 provided Fitbit data and underwent successful surgery. The Fitbit data were analyzed using 5 different daily compliance criteria, which consider patients as compliant with daily tracking if they either register >0 steps in a day, register >500 steps in a day, register at least one step in 10 different hours of the day, register >0 steps in 3 distinct time windows, or register >0 steps in 3 out of 4 six-hour time windows. The criteria were compared in terms of compliance outcomes produced for each patient. Data were explored using heatmaps and line graphs. Linear mixed models were used to identify factors that lead to variation between compliance outcomes across the sample. Results: The 5 compliance criteria produce different outcomes when applied to the patients' data, with an average 24% difference in reported compliance between the most lenient and strictest criteria. However, the extent to which each patient's reported compliance was impacted by different criteria was not uniform. Some individuals were relatively unaffected, whereas others varied by up to 72%. Wearing the activity tracker as a clip-on device, rather than on the wrist, was associated with greater differences between compliance outcomes at the individual level (P=.004, r=.616). This effect was statistically significant (P<.001) in the first 2 weeks after surgery. There was also a small but significant main effect of age on compliance in the first 2 weeks after surgery (P=.040). Gender and BMI were not associated with differences in individual compliance outcomes. Finally, the analysis revealed that surgery has an impact on patients' compliance, with noticeable reductions in activity following surgery. These reductions affect compliance calculations by discarding greater amounts of data under strict criteria. Conclusions: This study suggests that different compliance criteria cannot be used interchangeably to analyze activity data provided by TKA patients. Surgery leads to a temporary reduction in patients' mobility, which affects their reported compliance when strict thresholds are used. Reductions in mobility suggest that the use of lenient compliance criteria, such as >0 steps or windowed approaches, can avoid unnecessary data exclusion over the perioperative period. Encouraging patients to wear the device at their wrist may improve data quality by increasing the likelihood of patients wearing their tracker and ensuring that activity is registered in the 2 weeks after surgery.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33496677/", "newWindow": true } ] }, { "title": "Impact of the COVID-19 Pandemic on Objectively Measured Physical Activity and Sedentary Behavior Among Overweight Young Adults: Yearlong Longitudinal Analysis", "author": "Lawhun Costello, Victoria; Chevance, Guillaume; Wing, David; Mansour-Assi, Shadia J.; Sharp, Sydney; Golaszewski, Natalie M.; Young, Elizabeth A.; Higgins, Michael; Ibarra, Anahi; Larsen, Britta; Godino, Job G.", "year": "2021", "journalProceedings": "JMIR public health and surveillance", "category": "Measurement", "devices": "Charge 3", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": null, "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34665759/", "newWindow": true } ] }, { "title": "Feasibility of a mental health informed physical activity intervention for the carers of children with developmental and epileptic encephalopathy", "author": "McKeon, Grace; Palmer, Elizabeth E.; Macintosh, Rebecca; Nevin, Suzanne M.; Wheatley, Lauren; Rosenbaum, Simon", "year": "2021", "journalProceedings": "Epilepsy & behavior : E&B", "category": "Intervention", "devices": "Inspire", "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "Aim: Parents and carers of children with developmental and epileptic encephalopathies (DEEs) experience high rates of mental health disorders including depression and posttraumatic stress disorder. Physical activity is an evidence-based strategy which may help to improve the wellbeing of this population. Method: We delivered a 4-week physical activity group program via a private Facebook group for carers of children with DEEs and their nominated support person. The facilitators provided education and motivation on different weekly topics (e.g. goal setting, overcoming barriers to exercise) and encouraged social support between participants. All participants were provided with a physical activity tracker (Fitbit). The primary outcome was feasibility and secondary outcomes included psychological distress, quality of life, physical activity levels, and PTSD symptoms. Results: N = 20 (parents and support partners) were recruited. All participants remained in the program for the full duration and 85% completed the post assessment questionnaires. High acceptability was observed in the qualitative interviews and exploratory analysis of pre-post outcomes found significant improvements in psychological distress and quality of life (ps < 0.01), while changes in physical activity levels and PTSD symptoms were non-significant. Conclusion: A mental health informed physical activity program delivered via Facebook is feasible for carers of children with DEEs and may help improve wellbeing.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34020203/", "newWindow": true } ] }, { "title": "Changes in physical activity associated with the COVID-19 pandemic in individuals with overweight and obesity: an interrupted time series analysis with historical controls", "author": "Robertson, Michael C.; Lee, Che Young; Wu, Ivan Haw-Chong; Liao, Yue; Raber, Margaret; Parker, Nathan; Le, Thuan; Gatus, Leticia; Basen-Engquist, Karen M.", "year": "2021", "journalProceedings": "Journal of behavioral medicine", "category": "Measurement", "devices": "Flex 2", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": null, "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34698998/", "newWindow": true } ] }, { "title": "The Feasibility of a Lifestyle Physical Activity Intervention for Black Women with Asthma", "author": "Nyenhuis, Sharmilee M.; Shah, Nida; Kim, Hajwa; Marquez, David X.; Wilbur, Jo Ellen; Sharp, Lisa K.", "year": "2021", "journalProceedings": "The journal of allergy and clinical immunology. In practice", "category": "Measurement", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: Black women are disproportionately affected by both physical inactivity and asthma. Lifestyle physical activity (PA) interventions targeted for Black women with asthma are lacking. Objective: To assess the feasibility and acceptability as well as preliminary effects of a lifestyle PA intervention culturally tailored for Black women with asthma. Methods: Black women (age 18-70 years) with uncontrolled asthma (Asthma Control Test <20) were recruited. Outcome assessments at baseline and 24 weeks included measures of: feasibility and acceptability, asthma control, quality of life, health care use, and PA levels. Participants were randomized to the intervention (asthma education, Fitbit, monthly group sessions, text messages, individual step goals, and study manual) or enhanced usual care (EUC) (asthma education plus Fitbit) group. Results: Of the 53 women randomized (EUC = 28; intervention = 25), 92% remained in the intervention (23 of 25) and 76% completing the 24-week outcome assessment. Overall intervention satisfaction (mean score, 6.88 of 7) and individual components were high at 24 weeks. Mean change in asthma control questionnaire between groups was not significant at 24 weeks (intervention = –0.41 vs EUC = 0.03 [P = .08]; effect size = –0.38) but approached clinical significance (0.5). At 24 weeks, more women receiving the intervention had controlled asthma compared with EUC (36.84% vs 9.52%; P = .04). Clinically significant improvements (0.5) in quality of life were found in the intervention group (mean change: intervention = 0.58 vs EUC = 0.10; P = .10) at 24 weeks. Conclusions: A culturally tailored lifestyle PA intervention is feasible and demonstrates improvements in asthma control and quality of life among Black women with asthma. These preliminary findings support the need for PA lifestyle interventions in urban Black women with asthma.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34333191/", "newWindow": true } ] }, { "title": "Rates, patterns, and correlates of fitness tracker use among older adults with multiple sclerosis", "author": "Silveira, Stephanie L.; Baird, Jessica F.; Motl, Robert W.", "year": "2021", "journalProceedings": "Disability and health journal", "category": "Usability,Validation", "devices": null, "population": "Older Adults", "dataUsed": "Steps", "abstract": "Background: Older adults with multiple sclerosis (MS) engage in alarmingly low levels of physical activity. Fitness trackers may be a promising approach for promoting and monitoring physical activity among older adults with MS. Objective/Hypothesis: This study reports on the rates, patterns of fitness tracker use in adults with MS who are over 60 years of age. We hypothesized that older adults with MS who use fitness trackers “users” would report significantly more physical activity than those who don't “non-users.” Methods: Participants across the United States completed an online survey that included self-reported demographic and clinical characteristics, fitness tracker use questionnaire, and Godin Leisure-Time Exercise Questionnaire (GLTEQ) for measuring total and health-promoting physical activity (GLTEQ-HCS). Results: Of the 440 participants who completed the full survey, 112 (28%) identified as fitness tracker users. The most common activity monitors were Fitbit{\\textregistered}, Smartphone app, Apple{\\textregistered} watch, and Garmin{\\textregistered}. Fitness tracker users mostly reported having relapsing-remitting MS, less disability (i.e., lower Patient Determined Disability Steps), higher income, and higher rates of employment. There was a statistically significant difference in GLTEQ Total (t(438) = −3.8, p = .001) and GLTEQ-HCS (t(438) = −2.8, p = .006) scores between fitness tracker users and non-users. Self-reported step counts were strongly correlated with both GLTEQ Total ($\\rho$ = .50) and GLTEQ-HCS ($\\rho$ = 0.54) scores in fitness tracker users. Conclusions: Further research is warranted investigating fitness tracker use and interests among older adults with MS and how technology may be applied as a behavioral tool to increase physical activity among this growing portion of the MS population.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/32811785/", "newWindow": true } ] }, { "title": "Research on physical activity variability and changes of metabolic profile in patients with prediabetes using Fitbit activity trackers data", "author": "Bliudzius, Antanas; Puronaite, Roma; Trinkunas, Justas; Jakaitiene, Audrone; Kasiulevicius, Vytautas", "year": "2021", "journalProceedings": "Technology and health care : official journal of the European Society for Engineering and Medicine", "category": "Validation", "devices": null, "population": "Older Adults", "dataUsed": null, "abstract": "BACKGROUND: Monitoring physical activity with consumers wearables is one of the possibilities to control a patient's self-care and adherence to recommendations. However, clinically approved methods, software, and data analysis technologies to collect data and make it suitable for practical use for patient care are still lacking. OBJECTIVE: This study aimed to analyze the potential of patient physical activity monitoring using Fitbit physical activity trackers and find solutions for possible implementation in the health care routine. METHODS: Thirty patients with impaired fasting glycemia were randomly selected and participated for 6 months. Physical activity variability was evaluated and parameters were calculated using data from Fitbit Inspire devices. RESULTS: Changes in parameters were found and correlation between clinical data (HbA1c, lipids) and physical activity variability were assessed. Better correlation with variability than with body composition changes shows the potential to include nonlinear variability parameters analysing physical activity using mobile devices. Less expressed variability shows better relationship with control of prediabetic and lipid parameters. CONCLUSIONS: Evaluation of physical activity variability is essential for patient health, and these methods used to calculate it is an effective way to analyze big data from wearable devices in future trials.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34806636/", "newWindow": true } ] }, { "title": "The relationship between sleep and physical activity in an in-patient rehabilitation stroke setting: a cross-sectional study", "author": "Hei Chow, Ching; Fraysse, Francois; Hillier, Susan", "year": "2021", "journalProceedings": "Topics in stroke rehabilitation", "category": "Validation", "devices": "Flex", "population": "Patients", "dataUsed": "Steps,Sleep", "abstract": "Background: Appropriate sleep and physical activity are known to be important for positive neuroplastic changes in the brain and therefore may affect stroke recovery. Objective: To investigate the relationship between sleep and participation in different intensity levels of physical activity; to investigate the convergent validity of a commercially available device (Fitbit Flex) in measuring sleep and physical activity in people with stroke. Methods: A cross-sectional observational study in people with stroke undergoing rehabilitation. Participants wore two accelerometers on their unaffected wrist for seven consecutive days and recorded a sleep log, the Pittsburgh Sleep Quality Index and Fatigue Assessment Scale. Any relationships between sleep and activity were assessed with linear regression. Pearson and intra-class correlation coefficients were used to assess the validity of the two accelerometers (Fitbit Flex against the validated GENEActiv). Results: Twenty-three patients with stroke were recruited. Twenty complete data sets were analyzed. Participants had approximately 9 hours of sleep and 13 hours of sedentary behavior per day, with 99 minutes spent on physical activity (16 min spent on moderate to vigorous activity). Time spent on sleep was significantly related to sedentary, light and moderate physical activity time (r = −.67,.22,.20). The ICC of the Fitbit Flex in measuring light physical activity was.884 p < .001 but was not correlated for other measures. Conclusions: More sleep was related to less sedentary behavior and more time spent on physical activity. Fitbit Flex was only valid for measuring light physical activity.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34842058/", "newWindow": true } ] }, { "title": "Using an activity tracker to increase motivation for physical activity in patients with type 2 diabetes in primary care: a randomized pilot trial", "author": "Pelletier, Cynthia; Gagnon, Marie Pierre; Alm{\\'{e}}ras, Natalie; Despr{\\'{e}}s, Jean Pierre; Poirier, Paul; Tremblay, Angelo; Chabot, Christian; Rh{\\'{e}}aume, Caroline", "year": "2021", "journalProceedings": "mHealth", "category": "Usability", "devices": "Charge HR", "population": "Patients", "dataUsed": "Steps,Energy Expenditure,Distance,Sleep,Heart Rate", "abstract": "Background: Adopting healthy lifestyle habits reduces the risk of type 2 diabetes (T2D) and its complications. The use of an activity tracker to monitor physical activity (PA) could favor behavior changes in patients with chronic diseases such as diabetes. The aims of this study were: (I) to evaluate the impact of an activity tracker on PA and cardiometabolic risk variables in patients with T2D; (II) to assess the feasibility of its implantation in a primary care setting. Methods: This 3-month study was a pilot randomized controlled trial of 30 patients with T2D followed at a university-affiliated Family Medicine Group. Patients were randomly assigned to either: (I) control group, including a PA promotion intervention supported by a kinesiologist or (II) intervention group, including a PA promotion intervention supported by a kinesiologist with the addition of an activity tracker (Fitbit). Cardiometabolic risk variables, PA and motivation were assessed at baseline and after three months. Satisfaction and acceptability of wearing the activity tracker were measured in the intervention group. Results: PA assessed by questionnaires increased in both groups, change being greater in the intervention group (P<0.05). Autonomous motivation in both groups was higher than controlled motivation (P<0.001). Eighty-six percent of the participants in the intervention group were satisfied with their activity tracker use and the compliance remained high. High-density lipoprotein cholesterol increased in the intervention group and decreased in the control group (P=0.014). Resting systolic and diastolic blood pressure decreased over time in both groups (P<0.05) whereas glycated hemoglobin tended to decrease in both groups (P=0.080). Significant correlations were observed between average steps per day and changes in waist circumference (pre: -0.721, P=0.044; post: -0.736, P=0.038), body mass index (pre: -0.764, P=0.010; post: -0.771, P=0.009) and fat percentage (pre: -0.654, P=0.040; post: -0.686, P=0.028) in the intervention group. Conclusions: Our pilot study shows that the use of an activity tracker improves cardiometabolic risk variables in patients with T2D and could potentially be a motivation tool to increase PA in primary care setting.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34805390/", "newWindow": true } ] }, { "title": "Feasibility, Usability, and Effectiveness of a Machine Learning-Based Physical Activity Chatbot: Quasi-Experimental Study", "author": "To, Quyen G.; Green, Chelsea; Vandelanotte, Corneel", "year": "2021", "journalProceedings": "JMIR mHealth and uHealth", "category": "Usability", "devices": "Flex", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Behavioral eHealth and mobile health interventions have been moderately successful in increasing physical activity, although opportunities for further improvement remain to be discussed. Chatbots equipped with natural language processing can interact and engage with users and help continuously monitor physical activity by using data from wearable sensors and smartphones. However, a limited number of studies have evaluated the effectiveness of chatbot interventions on physical activity. Objective: This study aims to investigate the feasibility, usability, and effectiveness of a machine learning-based physical activity chatbot. Methods: A quasi-experimental design without a control group was conducted with outcomes evaluated at baseline and 6 weeks. Participants wore a Fitbit Flex 1 (Fitbit LLC) and connected to the chatbot via the Messenger app. The chatbot provided daily updates on the physical activity level for self-monitoring, sent out daily motivational messages in relation to goal achievement, and automatically adjusted the daily goals based on physical activity levels in the last 7 days. When requested by the participants, the chatbot also provided sources of information on the benefits of physical activity, sent general motivational messages, and checked participants' activity history (ie, the step counts/min that were achieved on any day). Information about usability and acceptability was self-reported. The main outcomes were daily step counts recorded by the Fitbit and self-reported physical activity. Results: Among 116 participants, 95 (81.9%) were female, 85 (73.3%) were in a relationship, 101 (87.1%) were White, and 82 (70.7%) were full-time workers. Their average age was 49.1 (SD 9.3) years with an average BMI of 32.5 (SD 8.0) kg/m2. Most experienced technical issues were due to an unexpected change in Facebook policy (93/113, 82.3%). Most of the participants scored the usability of the chatbot (101/113, 89.4%) and the Fitbit (99/113, 87.6%) as at least “OK.” About one-third (40/113, 35.4%) would continue to use the chatbot in the future, and 53.1% (60/113) agreed that the chatbot helped them become more active. On average, 6.7 (SD 7.0) messages/week were sent to the chatbot and 5.1 (SD 7.4) min/day were spent using the chatbot. At follow-up, participants recorded more steps (increase of 627, 95% CI 219-1035 steps/day) and total physical activity (increase of 154.2 min/week; 3.58 times higher at follow-up; 95% CI 2.28-5.63). Participants were also more likely to meet the physical activity guidelines (odds ratio 6.37, 95% CI 3.31-12.27) at follow-up. Conclusions: The machine learning-based physical activity chatbot was able to significantly increase participants' physical activity and was moderately accepted by the participants. However, the Facebook policy change undermined the chatbot functionality and indicated the need to use independent platforms for chatbot deployment to ensure successful delivery of this type of intervention.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34842552/", "newWindow": true } ] }, { "title": "Validity of Tools to Measure Physical Activity in Older Adults Following Total Knee Arthroplasty", "author": "Jasper, Lisa; Beaupre, Lauren A.; Spence, John C.; Jones, C. Allyson", "year": "2021", "journalProceedings": "Journal of aging and physical activity", "category": "Validation", "devices": null, "population": "Patients", "dataUsed": "Steps,Energy Expenditure", "abstract": "Few validated tools exist for measuring physical activity following total knee arthroplasty (TKA) despite the importance of returning to sufficient levels of physical activity post-TKA to achieve health benefits. This study examined the validity of two clinical measures-the Fitbit, a commercially available personal activity monitor, and the Community Healthy Activities Model Program for Seniors (CHAMPS), a self-report questionnaire-compared with a reference standard accelerometer, the SenseWearTM Armband (SWA). At 6-month post-TKA, 47 participants wore the Fitbit and SWA for 4 days and then completed the CHAMPS. Moderate-to-good correlation was observed between the Fitbit and SWA for steps (intraclass correlation coefficient [ICC] = .79), energy expenditure (ICC = .78), and energy expenditure <3 METS (ICC = .79). Poor-to-moderate correlation was observed between the CHAMPS and SWA (ICC = .43) with the questionnaire reporting lower daily energy expenditures than the SWA. Results showed that Fitbit may be a reasonable measurement tool to measure steps and energy expenditures in older adults following TKA.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33378742/", "newWindow": true } ] }, { "title": "The Effect of Aerobic Training and Increasing Nonexercise Physical Activity on Cardiometabolic Risk Factors", "author": "Swift, Damon L.; Nevels, Tyara R.; Solar, Chelsey A.; Brophy, Patricia M.; McGee, Joshua E.; Brewer, Savanna B.; Clark, Angela; Houmard, Joseph A.; Lutes, Lesley D.", "year": "2021", "journalProceedings": "Medicine and science in sports and exercise", "category": "Intervention", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "PURPOSE: Epidemiological studies suggest that sedentary behavior is an independent risk factor for cardiovascular mortality independent of meeting physical activity guidelines. However, limited evidence of this relationship is available from prospective interventions. The purpose of the present study is to evaluate the combined effect of aerobic training and increasing nonexercise physical activity on body composition and cardiometabolic risk factors. METHODS: Obese adults (N = 45) were randomized to 6 months of aerobic training (AERO), aerobic training and increasing nonexercise physical activity ($\\sim$3000 steps above baseline levels; AERO-PA), or a control (CON) group. The AERO and AERO-PA groups performed supervised aerobic training (3-4 times per week). The AERO-PA group wore Fitbit One accelerometers and received behavioral coaching to increase nonexercise physical activity. RESULTS: There was a larger increase in fitness in the AERO-PA group (0.27 L{\\textperiodcentered}min-1; confidence interval (CI), 0.16 to 0.40 L{\\textperiodcentered}min-1) compared with the AERO group (0.09 L{\\textperiodcentered}min-1; CI, -0.04 to 0.22 L{\\textperiodcentered}min-1) and the CON group (0.01; CI, -0.11 to 0.12 L{\\textperiodcentered}min-1). Although significant findings were not observed in the entire study sample, when the analysis was restricted to participants compliant to the intervention (n = 33), we observed significant reductions in waist circumference, percent weight loss, body fat, 2-h glucose, and 2-h insulin in comparison to the CON group (P < 0.05), but not the AERO group. Furthermore, linear regression models showed that change in steps was associated with 21% and 26% of the variation in percent weight loss and percent fat loss, respectively. CONCLUSIONS: Increasing nonexercise physical activity with aerobic training may represent a viable strategy to augment the fitness response in comparison to aerobic training alone and has promise for other health indicators.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33867498/", "newWindow": true } ] }, { "title": "Validity of Wrist-Wearable Activity Devices for Estimating Physical Activity in Adolescents: Comparative Study", "author": "Hao, Yingying; Ma, Xiao Kai; Zhu, Zheng; Cao, Zhen Bo", "year": "2021", "journalProceedings": "JMIR mHealth and uHealth", "category": "Validation", "devices": "Flex", "population": "Adolescents", "dataUsed": "Steps,Energy Expenditure", "abstract": "Background: The rapid advancements in science and technology of wrist-wearable activity devices offer considerable potential for clinical applications. Self-monitoring of physical activity (PA) with activity devices is helpful to improve the PA levels of adolescents. However, knowing the accuracy of activity devices in adolescents is necessary to identify current levels of PA and assess the effectiveness of intervention programs designed to increase PA. Objective: The study aimed to determine the validity of the 11 commercially available wrist-wearable activity devices for monitoring total steps and total 24-hour total energy expenditure (TEE) in healthy adolescents under simulated free-living conditions. Methods: Nineteen (10 male and 9 female) participants aged 14 to 18 years performed a 24-hour activity cycle in a metabolic chamber. Each participant simultaneously wore 11 commercial wrist-wearable activity devices (Mi Band 2 [XiaoMi], B2 [Huawei], Bong 2s [Meizu], Amazfit [Huamei], Flex [Fitbit], UP3 [Jawbone], Shine 2 [Misfit], GOLiFE Care-X [GoYourLife], Pulse O2 [Withings], Vivofit [Garmin], and Loop [Polar Electro]) and one research-based triaxial accelerometer (GT3X+ [ActiGraph]). Criterion measures were total EE from the metabolic chamber (mcTEE) and total steps from the GT3X+ (AGsteps). Results: Pearson correlation coefficients r for 24-hour TEE ranged from.78 (Shine 2, Amazfit) to.96 (Loop) and for steps ranged from 0.20 (GOLiFE) to 0.57 (Vivofit). Mean absolute percent error (MAPE) for TEE ranged from 5.7% (Mi Band 2) to 26.4% (Amazfit) and for steps ranged from 14.2% (Bong 2s) to 27.6% (Loop). TEE estimates from the Mi Band 2, UP3, Vivofit, and Bong 2s were equivalent to mcTEE. Total steps from the Bong 2s were equivalent to AGsteps. Conclusions: Overall, the Bong 2s had the best accuracy for estimating TEE and total steps under simulated free-living conditions. Further research is needed to examine the validity of these devices in different types of physical activities under real-world conditions.", "links": [ { "caption": "URL", "url": "/pmc/articles/PMC7819784/", "newWindow": true }, { "caption": "URL", "url": "/pmc/articles/PMC7819784/?report=abstract", "newWindow": true }, { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819784/", "newWindow": true } ] }, { "title": "A meta-analysis of Fitbit devices: same company, different models, different validity evidence", "author": "Leung, Willie; Case, Layne; Sung, Ming-Chih; Jung, Jaehun", "year": "2021", "journalProceedings": "https://doi.org/10.1080/03091902.2021.2006350", "category": "Validation,Systematic Review", "devices": "Classic,Ultra,One,Zip,Flex,Charge,Charge HR,Surge,Flex 2,Charge 2,Blaze,Alta,Alta HR", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Heart Rate", "abstract": "Fitbit devices are among the most commonly used physical activity devices used by the general public. Multiple studies have examined the validity evidence of Fitbit devices of estimating energy exp...", "links": [ { "caption": "URL", "url": "https://www.tandfonline.com/doi/abs/10.1080/03091902.2021.2006350", "newWindow": true } ] }, { "title": "Gamifying accelerometer use increases physical activity levels of individuals pre-disposed to type II diabetes", "author": "Francis, Shelby L.; Simmering, Jacob E.; Polgreen, Linnea A.; Evans, Nicholas J.; Hosteng, Katie R.; Carr, Lucas J.; Cremer, James F.; Coe, Sarah; Cavanaugh, Joe E.; Segre, Alberto M.; Polgreen, Philip M.", "year": "2021", "journalProceedings": "Preventive medicine reports", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Physical activity is important for preventing obesity and diabetes, but most obese and pre-diabetic patients are not physically active. We developed a Fitbit-based game called MapTrek that promotes walking. We recruited obese and pre-diabetic patients. Half were randomly assigned to the control group and given a Fitbit alone. The others were given a Fitbit plus MapTrek. The MapTrek group participated in 6 months of weekly virtual races. Each week, participants were placed in a race with 9 others who achieved a similar number of steps in the previous week's race. Participants moved along the virtual route by the steps recorded on their Fitbit and received daily walking challenges via text message. Text messages also had links to the race map and leaderboard. We used a Bayesian mixed effects model to analyze the number of steps taken during the intervention. A total of 192 (89%) participants in the control group and 196 (91%) in the MapTrek group were included in the analyses. MapTrek significantly increased step counts when it began: MapTrek participants walked almost 1,700 steps more than the control group on the first day of the intervention. We estimate that there is a 97% probability that the effect of MapTrek is at least 1,000 additional steps per day throughout the course of the 6-month intervention and that MapTrek participants would have walked an additional 81 miles, on average, before the effect ended. Our MapTrek intervention led to significant extra walking by the MapTrek participants.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34178586/", "newWindow": true } ] }, { "title": "BAILAMOS With mHealth Technology! Improving Physical Activity and Well-Being in Middle-Aged and Older Latinxs: A Pre-Post Feasibility Study", "author": "Aguinaga, Susan; Marques, Isabela G.; Kitsiou, Spyros; Balbim, Guilherme M.; Gerber, Ben S.; Buchholz, Susan W.; Bustamante, Eduardo E.; Marquez, David X.", "year": "2021", "journalProceedings": "Health education & behavior : the official publication of the Society for Public Health Education", "category": "Intervention", "devices": "Charge 2", "population": "Older Adults", "dataUsed": "Steps,Energy Expenditure,Intensity", "abstract": "Older Latinxs engage in lower levels of leisure-time physical activity (PA) compared with non-Latinx Whites. Latin dance is a culturally relevant type of leisure-time PA that may engage older Latinx populations, particularly when coupled with mobile health technologies (mHealth). This single group pre–post feasibility study described the PA and health outcomes of middle-aged and older Latinxs participating in BAILA TECH—an intervention that combines the BAILAMOS Latin dance program with mHealth (Fitbit Charge 2, Fitbit app, and motivational text messages). Participants (n = 20, Mage = 67 ± 7.1, female n = 15, 75%) were enrolled in the 16-week BAILA TECH intervention held twice a week. Participants received a Fitbit Charge 2 to assess PA at baseline, during the intervention, and postintervention. An mHealth platform (iCardia) collected Fitbit data and staff delivered weekly motivational and informational text messages. Participants completed questionnaires about PA, sedentary behavior, cardiorespiratory fitness, social support, quality of life, and cognitive function at baseline and postintervention. Paired t tests evaluated change in pre–post measures. There was a significant increase in device-assessed moderate-to-vigorous PA (d = 0.69), self-reported light-leisure (d = 1.91) and moderate-to-vigorous PA (d = 1.05), moderate-to-vigorous leisure PA (d = 1.55), predicted cardiorespiratory fitness (d = 1.10), and PA social support (d = 0.81 [family]; d = 0.95 [friends]) from baseline to postintervention. Although nonsignificant, there was a small effect on physical health–related quality of life (d = 0.32) and executive function (d = 0.29). These data describe an increase in PA levels and health-related outcomes of middle-aged and older Latinxs from participation in an mHealth-infused Latin dance intervention. An adequately powered trial is necessary to establish efficacy.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34521228/", "newWindow": true } ] }, { "title": "Effectiveness of Distance Technology in Promoting Physical Activity in Cardiovascular Disease Rehabilitation: Cluster Randomized Controlled Trial, A Pilot Study", "author": "Hakala, Sanna; Kivisto; Heikki; Paajanen; Teemu; Kankainen; Annaliisa; Anttila; Marjo Riitta; Heinonen; Ari; Sjogren; Tuulikki", "year": "2021", "journalProceedings": "JMIR rehabilitation and assistive technologies", "category": "Intervention", "devices": "Zip,Charge HR", "population": "Patients", "dataUsed": "Steps,Energy Expenditure,Intensity,Goals,Sleep,Heart Rate", "abstract": "Background: Physical activity is beneficial for cardiovascular rehabilitation. Digitalization suggests using technology in the promotion of physical activity and lifestyle changes. The effectiveness of distance technology interventions has previously been found to be similar to that of conventional treatment, but the added value of the technology has not been frequently studied. Objective: The aim of this pilot study was to investigate whether additional distance technology intervention is more effective in promoting physical activity than non-technology-based treatment in 12 months of cardiac rehabilitation. Methods: The cardiovascular disease rehabilitation intervention consisted of three 5-day inpatient periods in a rehabilitation center and two 6-month self-exercise periods at home in between. Participants were recruited from among cardiac patients who attended the rehabilitation program and were cluster-randomized into unblinded groups: conventional rehabilitation control clusters (n=3) and similar rehabilitation with additional distance technology experimental group clusters (n=3). Experimental groups used Fitbit Charge HR for self-monitoring, and they set goals and reported their activity using Movendos mCoach, through which they received monthly automated and in-person feedback. Physical activity outcomes for all participants were measured using the Fitbit Zip accelerometer and the International Physical Activity Questionnaire. Results: During the first 6 months, the experimental group (n=29) engaged in light physical activity more often than the control group (n=30; mean difference [MD] 324.2 minutes per week, 95% CI 77.4 to 571.0; P=.01). There were no group differences in the duration of moderate to vigorous physical activity (MD 12.6 minutes per week, 95% CI -90.5 to 115.7; P=.82) or steps per day (MD 1084.0, 95% CI -585.0 to 2752.9; P=.20). During the following 6 months, no differences between the groups were observed in light physical activity (MD -87.9 minutes per week, 95% CI -379.2 to 203.3; P=.54), moderate to vigorous physical activity (MD 70.9 minutes per week, 95% CI -75.7 to 217.6; P=.33), or steps per day (MD 867.1, 95% CI -2099.6 to 3833.9; P=.55). Conclusions: The use of additional distance technology increased the duration of light physical activity at the beginning of cardiac rehabilitation (for the first 6 months), but statistically significant differences were not observed between the two groups for moderate or vigorous physical activity or steps per day for both 6-month self-exercise periods.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34142970/", "newWindow": true } ] }, { "title": "Mobile Health Intervention Promoting Physical Activity in Adults Post Cardiac Rehabilitation: Pilot Randomized Controlled Trial", "author": "Park, Linda G.; Elnaggar, Abdelaziz; Lee, Sei J.; Merek, Stephanie; Hoffmann, Thomas J.; von Oppenfeld, Julia; Ignacio, Nerissa; Whooley, Mary A.", "year": "2021", "journalProceedings": "JMIR formative research", "category": "Measurement", "devices": "Charge 2", "population": "Patients", "dataUsed": "Steps", "abstract": "Background: Cardiac rehabilitation (CR) is an exercise-based program prescribed after cardiac events associated with improved physical, mental, and social functioning; however, many patients return to a sedentary lifestyle leading to deteriorating functional capacity after discharge from CR. Physical activity (PA) is critical to avoid recurrence of cardiac events and mortality and maintain functional capacity. Leveraging mobile health (mHealth) strategies to increase adherence to PA is a promising approach. Based on the social cognitive theory, we sought to determine whether mHealth strategies (Movn mobile app for self-monitoring, supportive push-through messages, and wearable activity tracker) would improve PA and functional capacity over 2 months. Objective: The objectives of this pilot randomized controlled trial were to examine preliminary effects of an mHealth intervention on group differences in PA and functional capacity and group differences in depression and self-efficacy to maintain exercise after CR. Methods: During the final week of outpatient CR, patients were randomized 1:1 to the intervention group or usual care. The intervention group downloaded the Movn mobile app, received supportive push-through messages on motivation and educational messages related to cardiovascular disease (CVD) management 3 times per week, and wore a Charge 2 (Fitbit Inc) activity tracker to track step counts. Participants in the usual care group wore a pedometer and recorded their daily steps in a diary. Data from the 6-minute walk test (6MWT) and self-reported questionnaires were collected at baseline and 2 months. Results: We recruited 60 patients from 2 CR sites at a community hospital in Northern California. The mean age was 68.0 (SD 9.3) years, and 23% (14/60) were female; retention rate was 85% (51/60). Our results from 51 patients who completed follow-up showed the intervention group had a statistically significant higher mean daily step count compared with the control (8860 vs 6633; P=.02). There was no difference between groups for the 6MWT, depression, or self-efficacy to maintain exercise. Conclusions: This intervention addresses a major public health initiative to examine the potential for mobile health strategies to promote PA in patients with CVD. Our technology-based pilot mHealth intervention provides promising results on a pragmatic and contemporary approach to promote PA by increasing daily step counts after completing CR.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33861204/", "newWindow": true } ] }, { "title": "A systematic review of the validity, reliability, and feasibility of measurement tools used to assess the physical activity and sedentary behaviour of pre-school aged children", "author": "Phillips, Sophie M.; Summerbell, Carolyn; Hobbs, Matthew; Hesketh, Kathryn R.; Saxena, Sonia; Muir, Cassey; Hillier-Brown, Frances C.", "year": "2021", "journalProceedings": "The international journal of behavioral nutrition and physical activity", "category": "Systematic Review", "devices": "Zip,Flex", "population": "Children", "dataUsed": "Steps,Energy Expenditure,Intensity,Heart Rate", "abstract": "Physical activity (PA) and sedentary behaviour (SB) of pre-school aged children are associated with important health and developmental outcomes. Accurate measurement of these behaviours in young children is critical for research and practice in this area. The aim of this review was to examine the validity, reliability, and feasibility of measurement tools used to assess PA and SB of pre-school aged children. Searches of electronic databases, and manual searching, were conducted to identify articles that examined the measurement properties (validity, reliability or feasibility) of measurement tools used to examine PA and/or SB of pre-school aged children (3–7 years old). Following screening, data were extracted and risk of bias assessment completed on all included articles. A total of 69 articles, describing 75 individual studies were included. Studies assessed measurement tools for PA (n = 27), SB (n = 5), and both PA and SB (n = 43). Outcome measures of PA and SB differed between studies (e.g. moderate to vigorous activity, step count, posture allocation). Most studies examined the measurement properties of one measurement tool only (n = 65). Measurement tools examined included: calorimetry, direct observation, combined heart rate and accelerometry, heart rate monitors, accelerometers, pedometers, and proxy report (parent, carer or teacher reported) measures (questionnaires or diaries). Studies most frequently assessed the validity (criterion and convergent) (n = 65), face and content validity (n = 2), test-retest reliability (n = 10) and intra-instrument reliability (n = 1) of the measurement tools. Feasibility data was abstracted from 41 studies. Multiple measurement tools used to measure PA and SB in pre-school aged children showed some degree of validity, reliability and feasibility, but often for different purposes. Accelerometers, including the Actigraph (in particular GT3X versions), Actical, ActivPAL and Fitbit (Flex and Zip), and proxy reported measurement tools used in combination may be useful for a range of outcome measures, to measure intensity alongside contextual information.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34732219/", "newWindow": true } ] }, { "title": "Optimization of a technology-supported physical activity promotion intervention for breast cancer survivors: Results from Fit2Thrive", "author": "Phillips, Siobhan M.; Penedo, Frank J.; Collins, Linda M.; Solk, Payton; Siddique, Juned; Song, Jing; Cella, David; Courneya, Kerry S.; Ackermann, Ronald T.; Welch, Whitney A.; Auster-Gussman, Lisa A.; Whitaker, Madelyn; Cullather, Erin; Izenman, Emily; Spring, Bonnie", "year": "2021", "journalProceedings": "Cancer", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps,Intensity,Goals", "abstract": "Background: The benefits of moderate to vigorous physical activity (MVPA) for breast cancer survivors are well established. However, most are insufficiently active. Fit2Thrive used the Multiphase Optimization Strategy methodology to determine the effect of 5 intervention components on MVPA in this population. Methods: Two hundred sixty-nine participants (mean age, 52.5 years; SD, 9.9 years) received a core intervention (the Fit2Thrive self-monitoring app and Fitbit) and were randomly assigned to 5 intervention components set to on/off in a full factorial experiment: support calls, deluxe app, buddy, online gym, and text messages. The intervention was delivered over 12 weeks with a 12-week follow-up. MVPA was measured via accelerometry at the baseline (T1), at 12 weeks (T2), and at 24 weeks (T3). The main effects and interaction effects at each time point were examined for all components. Results: Trial retention was high: 91.8% had valid accelerometer data at T2 or T3. Across all conditions, there were significant increases in MVPA (+53.6 min/wk; P <.001) and in the proportion of survivors meeting MVPA guidelines (+22.3%; P <.001) at T2 that were maintained but attenuated at T3 (MVPA, +24.6 min/wk; P <.001; meeting guidelines, +12.6%; P <.001). No individual components significantly improved MVPA, although increases were greater for the on level versus the off level for support calls, buddy, and text messages at T2 and T3. Conclusions: The Fit2Thrive core intervention (the self-monitoring app and Fitbit) is promising for increasing MVPA in breast cancer survivors, but the components provided no additional increases in MVPA. Future research should evaluate the core intervention in a randomized trial and determine what components optimize MVPA behaviors in breast cancer survivors.", "links": [ { "caption": "URL", "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.34012", "newWindow": true }, { "caption": "URL", "url": "https://onlinelibrary.wiley.com/doi/abs/10.1002/cncr.34012", "newWindow": true }, { "caption": "URL", "url": "https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.34012", "newWindow": true } ] }, { "title": "Effect of commercial wearables and digital behaviour change resources on the physical activity of adolescents attending schools in socio-economically disadvantaged areas: the RAW-PA cluster-randomised controlled trial", "author": "Ridgers, Nicola D.; Timperio, Anna; Ball, Kylie; Lai, Samuel K.; Brown, Helen; Macfarlane, Susie; Salmon, Jo", "year": "2021", "journalProceedings": "The international journal of behavioral nutrition and physical activity", "category": "Intervention", "devices": "Flex", "population": "Adolescents", "dataUsed": "Intensity", "abstract": "Background: There has been increasing interest in using wearable activity trackers to promote physical activity in youth. This study examined the short- and longer-term effects of a wearable activity tracker combined with digital behaviour change resources on the physical activity of adolescents attending schools in socio-economically disadvantaged areas. Methods: The Raising Awareness of Physical Activity (RAW-PA) Study was a 12-week, multicomponent intervention that combined a Fitbit Flex (and accompanying app), and online digital behaviour change resources and weekly challenges delivered via Facebook. RAW-PA was evaluated using a cluster-randomised controlled trial with 275 adolescents (50.2% female; 13.7 ± 0.4 years) from 18 Melbourne secondary schools (intervention n = 9; wait-list control group n = 9). The primary outcome was moderate- to vigorous-intensity physical activity (MVPA), measured using hip-worn ActiGraph accelerometers. The secondary outcome was self-reported physical activity. Data were collected at baseline, 12-weeks (immediately post-intervention), and 6-months post-intervention (follow-up). Multilevel models were used to determine the effects of the intervention on daily MVPA over time, adjusting for covariates. Results: No significant differences were observed between intervention and wait-list control adolescents' device-assessed MVPA immediately post-intervention. At 6-months post-intervention, adolescents in the intervention group engaged in 5 min (95% CI: − 9.1 to − 1.0) less MVPA per day than those in the wait-list control group. Males in the intervention group engaged in 11 min (95% CI: − 17.6 to − 4.5) less MVPA than males in the wait-list control group at 6-months post-intervention. No significant differences were observed for females at either time point. For self-reported physical activity, no significant effects were found at 12-weeks and 6-months post-intervention. Conclusions: Combining a wearable activity tracker with digital behaviour change resources and weekly challenges did not increase inactive adolescents' accelerometer-derived and self-reported physical activity levels immediately post-intervention. This contrasts previous research that has suggested wearable activity tracker may increase youth physical activity levels in the short-term. Lower engagement in MVPA 6-months post-intervention was observed for males but not for females, though it is unclear why this finding was observed. The results suggest wearable activity trackers, in combination with supporting materials, may not be effective for increasing physical activity levels in adolescents. Trial registration: ACTRN12616000899448. Australian and New Zealand Clinical Trials Registry. Registered 7 July 2016.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33845853/", "newWindow": true } ] }, { "title": "Stepping into survivorship pilot study: Harnessing mobile health and principles of behavioral economics to increase physical activity in ovarian cancer survivors", "author": "Schrier, Elizabeth; Xiong, Niya; Thompson, Embree; Poort, Hanneke; Schumer, Susan; Liu, Joyce F.; Krasner, Carolyn; Campos, Susana M.; Horowitz, Neil S.; Feltmate, Colleen; Konstantinopoulos, Panagiotis A.; Dinardo, Margaret M.; Tayob, Nabihah; Matulonis, Ursula A.; Patel, Mitesh; Wright, Alexi A.", "year": "2021", "journalProceedings": "Gynecologic oncology", "category": "Intervention", "devices": "Charge 2", "population": "Patients", "dataUsed": "Steps,Goals", "abstract": "Objective: Physical activity improves physical function, quality of life, and mental health, yet fewer than 80% of ovarian cancer survivors meet activity guidelines. This pilot intervention study aimed to increase physical activity in ovarian cancer survivors by leveraging principles of behavioral economics, gamification, and social support. Methods: This 24-week study (12-week intervention; 12-week follow-up) enrolled women with ovarian cancer after completion of first-line treatment with a self-selected “teammate.” Participants used Fitbits to measure daily steps, select an increased step goal, and enroll in a collaborative game, including points and levels for achieving step goals. Primary outcomes were feasibility (defined a priori as ≥60% approach-to-consent ratio and ≥ 70% adherence to Fitbit), acceptability (≤20% of participants reporting burden or regret for participation) and preliminary efficacy (≥70% reporting increased motivation); exploratory outcomes included change in steps. Results: We recruited 24 participants (mean age = 63 years, range = 37–79 years) with a 94% approach-to-consent ratio. All participants completed the intervention with 94% tracker adherence. At 24-week follow-up, 1/24 (≤5%) of participants reported burden; 0/24 (0%) reported regret for study participation; and 22/24 (>90%) agreed/strongly agreed that “the study motivated me to increase activity levels.” Participants' mean daily steps were 6210.7 (±3328.1) at baseline and increased to 7643 (± 3610.9) steps (p < 0.001) during the 12-week intervention. Conclusions: This pilot study demonstrated feasibility, acceptability, and preliminary efficacy, justifying a larger randomized clinical trial to test efficacy at increasing activity levels. Future studies should examine strategies for maintaining increased activity levels in survivors over time.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33637350/", "newWindow": true } ] }, { "title": "Feasibility of a theory-informed mobile app for changing physical activity in youth with multiple sclerosis", "author": "Stephens, S.; Schneiderman, Jane E.; Finlayson, Marcia; Berenbaum, Tara; Motl, Robert W.; Yeh, E. Ann", "year": "2021", "journalProceedings": "Multiple sclerosis and related disorders", "category": "Intervention", "devices": "Charge 2", "population": "Children", "dataUsed": "Steps", "abstract": null, "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34954651/", "newWindow": true } ] }, { "title": "Using a consumer-based wearable activity tracker for physical activity goal setting and measuring steps in pregnant women with gestational diabetes mellitus: exploring acceptance and validity", "author": "Ehrlich, Samantha F.; Maples, Jill M.; Barroso, Cristina S.; Brown, Kathleen C.; Bassett, David R.; Zite, Nikki B.; Fortner, Kimberly B.", "year": "2021", "journalProceedings": "BMC Pregnancy and Childbirth", "category": "Validation", "devices": "Charge 3", "population": "Pregnant Women", "dataUsed": "Steps", "abstract": "Background: Activity monitoring devices may be used to facilitate goal-setting, self-monitoring, and feedback towards a step-based physical activity (PA) goal. This study examined the performance of the wrist-worn Fitbit Charge 3™ (FC3) and sought opinions on walking and stepping-in-place from women with gestational diabetes (GDM). Methods: Participants completed six 2-min metronome-assisted over ground bouts that varied by cadence (67, 84, or 100 steps per minute) and mode (walking or stepping-in-place; N = 15), with the sequence randomized. Steps were estimated by FC3 and measured, in duplicate, by direct observation (hand-tally device, criterion). Equivalence testing by the two one-sided tests (TOST) method assessed agreement within ± 15%. Mean absolute percent error (MAPE) of steps were compared to 10%, the accuracy standard of the Consumer Technology Association (CTA)™. A subset (n = 10) completed a timed, 200-m self-paced walk to assess natural walking pace and cadence. All participants completed semi-structured interviews, which were transcribed and analyzed using descriptive and interpretive coding. Results: Mean age was 27.0 years (SD 4.2), prepregnancy BMI 29.4 kg/m2 (8.3), and gestational age 32.8 weeks (SD 2.6). The FC3 was equivalent to hand-tally for bouts of metronome-assisted walking and stepping-in-place at 84 and 100 steps per minute (i.e., P <.05), although walking at 100 steps per minute (P =.01) was no longer equivalent upon adjustment for multiple comparisons (i.e., at P <.007). The FC3 was equivalent to hand-tally during the 200-m walk (i.e., P <.001), in which mean pace was 68.2 m per minute (SD 10.7), or 2.5 miles per hour, and mean cadence 108.5 steps per minute (SD 6.5). For walking at 84 and 100 steps per minute, stepping-in-place at 100 steps per minute, and the 200-m walk, MAPE was within 10%, the accuracy standard of the CTA™. Interviews revealed motivation for PA, that stepping-in-place was an acceptable alternative to walking, and competing responsibilities made it difficult to find time for PA. Conclusions: The FC3 appears to be a valid step counter during the third trimester, particularly when walking or stepping-in-place at or close to women's preferred cadence.", "links": [] }, { "title": "Relationship quality and objectively measured physical activity before and after implementation of COVID-19 stay-home orders:", "author": "Cornelius, Talea; Denes, Amanda; Webber, Katrina T.; Guest, Chelsea; Goldsmith, Jeff; Schwartz, Joseph E.; Gorin, Amy A.", "year": "2021", "journalProceedings": "https://doi.org/10.1177/13591053211042075", "category": "Measurement", "devices": null, "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "In a sample of 28 individuals cohabiting with a partner in NYC, Boston, or Chicago, this study tested whether implementation of stay-home orders to combat the spread of COVID-19 disrupted physical ...", "links": [ { "caption": "URL", "url": "https://journals.sagepub.com/doi/abs/10.1177/13591053211042075?journalCode=hpqa", "newWindow": true } ] }, { "title": "Heart failure and promotion of physical activity before and after cardiac rehabilitation (HF-aPProACH): a study protocol\t\t8", "author": "Limpens, Marlou A. M.; Gurgoze Muhammed T.; Lenzen Mattie J.; Roest Stefan; Voortman Trudy; Kavousi Maryam; ter Hoeve Nienke; Sunamura Madoka; den Uijl Iris; van der Spek Peter J.; Brugts Jasper J.; Manintveld Olivier C.; IJpma Arne S.; Boersma Eric", "year": "2021", "journalProceedings": "ESC Heart Failure", "category": "Intervention", "devices": "Charge 3", "population": "Patients", "dataUsed": "Steps,Goals", "abstract": "Aims: Lifestyle changes, such as increasing physical activity (PA), are a cornerstone of treatment of patients with chronic heart failure (HF). However, improving PA in HF patients is challenging, and low participation rates for cardiac rehabilitation (CR) as well as relapse to low PA levels after CR are major issues. We designed a randomized controlled trial to investigate if PA monitoring with motivational feedback before and after centre-based CR in HF patients with reduced ejection fraction (HFrEF) will lead to a clinically meaningful increase in physical fitness. Methods and results: A randomized controlled trial will be conducted in a sample of 180 HFrEF patients (New York Heart Association Class II/III) who are referred to 12-week standard CR. Patients will be randomized (2:1) to (1) standard of care (SoC) plus wearing a PA monitoring device (Fitbit Charge 3) with personalized step goals, feedback and motivation or (2) SoC only. The intervention lasts ±7 months: 4–5 weeks before CR, 12 weeks during CR and 12 weeks after CR. Measurements will take place at three time points. The primary endpoint is the change in the distance in 6-min walking test (6MWT) over the entire study period. Other endpoints include step count, grip strength, quality of life and all-cause mortality or hospitalization. Conclusions: HF-aPProACH will provide novel information on the effectiveness of remote PA stimulation and feedback before, during and after standard CR using a commercially available device to improve physical fitness in HFrEF patients.", "links": [] }, { "title": "Quantitative activity levels and gestational age at delivery: a prospective cohort study among nulliparous women", "author": "Booker, Whitney A.; Ekpe, Etoroabasi E.; Handal-Orefice, Roxane C.; Zhang, Yuan; Cande, Ananth; Gyamfi-Bannerman, Cynthia; Nieto, Vanessa", "year": "2022", "journalProceedings": "American journal of obstetrics & gynecology MFM", "category": "Case Study", "devices": "Flex 2", "population": "Pregnant Women", "dataUsed": "Steps", "abstract": "OBJECTIVE: Despite the knowledge that bed rest does not reduce the risk of preterm birth (PTB), it continues to be recommended by many providers worldwide. This is because there are no quantitative data assessing the relationship between PTB and physical activity in pregnancy.1–3 We designed a prospective cohort study using a Fitbit activity tracker to quantitatively explore the association between baseline physical activity in pregnancy in steps/day and the risk of PTB (<37 weeks). STUDY DESIGN: This was a prospective cohort study assessing the association between the risk of PTB and physical activity in healthy nulliparous women from 10 to 24 weeks to delivery. The physical activity (San Francisco, California) was measured from the time of entry into the study until the day before admission for delivery using the Fitbit Flex 2. The participants wore the faceless device 24/7 without modifying their activity. The primary exposure was steps/day in low- (<5000 steps/d) and high-level (≥5000 steps/d) activity groups. The primary outcome was the rate of PTB (<37 weeks). An additional unplanned secondary analysis was performed using a 3500 steps/d cutoff. The secondary outcomes included peripartum complications and median steps/day in term vs preterm groups. Adjusted analyses were performed to account for possible confounders. RESULTS: A total of 134 women were enrolled, of which 25 (19%) and 109 (81%) were in the low- and high-level activity groups, respectively. Overall, 11 (8.2%) women delivered preterm. The high-level activity group was older, partnered, employed, and had a higher education level. The PTB did not differ between the groups (adjusted risk ratio, 0.99; 95% confidence interval [CI], 0.99–1.00) (Table). There was no difference in the median steps/d between preterm and term deliveries (7767 interquartile range, [5188–10,387] vs 6986 [5412–8528]); percentile difference, −442; (95% CI, −2233 to 1507) steps. Using a 3500 steps/d cutoff, there was a 75% reduction in the PTB risk (29% vs 7%, respectively; risk ratio, 0.25; 95% CI, 0.05–2.35) (Table). CONCLUSION: This prospective study of nulliparous women showed no difference in the risk of PTB between low- vs high-activity groups using a cutoff of 5000 steps/d. The gestational age at delivery was similar between the groups. No significant difference in the number of steps/d was observed between women who delivered preterm compared with term. The women who were prescribed activity restriction (AR) had a marked reduction in their median number of steps/d after AR was prescribed. However, their median number of steps per day (>5000) reflected that they remained active despite this instruction. An additional analysis using 3500 steps/d as a cutoff for exposure groups showed a significantly increased risk of PTB in the <3500 steps/d group than the ≥3500 steps/d group. It is therefore plausible that activity levels <3500 steps/d are associated with an increased risk of PTB.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34666197/", "newWindow": true } ] }, { "title": "Emerging wearable technology applications in gastroenterology: A review of the literature", "author": "Chong, Kimberly P. L.; Woo, Benjamin K. P.", "year": "2021", "journalProceedings": "World journal of gastroenterology", "category": "Review", "devices": null, "population": "Patients,Children,Adults", "dataUsed": "Steps,Energy Expenditure,Sleep", "abstract": "The field of gastroenterology has recently seen a surge in wearable technology to monitor physical activity, sleep quality, pain, and even gut activity. The past decade has seen the emergence of wearable devices including Fitbit, Apple Watch, AbStats, and ingestible sensors. In this review, we discuss current and future devices designed to measure sweat biomarkers, steps taken, sleep efficiency, gastric electrical activity, stomach pH, and intestinal contents. We also summarize several clinical studies to better understand wearable devices so that we may assess their potential benefit in improving healthcare while also weighing the challenges that must be addressed.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33828391/", "newWindow": true } ] }, { "title": "Day-to-day associations between sleep and physical activity: a set of person-specific analyses in adults with overweight and obesity", "author": "Chevance, Guillaume; Baretta, Dario; Romain, Ahmed J{\\'{e}}r{\\^{o}}me; Godino, Job G.; Bernard, Paquito", "year": "2021", "journalProceedings": "Journal of behavioral medicine", "category": "Intervention", "devices": "Charge 3", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "The objective of the present study was to estimate whether physical activity on one day was associated with both sleep quality and quantity the following night and to examine to what extent sleep on one night was associated with physical activity the next day. We collected data from 33 young adults who were overweight or obese and consistently wore a Fitbit Charge 3. A total of 7094 days and nights were analyzed. Person-specific models were conducted to test the bi-directional associations for each participant separately. Results suggest an absence of association between steps and sleep efficiency in the two directions. More heterogeneous results were observed for the association between steps and total sleep time, with 19 participants (58%) showing a negative association between total sleep time and next day steps, and 9 (27%) showing a negative association between steps and next day total sleep time. Taken together, these results suggest a potential conflicting association between total sleep time and physical activity for some participants. Pre- and post-print doi: https://doi.org/10.31236/osf.io/nfjqv; supplemental material: https://osf.io/y7nxg/.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34427820/", "newWindow": true } ] }, { "title": "A Technology-Based Physical Activity Intervention for Patients With Metastatic Breast Cancer (Fit2ThriveMB): Protocol for a Randomized Controlled Trial", "author": "Phillips, Siobhan; Solk, Payton; Welch, Whitney; Auster-Gussman, Lisa; Lu, Marilyn; Cullather, Erin; Torre, Emily; Whitaker, Madelyn; Izenman, Emily; La, Jennifer; Lee, Jungwha; Spring, Bonnie; Gradishar, William", "year": "2021", "journalProceedings": "JMIR research protocols", "category": "Intervention", "devices": "Inspire", "population": "Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Background: Increased incidence and life expectancy have resulted in a growing population of patients with metastatic breast cancer, and these patients experience high rates of morbidity and premature mortality. Increased physical activity (PA) is consistently associated with improved health and disease outcomes among early-stage survivors. However, there is a paucity of research on PA in patients with metastatic breast cancer, and existing PA interventions have exhibited low feasibility because of their focus on intense PA and/or requirement of on-site visits. Mobile health (mHealth)–based PA interventions may be particularly useful for patients with metastatic breast cancer because they allow for remote monitoring, which facilitates individual tailoring of PA recommendations to patients' abilities and may minimize participant burden. However, no studies have examined mHealth PA interventions in patients with metastatic breast cancer. Objective: We aim to address these critical research gaps by testing a highly tailored technology-based intervention to promote PA of any intensity (ie, light, moderate, or vigorous) by increasing daily steps in patients with metastatic breast cancer. The primary aim of this study is to test the feasibility and acceptability of the Fit2ThriveMB intervention. We will also examine outcome patterns suggesting the efficacy of Fit2ThriveMB on symptom burden, quality of life, and functional performance. Methods: The Fit2ThriveMB trial is a two-arm pilot randomized controlled trial that will compare the effects of a smartphone-delivered, home-based PA intervention and an attention-control education condition on PA and quality of life in low-active female patients with metastatic breast cancer. A subsample (n=25) will also complete functional performance measures. This innovative trial will recruit 50 participants who will be randomized into the study's intervention or control arm. The intervention will last 12 weeks. The Fit2ThriveMB intervention consists of a Fitbit, coaching calls, and the Fit2ThriveMB smartphone app that provides self-monitoring, a tailored goal-setting tool, real-time tailored feedback, app notifications, and a group message board. Assessments will occur at baseline and post intervention. Results: The Fit2ThriveMB study is ongoing. Data collection ended in February 2021. Conclusions: Data from this study will provide the preliminary effect sizes needed to assemble an intervention that is to be evaluated in a fully powered trial. In addition, these data will provide essential evidence to support the feasibility and acceptability of using a technology-based PA promotion intervention, a scalable strategy that could be easily integrated into care, among patients with metastatic breast cancer.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33890857/", "newWindow": true } ] }, { "title": "Feasibility Trial of a Mind–Body Activity Pain Management Program for Older Adults With Cognitive Decline", "author": "Mace, Ryan A.; Gates, Melissa V.; Popok, Paula J.; Kulich, Ron; Quiroz, Yakeel T.; Vranceanu, Ana-Maria", "year": "2021", "journalProceedings": "The Gerontologist", "category": "Intervention", "devices": "Alta HR", "population": "Older Adults", "dataUsed": "Steps,Goals", "abstract": "Background and Objectives: The relationship between chronic pain (CP) and cognitive decline (CD) is bidirectional among older adults. The CP-CD comorbidity can progressively worsen cognitive, physical, emotional, and social functioning with aging. We explored the feasibility and outcomes associated with 2 mind-body activity programs for CP and CD that focus on increasing walking using time goals (Active Brains) or step-count reinforced via Fitbit (Active Brains-Fitbit). Research Design and Methods: Older adults with CP and CD participated in a nonrandomized open pilot of Active Brains (n = 6) and Active Brains-Fitbit (n = 6) followed by exit interviews. Quantitative analysis explored feasibility markers and signals of improvement on physical, cognitive, and emotional function, as well as additional program targets. Qualitative analyses were predominantly deductive and applied the Framework Method to enhance the programs and methodology. Results: Both programs met a priori feasibility benchmarks. We found within-group improvements for pain intensity, pain-specific coping, physical function, and cognitive function in both programs. Exit interviews confirmed high satisfaction with both programs. Discussion and Implications: Our mixed-methods data provide preliminary evidence of feasibility, showed promise for improving outcomes, and yielded critical information to further enhance the programs. We discuss lessons learned\"and future directions.\"", "links": [ { "caption": "URL", "url": "https://academic.oup.com/gerontologist/article/61/8/1326/5960109", "newWindow": true } ] }, { "title": "Feasibility and potential efficacy of commercial mHealth/eHealth tools for weight loss in African American breast cancer survivors: pilot randomized controlled trial", "author": "Ferrante, Jeanne M.; Devine, Katie A.; Bator, Alicja; Rodgers, Ashley; Ohman-Strickland, Pamela A.; Bandera, Elisa V.; Hwang, Kevin O.", "year": "2020", "journalProceedings": "Translational behavioral medicine", "category": "Usability,Intervention", "devices": "Charge,Alta", "population": "Adults", "dataUsed": "Steps", "abstract": "Weight management after breast cancer (BC) treatment in African American (AA) women is crucial to reduce comorbid conditions and health disparities. We examined feasibility and potential efficacy of commercial eHealth/mHealth tools for weight management in AA BC survivors in New Jersey. Participants (N = 35) were randomized to an intervention (SparkPeople) plus activity tracker, Fitbit Charge (n = 18), or wait-list active control group (Fitbit only, n = 17). Anthropometric, behavioral, and quality of life (QOL) outcomes were collected at baseline, 3, 6, and 12 months. Differences in outcomes were assessed using intent-to-treat analysis. Retention was 97.1%. Both groups lost weight, with no significant differences between groups. At month 6, mean weight change was: intervention: -1.71 kg (SD 2.33; p =. 006), 33.3% lost ≥3% of baseline weight; control: -2.54 kg (SD 4.00, p =. 002), 23.5% lost ≥3% weight. Intervention participants achieved significant improvements in waist circumference (-3.56 cm, SD 4.70, p =. 005), QOL (p =. 030), and use of strategies for healthy eating (p =. 025) and decreasing calories (p <. 001). Number of days logged food per week was associated with decreases in waist circumference at 6 months ($\\beta$ -0.79, 95% CI, -1.49, -0.09, p =. 030) and 12 months ($\\beta$ -2.16, 95% CI, -4.17, -0.15, p =. 038). Weight loss was maintained at 12 months. This is the first study to demonstrate potential efficacy of commercial eHealth/mHealth tools for weight loss in AA BC survivors, without additional counseling from the research team. If effective, they may be convenient weight loss tools that can be easily and widely disseminated. Clinical Trials registration: ClinicalTrials.gov NCT02699983.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/30535101/", "newWindow": true } ] }, { "title": "Use of consumer wearable devices to promote physical activity among breast, prostate, and colorectal cancer survivors: a review of health intervention studies", "author": "Coughlin, Steven S.; Caplan, Lee S.; Stone, Rebecca", "year": "2020", "journalProceedings": "Journal of cancer survivorship : research and practice", "category": "Systematic Review", "devices": "One,Zip,Flex,Charge", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Distance,Sleep,Heart Rate", "abstract": "Purpose: A growing amount of research has successfully incorporated Fitbit devices and other wearable activity trackers into technology-oriented lifestyle interventions to increase physical activity among cancer survivors. Methods: The present review of this literature is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles published in English from January 1, 2009, through October 16, 2019, were considered. Results: A total of 1726 article citations were identified in PubMed and non-duplicates in CINAHL. After screening the abstracts or full texts of these articles and reviewing the references of previous review articles, we found 13 studies that met the eligibility criteria. Of these, 8 were randomized controlled trials, one was a pre-post-test trial, and 4 were qualitative studies (focus groups, in-depth interviews). The studies focused on breast cancer (n = 8), prostate cancer (n = 2), and colorectal cancer (n = 1), and the remainder focused on more than one cancer site. Conclusions: Additional research is needed to examine the efficacy of consumer wearable devices in promoting physical activity and weight management among cancer survivors. Implications for Cancer Survivors: Cancer survivors show an increase in physical activity when using consumer wearable activity trackers. Increased physical activity plays an important role in alleviating many adverse effects of breast cancer therapy as well as improving morbidity and mortality. Additional research such as clinical trials focused on the development of successful interventions utilizing these devices is warranted.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/31933148/", "newWindow": true } ] }, { "title": "Wrist-Worn Wearables for Monitoring Heart Rate and Energy Expenditure While Sitting or Performing Light-to-Vigorous Physical Activity: Validation Study", "author": "Duking Peter; Giessing Laura; Frenkel Marie Ottilie; Koehler Karsten; Holmberg Hans Christer; Sperlich Billy", "year": "2020", "journalProceedings": "JMIR mHealth and uHealth", "category": "Validation", "devices": "Versa", "population": "Adults", "dataUsed": "Energy Expenditure,Heart Rate", "abstract": "Background: Physical activity reduces the incidences of noncommunicable diseases, obesity, and mortality, but an inactive lifestyle is becoming increasingly common. Innovative approaches to monitor and promote physical activity are warranted. While individual monitoring of physical activity aids in the design of effective interventions to enhance physical activity, a basic prerequisite is that the monitoring devices exhibit high validity. Objective: Our goal was to assess the validity of monitoring heart rate (HR) and energy expenditure (EE) while sitting or performing light-to-vigorous physical activity with 4 popular wrist-worn wearables (Apple Watch Series 4, Polar Vantage V, Garmin Fenix 5, and Fitbit Versa). Methods: While wearing the 4 different wearables, 25 individuals performed 5 minutes each of sitting, walking, and running at different velocities (ie, 1.1 m/s, 1.9 m/s, 2.7 m/s, 3.6 m/s, and 4.1 m/s), as well as intermittent sprints. HR and EE were compared to common criterion measures: Polar-H7 chest belt for HR and indirect calorimetry for EE. Results: While monitoring HR at different exercise intensities, the standardized typical errors of the estimates were 0.09-0.62, 0.13-0.88, 0.62-1.24, and 0.47-1.94 for the Apple Watch Series 4, Polar Vantage V, Garmin Fenix 5, and Fitbit Versa, respectively. Depending on exercise intensity, the corresponding coefficients of variation were 0.9%-4.3%, 2.2%-6.7%, 2.9%-9.2%, and 4.1%-19.1%, respectively, for the 4 wearables. While monitoring EE at different exercise intensities, the standardized typical errors of the estimates were 0.34-1.84, 0.32-1.33, 0.46-4.86, and 0.41-1.65 for the Apple Watch Series 4, Polar Vantage V, Garmin Fenix 5, and Fitbit Versa, respectively. Depending on exercise intensity, the corresponding coefficients of variation were 13.5%-27.1%, 16.3%-28.0%, 15.9%-34.5%, and 8.0%-32.3%, respectively. Conclusions: The Apple Watch Series 4 provides the highest validity (ie, smallest error rates) when measuring HR while sitting or performing light-to-vigorous physical activity, followed by the Polar Vantage V, Garmin Fenix 5, and Fitbit Versa, in that order. The Apple Watch Series 4 and Polar Vantage V are suitable for valid HR measurements at the intensities tested, but HR data provided by the Garmin Fenix 5 and Fitbit Versa should be interpreted with caution due to higher error rates at certain intensities. None of the 4 wrist-worn wearables should be employed to monitor EE at the intensities and durations tested.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/32374274/", "newWindow": true } ] }, { "title": "Reporting adherence, validity and physical activity measures of wearable activity trackers in medical research: A systematic review", "author": "Chan, Alexandre; Chan, Daniella; Lee, Hui; Ng, Chiu Chin; Yeo, Angie Hui Ling", "year": "2022", "journalProceedings": "International journal of medical informatics", "category": "Systematic Review", "devices": null, "population": "Children,Adults,Adolescents", "dataUsed": "Steps,Energy Expenditure,Intensity", "abstract": null, "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35121356/", "newWindow": true } ] }, { "title": "Functional Connectivity, Physical Activity, and Neurocognitive Performances in Patients with Vascular Cognitive Impairment, No Dementia", "author": "Chang, Ya-Ting; Liu, Chun-Ting; Hsu, Shih-Wei; Lee, Chen-Chang; Huang, Pei-Ching", "year": "2022", "journalProceedings": "Current Alzheimer research", "category": "Intervention", "devices": "Charge 2", "population": "Patients", "dataUsed": "Steps,Energy Expenditure,Distance", "abstract": "Background: Vascular Cognitive Impairment, No Dementia (VCIND) is a key stage at which early intervention will delay or prevent dementia. The pathophysiology of VCIND posits that a lesion in a single location in the brain has the ability to disrupt brain networks, and the subsequent abnormal Functional Connectivity (FC) of brain networks leads to deficits in corresponding neurobehavioral domains. In this study, we tested the hypothesis that disrupted anterior cingulate cortex and striatal networks mediated the effects of Physical Activity (PA) on neurobehavioral function.\n\nMethods: In 27 patients with VCIND, FC within the brain networks and neurobehavioral dysfunction were assessed. The relationship between the cognitive scores, FC, and PA was studied. The Fitbit Charge 2 was used to measure step counts, distance, and calories burned. In patients with VCIND, a cross-sectional Spearman's correlation to analyze the relationship among patient-level measures of PA, cognitive function scores, and FC strength within the brain networks.\n\nResults: Average step counts and average distance were associated with Trail Making Test B (TM-B) time to completion (seconds) and Instrumental Activities of Daily Living (IADL) score (P <0.05). The average calories burned were associated with IADL score (P = 0.009). The FC within the brain networks anchored by left caudal Anterior Cingulate Cortex (ACC) seeds (x= -5, y= 0, z= 36) and (x= -5, y= -10, z= 47) were positively correlated with average step counts and average distance, were negatively correlated with TMB time to completion (seconds), and were positively correlated with IADL score (P < 0.05). The FC within the brain networks anchored by left subgenual ACC seed (x= -5, y= 25, z= -10) were negatively correlated with average step counts and average distance were positively correlated with TMB time to completion (seconds), and were negatively correlated with IADL score (P < 0.05). The FC within the striatal networks was positively correlated with average calories burned and IADL score (P < 0.05).\n\nKeywords: Actigraphy; brain network; cognition; executive function; functional connectivity; physical activity.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35086448/", "newWindow": true } ] }, { "title": "Accuracy and Acceptability of Wrist-Wearable Activity-Tracking Devices: Systematic Review of the Literature", "author": "Germini, Federico; Noronha, Noella; Borg Debono, Victoria; Abraham Philip, Binu; Pete, Drashti; Navarro, Tamara; Keepanasseril, Arun; Parpia, Sameer; de Wit, Kerstin; Iorio, Alfonso", "year": "2022", "journalProceedings": "Journal of medical Internet research", "category": "Systematic Review", "devices": "Charge,Charge HR", "population": "Older Adults,Adults,Adolescents", "dataUsed": "Steps,Energy Expenditure,Heart Rate", "abstract": "Background: Numerous wrist-wearable devices to measure physical activity are currently available, but there is a need to unify the evidence on how they compare in terms of acceptability and accuracy. Objective: The aim of this study is to perform a systematic review of the literature to assess the accuracy and acceptability (willingness to use the device for the task it is designed to support) of wrist-wearable activity trackers. Methods: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and SPORTDiscus for studies measuring physical activity in the general population using wrist-wearable activity trackers. We screened articles for inclusion and, for the included studies, reported data on the studies' setting and population, outcome measured, and risk of bias. Results: A total of 65 articles were included in our review. Accuracy was assessed for 14 different outcomes, which can be classified in the following categories: count of specific activities (including step counts), time spent being active, intensity of physical activity (including energy expenditure), heart rate, distance, and speed. Substantial clinical heterogeneity did not allow us to perform a meta-analysis of the results. The outcomes assessed most frequently were step counts, heart rate, and energy expenditure. For step counts, the Fitbit Charge (or the Fitbit Charge HR) had a mean absolute percentage error (MAPE) <25% across 20 studies. For heart rate, the Apple Watch had a MAPE <10% in 2 studies. For energy expenditure, the MAPE was >30% for all the brands, showing poor accuracy across devices. Acceptability was most frequently measured through data availability and wearing time. Data availability was ≥75% for the Fitbit Charge HR, Fitbit Flex 2, and Garmin Vivofit. The wearing time was 89% for both the GENEActiv and Nike FuelBand. Conclusions: The Fitbit Charge and Fitbit Charge HR were consistently shown to have a good accuracy for step counts and the Apple Watch for measuring heart rate. None of the tested devices proved to be accurate in measuring energy expenditure. Efforts should be made to reduce the heterogeneity among studies.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35060915/", "newWindow": true } ] }, { "title": "Exploring the Use of Fitbit Consumer Activity Trackers to Support Active Lifestyles in Adults with Type 2 Diabetes: A Mixed-Methods Study", "author": "Hodgson, William; Kirk, Alison; Lennon, Marilyn; Paxton, Gregor", "year": "2021", "journalProceedings": "International journal of environmental research and public health", "category": "Methods", "devices": "Charge 4", "population": "Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Background: People with type 2 diabetes are less active than those without the condition. Physical activity promotion within diabetes health care is limited. This project explored the use of Fitbit activity trackers (Fitbit, San Francisco, CA, USA) to support active lifestyles in adults with type 2 diabetes through a mixed-methods study. Methods: Two stages were conducted. In stage 1, adults with type 2 diabetes used a Fitbit Charge 4 (Fitbit, San Francisco, CA, USA) for 4 weeks. Fitbit and self-reported physical activity data was examined through quantitative analysis. Qualitative analysis was conducted to explore the experiences of participants. In stage 2, health professionals were interviewed to examine their views on using Fitbit activity trackers within type 2 diabetes care. Results: Adults with type 2 diabetes were recruited for stage 1 and adult health care and fitness professionals were recruited for stage 2. Stage 1 participants' self-reported increases in physical activity (mean weekly minutes of walking increased from 358.75 to 507.50 min, p = 0.046) and a decrease in sedentary behaviour (mean daily hours of sedentary behaviour decreased from 10.65 to 10.05 h, p = 0.575). Fitbit activity data ranges identified individuals who led inactive and sedentary lifestyles below levels recommended and in need of physical activity support to reduce the risk to their health. During interviews, participants stated that the Fitbit activity tracker motivated them to be more active. Stage 2 participants intimated that Fitbit activity trackers could improve the promotion of physical activity within type 2 diabetes care. Interventions involving the Fitbit premium service, community prescription and combined use of Fitbits with physical activity behaviour change models were recommended by stage 2 participants. Conclusion: This study found that there is future scope for using Fitbit activity trackers to support active lifestyles in adults diagnosed with type 2 diabetes.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34770110/", "newWindow": true } ] }, { "title": "Is physical activity before the end of the workday a drain or a gain? Daily implications on work focus in regular exercisers", "author": "ten Brummelhuis, Lieke L.; Calderwood, Charles; Rosen, Christopher C.; Gabriel, Allison S.", "year": "2021", "journalProceedings": "The Journal of applied psychology", "category": "Case Study", "devices": null, "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Although Organizations Increasingly Offer Wellness Programs That Enable Employees To Work Out Before Or During Work, It Remains Unknown What Implications Physical Activity Before Or During The Workday Might Have For Work Outcomes. Whereas A Workout Might Be Rewarding, Especially For Those Who Enjoy Exercise, Working Out Might Also Be Draining, Especially For Those Who Are Less Intrinsically Motivated To Exercise. Integrating The Work–Home Resources Model With Self-Determination Theory, We Develop And Test Theory Which Identifies How Physical Activity Before The End Of The Workday Might Exert Countervailing Effects By Impeding Work Focus Through Drained Personal Resources (I.E., Ego Depletion), While Also Improving Work Focus Via Enhanced Personal Resources (I.E., Self-Efficacy). We Further Theorized That Motivation For Exercise—Whether It Is Intrinsically Or Extrinsically Motivated—Serves As A Cross-Level Moderator Of These Relations. In A 5-Day Experience Sampling Study Tracking 74 Regularly Exercising Employees With Fitbit Activity Monitors, Results Indicated That Physical Activity Was Not Significantly Related To Ego Depletion. However, We Found That Light Physical Activity Was Positively Related To Self-Efficacy And Self-Efficacy Positively Related To Work Focus (As Rated By Coworkers). Further, Vigorous Physical Activity Only Resulted In Better Work Focus Among Employees With An Intrinsic (Vs. Extrinsic) Motivation For Exercise. Finally, Moderate Physical Activity Resulted In Better Work Focus Via Self-Efficacy Among Extrinsically Motivated Exercises, Whereas This Relation Was Negative For Intrinsically Motivated Exercisers. Combined, Our Results Highlight That Physical Activity Can Improve Work Focus When There Is A Match Between Physical Activity Intensity And Exercise Motivation", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34735176/", "newWindow": true } ] }, { "title": "Feasibility and Acceptability of a Physical Activity Tracker and Text Messages to Promote Physical Activity During Chemotherapy for Colorectal Cancer: Pilot Randomized Controlled Trial (Smart Pace II)", "author": "Van Blarigan, Erin L.; Dhruva, Anand; Atreya, Chloe E.; Kenfield, Stacey A.; Chan, June M.; Milloy, Alexandra; Kim, Iris; Steiding, Paige; Laffan, Angela; Zhang, Li; Piawah, Sorbarikor; Fukuoka, Yoshimi; Miaskowski, Christine; Hecht, Frederick M.; Kim, Mi-Ok; Venook, Alan P.; Van Loon, Katherine", "year": "2022", "journalProceedings": "JMIR cancer", "category": "Intervention", "devices": "Flex 2", "population": "Patients", "dataUsed": "Steps", "abstract": "Background: We conducted a pilot 2-arm randomized controlled trial to assess the feasibility of a digital health intervention to increase moderate-to-vigorous physical activity in patients with colorectal cancer (CRC) during chemotherapy. Objective: This study aimed to determine whether a digital health physical activity intervention is feasible and acceptable during chemotherapy for CRC. Methods: Potentially eligible patients with CRC expected to receive at least 12 weeks of chemotherapy were identified in person at the University of California, San Francisco, and on the web through advertising. Eligible patients were randomized 1:1 to a 12-week intervention (Fitbit Flex, automated SMS text messages) versus usual care. At 0 and 12 weeks, patients wore an Actigraph GT3X+ accelerometer for 7 days and completed surveys, body size measurements, and an optional 6-minute walk test. Participants could not be masked to their intervention arm, but people assessing the body size and 6-minute walk test outcomes were masked. The primary outcomes were adherence (eg, Fitbit wear and text response rate) and self-assessed acceptability of the intervention. The intervention would be considered feasible if we observed at least 80% complete follow-up and 70% adherence and satisfaction, a priori. Results: From 2018 to 2020, we screened 240 patients; 53.3% (128/240) of patients were ineligible and 26.7% (64/240) declined to participate. A total of 44 patients (44/240, 18%) were randomized to the intervention (n=22) or control (n=22) groups. Of these, 57% (25/44) were women; 68% (30/44) identified as White and 25% (11/44) identified as Asian American or Pacific Islander; and 77% (34/44) had a 4-year college degree. The median age at enrollment was 54 years (IQR 45-62 years). Follow-up at 12 weeks was 91% (40/44) complete. In the intervention arm, patients wore Fitbit devices on a median of 67 out of 84 (80%) study days and responded to a median of 17 out of 27 (63%) questions sent via SMS text message. Among 19 out of 22 (86%) intervention patients who completed the feedback survey, 89% (17/19) were satisfied with the Fitbit device; 63% (12/19) were satisfied with the SMS text messages; 68% (13/19) said the SMS text messages motivated them to exercise; 74% (14/19) said the frequency of SMS text messages (1-3 days) was ideal; and 79% (15/19) said that receiving SMS text messages in the morning and evening was ideal. Conclusions: This pilot study demonstrated that many people receiving chemotherapy for CRC are interested in participating in digital health physical activity interventions. Fitbit adherence was high; however, participants indicated a desire for more tailored SMS text message content. Studies with more socioeconomically diverse patients with CRC are required.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35014958/", "newWindow": true } ] }, { "title": "Monitoring work-related physical activity and estimating lower-limb loading: a proof-of-concept study", "author": "Wang, Xia; Perry, Thomas A.; Caroupapoull{\\'{e}}, Jimmy; Forrester, Alexander; Arden, Nigel K.; Hunter, David J.", "year": "2021", "journalProceedings": "BMC musculoskeletal disorders", "category": "Measurement", "devices": "Versa 2", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Physical activity (PA) is important to general health and knee osteoarthritis (OA). Excessive workplace PA is an established risk factor for knee OA however, appropriate methods of measurement are unclear. There is a need to examine and assess the utility of new methods of measuring workplace PA and estimating knee load prior to application to large-scale, knee OA cohorts. Our aims, therefore, were to monitor workplace PA and estimate lower-limb loading across different occupations in health participants. Methods: Twenty-four healthy adults, currently working full-time in a single occupation (≥ 35 h/week) and free of musculoskeletal disease, comorbidity and had no history of lower-limb injury/surgery (past 12-months) were recruited across New South Wales (Australia). A convenience sample was recruited with occupations assigned to levels of workload; sedentary, light manual and heavy manual. Metrics of workplace PA including tasks performed (i.e., sitting), step-count and lower-limb loading were monitored over 10 working days using a daily survey, smartwatch, and a smartphone. Results: Participants of light manual occupations had the greatest between-person variations in mean lower-limb load (from 2 to 59 kg*m/s3). Lower-limb load for most participants of the light manual group was similar to a single participant in heavy manual work (30 kg*m/s3) and was at least three times greater than the sedentary group (2 kg*m/s3). The trends of workplace PA over working hours were largely consistent, per individual, but rare events of extreme loads were observed across all participants (up to 760 kg*m/s3). Conclusions: There are large interpersonal variations in metrics of workplace PA, particularly among light and heavy manual occupations. Our estimates of lower-limb loading were largely consistent with pre-conceived levels of physical demand. We present a new approach to monitoring PA and estimating lower-limb loading, which could be applied to future occupational studies of knee OA.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34144697/", "newWindow": true } ] }, { "title": "Risk Factors for COVID-19 in College Students Identified by Physical, Mental, and Social Health Reported During the Fall 2020 Semester: Observational Study Using the Roadmap App and Fitbit Wearable Sensors", "author": "Gilley, Kristen N.; Baroudi, Loubna; Yu, Miao; Gainsburg, Izzy; Reddy, Niyanth; Bradley, Christina; Cislo, Christine; Rozwadowski, Michelle Lois; Clingan, Caroline Ashley; DeMoss, Matthew Stephen; Churay, Tracey; Birditt, Kira; Colabianchi, Natalie; Chowdhury, Mosharaf; Forger, Daniel; Gagnier, Joel; Zernicke, Ronald F.; Cunningham, Julia Lee; Cain, Stephen M.; Tewari, Muneesh; Choi, Sung Won", "year": "2022", "journalProceedings": "JMIR mental health", "category": "Case Study", "devices": null, "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic triggered a seismic shift in education, to online learning. With nearly 20 million students enrolled in colleges across the U.S., the long-simmering mental health crisis in college students was likely further exacerbated by the pandemic. OBJECTIVE: This study leveraged mobile health (mHealth) technology and sought to: i) characterize self-reported outcomes of physical, mental, and social health by COVID-19 status; ii) assess physical activity through consumer-grade wearable sensors (Fitbit{\\textregistered}); and iii) identify risk factors associated with COVID-19 positivity in a population of college students prior to release of the vaccine. METHODS: Detailed methods were previously published in JMIR Res Protocols (Cislo et al). After completing a baseline assessment (i.e., Time 0 [T0]) of demographics, mental, and social health constructs through the Roadmap 2.0 app, participants were instructed to use the app freely, to wear the Fitbit{\\textregistered}, and complete subsequent assessments at T1, T2 and T3, followed by a COVID-19 assessment of history and timing of COVID-19 testing and diagnosis (T4: $\\sim$14 days after T3). Continuous measures were described using means (M) and standard deviations (SD), while categorical measures were summarized using frequencies and proportions. Formal comparisons were made based on COVID-19 status. The multivariate model was determined by entering all statistically significant variables (P<.05) in univariable associations at once and then removing one variable at a time by backward selection until the optimal model was obtained. RESULTS: During the fall 2020 semester, 1,997 participants consented, enrolled, and met criteria for data analyses. There was a high prevalence of anxiety, as assessed by the State Trait Anxiety Index (STAI), with moderate and severe levels in N=465 (24%) and N=970 (49%) students, respectively. Approximately, one-third of students reported having a mental health disorder (N=656, 33%). The average daily steps recorded in this student population was approximately 6500 (M=6474, SD=3371). Neither reported mental health nor step count were significant based on COVID-19 status (P=.52). Our analyses revealed significant associations of COVID-positivity with use of marijuana and alcohol (P =.020 and .046, respectively) and lower belief in public health measures (P=.003). In addition, graduate students were less likely and those with ≥20 roommates were more likely to report a COVID-19 diagnosis (P=.009). CONCLUSIONS: Mental health problems were common in this student population. Several factors, including substance use, were associated with risk of COVID-19. These data highlight important areas for further attention, such as prioritizing innovative strategies that address health and well-being, considering the potential long-term effects of COVID-19 on college students. CLINICALTRIAL: ClinicalTrials.gov NCT04766788. INTERNATIONAL REGISTERED REPORT: RR2-10.2196/29561.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34992051/", "newWindow": true } ] }, { "title": "Moving from intention to behaviour: a randomised controlled trial protocol for an app-based physical activity intervention (i2be)", "author": "Kokai, Lili L.; O Ceallaigh, Diarmaid T.; Wijtzes, Anne I.; Roeters Van Lennep, Jeanine E.; Hagger, Martin S.; Cawley, John; Rohde, Kirsten I. M.; Van Kippersluis, Hans; Burdorf, Alex", "year": "2022", "journalProceedings": "BMJ open", "category": "Intervention", "devices": "Inspire", "population": "Pregnant Women", "dataUsed": "Intensity,Heart Rate", "abstract": "Introduction Efficacy tests of physical activity interventions indicate that many have limited or short-term efficacy, principally because they do not sufficiently build on theory-based processes that determine behaviour. The current study aims to address this limitation. Methods and analysis The efficacy of the 8-week intervention will be tested using a three-condition randomised controlled trial delivered through an app, in women with a prior hypertensive pregnancy disorder. The intervention is based on the integrated behaviour change model, which outlines the motivational, volitional and automatic processes that lead to physical activity. The mechanisms by which the behaviour change techniques lead to physical activity will be tested. Following stratification on baseline factors, participants will be randomly allocated in-app to one of three conditions (1:1:1). The information condition will receive information, replicating usual care. Additionally to what the information condition receives, the motivation condition will receive content targeting motivational processes. Additionally to what the motivation condition receives, the action condition will receive content targeting volitional and automatic processes. The primary outcome is weekly minutes of moderate-to-vigorous physical activity, as measured by an activity tracker (Fitbit Inspire 2). Secondary outcomes include weekly average of Fitbit-measured daily resting heart rate, and self-reported body mass index, waist-hip ratio, cardiorespiratory fitness and subjective well-being. Tertiary outcomes include self-reported variables representing motivational, volitional, and automatic processes. Outcome measures will be assessed at baseline, immediately post-intervention, and at 3 and 12 months post-intervention. Physical activity will also be investigated at intervention midpoint. Efficacy will be determined by available case analysis. A process evaluation will be performed based on programme fidelity and acceptability measures. Ethics and dissemination The Medical Ethics Committee of the Erasmus MC has approved this study (MEC-2020-0981). Results will be published in peer reviewed scientific journals and presented at scientific conferences. Trial registration number Netherlands trial register, NL9329.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34996794/", "newWindow": true } ] }, { "title": "Acceptability of a Mobile Health Behavior Change Intervention for Cancer Survivors With Obesity or Overweight: Nested Mixed Methods Study Within a Randomized Controlled Trial", "author": "Groarke, Jenny M.; Richmond, Janice; Mc Sharry, Jenny; Groarke, Ann Marie; Harney, Owen M.; Kelly, Mary Grace; Walsh, Jane C.", "year": "2021", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": null, "population": "Older Adults,Adults", "dataUsed": "Steps,Goals", "abstract": "Background: A significant proportion of cancer survivors have overweight or obesity. Although this has negative implications for health, weight management is not a standard component of oncology aftercare. Mobile health (mHealth) technology, in combination with behavior change techniques (BCTs), has the potential to support positive lifestyle changes. Few studies have been carried out with cancer survivors; therefore, the acceptability of these tools and techniques requires further investigation. Objective: The aim of this study is to examine the acceptability of a behavior change intervention using mHealth for cancer survivors with a BMI of 25 or more and to gather constructive feedback from participants. Methods: The intervention consisted of educational sessions and an 8-week physical activity goal setting intervention delivered using mobile technology (ie, Fitbit activity monitor plus SMS contact). In the context of a two-arm randomized controlled trial, semistructured interviews were conducted to assess the retrospective acceptability of the intervention from the perspective of the recipients. The theoretical framework for the acceptability of health care interventions was used to inform a topic guide. The interviews were transcribed and analyzed using thematic analysis. A quantitative survey was also conducted to determine the acceptability of the intervention. A total of 13 participants were interviewed, and 36 participants completed the quantitative survey. Results: The results strongly support the acceptability of the intervention. The majority of the survey respondents held a positive attitude toward the intervention (35/36, 97%). In qualitative reports, many of the intervention components were enjoyed and the mHealth components (ie, Fitbit and goal setting through text message contact) were rated especially positively. Responses were mixed as to whether the burden of participating in the intervention was high (6/36, 17%) or low (5/36, 14%). Participants perceived the intervention as having high efficacy in improving health and well-being (34/36, 94%). Most respondents said that they understood how the intervention works (35/36, 97%), and qualitative data show that participants' understanding of the aim of the intervention was broader than weight management and focused more on moving on psychologically from cancer. Conclusions: On the basis of the coherence of responses with theorized aspects of intervention acceptability, we are confident that this intervention using mHealth and BCTs is acceptable to cancer survivors with obesity or overweight. Participants made several recommendations concerning the additional provision of social support. Future studies are needed to assess the feasibility of delivery in clinical practice and the acceptability of the intervention to those delivering the intervention.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33591290/", "newWindow": true } ] }, { "title": "A 'novel' multi-component approach to promote physical activity among older cancer survivors: a pilot randomized controlled trial", "author": "Pinto, Bernardine M.; Kindred, Madison; Franco, Regina; Simmons, Virginia; Hardin, James", "year": "2021", "journalProceedings": "Acta oncologica (Stockholm, Sweden)", "category": "Usability", "devices": "Charge 2", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Background: Physical activity (PA) provides many benefits for recovery from cancer treatments. Many older (65+ years) cancer survivors which comprise the majority of the cancer survivor population, do not meet recommended PA guidelines. This study explored the feasibility and acceptability of using audiobooks as part of a 12-week multi-component intervention to increase steps/day, light and moderate-to-vigorous intensity PA among older survivors. Methods: Twenty older cancer survivors (95% female, mean age = 71.55 years, 90% White, 85% overweight/obese, 75% breast cancer survivors, mean 1.96 years since treatment completion) were randomized into one of the two study groups (Audiobook Group, n = 12, Comparison Group, n = 8). Both study groups were provided a tailored step goal program over the 12-week intervention; weekly step increases were based on a percent increase from baseline. Participant self-monitored their steps using a Fitbit Charge 2. In addition, the Audiobook group were encouraged to listen to audiobooks (downloaded onto a smartphone device via an app available at no cost from the local library) during PA to add enjoyment and increase PA. Regression analyses on steps/day, light and moderate-to-vigorous PA/week and sedentary time/week as assessed by the Actigraph were conducted, after adjusting for Actigraph wear time. Data from the post-intervention questionnaire were summarized. Results: Overall, majority of participants (89%) stated they were very satisfied with their participation and 100% reported that they were able to maintain their activity upon study completion. Retention rates were high. At post-intervention, there were significant differences favoring the Audiobook group for steps/day and moderate-to-vigorous PA/week. No significant group differences were found for minutes of light intensity PA/week and sedentary time/week. Conclusion: Piloting the implementation of a sustainable, innovative intervention among older survivors to increase their PA has significance for this group of survivors.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33689553/", "newWindow": true } ] }, { "title": "¡Mi Vida Saludable! A randomized, controlled, 2 × 2 factorial trial of a diet and physical activity intervention among Latina breast cancer survivors: Study design and methods", "author": "Santiago-Torres, Margarita; Contento, Isobel; Koch, Pamela; Tsai, Wei Yann; Brickman, Adam M.; Gaffney, Ann Ogden; Thomson, Cynthia A.; Crane, Tracy E.; Dominguez, Naxielly; Sepulveda, Jhack; Mar{\\'{i}}n-Chollom, Amanda M.; Paul, Rachel; Shi, Zaixing; Ulanday, Kathleene T.; Hale, Christiane; Hershman, Dawn; Greenlee, Heather", "year": "2021", "journalProceedings": "Contemporary clinical trials", "category": "Methods", "devices": "Zip", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: Most Latina breast cancer survivors do not meet diet and physical activity (PA) guidelines for cancer survivors and effective lifestyle interventions to adopt and maintain these recommendations are limited, especially among underserved populations. Here we describe the design, methods and enrollment of a 2 × 2 factorial-designed trial testing the separate effects of the ¡Mi Vida Saludable! (My Healthy Life!) intervention program on changes in diet and PA behaviors among Latina breast cancer survivors. Methods: Latinas with a history of stage 0-III breast cancer, no evidence of recurrent/metastatic disease, and > 90 days post-treatment were primarily identified via cancer registries and physician referral. Participants were randomized to four arms: 1) 4 weeks of in-person group sessions plus 11 months of eHealth communication, 2) in-person group sessions alone, 3) eHealth alone, or 4) control. All participants received a Fitbit to self-monitor PA. Assessments at baseline, 6 and 12 months include diet, PA, anthropometrics, predictors and mediators of behavior change, psychosocial and quality of life outcomes, and blood draw. Results: Of 884 women screened between January 2016 and September 2018, 27% were eligible. Primary reasons for ineligibility included not being willing/able to participate due to work/life responsibilities, health reasons, or transportation. Of 241 eligible women, 167 completed baseline assessment and enrolled. Conclusions: We successfully enrolled a diverse group of breast cancer survivors representing more than 15 Latin American nationalities to a diet and physical activity trial. If effective, the ¡Mi Vida Saludable! program can be implemented by community groups and medical centers. Trial registration: ClinicalTrials.gov, NCT02780271, registered May 2016.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34365016/", "newWindow": true } ] }, { "title": "Connecting breast cancer survivors for exercise: protocol for a two-arm randomized controlled trial", "author": "Smith-Turchyn, Jenna; McCowan, Michelle E.; O'Loughlin, Erin; Fong, Angela J.; McDonough, Meghan H.; Santa Mina, Daniel; Arbour-Nicitopoulos, Kelly P.; Trinh, Linda; Jones, Jennifer M.; Bender, Jackie L.; Culos-Reed, S. Nicole; Tomasone, Jennifer R.; Vani, Madison F.; Sabiston, Catherine M.", "year": "2021", "journalProceedings": "BMC sports science, medicine & rehabilitation", "category": "Methods", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: Peer-based exercise interventions that cultivate new opportunities for support with a fellow cancer survivor may result in increased exercise volume. It is not clear whether adding qualified exercise professional (QEP) support to peer-based interventions improves health outcomes. Therefore, the purpose of this study is to determine whether breast cancer survivor (BCS) dyads who receive 10 weekly sessions of virtually delivered QEP support have improved outcomes compared to BCS dyads who do not receive QEP support. Methods: Participants Adult BCS with medical clearance for exercise, who have an internet-connected device, and currently engage in < 150 min of moderate-intensity exercise per week. Intervention BCS will be matched using evidence-based criteria. The intervention group will receive dyadic exercise information sessions and a program tailored by a QEP for 10 weeks (intervention period) and have access to the QEP for an additional 4 weeks (tapering period). The control will not receive any QEP support. Outcomes The primary outcome is post-intervention self-reported exercise volume. Secondary outcomes include device-assessed exercise volume (i.e., Fitbit), social support, and health-related quality of life. Randomization 108 participants, matched in dyads, will be randomized 1:1 to the MatchQEP or Match groups using a web-based scheme. Statistical analysis Outcomes will be measured at baseline, post-intervention, post-tapering, and at 12 weeks post-intervention follow-up. Discussion: The findings from this RCT will determine if matched BCS dyads who receive 10 weeks of virtually delivered QEP support have higher levels of self-report and device-measured exercise, social support, and health related quality of life compared to matched dyads without QEP-delivered exercise guidance. To our knowledge this will be the first study to assess the combined effect of peer- and QEP support on exercise volume. Project findings will inform and optimize intervention methods aimed to increase exercise among BCS through accessible exercise supports. Trial Registration: The study is registered on ClinicalTrials.gov (study identifier: NCT04771975, protocol Version Number: 2, date: July 22, 2021).", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34649590/", "newWindow": true } ] }, { "title": "Quality of life of colorectal cancer survivors participating in a pilot randomized controlled trial of physical activity trackers and daily text messages", "author": "Chan, Hilary; Van Loon, Katherine; Kenfield, Stacey A.; Chan, June M.; Mitchell, Emily; Zhang, Li; Paciorek, Alan; Joseph, Galen; Laffan, Angela; Atreya, Chloe; Fukuoka, Yoshimi; Miaskowski, Christine; Meyerhardt, Jeffrey A.; Venook, Alan P.; Van Blarigan, Erin L.", "year": "2022", "journalProceedings": "Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": null, "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35119520/", "newWindow": true } ] }, { "title": "Charity-based incentives motivate young adult cancer survivors to increase physical activity: a pilot randomized clinical trial", "author": "Keadle, Sarah Kozey; Meuter, Leah; Phelan, Suzanne; Phillips, Siobhan M.", "year": "2021", "journalProceedings": "Journal of behavioral medicine", "category": "Usability", "devices": "One", "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "To determine the feasibility, acceptability and preliminary efficacy of an eHealth intervention with charity-based incentives to increase physical activity (PA) among young adult cancer survivors. Participants were randomized into two groups: PA (N = 25; Fitbit, step goal, electronic weekly newsletter) or PA + Charity (N = 26; same as PA plus charity donation if step goal achieved). At baseline and 12 weeks, steps/day were assessed using an activPAL. Motivation (e.g., BREQ-3) and patient reported outcomes (e.g., sleep quality, fatigue) were self-reported. The mean age was 36.8 years, 56.9% were Non-Hispanic White. We retained 82% (42/51) of participants. The PA + Charity vs. PA group had significantly higher satisfaction with intervention experience (100% vs 85%), greater increases in steps/day (1689 vs 516) and increases in overall self-determination score (13.5 vs 2.2). Both groups significantly improved sleep quality and reduced fatigue. A low-intensity eHealth intervention with charity-based incentives was feasible, acceptable, increased PA and self-determination. Trial registration Clinicaltrials.gov NCT03322059.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33825070/", "newWindow": true } ] }, { "title": "Feasibility and efficacy of enteral tube feeding on weight stability, lean body mass, and patient-reported outcomes in pancreatic cancer cachexia", "author": "Gresham, Gillian; Placencio-Hickok, Veronica R.; Lauzon, Marie; Nguyen, Tyra; Kim, Haesoo; Mehta, Sejal; Paski, Shirley; Pandol, Stephen J.; Osipov, Arsen; Gong, Jun; Jamil, Laith H.; Nissen, Nicholas; Lo, Simon K.; Hendifar, Andrew E.", "year": "2021", "journalProceedings": "Journal of cachexia, sarcopenia and muscle", "category": "Intervention", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Intensity,Distance,Sleep,Heart Rate", "abstract": "Background: Advanced pancreatic ductal adenocarcinoma (PDAC) is characterized by progressive weight loss and nutritional deterioration. This wasting has been linked to poor survival outcomes, alterations in host defenses, decreased functional ability, and diminished health-related quality of life (HRQOL) in pancreatic cancer patients. There are currently no standardized approaches to the management of pancreatic cancer cachexia. This study explores the feasibility and efficacy of enteral tube feeding of a peptide-based formula to improve weight stability and patient-reported outcomes (PROs) in advanced PDAC patients with cachexia. Methods: This was a single-institution, single-arm prospective trial conducted between April 2015 and March 2019. Eligible patients were adults (>18 years) diagnosed with advanced or locally advanced PDAC and cachexia, defined as greater than 5% unexplained weight loss within 6 months from screening. The study intervention included three 28 day cycles of a semi-elemental peptide-based formula, administered through a jejunal or gastrojejunal feeding tube. The primary outcome was weight stability at 3 months (Cycle 3), defined as weight change less than 0.1 kg/baseline BMI unit from baseline. Secondary outcomes included changes in lean body mass, appendicular lean mass, bone mineral density, fat mass, and percent body fat, as measured with a DEXA scan, HRQOL (EORTC QLQC30) and NIH PROMIS PROs assessed at each cycle. Daily activity (steps, distance, active minutes, heart rate, and sleep) were remotely monitored using a wearable activity monitor (Fitbit) over the 3 month study period. Results: Thirty-six patients were screened for eligibility, 31 patients consented onto study and underwent jejunal tube placement, and 16 patients completed treatment: mean age 67 years (SD 9.3), 43.8% male. Among evaluable patients (n = 16), weight stability was achieved in 10 patients (62.5%), thus completing the trial early. Increases in lean body mass (1273.1, SD: 4078, P = 0.01) and appendicular lean mass (0.45, SD: 0.6, P = 0.02) were observed. Statistically significant improvements at Cycle 3 from baseline were also observed for QLQC30 role function [mean difference (MD): 20.1, P = 0.03], appetite (MD: 27.4, P = 0.02), and global health scores (MD: 13.3, P = 0.05) as well as for NIH PROMIS t-scores for depression (MD: −10.4, P = 0.006) and pain interference (MD: −7.5, P = 0.05). Objectively monitored (Fitbit) activity levels increased, although statistical significance was not reached. Conclusions: Our findings suggest that enteral nutrition support may improve weight stability, lean body mass, appendicular lean mass and PROs in PDAC patients with cachexia who completed treatment, representing a subsample of the study population. The feasibility and role of enteral feeding in routine care remain unclear, and larger and randomized controlled trials are warranted.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34609081/", "newWindow": true } ] }, { "title": "Feasibility of Fitness Tracker Usage to Assess Activity Level and Toxicities in Patients With Colorectal Cancer", "author": "Ward, William H.; Meeker, Caitlin R.; Handorf, Elizabeth; Hill, Maureen V.; Einarson, Margret; Alpaugh, R. Katherine; Holden, Thomas L.; Astsaturov, Igor; Denlinger, Crystal S.; Hall, Michael J.; Reddy, Sanjay S.; Sigurdson, Elin R.; Dotan, Efrat; Zibelman, Matthew; Meyer, Joshua E.; Farma, Jeffrey M.; Vijayvergia, Namrata", "year": "2021", "journalProceedings": "JCO clinical cancer informatics", "category": "Usability", "devices": "Charge", "population": "Patients", "dataUsed": "Steps", "abstract": "PURPOSE: Performance status (PS) is a subjective assessment of patients' overall health. Quantification of physical activity using a wearable tracker (Fitbit Charge [FC]) may provide an objective measure of patient's overall PS and treatment tolerance. MATERIALS AND METHODS: Patients with colorectal cancer were prospectively enrolled into two cohorts (medical and surgical) and asked to wear FC for 4 days at baseline (start of new chemotherapy [± 4 weeks] or prior to curative resection) and follow-up (4 weeks [± 2 weeks] after initial assessment in medical and postoperative discharge in surgical cohort). Primary end point was feasibility, defined as 75% of patients wearing FC for at least 12 hours/d, 3 of 4 assigned days. Mean steps per day (SPD) were correlated with toxicities of interest (postoperative complication or ≥ grade 3 toxicity). A cutoff of 5,000 SPD was selected to compare outcomes. RESULTS: Eighty patients were accrued over 3 years with 55% males and a median age of 59.5 years. Feasibility end point was met with 68 patients (85%) wearing FC more than predefined duration and majority (91%) finding its use acceptable. The mean SPD count for patients with PS 0 was 6,313, and for those with PS 1, it was 2,925 (122 and 54 active minutes, respectively) (P = .0003). Occurrence of toxicity of interest was lower among patients with SPD > 5,000 (7 of 33, 21%) compared with those with SPD < 5,000 (14 of 43, 32%), although not significant (P = .31). CONCLUSION: Assessment of physical activity with FC is feasible in patients with colorectal cancer and well-accepted. SPD may serve as an adjunct to PS assessment and a possible tool to help predict toxicities, regardless of type of therapy. Future studies incorporating FC can standardize patient assessment and help identify vulnerable population.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33492994/", "newWindow": true } ] }, { "title": "Wrist-worn devices for the measurement of heart rate and energy expenditure: A validation study for the Apple Watch 6, Polar Vantage V and Fitbit Sense", "author": "Hajj-Boutros, Guy; Landry-Duval, Marie Anne; Comtois, Alain Steve; Gouspillou, Gilles; Karelis, Antony D.", "year": "2022", "journalProceedings": "European journal of sport science", "category": "Validation", "devices": "Sense", "population": "Adults", "dataUsed": "Energy Expenditure,Heart Rate", "abstract": "The purpose of this study was to investigate the accuracy of 3 recently released wrist-worn devices (Apple Watch 6, Polar Vantage V and Fitbit Sense) for heart rate and energy expenditure during various activities. The study population consisted of 60 young healthy individuals (30 men and 30 women; age: 24.9 ± 3.0 years, BMI: 23.1 ± 2.7 kg/m2). Heart rate and energy expenditure were measured using the Polar H10 and Metamax 3B, respectively (reference measures) as well as with the 3 wrist-worn devices during 5 different activities (sitting, walking, running, resistance exercises and cycling). The Apple Watch 6 displayed the highest level of accuracy for heart rate measurement with a coefficient of variation (CV) (%) of less than 5% for all 5 activities, whereas the Polar Vantage V and the Fitbit Sense presented various degrees of accuracy (from high to poor accuracy) dependent on the activity (CVs between 2.44-8.80% and 4.14-10.76%, respectively). As for energy expenditure, all 3 devices displayed poor accuracy for all 5 physical activities (CVs between 14.68-24.85% for Apple Watch 6, 16.54-25.78% for Polar Vantage V and 13.44-29.66% for Fitbit Sense). Results of the present study indicate that the Apple Watch 6 was the most accurate for measuring heart rate across all 5 activities, whereas variable levels of accuracy for heart rate measurement for the Polar Vantage V and the Fitbit Sense were observed depending on the activity. As for energy expenditure, all 3 devices showed poor accuracy during all activities. Highlights The Apple Watch 6 was the most accurate for measuring heart rate, whereas the Polar Vantage V and Fitbit Sense showed variable results dependent on the activity The Apple Watch 6, Polar Vantage V and Fitbit Sense showed poor accuracy for energy expenditure during 5 different physical activities Healthcare care professionals, athletes/coaches and the general population may want to proceed with caution on the clinical utility of energy expenditure of these devices during the implementation of an exercise training or nutritional programme.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34957939/", "newWindow": true } ] }, { "title": "Accuracy of Heart Rate Measurement by the Fitbit Charge 2 During Wheelchair Activities in People With Spinal Cord Injury: Instrument Validation Study", "author": "Hoevenaars, Dirk; Yocarini, Iris E.; Paraschiakos, Stylianos; Holla, Jasmijn F. M.; de Groot, Sonja; Kraaij, Wessel; Janssen, Thomas W. J.", "year": "2022", "journalProceedings": "JMIR rehabilitation and assistive technologies", "category": "Usability,Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Heart Rate", "abstract": null, "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35044306/", "newWindow": true } ] }, { "title": "Stepping Up: An Evaluation of Social Comparison of Physical Activity During Fitbit Challenges", "author": "Nastasi, Jessica A.; Curry, Erin M.; Martinez, Romina E.; Arigo, Danielle; Raiff, Bethany R.", "year": "2022", "journalProceedings": "Journal of technology in behavioral science", "category": "Case Study", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps", "abstract": "The current set of within-subject, single-case design studies examined how exposure to social comparison information may impact physical activity in sedentary individuals. In Study 1, participants (N = 6) were exposed to two Fitbit challenges, one with a physically active confederate and another with a sedentary confederate. Each challenge phase lasted 7 days, during which participants were able to compare their daily steps to the assigned confederate on a ranked leaderboard, received notifications if their cumulative steps were surpassed by the confederate, and a notification indicating if they won at the conclusion of each challenge (i.e., active confederate in challenge one then sedentary confederate in challenge two, or vice versa). Study 2 replicated the procedures used in Study 1 but controlled for the distance between confederate and participant daily steps (N = 4). In Study 3, participants (N = 4) were exposed to the same confederate twice to evaluate potential order effects. Results showed that physical activity increased for most participants, but the direction and magnitude of effects differed across participants, challenge type, and order of confederate exposure. The factors producing differential responding to the Fitbit challenges, and the implications for future research on the effects of competition and social comparison on behavior, are discussed.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35224181/", "newWindow": true } ] }, { "title": "Concurrent and prospective associations between fitbit wearable-derived RDoC arousal and regulatory constructs and adolescent internalizing symptoms", "author": "Nelson, Benjamin W.; Flannery, Jessica E.; Flournoy, John; Duell, Natasha; Prinstein, Mitchell J.; Telzer, Eva", "year": "2022", "journalProceedings": "Journal of child psychology and psychiatry, and allied disciplines", "category": "Case Study", "devices": "Charge 2", "population": "Children", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Background: Adolescence is characterized by alterations in biobehavioral functioning, during which individuals are at heightened risk for onset of psychopathology, particularly internalizing disorders. Researchers have proposed using digital technologies to index daily biobehavioral functioning, yet there is a dearth of research examining how wearable metrics are associated with mental health. Methods: We preregistered analyses using the Adolescent Brain Cognitive Development Study dataset using wearable data collection in 5,686 adolescents (123,862 person-days or 2,972,688 person-hours) to determine whether wearable indices of resting heart rate (RHR), step count, and sleep duration and variability in these measures were cross-sectionally associated with internalizing symptomatology. All models were also run controlling for age, sex, body mass index, socioeconomic status, and race. We then performed prospective analyses on a subset of this sample (n = 143) across 25 months that had Fitbit data available at baseline and follow-up in order to explore directionality of effects. Results: Cross-sectional analyses revealed a small, yet significant, effect size (R2 =.053) that higher RHR, lower step count and step count variability, and greater variability in sleep duration were associated with greater internalizing symptoms. Cross-lagged panel model analysis revealed that there were no prospective associations between wearable variables and internalizing symptoms (partial R2 =.026), but greater internalizing symptoms and higher RHR predicted lower step count 25 months later (partial R2 =.010), while higher RHR also predicted lower step count variability 25 months later (partial R2 =.008). Conclusions: Findings indicate that wearable indices concurrently associate with internalizing symptoms during early adolescence, while a larger sample size is likely required to accurately assess prospective or directional effects between wearable indices and mental health. Future research should capitalize on the temporal resolution provided by wearable devices to determine the intensive longitudinal relations between biobehavioral risk factors and acute changes in mental health.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34184767/", "newWindow": true } ] }, { "title": "Heart Rate Measurement Accuracy of Fitbit Charge 4 and Samsung Galaxy Watch Active2: Device Evaluation Study", "author": "Nissen, Michael; Slim, Syrine; Jager Katharina; Flaucher Madeleine; Huebner Hanna; Danzberger Nina; Fasching Peter A.; Beckmann Matthias W.; Gradl Stefan; Eskofier Bjoern M.", "year": "2022", "journalProceedings": "JMIR formative research", "category": "Validation", "devices": "Charge 4", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Background: Fitness trackers and smart watches are frequently used to collect data in longitudinal medical studies. They allow continuous recording in real-life settings, potentially revealing previously uncaptured variabilities of biophysiological parameters and diseases. Adequate device accuracy is a prerequisite for meaningful research.\n\nObjective: This study aims to assess the heart rate recording accuracy in two previously unvalidated devices: Fitbit Charge 4 and Samsung Galaxy Watch Active2.\n\nMethods: Participants performed a study protocol comprising 5 resting and sedentary, 2 low-intensity, and 3 high-intensity exercise phases, lasting an average of 19 minutes 27 seconds. Participants wore two wearables simultaneously during all activities: Fitbit Charge 4 and Samsung Galaxy Watch Active2. Reference heart rate data were recorded using a medically certified Holter electrocardiogram. The data of the reference and evaluated devices were synchronized and compared at 1-second intervals. The mean, mean absolute error, mean absolute percentage error, Lin concordance correlation coefficient, Pearson correlation coefficient, and Bland-Altman plots were analyzed.\n\nResults: A total of 23 healthy adults (mean age 24.2, SD 4.6 years) participated in our study. Overall, and across all activities, the Fitbit Charge 4 slightly underestimated the heart rate, whereas the Samsung Galaxy Watch Active2 overestimated it (-1.66 beats per minute [bpm]/3.84 bpm). The Fitbit Charge 4 achieved a lower mean absolute error during resting and sedentary activities (seated rest: 7.8 vs 9.4; typing: 8.1 vs 11.6; laying down [left]: 7.2 vs 9.4; laying down [back]: 6.0 vs 8.6; and walking slowly: 6.8 vs 7.7 bpm), whereas the Samsung Galaxy Watch Active2 performed better during and after low- and high-intensity activities (standing up: 12.3 vs 9.0; walking fast: 6.1 vs 5.8; stairs: 8.8 vs 6.9; squats: 15.7 vs 6.1; resting: 9.6 vs 5.6 bpm).\n\nConclusions: Device accuracy varied with activity. Overall, both devices achieved a mean absolute percentage error of just <10%. Thus, they were considered to produce valid results based on the limits established by previous work in the field. Neither device reached sufficient accuracy during seated rest or keyboard typing. Thus, both devices may be eligible for use in respective studies; however, researchers should consider their individual study requirements.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35230250/", "newWindow": true } ] }, { "title": "Comparison of Different Physical Activity Measures in a Cardiac Rehabilitation Program: A Prospective Study", "author": "Alharbi, Muaddi; Bauman, Adrian; Alabdulaali, Mohammed; Neubeck, Lis; Smith, Sidney; Naismith, Sharon; Jeon, Yun Hee; Tofler, Geoffrey; Surour, Atef; Gallagher, Robyn", "year": "2022", "journalProceedings": "Sensors (Basel, Switzerland)", "category": "Usability", "devices": "Flex", "population": "Patients", "dataUsed": "Steps,Intensity", "abstract": "Concordant assessments of physical activity (PA) and related measures in cardiac rehabilitation (CR) is essential for exercise prescription. This study compared exercise measurement from an in-person walk test; wearable activity tracker; and self-report at CR entry, completion (8-weeks) and follow-up (16-weeks). Forty patients beginning CR completed the Six-Minute Walk Test (6MWT), Physical Activity Scale for the Elderly (PASE), and wore Fitbit-Flex for four consecutive days in-cluding two weekend days. The sample mean age was 66 years; 67% were male. Increased exercise capacity at CR completion and follow-up was detected by a 6MWT change in mean distance (39 m and 42 m; p = 0.01, respectively). Increased PA participation at CR completion was detected by Fitbit-Flex mean change in step counts (1794; p = 0.01). Relative changes for Fitbit-Flex step counts and a 6MWT were consistent with previous research, demonstrating Fitbit-Flex's potential as an outcome measure. With four days of data, Fitbit-Flex had acceptable ICC values in measuring step counts and MVPA minutes. Fitbit-Flex steps and 6MWT meters are more responsive to changes in PA patterns following exposure to a cardiac rehabilitation program than Fitbit-Flex or PASE-estimated moderate–vigorous PA (MVPA) minutes. Fitbit-Flex step counts provide a useful additional measure for assessing PA outside of the CR setting and accounts for day-to-day variations. Two weekend days and two weekdays are needed for Fitbit-Flex to estimate PA levels more precisely.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35214540/", "newWindow": true } ] }, { "title": "Consistency With and Disengagement From Self-monitoring of Weight, Dietary Intake, and Physical Activity in a Technology-Based Weight Loss Program: Exploratory Study", "author": "Carpenter, Chelsea A.; Eastman, Abraham; Ross, Kathryn M.", "year": "2022", "journalProceedings": "JMIR formative research", "category": "Intervention", "devices": "Zip,Aria", "population": "Adults", "dataUsed": "Steps,Weight,Food", "abstract": "Background: Digital self-monitoring tools offer promise to improve adherence to self-monitoring of weight and weight-related behaviors; however, less is known regarding the patterns of participant consistency and disengagement with these tools. Objective: This study characterizes the consistency of use and time to disengagement with digital self-monitoring tools during a 6-month weight loss intervention and investigates whether the provision of phone-based intervention improved self-monitoring adherence. Methods: Participants were 54 adults with overweight or obesity (mean age 49.6 years, SD 12.4 years; mean BMI 32.6 kg/m2, SD 3.2 kg/m2) enrolled in a pilot trial assessing the impact of self-monitoring technology (Fitbit Zip, Aria scale, and smartphone app), with and without additional interventionist contact, on weight loss. All participants received weight loss education and were asked to self-monitor weight, dietary intake, and physical activity daily throughout the 6-month program. Consistency was defined as the number of weeks that participants adhered to self-monitoring recommendations (7 out of 7 days). Disengagement was defined as the first of 2 consecutive weeks that the 7-day self-monitoring adherence goal was not met. Wilcoxon signed-rank tests were used to examine differences in consistency and disengagement by behavioral targets. t tests (2-tailed) and Cox proportional hazards models were used to examine whether providing additional interventionist contact would lead to significant improvements in consistency and time to disengagement from self-monitoring tools, respectively. Linear regressions were used to examine associations between consistency, time to disengagement, and weight loss. Results: Participants consistently self-monitored physical activity for more weeks (mean 17.4 weeks, SD 8.5 weeks) than weight (mean 11.1 weeks, SD 8.5 weeks) or dietary intake (mean 10.8 weeks, SD 8.7 weeks; P<.05). Similarly, participants had a significantly longer time to disengagement from self-monitoring of physical activity (median 19.5 weeks) than weight (4 weeks) or dietary intake (10 weeks; P<.001). Participants randomized to receive additional interventionist contact had significantly greater consistency and longer time to disengagement for self-monitoring of dietary intake compared with participants who did not (P=.006); however, there were no statistically significant differences between groups for self-monitoring of weight or physical activity (P=.24 and P=.25, respectively). Greater consistency and longer time to disengagement were associated with greater weight loss for self-monitoring of weight and dietary intake (P<.001 and P=.004, respectively) but not for physical activity (P=.57). Conclusions: Results demonstrated that self-monitoring adherence differed by behavioral target, with greater consistency and longer time to disengagement associated with lower-burden tools (ie, self-monitoring of physical activity). Consistent with supportive accountability theory, additional interventionist contact improved consistency and lengthened time to disengagement from self-monitoring of dietary intake. Given the observed associations between consistency, disengagement, and weight loss outcomes, it is important to identify additional methods of increasing consistency and engagement with digital self-monitoring tools.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35179513/", "newWindow": true } ] }, { "title": "HRV Monitoring Using Commercial Wearable Devices as a Health Indicator for Older Persons during the Pandemic", "author": "Rodrigues, Eujessika; Lima, Daniella; Barbosa, Paulo; Gonzaga, Karoline; Guerra, Ricardo Oliveira; Pimentel, Marcela; Barbosa, Humberto; Maciel, {\\'{A}}lvaro", "year": "2022", "journalProceedings": "Sensors (Basel, Switzerland)", "category": "Validation", "devices": "Inspire HR", "population": "Older Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Remote monitoring platforms based on advanced health sensors have the potential to become important tools during the COVID-19 pandemic, supporting the reduction in risks for affected populations such as the elderly. Current commercially available wearable devices still have limitations to deal with heart rate variability (HRV), an important health indicator of human aging. This study analyzes the role of a remote monitoring system designed to support health services to older people during the complete course of the COVID-19 pandemic in Brazil, since its beginning in Brazil in March 2020 until November 2021, based on HRV. Using different levels of analysis and data, we validated HRV parameters by comparing them with reference sensors and tools in HRV measurements. We compared the results obtained for the cardiac modulation data in time domain using samples of 10 elderly people's HRV data from Fitbit Inspire HR with the results provided by Kubios for the same population using a cardiac belt, with the data divided into train and test, where 75% of the data were used for training the models, with the remaining 25% as a test set for evaluating the final performance of the models. The results show that there is very little difference between the results obtained by the remote monitoring system compared with Kubios, indicating that the data obtained from these devices might provide accurate results in evaluating HRV in comparison with gold standard devices. We conclude that the application of the methods and techniques used and reported in this study are useful for the creation and validation of HRV indicators in time series obtained by means of wearable devices based on photoplethysmography sensors; therefore, they can be incorporated into remote monitoring processes as seen during the pandemic.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35271148/", "newWindow": true } ] }, { "title": "Commercial Devices Provide Estimates of Energy Balance with Varying Degrees of Validity in Free-Living Adults", "author": "Shook, Robin P.; Yeh, Hung Wen; Welk, Gregory J.; Davis, Ann M.; Ries, Daniel", "year": "2022", "journalProceedings": "The Journal of nutrition", "category": "Validation", "devices": "Aria,Alta HR", "population": "Adults", "dataUsed": "Heart Rate,Weight", "abstract": "Background: The challenges of accurate estimation of energy intake (EI) are well-documented, with self-reported values 12%-20% below expected values. New approaches rely on gold-standard assessments of the other components of energy balance, energy expenditure (EE) and energy storage (ES), to estimate EI. Objectives: The purpose of this study was to evaluate the validity, repeatability, and measurement error of consumer devices when estimating energy balance in a free-living population. Methods: Twenty-four healthy adults (14 women, 10 men; mean ± SD age: 30.7 ± 8.2 y) completed two 14-d assessment periods, including assessments of EE and ES using gold-standard [doubly labeled water (DLW) and DXA] and commercial devices [Fitbit Alta HR activity monitor (Alta) and Fitbit Aria wireless body composition scale (Aria)], and of EI by dietician-administered recalls. Accuracy and validity were assessed using Spearman correlation, interclass correlation, mean absolute percentage error, and equivalency testing. We also applied linear measurement error modeling including error in gold-standard devices and within-subject repeated-measures design to calibrate consumer devices and quantify error. Results: There was moderate to strong agreement for EE between the Fitbit Alta and DLW at each time point (rs = 0.82 and 0.66 for Times 1 and 2, respectively). There was weak agreement for ES between the Fitbit Aria and DXA (rs = 0.15 and 0.49 for Times 1 and 2, respectively). Correlations between methods to assess EI ranged from weak to strong, with agreement between the DXA/DLW-calculated EI and dietary recalls being the highest (rs = 0.63 for Time 1 and 0.73 for Time 2). Only EE from the Fitbit Alta at Time 1 was equivalent to the DLW value using equivalency testing. Conclusions: Commercial devices provide estimates of energy balance in free-living adults with varying degrees of validity compared to gold-standard techniques. EE estimates were the most robust overall, whereas ES estimates were generally poor.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34642741/", "newWindow": true } ] }, { "title": "Effect of tailored, daily feedback with lifestyle self-monitoring on weight loss: The SMARTER randomized clinical trial", "author": "Burke, Lora E.; Sereika, Susan M.; Parmanto, Bambang; Bizhanova, Zhadyra; Kariuki, Jacob K.; Cheng, Jessica; Beatrice, Britney; Loar, India; Pulantara, I. Wayan; Wang, Yuhan; Cedillo, Maribel; Conroy, Molly B.", "year": "2022", "journalProceedings": "Obesity (Silver Spring, Md.)", "category": "Usability", "devices": "Charge 2", "population": "Adults", "dataUsed": "Intensity", "abstract": "Objective: This study aimed to test the efficacy of self-monitoring and feedback (SM+FB) versus SM without FB (SM) in a behavioral weight-loss intervention at 6 months. Methods: This was a randomized clinical trial. Eligibility criteria included the following: ≥18 years of age, BMI ≥ 27 and ≤43, smartphone user, and ability to engage in moderate physical activity. All participants received a 90-minute 1:1 counseling session, a Fitbit Charge 2, and a digital scale for SM. SM+FB participants were provided access to a customized smartphone application that provided three daily FB messages. The primary outcome was percentage of weight change from 0 to 6 months. Results: The sample (N = 502) was 45 (SD 14.4) years old, BMI was 33.7 (SD 4.00) kg/m2, 79.5% of participants were female (n = 399), and 84.3% were White (n = 423). At 6 months, there was 85.86% retention and a significant percentage of weight change in both groups (SM+FB: −3.16%, 95% CI: −3.85% to −2.47%, p < 0.0001; SM: −3.20%, 95% CI: −3.86% to −2.54%, p < 0.0001) but no significant between-group mean difference (−0.04%, 95% CI: −0.99% to 0.91%, p = 0.940). A ≥5% weight loss was achieved by 31.9% of the SM+FB group and 28.3% of the SM group. Conclusions: There was no significant between-group difference in weight loss at 6 months.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34898011/", "newWindow": true } ] }, { "title": "A multiple technology-based physical activity intervention for Latina adolescents in the USA: randomized controlled trial study protocol for Chicas Fuertes", "author": "Larsen, Britta; Greenstadt, Emily; Olesen, Brittany; Osuna, Lilliana; Godino, Job; Marcus, Bess; Dunsiger, Shira; Meyer, Dawn; Zive, Michelle", "year": "2022", "journalProceedings": "Trials", "category": "Intervention", "devices": "Inspire HR", "population": "Adolescents", "dataUsed": "Steps,Intensity,Goals,Heart Rate", "abstract": "Background: Latina adolescents in the USA report some of the lowest rates of physical activity of any demographic subgroup; this is paralleled by a markedly higher lifetime risk of obesity, type 2 diabetes, and other conditions related to inactivity. Despite this, to date, no fully powered clinical trials have tested physical activity interventions specifically for this population. High use of mobile technologies (including text messages, smartphone apps, and social media) suggests this could be an appropriate intervention channel, while also having potential for broad reach. This paper describes the protocol for Chicas Fuertes, a fully powered randomized trial of a mobile technology-based physical activity intervention for Latina adolescents. Methods: We plan to recruit 200 Latina teens (age 13-18) in San Diego, CA, currently engaging in ≤ 150 min/week of moderate-to-vigorous physical activity (MVPA) to be assigned 1:1 to the intervention or control groups. Those randomly assigned to the intervention group receive a one-on-one goal setting session followed by 6 months of mobile technology-based intervention, including a personalized website, Fitbit activity tracker and app, individually tailored text messages based on Fitbit data, and daily intervention content on Instagram. Those randomized to the control group receive only a Fitbit activity tracker. The main outcome is change in weekly minutes of MVPA from baseline to 6 months, measured both objectively (ActiGraph accelerometers and Fitbit Inspire HR) and subjectively (7-Day Physical Activity Recall Interview). Additional outcomes are maintenance of activity change at 12 months and changes in psychosocial constructs, including social support and self-efficacy, engagement with mobile technology channels, and costs of intervention delivery. We are also examining the potential mediators and moderators of the intervention. The efficacy of the intervention is analyzed using a mixed effects regression model, adjusting for any potential confounders not balanced by randomization. All analyses of accelerometer measured MVPA are also adjusted for wear time.", "links": [ { "caption": "URL", "url": "/pmc/articles/PMC8864594/", "newWindow": true }, { "caption": "URL", "url": "/pmc/articles/PMC8864594/?report=abstract", "newWindow": true }, { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8864594/", "newWindow": true } ] }, { "title": "Fitbeat: COVID-19 estimation based on wristband heart rate using a contrastive convolutional auto-encoder", "author": "Liu, Shuo; Han, Jing; Puyal, Estela Laporta; Kontaxis, Spyridon; Sun, Shaoxiong; Locatelli, Patrick; Dineley, Judith; Pokorny, Florian B.; Costa, Gloria Dalla; Leocani, Letizia; Guerrero, Ana Isabel; Nos, Carlos; Zabalza, Ana; Sorensen, Per Soelberg; Buron, Mathias; Magyari, Melinda; Ranjan, Yatharth; Rashid, Zulqarnain; Conde, Pauline; Stewart, Callum; Folarin, Amos A.; Dobson, Richard J. B.; Bailon, Raquel; Vairavan, Srinivasan; Cummins, Nicholas; Narayan, Vaibhav A.; Hotopf, Matthew; Comi, Giancarlo; Schuller, Bjorn; Consortium; RADAR-CNS", "year": "2022", "journalProceedings": "Pattern Recognition", "category": "Medical", "devices": "Charge 2,Charge 3", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "This study proposes a contrastive convolutional auto-encoder (contrastive CAE), a combined architecture of an auto-encoder and contrastive loss, to identify individuals with suspected COVID-19 infection using heart-rate data from participants with multiple sclerosis (MS) in the ongoing RADAR-CNS mHealth research project. Heart-rate data was remotely collected using a Fitbit wristband. COVID-19 infection was either confirmed through a positive swab test, or inferred through a self-reported set of recognized symptoms of the virus. The contrastive CAE outperforms a conventional convolutional neural network (CNN), a long short-term memory (LSTM) model, and a convolutional auto-encoder without contrastive loss (CAE). On a test set of 19 participants with MS with reported symptoms of COVID-19, each one paired with a participant with MS with no COVID-19 symptoms, the contrastive CAE achieves an unweighted average recall of 95.3%, a sensitivity of 100% and a specificity of 90.6%, an area under the receiver operating characteristic curve (AUC-ROC) of 0.944, indicating a maximum successful detection of symptoms in the given heart rate measurement period, whilst at the same time keeping a low false alarm rate.", "links": [ { "caption": "URL", "url": "/pmc/articles/PMC8547790/", "newWindow": true }, { "caption": "URL", "url": "/pmc/articles/PMC8547790/?report=abstract", "newWindow": true }, { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547790/", "newWindow": true } ] }, { "title": "User Engagement and Abandonment of mHealth: A Cross-Sectional Survey", "author": "Mustafa, Abdulsalam Salihu; Ali, Nor'Ashikin; Dhillon, Jaspaljeet Singh; Alkawsi, Gamal; Baashar, Yahia", "year": "2022", "journalProceedings": "Healthcare", "category": "Review,Survey Research", "devices": null, "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Weight", "abstract": "Mobile health (mHealth) apps have great potential to improve health outcomes. Given that mHealth apps have become ubiquitous, there is limited focus on their abandonment. Data concerning crucial metrics, including reasons for adoption and discontinued use, are limited. This study aims to gain broad insights into utilization of mHealth and game-like features promoting user engagement. We conducted a cross-sectional survey of 209 mHealth users worldwide. The 17-item survey assessed sociodemographics, as well as the key motivators for mHealth uptake and discontinued use. Our findings show that sports and fitness activity tracking were the most common categories of health apps, with most users engaging with them at least several times a week. Interestingly, the most downloaded mHealth apps among younger adults include MyFitnessPal, Fitbit, Nike Run Club, and Samsung Health. Critical drivers of abandonment of mHealth apps were amotivation, loss of interest, and experimenting with different apps to identify the most suitable tool. Additionally, the financial cost of mHealth apps is crucial, with most participants advocating for free or more affordable apps. The study findings suggest that while many individuals utilize mHealth, several factors drive their abandonment. Moreover, data indicate that mHealth developers need to consider gamification strategies to sustain user commitment, as well as psychological variables, such as intrinsic motivation.", "links": [ { "caption": "URL", "url": "/pmc/articles/PMC8872344/", "newWindow": true }, { "caption": "URL", "url": "/pmc/articles/PMC8872344/?report=abstract", "newWindow": true }, { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8872344/", "newWindow": true } ] }, { "title": "A randomized controlled trial of the effect of supervised exercise on functional outcomes in older African American and non-Hispanic White breast cancer survivors: Are there racial differences in the effects of exercise on functional outcomes?", "author": "Owusu, Cynthia; Margevicius, Seunghee; Nock, Nora L.; Austin, Kristina; Bennet, Elizabeth; Ld, Rd; Cerne, Stephen; Acs-Cet, Acsm; Paul Hergenroeder; Halle; Moore, C. F.; Petkac, Jean; Schluchter; Mark; Schmitz, Kathryn H.; Monica; Hooper, Webb; Wimbley; Leonard; Ma, Ba /; Berger, Nathan A.", "year": "2022", "journalProceedings": "Cancer", "category": "Usability", "devices": "Blaze,Versa", "population": "Older Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: The objective of this study was to test the hypothesis that exercise would be more effective than a support group plus Fitbit (SG+Fitbit) program in improving functional outcomes in older breast cancer survivors (BCSs) and that race would moderate the exercise effect on outcomes. METHODS: Older African American (AA) and non-Hispanic White (NHW) BCSs were purposively recruited and enrolled into the 52-week randomized controlled trial. The interventions included 20 weeks of supervised moderate-intensity aero-bic and resistance training followed by 32 weeks of unsupervised exercise called IMPROVE (n = 108) and a 20-week SG+Fitbit program followed by 32 weeks of unsupervised activity (n = 105). Study outcomes were assessed at 20 and 52 weeks. The primary outcome was the change in Short Physical Performance Battery (SPPB) scores 20 weeks from the baseline between arms. Secondary outcomes included change in the 6-Minute Walk Test (6MWT) in meters 20 weeks from the baseline between arms. General linear regression and multivariable logistic regression analyses were used. RESULTS: The mean age was 71.9 years (SD, 5.9 years), and 44% were AA. SPPB scores did not differ between arms (adjusted difference in mean change, 0.13; 95% CI,-0.28 to 0.55; P = .53). However, the exercise arm (vs the SG+Fitbit arm) improved on the 6MWT (21.6 m; 95% CI, 2.5-40.6 m; P = .03). Race moderated the exercise effect on the 6MWT (adjusted interaction effect, 43.3 m; 95% CI, 6.3-80.2 m; P = .02); this implied that the change in the adjusted mean for the 6MWT at 20 weeks from the baseline was 43.3 m higher in AA exercise participants versus NHW exercise participants. CONCLUSIONS: Combined aerobic and resistance exercise appears to improve physical performance in older BCSs, and the exercise effect might be moderated by race, with AAs appearing to derive larger benefits in comparison with NHWs. Larger studies are warranted to confirm the study findings. Cancer 2022;0:1-19.", "links": [ { "caption": "URL", "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.34184", "newWindow": true }, { "caption": "URL", "url": "https://onlinelibrary.wiley.com/doi/abs/10.1002/cncr.34184", "newWindow": true }, { "caption": "URL", "url": "https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.34184", "newWindow": true } ] }, { "title": "Perceptions of patients and nurses regarding the use of wearables in inpatient settings: a mixed methods study", "author": "Patel, Vikas; Moosa, Sabreena; Sundaram, Sanjana; Langer, Laura; MacMillan, Thomas E.; Cavalcanti, Rodrigo; Cram, Peter; Gunaratne, Keith; Bayley, Mark; Wu, Robert", "year": "2022", "journalProceedings": "Informatics for health & social care", "category": "Usability", "devices": "Charge 2,Charge 3", "population": "Patients,Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Wearable devices for hospitalized patients could help improve care. The purpose of this study was to highlight key barriers and facilitators involved in adopting wearable technology in acute care settings using patient and clinician feedback. Hospitalized patients, 18 years or older, were recruited at the General Medicine inpatient units in Toronto, Ontario to wear the Fitbit® Charge 2 or Charge 3. Fifty General Medicine adult inpatients were recruited. Patients and nurses provided feedback on structured questionnaires. Key themes from open-ended questions were analyzed. Primary outcomes of interest included the exploring patient and nurse perceptions of their experiences with wearable devices as well as their feasibility in clinical settings. Overall, both patients (n = 39) and nurses (n = 28) valued the information provided by Fitbits and shared concerns about device functionality and wearable design. Specifically, patients were interested in using wearables to enhance their self-monitoring, while nurses questioned data validity, as well as ease of incorporating wearables into their workflow. We found that patients wanted improved device design and functionality and valued the opportunity to improve their self-efficacy and to work in partnership with the medical team using wearable technology. Nurses wanted more device functionality and validation and easier ways to incorporate them into their workflow. To achieve the potential benefits of using wearable devices for enhanced monitoring, this study identifies challenges that must first be addressed in order for this technology to be widely adopted in clinical settings.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35220867/", "newWindow": true } ] }, { "title": "Improving Sleep Among Teachers: an Implementation-Intention Intervention", "author": "Schmidt, Laura I.; Steenbock, Lisa M.; Sieverding, Monika", "year": "2022", "journalProceedings": "International journal of behavioral medicine", "category": "Intervention", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Background: Insufficient sleep is common among teachers and is associated with diverse health risks. This study aimed to predict intention and sleep duration by applying the Theory of Planned Behavior (TPB) and to examine the effectiveness of an implementation-intention intervention to improve sleep duration and quality.\n\nMethod: Sixty-nine teachers (M = 36.8 years, SD = 10.4) were assigned to an active control group (CG) or intervention group (IG). At baseline, TPB variables were assessed and participants of the IG received instructions to develop implementation intentions to reach the goal of sleeping 8 h on average. During a 3-week intervention period, all participants wore an activity tracker (Fitbit Charge HR) to measure sleep duration and kept diaries to assess sleep quality, physical activity, and stress. After 1 month, a 1-week follow-up, including a booster for the IG, was conducted.\n\nResults: Forty-two percent of variance in sleep duration were explained by control variables, past behavior, perceived behavioral control, and intention. Mixed ANOVAS with baseline covariates found a large main effect with longer sleep duration in the IG. A time x group interaction suggested that only the IG slept significantly longer in the follow-up period compared to the intervention period. For sleep quality, a medium-sized main effect for study group was found and a time x group interaction indicated higher sleep quality in the IG for week 3 and the follow-up.\n\nConclusion: The TPB was effective in predicting sleep intention and duration. Implementation intentions accompanied by daily monitoring and a booster appear to be promising for improving sleep.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35233749/", "newWindow": true } ] }, { "title": "Using Fitbit data to monitor the heart rate evolution patterns of college students", "author": "Wang, Cheng; Lizardo, Omar; Hachen, David S.", "year": "2022", "journalProceedings": "Journal of American college health : J of ACH", "category": "Measurement", "devices": null, "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Objective: To investigate what social, psychological, personality, and behavioral factors affect overtime heart rate changes of college students. Participants: The daily heart rates of over 600 undergraduates at the University of Notre Dame were unobtrusively recorded via Fitbit devices from August 16, 2015, to May 13, 2017. Method: Latent Growth-Curve modeling strategy is utilized to examine how daily mean heart rate and its standard deviation change over time, and what foregoing factors predict observed changes. Results: The mean heart rate increased and its standard deviation stayed the same over the 637 days. Heart rate levels go up with that of social contacts, an indicator of peer influence. Both daily heart rate levels and changes are also affected by multiple external factors. Conclusion: Human heart rate is not only a physiological phenomenon but also a social-psychological one, as it is systematically affected by peer networks, social contexts, and human activities.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/32569509/", "newWindow": true } ] }, { "title": "Accuracy and Precision of Energy Expenditure, Heart Rate, and Steps Measured by Combined-Sensing Fitbits Against Reference Measures: Systematic Review and Meta-analysis", "author": "Chevance, Guillaume; Golaszewski, Natalie M.; Tipton, Elizabeth; Hekler, Eric B.; Buman, Matthew; Welk, Gregory; Patrick, Kevin; Godino, Job G.", "year": "2022", "journalProceedings": "JMIR mHealth and uHealth", "category": "Review", "devices": "Charge HR,Surge,Charge 2,Alta HR,Ionic,Versa,Charge 3,Charge 4,Versa 2,Versa 3,Inspire HR,Inspire 2", "population": "Older Adults,Adults", "dataUsed": "Steps,Energy Expenditure,Heart Rate", "abstract": "Background: Although it is widely recognized that physical activity is an important determinant of health, assessing this complex behavior is a considerable challenge.\n\nObjective: The purpose of this systematic review and meta-analysis is to examine, quantify, and report the current state of evidence for the validity of energy expenditure, heart rate, and steps measured by recent combined-sensing Fitbits.\n\nMethods: We conducted a systematic review and Bland-Altman meta-analysis of validation studies of combined-sensing Fitbits against reference measures of energy expenditure, heart rate, and steps.\n\nResults: A total of 52 studies were included in the systematic review. Among the 52 studies, 41 (79%) were included in the meta-analysis, representing 203 individual comparisons between Fitbit devices and a criterion measure (ie, n=117, 57.6% for heart rate; n=49, 24.1% for energy expenditure; and n=37, 18.2% for steps). Overall, most authors of the included studies concluded that recent Fitbit models underestimate heart rate, energy expenditure, and steps compared with criterion measures. These independent conclusions aligned with the results of the pooled meta-analyses showing an average underestimation of -2.99 beats per minute (k comparison=74), -2.77 kcal per minute (k comparison=29), and -3.11 steps per minute (k comparison=19), respectively, of the Fitbit compared with the criterion measure (results obtained after removing the high risk of bias studies; population limit of agreements for heart rate, energy expenditure, and steps: -23.99 to 18.01, -12.75 to 7.41, and -13.07 to 6.86, respectively).\n\nConclusions: Fitbit devices are likely to underestimate heart rate, energy expenditure, and steps. The estimation of these measurements varied by the quality of the study, age of the participants, type of activities, and the model of Fitbit. The qualitative conclusions of most studies aligned with the results of the meta-analysis. Although the expected level of accuracy might vary from one context to another, this underestimation can be acceptable, on average, for steps and heart rate. However, the measurement of energy expenditure may be inaccurate for some research purposes.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35416777/", "newWindow": true } ] }, { "title": "A Digital Health Program Targeting Physical Activity Among Adolescents With Overweight or Obesity: Open Trial", "author": "Cummings, Caroline; Crochiere, Rebecca; Lansing, Amy Hughes; Patel, Riya; Stanger, Catherine", "year": "2022", "journalProceedings": "JMIR pediatrics and parenting", "category": "Intervention", "devices": "Charge HR", "population": "Adolescents", "dataUsed": "Steps,Goals", "abstract": "Background: Prior studies suggest that mobile health physical activity programs that provide only weekly or daily text-based health coaching evidence limit the efficacy in improving physical activity in adolescents with overweight or obesity. It is possible that incentives, combined with health coaching and daily feedback on goal success, may increase program efficacy; however, such programs have not yet been tested with adolescents with overweight and obesity.\n\nObjective: This study aims to examine the feasibility and acceptability of a 12-week, incentive-based, mobile health physical activity program with text-based health coaching, goal setting, and self-monitoring for adolescents with overweight or obesity. Program adherence and changes in tracked physical activity (ie, steps and active minutes while wearing a Fitbit [Google LLC]), body mass, and body fat are assessed.\n\nMethods: A total of 28 adolescents aged 13 to 18 years with a BMI ≥90th percentile participated in the program. Of the 28 participants, 2 (7%) were lost to follow-up; thus, data from 26 (93%) participants were used in analyses.\n\nResults: Participant-reported acceptability was high, with all mean ratings of text-based coaching, Fitbit use, and the overall program being >5 on a 7-point scale. In addition, 85% (23/26) of participants reported that they would like to continue to wear the Fitbit. Program adherence was also high, as participants wore the Fitbit on 91.1% (SD 12.6%) of days on average and met their weekly goals for an average of 7 (SD 3.5) of 11 possible weeks. There were no demographic (ie, sex, age, and baseline body mass) differences in the percentage of days participants wore their Fitbit. Across the 12-week study, there were significant improvements in tracked daily active minutes (P=.006) and steps (P<.001) and significant pre- to posttest improvements in body fat percentage (P=.04).\n\nConclusions: The pilot program improved adolescent physical activity and physical health. A larger factorial design trial with adaptive daily goals may clarify the role of each program component in driving physical activity.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35343903/", "newWindow": true } ] }, { "title": "Using smartwatches to observe changes in activity during recovery from critical illness following COVID-19: a 1 year multi-centre observational study", "author": "Hunter, Alex; Leckie, Todd; Coe, Oliver; Hardy, Benjamin; Fitzpatrick, Daniel; Gon{\\c{c}}alves, Ana-Carolina; Standing, Mary-Kate; Koulouglioti, Christina; Richardson, Alan; Hodgson, Luke", "year": "2022", "journalProceedings": "JMIR rehabilitation and assistive technologies", "category": "Usability", "devices": "Charge 3", "population": "Patients", "dataUsed": "Steps,Heart Rate", "abstract": null, "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35417402/", "newWindow": true } ] }, { "title": "Virtual AppLication-supported Environment To INcrease Exercise (VALENTINE) during cardiac rehabilitation study: Rationale and design", "author": "Jeganathan, V. Swetha; Golbus, Jessica R.; Gupta, Kashvi; Luff, Evan; Dempsey, Walter; Boyden, Thomas; Rubenfire, Melvyn; Mukherjee, Brahmar; Klasnja, Predrag; Kheterpal, Sachin; Nallamothu, Brahmajee K.", "year": "2022", "journalProceedings": "American heart journal", "category": "Usability", "devices": "Versa 2", "population": "Patients,Adults", "dataUsed": "Steps,Distance", "abstract": "Background: In-person, exercise-based cardiac rehabilitation improves physical activity and reduces morbidity and mortality for patients with cardiovascular disease. However, activity levels may not be optimized and decline over time after patients graduate from cardiac rehabilitation. Scalable interventions through mobile health (mHealth) technologies have the potential to augment activity levels and extend the benefits of cardiac rehabilitation. Methods: The VALENTINE Study is a prospective, randomized-controlled, remotely-administered trial designed to evaluate an mHealth intervention to supplement cardiac rehabilitation for low- and moderate-risk patients (ClinicalTrials.gov NCT04587882). Participants are randomized to the control or intervention arms of the study. Both groups receive a compatible smartwatch (Fitbit Versa 2 or Apple Watch 4) and usual care. Participants in the intervention arm of the study additionally receive a just-in-time adaptive intervention (JITAI) delivered as contextually tailored notifications promoting low-level physical activity and exercise throughout the day. In addition, they have access to activity tracking and goal setting through the mobile study application and receive weekly activity summaries via email. The primary outcome is change in 6-minute walk distance at 6-months and, secondarily, change in average daily step count. Exploratory analyses will examine the impact of notifications on immediate short-term smartwatch-measured step counts and exercise minutes. Conclusions: The VALENTINE study leverages innovative techniques in behavioral and cardiovascular disease research and will make a significant contribution to our understanding of how to support patients using mHealth technologies to promote and sustain physical activity.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35235834/", "newWindow": true } ] }, { "title": "Efficacy and acceptability of using wearable activity trackers in older adults living in retirement communities: a mixed method study", "author": "Zhang, Zhanjia; Giordani, Bruno; Margulis, Alayna; Chen, Weiyun", "year": "2022", "journalProceedings": "BMC geriatrics", "category": "Usability", "devices": "Inspire HR", "population": "Older Adults", "dataUsed": "Steps,Goals", "abstract": "Background: Wearable activity trackers hold the potential for enhancing health and fitness, but the use of wearable activity trackers has remained largely unexplored in older adults. The purpose of the current study was to examine the effectiveness and acceptability of wearable activity trackers for promoting physical activity (PA) in older adults living in retirement communities. Methods: Forty older adult participants (mean age = 85.4 years) used a wearable activity tracker (Fitbit InspireHR) for 12 weeks. Participants were provided with personalized activity goals and weekly feedback of PA during the 12 weeks. The main outcomes were daily step counts collected at baseline and the end of the intervention, and participants' experiences of using the wearable activity tracker assessed after the 12-week intervention through an 8-item questionnaire and individual interviews. Results: Participants used the activity tracker on 97.5% of measured days and had an average increase of 900 steps/day (p < 0.001). The Acceptance questionnaire revealed that the wearable activity tracker was acceptable, useful, and easy to use. Participants found that wearable activity trackers helped improve self-awareness and motivation of PA but reported a few concerns regarding the comfort of wearing the activity trackers and the ease of reading visual feedback. Conclusions: Wearable activity trackers lead to a small but significant increase of PA and are perceived as acceptable and useful in older adults. Given the rapidly growing older population, wearable activity trackers are promising tools that could be used in large-scale interventions to improve PA and health in older adults. Trial registration: Registered on Clinicaltrials.gov # NCT05233813 (Registered on 10/02/2022).", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35313819/", "newWindow": true } ] }, { "title": "Exploring Families' Acceptance of Wearable Activity Trackers: A Mixed-Methods Study", "author": "Creaser, Amy V.; Hall, Jennifer; Costa, Silvia; Bingham, Daniel D.; Clemes, Stacy A.", "year": "2022", "journalProceedings": "International journal of environmental research and public health", "category": "Usability", "devices": "Alta HR", "population": "Children,Adults", "dataUsed": "NA", "abstract": "Background: The family environment plays a crucial role in child physical activity (PA). Wearable activity trackers (wearables) show potential for increasing children's PA; however, few studies have explored families' acceptance of wearables. This study investigated the acceptability of using wearables in a family setting, aligning experiences with components of the Technology Acceptance Model and Theoretical Domains Framework. Methods: Twenty-four families, with children aged 5–9 years, took part in a 5-week study, where all members were provided with a Fitbit Alta HR for 4 weeks. Acceptability was measured using weekly surveys and pre-post-questionnaires. Nineteen families participated in a focus group. Quantitative and qualitative data were integrated using the Pillar Integration Process technique. Results: Pillars reflected (1) external variables impacting wearable use and PA and (2) wearable use, (3) ease of use, (4) usefulness for increasing PA and other health outcomes, (5) attitudes, and (6) intention to use a wearable, including future intervention suggestions. Conclusions: Families found the Fitbit easy to use and acceptable, but use varied, and perceived impact on PA were mixed, with external variables contributing towards this. This study provides insights into how wearables may be integrated into family-based PA interventions and highlights barriers and facilitators of family wearable use.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35329166/", "newWindow": true } ] }, { "title": "On the Security of Bluetooth Low Energy in Two Consumer Wearable Heart Rate Monitors/Sensing Devices", "author": "Kurt Peker, Yeṣem; Bello, Gabriel; Perez, Alfredo J.", "year": "2022", "journalProceedings": "Sensors (Basel, Switzerland)", "category": "Validation", "devices": "Charge 4", "population": "NA", "dataUsed": "Heart Rate", "abstract": "Since its inception in 2013, Bluetooth Low Energy (BLE) has become the standard for shortdistance wireless communication in many consumer devices, as well as special‐purpose devices. In this study, we analyze the security features available in Bluetooth LE standards and evaluate the features implemented in two BLE wearable devices (a Fitbit heart rate wristband and a Polar heart rate chest wearable) and a BLE keyboard to explore which security features in the BLE standards are implemented in the devices. In this study, we used the ComProbe Bluetooth Protocol Analyzer, along with the ComProbe software to capture the BLE traffic of these three devices. We found that even though the standards provide security mechanisms, because the Bluetooth Special Interest Group does not require that manufacturers fully comply with the standards, some manufacturers fail to implement proper security mechanisms. The circumvention of security in Bluetooth devices could leak private data that could be exploited by rogue actors/hackers, thus creating security, privacy, and, possibly, safety issues for consumers and the public. We propose the design of a Bluetooth Security Facts Label (BSFL) to be included on a Bluetooth/BLE enabled device's commercial packaging and conclude that there should be better mechanisms for informing users about the security and privacy provisions of the devices they acquire and use and to educate the public on protection of their privacy when buying a connected device.", "links": [ { "caption": "URL", "url": "/pmc/articles/PMC8839540/", "newWindow": true }, { "caption": "URL", "url": "/pmc/articles/PMC8839540/?report=abstract", "newWindow": true }, { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8839540/", "newWindow": true } ] }, { "title": "A pilot randomized trial of simplified versus standard calorie dietary self-monitoring in a mobile weight loss intervention", "author": "Nezami, Brooke T.; Hurley, Lex; Power, Julianne; Valle, Carmina G.; Tate, Deborah F.", "year": "2022", "journalProceedings": "Obesity (Silver Spring, Md.)", "category": "Intervention", "devices": "Inspire", "population": "Adults", "dataUsed": "Energy Expenditure,Food", "abstract": "Objective: This study tested the efficacy of a lower-burden, simplified dietary self-monitoring approach compared with a standard calorie monitoring approach for self-monitoring adherence and weight loss in a mobile-delivered behavioral weight loss intervention. Methods: Participants (n = 72) with overweight or obesity who had children 2 to 12 years of age living in the home were randomly assigned to a group that used simplified dietary self-monitoring of high-calorie foods (Simplified) or a group that tracked calories (Standard). Both groups received a wireless scale, Fitbit trackers, and a 6-month intervention delivered via a smartphone application with lessons, text messages, and weekly personalized feedback messages. Results: Percentage weight loss at 6 months was 5.7% (95% CI: −8.3% to −3.2%) in the Standard group and 4.0% (95% CI: −5.7% to −2.3%) in the Simplified group, which was not significantly different. Similar proportions reached 5% weight loss at 6 months (43.2% in Standard and 42.9% in Simplified). There were no differences in number of dietary tracking days or change in average daily caloric intake between groups. Conclusions: Two mobile-delivered weight loss interventions produced clinically meaningful levels of weight loss at 6 months, with no differences in dietary tracking adherence or dietary intake. The results suggest that simplified monitoring of high-calorie foods could be a promising alternative to calorie monitoring.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35146942/", "newWindow": true } ] }, { "title": "Sex-based differences in remote monitoring of biometric, psychometric and biomarker indices in stable ischemic heart disease", "author": "Barsky, Lili; Speier, William; Fuller, Garth; Cheng, Susan; Kim, Andy; Joung, Sandy; Arnold, Corey; Dhawan, Shivani; Lopez, Mayra; Mastali, Mitra; van den Broek, Irene; Wei, Janet; Spiegel, Brennan; Van Eyk, Jennifer E.; Bairey Merz, C. Noel; Shufelt, Chrisandra", "year": "2022", "journalProceedings": "Biology of sex differences", "category": "Measurement", "devices": "Charge 2", "population": "Older Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Background: Sex-based differences are crucial to consider in the formulation of a personalized treatment plan. We evaluated sex-based differences in adherence and remotely monitored biometric, psychometric, and biomarker data among patients with stable ischemic heart disease (IHD).\n\nMethods: The Prediction, Risk, and Evaluation of Major Adverse Cardiac Events (PRE-MACE) study evaluated patients with stable IHD over a 12-week period. We collected biometric and sleep data using remote patient monitoring via FitBit and psychometric data from Patient-Reported Outcomes Measurement Information System (PROMIS), Kansas City Cardiomyopathy (KCC) and Seattle Angina Questionnaire-7 (SAQ-7) questionnaires. Serum biomarker levels were collected at the baseline visit. We explored sex-based differences in demographics, adherence to study protocols, biometric data, sleep, psychometric data, and biomarker levels.\n\nResults: There were 198 patients enrolled, with mean age 65.5 ± 11 years (± Standard deviation, SD), and 60% were females. Females were less adherent to weekly collection of PROMIS, KCC and SAQ-7 physical limitations questionnaires (all p < 0.05), compared to males. There was no difference in biometric physical activity. There was a statistically significant (p < 0.05) difference in sleep duration between sexes, with females sleeping 6 min longer. However, females reported higher PROMIS sleep disturbance scores (p < 0.001) and poorer psychometric scores overall (p < 0.05). A higher proportion of males had clinically significant elevations of median N-terminal pro-brain natriuretic peptide (p = 0.005) and high-sensitivity cardiac troponin levels (p < 0.001) compared to females.\n\nConclusions: Among females and males with stable IHD, there are sex-based differences in remote monitoring behavior and data. Females are less adherent to psychometric data collection and report poorer psychometric and sleep quality scores than males. Elevated levels of biomarkers for MACE are more common in males. These findings may improve sex-specific understanding of IHD using remote patient monitoring.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35410392/", "newWindow": true } ] }, { "title": "“The Ripple Effect”: The influence of social support on participation in a small workplace health promotion program", "author": "Bell, Alexandra; Barrett, Norma; Lamaro Haintz, Greer", "year": "2022", "journalProceedings": "Health Promotion Journal of Australia", "category": "Usability,Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "NA", "abstract": "Issue addressed: Workplaces are key settings for health promotion. There is limited evidence pertaining to workplace health promotion [WHP] in Australian small and medium enterprises [SMEs], particularly in regional areas. This qualitative study explored employee perceptions of a pilot workplace health promotion program, LifeMAP, conducted in a small health service enterprise in regional Victoria 2014-2017, including facilitators of participation and perceived benefits of participation. Method: Ten LifeMAP participants were recruited using convenience sampling. Individual semi-structured interviews (n = 7) and one focus group (n = 3) were conducted between August and September 2017. Data were analysed inductively and thematically to elicit emergent themes. Results: Social support emerged as the overarching theme influencing participation in LifeMAP, and a perceived benefit of participation. Using FitBits{\\textregistered} and setting exercise challenges enabled social support to be fostered through role modelling, staff collegiality and community. There may be gendered differences in the experiences of role modelling in WHP. Conclusions: This SME, and others like it, often feature high levels of employee social connectedness, with a strong workplace and community networks. Social support is a critical influence in social connectedness which needs to be considered and incorporated into the design, implementation and evaluation of WHP programs as a means of overcoming WHP recruitment and participation challenges in regional SMEs. So what?: The identification of social support as a key factor for WHP participation and employee satisfaction is a valuable finding providing insight into how similar programs may be better designed and implemented to enhance WHP program recruitment and retention.", "links": [ { "caption": "URL", "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/hpja.511", "newWindow": true }, { "caption": "URL", "url": "https://onlinelibrary.wiley.com/doi/abs/10.1002/hpja.511", "newWindow": true }, { "caption": "URL", "url": "https://onlinelibrary.wiley.com/doi/10.1002/hpja.511", "newWindow": true } ] }, { "title": "Impact of the COVID-19 pandemic on elementary schoolers' physical activity, sleep, screen time and diet: A quasi-experimental interrupted time series study", "author": "Burkart, Sarah; Parker, Hannah; Weaver, R. Glenn; Beets, Michael W.; Jones, Alexis; Adams, Elizabeth L.; Chaput, Jean Philippe; Armstrong, Bridget", "year": "2022", "journalProceedings": "Pediatric obesity", "category": "Measurement", "devices": "Charge 2", "population": "Children", "dataUsed": "Intensity,Sleep,Heart Rate", "abstract": "Background: COVID-19 school closures pose a threat to children's wellbeing, but no COVID-19-related studies have assessed children's behaviours over multiple years. Objective: To examine children's obesogenic behaviours during spring and summer of the COVID-19 pandemic compared to previous data collected from the same children during the same calendar period in the 2 years prior. Methods: Physical activity and sleep data were collected via Fitbit Charge-2 in 231 children (7–12 years) over 6 weeks during spring and summer over 3 years. Parents reported their child's screen time and dietary intake via a survey on 2–3 random days/week. Results: Children's behaviours worsened at a greater rate following the pandemic onset compared to pre-pandemic trends. During pandemic spring, sedentary behaviour increased (+79 min; 95% CI = 60.6, 97.1) and MVPA decreased (−10 min, 95% CI = −18.2, −1.1) compared to change in previous springs (2018–2019). Sleep timing shifted later (+124 min; 95% CI = 112.9, 135.5). Screen time (+97 min, 95% CI = 79.0, 115.4) and dietary intake increased (healthy: +0.3 foods, 95% CI = 0.2, 0.5; unhealthy: +1.2 foods, 95% CI = 1.0, 1.5). Similar patterns were observed during summer. Conclusions: Compared to pre-pandemic measures, children's PA, sedentary behaviour, sleep, screen time, and diet were adversely altered during the COVID-19 pandemic. This may ultimately exacerbate childhood obesity.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34409754/", "newWindow": true } ] }, { "title": "Relationship Between Life-Space Mobility and Health Characteristics in Older Adults Using Global Positioning System Watches", "author": "Chung, Jane; Boyle, Joseph; Wheeler, David C.", "year": "2022", "journalProceedings": "Journal of applied gerontology : the official journal of the Southern Gerontological Society", "category": "Validation", "devices": "Surge", "population": "Older Adults", "dataUsed": "Distance", "abstract": "This study aimed to examine the feasibility of using global positioning system (GPS) watches to examine relationships between GPS-based life-space mobility (LSM) metrics and self-report LSM and health measures (physical, psychological, and cognitive function) among older adults. Thirty participants wore a Fitbit Surge for 3 days. Eight spatial and temporal LSM measures were derived from GPS data. About 90% of in-home movement speeds were zero, indicating the sedentary lifestyle, but they made some active out-of-home trips as the total distance traveled and size of movement area indicated. There was a significant difference in total distance traveled and 95th percentile of movement speed between mild cognitive and intact cognition groups. GPS-based higher proportion of out-of-home time was significantly associated with greater functional fitness. Greater GPS use hours were significantly associated with higher cognition. These findings suggest the potential of GPS watches to continuously monitor changes in functional health to inform prevention efforts.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34719296/", "newWindow": true } ] }, { "title": "Wrist-mounted accelerometers provide objective evidence of disease and recovery in patients with frozen shoulder", "author": "Mackenzie, Samuel P.; McLean, Michael; Spasojevic, Milo{\\v{s}}; Niu, Rui; Kruse, Lisa; Gwynne, Jasmin; Young, Allan; Cass, Benjamin", "year": "2021", "journalProceedings": "JSES international", "category": "Usability", "devices": "Flex 2", "population": "Patients", "dataUsed": "Steps,Intensity", "abstract": "Background: Commercially available wrist-mounted exercise monitors may offer objective data on disease and recovery. This study is the first to evaluate the potential of such devices in the assessment of frozen shoulder and the effects of treatment. Methods: Twenty-one patients with isolated, unilateral frozen shoulder wore a wrist-mounted accelerometer (Fitbit Fire II, Fitbit Inc. 2007, California, USA) on each wrist for two separate seven-day periods, one week before and six months after treatment. The monitors produced an activity count for each 24-hour period, accounting for all movements of the upper limb. Three values were calculated for each time period: (1) the mean activity count for each limb, (2) the total activity count for both limbs, and (3) an activity count ratio calculated by dividing the activity of the frozen limb by the unaffected limb. Constant score, American Shoulder and Elbow Surgeons, visual analog scale–pain, and range of movement were recorded before and after treatment. Results: Mean activity counts were significantly lower in the frozen shoulder limb than those in the unaffected limb over the initial seven-day period (6066 vs. 7516; P = .04). The activity count ratio significantly improved after treatment (0.83 vs. 096; p 0.01), whereas the mean total activity count remained similar before and after treatment (14915 vs. 12371; P = .18), demonstrating that activity transferred from the unaffected limb back to the previously frozen limb. Range of movement (P < .01), Constant (P < .01), American Shoulder and Elbow Surgeons (P < .01), and visual analog scale–pain (P < .01) scores all significantly improved after treatment, but there was no correlation with the data from the activity monitor. Discussion: Wrist-mounted accelerometers are sufficiently sensitive to detect a difference in limb activity in patients affected by frozen shoulder. The movement deficit between the affected and unaffected limbs improved by 14% after treatment. These data could be used in conjunction with subjective scores to offer a clearer insight into patient disease burden and recovery.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35141684/", "newWindow": true } ] }, { "title": "Consumer-grade wearables identify changes in multiple physiological systems during COVID-19 disease progression", "author": "Mayer, Caleb; Tyler, Jonathan; Fang, Yu; Flora, Christopher; Frank, Elena; Tewari, Muneesh; Choi, Sung Won; Sen, Srijan; Forger, Daniel B.", "year": "2022", "journalProceedings": "Cell reports. Medicine", "category": "Review", "devices": "Charge 2,Charge 3", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Consumer-grade wearables are needed to track disease, especially in the ongoing pandemic, as they can monitor patients in real time. We show that decomposing heart rate from low-cost wearable technologies into signals from different systems can give a multidimensional description of physiological changes due to COVID-19 infection. We find that the separate physiological features of basal heart rate, heart rate response to physical activity, circadian variation in heart rate, and autocorrelation of heart rate are significantly altered and can classify symptomatic versus healthy periods. Increased heart rate and autocorrelation begin at symptom onset, while the heart rate response to activity increases soon after symptom onset and increases more in individuals exhibiting cough. Symptom onset is associated with a blunting of circadian variation in heart rate, as measured by the uncertainty in the phase estimate. This work establishes an innovative data analytic approach to monitor disease progression remotely using consumer-grade wearables.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35480626/", "newWindow": true } ] }, { "title": "Validity of the Fitbit Ace and Moki Devices for Assessing Steps During Different Walking Conditions in Young Adolescents", "author": "Sun, Xiyao; Adams, Stephanie A.; Li, Chuchu; Booth, Josephine N.; Robertson, Judy; Fawkner, Samantha", "year": "2022", "journalProceedings": "Pediatric exercise science", "category": "Validation", "devices": null, "population": "Adolescents", "dataUsed": "Steps", "abstract": "PURPOSE: Using wearable monitoring devices is increasingly ubiquitous, including among young people. However, there is limited evidence of the validity of devices which are aimed at children and adolescents. The purpose of this study was to evaluate the validity of Fitbit Ace and Moki monitors in healthy young adolescents. METHODS: This cross-sectional study included 17 young adolescents (ages 11-13 y) ambulating between 3 different walking conditions (incidental [∼6 min], controlled, and treadmill [each 3 min], while wearing wrist-worn devices [Fitbit Ace, Moki] on each wrist [left and right, respectively]). Data from the devices were compared with observer counts (criterion). Bland-Altman plots and mean absolute percentage errors were computed. RESULTS: Analyses identified that the Fitbit Ace showed higher levels of bias across conditions compared with the Moki device: (mean difference [SD]; Fitbit Ace: 30.0 [38.0], 3.0 [13.0], and 13.0 [23.0] steps and Moki: 1.0 [19.0], 4.0 [16.0], and 6.0 [14.0] steps, incidental, controlled, and treadmill, respectively). Mean absolute percentage errors ranged from 3.1% to 9.5% for the Fitbit Ace and 3.0% to 4.0% for the Moki device. CONCLUSION: The Fitbit Ace and Moki devices might not provide acceptable validity under all walking conditions, but the Moki provides more accurate estimates of incidental walking and might therefore be a good choice for free-living research or school-based interventions.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34784580/", "newWindow": true } ] }, { "title": "Impact of a Pilot Structured Mobile Technology Based Lifestyle Intervention for Patients with Nonalcoholic Fatty Liver Disease", "author": "Tincopa, Monica A.; Lyden, Angela; Wong, Jane; Jackson, Elizabeth A.; Richardson, Caroline; Lok, Anna S.", "year": "2022", "journalProceedings": "Digestive diseases and sciences", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Background and Aims: Lifestyle modification is the main treatment for nonalcoholic fatty liver disease (NAFLD), but remains challenging to implement. The aim of this pilot was to assess the acceptability and feasibility of a mobile-technology based lifestyle program for NAFLD patients. Methods: We enrolled adult patients with NAFLD in a 6-month mobile-technology based program where participants received a FitBit with weekly tailored step count goals and nutritional assessments. Anthropometrics, hepatic and metabolic parameters, Fibroscan, physical function and activity, and health-related quality of life measures were obtained at enrollment and month 6. Semi-structured exit interviews were conducted to assess patient's experience with the program. Results: 40 (63%) eligible patients were enrolled. Median age was 52.5 with 53% males, 93% whites, 43% with diabetes and median BMI 33.9. On baseline Fibroscan, 59% had F0-2 fibrosis and 70% had moderate-severe steatosis. 33 patients completed the study. Median percentage of days with valid FitBit data collection was 91. 4 patients increased and maintained, 19 maintained, and 8 increased but subsequently returned to baseline weekly step count. 59% of patients reported Fitbit was easy to use and 66% felt step count feedback motivated them to increase their activity. Roughly 50% of patients had reduction in weight, triglycerides and Fibroscan liver stiffness, and 75% had improvement in controlled attenuation parameter and physical function. Conclusions: A 6-month mobile-technology based pilot lifestyle intervention was feasible and acceptable to NAFLD patients. The program promoted physical activity and was associated with improvement in clinical parameters in some patients.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/33939147/", "newWindow": true } ] }, { "title": "A distance-based, randomized controlled trial for reducing sedentary behavior among prostate cancer survivors: a study protocol", "author": "Trinh, Linda; Sabiston, Catherine M.; Alibhai, Shabbir M. H.; Jones, Jennifer M.; Arbour-Nicitopoulos, Kelly P.; Mina, Daniel Santa; Campbell, Kristin; Faulkner, Guy E.", "year": "2022", "journalProceedings": "BMC public health", "category": "Usability,Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Distance,Sleep", "abstract": "Background: Prostate cancer survivors (PCS) experience long-term side effects beyond treatment such as fatigue, depression and anxiety. Quality and engaging supportive care programs are needed to reduce these chronic and debilitating effects. Independent of physical activity (PA), high volumes of sedentary behavior (SB) are associated with chronic disease-related risk factors and poorer cancer-specific quality of life (QoL). Simultaneously increasing PA and decreasing SB may be an effective health promotion strategy. Given that PCS may face several barriers to engaging in supervised programs, there is a need to develop and assess the efficacy of interventions that employ distance-based approaches for behavior change. The primary aim of this study is to determine the effects of a 12-week intervention (Fitbit + behavioral counselling) vs. Fitbit-only control group in reducing SB among PCS. Secondary outcomes include light-intensity PA, QoL, motivational outcomes, and patient satisfaction.\n\nMethods: This two-armed, randomized controlled trial will recruit inactive PCS (stage I-IV) across Canada who self-report engaging in >8 hours/day of SB. Participants will be randomized to the intervention (n=60; Fitbit and behavioral support) or active control group (n=60; Fitbit-only). The intervention consists of the use of a Fitbit and a series of six behavioral support sessions (two group, four individual) to aid PCS in gradually replacing SB with light-intensity PA by increasing their daily step counts to 3,000 steps above their baseline values. The Fitbit-only control condition will receive a Fitbit and public health PA resources. The primary outcome is change in SB measured objectively using activPAL inclinometers. All secondary outcomes will be measured via self-report, except for PA which will be measuring using Fitbits. Data will be collected at baseline, post-intervention, and at 6-month post-intervention.\n\nDiscussion: Reducing SB and increasing light-intensity PA plays an important, yet often undervalued role in the health and well-being of PCS. This study will create a unique distance-based platform that can be used by clinical and community-based organizations as a low-cost, supportive care tool to improve health outcomes for PCS.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35484523/", "newWindow": true } ] }, { "title": "Responsiveness of an activity tracker as a measurement tool in a knee osteoarthritis clinical trial (ACTIVe-OA study)", "author": "Yu, Shirley P.; Ferreira, Manuela L.; Duong, Vicky; Caroupapoull{\\'{e}}, Jimmy; Arden, Nigel K.; Bennell, Kim L.; Hunter, David J.", "year": "2022", "journalProceedings": "Annals of physical and rehabilitation medicine", "category": "Usability", "devices": "Flex 2", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Background: In osteoarthritis (OA) clinical trials, reliable and responsive outcome measures to document physical and functional improvements are limited. Objective: This study aimed to assess whether the use of an activity tracker in an OA clinical trial is a responsive measurement tool. Secondary objectives assessed feasibility and validity. Methods: We recruited 65 participants in a prospective cohort study nested in a placebo-controlled clinical trial of platelet-rich plasma injection in knee OA. Participants wore an activity tracker (Fitbit Flex 2), and a smartphone was preloaded with a mobile application (OApp) designed to monitor load rates as a surrogate of knee loading. Participants used the systems for 7 days at baseline and for 7 days before the 2-month follow-up assessment. Effect size (ES) and standardised response mean (SRM) were calculated for change in step count and knee loading rate and regularly used knee OA outcome measures. Correlation coefficients (r) were calculated to examine the strength of the association between outcome measures. Results:. Step count showed a trivial ES and SRM and mean knee loading rate measurements a moderate ES and SRM. We found a weak but significant correlation between change in mean steps per day and global improvement overall (r= 0.28) and Western Ontario and McMaster Universities Osteoarthritis Index function (r = -0.28). Compliance was high with the activity trackers. Conclusions: Despite good feasibility, this study did not show significant responsiveness or validity of the activity trackers as compared with currently recommended outcome measures in OA clinical trials. The main challenge is the lack of a gold standard outcome measure to validate against, and because of the complex interplay between pain and measured function, a lack of correlation does not necessarily represent a failed validation in this context. Australian New Zealand Clinical Trials Registry: ACTRN12617000853347. This trial is a substudy of the “Platelet-rich plasma as a symptom-and disease-modifying treatment for knee osteoarthritis – the RESTORE trial”.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34879312/", "newWindow": true } ] }, { "title": "Associations of COVID-19 lockdown restrictions with longer-term activity levels of working adults with type 2 diabetes", "author": "Brakenridge, Christian; Salim, Agus; Healy, Genevieve Nissa; Grigg, Ruth; Carver, Alison; Rickards, Kym; Owen, Neville; Dunstan, David", "year": "2022", "journalProceedings": "JMIR diabetes", "category": "Intervention", "devices": "Inspire HR", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: Lockdown restrictions reduce COVID-19 community transmission; however, they may pose challenges for non-communicable disease management. A 112-day hard lockdown in Victoria, Australia (commencing March 23, 2020), coincided with an intervention trial of reducing and breaking up sitting time in desk workers with type 2 diabetes who were using a provided consumer grade activity tracker (Fitbit).\n\nObjective: To compare continuously recorded activity levels preceding and during COVID-19 lockdown restrictions among working adults with type 2 diabetes participating in a sitting less and moving more intervention.\n\nMethods: Eleven participants (8/11 male; mean [SD] age 52.8 [5.0] years) in Melbourne, Australia had Fitbit activity tracked before (mean [SD]: 122.7 [47.9] days) and during (99.7 [62.5] days) city-wide COVID-19 lockdown restrictions. Regression models compared device (Fitbit Inspire HR)-derived activity (steps; METs [metabolic equivalents], mean time in sedentary, lightly, fairly, and very active minutes, and usual bout durations) during restrictions, to pre-restriction. Changes in activity were statistically significant when estimates (Δ%) did not intercept zero.\n\nResults: Overall, there was a decrease in mean: steps (-1,584 steps/day; Δ% : 9%; 95%CI: -11, -7); METs (-83 METs/day; Δ% : -5%; 95%CI: -6, -5); and, lightly active (Δ% : -4%; 95%CI: -8, -1), fairly active (Δ% : -8%; 95%CI: -21, -15), and very active (Δ% : -8%; 95%CI: -11, -5) intensity minutes per day, and increases in mean sedentary minutes per day (+51 mins/day; Δ% : +3%; 95%CI: 1, 6). Only very active (+5.1 mins) and sedentary (+4.3 mins) bout durations changed significantly.\n\nConclusions: In a convenience sample of adults with type 2 diabetes, COVID-19 lockdown restrictions were associated with decreases in overall activity levels and increases in very active and sedentary bout durations. A Fitbit monitor provided meaningful continuous long-term data in this context.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35486904/", "newWindow": true } ] }, { "title": "Something Tells Me I Can't Do That No More\": Experiences With Real-Time Glucose and Activity Monitoring Among Underserved Black Women With Type 2 Diabetes\"", "author": "Fritschi, Cynthia; Kim, Min Jung; Srimoragot, Manassawee; Jun, Jeehye; Sanchez, Lidia Emily; Sharp, Lisa K.", "year": "2022", "journalProceedings": "The science of diabetes self-management and care", "category": "Usability,Intervention", "devices": "Charge", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Purpose: The purpose of the study was to explore self-regulation skills with real-time activity and glucose monitoring among Black women with type 2 diabetes (T2DM). Methods: A small acceptability trial was conducted using technology (continuous glucose monitors and Fitbit) to facilitate core behaviors associated with self-regulation (self-monitoring/assessment, learning, mental contrasting [comparing current values with goal values], and goal setting/review). Participants were given continuous glucose monitors and Fitbit activity trackers for self-monitoring of blood glucose and activity. Two sessions of group diabetes education were also offered. Following the intervention, semistructured interviews and subsequent content analyses were conducted to explore how the women's experiences reflected certain self-regulation behaviors. Results: Eight underserved Black women with non-insulin-requiring T2DM were included (age = 68 ± 5.2 years; A1C = 6.6% ± 1.1%; 15.3 ± 7.2 years since diagnosis). Content analysis revealed themes that were consistent with core self-regulation behaviors: experiential learning through self-monitoring, mental contrasting, and impact on behavior (actual behavior change and motivation to change behavior). Conclusions: With use of real-time glucose and activity monitoring, underserved Black women with T2DM described how they used the data from the devices to make choices about eating and activity behaviors.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35118920/", "newWindow": true } ] }, { "title": "Continuous Monitoring of Vital Signs With Wearable Sensors During Daily Life Activities: Validation Study", "author": "Haveman, Marjolein E.; van Rossum, Mathilde C.; Vaseur, Roswita M. E.; van der Riet, Claire; Schuurmann, Richte C. L.; Hermens, Hermie J.; de Vries, Jean Paul P. M.; Tabak, Monique", "year": "2022", "journalProceedings": "JMIR formative research", "category": "Validation", "devices": "Charge 3", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Background: Continuous telemonitoring of vital signs in a clinical or home setting may lead to improved knowledge of patients' baseline vital signs and earlier detection of patient deterioration, and it may also facilitate the migration of care toward home. Little is known about the performance of available wearable sensors, especially during daily life activities, although accurate technology is critical for clinical decision-making. Objective: The aim of this study is to assess the data availability, accuracy, and concurrent validity of vital sign data measured with wearable sensors in volunteers during various daily life activities in a simulated free-living environment. Methods: Volunteers were equipped with 4 wearable sensors (Everion placed on the left and right arms, VitalPatch, and Fitbit Charge 3) and 2 reference devices (Oxycon Mobile and iButton) to obtain continuous measurements of heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), and temperature. Participants performed standardized activities, including resting, walking, metronome breathing, chores, stationary cycling, and recovery afterward. Data availability was measured as the percentage of missing data. Accuracy was evaluated by the median absolute percentage error (MAPE) and concurrent validity using the Bland-Altman plot with mean difference and 95% limits of agreement (LoA). Results: A total of 20 volunteers (median age 64 years, range 20-74 years) were included. Data availability was high for all vital signs measured by VitalPatch and for HR and temperature measured by Everion. Data availability for HR was the lowest for Fitbit (4807/13,680, 35.14% missing data points). For SpO2 measured by Everion, median percentages of missing data of up to 100% were noted. The overall accuracy of HR was high for all wearable sensors, except during walking. For RR, an overall MAPE of 8.6% was noted for VitalPatch and that of 18.9% for Everion, with a higher MAPE noted during physical activity (up to 27.1%) for both sensors. The accuracy of temperature was high for VitalPatch (MAPE up to 1.7%), and it decreased for Everion (MAPE from 6.3% to 9%). Bland-Altman analyses showed small mean differences of VitalPatch for HR (0.1 beats/min [bpm]), RR (−0.1 breaths/min), and temperature (0.5 °C). Everion and Fitbit underestimated HR up to 5.3 (LoA of −39.0 to 28.3) bpm and 11.4 (LoA of −53.8 to 30.9) bpm, respectively. Everion had a small mean difference with large LoA (−10.8 to 10.4 breaths/min) for RR, underestimated SpO2 (>1%), and overestimated temperature up to 2.9 °C. Conclusions: Data availability, accuracy, and concurrent validity of the studied wearable sensors varied and differed according to activity. In this study, the accuracy of all sensors decreased with physical activity. Of the tested sensors, VitalPatch was found to be the most accurate and valid for vital signs monitoring.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34994703/", "newWindow": true } ] }, { "title": "Dataset of consumer-based activity trackers as a tool for physical activity monitoring in epidemiological studies during the COVID-19 Pandemic", "author": "Henriksen, Andre; Johannessen, Erlend; Hartvigsen, Gunnar; Grimsgaard, Sameline; Hopstock, Laila Arnesdatter", "year": "2022", "journalProceedings": "Data in brief", "category": "Systematic Review", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity", "abstract": "Physical activity (PA) data were downloaded from 113 participants who owned a Garmin or Fitbit activity tracker in 2019 and 2020. Upon participant authorization, data were automatically downloaded from the Garmin and Fitbit cloud storages. The mSpider tool, a solution for automatic and continuous data extraction from activity tracker providers, were used to download participant data. Available data are daily averages by year, as well as monthly averages between 2019 and 2020, for steps, activity energy expenditure (AEE), total energy expenditure (TEE), moderate-to-vigorous physical activity (MVPA), light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and sedentary time. In addition, March 2020 was divided in two, giving the daily average before and after the Norwegian COVID-19 lockdown date. Raw daily values for these variables are also included in a separate file. In addition, daily values for non-wear time are also include as raw data. In a previous study, differences between months, i.e., comparing 2019 with 2020 for months between March to December, were analysed for steps, MVPA, and AEE [1]. Further insights may be achieved by exploring other variables. This includes: (1) monthly averages for TEE, LPA, MPA, VPA, and sedentary time, (2) yearly averages (2019 and 2020) for steps, MVPA, TEE, AEE, LPA, MPA, VPA, and sedentary time (3) monthly average for steps, MVPA, TEE, AEE, LPA, MPA, VPA, and sedentary time for January, February, and March 2019, as well as March 2020. Additional analysis can also be conducted on the raw data.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35274029/", "newWindow": true } ] }, { "title": "Evaluation of Sleep Parameters and Sleep Staging (Slow Wave Sleep) in Athletes by Fitbit Alta HR, a Consumer Sleep Tracking Device", "author": "Kawasaki, Yu; Kasai, Takatoshi; Sakurama, Yuko; Sekiguchi, Akiko; Kitamura, Eri; Midorikawa, Itsuki; Shiroshita, Nanako; Kawana, Fusae; Ogasawara, Etsuko; Kitade, Mari; Koikawa, Natsue; Matsuda, Takao", "year": "2022", "journalProceedings": "Nature and science of sleep", "category": "Validation", "devices": "Alta HR", "population": "Adults", "dataUsed": "Sleep,Heart Rate", "abstract": "Purpose: Sleep is an essential factor for athletes, and it is important to intervene in sleep to manage it. We need a device that can evaluate sleep easily and constantly. Consumer wearable devices can be useful tools for athletes. In order to use consumer wearable devices in clinical research, it is essential to conduct a validation study. Thus, we conducted a validation study to assess the Fitbit Alta HRTM (FBA)- a consumer wearable device with an accelerometer and a heart rate monitor to detect sleep stages and quality against electroencephalographic (EEG) studies in athletes.\n\nPatients and methods: Forty college athletes participated in the study. EEG was applied to participants simultaneously while wearing FBA.\n\nResults: Regarding sleep parameters, there was a strong correlation between the total sleep time (TST)-EEG and the TST-Fitbit (r = 0.83; p < 0.001). Regarding the sleep stages, there was a modest correlation between the N3 sleep-EEG and the N3 sleep-Fitbit (r = 0.68; p < 0.001). In addition, there was a strong correlation between the percentage of N3 sleep in between sleep onset and initial rapid eye movement sleep-EEG and those on Fitbit (r = 0.73; p < 0.001).\n\nConclusion: These results demonstrate that FBA facilitates sleep monitoring and exhibits acceptable agreement with EEG. Therefore, FBA is a useful tool in athletes' sleep management.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35502231/", "newWindow": true } ] }, { "title": "Reference Values for Wristband Accelerometry Data in Children Aged 6-11 Years of Age", "author": "Lammers, Astrid E.; Romanowski, Anna Lena; Baumgartner, Helmut; Diller, Gerhard-Paul; Uebing, Anselm", "year": "2022", "journalProceedings": "Frontiers in pediatrics", "category": "Usability", "devices": "Charge 2", "population": "Children", "dataUsed": "Steps,Heart Rate", "abstract": "Objectives: Wristband activity trackers (accelerometers) could serve as a convenient monitoring tool to continuously quantify physical activity throughout the day. We aim to provide reference values for the use of these devices in healthy children.\n\nMethods: Children were recruited at a local school and provided with activity trackers (Fitbit Charge 2). Pupils were instructed to wear devices during all normal daytime activities over a period of 11-15 days. Demographic data, total number of daily steps and heart rate were recorded. In addition, all children/parents were asked to complete a questionnaire providing information about daily physical routine (mode of transport to school, sporting activities as well as sport club memberships).\n\nResults: Three hundred two children (54.6% boys; median age 8.7 years) participated in this prospective study. Median wearing time of the device was 12.1 h/day. Overall, the median daily total step count was 12,095. Median step counts/day were significantly higher in boys compared to girls (13,015 vs. 11,305 steps/day; p < 0.0001). In addition, step counts were significantly higher during the week, compared to weekend days. The effect of age on daily step count was found to be non-linear: the total daily step count increased from 6 to 8.5 years of age, while older children (aged >8.5 years) had lower step counts compared to the younger children. Significant predictors of the daily step count were male gender (+1,324.9 steps, p = 0.0008), mode of transportation to school (walking, bicycle, scooter: +865.5 steps p = 0.049), active membership in a sports club (+1,324.9 steps/day, p = 0.0008), and number of structured units of physical exercise performed (+336.5/per 45 min, p < 0.0001). Severe obesity was associated with a significant reduction in total daily step count (-3037.7 steps/day, p = 0.015).\n\nConclusion: Our prospective cohort study of healthy school children provides reference values for wristband accelerometers in normal individuals. In addition, it clarifies the effect of age, body weight and lifestyle on normal daily step counts in school children. This data should be helpful to judge the degree of physical limitation of patients compared to healthy peers.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35498803/", "newWindow": true } ] }, { "title": "Home-based cardiac rehabilitation using information and communication technology for heart failure patients with frailty", "author": "Nagatomi, Yuta; Ide, Tomomi; Higuchi, Tae; Nezu, Tomoyuki; Fujino, Takeo; Tohyama, Takeshi; Nagata, Takuya; Higo, Taiki; Hashimoto, Toru; Matsushima, Shouji; Shinohara, Keisuke; Yokoyama, Tomiko; Eguchi, Aika; Ogusu, Ayumi; Ikeda, Masataka; Ishikawa, Yusuke; Yamashita, Fumika; Kinugawa, Shintaro; Tsutsui, Hiroyuki", "year": "2022", "journalProceedings": "ESC heart failure", "category": "Measurement", "devices": "Inspire HR", "population": "Patients", "dataUsed": "Steps", "abstract": "Aims: Cardiac rehabilitation (CR) is an evidence-based, secondary preventive strategy that improves mortality and morbidity rates in patients with heart failure (HF). However, the implementation and continuation of CR remains unsatisfactory, particularly for outpatients with physical frailty. This study investigated the efficacy and safety of a comprehensive home-based cardiac rehabilitation (HBCR) programme that combines patient education, exercise guidance, and nutritional guidance using information and communication technology (ICT).\n\nMethods and results: This study was a single-centre, open-label, randomized, controlled trial. Between April 2020 and November 2020, 30 outpatients with chronic HF (New York Heart Association II-III) and physical frailty were enrolled. The control group (n = 15) continued with standard care, while the HBCR group (n = 15) also received comprehensive, individualized CR, including ICT-based exercise and nutrition guidance using ICT via a Fitbit® device for 3 months. The CR team communicated with each patient in HBCR group once a week via the application messaging tool and planned the training frequency and intensity of training individually for the next week according to each patient's symptoms and recorded pulse data during exercise. Dietitians conducted a nutritional assessment and then provided individual nutritional advice using the picture-posting function of the application. The primary outcome was the change in the 6 min walking distance (6MWD). The participants' mean age was 63.7 ± 10.1 years, 53% were male, and 87% had non-ischaemic heart disease. The observed change in the 6MWD was significantly greater in the HBCR group (52.1 ± 43.9 m vs. -4.3 ± 38.8 m; P < 0.001) at a 73% of adherence rate. There was no significant change in adverse events in either group.\n\nConclusions: Our comprehensive HBCR programme using ICT for HF patients with physical frailty improved exercise tolerance and improved lower extremity muscle strength in our sample, suggesting management with individualized ICT-based programmes as a safe and effective approach. Considering the increasing number of HF patients with frailty worldwide, our approach provides an efficient method to keep patients engaged in physical activity in their daily life.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35534907/", "newWindow": true } ] }, { "title": "A Remote Health Coaching, Text-Based Walking Program in Ethnic Minority Primary Care Patients With Overweight and Obesity: Feasibility and Acceptability Pilot Study", "author": "Smart, Mary H.; Nabulsi, Nadia A.; Gerber, Ben S.; Gupta, Itika; Di Eugenio, Barbara; Ziebart, Brian; Sharp, Lisa K.", "year": "2022", "journalProceedings": "JMIR formative research", "category": "Usability,Intervention", "devices": "Charge 2,Charge 3", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Over half of US adults have at least one chronic disease, including obesity. Although physical activity is an important component of chronic disease self-management, few reach the recommended physical activity goals. Individuals who identify as racial and ethnic minorities are disproportionally affected by chronic diseases and physical inactivity. Interventions using consumer-based wearable devices have shown promise for increasing physical activity among patients with chronic diseases; however, populations with the most to gain, such as minorities, have been poorly represented to date. Objective: This study aims to assess the feasibility, acceptability, and preliminary outcomes of an 8-week text-based coaching and Fitbit program aimed at increasing the number of steps in a predominantly overweight ethnic minority population. Methods: Overweight patients (BMI >25 kg/m2) were recruited from an internal medicine clinic located in an inner-city academic medical center. Fitbit devices were provided. Using 2-way SMS text messaging, health coaches (HCs) guided patients to establish weekly step goals that were specific, measurable, attainable, realistic, and time-bound. SMS text messaging and Fitbit activities were managed using a custom-designed app. Program feasibility was assessed via the recruitment rate, retention rate (the proportion of eligible participants completing the 8-week program), and patient engagement (based on the number of weekly text message goals set with the HC across the 8-week period). Acceptability was assessed using a qualitative, summative evaluation. Exploratory statistical analysis included evaluating the average weekly steps in week 1 compared with week 8 using a paired t test (2-tailed) and modeling daily steps over time using a linear mixed model. Results: Of the 33 patients initially screened; 30 (91%) patients were enrolled in the study. At baseline, the average BMI was 39.3 (SD 9.3) kg/m2, with 70% (23/33) of participants presenting as obese. A total of 30% (9/30) of participants self-rated their health as either fair or poor, and 73% (22/30) of participants set up ≥6 weekly goals across the 8-week program. In total, 93% (28/30) of participants completed a qualitative summative evaluation, and 10 themes emerged from the evaluation: patient motivation, convenient SMS text messaging experience, social support, supportive accountability, technology support, self-determined goals, achievable goals, feedback from Fitbit, challenges, and habit formation. There was no significant group change in the average weekly steps for week 1 compared with week 8 (mean difference 7.26, SD 6209.3; P=.99). However, 17% (5/30) of participants showed a significant increase in their daily steps. Conclusions: Overall, the results demonstrate the feasibility and acceptability of a remotely delivered walking study that included an HC; SMS text messaging; a wearable device (Fitbit); and specific, measurable, attainable, realistic, and time-bound goals within an ethnic minority patient population. Results support further development and testing in larger samples to explore efficacy.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35044308/", "newWindow": true } ] }, { "title": "Factors related to daily step counts of stroke patients during hospitalization in a convalescent rehabilitation ward", "author": "Yamada, Ryuichiro; Shimizu, Shinobu; Suzuki, Yuta; Nakachi, Yuki; Takemura, Nami; Taira, Katsuya; Yamazato, Tomoya; Shimabukuro, Michiru; Tsunoda, Satoshi; Shimose, Ryota; Ogura, Misao; Higa, Jun; Nakanishi, Takayuki; Matsunaga, Atsuhiko", "year": "2022", "journalProceedings": "Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association", "category": "Measurement", "devices": "Flex 2", "population": "Patients", "dataUsed": "Steps", "abstract": "Objectives: Clarifying the factors related to decreased physical activity in post-stroke patients is essential for effective disease management. This study aimed to examine the factors influencing the amount of daily steps taken by post-stroke patients in a convalescent rehabilitation ward during activities other than rehabilitation (non-rehabilitation steps). Materials and methods: Eighty-nine post-stroke patients (60.8±14.4 years; 55 men) were enrolled. The inclusion criteria were walking independently within the ward and having a walking speed of ≥24 m/min. Data on patient clinical characteristics including age, sex, body mass index, stroke type, hemiparetic side, and time from stroke onset were collected. Stroke impairment and motor and cognitive functional disabilities were assessed using the Stroke Impairment Assessment Set and the Functional Independence Measure, respectively. The non-rehabilitation steps were calculated by subtracting the steps during the rehabilitation activities from the total steps using Fitbit Flex2. Results: The average number of non-rehabilitation steps was 4,523±2,339 steps/day. The hierarchical multiple regression analysis revealed that sex, motor disability, and the interaction term of stroke impairment with cognitive disability were significantly related to non-rehabilitation steps. Simple slope analysis demonstrated that the stroke impairment slope was steeper at lower levels than at higher levels of cognitive disability for non-rehabilitation steps. Conclusions: In addition to independent effects of sex and motor disability, this study found that stroke impairment and cognitive disability were interactively related to non-rehabilitation steps in post-stroke patients in a convalescent rehabilitation ward. These findings may provide useful information for managing physical activity in post-stroke patients after hospital discharge.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35219974/", "newWindow": true } ] }, { "title": "Real-time infection prediction with wearable physiological monitoring and AI to aid military workforce readiness during COVID-19", "author": "Conroy, Bryan; Silva, Ikaro; Mehraei, Golbarg; Damiano, Robert; Gross, Brian; Salvati, Emmanuele; Feng, Ting; Schneider, Jeffrey; Olson, Niels; Rizzo, Anne G.; Curtin, Catherine M.; Frassica, Joseph; McFarlane, Daniel C.", "year": "2022", "journalProceedings": "Scientific Reports", "category": "Usability", "devices": "Garmin Fenix 6,Garmin Vivoactive 4", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Infectious threats, like the COVID-19 pandemic, hinder maintenance of a productive and healthy workforce. If subtle physiological changes precede overt illness, then proactive isolation and testing can reduce labor force impacts. This study hypothesized that an early infection warning service based on wearable physiological monitoring and predictive models created with machine learning could be developed and deployed. We developed a prototype tool, first deployed June 23, 2020, that delivered continuously updated scores of infection risk for SARS-CoV-2 through April 8, 2021. Data were acquired from 9381 United States Department of Defense (US DoD) personnel wearing Garmin and Oura devices, totaling 599,174 user-days of service and 201 million hours of data. There were 491 COVID-19 positive cases. A predictive algorithm identified infection before diagnostic testing with an AUC of 0.82. Barriers to implementation included adequate data capture (at least 48% data was needed) and delays in data transmission. We observe increased risk scores as early as 6 days prior to diagnostic testing (2.3 days average). This study showed feasibility of a real-time risk prediction score to minimize workforce impacts of infection.", "links": [ { "caption": "URL", "url": "https://www.nature.com/articles/s41598-022-07764-6", "newWindow": true } ] }, { "title": "The Effectiveness of a Computer-Tailored Web-Based Physical Activity Intervention Using Fitbit Activity Trackers in Older Adults (Active for Life): Randomized Controlled Trial", "author": "Alley, Stephanie J.; van Uffelen, Jannique; Schoeppe, Stephanie; Parkinson, Lynne; Hunt, Susan; Power, Deborah; Waterman, Natasha; Waterman, Courtney; To, Quyen G.; Duncan, Mitch J.; Schneiders, Anthony; Vandelanotte, Corneel", "year": "2022", "journalProceedings": "Journal of medical Internet research", "category": "Intervention", "devices": "Flex", "population": "Older Adults", "dataUsed": "Steps,Intensity", "abstract": "Background\nPhysical activity is an integral part of healthy aging; yet, most adults aged ≥65 years are not sufficiently active. Preliminary evidence suggests that web-based interventions with computer-tailored advice and Fitbit activity trackers may be well suited for older adults.\n\nObjective\nThe aim of this study was to examine the effectiveness of Active for Life, a 12-week web-based physical activity intervention with 6 web-based modules of computer-tailored advice to increase physical activity in older Australians.\n\nMethods\nParticipants were recruited both through the web and offline and were randomly assigned to 1 of 3 trial arms: tailoring+Fitbit, tailoring only, or a wait-list control. The computer-tailored advice was based on either participants’ Fitbit data (tailoring+Fitbit participants) or self-reported physical activity (tailoring-only participants). The main outcome was change in wrist-worn accelerometer (ActiGraph GT9X)–measured moderate to vigorous physical activity (MVPA) from baseline to after the intervention (week 12). The secondary outcomes were change in self-reported physical activity measured by means of the Active Australia Survey at the midintervention point (6 weeks), after the intervention (week 12), and at follow-up (week 24). Participants had a face-to-face meeting at baseline for a demonstration of the intervention and at baseline and week 12 to return the accelerometers. Generalized linear mixed model analyses were conducted with a γ distribution and log link to compare MVPA and self-reported physical activity changes over time within each trial arm and between each of the trial arms.\n\nResults\nA total of 243 participants were randomly assigned to tailoring+Fitbit (n=78, 32.1%), tailoring only (n=96, 39.5%), and wait-list control (n=69, 28.4%). Attrition was 28.8% (70/243) at 6 weeks, 31.7% (77/243) at 12 weeks, and 35.4% (86/243) at 24 weeks. No significant overall time by group interaction was observed for MVPA (P=.05). There were no significant within-group changes for MVPA over time in the tailoring+Fitbit group (+3%, 95% CI –24% to 40%) or the tailoring-only group (–4%, 95% CI –24% to 30%); however, a significant decline was seen in the control group (–35%, 95% CI –52% to –11%). The tailoring+Fitbit group participants increased their MVPA 59% (95% CI 6%-138%) more than those in the control group. A significant time by group interaction was observed for self-reported physical activity (P=.02). All groups increased their self-reported physical activity from baseline to week 6, week 12, and week 24, and this increase was greater in the tailoring+Fitbit group than in the control group at 6 weeks (+61%, 95% CI 11%-133%).\n\nConclusions\nA computer-tailored physical activity intervention with Fitbit integration resulted in improved MVPA outcomes in comparison with a control group in older adults.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35552166/", "newWindow": true } ] }, { "title": "The effectiveness of the Structured Health Intervention For Truckers (SHIFT): a cluster randomised controlled trial (RCT)", "author": "Clemes, Stacy A.; Varela-Mato, Veronica; Bodicoat, Danielle H.; Brookes, Cassandra L.; Chen, Yu-Ling; Edwardson, Charlotte L.; Gray, Laura J.; Guest, Amber J.; Johnson, Vicki; Munir, Fehmidah; Paine, Nicola J.; Richardson, Gerry; Ruettger, Katharina; Sayyah, Mohsen; Sherry, Aron; Paola, Ana Suazo Di; Troughton, Jacqui; Yates, Thomas; King, James A.", "year": "2022", "journalProceedings": "BMC Medicine", "category": "Intervention", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "Background\nLong distance heavy goods vehicle (HGV) drivers exhibit higher than nationally representative rates of obesity, and obesity-related co-morbidities, and are underserved in terms of health promotion initiatives. The purpose of this study was to evaluate the effectiveness of the multicomponent ‘Structured Health Intervention For Truckers’ (SHIFT), compared to usual care, at 6- and 16–18-month follow-up.\n\nMethods\nWe conducted a two-arm cluster RCT in transport sites throughout the Midlands, UK. Outcome measures were assessed at baseline, at 6- and 16–18-month follow-up. Clusters were randomised (1:1) following baseline measurements to either the SHIFT arm or usual practice control arm. The 6-month SHIFT programme included a group-based interactive 6-h education and behaviour change session, health coach support and equipment provision (Fitbit® and resistance bands/balls to facilitate a ‘cab workout’). The primary outcome was device-assessed physical activity (mean steps/day) at 6 months. Secondary outcomes included the following: device-assessed sitting, physical activity intensity and sleep; cardiometabolic health, diet, mental wellbeing and work-related psychosocial variables. Data were analysed using mixed-effect linear regression models using a complete-case population.\n\nResults\nThree hundred eighty-two HGV drivers (mean ± SD age: 48.4 ± 9.4 years, BMI: 30.4 ± 5.1 kg/m2, 99% male) were recruited across 25 clusters (sites) and randomised into either the SHIFT (12 clusters, n = 183) or control (13 clusters, n = 199) arms. At 6 months, 209 (55%) participants provided primary outcome data. Significant differences in mean daily steps were found between groups, in favour of the SHIFT arm (adjusted mean difference: 1008 steps/day, 95% CI: 145–1871, p = 0.022). Favourable differences were also seen in the SHIFT group, relative to the control group, in time spent sitting (− 24 mins/day, 95% CI: − 43 to − 6), and moderate-to-vigorous physical activity (6 mins/day, 95% CI: 0.3–11). Differences were not maintained at 16–18 months. No differences were observed between groups in the other secondary outcomes at either follow-up.\n\nConclusions\nThe SHIFT programme led to a potentially clinically meaningful difference in daily steps, between trial arms, at 6 months. Whilst the longer-term impact is unclear, the programme offers potential to be incorporated into driver training courses to promote activity in this at-risk, underserved and hard-to-reach essential occupational group.", "links": [ { "caption": "URL", "url": "/pmc/articles/PMC9126630/", "newWindow": true }, { "caption": "URL", "url": "/pmc/articles/PMC9126630/?report=abstract", "newWindow": true }, { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9126630/", "newWindow": true } ] }, { "title": "Investigation of physical activity, sleep, and mental health recovery in treatment resistant depression (TRD) patients receiving repetitive transcranial magnetic stimulation (rTMS) treatment", "author": "Griffiths, Chris; da Silva, Ksenija Maravic; Leathlean, Chloe; Jiang, Harmony; Ang, Chee Siang; Searle, Ryan", "year": "2022", "journalProceedings": "Journal of affective disorders reports", "category": "Usability", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "Background: Repetitive transcranial magnetic stimulation (rTMS) is effective in treating depression; however, the effect on physical activity, sleep and recovery is unclear. This study investigated rTMS effect on physical activity and sleep through providing patients with a Fitbit and software apps; and reports the impact of rTMS on depression, anxiety and mental health recovery.\n\nMethods: Study design was a pre and post data collection without a control, with twenty-four participants with treatment-resistant depression (TRD). Measures used were Fitbit activity and sleep data, and patient-rated Recovering Quality of Life (ReQoL-20), Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder (GAD-7).\n\nResults: Response and remission rates were, respectively: 34.8% and 39% for PHQ-9; 34.8% and 47.8% for GAD-7. ReQoL-20 response and reliable improvement were 29.4% and 53%. PHQ-9, GAD-7 and ReQol-20 scores significantly improved, with large effect sizes. Analysis of Fitbit activity and sleep data yielded non-significant results. The Fitbit data machine learning model classified two levels of depression to 82% accuracy.\n\nLimitations: rTMS treatment was open-label and adjunct to existing antidepressant medication. No control group. Female patients were overrepresented.\n\nConclusions: Improvements on the ReQoL-20 and aspects of sleep and activity indicate the positive impact of rTMS on the individual's real world functioning and quality of life. A wearable activity tracker can provide feedback to patients and clinicians on sleep, physical activity and depression levels. Further research could be undertaken through a sufficiently powered RCT comparing rTMS versus rTMS with use of a Fitbit, its software applications, and sleep and physical activity advice.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35619990/", "newWindow": true } ] }, { "title": "Human-Centered Design of a Digital Health Tool to Promote Effective Self-care in Patients With Heart Failure: Mixed Methods Study", "author": "Johnston, William; Keogh, Alison; Dickson, Jane; Leslie, Stephen J.; Megyesi, Peter; Connolly, Rachelle; Burke, David; Caulfield, Brian", "year": "2022", "journalProceedings": "JMIR Formative Research", "category": "Methods", "devices": "Charge 4", "population": "Older Adults,Adults", "dataUsed": "Steps,Sleep,Heart Rate,Weight", "abstract": "Background\nEffective self-care is an important factor in the successful management of patients with heart failure (HF). Despite the importance of self-care, most patients with HF are not adequately taught the wide range of skills required to become proficient in self-care. Digital health technology (DHT) may provide a novel solution to support patients at home in effective self-care, with the view to enhancing the quality of life and ultimately improving patient outcomes. However, many of the solutions developed to date have failed to consider users’ perspectives at the point of design, resulting in poor effectiveness. Leveraging a human-centered design (HCD) approach to the development of DHTs may lead to the successful promotion of self-care behaviors in patients with HF.\n\nObjective\nThis study aimed to outline the HCD, development, and evaluation process of a DHT designed to promote effective self-care in patients with HF.\n\nMethods\nA design thinking approach within the HCD framework was undertaken, as described in the International Organization for Standardization 9241-210:2019 regulations, using a 5-step process: empathize, ideate, design, develop, and test. Patients with HF were involved throughout the design and evaluation of the system. The designed system was grounded in behavior change theory using the Theoretical Domains Framework and included behavior change techniques. Mixed methods were used to evaluate the DHT during the testing phase.\n\nResults\nSteps 1 to 3 of the process resulted in a set of evidence- and user-informed design requirements that were carried forward into the iterative development of a version 1 system. A cross-platform (iOS and Android) mobile app integrated with Fitbit activity trackers and smart scales was developed. A 2-week user testing phase highlighted the ease of use of the system, with patients demonstrating excellent adherence. Qualitative analysis of semistructured interviews identified the early potential for the system to positively influence self-care. Specifically, users perceived that the system increased their confidence and motivation to engage in key self-care behaviors, provided them with skills and knowledge that made them more aware of the importance of self-care behaviors, and might facilitate timely help seeking.\n\nConclusions\nThe use of an HCD methodology in this research has resulted in the development of a DHT that may engage patients with HF and potentially affect their self-care behaviors. This comprehensive work lays the groundwork for further development and evaluation of this solution before its implementation in health care systems. A detailed description of the HCD process used in this research will help guide the development and evaluation of future DHTs across a range of disease use cases.", "links": [ { "caption": "URL", "url": "/pmc/articles/PMC9131139/", "newWindow": true }, { "caption": "URL", "url": "/pmc/articles/PMC9131139/?report=abstract", "newWindow": true }, { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131139/", "newWindow": true } ] }, { "title": "Occurrence of Relative Bradycardia and Relative Tachycardia in Individuals Diagnosed With COVID-19", "author": "Natarajan, Aravind; Su, Hao-Wei; Heneghan, Conor", "year": "2022", "journalProceedings": "Frontiers in Physiology", "category": "Survey Research", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "The COVID-19 disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has become one of the worst global pandemics of the century. Wearable devices are well suited for continuously measuring heart rate. Here we show that the Resting Heart Rate is modified for several weeks following a COVID-19 infection. The Resting Heart Rate shows 3 phases: 1) elevated during symptom onset, with average peak increases relative to the baseline of 1.8% (3.4%) for females (males), 2) decrease thereafter, reaching a minimum on average ≈13 days after symptom onset, and 3) subsequent increase, reaching a second peak on average ≈28 days from symptom onset, before falling back to the baseline ≈112 days from symptom onset. All estimates vary with disease severity 1 .", "links": [ { "caption": "URL", "url": "/pmc/articles/PMC9127385/", "newWindow": true }, { "caption": "URL", "url": "/pmc/articles/PMC9127385/?report=abstract", "newWindow": true }, { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9127385/", "newWindow": true } ] }, { "title": "A Facebook-Delivered Weight Loss Intervention Using Open Enrollment: Randomized Pilot Feasibility Trial", "author": "Pagoto, Sherry L.; Schroeder, Matthew W.; Xu, Ran; Waring, Molly E.; Groshon, Laurie; Goetz, Jared M.; Idiong, Christie; Troy, Haley; DiVito, Joseph; Bannor, Richard", "year": "2022", "journalProceedings": "JMIR Formative Research", "category": "Intervention,Measurement", "devices": "Aria", "population": "Adults", "dataUsed": "Weight", "abstract": "Background\nBehavioral weight loss programs typically enroll 12-40 people into groups that then suffer from declining engagement over time. Web-based patient communities, on the other hand, typically offer no limits on capacity and membership is fluid. This model may be useful for boosting engagement in behavioral weight loss interventions, which could lead to better outcomes.\n\nObjective\nIn this study, we aimed to examine the feasibility and acceptability of continuously enrolling participants into a Facebook-delivered weight loss intervention for the first 8 of 16 weeks relative to the same intervention where no new participants were enrolled after randomization.\n\nMethods\nWe conducted a randomized pilot trial to compare a Facebook weight loss group that used open enrollment with a group that used closed enrollment on feasibility and acceptability in adults with BMI 27-45 kg/m2. The feasibility outcomes included retention, engagement, and diet tracking adherence. We described the percentage loss of ≥5% weight in both groups as an exploratory outcome. We also explored the relationship between total volume of activity in the group and weight loss. The participants provided feedback via web-based surveys and focus groups.\n\nResults\nRandomized participants (68/80, 85% women) were on average, aged 40.2 (SD 11.2) years with a mean BMI of 34.4 (SD 4.98) kg/m2. We enrolled an additional 54 participants (50/54, 93% female) in the open enrollment condition between weeks 1 and 8, resulting in a total group size of 94. Retention was 88% and 98% under the open and closed conditions, respectively. Randomized participants across conditions did not differ in engagement (P=.72), or diet tracking adherence (P=.42). Participant feedback in both conditions revealed that sense of community was what they liked most about the program and not enough individualized feedback was what they liked the least. Weight loss of ≥5% was achieved by 30% (12/40) of the participants randomized to the open enrollment condition and 18% (7/40) of the participants in the closed enrollment condition. Exploratory analyses revealed that the open condition (median 385, IQR 228-536.5) had a greater volume of engagement than the closed condition (median 215, IQR 145.5-292; P=.007). Furthermore, an increase of 100 in the total volume of engagement in the Facebook group each week was associated with an additional 0.1% weekly weight loss among the randomized participants (P=.02), which was independent of time, individual participant engagement, and sociodemographic characteristics.\n\nConclusions\nOpen enrollment was as feasible and acceptable as closed enrollment. A greater volume of engagement in the Facebook group was associated with weight loss, suggesting that larger groups that produce more engagement overall may be beneficial. Future research should examine the efficacy of the open enrollment approach for weight loss in a fully powered randomized trial.", "links": [ { "caption": "URL", "url": "/pmc/articles/PMC9123537/", "newWindow": true }, { "caption": "URL", "url": "/pmc/articles/PMC9123537/?report=abstract", "newWindow": true }, { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9123537/", "newWindow": true } ] }, { "title": "Effect of Walking Steps Measured by a Wearable Activity Tracker on Improving Components of Metabolic Syndrome: A Prospective Study", "author": "Park, Jae-Min; Choi, Ja-Eun; Lee, Hye Sun; Jeon, Soyoung; Lee, Ji-Won; Hong, Kyung-Won", "year": "2022", "journalProceedings": "International Journal of Environmental Research and Public Health", "category": "Measurement", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "We compared the improvement in components of metabolic syndrome (MS) before and after lifestyle modification, as determined by daily step counts (on a wrist-worn Fitbit®) in participants with and without MS recruited from volunteers attending medical health checkup programs. A linear mixed model was used to analyze the change in MS components between participants with and without MS by group × time interaction. Multiple logistic regression analysis after adjustment for confounders was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) for improvements in MS components per 1000-steps/day increments. Waist circumference, triglycerides, fasting plasma glucose, and diastolic blood pressure were significantly different between participants with and without MS (group × time: p = 0.010, p < 0.001, p = 0.025, and p = 0.010, respectively). Multivariable-adjusted ORs (95% CI) of improvement in MS components per 1000-steps/day increments were 1.24 (1.01–1.53) in participants with and 1.14 (0.93–1.40) in participants without MS. Walking improved MS components more in individuals with than without MS. From a public health perspective, walking should be encouraged for high-risk MS individuals.", "links": [ { "caption": "URL", "url": "/pmc/articles/PMC9101547/", "newWindow": true }, { "caption": "URL", "url": "/pmc/articles/PMC9101547/?report=abstract", "newWindow": true }, { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9101547/", "newWindow": true } ] }, { "title": "Predictors of engagement with remote sensing technologies for symptom measurement in Major Depressive Disorder", "author": "Matcham, F.; Carr, E.; White, K. M.; Leightley, D.; Lamers, F.; Siddi, S.; Annas, P.; de Girolamo, G.; Haro, J. M.; Horsfall, M.; Ivan, A.; Lavelle, G.; Li, Q.; Lombardini, F.; Mohr, D. C.; Narayan, V. A.; Penninx, B. W. H. J.; Oetzmann, C.; Coromina, M.; Simblett, S. K.; Weyer, J.; Wykes, T.; Zorbas, S.; Brasen, J. C.; Myin-Germeys, I.; Conde, P.; Dobson, R. J. B.; Folarin, A. A.; Ranjan, Y.; Rashid, Z.; Cummins, N.; Dineley, J.; Vairavan, S.; Hotopf, M.", "year": "2022", "journalProceedings": "Journal of Affective Disorders", "category": "Usability", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Background\nRemote sensing for the measurement and management of long-term conditions such as Major Depressive Disorder (MDD) is becoming more prevalent. User-engagement is essential to yield any benefits. We tested three hypotheses examining associations between clinical characteristics, perceptions of remote sensing, and objective user engagement metrics.\n\nMethods\nThe Remote Assessment of Disease and Relapse – Major Depressive Disorder (RADAR-MDD) study is a multicentre longitudinal observational cohort study in people with recurrent MDD. Participants wore a FitBit and completed app-based assessments every two weeks for a median of 18 months. Multivariable random effects regression models pooling data across timepoints were used to examine associations between variables.\n\nResults\nA total of 547 participants (87.8% of the total sample) were included in the current analysis. Higher levels of anxiety were associated with lower levels of perceived technology ease of use; increased functional disability was associated with small differences in perceptions of technology usefulness and usability. Participants who reported higher system ease of use, usefulness, and acceptability subsequently completed more app-based questionnaires and tended to wear their FitBit activity tracker for longer. All effect sizes were small and unlikely to be of practical significance.\n\nLimitations\nSymptoms of depression, anxiety, functional disability, and perceptions of system usability are measured at the same time. These therefore represent cross-sectional associations rather than predictions of future perceptions.\n\nConclusions\nThese findings suggest that perceived usability and actual use of remote measurement technologies in people with MDD are robust across differences in severity of depression, anxiety, and functional impairment.", "links": [ { "caption": "URL", "url": "https://linkinghub.elsevier.com/retrieve/pii/S0165032722005079", "newWindow": true } ] }, { "title": "Predictive Modeling of Mental Illness Onset Using Wearable Devices and Medical Examination Data: Machine Learning Approach", "author": "Saito, Tomoki; Suzuki, Hikaru; Kishi, Akifumi", "year": "2022", "journalProceedings": "Frontiers in Digital Health", "category": "Intervention,Measurement", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "The prevention and treatment of mental illness is a serious social issue. Prediction and intervention, however, have been difficult because of lack of objective biomarkers for mental illness. The objective of this study was to use biometric data acquired from wearable devices as well as medical examination data to build a predictive model that can contribute to the prevention of the onset of mental illness. This was an observational study of 4,612 subjects from the health database of society-managed health insurance in Japan provided by JMDC Inc. The inputs to the predictive model were 3-months of continuous wearable data and medical examinations within and near that period; the output was the presence or absence of mental illness over the following month, as defined by insurance claims data. The features relating to the wearable data were sleep, activity, and resting heart rate, measured by a consumer-grade wearable device (specifically, Fitbit). The predictive model was built using the XGBoost algorithm and presented an area-under-the-receiver-operating-characteristic curve of 0.712 (SD = 0.02, a repeated stratified group 10-fold cross validation). The top-ranking feature importance measure was wearable data, and its importance was higher than the blood-test values from medical examinations. Detailed verification of the model showed that predictions were made based on disrupted sleep rhythms, mild physical activity duration, alcohol use, and medical examination data on disrupted eating habits as risk factors. In summary, the predictive model showed useful accuracy for grouping the risk of mental illness onset, suggesting the potential of predictive detection, and preventive intervention using wearable devices. Sleep abnormalities in particular were detected as wearable data 3 months prior to mental illness onset, and the possibility of early intervention targeting the stabilization of sleep as an effective measure for mental illness onset was shown.", "links": [ { "caption": "URL", "url": "/pmc/articles/PMC9046696/", "newWindow": true }, { "caption": "URL", "url": "/pmc/articles/PMC9046696/?report=abstract", "newWindow": true }, { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9046696/", "newWindow": true } ] }, { "title": "Agreement of the Apple Watch\\textregistered and Fitbit Charge\\textregistered for recording step count and heart rate when exercising in water", "author": "Held, Nicholas J.; Perrotta, Andrew S.; Mueller, Tyler; Pfoh-MacDonald, Selina J.", "year": "2022", "journalProceedings": "Medical and Biological Engineering and Computing", "category": "Validation", "devices": "Charge 3", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "This study examined the association and level of agreement between criterion methods and the Apple Watch 4{\\textregistered} and Fitbit Charge 3{\\textregistered} for recording step count and heart rate when exercising in water on an aquatic treadmill (ATM). Sixteen healthy participants (13 females and 3 males) volunteered to take part in this study. Participants were submerged in an ATM pool to the level of their xiphoid process and completed 3-min exercise bouts at intensities that corresponded to a comfortable walk, brisk walk, jog, and running. A Polar{\\textregistered} T31 chest strap recorded heart rate (HR) and a high-definition digital camera was utilized for recording step count (SC). Significant associations (p < 0.001) were observed between criterion methods and the Apple{\\textregistered} (HR: R2 = 0.99 and SC: R2 = 0.87) and Fitbit{\\textregistered} (HR: R2 = 0.72 and SC: R2 = 0.83) devices. The mean absolute error and relative error (%) for recording step count were 19.8 (7.4%) in the Apple Watch and 21.4 (8.5%) in the Fitbit and 0.90 (0.76%) in the Apple Watch and 4.2 (3.0%) in the Fitbit for recording heart rate. Both devices displayed a reasonable level of agreement for recording step count and heart rate when exercising in water. Graphical abstract: Linear regression analysis demonstrating the association between each wearable device and the Apple Watch and Fit Bit Charge for recording step count and heart rate [Figure not available: see fulltext.]", "links": [ { "caption": "URL", "url": "https://link.springer.com/article/10.1007/s11517-022-02536-w", "newWindow": true } ] }, { "title": "Longitudinal Collection of Patient-Reported Outcomes and Activity Data during CAR-T Therapy: Feasibility, Acceptability, and Data Visualization", "author": "Oswald, Laura B.; Li, Xiaoyin; Carvajal, Rodrigo; Hoogland, Aasha I.; Gudenkauf, Lisa M.; Hansen, Doris K.; Alsina, Melissa; Locke, Frederick L.; Rodriguez, Yvelise; Irizarry-Arroyo, Nathaly; Robinson, Edmondo J.; Jim, Heather S. L.; Gonzalez, Brian D.; Kirtane, Kedar", "year": "2022", "journalProceedings": "Cancers", "category": "Usability", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Background: Clinicians must closely monitor patients for toxicities after chimeric antigen receptor T-cell therapy (CAR-T). Patient-reported outcomes (PROs) (e.g., toxicities, quality of life) and activity data (e.g., steps, sleep) may complement clinicians' observations. This study tested the feasibility and acceptability of collecting PROs and activity data from patients with hematologic malignancies during CAR-T and explored preliminary data patterns. Methods: Participants wore a Fitbit tracker and completed PROs at several timepoints through 90-days post-infusion. Feasibility was assessed with a priori benchmarks for recruitment (≥50%), retention (≥70%), PRO completion (≥70%), and days wearing the Fitbit (≥50%). Acceptability was assessed with participant satisfaction (a priori benchmark > 2 on a 0–4 scale). Results: Participants (N = 12) were M = 66 years old (SD = 7). Rates of recruitment (68%), retention (83%), PRO completion (85%), and days wearing the Fitbit (85%) indicated feasibility. Satisfaction with completing the PROs (M = 3.2, SD = 0.5) and wearing the Fitbit (M = 2.9, SD = 0.5) indicated acceptability. Preliminary data patterns suggested that participants with better treatment response (vs. progressive disease) had a higher toxicity burden. Conclusions: Longitudinal PRO and activity data collection was feasible and acceptable. Data collected on a larger scale may be used to specify risk prediction models to identify predictors of severe CAR-T-related toxicities and inform early interventions.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35681722/", "newWindow": true } ] }, { "title": "Sleep habits of high school student-athletes and non-athletes during a semester", "author": "Ungaro, Corey T.; Chavez, Peter John D. De", "year": "2022", "journalProceedings": "Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine", "category": "Intervention", "devices": "Device unspecified", "population": "Children", "dataUsed": "Steps,Sleep", "abstract": "Study objectives: Lack of sleep has been shown to be harmful to athletic and academic performance as well as health and well-being. The primary purpose of this study was to analyze the sleep and physical activity differences between U.S. high school student-athletes and non-athletes during a semester of school and competition.\n\nMethods: Participants included 34 student-athletes (18 males and 16 females), age 15.8 ± 0.8 years and 38 non-athletes (10 males and 28 females), age 16.3 ± 0.7 years. Objective sleep and physical activity outcomes were collected using Fitbit wrist-worn activity trackers for 8-14 consecutive days and nights, measuring total sleep time (TST), sleep efficiency (SE), bedtimes, wake times, and steps counted.\n\nResults: Student-athletes and non-athletes did not differ in TST (440.4 ± 46.4 vs. 438.1 ± 41.7 min, p = 0.82) and SE (93.6 ± 2.3 vs. 92.9 ± 2.3%, p = 0.20). Fitbit data revealed that 79% of student-athletes and 87% of non-athletes failed to get greater than the minimally recommended 8 hours of total sleep time per night. Student-athletes had significantly more steps per day (10,163 ± 2,035 vs. 8,418 ± 2,489, p < 0.01). Student-athletes had earlier bedtimes and wake times. Earlier bedtimes were significantly correlated with increased TST (p < 0.01). Earlier wake times were significantly correlated to increased steps per day (p < 0.01).\n\nConclusions: Participation in high school sports may not have a detrimental effect on a student's sleep habits. High school students are not meeting the recommended 8-10 hours of sleep per night. Going to bed and waking up early were linked to healthier outcomes. Consistent and earlier sleep/wake schedules may optimize students sleep and health.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35686368/", "newWindow": true } ] }, { "title": "Low- and High-Intensity Physical Activity Among People with HIV: Multilevel Modeling Analysis Using Sensor- and Survey-Based Predictors", "author": "Cook, Paul; Jankowski, Catherine; Erlandson, Kristine M.; Reeder, Blaine; Starr, Whitney; Makic, Mary Beth Flynn", "year": "2022", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "Alta HR", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: High-intensity physical activity improves the health of people with HIV. Even when people have good intentions to engage in physical activity, they often find it difficult to maintain physical activity behavior in the long term. Two Minds Theory is a neurocognitive model that explains gaps between people's intentions and behaviors based on the operations of 2 independent mental systems. This model predicts that everyday experiences will affect physical activity and that factors outside people's awareness, such as sleep and stress, can have particularly strong effects on physical activity behaviors.\n\nObjective: We designed this study to test the effects of daily experiences on physical activity among people with HIV, including measures of people's conscious experiences using daily electronic surveys and measures of nonconscious influences using sensor devices.\n\nMethods: In this study, 55 people with HIV wore a Fitbit Alta for 30 days to monitor their physical activity, sleep, and heart rate variability (HRV) as a physiological indicator of stress. Participants also used their smartphones to complete daily electronic surveys for the same 30 days about fatigue, self-efficacy, mood, stress, coping, motivation, and barriers to self-care. Time-lagged, within-person, multilevel models were used to identify the best prospective predictors of physical activity, considering the daily survey responses of people with HIV and sensor data as predictors of their physical activity the following day. We also tested baseline surveys as predictors of physical activity for comparison with daily variables.\n\nResults: Different people had different average levels of physical activity; however, physical activity also varied substantially from day to day, and daily measures were more predictive than baseline surveys. This suggests a chance to intervene based on day-to-day variations in physical activity. High-intensity physical activity was more likely when people with HIV reported less subjective fatigue on the prior day (r=-0.48) but was unrelated to actual sleep based on objective sensor data. High-intensity physical activity was also predicted by higher HRV (r=0.56), indicating less stress, lower HIV-related stigma (r=-0.21), fewer barriers to self-care (r=-0.34), and less approach coping (r=-0.34). Similar variables predicted lower-level physical activity measured based on the number of steps per day of people with HIV.\n\nConclusions: Some predictors of physical activity, such as HRV, were only apparent based on sensor data, whereas others, such as fatigue, could be measured via self-report. Findings about coping were unexpected; however, other findings were in line with the literature. This study extends our prior knowledge on physical activity by demonstrating a prospective effect of everyday experiences on physical activity behavior, which is in line with the predictions of Two Minds Theory. Clinicians can support the physical activity of people with HIV by helping their patients reduce their daily stress, fatigue, and barriers to self-care.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35436236/", "newWindow": true } ] }, { "title": "Quality Evaluation of Free-living Validation Studies for the Assessment of 24-Hour Physical Behavior in Adults via Wearables: Systematic Review", "author": "Giurgiu, Marco; Timm, Irina; Becker, Marlissa; Schmidt, Steffen; Wunsch, Kathrin; Nissen, Rebecca; Davidovsky, Denis; Bussmann, Johannes B. J.; Nigg, Claudio R.; Reichert, Markus; Ebner-Priemer, Ulrich W.; Woll, Alex; von Haaren-Mack, Birte", "year": "2022", "journalProceedings": "JMIR mHealth and uHealth", "category": "Systematic Review", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity", "abstract": "Background: Wearable technology is a leading fitness trend in the growing commercial industry and an established method for collecting 24-hour physical behavior data in research studies. High-quality free-living validation studies are required to enable both researchers and consumers to make guided decisions on which study to rely on and which device to use. However, reviews focusing on the quality of free-living validation studies in adults are lacking.\n\nObjective: This study aimed to raise researchers' and consumers' attention to the quality of published validation protocols while aiming to identify and compare specific consistencies or inconsistencies between protocols. We aimed to provide a comprehensive and historical overview of which wearable devices have been validated for which purpose and whether they show promise for use in further studies.\n\nMethods: Peer-reviewed validation studies from electronic databases, as well as backward and forward citation searches (1970 to July 2021), with the following, required indicators were included: protocol must include real-life conditions, outcome must belong to one dimension of the 24-hour physical behavior construct (intensity, posture or activity type, and biological state), the protocol must include a criterion measure, and study results must be published in English-language journals. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool with 9 questions separated into 4 domains (patient selection or study design, index measure, criterion measure, and flow and time).\n\nResults: Of the 13,285 unique search results, 222 (1.67%) articles were included. Most studies (153/237, 64.6%) validated an intensity measure outcome such as energy expenditure. However, only 19.8% (47/237) validated biological state and 15.6% (37/237) validated posture or activity-type outcomes. Across all studies, 163 different wearables were identified. Of these, 58.9% (96/163) were validated only once. ActiGraph GT3X/GT3X+ (36/163, 22.1%), Fitbit Flex (20/163, 12.3%), and ActivPAL (12/163, 7.4%) were used most often in the included studies. The percentage of participants meeting the quality criteria ranged from 38.8% (92/237) to 92.4% (219/237). On the basis of our classification tree to evaluate the overall study quality, 4.6% (11/237) of studies were classified as low risk. Furthermore, 16% (38/237) of studies were classified as having some concerns, and 72.9% (173/237) of studies were classified as high risk.\n\nConclusions: Overall, free-living validation studies of wearables are characterized by low methodological quality, large variability in design, and focus on intensity. Future research should strongly aim at biological state and posture or activity outcomes and strive for standardized protocols embedded in a validation framework. Standardized protocols for free-living validation embedded in a framework are urgently needed to inform and guide stakeholders (eg, manufacturers, scientists, and consumers) in selecting wearables for self-tracking purposes, applying wearables in health studies, and fostering innovation to achieve improved validity.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35679106/", "newWindow": true } ] }, { "title": "Comparison of the Fitbit\\textregistered charge and polysomnography for measuring sleep quality in children with sleep disordered breathing", "author": "Hakim, Mohammed; Miller, Rebecca; Hakim, Mumin; Tumin, Dmitry; Tobias, Joseph D.; Jatana, Kris R.; Raman, Vidya T.", "year": "2022", "journalProceedings": "Minerva pediatrics", "category": "Usability", "devices": "Charge", "population": "Children", "dataUsed": "Sleep", "abstract": "Background: Due to the cost and inconvenience of polysomnography (PSG), wrist-worn accelerometers have been explored as an alternative method to measure sleep efficacy in children with obstructive sleep apnea (OSA) or sleep-disordered breathing (SDB). We compared the measurement of sleep quality with the Fitbit® charge (Fitbit Inc., San Francisco, CA, USA) compared to PSG in children presenting for sleep studies.\n\nMethods: Children ages 3 to 18 years presenting for PSG with persistent SDB symptoms were enrolled. During PSG, the Fitbit® charge (Fitbit Inc.) was placed on the wrist and time-synchronized with sleep laboratory devices, which were worn while a single-night PSG was performed. Bias and concordance in measurements of total sleep time (TST), total wake time (TWT), and number of awakenings were assessed using paired t-tests, sign-rank tests, and Lin's concordance coefficient.\n\nResults: The study cohort included 22 patients (9 boys and 13 girls; 9±3 years). TST was significantly overestimated using the Fitbit® charge (Fitbit Inc.) (difference in means: 30 min; 95% confidence interval [CI] of difference: 3-58; P=0.031), while TWT was underestimated (difference: 23 min; 95% CI: 4-42; P=0.018). All measures showed a lack of concordance between the Fitbit® charge (Fitbit Inc.) and PSG.\n\nConclusions: The current prospective study confirms that the Fitbit® charge (Fitbit Inc.) overestimates time spent asleep compared to PSG in children with OSA/SDB symptoms, limiting the validity of sleep monitoring with wearable activity trackers appears in these patients.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/30419745/", "newWindow": true } ] }, { "title": "Integrating a physical activity coaching intervention into diabetes care: a mixed-methods evaluation of a pilot pragmatic trial", "author": "Huebschmann, Amy G.; Glasgow, Russell E.; Leavitt, Ian M.; Chapman, Kristi; Rice, John D.; Lockhart, Steven; Stevens-Lapsley, Jennifer E.; Reusch, Jane E. B.; Dunn, Andrea L.; Regensteiner, Judith G.", "year": "2022", "journalProceedings": "Translational behavioral medicine", "category": "Methods", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps", "abstract": "Physical activity (PA) counseling is under-utilized in primary care for patients with type 2 diabetes mellitus (T2D), despite improving important health outcomes, including physical function. We adapted evidence-based PA counseling programs to primary care patients, staff, and leader's needs, resulting in \"Be ACTIVE\" comprised of shared PA tracker data (FitBit), six theory-informed PA coaching calls, and three in-person clinician visits. In a pilot randomized pragmatic trial, we evaluated the feasibility, acceptability, and effectiveness of Be ACTIVE. Sedentary patients with T2D were randomized to Be ACTIVE versus an enhanced control condition. Mixed methods assessments of feasibility and acceptability included costs. Objective pilot effectiveness outcomes included PA (primary outcome, accelerometer steps/week), the Short Physical Performance Battery (SPPB) physical function measure, and behavioral PA predictors. Fifty patients were randomized to Be ACTIVE or control condition. Acceptability was >90% for patients and clinic staff. Coaching and PA tracking costs of ~$90/patient met Medicare reimbursement criteria. Pre-post PA increased by ~11% (Be ACTIVE) and ~6% in controls (group difference: 1574 ± 4391 steps/week, p = .72). As compared to controls, Be ACTIVE participants significantly improved SPPB (0.9 ± 0.3 vs. -0.1 ± 0.3, p = .01, changes >0.5 points prevent falls clinically), and PA predictors of self-efficacy (p = .02) and social-environmental support (p < .01). In this pilot trial, Be ACTIVE was feasible and highly acceptable to stakeholders and yielded significant improvements in objective physical function consistent with lower fall risk, whereas PA changes were less than anticipated. Be ACTIVE may need additional adaptation or a longer duration to improve PA outcomes.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35312788/", "newWindow": true } ] }, { "title": "Evaluation of the Immediate Effects of Web-Based Intervention Modules for Goals, Planning, and Coping Planning on Physical Activity: Secondary Analysis of a Randomized Controlled Trial on Weight Loss Maintenance", "author": "Mattila, Elina; Horgan, Graham; Palmeira, Antonio L.; O'Driscoll, Ruairi; Stubbs, R. James; Heitmann, Berit L.; Marques, Marta M.", "year": "2022", "journalProceedings": "Journal of medical Internet research", "category": "Intervention", "devices": "Charge 2,Aria", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance,Goals,Weight", "abstract": "Background: The use of digital interventions can be accurately monitored via log files. However, monitoring engagement with intervention goals or enactment of the actual behaviors targeted by the intervention is more difficult and is usually evaluated based on pre-post measurements in a controlled trial.\n\nObjective: The objective of this paper is to evaluate if engaging with 2 digital intervention modules focusing on (1) physical activity goals and action plans and (2) coping with barriers has immediate effects on the actual physical activity behavior.\n\nMethods: The NoHoW Toolkit (TK), a digital intervention developed to support long-term weight loss maintenance, was evaluated in a 2 x 2 factorial randomized controlled trial. The TK contained various modules based on behavioral self-regulation and motivation theories, as well as contextual emotion regulation approaches, and involved continuous tracking of weight and physical activity through connected commercial devices (Fitbit Aria and Charge 2). Of the 4 trial arms, 2 had access to 2 modules directly targeting physical activity: a module for goal setting and action planning (Goal) and a module for identifying barriers and coping planning (Barriers). Module visits and completion were determined based on TK log files and time spent in the module web page. Seven physical activity metrics (steps; activity; energy expenditure; fairly active, very active and total active minutes; and distance) were compared before and after visiting and completing the modules to examine whether the modules had immediate or sustained effects on physical activity. Immediate effect was determined based on 7-day windows before and after the visit, and sustained effects were evaluated for 1 to 8 weeks after module completion.\n\nResults: Out of the 811 participants, 498 (61.4%) visited the Goal module and 406 (50.1%) visited the Barriers module. The Barriers module had an immediate effect on very active and total active minutes (very active minutes: before median 24.2, IQR 10.4-43.0 vs after median 24.9, IQR 10.0-46.3; P=.047; total active minutes: before median 45.1, IQR 22.9-74.9 vs after median 46.9, IQR 22.4-78.4; P=.03). The differences were larger when only completed Barriers modules were considered. The Barriers module completion was also associated with sustained effects in fairly active and total active minutes for most of the 8 weeks following module completion and for 3 weeks in very active minutes.\n\nConclusions: The Barriers module had small, significant, immediate, and sustained effects on active minutes measured by a wrist-worn activity tracker. Future interventions should pay attention to assessing barriers and planning coping mechanisms to overcome them.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35436232/", "newWindow": true } ] }, { "title": "Obstructive Sleep Apnea Home-Monitoring Using a Commercial Wearable Device", "author": "Mokhtaran, Mehrshad; Sacchi, Lucia; Tibollo, Valentina; Risi, Irene; Ramella, Vittoria; Quaglini, Silvana; Fanfulla, Francesco", "year": "2022", "journalProceedings": "Studies in health technology and informatics", "category": "Intervention", "devices": "Charge HR", "population": "Patients", "dataUsed": "Sleep", "abstract": "Obstructive sleep apnea (OSA) is a common sleep disorder and polysomnography (PSG) is the gold standard for its diagnosis and treatment monitoring. There are nowadays several activity trackers measuring sleep quality through the detection of sleep stages. To allow an easier monitoring of the treatment efficacy at home, this work explores the possibility of using one of those commercial smart-bands. To this aim, we studied the signals provided by PSG and a Fitbit smart-band on 26 consecutive patients, admitted to the hospital after the diagnosis of OSA, and submitted to ventilation or positional treatment. They underwent monitoring for three nights (basal, titration, and control). We developed both a visualization software allowing doctors to visually compare the two hypnograms, and a set of statistics for assessing the concordance of the two methods. Results indicate that Fitbit can detect normal sleep patterns, while it is less able to detect the abnormal ones.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35673070/", "newWindow": true } ] }, { "title": "A Longitudinal Study of Fitbit Usage Behavior Among College Students", "author": "Wang, Cheng; Lizardo, Omar; Hachen, David S.", "year": "2022", "journalProceedings": "Cyberpsychology, behavior and social networking", "category": "Usability", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Fitbit wearable devices provide users with objective data on their physical activity and sleep habits. However, little is known about how users develop their usage patterns and the key mechanisms underlying the development of such patterns. In this article, we report results from a longitudinal analysis of Fitbit usage behavior among a sample of college students. Survey and Fitbit data were collected from 692 undergraduates at the University of Notre Dame across two waves. We use a structural equation modeling strategy to examine the relationships among three dimensions of Fitbit usage behavior corresponding to three elements of the habit loop model: trust in the accuracy of Fitbit physical activity and sleep data (cue), intensity of Fitbit device use (routine), and adjustment of physical activity and sleep behaviors based on Fitbit data (reward). More than 75 percent of participants trusted the accuracy of Fitbit data and nearly half of the participants reported they adjusted their physical activities based on the data reported by their devices. Participants who trusted the Fitbit physical activity data also tended to trust the sleep data, and those who intensively used Fitbit devices tended to adjust both their physical activities and then sleep habits. Psychological states and traits such as depression, extroversion, agreeableness, and neuroticism help predict multiple dimensions of Fitbit usage behaviors. However, we find little evidence that trust, Fitbit usage, or perceived adjustment of activity or sleep were associated with actual changes in levels of sleep and activity. We discuss the implications of these findings for understanding when and how this new monitoring technology results in changes in people's behavior.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35108106/", "newWindow": true } ] }, { "title": "Fitbit Use and Activity Levels From Intervention to 2 Years After: Secondary Analysis of a Randomized Controlled Trial", "author": "Hartman, Sheri J.; Chen, Ruohui; Tam, Rowena M.; Narayan, Hari K.; Natarajan, Loki; Liu, Lin", "year": "2022", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "One", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: There has been a rapid increase in the use of commercially available activity trackers, such as Fitbit, in physical activity intervention research. However, little is known about the long-term sustained use of trackers and behavior change after short-term interventions.\n\nObjective: This study aims to use minute-level data collected from a Fitbit tracker for up to 2 years after the end of a randomized controlled trial to examine patterns of Fitbit use and activity over time.\n\nMethods: Participants in this secondary data analysis were 75 female breast cancer survivors who had been enrolled in a 12-week physical activity randomized controlled trial. Participants randomized to the exercise intervention (full intervention arm) received a Fitbit One, which was worn daily throughout the 12-week intervention, and then were followed for 2 years after the intervention. Participants randomized to the waitlist arm, after completing the randomized controlled trial, received a Fitbit One and a minimal version of the exercise intervention (light intervention arm), and then were followed for 2 years after the intervention. Average and daily adherence and MVPA were compared between the 2 groups in the interventional and postinterventional periods using both linear and generalized additive mixed effects models.\n\nResults: Adherence to wearing the Fitbit during the 12-week intervention period was significantly higher in the full intervention arm than in the light intervention arm (85% vs 60%; P<.001). Average adherence was significantly lower for both study arms during the follow-up period than in the intervention period; however, there were statistically different patterns of adherence during the follow-up period, with the light intervention arm having steeper declines than the full intervention arm over time (P<.001). Similar to the adherence results, mean minutes of Fitbit-measured MVPA was higher for the full intervention arm than for the light intervention arm during the 12-week intervention period (mean MVPA 27.89 minutes/day, SD 16.38 minutes/day vs 18.35 minutes/day, SD 12.64 minutes/day; P<.001). During the follow-up period, average MVPA was significantly lower than the 12-week intervention period for both the full intervention arm (21.74 minutes/day, SD 24.65 minutes/day; P=.002) and the light intervention arm (15.03 minutes/day, SD 13.27 minutes/day; P=.004). Although the mean MVPA in each arm was similar across the follow-up period (P=.33), the pattern of daily MVPA was significantly different between the 2 groups (P<.001).\n\nConclusions: While adherence to wearing activity trackers and maintaining physical activities declined after completion of a 12-week exercise intervention, a more active interventional strategy resulted in greater wear time and activity levels during the intervention and more stable patterns of adherence and activity in the long term. An improved understanding of long-term maintenance patterns may inform improved exercise interventions that result in sustained increases in physical activity.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35771607/", "newWindow": true } ] }, { "title": "Identification of Healthy and Unhealthy Lifestyles by a Wearable Activity Tracker in Type 2 Diabetes: A Machine Learning-Based Analysis", "author": "Kim, Kyoung Jin; Lee, Jung-Been; Choi, Jimi; Seo, Ju Yeon; Yeom, Ji Won; Cho, Chul-Hyun; Bae, Jae Hyun; Kim, Sin Gon; Lee, Heon-Jeong; Kim, Nam Hoon", "year": "2022", "journalProceedings": "Endocrinology and metabolism (Seoul, Korea)", "category": "Case Study", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Lifestyle is a critical aspect of diabetes management. We aimed to define a healthy lifestyle using objectively measured parameters obtained from a wearable activity tracker (Fitbit) in patients with type 2 diabetes. This prospective observational study included 24 patients (mean age, 46.8 years) with type 2 diabetes. Expectation-maximization clustering analysis produced two groups: A (n=9) and B (n=15). Group A had a higher daily step count, lower resting heart rate, longer sleep duration, and lower mean time differences in going to sleep and waking up than group B. A Shapley additive explanation summary analysis indicated that sleep-related factors were key elements for clustering. The mean hemoglobin A1c level was 0.3 percentage points lower at the end of follow-up in group A than in group B. Factors related to regular sleep patterns could be possible determinants of lifestyle clustering in patients with type 2 diabetes.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35798553/", "newWindow": true } ] }, { "title": "Comparison of free-living physical activity measurements between ActiGraph GT3X-BT and Fitbit Charge 3 in young people with haemophilia", "author": "Matlary, Ruth Elise D.; Holme, Paal Andre; Glosli, Heidi; Rueegg, Corina Silvia; Grydeland, May", "year": "2022", "journalProceedings": "Haemophilia : the official journal of the World Federation of Hemophilia", "category": "Validation", "devices": "Charge 3", "population": "Patients", "dataUsed": "Steps,Intensity", "abstract": "Introduction: Measurement of physical activity (PA) using commercial activity trackers such as Fitbit devices has become increasingly popular, also for people with haemophilia (PWH). The accuracy of the Fitbit model Charge 3 has not yet been examined.\n\nAims: To compare the Fitbit Charge 3 against the research-grade accelerometer ActiGraph GT3X-BT in measuring average daily steps and minutes spent in different PA intensities.\n\nMethods: Twenty-four young PWH wore a wrist-worn Fitbit Charge 3 and hip-worn ActiGraph GT3X-BT simultaneously for seven consecutive days in free-living conditions. Correlation of and differences between the devices for daily averages of PA parameters were assessed using Pearson's correlation coefficient and paired t-test, respectively. Agreement between devices was assessed using Bland-Altman plots.\n\nResults: Twenty participants (mean age 21.8) were included in the analyses. We found moderate to high correlations between Fitbit and ActiGraph measured daily averages for all PA variables, but statistically significant differences between devices for all variables except daily minutes of moderate PA. Fitbit overestimated average daily steps, minutes of light, vigorous and moderate-to-vigorous PA. Bland-Altman plots showed a measurement bias between devices for all parameters with increasing overestimation by the Fitbit for higher volumes of PA.\n\nConclusion: The Fitbit Charge 3 overestimated steps and minutes of light, moderate and moderate-to-vigorous PA as compared to the ActiGraph GT3X-BT, and this bias increased with PA volume. The Fitbit should therefore be used with caution in research, and we advise users of the device to be cognizant of this overestimation.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35830613/", "newWindow": true } ] }, { "title": "A randomized trial to promote physical activity in adult pre-hypertensive and hypertensive patients", "author": "Bai, Yang; Burns, Ryan; Gell, Nancy; Byun, Wonwoo", "year": "2022", "journalProceedings": "Journal of sports sciences", "category": "Usability,Intervention", "devices": "Charge HR", "population": "Adults", "dataUsed": "NA", "abstract": null, "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35830497/", "newWindow": true } ] }, { "title": "Playing With a Purpose: The Impact of Therapeutic Recreation During Hospitalization", "author": "Hoag, Jennifer A.; Bingen, Kristin; Karst, Jeffrey; Palou, Akasha; Yan, Ke; Zhang, Jian", "year": "2022", "journalProceedings": "Journal of pediatric hematology/oncology nursing", "category": "Measurement", "devices": "Charge HR", "population": "Patients,Children", "dataUsed": "Steps", "abstract": "Background: Youth undergoing cancer treatment and hematopoietic stem cell transplant (HSCT) spend significant time in the hospital, which is disruptive to their physical, social, and emotional development. Therapeutic recreation (TR) can help individuals with an illness maintain or improve their health, quality of life, and physical functioning. TR is an understudied intervention, particularly with youth in the hospital setting. Methods: Forty-nine children (median age = 12 years, interquartile range [IQR] 11–15 years) hospitalized for cancer treatment or HSCT were assigned to participate in either the historical control or TR intervention. Participants wore a Fitbit charge HR for three days to measure movement. At the end of the study participation, they completed self-report measures of mood, social connectedness, and health-related quality of life. Results: Compared with historical controls, the TR intervention group had improved positive affect and decreased mood disturbance (p = 0.03); had better sleep quality (p = 0.003); and was more satisfied with the leisure activities offered in the hospital (p = 0.01). There were no differences in the number of steps taken per day, somatic distress, cooperation with cares, or interaction with medical personnel or caregivers. Both groups reported poor availability and support of peer companions. Discussion: TR is one avenue to increase leisure activities and positively impact mood. More thought needs to be given to how TR programs can be leveraged to increase physical activity and social connectedness.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35722870/", "newWindow": true } ] }, { "title": "Effects of Sleep-Extend on glucose metabolism in women with a history of gestational diabetes: a pilot randomized trial", "author": "Reutrakul, Sirimon; Martyn-Nemeth, Pamela; Quinn, Lauretta; Rydzon, Brett; Priyadarshini, Medha; Danielson, Kirstie K.; Baron, Kelly G.; Duffecy, Jennifer", "year": "2022", "journalProceedings": "Pilot and feasibility studies", "category": "Measurement", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Sleep", "abstract": "Women with a history of gestational diabetes (GDM) are at 7-fold increase in the risk of developing diabetes. Insufficient sleep has also been shown to increase diabetes risk. This study aimed to explore the feasibility of a sleep extension in women with a history of GDM and short sleep, and effects on glucose metabolism. Women age 18–45 years with a history of GDM and actigraphy confirmed short sleep duration (<7 h/night) on weekdays were randomized at a ratio of 1 control (heathy living information) to 2 cases (6 weeks of “Sleep-Extend” intervention: use of a Fitbit, weekly digital content, and weekly coaching to increase sleep duration). An oral glucose tolerance test (OGTT), 7-day actigraphy recording, and questionnaires were obtained at baseline and 6 weeks. Mean differences between baseline and end-of-intervention parameters were compared using independent samples t-tests. Mean (SD) sleep duration increased within the Sleep-Extend group (n=9, +26.9 (42.5) min) but decreased within the controls (n=5, − 9.1 (20.4) min), a mean difference (MD) of 35.9 min (95% confidence interval (CI) − 8.6, 80.5). Fasting glucose increased, but less in Sleep-Extend vs. control groups (1.6 (9.4) vs 10.4 (8.2) mg/dL, MD − 8.8 mg/dL (95% CI − 19.8, 2.1), while 2-h glucose levels after an OGTT did not differ. Compared to controls, Sleep-Extend had decreased fatigue score (MD − 10.6, 95%CI − 20.7, − 0.6), and increased self-report physical activity (MD 5036 MET- minutes/week, 95%CI 343, 9729. Fitbit compliance and satisfaction in Sleep-Extend group was high. Sleep extension is feasible in women with a history of GDM, with benefits in fatigue and physical activity, and possibly glucose metabolism. These data support a larger study exploring benefits of sleep extension on glucose metabolism in these high-risk women. ClinicalTrials.gov , NCT03638102 (8/20/2018)", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35659776/", "newWindow": true } ] }, { "title": "Exercise motives impact on physical activities measured using wearable devices", "author": "Hewitt, Barbara; Deranek, Kimberly; McLeod, Alex; Gudi, Arvind", "year": "2022", "journalProceedings": "Health promotion international", "category": "Measurement", "devices": "Charge HR", "population": "Adults", "dataUsed": "NA", "abstract": "Health officials advocate for increased physical activity to address negative health consequences. While previous studies have investigated what motivates different individuals to exercise, the motives were not verified using unbiased measurements. Information and Communication Technologies (ICT), including wearables, are essential for collecting and sharing data necessary for improving health initiatives. The purpose of this study was to use objective measures collected by wearable devices (Fitbit) to track activity and explore whether specific exercise motives impact participants' physical activities. Ninety-six college freshmen enrolled in the 90-day study. During orientation, participants completed an Exercise Motives Inventory-2 (EMI-2), and their current physical state was baselined. Partial Least Squares (PLS)-Structural Equation Modeling (SEM) was used to model the relationship between variables. The results revealed a relationship between Interpersonal Motives, Health Motives, and Fitness Motives, and participants' physical activities. Those striving to facilitate a change in exercise behavior in young adults should leverage activities that align with their motives of interest and consider the use of wearable devices to track physical activity.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35788302/", "newWindow": true } ] }, { "title": "A Randomized Clinical Trial Demonstrating Feasibility and Preliminary Efficacy of a Videoconference-Delivered Physical Activity Lifestyle Intervention Among Adolescents With a Congenital Heart Defect", "author": "Jackson, Jamie L.; Fox, Kristen R.; Rausch, Joseph R.; Swenski, Taylor N.; Neville, Steven P.; Marousis, Noelle C.; Korth, Christina X.; Cua, Clifford L.; Garg, Vidu; Vannatta, Kathryn", "year": "2022", "journalProceedings": "Annals of behavioral medicine : a publication of the Society of Behavioral Medicine", "category": "Intervention", "devices": "Device unspecified", "population": "Adolescents", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Background: Individuals with congenital heart defects are at increased risk for developing further cardiovascular complications, which can be mitigated by increasing physical activity. Given that positive health behaviors begin declining during older adolescence, it is vital to promote lifestyle changes in this population.\n\nPurpose: The current study aims to (a) determine the feasibility/acceptability of the Congenital Heart Disease Physical Activity Lifestyle (CHD-PAL) intervention among adolescents (ages 15-18) with moderate and complex congenital heart defects, and (b) estimate the preliminary efficacy of CHD-PAL for increasing time spent in moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness and decreasing sedentary behavior.\n\nMethods: Eligible participants were randomized into either CHD-PAL (eight 30-min videoconferencing sessions over 20 weeks with an interventionist + Fitbit + exercise prescription) or a comparator (Fitbit + exercise prescription).\n\nResults: Sixty adolescents were randomized (76% recruitment rate; 94% of participants were retained from baseline to follow-up). Most adolescents (73%) and their parents/guardians (76%) reported that the trial was enjoyable. While there was no effect of arm on change in MVPA, sedentary behavior, or cardiorespiratory fitness for the entire sample, among those who engaged in <21 min of MVPA on average at baseline, adolescents in the CHD-PAL intervention had an increase of 16 min/day of MVPA more than comparators (d = 0.90).\n\nConclusions: The CHD-PAL intervention warrants examination in a larger trial to establish efficacy among those adolescents with a congenital heart defect who engage in <21 min of MVPA/day and should include follow-up assessments to examine effect durability.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/34951444/", "newWindow": true } ] }, { "title": "Performance of a Multisensor Smart Ring to Evaluate Sleep: In-Lab and Home-Based Evaluation of Generalized and Personalized Algorithms", "author": "Grandner, Michael A.; Bromberg, Zohar; Hadley, Aaron; Morrell, Zoe; Graf, Arnulf; Hutchison, Stephen; Freckleton, Dustin", "year": "2022", "journalProceedings": "Sleep", "category": "Validation", "devices": "Charge 4", "population": "Adults", "dataUsed": "Sleep", "abstract": "Study objectives: Wearable sleep technology has rapidly expanded across the consumer market due to advances in technology and increased interest in personalized sleep assessment to improve health and mental performance. We tested the performance of a novel device, the Happy Ring, alongside other commercial wearables (Actiwatch 2, Fitbit Charge 4, Whoop 3.0, Oura Ring V2), against in-lab polysomnography (PSG) and an at-home EEG-derived sleep monitoring device, the Dreem 2 Headband.\n\nMethods: 36 healthy adults with no diagnosed sleep disorders and no recent use of medications or substances known to affect sleep pattern were assessed across 77 nights. Subjects participated in a single night of in-lab PSG and 2 nights of at-home data collection. The Happy Ring includes sensors for skin conductance, movement, heart rate, and skin temperature. The Happy Ring utilized two machine-learning derived scoring algorithms: a \"generalized\" algorithm that applied broadly to all users, and a \"personalized\" algorithm that adapted to individual subjects' data. Epoch-by-epoch analyses compared the wearable devices to in-lab PSG and to at-home EEG Headband.\n\nResults: Compared to in-lab PSG, the \"generalized\" and \"personalized\" algorithms demonstrated good sensitivity (94% and 93%, respectively) and specificity (70% and 83%, respectively). The Happy Personalized model demonstrated a lower bias and more narrow limits of agreement across Bland-Altman measures.\n\nConclusion: The Happy Ring performed well at home and in the lab, especially regarding sleep/wake detection. The personalized algorithm demonstrated improved detection accuracy over the generalized approach and other devices, suggesting that adaptable, dynamic algorithms can enhance sleep detection accuracy.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35767600/", "newWindow": true } ] }, { "title": "The Need for Objective Physical Activity Measurements in Routine Bariatric Care", "author": "Kuipers, Ellen; Timmerman, Josien; van Det, Marc; Vollenbroek-Hutten, Miriam", "year": "2022", "journalProceedings": "Obesity surgery", "category": "Measurement", "devices": "Charge HR,Charge 2,Inspire 2", "population": "Patients", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Purpose\nThis study aims to (1) quantify physical behavior through self-reports and sensor-based measures, (2) examine the correlation between self-reported and sensor-based physical activity (PA) and (3) assess whether bariatric patients adhere to PA guidelines.\n\nMethods\nA Fitbit accelerometer was used to collect minute-to-minute step count and heart rate data for 14 consecutive days. Total physical activity levels (PAL), moderate-to-vigorous intensity physical activity (MVPA) and sedentary behavior (SB) were used to quantify physical behavior. Self-reported PA was assessed with the International Physical Activity Questionnaire (IPAQ). To analyze the association between sensor-based and self-reported PA, Spearman’s correlation was used. A minimum of 150 MVPA minutes per week was considered as compliance with the PA guidelines.\n\nResults\nFitbit data of 37 pre- and 18 post-surgery patients was analyzed. Participants averaged 7403 ± 3243 steps/day and spent most of their time sedentary (832 min, IQR: 749 – 879), especially in prolonged periods of ≥ 30 min (525, IQR: 419 – 641). Median MVPA time was 5.6 min/day (IQR: 1.7 – 10.6). Correlations between self-reported and sensor-based MVPA and SB were respectively 0.072 and 0.455. Only 17.1% was objectively adherent to MVPA guidelines ≥ 150 min/week, while 94.3% met the guidelines in case of self-reports.\n\nConclusion\nPA quantification confirmed that bariatric patients are highly sedentary and rarely engage in MVPA, despite a relatively high daily step count. Moreover, bariatric patients are not able to assess MVPA and moderately their SB by self-reports. Our results indicate the need for sensor-based PA monitoring in routine bariatric care.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35739414/", "newWindow": true } ] }, { "title": "Physical Activity Evaluation Using Activity Trackers for Type 2 Diabetes Prevention in Patients with Prediabetes", "author": "Bliudzius, Antanas; Svaikeviciene, Kristina; Puronaite, Roma; Kasiulevicius, Vytautas", "year": "2022", "journalProceedings": "International journal of environmental research and public health", "category": "Usability", "devices": "Inspire", "population": "Adults", "dataUsed": "Steps,Distance", "abstract": "Background: Prediabetes is a reversible condition, but lifestyle-changing measures, such as increasing physical activity, should be taken. This article explores the use of Fitbit activity trackers to assess physical activity and its impact on prediabetic patient health.\n\nMethods: Intervention study. In total, 30 volunteers (9 males and 21 females), aged 32-65 years, with impaired glucose levels and without diabetes or moving disorders, received Fitbit Inspire activity trackers and physical activity recommendations. A routine blood check was taken during the first and second visits, and body composition was analyzed. Physical activity variability in time was assessed using a Poincare plot.\n\nResults: The count of steps per day and variability differed between patients and during the research period, but the change in total physical activity was not statistically significant. Significant positive correlations between changes in lipid values, body mass composition, and variability of steps count, distance, and minutes of very active physical activity were observed.\n\nConclusions: When assessing physical activity, data doctors should evaluate not just the totals or the medians of the steps count, but also physical activity variability in time. The study shows that most changes were better linked to the physical activity variability than the total count of physical activity.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35886100/", "newWindow": true } ] }, { "title": "Sign of the times: Community engagement to refine a cardiovascular mHealth intervention through a virtual focus group series during the COVID-19 Pandemic", "author": "Brewer, LaPrincess C.; Cyriac, Jissy; Kumbamu, Ashok; Burke, Lora E.; Jenkins, Sarah; Hayes, Sharonne N.; Jones, Clarence; Cooper, Lisa A.; Patten, Christi A.", "year": "2022", "journalProceedings": "Digital health", "category": "Intervention", "devices": "Versa 2", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: African-Americans are underrepresented in mobile health intervention research studies which can perpetuate health inequities and the digital divide. A community-based, user-centered approach to designing mobile health interventions may increase their sociocultural relevance and effectiveness, especially with increased smartphone use during the coronavirus disease 2019 pandemic. We aimed to refine an existing mobile health intervention via a virtual focus group series.\n\nMethods: African-American community members (n = 15) from churches in Minneapolis-St. Paul and Rochester, Minnesota were enrolled in a virtual (via videoconferencing), three-session focus group series over five months to refine a cardiovascular health-focused mobile health application (FAITH! [Fostering African-American Improvement in Total Health!] App). Participants accessed the app via their smartphones and received a Fitbit synced to the app. Participants engaged with multimedia cardiovascular health-focused education modules, a sharing board for social networking, and diet/physical activity self-monitoring. Participant feedback on app features prompted iterative revisions to the FAITH! App. Primary outcomes were app usability (assessed via Health Information Technology Usability Evaluation Scale range: 0-5) and user satisfaction.\n\nResults: Participants (mean age [SD]: 56.9 [12.3] years, 86.7% female) attended a mean 2.8 focus groups (80% attended all sessions). The revised FAITH! App exceeded the goal Health Information Technology Usability Evaluation Scale score threshold of ≥4 (mean: 4.39, range: 3.20-4.95). Participants positively rated updated app content, visual appeal, and use of social incentives to maintain engagement. Increasing user control and refinement of the moderated sharing board were identified as areas for future improvement.\n\nConclusions: Community-partnered, virtual focus groups can optimize usability and increase participant satisfaction of mobile health lifestyle interventions that aim to promote cardiovascular health in African-Americans.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35874864/", "newWindow": true } ] }, { "title": "Daily steps are associated with walking ability in hospitalized patients with sub-acute stroke", "author": "Kubo, Hiroki; Kanai, Masashi; Nozoe, Masafumi; Inamoto, Asami; Taguchi, Akira; Mase, Kyoshi; Shimada, Shinichi", "year": "2022", "journalProceedings": "Scientific reports", "category": "Case Study", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "Increased physical activity is required in patients with stroke that are hospitalized in the rehabilitation unit. This study investigated the association between the daily number of steps and walking independence in order to determine the cutoff value of daily number of steps that can predict walking independence in hospitalized patients with sub-acute stroke. This cross-sectional observational study included 85 stroke patients admitted to the rehabilitation unit. The average daily number of steps was measured using Fitbit One for 4 days starting at 30 days after stroke onset. 6-min walk test, and Fugl-Meyer assessment of the lower extremities were measured The category of walking independence was classified using the Functional Ambulation Category (FAC). The subjects were divided into two groups according to the FAC score: a walking independence group (FAC ≥ 4) and a walking non-independence group (FAC ≤ 3). Logistic regression analysis was conducted to investigate the association of daily number of steps with walking independence and a receiver operating characteristic curve was used to identify the cutoff value of daily number of steps for predicting walking independence. The daily number of steps (per 1000 steps) was independently associated with walking independence (odds ratio (OR); 2.53, 95% confidence interval (CI); 1.40-5.73, p = 0.009). The cutoff value of daily number of steps for predicting independent walking was 4286 steps (area under the curve = 0.914, sensitivity of 0.731, and specificity of 0.949). The daily number of steps was associated with independent walking in hospitalized patients with sub-acute stroke. The daily number of steps may be a useful target in rehabilitation for patients with sub-acute stroke.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35843983/", "newWindow": true } ] }, { "title": "Protocol for a multi-center randomized controlled trial to evaluate the benefits of exercise incentives and corticosteroid injections in osteoarthritis of the knee (MOVE-OK)", "author": "Leach, William; Doherty, Caleigh; Olave, Marianna; England, Bryant R.; Wysham, Katherine; Kerr, Gail; Quinones, Mercedes; Ogdie, Alexis; White, Dan; Neogi, Tuhina; Scanzello, Carla R.; Baker, Joshua F.", "year": "2022", "journalProceedings": "Trials", "category": "Intervention", "devices": "Device unspecified", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Background: Knee osteoarthritis (KOA) is a high-priority problem among the aging population. While exercise has been shown to be beneficial in management of the disease, scalable and low-cost interventions to improve exercise in this population are lacking. Recent controversy over the value of corticosteroid injections for palliation has also arisen. Therefore, we designed a randomized, double-blind, placebo-controlled clinical trial with a 2-period crossover design to study (1) behavioral incentives to promote exercise and (2) corticosteroid injections to reduce pain and improve function in patients with KOA when compared to lidocaine only.\n\nMethods: The study design is a pragmatic factorial and crossover randomized clinical trial. Patients with KOA who are deemed eligible by their provider to receive knee injections and are able to walk without assistive devices will be recruited from clinical practices at four sites within the Veterans Affairs (VA) Health System in the USA. In total, 220 participants will be randomized to receive social incentives with gamification (i.e., incorporation of game elements) to promote exercise and compared to controls that receive a Fitbit but no incentive. Each patient will also be assigned to receive a blinded corticosteroid injection and a lidocaine-only injection in random order. The primary outcomes are the change in average daily step counts from baseline and the change in Knee Osteoarthritis Outcome Score (KOOS) from baseline. The study team will continuously collect step count, heart rate, and sleep data using activity monitors and patient-reported outcomes using the Way to Health (WTH) platform at two four-week intervals over eight months of follow-up. Mixed effects regression incorporating all available data points will be used for analysis.\n\nDiscussion: The \"Marching on for Veterans with Osteoarthritis of the Knee\" (MOVE-OK) trial will take a pragmatic approach to evaluate (1) whether incentives based on behaviorally enhanced gamification can improve physical activity in this patient population and (2) whether corticosteroids injections reduce pain and disability in patients with KOA. Results of this trial will help to direct clinical practice and inform management guidelines.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35897080/", "newWindow": true } ] }, { "title": "Using wearables to promote physical activity in old age : Feasibility, benefits, and user friendliness", "author": "Schmidt, Laura I.; Jansen, Carl-Philipp; Depenbusch, Johanna; Gabrian, Martina; Sieverding, Monika; Wahl, Hans-Werner", "year": "2022", "journalProceedings": "Zeitschrift fur Gerontologie und Geriatrie", "category": "Usability", "devices": "Charge HR", "population": "Older Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: Wearables provide new opportunities to promote physical activity also among older adults but data on effectiveness and user friendliness are rare.\n\nObjective: The effects of a comprehensive self-regulative intervention on moderate to vigorous physical activity (MVPA) and number of steps were examined using commercially available activity trackers. Acceptance regarding the devices was analysed in various domains.\n\nMethods: In this study 80 older adults (mean = 67.03 years, standard deviation = 3.97 years; 59% women) wore a Fitbit Charge HR for 21 days including a baseline, a postintervention and a follow-up week. The intervention comprised feedback, goal setting and planning and 50% of the participants were additionally randomized to a role model component. Social cognitive predictors based on the health action process approach (HAPA) and user experience were assessed via questionnaires.\n\nResults: The MVPA increased by an average of 19 min per week and steps by 1317 per day. An additional benefit of the role model component could be observed for MVPA. In the follow-up, the intervention effect was still significant for the number of steps, while MVPA dropped back to baseline. Multilevel models including HAPA variables explained small but significant amounts of variance in MVPA (8% within-person, 26% between-person) and steps (11% within-person, 12% between-person). User experience was rated as very high.\n\nConclusion: Providing an intervention based on established behavior change techniques and self-monitoring via wearables seems to be effective for increasing physical activity among older adults. The HAPA variables seem to play a limited role to explain activity levels. Acceptance of wearables can be expected to be high.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35849158/", "newWindow": true } ] }, { "title": "The Effect of Tailored, Daily, Smartphone Feedback to Lifestyle Self-Monitoring on Weight Loss at 12 Months: the SMARTER Randomized Clinical Trial", "author": "Burke, Lora E.; Sereika, Susan M.; Bizhanova, Zhadyra; Parmanto, Bambang; Kariuki, Jacob; Cheng, Jessica; Beatrice, Britney; Cedillo, Maribel; Loar, India; Pulantara, I. Wayan; Wang, Yuhan; Conroy, Molly B.", "year": "2022", "journalProceedings": "Journal of medical Internet research", "category": "Intervention", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps,Food", "abstract": "Background: Self-monitoring (SM) is the centerpiece of behavioral weight loss treatment, but the efficacy of smartphone-delivered SM feedback (FB) has not been tested in large, long-term, randomized trials.\n\nObjective: The aim of this study was to establish the efficacy of providing remote FB to diet, physical activity (PA), and weight SM on improving weight loss outcomes when comparing the SM plus FB (SM+FB) condition to the SM-only condition in a 12-month randomized controlled trial. The study was a single-site, population-based trial that took place in southwestern Pennsylvania, USA, conducted between 2018 and 2021. Participants were smartphone users age ≥18 years, able to engage in moderate PA, with a mean BMI between 27 and 43 kg/m2.\n\nMethods: All participants received a 90-minute, one-to-one, in-person behavioral weight loss counseling session addressing behavioral strategies, establishing participants' dietary and PA goals, and instructing on use of the PA tracker (Fitbit Charge 2), smart scale, and diet SM app. Only SM+FB participants had access to an investigator-developed smartphone app that read SM data, in which an algorithm selected tailored messages sent to the smartphone up to 3 times daily. The SM-only participants did not receive any tailored FB based on SM data. The primary outcome was percent weight change from baseline to 12 months. Secondary outcomes included engagement with digital tools (eg, monthly percentage of FB messages opened and monthly percentage of days adherent to the calorie goal).\n\nResults: Participants (N=502) were on average 45.0 (SD 14.4) years old with a mean BMI of 33.7 (SD 4.0) kg/m2. The sample was 79.5% female (n=399/502) and 82.5% White (n=414/502). At 12 months, retention was 78.5% (n=394/502) and similar by group (SM+FB: 202/251, 80.5%; SM: 192/251, 76.5%; P=.28). There was significant percent weight loss from baseline in both groups (SM+FB: -2.12%, 95% CI -3.04% to -1.21%, P<.001; SM: -2.39%, 95% CI -3.32% to -1.47%; P<.001), but no difference between the groups (-0.27%; 95% CI -1.57% to 1.03%; t =-0.41; P=.68). Similarly, 26.3% (66/251) of the SM+FB group and 29.1% (73/251) of the SM group achieved ≥5% weight loss (chi-square value=0.49; P=.49). A 1% increase in FB messages opened was associated with a 0.10 greater percent weight loss at 12 months (b=-0.10; 95% CI -0.13 to -0.07; t =-5.90; P<.001). A 1% increase in FB messages opened was associated with 0.12 greater percentage of days adherent to the calorie goal per month (b=0.12; 95% CI 0.07-0.17; F=22.19; P<.001).\n\nConclusions: There were no significant between-group differences in weight loss; however, the findings suggested that the use of commercially available digital SM tools with or without FB resulted in a clinically significant weight loss in over 25% of participants. Future studies need to test additional strategies that will promote greater engagement with digital tools.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35787516/", "newWindow": true } ] }, { "title": "The structured health intervention for truckers (SHIFT) cluster randomised controlled trial: a mixed methods process evaluation", "author": "Guest, Amber J.; Paine, Nicola J.; Chen, Yu-Ling; Chalkley, Anna; Munir, Fehmidah; Edwardson, Charlotte L.; Gray, Laura J.; Johnson, Vicki; Ruettger, Katharina; Sayyah, Mohsen; Sherry, Aron; Troughton, Jacqui; Varela-Mato, Veronica; Yates, Thomas; King, James; Clemes, Stacy A.", "year": "2022", "journalProceedings": "The international journal of behavioral nutrition and physical activity", "category": "Methods", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Long distance heavy goods vehicle (HGV) drivers exhibit higher than nationally representative rates of obesity, and obesity-related co-morbidities, and are underserved in terms of health promotion initiatives. The purpose of this study was to evaluate the effectiveness of the multicomponent 'Structured Health Intervention For Truckers' (SHIFT), compared to usual care, at 6- and 16-18-month follow-up. METHODS: We conducted a two-arm cluster RCT in transport sites throughout the Midlands, UK. Outcome measures were assessed at baseline, at 6- and 16-18-month follow-up. Clusters were randomised (1:1) following baseline measurements to either the SHIFT arm or usual practice control arm. The 6-month SHIFT programme included a group-based interactive 6-h education and behaviour change session, health coach support and equipment provision (Fitbit{\\textregistered} and resistance bands/balls to facilitate a 'cab workout'). The primary outcome was device-assessed physical activity (mean steps/day) at 6 months. Secondary outcomes included the following: device-assessed sitting, physical activity intensity and sleep; cardiometabolic health, diet, mental wellbeing and work-related psychosocial variables. Data were analysed using mixed-effect linear regression models using a complete-case population. RESULTS: Three hundred eighty-two HGV drivers (mean ± SD age: 48.4 ± 9.4 years, BMI: 30.4 ± 5.1 kg/m(2), 99% male) were recruited across 25 clusters (sites) and randomised into either the SHIFT (12 clusters, n = 183) or control (13 clusters, n = 199) arms. At 6 months, 209 (55%) participants provided primary outcome data. Significant differences in mean daily steps were found between groups, in favour of the SHIFT arm (adjusted mean difference: 1008 steps/day, 95% CI: 145-1871, p = 0.022). Favourable differences were also seen in the SHIFT group, relative to the control group, in time spent sitting (- 24 mins/day, 95% CI: - 43 to - 6), and moderate-to-vigorous physical activity (6 mins/day, 95% CI: 0.3-11). Differences were not maintained at 16-18 months. No differences were observed between groups in the other secondary outcomes at either follow-up. CONCLUSIONS: The SHIFT programme led to a potentially clinically meaningful difference in daily steps, between trial arms, at 6 months. Whilst the longer-term impact is unclear, the programme offers potential to be incorporated into driver training courses to promote activity in this at-risk, underserved and hard-to-reach essential occupational group. TRIAL REGISTRATION: ISRCTN10483894 (date registered: 01/03/2017).", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35799298/", "newWindow": true } ] }, { "title": "Utilizing daily mood diaries and wearable sensor data to predict depression and suicidal ideation among medical interns", "author": "Horwitz, Adam; Czyz, Ewa; Al-Dajani, Nadia; Dempsey, Walter; Zhao, Zhuo; Nahum-Shani, Inbal; Sen, Srijan", "year": "2022", "journalProceedings": "Journal of affective disorders", "category": "Measurement", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Background: Intensive longitudinal methods (ILMs) for collecting self-report (e.g., daily diaries, ecological momentary assessment) and passive data from smartphones and wearable sensors provide promising avenues for improved prediction of depression and suicidal ideation (SI). However, few studies have utilized ILMs to predict outcomes for at-risk, non-clinical populations in real-world settings. Methods: Medical interns (N = 2881; 57 % female; 58 % White) were recruited from over 300 US residency programs. Interns completed a pre-internship assessment of depression, were given Fitbit wearable devices, and provided daily mood ratings (scale: 1-10) via mobile application during the study period. Three-step hierarchical logistic regressions were used to predict depression and SI at the end of the first quarter utilizing pre-internship predictors in step 1, Fitbit sleep/step features in step 2, and daily diary mood features in step 3. Results: Passively collected Fitbit features related to sleep and steps had negligible predictive validity for depression, and no incremental predictive validity for SI. However, mean-level and variability in mood scores derived from daily diaries were significant independent predictors of depression and SI, and significantly improved model accuracy. Limitations: Work schedules for interns may result in sleep and activity patterns that differ from typical associations with depression or SI. The SI measure did not capture intent or severity. Conclusions: Mobile self-reporting of daily mood improved the prediction of depression and SI during a meaningful at-risk period under naturalistic conditions. Additional research is needed to guide the development of adaptive interventions among vulnerable populations.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35764227/", "newWindow": true } ] }, { "title": "Acute pain pathways: protocol for a prospective cohort study", "author": "Jeffery, Molly Moore; Ahadpour, Mitra; Allen, Summer; Araojo, Richardae; Bellolio, Fernanda; Chang, Nancy; Ciaccio, Laura; Emanuel, Lindsay; Fillmore, Jonathan; Gilbert, Gregg H.; Koussis, Patricia; Lee, Christine; Lipkind, Heather; Mallama, Celeste; Meyer, Tamra; Moncur, Megan; Nuckols, Teryl; Pacanowski, Michael A.; Page, David B.; Papadopoulos, Elektra; Ritchie, Jessica D.; Ross, Joseph S.; Shah, Nilay D.; Soukup, Mat; St. Clair, Christopher O.; Tamang, Stephen; Torbati, Sam; Wallace, Douglas W.; Zhao, Yueqin; Heckmann, Rebekah", "year": "2022", "journalProceedings": "BMJ open", "category": "Methods", "devices": "Device unspecified", "population": "Children,Adults", "dataUsed": "Steps,Sleep", "abstract": "Introduction\nOpioid analgesics are often used to treat moderate-to-severe acute non-cancer pain; however, there is little high-quality evidence to guide clinician prescribing. An essential element to developing evidence-based guidelines is a better understanding of pain management and pain control among individuals experiencing acute pain for various common diagnoses.\n\nMethods and analysis\nThis multicentre prospective observational study will recruit 1550 opioid-naïve participants with acute pain seen in diverse clinical settings including primary/urgent care, emergency departments and dental clinics. Participants will be followed for 6 months with the aid of a patient-centred health data aggregating platform that consolidates data from study questionnaires, electronic health record data on healthcare services received, prescription fill data from pharmacies, and activity and sleep data from a Fitbit activity tracker. Participants will be enrolled to represent diverse races and ethnicities and pain conditions, as well as geographical diversity. Data analysis will focus on assessing patients’ patterns of pain and opioid analgesic use, along with other pain treatments; associations between patient and condition characteristics and patient-centred outcomes including resolution of pain, satisfaction with care and long-term use of opioid analgesics; and descriptive analyses of patient management of leftover opioids.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35790333/", "newWindow": true } ] }, { "title": "A Smartwatch Step-Counting App for Older Adults: Development and Evaluation Study", "author": "Boateng, George; Petersen, Curtis L.; Kotz, David; Fortuna, Karen L.; Masutani, Rebecca; Batsis, John A.", "year": "2022", "journalProceedings": "JMIR aging", "category": "Validation,Measurement", "devices": "Flex 2", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Background: Older adults who engage in physical activity can reduce their risk of mobility impairment and disability. Short amounts of walking can improve quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues to be a challenge. Ubiquitous devices, such as mobile phones and smartwatches, coupled with machine-learning algorithms, can potentially encourage older adults to be more physically active. Current algorithms that are deployed in consumer devices (eg, Fitbit) are proprietary, often are not tailored to the movements of older adults, and have been shown to be inaccurate in clinical settings. Step-counting algorithms have been developed for smartwatches, but only using data from younger adults and, often, were only validated in controlled laboratory settings.\n\nObjective: We sought to develop and validate a smartwatch step-counting app for older adults and evaluate the algorithm in free-living settings over a long period of time.\n\nMethods: We developed and evaluated a step-counting app for older adults on an open-source wrist-worn device (Amulet). The app includes algorithms to infer the level of physical activity and to count steps. We validated the step-counting algorithm in the lab (counting steps from a video recording, n=20) and in free-living conditions-one 2-day field study (n=6) and two 12-week field studies (using the Fitbit as ground truth, n=16). During app system development, we evaluated 4 walking patterns: normal, fast, up and down a staircase, and intermittent speed. For the field studies, we evaluated 5 different cut-off values for the algorithm, using correlation and error rate as the evaluation metrics.\n\nResults: The step-counting algorithm performed well. In the lab study, for normal walking (R2=0.5), there was a stronger correlation between the Amulet steps and the video-validated steps; for all activities, the Amulet's count was on average 3.2 (2.1%) steps lower (SD 25.9) than the video-validated count. For the 2-day field study, the best parameter settings led to an association between Amulet and Fitbit (R2=0.989) and 3.1% (SD 25.1) steps lower than Fitbit, respectively. For the 12-week field study, the best parameter setting led to an R2 value of 0.669.\n\nConclusions: Our findings demonstrate the importance of an iterative process in algorithm development before field-based deployment. This work highlights various challenges and insights involved in developing and validating monitoring systems in real-world settings. Nonetheless, our step-counting app for older adults had good performance relative to the ground truth (a commercial Fitbit step counter). Our app could potentially be used to help improve physical activity among older adults.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35947445/", "newWindow": true } ] }, { "title": "Feasibility of Conducting Long-term Health and Behaviors Follow-up in Adolescents: Longitudinal Observational Study", "author": "Cucchiaro, Giovanni; Ahumada, Luis; Gray, Geoffrey; Fierstein, Jamie; Yates, Hannah; Householder, Kym; Frye, William; Rehman, Mohamed", "year": "2022", "journalProceedings": "JMIR formative research", "category": "Usability", "devices": "Charge 4", "population": "Adolescents", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Background: Machine learning uses algorithms that improve automatically through experience. This statistical learning approach is a natural extension of traditional statistical methods and can offer potential advantages for certain problems. The feasibility of using machine learning techniques in health care is predicated on access to a sufficient volume of data in a problem space.\n\nObjective: This study aimed to assess the feasibility of data collection from an adolescent population before and after a posterior spine fusion operation.\n\nMethods: Both physical and psychosocial data were collected. Adolescents scheduled for a posterior spine fusion operation were approached when they were scheduled for the surgery. The study collected repeated measures of patient data, including at least 2 weeks prior to the operation and 6 months after the patients were discharged from the hospital. Patients were provided with a Fitbit Charge 4 (consumer-grade health tracker) and instructed to wear it as often as possible. A third-party web-based portal was used to collect and store the Fitbit data, and patients were trained on how to download and sync their personal device data on step counts, sleep time, and heart rate onto the web-based portal. Demographic and physiologic data recorded in the electronic medical record were retrieved from the hospital data warehouse. We evaluated changes in the patients' psychological profile over time using several validated questionnaires (ie, Pain Catastrophizing Scale, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and Pediatric Quality of Life Inventory). Questionnaires were administered to patients using Qualtrics software. Patients received the questionnaire prior to and during the hospitalization and again at 3 and 6 months postsurgery. We administered paper-based questionnaires for the self-report of daily pain scores and the use of analgesic medications.\n\nResults: There were several challenges to data collection from the study population. Only 38% (32/84) of the patients we approached met eligibility criteria, and 50% (16/32) of the enrolled patients dropped out during the follow-up period-on average 17.6 weeks into the study. Of those who completed the study, 69% (9/13) reliably wore the Fitbit and downloaded data into the web-based portal. These patients also had a high response rate to the psychosocial surveys. However, none of the patients who finished the study completed the paper-based pain diary. There were no difficulties accessing the demographic and clinical data stored in the hospital data warehouse.\n\nConclusions: This study identifies several challenges to long-term medical follow-up in adolescents, including willingness to participate in these types of studies and compliance with the various data collection approaches. Several of these challenges-insufficient incentives and personal contact between researchers and patients-should be addressed in future studies.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35969442/", "newWindow": true } ] }, { "title": "Pre S cription Digita L Th E rap E utic for P atients with I nsomnia ( SLEEP-I): a protocol for a pragmatic randomised controlled trial", "author": "Dreyer, Rachel P.; Berkowitz, Alyssa; Yaggi, Henry Klar; Schneeberg, Lynelle; Shah, Nilay D.; Emanuel, Lindsay; Kolla, Bhanuprakash; Jeffery, Molly Moore; Deeg, Mark; Ervin, Keondae; Thorndike, Frances; Ross, Joseph S.", "year": "2022", "journalProceedings": "BMJ open", "category": "Intervention", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Sleep", "abstract": "Introduction Cognitive behavioural therapy for insomnia (CBT-I) is effective at treating chronic insomnia, yet in-person CBT-I can often be challenging to access. Prior studies have used technology to bridge barriers but have been unable to extensively assess the impact of the digital therapeutic on real-world patient experience and multidimensional outcomes. Among patients with insomnia, our aim is to determine the impact of a prescription digital therapeutic (PDT) (PEAR-003b, FDA-authorised as Somryst; herein called PDT) that provides mobile-delivered CBT-I on patient-reported outcomes (PROs) and healthcare utilisation. Methods and analysis We are conducting a pragmatically designed, prospective, multicentre randomised controlled trial that leverages Hugo, a unique patient-centred health data-aggregating platform for data collection and patient follow-up from Hugo Health. A total of 100 participants with insomnia from two health centres will be enrolled onto the Hugo Health platform, provided with a linked Fitbit (Inspire 2) to track activity and then randomised 1:1 to receive (or not) the PDT for mobile-delivered CBT-I (Somryst). The primary outcome is a change in the insomnia severity index score from baseline to 9-week postrandomisation. Secondary outcomes include healthcare utilisation, health utility scores and clinical outcomes; change in sleep outcomes as measured with sleep diaries and a change in individual PROs including depressive symptoms, daytime sleepiness, health status, stress and anxiety. For those allocated to the PDT, we will also assess engagement with the PDT. Ethics and dissemination The Institutional Review Boards at Yale University and the Mayo Clinic have approved the trial protocol. This trial will provide important data to patients, clinicians and policymakers about the impact of the PDT device delivering CBT-I on PROs, clinical outcomes and healthcare utilisation. Findings will be disseminated to participants, presented at professional meetings and published in peer-reviewed journals. Trial registration number NCT04909229.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35940841/", "newWindow": true } ] }, { "title": "Utility of Fitbit devices among children and adolescents with chronic health conditions: a scoping review", "author": "Kasparian, Alexandra M.; Badawy, Sherif M.", "year": "2022", "journalProceedings": "mHealth", "category": "Usability", "devices": "Ultra,One,Zip,Flex,Charge,Charge HR,Charge 2", "population": "Children,Adolescents", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance,Sleep,Heart Rate", "abstract": "Background: While Fitbit® devices were initially intended for leisurely, consumer use, there has been recent interest among scientific and medical communities in the prospective use of Fitbit devices for clinical and research purposes. Those who have chronic health conditions are often required to spend considerable amounts of money and time undergoing physiological tests and activity monitoring to support, stabilize, and manage their health. This disease burden is only amplified in pediatric populations. Devices that are used to collect these data can be invasive, uncomfortable, and disconcerting. Using the Fitbit tracker to acquire such biometric data could ease this burden. Our scoping review seeks to summarize the research that has been conducted on the utilization of Fitbit devices in studies of children and adolescents with chronic health conditions and the feasibility, accuracy, and potential benefits of doing so.\n\nMethods: Searches were conducted on PubMed for articles relating pediatric health to Fitbit device usage (using a Boolean search strategy). The eligibility criteria included trials being clinical and/or randomized controlled and articles being in English. Once articles were obtained, they underwent screening and exclusion processes and were charted for their titles, authors, objectives, results, and respective chronic illnesses. In the subsequent full-text review, further charting was conducted, collecting study designs, Fitbit parameters, feasibility, accuracy, and related health and clinical outcomes.\n\nResults: Fitbit trackers were unanimously demonstrated to be feasible devices in this population for physical activity monitoring and were determined to be potentially beneficial in measuring and improving overall wellbeing and physical health in children with chronic illness. Nevertheless, sufficient evidence was not found in support of Fitbit accuracy. Additional biases were identified against the population of children with chronic health conditions that may further enable inaccurate data.\n\nConclusions: While Fitbit devices may be beneficial for those interested in improving physical health, discretion is advised for those seeking to collect accurate and/or medically necessitated data. Given the existing literature evaluated, medical-grade technologies are preferred in instances of the latter, as Fitbit devices have not been found to provide reliably accurate data.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35928511/", "newWindow": true } ] }, { "title": "A catalog of validity indices for step counting wearable technologies during treadmill walking: the CADENCE-adults study", "author": "Mora-Gonzalez, Jose; Gould, Zachary R.; Moore, Christopher C.; Aguiar, Elroy J.; Ducharme, Scott W.; Schuna, John M.; Barreira, Tiago V.; Staudenmayer, John; McAvoy, Cayla R.; Boikova, Mariya; Miller, Taavy A.; Tudor-Locke, Catrine", "year": "2022", "journalProceedings": "The international journal of behavioral nutrition and physical activity", "category": "Validation", "devices": "One,Zip,Ionic", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Standardized validation indices (i.e., accuracy, bias, and precision) provide a comprehensive comparison of step counting wearable technologies.\n\nPurpose: To expand a previously published child/youth catalog of validity indices to include adults (21-40, 41-60 and 61-85 years of age) assessed across a range of treadmill speeds (slow [0.8-3.2 km/h], normal [4.0-6.4 km/h], fast [7.2-8.0 km/h]) and device wear locations (ankle, thigh, waist, and wrist).\n\nMethods: Two hundred fifty-eight adults (52.5 ± 18.7 years, 49.6% female) participated in this laboratory-based study and performed a series of 5-min treadmill bouts while wearing multiple devices; 21 devices in total were evaluated over the course of this multi-year cross-sectional study (2015-2019). The criterion measure was directly observed steps. Computed validity indices included accuracy (mean absolute percentage error, MAPE), bias (mean percentage error, MPE), and precision (correlation coefficient, r; standard deviation, SD; coefficient of variation, CoV).\n\nResults: Over the range of normal speeds, 15 devices (Actical, waist-worn ActiGraph GT9X, activPAL, Apple Watch Series 1, Fitbit Ionic, Fitbit One, Fitbit Zip, Garmin vivoactive 3, Garmin vivofit 3, waist-worn GENEActiv, NL-1000, PiezoRx, Samsung Gear Fit2, Samsung Gear Fit2 Pro, and StepWatch) performed at < 5% MAPE. The wrist-worn ActiGraph GT9X displayed the worst accuracy across normal speeds (MAPE = 52%). On average, accuracy was compromised across slow walking speeds for all wearable technologies (MAPE = 40%) while all performed best across normal speeds (MAPE = 7%). When analyzing the data by wear locations, the ankle and thigh demonstrated the best accuracy (both MAPE = 1%), followed by the waist (3%) and the wrist (15%) across normal speeds. There were significant effects of speed, wear location, and age group on accuracy and bias (both p < 0.001) and precision (p ≤ 0.045).\n\nConclusions: Standardized validation indices cataloged by speed, wear location, and age group across the adult lifespan facilitate selecting, evaluating, or comparing performance of step counting wearable technologies. Speed, wear location, and age displayed a significant effect on accuracy, bias, and precision. Overall, reduced performance was associated with very slow walking speeds (0.8 to 3.2 km/h). Ankle- and thigh-located devices logged the highest accuracy, while those located at the wrist reported the worst accuracy.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36076265/", "newWindow": true } ] }, { "title": "Feasibility, acceptability, and effectiveness of school-based dance movement psychotherapy for children with emotional and behavioral difficulties", "author": "Moula, Zoe; Powell, Joanne; Brocklehurst, Shirley; Karkou, Vicky", "year": "2022", "journalProceedings": "Frontiers in psychology", "category": "Intervention", "devices": "Device unspecified", "population": "Children", "dataUsed": "Sleep", "abstract": "Background: Schools have been increasingly employing dance movement psychotherapists to support children cope with daily worries and stress, express and understand their emotions, develop self-awareness and self-esteem. However, evidence on the impact of dance movement psychotherapy as a tool for prevention of mental health difficulties in childhood remains limited.\n\nMethods: Sixteen children (aged 7-9) with mild emotional and behavioral difficulties from two primary schools were randomly assigned to a Dance Movement Psychotherapy (DMP) intervention or to a waiting list, within a larger pilot cross-over randomized controlled study which aimed to (a) test whether all elements of study design can work together and run smoothly in a full-scale RCT; and (b) investigate the effectiveness of arts therapies in improving children's health related quality of life (HRQOL; EQ-5D-Y), wellbeing and life functioning (Child Outcome Rating Scale; CORS), emotional and behavioral difficulties (Strengths and Difficulties Questionnaire; SDQ), and duration of sleep (Fitbits). The therapeutic process was also evaluated through interviews with children, participant observations, the Children's Session Rating Scale (CSRS), and ratings of adherence to the therapeutic protocol.\n\nResults: The findings indicated that DMP led to improvements in children's life functioning, wellbeing, duration of sleep, emotional and behavioral difficulties, but not in quality of life. The improvements were maintained at the follow-up stages, up to 6 months post-intervention. Interviews with children also suggested positive outcomes, such as self-expression; emotional regulation; mastery and acceptance of emotions; improved self-confidence and self-esteem; reduced stress; and development of positive relationships. However, children would have preferred smaller groups and longer sessions.\n\nConclusion: This study indicated that all outcome measures would be suitable for inclusion in a larger randomized controlled trial, though the EQ-5D-Y is not recommended as a stand-alone measure due to its lack of sensitivity and specificity for young participants. The adherence to the therapeutic protocol ratings differed between children and adults, highlighting the need to include children's voice in future research. Strategies are also proposed of how to conduct randomization of participants in ways that do not hinder the therapeutic process.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36072049/", "newWindow": true } ] }, { "title": "Estimating Physical/Mental Health Condition Using Heart Rate Data from a Wearable Device", "author": "Onuki, Masaki; Sato, Makito; Sese, Jun", "year": "2022", "journalProceedings": "Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference", "category": "Intervention", "devices": "Inspire HR", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "We propose an estimation method of subjects' physical/mental health condition from their heart rate (HR) and evaluate it on the newly collected data including 25 million points over 97 participants. The accurate health condition estimation is important for an employee's mental health care and an objective understanding of our condition. For the estimation, the heart rate variability (HRV) has been widely used, but there are some technical difficulties with measuring the HRV, such as maintaining a good quality of data for a long period of time. Here, we predict the subjects' physical/mental health only from the HR measured by Fitbit instead of the HRV. We first measured more than 25 million points of HR and steps data from 97 participants over 3 months using the Fitbit Inspire HRTM. We also conducted questionnaires to check their physical conditions each day. We then predict their condition by focusing on the inactive period of HR and applying the support vector machine to the preprocessed data. The best balanced accuracy of our method achieved 0.582, which was higher than the state-of-the-art method with HRV whose accuracy is 0.565.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36086284/", "newWindow": true } ] }, { "title": "Monitoring postoperative ambulation and sleep after head and neck surgery: A feasibility and utility study using wearable devices", "author": "Pandrangi, Vivek C.; Jorizzo, Matthew; Shah, Suparna; Bruening, Jennifer; Wax, Mark K.; Clayburgh, Daniel; Andersen, Peter; Li, Ryan J.", "year": "2022", "journalProceedings": "Head & neck", "category": "Usability", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps,Sleep", "abstract": "Background: To evaluate use of wearable activity devices to monitor trends in ambulation and sleep after head and neck surgery. Methods: Patients utilized Fitbit devices after surgery. Daily activity and sleep scores, step counts, and total sleep time (TST) were obtained. Results: There were 30 patients within the final cohort. Trends in step counts after specific procedures were identified, and higher subjective activity level correlated with step counts (r = 0.25, 95% CI = 0.07–0.41). Among patients with complete step data (n = 24), POD1 steps ≥200 were associated with reduced length of stay (4.5 ± 1.7 days vs. 7.2 ± 4.0 days, 95% CI = 0.33–5.0). Mean TST was 5.4 ± 2.5 h, TST correlated with subjective sleep scores (r = 0.25, 95% CI = 0.03–0.044), and clinical events associated with sleep–wake transitions on Fitbit devices were identified. Conclusions: Wearable activity devices appear feasible for monitoring trends in postoperative ambulation and sleep. Use of these devices may facilitate postoperative recovery.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36052957/", "newWindow": true } ] }, { "title": "A method for intelligent allocation of diagnostic testing by leveraging data from commercial wearable devices: a case study on COVID-19", "author": "Shandhi, Md Mobashir Hasan; Cho, Peter J.; Roghanizad, Ali R.; Singh, Karnika; Wang, Will; Enache, Oana M.; Stern, Amanda; Sbahi, Rami; Tatar, Bilge; Fiscus, Sean; Khoo, Qi Xuan; Kuo, Yvonne; Lu, Xiao; Hsieh, Joseph; Kalodzitsa, Alena; Bahmani, Amir; Alavi, Arash; Ray, Utsab; Snyder, Michael P.; Ginsburg, Geoffrey S.; Pasquale, Dana K.; Woods, Christopher W.; Shaw, Ryan J.; Dunn, Jessilyn P.", "year": "2022", "journalProceedings": "NPJ digital medicine", "category": "Intervention", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Mass surveillance testing can help control outbreaks of infectious diseases such as COVID-19. However, diagnostic test shortages are prevalent globally and continue to occur in the US with the onset of new COVID-19 variants and emerging diseases like monkeypox, demonstrating an unprecedented need for improving our current methods for mass surveillance testing. By targeting surveillance testing toward individuals who are most likely to be infected and, thus, increasing the testing positivity rate (i.e., percent positive in the surveillance group), fewer tests are needed to capture the same number of positive cases. Here, we developed an Intelligent Testing Allocation (ITA) method by leveraging data from the CovIdentify study (6765 participants) and the MyPHD study (8580 participants), including smartwatch data from 1265 individuals of whom 126 tested positive for COVID-19. Our rigorous model and parameter search uncovered the optimal time periods and aggregate metrics for monitoring continuous digital biomarkers to increase the positivity rate of COVID-19 diagnostic testing. We found that resting heart rate (RHR) features distinguished between COVID-19-positive and -negative cases earlier in the course of the infection than steps features, as early as 10 and 5 days prior to the diagnostic test, respectively. We also found that including steps features increased the area under the receiver operating characteristic curve (AUC-ROC) by 7–11% when compared with RHR features alone, while including RHR features improved the AUC of the ITA model's precision-recall curve (AUC-PR) by 38–50% when compared with steps features alone. The best AUC-ROC (0.73 ± 0.14 and 0.77 on the cross-validated training set and independent test set, respectively) and AUC-PR (0.55 ± 0.21 and 0.24) were achieved by using data from a single device type (Fitbit) with high-resolution (minute-level) data. Finally, we show that ITA generates up to a 6.5-fold increase in the positivity rate in the cross-validated training set and up to a 4.5-fold increase in the positivity rate in the independent test set, including both symptomatic and asymptomatic (up to 27%) individuals. Our findings suggest that, if deployed on a large scale and without needing self-reported symptoms, the ITA method could improve the allocation of diagnostic testing resources and reduce the burden of test shortages.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36050372/", "newWindow": true } ] }, { "title": "A randomized controlled trial for reduction of risk factors for cardiovascular disease in young adults: Methods of the Aspire study", "author": "Stephens, Janna; Randolph, Jillian; Burke, Lora; Miller, Carla; Tan, Alai; Buffington, Brenda; Melnyk, Bernadette; Perkins, Antoinette", "year": "2022", "journalProceedings": "Contemporary clinical trials", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,User Friendliness", "abstract": "Background: Being overweight or obese is a large public health problem, especially in the African American/Black and Hispanic communities. Having a body mass index (BMI) > 25 can lead to chronic health conditions, such as heart disease, stroke, and type 2 diabetes. The transition into adulthood may be an excellent time to intervene due to young adults gaining independence; however, little research has focused on community college students and weight change. The purpose of this randomized controlled trial is to test the efficacy of an intervention tool that is personalized for weight loss through healthy eating and increased physical activity in Black and Hispanic community college students. Methods: Community college students who identify as Black or Hispanic (N = 256) will be recruited and randomized 1:1 to a 12-month, health coach and smartphone application (app) driven intervention or an attention-control condition. The intervention is implemented by health coaches, trained in a health coach specialty program at a university. The intervention includes a Smartphone app for tracking dietary intake, a Fitbit Inspire 2 for tracking physical activity, and daily personalized text messages from a health coach. The main outcome is percent weight loss at 6- and 12-month follow-up assessments. Secondary outcomes include self-efficacy for eating and physical activity, adherence to self-monitoring, Healthy Eating Index scores, and physical activity levels. Discussion: If the intervention is demonstrated to be efficacious, broader dissemination across college/university campuses to assist young adults to develop sustainable healthy habits may be possible. ClinicalTrials.gov Identifier: NCT04412954 R01 Trial Number: 1R01NR018699–02.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36070664/", "newWindow": true } ] }, { "title": "Lifestyle and health changes in wheelchair users with a chronic disability after 12 weeks of using the WHEELS mHealth application", "author": "Hoevenaars, Dirk; Holla, Jasmijn F. M.; de Groot, Sonja; Weijs, Peter J. M.; Kraaij, Wessel; Janssen, Thomas W. J.", "year": "2022", "journalProceedings": "Disability and Rehabilitation. Assistive Technology", "category": "Measurement", "devices": "Charge 3", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Sleep", "abstract": "PURPOSE: The aim of this study was to determine changes in physical activity, nutrition, sleep behaviour and body composition in wheelchair users with a chronic disability after 12 weeks of using the WHEELS mHealth application (app). METHODS: A 12-week pre-post intervention study was performed, starting with a 1-week control period. Physical activity and sleep behaviour were continuously measured with a Fitbit charge 3. Self-reported nutritional intake, body mass and waist circumference were collected. Pre-post outcomes were compared with a paired-sample t-test or Wilcoxon signed-rank test. Fitbit data were analysed with a mixed model or a panel linear model. Effect sizes were determined and significance was accepted at p {\\textless} .05. RESULTS: Thirty participants completed the study. No significant changes in physical activity (+1.5 √steps) and sleep quality (-9.7 sleep minutes; -1.2\\% sleep efficiency) were found. Significant reduction in energy (-1022 kJ, d = 0.71), protein (-8.3 g, d = 0.61) and fat (-13.1 g, d = 0.87) intake, body mass (-2.2 kg, d = 0.61) and waist circumference (-3.3 cm, d = 0.80) were found. CONCLUSION: Positive changes were found in nutritional behaviour and body composition, but not in physical activity and sleep quality. The WHEELS app seems to partly support healthy lifestyle behaviour.Implications for RehabilitationHealthy lifestyle promotion is crucial, especially for wheelchair users as they tend to show poorer lifestyle behaviour despite an increased risk of obesity and comorbidity.The WHEELS lifestyle app seems to be a valuable tool to support healthy nutrition choices and weight loss and to improve body satisfaction, mental health and vitality.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36165036/", "newWindow": true } ] }, { "title": "Detection of Atrial Fibrillation in a Large Population Using Wearable Devices: The Fitbit Heart Study", "author": "Lubitz, Steven A.; Faranesh, Anthony Z.; Selvaggi, Caitlin; Atlas, Steven J.; McManus, David D.; Singer, Daniel E.; Pagoto, Sherry; McConnell, Michael V.; Pantelopoulos, Alexandros; Foulkes, Andrea S.", "year": "2022", "journalProceedings": "Circulation", "category": "Case Study", "devices": "Ionic,Versa,Charge 3,Charge 4,Versa 2,Sense,Inspire HR,Inspire 2,Versa Lite", "population": "Adults", "dataUsed": "Sleep,Heart Rate", "abstract": "BACKGROUND: Morbidity from undiagnosed atrial fibrillation (AF) may be preventable with early detection. Many consumer wearables contain optical photoplethysmography (PPG) sensors to measure pulse rate. PPG-based software algorithms that detect irregular heart rhythms may identify undiagnosed AF in large populations using wearables, but minimizing false-positive detections is essential. METHODS: We performed a prospective remote clinical trial to examine a novel PPG-based algorithm for detecting undiagnosed AF from a range of wrist-worn devices. Adults aged ≥22 years in the United States without AF, using compatible wearable Fitbit devices and Android or iOS smartphones, were included. PPG data were analyzed using a novel algorithm that examines overlapping 5-minute pulse windows (tachograms). Eligible participants with an irregular heart rhythm detection (IHRD), defined as 11 consecutive irregular tachograms, were invited to schedule a telehealth visit and were mailed a 1-week ambulatory ECG patch monitor. The primary outcome was the positive predictive value of the first IHRD during ECG patch monitoring for concurrent AF. RESULTS: A total of 455 699 participants enrolled (median age 47 years, 71\\% female, 73\\% White) between May 6 and October 1, 2020. IHRDs occurred for 4728 (1\\%) participants, and 2070 (4\\%) participants aged ≥65 years during a median of 122 (interquartile range, 110-134) days were at risk for an IHRD. Among 1057 participants with an IHRD notification and subsequent analyzable ECG patch monitor, AF was present in 340 (32.2\\%). Of the 225 participants with another IHRD during ECG patch monitoring, 221 had concurrent AF on the ECG and 4 did not, resulting in an IHRD positive predictive value of 98.2\\% (95\\% CI, 95.5\\%-99.5\\%). For participants aged ≥65 years, the IHRD positive predictive value was 97.0\\% (95\\% CI, 91.4\\%-99.4\\%). CONCLUSIONS: A novel PPG software algorithm for wearable Fitbit devices exhibited a high positive predictive value for concurrent AF and identified participants likely to have AF on subsequent ECG patch monitoring. Wearable devices may facilitate identifying individuals with undiagnosed AF. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04380415.", "links": [ { "caption": "URL", "url": "https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.060291", "newWindow": true } ] }, { "title": "Physical Activity Dynamics During a Digital Messaging Intervention Changed After the Pandemic Declaration", "author": "Hojjatinia, Sahar; Lee, Alexandra M.; Hojjatinia, Sarah; Lagoa, Constantino M.; Brunke-Reese, Deborah; Conroy, David E.", "year": "2022", "journalProceedings": "Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine", "category": "Measurement", "devices": "Versa,Versa Lite", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "BACKGROUND: The COVID-19 pandemic adversely impacted physical activity, but little is known about how contextual changes following the pandemic declaration impacted either the dynamics of people's physical activity or their responses to micro-interventions for promoting physical activity. PURPOSE: This paper explored the effect of the COVID-19 pandemic on the dynamics of physical activity responses to digital message interventions. METHODS: Insufficiently-active young adults (18-29 years; N = 22) were recruited from November 2019 to January 2020 and wore a Fitbit smartwatch for 6 months. They received 0-6 messages/day via smartphone app notifications, timed and selected at random from three content libraries (Move More, Sit Less, and Inspirational Quotes). System identification techniques from control systems engineering were used to identify person-specific dynamical models of physical activity in response to messages before and after the pandemic declaration on March 13, 2020. RESULTS: Daily step counts decreased significantly following the pandemic declaration on weekdays (Cohen's d = -1.40) but not on weekends (d = -0.26). The mean overall speed of the response describing physical activity (dominant pole magnitude) did not change significantly on either weekdays (d = -0.18) or weekends (d = -0.21). In contrast, there was limited rank-order consistency in specific features of intervention responses from before to after the pandemic declaration. CONCLUSIONS: Generalizing models of behavioral dynamics across dramatically different environmental contexts (and participants) may lead to flawed decision rules for just-in-time physical activity interventions. Periodic model-based adaptations to person-specific decision rules (i.e., continuous tuning interventions) for digital messages are recommended when contexts change.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35972330/", "newWindow": true } ] }, { "title": "Effectiveness of wearable technology to optimize youth soccer players' off-training behaviour and training responses: a cluster-randomized trial", "author": "Mateus, Nuno; Exel, Juliana; Santos, Sara; Gonçalves, Bruno; Sampaio, Jaime", "year": "2022", "journalProceedings": "Science & Medicine in Football", "category": "Intervention", "devices": "Charge 2", "population": "Children", "dataUsed": "Steps", "abstract": "PURPOSE: A cluster-randomized trial examined the effect of activity wristbands on young players' off-training PA and SB profiles; assessed the added value of wearable wristbands with PA warnings; and investigated whether manipulating off-training PA can affect the players' training responses. METHODS: Thirty-two adolescent soccer players (16.1 ± 0.9 years old) were monitored during weekdays for two weeks (interspersed with one week). Players were randomly assigned to a reminder to move (REM) and a non-reminder to move group (nREM). The REM wore an activity wristband (Fitbit Charge 2) with PA warnings in the last week of research, while the nREM wore identical monitors without PA feedback. Throughout the study, off-training PA was assessed using tri-axial accelerometers, and training responses were analysed using wearable inertial monitoring units. Gardner-Altman estimation plots and a Fisher's Exact Test of Independence estimated each group's off-training PA changes between the monitored weeks. Complementary, an analysis of covariance identified the effect of the activity wristband configuration (REM vs nREM) on players' off-training PA profiles and soccer training responses. RESULTS: Interestingly, results showed that different wearable wristbands did not influence the players' off-training PA profiles (p {\\textgreater} 0.05). Concomitantly, no differences were observed in training responses (p {\\textgreater} 0.05). CONCLUSION: Findings emphasize the importance of health and youth sports organizations in developing newer approaches for promoting healthier lifestyles, beyond training practices, with potentially favourable implications for sports performance.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35983660/", "newWindow": true } ] }, { "title": "mHealth Support to Stimulate Physical Activity in Individuals With Intellectual Disability: Protocol for a Mixed Methods Pilot Study", "author": "Michalsen, Henriette; Wangberg, Silje C.; Hartvigsen, Gunnar; Henriksen, André; Pettersen, Gunn; Jaccheri, Letizia; Jahnsen, Reidun Birgitta; Thrane, Gyrd; Arntzen, Cathrine; Anke, Audny", "year": "2022", "journalProceedings": "JMIR research protocols", "category": "Validation,Intervention,Methods", "devices": "Versa", "population": "Children,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Several studies have shown that individuals with intellectual disabilities (IDs) have low levels of physical activity (PA), and intervention studies on PA suggest inconsistent evidence. The use of technology as a means of motivation for PA has yet to be extensively explored and needs to be further investigated. OBJECTIVE: We aim to assess the feasibility and acceptability of procedures for an intervention arm in a future trial on mobile health (mHealth) to support PA for individuals with IDs. In addition, we aim to examine how the use of technology can influence motivation for PA among participants, their caregivers, and staff members. METHODS: A mixed methods pilot study of an intervention arm will be carried out in a planned randomized controlled trial (RCT). Ten participants with ID and their caregivers or a staff member will be included. Information will always be provided by a caregiver or a staff member, or participants with ID if possible. Assessments will be carried out at baseline, follow-up after 4 weeks, and 12 weeks, and include questionnaires on PA, social support, self-efficacy, and challenging behavior. PA will be measured with 2 different activity trackers (Fitbit and Axivity) for 1 week at all assessments. Feasibility will be assessed as recruitment and adherence rate, missing data, usability of the motivational mHealth tool, and estimates of effectiveness. Acceptability of study procedures, activity measures, and motivation for participation in PA will be additionally assessed with qualitative methods at the end of the intervention. RESULTS: Enrollment commenced in May 2021. Data collection was completed in March 2022. CONCLUSIONS: This pilot study will evaluate the feasibility and acceptability of study procedures of the intervention arm of a planned RCT to address feasibility issues, improve study procedures, and estimate effectiveness of the study measures. How the use of technology can influence motivation for PA will also be examined, which can help guide and improve future PA interventions involving the use of technology. TRIAL REGISTRATION: ClinicalTrials.gov NCT04929106; https://clinicaltrials.gov/ct2/show/NCT04929106. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37849.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9523523/", "newWindow": true } ] }, { "title": "Step-count outcomes of 13 different activity trackers: Results from laboratory and free-living experiments", "author": "Nakagata, Takashi; Murakami, Haruka; Kawakami, Ryoko; Tripette, Julien; Nakae, Satoshi; Yamada, Yosuke; Ishikawa-Takata, Kazuko; Tanaka, Shigeho; Miyachi, Motohiko", "year": "2022", "journalProceedings": "Gait \\& Posture", "category": "Validation", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Many activity trackers have been developed, but steps can still be inconsistent from one monitor to another. RESEARCH QUESTION: What are the differences and associations between the steps of 13 selected consumer-based and research-grade wearable devices during 1 standardized day in a metabolic chamber and 15-day free-living trials? METHODS: In total, 19 healthy adults between 21 and 50 years-old participated in this study. Participants were equipped with 12 accelerometer-based active trackers and one pedometer (Yamasa) in order to monitor the number of steps per day. The devices were worn on the waist (ActiGraph, Omron, Actimarker, Lifedorder, Withings, and Yamasa) or non-dominant wrist (Fitbit, Garmin, Misfit, EPSON, and Jawbone), or placed in a pocket (Omron CaloriScan, and TANITA). Participants performed structured activities over a 24 h period in a chamber (Standardized day), and steps were monitored in the same participants in free-living trials for 15 successive days using the same monitors (free-living days). RESULTS: When the 13 monitors were ranked by their steps, waist-worn ActiGraph was located at the center (7th) of the monitors both in the Standardized (12,252 ± 598 steps/day, mean ± SD) and free-living days (9295 ± 4027 steps/day). The correlation between the accelerometer-based devices was very high (r = 0.87-0.99). However, the steps of Yamasa was significantly lower in both trials than ActiGraph. The wrist-worn accelerometers had significantly higher steps than other devices both trials (P {\\textless} 0.05). The differences between ActiGraph and Actimarker or Lifecorder was less than 100 steps/day in the Standardized day, and the differences between ActiGraph and Active Style Pro was less than 100 steps/day in the free-living days. Regression equation was also performed for inter-device compatibility. SIGNIFICANCE: Step obtained from the wrist-worn, waist-worn, and pocket-type activity trackers were significantly different from each other but still highly correlated in free-living conditions.", "links": [ { "caption": "URL", "url": "https://www.sciencedirect.com/science/article/pii/S0966636222004696", "newWindow": true } ] }, { "title": "Activity monitoring and patient-reported outcome measures in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients", "author": "Rekeland, Ingrid G.; Sørland, Kari; Bruland, Ove; Risa, Kristin; Alme, Kine; Dahl, Olav; Tronstad, Karl J.; Mella, Olav; Fluge, Øystein", "year": "2022", "journalProceedings": "PloS One", "category": "Case Study", "devices": "Charge 3", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "INTRODUCTION: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a disease with no validated specific and sensitive biomarker, and no standard approved treatment. In this observational study with no intervention, participants used a Fitbit activity tracker. The aims were to explore natural symptom variation, feasibility of continuous activity monitoring, and to compare activity data with patient reported outcome measures (PROMs). MATERIALS AND METHODS: In this pilot study, 27 patients with mild to severe ME/CFS, of mean age 42.3 years, used the Fitbit Charge 3 continuously for six months. Patients wore a SenseWear activity bracelet for 7 days at baseline, at 3 and 6 months. At baseline and follow-up they completed the Short Form 36 Health Survey (SF-36) and the DePaul Symptom Questionnaire-Short Form (DSQ-SF). RESULTS: The mean number of steps per day decreased with increasing ME/CFS severity; mild 5566, moderate 4991 and severe 1998. The day-by-day variation was mean 47\\% (range 25\\%-79\\%). Mean steps per day increased from the first to the second three-month period, 4341 vs 4781 steps, p = 0.022. The maximum differences in outcome measures between 4-week periods (highest vs lowest), were more evident in a group of eight patients with milder disease (baseline SF-36 PF {\\textgreater} 50 or DSQ-SF {\\textless} 55) as compared to 19 patients with higher symptom burden (SF-36 PF {\\textless} 50 and DSQ-SF {\\textgreater} 55), for SF-36 PF raw scores: 16.9 vs 3.4 points, and for steps per day: 958 versus 479 steps. The correlations between steps per day and self-reported SF-36 Physical function, SF-36 Social function, and DSQ-SF were significant. Fitbit recorded significantly higher number of steps than SenseWear. Resting heart rates were stable during six months. CONCLUSION: Continuous activity registration with Fitbit Charge 3 trackers is feasible and useful in studies with ME/CFS patients to monitor steps and resting heart rate, in addition to self-reported outcome measures. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov: NCT04195815.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36121803/", "newWindow": true } ] }, { "title": "The use of wearable devices for predicting biphasic basal body temperature to estimate the date of ovulation in women", "author": "Uchida, Yuki; Izumizaki, Masahiko", "year": "2022", "journalProceedings": "Journal of Thermal Biology", "category": null, "devices": null, "population": null, "dataUsed": null, "abstract": "The basal body temperature (BBT) in women is biphasic, with high- and low-temperature phases during the menstrual cycle. Biphasic BBT predicts the date of ovulation for contraception and family planning. Although the BBT is measured with a basal thermometer at rest, upon waking up, it is often tedious to measure for women. Additionally, the single measured values are not sufficient to reflect biphasic BBT. To solve these problems, various wearable devices have been developed. In the present review, we introduce these devices, compare them to other available basal thermometers, and discuss possible future devices. Wearable devices used to measure skin temperature, ear canal temperature, and temperature in clothes during nighttime to predict BBT (the type of bracelet, ring, armband, ear, and waist), have been developed. These devices are convenient for users, because they measure and record temperature automatically during the nighttime instead of every morning. The scientific evidence was most documented for the type of bracelet, wherein the wrist skin temperature measured during the nighttime reflected the biphasic BBT and predicted the date of ovulation. The popular wearable device, FitbitⓇ measures the wrist skin temperature; in addition, the recent patent information states that the Apple WatchⓇ might have added the same function. Although there have been no previous studies, these devices might reflect biphasic BBT, because they are similar to bracelets. These devices are popular in the healthcare market; therefore, their function to measure wrist skin temperature may supplant other devices to predict the date of ovulation in the future.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36031211/", "newWindow": true } ] }, { "title": "Physical activity measurement in older adults: Wearables versus self-report", "author": "VandeBunte, Anna; Gontrum, Eva; Goldberger, Lauren; Fonseca, Corrina; Djukic, Nina; You, Michelle; Kramer, Joel H.; Casaletto, Kaitlin B.", "year": "2022", "journalProceedings": "Frontiers in Digital Health", "category": "Usability", "devices": "Flex 2", "population": "Older Adults", "dataUsed": "Steps,Energy Expenditure,Heart Rate", "abstract": "Physical activity (PA) is associated with preserved age-related body and brain health. However, PA quantification can vary. Commercial-grade wearable monitors are objective, low burden tools to capture PA but are less well validated in older adults. Self-report PA questionnaires are widely accepted and more frequently used but carry inherent limitations. We aimed to compare these commonly used PA measures against one another and examine their convergent validity with a host of relevant outcomes. We also examined the factors that drive differences in PA self-reporting styles in older adults. 179 older adults completed 30-day Fitbit Flex2™ monitoring and reported PA levels via two widely used PA questionnaires: PASE and CHAMPS-METs (metabolic expenditure calories burned). Participants also completed measures of cardiometabolic (hypertension diagnosis, resting heart rate, A1C levels), cognitive (memory, processing speed, executive functioning), and brain MRI (medial temporal lobe volume) outcomes. The discrepancy between objective Fitbit monitoring and self-reported PA was evaluated using a sample-based z difference score. There were only modest relationships across all PA metrics. Fitbit step count demonstrated a stronger association with the PASE, whereas Fitbit calories burned was more strongly associated with CHAMPS-MET. Fitbit outcomes had more consistent convergence with relevant outcomes of interest (e.g., cardiometabolic and brain health indices) when compared to subjective measures; however, considerable heterogeneity within these associations was observed. A higher degree of overreporting was associated with worse memory and executive performances, as well as hypertension diagnoses. We build on prior findings that wearable, digital health indicators of PA demonstrate greater construct validity than self-report in older adults. We further show important clinical features (e.g., poorer cognitive status) of older adults that could contribute to a higher level of overreporting on self-report measures. Characterization of what PA measures truly operationalize will help elucidate relationships between most relevant facets of PA and outcomes of interest.", "links": [ { "caption": "URL", "url": "https://www.frontiersin.org/articles/10.3389/fdgth.2022.869790/full", "newWindow": true } ] }, { "title": "Mediators of Effects on Physical Activity and Sedentary Time in an Activity Tracker and Behavior Change Intervention for Adolescents: Secondary Analysis of a Cluster Randomized Controlled Trial", "author": "Verswijveren, Simone Johanna Josefa Maria; Abbott, Gavin; Lai, Samuel K.; Salmon, Jo; Timperio, Anna; Brown, Helen; Macfarlane, Susie; Ridgers, Nicola D.", "year": "2022", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "Flex", "population": "Older Adults", "dataUsed": "User Friendliness", "abstract": "BACKGROUND: Adolescence is a critical age where steep declines in physical activity and increases in sedentary time occur. Promoting physical activity should therefore be a priority for short- and long-term health benefits. Wearable activity trackers in combination with supportive resources have the potential to influence adolescents' physical activity levels and sedentary behavior. Examining the pathways through which such interventions work can inform which mediators to target in future studies. OBJECTIVE: The aim of this paper is to examine the impact of the Raising Awareness of Physical Activity (RAW-PA) intervention on potential mediators of behavior change after intervention, and whether these mediated the intervention effects on physical activity and sedentary time at 6-month follow-up. METHODS: RAW-PA was a 12-week intervention, grounded in social cognitive theory and behavioral choice theory, aimed at increasing physical activity among inactive adolescents through combining a wearable activity tracker with digital resources delivered via a private Facebook group (n=159 complete cases). The targeted potential mediators were identified from previous studies conducted in adolescents and included self-efficacy, peer support, family support, teacher support, self-regulation strategies, barriers, and enjoyment. Outcomes included sedentary time as well as light- and moderate-to-vigorous-intensity physical activity. A series of mixed linear models were used to estimate intervention effects on physical activity and sedentary behavior at follow-up and on potential mediators after intervention and to test whether there were indirect effects of the intervention on physical activity and sedentary behavior via mediators. RESULTS: Adolescents in the intervention group (n=75) engaged in higher sedentary time and lower light intensity at 6-month follow-up compared to the wait-list controls (n=84). There were no intervention effects for moderate-to-vigorous-intensity physical activity. The intervention group perceived more barriers to physical activity than the wait-list control group at 6-month follow-up (mean adjusted difference=1.77; 95\\% CI 0.19-3.34; P=.03). However, indirect effects for each outcome were not statistically significant, indicating that perceived barriers to physical activity did not mediate intervention effects for physical activity or sedentary time. CONCLUSIONS: RAW-PA did not beneficially impact hypothesized mediators in these inactive adolescents, despite strategies being designed to target them. This suggests that the lack of overall intervention effects on physical activity and sedentary time observed in the RAW-PA study could be due to the limited impact of the intervention on the targeted mediators. Future studies should consider different strategies to target theoretically informed potential mediators and identify intervention strategies that effectively target key mediators to improve physical activity among inactive adolescents. Finally, intervention effects according to level of wearable tracker use or level of engagement with the intervention should be explored. This may provide important insights for designing successful wearable activity tracker interventions. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616000899448; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370716\\&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-016-3945-5.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/35972777/", "newWindow": true } ] }, { "title": "TILES-2019: A longitudinal physiologic and behavioral data set of medical residents in an intensive care unit", "author": "Yau, Joanna C.; Girault, Benjamin; Feng, Tiantian; Mundnich, Karel; Nadarajan, Amrutha; Booth, Brandon M.; Ferrara, Emilio; Lerman, Kristina; Hsieh, Eric; Narayanan, Shrikanth", "year": "2022", "journalProceedings": "Scientific Data", "category": "Measurement", "devices": "Charge 3", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "The TILES-2019 data set consists of behavioral and physiological data gathered from 57 medical residents (i.e., trainees) working in an intensive care unit (ICU) in the United States. The data set allows for the exploration of longitudinal changes in well-being, teamwork, and job performance in a demanding environment, as residents worked in the ICU for three weeks. Residents wore a Fitbit, a Bluetooth-based proximity sensor, and an audio-feature recorder. They completed daily surveys and interviews at the beginning and end of their rotation. In addition, we collected data from environmental sensors (i.e., Internet-of-Things Bluetooth data hubs) and obtained hospital records (e.g., patient census) and residents' job evaluations. This data set may be may be of interest to researchers interested in workplace stress, group dynamics, social support, the physical and psychological effects of witnessing patient deaths, predicting survey data from sensors, and privacy-aware and privacy-preserving machine learning. Notably, a small subset of the data was collected during the first wave of the COVID-19 pandemic.", "links": [ { "caption": "URL", "url": "https://www.nature.com/articles/s41597-022-01636-4", "newWindow": true } ] }, { "title": "A Smartphone Physical Activity App for Patients in Alcohol Treatment: Single-Arm Feasibility Trial", "author": "Abrantes, Ana M.; Meshesha, Lidia Z.; Blevins, Claire E.; Battle, Cynthia L.; Lindsay, Clifford; Marsh, Eliza; Feltus, Sage; Buman, Matthew; Agu, Emmanuel; Stein, Michael", "year": "2022", "journalProceedings": "JMIR Formative Research", "category": "Usability,Medical", "devices": "Device unspecified", "population": "Older Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Background: Alcohol use disorder (AUD) is a significant public health concern worldwide. Alcohol consumption is a leading cause of death in the United States and has a significant negative impact on individuals and society. Relapse following treatment is common, and adjunct intervention approaches to improve alcohol outcomes during early recovery continue to be critical. Interventions focused on increasing physical activity (PA) may improve AUD treatment outcomes. Given the ubiquity of smartphones and activity trackers, integrating this technology into a mobile app may be a feasible, acceptable, and scalable approach for increasing PA in individuals with AUD. Objective: This study aims to test the Fit\\&Sober app developed for patients with AUD. The goals of the app were to facilitate self-monitoring of PA engagement and daily mood and alcohol cravings, increase awareness of immediate benefits of PA on mood and cravings, encourage setting and adjusting PA goals, provide resources and increase knowledge for increasing PA, and serve as a resource for alcohol relapse prevention strategies. Methods: To preliminarily test the Fit\\&Sober app, we conducted an open pilot trial of patients with AUD in early recovery (N=22; 13/22, 59\\% women; mean age 43.6, SD 11.6 years). At the time of hospital admission, participants drank 72\\% of the days in the last 3 months, averaging 9 drinks per drinking day. The extent to which the Fit\\&Sober app was feasible and acceptable among patients with AUD during early recovery was examined. Changes in alcohol consumption, PA, anxiety, depression, alcohol craving, and quality of life were also examined after 12 weeks of app use. Results: Participants reported high levels of satisfaction with the Fit\\&Sober app. App metadata suggested that participants were still using the app approximately 2.5 days per week by the end of the intervention. Pre-post analyses revealed small-to-moderate effects on increase in PA, from a mean of 5784 (SD 2511) steps per day at baseline to 7236 (SD 3130) steps per day at 12 weeks (Cohen d=0.35). Moderate-to-large effects were observed for increases in percentage of abstinent days (Cohen d=2.17) and quality of life (Cohen d=0.58) as well as decreases in anxiety (Cohen d=−0.71) and depression symptoms (Cohen d=−0.58). Conclusions: The Fit\\&Sober app is an acceptable and feasible approach for increasing PA in patients with AUD during early recovery. A future randomized controlled trial is necessary to determine the efficacy of the Fit\\&Sober app for long-term maintenance of PA, ancillary mental health, and alcohol outcomes. If the efficacy of the Fit\\&Sober app could be established, patients with AUD would have a valuable adjunct to traditional alcohol treatment that can be delivered in any setting and at any time, thereby improving the overall health and well-being of this population. Trial Registration: ClinicalTrials.gov NCT02958280; https://www.clinicaltrials.gov/ct2/show/NCT02958280", "links": [ { "caption": "URL", "url": "https://formative.jmir.org/2022/10/e35926", "newWindow": true } ] }, { "title": "Validation of Fitbit Charge 4 for assessing sleep in Chinese patients with chronic insomnia: A comparison against polysomnography and actigraphy", "author": "Dong, Xiaofang; Yang, Sen; Guo, Yuanli; Lv, Peihua; Wang, Min; Li, Yusheng", "year": "2022", "journalProceedings": "PloS One", "category": "Usability", "devices": "Charge 4", "population": "Adults", "dataUsed": "Sleep", "abstract": "Our research aims to assess the performance of a new generation of consumer activity trackers (Fitbit Charge 4TM: FBC) to measure sleep variables and sleep stage classifications in patients with chronic insomnia, compared to polysomnography (PSG) and a widely used actigraph (Actiwatch Spectrum Pro: AWS). We recruited 37 participants, all diagnosed with chronic insomnia disorder, for one night of sleep monitoring in a sleep laboratory using PSG, AWS, and FBC. Epoch-by-epoch analysis along with Bland-Altman plots was used to evaluate FBC and AWS against PSG for sleep-wake detection and sleep variables: total sleep time (TST), sleep efficiency (SE), waking after sleep onset (WASO), and sleep onset latency (SOL). FBC sleep stage classification of light sleep (LS), deep sleep (DS), and rapid eye movement (REM) was also compared to that of PSG. When compared with PSG, FBC notably underestimated DS (-41.4, p {\\textless} 0.0001) and SE (-4.9\\%, p = 0.0016), while remarkably overestimating LS (37.7, p = 0.0012). However, the TST, WASO, and SOL assessed by FBC presented no significant difference from that assessed by PSG. Compared with PSG, AWS and FBC showed great accuracy (86.9\\% vs. 86.5\\%) and sensitivity (detecting sleep; 92.6\\% vs. 89.9\\%), but comparatively poor specificity (detecting wake; 35.7\\% vs. 62.2\\%). Both devices showed better accuracy in assessing sleep than wakefulness, with the same sensitivity but statistically different specificity. FBC supplied equivalent parameters estimation as AWS in detecting sleep variables except for SE. This research shows that FBC cannot replace PSG thoroughly in the quantification of sleep variables and classification of sleep stages in Chinese patients with chronic insomnia; however, the user-friendly and low-cost wearables do show some comparable functions. Whether FBC can serve as a substitute for actigraphy and PSG in patients with chronic insomnia needs further investigation.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36256631/", "newWindow": true } ] }, { "title": "The Accuracy of Commercially Available Fitness Trackers in Patients after Stroke", "author": "Holubová, Anna; Malá, Eliška; Hoidekrová, Kristýna; Pětioký, Jakub; Ďuriš, Andrea; Mužík, Jan", "year": "2022", "journalProceedings": "Sensors (Basel, Switzerland)", "category": "Validation", "devices": "Alta HR", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Fitness trackers could represent an easy-to-use and cheap tool for continuous tracking of physical activity of stroke survivors during the period of their recovery at home. The aim of the study was to examine the accuracy of the Fitbit activity tracker in locomotor activity monitoring of stroke survivors with respect to gait disorders, walking speed, walking aid, and placement of the tracker on body. Methods: Twenty-four ambulatory stroke survivors (15 men and 9 women) with locomotion/gait disorder were involved in the study. Patients underwent two walking tests with the Fitbit Alta HR trackers attached on 5 different places on body. The accuracy of the trackers has been analyzed on 3 groups of patients-those walking without any walking aid, those using a single-point stick and those using a rolling walker. Results: For no-aid patients, the most accurate place was the waist. Patients with a single-point stick revealed the smallest deviations for a tracker attached to a healthy lower limb, and patients with a rolling walker revealed the smallest deviations for a tracker attached on the paretic lower limb. Conclusions: An accuracy comparable with the healthy population can be reached for all of the three groups of patients, while fulfilling the conditions for minimum speed of 2 km/h and optimal placement of the trackers with respect to a walking aid and aspect to impairment.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36236491/", "newWindow": true } ] }, { "title": "Intra-individual impact of the COVID-19 pandemic on mental health and sleep in young adults", "author": "Knickerbocker, Kelly J.; Cox, Evelyn A.; Dhawka, Luvna; Woods, Kerri; Ingram, Krista K.", "year": "2022", "journalProceedings": "PloS One", "category": "Case Study,Measurement", "devices": "Versa 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "The COVID-19 pandemic has posed unique academic, social, financial, and health-related challenges for young adults. While numerous studies have documented average increases in reported mental health issues in the general population, few have measured the magnitude of changes in mental health symptoms and sleep difficulties within individuals. Here, we measure the impact of the COVID-19 pandemic on mental health and sleep of university students pre- and mid-pandemic. Prior to the pandemic (Fall 2019), individuals (n = 23) were recruited to participate in an eight-day, comprehensive sleep study using Fitbit® actigraphy. Participants also completed detailed mental health and sleep surveys, including depression (BDI-II), anxiety (STAI), and sleep disturbance (PROMIS) surveys. One year later, these individuals repeated the study during the pandemic (Fall 2020); participants completed the original surveys and sleep study, in addition to a targeted survey on mental and sleep health due to the pandemic. Self-reported levels of anxiety, depression, and sleep disturbance, and sleep parameters, measured by actigraphy, were compared within the same individuals pre- and mid-pandemic. Self-report survey data revealed that three-quarters of participants experienced an increase in stress and anxiety due to the pandemic. In addition, intra-individual depression and anxiety symptoms increased to clinically significant levels within individuals from pre- to mid-pandemic. Over two-thirds of participants reported sleeping less, and more than half reported that their sleep health had worsened during the pandemic. Changes in sleep disturbance were positively associated with changes in depression and anxiety, reinforcing the robust relationship between poor sleep quality and mental health. Furthermore, individuals who reported greater sleep disturbance during the pandemic experienced lower relative proportions of both REM and deep sleep. The impact of the COVID-19 pandemic on university students is multi-faceted-mental health, sleep quality, and the amount of restorative sleep are negatively affected by the pandemic environment. These compounded effects exacerbate the health consequences of the pandemic and highlight a need for increased attention to the prevention and treatment of mental health disorders, particularly in vulnerable populations of young adults.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36301946/", "newWindow": true } ] }, { "title": "Association of step counts over time with the risk of chronic disease in the All of Us Research Program", "author": "Master, Hiral; Annis, Jeffrey; Huang, Shi; Beckman, Joshua A.; Ratsimbazafy, Francis; Marginean, Kayla; Carroll, Robert; Natarajan, Karthik; Harrell, Frank E.; Roden, Dan M.; Harris, Paul; Brittain, Evan L.", "year": "2022", "journalProceedings": "Nature Medicine", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps", "abstract": "The association between physical activity and human disease has not been examined using commercial devices linked to electronic health records. Using the electronic health records data from the All of Us Research Program, we show that step count volumes as captured by participants’ own Fitbit devices were associated with risk of chronic disease across the entire human phenome. Of the 6,042 participants included in the study, 73\\% were female, 84\\% were white and 71\\% had a college degree, and participants had a median age of 56.7 (interquartile range 41.5–67.6) years and body mass index of 28.1 (24.3–32.9) kg m–2. Participants walked a median of 7,731.3 (5,866.8–9,826.8) steps per day over the median activity monitoring period of 4.0 (2.2–5.6) years with a total of 5.9 million person-days of monitoring. The relationship between steps per day and incident disease was inverse and linear for obesity (n = 368), sleep apnea (n = 348), gastroesophageal reflux disease (n = 432) and major depressive disorder (n = 467), with values above 8,200 daily steps associated with protection from incident disease. The relationships with incident diabetes (n = 156) and hypertension (n = 482) were nonlinear with no further risk reduction above 8,000–9,000 steps. Although validation in a more diverse sample is needed, these findings provide a real-world evidence-base for clinical guidance regarding activity levels that are necessary to reduce disease risk.", "links": [ { "caption": "URL", "url": "https://www.nature.com/articles/s41591-022-02012-w", "newWindow": true } ] }, { "title": "Fitbits for monitoring depressive symptoms in older aged persons: Qualitative outcomes of a feasibility study", "author": "Mughal, Fiza; Raffe, William; Stubbs, Peter; Kneebone, Ian; Garcia, Jaime", "year": "2022", "journalProceedings": "JMIR formative research", "category": "Usability", "devices": "Alta HR", "population": "Older Adults", "dataUsed": "User Friendliness", "abstract": "BACKGROUND: In 2022, an estimated 1.105 billion people used smart wearables and 31 million used Fitbit devices, worldwide. While there is growing evidence for the use of smart wearables to benefit physical health, more research is required on the feasibility of using these devices for mental health and wellbeing. In studies focusing on emotion recognition, emotions are often inferred and dependent on external cues, which may not be representative of true emotional states. OBJECTIVE: The aim of this study was to evaluate the feasibility and acceptability of utilizing consumer-grade activity trackers for applications in remote mental health monitoring of older aged people. METHODS: Older adults were recruited using criterion sampling. Participants were provided an activity tracker (Fitbit Alta HR) and completed weekly online questionnaires, including the Geriatric Depression Scale, for 4 weeks. Before and after the study period semi-structured qualitative interviews were conducted to provide insight on the acceptance and feasibility of performing the protocol over a 4-week period. Interview transcripts were analyzed using a hybrid inductive-deductive thematic analysis. RESULTS: Twelve participants enrolled in the study, and 9 returned for interviews after the study period. Participants had positive attitudes towards being remotely monitored with 78\\% (7/9) participants experiencing no inconvenience throughout the study period. Sixty-seven percent (6/9) of were interested in trialing our prototype when it is implemented. Participants stated they would feel more comfortable that mental wellbeing was being monitored by carers remotely. CONCLUSIONS: Fitbit-like devices were an unobtrusive and convenient tool to collect physiological user data. Future research should integrate physiological user inputs to differentiate and predict depressive tendencies in users. CLINICALTRIAL:", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36268552/", "newWindow": true } ] }, { "title": "Digital phenotyping by wearable-driven artificial intelligence in older adults and people with Parkinson's disease: Protocol of the mixed method, cyclic ActiveAgeing study", "author": "Torrado, Juan C.; Husebo, Bettina S.; Allore, Heather G.; Erdal, Ane; Fæø, Stein E.; Reithe, Haakon; Førsund, Elise; Tzoulis, Charalampos; Patrascu, Monica", "year": "2022", "journalProceedings": "PloS One", "category": "Measurement", "devices": "Sense", "population": "Older Adults", "dataUsed": "NA", "abstract": "BACKGROUND: Active ageing is described as the process of optimizing health, empowerment, and security to enhance the quality of life in the rapidly growing population of older adults. Meanwhile, multimorbidity and neurological disorders, such as Parkinson's disease (PD), lead to global public health and resource limitations. We introduce a novel user-centered paradigm of ageing based on wearable-driven artificial intelligence (AI) that may harness the autonomy and independence that accompany functional limitation or disability, and possibly elevate life expectancy in older adults and people with PD. METHODS: ActiveAgeing is a 4-year, multicentre, mixed method, cyclic study that combines digital phenotyping via commercial devices (Empatica E4, Fitbit Sense, and Oura Ring) with traditional evaluation (clinical assessment scales, in-depth interviews, and clinical consultations) and includes four types of participants: (1) people with PD and (2) their informal caregiver; (3) healthy older adults from the Helgetun living environment in Norway, and (4) people on the Helgetun waiting list. For the first study, each group will be represented by N = 15 participants to test the data acquisition and to determine the sample size for the second study. To suggest lifestyle changes, modules for human expert-based advice, machine-generated advice, and self-generated advice from accessible data visualization will be designed. Quantitative analysis of physiological data will rely on digital signal processing (DSP) and AI techniques. The clinical assessment scales are the Unified Parkinson's Disease Rating Scale (UPDRS), Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), Apathy Evaluation Scale (AES), and the REM Sleep Behaviour Disorder Screening Questionnaire (RBDSQ). A qualitative inquiry will be carried out with individual and focus group interviews and analysed using a hermeneutic approach including narrative and thematic analysis techniques. DISCUSSION: We hypothesise that digital phenotyping is feasible to explore the ageing process from clinical and lifestyle perspectives including older adults and people with PD. Data is used for clinical decision-making by symptom tracking, predicting symptom evolution, and discovering new outcome measures for clinical trials.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9565381/", "newWindow": true } ] }, { "title": "Virtual cardiac fitness training in pediatric heart transplant patients: A pilot study", "author": "Ziebell, Daniel; Stark, Megan; Xiang, Yijin; Mckane, Megan; Mao, Chad", "year": "2022", "journalProceedings": "Pediatric Transplantation", "category": "Intervention", "devices": "Inspire", "population": "Children,Adults", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Cardiac fitness training in pediatric heart transplant recipients can improve functional capacity. Widespread implementation has been limited mostly due to logistical constraints, specifically related to travel. The aim of this study was to implement and assess a virtual cardiac fitness program for pediatric heart transplant patients. METHODS: Participants were between the age of 10 and 20 years old. All subjects completed an initial 6MWT, strength/flexibility assessment, and QOL assessment with the PROMIS measurement. Participants then underwent a 16-week intervention with exercise sessions twice weekly for 30 min with a trained exercise physiologist over a virtual platform. At the end of the intervention period, participants repeated a 6MWT, strength/flexibility assessment, and PROMIS measurement. Throughout the study, patients wore a FitBit accelerometer to monitor daily activity levels. RESULTS: Thirteen individuals were enrolled. Mean age was 15.4 years (SD =3.4) with a mean post-transplant period of 9.7 years (SD = 4.3). Session attendance was 83\\%. Post-intervention measurements showed improvements in 6MWT (median, +21 m, p = .02), push-up repetitions (median, +5 rep, p = .0005), wall-sit duration (median, +10 s, p = .001), plank duration (median, +9 s, p = .03), sit-up repetitions (median, +7 rep, p = .002), and sit and reach distance (median, +5 cm, p = .04). PROMIS measurement showed significant improvements in self-reported fatigue (Δz-score, -7.7, p = .008) and sleep impairment (Δz-score, -5.9, p = .002). Average daily step count increased 1464 steps per day per patient (p = .008). CONCLUSION: We have demonstrated the successful implementation of a virtual cardiac fitness with excellent adherence and improvement in physical fitness and QOL metrics.", "links": [ { "caption": "URL", "url": "https://onlinelibrary.wiley.com/doi/abs/10.1111/petr.14419", "newWindow": true } ] }, { "title": "A qualitative study to explore the acceptability and usefulness of personalized biofeedback to motivate physical activity in cancer survivors", "author": "Brannon, Grace E.; Ray, Madison; Cho, Patrick; Baum, Miranda; Beg, Muhammad Shaalan; Bevers, Therese; Schembre, Susan M.; Basen-Engquist, Karen; Liao, Yue", "year": "2022", "journalProceedings": "Digital Health", "category": "Intervention,Measurement", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate,User Friendliness", "abstract": "Objective: Many cancer survivors do not meet recommended levels of exercise, despite the benefits physical activity offers. This study aimed to understand experiences of insufficiently active overweight/obese breast or colorectal cancer survivors, in efforts to (1) examine regular physical activity barriers, and (2) determine perceptions and acceptability of a remotely delivered physical activity intervention utilizing wearable sensors and personalized feedback messages. Methods: In-person and virtual small group interviews were conducted engaging overweight/obese cancer survivors (n = 16, 94\\% female, 94\\% breast cancer survivors) in discussions resulting in 314 pages of transcribed data analyzed by multiple coders. Results: All participants expressed needing to increase physical activity, identifying lack of motivation centering on survivorship experiences and symptom management as the most salient barrier. They indicated familiarity with activity trackers (i.e., Fitbit) and expressed interest in biosensors (i.e., continuous glucose monitors [CGMs]) as CGMs show biological metrics in real-time. Participants reported (1) personalized feedback messages can improve motivation and accountability; (2) CGM acceptability is high given survivors' medical history; and (3) glucose data is a relevant health indicator and they appreciated integrated messages (between Fitbit and CGM) in demonstrating how behaviors immediately affect one's body. Conclusions: This study supports the use of wearable biosensors and m-health interventions to promote physical activity in cancer survivors. Glucose-based biofeedback provides relevant and motivating information for cancer survivors regarding their daily activity levels by demonstrating the immediate effects of physical activity. Integrating biofeedback into physical activity interventions could be an effective behavioral change strategy to promote a healthy lifestyle in cancer survivors.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36238756/", "newWindow": true } ] }, { "title": "Evaluation of sleep quality and duration using wearable sensors in shift laborers of construction industry: A public health perspective", "author": "Sathvik, S.; Krishnaraj, L.; Irfan, Muhammad", "year": "2022", "journalProceedings": "Frontiers in Public Health", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Sleep", "abstract": "Approximately 21\\% of the workers in developing and developed countries are shift laborers. The laborer's work shifts can affect personal life and sleep standards, adversely impacting laborers and their manage. This study assesses the impact of various shift plans (seven evenings/7 days, fixed-night or fixed-day, and backup shifts) on shift laborers, considering four shift schedules. Most laborers were on rotational shifts, whereas others were on a permanent day, permanent night, and standby shifts. In a cross-sectional study, 45 development laborers from the National Construction firm were enlisted. Bio-wearable sensors were provided to monitor sleep. Participants were approached and asked to complete a survey bundle comprising the Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS). Differences in sleep models were estimated using a Fitbit watch at various shift schedules. The average age of laborers who participated in the study was 37.5 years, and their average experience in the construction company was 6.5 years. The average total sleep time was 346 ± 46 min. The rotational shift laborers yielded the minimum total sleep time compared to the average PSQI and ESS scores of 7.66 ± 1.3 and 6.94 ± 3.4, respectively. Fifteen shift laborers (33.33\\%) were affected by a sleeping disorder in the present experimental investigation, and 30 participants had inadequate standards of sleep based on the PSQI scores. Poor sleep quality and duration among construction shift laborers decrease productivity at work. Additional studies are expected to assess sleep-related issues affecting construction shift laborers.", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/36203668/", "newWindow": true } ] }, { "title": "A Remotely Delivered Progressive Walking Intervention for Adults With Persistent Symptoms of a Mild Traumatic Brain Injury: Feasibility and Exploration of Its Impact", "author": "Alarie, Christophe; Gagnon, Isabelle; de Guise, Elaine; McKerral, Michelle; Kersalé, Marietta; Hoog, Béatrice van Het; Swaine, Bonnie", "year": "2022", "journalProceedings": "Frontiers in Rehabilitation Sciences", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps", "abstract": "Introduction: Persistent post-concussion symptoms following a mild traumatic brain injury (mTBI) can impact function and participation of adults. Physical activity is recommended to reduce symptoms and foster return to normal activities. Adults with a mTBI may have personal factors or experience accessibility issues restricting physical activity. Walking is a physical activity accessible to most that could be delivered remotely. Objectives: Determine the feasibility, safety, and acceptability of a remotely delivered progressive walking intervention designed for adults with persistent mTBI symptoms and explore its effects on health-related outcomes. Methodology: This feasibility study using a single-group pre-post mixed methods convergent parallel design was conducted remotely. Adults aged 18-65 years with a mTBI reporting persistent symptoms for ≥3 months were recruited. The 8-week remote progressive walking intervention aimed to increase the weekly number of steps walked by 40\\% based on a 1-week baseline measured by a Fitbit Inspire 2 activity monitor. Feasibility measures were about the intervention, its remote delivery, safety, and acceptability. Health-related outcomes were post-concussion symptoms, kinesiophobia, mood, sleep, fatigue, and quality of life. Semi-structured exit interviews were recorded and transcribed verbatim. Quantitative and qualitative data were analyzed separately, and results merged, compared, and contrasted. Descriptive statistics and paired samples t-tests were used. The qualitative analyses followed an iterative content analysis approach using reflexivity and triangulation of sources. Results: Twenty adults (16 women) aged 42.5 ± 11.51 years with persisting symptoms for 9.25 ± 6.43 months participated, adhered to 94.38\\% of sessions, completed the intervention, and found it to be feasible, safe and acceptable. Participants increased weekly total number of steps walked (change = 14,886 ± 18,283; t = 3.55, p = 0.002). Severity of post-concussion symptoms (change = -6.42 ± 10.69; t = -2.62, p = 0.018), kinesiophobia (change = -5 ± 6.86; t = 3.18, p = 0.005), anxiety (change = -1.53 ± 3.01; t = -2.21, p = 0.04), and fatigue (change = -10.21 ± 10.20; t = -4.37, p {\\textless} 0.001) were reduced, whilst quality of life improved (change = 10.58 ± 13.35; t = 3.46, p = 0.003). Participants' perceptions corroborate most quantitative results; they felt improved self-efficacy about physical activity and provided five key recommendations. Discussion: This study demonstrates the feasibility, safety, and acceptability of the remote 8-week progressive walking intervention, a promising approach to reduce persisting symptoms, improve physical activity level health-related outcomes and quality of life of adults with persistent post-concussion symptoms following a mTBI.", "links": [ { "caption": "URL", "url": "https://www.frontiersin.org/articles/10.3389/fresc.2022.898804/full", "newWindow": true } ] }, { "title": "An app-based just-in-time-adaptive self-management intervention for care partners: The CareQOL feasibility pilot study", "author": "Carlozzi, Noelle E.; Choi, Sung Won; Wu, Zhenke; Troost, Jonathan P.; Lyden, Angela K.; Miner, Jennifer A.; Graves, Christopher M.; Wang, Jitao; Yan, Xinghui; Sen, Srijan", "year": "2022", "journalProceedings": "Rehabilitation Psychology", "category": "Methods", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "PURPOSE/OBJECTIVE: The primary objective of this study was to establish the feasibility and acceptability of an intensive data collection protocol that involves the delivery of a personalized just-in-time adaptive intervention (JITAI) in three distinct groups of care partners (care partners of persons with spinal cord injury [SCI], Huntington's disease [HD], or hematopoietic cell transplantation [HCT]). RESEARCH METHOD/DESIGN: Seventy care partners were enrolled in this study (n = 19 SCI; n = 21 HD, n = 30 HCT). This three-month (90 day) randomized control trial involved wearing a Fitbit to track sleep and steps, providing daily reports of health-related quality of life (HRQOL), and completing end of month HRQOL surveys. Care partners in the JITAI group also received personalized pushes (i.e., text-based phone notifications that include brief tips or suggestions for improving self-care). At the end of three-months, care partners in both groups completed a feasibility and acceptability questionnaire. RESULTS: Most (98.6\\%) care partners completed the study, average compliance was 88\\% for daily HRQOL surveys, 96\\% for daily steps, and 85\\% for daily sleep (from wearing the Fitbit), and all monthly surveys were completed with the exception of one missed 3-month assessment. The acceptability of the protocol was high; ratings exceeded 80\\% agreement for the different elements of the study. Improvements were seen for the majority of the HRQOL measures. There was no evidence of measurement reactivity. CONCLUSIONS/IMPLICATIONS: Findings provide strong support for the acceptability and feasibility of an intensive data collection protocol that involved the administration of a JITAI. Although this trial was not powered to establish efficacy, findings indicated improvements across a variety of different HRQOL measures ({\\textasciitilde}1/3 of which were statistically significant). (PsycInfo Database Record (c) 2022 APA, all rights reserved).", "links": [] }, { "title": "A Positive Emotion-Focused Intervention to Increase Physical Activity After Bariatric Surgery: Protocol for a Pilot Randomized Controlled Trial", "author": "Feig, Emily H.; Harnedy, Lauren E.; Thorndike, Anne N.; Psaros, Christina; Healy, Brian C.; Huffman, Jeff C.", "year": "2022", "journalProceedings": "JMIR research protocols", "category": "Intervention,Measurement", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND: Physical activity levels after bariatric surgery are usually low, despite the significant protective health benefits of physical activity in this population. Positive psychological well-being is associated with improved adherence to health behaviors, but bariatric surgery patients often have negative associations with physical activity that prevent sustained engagement. OBJECTIVE: The Gaining Optimism After weight Loss Surgery (GOALS) pilot randomized controlled trial is aimed at testing a novel intervention to increase physical activity after bariatric surgery, which incorporates positive psychological skill-building with motivational interviewing and goal-setting. METHODS: The GOALS trial is a 2-arm, 24-week pilot randomized controlled trial that aims to enroll 58 adults who report less than 200 minutes per week of moderate to vigorous physical activity and a desire to become more active 6-12 months after bariatric surgery. GOALS is testing the feasibility, acceptability, and preliminary efficacy of a positive psychology-motivational interviewing telephone intervention targeting to increase physical activity and associated positive affect. Intervention components include positive psychology, goal-setting, self-monitoring via provided Fitbits, and motivational interviewing to overcome barriers and increase motivation. The intervention is compared to a physical activity education control that includes mailings with psychoeducation around physical activity and provision of a Fitbit. The primary outcomes of the pilot trial are feasibility and acceptability, measured as session completion rates and participant ratings of ease and helpfulness of each session. The main secondary outcome is change in accelerometer-measured moderate to vigorous physical activity post intervention and at 24-week follow-up. Additional outcomes include changes in attitudes related to physical activity, psychological well-being, and physical health measures. RESULTS: This multiphase project was funded in 2020 and institutional review board approval was obtained for the proposed trial in 2021. Recruitment for the randomized controlled trial began in July 2022. Upon completion of the pilot trial, we will examine the feasibility, acceptability, and preliminary efficacy of the intervention. CONCLUSIONS: Although bariatric surgery is the most effective treatment available for severe obesity, weight regain occurs, often in the context of low psychological well-being. Many individuals would benefit from learning strategies to increase positive psychological well-being after bariatric surgery, which could help them maintain lifestyle changes. Positive psychology is a novel approach to improve adherence by increasing positive associations with health behaviors including physical activity. The GOALS pilot trial will determine whether this type of intervention is feasible and acceptable to this population and will provide a foundation for a future full-scale randomized controlled efficacy trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT04868032; https://clinicaltrials.gov/ct2/show/NCT04868032. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/39856.", "links": [] }, { "title": "How is the usability of commercial activity monitors perceived by older adults and by researchers? A cross-sectional evaluation of community-living individuals", "author": "Hofbauer, Lena M.; Rodriguez, Francisca S.", "year": "2022", "journalProceedings": "BMJ open", "category": "Usability", "devices": "Charge 4", "population": "Older Adults", "dataUsed": "User Friendliness", "abstract": "OBJECTIVES: Using commercial activity monitors may advance research with older adults. However, usability for the older population is not sufficiently established. This study aims at evaluating the usability of three wrist-worn monitors for older adults. In addition, we report on usability (including data management) for research. DESIGN: Data were collected cross-sectionally. Between-person of three activity monitor type (Apple Watch 3, Fitbit Charge 4, Polar A370) were made. SETTING: The activity monitors were worn in normal daily life in an urban community in Germany. The period of wear was 2 weeks. PARTICIPANTS: Using convenience sampling, we recruited N=27 healthy older adults (≥60 years old) who were not already habitual users of activity monitors. OUTCOMES: To evaluate usability from the participant perspective, we used the System Usability Scale (SUS) as well as a study-specific qualitative checklist. Assessment further comprised age, highest academic degree, computer proficiency and affinity for technology interaction. Usability from the researchers' perspective was assessed using quantitative data management markers and a study-specific qualitative check-list. RESULTS: There was no significant difference between monitors in the SUS. Female gender was associated with higher SUS usability ratings. Qualitative participant-usability reports revealed distinctive shortcomings, for example, in terms of battery life and display readability. Usability for researchers came with problems in data management, such as completeness of the data download. CONCLUSION: The usability of the monitors compared in this work differed qualitatively. Yet, the overall usability ratings by participants were comparable. Conversely, from the researchers' perspective, there were crucial differences in data management and usability that should be considered when making monitor choices for future studies.", "links": [] }, { "title": "Effect of a 12-week non-contact exercise intervention on body composition and health-related physical fitness in adults: a pilot test", "author": "Kim, Sung-Woo; Choi, Jae-Ho; Sun, Yerin; Seo, Jisoo; Jung, Won-Sang; Park, Hun-Young; Kim, Jisu; Lim, Kiwon", "year": "2022", "journalProceedings": "Physical Activity and Nutrition", "category": "Intervention", "devices": "Charge 4", "population": "Adults", "dataUsed": "NA", "abstract": "PURPOSE: The purpose of this study was to evaluate the effects of a 12-week non-contact exercise intervention on body composition and health-related physical fitness in adults. METHODS: One hundred adults were initially enrolled; however, ninety-seven participants (men: n = 41, women: n = 56) completed the study. The non-contact exercise was performed for 12 weeks using a smart tracker (Charge 4, Fitbit, USA) and mobile phone applications. The non-contact exercise program included resistance, aerobic, and flexibility exercises. RESULTS: The results showed that percent body fat (F=4.993, p=.016, ηp2=.049), fat-free mass (F=4.690, p=.024, ηp2=.047), and skeletal muscle mass (F=5.623, p=.004, ηp2=.055) significantly changed during the intervention period. Further, significant increases were seen in hand grip strength (F=12.167, p{\\textless}.001, ηp2=.112), sit-and-reach (F=20.497, p{\\textless}.001, ηp2=.176), sit-ups (F=42.107, p{\\textless}.001, ηp2=.305), and VO2max (F=4.311, p=.037, ηp2=.043). CONCLUSION: Our findings suggest that 12 weeks of non-contact exercise improves body composition and health-related physical fitness. Wearable technologies encourage individuals to modify their lifestyles by increasing physical activity and achieving the goal of maintaining health conditions among adults.", "links": [] }, { "title": "Validity and Acceptability of Wearable Devices for Monitoring Step-Count and Activity Minutes Among People With Multiple Sclerosis", "author": "Lavelle, Grace; Norris, Meriel; Flemming, Julie; Harper, Jamie; Bradley, Joan; Johnston, Helen; Fortune, Jennifer; Stennett, Andrea; Kilbride, Cherry; Ryan, Jennifer M.", "year": "2021", "journalProceedings": "Frontiers in Rehabilitation Sciences", "category": "Validation", "devices": "Zip,Alta,Garmin Vivofit 4", "population": "Adults", "dataUsed": "Steps", "abstract": "Multiple wearable devices that purport to measure physical activity are widely available to consumers. While they may support increases in physical activity among people with multiple sclerosis (MS) by providing feedback on their performance, there is little information about the validity and acceptability of these devices. Providing devices that are perceived as inaccurate and difficult to use may have negative consequences for people with MS, rather than supporting participation in physical activity. The aim of this study was, therefore, to assess the validity and acceptability of commercially available devices for monitoring step-count and activity time among people with MS. Nineteen ambulatory adults with MS [mean (SD) age 52.1 (11.9) years] participated in the study. Step-count was assessed using five commercially available devices (Fitbit Alta, Fitbit Zip, Garmin Vivofit 4, Yamax Digi Walker SW200, and Letscom monitor) and an activPAL3μ while completing nine everyday activities. Step-count was also manually counted. Time in light activity, moderate-to-vigorous activity, and total activity were measured during activities using an Actigraph GT3X accelerometer. Of the 19 participants who completed the validity study, fifteen of these people also wore the five commercially available devices for three consecutive days each, and participated in a semi-structured interview regarding their perception of the acceptability of the monitors. Mean percentage error for step-count ranged from 12.1\\% for the Yamax SW200 to -112.3\\% for the Letscom. Mean step-count as manually determined differed to mean step-count measured by the Fitbit Alta (p = 0.002), Garmin vivofit 4 (p {\\textless} 0.001), Letscom (p {\\textless} 0.001) and the research standard device, the activPAL3μ (p {\\textless} 0.001). However, 95\\% limits of agreement were smallest for the activPAL3μ and largest for the Fitbit Alta. Median percentage error for activity minutes was 52.9\\% for the Letscom and 100\\% for the Garmin Vivofit 4 and Fitbit Alta compared to minutes in total activity. Three inductive themes were generated from participant accounts: Interaction with device; The way the device looks and feels; Functionality. In conclusion, commercially available devices demonstrated poor criterion validity when measuring step-count and activity time in people with MS. This negatively affected the acceptability of devices, with perceived inaccuracies causing distrust and frustration. Additional considerations when designing devices for people with MS include an appropriately sized and lit display and ease of attaching and charging devices.", "links": [] }, { "title": "A digital health intervention to improve nutrition and physical activity in breast cancer survivors: Rationale and design of the Cook and Move for Your Life pilot and feasibility randomized controlled trial", "author": "Ueland, Katherine; Sanchez, Sofia Cobos; Rillamas-Sun, Eileen; Shen, Hanjie; Schattenkerk, Liza; Garcia, Gino; VanDoren, Matthew; Myers, Samantha A.; Santiago-Torres, Margarita; Di, Chongzhi; Dey, Neelendu; Guthrie, Katherine A.; Yung, Rachel; Davidson, Nancy E.; Greenlee, Heather", "year": "2022", "journalProceedings": "Contemporary Clinical Trials", "category": "Intervention", "devices": "Aria,Inspire HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Background: The design of a randomized pilot trial evaluating the feasibility of two doses of a digital health intervention promoting changes in nutrition and physical activity in breast cancer (BC) survivors is described.\n\nMethods: Eligible women were adults with history of early-stage breast cancer and > 60 days post-treatment, consumed <5 servings/day of fruits/vegetables and/or engaged in <150 min/week of aerobic moderate-to-vigorous physical activity, and had internet access. Participants were randomized to 6 months of either a \"low\" (1 session) or \"high\" (12 sessions) dose digital health intervention. Zoom-delivered sessions focused on improving diet and physical activity through didactic and experiential classes delivered by a registered dietitian, chef, exercise physiologist, and culinary educator. All study participants received weekly motivational texts, a Fitbit, and study website access. Diet, accelerometry, anthropometric, psychosocial, and biospecimen data were collected remotely at baseline and six months. Primary outcome was feasibility measured via accrual rate, adherence, retention, and acceptability.\n\nResults: Recruitment began in December 2019, was suspended in March 2020 due to the COVID-19 pandemic, resumed September 2020, and concluded in January 2021. Women were identified from the local BC registry and flyers posted in the oncology clinic. Of 929 women recruited, 321 completed the screening assessment, and of these, 138 were eligible. A total of 74 women were enrolled and randomized to the study.\n\nConclusion: BC survivors were successfully enrolled in a digital health nutrition and physical activity intervention. If feasible, this intervention will be tested in larger and more diverse populations of cancer survivors.", "links": [] }, { "title": "Correlation Between Right Ventricular Echocardiography Measurements and Functional Capacity in Patients With Pulmonary Arterial Hypertension", "author": "Woo, Joyce L.; DiLorenzo, Michael P.; Rosenzweig, Eliana; Pasumarti, Nikhil; Villeda, Gerson Valencia; Berman-Rosenzweig, Erika; Krishnan, Usha", "year": "2022", "journalProceedings": "Texas Heart Institute Journal", "category": "Clinical Care", "devices": "Charge HR", "population": "Children,Adults", "dataUsed": "Steps,Heart Rate", "abstract": "BACKGROUND: Accelerometry is an emerging option for real-time evaluation of functional capacity in patients with pulmonary arterial hypertension (PAH). This prospective pilot study assesses the relationship between functional capacity by accelerometry and right ventricular measurements on echocardiography for this high-risk cohort. METHODS: Patients with PAH were prospectively enrolled and underwent 6-Minute Walk Test and cardiopulmonary exercise testing. They were given a Fitbit, which collected steps and sedentary time per day. Echocardiographic data included right ventricular global longitudinal, free wall, and septal strain; tricuspid regurgitant peak velocity; tricuspid annular plane systolic excursion; tricuspid annular plane systolic velocity; right ventricular myocardial performance index; and pulmonary artery acceleration time. Pairwise correlations were performed. RESULTS: The final analysis included 22 patients aged 13 to 59 years. Tricuspid regurgitant peak velocity had a negative correlation with 6-Minute Walk Test (r = -0.58, P = .02), peak oxygen consumption on exercise testing (r = -0.56, P = .03), and average daily steps on accelerometry (r = -0.59, P = .03), but a positive correlation with median sedentary time on accelerometry (r = 0.64, P = .02). Pulmonary artery acceleration time positively correlated with peak oxygen consumption on exercise testing (r = 0.64, P = .002). There was no correlation between right ventricular strain measurements and functional capacity testing. CONCLUSION: In this pilot study, tricuspid regurgitant jet and pulmonary artery acceleration time were the echocardiographic variables that correlated most with accelerometry data. With further echocardiographic validation, accelerometry can be a useful, noninvasive, and cost-effective tool to monitor disease progression in patients with PAH.", "links": [] }, { "title": "Evaluation of physical health status beyond daily step count using a wearable activity sensor", "author": "Xu, Zheng; Zahradka, Nicole; Ip, Seyvonne; Koneshloo, Amir; Roemmich, Ryan T.; Sehgal, Sameep; Highland, Kristin B.; Searson, Peter C.", "year": "2022", "journalProceedings": "NPJ digital medicine", "category": "Usability", "devices": "Charge HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Physical health status defines an individual's ability to perform normal activities of daily living and is usually assessed in clinical settings by questionnaires and/or by validated tests, e.g. timed walk tests. These measurements have relatively low information content and are usually limited in frequency. Wearable sensors, such as activity monitors, enable remote measurement of parameters associated with physical activity but have not been widely explored beyond measurement of daily step count. Here we report on results from a cohort of 22 individuals with Pulmonary Arterial Hypertension (PAH) who were provided with a Fitbit activity monitor (Fitbit Charge HR®) between two clinic visits (18.4 ± 12.2 weeks). At each clinical visit, a maximum of 26 measurements were recorded (19 categorical and 7 continuous). From analysis of the minute-to-minute step rate and heart rate we derive several metrics associated with physical activity and cardiovascular function. These metrics are used to identify subgroups within the cohort and to compare to clinical parameters. Several Fitbit metrics are strongly correlated to continuous clinical parameters. Using a thresholding approach, we show that many Fitbit metrics result in statistically significant differences in clinical parameters between subgroups, including those associated with physical status, cardiovascular function, pulmonary function, as well as biomarkers from blood tests. These results highlight the fact that daily step count is only one of many metrics that can be derived from activity monitors.", "links": [] }, { "title": "Feasibility and preliminary efficacy of a physiotherapy-led remotely delivered physical activity intervention in cancer survivors using wearable technology. The IMPETUS trial", "author": "Broderick, Julie; Haberlin, Ciarán; O Donnell, Dearbhaile M.", "year": "2022", "journalProceedings": "Physiotherapy Theory and Practice", "category": "Intervention", "devices": "One,Flex", "population": "Adults", "dataUsed": "User Friendliness", "abstract": "BACKGROUND: Physical activity levels are low in cancer survivors. Remotely delivered programs which harness wearable technology may potentially be beneficial. OBJECTIVE: To evaluate the feasibility and preliminary efficacy of a remotely delivered, physical activity intervention which harnessed wearable technology. METHODS: This single arm pre-post longitudinal study included cancer survivors who had completed treatment in the preceding 3 years. Participants were supplied with a Fitbit One® or Flex® for 12 weeks. Physical activity goals were discussed during support phone calls. Outcome measures, assessed at baseline (T1), 12 weeks (T2), and 24 weeks (T3), included feasibility (recruitment, adherence, safety, acceptability) and efficacy [physical activity (Godin leisure time Index, ActiGraph GT3X+), quality of life (functional assessment of cancer therapy - general, short form 36 physical functioning component), functional capacity (six-minute walk test)]. RESULTS: Forty-five participants completed T1 assessments (10 males, 35 females). Thirty-nine (86.6\\%) of those underwent assessment at T2 and 31 (68.8\\%) at T3. The intervention was perceived positively with no adverse effects. There were increases in functional capacity (six-minute walk test, p = .002) between T1-T3, an increase in quality of life [short form 36 physical functioning measure (p = .0035), functional assessment of cancer total score (p = .02)] and self-report physical activity levels (p = .000123) between T1-T2, although effect sizes were generally low (d = 0.180 to d = 0.418). Objectively measured physical activity did not change. CONCLUSION: A physical activity intervention including wearable technology was safe, feasible, and well received by cancer survivors. An intervention based on this proof of concept should be followed up in further studies.", "links": [] }, { "title": "Comparing three wearable accelerometers to measure early activity after cardiac surgery", "author": "Brown, Charles H.; Yanek, Lisa; Healy, Ryan; Tsay, Tiffany; Di, Junrui; Goeddel, Lee; Young, Daniel; Zipunnikov, Vadim; Schrack, Jennifer; Cardiac Surgery Mobility Working Group", "year": "2022", "journalProceedings": "JTCVS open", "category": "Usability,Validation", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps", "abstract": "OBJECTIVE: Wearable activity monitors can provide detailed data on activity after cardiac surgery and discriminate a patient's risk for hospital-based outcomes. However, comparative data for different monitoring approaches, as well as predictive ability over clinical characteristics, are lacking. In addition, data on specific thresholds of activity are needed. The objective of this study was to compare 3 wearable activity monitors and 1 observational mobility scale in discriminating risk for 3 hospital-based outcomes, and to establish clinically relevant step thresholds. METHODS: Cardiac surgery patients were enrolled between June 2016 and August 2017 in a cohort study. Postoperative activity was measured by 3 accelerometry monitors (StepWatch Ambulation Monitor, Fitbit Charge HR, and ActiGraph GT9X) and 1 nurse-based observation scale. Monitors represent a spectrum of characteristics, including wear location (ankle/wrist), output (activity counts/steps), consumer accessibility, and cost. Primary outcomes were duration of hospitalization {\\textgreater}7 days, discharge to a nonhome location, and 30-day readmission. RESULTS: Data were available from 193 patients (median age 67 years [interquartile range, 58-72]). All postoperative day 2 activity metrics (ie, from StepWatch, Fitbit, ActiGraph, and the observation scale) were independently associated with prolonged hospitalization and discharge to a nonhome location. Only steps as measured by StepWatch was independently associated with 30-day readmission. Overall, StepWatch provided the greatest discrimination (C-statistics 0.71-0.76 for all outcomes). Step thresholds between 250 and 500 steps/day identified between 74\\% and 96\\% of patients with any primary outcome. CONCLUSIONS: Data from wearable accelerometers provide additive value in early postoperative risk-stratification for hospital-based outcomes. These results both support and provide guidance for activity-monitoring programs after cardiac surgery.", "links": [] }, { "title": "HEART rate variability biofeedback for long COVID symptoms (HEARTLOC): protocol for a feasibility study", "author": "Corrado, Joanna; Halpin, Stephen; Preston, Nick; Whiteside, Diana; Tarrant, Rachel; Davison, Jennifer; Simms, Alexander D.; O'Connor, Rory J.; Casson, Alexander; Sivan, Manoj", "year": "2022", "journalProceedings": "BMJ open", "category": "Measurement", "devices": null, "population": "Adults", "dataUsed": "Heart Rate", "abstract": "INTRODUCTION: Long COVID (LC), also known as post-COVID-19 syndrome, refers to symptoms persisting 12 weeks after COVID-19 infection. It affects up to one in seven people contracting the illness and causes a wide range of symptoms, including fatigue, breathlessness, palpitations, dizziness, pain and brain fog. Many of these symptoms can be linked to dysautonomia or dysregulation of the autonomic nervous system after SARS-CoV2 infection. This study aims to test the feasibility and estimate the efficacy, of the heart rate variability biofeedback (HRV-B) technique via a standardised slow diaphragmatic breathing programme in individuals with LC. METHODS AND ANALYSIS: 30 adult LC patients with symptoms of palpitations or dizziness and an abnormal NASA Lean Test will be selected from a specialist Long COVID rehabilitation service. They will undergo a 4-week HRV-B intervention using a Polar chest strap device linked to the Elite HRV phone application while undertaking the breathing exercise technique for two 10 min periods everyday for at least 5 days a week. Quantitative data will be gathered during the study period using: HRV data from the chest strap and wrist-worn Fitbit, the modified COVID-19 Yorkshire Rehabilitation Scale, Composite Autonomic Symptom Score, WHO Disability Assessment Schedule and EQ-5D-5L health-related quality of life measures. Qualitative feedback on user experience and feasibility of using the technology in a home setting will also be gathered. Standard statistical tests for correlation and significant difference will be used to analyse the quantitate data. ETHICS AND DISSEMINATION: The study has received ethical approval from Health Research Authority (HRA) Leicester South Research Ethics Committee (21/EM/0271). Dissemination plans include academic and lay publications. TRIAL REGISTRATION NUMBER: NCT05228665.", "links": [] }, { "title": "Steps Ahead: Optimising physical activity in adults with cystic fibrosis: A pilot randomised trial using wearable technology, goal setting and text message feedback", "author": "Curran, Máire; Tierney, Audrey C.; Collins, Louise; Kennedy, Lauren; McDonnell, Ciara; Jurascheck, Andrew J.; Sheikhi, Ali; Walsh, Cathal; Button, Brenda; Casserly, Brian; Cahalan, Roisin", "year": "2022", "journalProceedings": "Journal of Cystic Fibrosis: Official Journal of the European Cystic Fibrosis Society", "category": "Intervention", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "BACKGROUND: Regular participation in physical activity (PA) is encouraged for people with Cystic Fibrosis (CF). This study aimed to assess the effectiveness of an intervention using wearable technology, goal setting and text message feedback on PA and health outcomes in people with CF. METHODS: This was a pilot randomised trial conducted at University Hospital Limerick. Participants were randomly assigned to the intervention (INT) or active comparator (AC). The 12-week intervention consisted of wearable technology (Fitbit Charge 2) which was remotely monitored, and participants set step count goals. Participants were sent a one-way text message once a week over 12 weeks to positively reinforce and encourage PA participation. The AC group received the wearable technology alone. Follow up was assessed at 24 weeks. Outcomes assessed were PA, aerobic capacity, lung function, sleep, quality of life and wellbeing. RESULTS: Step count increased significantly for the INT group over 12 weeks when compared to the AC group (p=0.019). The INT group had a 28\\% week-to-week percentage change (Weeks 1-12), while the AC group reduced by 1\\%, p=0.023. Within group changes demonstrated that VO2 peak (ml/kg/min) significantly increased for the INT group at 12 weeks (24.4 ±7.65 to 26.13 ±7.79, p=0.003) but not at 24 weeks (24.45 ±7.05, p=0.776). There were no significant differences observed for VO2 peak (ml/kg/min) for the AC group. There was no significant effect on lung function, sleep, well-being, or quality of life for either group. CONCLUSIONS: A personalised PA intervention using wearable technology, goal setting and text message feedback increased PA and aerobic capacity in people with CF. Integration of this intervention into usual care may encourage regular PA participation for people with CF.", "links": [] }, { "title": "mHealth-Supported Gender- and Culturally Sensitive Weight Loss Intervention for Hispanic Men With Overweight and Obesity: Single-Arm Pilot Study", "author": "Garcia, David O.; Valdez, Luis A.; Aceves, Benjamin; Bell, Melanie L.; Rabe, Brooke A.; Villavicencio, Edgar A.; Marrero, David G.; Melton, Forest; Hooker, Steven P.", "year": "2022", "journalProceedings": "JMIR formative research", "category": "Intervention", "devices": "Charge 2", "population": "Adults", "dataUsed": "User Friendliness", "abstract": "BACKGROUND: Hispanic men have disproportionate rates of overweight and obesity compared with other racial and ethnic subpopulations. However, few weight loss interventions have been developed specifically for this high-risk group. Furthermore, the use of mobile health (mHealth) technologies to support lifestyle behavior changes in weight loss interventions for Hispanic men is largely untested. OBJECTIVE: This single-arm pilot study examined the feasibility and acceptability of integrating mHealth technology into a 12-week gender- and culturally sensitive weight loss intervention (GCSWLI) for Hispanic men with overweight and obesity. METHODS: A total of 18 Hispanic men (mean age 38, SD 10.9 years; mean BMI 34.3, SD 5.5 kg/m²; 10/18, 56\\% Spanish monolingual) received a GCSWLI, including weekly in-person individual sessions, a daily calorie goal, and prescription of ≥225 minutes of moderate-intensity physical activity per week. mHealth technology support included tailored SMS text messaging, behavior self-monitoring support using Fitbit Charge 2, and weight tracking using a Fitbit Aria Wi-Fi Smart Scale. Changes in weight from baseline to 12 weeks were estimated using a paired 2-tailed t test. Descriptive analyses characterized the use of Fitbit and smart scales. Semistructured interviews were conducted immediately after intervention to assess the participants' weight loss experiences and perspectives on mHealth technologies. RESULTS: Of 18 participants, 16 (89\\%) completed the 12-week assessments; the overall attrition rate was 11.1\\%. The mean weight loss at week 12 was -4.7 kg (95\\% CI 7.1 to -2.4 kg; P{\\textless}.001). Participants wore the Fitbit 71.58\\% (962/1344) of the intervention days and logged their body weight using the smart scale (410/1344, 30.51\\% of the intervention days). Participants identified barriers to the use of the technology, such as lack of technological literacy and unreliable internet access for the smart scale. CONCLUSIONS: Although clinically significant weight loss was achieved by integrating mHealth technology into the GCSWLI, adherence to the prescribed use of technology was modest. Addressing barriers to the use of such technologies identified in our work may help to refine an mHealth intervention approach for Hispanic men. TRIAL REGISTRATION: ClinicalTrials.gov NCT02783521; https://clinicaltrials.gov/ct2/show/NCT02783521.", "links": [] }, { "title": "Mining associations between glycemic variability in awake-time and in-sleep among non-diabetic adults", "author": "Liang, Zilu", "year": "2022", "journalProceedings": "Frontiers in Medical Technology", "category": "Measurement", "devices": "Charge 3", "population": "Adults", "dataUsed": "Sleep", "abstract": "It is often assumed that healthy people have the genuine ability to maintain tight blood glucose regulation. However, a few recent studies revealed that glucose dysregulation such as hyperglycemia may occur even in people who are considered normoglycemic by standard measures and were more prevalent than initially thought, suggesting that more investigations are needed to fully understand the within-day glucose dynamics of healthy people. In this paper, we conducted an analysis on a multi-modal dataset to examine the relationships between glycemic variability when people were awake and that when they were sleeping. The interstitial glucose levels were measured with a wearable continuous glucose monitoring (CGM) technology FreeStyle Libre 2 at every 15 min interval. In contrast to the traditional single-time-point measurements, the CGM data allow the investigation into the temporal patterns of glucose dynamics at high granularity. Sleep onset and offset timestamps were recorded daily with a Fitbit Charge 3 wristband. Our analysis leveraged the sleep data to split the glucose readings into segments of awake-time and in-sleep, instead of using fixed cut-off time points as has been done in existing literature. We combined repeated measure correlation analysis and quantitative association rules mining, together with an original post-filtering method, to identify significant and most relevant associations. Our results showed that low overall glucose in awake time was strongly correlated to low glucose in subsequent sleep, which in turn correlated to overall low glucose in the next day. Moreover, both analysis techniques identified significant associations between the minimal glucose reading in sleep and the low blood glucose index the next day. In addition, the association rules discovered in this study achieved high confidence (0.75-0.88) and lift (4.1-11.5), which implies that the proposed post-filtering method was effective in selecting quality rules.", "links": [] }, { "title": "A randomized, double-blind, placebo-controlled trial investigating the effects of an Ocimum tenuiflorum (Holy Basil) extract (HolixerTM) on stress, mood, and sleep in adults experiencing stress", "author": "Lopresti, Adrian L.; Smith, Stephen J.; Metse, Alexandra P.; Drummond, Peter D.", "year": "2022", "journalProceedings": "Frontiers in Nutrition", "category": "Medical,Case Study", "devices": "Charge 4", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background: In Ayurveda, Ocimum tenuiflorum (Holy Basil) is referred to as \"the elixir of life\" and is believed to promote longevity and general wellbeing. Although limited, there are clinical trials to suggest Ocimum tenuiflorum has anti-stress effects.\n\nPurpose: Examine the effects of a standardized Ocimum tenuiflorum extract (HolixerTM) on subjective and objective measures of stress and sleep quality in adults experiencing stress.\n\nStudy design: Two-arm, parallel-group, 8-week, randomized, double-blind, placebo-controlled trial. Australian and New Zealand Clinical Trials Registry trial registration number ACTRN12621000609853.\n\nMethods: One hundred volunteers aged 18-65 years received either 125 mg of Ocimum tenuiflorum twice daily or a placebo. Outcome measures included the Perceived Stress Scale (PSS) (primary outcome measure), Profile of Mood States, Athens Insomnia Scale (AIS), Restorative Sleep Questionnaire, and the Patient-Reported Outcomes Measurement Information System-29. Sleep quality was also assessed using a wrist-worn sleep tracker (Fitbit), and stress changes were examined by measuring between-group differences in hair cortisol and stress responses after exposure to an experiment stress procedure known as the Maastricht Acute Stress Test (MAST).\n\nResults: Compared to the placebo, Ocimum tenuiflorum supplementation was associated with greater improvements in PSS (p = 0.003) and AIS (p = 0.025) scores; and at week 8, concentrations in hair cortisol were also lower (p = 0.025). Moreover, Ocimum tenuiflorum supplementation was associated with a buffered stress responses after exposure to the MAST as demonstrated by significantly lower concentrations in salivary cortisol (p = 0.001), salivary amylase (p = 0.001), systolic (p = 0.010) and diastolic (p = 0.025) blood pressure, and subjective stress ratings (p < 0.001). Ocimum tenuiflorum supplementation was well-tolerated with no reports of major adverse effects.\n\nConclusion: The results from this trial suggest that 8 weeks of supplementation with an Ocimum tenuiflorum extract (HolixerTM) may reduce objective and subjective measures of stress, and improve subjective measures of sleep quality. However, further research using gold-standard objective sleep measures will be required to substantiate the sleep-related findings.", "links": [] }, { "title": "Physical Activity Intervention in Patients with Metastatic Breast Cancer During Active Treatment: Quality of Life and Function", "author": "Shachar, Shlomit Strulov; Heiling, Hillary; Muss, Hyman B.; Meghan, Damone; Wagoner, Chad W.; Deal, Allison M.; Nyrop, Kirsten A.", "year": "2022", "journalProceedings": "The Oncologist", "category": "Intervention", "devices": "Zip", "population": "Patients", "dataUsed": "Steps", "abstract": "BACKGROUND: In this study, we explore recruitment, retention, and potential quality of life (QoL) and function benefits from a self-directed, home-based walking intervention in women during active treatment for metastatic breast cancer (MBC). METHODS: In this single-arm pilot study, women with stage IV BC wore an activity tracker (FitbitTM) to measure steps per week throughout the intervention study. Participants were asked to walk 150 min per week at a comfortable and safe pace. Patient-reported outcome measures (PRO) were collected at baseline and follow-up. RESULTS: Target recruitment of 60 patients was achieved. In 52 patients who completed all baseline measures, mean age was 55 (SD 11.1), 23\\% were pre-menopausal, and 19\\% non-White. Forty patients (77\\%) were retained at 3 months and 29 (56\\%) at 6 months. Baseline walking was the strongest predictor of retention at 3 months (P = .02). For 24 patients (46\\%) with analyzable Fitbit data at 3 months, mean steps/week rose from 19,175 to 31,306. Higher number of steps correlated with larger improvements FACT-G General well-being (FACT-G, rho = 0.55, P = .01), FACT-G Physical well-being (rho = 0.48, P = .03), and PROMIS Mental Health (rho = 0.55, P = .01). CONCLUSION: Recruitment into a walking intervention is feasible (a priory target of N = 60) in women during treatment for MBC, but retention at 3 months follow-up fell short (77\\% versus a priori 80\\%), yet there were potential benefits in general and physical well-being and mental health. CLINICALTRIALS.GOV IDENTIFIER: NCT02682836.", "links": [] }, { "title": "Feasibility, acceptability, and preliminary efficacy of a single-arm, remotely-delivered health coaching intervention to increase physical activity and reduce sedentary behavior during pregnancy", "author": "Whitaker, Kara M.; Jones, Melissa A.; Dziewior, Jaclyn; Anderson, Megan; Anderson, Chelsie; Gibbs, Bethany Barone; Carr, Lucas J.", "year": "2022", "journalProceedings": "BMC pregnancy and childbirth", "category": "Intervention", "devices": "Inspire", "population": "Pregnant Women", "dataUsed": "Steps", "abstract": "BACKGROUND: Interventions targeting physical activity and sedentary behavior concurrently in pregnancy may be an ideal strategy to reduce the risk of pregnancy complications. We assessed the feasibility, acceptability, and preliminary efficacy of a single-arm, remotely-delivered health coaching intervention to promote physical activity and reduce sedentary behavior in pregnancy. METHODS: Women (n = 34) between 8 and 12 weeks gestation were recruited to take part in the INcreasing Steps in PREgnancy (INSPiRE) study. Participants were given an activity tracker (Fitbit Inspire) and met virtually with their health coach throughout the second and third trimesters of pregnancy. Feasibility was based on enrollment, retention, and adherence rates. Acceptance was assessed using a process evaluation survey. Intervention efficacy was based on activPAL data obtained at baseline and the end of the second trimester. RESULTS: Feasibility objectives were met, with greater than 70\\% enrollment, 97\\% retention, and 99\\% adherence. All participants reported high levels of satisfaction with the program. ActivPAL data indicated statistically significant increases in daily steps (+ 1715.8 steps/day, Cohen's d = 0.97), stepping time (+ 1.9\\%, d = 0.75), standing time (+ 2.3\\%, d = 0.29), and decreases in total sedentary time (- 4.2\\%, d = 0.43) and sedentary bouts of 30 minutes (- 4.1\\%, d = 0.36) from baseline to the end of the second trimester, all p {\\textless} 0.05. Decreases were also observed in sedentary bouts of 60 minutes (- 3.9\\%, d = 0.40), but this was not statistically significant. CONCLUSIONS: The INSPiRE study demonstrated feasibility, high acceptability, and preliminary efficacy for improving movement behaviors in women during pregnancy, supporting future testing in a randomized controlled trial.", "links": [] }, { "title": "Feasibility of Fitbit Use in Adolescent Survivors of Pediatric Cancer: Who Consistently Uses It and for How Long?", "author": "Williamson Lewis, Rebecca; Howell, Kristen E.; Effinger, Karen E.; Meacham, Lillian R.; Wasilewski-Masker, Karen; Mertens, Ann; Marchak, Jordan Gilleland", "year": "2022", "journalProceedings": "Journal of Adolescent and Young Adult Oncology", "category": "Usability", "devices": "Flex", "population": "Children", "dataUsed": "Steps", "abstract": "Purpose: Wearable activity trackers with real-time feedback and goal-setting features are being incorporated into programs to increase physical activity among childhood cancer survivors. This analysis describes the adoption and use of a Fitbit® Flex™ among adolescent-aged survivors of childhood cancer without incentives, reminders, or interventions to encourage use. Procedures: Cancer survivors aged 13-18 and ≥2 years from therapy received a Fitbit Flex with instructions to wear it daily. Researchers downloaded participants' daily total steps and active minutes for 1 year. Participants were classified as consistent (≥5 days/week for {\\textgreater}4 weeks during the first 12 weeks) or inconsistent users, and comparisons between user types were made. Longitudinal use of the Fitbit and participants' 1-year acceptability evaluations are described. Results: Overall, 67.1\\% (47/70) of survivors enrolled, and Fitbit data were available for 36 participants. Initially, 30.6\\% (11/36) were consistent users. Consistent users had lower body mass index z-scores at enrollment (0.4 ± 0.7 vs. 1.2 ± 0.9; p = 0.01), but were otherwise comparable with inconsistent users. Over time survivors' use declined; at 12 months, only one participant was using his or her Fitbit. Survivors who completed a survey (n = 22) reported their Fitbit helped them self-monitor their exercise (72.7\\%, 16/22) and lead a more active lifestyle (63.6\\%, 14/22), but found it challenging to charge and not lose, forget about, or break the device. Conclusions: In the real-world setting, only a small subset of adolescent-aged survivors will initially consistently use a Fitbit and their interest diminishes over time. To maximize engagement, interventions incorporating wearable activity trackers likely need to include additional behavior change strategies.", "links": [] }, { "title": "Escalating schedules of incentives increase physical activity with no differences between deposit and no-deposit groups: A systematic replication", "author": "Batchelder, Sydney R.; Van Heukelom, Justin T.; Proctor, Kaitlyn; Washington, Wendy Donlin", "year": "2022", "journalProceedings": "Journal of Applied Behavior Analysis", "category": "Intervention", "devices": "Zip,Charge", "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "Physical inactivity has increasingly affected public health in the United States during the COVID-19 pandemic as it is associated with chronic diseases such as arthritis, cancer, and heart disease. Contingency management has been shown to increase physical activity. Therefore, the present study sought to evaluate the effects of an escalating schedule of monetary reinforcement with a reset contingency on physical activity, as compared between 2 counterbalanced groups in which a monetary deposit of \\$25 was either required (deposit group) or not (no-deposit group). Twenty-five adults wore Fitbit accelerometers to monitor step counts. An ABA reversal design was used; in the 2 baseline phases, no programmed contingencies were in place for step counts. During intervention, step goals were set using a modified 70th percentile schedule with a 7-day window: Reaching the first goal would result in \\$0.25, and incentives increased by \\$0.25 for each subsequent day in which the goal was met. Failure to reach a goal resulted in a reset of the monetary incentive value to \\$0.25. Ten out of 12 participants from the deposit group were determined to be responders to intervention, whereas 8 out of 13 participants from the no-deposit group were determined to be responders to intervention. Overall, there were no significant differences between the groups' step counts. However, the deposit group's intervention was cheaper to implement, which suggests that deposit contracts are a viable modification for physical activity interventions.", "links": [] }, { "title": "Monitoring postoperative ambulation and sleep after head and neck surgery: Feasibility and utility study using wearable devices", "author": "Pandrangi, Vivek C.; Jorizzo, Matthew; Shah, Suparna; Bruening, Jennifer; Wax, Mark K.; Clayburgh, Daniel; Andersen, Peter; Li, Ryan J.", "year": "2022", "journalProceedings": "Head \\& Neck", "category": "Intervention", "devices": "Inspire HR", "population": "Patients", "dataUsed": "Steps,Sleep", "abstract": "BACKGROUND: To evaluate use of wearable activity devices to monitor trends in ambulation and sleep after head and neck surgery. METHODS: Patients utilized Fitbit devices after surgery. Daily activity and sleep scores, step counts, and total sleep time (TST) were obtained. RESULTS: There were 30 patients within the final cohort. Trends in step counts after specific procedures were identified, and higher subjective activity level correlated with step counts (r = 0.25, 95\\% CI = 0.07-0.41). Among patients with complete step data (n = 24), POD1 steps ≥200 were associated with reduced length of stay (4.5 ± 1.7 days vs. 7.2 ± 4.0 days, 95\\% CI = 0.33-5.0). Mean TST was 5.4 ± 2.5 h, TST correlated with subjective sleep scores (r = 0.25, 95\\% CI = 0.03-0.044), and clinical events associated with sleep-wake transitions on Fitbit devices were identified. CONCLUSIONS: Wearable activity devices appear feasible for monitoring trends in postoperative ambulation and sleep. Use of these devices may facilitate postoperative recovery.", "links": [] }, { "title": "The Development of a Novel mHealth Tool for Obstructive Sleep Apnea: Tracking Continuous Positive Airway Pressure Adherence as a Percentage of Time in Bed", "author": "Pfammatter, Angela Fidler; Hughes, Bonnie Olivia; Tucker, Becky; Whitmore, Harry; Spring, Bonnie; Tasali, Esra", "year": "2022", "journalProceedings": "Journal of Medical Internet Research", "category": "Intervention", "devices": "Inspire HR", "population": "Patients", "dataUsed": "Steps,Weight", "abstract": "Background: Continuous positive airway pressure (CPAP) is the mainstay obstructive sleep apnea (OSA) treatment; however, poor adherence to CPAP is common. Current guidelines specify 4 hours of CPAP use per night as a target to define adequate treatment adherence. However, effective OSA treatment requires CPAP use during the entire time spent in bed to optimally treat respiratory events and prevent adverse health effects associated with the time spent sleeping without wearing a CPAP device. Nightly sleep patterns vary considerably, making it necessary to measure CPAP adherence relative to the time spent in bed. Weight loss is an important goal for patients with OSA. Tools are required to address these clinical challenges in patients with OSA.\n\nObjective: This study aimed to develop a mobile health tool that combined weight loss features with novel CPAP adherence tracking (ie, percentage of CPAP wear time relative to objectively assessed time spent in bed) for patients with OSA.\n\nMethods: We used an iterative, user-centered process to design a new CPAP adherence tracking module that integrated with an existing weight loss app. A total of 37 patients with OSA aged 20 to 65 years were recruited. In phase 1, patients with OSA who were receiving CPAP treatment (n=7) tested the weight loss app to track nutrition, activity, and weight for 10 days. Participants completed a usability and acceptability survey. In phase 2, patients with OSA who were receiving CPAP treatment (n=21) completed a web-based survey about their interpretations and preferences for wireframes of the CPAP tracking module. In phase 3, patients with recently diagnosed OSA who were CPAP naive (n=9) were prescribed a CPAP device (ResMed AirSense10 AutoSet) and tested the integrated app for 3 to 4 weeks. Participants completed a usability survey and provided feedback.\n\nResults: During phase 1, participants found the app to be mostly easy to use, except for some difficulty searching for specific foods. All participants found the connected devices (Fitbit activity tracker and Fitbit Aria scale) easy to use and helpful. During phase 2, participants correctly interpreted CPAP adherence success, expressed as percentage of wear time relative to time spent in bed, and preferred seeing a clearly stated percentage goal (\"Goal: 100%\"). In phase 3, participants found the integrated app easy to use and requested push notification reminders to wear CPAP before bedtime and to sync Fitbit in the morning.\n\nConclusions: We developed a mobile health tool that integrated a new CPAP adherence tracking module into an existing weight loss app. Novel features included addressing OSA-obesity comorbidity, CPAP adherence tracking via percentage of CPAP wear time relative to objectively assessed time spent in bed, and push notifications to foster adherence. Future research on the effectiveness of this tool in improving OSA treatment adherence is warranted.", "links": [] }, { "title": "Validity of a Global Positioning System-Based Algorithm and Consumer Wearables for Classifying Active Trips in Children and Adults", "author": "Steel, Chelsea; Crist, Katie; Grimes, Amanda; Bejarano, Carolina; Ortega, Adrian; Hibbing, Paul R.; Schipperijn, Jasper; Carlson, Jordan A.", "year": "2021", "journalProceedings": "Journal for the Measurement of Physical Behaviour", "category": "Validation", "devices": "Alta", "population": "Adults", "dataUsed": "Distance", "abstract": "OBJECTIVE: To investigate the convergent validity of a global positioning system (GPS)-based and two consumer-based measures with trip logs for classifying pedestrian, cycling, and vehicle trips in children and adults. METHODS: Participants (N = 34) wore a Qstarz GPS tracker, Fitbit Alta, and Garmin vivosmart 3 on multiple days and logged their outdoor pedestrian, cycling, and vehicle trips. Logged trips were compared with device-measured trips using the Personal Activity Location Measurement System (PALMS) GPS-based algorithms, Fitbit's SmartTrack, and Garmin's Move IQ. Trip- and day-level agreement were tested. RESULTS: The PALMS identified and correctly classified the mode of 75.6\\%, 94.5\\%, and 96.9\\% of pedestrian, cycling, and vehicle trips (84.5\\% of active trips, F1 = 0.84 and 0.87) as compared with the log. Fitbit and Garmin identified and correctly classified the mode of 26.8\\% and 17.8\\% (22.6\\% of active trips, F1 = 0.40 and 0.30) and 46.3\\% and 43.8\\% (45.2\\% of active trips, F1 = 0.58 and 0.59) of pedestrian and cycling trips. Garmin was more prone to false positives (false trips not logged). Day-level agreement for PALMS and Garmin versus logs was favorable across trip modes, though PALMS performed best. Fitbit significantly underestimated daily cycling. Results were similar but slightly less favorable for children than adults. CONCLUSIONS: The PALMS showed good convergent validity in children and adults and were about 50\\% and 27\\% more accurate than Fitbit and Garmin (based on F1). Empirically-based recommendations for improving PALMS' pedestrian classification are provided. Since the consumer devices capture both indoor and outdoor walking/running and cycling, they are less appropriate for trip-based research.", "links": [] }, { "title": "A remotely delivered, peer-led intervention to improve physical activity and quality of life in younger breast cancer survivors", "author": "Weiner, Lauren S.; Nagel, Stori; Irene Su, H.; Hurst, Samantha; Levy, Susan S.; Arredondo, Elva M.; Hekler, Eric; Hartman, Sheri J.", "year": "2022", "journalProceedings": "Journal of Behavioral Medicine", "category": "Intervention", "devices": "Charge 3", "population": "Adults", "dataUsed": "Steps,Heart Rate,User Friendliness", "abstract": "Younger breast cancer survivors (YBCS) consistently report poorer quality of life (QOL) than older survivors. Increasing physical activity (PA) may improve QOL, but this has been understudied in YBCS. This single arm pilot study evaluated the feasibility and acceptability of a 3-month, peer-delivered, remote intervention to increase PA and improve QOL in YBCS. Data were collected from October 2019 - July 2020. Participants (n = 34, 43.1 ± 5.5 years old, 46 ± 34.4 months post-diagnosis, BMI = 30.2 ± 7.4 kg/m2) completed six video sessions with a trained peer mentor; self-monitored PA with a Fitbit activity tracker; and interacted with a private Fitbit Community for social support. At baseline, 3-and 6-months, participants completed QOL questionnaires and PA was measured through accelerometer (moderate-to-vigorous PA [MVPA]) and self-report (strength and flexibility). A parallel mixed-methods approach (qualitative interviews and quantitative satisfaction survey at 3-months) explored intervention feasibility and acceptability. One-way repeated-measures ANOVAs examined impacts on PA and QOL at 3-and 6-months. The intervention was feasible as evidenced by efficient recruitment, high retention, and adherence to intervention components. Remote delivery, working with a peer mentor, and using Fitbit tools were highly acceptable. From baseline to 3-months, participants increased time spent in objectively measured MVPA, strength, and flexibility exercises, and reported meaningful improvements to body image, fatigue, anxiety, and emotional support. A fully remote, peer-to-peer intervention is an acceptable and promising strategy to increase PA and improve QOL in YBCS. Refinements to the intervention and its delivery should be further assessed in future studies, toward the goal of disseminating an evidence-based, scalable intervention to the growing number of YBCS.Trial registration Prospectively registered as NCT04064892.", "links": [] }, { "title": "Recommendations for Identifying Valid Wear for Consumer-Level Wrist-Worn Activity Trackers and Acceptability of Extended Device Deployment in Children", "author": "Wing, David; Godino, Job G.; Baker, Fiona C.; Yang, Rongguang; Chevance, Guillaume; Thompson, Wesley K.; Reuter, Chase; Bartsch, Hauke; Wilbur, Aimee; Straub, Lisa K.; Castro, Norma; Higgins, Michael; Colrain, Ian M.; de Zambotti, Massimiliano; Wade, Natasha E.; Lisdahl, Krista M.; Squeglia, Lindsay M.; Ortigara, Joseph; Fuemmeler, Bernard; Patrick, Kevin; Mason, Michael J.; Tapert, Susan F.; Bagot, Kara S.", "year": "2022", "journalProceedings": "Sensors (Basel, Switzerland)", "category": "Usability", "devices": "Charge HR", "population": "Children", "dataUsed": "Steps,Intensity,Heart Rate,User Friendliness", "abstract": "BACKGROUND: Self-reported physical activity is often inaccurate. Wearable devices utilizing multiple sensors are now widespread. The aim of this study was to determine acceptability of Fitbit Charge HR for children and their families, and to determine best practices for processing its objective data. METHODS: Data were collected via Fitbit Charge HR continuously over the course of 3 weeks. Questionnaires were given to each child and their parent/guardian to determine the perceived usability of the device. Patterns of data were evaluated and best practice inclusion criteria recommended. RESULTS: Best practices were established to extract, filter, and process data to evaluate device wear, r and establish minimum wear time to evaluate behavioral patterns. This resulted in usable data available from 137 (89\\%) of the sample. CONCLUSIONS: Activity trackers are highly acceptable in the target population and can provide objective data over longer periods of wear. Best practice inclusion protocols that reflect physical activity in youth are provided.", "links": [] }, { "title": "Self-expansion is positively associated with Fitbit-measured daily steps across 4-weeks", "author": "Xu, Xiaomeng; Tupy, Samantha; Sharp, Julia L.; Miller, Ashley L.; Correll, Danielle; Nigg, Claudio R.", "year": "2022", "journalProceedings": "Scientific Reports", "category": "Case Study", "devices": "One", "population": "Adults", "dataUsed": "Steps", "abstract": "The growth of the self-concept through increasing perspectives, identities, resources, and efficacy is known as self-expansion and typically involves novelty, challenge, interest, and/or excitement. Self-expansion is positively associated with health factors including self-reported physical activity (PA). This study is the first to investigate self-expansion and daily PA, and with a PA monitor. Fifty community participants completed baseline questionnaires, wore a Fitbit One and completed daily self-report questionnaires for 28 days, and completed follow-up questionnaires. Daily surveys included questions about both general and PA-specific self-expansion. Across the 4 weeks, steps taken was positively correlated with both general (all maximum likelihood r = 0.17) and PA-specific self-expansion (maximum likelihood rs of 0.15 and 0.16), and PA-specific self-expansion was positively correlated (maximum likelihood rs of 0.38 and 0.50) with aerobic activity. Future research should investigate this relationship in a larger more diverse sample and test whether PA-specific self-expansion can be utilized as an acceptable, feasible, and effective intervention to increase daily steps and other forms of PA.", "links": [] }, { "title": "PreScription DigitaL ThErapEutic for Patients with Insomnia (SLEEP-I): a protocol for a pragmatic randomised controlled trial", "author": "Dreyer, Rachel P.; Berkowitz, Alyssa; Yaggi, Henry Klar; Schneeberg, Lynelle; Shah, Nilay D.; Emanuel, Lindsay; Kolla, Bhanuprakash; Jeffery, Molly Moore; Deeg, Mark; Ervin, Keondae; Thorndike, Frances; Ross, Joseph S.", "year": "2022", "journalProceedings": "BMJ open", "category": "Intervention", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Steps,Sleep", "abstract": "INTRODUCTION: Cognitive behavioural therapy for insomnia (CBT-I) is effective at treating chronic insomnia, yet in-person CBT-I can often be challenging to access. Prior studies have used technology to bridge barriers but have been unable to extensively assess the impact of the digital therapeutic on real-world patient experience and multidimensional outcomes. Among patients with insomnia, our aim is to determine the impact of a prescription digital therapeutic (PDT) (PEAR-003b, FDA-authorised as Somryst; herein called PDT) that provides mobile-delivered CBT-I on patient-reported outcomes (PROs) and healthcare utilisation. METHODS AND ANALYSIS: We are conducting a pragmatically designed, prospective, multicentre randomised controlled trial that leverages Hugo, a unique patient-centred health data-aggregating platform for data collection and patient follow-up from Hugo Health. A total of 100 participants with insomnia from two health centres will be enrolled onto the Hugo Health platform, provided with a linked Fitbit (Inspire 2) to track activity and then randomised 1:1 to receive (or not) the PDT for mobile-delivered CBT-I (Somryst). The primary outcome is a change in the insomnia severity index score from baseline to 9-week postrandomisation. Secondary outcomes include healthcare utilisation, health utility scores and clinical outcomes; change in sleep outcomes as measured with sleep diaries and a change in individual PROs including depressive symptoms, daytime sleepiness, health status, stress and anxiety. For those allocated to the PDT, we will also assess engagement with the PDT. ETHICS AND DISSEMINATION: The Institutional Review Boards at Yale University and the Mayo Clinic have approved the trial protocol. This trial will provide important data to patients, clinicians and policymakers about the impact of the PDT device delivering CBT-I on PROs, clinical outcomes and healthcare utilisation. Findings will be disseminated to participants, presented at professional meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04909229.", "links": [] }, { "title": "Adverse Effects of Sit and Stand Workstations on the Health Outcomes of Assembly Line Workers: A Cross-sectional Study", "author": "Moshref Javadi, Amir-Milad; Choobineh, Alireza; Razeghi, Mohsen; Ghaem, Haleh; Daneshmandi, Hadi", "year": "2022", "journalProceedings": "Journal of Preventive Medicine and Hygiene", "category": "Intervention", "devices": "Charge", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "INTRODUCTION: Sitting and standing workstations can affect individual's health outcomes differently. This study aimed to assess the effects of sit and stand workstations on energy expenditure and blood parameters, including glucose and triglyceride, musculoskeletal symptoms/pain and discomfort, fatigue, and productivity among workers of assembly line of a belt factory. METHODS: This cross-sectional study was conducted on 47 male assembly line workers (24 workers in sitting workstation and 23 workers in standing workstation) with at least one year of working experience. Data were gathered via demographic/occupational characteristics, Fitbit system, medical records, the Persian version of the Nordic Musculoskeletal Questionnaire (P-NMQ), the Persian version of the Numeric Rating Scale (P-NRS), the Persian version of the Swedish Occupational Fatigue (P-SOFI), and Persian version of the Health and Work Questionnaire (P-HWQ). RESULTS: The results showed that there were no statistically significant between the demographic/occupational details of the participants in sitting and standing groups, except work experience. The findings of the present study revealed that the energy expenditure, and blood glucose/triglyceride there are not statistically differences between sitting and standing groups. In addition, the prevalence of musculoskeletal symptoms in the neck, lower back, knees, and ankles/feet in standing group was significantly higher than the sitting group. The means of severity of discomfort/pain in all body regions were significantly higher in standing group compared to other group. Generally, occupational fatigue was higher among the standing group compared to sitting group. About productivity, the 'concentration/focus' and 'impatience/irritability' subscales in sitting group were higher than the standing group. Contrariwise, other subscales of the productivity, including 'productivity', 'supervisor relations', 'non-work satisfaction', 'work satisfaction' in the standing group were higher than the sitting group. CONCLUSIONS: To reduce the adverse effects of sitting and standing workstations on individual's health outcomes, planning to use sit-stand workstations is recommended.", "links": [] }, { "title": "Identifying Predictors of Adherence to the Physical Activity Goal: A Secondary Analysis of the SMARTER Weight Loss Trial", "author": "Bizhanova, Zhadyra; Sereika, Susan M.; Brooks, Maria M.; Rockette-Wagner, Bonny; Kariuki, Jacob K.; Burke, Lora E.", "year": "2022", "journalProceedings": "Medicine and Science in Sports and Exercise", "category": "Case Study", "devices": "Charge 2", "population": "Adults", "dataUsed": "Intensity", "abstract": "INTRODUCTION/PURPOSE: Research is needed to inform tailoring supportive strategies for promoting physical activity (PA) in the context of behavioral treatment of obesity. We aimed to identify baseline participant characteristics and short-term intervention response predictors associated with adherence to the study-defined PA goal in a mobile health (mHealth) weight loss trial. METHODS: A secondary analysis was conducted of a 12-month weight loss trial (SMARTER) that randomized 502 adults with overweight or obesity to either self-monitoring of diet, PA, and weight with tailored feedback messages (n = 251) or self-monitoring alone (n = 251). The primary outcome was average adherence to the PA goal of ≥150 min/week of moderate- and vigorous-intensity aerobic activities (MVPA) from Fitbit Charge 2™ trackers over 52 weeks. Twenty-five explanatory variables were considered. Machine learning methods and linear regression were used to identify predictors of adherence to the PA goal. RESULTS: The sample (N = 502) was mostly female (80\\%), White (83\\%) with the average age of 45 ± 14.4 years and body mass index of 33.7 ± 4.0 kg/m2. Machine learning methods identified PA goal adherence for the first week as the most important of long-term PA goal adherence. In the parsimonious linear regression model, higher PA goal adherence for the first week, greater PA FB messages opened, older age, being male, higher education, being single and not having obstructive sleep apnea were associated with higher long-term PA goal adherence. CONCLUSIONS: To our knowledge, this is the first study using machine learning approaches to identify predictors of long-term PA goal adherence in a mHealth weight loss trial. Future studies focusing on facilitators or barriers to PA among young and middle-aged adults and women with low PA goal adherence are warranted.", "links": [] }, { "title": "Association of daily physical activity with brain volumes and cervical spinal cord areas in multiple sclerosis", "author": "Block, Valerie J.; Cheng, Shuiting; Juwono, Jeremy; Cuneo, Richard; Kirkish, Gina; Alexander, Amber M.; Khan, Mahir; Akula, Amit; Caverzasi, Eduardo; Papinutto, Nico; Stern, William A.; Pletcher, Mark J.; Marcus, Gregory M.; Olgin, Jeffrey E.; Hauser, Stephen L.; Gelfand, Jeffrey M.; Bove, Riley; Cree, Bruce Ac; Henry, Roland G.", "year": "2022", "journalProceedings": "Multiple Sclerosis (Houndmills, Basingstoke, England)", "category": "Case Study", "devices": "Flex 2", "population": "Patients", "dataUsed": "Steps", "abstract": "BACKGROUND: Remote activity monitoring has the potential to evaluate real-world, motor function, and disability at home. The relationships of daily physical activity with spinal cord white matter and gray matter (GM) areas, multiple sclerosis (MS) disability and leg function, are unknown. OBJECTIVE: Evaluate the association of structural central nervous system pathology with ambulatory disability. METHODS: Fifty adults with progressive or relapsing MS with motor disability who could walk {\\textgreater}2 minutes were assessed using clinician-evaluated, patient-reported outcomes, and quantitative brain and spinal cord magnetic resonance imaging (MRI) measures. Fitbit Flex2, worn on the non-dominant wrist, remotely assessed activity over 30 days. Univariate and multivariate analyses were performed to assess correlations between physical activity and other disability metrics. RESULTS: Mean age was 53.3 years and median Expanded Disability Status Scale (EDSS) was 4.0. Average daily step counts (STEPS) were highly correlated with EDSS and walking measures. Greater STEPS were significantly correlated with greater C2-C3 spinal cord GM areas (ρ = 0.39, p = 0.04), total cord area (TCA; ρ = 0.35, p = 0.04), and cortical GM volume (ρ = 0.32, p = 0.04). CONCLUSION: These results provide preliminary evidence that spinal cord GM area is a neuroanatomical substrate associated with STEPS. STEPS could serve as a proxy to alert clinicians and researchers to possible changes in structural nervous system pathology.", "links": [] }, { "title": "Moderate-vigorous physical activity attenuates premature senescence of immune cells in sedentary adults with obesity: a pilot randomized controlled trial", "author": "Chen, Xiang-Ke; Zheng, Chen; Wong, Stephen Heung-Sang; Ma, Alvin Chun-Hang", "year": "2022", "journalProceedings": "Aging", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Despite the well-known senolytic effects of physical exercise on immune cells in older adults, the effect of physical activity (PA) on premature immune senescence in sedentary adults with obesity remains largely unknown. This pilot study aimed to investigate the role of objectively measured physical behaviors and Fitbit watch-based free-living PA intervention in premature senescence of immune cells in sedentary adults with obesity. Forty-five participants were recruited in the cross-sectional analysis, and forty of them further participated in the randomized controlled trial. We found that objectively measured moderate-vigorous PA was independently and inversely correlated with the expression of p16INK4a and p21Cip1 in the peripheral blood mononuclear cell (PBMCs) of adults with obesity; however, chronological age, body mass index, body fat, maximal oxygen consumption, light PA, sedentary behaviors, and sleep duration were not. More importantly, the 12-week PA intervention mitigated the elevated p16INK4a levels in PBMCs, though it showed no effect on p21Cip1 and senescence-associated secretory phenotypes. Taken together, physical inactivity is an independent determinant of premature senescence in immune cells, while the 12-week PA intervention is a promising strategy to alleviate premature immune senescence in adults with obesity.", "links": [] }, { "title": "Comparing a Fitbit Wearable to an Electrocardiogram Gold Standard as a Measure of Heart Rate Under Psychological Stress: A Validation Study", "author": "Gagnon, Joel; Khau, Michelle; Lavoie-Hudon, Léandre; Vachon, François; Drapeau, Vicky; Tremblay, Sébastien", "year": "2022", "journalProceedings": "JMIR formative research", "category": "Usability", "devices": "Versa 2", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Wearable devices collect physiological and behavioral data that have the potential to identify individuals at risk of declining mental health and well-being. Past research has mainly focused on assessing the accuracy and the agreement of heart rate (HR) measurement of wearables under different physical exercise conditions. However, the capacity of wearables to sense physiological changes, assessed by increasing HR, caused by a stressful event has not been thoroughly studied. OBJECTIVE: This study followed 3 objectives: (1) to test the ability of a wearable device (Fitbit Versa 2) to sense an increase in HR upon induction of psychological stress in the laboratory; (2) to assess the accuracy of the wearable device to capture short-term HR variations caused by psychological stress compared to a gold-standard electrocardiogram (ECG) measure (Biopac); and (3) to quantify the degree of agreement between the wearable device and the gold-standard ECG measure across different experimental conditions. METHODS: Participants underwent the Trier Social Stress Test protocol, which consists of an oral phase, an arithmetic stress phase, an anticipation phase, and 2 relaxation phases (at the beginning and the end). During the stress protocol, the participants wore a Fitbit Versa 2 and were also connected to a Biopac. A mixed-effect modeling approach was used (1) to assess the effect of experimental conditions on HR, (2) to estimate several metrics of accuracy, and (3) to assess the agreement: the Bland-Altman limits of agreement (LoA), the concordance correlation coefficient, the coverage probability, the total deviation index, and the coefficient of an individual agreement. Mean absolute error and mean absolute percent error were calculated as accuracy indices. RESULTS: A total of 34 university students were recruited for this study (64\\% of participants were female with a mean age of 26.8 years, SD 8.3). Overall, the results showed significant HR variations across experimental phases. Post hoc tests revealed significant pairwise differences for all phases. Accuracy analyses revealed acceptable accuracy according to the analyzed metrics of accuracy for the Fitbit Versa 2 to capture the short-term variations in psychological stress levels. However, poor indices of agreement between the Fitbit Versa 2 and the Biopac were found. CONCLUSIONS: Overall, the results support the use of the Fitbit Versa 2 to capture short-term stress variations. The Fitbit device showed acceptable levels of accuracy but poor agreement with an ECG gold standard. Greater inaccuracy and smaller agreement were found for stressful experimental conditions that induced a higher HR. Fitbit devices can be used in research to measure HR variations caused by stress, although they cannot replace an ECG instrument when precision is of utmost importance.", "links": [] }, { "title": "Accuracy and Systematic Biases of Heart Rate Measurements by Consumer-Grade Fitness Trackers in Postoperative Patients: Prospective Clinical Trial", "author": "Helmer, Philipp; Hottenrott, Sebastian; Rodemers, Philipp; Leppich, Robert; Helwich, Maja; Pryss, Rüdiger; Kranke, Peter; Meybohm, Patrick; Winkler, Bernd E.; Sammeth, Michael", "year": "2022", "journalProceedings": "Journal of Medical Internet Research", "category": "Validation", "devices": "Sense,Garmin Fenix 6", "population": "Patients", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Over the recent years, technological advances of wrist-worn fitness trackers heralded a new era in the continuous monitoring of vital signs. So far, these devices have primarily been used for sports. OBJECTIVE: However, for using these technologies in health care, further validations of the measurement accuracy in hospitalized patients are essential but lacking to date. METHODS: We conducted a prospective validation study with 201 patients after moderate to major surgery in a controlled setting to benchmark the accuracy of heart rate measurements in 4 consumer-grade fitness trackers (Apple Watch 7, Garmin Fenix 6 Pro, Withings ScanWatch, and Fitbit Sense) against the clinical gold standard (electrocardiography). RESULTS: All devices exhibited high correlation (r≥0.95; P{\\textless}.001) and concordance (rc≥0.94) coefficients, with a relative error as low as mean absolute percentage error {\\textless}5\\% based on 1630 valid measurements. We identified confounders significantly biasing the measurement accuracy, although not at clinically relevant levels (mean absolute error{\\textless}5 beats per minute). CONCLUSIONS: Consumer-grade fitness trackers appear promising in hospitalized patients for monitoring heart rate. TRIAL REGISTRATION: ClinicalTrials.gov NCT05418881; https://www.clinicaltrials.gov/ct2/show/NCT05418881.", "links": [] }, { "title": "How Fitbit data are being made available to registered researchers in All of Us Research Program", "author": "Master, Hiral; Kouame, Aymone; Marginean, Kayla; Basford, Melissa; Harris, Paul; Holko, Michelle", "year": "2023", "journalProceedings": "Pacific Symposium on Biocomputing. Pacific Symposium on Biocomputing", "category": null, "devices": null, "population": null, "dataUsed": null, "abstract": "The National Institutes of Health's (NIH) All of Us Research Program aims to enroll at least one million US participants from diverse backgrounds; collect electronic health record (EHR) data, survey data, physical measurements, biospecimens for genomics and other assays, and digital health data; and create a researcher database and tools to enable precision medicine research [1]. Since inception, digital health technologies (DHT) have been envisioned as essential to achieving the goals of the program [2]. A bring your own device\" (BYOD) study for collecting Fitbit data from participants' devices was developed with integration of additional DHTs planned in the future [3]. Here we describe how participants can consent to share their digital health technology data", "links": [] }, { "title": "Wearable and mobile technology to characterize daily patterns of sleep, stress, presleep worry, and mood in adolescent insomnia", "author": "Menghini, Luca; Yuksel, Dilara; Prouty, Devin; Baker, Fiona C.; King, Christopher; de Zambotti, Massimiliano", "year": "2022", "journalProceedings": "Sleep Health", "category": "Case Study", "devices": "Charge 3", "population": "Adolescents", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "OBJECTIVES: Characterizing daily patterns of sleep, stress, presleep worry, and mood in adolescents with and without insomnia symptomatology. DESIGN: Two months of continuous wearable tracking and daily diary ratings. SETTING: Free-living conditions. PARTICIPANTS: Ninety-three adolescents (59 girls; 16-19 years old) with (N = 47; 26 with clinical and 21 with sub-clinical) and without (N = 46; control) DSM-5 insomnia symptomatology. MEASUREMENTS: Fitbit Charge 3 tracked sleep, heart rate, and steps. Evening electronic diaries collected ratings of daily stress, presleep worry, and mood. RESULTS: While sleep duration (control: 6.88 ± 1.41 hours; insomnia: 6.92 ± 1.28 hours), architecture, timing, and night-to-night variability were similar between groups, the insomnia group reported higher levels of stress and worry, being mainly related to school\". At the intraindividual level", "links": [] }, { "title": "Lower daily steps among U.S. adolescents during the COVID-19 pandemic: Objective findings from the Adolescent Brain Cognitive Development Study", "author": "Nagata, Jason M.; Yu, Jiayue; Dooley, Erin E.; Baker, Fiona C.; Alsamman, Sana; Wing, David; Ganson, Kyle T.; Pettee Gabriel, Kelley", "year": "2023", "journalProceedings": "Preventive Medicine Reports", "category": "Case Study", "devices": "Charge", "population": "Adolescents", "dataUsed": "Steps", "abstract": null, "links": [] }, { "title": "Medicinal cannabis improves sleep in adults with insomnia: a randomised double-blind placebo-controlled crossover study", "author": "Ried, Karin; Tamanna, Tasnuva; Matthews, Sonja; Sali, Avni", "year": "2022", "journalProceedings": "Journal of Sleep Research", "category": "Intervention", "devices": "Inspire HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "Insomnia or difficulty falling and or staying asleep is experienced by up to 30\\% of the general population. This randomised crossover double-blind placebo-controlled 6-week trial aimed to assess the tolerability and effectiveness of the Entoura-10:15 medicinal cannabis oil on sleep in adults with insomnia. A total of 29 participants with self-reported clinical insomnia completed the crossover trial. Participants were randomly allocated to receive placebo or active oil containing 10 mg/ml tetrahydrocannabinol (THC) and 15 mg/ml cannabidiol (CBD) over 2-weeks titrated 0.2-1.5 ml/day, followed by a 1-week wash-out period before crossover. Tolerability was assessed by daily diary. Effectiveness was measured by saliva midnight melatonin levels, validated questionnaires, i.e., the Insomnia Severity Index, and the Fitbit activity/sleep wrist tracker. Entoura-10:15 medicinal cannabis oil was generally well tolerated, and was effective in improving sleep, whereby 60\\% of participants no longer classified as clinical insomniacs at the end of the 2-week intervention period. Midnight melatonin levels significantly improved in the active group by 30\\% compared to a 20\\% decline in the placebo group (p = 0.035). Medicinal cannabis oil improved both time and quality of sleep, in particular light sleep increased by 21 min/night compared to placebo (p = 0.041). The quality of sleep improved overall by up to 80\\% in the active group (pPhase2  = 0.003), including higher daily functioning (p = 0.032). Observed effects were more pronounced in Phase 2 due to the period effect and loss of blinding. Entoura-10:15 medicinal cannabis oil was well tolerated and effective in improving sleep in adults with insomnia.", "links": [] }, { "title": "Objective and subjective measures of daily physical activity in persons with Multiple Sclerosis beginning a rehabilitation regime: A cross-sectional study", "author": "Torchio, Alessandro; Fusari, Giulia; Perini, Gloria; Crispiatico, Valeria; Grosso, Cristina; Cattaneo, Davide; Pagliari, Chiara; Jonsdottir, Johanna", "year": "2022", "journalProceedings": "Multiple Sclerosis and Related Disorders", "category": "Case Study", "devices": "Versa", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "INTRODUCTION: Fatigue, and balance and gait disorders can impact on physical activity (PA) levels in persons with Multiple Sclerosis (pwMS). To date, several studies have examined PA in pwMS during daily life, but little is known about PA levels in pwMS during a rehabilitation period. The present study investigated PA levels (daily steps, light physical activity (LPA), and moderate-vigorous physical activity (MVPA)) in inpatient and outpatients with MS during their rehabilitation period and described the relationship between objectively measured PA and levels of disability, quality of life, fatigue, and self-efficacy. METHODS: In this exploratory cross-sectional study, we examined 40 pwMS during their inpatient or outpatient rehabilitation regime. Participants included in the study (N = 34) wore a Fitbit Versa tracker for one week recording daily steps, minutes of LPA, and minutes of MVPA (primary outcomes). They underwent a clinical assessment of physical activity levels (Godin Leisure-Time Exercise Questionnaire(GLTEQ)), fatigue (Fatigue Severity Scale(FSS)), walking ability (10 Meter Walk Test(10MWT), 2-Min Walk Test(2MWT), 12-item Multiple Sclerosis Walking scale(MSWS-12)), quality of life (12-Item Short Form Survey (SF-12)), and self-efficacy (Self-Efficacy in Multiple Sclerosis scale (SEMS)) (secondary outcomes). Multiple linear regressions (MLR) models were used to test whether the demographic difference between the two groups influenced the estimation of objective variables measured by Fitbit. Finally, correlations between objectively measured physical activity and subjective clinical scales were estimated with Spearman correlations. RESULTS: Our sample consisted of 21 females and 13 males with a mean (interquartile range) age of 52 (20) years and an Expanded Disability Status scale(EDSS) score of 6.0 (1.50) points; baseline characteristics of inpatients (N = 18) and outpatients (N = 16) differed statistically only in EDSS levels (p-value = 0.008) and use of assistive devices (p=0.007). The whole sample performed (mean±standard deviation) 3969±2190 steps per day, with no significant difference between inpatients (3318±1515) and outpatients (4660±2606). No statistical difference was found between the groups in LPA (p-value=0.064). A significant difference in MVPA (p-value {\\textless} 0.001) was found between inpatients and outpatients, 1.52±3.98 and 14.69±11.56 min per day, respectively. Significant correlations were found between FSS and MVPA both in the whole sample (r(32)= -0.62, p {\\textless} 0.001) and in the outpatients group (r(14) = -0.66, p = 0.005), and between 10MWT and daily steps (whole sample:(r(32) = 0.48, p = 0.005), outpatients:(r(14)= -0.51, p = 0.05)). CONCLUSIONS: PwMS in our study overall engaged in reduced and less intense levels of daily PA with respect to the guidelines with inpatients performing almost no vigorous activities. Considering the importance of PA in improving physical and mental well-being, clinicians and researchers should develope strategies to increase daily PA of PwMS during their rehabilitation programs and daily life.", "links": [] }, { "title": "Personal Devices to Monitor Physical Activity and Nutritional Intake After Colorectal Cancer Surgery: Feasibility Study", "author": "van der Linden, Manouk J. W.; Nahar van Venrooij, Lenny M. W.; Verdaasdonk, Emiel G. G.", "year": "2022", "journalProceedings": "JMIR perioperative medicine", "category": "Usability", "devices": "Charge 3", "population": "Adults", "dataUsed": "User Friendliness", "abstract": "BACKGROUND: The use of self-monitoring devices is promising for improving perioperative physical activity and nutritional intake. OBJECTIVE: This study aimed to assess the feasibility, usability, and acceptability of a physical activity tracker and digital food record in persons scheduled for colorectal cancer (CRC) surgery. METHODS: This observational cohort study was conducted at a large training hospital between November 2019 and November 2020. The study population consisted of persons with CRC between 18- and 75 years of age who were able to use a smartphone or tablet and scheduled for elective surgery with curative intent. Excluded were persons not proficient in Dutch or following a protein-restricted diet. Participants used an activity tracker (Fitbit Charge 3) from 4 weeks before until 6 weeks after surgery. In the week before surgery (preoperative) and the fifth week after surgery (postoperative), participants also used a food record for 1 week. They shared their experience regarding usability (system usability scale, range 0-100) and acceptability (net promoter score, range -100 to +100). RESULTS: In total, 28 persons were included (n=16, 57\\% male, mean age 61, SD 8 years), and 27 shared their experiences. Scores regarding the activity tracker were as follows: preoperative median system usability score, 85 (IQR 73-90); net promoter score, +65; postoperative median system usability score, 78 (IQR 68-85); net promotor score, +67. The net promoter scores regarding the food record were +37 (preoperative) and-7 (postoperative). CONCLUSIONS: The perioperative use of a physical activity tracker is considered feasible, usable, and acceptable by persons with CRC in this study. Preoperatively, the use of a digital food record was acceptable, and postoperatively, the acceptability decreased.", "links": [] }, { "title": "Usability and acceptability of wearable technology in the early detection of dementia", "author": "Wilson, Sarah; Ardle, Ríona Mc; Tolley, Clare; Slight, Sarah", "year": "2022", "journalProceedings": "Alzheimer's \\& Dementia: The Journal of the Alzheimer's Association", "category": "Usability", "devices": "Charge 4", "population": "Adults", "dataUsed": "User Friendliness", "abstract": "BACKGROUND: The Early Detection of Neurodegeneration (EDoN) is a global initiative that aims to explore the potential of wearable technologies and smartphone applications to detect preclinical dementia, with aspirations to validate a digital toolkit for clinical practice. To enhance the development of an inclusive digital toolkit, we conducted a study to assess the usability and acceptability of different digital devices in people with cognitive impairments and their carers. METHOD: Recruitment was conducted across various UK networks such as Join Dementia Research. Participants received the EDoN toolkit, which includes a smartwatch (Fitbit Charge 4), EEG headband (Dreem 3) and two smartphone applications (Longevity and Mezurio). Guides were provided to support the setup process. Initial interviews were conducted approximately three days after the participant received the devices, to explore initial perspectives regarding the toolkit and experiences of the setup process. Follow-up interviews were conducted two weeks later to explore the acceptability and usability of the toolkit. NVivo was used to thematically analyse the interview transcripts. Emerging themes were discussed and refined by the research group. RESULT: Sixteen semi-structured interviews were conducted with nine participants, at two-time points. Four participants had mild cognitive impairment, two had frontotemporal dementia, one had Alzheimer's and two were carers. We identified three key themes, which centred around usability, acceptability and inequity. Participants expressed the wearable devices were comfortable but individuals with physical disabilities or cognitive impairments struggled to use some devices. Participants valued the feedback the devices provided such as information on sleep and heart rate, although some information was not fully understood. Participants also shared their concerns around detecting preclinical dementia and the increased anxiety around the consequences of this such as being put in a home\". Various inequities of the toolkit were uncovered such as digital exclusion relating to a lack of access to strong WiFi connection", "links": [] }, { "title": "Use of coaching and technology to improve blood pressure control in Black women with hypertension: Pilot randomized controlled trial study", "author": "Abel, Willie M.; Efird, Jimmy T.; Crane, Patricia B.; Ferdinand, Keith C.; Foy, Capri G.; DeHaven, Mark J.", "year": "2023", "journalProceedings": "Journal of Clinical Hypertension (Greenwich, Conn.)", "category": "Case Study", "devices": "Inspire HR", "population": "Adults", "dataUsed": "Steps,Weight", "abstract": "Hypertension is the main cause of cardiovascular disease, especially in women. Black women (58\\%) are affected by higher rates of hypertension than other racial/ethnic groups contributing to increased cardio-metabolic disorders. To decrease blood pressure (BP) in this population, a pilot randomized controlled trial was conducted to examine the effects of Interactive Technology Enhanced Coaching (ITEC) versus Interactive Technology (IT) alone in achieving BP control, adherence to antihypertensive medication, and adherence to lifestyle modifications among Black women diagnosed with and receiving medication for their hypertension. Participants completed a 6-week Chronic Disease Self-Management Program (CDSMP), and 83 participants were randomly assigned to ITEC versus IT. Participants were trained to use three wireless tools and five apps that were synchronized to smartphones to monitor BP, weight, physical activity (steps), diet (caloric and sodium intake), and medication adherence. Fitbit Plus, a cloud-based collaborative care platform was used to collect, track, and store data. Using a mixed-effects repeated measures model, the main effect of group means indicated no significant difference between the treatment and referent groups on study variables. The main effect of time indicated significant differences between repeated measures for systolic BP (p {\\textless} .0001), weight (p {\\textless} .0001), and steps (p = .018). An interaction effect revealed differences over time and was significant for study measures except diastolic BP. An important goal of this preliminary analysis is to help Black women prioritize self-care management in their everyday environment. Future research is warranted in a geographically broader population of hypertensive Black women.", "links": [] }, { "title": "Magnetic field interactions of smartwatches and portable electronic devices with CIEDs - Did we open a Pandora's box?", "author": "Badertscher, Patrick; Vergne, Céline; Féry, Corentin; Mannhart, Diego; Quirin, Thomas; Osswald, Stefan; Kühne, Michael; Sticherling, Christian; Knecht, Sven; Pascal, Joris", "year": "2022", "journalProceedings": "International Journal of Cardiology. Heart \\& Vasculature", "category": "Review", "devices": "Sense", "population": "NA", "dataUsed": "NA", "abstract": "INTRODUCTION: Magnetic interaction of portable electronic devices (PEDs), such as state-of-the art mobile phones, with cardiovascular implantable electronic devices (CIEDs) has been reported. The aim of the study was to quantify the magnetic fields of latest generation smartwatches and other PEDs and to evaluate and predict their risk of CIED interactions. METHODS: High resolution magnetic field characterization of five smartwatches (Apple Watch 6/7, Fitbit Sense, Samsung Galaxy 3, Withings Scanwatch) was performed using a novel magnetic field camera. Ex vivo measurements of the minimal safety distance (MSD) at which no mode switch can be observed were performed between 11 PEDs and six representative CIEDs. RESULTS: Maximal 1 mT distances ranged between 10 mm (Withings) and 19 mm (Fitbit and AppleWatch), and 1 mT volumes between 6 cm3 (Withings) and 19 cm3 (Fitbit). All these measures were observed only for the back side of the smartwatches. While most smartwatches with measured 1 mT distance {\\textless} 15 mm posed low ex vivo interaction within a distance of {\\textless} 10 mm, PEDs such as electronic pens and in-ear-headphones with measured 1 mT distance {\\textgreater} 15 mm showed device interaction up to {\\textgreater} 15 mm. Linear regression analysis showed a linear relationship of the MSD with 1 mT distance (B coefficient: 0.46; 95 \\%-CI: 0.25-0.67, p {\\textless} 0.001). CONCLUSION: Smartwatches are safer compared to other PEDs such as electronic pens or in-ear headphones with regards to CIED interaction. With a standardized magnetic field camera, the risk assessment of CIED interaction of novel PEDs is feasible.", "links": [] }, { "title": "Detailed Versus Simplified Dietary Self-monitoring in a Digital Weight Loss Intervention Among Racial and Ethnic Minority Adults: Fully Remote, Randomized Pilot Study", "author": "Patel, Michele L.; Cleare, Angel E.; Smith, Carly M.; Rosas, Lisa Goldman; King, Abby C.", "year": "2022", "journalProceedings": "JMIR formative research", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "BACKGROUND: Detailed self-monitoring (or tracking) of dietary intake is a popular and effective weight loss approach that can be delivered via digital tools, although engagement declines over time. Simplifying the experience of self-monitoring diet may counteract this decline in engagement. Testing these strategies among racial and ethnic minority groups is important as these groups are often disproportionately affected by obesity yet underrepresented in behavioral obesity treatment. OBJECTIVE: In this 2-arm pilot study, we aimed to evaluate the feasibility and acceptability of a digital weight loss intervention with either detailed or simplified dietary self-monitoring. METHODS: We recruited racial and ethnic minority adults aged ≥21 years with a BMI of 25 kg/m2 to 45 kg/m2 and living in the United States. The Pacific time zone was selected for a fully remote study. Participants received a 3-month stand-alone digital weight loss intervention and were randomized 1:1 to either the detailed arm that was instructed to self-monitor all foods and drinks consumed each day using the Fitbit mobile app or to the simplified arm that was instructed to self-monitor only red zone foods (foods that are highly caloric and of limited nutritional value) each day via a web-based checklist. All participants were instructed to self-monitor both steps and body weight daily. Each week, participants were emailed behavioral lessons, action plans, and personalized feedback. In total, 12 a priori benchmarks were set to establish feasibility, including outcomes related to reach, retention, and self-monitoring engagement (assessed objectively via digital tools). Acceptability was assessed using a questionnaire. Weight change was assessed using scales shipped to the participants' homes and reported descriptively. RESULTS: The eligibility screen was completed by 248 individuals, of whom 38 (15.3\\%) were randomized, 18 to detailed and 20 to simplified. At baseline, participants had a mean age of 47.4 (SD 14.0) years and BMI of 31.2 (SD 4.8) kg/m2. More than half (22/38, 58\\%) were identified as Hispanic of any race. The study retention rate was 92\\% (35/38) at 3 months. The detailed arm met 9 of 12 feasibility benchmarks, while the simplified arm met all 12. Self-monitoring engagement was moderate to high (self-monitoring diet: median of 49\\% of days for detailed, 97\\% for simplified; self-monitoring steps: 99\\% for detailed, 100\\% for simplified; self-monitoring weight: 67\\% for detailed, 80\\% for simplified). Participants in both arms reported high satisfaction, with 89\\% indicating that they would recommend the intervention. Weight change was -3.4 (95\\% CI -4.6 to -2.2) kg for detailed and -3.3 (95\\% CI -4.4 to -2.2) kg for simplified. CONCLUSIONS: A digital weight loss intervention that incorporated either detailed or simplified dietary self-monitoring was feasible, with high retention and engagement, and acceptable to racial and ethnic minority adults. TRIAL REGISTRATION: ASPREDICTED \\#66674; https://aspredicted.org/ka478.pdf.", "links": [] }, { "title": "Sleep and seizure risk in epilepsy: bed and wake times are more important than sleep duration", "author": "Stirling, Rachel E.; Hidajat, Cindy M.; Grayden, David B.; D'Souza, Wendyl J.; Naim-Feil, Jodie; Dell, Katrina L.; Schneider, Logan D.; Nurse, Ewan; Freestone, Dean; Cook, Mark J.; Karoly, Philippa J.", "year": "2022", "journalProceedings": "Brain: A Journal of Neurology", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Sleep", "abstract": "Sleep duration, sleep deprivation and the sleep-wake cycle are thought to play an important role in the generation of epileptic activity and may also influence seizure risk. Hence, people diagnosed with epilepsy are commonly asked to maintain consistent sleep routines. However, emerging evidence paints a more nuanced picture of the relationship between seizures and sleep, with bidirectional effects between changes in sleep and seizure risk in addition to modulation by sleep stages and transitions between stages. We conducted a longitudinal study investigating sleep parameters and self-reported seizure occurrence in an ambulatory at-home setting using mobile and wearable monitoring. Sixty subjects wore a Fitbit smartwatch for at least 28 days while reporting their seizure activity in a mobile app. Multiple sleep features were investigated, including duration, oversleep and undersleep, and sleep onset and offset times. Sleep features in participants with epilepsy were compared to a large (n = 37921) representative population of Fitbit users, each with 28 days of data. For participants with at least 10 seizure days (n = 34), sleep features were analysed for significant changes prior to seizure days. A total of 4956 reported seizures (M = 83, SD = 130) and 30485 recorded sleep nights (M = 508, SD = 445) were included in the study. There was a trend for participants with epilepsy to sleep longer than the general population, although this difference was not significant. Just 5 of 34 participants showed a significant difference in sleep duration the night before seizure days compared to seizure-free days. However, 14 of 34 subjects showed significant differences between their sleep onset (bed) and/or offset (wake) times prior to seizure occurrence. In contrast to previous studies, the current study found undersleeping was associated with a marginal 2\\% decrease in seizure risk in the following 48 h (p {\\textless} 0.01). Nocturnal seizures were associated with both significantly longer sleep durations and increased risk of a seizure occurring in the following 48 h. Overall, the presented results demonstrated that day-to-day changes in sleep duration had a minimal effect on reported seizures, while patient-specific changes in bed- and wake-times were more important for identifying seizure risk the following day. Nocturnal seizures were the only factor that significantly increased the risk of seizures in the following 48 h on a group level. Wearables can be utilised to identify these sleep-seizure relationships and guide clinical recommendations or improve seizure forecasting algorithms.", "links": [] }, { "title": "Healthy hearts healthy minds: A randomized trial of online interventions to improve physical activity", "author": "Sylvia, Louisa G.; Gold, Alexandra K.; Rakhilin, Marina; Amado, Selen; Modrow, Madelaine Faulkner; Albury, Evan A.; George, Nevita; Peters, Amy T.; Selvaggi, Caitlin A.; Horick, Nora; Rabideau, Dustin J.; Dohse, Heidi; Tovey, Roberta E.; Turner, Jon A.; Schopfer, David W.; Pletcher, Mark J.; Katz, Doug; Deckersbach, Thilo; Nierenberg, Andrew A.", "year": "2023", "journalProceedings": "Journal of Psychosomatic Research", "category": "Intervention", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps", "abstract": "INTRODUCTION: Depressed individuals are more likely to die from cardiovascular disease (CVD) than those without depression. People with CVD have higher rates of depression than those without and have higher mortality rates if they have comorbid depression. While physical activity (PA) improves both, few people engage in enough. We compared self-guided internet-based cognitive behavior therapy (CBT) + Fitbit or mindfulness-based cognitive therapy (MBCT) + Fitbit, with Fitbit only to increase daily steps for participants with depression who have low PA. METHODS: Adult participants (N = 340) were recruited from two online patient-powered research networks and randomized to one of three study interventions for 8 weeks with an additional 8 weeks of follow-up. Using linear mixed effects models, we evaluated the effect of the intervention on average daily steps (NCT03373110). RESULTS: Average daily steps increased 2.8 steps per day in MBCT+Fitbit, 2.9 steps/day in CBT + Fitbit, but decreased 8.2 steps/day in Fitbit Only. These changes were not statistically different between the MBCT+Fitbit and CBT + Fitbit groups, but were different from Fitbit Only across the initial 8-week period. Group differences were not maintained across follow-up. Exploratory analyses identified comorbid anxiety disorders, self-reported PA, and employment status as moderators. DISCUSSION: Changes in daily steps over both 8- and 16-week periods-regardless of intervention group-were minimal. The results emphasize the limits of using self-guided web-based psychotherapy with an activity tracker to increase PA in participants with a history of depression and low PA.", "links": [] }, { "title": "Living labs for a mobile app-based health program: effectiveness of a 24-week walking intervention for cardiovascular disease risk reduction among female Korean-Chinese migrant workers: a randomized controlled trial", "author": "Kim, Youlim; Lee, Hyeonkyeong; Chung, Misook Lee", "year": "2022", "journalProceedings": "Archives of Public Health = Archives Belges De Sante Publique", "category": "Intervention", "devices": "Alta", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND: The risk of Cardiovascular disease (CVDs) among adult populations is influenced by environmental factors, and immigrant populations tend to be more vulnerable. This study examined the effectiveness of a 24-week walking program based on social-cognitive determinants through mobile app for CVD risk reduction among female Korean-Chinese middle-aged workers. METHODS: This study used a parallel randomized controlled trial. Participants were recruited by distributing posters and flyers and randomly assigned to either the standard treatment (ST, n = 22) or enhanced treatment group (ET, n = 28). Participants were provided with a mobile app linked to Fitbit Alta for 24 weeks and instructed to walk at least 30 minutes five times a week and moderate-intensity physical activity. The ET group had additional interventions that enhanced social-cognitive determinants such as self-efficacy, social support. All participants were guided to voluntary physical activity during the 12-week maintenance period. Data were analyzed by the Mann Whitney U-test and a generalized estimating equation. RESULTS: There were significant between-group differences regarding the number of steps (B = 1.295, P {\\textless} .001) and moderate physical activity time (OR = 6.396, P = .030) at week 12. ET group had significant changes in high-density lipoprotein cholesterol (B = 10.522, P = .007), low-density lipoprotein cholesterol (B = -16.178, P = .024), total cholesterol (B = -20.325, P = .039), fasting blood sugar (B = - 8.138, P = -.046). In addition, there was a significant reduction of 10-year CVD risk for the ET group over 12 weeks compared to the ST group (B = -0.521, P{\\textless}. 001). CONCLUSIONS: Long-term studies are needed to reduce the risk of cardiovascular disease in large-scale migrant workers and to confirm the direct and insdirect effects of social-cognitive determinants on health outcomes. TRIAL REGISTRATION: The trial was retrospectively registered in WHO ICTRP (KCT0006467) August 19th, 2021. ( https://trialsearch.who.int/Trial2.aspx?TrialID=KCT0006467.", "links": [] }, { "title": "Prescribing Time in Nature for Human Health and Well-Being: Study Protocol for Tailored Park Prescriptions", "author": "Schultz, Courtney L.; Bocarro, Jason N.; Hipp, J. Aaron; Bennett, Gary J.; Floyd, Myron F.", "year": "2022", "journalProceedings": "Frontiers in Digital Health", "category": "Methods", "devices": "Flex 2", "population": "Patients", "dataUsed": "Steps", "abstract": "BACKGROUND: eHealth technologies offer an efficient method to integrate park prescriptions into clinical practice by primary health care (PHC) providers to help patients improve their health via tailored, nature-based health behavior interventions. This paper describes the protocol of the GoalRx Prescription Intervention (GPI) which was designed to leverage community resources to provide tailored park prescriptions for PHC patients. METHODS: The GPI study was designed as a 3-arm, multi-site observational study. We enrolled low-income, rural adults either at-risk of or living with hypertension or diabetes (n = 75) from Federally Qualified Health Centers (FQHC) in two counties in North Carolina, USA into the 3-month intervention. Eligible participants self-selected to receive (1) a tailored park prescription intervention; (2) a tailored home/indoor PA prescription intervention; or (3) a healthy eating prescription (with no PA prescription beyond standard PA counseling advice that is already routinely provided in PHC) as the comparison group. The GPI app paired patient health data from the electronic health record with stated patient preferences and triggered app-integrated SMS motivation and compliance messaging directly to the patient. Patients were assessed at baseline and at a 3-month follow-up upon the completion of the intervention. The primary outcome (mean difference in weekly physical activity from baseline (T0) to post-intervention (T1) as measured by the Fitbit Flex 2) was assessed at 3 months. Secondary outcomes included assessment of the relationship between the intervention and biological markers of health, including body mass index (BMI), systolic and diastolic blood pressure, HbA1c or available glucose test (if applicable), and a depression screen score using the Patient Health Questionnaire 9. Secondary outcomes also included the total number of SMS messages sent, number of SMS messages responded to, number of SMS messages ignored, and opt-out rate. DISCUSSION: The goal was to create a protocol utilizing eHealth technologies that addressed the specific needs of rural low-income communities and fit into the natural rhythms and processes of the selected FQHC clinics in North Carolina. This protocol offered a higher standard of health care by connecting patients to their PHC teams and increasing patient motivation to make longer-lasting health behavior changes.", "links": [] }, { "title": "Telehealth acceptance and commitment therapy for weight loss: Protocol of the WeLNES full scale randomized controlled trial", "author": "Bricker, Jonathan B.; Mull, Kristin E.; Sullivan, Brianna M.; Forman, Evan M.; Lillis, Jason; McTiernan, Anne; Santiago-Torres, Margarita", "year": "2023", "journalProceedings": "Contemporary Clinical Trials", "category": "Intervention", "devices": "Inspire", "population": "Adults", "dataUsed": "Steps,Food", "abstract": "Behavioral interventions delivered via one-on-one telephone coaching (hereafter referred to as telehealth) for weight loss have had great population-level reach but to date limited efficacy. Acceptance and Commitment Therapy (ACT) has promise to improve behavioral weight loss treatment efficacy by addressing the fundamental challenges of weight loss and maintenance: overeating in response to internal (e.g., stress) and external (e.g., high calorie foods) cues. Here we describe the Weight Loss, Nutrition, and Exercise Study (WeLNES) randomized controlled trial that is testing the efficacy of an ACT-based telehealth coaching intervention for weight loss in comparison to a Standard Behavioral Therapy (SBT)-based telehealth coaching intervention. A total of 398 adults with overweight or obesity are being recruited and randomized to either ACT or SBT telehealth coaching. Participants in both arms are offered twenty-five telehealth coaching sessions in year one and nine booster sessions in year two. All participants receive a Bluetooth-enabled scale to self-monitor weight and a Fitbit Inspire + Fitbit app for tracking diet and physical activity. The primary aim is to determine whether a greater proportion of ACT participants will achieve a clinically significant weight loss of ≥10\\% compared with SBT participants at 12-months. Secondary outcomes include change in weight from baseline to 6, 12, and 24-months. Whether the effect of ACT on weight loss is mediated by ACT processes and is moderated by baseline factors will also be examined. If ACT proves efficacious, ACT telehealth coaching will offer an effective, broadly scalable weight loss treatment-thereby making a high public health impact.", "links": [] }, { "title": "Design and rationale of a pilot randomized clinical trial investigating the use of a mHealth app for sarcoidosis-associated fatigue", "author": "Chandler, Jessica; Christon, Lillian M.; Benfield, Katie; Pairet, Samantha; Hoffman, Maria; Treiber, Frank; Mueller, Martina; James, W. Ennis", "year": "2023", "journalProceedings": "Contemporary Clinical Trials Communications", "category": "Methods", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Heart Rate", "abstract": "Fatigue is the most reported symptom in patients with sarcoidosis (SPs) and is a significant predictor of decreased quality of life that is strongly associated with stress and negative mood states. Few medications exist for treating fatigue in SPs, and outpatient physical rehabilitation programs are limited by availability and cost. Sarcoidosis in the US predominantly impacts minorities and underserved populations who are of working age and often have limited resources (e.g., financial, transportation, time off work) that may prevent them from attending in-person programs. The use of mobile health (mHealth) is emerging as a viable alternative to provide access to self-management resources to improve quality of life. The Sarcoidosis Patient Assessment and Resource Companion (SPARC) App is a sarcoidosis-specific mHealth App intended to improve fatigue and stress in SPs. It prompts SPs to conduct breathing awareness meditation (BAM) and contains educational modules aimed at improving self-efficacy. Herein we describe the design and methods of a 3-month randomized control trial comparing use of the SPARC App (10-min BAM twice daily) to standard care in 50 SPs with significant fatigue (FAS ≥22). A Fitbit® watch will provide immediate heartrate feedback after BAM sessions to objectively monitor adherence. The primary outcomes are feasibility and usability of the SPARC App (collected monthly). Secondary endpoints include preliminary efficacy at improving fatigue, stress, and quality of life. We expect the SPARC App to be a useable and feasible intervention that has potential to overcome barriers of more traditional in-person programs.", "links": [] }, { "title": "The Feasibility of Implementing Remote Measurement Technologies in Psychological Treatment for Depression: Mixed Methods Study on Engagement", "author": "de Angel, Valeria; Adeleye, Fadekemi; Zhang, Yuezhou; Cummins, Nicholas; Munir, Sara; Lewis, Serena; Laporta Puyal, Estela; Matcham, Faith; Sun, Shaoxiong; Folarin, Amos A.; Ranjan, Yatharth; Conde, Pauline; Rashid, Zulqarnain; Dobson, Richard; Hotopf, Matthew", "year": "2023", "journalProceedings": "JMIR mental health", "category": "Validation", "devices": "Charge 4", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "BACKGROUND: Remote measurement technologies (RMTs) such as smartphones and wearables can help improve treatment for depression by providing objective, continuous, and ecologically valid insights into mood and behavior. Engagement with RMTs is varied and highly context dependent; however, few studies have investigated their feasibility in the context of treatment. OBJECTIVE: A mixed methods design was used to evaluate engagement with active and passive data collection via RMT in people with depression undergoing psychotherapy. We evaluated the effects of treatment on 2 different types of engagement: study attrition (engagement with study protocol) and patterns of missing data (engagement with digital devices), which we termed data availability. Qualitative interviews were conducted to help interpret the differences in engagement. METHODS: A total of 66 people undergoing psychological therapy for depression were followed up for 7 months. Active data were gathered from weekly questionnaires and speech and cognitive tasks, and passive data were gathered from smartphone sensors and a Fitbit (Fitbit Inc) wearable device. RESULTS: The overall retention rate was 60\\%. Higher-intensity treatment (χ21=4.6; P=.03) and higher baseline anxiety (t56.28=-2.80, 2-tailed; P=.007) were associated with attrition, but depression severity was not (t50.4=-0.18; P=.86). A trend toward significance was found for the association between longer treatments and increased attrition (U=339.5; P=.05). Data availability was higher for active data than for passive data initially but declined at a sharper rate (90\\%-30\\% drop in 7 months). As for passive data, wearable data availability fell from a maximum of 80\\% to 45\\% at 7 months but showed higher overall data availability than smartphone-based data, which remained stable at the range of 20\\%-40\\% throughout. Missing data were more prevalent among GPS location data, followed by among Bluetooth data, then among accelerometry data. As for active data, speech and cognitive tasks had lower completion rates than clinical questionnaires. The participants in treatment provided less Fitbit data but more active data than those on the waiting list. CONCLUSIONS: Different data streams showed varied patterns of missing data, despite being gathered from the same device. Longer and more complex treatments and clinical characteristics such as higher baseline anxiety may reduce long-term engagement with RMTs, and different devices may show opposite patterns of missingness during treatment. This has implications for the scalability and uptake of RMTs in health care settings, the generalizability and accuracy of the data collected by these methods, feature construction, and the appropriateness of RMT use in the long term.", "links": [] }, { "title": "Linking Electronic Health Records With Wearable Technology From the All of Us Research Program", "author": "Epstein, Crystal Modde; McCoy, Thomas P.", "year": "2023", "journalProceedings": "Journal of obstetric, gynecologic, and neonatal nursing: JOGNN", "category": "Usability", "devices": "Device unspecified", "population": "Pregnant Women", "dataUsed": "Heart Rate", "abstract": "OBJECTIVE: To evaluate the feasibility of using electronic health records (EHRs) and wearable data to describe patterns of longitudinal change in day-level heart rate before, during, and after pregnancy and how these patterns differ by age and body mass index. DESIGN: Descriptive secondary analysis feasibility study using data from the National Institutes of Health All of Us Research Program. SETTING: United States. PARTICIPANTS: Women (N = 89) who had a birth or length of gestation code in the EHR and at least 60 days of Fitbit heart rate data during pregnancy. METHODS: We estimated pregnancy-related episodes using EHR codes. Time consisted of five 3-month periods: before pregnancy, first trimester, second trimester, third trimester, and after birth. We analyzed data using descriptive statistics and locally estimated scatterplot smoothing. RESULTS: An average of 330 days (SD = 112) of Fitbit heart rate data (29,392 days) were available from participants. During pregnancy, distinct peaks in heart rate occurred during the first trimester (6\\% increase) and third trimester (15\\% increase). CONCLUSION: Future researchers can examine whether longitudinal timing and patterns of heart rate from wearable devices could be leveraged to detect health problems early in pregnancy.", "links": [] }, { "title": "Feasibility and Acceptability of a Preoperative Multimodal Mobile Health Assessment in Spine Surgery Candidates", "author": "Greenberg, Jacob K.; Frumkin, Madelyn R.; Javeed, Saad; Zhang, Justin K.; Dai, Ruixuan; Molina, Camilo A.; Pennicooke, Brenton H.; Agarwal, Nitin; Santiago, Paul; Goodwin, Matthew L.; Jain, Deeptee; Pallotta, Nicholas; Gupta, Munish C.; Buchowski, Jacob M.; Leuthardt, Eric C.; Ghogawala, Zoher; Kelly, Michael P.; Hall, Bruce L.; Piccirillo, Jay F.; Lu, Chenyang; Rodebaugh, Thomas L.; Ray, Wilson Z.", "year": "2022", "journalProceedings": "Neurosurgery", "category": "Usability", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Heart Rate,User Friendliness", "abstract": "BACKGROUND: Rapid growth in smartphone use has expanded opportunities to use mobile health (mHealth) technology to collect real-time patient-reported and objective biometric data. These data may have important implication for personalized treatments of degenerative spine disease. However, no large-scale study has examined the feasibility and acceptability of these methods in spine surgery patients. OBJECTIVE: To evaluate the feasibility and acceptability of a multimodal preoperative mHealth assessment in patients with degenerative spine disease. METHODS: Adults undergoing elective spine surgery were provided with Fitbit trackers and sent preoperative ecological momentary assessments (EMAs) assessing pain, disability, mood, and catastrophizing 5 times daily for 3 weeks. Objective adherence rates and a subjective acceptability survey were used to evaluate feasibility of these methods. RESULTS: The 77 included participants completed an average of 82 EMAs each, with an average completion rate of 86\\%. Younger age and chronic pulmonary disease were significantly associated with lower EMA adherence. Seventy-two (93\\%) participants completed Fitbit monitoring and wore the Fitbits for an average of 247 hours each. On average, participants wore the Fitbits for at least 12 hours per day for 15 days. Only worse mood scores were independently associated with lower Fitbit adherence. Most participants endorsed positive experiences with the study protocol, including 91\\% who said they would be willing to complete EMAs to improve their preoperative surgical guidance. CONCLUSION: Spine fusion candidates successfully completed a preoperative multimodal mHealth assessment with high acceptability. The intensive longitudinal data collected may provide new insights that improve patient selection and treatment guidance.", "links": [] }, { "title": "Systematic Review of Fitbit Charge 2 Validation Studies for Exercise Tracking", "author": "Irwin, Crista; Gary, Rebecca", "year": "2022", "journalProceedings": "Translational Journal of the American College of Sports Medicine", "category": "Validation,Systematic Review", "devices": "Charge 2", "population": "NA", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "CONTEXT: There are research-grade devices that have been validated to measure either heart rate (HR) by electrocardiography (ECG) with a Polar chest strap, or step count with ACTiGraph accelerometer. However, wearable activity trackers that measure HR and steps concurrently have been tested against research-grade accelerometers and HR monitors with conflicting results. This review examines validation studies of the Fitbit Charge 2 (FBC2) for accuracy in measuring HR and step count and evaluates the device's reliability for use by researchers and clinicians. DESIGN: This registered review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The robvis (risk-of-bias visualization) tool was used to assess the strength of each considered article. ELIGIBILITY CRITERIA: Eligible articles published between 2018 and 2019 were identified using PubMed, CINHAL, Embase, Cochran, and World of Science databases and hand-searches. All articles were HR and/or step count validation studies for the FBC2 in adult ambulatory populations. STUDY SELECTION: Eight articles were examined in accordance with the eligibility criteria alignment and agreement among the authors and research librarian. MAIN OUTCOME MEASURES: Concordance correlation coefficients (CCC) were used to measure agreement between the tracker and criterion devices. Mean absolute percent error (MAPE) was used to average the individual absolute percent errors. RESULTS: Studies that measured CCC found agreement between the FBC2 and criterion devices ranged between 26\\% and 92\\% for HR monitoring, decreasing in accuracy as exercise intensity increased. Inversely, CCC increased from 38\\% to 99\\% for step count when exercise intensity increased. HR error between MAPE was 9.21\\% to 68\\% and showed more error as exercise intensity increased. Step measurement error MAPE was 12\\% for healthy persons aged 24-72 years but was reported at 46\\% in an older population with heart failure. CONCLUSIONS: Relative agreement with criterion and low-to-moderate MAPE were consistent in most studies reviewed and support validation of the FBC2 to accurately measure HR at low or moderate exercise intensities. However, more investigation controlling testing and measurement congruency is needed to validate step capabilities. The literature supports the validity of the FBC2 to accurately monitor HR, but for step count is inconclusive so the device may not be suitable for recommended use in all populations.", "links": [] }, { "title": "An online mental health informed physical activity intervention for emergency service workers and their families: A stepped-wedge trial", "author": "McKeon, Grace; Wells, Ruth; Steel, Zachary; Hadzi-Pavlovic, Dusan; Teasdale, Scott; Vancampfort, Davy; Rosenbaum, Simon", "year": "2023", "journalProceedings": "Digital Health", "category": "Intervention", "devices": "Inspire", "population": "Adults", "dataUsed": "Steps", "abstract": "OBJECTIVE: Emergency service workers are at risk of experiencing poor mental health due to repeated exposure to potentially traumatic events. Promoting healthy lifestyle factors may help improve health outcomes and quality of life among this population. This study aimed to evaluate the efficacy of a 10-week physical activity (PA) and diet programme delivered via Facebook for sedentary emergency service workers and their support partners on levels of psychological distress. METHODS: We delivered a 10-week intervention via a private Facebook group facilitated by exercise physiologists, a dietitian and peer-facilitators. Weekly education modules and telehealth calls were delivered, and participants were provided with a PA tracking device (Fitbit accelerometer). A stepped-wedge design was applied to compare levels of psychological distress (K6) during baseline, to intervention by comparing slopes of change. Secondary pre-post outcomes included mental health symptoms, PA, quality of life, social support to exercise, sleep quality and suicidal ideation. RESULTS: In total, N=90 participants (n=47 emergency service workers and n=43 support partners) were recruited in 4 cohorts (aged 42.3±11.5 years, 51\\% male). Levels of psychological distress did not change significantly during the baseline (control) slope and reduced significantly during the first 6 weeks of intervention (intervention slope 1). The slopes were significantly different, b=-0.351, p = 0.003 (i.e. the trajectories of change) and improvements plateaued until follow up. Retention was high (92\\%) and improvements in mental health symptoms, minutes of PA, sedentary time and quality of life were significant. CONCLUSIONS: Our intervention delivered via social media is feasible and associated with reduced levels of psychological distress among emergency service workers and support partners. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN): 12619000877189.", "links": [] }, { "title": "Piloting HealthScore: Feasibility and acceptability of a clinically integrated health coaching program for people living with cancer", "author": "Wood, William A.; Bailey, Carly; Castrogivanni, Brianna; Mehedint, Diana; Bryant, Ashley Leak; Lavin, Kyle; Tan, Xianming; Richardson, Jaime; Qian, Yiqing; Tan, Kelly R.; Kent, Erin E.", "year": "2023", "journalProceedings": "Cancer Medicine", "category": "Intervention", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps,Heart Rate,User Friendliness", "abstract": "BACKGROUND: Cancer supportive care interventions often have limited generalizability, goal misalignment, and high costs. We developed and piloted a health coaching intervention, UNC HealthScore, in patients undergoing cancer treatment (ClinicalTrials.gov identifier NCT04923997). We present feasibility, acceptability, and preliminary outcome data. METHODS: HealthScore is a six-month, theory-based, multicomponent intervention delivered through participant-driven coaching sessions. For the pilot study, participants were provided a Fitbit, responded to weekly symptom and physical function digital surveys, and met with a health coach weekly to develop and monitor goals. Coaching notes were discussed in weekly interdisciplinary team meetings and provided back to the treating oncology team. Symptom alerts were monitored and triaged through a study resource nurse to relevant supportive care services. Feasibility was determined based on intervention enrollment and completion. Acceptability was based on satisfaction with coaching and Fitbit-wearing and was informed by semistructured exit interviews. Outcomes evaluated for signs of improvement included several PROMIS (Patient-Reported Outcomes Measurement Information System) measures, including the primary intervention target, physical function. RESULTS: From May 2020 to March 2022, 50 participants completed the single-arm pilot. Feasibility was high: 66\\% enrolled and 71\\% completed the full intervention. Participants reported an average of 4.8 and 4.7 (out of 5) on the acceptability of coaching calls and using the Fitbit, respectively. Physical function scores rose 3.1 points (SE = 1.1) from baseline to 3 months, and 4.3 (SE = 1.0) from baseline to 6 months, above established minimal clinically important difference (MCID). Improvements above MCID were also evident in anxiety and depression, and smaller improvements were demonstrated for emotional support, social isolation, cognitive function, symptom burden, and self-efficacy. DISCUSSION: HealthScore shows feasibility, acceptability, and promising preliminary outcomes. Randomized studies are underway to determine the efficacy of preserving physical function in patients with advanced cancer.", "links": [] }, { "title": "LifeSnaps, a 4-month multi-modal dataset capturing unobtrusive snapshots of our lives in the wild", "author": "Yfantidou, Sofia; Karagianni, Christina; Efstathiou, Stefanos; Vakali, Athena; Palotti, Joao; Giakatos, Dimitrios Panteleimon; Marchioro, Thomas; Kazlouski, Andrei; Ferrari, Elena; Girdzijauskas, Šarūnas", "year": "2022", "journalProceedings": "Scientific Data", "category": "Survey Research", "devices": "Sense", "population": "Older Adults,Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance,Sleep,Heart Rate", "abstract": "Ubiquitous self-tracking technologies have penetrated various aspects of our lives, from physical and mental health monitoring to fitness and entertainment. Yet, limited data exist on the association between in the wild large-scale physical activity patterns, sleep, stress, and overall health, and behavioral and psychological patterns due to challenges in collecting and releasing such datasets, including waning user engagement or privacy considerations. In this paper, we present the LifeSnaps dataset, a multi-modal, longitudinal, and geographically-distributed dataset containing a plethora of anthropological data, collected unobtrusively for the total course of more than 4 months by n = 71 participants. LifeSnaps contains more than 35 different data types from second to daily granularity, totaling more than 71 M rows of data. The participants contributed their data through validated surveys, ecological momentary assessments, and a Fitbit Sense smartwatch and consented to make these data available to empower future research. We envision that releasing this large-scale dataset of multi-modal real-world data will open novel research opportunities and potential applications in multiple disciplines.", "links": [] }, { "title": "Selection of and Response to Physical Activity-Based Social Comparisons in a Digital Environment: Series of Daily Assessment Studies", "author": "Arigo, Danielle; Gray, Robert C.; Dallal, Diane H.; Villareale, Jennifer; Zhu, Jichen", "year": "2023", "journalProceedings": "JMIR human factors", "category": "Systematic Review", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Innovative approaches are needed to understand barriers to and facilitators of physical activity among insufficiently active adults. Although social comparison processes (ie, self-evaluations relative to others) are often used to motivate physical activity in digital environments, user preferences and responses to comparison information are poorly understood. OBJECTIVE: We used an iterative approach to better understand users' selection of comparison targets, how they interacted with their selected targets, and how they responded to these targets. METHODS: Across 3 studies, different samples of insufficiently active college students used the Fitbit system (Fitbit LLC) to track their steps per day as well as a separate, adaptive web platform each day for 7 to 9 days (N=112). The adaptive platform was designed with different layouts for each study; each allowed participants to select their preferred comparison target from various sets of options, view the desired amount of information about their selected target, and rate their physical activity motivation before and after viewing information about their selected target. Targets were presented as achieving physical activity at various levels below and above their own, which were accessed via the Fitbit system each day. We examined the types of comparison target selections, time spent viewing and number of elements viewed for each type of target, and day-level associations between comparison selections and physical activity outcomes (motivation and behavior). RESULTS: Study 1 (n=5) demonstrated that the new web platform could be used as intended and that participants' interactions with the platform (ie, the type of target selected, the time spent viewing the selected target's profile, and the number of profile elements viewed) varied across the days. Studies 2 (n=53) and 3 (n=54) replicated these findings; in both studies, age was positively associated with time spent viewing the selected target's profile and the number of profile elements viewed. Across all studies, upward targets (who had more steps per day than the participant) were selected more often than downward targets (who had fewer steps per day than the participant), although only a subset of either type of target selection was associated with benefits for physical activity motivation or behavior. CONCLUSIONS: Capturing physical activity-based social comparison preferences is feasible in an adaptive digital environment, and day-to-day differences in preferences for social comparison targets are associated with day-to-day changes in physical activity motivation and behavior. Findings show that participants only sometimes focus on the comparison opportunities that support their physical activity motivation or behavior, which helps explain previous, equivocal findings regarding the benefits of physical activity-based comparisons. Additional investigation of day-level determinants of comparison selections and responses is needed to fully understand how best to harness comparison processes in digital tools to promote physical activity.", "links": [] }, { "title": "The development of a family-based wearable intervention using behaviour change and co-design approaches: move and connect", "author": "Creaser, A. V.; Bingham, D. D.; Bennett, H. a. J.; Costa, S.; Clemes, S. A.", "year": "2023", "journalProceedings": "Public Health", "category": "Intervention", "devices": "Alta HR", "population": "Children,Adults", "dataUsed": "User Friendliness", "abstract": "BACKGROUND: Previous research has explored the effectiveness of wearable activity trackers (wearables) for increasing child physical activity (PA) levels, but there have been mixed results. The use of theoretical frameworks and co-design techniques are recognised ways of increasing an intervention's acceptability and effectiveness. AIMS: This study aims to use co-design workshops and an evidence-based theoretical framework (the Behaviour Change Wheel) to develop a family-based PA intervention using wearables. METHODS: Three stages of intervention development outlined by the Behaviour Change Wheel were used. Co-design workshops with seven families (11 parents and 12 children) and seven PA experts were conducted where stakeholders discussed how to overcome previously identified barriers to families being active and using wearables. This resulted in the intervention's components being developed, with each component's mechanisms of action (e.g. intervention functions and behaviour change techniques) being retrospectively identified. RESULTS: The 'Move \\& Connect' intervention was developed, which targets family PA and wearable use. The intervention takes a flexible approach and includes eight components, including wearable devices (Fitbit Alta HR), support resources, an introductory workshop, collective challenges, goal setting and reviewing, engagement prompts, social support and health-related resources (e.g. educational videos). The intervention incorporates six intervention functions targeting PA and wearable use: education, training, modelling, persuasion, incentivisation and environmental restructuring and 24 behaviour change techniques, including goal setting, social comparison, feedback on behaviour and graded task. CONCLUSIONS: This is the first known study to use an evidence-based framework and co-design to develop a family-based wearable intervention. The identification of the intervention's mechanisms of action will prove useful when implementing and evaluating the 'Move \\& Connect' intervention and allow researchers to replicate its components.", "links": [] }, { "title": "How many days are needed? Measurement reliability of wearable device data to assess physical activity", "author": "Hilden, Patrick; Schwartz, Joseph E.; Pascual, Christian; Diaz, Keith M.; Goldsmith, Jeff", "year": "2023", "journalProceedings": "PloS One", "category": "Intervention", "devices": "Flex", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "INTRODUCTION/PURPOSE: Physical activity studies often utilize wearable devices to measure participants' habitual activity levels by averaging values across several valid observation days. These studies face competing demands-available resources and the burden to study participants must be balanced with the goal to obtain reliable measurements of a person's longer-term average. Information about the number of valid observation days required to reliably measure targeted metrics of habitual activity is required to inform study design. METHODS: To date, the number of days required to achieve a desired level of aggregate long-term reliability (typically 0.80) has often been estimated by applying the Spearman-Brown Prophecy formula to short-term test-retest reliability data from studies with single, relatively brief observation windows. Our work, in contrast, utilizes a resampling-based approach to quantify the long-term test-retest reliability of aggregate measures of activity in a cohort of 79 participants who were asked to wear a FitBit Flex every day for approximately one year. RESULTS: The conventional approach can produce reliability estimates that substantially overestimate the actual test-retest reliability. Six or more valid days of observation for each participant appear necessary to obtain 0.80 reliability for the average amount of time spent in light physical activity; 8 and 10 valid days are needed for sedentary time and moderate/vigorous activity respectively. CONCLUSION: Protocols that result in 7-10 valid observation days for each participant may be needed to obtain reliable measurements of key physical activity metrics.", "links": [] }, { "title": "Are Activity Wrist-Worn Devices Accurate for Determining Heart Rate during Intense Exercise?", "author": "Martín-Escudero, Pilar; Cabanas, Ana María; Dotor-Castilla, María Luisa; Galindo-Canales, Mercedes; Miguel-Tobal, Francisco; Fernández-Pérez, Cristina; Fuentes-Ferrer, Manuel; Giannetti, Romano", "year": "2023", "journalProceedings": "Bioengineering (Basel, Switzerland)", "category": "Usability,Validation", "devices": "Charge", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "The market for wrist-worn devices is growing at previously unheard-of speeds. A consequence of their fast commercialization is a lack of adequate studies testing their accuracy on varied populations and pursuits. To provide an understanding of wearable sensors for sports medicine, the present study examined heart rate (HR) measurements of four popular wrist-worn devices, the (Fitbit Charge (FB), Apple Watch (AW), Tomtom runner Cardio (TT), and Samsung G2 (G2)), and compared them with gold standard measurements derived by continuous electrocardiogram examination (ECG). Eight athletes participated in a comparative study undergoing maximal stress testing on a cycle ergometer or a treadmill. We analyzed 1,286 simultaneous HR data pairs between the tested devices and the ECG. The four devices were reasonably accurate at the lowest activity level. However, at higher levels of exercise intensity the FB and G2 tended to underestimate HR values during intense physical effort, while the TT and AW devices were fairly reliable. Our results suggest that HR estimations should be considered cautiously at specific intensities. Indeed, an effective intervention is required to register accurate HR readings at high-intensity levels (above 150 bpm). It is important to consider that even though none of these devices are certified or sold as medical or safety devices, researchers must nonetheless evaluate wrist-worn wearable technology in order to fully understand how HR affects psychological and physical health, especially under conditions of more intense exercise.", "links": [] }, { "title": "Challenges of using a Fitbit smart wearable among people with dementia", "author": "O'Sullivan, Grace; Whelan, Barbara; Gallagher, Niamh; Doyle, Priscilla; Smyth, Siobhán; Murphy, Kathleen; Dröes, Rose-Marie; Devane, Declan; Casey, Dympna", "year": "2023", "journalProceedings": "International Journal of Geriatric Psychiatry", "category": "Usability", "devices": "Charge 3", "population": "Patients", "dataUsed": "Steps", "abstract": "OBJECTIVES: Limited research on using smart wearables such as Fitbit devices among people with dementia has shown favourable outcomes. The aim of this study was to explore the acceptability and feasibility of using a Fitbit Charge 3 among people with dementia, living in the community, who took part in the physical exercise component of the Comprehensive REsilience-building psychoSocial intervenTion pilot study. METHODS: A mixed methods study was conducted; Quantitative data relating to wear rates for the Fitbit were recorded and qualitative data were collected by group and individual interviews with the people with dementia and their caregiver about their experience of wearing/using the Fitbit in the study. RESULTS: Nine people with dementia and their caregiver completed the intervention. Only one participant wore the Fitbit consistently. Supporting set-up and use of the devices was time consuming and caregiver involvement was essential for day-to-day support: none of the people with dementia owned a smartphone. Few of them engaged with the Fitbit features, primarily only using it to check the time and only a minority wanted to keep the device beyond the intervention. DISCUSSION: When designing a study using smart wearables such as a Fitbit among people with dementia, consideration should be given to the following: the possible burden on caregivers supporting the use of the device; a lack of familiarity with this technology in the target population; dealing with missing data, and the involvement of the researcher in setting up and supporting use of the device.", "links": [] }, { "title": "Non-equivalent, but still valid: Establishing the construct validity of a consumer fitness tracker in persons with multiple sclerosis", "author": "Polhemus, Ashley; Sieber, Chloé; Haag, Christina; Sylvester, Ramona; Kool, Jan; Gonzenbach, Roman; von Wyl, Viktor", "year": "2023", "journalProceedings": "PLOS digital health", "category": "Validation", "devices": "Inspire HR", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Tools for monitoring daily physical activity (PA) are desired by persons with multiple sclerosis (MS). However, current research-grade options are not suitable for longitudinal, independent use due to their cost and user experience. Our objective was to assess the validity of step counts and PA intensity metrics derived from the Fitbit Inspire HR, a consumer-grade PA tracker, in 45 persons with MS (Median age: 46, IQR: 40-51) undergoing inpatient rehabilitation. The population had moderate mobility impairment (Median EDSS 4.0, Range 2.0-6.5). We assessed the validity of Fitbit-derived PA metrics (Step count, total time in PA, time in moderate to vigorous PA (MVPA)) during scripted tasks and free-living activity at three levels of data aggregation (minute, daily, and average PA). Criterion validity was assessed though agreement with manual counts and multiple methods for deriving PA metrics via the Actigraph GT3X. Convergent and known-groups validity were assessed via relationships with reference standards and related clinical measures. Fitbit-derived step count and time in PA, but not time in MVPA, exhibited excellent agreement with reference measures during scripted tasks. During free-living activity, step count and time in PA correlated moderately to strongly with reference measures, but agreement varied across metrics, data aggregation levels, and disease severity strata. Time in MVPA weakly agreed with reference measures. However, Fitbit-derived metrics were often as different from reference measures as reference measures were from each other. Fitbit-derived metrics consistently exhibited similar or stronger evidence of construct validity than reference standards. Fitbit-derived PA metrics are not equivalent to existing reference standards. However, they exhibit evidence of construct validity. Consumer-grade fitness trackers such as the Fitbit Inspire HR may therefore be suitable as a PA tracking tool for persons with mild or moderate MS.", "links": [] }, { "title": "Assessing the Suitability of a Virtual 'Pink Warrior' for Older Breast Cancer Survivors during COVID-19: A Pilot Study", "author": "Swartz, Maria C.; Robertson, Michael C.; Christopherson, Ursela; Wells, Stephanie J.; Lewis, Zakkoyya H.; Bai, Jinbing; Swartz, Michael D.; Silva, H. Colleen; Martinez, Eloisa; Lyons, Elizabeth J.", "year": "2023", "journalProceedings": "Life (Basel, Switzerland)", "category": "Intervention", "devices": "Alta HR", "population": "Patients", "dataUsed": "Steps,User Friendliness", "abstract": "The COVID-19 pandemic impacted the conduct of in-person physical activity (PA) interventions among older survivors of BC, who need such interventions to stay active and prevent functional decline. We tested the feasibility of virtually delivering an exergame-based PA intervention to older BC survivors. We enrolled 20 female BC survivors ≥55 years and randomly assigned them to two groups. The intervention group (Pink Warrior 2) received 12 weekly virtual exergame sessions with behavioral coaching, survivorship navigation support, and a Fitbit for self-monitoring. The control group received 12 weekly phone-based survivorship discussion sessions and wore a Mi Band 3. Feasibility was evaluated by rates of recruitment (≥0.92 participants/center/month), retention (≥80\\%), and group attendance (≥10 sessions), percentage of completed virtual assessments, and number of technology-related issues and adverse events. Intervention acceptability was measured by participants' ratings on a scale of 1 (strongly disagree) to 5 (strongly agree). The recruitment rate was 1.93. The retention and attendance rates were 90\\% and 88\\% (≥10 sessions), respectively. Ninety-six percent completed virtual assessments without an adverse event. Acceptability was high (≥4). The intervention met benchmarks for feasibility. Additional research is needed to further understand the impact of virtually delivered PA interventions on older BC survivors.", "links": [] }, { "title": "Wearable sensor-based performance status assessment in cancer: A pilot multicenter study from the Alliance for Clinical Trials in Oncology (A19\\_Pilot2)", "author": "Wood, William A.; Dilip, Deepika; Derkach, Andriy; Grover, Natalie S.; Elemento, Olivier; Levine, Ross; Thanarajasingam, Gita; Batsis, John A.; Bailey, Charlotte; Kannappan, Arun; Devine, Steven M.; Artz, Andrew S.; Ligibel, Jennifer A.; Basch, Ethan; Kent, Erin; Glass, Jacob", "year": "2023", "journalProceedings": "PLOS digital health", "category": "Case Study", "devices": "Charge HR", "population": "Patients", "dataUsed": "Intensity,Sleep,Heart Rate", "abstract": "Clinical performance status is designed to be a measure of overall health, reflecting a patient's physiological reserve and ability to tolerate various forms of therapy. Currently, it is measured by a combination of subjective clinician assessment and patient-reported exercise tolerance in the context of daily living activities. In this study, we assess the feasibility of combining objective data sources and patient-generated health data (PGHD) to improve the accuracy of performance status assessment during routine cancer care. Patients undergoing routine chemotherapy for solid tumors, routine chemotherapy for hematologic malignancies, or hematopoietic stem cell transplant (HCT) at one of four sites in a cancer clinical trials cooperative group were consented to a six-week prospective observational clinical trial (NCT02786628). Baseline data acquisition included cardiopulmonary exercise testing (CPET) and a six-minute walk test (6MWT). Weekly PGHD included patient-reported physical function and symptom burden. Continuous data capture included use of a Fitbit Charge HR (sensor). Baseline CPET and 6MWT could only be obtained in 68\\% of study patients, suggesting low feasibility during routine cancer treatment. In contrast, 84\\% of patients had usable fitness tracker data, 93\\% completed baseline patient-reported surveys, and overall, 73\\% of patients had overlapping sensor and survey data that could be used for modeling. A linear model with repeated measures was constructed to predict the patient-reported physical function. Sensor-derived daily activity, sensor-derived median heart rate, and patient-reported symptom burden emerged as strong predictors of physical function (marginal R2 0.429-0.433, conditional R2 0.816-0.822). Trial Registration: Clinicaltrials.gov Id NCT02786628.", "links": [] }, { "title": "Long-term participant retention and engagement patterns in an app and wearable-based multinational remote digital depression study", "author": "Zhang, Yuezhou; Pratap, Abhishek; Folarin, Amos A.; Sun, Shaoxiong; Cummins, Nicholas; Matcham, Faith; Vairavan, Srinivasan; Dineley, Judith; Ranjan, Yatharth; Rashid, Zulqarnain; Conde, Pauline; Stewart, Callum; White, Katie M.; Oetzmann, Carolin; Ivan, Alina; Lamers, Femke; Siddi, Sara; Rambla, Carla Hernández; Simblett, Sara; Nica, Raluca; Mohr, David C.; Myin-Germeys, Inez; Wykes, Til; Haro, Josep Maria; Penninx, Brenda W. J. H.; Annas, Peter; Narayan, Vaibhav A.; Hotopf, Matthew; Dobson, Richard J. B.; RADAR-CNS consortium", "year": "2023", "journalProceedings": "NPJ digital medicine", "category": "Survey Research", "devices": "Charge 2,Charge 3", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Recent growth in digital technologies has enabled the recruitment and monitoring of large and diverse populations in remote health studies. However, the generalizability of inference drawn from remotely collected health data could be severely impacted by uneven participant engagement and attrition over the course of the study. We report findings on long-term participant retention and engagement patterns in a large multinational observational digital study for depression containing active (surveys) and passive sensor data collected via Android smartphones, and Fitbit devices from 614 participants for up to 2 years. Majority of participants (67.6\\%) continued to remain engaged in the study after 43 weeks. Unsupervised clustering of participants' study apps and Fitbit usage data showed 3 distinct engagement subgroups for each data stream. We found: (i) the least engaged group had the highest depression severity (4 PHQ8 points higher) across all data streams; (ii) the least engaged group (completed 4 bi-weekly surveys) took significantly longer to respond to survey notifications (3.8 h more) and were 5 years younger compared to the most engaged group (completed 20 bi-weekly surveys); and (iii) a considerable proportion (44.6\\%) of the participants who stopped completing surveys after 8 weeks continued to share passive Fitbit data for significantly longer (average 42 weeks). Additionally, multivariate survival models showed participants' age, ownership and brand of smartphones, and recruitment sites to be associated with retention in the study. Together these findings could inform the design of future digital health studies to enable equitable and balanced data collection from diverse populations.", "links": [] }, { "title": "Performance of the Fitbit Charge 2 and Galaxy Watch 2 compared with polysomnography in assessing patients with obstructive sleep apnoea", "author": "Byun, Jung-Ick; Noh, Kyung Chul; Shin, Won Chul", "year": "2023", "journalProceedings": "Chronobiology International", "category": "Usability", "devices": "Charge 2", "population": "Patients", "dataUsed": "Sleep", "abstract": "Wearable devices may be used to evaluate sleep in patients with obstructive sleep apnoea (OSA). This study compared the use of two wearable devices (the Fitbit Charge 2 (FC2) and Galaxy Watch 2 (GW2)) with that of polysomnography (PSG) for assessing the sleep time of OSA patients. A total of 127 consecutive patients with OSA underwent overnight PSG while wearing the FC2 and GW2 on their nondominant wrist. We compared the total sleep time (TST) determined by the devices with that obtained by PSG with paired t tests, Bland‒Altman plots, and interclass correlations. Moreover, we evaluated the time in each sleep stage and differences due to OSA severity. The mean age of the OSA patients was 50 years, and the mean apnoea-hypopnea index was 38.3 events/h. The recording failure rate was not significantly different between the GW2 and FC2 (15.7% vs. 8.7%, p = 0.106). Compared to PSG, both the FC2 and GW2 underestimated TST by 27.5 and 24.9 minutes, respectively. TST bias in both devices did not correlate with OSA severity. The FC2 and GW2 underestimated TST, which should be considered when monitoring sleep time in patients with OSA.", "links": [] }, { "title": "Using Wearable Technology to Quantify Physical Activity Recovery: Secondary Report From the AFTER (App-Facilitated Tele-Rehabilitation) Program for COVID-19 Survivors Randomized Study", "author": "Churchill, Laura; Morrow, Mary; Capin, Jacob J.; Jolley, Sarah E.; Hare, Kristine; MaWhinney, Samantha; Stevens-Lapsley, Jennifer E.; Erlandson, Kristine M.", "year": "2023", "journalProceedings": "JMIR rehabilitation and assistive technologies", "category": "Case Study", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Knowledge on physical activity recovery after COVID-19 survival is limited. The AFTER (App-Facilitated Tele-Rehabilitation) program for COVID-19 survivors randomized participants, following hospital discharge, to either education and unstructured physical activity or a telerehabilitation program. Step count data were collected as a secondary outcome, and we found no significant differences in total step count trajectories between groups at 6 weeks. Further step count data were not analyzed.\n\nObjective: The purpose of this analysis was to examine step count trajectories and correlates among all participants (combined into a single group) across the 12-week study period.\n\nMethods: Linear mixed models with random effects were used to model daily steps over the number of study days. Models with 0, 1, and 2 inflection points were considered, and the final model was selected based on the highest log-likelihood value.\n\nResults: Participants included 44 adults (41 with available Fitbit [Fitbit LLC] data). Initially, step counts increased by an average of 930 (95% CI 547-1312; P<.001) steps per week, culminating in an average daily step count of 7658 (95% CI 6257-9059; P<.001) at the end of week 3. During the remaining 9 weeks of the study, weekly step counts increased by an average of 67 (95% CI -30 to 163; P<.001) steps per week, resulting in a final estimate of 8258 (95% CI 6933-9584; P<.001) steps.\n\nConclusions: Participants showed a marked improvement in daily step counts during the first 3 weeks of the study, followed by more gradual improvement in the remaining 9 weeks. Physical activity data and step count recovery trajectories may be considered surrogates for physiological recovery, although further research is needed to examine this relationship.", "links": [] }, { "title": "Harnessing digital health to optimise the delivery of guideline-based cardiac rehabilitation during COVID-19: an observational study", "author": "Gibson, Irene; McCrudden, Zoe; Dunne, Denise; Harris, Aisling; Hynes, Lisa; Murphy, Ella; Murphy, Andrew William; Byrne, Molly; McEvoy, John William", "year": "2023", "journalProceedings": "Open Heart", "category": "Intervention", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps,Heart Rate", "abstract": "Background: The COVID-19 pandemic accelerated the uptake of digital health interventions for the delivery of cardiac rehabilitation (CR). However, there is a need to evaluate these interventions.\n\nMethods: We examined the impact of an evidence-based, digital CR programme on medical, lifestyle and psychosocial outcomes. Delivered by an interdisciplinary team of healthcare professionals, the core components of this 12-week programme included lifestyle modification, medical risk factor management, psychosocial and behavioural change support. To support self-management, patients were provided with a Fitbit, a home blood pressure (BP) monitor and an interactive workbook. Patients received access to a bespoke web-based platform and were invited to attend weekly, online group-based supervised exercise sessions and educational workshops. Outcomes were assessed at baseline, end of programme and at 6-month follow-up.\n\nResults: Over a 3-month period, 105 patients (88% with coronary heart disease) were referred with 74% (n=77) attending initial assessment. Of these, 97% (n=75) enrolled in the programme, with 85% (n=64) completing the programme, 86% (n=55) of completers attended 6-month follow-up. Comparing baseline to end of programme, we observed significant improvements in the proportion of patients meeting guideline-recommended targets for physical activity (+68%, p<0.001), BP (+44%, p<0.001) and low-density lipoprotein cholesterol (+27%, p<0.001). There were significant reductions in mean weight (-2.6 kg, p<0.001). Adherence to the Mediterranean diet score improved from 5.2 to 7.3 (p<0.001). Anxiety and depression levels (Hospital Anxiety and Depression score) both reduced by more than 50% (p<0.001). The majority of these improvements were sustained at 6-month follow-up.\n\nConclusion: Outcomes from this study suggest that interdisciplinary digital CR programmes can be successfully implemented and help patients achieve guideline recommended lifestyle, medical and therapeutic targets.", "links": [] }, { "title": "Learning in a Virtual Environment to Improve Type 2 Diabetes Outcomes: A Randomized Controlled Trial", "author": "Johnson, Constance; D'Eramo Melkus, Gail; Reagan, Louise; Pan, Wei; Amarasekara, Sathya; Pereira, Katherine; Hassell, Nancy; Nowlin, Sarah; Vorderstrasse, Allison", "year": "2023", "journalProceedings": "JMIR formative research", "category": "Intervention", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Given the importance of self-management in type 2 diabetes mellitus (T2DM) (T2D), a major aspect of health is providing diabetes self-management education and support (DSME/S). There are known barriers including access, availability, and lack of follow through on referral to education programs. Virtual education and support have increased in use, particularly over the last few years.\n\nObjective: The purpose of the Diabetes LIVE (Learning in a Virtual Environment) study was to compare the effects of the LIVE intervention (educational 3D world) on diet and physical activity behaviors, behavioral and metabolic outcomes in adults with T2DM over 12 months to an online DSME/S control website.\n\nMethods: The LIVE study was a 52-week multi-site randomized controlled trial with longitudinal repeated measures. Participants were randomized to Diabetes LIVE (n =101) or a web control site (n=110). Both contained the same educational materials, but the VE was synchronous and interactive and the other was a flat website. Data were collected at baseline, 3, 6, and 12 months using surveys, clinical, laboratory, and Fitbit measures. Descriptive statistics for baseline characteristics and demographics were used. The effects of the intervention on outcomes were initially examined by comparing the means and standard deviations across the four time points of the outcomes between study arms, followed by multilevel modeling on trajectories of the outcomes over the 12 months.\n\nResults: 211 participants consented to participate in this trial. The mean age of participants was 58.85 (+10.1) years, and a majority were White (60.2%), non-Hispanic (93.8%), married (56.3%), and female (59.2%). Mean A1c at baseline was 7.64% (+1.79) and the mean BMI was 33.51 (+7.25). We examined weight loss status vs. randomized group, where data with no weight change were eliminated, and we found a statistically significant difference with the LIVE group experiencing more weight loss than the WebControl group (P=.04). There were no statistically significant differences between groups in changes in physical activity and dietary outcomes, but each group showed an increase in physical activity. Both groups experienced a decrease in mean A1c, systolic and diastolic blood pressure, cholesterol, and triglycerides over the course of 12 months of study participation, including those participants whose baseline A1c was 8.6 or higher.\n\nConclusions: This study confirmed that there were minor positive changes on metabolic controlglycemic targets in both groups over the 12-month study period, however, the majority of the participants began with optimal metabolic controlA1c levels. We did find clinically relevant metabolic changes in those who began with an A1c level >8.6% in both groups. This study provided a variety of resources to our participants in both study groups, and we conclude that a toolkit with a variety of services would be helpful to improving self-care in the future for persons with T2DM.", "links": [] }, { "title": "Use of Wearable Activity-Monitoring Technologies to Promote Physical Activity in Cancer Survivors: Challenges and Opportunities for Improved Cancer Care", "author": "Keats, Melanie R.; Yu, Xing; Sweeney Magee, Molly; Forbes, Cynthia C.; Grandy, Scott A.; Sweeney, Ellen; Dummer, Trevor J. B.", "year": "2023", "journalProceedings": "International Journal of Environmental Research and Public Health", "category": "Review", "devices": "Alta", "population": "Adults", "dataUsed": "Steps", "abstract": "The aim of this review was to explore the acceptability, opportunities, and challenges associated with wearable activity-monitoring technology to increase physical activity (PA) behavior in cancer survivors. A search of Medline, Embase, CINAHL, and SportDiscus was conducted from 1 January 2011 through 3 October 2022. The search was limited to English language, and peer-reviewed original research. Studies were included if they reported the use of an activity monitor in adults (+18 years) with a history of cancer with the intent to motivate PA behavior. Our search identified 1832 published articles, of which 28 met inclusion/exclusion criteria. Eighteen of these studies included post-treatment cancer survivors, eight were on active cancer treatment, and two were long-term cancer survivor studies. ActiGraph accelerometers were the primary technology used to monitor PA behaviors, with Fitbit as the most commonly utilized self-monitoring wearable technology. Overall, wearable activity monitors were found to be an acceptable and useful tool in improving self-awareness, motivating behavioral change, and increasing PA levels. Self-monitoring wearable activity devices have a positive impact on short-term PA behaviors in cancer survivors, but the increase in PA gradually attenuated through the maintenance phase. Further study is needed to evaluate and increase the sustainability of the use of wearable technologies to support PA in cancer survivors.", "links": [] }, { "title": "Potential limitations of activity tracking devices in monitoring effects of treatment for sarcoidosis", "author": "Klein, Rebecca; Judson, Marc; Barkes, Briana; Maier, Lisa; Zeigler, Joyce; Culver, Daniel; Sweiss, Nadera; Chen, Edward; Hamzeh, Nabeel; Grutters, Jan; Valeyre, Dominique; Singh, Noopur; Spitzer, Ginger; Shivas, Tricha; Baughman, Robert", "year": "2023", "journalProceedings": "Sarcoidosis, vasculitis, and diffuse lung diseases: official journal of WASOG", "category": "Usability", "devices": "One", "population": "Patients", "dataUsed": "User Friendliness", "abstract": "Introduction: activity tracker device usage can help analyze the impact of disease state and therapy on patients in clinical practice. factors such as age, race, and gender may contribute to difficulties with using such technology. Objective: we evaluated the effect of age, race, and gender on the usability of the Fitbit OneTM activity tracking device in sarcoidosis patients and the impact of device on sarcoidosis patients' activity.\n\nMethod: patients participated in a six-month prospective study where were asked to wear a Fitbit OneTM activity tracker daily. device usage education was provided at study enrollment. weekly data download and submission reports to participating centers was required. patients were asked to complete a post-study questionnaire reviewing the motivation of the activity tracker on daily activity.\n\nResults: at three centers, 91 patients completed all study visits and the post study questionnaire with a mean age of 55 and 75% were female and 34% african american. accurate downloads occurred >75% of the time, regardless of age, race, or sex. results of the post-study questionnaire did not show a correlation between the likelihood of wearing the device and motivation to increase activity.\n\nConclusion: using an activity tracking device to evaluate and/or correlated with quality of life (QOL) instruments may prove beneficial for gathering more data on patients. age, race, and gender did not contribute to differences in usability among sarcoidosis patients.", "links": [] }, { "title": "A useful tool or a new challenge? Hand-wrist-worn sleep trackers in patients with insomnia", "author": "Ojalvo, Dávid; Pacheco, André Pekkola; Benedict, Christian", "year": "2023", "journalProceedings": "Journal of Sleep Research", "category": "Usability", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Sleep", "abstract": "Consumer sleep wearables are increasingly popular, even among patients with sleep problems. However, the daily feedback provided by these devices could exacerbate sleep-related worry. To investigate this issue, 14 patients received a self-help guide booklet to improve sleep and wore the sleep tracker Fitbit Inspire 2 on their non-dominant hand for 4 weeks, while a control group of 12 patients only kept a handwritten sleep diary. All patients completed questionnaires at a primary care centre's first and final visit to assess general anxiety, sleep quality, sleep reactivity to stress, and quality of life. Our analysis showed that sleep quality, sleep reactivity to stress, and quality of life improved significantly for all patients between the first and final visit (p < 0.05). However, there were no significant differences between the Fitbit and control groups. Using sleep diary-derived estimates from the first and last week, we found that the control group but not the Fitbit group, increased their average time asleep each night and sleep efficiency (p < 0.05). However, these differences were primarily driven by baseline differences between the two groups. Our findings suggest that using wearables does not necessarily exacerbate sleep worries among people with insomnia.", "links": [] }, { "title": "Real-time Assessment of the Bidirectional Relationship Between Affective States and Glucose: Protocol for a 14-Day Observational Study", "author": "Rethorst, Chad D.; Githinji, Phrashiah; Seguin-Fowler, Rebecca A.; MacMillan Uribe, Alexandra L.; Szeszulski, Jacob; Liao, Yue", "year": "2023", "journalProceedings": "JMIR research protocols", "category": "Methods", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Background: Glucose variability increases cardiometabolic disease risk. While many factors can influence glucose levels, postprandial glucose response is the primary driver of glucose variability. Furthermore, affect may directly and indirectly impact glucose variability through its effect on eating behavior. Continuous glucose monitors (CGMs) facilitate the real-time evaluation of blood glucose, and ecological momentary assessment (EMA) can be used to assess affect in real time. Together, data collected from these sources provide the opportunity to further understand the role of affect in glucose levels.\n\nObjective: This paper presents the protocol for a study that aims to (1) evaluate the feasibility and acceptability of using CGMs along with EMA in nondiabetic populations and (2) examine the bidirectional relationship between affect and glucose in nondiabetic adults with overweight or obesity using a CGM and EMA.\n\nMethods: Eligibility criteria for the study include participants (1) aged 18 to 65 years old, (2) with a BMI of ≥25 kg/m2, (3) who are able to read and write in English, and (4) who own a smartphone. Individuals will be excluded if they (1) have type 1 or 2 diabetes or have any other condition that requires glucose monitoring, (2) are pregnant, (3) use any medications that have the potential to alter blood glucose levels or interfere with the glucose sensing process, or (4) have a diagnosed gastrointestinal condition or eating disorder. In a 14-day observational study, participants will wear a FreeStyle Libre Pro CGM sensor (Abbott) and will receive mobile phone-based EMA prompts 6 times per day (randomly within six 2-hour windows between 8 AM and 8 PM) to assess positive and negative affect. Participants will also wear a Fitbit Inspire 2 (Fitbit) to continuously monitor physical activity and sleep, which will be included as covariates in the analysis. Multilevel linear regression models will be used to evaluate the acute relationship between glucose level and affect.\n\nResults: Recruitment started in October 2022 and is expected to be completed in March 2023. We will aim to recruit 100 participants. As of December 12, 2022, a total of 39 participants have been enrolled.\n\nConclusions: The results of this study will further elucidate the role of affect in glucose variability. By identifying affective states that may lead to glucose excursions, our findings could inform just-in-time behavioral interventions by indicating opportunities for intervention delivery.", "links": [] }, { "title": "Feasibility and scalability of a fitness tracker study: Results from a longitudinal analysis of persons with multiple sclerosis", "author": "Sieber, Chloé; Haag, Christina; Polhemus, Ashley; Sylvester, Ramona; Kool, Jan; Gonzenbach, Roman; von Wyl, Viktor", "year": "2023", "journalProceedings": "Frontiers in Digital Health", "category": "Case Study", "devices": "Inspire HR", "population": "Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Background: Consumer-grade fitness trackers offer exciting opportunities to study persons with chronic diseases in greater detail and in their daily-life environment. However, attempts to bring fitness tracker measurement campaigns from tightly controlled clinical environments to home settings are often challenged by deteriorating study compliance or by organizational and resource limitations.\n\nObjectives: By revisiting the study design and patient-reported experiences of a partly remote study with fitness trackers (BarKA-MS study), we aimed to qualitatively explore the relationship between overall study compliance and scalability. On that account, we aimed to derive lessons learned on strengths, weaknesses, and technical challenges for the conduct of future studies.\n\nMethods: The two-phased BarKA-MS study employed Fitbit Inspire HR and electronic surveys to monitor physical activity in 45 people with multiple sclerosis in a rehabilitation setting and in their natural surroundings at home for up to 8 weeks. We examined and quantified the recruitment and compliance in terms of questionnaire completion and device wear time. Furthermore, we qualitatively evaluated experiences with devices according to participants' survey-collected reports. Finally, we reviewed the BarKA-MS study conduct characteristics for its scalability according to the Intervention Scalability Assessment Tool checklist.\n\nResults: Weekly electronic surveys completion reached 96%. On average, the Fitbit data revealed 99% and 97% valid wear days at the rehabilitation clinic and in the home setting, respectively. Positive experiences with the device were predominant: only 17% of the feedbacks had a negative connotation, mostly pertaining to perceived measurement inaccuracies. Twenty-five major topics and study characteristics relating to compliance were identified. They broadly fell into the three categories: \"effectiveness of support measures\", \"recruitment and compliance barriers\", and \"technical challenges\". The scalability assessment revealed that the highly individualized support measures, which contributed greatly to the high study compliance, may face substantial scalability challenges due to the strong human involvement and limited potential for standardization.\n\nConclusion: The personal interactions and highly individualized participant support positively influenced study compliance and retention. But the major human involvement in these support actions will pose scalability challenges due to resource limitations. Study conductors should anticipate this potential compliance-scalability trade-off already in the design phase.", "links": [] }, { "title": "mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED): rationale and study protocol for a pragmatic randomised controlled trial", "author": "Vetrovsky, Tomas; Kral, Norbert; Pfeiferova, Marketa; Kuhnova, Jitka; Novak, Jan; Wahlich, Charlotte; Jaklova, Andrea; Jurkova, Katerina; Janek, Michael; Omcirk, Dan; Capek, Vaclav; Maes, Iris; Steffl, Michal; Ussher, Michael; Tufano, James J.; Elavsky, Steriani; Van Dyck, Delfien; Cimler, Richard; Yates, Tom; Harris, Tess; Seifert, Bohumil", "year": "2023", "journalProceedings": "BMC public health", "category": "Methods", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Steps", "abstract": "Background: The growing number of patients with type 2 diabetes and prediabetes is a major public health concern. Physical activity is a cornerstone of diabetes management and may prevent its onset in prediabetes patients. Despite this, many patients with (pre)diabetes remain physically inactive. Primary care physicians are well-situated to deliver interventions to increase their patients' physical activity levels. However, effective and sustainable physical activity interventions for (pre)diabetes patients that can be translated into routine primary care are lacking.\n\nMethods: We describe the rationale and protocol for a 12-month pragmatic, multicentre, randomised, controlled trial assessing the effectiveness of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED). Twenty-one general practices will recruit 340 patients with (pre)diabetes during routine health check-ups. Patients allocated to the active control arm will receive a Fitbit activity tracker to self-monitor their daily steps and try to achieve the recommended step goal. Patients allocated to the intervention arm will additionally receive the mHealth intervention, including the delivery of several text messages per week, with some of them delivered just in time, based on data continuously collected by the Fitbit tracker. The trial consists of two phases, each lasting six months: the lead-in phase, when the mHealth intervention will be supported with human phone counselling, and the maintenance phase, when the intervention will be fully automated. The primary outcome, average ambulatory activity (steps/day) measured by a wrist-worn accelerometer, will be assessed at the end of the maintenance phase at 12 months.\n\nDiscussion: The trial has several strengths, such as the choice of active control to isolate the net effect of the intervention beyond simple self-monitoring with an activity tracker, broad eligibility criteria allowing for the inclusion of patients without a smartphone, procedures to minimise selection bias, and involvement of a relatively large number of general practices. These design choices contribute to the trial's pragmatic character and ensure that the intervention, if effective, can be translated into routine primary care practice, allowing important public health benefits.", "links": [] }, { "title": "Physical Activity and Social Comparison: The Importance of Group Composition in an Employee Fitbit Intervention", "author": "Wentz, Jennifer R.; Wilhelm Stanis, Sonja", "year": "2023", "journalProceedings": "Health Promotion Practice", "category": "Intervention", "devices": "Zip,Flex 2", "population": "Adults", "dataUsed": "Steps", "abstract": "This study examined the impact of group composition of a 6-week group-based employee Fitbit intervention on daily physical activity steps. Group composition comprised heterogenous and homogeneous groupings based on variations in baseline high, medium, and low steppers. The intervention included weekly step leaderboard information, motivational and informative messages, and the ability to participate in group step challenges. Repeated measures analysis of variance (ANOVA) examined differences in change of steps across time, step-level groups (low, medium, and high), and group composition (low/high, similar, and mixed), and replicated with a subgroup of participants who participated in group step challenges. While group and step level did not emerge as significant interactions in the overall sample, when focused within the group step challenge subsample, relationships among time, the group composition, and participant step-level categories emerged. Overall, the greatest increases in steps occurred at the mid-point time period, among lower steppers, and within the low/high comparison group. This study provides evidence of the importance of group composition in physical activity interventions as well as the fidelity of intervention design in facilitating group comparisons.", "links": [] }, { "title": "Daytime Sleep-Tracking Performance of Four Commercial Wearable Devices During Unrestricted Home Sleep", "author": "Chinoy, Evan D.; Cuellar, Joseph A.; Jameson, Jason T.; Markwald, Rachel R.", "year": "2023", "journalProceedings": "Nature and Science of Sleep", "category": "Usability", "devices": "Inspire HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "Purpose: Previous studies have found that many commercial wearable devices can accurately track sleep-wake patterns in laboratory or home settings. However, nearly all previous studies tested devices under conditions with fixed time in bed (TIB) and during nighttime sleep episodes only. Despite its relevance to shift workers and others with irregular sleep schedules, it is largely unknown how devices track daytime sleep. Therefore, we tested the sleep-tracking performance of four commercial wearable devices during unrestricted home daytime sleep.\nParticipants and Methods: Participants were 16 healthy young adults (6 men, 10 women; 26.6 ± 4.6 years, mean ± SD) with habitual daytime sleep schedules. Participants slept at home for 1 week under unrestricted conditions (ie, self-selecting TIB) using a set of four commercial wearable devices and completed reference sleep logs. Wearables included the Fatigue Science ReadiBand, Fitbit Inspire HR, Oura Ring, and Polar Vantage V Titan. Daytime sleep episode TIB biases and frequencies of missed and false-positive daytime sleep episodes were examined.\nResults: TIB bias was low in general for all devices on most daytime sleep episodes, but some exhibited large biases (eg, > 1 h). Total missed daytime sleep episodes were as follows: Fatigue Science: 3.6%; Fitbit: 4.8%; Oura: 6.0%; Polar: 37.3%. Missed episodes occurred most often when TIB was short (eg, naps < 4 h).\nConclusion: When daytime sleep episodes were recorded, the devices generally exhibited similar performance for tracking TIB (ie, most episodes had low bias). However, the devices failed to detect some daytime episodes, which occurred most often when TIB was short, but varied across devices (especially Polar, which missed over one-third of episodes). Findings suggest that accurate daytime sleep tracking is largely achievable with commercial wearable devices. However, performance differences for missed recordings suggest that some devices vary in reliability (especially for naps), but improvements could likely be made with changes to algorithm sensitivities.", "links": [ { "caption": "URL", "url": "https://www.dovepress.com/daytime-sleep-tracking-performance-of-four-commercial-wearable-devices-peer-reviewed-fulltext-article-NSS", "newWindow": true } ] }, { "title": "Performance of seven consumer sleep-tracking devices compared with polysomnography", "author": "Chinoy, Evan D.; Cuellar, Joseph A.; Huwa, Kirbie E.; Jameson, Jason T.; Watson, Catherine H.; Bessman, Sara C.; Hirsch, Dale A.; Cooper, Adam D.; Drummond, Sean P. A.; Markwald, Rachel R.", "year": "2021", "journalProceedings": "Sleep", "category": "Usability,Validation", "devices": "Alta HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "STUDY OBJECTIVES: Consumer sleep-tracking devices are widely used and becoming more technologically advanced, creating strong interest from researchers and clinicians for their possible use as alternatives to standard actigraphy. We, therefore, tested the performance of many of the latest consumer sleep-tracking devices, alongside actigraphy, versus the gold-standard sleep assessment technique, polysomnography (PSG). METHODS: In total, 34 healthy young adults (22 women; 28.1 ± 3.9 years, mean ± SD) were tested on three consecutive nights (including a disrupted sleep condition) in a sleep laboratory with PSG, along with actigraphy (Philips Respironics Actiwatch 2) and a subset of consumer sleep-tracking devices. Altogether, four wearable (Fatigue Science Readiband, Fitbit Alta HR, Garmin Fenix 5S, Garmin Vivosmart 3) and three nonwearable (EarlySense Live, ResMed S+, SleepScore Max) devices were tested. Sleep/wake summary and epoch-by-epoch agreement measures were compared with PSG. RESULTS: Most devices (Fatigue Science Readiband, Fitbit Alta HR, EarlySense Live, ResMed S+, SleepScore Max) performed as well as or better than actigraphy on sleep/wake performance measures, while the Garmin devices performed worse. Overall, epoch-by-epoch sensitivity was high (all ≥0.93), specificity was low-to-medium (0.18-0.54), sleep stage comparisons were mixed, and devices tended to perform worse on nights with poorer/disrupted sleep. CONCLUSIONS: Consumer sleep-tracking devices exhibited high performance in detecting sleep, and most performed equivalent to (or better than) actigraphy in detecting wake. Device sleep stage assessments were inconsistent. Findings indicate that many newer sleep-tracking devices demonstrate promising performance for tracking sleep and wake. Devices should be tested in different populations and settings to further examine their wider validity and utility.", "links": [] }, { "title": "Performance of Four Commercial Wearable Sleep-Tracking Devices Tested Under Unrestricted Conditions at Home in Healthy Young Adults", "author": "Chinoy, Evan D.; Cuellar, Joseph A.; Jameson, Jason T.; Markwald, Rachel R.", "year": "2022", "journalProceedings": "Nature and Science of Sleep", "category": "Usability,Validation", "devices": "Inspire HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "PURPOSE: Commercial wearable sleep-tracking devices are growing in popularity and in recent studies have performed well against gold standard sleep measurement techniques. However, most studies were conducted in controlled laboratory conditions. We therefore aimed to test the performance of devices under naturalistic unrestricted home sleep conditions. PARTICIPANTS AND METHODS: Healthy young adults (n = 21; 12 women, 9 men; 29.0 ± 5.0 years, mean ± SD) slept at home under unrestricted conditions for 1 week using a set of commercial wearable sleep-tracking devices and completed daily sleep diaries. Devices included the Fatigue Science Readiband, Fitbit Inspire HR, Oura ring, and Polar Vantage V Titan. Participants also wore a research-grade actigraphy watch (Philips Respironics Actiwatch 2) for comparison. To assess performance, all devices were compared with a high performing mobile sleep electroencephalography headband device (Dreem 2). Analyses included epoch-by-epoch and sleep summary agreement comparisons. RESULTS: Devices accurately tracked sleep-wake summary metrics (ie, time in bed, total sleep time, sleep efficiency, sleep latency, wake after sleep onset) on most nights but performed best on nights with higher sleep efficiency. Epoch-by-epoch sensitivity (for sleep) and specificity (for wake), respectively, were as follows: Actiwatch (0.95, 0.35), Fatigue Science (0.94, 0.40), Fitbit (0.93, 0.45), Oura (0.94, 0.41), and Polar (0.96, 0.35). Sleep stage-tracking performance was mixed, with high variability. CONCLUSION: As in previous studies, all devices were better at detecting sleep than wake, and most devices compared favorably to actigraphy in wake detection. Devices performed best on nights with more consolidated sleep patterns. Unrestricted sleep TIB differences were accurately tracked on most nights. High variability in sleep stage-tracking performance suggests that these devices, in their current form, are still best utilized for tracking sleep-wake outcomes and not sleep stages. Most commercial wearables exhibited promising performance for tracking sleep-wake in real-world conditions, further supporting their consideration as an alternative to actigraphy.", "links": [] }, { "title": "Fitbit Data to Assess Functional Capacity in Patients Before Elective Surgery: Pilot Prospective Observational Study", "author": "Angelucci, Alessandra; Greco, Massimiliano; Canali, Stefano; Marelli, Giovanni; Avidano, Gaia; Goretti, Giulia; Cecconi, Maurizio; Aliverti, Andrea", "year": "2023", "journalProceedings": "Journal of Medical Internet Research", "category": "Usability", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Steps,Heart Rate", "abstract": "Background: Preoperative assessment is crucial to prevent the risk of complications of surgical operations and is usually focused on functional capacity. The increasing availability of wearable devices (smartwatches, trackers, rings, etc) can provide less intrusive assessment methods, reduce costs, and improve accuracy.\n\nObjective: The aim of this study was to present and evaluate the possibility of using commercial smartwatch data, such as those retrieved from the Fitbit Inspire 2 device, to assess functional capacity before elective surgery and correlate such data with the current gold standard measure, the 6-Minute Walk Test (6MWT) distance.\n\nMethods: During the hospital visit, patients were evaluated in terms of functional capacity using the 6MWT. Patients were asked to wear the Fitbit Inspire 2 for 7 days (with flexibility of -2 to +2 days) after the hospital visit, before their surgical operation. Resting heart rate and daily steps data were retrieved directly from the smartwatch. Feature engineering techniques allowed the extraction of heart rate over steps (HROS) and a modified version of Non-Exercise Testing Cardiorespiratory Fitness. All measures were correlated with 6MWT.\n\nResults: In total, 31 patients were enrolled in the study (n=22, 71% men; n=9, 29% women; mean age 76.06, SD 4.75 years). Data were collected between June 2021 and May 2022. The parameter that correlated best with the 6MWT was the Non-Exercise Testing Cardiorespiratory Fitness index (r=0.68; P<.001). The average resting heart rate over the whole acquisition period for each participant had r=-0.39 (P=.03), even if some patients did not wear the device at night. The correlation of the 6MWT distance with the HROS evaluated at 1% quantile was significant, with Pearson coefficient of -0.39 (P=.04). Fitbit step count had a fair correlation of 0.59 with 6MWT (P<.001).\n\nConclusions: Our study is a promising starting point for the adoption of wearable technology in the evaluation of functional capacity of patients, which was strongly correlated with the gold standard. The study also identified limitations in the availability of metrics, variability of devices, accuracy and quality of data, and accessibility as crucial areas of focus for future studies.", "links": [] }, { "title": "Influence of sleep duration and sex on age-related differences in heart rate variability: Findings from program 4 of the HAIE study", "author": "Gonzales, Joaquin U.; Elavsky, Steriani; Cipryan, Lukáš; Jandačková, Vera; Burda, Michal; Jandačka, Daniel", "year": "2023", "journalProceedings": "Sleep Medicine", "category": "Measurement", "devices": "Charge 3,Charge 4", "population": "Adults", "dataUsed": "Sleep", "abstract": "Heart rate variability (HRV) is an important marker of cardiac autonomic regulation and health. We examined the influence of sleep duration and sex on HRV in younger and middle-aged adults. Cross-sectional data (888 participants, 44% women) were analyzed from Program 4 of the Healthy Aging in Industrial Environment study (HAIE). Sleep duration was measured across 14 days using Fitbit Charge monitors. Short-term EKG recordings were used to evaluate HRV in the time (RMSSD) and frequency domains (low frequency (LF) and high frequency (HF) power). Regression analysis showed age was associated with lower HRV across all HRV variables (all P < 0.001). Sex was a significant predictor for LF (β = 0.52) and HF (β = 0.54; both P < 0.001) in normalized units. Similarly, sleep duration was only associated with HF in normalized units (β = 0.06, P = 0.04). To explore this finding further, participants within each sex were separated into groups based on age (<40 and ≥ 40y) and adequate sleep duration (<7 and ≥7 h). Middle-aged women with sleep durations <7 h, but not ≥7 h, had lower HRV than younger women after adjusting for medications, respiratory frequency, and cardiorespiratory fitness (peak VO2). Middle-aged women with sleep durations <7 h also had lower RMSSD (33 ± 2 vs. 41±4 ms, P = 0.04), HF power (5.6 ± 0.1 vs. 6.0 ± 0.1 log ms2, P = 0.04), and HF in normalized units (39 ± 1 vs. 48 ± 2, P = 0.01) than middle-aged women with sleep durations ≥7 h. In contrast, middle-aged men irrespective of sleep duration had lower HRV than younger men. These results suggest that adequate sleep duration may positively influence HRV in middle-aged women but not men.", "links": [ { "caption": "URL", "url": "https://www.sciencedirect.com/science/article/pii/S1389945723001247", "newWindow": true } ] }, { "title": "The Added Value of Remote Technology in Cardiac Rehabilitation on Physical Function, Anthropometrics, and Quality of Life: Cluster Randomized Controlled Trial", "author": "Lahtio, Heli; Heinonen, Ari; Paajanen, Teemu; Sjögren, Tuulikki", "year": "2023", "journalProceedings": "Journal of Medical Internet Research", "category": "Usability,Intervention", "devices": "Charge HR", "population": "Adults", "dataUsed": "NA", "abstract": "Background: Cardiovascular diseases (CVDs) cause most deaths globally and can reduce quality of life (QoL) of rehabilitees with cardiac disease. The risk factors of CVDs are physical inactivity and increased BMI. With physical activity, it is possible to prevent CVDs, improve QoL, and help maintain a healthy body mass. Current literature shows the possibilities of digitalization and advanced technology in supporting independent self-rehabilitation. However, the interpretation of the results is complicated owing to the studies' high heterogeneity. In addition, the added value of this technology has not been studied well, especially in cardiac rehabilitation.\n\nObjective: We aimed to examine the effectiveness of added remote technology in cardiac rehabilitation on physical function, anthropometrics, and QoL in rehabilitees with CVD compared with conventional rehabilitation.\n\nMethods: Rehabilitees were cluster randomized into 3 remote technology intervention groups (n=29) and 3 reference groups (n=30). The reference group received conventional cardiac rehabilitation, and the remote technology intervention group received conventional cardiac rehabilitation with added remote technology, namely, the Movendos mCoach app and Fitbit charge accelerometer. The 12 months of rehabilitation consisted of three 5-day in-rehabilitation periods in the rehabilitation center. Between these periods were two 6-month self-rehabilitation periods. Outcome measurements included the 6-minute walk test, body mass, BMI, waist circumference, and World Health Organization QoL-BREF questionnaire at baseline and at 6 and 12 months. Between-group differences were assessed using 2-tailed t tests and Mann-Whitney U test. Within-group differences were analyzed using a paired samples t test or Wilcoxon signed-rank test.\n\nResults: Overall, 59 rehabilitees aged 41 to 66 years (mean age 60, SD 6 years; n=48, 81% men) were included in the study. Decrement in waist circumference (6 months: 1.6 cm; P=.04; 12 months: 3 cm; P<.001) and increment in self-assessed QoL were greater (environmental factors: 0.5; P=.02) in the remote technology intervention group than the reference group. Both groups achieved statistically significant improvements in the 6-minute walk test in both time frames (P=.01-.03). Additionally, the remote technology intervention group achieved statistically significant changes in the environmental domain at 0-6 months (P=.03) and waist circumference at both time frames (P=.01), and reference group achieve statistically significant changes in waist circumference at 0-6 months (P=.02).\n\nConclusions: Remote cardiac rehabilitation added value to conventional cardiac rehabilitation in terms of waist circumference and QoL. The results were clinically small, but the findings suggest that adding remote technology to cardiac rehabilitation may increase beneficial health outcomes. There was some level of systematic error during rehabilitation intervention, and the sample size was relatively small. Therefore, care must be taken when generalizing the study results beyond the target population. To confirm assumptions of the added value of remote technology in rehabilitation interventions, more studies involving different rehabilitees with cardiac disease are required.", "links": [] }, { "title": "Matched and moving: exploring daily social support among women partnered for exercise after a breast cancer diagnosis", "author": "Murray, Ross M.; Smith-Turchyn, Jenna; Vani, Madison F.; McDonough, Meghan H.; Fong, Angela J.; Mina, Daniel Santa; Arbour-Nicitopoulos, Kelly P.; Trinh, Linda; Jones, Jennifer M.; Bender, Jackie L.; Culos-Reed, S. Nicole; Tomasone, Jennifer R.; Sabiston, Catherine M.", "year": "2023", "journalProceedings": "Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer", "category": "Case Study", "devices": "Inspire HR", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Purpose: Exercise and social support are non-pharmacological strategies that improve health and wellbeing in women treated for breast cancer (WTBC). However, strategies to facilitate support and exercise in WTBC are typically resource intensive. The purpose of this study was to examine whether various forms of social support received from a matched peer were associated with increased exercise among WTBC.\n\nMethods: A daily diary study was conducted to examine naturally occurring social support as it relates to daily exercise behavior. Forty-six WTBC were matched (23 pairs) and completed pre-screening survey assessing eligibility and baseline levels of exercise. Participants were given Fitbit devices to track physical activity behavior and completed daily surveys across 3 weeks assessing perceptions of exercise-related social support at fixed times at the end of each day.\n\nResults: Mixed models accounting for day of study, baseline support, and baseline exercise levels revealed that higher levels of daily exercise-related tangible social support were associated with more daily steps (b = 506, SE = 143) and more light physical activity (LPA) minutes (b = 7.01, SE = 3.15). Informational social support was associated with higher moderate to vigorous physical activity (MVPA) minutes (b = 3.18, SE = 1.60).\n\nConclusions: Overall, peer matching programs aimed at increasing exercise-related social support among WTBC might encourage exercise behaviors, especially among women who share exercise-specific information (e.g., benefits, type, activities).", "links": [] }, { "title": "Validation of an open-source smartphone step counting algorithm in clinical and non-clinical settings", "author": "Straczkiewicz, Marcin; Keating, Nancy L.; Thompson, Embree; Matulonis, Ursula A.; Campos, Susana M.; Wright, Alexi A.; Onnela, Jukka-Pekka", "year": "2023", "journalProceedings": "medRxiv: The Preprint Server for Health Sciences", "category": "Validation", "devices": "Charge 2", "population": "Patients", "dataUsed": "Steps", "abstract": "Background: Step counts are increasingly used in public health and clinical research to assess wellbeing, lifestyle, and health status. However, estimating step counts using commercial activity trackers has several limitations, including a lack of reproducibility, generalizability, and scalability. Smartphones are a potentially promising alternative, but their step-counting algorithms require robust validation that accounts for temporal sensor body location, individual gait characteristics, and heterogeneous health states.\n\nObjective: Our goal was to evaluate an open-source step-counting method for smartphones under various measurement conditions against step counts estimated from data collected simultaneously from different body locations (\"internal\" validation), manually ascertained ground truth (\"manual\" validation), and step counts from a commercial activity tracker (Fitbit Charge 2) in patients with advanced cancer (\"wearable\" validation).\n\nMethods: We used eight independent datasets collected in controlled, semi-controlled, and free-living environments with different devices (primarily Android smartphones and wearable accelerometers) carried at typical body locations. Five datasets (N=103) were used for internal validation, two datasets (N=107) for manual validation, and one dataset (N=45) used for wearable validation. In each scenario, step counts were estimated using a previously published step-counting method for smartphones that uses raw sub-second level accelerometer data. We calculated mean bias and limits of agreement (LoA) between step count estimates and validation criteria using Bland-Altman analysis.\n\nResults: In the internal validation datasets, participants performed 751.7±581.2 (mean±SD) steps, and the mean bias was -7.2 steps (LoA -47.6, 33.3) or -0.5%. In the manual validation datasets, the ground truth step count was 367.4±359.4 steps while the mean bias was -0.4 steps (LoA -75.2, 74.3) or 0.1 %. In the wearable validation dataset, Fitbit devices indicated mean step counts of 1931.2±2338.4, while the calculated bias was equal to -67.1 steps (LoA -603.8, 469.7) or a difference of 0.3 %.\n\nConclusions: This study demonstrates that our open-source step counting method for smartphone data provides reliable step counts across sensor locations, measurement scenarios, and populations, including healthy adults and patients with cancer.", "links": [] }, { "title": "Wearable Sensor and Mobile App-Based mHealth Approach for Investigating Substance Use and Related Factors in Daily Life: Protocol for an Ecological Momentary Assessment Study", "author": "Takano, Ayumi; Ono, Koki; Nozawa, Kyosuke; Sato, Makito; Onuki, Masaki; Sese, Jun; Yumoto, Yosuke; Matsushita, Sachio; Matsumoto, Toshihiko", "year": "2023", "journalProceedings": "JMIR research protocols", "category": "Case Study", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Background: Digital health technologies using mobile apps and wearable devices are a promising approach to the investigation of substance use in the real world and for the analysis of predictive factors or harms from substance use. Moreover, consecutive repeated data collection enables the development of predictive algorithms for substance use by machine learning methods.\n\nObjective: We developed a new self-monitoring mobile app to record daily substance use, triggers, and cravings. Additionally, a wearable activity tracker (Fitbit) was used to collect objective biological and behavioral data before, during, and after substance use. This study aims to describe a model using machine learning methods to determine substance use.\n\nMethods: This study is an ongoing observational study using a Fitbit and a self-monitoring app. Participants of this study were people with health risks due to alcohol or methamphetamine use. They were required to record their daily substance use and related factors on the self-monitoring app and to always wear a Fitbit for 8 weeks, which collected the following data: (1) heart rate per minute, (2) sleep duration per day, (3) sleep stages per day, (4) the number of steps per day, and (5) the amount of physical activity per day. Fitbit data will first be visualized for data analysis to confirm typical Fitbit data patterns for individual users. Next, machine learning and statistical analysis methods will be performed to create a detection model for substance use based on the combined Fitbit and self-monitoring data. The model will be tested based on 5-fold cross-validation, and further preprocessing and machine learning methods will be conducted based on the preliminary results. The usability and feasibility of this approach will also be evaluated.\n\nResults: Enrollment for the trial began in September 2020, and the data collection finished in April 2021. In total, 13 people with methamphetamine use disorder and 36 with alcohol problems participated in this study. The severity of methamphetamine or alcohol use disorder assessed by the Drug Abuse Screening Test-10 or the Alcohol Use Disorders Identification Test-10 was moderate to severe. The anticipated results of this study include understanding the physiological and behavioral data before, during, and after alcohol or methamphetamine use and identifying individual patterns of behavior.\n\nConclusions: Real-time data on daily life among people with substance use problems were collected in this study. This new approach to data collection might be helpful because of its high confidentiality and convenience. The findings of this study will provide data to support the development of interventions to reduce alcohol and methamphetamine use and associated negative consequences.", "links": [] }, { "title": "Opportune warning of COVID-19 in a Mexican health care worker cohort: Discrete beta distribution entropy of smartwatch physiological records", "author": "Aguado-García, Alejandro; Arroyo-Valerio, América; Escobedo, Galileo; Bueno-Hernández, Nallely; Olguín-Rodríguez, P. V.; Müller, Markus F.; Carrillo-Ruiz, José Damián; Martínez-Mekler, Gustavo", "year": "2023", "journalProceedings": "Biomedical Signal Processing and Control", "category": "Measurement", "devices": "Charge 3", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "We present a statistical study of heart rate, step cadence, and sleep stage registers of health care workers in the Hospital General de México \"Dr. Eduardo Liceaga\" (HGM), monitored continuously and non-invasively during the COVID-19 contingency from May to October 2020, using the Fitbit Charge 3® Smartwatch device. The HGM-COVID cohort consisted of 115 participants assigned to areas of COVID-19 exposure. We introduce a novel biomarker for an opportune signal for the likelihood of SARS-CoV-2 infection based on the Shannon Entropy of the Discrete Generalized Beta Distribution fit of rank ordered smartwatch registers. Our statistical test indicated infection for 94% of patients confirmed by positive polymer chain reaction (PCR+) test, 47% before the test, and 47% in coincidence. These results required innovative data preprocessing for the definition of a new biomarker index. The statistical method parameters are data-driven, confidence estimates were calibrated based on sensitivity tests using appropriately derived surrogate data as a benchmark. Our surrogate tests can also provide a benchmark for comparing results from other anomaly detection methods (ADMs). Biomarker comparison of the negative Immunoglobulin G Antibody (IgG-) subgroup with the PCR+ subgroup showed a statistically significant difference (p < 0.01, effect size = 1.44). The distribution of the uninfected population had a lower median and less dispersion than the PCR+ population. A retrospective study of our results confirmed that the biomarker index provides an early warning of the likelihood of COVID-19, even several days before the onset of symptoms or the PCR+ test request. The method can be calibrated for the analysis of different SARS-CoV-2 strains, the effect of vaccination, and previous infections. Furthermore, our biomarker screening could be implemented to provide general health profiles for other population sectors based on physiological signals from smartwatch wearable devices.", "links": [] }, { "title": "Predicting Hospital Readmission among Patients with Sepsis using Clinical and Wearable Data", "author": "Amrollahi, Fatemeh; Shashikumar, Supreeth Prajwal; Yhdego, Haben; Nayebnazar, Arshia; Yung, Nathan; Wardi, Gabriel; Nemati, Shamim", "year": "2023", "journalProceedings": "medRxiv: The Preprint Server for Health Sciences", "category": "Case Study", "devices": "Device unspecified", "population": "Patients,Adults", "dataUsed": "Energy Expenditure,Intensity,Heart Rate", "abstract": "Sepsis is a life-threatening condition that occurs due to a dysregulated host response to infection. Recent data demonstrate that patients with sepsis have a significantly higher readmission risk than other common conditions, such as heart failure, pneumonia and myocardial infarction and associated economic burden. Prior studies have demonstrated an association between a patient’s physical activity levels and readmission risk. In this study, we show that distribution of activity level prior and post-discharge among patients with sepsis are predictive of unplanned rehospitalization in 90 days (P-value < 1e-3). Our preliminary results indicate that integrating Fitbit data with clinical measurements may improve model performance on predicting 90 days readmission.", "links": [] }, { "title": "A multi-site trial of an electronic health integrated physical activity promotion intervention in breast and endometrial cancers survivors: MyActivity study protocol", "author": "Cadmus-Bertram, Lisa; Solk, Payton; Agnew, Megan; Starikovsky, Julia; Schmidt, Christian; Morelli, Whitney A.; Hodgson, Vanessa; Freeman, Hannah; Muller, Laura; Mishory, Abby; Naxi, Sondra; Carden, Lillian; Tevaarwerk, Amye J.; Wolter, Melanie; Barber, Emma; Spencer, Ryan; Sesto, Mary E.; Gradishar, William; Gangnon, Ronald; Spring, Bonnie; Nahum-Shani, Inbal; Phillips, Siobhan M.", "year": "2023", "journalProceedings": "Contemporary Clinical Trials", "category": "Intervention", "devices": "Charge 3", "population": "Adults", "dataUsed": "User Friendliness", "abstract": "Despite the known benefits of moderate-to-vigorous physical activity (MVPA) for breast and endometrial cancer survivors, most are insufficiently active, interventions response is heterogeneous, and MVPA programming integration into cancer care is limited. A stepped care approach, in which the least resource-intensive intervention is delivered first and additional components are added based on individual response, is one strategy to enhance uptake of physical activity programming. However, the most effective intervention augmentation strategies are unknown. In this singly randomized trial of post-treatment, inactive breast and endometrial cancer survivors (n = 323), participants receive a minimal intervention including a Fitbit linked with their clinic's patient portal and, in turn, the electronic health record (EHR) with weekly feedback delivered via the portal. MVPA progress summaries are sent to participants' oncology team via the EHR. MVPA adherence is evaluated at 4, 8, 12, 16 and 20 weeks; non-responders (those meeting ≤80% of the MVPA goal over previous 4 weeks) at each timepoint are randomized once for the remainder of the 24-week intervention to one of two \"step-up\" conditions: (1) online gym or (2) coaching calls, while responders continue with the minimal Fitbit+EHR intervention. The primary outcome is ActiGraph-measured MVPA at 24 and 48 weeks. Secondary outcomes include symptom burden and functional performance at 24 and 48 weeks. This trial will inform development of an effective, scalable, and tailored intervention for survivors by identifying non-responders and providing them with the intervention augmentations necessary to increase MVPA and improve health outcomes. Clinical Trials Registration # NCT04262180.", "links": [] }, { "title": "Motivational Message Framing Effects on Physical Activity Dynamics in a Digital Messaging Intervention: Secondary Analysis", "author": "Lee, Alexandra M.; Hojjatinia, Sahar; Courtney, Jimikaye B.; Brunke-Reese, Deborah; Hojjatinia, Sarah; Lagoa, Constantino M.; Conroy, David E.", "year": "2023", "journalProceedings": "JMIR formative research", "category": "Intervention,Measurement", "devices": "Versa,Versa Lite", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Background: Digital smartphone messaging can be used to promote physical activity to large populations with limited cost. It is not clear which psychological constructs should be targeted by digital messages to promote physical activity. This gap presents a challenge for developing optimal content for digital messaging interventions.\n\nObjective: The aim of this study is to compare affectively framed and social cognitively framed messages on subsequent changes in physical activity using dynamical modeling techniques.\n\nMethods: We conducted a secondary analysis of data collected from a digital messaging intervention in insufficiently active young adults (18-29 years) recruited between April 2019 and July 2020 who wore a Fitbit smartwatch for 6 months. Participants received 0 to 6 messages at random per day across the intervention period. Messages were drawn from 3 content libraries: affectively framed, social cognitively framed, or inspirational quotes. Person-specific dynamical models were identified, and model features of impulse response and cumulative step response were extracted for comparison. Two-way repeated-measures ANOVAs evaluated the main effects and interaction of message type and day type on model features. This early-phase work with novel dynamic features may have been underpowered to detect differences between message types so results were interpreted descriptively.\n\nResults: Messages (n=20,689) were paired with valid physical activity monitoring data from 45 participants for analysis. Received messages were distributed as 40% affective (8299/20,689 messages), 39% social-cognitive (8187/20,689 messages), and 20% inspirational quotes (4219/20,689 messages). There were no statistically significant main effects for message type when evaluating the steady state of step responses. Participants demonstrated heterogeneity in intervention response: some had their strongest responses to affectively framed messages, some had their strongest responses to social cognitively framed messages, and some had their strongest responses to the inspirational quote messages.\n\nConclusions: No single type of digital message content universally promotes physical activity. Future work should evaluate the effects of multiple message types so that content can be continuously tuned based on person-specific responses to each message type.", "links": [] }, { "title": "Exploratory Validation of Sleep-Tracking Devices in Patients with Psychiatric Disorders", "author": "Ogasawara, Masaya; Takeshima, Masahiro; Kosaka, Shumpei; Imanishi, Aya; Itoh, Yu; Fujiwara, Dai; Yoshizawa, Kazuhisa; Ozaki, Norio; Nakagome, Kazuyuki; Mishima, Kazuo", "year": "2023", "journalProceedings": "Nature and Science of Sleep", "category": "Usability", "devices": "Sense", "population": "Patients", "dataUsed": "Sleep", "abstract": "Purpose: Sleep-tracking devices have performed well in recent studies that evaluated their use in healthy adults by comparing them with the gold standard sleep assessment technique, polysomnography (PSG). These devices have not been validated for use in patients with psychiatric disorders. Therefore, we tested the performance of three sleep-tracking devices against PSG in patients with psychiatric disorders.\n\nPatients and methods: In total, 52 patients (32 women; 48.1 ± 17.2 years, mean ± SD; 18 patients diagnosed with schizophrenia, 19 with depressive disorder, 3 with bipolar disorder, and 12 with sleep disorder cases) were tested in a sleep laboratory with PSG, along with portable electroencephalography (EEG) device (Sleepgraph), actigraphy (MTN-220/221) and consumer sleep-tracking device (Fitbit Sense).\n\nResults: Epoch-by-epoch sensitivity (for sleep) and specificity (for wake), respectively, were as follows: Sleepgraph (0.95, 0.76), Fitbit Sense (0.95, 0.45) and MTN-220/221 (0.93, 0.40). Portable EEG (Sleepgraph) had the best sleep stage-tracking performance. Sleep-wake summary metrics demonstrated lower performance on poor sleep (ice, shorter total sleep time, lower sleep efficiency, longer sleep latency, longer wake after sleep onset).\n\nConclusion: Devices demonstrated similar sleep-wake detecting performance as compared with previous studies that evaluated sleep in healthy adults. Consumer sleep device may exhibit poor sleep stage-tracking performance in patients with psychiatric disorders due to factors that affect the sleep determination algorithm, such as changes in autonomic nervous system activity. However, Sleepgraph, a portable EEG device, demonstrated higher performance in mental disorders than the Fitbit Sense and actigraphy.", "links": [] }, { "title": "Considering depression as a secondary outcome in the optimization of physical activity interventions for breast cancer survivors in the PACES trial: a factorial randomized controlled trial", "author": "Rethorst, Chad D.; Carmody, Thomas J.; Argenbright, Keith E.; Mayes, Taryn L.; Hamann, Heidi A.; Trivedi, Madhukar H.", "year": "2023", "journalProceedings": "The International Journal of Behavioral Nutrition and Physical Activity", "category": "Intervention", "devices": "Alta HR", "population": "Patients", "dataUsed": "Goals,User Friendliness", "abstract": "Background: Depressive symptoms result in considerable burden for breast cancer survivors. Increased physical activity may reduce these burdens but existing evidence from physical activity interventions in equivocal. Furthermore, physical activity intervention strategies may differentially impact depressive symptoms, which should be considered in designing and optimizing behavioral interventions for breast cancer survivors.\n\nMethods: The Physical Activity for Cancer Survivors (PACES) trial enrolled 336 participants breast cancer survivors, who were 3 months to 10 years post-treatment, and insufficiently active (< 150 min of moderate-to-vigorous physical activity per week). Participants were randomly assigned to a combination of 4 intervention strategies in a full-factorial design: 1) supervised exercise sessions, 2) facility access, 3) Active Living Every Day, and 4) Fitbit self-monitoring. Depressive symptoms were assessed at baseline, mid-intervention (3 months), and post-intervention (6 months) using the Quick Inventory for Depressive Symptoms. Change in depressive symptoms were analyzed using a linear mixed-effects model.\n\nResults: Results from the linear mixed-effects model indicated that depressive symptoms decreased significantly across the entire study sample over the 6-month intervention (F = 4.09, p = 0.044). A significant ALED x time interaction indicated participants who received the ALED intervention experienced greater reductions in depressive symptoms (F = 5.29, p = 0.022). No other intervention strategy significantly impacted depressive symptoms.\n\nConclusions: The ALED intervention consists of strategies (i.e., goal setting, social support) that may have a beneficial impact on depressive symptoms above and beyond the effect of increased physical activity. Our findings highlight the need to consider secondary outcomes when designing and optimizing physical activity interventions.", "links": [] }, { "title": "An overview of the together everyone achieves more physical activity (TEAM-PA) trial to increase physical activity among African American women", "author": "Sweeney, Allison M.; Wilson, Dawn K.; Zarrett, Nicole; Martin, Pamela; Hardin, James W.; Fairchild, Amanda; Mitchell, Sheryl; Decker, Lindsay", "year": "2023", "journalProceedings": "Contemporary Clinical Trials", "category": "Intervention", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,User Friendliness", "abstract": "Background: The Together Everyone Achieves More Physical Activity (TEAM-PA) trial is a randomized controlled trial testing the efficacy of a group-based intervention for increasing physical activity (PA) among insufficiently active African American women.\n\nDesign: The TEAM-PA trial uses a group cohort design, is implemented at community sites, and will involve 360 African American women. The trial compares a 10-week group-based intervention vs. a standard group-delivered PA comparison program. Measures include minutes of total PA/day using 7-day accelerometer estimates (primary outcome), and body mass index, blood pressure, waist circumference, walking speed, sedentary behavior, light physical activity, and the percentage achieving ≥150 min of moderate to vigorous PA/week (secondary outcomes) at baseline, post-intervention, and 6-months post-intervention.\n\nIntervention: The intervention integrates elements from Social Cognitive Theory, Self-Determination Theory, Group Dynamics Theory, and a focus on collectivism to evaluate different components of social affiliation (relatedness, reciprocal support, group cohesion, and collective efficacy). The intervention integrates shared goal-setting via Fitbits, group-based problem-solving, peer-to-peer positive communication, friendly competition, and cultural topics related to collectivism. Compared to the standard group-delivered PA program, participants in the intervention are expected to show greater improvements from baseline to post- and 6-month follow-up on minutes of total PA/day and secondary outcomes. Social affiliation variables (vs. individual-level factors) will be evaluated as mediators of the treatment effect.\n\nImplications: The results of the TEAM-PA trial will determine the efficacy of the intervention and identify which aspects of social affiliation are most strongly related to increased PA among African American women.\n\nTrial registration: This study was registered on Clinicaltrials.gov (# NCT05519696) in August 2022 prior to initial participant enrollment.", "links": [] }, { "title": "Efficacy of the Aim2Be Intervention in Changing Lifestyle Behaviors Among Adolescents With Overweight and Obesity: Randomized Controlled Trial", "author": "Tugault-Lafleur, Claire N.; De-Jongh González, Olivia; Macdonald, Janice; Bradbury, Jennifer; Warshawski, Tom; Ball, Geoff D. C.; Morrison, Katherine; Ho, Josephine; Hamilton, Jill; Buchholz, Annick; Mâsse, Louise", "year": "2023", "journalProceedings": "Journal of Medical Internet Research", "category": "Intervention", "devices": "Flex 2", "population": "Adults,Adolescents", "dataUsed": "Steps", "abstract": "Background: Aim2Be is a gamified lifestyle app designed to promote lifestyle behavior changes among Canadian adolescents and their families.\n\nObjective: The primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (BMI Z score [zBMI]) and improve lifestyle behaviors among adolescents with overweight and obesity and their parents versus a waitlist control group over 3 months. The secondary aim was to compare health trajectories among waitlist control participants over 6 months (before and after receiving access to the app), assess whether support from a live coach enhanced intervention impact, and evaluate whether the app use influenced changes among intervention participants.\n\nMethods: A 2-arm parallel randomized controlled trial was conducted from November 2018 to June 2020. Adolescents aged 10 to 17 years with overweight or obesity and their parents were randomized into an intervention group (Aim2Be with a live coach for 6 months) or a waitlist control group (Aim2Be with no live coach; accessed after 3 months). Adolescents' assessments at baseline and at 3 and 6 months included measured height and weight, 24-hour dietary recalls, and daily step counts measured with a Fitbit. Data on self-reported physical activity, screen time, fruit and vegetable intake, and sugary beverage intake of adolescents and parents were also collected.\n\nResults: A total of 214 parent-child participants were randomized. In our primary analyses, there were no significant differences in zBMI or any of the health behaviors between the intervention and control groups at 3 months. In our secondary analyses, among waitlist control participants, zBMI (P=.02), discretionary calories (P=.03), and physical activity outside of school (P=.001) declined, whereas daily screen time increased (P<.001) after receiving access to the app compared with before receiving app access. Adolescents randomized to Aim2Be with live coaching reported more time being active outside of school compared with adolescents who used Aim2Be with no coaching over 3 months (P=.001). App use did not modify any changes in outcomes among adolescents in the intervention group.\n\nConclusions: The Aim2Be intervention did not improve zBMI and lifestyle behaviors in adolescents with overweight and obesity compared with the waitlist control group over 3 months. Future studies should explore the potential mediators of changes in zBMI and lifestyle behaviors as well as predictors of engagement.\n\nTrial registration: ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/study/NCT03651284.", "links": [] }, { "title": "Prediction of Unplanned Hospital Readmission using Clinical and Longitudinal Wearable Sensor Features", "author": "Yhdego, Haben H.; Nayebnazar, Arshia; Amrollahi, Fatemeh; Boussina, Aaron; Shashikumar, Supreeth; Wardi, Gabriel; Nemati, Shamim", "year": "2023", "journalProceedings": "medRxiv", "category": "Case Study", "devices": "Device unspecified", "population": "Patients,Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Heart Rate", "abstract": "Predictive models have been suggested as potential tools for identifying highest risk patients for hospital readmissions, in order to improve care coordination and ultimately long-term patient outcomes. However, the accuracy of current predictive models for readmission prediction is still moderate and further data enrichment is needed to identify at risk patients. This paper describes models to predict 90-day readmission, focusing on testing the predictive performance of wearable sensor features generated using multiscale entropy techniques and clinical features. Our study explores ways to incorporate pre-discharge and post-discharge wearable sensor features to make robust patient predictions. Data were used from participants enrolled in the AllofUs Research program. We extracted the inpatient cohort of patients and integrated clinical data from the electronic health records (EHR) and Fitbit sensor measurements. Entropy features were calculated from the longitudinal wearable sensor data, such as heart rate and mobility-related measurements, in order to characterize time series variability and complexity. Our best performing model achieved an AUC of 83%, and at 80% sensitivity achieved 75% specificity and 57% positive predictive value. Our results indicate that it would be possible to improve the ability to predict unplanned hospital readmissions by considering pre-discharge and post-discharge wearable features.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10120790/", "newWindow": true } ] }, { "title": "Health-related impact of illness associated with excessive daytime sleepiness in patients with obstructive sleep apnea", "author": "Grandner, Michael A.; Min, Jae S.; Saad, Ragy; Leary, Eileen B.; Eldemir, Lev; Hyman, Danielle", "year": "2023", "journalProceedings": "Postgraduate Medicine", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Intensity,Sleep,User Friendliness", "abstract": "OBJECTIVES: This real-world study aimed to characterize the impact of illness of excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA) who are adherent to continuous positive airway pressure (CPAP). METHODS: This cross-sectional study surveyed participants in Evidation Health's Achievement app (November 2020-January 2021), a mobile consumer platform that encourages users to develop healthy habits and provides incentives to participate in research. Participants were US-resident adults who self-reported a physician diagnosis of OSA and adherence to CPAP (≥4 hours/night, ≥5 nights/week) for≥6 months. The survey included the Functional Outcomes of Sleep Questionnaire-Short Version (FOSQ-10), Epworth Sleepiness Scale (ESS), and questions regarding comorbidities, CPAP use, caffeine consumption, and physical activity. EDS was defined as ESS score {\\textgreater}10. There were more female than male participants; therefore, data were reported separately for females/males. RESULTS: In total, 476 participants (female, n = 283 [59\\%]; mean [SD] age, 49.7 [10.8] years; obese, 74.4\\%) completed the survey; 209 had EDS (mean [SD] ESS, 13.8 [2.5]) and 267 did not (mean [SD] ESS, 6.3 [2.5]). Self-reported duration of CPAP use was consistent between the EDS/no EDS cohorts, with most participants using CPAP for 7 to 9 hours/night, 7 nights/week. Participants with EDS commonly reported anxiety ([EDS/no EDS] males: 31.5\\%/20.0\\%; females: 53.7\\%/39.5\\%), depression (males: 35.6\\%/24.2\\%; females: 55.9\\%/44.9\\%), and insomnia (males: 19.2\\%/6.7\\%; females: 25.7\\%/12.9\\%) and showed impairment on the FOSQ-10 ([EDS/no EDS] males: 80.8\\%/35.0\\%; females: 91.9\\%/53.1\\%). Participants with EDS reported that sleepiness 'very often' prevented physical activity and influenced dietary choices. CONCLUSION: EDS influences choices related to physical activity, caffeine consumption, and diet in patients who are adherent with CPAP. More research is needed to understand the association between EDS and choices of CPAP-adherent patients. Future research should explore the health-related consequences of residual EDS associated with OSA and whether they can be mitigated by improving EDS.", "links": [] }, { "title": "PCovNet+: A CNN-VAE anomaly detection framework with LSTM embeddings for smartwatch-based COVID-19 detection", "author": "Abir, Farhan Fuad; Chowdhury, Muhammad E. H.; Tapotee, Malisha Islam; Mushtak, Adam; Khandakar, Amith; Mahmud, Sakib; Hasan, Md Anwarul", "year": "2023", "journalProceedings": "Engineering Applications of Artificial Intelligence", "category": "Review", "devices": "Device unspecified", "population": "NA", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "The world is slowly recovering from the Coronavirus disease 2019 (COVID-19) pandemic; however, humanity has experienced one of its According to work by Mishra et al. (2020), the study's first phase included a cohort of 5,262 subjects, with 3,325 Fitbit users constituting the majority. However, among this large cohort of 5,262 subjects, most significant trials in modern times only to learn about its lack of preparedness in the face of a highly contagious pathogen. To better prepare the world for any new mutation of the same pathogen or the newer ones, technological development in the healthcare system is a must. Hence, in this work, PCovNet+, a deep learning framework, was proposed for smartwatches and fitness trackers to monitor the user's Resting Heart Rate (RHR) for the infection-induced anomaly. A convolutional neural network (CNN)-based variational autoencoder (VAE) architecture was used as the primary model along with a long short-term memory (LSTM) network to create latent space embeddings for the VAE. Moreover, the framework employed pre-training using normal data from healthy subjects to circumvent the data shortage problem in the personalized models. This framework was validated on a dataset of 68 COVID-19-infected subjects, resulting in anomalous RHR detection with precision, recall, F-beta, and F-1 score of 0.993, 0.534, 0.9849, and 0.6932, respectively, which is a significant improvement compared to the literature. Furthermore, the PCovNet+ framework successfully detected COVID-19 infection for 74\\% of the subjects (47\\% presymptomatic and 27\\% post-symptomatic detection). The results prove the usability of such a system as a secondary diagnostic tool enabling continuous health monitoring and contact tracing.", "links": [] }, { "title": "Gut microbiota composition and functionality are associated with REM sleep duration and continuous glucose levels", "author": "Arnoriaga-Rodríguez, María; Leal, Yenny; Mayneris-Perxachs, Jordi; Pérez-Brocal, Vicente; Moya, Andrés; Ricart, Wifredo; Fernández-Balsells, Mercè; Fernández-Real, José Manuel", "year": "2023", "journalProceedings": "The Journal of Clinical Endocrinology and Metabolism", "category": "Case Study", "devices": "Charge 3", "population": "Adults", "dataUsed": "Sleep", "abstract": "CONTEXT: Sleep disruption is associated with poorer glucose metabolic control and altered gut microbiota in animal models. OBJECTIVE: We aimed to evaluate the possible links among REM sleep duration, continuous glucose levels and gut microbiota composition. DESIGN: This is an observational, prospective, real-life, cross-sectional case-control study. SETTING: Tertiary Hospital recruiting healthy volunteers. PATIENTS OR OTHER PARTICIPANTS: One-hundred and eighteen (60 with obesity), middle-aged (39.1-54.8) subjects. INTERVENTION(S): Glucose variability and REM sleep duration were assessed by 10-day continuous glucose monitoring (CGM) (Dexcom G6®) and wrist-actigraphy (Fitbit Charge 3®), respectively. MAIN OUTCOME MEASURE(S): . Glucose variability was evaluated through standard deviation (SD), coefficient of variation (CV) and interquartile range (IQR). The percentage of time in range (\\% TIR), 126-139 mg/dL (TIR2) and 140-199 mg/dL (TIR3) were calculated. Shotgun metagenomics sequencing was applied to study gut microbiota taxonomy and functionality. RESULTS: Increased glycemic variability (SD, CV and IQR) was observed among subjects with obesity in parallel to increased \\% TIR2 and \\% TIR3. REM sleep duration was independently associated with the \\% TIR3 (β=-0.339; p {\\textless} 0.001) and glucose variability (SD, β=-0.350; p {\\textless} 0.001). Microbial taxa from Christensenellaceae family (Firmicutes phylum) were positively associated with REM sleep and negatively with glucose continuous monitoring levels, while bacteria from Enterobacteriacea family and bacterial functions involved in iron metabolism showed opposite associations. CONCLUSIONS: Decreased REM sleep duration was independently associated with a worse glucose profile. The associations of species from Christensenellaceae and Enterobacteriaceae families with REM sleep duration and continuous glucose values suggest an integrated picture of metabolic health.", "links": [] }, { "title": "Effect of an Automated Advice Algorithm (CloudConnect) on Adolescent-Parent Diabetes-Specific Communication and Glycemic Management: A Randomized Trial", "author": "DeBoer, Mark D.; Valdez, Rupa; Corbett, John P.; Krauthause, Katie; Wakeman, Christian A.; Luke, Alexander S.; Oliveri, Mary C.; Cherñavvsky, Daniel R.; Patek, Stephen D.", "year": "2023", "journalProceedings": "Diabetes Therapy: Research, Treatment and Education of Diabetes and Related Disorders", "category": "Case Study", "devices": "Charge 3", "population": "Adults,Adolescents", "dataUsed": "NA", "abstract": "INTRODUCTION: Because adolescence is a time of difficult management of Type 1 diabetes (T1D) in part from adolescent-parent shared responsibility of T1D management, our objective was to assess the effects of a decision support system (DSS) CloudConnect on T1D-related communication between adolescents and their parents and on glycemic management. METHODS: We followed 86 participants including 43 adolescents with T1D (not on automated insulin delivery systems, AID) and their parents/care-giver for a 12-week intervention of UsualCare + CGM or CloudConnect, which included a Weekly Report of automated T1D advice, including insulin dose adjustments, based on data from continuous glucose monitors (CGM), Fitbit and insulin use. Primary outcome was T1D-specific communication and secondary outcomes were hemoglobin A1c, time-in-target range (TIR) 70-180 mg/dl, and additional psychosocial scales. RESULTS: Adolescents and parents reported a similar amount of T1D-related communication in both the UsualCare + CGM or CloudConnect groups and had similar levels of final HbA1c. Overall blood glucose time in range 70-180 mg/dl and time below 70 mg/dl were not different between groups. Parents but not children in the CloudConnect group reported less T1D-related conflict; however, compared to the UsualCare + CGM group, adolescents and parents in the CloudConnect reported a more negative tone of T1D-related communication. Adolescent-parent pairs in the CloudConnect group reported more frequent changes in insulin dose. There were no differences in T1D quality of life between groups. CONCLUSIONS: While feasible, the CloudConnect DSS system did not increase T1D communication or provide improvements in glycemic management. Further efforts are needed to improve T1D management in adolescents with T1D not on AID systems.", "links": [] }, { "title": "Mindfulness Combined with Exercise Online (MOVE) Compared with a Self-Management Guide for Adults with Chronic Pain: A Feasibility Randomised Controlled Trial", "author": "Deegan, Orla; Fullen, Brona M.; Casey, Maire-Brid; Segurado, Ricardo; Hearty, Conor; Doody, Catherine", "year": "2023", "journalProceedings": "The Clinical Journal of Pain", "category": "Intervention", "devices": "Device unspecified", "population": "Adults", "dataUsed": "User Friendliness", "abstract": "OBJECTIVE: Limited studies exist combining mindfulness-based stress reduction (MBSR) and exercise in a pain management programme (PMP), with none thus far delivering a combined intervention as an online PMP. This study aimed to explore the acceptability and feasibility of a combined MBSR and exercise online PMP for adults with chronic pain and to examine the feasibility of conducting a Randomised Controlled Trial (RCT) comparing MBSR and exercise delivered online with an online self-management guide. METHODS: A feasibility RCT was conducted with participants randomised into the MOVE Group (8-week MBSR and exercise live online) or the self-management (SM) group (8-week online self-management guide). Primary outcomes included recruitment, attrition, intervention adherence, and satisfaction. Participants wore a Fitbit watch during the study and completed patient reported outcome measures at baseline, post-intervention and 12-week follow-up. RESULTS: Ninety-six participants were randomised and 80 (83.3\\%) completed the interventions. Higher mean satisfaction (Client Satisfaction Questionnaire-8) was reported in the MOVE group 26.2(±5.5) than the SM group 19.4(±5.6). The Patient Global Impression of Change scale showed favourable changes in both groups; 65.1\\% of the MOVE group, 42.3\\% of the SM Group reporting improvement. 73 participants (76.3\\%) adhered to wearing the Fitbit for 8-weeks. Comparable improvements post-intervention and at a 12-week follow-up were noted within both groups for Brief Pain Inventory, Pain Self Efficacy Questionnaire, Pain Disability Index, Pain Catastrophising Scale, Fear Avoidance Belief Questionnaire and Short Form-36 Health Survey. DISCUSSION: The findings suggest both interventions explored are acceptable and feasible. A fully powered RCT examining the effectiveness of MBSR combined with exercise, delivered live online is warranted.", "links": [] }, { "title": "Clinical validation of an artificial intelligence algorithm offering cross-platform detection of atrial fibrillation using smart device electrocardiograms", "author": "Mannhart, Diego; Lefebvre, Baptiste; Gardella, Christophe; Henry, Christine; Serban, Teodor; Knecht, Sven; Kühne, Michael; Sticherling, Christian; Badertscher, Patrick", "year": "2023", "journalProceedings": "Archives of Cardiovascular Diseases", "category": "Validation", "devices": "Sense", "population": "Patients", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Several smart devices are able to detect atrial fibrillation automatically by recording a single-lead electrocardiogram, and have created a work overload at the hospital level as a result of the need for over-reads by physicians. AIM: To compare the atrial fibrillation detection performances of the manufacturers' algorithms of five smart devices and a novel deep neural network-based algorithm. METHODS: We compared the rate of inconclusive tracings and the diagnostic accuracy for the detection of atrial fibrillation between the manufacturers' algorithms and the deep neural network-based algorithm on five smart devices, using a physician-interpreted 12-lead electrocardiogram as the reference standard. RESULTS: Of the 117 patients (27\\% female, median age 65 years, atrial fibrillation present at time of recording in 30\\%) included in the final analysis (resulting in 585 analyzed single-lead electrocardiogram tracings), the deep neural network-based algorithm exhibited a higher conclusive rate relative to the manufacturer algorithm for all five models: 98\\% vs. 84\\% for Apple; 99\\% vs. 81\\% for Fitbit; 96\\% vs. 77\\% for AliveCor; 99\\% vs. 85\\% for Samsung; and 97\\% vs. 74\\% for Withings (P{\\textless}0.01, for each model). When applying our deep neural network-based algorithm, sensitivity and specificity to correctly identify atrial fibrillation were not significantly different for all assessed smart devices. CONCLUSION: In this clinical validation, the deep neural network-based algorithm significantly reduced the number of tracings labeled inconclusive, while demonstrating similarly high diagnostic accuracy for the detection of atrial fibrillation, thereby providing a possible solution to the data surge created by these smart devices.", "links": [] }, { "title": "Machine Learning Approaches to Classify Self-Reported Rheumatoid Arthritis Health Scores Using Activity Tracker Data", "author": "Rao, Kaushal; Speier, William; Meng, Yiwen; Wang, Jinhan; Ramesh, Nidhi; Xie, Fenglong; Su, Yujie; Nowell, Benjamin; Curtis, Jeffrey; Arnold, Corey", "year": "2023", "journalProceedings": "JMIR formative research", "category": "Intervention", "devices": "Versa 2", "population": "Patients", "dataUsed": "Steps,Energy Expenditure,Sleep,Heart Rate", "abstract": "BACKGROUND: The increasing use of activity trackers in mobile health studies to passively collect physical data has shown promise to lessen participation burden to provide actively contributed patient reported outcome (PRO) information. Our goal was to develop machine learning models to classify patient-reported outcome (PRO) scores using Fitbit data from a cohort of patients with rheumatoid arthritis (RA). OBJECTIVE: The increasing use of activity trackers in mobile health studies to passively collect physical data has shown promise to lessen participation burden to provide actively contributed patient reported outcome (PRO) information. Our goal was to develop machine learning models to classify patient-reported outcome (PRO) scores using Fitbit data from a cohort of patients with rheumatoid arthritis (RA). METHODS: Two different models were built to classify PRO scores; a random forest (RF) Classifier model that treated each week of observations independently when making weekly predictions of PRO scores, and a hidden Markov model (HMM) that additionally took correlations between successive weeks into account. Analyses compared model evaluation metrics for: 1) a binary task of distinguishing a normal PRO score from a severe PRO score, and 2) a multiclass task of classifying a PRO score state for a given week. RESULTS: For both the binary and multiclass tasks, the HMM significantly (p {\\textless} 0.05) outperformed the RF for most PRO scores, and the highest AUC, Pearson's Correlation coefficient, and Cohen's Kappa coefficient were 0.751, 0.458, and 0.450 respectively. CONCLUSIONS: While further validation of our results and evaluation in a real-world setting yet remains, this study demonstrates the ability of physical activity tracker data to classify health status over time in patients with RA and enables the possibility of scheduling preventive clinical interventions as needed. If patient outcomes can be monitored in real time, there is potential to improve clinical care for patients with other chronic conditions.", "links": [] }, { "title": "The usability of daytime and night-time heart rate dynamics as digital biomarkers of depression severity", "author": "Siddi, S.; Bailon, R.; Giné-Vázquez, I.; Matcham, F.; Lamers, F.; Kontaxis, S.; Laporta, E.; Garcia, E.; Lombardini, F.; Annas, P.; Hotopf, M.; Penninx, B. W. J. H.; Ivan, A.; White, K. M.; Difrancesco, S.; Locatelli, P.; Aguiló, J.; Peñarrubia-Maria, M. T.; Narayan, V. A.; Folarin, A.; Leightley, D.; Cummins, N.; Vairavan, S.; Ranjan, Y.; Rintala, A.; de Girolamo, G.; Simblett, S. K.; Wykes, T.; PAB members; Myin-Germeys, I.; Dobson, R.; Haro, J. M.; RADAR-CNS consortium", "year": "2023", "journalProceedings": "Psychological Medicine", "category": "Case Study,Measurement", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Alterations in heart rate (HR) may provide new information about physiological signatures of depression severity. This 2-year study in individuals with a history of recurrent major depressive disorder (MDD) explored the intra-individual variations in HR parameters and their relationship with depression severity. METHODS: Data from 510 participants (Number of observations of the HR parameters = 6666) were collected from three centres in the Netherlands, Spain, and the UK, as a part of the remote assessment of disease and relapse-MDD study. We analysed the relationship between depression severity, assessed every 2 weeks with the Patient Health Questionnaire-8, with HR parameters in the week before the assessment, such as HR features during all day, resting periods during the day and at night, and activity periods during the day evaluated with a wrist-worn Fitbit device. Linear mixed models were used with random intercepts for participants and countries. Covariates included in the models were age, sex, BMI, smoking and alcohol consumption, antidepressant use and co-morbidities with other medical health conditions. RESULTS: Decreases in HR variation during resting periods during the day were related with an increased severity of depression both in univariate and multivariate analyses. Mean HR during resting at night was higher in participants with more severe depressive symptoms. CONCLUSIONS: Our findings demonstrate that alterations in resting HR during all day and night are associated with depression severity. These findings may provide an early warning of worsening depression symptoms which could allow clinicians to take responsive treatment measures promptly.", "links": [] }, { "title": "A culturally tailored personaliseD nutrition intErvention in South ASIan women at risk of Gestational Diabetes Mellitus (DESI-GDM): a randomised controlled trial protocol", "author": "Stennett, Rosain N.; Adamo, Kristi B.; Anand, Sonia S.; Bajaj, Harpreet S.; Bangdiwala, Shrikant I.; Desai, Dipika; Gerstein, Hertzel C.; Kandasamy, Sujane; Khan, Farah; Lear, Scott A.; McDonald, Sarah D.; Pocsai, Tayler; Ritvo, Paul; Rogge, Andrea; Schulze, Karleen M.; Sherifali, Diana; Stearns, Jennifer C.; Wahi, Gita; Williams, Natalie C.; Zulyniak, Michael A.; de Souza, Russell J.", "year": "2023", "journalProceedings": "BMJ open", "category": "Intervention", "devices": "Device unspecified", "population": "Pregnant Women", "dataUsed": "Steps", "abstract": "INTRODUCTION: South Asians are more likely to develop gestational diabetes mellitus (GDM) than white Europeans. Diet and lifestyle modifications may prevent GDM and reduce undesirable outcomes in both the mother and offspring. Our study seeks to evaluate the effectiveness and participant acceptability of a culturally tailored, personalised nutrition intervention on the glucose area under the curve (AUC) after a 2-hour 75 g oral glucose tolerance test (OGTT) in pregnant women of South Asian ancestry with GDM risk factors. METHODS AND ANALYSIS: A total of 190 South Asian pregnant women with at least 2 of the following GDM risk factors-prepregnancy body mass index{\\textgreater}23, age{\\textgreater}29, poor-quality diet, family history of type 2 diabetes in a first-degree relative or GDM in a previous pregnancy will be enrolled during gestational weeks 12-18, and randomly assigned in a 1:1 ratio to: (1) usual care, plus weekly text messages to encourage walking and paper handouts or (2) a personalised nutrition plan developed and delivered by a culturally congruent dietitian and health coach; and FitBit to track steps. The intervention lasts 6-16 weeks, depending on week of recruitment. The primary outcome is the glucose AUC from a three-sample 75 g OGTT 24-28 weeks' gestation. The secondary outcome is GDM diagnosis, based on Born-in-Bradford criteria (fasting glucose{\\textgreater}5.2 mmol/L or 2 hours post load{\\textgreater}7.2 mmol/L). ETHICS AND DISSEMINATION: The study has been approved by the Hamilton Integrated Research Ethics Board (HiREB \\#10942). Findings will be disseminated among academics and policy-makers through scientific publications along with community-orientated strategies. TRIAL REGISTRATION NUMBER: NCT03607799.", "links": [] }, { "title": "A feasibility study to understand the components of behavioral sleep extension", "author": "Baron, Kelly G.; Trela-Hoskins, Sarah R.; Duffecy, Jennifer; Allen, Chelsea M.", "year": "2022", "journalProceedings": "PEC Innovation", "category": "Intervention", "devices": "Flex 2", "population": "Adults", "dataUsed": "User Friendliness", "abstract": "Objectives: The goal of this study was to examine the contribution of sleep extension intervention components (wearable sleep tracker and coaching) on sleep extension outcomes.\n\nPatient involvement: This study collected open ended qualitative responses of treatment preference, acceptability, and feasibility as a key outcome.\n\nMethods: Adults aged 25 to 65 years with sleep duration <7 h and BMI ≥ 25 were randomized into one of four groups: Self-Management (control), Fitbit, Telephone Coaching, or Fitbit + Coaching. Self-report questionnaires and actigraphy were completed at baseline, post-intervention (6 weeks), and 12-weeks. Analyses used mixed models.\n\nResults: Among the 38 adults randomized, the Fitbit + Coaching group had larger but non-significant improvements in sleep duration compared with the self-management group. The coaching group demonstrated significant improvements in sleep-related impairment. All groups demonstrated feasibility and acceptability but the Fitbit + Coaching group reported themes of accountability.\n\nConclusions: Results suggest that sleep extension interventions are feasible and acceptable but components affect the pattern of sleep and other outcomes.\n\nPractical implications: Sleep extension is feasible and acceptable; the combination of coaching and the wearable device may lead to larger changes in sleep due to enhanced accountability.\n\nKeywords: Coaching; Sleep; Sleep extension; Wearable technology.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10194216/", "newWindow": true } ] }, { "title": "Feasibility and Utility of a Fitbit Tracker Among Ambulatory Children and Youth With Disabilities", "author": "Bremer, Emily; Arbour-Nicitopoulos, Kelly P.; Tsui, Brianna; Ginis, Kathleen A. Martin; Moore, Sarah A.; Best, Krista L.; Voss, Christine", "year": "2023", "journalProceedings": "Pediatric Exercise Science", "category": "Usability", "devices": "Charge HR", "population": "Children", "dataUsed": "Steps,User Friendliness", "abstract": "PURPOSE: To examine the feasibility and utility of the Fitbit Charge HR to estimate physical activity among ambulatory children and youth with disabilities. METHOD: Participants (4-17 y old) with disabilities were recruited and asked to wear a Fitbit for 28 days. Feasibility was assessed as the number of participants who adhered to the 28-day protocol. Heat maps were generated to visually examine variability in step count by age, gender, and disability group. Between-group differences for wear time and step counts by age, gender, and disability type were assessed by independent sample t tests for gender and disability group, and a 1-way analysis of variance for age group. RESULTS: Participants (N = 157; median age = 10 y; 71\\% boys; 71\\% nonphysical disabilities) averaged 21 valid days of wear time. Wear time was higher in girls than boys (mean difference = 18.0; 95\\% confidence interval [CI], 6.8 to 29.1), and in preadolescents (mean difference = 27.6; 95\\% CI, 15.5 to 39.7) and adolescents (mean difference = -21.2; 95\\% CI, -33.6 to -8.7) than children. More daily steps were taken by boys than girls (mean difference = -1040; 95\\% CI, -1465 to -615) and individuals with a nonphysical disability than a physical disability (mean difference = -1120; 95\\% CI, -1474 to -765). The heat maps showed peaks in physical activity on weekdays before school, at recess, lunchtime, and after school. CONCLUSION: The Fitbit is a feasible tool for monitoring physical activity among ambulatory children and youth with disabilities and may be useful for population-level surveillance and intervention.", "links": [] }, { "title": "Performance evaluation of Fitbit Charge 3 and actigraphy vs. polysomnography: Sensitivity, specificity, and reliability across participants and nights", "author": "Eylon, Gal; Tikotzky, Liat; Dinstein, Ilan", "year": "2023", "journalProceedings": "Sleep Health", "category": "Validation", "devices": "Charge 3", "population": "Adults", "dataUsed": "Sleep", "abstract": "GOAL AND AIMS: Compare the accuracy and reliability of sleep/wake classification between the Fitbit Charge 3 and the Micro Motionlogger actigraph when applying either the Cole-Kripke or Sadeh scoring algorithms. Accuracy was established relative to simultaneous Polysomnography recording. Focus technology: Fitbit Charge 3 and actigraphy. Reference technology: Polysomnography. SAMPLE: Twenty-one university students (10 females). DESIGN: Simultaneous Fitbit Charge 3, actigraphy, and polysomnography were recorded over 3 nights at the participants' homes. CORE ANALYTICS: Total sleep time, wake after sleep onset, sensitivity, specificity, positive predictive value, and negative predictive value. ADDITIONAL ANALYTICS AND EXPLORATORY ANALYSES: Variability of specificity and negative predictive value across subjects and across nights. CORE OUTCOMES: Fitbit Charge 3 and actigraphy using the Cole-Kripke or Sadeh algorithms exhibited similar sensitivity in classifying sleep segments relative to polysomnography (sensitivity of 0.95, 0.96, and 0.95, respectively). Fitbit Charge 3 was significantly more accurate in classifying wake segments (specificity of 0.69, 0.33, and 0.29, respectively). Fitbit Charge 3 also exhibited significantly higher positive predictive value than actigraphy (0.99 vs. 0.97 and 0.97, respectively) and a negative predictive value that was significantly higher only relative to the Sadeh algorithm (0.41 vs. 0.25, respectively). IMPORTANT ADDITIONAL OUTCOMES: Fitbit Charge 3 exhibited significantly lower standard deviation in specificity values across subjects and negative predictive value across nights. CORE CONCLUSION: This study demonstrates that Fitbit Charge 3 is more accurate and reliable in identifying wake segments than the examined FDA-approved Micro Motionlogger actigraphy device. The results also highlight the need to create devices that record and save raw multi-sensor data, which are necessary for developing open-source sleep or wake classification algorithms.", "links": [] }, { "title": "The feasibility of remotely monitoring physical, cognitive, and psychosocial function in individuals with stroke or chronic obstructive pulmonary disease", "author": "French, Margaret A.; Keatley, Eva; Li, Junyao; Balasubramanian, Aparna; Hansel, Nadia N.; Wise, Robert; Searson, Peter; Singh, Anil; Raghavan, Preeti; Wegener, Stephen; Roemmich, Ryan T.; Celnik, Pablo", "year": "2023", "journalProceedings": "Digital Health", "category": "Usability", "devices": "Inspire 2", "population": "Adults", "dataUsed": "User Friendliness", "abstract": "OBJECTIVE: Clinical implementation of remote monitoring of human function requires an understanding of its feasibility. We evaluated adherence and the resources required to monitor physical, cognitive, and psychosocial function in individuals with either chronic obstructive pulmonary disease or stroke during a three-month period. METHODS: Seventy-three individuals agreed to wear a Fitbit to monitor physical function and to complete monthly online assessments of cognitive and psychosocial function. During a three-month period, we measured adherence to monitoring (1) physical function using average daily wear time, and (2) cognition and psychosocial function using the percentage of assessments completed. We measured the resources needed to promote adherence as (1) the number of participants requiring at least one reminder to synchronize their Fitbit, and (2) the number of reminders needed for each completed cognitive and psychosocial assessment. RESULTS: After accounting for withdrawals, the average daily wear time was 77.5 ± 19.9\\% of the day and did not differ significantly between months 1, 2, and 3 (p = 0.30). To achieve this level of adherence, 64.9\\% of participants required at least one reminder to synchronize their device. Participants completed 61.0\\% of the cognitive and psychosocial assessments; the portion of assessments completed each month didnot significantly differ (p = 0.44). Participants required 1.13 ± 0.57 reminders for each completed assessment. Results did not differ by disease diagnosis. CONCLUSIONS: Remote monitoring of human function in individuals with either chronic obstructive pulmonary disease or stroke is feasible as demonstrated by high adherence. However, the number of reminders required indicates that careful consideration must be given to the resources available to obtain high adherence.", "links": [] }, { "title": "Working-from-home persistently influences sleep and physical activity 2 years after the Covid-19 pandemic onset: a longitudinal sleep tracker and electronic diary-based study", "author": "Massar, Stijn A. A.; Ong, Ju Lynn; Lau, TeYang; Ng, Ben K. L.; Chan, Lit Fai; Koek, Daphne; Cheong, Karen; Chee, Michael W. L.", "year": "2023", "journalProceedings": "Frontiers in Psychology", "category": "Case Study", "devices": "Versa 2", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Objective Working from home (WFH) has become common place since the Covid-19 pandemic. Early studies observed population-level shifts in sleep patterns (later and longer sleep) and physical activity (reduced PA), during home confinement. Other studies found these changes to depend on the proportion of days that individuals WFH (vs. work from office; WFO). Here, we examined the effects of WFH on sleep and activity patterns in the transition to normality during the later stages of the Covid-19 pandemic (Aug 2021–Jan 2022). Methods Two-hundred and twenty-five working adults enrolled in a public health study were followed for 22  weeks. Sleep and activity data were collected with a consumer fitness tracker (Fitbit Versa 2). Over three 2-week periods (Phase 1/week 1–2: August 16–29, 2021; Phase 2/week 11–12: October 25–November 7, 2021; Phase 3/week 21–22: January 3–16, 2022), participants provided daily Fitbit sleep and activity records. Additionally, they completed daily phone-based ecological momentary assessment (EMA), providing ratings of sleep quality, wellbeing (mood, stress, motivation), and information on daily work arrangements (WFH, WFO, no work). Work arrangement data were used to examine the effects of WFH vs. WFO on sleep, activity, and wellbeing. Results The proportion of WFH vs. WFO days fluctuated over the three measurement periods, mirroring evolving Covid restrictions. Across all three measurement periods WFH days were robustly associated with later bedtimes (+14.7 min), later wake times (+42.3 min), and longer Total Sleep Time (+20.2 min), compared to WFO days. Sleep efficiency was not affected. WFH was further associated with lower daily step count than WFO (−2,471 steps/day). WFH was associated with higher wellbeing ratings compared to WFO for those participants who had no children. However, for participants with children, these differences were not present. Conclusion Pandemic-initiated changes in sleep and physical activity were sustained during the later stage of the pandemic. These changes could have longer term effects, and conscious effort is encouraged to harness the benefits (i.e., longer sleep), and mitigate the pitfalls (i.e., less physical activity). These findings are relevant for public health as hybrid WHF is likely to persist in a post-pandemic world.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10196619/", "newWindow": true } ] }, { "title": "Data-driven physical actigraphy patterns relate to cognitive and vascular health in older adults", "author": "Paolillo, Emily W.; Lee, Shannon Y.; VandeBunte, Anna; Saloner, Rowan; Gaynor, Leslie S.; Djukic, Nina; Tsuei, Torie; Cobigo, Yann; Kramer, Joel H.; Casaletto, Kaitlin B.", "year": "2023", "journalProceedings": "Experimental Gerontology", "category": "Case Study", "devices": "Flex 2", "population": "Older Adults", "dataUsed": "Steps,Intensity", "abstract": "Health benefits of physical activity (PA) are well known; however, specific PA patterns that relate most strongly to cognitive aging outcomes are poorly understood. We characterized latent profiles of PA among older adults and examined associations with cognition and vascular burden. 124 functionally normal older adults wore a Fitbit™ for 30 days. Daily average step count, sedentary time (0 steps/min), and high-intensity time (≥120 steps/min) were calculated. Participants completed neurocognitive testing assessing cognitive domains of executive functioning and memory; medical history, from which vascular burden (i.e., a count of cardiovascular conditions) was calculated; and brain MRI (n = 44). Subgroups with similar PA patterns were identified via latent profile analysis. Three latent PA classes emerged: Class 1Low PA (n = 49), Class 2Average PA (n = 59), and Class 3High-intensity PA (n = 16). PA class related to executive functioning and vascular burden, driven by better outcomes in Class 3 than Class 1. Sex-stratified analyses revealed these associations were strongest in males. Post hoc analyses showed a positive association between high-intensity PA and white matter integrity among males. High-intensity PA related to better cognitive and vascular health, particularly among males. Findings inform physical activity-specific and person-specific recommendations for optimal cognitive aging.", "links": [] }, { "title": "Natural patterns of social support for physical activity participation in newly matched breast cancer survivor dyads", "author": "Peck, Serena S.; Vani, Madison F.; Smith-Turchyn, Jenna; Sabiston, Catherine M.", "year": "2023", "journalProceedings": "BMC women's health", "category": "Case Study", "devices": "Inspire HR", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND: Physical activity (PA) can be a beneficial strategy to mitigate physical, emotional, and social-related challenges in women living beyond breast cancer treatment (WBC). However, PA levels among WBC remain low. Optimizing social support provided in a peer-matched setting may increase PA behavior. Unfortunately, factors that lead to an ideal peer-match among WBC are not well understood. The purpose of this study was to contextualize the natural social support environment and PA behavior in newly formed peer WBC dyads participating in an ecological momentary assessment study. METHODS: WBC were matched with a partner and provided with a Fitbit activity tracker. Social support was measured using 21-daily surveys, and a 3-week follow-up survey. Descriptive statistics were calculated. Open-ended survey questions were analyzed using content analysis. Data were analyzed based on (i) social support types (informational, tangible, esteem, and emotional support); and (ii) WBC' reports of being in a good, neutral, or poor match at the end of the study. RESULTS: Women (n = 46; Mage = 42.4 ± 7.6 years; 89.2\\% stage I-III breast cancer) connected with their partner (58.1\\%) and participated in moderate-vigorous PA (MVPA)(77.1\\%) on most days over the 21-day study period. Women were identified as being in good (63\\%), neutral (20\\%), or poor (17\\%) dyad matches. The most frequently documented social support received by WBC was esteem support. Participants in a good match were more likely to report receiving all types of social support compared to neutral or poor matches. CONCLUSION \\& CLINICAL IMPLICATIONS: Findings describe the social support characteristics important to WBC for facilitating their PA participation in a partner-based setting. This study provides valuable insight that can inform the development of partner-based PA interventions for WBC.", "links": [] }, { "title": "Development of a Mobile Health Snacktivity App to Promote Physical Activity in Inactive Adults (SnackApp): Intervention Mapping and User Testing Study", "author": "Sanders, James P.; Gokal, Kajal; Thomas, Jonah J. C.; Rawstorn, Jonathan C.; Sherar, Lauren B.; Maddison, Ralph; Greaves, Colin J.; Esliger, Dale; Daley, Amanda J.; Snacktivity Investigators", "year": "2023", "journalProceedings": "JMIR formative research", "category": "Intervention,Measurement", "devices": "Versa Lite", "population": "Adults", "dataUsed": "User Friendliness", "abstract": "BACKGROUND: Despite the unequivocal evidence demonstrating the benefits of being physically active, many people do not meet the recommended guidelines of at least 150 minutes of moderate- to vigorous-intensity physical activity per week. This can be changed with the development and implementation of innovative interventions. The use of mobile health (mHealth) technologies has been suggested as a mechanism to offer people innovative health behavior change interventions. OBJECTIVE: This study aims to outline the systematic, theory-driven processes and user testing applied to the development of a smartphone-based physical activity app (SnackApp) to promote participation in a novel physical activity intervention called Snacktivity. The acceptability of the app was explored and reported. METHODS: Intervention mapping involves a 6-step process, the first 4 of which were presented in this study. These steps were used to develop the SnackApp for use within the Snacktivity intervention. The first step involved a needs assessment, which included composing an expert planning group, patient and public involvement group, and gathering the views of the public on Snacktivity and the public perception of the use of wearable technology to support Snacktivity. This first step aimed to determine the overall purpose of the Snacktivity intervention. Steps 2 to 4 involved determining the intervention objectives, the behavior change theory and techniques on which the intervention is based, and the development of the intervention resources (ie, SnackApp). After the completion of steps 1 to 3 of the intervention mapping process, the SnackApp was developed and linked to a commercial physical activity tracker (Fitbit Versa Lite) for the automated capture of physical activity. SnackApp includes provisions for goal setting, activity planning, and social support. Stage 4 involved users (inactive adults, N=15) testing the SnackApp for 28 days. App engagement (mobile app use analytics) was analyzed to determine app use and to inform the further development of SnackApp. RESULTS: Over the study period (step 4), participants engaged with SnackApp an average of 77 (SD 80) times. On average, participants used the SnackApp for 12.6 (SD 47) minutes per week, with most of the time spent on the SnackApp dashboard and engaging, on average, 14 (SD 12.1) times, lasting 7 to 8 minutes per week. Overall, male participants used the SnackApp more than female participants did. The app rating score was 3.5 (SD 0.6) out of 5, suggesting that SnackApp was rated as fair to good. CONCLUSIONS: This study outlines and reports data regarding the development of an innovative mHealth app using a systematic, theory-driven framework. This approach can guide the development of future mHealth programs. User testing of the SnackApp suggested that physically inactive adults will engage with the SnackApp, indicating its applicability of use in the Snacktivity physical activity intervention.", "links": [] }, { "title": "Accuracy of a Standalone Atrial Fibrillation Detection Algorithm Added to a Popular Wristband and Smartwatch: Prospective Diagnostic Accuracy Study", "author": "Selder, Jasper L.; Te Kolste, Henryk Jan; Twisk, Jos; Schijven, Marlies; Gielen, Willem; Allaart, Cornelis P.", "year": "2023", "journalProceedings": "Journal of Medical Internet Research", "category": "Validation", "devices": "Ionic", "population": "Patients", "dataUsed": "NA", "abstract": "BACKGROUND: Silent paroxysmal atrial fibrillation (AF) may be difficult to diagnose, and AF burden is hard to establish. In contrast to conventional diagnostic devices, photoplethysmography (PPG)-driven smartwatches or wristbands allow for long-term continuous heart rhythm assessment. However, most smartwatches lack an integrated PPG-AF algorithm. Adding a standalone PPG-AF algorithm to these wrist devices might open new possibilities for AF screening and burden assessment. OBJECTIVE: The aim of this study was to assess the accuracy of a well-known standalone PPG-AF detection algorithm added to a popular wristband and smartwatch, with regard to discriminating AF and sinus rhythm, in a group of patients with AF before and after cardioversion (CV). METHODS: Consecutive consenting patients with AF admitted for CV in a large academic hospital in Amsterdam, the Netherlands, were asked to wear a Biostrap wristband or Fitbit Ionic smartwatch with Fibricheck algorithm add-on surrounding the procedure. A set of 1-min PPG measurements and 12-lead reference electrocardiograms was obtained before and after CV. Rhythm assessment by the PPG device-software combination was compared with the 12-lead electrocardiogram. RESULTS: A total of 78 patients were included in the Biostrap-Fibricheck cohort (156 measurement sets) and 73 patients in the Fitbit-Fibricheck cohort (143 measurement sets). Of the measurement sets, 19/156 (12\\%) and 7/143 (5\\%), respectively, were not classifiable by the PPG algorithm due to bad quality. The diagnostic performance in terms of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy was 98\\%, 96\\%, 96\\%, 99\\%, 97\\%, and 97\\%, 100\\%, 100\\%, 97\\%, and 99\\%, respectively, at an AF prevalence of {\\textasciitilde}50\\%. CONCLUSIONS: This study demonstrates that the addition of a well-known standalone PPG-AF detection algorithm to a popular PPG smartwatch and wristband without integrated algorithm yields a high accuracy for the detection of AF, with an acceptable unclassifiable rate, in a semicontrolled environment.", "links": [] }, { "title": "Sleep Duration on Workdays Is Correlated with Subjective Workload and Subjective Impact of High Workload on Sleep in Young Healthy Adults", "author": "von Gall, Charlotte; Muth, Thomas; Angerer, Peter", "year": "2023", "journalProceedings": "Brain Sciences", "category": "Case Study", "devices": "Inspire", "population": "Adults", "dataUsed": "Sleep", "abstract": "Psychosocial stress is widespread worldwide and particularly affects young adults. There is a close and bidirectional relationship between sleep quality and mental health. Sleep duration, which is an important feature of sleep quality, shows both intra-individual variations and inter-individual differences. Internal clocks control individual sleep timing, which, in turn, defines the chronotype. On workdays, however, the end and duration of sleep are largely limited by external factors, such as alarm clocks, especially in later chronotypes. The aim of this study is to investigate whether there is a relationship between sleep timing and duration on workdays and measures for psychosocial stress, such as anxiety and depression; subjective workload; and the subjective impact of a high workload on sleep. We used a combination of Fitbit wearable actigraphy data and a questionnaire survey of young, healthy medical students and calculated correlations between the respective variables. We found that a shorter sleep duration on workdays is associated with a higher subjective workload and a higher subjective impact of a high workload on sleep, which, in turn, are associated with higher measures of anxiety and depression. Our study contributes to understanding the importance of sleep timing/duration and their regularity on weekdays for subjectively perceived psychosocial stress.", "links": [] }, { "title": "Linking Sleep and Aggression: Examining the Role of Response Inhibition and Emotional Processing", "author": "Bozzay, Melanie L.; Verona, Edelyn", "year": "2023", "journalProceedings": "Clinical Psychological Science: A Journal of the Association for Psychological Science", "category": "Case Study", "devices": "Flex", "population": "Adults", "dataUsed": "Sleep", "abstract": "Although sleep loss is theorized to increase aggression risk, knowledge regarding the sleep-aggression relationship, or explanatory psychological processes, is limited. This study examined whether recent sleep duration predicted subsequent laboratory aggression, and whether neurocognitive indices of attentional and motor inhibition and negative emotional processing explained the sleep-aggression relationship. Participants (n=141) wore Fitbit Flex devices and kept a sleep diary for three days. Event-related potentials were measured during an Emotional-Linguistic Go/No-Go task, followed by a laboratory aggression paradigm. Results of mixed-model repeated measures ANOVAs linked shorter sleep duration with reduced motor inhibition processing during negative and neutral word blocks, and greater aggression. However, neurocognitive indices did not explain the sleep-aggression link. This is the first evidence that naturally occurring sleep loss predicts increases in laboratory aggression across the task and suggests that shorter sleepers are more vulnerable to rash action in negative and neutral contexts. Implications of these findings for understanding aggression will be discussed.", "links": [] }, { "title": "Effects of a Mobile-Health Exercise Intervention on Body Composition, Vascular Function, and Autonomic Nervous System Function in Obese Women: A Randomized Controlled Trial", "author": "Choi, Jae-Ho; Kim, Sung-Woo; Seo, Jisoo; Sun, Yerin; Jung, Won-Sang; Park, Hun-Young; Kim, Jisu; Lim, Kiwon", "year": "2023", "journalProceedings": "Journal of Multidisciplinary Healthcare", "category": "Intervention,Measurement", "devices": "Charge 4", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Heart Rate", "abstract": "Purpose: The present study verified the effect of an m-health exercise intervention using a 12-week exercise program on body composition, vascular function, and the ANS.\n\nPatients and methods: Thirty obese adult women participants were randomized (n = 15 each) into the experimental (EXP) group, those who performed mobile-health (m-health) exercises using a wearable device (Charge 4, Fitbit, USA) and AI-fit web page, or the control (CON) group, those who continued their daily activities as before. Muscle function, cardiorespiratory endurance, and flexibility were assessed during the exercise program using the AI-fit web page and wearable device. The EXP group participated in exercise interventions using the m-health system for 12 weeks, while the CON group was encouraged to maintain their normal daily routines. Body composition, vascular function, and autonomic nervous system (ANS) were evaluated before and after the intervention.\n\nResults: Significant decreases were noted in fat mass (Post - Pre: -1.47 kg; p < 0.001) and percent body fat (Post - Pre: -2.11%; p < 0.05). Flow-mediated dilatation (Post - Pre: 2.63%; p < 0.001) was significantly increased, and brachial-ankle pulse wave velocity (Post - Pre: -91.49 cm·sec-1; p < 0.01) was significantly decreased. RMSSD (Post - Pre: 10.43 ms; p < 0.01), NN50 (Post-Pre: 24.04; p < 0.05), pNN50 (Post - Pre: 7.70%; p < 0.05) and HF (Post-Pre: 179.60 ms2; p < 0.05) increased significantly.\n\nConclusion: In conclusion, m-health exercise interventions using AI fit and wearable devices are effective in preventing obesity and improving vascular function, and ANS.", "links": [] }, { "title": "Assessment of 24-hour physical behaviour in adults via wearables: a systematic review of validation studies under laboratory conditions", "author": "Giurgiu, Marco; Ketelhut, Sascha; Kubica, Claudia; Nissen, Rebecca; Doster, Ann-Kathrin; Thron, Maximiliane; Timm, Irina; Giurgiu, Valeria; Nigg, Claudio R.; Woll, Alexander; Ebner-Priemer, Ulrich W.; Bussmann, Johannes B. J.", "year": "2023", "journalProceedings": "The International Journal of Behavioral Nutrition and Physical Activity", "category": "Systematic Review", "devices": "Classic,One,Flex,Charge 2", "population": "NA", "dataUsed": "Steps,Energy Expenditure,Intensity,Sleep", "abstract": "Background: Wearable technology is used by consumers and researchers worldwide for continuous activity monitoring in daily life. Results of high-quality laboratory-based validation studies enable us to make a guided decision on which study to rely on and which device to use. However, reviews in adults that focus on the quality of existing laboratory studies are missing.\n\nMethods: We conducted a systematic review of wearable validation studies with adults. Eligibility criteria were: (i) study under laboratory conditions with humans (age ≥ 18 years); (ii) validated device outcome must belong to one dimension of the 24-hour physical behavior construct (i.e., intensity, posture/activity type, and biological state); (iii) study protocol must include a criterion measure; (iv) study had to be published in a peer-reviewed English language journal. Studies were identified via a systematic search in five electronic databases as well as back- and forward citation searches. The risk of bias was assessed based on the QUADAS-2 tool with eight signaling questions.\n\nResults: Out of 13,285 unique search results, 545 published articles between 1994 and 2022 were included. Most studies (73.8% (N = 420)) validated an intensity measure outcome such as energy expenditure; only 14% (N = 80) and 12.2% (N = 70) of studies validated biological state or posture/activity type outcomes, respectively. Most protocols validated wearables in healthy adults between 18 and 65 years. Most wearables were only validated once. Further, we identified six wearables (i.e., ActiGraph GT3X+, ActiGraph GT9X, Apple Watch 2, Axivity AX3, Fitbit Charge 2, Fitbit, and GENEActiv) that had been used to validate outcomes from all three dimensions, but none of them were consistently ranked with moderate to high validity. Risk of bias assessment resulted in 4.4% (N = 24) of all studies being classified as \"low risk\", while 16.5% (N = 90) were classified as \"some concerns\" and 79.1% (N = 431) as \"high risk\".\n\nConclusion: Laboratory validation studies of wearables assessing physical behaviour in adults are characterized by low methodological quality, large variability in design, and a focus on intensity. Future research should more strongly aim at all components of the 24-hour physical behaviour construct, and strive for standardized protocols embedded in a validation framework.", "links": [] }, { "title": "Nonlinear, Multicomponent Physical Exercise with Heart Rate Variability-Guided Prescription in Women with Breast Cancer during Treatment: Feasibility and Preliminary Results (ATOPE Study)", "author": "González-Santos, Á.; Lopez-Garzon, M.; Gil-Gutiérrez, R.; Salinas-Asensio, M. M.; Postigo-Martin, P.; Cantarero-Villanueva, I.", "year": "2023", "journalProceedings": "Physical Therapy", "category": "Intervention", "devices": "Inspire", "population": "Patients", "dataUsed": "Steps", "abstract": "Objective: The purpose of this study was to examine the feasibility, safety, adherence, and preliminary efficacy of the ATOPE program during radiotherapy (RT) or chemotherapy (CT) for women with breast cancer.\n\nMethods: This single-blind, pretest-posttest feasibility study included 38 women with breast cancer at the beginning of their treatment. The ATOPE program consisted of 12 to 18 sessions of a multimodal physical exercise program, prescribed based on daily heart rate variability (HRV) and clinimetric assessments using the ATOPE+ mHealth system. Overall health was assessed with quality of life, autonomous balance, and body composition, whereas health-related fitness (HRF) was measured through functional capacity, physical activity levels, and upper and lower limb strength.\n\nResults: The rates of recruitment, retention, and adherence were 52.35%, 73.68%, and 84.37%, respectively, and the satisfaction rating was 9.2 out of a possible 10 points. The perceived health status change score was 3.83 points, scored on a - 5 to 5 point scale. No adverse effects were found. Compliance results showed that the ATOPE+ mHealth system was used on 73.38% of the days, and the Fitbit bracelet (Google, Mountain View, CA, USA) was used on 84.91% of the days. Women stayed physically active 55% of days. Regarding preliminary results, for overall health, the percentage of body fat in the RT group decreased by 1.93%, whereas it increased by 5.03% in the CT group. Lower limb strength increased in the RT group, specifically knee extensor isometric strength (6.07%), isokinetic knee flexors 180°/s (1.53%) and isokinetic knee extensors 300°/s (4.53%), in contrast with the reductions found in the CT group (11.07%, 18.67%, and 14.89%, respectively).\n\nConclusions: The ATOPE program, through nonlinear prescription based on daily monitoring with the ATOPE+ mHealth system, is feasible and safe for application during breast cancer treatment. The results suggest that overall health can be maintained or even improved regarding most variables.\n\nImpact: This study focused on the feasibility, safety, and completion of a physical therapist-led program at early diagnosis for adults with breast cancer. The multimodal, supervised, tailored, nonlinear physical exercise program is feasible and safe, showed a good completion rate, and was able to prevent the quality-of-life deficits that are often triggered by systemic breast cancer treatment. This study highlights the importance of daily morning assessments using the ATOPE+ mHealth system in patients with breast cancer to prescribe nonlinear physical exercise.", "links": [] }, { "title": "Quantifying physical activity needed to mitigate genetic risk for obesity", "author": "Han, Lide; Annis, Jeffrey; Master, Hiral; Hughes, Andrew; Roden, Dan; Harris, Paul; Ruderfer, Douglas; Brittain, Evan", "year": "2023", "journalProceedings": "Research Square", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Despite consistent public health recommendations, obesity rates continue to increase. Physical activity (e.g. daily steps) is a well-established modifier of body weight. Genetic background is an important, but typically uncaptured, contributor to obesity risk. Leveraging physical activity, clinical, and genetic data from the All of Us Research Program, we measured the impact of genetic risk of obesity on the level of physical activity needed to reduce incident obesity. For example, we show that an additional 3,310 steps per day (11,910 steps total) would be needed to mitigate a 25% higher than average genetic risk of obesity. We quantify the number of daily steps needed to mitigate obesity risk across the spectrum of genetic risk. This work quantifies the relationship between physical activity and genetic risk showing significant independent effects and provides a first step towards personalized activity recommendations that incorporate genetic information to reduce incident obesity risk.", "links": [] }, { "title": "Heart rate responses in critical care trainees during airway intubation: a comparison between the simulated and clinical environments", "author": "Ji, Jackson; Langley, Bridget; Zordan, Rachel; van Dijk, Julian; Thies, Heidi Helene Graham; Brahmbhatt, Anjalee; Torcasio, Clarissa; Cunningham, Neil", "year": "2023", "journalProceedings": "BMC Emergency Medicine", "category": "Case Study", "devices": "Charge 2", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Objective\nThis study aimed to compare the heart rate response to stress during airway intubations in clinical practice and a simulated environment.\n\nMethods\nTwenty-five critical care registrars participated in the study over a 3-month period. Heart rate data during intubations was recorded by a FitBit® Charge 2 worn by each participant during their clinical practice, and during a single simulated airway management scenario. The heart rate range was calculated by subtracting the baseline working heart rate (BWHR) from the maximum functional heart rate (MFHR). For each airway intubation performed participants recorded an airway diary entry. Data from intubations performed in the clinical environment was compared to data from a simulated environment. Heart rate changes were observed in two ways: percentage rise (median) across the 20-min intubation period and; percentage rise at point of intubation (median).\n\nResults\nEighteen critical care registrars completed the study, mean age 31.8 years (SD = 2.015, 95% CI = 30.85–32.71). Throughout the 20-min peri-intubation recording period there was no significant difference in the median change in heart rates between the clinical (14.72%) and simulation (15.96%) environment (p = 0.149). At the point of intubation there was no significant difference in the median change in heart rate between the clinical (16.03%) and the simulation (25.65%) environment groups (p = 0.054).\n\nConclusion\nIn this small population of critical care trainees, a simulation scenario induced a comparable heart rate response to the clinical environment during intubation. This provides evidence that simulation scenarios are able to induce a comparable physiological stress response to the clinical environment and thus facilitates effective teaching of a high-risk procedure in a safe manner.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10257286/", "newWindow": true } ] }, { "title": "Validation of the relationship between rapid eye movement sleep and sleep-related erections in healthy adults by a feasible instrument Fitbit Charge2", "author": "Liu, Guodong; Zhang, Yuyang; Zhang, Wei; Wu, Xu; Jiang, Hui; Zhang, Xiansheng", "year": "2023", "journalProceedings": "Andrology", "category": "Case Study", "devices": "Charge 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background: Sleep, particularly rapid eye movement sleep, has been found to be associated with sleep-related erections. While RigiScan is currently a more accurate method for monitoring nocturnal erectile events, the Fitbit, a smart wearable device, shows great potential for sleep monitoring.\n\nObjectives: To analyze the relationship between sleep-related erections and sleep by recruiting sexually active, healthy men for simultaneous monitoring of sleep and nocturnal penile tumescence and rigidity.\n\nPatients and methods: Using Fitbit Charge2 and RigiScan, we simultaneously monitored nocturnal sleep and erections in 43 healthy male volunteers, and analyzed the relationship between sleep periods and erectile events with the Statistical Package for Social Sciences.\n\nResults: Among all erectile events, 89.8% were related to rapid eye movement, and 79.2% of all rapid eye movement periods were associated with erectile events. Moreover, a statistical correlation was shown between the duration of rapid eye movement and the time of total erectile events (first night: 𝜌 = 0.316, p = 0.039; second night: 𝜌 = 0.370, p = 0.015).\n\nDiscussion and conclusion: Our study shows a potential link between sleep-related erections and rapid eye movement sleep, which has implications for the current examination of sleep-related erections and further research into the mechanisms of erectile function. Meanwhile, the wearable device Fitbit has shown a potential promise for sleep monitoring in patients with erectile dysfunction. The results provide an alternative approach for further research on the relationship between erectile function and sleep with large sample sizes in the future.", "links": [ { "caption": "URL", "url": "https://onlinelibrary.wiley.com/doi/abs/10.1111/andr.13478", "newWindow": true } ] }, { "title": "Social epidemiology of Fitbit daily steps in early adolescence", "author": "Nagata, Jason M.; Alsamman, Sana; Smith, Natalia; Yu, Jiayue; Ganson, Kyle T.; Dooley, Erin E.; Wing, David; Baker, Fiona C.; Pettee Gabriel, Kelley", "year": "2023", "journalProceedings": "Pediatric Research", "category": "Case Study", "devices": "Charge 2", "population": "Adolescents", "dataUsed": "Steps", "abstract": "Background: Sociodemographic disparities in adolescent physical activity have been documented but mostly rely on self-reported data. Our objective was to examine differences in device-based step metrics, including daily step count (steps d-1), by sociodemographic factors among a diverse sample of 10-to-14-year-old adolescents in the US.\n\nMethods: We analyzed prospective cohort data from Year 2 (2018-2020) of the Adolescent Brain Cognitive Development (ABCD) Study (N = 6460). Mixed-effects models were conducted to estimate associations of sociodemographic factors (sex, sexual orientation, race/ethnicity, household income, parental education, and parental marital status) with repeated measures of steps d-1 over the course of 21 days.\n\nResults: Participants (49.6% female, 39.0% racial/ethnic minority) accumulated an average of 9095.8 steps d-1. In mixed-effects models, 1543.6 more steps d-1 were recorded for male versus female sex, Black versus White race (328.8 more steps d-1), heterosexual versus sexual minority sexual orientation (676.4 more steps d-1), >$200,000 versus <$25,000 household income (1003.3 more steps d-1), and having married/partnered parents versus unmarried/unpartnered parents (326.3 more steps d-1). We found effect modification by household income for Black adolescents and by sex for Asian adolescents.\n\nConclusions: Given sociodemographic differences in adolescent steps d-1, physical activity guidelines should focus on key populations and adopt strategies optimized for adolescents from diverse backgrounds.\n\nImpact: Sociodemographic disparities in physical activity have been documented but mostly rely on self-reported data, which can be limited by reporting and prevarication bias. In this demographically diverse sample of 10-14-year-old early adolescents in the U.S., we found notable and nuanced sociodemographic disparities in Fitbit steps per day. More daily steps were recorded for male versus female sex, Black versus White race, heterosexual versus sexual minority, >$100,000 versus <$25,000 household income, and having married/partnered versus unmarried/unpartnered parents. We found effect modification by household income for Black adolescents and by sex for Asian adolescents.", "links": [] }, { "title": "A Longitudinal Pilot Study of Stress and Sleep in First-Year Osteopathic Medical Students", "author": "Pattanaik, Sambit; Fastring, Danielle; Bateman, Robert C.", "year": "2023", "journalProceedings": "Journal of Medical Education and Curricular Development", "category": "Case Study", "devices": "Charge 3", "population": "Adults", "dataUsed": "Sleep", "abstract": "Objective: Poor sleep quality is thought to be a contributor to medical student stress. The authors evaluated the effect of high and low periods of academic stress on sleep quality and quantity in first-year medical students.\n\nMethods: A group of 25 students in their first year of medical school were provided Fitbit Charge 3 activity trackers for continual use and were surveyed at 4 intervals to assess stress level, sleep quantity, and sleep quality. Fitbit data were collected through the Fitbit mobile app and uploaded to the Fitabase (Small Steps Labs, LLC) server. Data collection times were scheduled around the academic exam schedule. Weeks in which testing occurred were identified as high-stress periods. Results from assessments were compared to nontesting periods of low stress.\n\nResults: During stressful periods, students slept an average of one hour less per 24-h period, took more naps, and reported poorer sleep quality than during the low-stress periods. No significant change was seen in the 4 surveyed intervals in sleep efficiency or sleep stages.\n\nConclusion: Students slept less and had poorer quality sleep in their main sleep event during stressful periods but attempted to compensate with increased napping and weekend catchup sleep. The objective Fitbit activity tracker data were consistent with and validated the self-reported survey data. Activity trackers could potentially be used to optimize the efficiency and quality of both student napping and main sleep events as one component of a stress reduction program for medical students.", "links": [] }, { "title": "Pain self-management plus activity tracking and nurse-led support in adults with chronic low back pain: feasibility and acceptability of the problem-solving pain to enhance living well (PROPEL) intervention", "author": "Xu, Wanli; Zhang, Yiming; Wang, Zequan; Dorsey, Susan G.; Starkweather, Angela; Kim, Kyounghae", "year": "2023", "journalProceedings": "BMC nursing", "category": "Usability,Intervention", "devices": "Flex 2", "population": "Adults", "dataUsed": "Intensity,User Friendliness", "abstract": "Background: Chronic low back pain can lead to individual suffering, high medical expenditures, and impaired social well-being. Although the role of physical activity in pain management is well established, the underlying mechanisms of biological and clinical outcomes are unknown. This study aimed to assess the feasibility and acceptability of a pain self-management intervention, Problem-Solving Pain to Enhance Living Well, which employs wearable activity tracking technology and nurse consultations for people with chronic low back pain.\n\nMethods: This one-arm longitudinal study recruited 40 adults aged 18-60 years with chronic low back pain. Over 12 weeks, participants watched 10 short video modules, wore activity trackers, and participated in nurse consultations every 2 weeks. At baseline and the 12-week follow-up, they completed study questionnaires, quantitative sensory testing, and blood sample collection.\n\nResults: Forty participants were recruited, and their mean age was 29.8. Thirty-two participants completed the survey questionnaire, quantitative sensory testing, Fitbit activity tracker, and bi-weekly nurse consultation, and 25 completed the evaluation of biological markers. The overall satisfaction with the Problem-Solving Pain to Enhance Living Well video modules, nurse consultations, and Fitbit in pain management was rated as excellent. No adverse events were reported. Between the baseline and 12-week follow-up, there was a significant decrease in pain intensity and interference and an increase in the warm detection threshold at the pain site.\n\nConclusions: Despite concerns about the participant burden due to multidimensional assessment and intensive education, the feasibility of the Problem-Solving Pain to Enhance Living Well intervention was favorable. Technology-based self-management interventions can offer personalized strategies by integrating pain phenotypes, genetic markers, and physical activity types affecting pain conditions.\n\nTrial registration: This pilot study was registered with ClinicalTrials.gov [NCT03637998, August 20, 2018]. The first participant was enrolled on September 21, 2018.", "links": [] }, { "title": "A Series of Remote Melatonin Supplement Interventions for Poor Sleep: Protocol for a Feasibility Pilot Study for a Series of Personalized (N-of-1) Trials", "author": "Butler, Mark; D’Angelo, Stefani; Perrin, Alexandra; Rodillas, Jordyn; Miller, Danielle; Arader, Lindsay; Chandereng, Thevaa; Cheung, Ying Kuen; Shechter, Ari; Davidson, Karina W.", "year": "2023", "journalProceedings": "JMIR Research Protocols", "category": "Intervention", "devices": "Charge 5", "population": "Adults", "dataUsed": "Sleep,User Friendliness", "abstract": "Background: Poor sleep, defined as short-duration or poor-quality sleep, is a frequently reported condition with many deleterious effects including poorer cognitive functioning, increased accidents, and poorer health. Melatonin has been shown to be an efficacious treatment to manage symptoms of poor sleep. However, the treatment effects of melatonin on sleep can vary greatly between participants. Personalized, or N-of-1, trial designs represent a method for identifying the best treatment for individual participants. Although using N-of-1 trials of melatonin to treat poor sleep is possible, the feasibility, acceptability, and effectiveness of N-of-1 trials using melatonin are unknown. Using the National Institutes of Health Stage Model for Behavioral Intervention Development, a stage IB (intervention refinement, modification, and adaptation and pilot testing) design appeared to be needed to address these feasibility questions. Objective: This trial series evaluates the feasibility, acceptability, and effectiveness of a series of personalized interventions for remote delivery of melatonin dose (3 and 0.5 mg) versus placebo supplements for self-reported poor sleep among 60 participants. The goal of this study is to provide valuable information about implementing remote N-of-1 randomized controlled trials to improve poor sleep. Methods: Participants will complete a 2-week baseline followed by six 2-week alternating intervention periods of 3 mg of melatonin, 0.5 mg of melatonin, and placebo. Participants will be randomly assigned to 2 intervention orders. The feasibility and acceptability of the personalized trial approach will be determined with participants’ ratings of usability and satisfaction with the remote, personalized intervention delivery system. The effectiveness of the intervention will be measured using participants’ self-reported sleep quality and duration and Fitbit tracker–measured sleep duration and efficiency. Additional measures will include ecological momentary assessment measures of fatigue, stress, pain, mood, concentration, and confidence as well as measures of participant adherence to the intervention, use of the Fitbit tracker, and survey data collection. Results: As of the submission of this protocol, recruitment for this National Institutes of Health stage IB personalized trial series is approximately 78.3\\% complete (47/60). We expect recruitment and data collection to be finalized by June 2023. Conclusions: Evaluating the feasibility, acceptability, and effectiveness of a series of personalized interventions of melatonin will address the longer term aim of this program of research—is integrating N-of-1 trials useful patient care? The personalized trial series results will be published in a peer-reviewed journal and will follow the CONSORT (Consolidated Standards of Reporting Trials) extension for N-of-1 trials (CENT 2015) reporting guidelines. This trial series was approved by the Northwell Health institutional review board. Trial Registration: ClinicalTrials.gov NCT05349188; https://www.clinicaltrials.gov/study/NCT05349188", "links": [ { "caption": "URL", "url": "https://www.researchprotocols.org/2023/1/e45313", "newWindow": true } ] }, { "title": "Ecological Momentary Assessments and Passive Sensing in the Prediction of Short-Term Suicidal Ideation in Young Adults", "author": "Czyz, Ewa K.; King, Cheryl A.; Al-Dajani, Nadia; Zimmermann, Lauren; Hong, Victor; Nahum-Shani, Inbal", "year": "2023", "journalProceedings": "JAMA network open", "category": "Case Study", "devices": "Charge 3", "population": "Patients,Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "IMPORTANCE: Advancements in technology, including mobile-based ecological momentary assessments (EMAs) and passive sensing, have immense potential to identify short-term suicide risk. However, the extent to which EMA and passive data, particularly in combination, have utility in detecting short-term risk in everyday life remains poorly understood. OBJECTIVE: To examine whether and what combinations of self-reported EMA and sensor-based assessments identify next-day suicidal ideation. DESIGN, SETTING, AND PARTICIPANTS: In this intensive longitudinal prognostic study, participants completed EMAs 4 times daily and wore a sensor wristband (Fitbit Charge 3) for 8 weeks. Multilevel machine learning methods, including penalized generalized estimating equations and classification and regression trees (CARTs) with repeated 5-fold cross-validation, were used to optimize prediction of next-day suicidal ideation based on time-varying features from EMAs (affective, cognitive, behavioral risk factors) and sensor data (sleep, activity, heart rate). Young adult patients who visited an emergency department with recent suicidal ideation and/or suicide attempt were recruited. Identified via electronic health record screening, eligible individuals were contacted remotely to complete enrollment procedures. Participants (aged 18 to 25 years) completed 14 708 EMA observations (64.4\\% adherence) and wore a sensor wristband approximately half the time (55.6\\% adherence). Data were collected between June 2020 and July 2021. Statistical analysis was performed from January to March 2023. MAIN OUTCOMES AND MEASURES: The outcome was presence of next-day suicidal ideation. RESULTS: Among 102 enrolled participants, 83 (81.4\\%) were female; 6 (5.9\\%) were Asian, 5 (4.9\\%) were Black or African American, 9 (8.8\\%) were more than 1 race, and 76 (74.5\\%) were White; mean (SD) age was 20.9 (2.1) years. The best-performing model incorporated features from EMAs and showed good predictive accuracy (mean [SE] cross-validated area under the receiver operating characteristic curve [AUC], 0.84 [0.02]), whereas the model that incorporated features from sensor data alone showed poor prediction (mean [SE] cross-validated AUC, 0.56 [0.02]). Sensor-based features did not improve prediction when combined with EMAs. Suicidal ideation-related features were the strongest predictors of next-day ideation. When suicidal ideation features were excluded, an alternative EMA model had acceptable predictive accuracy (mean [SE] cross-validated AUC, 0.76 [0.02]). Both EMA models included features at different timescales reflecting within-day, end-of-day, and time-varying cumulative effects. CONCLUSIONS AND RELEVANCE: In this prognostic study, self-reported risk factors showed utility in identifying near-term suicidal thoughts. Best-performing models required self-reported information, derived from EMAs, whereas sensor-based data had negligible predictive accuracy. These results may have implications for developing decision algorithms identifying near-term suicidal thoughts to guide risk monitoring and intervention delivery in everyday life.", "links": [] }, { "title": "Integrating Genome-wide information and Wearable Device Data to Explore the Link of Anxiety and Antidepressants with Heart Rate Variability", "author": "Friligkou, Eleni; Koller, Dora; Pathak, Gita A.; Miller, Edward J.; Lampert, Rachel; Stein, Murray B.; Polimanti, Renato", "year": "2023", "journalProceedings": "medRxiv: The Preprint Server for Health Sciences", "category": "Case Study,Measurement", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Anxiety disorders are associated with decreased heart rate variability (HRV), but the underlying mechanisms remain elusive. METHODS: We selected individuals with whole-genome sequencing, Fitbit, and electronic health record data (N=920; 61,333 data points) from the All of Us Research Program. Anxiety PRS were derived with PRS-CS after meta-analyzing anxiety genome-wide association studies from three major cohorts-UK Biobank, FinnGen, and the Million Veterans Program (N Total =364,550). The standard deviation of average RR intervals (SDANN) was calculated using five-minute average RR intervals over full 24-hour heart rate measurements. Antidepressant exposure was defined as an active antidepressant prescription at the time of the HRV measurement in the EHR. The associations of daily SDANN measurements with the anxiety PRS, antidepressant classes, and antidepressant substances were tested. Participants with lifetime diagnoses of cardiovascular disorders, diabetes mellitus, and major depression were excluded in sensitivity analyses. One-sample Mendelian randomization (MR) was employed to assess potential causal effect of anxiety on SDANN. RESULTS: Anxiety PRS was independently associated with reduced SDANN (beta=-0.08; p=0.003). Of the eight antidepressant medications and four classes tested, venlafaxine (beta=-0.12, p=0.002) and bupropion (beta=-0.071, p=0.01), tricyclic antidepressants (beta=-0.177, p=0.0008), selective serotonin reuptake inhibitors (beta=-0.069; p=0.0008) and serotonin and norepinephrine reuptake inhibitors (beta=-0.16; p=2×10 -6 ) were associated with decreased SDANN. One-sample MR indicated an inverse effect of anxiety on SDANN (beta=-2.22, p=0.03). CONCLUSIONS: Anxiety and antidepressants are independently associated with decreased HRV, and anxiety appears to exert a causal effect on HRV. Our observational findings provide novel insights into the impact of anxiety on HRV.", "links": [] }, { "title": "Health Wearables, Gamification, and Healthful Activity", "author": "Hydari, Muhammad Zia; Adjerid, Idris; Striegel, Aaron D.", "year": "2023", "journalProceedings": "Management Science", "category": "Usability", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Health wearables in combination with gamification enable interventions that have the potential to increase physical activity-a key determinant of health. However, the extant literature does not provide conclusive evidence on the benefits of gamification and there are persistent concerns that competition-based gamification approaches will only benefit those who are highly active at the expense of those who are sedentary. We investigate the effect of Fitbit leaderboards on the number of steps taken by the user. Using a unique dataset of Fitbit wearable users, some of whom participate in a leaderboard, we find that leaderboards lead to a 370 (3.5\\%) step increase in the users' daily physical activity. However, we find that the benefits of leaderboards are highly heterogeneous. Surprisingly, we find that those who were highly active prior to adoption are hurt by leaderboards and walk 630 fewer steps daily post adoption (a 5\\% relative decrease). In contrast, those who were sedentary prior to adoption benefited substantially from leaderboards and walked an additional 1,300 steps daily after adoption (a 15\\% relative increase). We find that these effects emerge because sedentary individuals benefit even when leaderboards are small and when they do not rank first on them. In contrast, highly active individuals are harmed by smaller leaderboards and only see benefit when they rank highly on large leaderboards. We posit that this unexpected divergence in effects could be due to the underappreciated potential of non-competition dynamics (e.g., changes in expectations for exercise) to benefit sedentary users, but harm more active ones.", "links": [] }, { "title": "Online Circuit Training Increases Adherence to Physical Activity: A Randomized Controlled Trial of Men with Obesity", "author": "Keshavarz, Mohammad; Sénéchal, Martin; Bouchard, Danielle R.", "year": "2023", "journalProceedings": "Medicine and Science in Sports and Exercise", "category": "Intervention", "devices": "Charge 3", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "PURPOSE: To examine adherence to the weekly physical activity guidelines; ≥150 minutes of aerobic activities at moderate-to-vigorous intensity and ≥ two session of strength training (yes or no), and health outcomes during the COVID-19 pandemic for men living with obesity, 46 weeks after being offered an online muscle strengthening circuit program for 12 weeks. METHODS: Sixty men (age ≥ 19 years) living with obesity (body fat \\% ≥ 25) were randomly assigned to the intervention group (N = 30) or the control condition (N = 30) for 12 weeks. The intervention group was offered an online CIRCUIT training, three sessions per week, while the control group received a website helping them to reach the physical activity guidelines. Adherence to the weekly physical activity guidelines was evaluated 46 weeks after enrolling in the program using a heart rate tracker (Fitbit Charge 3) and an exercise log. Health outcomes (e.g., anthropometrics, body composition) were measured at baseline and after 12, 24, and 46 weeks. RESULTS: Intervention group had higher adherence to physical activity guidelines at 46 weeks (36.8\\%) than control group (5.3\\%; p = 0.02). However, no difference in health outcomes was observed between participants in the intervention group compared to the control group after 12, 24, and 46 weeks. CONCLUSIONS: Increasing adherence to exercise in men living with obesity is challenging. The proposed program increased adherence to the physical activity guidelines after about a year for men living with obesity; however, more studies are needed to understand how to improve health outcomes when following an online delivery exercise program in this population.", "links": [] }, { "title": "The Effects of Auricular Acupressure on Menopausal Symptoms, Stress, and Sleep in Postmenopausal Middle-Aged Women: A Randomized Single-Blind Sham-Controlled Trial", "author": "Kim, Bomi; Park, Hyojung", "year": "2023", "journalProceedings": "Journal of Midwifery \\& Women's Health", "category": "Case Study", "devices": "Charge 4", "population": "Adults", "dataUsed": "Sleep", "abstract": "INTRODUCTION: Middle-aged women in the postmenopausal period experience menopause symptoms, stress, and poor sleep quality due to hormonal changes. Nonetheless, most of them recognize such symptoms as an aging process without receiving proper treatment, and there are few nonpharmacologic interventions available. METHODS: This was a randomized single-masked, sham-controlled trial. For the intervention group, a vaccaria seed was applied to the auricular points of Shenmen, anterior lobe, adrenal glands, central rim, and endocrine that are related to the menopause symptoms, stress, and sleep while applying a seed to the auricular points not related to the forementioned symptoms to the control group. The Menopause Rating Scale (MRS), Perceived Stress Scale (PSS), heart rate variability, and electroencephalogram (EEG) were measured before the intervention, 4 weeks after the intervention, and 8 weeks after the intervention. Actigraphy was measured with a Fitbit, and the Pittsburgh Sleep Quality Index (PSQI) was measured before and after the intervention. The study was registered with the World Health Organization International Clinical Trials Registry Platform (KCT0007364). RESULTS: The MRS showed significant differences over time in the intervention group (F, 22.057; P {\\textless} .001). There was a significant difference over time in the PSS (F, 22.576; P {\\textless} .001), stress index measured by heart rate variability (F, 14.027; P = .001), and antistress quotient of the right brain measured by EEG (F, 4.865; P = .033). Sleep quality, measured by the PSQI (t = -4.050, P {\\textless} .001), and sleep efficiency measured by actigraphy (t = 5.996, P {\\textless} .001) were found to be significantly different over time in the intervention group. DISCUSSION: This study demonstrated that auricular acupressure is effective in improving menopause symptoms, stress, and sleep in postmenopausal middle-aged women. Therefore, auricular acupressure may be a useful nonpharmacologic intervention for alleviating these symptoms in this population.", "links": [] }, { "title": "Blood glucose variance measured by continuous glucose monitors across the menstrual cycle", "author": "Lin, Georgianna; Siddiqui, Rumsha; Lin, Zixiong; Blodgett, Joanna M.; Patel, Shwetak N.; Truong, Khai N.; Mariakakis, Alex", "year": "2023", "journalProceedings": "NPJ digital medicine", "category": "Case Study", "devices": "Sense", "population": "Adults", "dataUsed": "Steps", "abstract": "Past studies on how blood glucose levels vary across the menstrual cycle have largely shown inconsistent results based on limited blood draws. In this study, 49 individuals wore a Dexcom G6 continuous glucose monitor and a Fitbit Sense smartwatch while measuring their menstrual hormones and self-reporting characteristics of their menstrual cycles daily. The average duration of participation was 79.3 ± 21.2 days, leading to a total of 149 cycles and 554 phases in our dataset. We use periodic restricted cubic splines to evaluate the relationship between blood glucose and the menstrual cycle, after which we assess phase-based changes in daily median glucose level and associated physiological parameters using mixed-effects models. Results indicate that daily median glucose levels increase and decrease in a biphasic pattern, with maximum levels occurring during the luteal phase and minimum levels occurring during the late-follicular phase. These trends are robust to adjustments for participant characteristics (e.g., age, BMI, weight) and self-reported menstrual experiences (e.g., food cravings, bloating, fatigue). We identify negative associations between each of daily estrogen level, step count, and low degrees of fatigue with higher median glucose levels. Conversely, we find positive associations between higher food cravings and higher median glucose levels. This study suggests that blood glucose could be an important parameter for understanding menstrual health, prompting further investigation into how the menstrual cycle influences glucose fluctuation.", "links": [] }, { "title": "Consumer Wearables Define a Normative Recovery Trajectory Following the Modified Nuss Procedure", "author": "Carter, M.; Linton, S.; Zeineddin, S.; Jb, Pitt; Figueroa, A.; Perez, A.; Park, E.; DeTella, M.; Kwon, S.; Sd, Goldstein; Ghomrawi, H.; Abdullah, F.", "year": "2023", "journalProceedings": "The Journal of surgical research", "category": "Measurement", "devices": "Inspire HR,Inspire 2", "population": "Patients,Children", "dataUsed": "Steps,Heart Rate", "abstract": "We have developed a normative recovery trajectory following the modified Nuss procedure using step count data collected by a consumer wearable device. This offers the potential to inform preoperative patient expectations and reduce avoidable health-care utilization through informed preoperative coun …", "links": [ { "caption": "URL", "url": "https://pubmed.ncbi.nlm.nih.gov/37567031/", "newWindow": true } ] }, { "title": "Validity of activity wristbands for estimating daily physical activity in primary schoolchildren under free-living conditions: School-Fit study", "author": "Mayorga-Vega, Daniel; Casado-Robles, Carolina; Guijarro-Romero, Santiago; Viciana, Jesús", "year": "2023", "journalProceedings": "Frontiers in Public Health", "category": "Validation", "devices": "Garmin Vivofit 2", "population": "Children", "dataUsed": "Steps,Intensity", "abstract": "INTRODUCTION: The use of activity wristbands to monitor and promote schoolchildren's physical activity (PA) is increasingly widespread. However, their validity has not been sufficiently studied, especially among primary schoolchildren. Consequently, the main purpose was to examine the validity of the daily steps and moderate-to-vigorous PA (MVPA) scores estimated by the activity wristbands Fitbit Ace 2, Garmin Vivofit Jr 2, and the Xiaomi Mi Band 5 in primary schoolchildren under free-living conditions. MATERIALS AND METHODS: An initial sample of 67 schoolchildren (final sample = 62; 50\\% females), aged 9-12 years old (mean = 10.4 ± 1.0 years), participated in the present study. Each participant wore three activity wristbands (Fitbit Ace 2, Garmin Vivofit Jr 2, and Xiaomi Mi Band 5) on his/her non-dominant wrist and a research-grade accelerometer (ActiGraph wGT3X-BT) on his/her hip as the reference standard (number of steps and time in MVPA) during the waking time of one day. RESULTS: Results showed that the validity of the daily step scores estimated by the Garmin Vivofit Jr 2 and Xiaomi Mi Band 5 were good and acceptable (e.g., MAPE = 9.6/11.3\\%, and lower 95\\% IC of ICC = 0.87/0.73), respectively, as well as correctly classified schoolchildren as meeting or not meeting the daily 10,000/12,000-step-based recommendations, obtaining excellent/good and good/acceptable results (e.g., Garmin Vivofit Jr 2, k = 0.75/0.62; Xiaomi Mi Band 5, k = 0.73/0.53), respectively. However, the Fitbit Ace 2 did not show an acceptable validity (e.g., daily steps: MAPE = 21.1\\%, and lower 95\\% IC of ICC = 0.00; step-based recommendations: k = 0.48/0.36). None of the three activity wristbands showed an adequate validity for estimating daily MVPA (e.g., MAPE = 36.6-90.3\\%, and lower 95\\% IC of ICC = 0.00-0.41) and the validity for the MVPA-based recommendation tended to be considerably lower (e.g., k = -0.03-0.54). CONCLUSIONS: The activity wristband Garmin Vivofit Jr 2 obtained the best validity for monitoring primary schoolchildren's daily steps, offering a feasible alternative to the research-grade accelerometers. Furthermore, this activity wristband could be used during PA promotion programs to provide accurate feedback to primary schoolchildren to ensure their accomplishment with the PA recommendations.", "links": [] }, { "title": "Feasibility of a wrist-worn wearable device for estimating mental health status in patients with mental illness", "author": "Nakagome, Kazuyuki; Makinodan, Manabu; Uratani, Mitsuhiro; Kato, Masaki; Ozaki, Norio; Miyata, Seiko; Iwamoto, Kunihiro; Hashimoto, Naoki; Toyomaki, Atsuhito; Mishima, Kazuo; Ogasawara, Masaya; Takeshima, Masahiro; Minato, Kazumichi; Fukami, Toshikazu; Oba, Mari; Takeda, Kazuyoshi; Oi, Hideki", "year": "2023", "journalProceedings": "Frontiers in Psychiatry", "category": "Usability", "devices": "Sense", "population": "Patients", "dataUsed": "Heart Rate", "abstract": "OBJECT: Real-world data from wearable devices has the potential to understand mental health status in everyday life. We aimed to investigate the feasibility of estimating mental health status using a wrist-worn wearable device (Fitbit Sense) that measures movement using a 3D accelerometer and optical pulse photoplethysmography (PPG). METHODS: Participants were 110 patients with mental illnesses from different diagnostic groups. The study was undertaken between 1 October 2020 and 31 March 2021. Participants wore a Fitbit Sense on their wrist and also completed the State-Trait Anxiety Inventory (STAI), Positive and Negative Affect Schedule (PANAS), and EuroQol 5 dimensions 5-level (EQ-5D-5L) during the study period. To determine heart rate (HR) variability (HRV), we calculated the sdnn (standard deviation of the normal-to-normal interval), coefficient of variation of R-R intervals, and mean HR separately for each sleep stage and the daytime. The association between mental health status and HR and HRV was analyzed. RESULTS: The following significant correlations were found in the wake after sleep onset stage within 3 days of mental health status assessment: sdnn, HR and STAI scores, HR and PANAS scores, HR and EQ-5D-5L scores. The association between mental health status and HR and HRV was stronger the closer the temporal distance between mental health status assessment and HR measurement. CONCLUSION: A wrist-worn wearable device that measures PPG signals was feasible for use with patients with mental illness. Resting state HR and HRV could be used as an objective assessment of mental health status within a few days of measurement.", "links": [] }, { "title": "'I saw it as a marriage-You can't have one without the other': A qualitative study of patient and physiotherapist experiences with a therapeutic combined strength and aerobic physical activity exercise programme for hip osteoarthritis", "author": "Allison, Kim; Hall, Michelle; Dobson, Fiona; Lawford, Belinda J.; Bennell, Kim; Spiers, Libby; Hinman, Rana S.", "year": "2023", "journalProceedings": "Musculoskeletal Care", "category": "Intervention", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps,Intensity,Heart Rate,User Friendliness", "abstract": "INTRODUCTION: To explore physiotherapist and patient experiences with, and acceptability of, a 12-week physiotherapist-guided combined strength and aerobic physical activity exercise programme for hip osteoarthritis (OA). METHODS: A qualitative study using semi-structured interviews with 13 people with hip OA and four physiotherapists. Patients underwent a 12-week home exercise programme customised by weekly visits with one of the four physiotherapists. The programme aimed for patients to participate in 150 min of moderate-intensity aerobic physical activity, and 20-30 min of strengthening exercise 2-3 times per week in concordance with American College of Sports Medicine (ACSM) dosage guidelines. Following the programme, patients and physiotherapists participated in individual semi-structured interviews to explore the acceptability of the exercise programme and barriers and facilitators to participation. Data were audio-recorded, transcribed and analysed using a thematic approach. RESULTS: Five over-arching themes (supporting subthemes) were identified from both patient and physiotherapist interviews: (i) positive outcomes (functional improvements, pain relief, empowerment through experience, commitment to continue); (ii) combined benefits of aerobic and strength exercises (complimentary effects, strengthening exercises key); (iii) valuing support from the physiotherapist (personalised care, skill performance feedback, coach effect, accountability); (iv) motivation and opportunity for exercise (positive symptom loop, integration into daily routine, prior exercise experience, Fitbit motivation); and (v) time-consuming commitment (physiotherapy visit frequency, travel inconvenience, time for exercise). CONCLUSIONS: Experiences of participants in this study indicate that, although time-consuming, a combined aerobic physical activity and strengthening programme prescribed at ACSM dosage guidelines is acceptable and confers positive outcomes in individuals with hip OA.", "links": [] }, { "title": "A feasibility study to evaluate a purposeful walk intervention with a distance goal using a commercially available activity monitor in elderly people post total hip replacement surgery", "author": "Bahadori, Shayan; Williams, Jonathan Mark; Collard, Sarah; Swain, Ian", "year": "2023", "journalProceedings": "Journal of Rehabilitation and Assistive Technologies Engineering", "category": "Intervention", "devices": "Charge 4", "population": "Patients", "dataUsed": "Distance,User Friendliness", "abstract": "INTRODUCTION: Total hip replacement (THR) is performed in an increasing number of individuals around the world and while improvements in pain reduction and long-term enhancement of muscle strength are well documented, the improvement in daily activity does not follow the same trend. This study aimed to determine the feasibility of a 5-week intervention where a personalised outdoor walking distance is monitored using a commercial activity monitor (Fitbit Charge 4). METHOD: Data was collected on gait and activities of daily living using patient reported outcome measures. Following the completion of the intervention period, participants took part in a semi-structured interview to voice their opinion on the use of the activity monitor, their experiences, and any challenges in order to assess the feasibility of the intervention. All quantitative data were presented descriptively, using appropriate summary statistics. Interviews were analysed using thematic analysis. RESULTS: Five participants who had undergone total hip replacement surgery within the postoperative period of 3 to 6 months were recruited from the local community. CONCLUSION: The findings suggest that the intervention was feasible and that it encouraged all participants to increase their daily activity. Therefore, it can be concluded that a follow-up effectiveness trial is warranted.", "links": [] }, { "title": "Applying machine learning to consumer wearable data for the early detection of complications after pediatric appendectomy", "author": "Ghomrawi, Hassan M. K.; O'Brien, Megan K.; Carter, Michela; Macaluso, Rebecca; Khazanchi, Rushmin; Fanton, Michael; DeBoer, Christopher; Linton, Samuel C.; Zeineddin, Suhail; Pitt, J. Benjamin; Bouchard, Megan; Figueroa, Angie; Kwon, Soyang; Holl, Jane L.; Jayaraman, Arun; Abdullah, Fizan", "year": "2023", "journalProceedings": "NPJ digital medicine", "category": "Usability", "devices": "Inspire HR,Inspire 2", "population": "Patients,Children", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "When children are discharged from the hospital after surgery, their caregivers often rely on subjective assessments (e.g., appetite, fatigue) to monitor postoperative recovery as objective assessment tools are scarce at home. Such imprecise and one-dimensional evaluations can result in unwarranted emergency department visits or delayed care. To address this gap in postoperative monitoring, we evaluated the ability of a consumer-grade wearable device, Fitbit, which records multimodal data about daily physical activity, heart rate, and sleep, in detecting abnormal recovery early in children recovering after appendectomy. One hundred and sixty-two children, ages 3-17 years old, who underwent an appendectomy (86 complicated and 76 simple cases of appendicitis) wore a Fitbit device on their wrist for 21 days postoperatively. Abnormal recovery events (i.e., abnormal symptoms or confirmed postoperative complications) that arose during this period were gathered from medical records and patient reports. Fitbit-derived measures, as well as demographic and clinical characteristics, were used to train machine learning models to retrospectively detect abnormal recovery in the two days leading up to the event for patients with complicated and simple appendicitis. A balanced random forest classifier accurately detected 83\\% of these abnormal recovery days in complicated appendicitis and 70\\% of abnormal recovery days in simple appendicitis prior to the true report of a symptom/complication. These results support the development of machine learning algorithms to predict onset of abnormal symptoms and complications in children undergoing surgery, and the use of consumer wearables as monitoring tools for early detection of postoperative events.", "links": [] }, { "title": "Mighty Men: A Pilot Test of the Feasibility and Acceptability of a Faith-Based, Individually Tailored, Cluster-Randomized Weight Loss Trial for Middle-Aged and Older African American Men", "author": "Griffith, Derek M.; Pennings, Jacquelyn S.; Jaeger, Emily C.", "year": "2023", "journalProceedings": "American Journal of Men's Health", "category": "Usability,Intervention", "devices": "Charge 2", "population": "Adults", "dataUsed": "User Friendliness", "abstract": "Two in five African American men have obesity, but they are underrepresented in community-based weight loss interventions. This pilot effectiveness trial examines the acceptability and feasibility of the first weight loss study for African American men that includes randomization and individual tailoring. Using a community-based, cluster-randomized, longitudinal parallel group design, four churches were randomized to a control condition or a weight loss condition. Each church received physical activity equipment, a coordinator, and small group physical activity sessions. A total of 71 African American men (mean age: 58.5) enrolled and received a Fitbit, Bluetooth-enabled scale, a t-shirt, gift cards for participation, and 45 min of small group physical activity led by a certified personal trainer. Men in the weight loss condition also received 45 min of health education and individually tailored SMS text messages. Multiple metrics suggest that Mighty Men was feasible, yet the acceptability of the intervention components was mixed. Participants in both the weight loss and control conditions lost weight between zero and 6 months (p {\\textless} .001), but body fat (p = .005) and visceral fat percentage (p = .001) of men in the weight loss condition decreased while men in the control condition did not (p {\\textless} .05). An increase in physical activity was seen among men in the weight loss condition (p = .030) but not among men in the control condition (p {\\textless} .05). It is acceptable and feasible to conduct a 6-month weight loss intervention with African American men that includes randomization and individually tailored text messages.", "links": [] }, { "title": "Feasibility and preliminary efficacy of a novel web-based physical activity intervention in adults with overweight/obesity: A pilot randomized controlled trial", "author": "Kariuki, Jacob K.; Sereika, Susan; Erickson, Kirk; Burke, Lora E.; Kriska, Andrea; Cheng, Jessica; Milton, Heather; Hirshfield, Sabina; Ogutu, David; Gibbs, Bethany", "year": "2023", "journalProceedings": "Contemporary Clinical Trials", "category": "Intervention", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Only 14\\% of adults with obesity attain federal guidelines for physical activity (PA), but few interventions address obesity-specific barriers to PA. We designed the web-based Physical Activity for The Heart (PATH) intervention to address this gap. PURPOSE: Test the feasibility and preliminary efficacy of PATH for promoting PA and reducing cardiovascular disease (CVD) risk in adults with overweight/obesity. METHODS: In a 12-week pilot RCT, participants were randomized to PATH (n = 41) or wait-list control (n = 41) groups. Treatment group received access to PATH and met twice/month with a remote coach. The control group received a self-help PA guide and newsletters on general health. Moderate-to-vigorous PA (MVPA) was assessed via Actigraph-GT3X, steps via Fitbit Charge 2™, weight via smart scale, blood pressure (BP) via Omron BP device, and lipids/HbAIC via dry blood spot. Linear mixed modeling examined between- and within-group differences in PA and CVD risk. RESULTS: The sample (N = 82) was on average 55.9 ± 8.2 years old; mean BMI 35.5 ± 6.2 kg/m2; 57.3\\% white and 80.5\\% female. Recruitment lasted 6-months, and 12-week retention was 96.3\\%. Treatment group accessed PATH ≥twice/week (92.1\\%), spent ≥10 min/visit (89.5\\%) and thought the site was culturally appropriate (79\\%). At 12 wks, the PATH group had greater mean changes in weekly MVPA (+58.9 vs. +0.9 min, p = .024) and daily steps (+1246.4 vs. -64.2 steps, p = .002) compared to the control group. Also, the PATH group improved in weight, BMI, body fat, waist circumference, and BP (p {\\textless} .05). CONCLUSION: The PATH intervention is feasible/acceptable and demonstrated preliminary efficacy for promoting PA among adults with overweight/obesity.", "links": [] }, { "title": "Clinical and Lifestyle Determinants of Continuous Glucose Monitoring Metrics in Insulin-Treated Patients with Type 2 Diabetes Mellitus", "author": "Lee, Da Young; Kim, Namho; Jung, Inha; Park, So Young; Yu, Ji Hee; Seo, Ji A.; Kim, Jihee; Kim, Kyeong Jin; Kim, Nam Hoon; Yoo, Hye Jin; Kim, Sin Gon; Choi, Kyung Mook; Baik, Sei Hyun; Park, Sung-Min; Kim, Nan Hee", "year": "2023", "journalProceedings": "Diabetes \\& Metabolism Journal", "category": "Case Study", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Steps,Energy Expenditure,Sleep,Heart Rate", "abstract": "BACKGROUND: There was limited evidence to evaluate the association between lifestyle habits and continuous glucose monitoring (CGM) metrics. Thus, we aimed to depict the behavioral and metabolic determinants of CGM metrics in insulin-treated patients with type 2 diabetes mellitus (T2DM). METHODS: This is a prospective observational study. We analyzed data from 122 insulin-treated patients with T2DM. Participants wore Dexcom G6 and Fitbit, and diet information was identified for 10 days. Multivariate-adjusted logistic regression analysis was performed for the simultaneous achievement of CGM-based targets, defined by the percentage of time in terms of hyper, hypoglycemia and glycemic variability (GV). Intake of macronutrients and fiber, step counts, sleep, postprandial C-peptide-to-glucose ratio (PCGR), information about glucose lowering medications and metabolic factors were added to the analyses. Additionally, we evaluated the impact of the distribution of energy and macronutrient during a day, and snack consumption on CGM metrics. RESULTS: Logistic regression analysis revealed that female, participants with high PCGR, low glycosylated hemoglobin (HbA1c) and daytime step count had a higher probability of achieving all targets based on CGM (odds ratios [95\\% confidence intervals] which were 0.24 [0.09 to 0.65], 1.34 [1.03 to 1.25], 0.95 [0.9 to 0.99], and 1.15 [1.03 to 1.29], respectively). And participants who ate snacks showed a shorter period of hyperglycemia and less GV compared to those without. Conclusion: We confirmed that residual insulin secretion, daytime step count, HbA1c, and women were the most relevant determinants of adequate glycemic control in insulin-treated patients with T2DM. In addition, individuals with snack consumption were exposed to lower times of hyperglycemia and GV.", "links": [] }, { "title": "Moderating role of physical activity on hippocampal iron deposition and memory outcomes in typically aging older adults", "author": "Lee, Shannon Y.; Paolillo, Emily W.; Saloner, Rowan; Cobigo, Yann; Diaz, Valentina E.; Gontrum, Eva Q.; VandeBunte, Anna; Chatterjee, Ankita; Tucker, Miwa; Kramer, Joel H.; Casaletto, Kaitlin B.", "year": "2023", "journalProceedings": "Neurobiology of Aging", "category": "Case Study", "devices": "Flex 2", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Physical activity (PA) is linked to better cognitive and brain health, though its mechanisms are unknown. While brain iron is essential for normal function, levels increase with age and, when excessive, can cause detrimental neural effects. We examined how objectively measured PA relates to cerebral iron deposition and memory functioning in normal older adults. Sixty-eight cognitively unimpaired older adults from the UCSF Memory and Aging Center completed neuropsychological testing and brain magnetic resonance imaging, followed by 30-day Fitbit monitoring. Magnetic resonance imaging quantitative susceptibility mapping (QSM) quantified iron deposition. PA was operationalized as average daily steps. Linear regression models examined memory as a function of hippocampal QSM, PA, and their interaction. Higher bilateral hippocampal iron deposition correlated with worse memory but was not strongly related to PA. Covarying for demographics, PA moderated the relationship between bilateral hippocampal iron deposition and memory such that the negative effect of hippocampal QSM on memory performances was no longer significant above 9120 daily steps. PA may mitigate adverse iron-related pathways for memory health.", "links": [] }, { "title": "Knee Extension Exercise Effects on Physiological and Psychophysical Performance: Normal Weight Versus Obese Office Workers", "author": "Mohammadian, Mostafa; Choobineh, Alireza; Razeghi, Mohsen; Daneshmandi, Hadi; Ghaem, Haleh; Kazemi, Reza; Jahani, Yunes; Hashemi Nejad, Naser", "year": "2023", "journalProceedings": "Workplace Health \\& Safety", "category": "Case Study", "devices": "Charge HR", "population": "Adults", "dataUsed": "Energy Expenditure,Heart Rate", "abstract": "BACKGROUND: Knee extension exercise is useful and practical for obese and overweight people as this form of exercise is effective in minimizing body weight loading on joints and improving the body's physiological function. This study aimed to compare the physiological and psychophysical parameters of office workers while computer-based working in an active workstation equipped with an active footrest (AFR) prototype with a mechanism for performing knee extension exercises in a sitting position, and also to compare the physiological and psychophysical parameters among normal-weight and obese office workers. METHODS: In this quasi-experimental study, the physiological parameters of heart rate (HR) and energy expenditure (EE) (measured with the Fitbit Charge HR smartwatch) were measured in two cross-over random sessions for 32 office workers (16 normal-weight and 16 obese) aged 28 to 50 years (M = 42.72, standard deviation [SD] = 4.37) while performing office tasks in sitting and active workstations (equipped with AFR). Perceived physical exertion, comfort, fatigue, and liking were also measured by rating the participants. FINDINGS: Short-term activity of the participants with AFR performing computer tasks significantly improved physiological and psychophysical parameters compared with the participants in sitting workstations. However, there was no significant difference in the effect of AFR on physiological and psychophysical parameters between normal-weight and obese participants. CONCLUSIONS/APPLICATION TO PRACTICE: Given the significant increase in EE and HR resulting from exercise with AFR compared with the conventional workstation, the use of AFR can help office workers achieve the minimum standard of physical activity at their workplace.", "links": [] }, { "title": "Start-of-day oculomotor screening demonstrates the effects of fatigue and rest during a total immersion training program", "author": "Roberts, Scott; Kufahl, Peter R.; Ryznar, Rebecca J.; Norris, Taylor; Patel, Sagar; Gubler, K. Dean; Paz, Dean; Schwimer, Greg; Besserman, Richard; LaPorta, Anthony J.", "year": "2023", "journalProceedings": "Surgery", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Sleep", "abstract": "BACKGROUND: Investigating changes in sleep and fatigue metrics during intensive surgical and trauma skills training, this study explored the dynamic association between oculomotor metrics and fatigue. Specifically, alterations in these relations over extended stress exposure, the influence of time of day, and the impact of fatigue exposure on sleep metrics were examined. METHODS: Thirty-nine military medical students participated in 6 days of immersion, hyper-realistic, and high-stress experiential casualty training. Participants completed surveys assessing the state of sleepiness with oculomotor tests performed each morning and evening, analyzing eye movement and pupillary change to characterize fatigue. Participants wore Fitbit TM devices to measure overall time asleep and time in each sleep stage during the training. RESULTS: Fitbit data showed increased average minutes in rapid eye movement, deep sleep, and less time in light sleep from day 1 to day 4. The microsaccade peak velocity-to-displacement ratio exhibited a morning decrease but not in afternoon sessions, indicating repeated but temporary effects of accumulated fatigue. There were no findings regarding pupil reactivity to illumination changes. CONCLUSION: This study describes characteristics of fatigue measured by rapid and individually calibrated oculomotor tests. It demonstrates oculomotor relationships to fatigue in start-of-day testing, providing a direction for timing for optimal fatigue testing. These data suggest that improved sleep could signal resilience to fatigue during afternoon testing. Further investigation with more participants and longer duration is warranted. A deeper understanding of the interrelationships between training, sleep, and fatigue could improve surgical and military fitness.", "links": [] }, { "title": "Association between the use of weight management strategies and weight change among Australian adults over 12 months: an observational study", "author": "Singh, Ben; Olds, Timothy; Curtis, Rachel; Ferguson, Ty; Matricciani, Lisa; Brown, Wendy J.; Dumuid, Dorothea; Esterman, Adrian; Maher, Carol", "year": "2023", "journalProceedings": "BMC public health", "category": "Case Study", "devices": "Charge 3,Aria 2", "population": "Adults", "dataUsed": "Weight", "abstract": "BACKGROUND: Obesity is a growing, global public health issue. This study aimed to describe the weight management strategies used by a sample of Australian adults; examine the socio-demographic characteristics of using each strategy; and examine whether use of each strategy was associated with 12-month weight change. METHODS: This observational study involved a community-based sample of 375 healthy adults (mean age: 40.1 ± 5.8 years, 56.8\\% female). Participants wore a Fitbit activity monitor, weighed themselves daily, and completed eight online surveys on socio-demographic characteristics. Participants also recalled their use of weight management strategies over the past month, at 8 timepoints during the 12-month study period. RESULTS: Most participants (81\\%) reported using at least one weight management strategy, with exercise/physical activity being the most common strategy at each timepoint (40-54\\%). Those who accepted their current bodyweight were less likely to use at least one weight management strategy (Odds ratio = 0.38, 95\\% CI = 0.22-0.64, p {\\textless} 0.01) and those who reported being physically active for weight maintenance had a greater reduction in bodyweight, than those who did not (between group difference: -1.2 kg, p {\\textless} 0.01). The use of supplements and fasting were associated with poorer mental health and quality of life outcomes (p {\\textless} 0.01). CONCLUSIONS: The use of weight management strategies appears to be common. Being physically active was associated with greater weight loss. Individuals who accepted their current body weight were less likely to use weight management strategies. Fasting and the use of supplements were associated with poorer mental health. Promoting physical activity as a weight management strategy appears important, particularly considering its multiple health benefits.", "links": [] }, { "title": "Measurement of Physical Activity by Actigraphy in Infants and Young Children with Pulmonary Arterial Hypertension", "author": "Avitabile, Catherine M.; Yung, Delphine; Handler, Stephanie; Hopper, Rachel K.; Fineman, Jeff; Freire, Grace; Varghese, Nidhy; Mullen, Mary P.; Krishnan, Usha S.; Austin, Eric; Silveira, Lori; Ivy, D. Dunbar", "year": "2023", "journalProceedings": "The Journal of Pediatrics", "category": "Usability", "devices": "Inspire", "population": "Children", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "OBJECTIVE: To evaluate the feasibility, tolerability, and adherence with wearable actigraphy devices among infants and children with pulmonary arterial hypertension (PAH). STUDY DESIGN: This multicenter, prospective, observational study included children ages 0-6 years with and without PAH. Participants wore the ActiGraph wGT3X-BT on the hip and FitBit Inspire on the wrist during waking hours for 14 days. Steps, vector magnitude counts per minute, activity intensity, heart rate, and heart rate variability were compared between groups. RESULTS: Forty-seven participants (18 PAH, 29 control) were enrolled from 10 North American sites. PAH patients were mostly functional class II (n = 16, 89\\%) and treated with oral medications at the time of enrollment. The number of wear days was not significantly different between the groups (ActiGraph: 10 [95\\% CI: 5.5, 12.2] in PAH vs 8 [4, 12] in control, P = .20; FitBit 13 [10, 13.8] in PAH vs 12 [8, 14] in control, P = .87). Complete data were obtained in 81\\% of eligible ActiGraph participants and 72\\% of FitBit participants. PAH participants demonstrated fewer steps, lower vector magnitude counts per minute, more sedentary activity, and less intense physical activity at all levels compared with control participants. No statistically significant differences in heart rate variability were demonstrated between the 2 groups. CONCLUSIONS: Measurement of physical activity and other end points using wearable actigraphy devices was feasible in young children with PAH. Larger studies should determine associations between physical activity and disease severity in young patients with PAH to identify relevant end points for pediatric clinical trials.", "links": [] }, { "title": "Evaluation of the effectiveness of sleep hygiene education and FITBIT devices on quality of sleep and psychological worry: a pilot quasi-experimental study among first-year college students", "author": "Bani Issa, Wegdan; Hijazi, Heba; Radwan, Hadia; Saqan, Roba; Al-Sharman, Alham; Samsudin, A. B. Rani; Fakhry, Randa; Al-Yateem, Nabeel; Rossiter, Rachel C.; Ibrahim, Ali; Moustafa, Ibrahim; Naja, Farah; Alameddine, Mohamad; Abbas, Nada; Abdelrahim, Dana N.; Al-Shujairi, Arwa; Awad, Manal", "year": "2023", "journalProceedings": "Frontiers in Public Health", "category": "Case Study", "devices": "Flex", "population": "Adults", "dataUsed": "Sleep", "abstract": "BACKGROUND: College students report disturbed sleep patterns that can negatively impact their wellbeing and academic performance. OBJECTIVES: This study examined the effect of a 4-week sleep hygiene program that included sleep education and actigraph sleep trackers (FITBITs) on improving sleep quality and reducing psychological worry without control group. DESIGN SETTINGS AND PARTICIPANTS: A pilot quasi-experimental design, participants were randomly selected medical and health sciences from a university students in the United-Arab-Emirates. METHODS: Students were asked to wear FITBITs and log their daily sleep data and completed the Pittsburgh Sleep Quality Index (PSQI) and Penn State Worry Questionnaire (PSWQ). Extensive sleep hygiene education was delivered via lectures, a WhatsApp group, and the Blackboard platform. In total, 50 students completed pre-and post-assessments and returned FITBIT data. RESULTS: There was a significant difference in the prevalence of good sleep postintervention compared with pre-intervention (46\\% vs. 28\\%; p = 0.0126). The mean PSQI score was significantly lower post-intervention compared with pre-intervention (6.17 ± 3.16 vs. 7.12.87; p = 0.04, Cohen's d 0.33). After the intervention, subjective sleep quality, sleep latency, and daytime dysfunction were significantly improved compared with pre-intervention (p {\\textless} 0.05). In addition, FITBIT data showed total sleep time and the number of restless episodes per night were significantly improved postintervention compared with pre-intervention (p = 0.013). The mean PSWQ score significantly decreased from pre-intervention to p = 0.049, Cohen' d = 0.25. The correlation between PSQI and PSWQ scores was significant post-intervention (β = 0.40, p = 0.02). CONCLUSION: Our results may inform university educational policy and curricular reform to incorporate sleep hygiene awareness programs to empower students and improve their sleep habits.", "links": [] }, { "title": "Examining changes in vascular function, arterial stiffness and systemic inflammation during hospitalization and recovery from an acute exacerbation of chronic obstructive pulmonary disease", "author": "Fuhr, Desi P.; Brotto, Andrew R.; Rowe, Brian H.; Bhutani, Mohit; Rosychuk, Rhonda J.; Stickland, Michael K.", "year": "2023", "journalProceedings": "Scientific Reports", "category": "Case Study", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps", "abstract": "An acute exacerbation of COPD (AECOPD) is associated with increased risk of cardiovascular (CV) events. The elevated risk during an AECOPD may be related to changes in vascular function, arterial stiffness, and systemic inflammation; the time course of these measures and their corresponding recovery are poorly understood. Further, physical activity is reduced during an AECOPD, and physical activity may influence the cardiovascular responses to an AECOPD. The purpose of the study was to examine the acute impact of an AECOPD requiring hospitalization on vascular function, arterial stiffness, and systemic inflammation and examine whether physical activity modulates these variables during recovery. Patients hospitalized for an AECOPD were prospectively recruited and compared to control patients with stable COPD. Vascular function, arterial stiffness, and systemic inflammation (CRP, IL-6) were measured at hospital admission, hospital discharge and within 14 days of discharge. Physical activity was electronically tracked daily while in hospital and for 7 days following discharge using a Fitbit. One hundred and twenty-one patients with an AECOPD requiring hospitalization and 33 control patients with stable COPD were enrolled in the study. Vascular function was significantly lower, and systemic inflammation higher at hospital admission in patients with an AECOPD compared to stable COPD. Significant improvements in vascular function and inflammation were observed within 14 days of hospital discharge; however, vascular function remained lower than stable COPD. Physical activity was low at admission and increased following discharge; however, physical activity was unrelated to measures of vascular function or inflammation at any time point. An AECOPD requiring hospitalization is associated with impaired vascular function that persists during recovery. These findings provide a mechanistic link to help explain the enduring increase in CV risk and mortality following a severe AECOPD event.Clinical trial registration: ClinicalTrials.gov \\#NCT01949727; Registered: 09/20/2013.", "links": [] }, { "title": "The impact of mindfulness training on posttraumatic stress disorder symptoms, subjective sleep quality, and objective sleep outcomes in police officers", "author": "Imhoff-Smith, Theodore P.; Grupe, Daniel W.", "year": "2023", "journalProceedings": "Psychological Trauma: Theory, Research, Practice and Policy", "category": "Case Study", "devices": "Charge 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "OBJECTIVE: Sleep disturbances cooccur with posttraumatic stress disorder (PTSD) and are often correlated with PTSD severity. Previous research has shown that sleep problems mediate the relationship between PTSD and negative physical and mental health outcomes but has relied on self-reported sleep quality. We tested the effects of mindfulness training-previously shown to improve sleep quality and reduce PTSD symptoms-on subjective and objective sleep metrics and relationships with reduced PTSD symptoms. METHOD: Following baseline data collection in 114 law enforcement officers, we randomly assigned participants to either an 8-week mindfulness training group or a waitlist control group. We repeated assessments immediately posttraining and at 3-month follow-up. Self-reported PTSD symptoms and subjective sleep quality were measured at each visit with the PTSD checklist and Pittsburgh Sleep Quality Index (PSQI), respectively. Participants also wore a Fitbit Charge 2 continuously over the course of a 4- to 6-day work week following each visit, from which we extracted two distinct objective sleep metrics: total minutes of sleep and sleep efficiency. RESULTS: At baseline, PTSD symptoms were correlated with PSQI scores but not objective Fitbit metrics. Relative to waitlist, mindfulness training led to improved subjective sleep quality and reduced PTSD symptoms. Reduced PTSD symptoms mediated the improvement in subjective sleep quality following mindfulness training. Neither objective sleep metric demonstrated improvements following mindfulness training, nor did these metrics mediate reduced PTSD symptoms. CONCLUSIONS: This study provides evidence linking improved subjective sleep quality, but not objective sleep markers, to reductions in PTSD symptoms following mindfulness training. (PsycInfo Database Record (c) 2023 APA, all rights reserved).", "links": [] }, { "title": "The Future of Stress Management: Integration of Smartwatches and HRV Technology", "author": "Jerath, Ravinder; Syam, Mohammad; Ahmed, Shajia", "year": "2023", "journalProceedings": "Sensors (Basel, Switzerland)", "category": "Review", "devices": "Versa 3,Sense", "population": "NA", "dataUsed": "Heart Rate", "abstract": "In the modern world, stress has become a pervasive concern that affects individuals' physical and mental well-being. To address this issue, many wearable devices have emerged as potential tools for stress detection and management by measuring heart rate, heart rate variability (HRV), and various metrics related to it. This literature review aims to provide a comprehensive analysis of existing research on HRV tracking and biofeedback using smartwatches pairing with reliable 3rd party mobile apps like Elite HRV, Welltory, and HRV4Training specifically designed for stress detection and management. We apply various algorithms and methodologies employed for HRV analysis and stress detection including time-domain, frequency-domain, and non-linear analysis techniques. Prominent smartwatches, such as Apple Watch, Garmin, Fitbit, Polar, and Samsung Galaxy Watch, are evaluated based on their HRV measurement accuracy, data quality, sensor technology, and integration with stress management features. We describe the efficacy of smartwatches in providing real-time stress feedback, personalized stress management interventions, and promoting overall well-being. To assist researchers, doctors, and developers with using smartwatch technology to address stress and promote holistic well-being, we discuss the data's advantages and limitations, future developments, and the significance of user-centered design and personalized interventions.", "links": [] }, { "title": "Identifying Unique Subgroups of Individuals With Stroke Using Heart Rate and Steps to Characterize Physical Activity", "author": "Koffman, Lily J.; Crainiceanu, Ciprian M.; Roemmich, Ryan T.; French, Margaret A.", "year": "2023", "journalProceedings": "Journal of the American Heart Association", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Background Low physical activity (PA) is associated with poor health outcomes after stroke. Step counts are a common metric of PA; however, other physiologic signals (eg, heart rate) may help to identify subgroups of individuals poststroke at varying levels of risk of poor health outcomes. Here, we aimed to identify clinically relevant subgroups of individuals poststroke based on PA profiles that leverage multiple data sources, including step count and heart rate data, from wearable devices. Methods and Results Seventy individuals poststroke participated. Participants wore a Fitbit Inspire 2 for 1 year and completed clinical assessments. We defined a group-based steps-per-minute threshold and an individual heart rate threshold to categorize each minute of PA into 1 of 4 states: high steps/high heart rate, low steps/low heart rate, high steps/low heart rate, and low steps/high heart rate. We used the proportion of time spent in each state along with steps per day, sedentary time, mean steps among minutes with high steps and high heart rate, and resting heart rate in a k-means clustering algorithm to identify subgroups and compared Activity Measure for Post-Acute Care Mobility T Score, Stroke Impact Scale, and gait speed among subgroups. We identified 3 subgroups, Active (n=8), Sedentary (n=29), and Deconditioned (n=33), which differed significantly on all clustering variables except resting heart rate. We observed significant differences in Activity Measure for Post-Acute Care Mobility T scores between subgroups, with the Deconditioned subgroup exhibiting the lowest score. Conclusions Quantifying PA with heart rate and step count using readily available wearable devices can identify clinically meaningful subgroups of individuals poststroke.", "links": [] }, { "title": "Promoting participation in physical activity through Snacktivity: A qualitative mixed methods study", "author": "Krouwel, Matthew; Greenfield, Sheila M.; Chalkley, Anna; Sanders, James P.; Parretti, Helen M.; Gokal, Kajal; Jolly, Kate; Skrybant, Magdalena; Biddle, Stuart J. H.; Greaves, Colin; Maddison, Ralph; Mutrie, Nanette; Ives, Natalie; Esliger, Dale W.; Sherar, Lauren; Edwardson, Charlotte L.; Yates, Tom; Frew, Emma; Tearne, Sarah; Daley, Amanda J.", "year": "2023", "journalProceedings": "PloS One", "category": "Intervention", "devices": "Versa 2", "population": "Adults", "dataUsed": "Steps,User Friendliness", "abstract": "BACKGROUND: Public health guidance acknowledges the benefits of physical activity of any duration. We have proposed a whole-day approach to promoting physical activity called Snacktivity™, which encourages frequent 2-5 minute 'activity snacks' of moderate-to-vigorous intensity. METHODS: Using repeated semi-structured interviews and a think aloud protocol, this study aimed to understand participants' experiences of integrating Snacktivity™ into daily life, to provide insights to refine the delivery of Snacktivity™ interventions. Physically inactive adults recruited via primary care and a community health service engaged with an intervention to encourage Snacktivity™ over three weeks, which included using a Fitbit and linked mobile phone app (SnackApp). Participants took part in semi-structured interviews on two occasions during the intervention, with a sub-group participating in a think aloud study. Three study data sets were generated and independently explored using inductive thematic analysis, with findings combined into a single set of themes. RESULTS: Eleven adults participated in the interview study who were interviewed twice (total interviews completed n = 21, 1 participant declined the second interview), of whom six completed the think aloud study (total voice recordings n = 103). Three main themes emerged from the combined data; lived experience of participating in Snacktivity™, motivation for Snacktivity™ and experiences with the Snacktivity™ technology. Participants undertook a variety of activity snacks, utilising their environment, which they believed improved their psychological wellbeing. Participants were enthusiastic about Snacktivity™, with some stating that activity snacks were more accessible than traditional exercise, but perceived they were often prevented from doing so in the presence of others. Participants were mostly enthusiastic about using the Snacktivity™ technology. CONCLUSION: Participants were able to incorporate Snacktivity™ into their lives, particularly at home, and found this approach acceptable. Participants felt they experienced health benefits from Snacktivity™ although barriers to participation were reported. This study offers insights for translating guidance into practice and supporting people to become more physically active.", "links": [] }, { "title": "Using mobile health to encourage physical activity in individuals with intellectual disability: a pilot mixed methods feasibility study", "author": "Michalsen, Henriette; Henriksen, André; Pettersen, Gunn; Hartvigsen, Gunnar; Wangberg, Silje; Thrane, Gyrd; Jahnsen, Reidun; Anke, Audny", "year": "2023", "journalProceedings": "Frontiers in Rehabilitation Sciences", "category": "Intervention", "devices": "Versa", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Many individuals with intellectual disability (ID) have a sedentary lifestyle. Few interventions aimed at increasing their level of physical activity (PA) have shown lasting effects. AIM: To assess the feasibility and acceptability of a pilot intervention study using innovative mobile health (mHealth) support systems to encourage PA in individuals with ID. METHODS: Nine individuals with ID and a low level of PA, aged 16-36 years, were included in the present convergent triangulation mixed method design. Two mHealth support systems (apps) were developed and tested. PA was measured with a Fitbit smartwatch, accelerometer, the International Physical Activity Questionnaire-Short Form (IPAQ-S), and Goal attainment scaling. Data were collected through online pre-, mid- (4 weeks), and post-intervention (12 weeks) questionnaires and activity trackers. Semi-structured qualitative interviews with participants and/or a family or staff member were held after the 12-week follow-up. Data were analyzed using conventional nonparametric statistics and thematic analyses. RESULTS: The response rate and retention to the trial were 16\\% and 100\\%, respectively. Data quality was high, except for missing data from Fitbit activity trackers of approximately 30\\% from the 4- and 12-week follow-up stages. The feasibility challenges with activity trackers include rashes, size, non-acceptance, and loss of motivation. Participants and family members/staff reported interest in the study theme and were pleased with the data collection method. All but one participant achieved their PA goals. Most participants reported being satisfied with the apps as they were enjoyable or provided a reminder for performing physical and other activities. Social support for PA among family members also increased. However, app support from staff and family members was needed, and apps were not used regularly. Two of nine participants (22\\%) had increased their PA measured as steps per day with Fitbit at the 12-week follow-up. CONCLUSIONS: The acceptability and feasibility of using tailored mobile applications in natural settings to increase PA among adults with ID are promising. This study aligns with previous studies in showing the challenges to increasing PA, which requires the inclusion of family members, staff, and stakeholders. The intervention requires modifications before a randomized controlled trial can be conducted.", "links": [] }, { "title": "Wellness in Nursing Education to Promote Resilience and Reduce Burnout: Protocol for a Holistic Multidimensional Wellness Intervention and Longitudinal Research Study Design in Nursing Education", "author": "Strout, Kelley; Schwartz-Mette, Rebecca; McNamara, Jade; Parsons, Kayla; Walsh, Dyan; Bonnet, Jen; O'Brien, Liam M.; Robinson, Kathryn; Sibley, Sean; Smith, Annie; Sapp, Maile; Sprague, Lydia; Sabegh, Nima Sajedi; Robinson, Kaitlin; Henderson, Amanda", "year": "2023", "journalProceedings": "JMIR research protocols", "category": "Intervention", "devices": "Versa 2", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "BACKGROUND: The United States faces a nursing shortage driven by a burnout epidemic among nurses and nursing students. Nursing students are an integral population to fuel the nursing workforce at high risk of burnout and increased rates of perceived stress. OBJECTIVE: The aim of this paper is to describe WellNurse, a holistic, interdisciplinary, multidimensional longitudinal research study that examines evidence-based interventions intended to reduce burnout and increase resilience among graduate and undergraduate nursing students. METHODS: Graduate and undergraduate nursing students matriculated at a large public university in the northeastern United States are eligible to enroll in this ongoing, longitudinal cohort study beginning in March 2021. Participants complete a battery of health measurements twice each semester during the fourth week and the week before final examinations. The measures include the Perceived Stress Scale, the Satisfaction with Life Scale, the Oldenburg Burnout Inventory, the Brief Resilience Scale, and the Pittsburgh Sleep Quality Index. Participants are eligible to enroll in a variety of interventions, including mindfulness-based stress reduction, mindful eating, fitness training, and massage therapy. Those who enroll in specific, targeted interventions complete additional measures designed to target the aim of the intervention. All participants receive a free Fitbit device. Additional environmental changes are being implemented to further promote a culture that supports academic well-being, including recruiting a diverse student population through evidence-based holistic admissions, inclusive teaching design, targeted resilience and stress reduction workshops, and cultural shifts within classrooms and curricula. The study design protocol is registered at Open Science Framework (DOI 10.17605/OSF.IO/NCBPE). RESULTS: The project was funded on January 1, 2022. Data collection started in March 2022. A total of 267 participants have been recruited. Results will be published after each semester starting in December 2023. WellNurse evaluation follows the Rapid Cycle Quality Improvement framework to continuously monitor ongoing project processes, activity outcomes, and progress toward reducing burnout and increasing resilience. Rapid Cycle Quality Improvement promotes the ability to alter WellNurse interventions, examine multiple interventions, and test their effectiveness among the nursing education population to identify the most effective interventions. CONCLUSIONS: Academic nursing organizations must address student burnout risk and increase resilience to produce a future workforce that provides high-quality patient care to a diverse population. Findings from WellNurse will support evidence-based implementations for public baccalaureate and master's nursing programs in the United States. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/49020.", "links": [] }, { "title": "Minute level smartphone derived exposure to greenness and consumer wearable derived physical activity in a cohort of US women", "author": "Wilt, Grete E.; Roscoe, Charlotte J.; Hu, Cindy R.; Mehta, Unnati V.; Coull, Brent A.; Hart, Jaime E.; Gortmaker, Steven; Laden, Francine; James, Peter", "year": "2023", "journalProceedings": "Environmental Research", "category": "Case Study", "devices": "Charge HR,Charge 2,Charge 3", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Inconsistent results have been found in the literature on associations of greenness, or vegetation quantity, and physical activity. However, few studies have assessed associations between mobility-based greenness and physical activity from mobile health data from smartphone and wearable devices with fine spatial and temporal resolution. METHODS: We assessed mobility-based greenness exposure and wearable accelerometer data from participants in the US-based prospective Nurses' Health Study 3 cohort Mobile Health (mHealth) Substudy (2018-2020). We recruited 500 female participants with instructions to wear devices over four 7-day sampling periods equally spaced throughout the year. After restriction criteria there were 337 participants (mean age 36 years) with n = 639,364 unique observations. Normalized Difference Vegetation Index (NDVI) data were derived from 30 m x 30 m Landsat-8 imagery and spatially joined to GPS points recorded every 10 min. Fitbit proprietary algorithms provided physical activity summarized as mean number of steps per minute, which we averaged during the 10-min period following a GPS-based greenness exposure assessment. We utilized Generalized Additive Mixed Models to examine associations (every 10 min) between greenness and physical activity adjusting for neighborhood and individual socioeconomic status, Census region, season, neighborhood walkability, daily mean temperature and precipitation. We assessed effect modification through stratification and interaction models and conducted sensitivity analyses. RESULTS: Mean 10-min step count averaged 7.0 steps (SD 14.9) and greenness (NDVI) averaged 0.3 (SD 0.2). Contrary to our hypotheses, higher greenness exposure was associated non-linearly with lower mean steps per minute after adjusting for confounders. We observed statistically significant effect modification by Census region and season. DISCUSSION: We utilized objective physical activity data at fine temporal and spatial scales to present novel estimates of the association between mobility-based greenness and step count. We found higher levels of greenness were inversely associated with steps per minute.", "links": [] }, { "title": "Measurement properties of device-based physical activity instruments in ambulatory adults with physical disabilities and/or chronic diseases: a scoping review", "author": "Brandenbarg, Pim; Hoekstra, Femke; Barakou, Ioulia; Seves, Bregje L.; Hettinga, Florentina J.; Hoekstra, Trynke; van der Woude, Lucas H. V.; Dekker, Rienk; Krops, Leonie A.", "year": "2023", "journalProceedings": "BMC sports science, medicine \\& rehabilitation", "category": "Usability,Systematic Review", "devices": "Classic,Ultra,One,Zip,Flex,Surge,Flex 2,Charge 2,Alta,Charge 3,Garmin Vivofit 4,Garmin Vivofit 3,Garmin Vivosmart 4", "population": "NA", "dataUsed": "Steps,Energy Expenditure,Intensity", "abstract": "BACKGROUND: People with physical disabilities and/or chronic diseases tend to have an inactive lifestyle. Monitoring physical activity levels is important to provide insight on how much and what types of activities people with physical disabilities and/or chronic diseases engage in. This information can be used as input for interventions to promote a physically active lifestyle. Therefore, valid and reliable physical activity measurement instruments are needed. This scoping review aims 1) to provide a critical mapping of the existing literature and 2) directions for future research on measurement properties of device-based instruments assessing physical activity behavior in ambulant adults with physical disabilities and/or chronic diseases. METHODS: Four databases (MEDLINE, CINAHL, Web of Science, Embase) were systematically searched from 2015 to April 16th 2023 for articles investigating measurement properties of device-based instruments assessing physical activity in ambulatory adults with physical disabilities and/or chronic diseases. For the majority, screening and selection of eligible studies were done in duplicate. Extracted data were publication data, study data, study population, device, studied measurement properties and study outcome. Data were synthesized per device. RESULTS: One hundred three of 21566 Studies were included. 55 Consumer-grade and 23 research-grade devices were studied on measurement properties, using 14 different physical activity outcomes, in 23 different physical disabilities and/or chronic diseases. ActiGraph (n = 28) and Fitbit (n = 39) devices were most frequently studied. Steps (n = 68) was the most common used physical activity outcome. 97 studies determined validity, 11 studies reliability and 6 studies responsiveness. CONCLUSION: This scoping review shows a large variability in research on measurement properties of device-based instruments in ambulatory adults with physical disabilities and/or chronic diseases. The variability highlights a need for standardization of and consensus on research in this field. The review provides directions for future research.", "links": [] }, { "title": "Resident Sleep During Traditional Home Call Compared to Night Float", "author": "Chowdhary, Apoorva; Davis, John A.; Ding, Leona; Taravati, Parisa; Feng, Shu", "year": "2023", "journalProceedings": "Journal of Academic Ophthalmology (2017)", "category": "Case Study", "devices": "Alta HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "Purpose  This article aims to compare resident sleep while on night float with a traditional home call. Methods  We conducted a crossover observational study assessing sleep patterns of seven postgraduate year-2 ophthalmology residents at the University of Washington from 2019 to 2021 using the Fitbit Alta HR device. Overnight call was scheduled from 5 p.m. to 8 a.m. on weekdays, and 8 a.m. to 8 a.m. on weekends. The residency program implemented a partial night float rotation, during which two to three nights of consecutive call were assigned to a resident without other clinical duties. Sleep was recorded using the Fitbit Alta HR for residents while on a 5-week partial night float rotation, on 10-week home call rotations, with postcall relief, and for stretches of seven or more days without call responsibilities. Mixed model regression analysis was used to compare average sleep on home call, night float, and periods without call. Results  Sleep data were recorded for a total of 1,015 nights, including 503 nights on home call rotation and 230 nights on night float rotation. Residents slept more during periods away from call compared to either night float or home call rotations ( p  {\\textless} 0.001). Residents experienced increased average overall sleep during 10-week rotations on night float compared to home call ( p  = 0.008). While there was no difference in overnight sleep on call between night float and home call ( p  = 0.701), residents experienced more sleep overall while on call on night float compared to home call due to more sleep being recorded during postcall naps ( p  = 0.016). Conclusion  Implementing a night float system can increase resident sleep by allowing for more sleep recovery during time away from clinical duties.", "links": [] }, { "title": "GamerFit-ASD beta test: adapting an evidence-based exergaming and telehealth coaching intervention for autistic youth", "author": "Hatfield, Daniel P.; Must, Aviva; Kennedy, Winston; Staiano, Amanda E.; Slavet, James; Sabelli, Rachael A.; Curtin, Carol; Bandini, Linda G.; Nauta, Phillip; Stuetzle, Christopher; Bowling, April B.", "year": "2023", "journalProceedings": "Frontiers in Pediatrics", "category": "Intervention", "devices": "Flex 2", "population": "Children", "dataUsed": "Steps,User Friendliness", "abstract": "BACKGROUND: Health disparities faced by autistic youth are exacerbated by inadequate physical activity (PA) and sleep, whereas healthy PA and sleep may improve mood and function. Adaptive Game Squad (AGS) is an evidence-based telehealth coaching and exergaming intervention to improve PA and sleep for adolescents with diverse neurodevelopmental and psychiatric conditions. This study aimed to adapt AGS for autistic youth ages 10-15 years; beta-test the modified intervention for feasibility, accessibility, and engagement; and further refine the intervention for a larger planned demonstration pilot. METHODS: Interdisciplinary experts adapted AGS to create GamerFit-ASD, a 12-week intervention that included a progressive exergame schedule, Fitbit step-tracking, weekly health coaching, and health tip/exercise videos. For beta testing, the intervention was shortened to a 4-week trial with 5 parent/child dyads. Children completed exit surveys and parents and children were interviewed about intervention feasibility, accessibility, and engagement. Exit survey data were summarized with descriptive statistics. Qualitative data were analyzed using a modified grounded-theory approach. RESULTS: All participants (n = 5; ages 10-14 years) attended all 4 planned coaching sessions and completed an average of 9 of 12 planned exergame challenges for a weekly average of 50 min. All participants reported enjoying coaching sessions, 4 of 5 reported enjoying exergames, and 3 of 5 reported enjoying on-demand exercise videos. In interviews, children generally reported finding participation feasible, exergaming challenges active and fun, and coaches friendly and helpful. Parents reported high feasibility of supporting their children's involvement and valued child goal-setting and intervention flexibility; however, some found telehealth sessions overly scripted. Several adaptations to coaching scripts, coach training, and parent materials were made for the larger demonstration pilot, including changes to reduce scriptedness of coaching sessions, to provide parents with more information specific to autism, and to make video content more appropriate to children's needs/preferences. DISCUSSION: A telehealth coaching and exergaming intervention appears feasible, accessible, and engaging for autistic youth aged 10-15. Future studies with larger, more diverse samples, longer study durations and/or follow-up periods, and more rigorous study designs are needed to advance understanding of the appropriateness and effectiveness of this type of intervention for this population.", "links": [] }, { "title": "Unpacking the Drivers of Dissatisfaction and Satisfaction in a Fitness Mobile Application", "author": "Kim, Minseong; Lee, Sae-Mi", "year": "2023", "journalProceedings": "Behavioral Sciences (Basel, Switzerland)", "category": "Usability,Review", "devices": "Device unspecified", "population": "NA", "dataUsed": "User Friendliness", "abstract": "This research investigates the factors influencing user satisfaction and dissatisfaction in fitness mobile applications. It employs Herzberg's two-factor model through text mining to classify Fitbit mobile app attributes into satisfiers and dissatisfiers. The Fitbit app was chosen due to its prevalence in the United States. The study analyzes 100,000 English reviews from the Fitbit app on the Google Play Store, categorizing attributes. It identifies three dissatisfying categories (functional, compatibility, paid services) and three satisfying categories (gratification, self-monitoring, self-regulation), comprising 25 sub-attributes. This classification offers in-depth insights into what drives user contentment or discontent with fitness apps. The findings contribute to the fitness app domain by applying text-mining and Herzberg's model. Researchers can build upon this foundation, and practitioners can use it to enhance app experiences. However, this research relies on user reviews, often lacking comprehensive explanations. This limitation may hinder a profound understanding of the underlying psychological aspects in user sentiments. Nonetheless, this study takes strides toward optimizing fitness apps for users and developers.", "links": [] }, { "title": "Advancing Understanding of Just-in-Time States for Supporting Physical Activity (Project JustWalk JITAI): Protocol for a System ID Study of Just-in-Time Adaptive Interventions", "author": "Park, Junghwan; Kim, Meelim; El Mistiri, Mohamed; Kha, Rachael; Banerjee, Sarasij; Gotzian, Lisa; Chevance, Guillaume; Rivera, Daniel E.; Klasnja, Predrag; Hekler, Eric", "year": "2023", "journalProceedings": "JMIR research protocols", "category": "Intervention", "devices": "Versa 3", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND: Just-in-time adaptive interventions (JITAIs) are designed to provide support when individuals are receptive and can respond beneficially to the prompt. The notion of a just-in-time (JIT) state is critical for JITAIs. To date, JIT states have been formulated either in a largely data-driven way or based on theory alone. There is a need for an approach that enables rigorous theory testing and optimization of the JIT state concept. OBJECTIVE: The purpose of this system ID experiment was to investigate JIT states empirically and enable the empirical optimization of a JITAI intended to increase physical activity (steps/d). METHODS: We recruited physically inactive English-speaking adults aged ≥25 years who owned smartphones. Participants wore a Fitbit Versa 3 and used the study app for 270 days. The JustWalk JITAI project uses system ID methods to study JIT states. Specifically, provision of support systematically varied across different theoretically plausible operationalizations of JIT states to enable a more rigorous and systematic study of the concept. We experimentally varied 2 intervention components: notifications delivered up to 4 times per day designed to increase a person's steps within the next 3 hours and suggested daily step goals. Notifications to walk were experimentally provided across varied operationalizations of JIT states accounting for need (ie, whether daily step goals were previously met or not), opportunity (ie, whether the next 3 h were a time window during which a person had previously walked), and receptivity (ie, a person previously walked after receiving notifications). Suggested daily step goals varied systematically within a range related to a person's baseline level of steps per day (eg, 4000) until they met clinically meaningful targets (eg, averaging 8000 steps/d as the lower threshold across a cycle). A series of system ID estimation approaches will be used to analyze the data and obtain control-oriented dynamical models to study JIT states. The estimated models from all approaches will be contrasted, with the ultimate goal of guiding rigorous, replicable, empirical formulation and study of JIT states to inform a future JITAI. RESULTS: As is common in system ID, we conducted a series of simulation studies to formulate the experiment. The results of our simulation studies illustrated the plausibility of this approach for generating informative and unique data for studying JIT states. The study began enrolling participants in June 2022, with a final enrollment of 48 participants. Data collection concluded in April 2023. Upon completion of the analyses, the results of this study are expected to be submitted for publication in the fourth quarter of 2023. CONCLUSIONS: This study will be the first empirical investigation of JIT states that uses system ID methods to inform the optimization of a scalable JITAI for physical activity. TRIAL REGISTRATION: ClinicalTrials.gov NCT05273437; https://clinicaltrials.gov/ct2/show/NCT05273437. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52161.", "links": [] }, { "title": "Moderate and increased physical activity is not detrimental to live birth rates among women with unexplained infertility and obesity", "author": "Vitek, Wendy S.; Sun, Fangbai; Cardozo, Eden; Hoeger, Kathleen M.; Hansen, Karl R.; Santoro, Nanette; Zhang, Heping; Legro, Richard S.", "year": "2023", "journalProceedings": "F\\&S Reports", "category": "Intervention", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps", "abstract": "OBJECTIVE: To determine if moderate physical activity is associated with live birth rates in women with unexplained infertility and obesity. DESIGN: Secondary analysis of the Improving Reproductive Fitness through Pretreatment with Lifestyle Modification in Obese Women with Unexplained Infertility trial. SETTING: US fertility centers, 2015-2019. PATIENTS: A total of 379 women participated in Improving Reproductive Fitness through Pretreatment with Lifestyle Modification in Obese Women with Unexplained Infertility trial, a lifestyle modification program with increased physical activity (phase I, 16 weeks) and up to three cycles of clomiphene citrate treatment and intrauterine insemination (phase II). INTERVENTIONS: Participants were instructed to add 500 steps/day weekly until a maximum of 10,000 steps/day was reached and maintained. Participants were stratified as active (top third, N = 125) and less active (lower third, N = 125) on the basis of the average number of steps per day recorded using a FitBit activity tracker. MAIN OUTCOME MEASURES: Live birth rate. RESULTS: Active participants were more physically active at the time of enrollment than less active participants (average baseline steps per day, 8,708 [7,079-10,000] vs. 4,695 [3,844-5,811]; P ≤ 0.001) and were more likely to reach 10,000 steps/day than less active participants (average steps per day, 10,526 [9,481-11,810] vs. 6,442 [4,644-7,747]; P ≤ 0.001), although both groups increased their average steps per day by a similar amount (1,818 vs.1,747; P = 0.57). There was no difference in live birth rates (24/125 [19.2\\%] vs. 25/125 [20\\%]; P = 0.87) between active and less active participants nor were there differences in clinical pregnancy rates (P = 0.45) or miscarriage rates (P = 0.49) between the two groups. CONCLUSIONS: Active participants were more likely to achieve the physical activity goal, although this was not associated with benefit or harm with respect to live birth. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT02432209), first posted: May 4, 2015.", "links": [] }, { "title": "Feasibility and Preliminary Effectiveness of the INSPIRE Pilot Study for Adolescent Girls", "author": "Voskuil, Vicki R.; Emmanuel, Johanna; Magnuson, Claire; Guidone, Marisa", "year": "2023", "journalProceedings": "Journal of Pediatric Health Care: Official Publication of National Association of Pediatric Nurse Associates \\& Practitioners", "category": "Intervention", "devices": "Inspire", "population": "Adolescents", "dataUsed": "Heart Rate", "abstract": "INTRODUCTION: This pilot study evaluated the feasibility and preliminary effectiveness of the Intervention to Support Physical Activity Independence and Routine Everyday program. METHOD: This quasi-experimental single-group pretest/posttest study included adolescent girls (n = 15) who received a Fitbit Inspire 2 wearable activity tracker and participated in the seven-week Intervention to Support Physical Activity Independence and Routine Everyday program on a college campus in the Midwest. Feasibility outcomes included intervention participation, fidelity, and satisfaction. Preliminary effectiveness outcomes included moderate-to-vigorous physical activity, cardiorespiratory fitness, and resting heart rate. RESULTS: For intervention sessions, the mean attendance rate was 83.42\\%, the mean minutes of moderate-to-vigorous physical activity was 62.03, and the mean satisfaction score was 28.90. Moderate-to-vigorous physical activity and resting heart rate improved significantly from baseline to postintervention, but cardiorespiratory fitness did not. DISCUSSION: Results suggest the need for a pilot randomized controlled trial to improve cardiorespiratory fitness and incorporating an objective measure of moderate-to-vigorous physical activity.", "links": [] }, { "title": "Addressing the Chronic Pain-Early Cognitive Decline Comorbidity Among Older Adults: Protocol for the Active Brains Remote Efficacy Trial", "author": "Vranceanu, Ana-Maria; Choukas, Nathaniel R.; Rochon, Elizabeth A.; Duarte, Brooke; Pietrzykowski, Malvina O.; McDermott, Katherine; Hooker, Julia E.; Kulich, Ronald; Quiroz, Yakeel T.; Parker, Robert A.; Macklin, Eric A.; Ritchie, Christine; Active Brains Project; Mace, Ryan A.", "year": "2023", "journalProceedings": "JMIR research protocols", "category": "Intervention", "devices": "Inspire", "population": "Older Adults", "dataUsed": "Steps,User Friendliness", "abstract": "BACKGROUND: Chronic pain and early cognitive decline, which are costly to treat and highly prevalent among older adults, commonly co-occur, exacerbate one another over time, and can accelerate the development and progression of Alzheimer disease and related dementias. We developed the first mind-body activity program (Active Brains [AB]) tailored to the needs of older adults with chronic pain and early cognitive decline. Results from our previous study strongly supported the feasibility of conducting AB remotely and provided evidence for improvements in outcomes. OBJECTIVE: We are conducting a single-blinded, National Institutes of Health stage-2, randomized clinical trial to establish the efficacy of AB versus a time-matched and dose-matched education control (Health Enhancement Program [HEP]) in improving self-reported and objective outcomes of physical, cognitive, and emotional functions in 260 participants. The methodology described in this paper was informed by the lessons learned from the first year of the trial. METHODS: Participants are identified and recruited through multidisciplinary clinician-referred individuals (eg, pain psychologists and geriatricians), the Rally Research platform, social media, and community partnerships. Interested participants complete eligibility screening and electronic informed consent. Baseline assessments include self-report, performance-based measures (eg, 6-min walk test) and objective measures (eg, Repeatable Battery for the Assessment of Neuropsychological Status). Participants are mailed a wrist-worn ActiGraph device (ActiGraph LLC) to passively monitor objective function (eg, steps) during the week between the baseline assessment and the beginning of the programs, which they continue to wear throughout the programs. After baseline assessments, participants are randomized to either AB or HEP and complete 8 weekly, remote, group sessions with a Massachusetts General Hospital psychologist. The AB group receives a Fitbit (Fitbit Inc) to help reinforce increased activity. Assessments are repeated after the intervention and at the 6-month follow-up. Coprimary outcomes include multimodal physical function (self-report, performance based, and objective). Secondary outcomes are cognitive function (self-report and objective), emotional function, and pain. RESULTS: We began recruitment in July 2022 and recruited 37 participants across 4 cohorts. Of them, all (n=37, 100\\%) have completed the baseline assessment, 26 (70\\%) have completed the posttest assessment, and 9 (24\\%) are actively enrolled in the intervention (total dropout: n=2, 5\\%). In the three cohorts (26/37, 70\\%) that have completed the AB or HEP, 26 (100\\%) participants completed all 8 group sessions (including minimal makeups), and watch adherence (1937/2072, 93.48\\%, average across ActiGraph and Fitbit devices) has been excellent. The fourth cohort is ongoing (9/37, 24\\%), and we plan to complete enrollment by March 2026. CONCLUSIONS: We aim to establish the efficacy of the AB program over a time-matched and dose-matched control in a live video-based trial and test the mechanisms through theoretically driven mediators and moderators. Findings will inform the development of a future multisite effectiveness-implementation trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT05373745; https://classic.clinicaltrials.gov/ct2/show/NCT05373745. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47319.", "links": [] }, { "title": "Accuracy in detecting atrial fibrillation in single-lead ECGs: an online survey comparing the influence of clinical expertise and smart devices", "author": "Weidlich, Simon; Mannhart, Diego; Serban, Teodor; Krisai, Philipp; Knecht, Sven; Du Fay de Lavallaz, Jeanne; Müller, Tatjana; Schaer, Beat; Osswald, Stefan; Kühne, Michael; Sticherling, Christian; Badertscher, Patrick", "year": "2023", "journalProceedings": "Swiss Medical Weekly", "category": "Case Study", "devices": "Sense", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Manual interpretation of single-lead ECGs (SL-ECGs) is often required to confirm a diagnosis of atrial fibrillation. However accuracy in detecting atrial fibrillation via SL-ECGs may vary according to clinical expertise and choice of smart device. AIMS: To compare the accuracy of cardiologists, internal medicine residents and medical students in detecting atrial fibrillation via SL-ECGs from five different smart devices (Apple Watch, Fitbit Sense, KardiaMobile, Samsung Galaxy Watch, Withings ScanWatch). Participants were also asked to assess the quality and readability of SL-ECGs. METHODS: In this prospective study (BaselWearableStudy, NCT04809922), electronic invitations to participate in an online survey were sent to physicians at major Swiss hospitals and to medical students at Swiss universities. Participants were asked to classify up to 50 SL-ECGs (from ten patients and five devices) into three categories: sinus rhythm, atrial fibrillation or inconclusive. This classification was compared to the diagnosis via a near-simultaneous 12-lead ECG recording interpreted by two independent cardiologists. In addition, participants were asked their preference of each manufacturer's SL-ECG. RESULTS: Overall, 450 participants interpreted 10,865 SL-ECGs. Sensitivity and specificity for the detection of atrial fibrillation via SL-ECG were 72\\% and 92\\% for cardiologists, 68\\% and 86\\% for internal medicine residents, 54\\% and 65\\% for medical students in year 4-6 and 44\\% and 58\\% for medical students in year 1-3; p {\\textless}0.001. Participants who stated prior experience in interpreting SL-ECGs demonstrated a sensitivity and specificity of 63\\% and 81\\% compared to a sensitivity and specificity of 54\\% and 67\\% for participants with no prior experience in interpreting SL-ECGs (p {\\textless}0.001). Of all participants, 107 interpreted all 50 SL-ECGs. Diagnostic accuracy for the first five interpreted SL-ECGs was 60\\% (IQR 40-80\\%) and diagnostic accuracy for the last five interpreted SL-ECGs was 80\\% (IQR 60-90\\%); p {\\textless}0.001. No significant difference in the accuracy of atrial fibrillation detection was seen between the five smart devices; p = 0.33. SL-ECGs from the Apple Watch were considered as having the best quality and readability by 203 (45\\%) and 226 (50\\%) participants, respectively. CONCLUSION: SL-ECGs can be challenging to interpret. Accuracy in correctly identifying atrial fibrillation depends on clinical expertise, while the choice of smart device seems to have no impact.", "links": [] }, { "title": "Minimally invasive versus open pancreatoduodenectomy for pancreatic and peri-ampullary neoplasm (DIPLOMA-2): study protocol for an international multicenter patient-blinded randomized controlled trial", "author": "de Graaf, Nine; Emmen, Anouk M. L. H.; Ramera, Marco; Björnsson, Bergthor; Boggi, Ugo; Bruna, Caro L.; Busch, Olivier R.; Daams, Freek; Ferrari, Giovanni; Festen, Sebastiaan; van Hilst, Jony; D'Hondt, Mathieu; Ielpo, Benedetto; Keck, Tobias; Khatkov, Igor E.; Koerkamp, Bas Groot; Lips, Daan J.; Luyer, Misha D. P.; Mieog, J. Sven D.; Morelli, Luca; Molenaar, I. Quintus; van Santvoort, Hjalmar C.; Sprangers, Mirjam A. G.; Ferrari, Clarissa; Berkhof, Johannes; Maisonneuve, Patrick; Abu Hilal, Mohammad; Besselink, Marc G.; European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)", "year": "2023", "journalProceedings": "Trials", "category": "Case Study", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Steps,Heart Rate", "abstract": "Background: Minimally invasive pancreatoduodenectomy (MIPD) aims to reduce the negative impact of surgery as compared to open pancreatoduodenectomy (OPD) and is increasingly becoming part of clinical practice for selected patients worldwide. However, the safety of MIPD remains a topic of debate and the potential shorter time to functional recovery needs to be confirmed. To guide safe implementation of MIPD, large-scale international randomized trials comparing MIPD and OPD in experienced high-volume centers are needed. We hypothesize that MIPD is non-inferior in terms of overall complications, but superior regarding time to functional recovery, as compared to OPD.\n\nMethods/design: The DIPLOMA-2 trial is an international randomized controlled, patient-blinded, non-inferiority trial performed in 14 high-volume pancreatic centers in Europe with a minimum annual volume of 30 MIPD and 30 OPD. A total of 288 patients with an indication for elective pancreatoduodenectomy for pre-malignant and malignant disease, eligible for both open and minimally invasive approach, are randomly allocated for MIPD or OPD in a 2:1 ratio. Centers perform either laparoscopic or robot-assisted MIPD based on their surgical expertise. The primary outcome is the Comprehensive Complication Index (CCI®), measuring all complications graded according to the Clavien-Dindo classification up to 90 days after surgery. The sample size is calculated with the following assumptions: 2.5% one-sided significance level (α), 80% power (1-β), expected difference of the mean CCI® score of 0 points between MIPD and OPD, and a non-inferiority margin of 7.5 points. The main secondary outcome is time to functional recovery, which will be analyzed for superiority. Other secondary outcomes include post-operative 90-day Fitbit™ measured activity, operative outcomes (e.g., blood loss, operative time, conversion to open surgery, surgeon-reported outcomes), oncological findings in case of malignancy (e.g., R0-resection rate, time to adjuvant treatment, survival), postoperative outcomes (e.g., clinically relevant complications), healthcare resource utilization (length of stay, readmissions, intensive care stay), quality of life, and costs. Postoperative follow-up is up to 36 months.\n\nDiscussion: The DIPLOMA-2 trial aims to establish the safety of MIPD as the new standard of care for this selected patient population undergoing pancreatoduodenectomy in high-volume centers, ultimately aiming for superior patient recovery.\n\nTrial registration: ISRCTN27483786. Registered on August 2, 2023.", "links": [] }, { "title": "Protocol for randomized personalized trial for stress management compared to standard of care", "author": "Goodwin, Ashley M.; Miller, Danielle; D'Angelo, Stefani; Perrin, Alexandra; Wiener, Ruby; Greene, Brittney; Romain, Anne-Marie N.; Arader, Lindsay; Chandereng, Thevaa; Kuen Cheung, Ying; Davidson, Karina W.; Butler, Mark", "year": "2023", "journalProceedings": "Frontiers in Psychology", "category": "Intervention", "devices": "Charge 4,Versa 3,Sense,Inspire 2,Charge 5", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Stress is a significant public health burden in the United States, with most Americans reporting unhealthy levels of stress. Stress management techniques include various evidence-based treatments shown to be effective but with heterogeneous treatment responses, indicating a lack of uniform benefits for all individuals. Designed to assess a participant's response to a specific intervention, personalized (N-of-1) trials provide guidance for which treatment (s) work (s) best for the individual. Prior studies examining the effects of mindfulness meditation, yoga, and walking for stress reduction found all three interventions to be associated with significant reductions in self-reported measures of stress. Delivering these treatments using a personalized trial approach has the potential to assist clinicians in identifying the best stress management techniques for individuals with persistently high stress while fostering treatment decisions that consider their personal condition/barriers. This trial will evaluate a personalized approach compared to standard of care for three interventions (guided mindfulness meditation; guided yoga; and guided brisk walking) to manage perceived stress. Participants will respond to daily surveys and wear a Fitbit device for 18 weeks. After a 2-week baseline period, participants in the personalized trial groups will receive 12 weeks of interventions in randomized order, while participants in the standard-of-care group will have access to all interventions for self-directed stress management. After intervention, all participants will undergo 2 weeks of observation, followed by two additional weeks of the stress management intervention of their choosing while continuing outcome measurement. At study completion, all participants will be sent a satisfaction survey. The primary analysis will compare perceived stress levels between the personalized and standard of care arms. The results of this trial will provide further support for the use of personalized designs for managing stress. Clinical Trial Registration: clinicaltrials.gov, NCT05408832. Protocol version: 9/14/2022, 21-0968-MRB.\n\nKeywords: N-of-1; mindfulness; personalized trials; physical activity; stress management techniques; yoga.", "links": [] }, { "title": "The Hospital to Home study (H2H): smartwatch technology-enabled rehabilitation following hip fracture in older adults, a feasibility non-randomised trial", "author": "Hewage, Kalon; Fosker, Samuel; Leckie, Todd; Venn, Richard; Gonçalves, Anna-Carolina; Koulouglioti, Christina; Hodgson, Luke E.", "year": "2023", "journalProceedings": "Future Healthcare Journal", "category": "Usability", "devices": "Charge 4", "population": "Older Adults", "dataUsed": "Steps,User Friendliness", "abstract": "Introduction: Hip fractures are associated with significant morbidity and mortality. This study assessed the feasibility of smartwatches supporting rehabilitation post-surgical fixation.\n\nMethods: This UK-based non-randomised intervention study recruited patients who had sustained a hip fracture (age ≥65 and Abbreviated Mental Test Score ≥8/10), following surgical fixation, at one hospital to the intervention group, and at a second hospital to a usual care group. The intervention group received a smartwatch (Fitbit Charge 4) and app (CUSH Health©). Feasibility measures included retention and completion of outcome measures.\n\nResults: Between November 2020 and November 21, 66 participants were recruited (median age 78 (IQR 74-84)). The intervention cohort were younger, with no significant differences in frailty or multi-morbidity between the cohorts. Hospital stay was shorter in the intervention cohort (10 days (7-16) versus 12 (10-18), p=0.05). There were 15 falls-related readmissions in the control cohort, including 11 fractures, with none in the intervention cohort (p=0.016). In the intervention group, median daily step counts increased from 477 (320-697) in hospital, to 931 (505-1238) 1 week post-discharge, to 5,352 (3,552-7,944) at 12-weeks (p=0.001). Of the intervention cohort, 12 withdrew.\n\nConclusion: This study found that smartwatch-supported rehabilitation was feasible in this cohort. A significant proportion of patients either chose not to participate or withdrew; such a decrease in participants must be addressed to avoid digital exclusion. Falls and fracture-related readmissions were more frequent at the control site compared with the intervention site.\n\nKeywords: digital health; hip fracture; rehabilitation; smartwatches.", "links": [] }, { "title": "Assessment of glycemic variability and lifestyle behaviors in healthy nondiabetic individuals according to the categories of body mass index", "author": "Kashiwagi, Kazuhiro; Inaishi, Jun; Kinoshita, Shotaro; Wada, Yasuyo; Hanashiro, Sayaka; Shiga, Kiko; Kitazawa, Momoko; Tsutsumi, Shiori; Yamakawa, Hiroyuki; Irie, Junichiro; Kishimoto, Taishiro", "year": "2023", "journalProceedings": "PloS One", "category": "Case Study", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: There are limited data about the association between body mass index (BMI), glycemic variability (GV), and life-related factors in healthy nondiabetic adults.\n\nMethods: This cross-sectional study was carried out within our ethics committee-approved study called \"Exploring the impact of nutrition advice on blood sugar and psychological status using continuous glucose monitoring (CGM) and wearable devices\". Prediabetes was defined by the HbA1c level of 5.7-6.4% and /or fasting glucose level of 100-125 mg/dL. Glucose levels and daily steps were measured for 40 participants using Free Style Libre and Fitbit Inspire 2 under normal conditions for 14 days. Dietary intakes and eating behaviors were assessed using a brief-type self-administered dietary history questionnaire and a modified questionnaire from the Obesity Guidelines.\n\nResults: All indices of GV were higher in the prediabetes group than in the healthy group, but a significant difference was observed only in mean amplitude of glycemic excursions (MAGE). In the multivariate analysis, only the presence of prediabetes showed a significant association with the risk of higher than median MAGE (Odds, 6.786; 95% CI, 1.596-28.858; P = 0.010). Additionally, the underweight (BMI < 18.5) group had significantly higher value in standard deviation (23.7 ± 3.5 vs 19.8 ± 3.7 mg/dL, P = 0.038) and coefficient variability (22.6 ± 4.6 vs 18.4 ± 3.2%, P = 0.015), compared to the normal group. This GV can be partially attributed to irregularity of eating habits. On the contrary, the overweight (BMI ≥ 25) group had the longest time above the 140 or 180 mg/dL range, which may be due to eating style and taking fewer steps (6394 ± 2337 vs 9749 ± 2408 steps, P = 0.013).\n\nConclusions: Concurrent CGM with diet and activity monitoring could reduce postprandial hyperglycemia through assessment of diet and daily activity, especially in non- normal weight individuals.", "links": [] }, { "title": "Association Between Health Information‒Seeking Behavior on YouTube and Physical Activity Among U.S. Adults: Results From Health Information Trends Survey 2020", "author": "Lee, Juhan; Turner, Kea; Xie, Zhigang; Kadhim, Bashar; Hong, Young-Rock", "year": "2022", "journalProceedings": "AJPM focus", "category": "Case Study,Survey Research", "devices": "Device unspecified", "population": "Adults", "dataUsed": "NA", "abstract": "Introduction: Although physical activity has many health benefits, 45.8% of U.S. adults did not meet the WHO recommendation in 2018. Delivering health-related content, particularly physical activity, through YouTube may help to overcome some barriers, such as lack of access to resources. This study aimed to examine the association between watching health-related information on YouTube and increased levels of physical activity among U.S. adults.\n\nMethods: Using the U.S. national cross-sectional survey-Health Information National Trends Survey 2020 (n=3,865), we conducted a multivariable logistic regression on obtaining 150 minutes of at least moderate-intensity physical activity per week (WHO guidelines) by watching health-related information on YouTube, controlling for demographics (age, sex, race/ethnicity), socioeconomics (income, education level, insurance coverage, employment), current use of cigarettes and e-cigarettes, use of electronic wearable devices (e.g., Fitbit), self-reported health status, BMI, and the presence of chronic conditions (e.g., diabetes, heart disease, cancer) and depression or anxiety disorders.\n\nResults: Overall, 40.8% (weighted) of respondents reported using YouTube to watch health-related videos, and 39.2% reported meeting the WHO-recommended physical activity level. After controlling for covariates, adults who reported watching health-related videos on YouTube in the past 12 months (versus not watching) were 1.33 times more likely to do 150 minutes or more of moderate physical activity a week (AOR=1.33; 95% CI=1.01, 1.76).\n\nConclusions: This study suggests that adults who view health-related YouTube videos may be more likely to meet the WHO-recommended level of physical activity. This finding could inform future behavioral interventions using online video platforms to promote physical activity.\n\nKeywords: HINTS; Physical activity; health promotion; social media.", "links": [] }, { "title": "Testing the Effects of App-Based Motivational Messages on Physical Activity and Resting Heart Rate Through Smartphone App Compliance in Patients With Vulnerable Coronary Artery Plaques: Protocol for a Microrandomized Trial", "author": "Mitra, Sayan; Kroeger, Cynthia M.; Xu, Jing; Avery, Leah; Masedunskas, Andrius; Cassidy, Sophie; Wang, Tian; Hunyor, Imre; Wilcox, Ian; Huang, Robin; Chakraborty, Bibhas; Fontana, Luigi", "year": "2023", "journalProceedings": "JMIR Research Protocols", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Background: Achieving the weekly physical activity recommendations of at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic exercise is important for reducing cardiometabolic risk, but evidence shows that most people struggle to meet these goals, particularly in the mid to long term.\n\nObjective: The Messages Improving Resting Heart Health (MIRTH) study aims to determine if (1) sending daily motivational messages through a research app is effective in improving motivation and in promoting adherence to physical activity recommendations in men and women with coronary heart disease randomized to a 12-month intensive lifestyle intervention, and (2) the time of the day when the message is delivered impacts compliance with exercise training.\n\nMethods: We will conduct a single-center, microrandomized trial. Participants will be randomized daily to either receive or not receive motivational messages over two 90-day periods at the beginning (phase 1: months 4-6) and at the end (phase 2: months 10-12) of the Lifestyle Vulnerable Plaque Study. Wrist-worn devices (Fitbit Inspire 2) and Bluetooth pairing with smartphones will be used to passively collect data for proximal (ie, physical activity duration, steps walked, and heart rate within 180 minutes of receiving messages) and distal (ie, change values for resting heart rate and total steps walked within and across both phases 1 and 2 of the trial) outcomes. Participants will be recruited from a large academic cardiology office practice (Central Sydney Cardiology) and the Royal Prince Alfred Hospital Departments of Cardiology and Radiology. All clinical investigations will be undertaken at the Charles Perkins Centre Royal Prince Alfred clinic. Individuals aged 18-80 years (n=58) with stable coronary heart disease who have low attenuation plaques based on a coronary computed tomography angiography within the past 3 months and have been randomized to an intensive lifestyle intervention program will be included in MIRTH.\n\nResults: The Lifestyle Vulnerable Plaque Study was funded in 2020 and started enrolling participants in February 2022. Recruitment for MIRTH commenced in November 2022. As of September 2023, 2 participants were enrolled in the MIRTH study and provided baseline data.\n\nConclusions: This MIRTH microrandomized trial will represent the single most detailed and integrated analysis of the effects of a comprehensive lifestyle intervention delivered through a customized mobile health app on smart devices on time-based motivational messaging for patients with coronary heart disease. This study will also help inform future studies optimizing for just-in-time adaptive interventions.\n\nTrial registration: Australian New Zealand Clinical Trials Registry ACTRN12622000731796; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382861.\n\nInternational registered report identifier (irrid): DERR1-10.2196/46082.\n\nKeywords: adherence; coronary artery disease; coronary heart disease; digital health; health behavior; heart rate; messages; mhealth; microrandomized trial; mobile app; physical activity; smartphone; telehealth; user motivation.", "links": [ { "caption": "URL", "url": "https://www.researchprotocols.org/2023/1/e46082", "newWindow": true } ] }, { "title": "Baseline Nutritional Status and In-Hospital Step Count are Associated with Muscle Quantity, Quality, and Function: Results of an Exploratory Study", "author": "Welch, Carly; Greig, Carolyn; Lewis, Danielle; Majid, Zeinab; Masud, Tahir; Moorey, Hannah; Pinkney, Thomas; Stanley, Benjamin; Jackson, Thomas", "year": "2023", "journalProceedings": "Journal of Nutrition in Gerontology and Geriatrics", "category": "Case Study,Methods", "devices": "Inspire", "population": "Older Adults", "dataUsed": "Steps", "abstract": "This exploratory study aimed to assess associations of baseline nutritional status and in-hospital step count with muscle quantity, quality, and function. Seventy-nine participants aged ≥70 years (mean age 79.1 years, 44.3% female) were recruited (elective colorectal surgery, emergency abdominal surgery, and general medical patients with infections). Baseline nutrition (Mini Nutritional Assessment) and in-hospital step count (Fitbit Inspire devices) were assessed. Ultrasound quadriceps, bioelectrical impedance analysis, and physical function were assessed at baseline and 7 (±2) days and 13 (±1) weeks post-admission/post-operatively. Baseline nutritional status was associated with baseline rectus femoris ultrasound echogenicity (normal: 58.5, at risk: 68.5, malnourished: 81.2; p = 0.025), bilateral anterior thigh thickness (normal: 5.07 cm, at risk: 4.03 cm, malnourished: 3.05 cm; p = 0.021), and skeletal muscle mass (Sergi equation) (normal: 21.6 kg, at risk: 18.2 kg, malnourished: 12.0 kg; p = 0.007). Step count was associated with baseline patient-reported physical function (<900 37.1, ≥900 44.5; p = 0.010). There was a significant interaction between nutrition, step count, and time for skeletal muscle mass (Janssen equation) (p = 0.022).\n\nKeywords: Sarcopenia; accelerometry; ultrasound.", "links": [] }, { "title": "Effects of sleep-corrected social jetlag on measures of mental health, cognitive ability, and brain functional connectivity in early adolescence", "author": "Yang, Fan Nils; Picchioni, Dante; Duyn, Jeff H.", "year": "2023", "journalProceedings": "Sleep", "category": "Case Study", "devices": "Charge HR", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "Approximately half of adolescents encounter a mismatch between their sleep patterns on school days and free days, also referred to as \"social jetlag\". This condition has been linked to various adverse outcomes, such as poor sleep, cognitive deficits, and mental disorders. However, prior research was unsuccessful in accounting for other variables that are correlated with social jetlag, including sleep duration and quality. To address this limitation, we applied a propensity score matching method on a sample of 6335 11-12-year-olds from the two-year follow-up (FL2) data of the Adolescent Brain Cognitive Development (ABCD) study. We identified 2424 pairs of participants with high sleep-corrected social jetlag (SJLsc, over 1 hour) and low SJLsc (<= 1 hour) at FL2 (1728 pairs have neuroimaging data), as well as 1626 pairs at three-year follow-up (FL3), after matching based on 11 covariates including socioeconomic status, demographics, and sleep duration and quality. Our results showed that high SJLsc, as measured by the Munich Chronotype Questionnaire, was linked to reduced crystallized intelligence, lower school performance - grades, and decreased functional connectivity between cortical networks and subcortical regions, specifically between cingulo-opercular network and right hippocampus. Further mediation and longitudinal mediation analyses revealed that this connection mediated the associations between SJLsc and crystallized intelligence at FL2, and between SJLsc and grades at both FL2 and FL3. We validated these findings by replicating these results using objective SJLsc measurements obtained via Fitbit watches. Overall, our study highlights the negative association between social jetlag and crystallized intelligence during early adolescence.", "links": [] }, { "title": "Latent Profiles of Sleep Patterns in Early Adolescence: Associations With Behavioral Health Risk", "author": "Zhang, Linhao; Sasser, Jeri; Doane, Leah D.; Peltz, Jack; Oshri, Assaf", "year": "2023", "journalProceedings": "The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine", "category": "Case Study", "devices": "Charge HR", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "Purpose: The present study characterized sleep profiles in a national longitudinal sample of early adolescents and examined whether profiles predicted later behavioral problems.\n\nMethods: Three waves of data (2016-2021) were obtained from the Adolescent Behavior and Cognitive Development study, including 3,326 participants with both weekday and weekend sleep data measured by Fitbit wearables (age range 10.58-13.67 years; 49.3% female). Latent profile analysis was utilized to identify sleep profiles using multiple sleep indicators (duration, latency, efficiency, wake minutes, wake counts, and midpoint). We then explored whether demographic predictors predicted profile membership and tested the latent sleep profiles' predictive utility of internalizing and externalizing symptoms.\n\nResults: Four profiles were identified: average sleep (40.39%), high duration & high wakefulness (28.58%), high efficiency, low duration &low wakefulness (16.86%), and low duration & low efficiency (14.17%). Participants with older age, males, higher body mass index, and advanced pubertal status were more likely to be classified in the low duration & low efficiency profile than the average group. Participants with lower income, minority identification, older age, and higher body mass index were more likely to be classified in the high efficiency, low duration &low wakefulness than the average group. Participants with lower parental education and males were more likely to be in the high sleep duration & high wakefulness than the average group. The low duration & low efficiency group had the highest attention problems, social problems, and rule-breaking behaviors.\n\nDiscussion: Our findings highlight unique sleep patterns in early adolescence and their prospective links with internalizing and externalizing problems.\n\nKeywords: Externalizing problems; Internalizing problems; Latent profile; Risk; Sleep.", "links": [] }, { "title": "Associations between adverse childhood experiences and early adolescent physical activity in the United States", "author": "Al-Shoaibi, Abubakr A. A.; Iyra, Puja; Raney, Julia H.; Ganson, Kyle T.; Dooley, Erin E.; Testa, Alexander; Jackson, Dylan B.; Gabriel, Kelley Pettee; Baker, Fiona C.; Nagata, Jason M.", "year": "2023", "journalProceedings": "Academic Pediatrics", "category": "Case Study", "devices": "Charge HR", "population": "Adolescents", "dataUsed": "Steps", "abstract": "Objective: To determine the associations between the number of adverse childhood experiences (ACEs) and objectively-measured physical activity (PA) in a population-based, demographically diverse cohort of 9-14-year-olds and to determine which subtypes of ACEs were associated with physical activity levels.\n\nMethods: We analyzed data (n=7,046) from the Adolescent Brain Cognitive Development (ABCD) Study 4.0 release at baseline and year 2 follow-up. ACE (cumulative score and subtypes) and physical activity (average Fitbit daily steps assessed at Year 2) were analyzed using linear regression analyses. Covariates included race/ethnicity, sex, household income, parent education, body mass index, study site, twins/siblings, and data collection period.\n\nResults: Adjusted models suggest an inverse association between number of ACEs and Fitbit daily steps, with ≥4 (compared to 0) ACEs associated with 526 fewer daily steps (95% CI -882.7, -222.6). Of the ACEs subtypes, emotional abuse (B= -716.8, 95% CI -1408.3, -25.3), physical neglect (B= -373.6, 95% CI -690.4, -56.7), household mental illness (B= -287.7, 95% CI -454.6, -120.7), and household divorce or separation (B= -24.1, 95% CI --482.1, -8.22) were inversely and statistically significant associated with Fitbit daily steps after adjusting for confounders.\n\nConclusions: Our results suggest that there is an inverse, dose-dependent relationship between cumulative number of ACEs and physical activity as measured by daily steps. This work highlights the importance of screening for ACEs among young people at an early age to help identify those who could benefit from interventions or community programs that support increased physical activity.", "links": [] }, { "title": "Physical and Mental Health in Adolescence: Novel Insights from a transdiagnostic examination of FitBit data in the ABCD Study", "author": "Damme, Katherine; Vargas, Teresa; Walther, Sebastian; Shankman, Stewart; Mittal, Vijay", "year": "2023", "journalProceedings": "Research Square", "category": "Case Study", "devices": "Charge HR", "population": "Adolescents", "dataUsed": "Intensity,Heart Rate", "abstract": "Adolescence is among the most vulnerable period for the emergence of serious mental illnesses. Addressing this vulnerability has generated interest in identifying markers of risk for symptoms and opportunities for early intervention. Physical fitness has been linked to psychopathology and may be a useful risk marker and target for early intervention. New wearable technology has made assessing fitness behavior more practical while avoiding recall and self-report bias. Still, questions remain regarding the clinical utility of physical fitness metrics for mental health, both transdiagnostically and along specific symptom dimensions. The current study includes 5007 adolescents (ages 10 to 13) who participated in the Adolescent Brain Cognitive Development (ABCD) study and additional sub-study that collected fitness data from wearable technology and clinical symptom measures. Physical fitness metrics included resting heart rate (RHR- an index of cardiovascular health), time spent sedentary (associated with increased inflammation and cardiovascular disease), and time spent in moderate physical activity (associated with increased neurogenesis, neuroplasticity, and healthy neurodevelopment). Self-report clinical symptoms included measures of internalizing symptoms, externalizing symptoms, and psychosis-like experiences - PLE). Increased RHR- lower cardiovascular fitness- related only to greater internalizing symptoms (t = 3.63). More sedentary behavior related to elevated PLE severity (t = 5.49). More moderate activity related to lower PLE (t=-2.69) and internalizing (t=-6.29) symptom severity. Wearable technology fitness metrics linked physical health to specific mental health dimensions, which emphasizes the utility of detailed digital health data as a marker for risk and the need for precision in targeting physical health behaviors to benefit symptoms of psychopathology.", "links": [] }, { "title": "A Digital Coach (E-Supporter 1.0) to Support Physical Activity and a Healthy Diet in People With Type 2 Diabetes: Acceptability and Limited Efficacy Testing", "author": "Hietbrink, Eclaire A. G.; Oude Nijeweme-d'Hollosy, Wendy; Middelweerd, Anouk; Konijnendijk, Annemieke A. J.; Schrijver, Laura K.; Ten Voorde, Anouk S.; Fokkema, Elise M. S.; Laverman, Gozewijn D.; Vollenbroek-Hutten, Miriam M. R.", "year": "2023", "journalProceedings": "JMIR formative research", "category": "Intervention", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: A healthy lifestyle, including regular physical activity and a healthy diet, is increasingly part of type 2 diabetes (T2D) management. As many people with T2D have difficulty living and maintaining a healthy lifestyle, there is a need for effective interventions. eHealth interventions that incorporate behavior change theories and tailoring are considered effective tools for supporting a healthy lifestyle. The E-Supporter 1.0 digital coach contains eHealth content for app-based eHealth interventions and offers tailored coaching regarding physical activity and a healthy diet for people with T2D.\n\nObjective: This study aimed to assess the acceptability of E-Supporter 1.0 and explore its limited efficacy on physical activity, dietary behavior, the phase of behavior change, and self-efficacy levels.\n\nMethods: Over a span of 9 weeks, 20 individuals with T2D received daily motivational messages and weekly feedback derived from behavioral change theories and determinants through E-Supporter 1.0. The acceptability of the intervention was assessed using telephone-conducted, semistructured interviews. The interview transcripts were coded using inductive thematic analysis. The limited efficacy of E-Supporter 1.0 was explored using the Fitbit Charge 2 to monitor step count to assess physical activity and questionnaires to assess dietary behavior (using the Dutch Healthy Diet index), phase of behavior change (using the single-question Self-Assessment Scale Stages of Change), and self-efficacy levels (using the Exercise Self-Efficacy Scale).\n\nResults: In total, 5 main themes emerged from the interviews: perceptions regarding remote coaching, perceptions regarding the content, intervention intensity and duration, perceived effectiveness, and overall appreciation. The participants were predominantly positive about E-Supporter 1.0. Overall, they experienced E-Supporter 1.0 as a useful and easy-to-use intervention to support a better lifestyle. Participants expressed a preference for combining E-Supporter with face-to-face guidance from a health care professional. Many participants found the intensity and duration of the intervention to be acceptable, despite the coaching period appearing relatively short to facilitate long-term behavior maintenance. As expected, the degree of tailoring concerning the individual and external factors that influence a healthy lifestyle was perceived as limited. The limited efficacy testing showed a significant improvement in the daily step count (z=-2.040; P=.04) and self-efficacy levels (z=-1.997; P=.046) between baseline and postintervention. Diet was improved through better adherence to Dutch dietary guidelines. No significant improvement was found in the phase of behavior change (P=.17), as most participants were already in the maintenance phase at baseline.\n\nConclusions: On the basis of this explorative feasibility study, we expect E-Supporter 1.0 to be an acceptable and potentially useful intervention to promote physical activity and a healthy diet in people with T2D. Additional work needs to be done to further tailor the E-Supporter content and evaluate its effects more extensively on lifestyle behaviors.\n\nKeywords: acceptability; eHealth; formative evaluation; lifestyle change; limited efficacy; mobile phone; nutrition; physical activity; type 2 diabetes.", "links": [] }, { "title": "Effects of Sleep on Adolescents' Appetite, Dietary Intake, and Weight", "author": "Juelich, Janell; Owens, Rhoda; Denny, Dawn; Raatz, Susan; Lindseth, Glenda", "year": "2023", "journalProceedings": "SAGE open nursing", "category": "Case Study", "devices": "Charge 3", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "Introduction: Several factors have been associated with excess weight gain in adolescents, including loss of sleep.\n\nObjective: The purpose of this study is to examine the effects of sleep factors on appetite, dietary intake, and the body weights of adolescent youth.\n\nMethods: A prospective correlational study design was used. Male and female adolescents (N = 76) ages 12-18 years completed a 5-night study. Sleep was assessed using Fitbits (88.5% accuracy) and the Pittsburgh Sleep Quality Index (PSQI) (test-retest reliability = .81); appetite was assessed by a Visual Analog Scale (α = 0.84); dietary intake was assessed by the Block Kids Food Screener (reliability up to .88); sleep hygiene was assessed using the Adolescent Sleep Hygiene Practice Scale (α = .67).\n\nResults: Poor sleep quality was reported by 39.5% of participants, and 75% of participants had inadequate sleep time (7.33 h). Participants' age significantly correlated with PSQI scores (r = .28, p < .05) and BMI (r = .37, p < .01). Participants' PSQI scores significantly correlated with sleep hygiene (r = .45, p = .05) and appetite (r = .3 3, p < .01). Sleep latency significantly correlated with sleep hygiene (r = .32, p < .05). Several sleep hygiene factors correlated significantly with the participants' sleep quality, quantity and latency scores and dietary intakes.\n\nConclusion: These findings suggest that changes in sleep hygiene practices may improve adolescent sleep quality and quantity as well as appetite and dietary intake.", "links": [] }, { "title": "Comparing sleep measures in cancer survivors: Self-reported sleep diary versus objective wearable sleep tracker", "author": "Li, Xiaotong; Mao, Jun J.; Garland, Sheila N.; Root, James; Li, Susan Q.; Ahles, Tim; Liou, Kevin T.", "year": "2023", "journalProceedings": "Research Square", "category": "Case Study", "devices": "Charge 4", "population": "Adults", "dataUsed": "Steps", "abstract": "Purpose Cancer survivors are increasingly using wearable fitness trackers, but it's unclear if they match traditional self-reported sleep diaries. We aimed to compare sleep data from Fitbit and the Consensus Sleep Diary (CSD) in this group. Methods We analyzed data from two randomized clinical trials, using both CSD and Fitbit to collect sleep outcomes: total sleep time (TST), wake time after sleep onset (WASO), number of awakenings (NWAK), time in bed (TIB) and sleep efficiency (SE). Insomnia severity was measured by Insomnia Severity Index (ISI). We used the Wilcoxon Singed Ranks Test, Spearman's rank correlation coefficients, and the Mann-Whitney Test to compare sleep outcomes and assess their ability to distinguish insomnia severity levels between CSD and Fitbit data. Results Among 62 participants, compared to CSD, Fitbit recorded longer TST by an average of 14.6 (SD = 84.9) minutes, longer WASO by an average of 28.7 (SD = 40.5) minutes, more NWAK by an average of 16.7 (SD = 6.6) times per night, and higher SE by an average of 7.1% (SD = 14.4); but shorter TIB by an average of 24.4 (SD = 71.5) minutes. All the differences were statistically significant (all p < 0.05), except for TST (p = 0.38). Moderate correlations were found for TST (r = 0.41, p = 0.001) and TIB (r = 0.44, p < 0.001). Compared to no/mild insomnia group, participants with clinical insomnia reported more NWAK (p = 0.009) and lower SE (p = 0.029) as measured by CSD, but Fitbit outcomes didn't. Conclusions TST was the only similar outcome between Fitbit and CSD. Our study highlights the advantages, disadvantages, and clinical utilization of sleep trackers in oncology.", "links": [] }, { "title": "Efficacy of a Commercial Physical Activity Monitor in Longitudinal Tracking of Patients With Pulmonary Hypertension: A Pilot Study", "author": "Rosenzweig, Eliana; Villeda, Gerson Antonio Valencia; Crook, Sarah; Koli, Fatima; Rosenzweig, Erika B.; Krishnan, Usha S.", "year": "2023", "journalProceedings": "Texas Heart Institute Journal", "category": "Validation", "devices": "Charge HR", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "Background: Patients with pulmonary arterial hypertension have quality-of-life limitations, decreased exercise capacity, and poor prognosis if the condition is left untreated. Standard exercise testing is routinely performed to evaluate patients with pulmonary arterial hypertension but may be limited in its ability to monitor activity levels in daily living.\n\nObjective: To evaluate the validity of the commercial Fitbit Charge HR as a tool to assess real-time exercise capacity as compared with standard exercise testing.\n\nMethods: Ambulatory pediatric and adult patients were enrolled and given a Fitbit with instructions to continuously wear the device during waking hours. Patients underwent a 6-minute walk test, cardiopulmonary exercise test, and a 36-Item Short Form Health Survey on the day of enrollment and follow-up. Twenty-seven ambulatory patients with pulmonary arterial hypertension were enrolled, and 21 had sufficient data for analyses (median age, 25 years [range, 13-59 years]; 14 female participants).\n\nResults: Daily steps measured by the Fitbit had a positive correlation with 6-minute walk distance (r = 0.72, P = .03) and an inverse trend with World Health Organization functional class. On the 36-Item Short Form Health Survey, 77% of patients reported improvement in vitality (P = .055). At follow-up, there was a strong correlation between number of steps recorded by Fitbit and role limitations because of physical problems (r = 0.88, P = .02) and weaker correlations with other quality-of-life markers.\n\nConclusion: The findings of this pilot study suggest activity monitors may have potential as a simple and novel method of assessing longitudinal exercise capacity and activity levels in patients with pulmonary hypertension. Further study in larger cohorts of patients is warranted to determine which accelerometer measures correlate best with outcomes.", "links": [] }, { "title": "Postponing sleep after a stressful day: Patterns of stress, bedtime procrastination, and sleep outcomes in a daily diary approach", "author": "Schmidt, Laura I.; Baetzner, Anke S.; Dreisbusch, Marina I.; Mertens, Alica; Sieverding, Monika", "year": "2023", "journalProceedings": "Stress and Health: Journal of the International Society for the Investigation of Stress", "category": "Case Study", "devices": "Charge HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "Sleep problems and stress are common among students and are associated with negative effects on academic performance as well as mental and physical health risks, but studies exploring mediating factors between stress and sleep on a daily basis are scarce. This study aimed to investigate the relationship of daily stress, Bedtime procrastination (BP) (i.e., postponing bedtime without external reasons), and sleep outcomes controlling for trait factors such as self-control. N = 96 students at a German university (M = 22.2 years, SD = 4.0) wore a sleep-tracking wearable (Fitbit Charge HR) for two weeks to assess sleep duration and to calculate the gap between the intended time to go to sleep and the objectively measured time of falling asleep. Stress, intended time to go to sleep, and sleep quality were assessed via daily diaries. Established questionnaires were used to measure trait self-control, trait BP, and smartphone addiction. Multilevel analyses indicated that more stress experienced during the day was associated with more BP (b = 2.32, p = 0.008), shorter sleep duration (b = -3.46, p = 0.003), and lower sleep quality (b = 1.03, p = 0.005) after controlling for several trait factors. The association of daily stress with sleep outcomes (quality and duration) was partly mediated by BP. Our findings indicate that BP might be one factor that contributes to stress-linked decreases in sleep duration and quality. Potential reasons for stress-related later time to fall asleep-like higher physiological arousal or stress-related worries-should be investigated in future studies.", "links": [] }, { "title": "Chronotype-Dependent Sleep Loss Is Associated with a Lower Amplitude in Circadian Rhythm and a Higher Fragmentation of REM Sleep in Young Healthy Adults", "author": "von Gall, Charlotte; Holub, Leon; Pfeffer, Martina; Eickhoff, Simon", "year": "2023", "journalProceedings": "Brain Sciences", "category": "Case Study", "devices": "Inspire", "population": "Adults", "dataUsed": "Sleep", "abstract": "In modern society, the time and duration of sleep on workdays are primarily determined by external factors, e.g., the alarm clock. This can lead to a misalignment of the intrinsically determined sleep timing, which is dependent on the individual chronotype, resulting in reduced sleep quality. Although this is highly relevant given the high incidence of sleep disorders, little is known about the effect of this misalignment on sleep architecture. Using Fitbit trackers and questionnaire surveys, our study aims to elucidate sleep timing, sleep architecture, and subjective sleep quality in young healthy adults (n = 59) under real-life conditions (average of 82.4 ± 9.7 days). Correlations between variables were calculated to identify the direction of relationships. On workdays, the midpoint of sleep was earlier, the sleep duration was shorter, and tiredness upon waking was higher than on free days. A higher discrepancy between sleep duration on workdays and free days was associated with a lower stability of the circadian rhythm of REM sleep and also with a higher fragmentation of REM sleep. Similarly, a higher tiredness upon waking on free days, thus under intrinsically determined sleep timing conditions, was associated with a lower proportion and a higher fragmentation of REM sleep. This suggests that the misalignment between extrinsically and intrinsically determined sleep timing affects the architecture of sleep stages, particularly REM sleep, which is closely connected to sleep quality.", "links": [] }, { "title": "The effect of sleep-corrected social jetlag on crystalized intelligence, school performance, and functional connectome in early adolescence", "author": "Yang, Fan Nils; Picchioni, Dante; Duyn, Jeff H.", "year": "2023", "journalProceedings": "medRxiv: The Preprint Server for Health Sciences", "category": "Case Study", "devices": "Charge HR", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "Approximately half of adolescents encounter a mismatch between their sleep patterns on school days and free days, also referred to as \"social jetlag\". This condition has been linked to various adverse outcomes, such as poor sleep, cognitive deficits, and mental disorders. However, prior research was unsuccessful in accounting for other variables that are correlated with social jetlag, including sleep duration and quality. To address this limitation, we applied a propensity score matching method on a sample of 8853 11-12-year-olds from the two-year follow-up (FL2) data of the Adolescent Brain Cognitive Development (ABCD) study. We identified 3366 pairs of participants with high sleep-corrected social jetlag (SJLsc, over 1 hour) and low SJLsc (<= 1 hour) at FL2, as well as 1277 pairs at three-year follow-up (FL3), after matching based on 11 covariates including socioeconomic status, demographics, and sleep duration and quality. Our results showed that high SJLsc, as measured by the Munich Chronotype Questionnaire, was linked to reduced crystallized intelligence, lower school performance - grades, and decreased functional connectivity between cortical networks and subcortical regions, specifically between cingulo-opercular network and right hippocampus (cerc-hprh). Further mediation and longitudinal mediation analyses revealed that cerc-hprh connection mediated the associations between SJLsc and crystallized intelligence at FL2, and between SJLsc and grades at both FL2 and FL3. We validated these findings by replicating these results using objective SJLsc measurements obtained via Fitbit watches. Overall, our study highlights the negative association between social jetlag and crystallized intelligence during early adolescence.", "links": [] }, { "title": "Effect of exercise intervention using mobile healthcare on blood lipid level and health-related physical fitness in obese women: a randomized controlled trial", "author": "Choi, Jae-Ho; Park, Hun-Young; Sun, Yerin; Seo, Jisoo; Lee, Eunjoo; Kim, Sung-Woo; Kim, Jisu; Lim, Kiwon", "year": "2023", "journalProceedings": "Physical Activity and Nutrition", "category": "Intervention", "devices": "Charge 4", "population": "Adults", "dataUsed": "NA", "abstract": "Purpose: This study aimed to evaluate the effects of 12 weeks of non-face-to-face exercise intervention using mobile health (mHealth) on blood lipid levels and health-related physical fitness in obese women.\n\nMethods: Thirty obese women (aged: 39.40 ± 11.07 years, percent body fat: 37.05 ± 5.15%) were enrolled, and all completed the study. Non-face-to-face exercises were performed for 12 weeks using a mHealth and smart tracker (Charge 4, Fitbit, USA). Participants were randomly assigned to an experimental (EXP) or control (CON) group. The 12-week exercise program using mHealth included resistance (twice a week for 60 min), aerobics (five times a week for 50 min), and flexibility (five times a week for 10 min).\n\nResults: The results showed that high-density lipoprotein cholesterol (Post - Pre: 9.07 mg·dL-1, p < 0.001) and ratio of low-density to high-density lipoprotein cholesterol (Post - Pre: -0.71 mg·dL-1, p < 0.05) significantly changed during the intervention period in EXP. There were significant increases in sit-ups (Post - Pre: 7.73 numbers, p < 0.001), grip strength (Post - Pre: 2.92 kg, p < 0.001), and sit and reach (Post - Pre: 2.51 cm, p < 0.01) in EXP.\n\nConclusion: Non-face-to-face exercise using mHealth for 12 weeks improved blood lipid levels and health-related physical fitness; therefore, it can help improve compliance through self-monitoring and lifestyle changes by increasing physical activity.\n\nKeywords: blood lipid levels; health-related physical fitness; mobile health; non-face-to-face exercise; obese women.", "links": [] }, { "title": "Reduced Physical Activity During COVID-19 in Children With Congenital Heart Disease: A Longitudinal Analysis", "author": "Kuan, Mimi T. Y.; Hemphill, Nicole M.; Harris, Kevin C.", "year": "2022", "journalProceedings": "CJC pediatric and congenital heart disease", "category": "Case Study", "devices": "Charge 2", "population": "Children,Adolescents", "dataUsed": "Steps", "abstract": "Background: Coronavirus disease 2019 (COVID-19) was associated with a reduction in physical activity in children with congenital heart disease (CHD) in early 2020. Given the increased cardiovascular risk of this population, optimizing cardiovascular health behaviour is important. The aim of the study is to determine how the ongoing COVID-19 pandemic has impacted longitudinal physical activity measures in children with CHD.\n\nMethods: As part of a prospective cohort study, children and adolescents aged 9-16 years old with moderate-to-complex CHD were recruited from British Columbia Children's Hospital and partnership clinics across British Columbia and the Yukon territory. Daily step counts were measured continuously over 3 years (2018-2021) with Fitbit Charge 2. School status during the COVID-19 pandemic was assessed with parent- or self-report survey.\n\nResults: A total of 102, 114, and 93 participants had valid Fitbit data during 2018, 2019, and 2020, respectively. There was a significant reduction in the annual mean step count for 2020 (8225 ± 4328 steps) compared with both 2018 (9416 ± 3770 steps) and 2019 (9533 ± 4114 steps) (P < 0.001). There was a loss of seasonal variation in physical activity, and reduced levels of physical activity persisted when most children resumed in-person schooling in September 2020.\n\nConclusions: We demonstrated a significant decrease in physical activity and loss of seasonal patterns in children with CHD during 2020. These findings represent a worsening of the cardiovascular risk profile in children with CHD, who are already at an increased risk of adverse cardiovascular outcomes. Mitigation strategies are needed to optimize the cardiovascular health status of children with CHD as the pandemic persists.", "links": [] }, { "title": "The Importance of Data Quality Control in Using Fitbit Device Data From the Research Program", "author": "Lederer, Lauren; Breton, Amanda; Jeong, Hayoung; Master, Hiral; Roghanizad, Ali R.; Dunn, Jessilyn", "year": "2023", "journalProceedings": "JMIR mHealth and uHealth", "category": "Review", "devices": "Charge 4,Versa 3", "population": "NA", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Wearable digital health technologies (DHTs) have become increasingly popular in recent years, enabling more capabilities to assess behaviors and physiology in free-living conditions. The All of Us Research Program (AoURP), a National Institutes of Health initiative that collects health-related information from participants in the United States, has expanded its data collection to include DHT data from Fitbit devices. This offers researchers an unprecedented opportunity to examine a large cohort of DHT data alongside biospecimens and electronic health records. However, there are existing challenges and sources of error that need to be considered before using Fitbit device data from the AoURP. In this viewpoint, we examine the reliability of and potential error sources associated with the Fitbit device data available through the AoURP Researcher Workbench and outline actionable strategies to mitigate data missingness and noise. We begin by discussing sources of noise, including (1) inherent measurement inaccuracies, (2) skin tone–related challenges, and (3) movement and motion artifacts, and proceed to discuss potential sources of data missingness in Fitbit device data. We then outline methods to mitigate such missingness and noise in the data. We end by considering how future enhancements to the AoURP’s Fitbit device data collection methods and the inclusion of new Fitbit data types would impact the usability of the data. Although the reliability considerations and suggested literature are tailored toward Fitbit device data in the AoURP, the considerations and recommendations are broadly applicable to data from wearable DHTs in free-living conditions.", "links": [] }, { "title": "Accuracy of 11 Wearable, Nearable, and Airable Consumer Sleep Trackers: Prospective Multicenter Validation Study", "author": "Lee, Taeyoung; Cho, Younghoon; Cha, Kwang Su; Jung, Jinhwan; Cho, Jungim; Kim, Hyunggug; Kim, Daewoo; Hong, Joonki; Lee, Dongheon; Keum, Moonsik; Kushida, Clete A.; Yoon, In-Young; Kim, Jeong-Whun", "year": "2023", "journalProceedings": "JMIR mHealth and uHealth", "category": "Validation,Systematic Review", "devices": "Sense 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background: Consumer sleep trackers (CSTs) have gained significant popularity because they enable individuals to conveniently monitor and analyze their sleep. However, limited studies have comprehensively validated the performance of widely used CSTs. Our study therefore investigated popular CSTs based on various biosignals and algorithms by assessing the agreement with polysomnography.\n\nObjective: This study aimed to validate the accuracy of various types of CSTs through a comparison with in-lab polysomnography. Additionally, by including widely used CSTs and conducting a multicenter study with a large sample size, this study seeks to provide comprehensive insights into the performance and applicability of these CSTs for sleep monitoring in a hospital environment.\n\nMethods: The study analyzed 11 commercially available CSTs, including 5 wearables (Google Pixel Watch, Galaxy Watch 5, Fitbit Sense 2, Apple Watch 8, and Oura Ring 3), 3 nearables (Withings Sleep Tracking Mat, Google Nest Hub 2, and Amazon Halo Rise), and 3 airables (SleepRoutine, SleepScore, and Pillow). The 11 CSTs were divided into 2 groups, ensuring maximum inclusion while avoiding interference between the CSTs within each group. Each group (comprising 8 CSTs) was also compared via polysomnography.\n\nResults: The study enrolled 75 participants from a tertiary hospital and a primary sleep-specialized clinic in Korea. Across the 2 centers, we collected a total of 3890 hours of sleep sessions based on 11 CSTs, along with 543 hours of polysomnography recordings. Each CST sleep recording covered an average of 353 hours. We analyzed a total of 349,114 epochs from the 11 CSTs compared with polysomnography, where epoch-by-epoch agreement in sleep stage classification showed substantial performance variation. More specifically, the highest macro F1 score was 0.69, while the lowest macro F1 score was 0.26. Various sleep trackers exhibited diverse performances across sleep stages, with SleepRoutine excelling in the wake and rapid eye movement stages, and wearables like Google Pixel Watch and Fitbit Sense 2 showing superiority in the deep stage. There was a distinct trend in sleep measure estimation according to the type of device. Wearables showed high proportional bias in sleep efficiency, while nearables exhibited high proportional bias in sleep latency. Subgroup analyses of sleep trackers revealed variations in macro F1 scores based on factors, such as BMI, sleep efficiency, and apnea-hypopnea index, while the differences between male and female subgroups were minimal.\n\nConclusions: Our study showed that among the 11 CSTs examined, specific CSTs showed substantial agreement with polysomnography, indicating their potential application in sleep monitoring, while other CSTs were partially consistent with polysomnography. This study offers insights into the strengths of CSTs within the 3 different classes for individuals interested in wellness who wish to understand and proactively manage their own sleep.\n\nKeywords: Fitbit Sense 2, Amazon Halo Rise, SleepRoutine; airables; artificial intelligence; comparative study; consumer sleep trackers; deep learning; multicenter study; nearables; polysomnography; sleep monitoring; sleep stage; wearables.", "links": [] }, { "title": "Harnessing technology and gamification to increase adult physical activity: a cluster randomized controlled trial of the Columbia Moves pilot", "author": "Monroe, Courtney M.; Cai, Bo; Edney, Sarah; Jake-Schoffman, Danielle E.; Brazendale, Keith; Bucko, Agnes; Armstrong, Bridget; Yang, Chih-Hsiang; Turner-McGrievy, Gabrielle", "year": "2023", "journalProceedings": "The International Journal of Behavioral Nutrition and Physical Activity", "category": "Intervention", "devices": "Alta HR", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: The use of health technologies and gamification to promote physical activity has increasingly been examined, representing an opportunistic method for harnessing social support inherent within existing social ties. However, these prior studies have yielded mixed findings and lacked long-term follow-up periods. Thus, a pilot cluster randomized controlled trial was conducted to gauge the feasibility and preliminary efficacy of a digital gamification-based physical activity promotion approach among teams of insufficiently active adults with existing social ties.\n\nMethods: Teams (N = 24; 116 total participants) were randomized to either a 12-week intervention (Fitbit, step goals, app, feedback; TECH) or the same program plus gamification (TECH + Gamification). Mixed effects models were used to compare group differences in treatment adherence, and changes in social support, steps, and moderate-to-vigorous physical activity at 12 weeks and 52 weeks from baseline, adjusted for sociodemographic characteristics and team size.\n\nResults: TECH had a lower mean number of days of Fitbit self-monitoring versus TECH + Gamification during the intervention (adjusted difference: -.30; 95% CI, -.54 to -.07; P = .01). Post-intervention, TECH had 47% lower odds of self-monitoring 7 days per week versus TECH + Gamification (.53; 95% CI, .31 to .89; P = .02). No differences were observed between TECH + Gamification and TECH in increases in social support (0.04; 95% CI, -.21 to .29; P = .76), ActiGraph-measured daily steps (-425; 95% CI, -1065 to 215; P = .19), or moderate-to-vigorous physical activity minutes (-3.36; 95% CI, -8.62 to 1.91; P = .21) from baseline to 12 weeks or in the regression of these improvements by 1 year (Ps > .05). Although not significant in the adjusted models (Ps > .05), clinically meaningful differences in Fitbit-measured daily steps (TECH, 7041 ± 2520; TECH + Gamification, 7988 ± 2707) and active minutes (TECH, 29.90 ± 29.76; TECH + Gamification, 36.38 ± 29.83) were found during the intervention.\n\nConclusions: A gamified physical activity intervention targeting teams of adults with existing social ties was feasible and facilitated favorable, clinically meaningful additive physical activity effects while in place but did not drive enhanced, long-term physical activity participation. Future investigations should explore optimal team dynamics and more direct ways of leveraging social support (training teams; gamifying social support).", "links": [] }, { "title": "Functional brain connectivity predicts sleep duration in youth and adults", "author": "Mummaneni, Anurima; Kardan, Omid; Stier, Andrew J.; Chamberlain, Taylor A.; Chao, Alfred F.; Berman, Marc G.; Rosenberg, Monica D.", "year": "2023", "journalProceedings": "Human Brain Mapping", "category": "Case Study", "devices": "Device unspecified", "population": "Children", "dataUsed": "Sleep", "abstract": "Sleep is critical to a variety of cognitive functions and insufficient sleep can have negative consequences for mood and behavior across the lifespan. An important open question is how sleep duration is related to functional brain organization which may in turn impact cognition. To characterize the functional brain networks related to sleep across youth and young adulthood, we analyzed data from the publicly available Human Connectome Project (HCP) dataset, which includes n-back task-based and resting-state fMRI data from adults aged 22-35 years (task n = 896; rest n = 898). We applied connectome-based predictive modeling (CPM) to predict participants' mean sleep duration from their functional connectivity patterns. Models trained and tested using 10-fold cross-validation predicted self-reported average sleep duration for the past month from n-back task and resting-state connectivity patterns. We replicated this finding in data from the 2-year follow-up study session of the Adolescent Brain Cognitive Development (ABCD) Study, which also includes n-back task and resting-state fMRI for adolescents aged 11-12 years (task n = 786; rest n = 1274) as well as Fitbit data reflecting average sleep duration per night over an average duration of 23.97 days. CPMs trained and tested with 10-fold cross-validation again predicted sleep duration from n-back task and resting-state functional connectivity patterns. Furthermore, demonstrating that predictive models are robust across independent datasets, CPMs trained on rest data from the HCP sample successfully generalized to predict sleep duration in the ABCD Study sample and vice versa. Thus, common resting-state functional brain connectivity patterns reflect sleep duration in youth and young adults.\n\nKeywords: connectome-based predictive modeling; fMRI; functional connectivity; sleep.", "links": [] }, { "title": "Design of intelligent monitoring of loneliness in the elderly using a serverless architecture with real-time communication API", "author": "Osa-Sanchez, Ainhoa; Jossa-Bastidas, Oscar; Mendez-Zorrilla, Amaia; Oleagordia-Ruiz, Ibon; Garcia-Zapirain, Begonya", "year": "2023", "journalProceedings": "Technology and Health Care: Official Journal of the European Society for Engineering and Medicine", "category": "Intervention,Methods", "devices": "Charge 5", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Distance,Sleep,Heart Rate", "abstract": "Background: Loneliness and social isolation are recognized as critical public health issues. Older people are at greater risk of loneliness and social isolation as they deal with things like living alone, loss of family or friends, chronic illness, and hearing loss. Loneliness increases a person's risk of premature death from all causes, including dementia, heart disease, and stroke. To address these issues, the inclusion of technological platforms and the use of commercial monitoring devices are vastly increasing in healthcare and elderly care.\n\nObjective: The objective of this study is to design and develop a loneliness monitor serverless architecture to obtain real-time data from commercial activity wristbands through an Application Programming Interface.\n\nMethods: For the design and development of the architecture, the Amazon Web Services platform has been used. To monitor loneliness, the Fitbit Charge 5 bracelet was selected, through the web Application Programming Interface offered by the AWS Lambda service, the data is obtained and stored in AWS services with an automated frequency thanks to the event bridge.\n\nResults: In the pilot stage in which the system is, it is showing great possibilities in the ease of collecting data and programming the sampling frequency. Once the request is made, the data is automatically analyzed to monitor loneliness.\n\nConclusion: The proposed architecture shows great potential for easy data collection, analysis, security, personalization, real-time inference, and scalability of sensors and actuators in the future. It has powerful benefits to apply in the health sector and reduces cases of depression and loneliness.\n\nKeywords: AWS; Loneliness; monitoring; serverless; wearables.", "links": [] }, { "title": "Ambulation for Latency during Expectant Management of PPROM: A Randomized Controlled Trial (AMBLE)", "author": "Pineles, Beth L.; Vial, Mallory; Castro, Ms Tania; Ghorayeb, Tala; Ajishegiri, Ms Oluwadare; Sadek, Sandra; Pedroza, Claudia; Blackwell, Sean C.; Chauhan, Suneet P.; Sibai, Baha M.", "year": "2023", "journalProceedings": "American journal of obstetrics \\& gynecology MFM", "category": "Case Study", "devices": "Inspire", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Individuals hospitalized with preterm prelabor rupture of the membranes (PPROM) are often advised to limit their activity or adhere to bedrest. Some evidence suggests that greater activity is associated with longer latency and improved outcomes, but no high-quality evidence from a randomized-controlled trial exists.\n\nObjective: To evaluate whether encouragement to ambulate at least 2,000 steps daily impacts latency among individuals with PPROM compared with usual care.\n\nStudy design: Multisite unblinded, two-arm randomized trial of individuals at 23 0/7 to 35 0/7 weeks gestation undergoing inpatient expectant management of PPROM with planned delivery at least 7 days away. Each participant wore a Fitbit InspireTM that tracked steps. The intervention arm was encouraged (verbal and Fitbit-based reminders) to reach a goal of 2,000 steps per day. The usual care arm was allowed ad lib activity with no step goal or reminders. The primary outcome was latency (days) from randomization to delivery. Secondary analyses included composite neonatal and maternal clinical outcomes and maternal mental health survey results. Statistical analyses were intent-to-treat under a Bayesian framework using neutral priors (a priori assumed 50:50 likelihood of longer latency in either arm). 100 participants were required to have 80% power to demonstrate a 4-day difference in latency with 75% certainty (Bayesian probability).\n\nResults: Among 163 eligible individuals, 100 (61%) were randomized, and after loss to follow-up, 95 were analyzed. Gestational age at randomization was 29 3/7 weeks (interquartile range [IQR] 26 2/7, 31 5/7) in the intervention arm and 27 4/7 weeks (IQR 25 4/7, 29 6/7) in the usual care arm. Median step counts were 1,690/day in the intervention arm (IQR 1,031-2,641) and 1,338/day in the usual care arm (IQR 784-1,913). Median days of latency were 9 days in the intervention arm (IQR 4-17) and 6 days in the usual care arm (IQR 2-14). The primary analysis indicated a 65% posterior probability that the intervention increased latency versus usual care (posterior relative risk [RR] 1.09; 95% credible interval [CrI], 0.70-1.71). The RR for composite neonatal adverse outcome was 0.55 (95% CrI 0.32-0.82) with 99% posterior probability of intervention benefit and for composite maternal adverse outcome was 0.94 (95% CrI 0.72-1.20), with 70% posterior probability of intervention benefit. There was a 94% posterior probability of the intervention arm having a greater decrease in maternal stress score from baseline to before delivery compared with the usual care arm (mean arm difference 3.24 points [95% CrI -7.23-0.79]). Adjustment for gestational age at randomization had minimal impact on secondary outcome results.\n\nConclusions: Individuals with PPROM randomized to encouragement to ambulate had a longer latency to delivery and improved neonatal and mental health outcomes with similar maternal clinical outcomes compared to usual care.\n\nKeywords: PROM; Walking; bedrest; exercise; limited activity; modified activity; pregnancy; prematurity; preterm delivery; preterm labor; preterm prelabor rupture of membranes; preterm premature rupture of membranes.", "links": [] }, { "title": "How shoulder immobilization after surgery influences daily activity - a prospective pedometer-based study", "author": "Rickert, Carolin; Ahlich, Stefanie; Gosheger, Georg; Kalisch, Tobias; Liem, Dennis; Schneider, Kristian Nikolaus; Klingebiel, Sebastian", "year": "2023", "journalProceedings": "International Orthopaedics", "category": "Case Study", "devices": "Charge", "population": "Patients", "dataUsed": "Steps", "abstract": "Purpose: Immobilization, especially of the lower extremity, after orthopaedic surgery has been associated with reduced physical activity. Previous interventions from our study group showed even in young, healthy people reduced activity levels after immobilization of the shoulder. Therefore, this study investigates the change in physical activity due to shoulder immobilization after a reconstructive surgery.\n\nMethods: This prospective study includes 40 patients undergoing surgery from May 2019 to December 2020. Daily activity was measured before surgery, after discharge and three weeks postoperatively each time for six days. Activity including step counts and active time were measured by Fitbit™ inspire. Range of motion before and after surgery as well as Pain (VAS) were documented.\n\nResults: Steps became significantly less immediately postoperatively with an immobilized shoulder joint than before surgery (9728.8 vs. 6022.6, p < 0.05). At follow-up, the number of steps increased again, but still showed a significantly lower number of steps (mean 8833.2) compared to preoperative. Patients preoperatively showed mostly an \"active\" activity pattern, whereas postoperatively a \"low active\" behaviour predominated. The proportion of sedentary behaviour (\"basal activity\" and \"limited activity\") was almost three times higher postoperatively (12.5% vs. 30%).\n\nConclusion: General physical activity is restricted during upper limb immobilization in adults. Therefore, activity-enhancing measures should be implemented in the early phase of rehabilitation after upper extremity surgery.\n\nKeywords: Activity of daily living; Physical activity; Rehabilitation; Rotator cuff; Shoulder arthroplasty; Shoulder immobilization.", "links": [] }, { "title": "Open-Source, Step-Counting Algorithm for Smartphone Data Collected in Clinical and Nonclinical Settings: Algorithm Development and Validation Study", "author": "Straczkiewicz, Marcin; Keating, Nancy L.; Thompson, Embree; Matulonis, Ursula A.; Campos, Susana M.; Wright, Alexi A.; Onnela, Jukka-Pekka", "year": "2023", "journalProceedings": "JMIR cancer", "category": "Validation", "devices": "Charge 2", "population": "NA", "dataUsed": "Steps", "abstract": "Background: Step counts are increasingly used in public health and clinical research to assess well-being, lifestyle, and health status. However, estimating step counts using commercial activity trackers has several limitations, including a lack of reproducibility, generalizability, and scalability. Smartphones are a potentially promising alternative, but their step-counting algorithms require robust validation that accounts for temporal sensor body location, individual gait characteristics, and heterogeneous health states.\n\nObjective: Our goal was to evaluate an open-source, step-counting method for smartphones under various measurement conditions against step counts estimated from data collected simultaneously from different body locations (\"cross-body\" validation), manually ascertained ground truth (\"visually assessed\" validation), and step counts from a commercial activity tracker (Fitbit Charge 2) in patients with advanced cancer (\"commercial wearable\" validation).\n\nMethods: We used 8 independent data sets collected in controlled, semicontrolled, and free-living environments with different devices (primarily Android smartphones and wearable accelerometers) carried at typical body locations. A total of 5 data sets (n=103) were used for cross-body validation, 2 data sets (n=107) for visually assessed validation, and 1 data set (n=45) was used for commercial wearable validation. In each scenario, step counts were estimated using a previously published step-counting method for smartphones that uses raw subsecond-level accelerometer data. We calculated the mean bias and limits of agreement (LoA) between step count estimates and validation criteria using Bland-Altman analysis.\n\nResults: In the cross-body validation data sets, participants performed 751.7 (SD 581.2) steps, and the mean bias was -7.2 (LoA -47.6, 33.3) steps, or -0.5%. In the visually assessed validation data sets, the ground truth step count was 367.4 (SD 359.4) steps, while the mean bias was -0.4 (LoA -75.2, 74.3) steps, or 0.1%. In the commercial wearable validation data set, Fitbit devices indicated mean step counts of 1931.2 (SD 2338.4), while the calculated bias was equal to -67.1 (LoA -603.8, 469.7) steps, or a difference of 3.4%.\n\nConclusions: This study demonstrates that our open-source, step-counting method for smartphone data provides reliable step counts across sensor locations, measurement scenarios, and populations, including healthy adults and patients with cancer.\n\nKeywords: accelerometer; cancer; open-source; smartphone; step count; validation; wearable.", "links": [] }, { "title": "Exploring mechanisms of improvement in the Active Brains intervention for older adults with chronic pain and early cognitive decline", "author": "Choukas, Nathaniel R.; Mace, Ryan A.; Rochon, Elizabeth A.; Brewer, Julie R.; Vranceanu, Ana-Maria", "year": "2023", "journalProceedings": "Archives of Gerontology and Geriatrics", "category": "Intervention", "devices": "Alta HR", "population": "Older Adults", "dataUsed": "Steps", "abstract": "OBJECTIVES: We iteratively developed, optimized, and established the feasibility of a virtual, group-based, mind-body activity program (Active Brains, AB), supported by Fitbit for older adults with chronic pain (CP) and early cognitive decline (ECD). Guided by the principles of the NIH stage model we 1) explore signals of improvement in AB outcomes and hypothesized mechanisms of action and 2) explore relationships between changes in outcomes with changes in mechanisms. METHODS: Participants were N = 15 older adults (age ≥ 60) with CP-ECD from two NIH stage 1 pilot studies of AB. We conducted paired t-tests to explore pre-post improvements, and correlations to investigate associations between changes in outcomes and mechanisms. RESULTS: We observed small to large improvements across co-primary and secondary outcomes (d = 0.24-1.09). We observed small to medium improvements in 4 out of 5 hypothesized mechanisms (d = 0.23-0.47). Overall, improvements in outcomes had moderate to large associations with improvements in hypothesized mechanisms. CONCLUSION: AB was associated with improvements across several co-primary and secondary outcomes, and hypothesized mechanisms. Pain-specific coping and general coping skills are promising treatment targets to address the CP-ECD comorbidity among older adults.", "links": [] }, { "title": "A wearable device perspective on the standard definitions of disability progression in multiple sclerosis", "author": "Dalla Costa, Gloria; Nos, Carlos; Zabalza, Ana; Buron, Mathias; Magyari, Melinda; Sellebjerg, Finn; Guerrero, Ana Isabel; Roselli, Lucia; La Porta, Maria Libera; Martinis, Matteo; Bailon, Raquel; Kontaxis, Spyridon; Laporta, Estela; Garcia, Esther; Pokorny, Florian B.; Schuller, Björn W.; Folarin, Amos; Stewart, Callum; Leocani, Letizia; Vairavan, Srinivasan; Cummins, Nicholas; Dobson, Richard; Hotopf, Matthew; Narayan, Vaibhav; Montalban, Xavier; Sorensen, Per Soelberg; Comi, Giancarlo", "year": "2023", "journalProceedings": "Multiple Sclerosis (Houndmills, Basingstoke, England)", "category": "Case Study", "devices": "Charge 3", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "INTRODUCTION: Multiple sclerosis (MS) is a leading cause of disability among young adults, but standard clinical scales may not accurately detect subtle changes in disability occurring between visits. This study aims to explore whether wearable device data provides more granular and objective measures of disability progression in MS. METHODS: Remote Assessment of Disease and Relapse in Central Nervous System Disorders (RADAR-CNS) is a longitudinal multicenter observational study in which 400 MS patients have been recruited since June 2018 and prospectively followed up for 24 months. Monitoring of patients included standard clinical visits with assessment of disability through use of the Expanded Disability Status Scale (EDSS), 6-minute walking test (6MWT) and timed 25-foot walk (T25FW), as well as remote monitoring through the use of a Fitbit. RESULTS: Among the 306 patients who completed the study (mean age, 45.6 years; females 67\\%), confirmed disability progression defined by the EDSS was observed in 74 patients, who had approximately 1392 fewer daily steps than patients without disability progression. However, the decrease in the number of steps experienced over time by patients with EDSS progression and stable patients was not significantly different. Similar results were obtained with disability progression defined by the 6MWT and the T25FW. CONCLUSION: The use of continuous activity monitoring holds great promise as a sensitive and ecologically valid measure of disability progression in MS.", "links": [] }, { "title": "The Role of Daily Steps in the Treatment of Major Depressive Disorder: Secondary Analysis of a Randomized Controlled Trial of a 6-Month Internet-Based, Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth", "author": "Dang, Kevin; Ritvo, Paul; Katz, Joel; Gratzer, David; Knyahnytska, Yuliya; Ortiz, Abigail; Walters, Clarice; Attia, Mohamed; Gonzalez-Torres, Christina; Lustig, Andrew; Daskalakis, Zafiris", "year": "2023", "journalProceedings": "Interactive Journal of Medical Research", "category": "Intervention,Case Study", "devices": "Charge HR 2", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Current evidence supports physical activity (PA) as an adjunctive treatment for major depressive disorder (MDD). Few studies, however, have examined the relationship between objectively measured PA and MDD treatment outcomes using prospective data. OBJECTIVE: This study is a secondary analysis of data from a 24-week internet-based, mindfulness-based cognitive behavioral therapy program for MDD. The purpose of this analysis was twofold: (1) to examine average daily step counts in relation to MDD symptom improvement, and whether pain moderated this relationship; and (2) to examine whether changes in step activity (ie, step trajectories) during treatment were associated with baseline symptoms and symptom improvement. METHODS: Patients from the Centre for Addiction and Mental Health were part of a randomized controlled trial evaluating the effects of internet-based, mindfulness-based cognitive behavioral therapy for young adults (aged 18-30 years old) with MDD. Data from 20 participants who had completed the intervention were analyzed. PA, in the form of objectively measured steps, was measured using the Fitbit-HR Charge 2 (Fitbit Inc), and self-reported depression severity was measured with the Beck Depression Inventory-II (BDI-II). Linear regression analysis was used to test PA's relationship with depression improvement and the moderating effect of pain severity and pain interference. Growth curve and multivariable regression models were used to test longitudinal associations. RESULTS: Participants walked an average of 8269 steps per day, and each additional +1000-step difference between participants was significantly associated with a 2.66-point greater improvement (reduction) in BDI-II, controlling for anxiety, pain interference, and adherence to Fitbit monitoring (P=.02). Pain severity appeared to moderate (reduce) the positive effect of average daily steps on BDI-II improvement (P=.03). Higher baseline depression and anxiety symptoms predicted less positive step trajectories throughout treatment (Ps≤.001), and more positive step trajectories early in the trial predicted greater MDD improvement at the end of the trial (Ps{\\textless}.04). However, step trajectories across the full duration of the trial did not significantly predict MDD improvement (Ps=.40). CONCLUSIONS: This study used objective measurements to demonstrate positive associations between PA and depression improvement in the context of cognitive behavioral treatment. Pain appeared to moderate this relationship, and baseline symptoms of anxiety and depression predicted PA trajectories. The findings inform future interventions for major depression. Future research with larger samples should consider additional moderators of PA-related treatment success and the extent to which outcomes are related to PA change in multimodal interventions. TRIAL REGISTRATION: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/11591.", "links": [] }, { "title": "Comparison of Polysomnography, Single-Channel Electroencephalogram, Fitbit, and Sleep Logs in Patients With Psychiatric Disorders: Cross-Sectional Study", "author": "Kawai, Keita; Iwamoto, Kunihiro; Miyata, Seiko; Okada, Ippei; Fujishiro, Hiroshige; Noda, Akiko; Nakagome, Kazuyuki; Ozaki, Norio; Ikeda, Masashi", "year": "2023", "journalProceedings": "Journal of Medical Internet Research", "category": "Validation", "devices": "Sense", "population": "Adults", "dataUsed": "Sleep", "abstract": "BACKGROUND: Sleep disturbances are core symptoms of psychiatric disorders. Although various sleep measures have been developed to assess sleep patterns and quality of sleep, the concordance of these measures in patients with psychiatric disorders remains relatively elusive. OBJECTIVE: This study aims to examine the degree of agreement among 3 sleep recording methods and the consistency between subjective and objective sleep measures, with a specific focus on recently developed devices in a population of individuals with psychiatric disorders. METHODS: We analyzed 62 participants for this cross-sectional study, all having data for polysomnography (PSG), Zmachine, Fitbit, and sleep logs. Participants completed questionnaires on their symptoms and estimated sleep duration the morning after the overnight sleep assessment. The interclass correlation coefficients (ICCs) were calculated to evaluate the consistency between sleep parameters obtained from each instrument. Additionally, Bland-Altman plots were used to visually show differences and limits of agreement for sleep parameters measured by PSG, Zmachine, Fitbit, and sleep logs. RESULTS: The findings indicated a moderate agreement between PSG and Zmachine data for total sleep time (ICC=0.46; P{\\textless}.001), wake after sleep onset (ICC=0.39; P=.002), and sleep efficiency (ICC=0.40; P=.006). In contrast, Fitbit demonstrated notable disagreement with PSG (total sleep time: ICC=0.08; wake after sleep onset: ICC=0.18; sleep efficiency: ICC=0.10) and exhibited particularly large discrepancies from the sleep logs (total sleep time: ICC=-0.01; wake after sleep onset: ICC=0.05; sleep efficiency: ICC=-0.02). Furthermore, subjective and objective concordance among PSG, Zmachine, and sleep logs appeared to be influenced by the severity of the depressive symptoms and obstructive sleep apnea, while these associations were not observed between the Fitbit and other sleep instruments. CONCLUSIONS: Our study results suggest that Fitbit accuracy is reduced in the presence of comorbid clinical symptoms. Although user-friendly, Fitbit has limitations that should be considered when assessing sleep in patients with psychiatric disorders.", "links": [] }, { "title": "Can we let our patients sleep in the hospital? A randomized controlled trial of a pragmatic sleep protocol in surgical oncology patients", "author": "Kelly, Kathrine; Kolbeinsson, Hordur; Blanck, Lauren M.; Khan, Mariam; Kyriakakis, Roxanne; Assifi, M. Mura; Wright, G. Paul; Chung, Mathew", "year": "2023", "journalProceedings": "Journal of Surgical Oncology", "category": "Clinical Care", "devices": "Charge 4", "population": "Patients", "dataUsed": "Steps,Sleep", "abstract": "BACKGROUND: Postoperative inpatients experience increased stress due to pain and poor restorative sleep than non-surgical inpatients. OBJECTIVES AND METHODS: A total of 101 patients, undergoing major oncologic surgery, were randomized to a postoperative sleep protocol (n = 50) or standard postoperative care (n = 51), between August 2020 and November 2021. The primary endpoint of the study was postoperative sleep time after major oncologic surgery. Sleep time and steps were measured using a Fitbit Charge 4®. RESULTS: There was no statistically significant difference found in postoperative sleep time between the sleep protocol and standard group (median sleep time of 427 min vs. 402 min; p = 0.852, respectively). Major complication rates were similar in both groups (7.4\\% vs. 8.9\\%). Multivariate analysis found sex and Charlson Comorbidity Index to be significant factors affecting postoperative sleep time and step count. Postoperative delirium was only observed in the standard group, although this did not reach statistical significance. There were no in hospital mortalities. CONCLUSION: The use of a sleep protocol was found to be safe in our study population. There was no statistical difference in postoperative sleep time or major complications. Institution of a more humane sleep protocol for postoperative inpatients should be considered.", "links": [] }, { "title": "Mothers' experiences of a lifestyle intervention for weight reduction 12 months after gestational diabetes mellitus: Qualitative findings from the PAIGE2 study", "author": "Kemp, Bridie J.; Creighton, Rachel M.; Cupples, Gina; Kelly, Bronagh; McAuley, Emma; Fleck, Olwen; Wallace, Helen; Graham, Una; McCance, David R.", "year": "2023", "journalProceedings": "Midwifery", "category": "Intervention", "devices": "Device unspecified", "population": "Pregnant Women", "dataUsed": "Steps,User Friendliness", "abstract": "The standardised pooled prevalence of gestational diabetes mellitus (GDM) globally is approximately 14 \\%, a reflection of increasing rates of obesity in women of childbearing age. Lifestyle interventions to reduce GDM and subsequent type 2 diabetes (T2D) have been deemed a research priority but are challenging to perform and have variable success rates. The PAIGE2 study was a pragmatic lifestyle randomised controlled trial for women with GDM and body mass index ≥25 kg/m2, which began during pregnancy and continued for one year postnatally. The primary outcome was weight loss 12 months postnatally compared with mothers receiving standard maternity care. Qualitative results are presented from end of study focus groups conducted amongst intervention mothers to gather feedback and determine acceptability of the PAIGE2 intervention. In total, 19 mothers participated in five virtual focus groups. Content analysis explored general study experience, longer term changes to lifestyle and suggested improvements of intervention components including monthly phone calls, motivational text messages, Fitbit experience, Slimming World, and study contact timings. Overall, most mothers found the individual PAIGE2 intervention components enjoyable, although opinions differed as to which were the most effective. Several mothers claimed the intervention helped them make long-term changes to their behaviours. A common suggested improvement was the establishment of a local group where mothers could share their experiences. In conclusion, most mothers deemed the intervention acceptable, and felt that with minor enhancements, it could be utilised as an effective tool to support weight loss after pregnancy and reduce future risk of obesity and T2D.", "links": [] }, { "title": "Effect of digital monitoring and counselling on self-management ability in patients with rheumatoid arthritis: a randomised controlled trial", "author": "Li, Linda C.; Xie, Hui; Feehan, Lynne M.; Shaw, Chris; Lu, Na; Ramachandran, Smruthi; Wang, Ellen; Therrien, Stephanie; Mucha, Julia; Hoens, Alison M.; English, Kelly; Davidson, Eileen; Liu-Ambrose, Teresa; Backman, Catherine L.; Esdaile, John M.; Miller, Kimberly J.; Lacaille, Diane", "year": "2023", "journalProceedings": "Rheumatology (Oxford, England)", "category": "Intervention", "devices": "Inspire", "population": "Adults", "dataUsed": "Intensity,Sleep", "abstract": "OBJECTIVES: To assess a remote physiotherapist (PT) counselling intervention using self-monitoring tools for improving self-management ability, physical activity participation, and health outcomes in people with rheumatoid arthritis (RA). METHODS: Eligible participants were randomly assigned to receive group education, a Fitbit®, a self-monitoring app, and PT counselling phone calls (Immediate Group). The Delayed Group received a monthly e-newsletter until week 26, and then the intervention. The primary outcome was Patient Activation Measure (PAM-13). Participants were assessed at baseline, 27 weeks (the primary end point) and 53 weeks. Secondary outcomes included disease activity, pain, fatigue, depression, sitting/walking habits, daily physical activity time, and daily awake sedentary time. Generalized Linear Mixed-effect Models (GLMMs) were used to assess the effect of the intervention on the change of each outcome measure from the initiation to 27 weeks after the intervention. RESULTS: Analysis included 131 participants (91.6\\% women; 80.2\\% completed during the COVID-19 pandemic). The mean change of PAM-13 at 27 weeks was 4.6 (SD = 14.7) in the Immediate Group vs -1.6 (SD = 12.5) in the Delayed Group. The mean change in Delayed Group at 53 weeks (after the 26-week intervention) was 3.6 (SD = 14.6). Overall, the intervention improved PAM-13 at 27 weeks post-intervention from the GLMM analysis (adjusted coefficient: 5.3; 95\\% CI: 2.0, 8.7; p = {\\textless}0.001). Favourable intervention effects were also found in disease activity, fatigue, depression, and self-reported walking habit. CONCLUSION: Remote counselling paired with self-monitoring tools improved self-management ability in people with RA. Findings of secondary outcomes indicate that the intervention had a positive effect on symptom management.", "links": [] }, { "title": "Association of self-directed walking with toxicity moderation during chemotherapy for the treatment of early breast cancer", "author": "Nyrop, K. A.; Page, A.; Deal, A. M.; Wagoner, C.; Kelly, E. A.; Kimmick, Gretchen G.; Copeland, Anureet; Speca, JoEllen; Wood, William A.; Muss, H. B.", "year": "2023", "journalProceedings": "Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer", "category": "Intervention", "devices": "Device unspecified", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: In the field of exercise oncology, there is a need to quantify the potential benefits of moderate, self-directed physical activity during active treatment. In a pooled analysis of three identical single-arm intervention studies, we investigate the association of activity tracker steps with patient-reported toxicities during chemotherapy. METHODS: Women with early breast cancer who were enrolled in the intervention studies reported their symptom severity every 2-3 weeks throughout chemotherapy, and daily steps were documented through a Fitbit activity tracker. Relative risks (RR) and 95\\% confidence intervals (CI) were calculated using Poisson regression models with robust variance. For outcomes significant in unadjusted models, adjusted RRs were calculated controlling for race, age, and education level. Tracker step cut point (high step, low step) was determined by the means. Cumulative incidence functions of moderate, severe, and very severe (MSVS) symptoms were estimated using the Kaplan-Meier method and compared using a Cox proportional hazard model. RESULTS: In a sample of 283 women, mean age was 56 years and 76\\% were White. Mean tracker-documented steps/week were 29,625, with 55\\% walking below the mean (low step) and 45\\% above (high step). In multivariable analysis, high step patients had lower risk for fatigue [RR 0.83 (0.70, 0.99)] (p = 0.04), anxiety [RR 0.59 (0.42, 0.84)] (p = 0.003), nausea [RR 0.66 (0.46, 0.96)] (p = 0.03), depression [RR 0.59 (0.37, 0.03)] (p = 0.02), and ≥ 6 MSVS symptoms [RR 0.73 (0.54, 1.00)] (p = 0.05) and had 36\\% lower risk for dose reductions [RR 0.64 (95\\% CI 0.43, 0.97)] (p = 0.03). CONCLUSION: Self-directed walking at a rate of at least 30,000 steps/week may moderate the severity of treatment side effects during chemotherapy for early breast cancer. TRIAL NUMBERS: NCT02167932, NCT02328313, NCT03761706.", "links": [] }, { "title": "Selecting a sleep tracker from EEG-based, iteratively improved, low-cost multisensor, and actigraphy-only devices", "author": "Ong, Ju Lynn; Golkashani, Hosein Aghayan; Ghorbani, Shohreh; Wong, Kian F.; Chee, Nicholas I. Y. N.; Willoughby, Adrian R.; Chee, Michael W. L.", "year": "2023", "journalProceedings": "Sleep Health", "category": "Validation,Systematic Review", "devices": "Sense", "population": "Adults", "dataUsed": "Sleep", "abstract": "AIMS: Evaluate the performance of 6 wearable sleep trackers across 4 classes (EEG-based headband, research-grade actigraphy, iteratively improved consumer tracker, low-cost consumer tracker). FOCUS TECHNOLOGY: Dreem 3 headband, Actigraph GT9X, Oura Ring Gen3, Fitbit Sense, Xiaomi Mi Band 7, Axtro Fit3. REFERENCE TECHNOLOGY: In-lab polysomnography with 3-reader, consensus sleep scoring. SAMPLE: Sixty participants (26 males) across 3 age groups (18-30, 31-50, and 51-70years). DESIGN: Overnight in a sleep laboratory from habitual sleep time to wake time. CORE ANALYTICS: Discrepancy and epoch-by-epoch analyses for sleep/wake (2-stage) and sleep-stage (4-stage; wake/light/deep/rapid eye movement) classification (devices vs. polysomnography). CORE OUTCOMES: EEG-based Dreem performed the best (2-stage kappa=0.76, 4-stage kappa=0.76-0.86) with the lowest total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset discrepancies vs. polysomnography. This was followed by the iteratively improved consumer trackers: Oura (2-stage kappa=0.64, 4-stage kappa=0.55-0.70) and Fitbit (2-stage kappa=0.58, 4-stage kappa=0.45-0.60) which had comparable total sleep time and sleep efficiency discrepancies that outperformed accelerometry-only Actigraph (2-stage kappa=0.47). The low-cost consumer trackers had poorest overall performance (2-stage kappa{\\textless}0.31, 4-stage kappa{\\textless}0.33). IMPORTANT ADDITIONAL OUTCOMES: Proportional biases were driven by nights with poorer sleep (longer sleep onset latencies and/or wake after sleep onset). CORE CONCLUSION: EEG-based Dreem is recommended when evaluating poor quality sleep or when highest accuracy sleep-staging is required. Iteratively improved non-EEG sleep trackers (Oura, Fitbit) balance classification accuracy with well-tolerated, and economic deployment at-scale, and are recommended for studies involving mostly healthy sleepers. The low-cost trackers, can log time in bed but are not recommended for research use.", "links": [] }, { "title": "Using Consumer Wearable Devices to Profile Postoperative Complications After Pediatric Appendectomy", "author": "Pitt, J. Benjamin; Zeineddin, Suhail; Carter, Michela; Figueroa, Angie; Park, Erica; Kwon, Soyang; Ghomrawi, Hassan; Abdullah, Fizan", "year": "2023", "journalProceedings": "The Journal of Surgical Research", "category": "Case Study", "devices": "Inspire HR,Inspire 2", "population": "Children", "dataUsed": "Steps", "abstract": "INTRODUCTION: Markers of postoperative recovery in pediatric patients are difficult for parents to evaluate after hospital discharge, who use subjective proxies to assess recovery and the onset of complications. Consumer-grade wearable devices (e.g., Fitbit) generate objective recovery data in near real time and thus may provide an opportunity to remotely monitor postoperative patients and identify complications beyond the initial hospitalization. The aim of this study was to use daily step counts from a Fitbit to compare recovery in patients with complications to those without complications after undergoing appendectomy for complicated appendicitis. METHODS: Children ages 3-17 years old undergoing laparoscopic appendectomy for complicated appendicitis were recruited. Patients wore a Fitbit device for 21 d after operation. After collection, patient data were included in the analysis if minimum wear-time criteria were achieved. Postoperative complications were identified through chart review, and step count trajectories for patients recovering with and without complications were compared. Additionally, to account for the patients experiencing a complication on different postoperative days, median daily step count for pre- and post-complication were analyzed. RESULTS: Eighty-six patients with complicated appendicitis were enrolled in the study, and fourteen children developed a postoperative complication. Three patients were excluded because they did not meet the minimum wear time requirements. Complications were divided into abscesses (n = 7, 64\\%), surgical site infections (n = 2, 18\\%), and other, which included small bowel obstruction and Clostridioides difficile infection (n = 2, 18\\%). Patients presented with a complication on mean postoperative day 8, while deviation from the normative recovery trajectory was evident 4 d prior. When compared to children with normative recovery, the patients with surgical complications experienced a slower increase in step count postoperatively, but the recovery trajectory was specific to each complication type. When corrected for day of presentation with complication, step count remained low prior to the discovery of the complication and increased after treatment resembling the normative recovery trajectory. CONCLUSIONS: This study profiled variations from the normative recovery trajectory in patients with complication after appendectomy for complicated appendicitis, with distinct trajectory patterns by complication type. Our findings have potentially profound clinical implications for monitoring pediatric patients postoperatively, particularly in the outpatient setting, thus providing objective data for potentially earlier identification of complications after hospital discharge.", "links": [] }, { "title": "A single-armed proof-of-concept study of Lymfit: A personalized, virtual exercise intervention to improve health outcomes in lymphoma survivors in the pandemic", "author": "Angelillo, Christopher; Tock, Wing Lam; Salaciak, Matthew; Reid, Ryan E. R.; Andersen, Ross E.; Maheu, Christine; Johnson, Nathalie A.", "year": "2024", "journalProceedings": "PloS One", "category": "Intervention", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "Background and objective: Treatments of lymphoma can lead to reduced physical functioning, cancer-related fatigue, depression, anxiety, and insomnia. These side effects can negatively impact the cancer survivor's quality of life. Mounting evidence indicates that physical activities are highly therapeutic in mitigating the short- and long-term side effects of cancer treatments. Yet, lymphoma survivors' participation in physical activities remains suboptimal, which has been further exacerbated by the deleterious effects of isolation during the COVID-19 pandemic. The Lymfit intervention aims to offer motivational support, expert guidance, and a personalized exercise prescription to optimize physical activities among lymphoma survivors. This proof-of-concept study explores implementation feasibility (retention, technical and safety), and the preliminary effects of Lymfit on various health outcomes.\n\nMethod: This was a single-armed trial with a pre-and post-test design. Twenty lymphoma survivors were recruited to participate in the 12-week Lymfit intervention. Wearable activity trackers (Fitbit) were given to participants as a motivational tool and for data collection purposes. Participants received a personalized exercise prescription designed by a kinesiologist. Physiologic metrics were collected by the Fitbit monitors and were stored in the Lymfit database. Self-reported questionnaires measuring health outcomes were collected at baseline and post-intervention.\n\nResults: The retention rate of this trial was 70%. Minimal technical issues and no adverse effects were reported. Lymfit led to significant improvements in sleep disturbances and the ability to participate in social activities and decreased fear of cancer recurrence. It also increased daily steps and decreased sedentary time in participants who did not meet the recommended physical activity guidelines.\n\nSignificance: With access to resources and fitness centers being limited during the pandemic, the Lymfit intervention filled an immediate need to provide physical activity guidance to lymphoma survivors. Findings provide preliminary support that implementing the Lymfit intervention is feasible and demonstrated promising results.", "links": [] }, { "title": "Museum-based art activities to stay young at heart? Results of a randomized controlled trial", "author": "Cami, Margot; Planta, Océane; Matskiv, Jacqueline; Plonka, Alexandra; Gros, Auriane; Beauchet, Olivier", "year": "2023", "journalProceedings": "Frontiers in Medicine", "category": "Intervention", "devices": "Alta HR", "population": "Older Adults", "dataUsed": "Heart Rate", "abstract": "Background: Health benefits have been reported with art activities. Heart rate is a biomarker of health state. The aim of this randomized controlled trial (RCT) was to compare the changes in heart rate over a 3 month-period in older adults participating in art-based activities at the Montreal Museum of Fine Arts (MMFA, Quebec, Canada) and in their control counterparts.\n\nMethods/design: Participants (mean age 71.0 ± 5.1; 84.9% female) were a subset of older community dwellers recruited in a RCT in two parallel groups (n = 28 in the intervention group and n = 25 in the control group) who had their heart rate recorded. They attended weekly participatory MMFA-based art activities over a 3-month period. Heart rate was collected via the smart watch Fitbit Alta HR at baseline (M0) and at 3 months (M3). The outcomes were mean heart rate per hour for the full day, including active and inactive hours.\n\nResults: Heart rate for full day (p = 0.018) and active hours (p = 0.028) were slower in the intervention group compared to the control group. Decrease in mean heart rate for full day between M0 and M3 in the intervention group was higher than in the control group (p = 0.030). The linear regression showed that MMFA-based art activities decreased full day heart rate (Coefficient of regression Beta = -6.2 with p = 0.010).\n\nConclusion: MMFA-based art activities significantly decreased full day heart rate, suggesting a health benefit in older community dwellers who participated in the RCT.Clinical trial registration: NCT03679715.\n\nKeywords: art; clinical trial; health; museum; older adult.", "links": [] }, { "title": "Step cadence as a novel objective postoperative recovery metric in children who undergo laparoscopic appendectomy", "author": "Carter, Michela; Zeineddin, Suhail; Bai, Iris; Pitt, J. Benjamin; Hua, Rui; Kwon, Soyang; Ghomrawi, Hassan M. K.; Abdullah, Fizan", "year": "2024", "journalProceedings": "Surgery", "category": "Case Study", "devices": "Inspire HR,Inspire 2", "population": "Patients,Children", "dataUsed": "Steps", "abstract": "Background: Daily step counts from consumer wearable devices have been used to objectively assess postsurgical recovery in children. However, step cadence, defined as steps taken per minute, may be a more specific measure of physiologic status. The purpose of this study is to define objective normative physical activity recovery trajectories after laparoscopic appendectomy using this novel metric. We hypothesized that patients would have a progressive increase in peak cadence until reaching a plateau representing baseline status, and this would occur earlier for simple compared with complicated appendicitis.\n\nMethods: Children aged 3 to 18 years were enrolled after laparoscopic appendectomy for simple or complicated appendicitis between March 2019 and December 2022 at a tertiary children's hospital. Participants wore a Fitbit for 21 postoperative days. The peak 1-minute cadence and peak 30-minute cadence were determined each postoperative day. Piecewise linear regression was conducted to generate normative peak step cadence recovery trajectories for simple and complicated appendicitis.\n\nResults: A total of 147 children met criteria (53.7% complicated appendicitis). Patients with simple appendicitis reached plateau postoperative day 10 at a mean peak 1-minute cadence of 111 steps/minute and a mean peak 30-minute cadence of 77 steps/minute. The complicated appendicitis recovery trajectory reached a plateau postoperative day 13 at a mean peak 1-minute cadence of 106 steps/minute and postoperative day 15 at a mean peak 30-minute cadence of 75 steps/minute.\n\nConclusion: Using step cadence, we defined procedure-specific normative peak cadence recovery trajectories after laparoscopic appendectomy. This can empower clinicians to set data-driven expectations for recovery after surgery and establish the groundwork for consumer wearable devices as a post-discharge remote monitoring tool.", "links": [] }, { "title": "Feasibility Test of Personalized (N-of-1) Trials for Increasing Middle-Aged and Older Adults' Physical Activity", "author": "Friel, Ciarán P.; Goodwin, Ashley M.; Robles, Patrick L.; Butler, Mark J.; Pahlevan-Ibrekic, Challace; Duer-Hefele, Joan; Vicari, Frank; Gordon, Samantha; Chandereng, Thevaa; Cheung, Ying Kuen Ken; Davidson, Karina W.", "year": "2023", "journalProceedings": "Research Square", "category": "Intervention", "devices": "Charge 4", "population": "Older Adults,Adults", "dataUsed": "Steps", "abstract": "Purpose: To test the feasibility of a remotely-delivered intervention to increase low-intensity physical activity (walking) in middle-aged and older adults.\n\nDesign: This study used a Personalized (N-of-1) trial design.\n\nSetting: This study took place at a major healthcare system from November 2021 to February 2022.\n\nSubjects: Sixty adults (45-75 years, 92% female, 80% white) were recruited.\n\nIntervention: A 10-week study comprising a 2-week baseline, followed by four 2-week periods where 4 Behavior Change Techniques (BCTs) - self-monitoring, goal setting, action planning and feedback - were delivered one at a time in random order.\n\nMeasures: Activity was measured by a Fitbit, and intervention components delivered by email/text. Average daily steps were compared between baseline and intervention. Participants completed satisfaction items derived from the System Usability Scale and reported attitudes and opinions about personalized trials.\n\nResults: Participants rated personalized trial components as feasible and acceptable. Changes in steps between baseline and intervention were not significant, but a large heterogeneity of treatment effects existed, suggesting some participants significantly increased walking while others significantly decreased.\n\nConclusions: Our intervention was well-accepted but use of BCTs delivered individually did not result in a significant increase in steps. Feasibility and heterogeneity of treatment effects support adopting a personalized trial approach to optimize intervention results.\n\nKeywords: Behavior Change Techniques; N-of-1; Older Adults; Personalized Trials; Physical Activity.", "links": [] }, { "title": "Promoting positive physical activity behaviours in children undergoing acute cancer treatment: feasibility of the CanMOVE intervention", "author": "Grimshaw, Sarah L.; Taylor, Nicholas F.; Conyers, Rachel; Shields, Nora", "year": "2023", "journalProceedings": "Brazilian Journal of Physical Therapy", "category": "Intervention", "devices": "Inspire", "population": "Children,Adolescents", "dataUsed": "Steps,User Friendliness", "abstract": "Background: Supporting children and adolescents with cancer to be physically active can improve medium- and long-term health outcomes.\n\nObjective: To assess the feasibility of CanMOVE, a 10-week complex, theoretically-informed, behaviour change intervention to promote physical activity for children and adolescents undergoing acute cancer treatment.\n\nMethods: A feasibility study using a single-group, repeated measures, mixed methods design. Participants completed CanMOVE, which included provision of a Fitbit (child/adolescent and carer) and structured support from a physical therapist. Feasibility domains of demand, acceptability, implementation, practicality, limited efficacy, and integration were evaluated. Data sources included service level data, objective assessment of physical activity, physical function, and health-related quality of life; and qualitative data collected via semi-structured interviews with participants and focus groups with staff.\n\nResults: Twenty children/adolescents (median age 13yrs, interquartile-range 9-14) with a mix of cancer diagnoses, 20 parents, and 16 clinicians participated. There was high demand with 95% enrolment rate. CanMOVE was acceptable for participants. All feasibility thresholds set for implementation were met. Under practicality, there were no serious adverse events related to the intervention. Limited efficacy data indicated CanMOVE showed positive estimates of effect in influencing child/adolescent physical activity behaviour, physical function, and health-related quality of life. Positive impacts were also seen in parent and staff attitudes towards physical activity promotion. To improve integration into the clinical setting, it was suggested the duration and scope of CanMOVE could be expanded.\n\nConclusion: CanMOVE was feasible to implement in a paediatric cancer setting. CanMOVE is appropriate to be tested in a large-scale trial.", "links": [] }, { "title": "Examining a Remote Group-Based Type 2 Diabetes Self-Management Education Program in the COVID-19 Era Using the ORBIT Model: Small 6-Week Feasibility Study", "author": "Hiemstra, Madison S.; Reichert, Sonja M.; Mitchell, Marc S.", "year": "2024", "journalProceedings": "JMIR formative research", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "Background: To date, most group-based diabetes self-management education (DSME) programs for type 2 diabetes (T2D) have been delivered in person. The rapid transition to remote care at the outset of the COVID-19 pandemic presented opportunities to test, evaluate, and iterate a new remote DSME program.\n\nObjective: We aim to refine the delivery and evaluation of a multicomponent remote DSME program for adults living with T2D by examining several feasibility outcomes.\n\nMethods: We recruited a convenience sample of patients from a London, Canada, outpatient diabetes clinic (serving high-risk, low-income adults) to participate in a 6-week, single cohort feasibility study from November 2020 to March 2021. This small ORBIT phase 1b feasibility study represents the first in a planned series guided by the ORBIT model for developing behavioral interventions for chronic diseases (phase 1: design; phase 2: preliminary testing; phase 3: efficacy; and phase 4: effectiveness). The feasibility of delivering and evaluating a remote DSME program, including (1) live video education classes, (2) individualized physical activity (PA) prescription and counseling, and (3) intermittently scanned continuous glucose and wearable PA monitoring, was assessed. Feasibility outcomes included recruitment and retention rates, program adherence, and acceptability (ie, technology issues and exit survey feedback). PA was assessed with Fitbit Inspire 2 (Fitbit Inc) and estimated glycated hemoglobin (HbA1c) using the FreeStyle Libre (Abbot). Given the small study sample, group- and individual-level data are reported descriptively.\n\nResults: A total of 10 adults living with T2D were recruited (female 60%; age 49.9, SD 14.3 years; estimated HbA1c 6.2%, SD 0.5%). Recruitment and retention rates were 29% and 80%, respectively. Participants attended 83% (25/30) and 93% (37/40) of education classes and PA counseling phone calls, respectively. There were 3.2 (SD 2.6) technology issues reported per person, most of which were related to study data transfer. Exit survey responses suggest most participants (8/9, 89%) were \"satisfied\" with the program. Recognizing the small sample size and the fact that no inferential statistics were conducted, the mean (SD) for the weekly daily step count and estimated HbA1c are provided for illustrative purposes. Participants accumulated 7103 (SD 2900) and 7515 (SD 3169) steps per day at baseline and week 6, respectively. The estimated HbA1c was 6.2% (SD 0.5%) and 6.2% (SD 0.6%) at baseline and week 6, respectively.\n\nConclusions: This ORBIT phase 1b study served to refine the delivery (eg, automatic study data upload process recommended to reduce participant burden) and evaluation (eg, purposeful sampling of participants with baseline HbA1c >8% recommended to address selection bias) of a remote DSME program. Preliminary proof-of-concept testing (ORBIT phase 2) incorporating some of these learnings is now warranted.", "links": [] }, { "title": "Improving multimodal physical function in adults with heterogeneous chronic pain; Protocol for a multisite feasibility RCT", "author": "Hooker, Julia E.; Brewer, Julie R.; McDermott, Katherine; Kanaya, Millan; Somers, Tamara J.; Keefe, Francis; Kelleher, Sarah; Fisher, Hannah M.; Burns, John; Wilson, Rebecca; Kulich, Ronald; Polykoff, Gary; Parker, Robert A.; Greenberg, Jonathan; Vranceanu, Ana-Maria; THRIVE Study TeamJennifer Plumb-Vilardaga, PhD. Shannon Miller, Allison Diachina, Sara Hogan, Latrice Yates", "year": "2024", "journalProceedings": "Contemporary Clinical Trials", "category": "Intervention", "devices": "Inspire 3", "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "Background: Chronic pain is associated with substantial impairment in physical function, which has been identified as a top concern among persons with pain. GetActive-Fitbit, a mind-body activity program, is feasible, acceptable, and associated with improvement in physical function among primarily White, sedentary individuals with pain. In preparation for a multisite efficacy trial, we must examine feasibility across multiple sites with diverse patient populations. Here we describe the protocol of a multisite, feasibility RCT comparing GetActive-Fitbit with a time- and attention-matched educational comparison (Healthy Living for Pain). We aim to 1) test multisite fidelity of clinician training; 2) evaluate multisite feasibility benchmarks, including recruitment of chronic pain patients taking <5000 steps/day and racial and ethnic minorities; and 3) optimize fidelity and study protocol in preparation for a future multisite efficacy trial.\n\nMethods: Clinician training fidelity was assessed via roleplays and mock group sessions. Feasibility (i.e., recruitment, acceptability, credibility, adherence, satisfaction), multimodal physical function (e.g., self-report, 6-Minute Walk Test, step-count), and other psychosocial outcomes are assessed at baseline, posttest, and 6 months. Protocol optimization will be assessed using exit interviews and cross-site meetings.\n\nResults: The trial is ongoing. Clinician training is complete. 87 participants have been recruited. 54 completed baseline assessments and randomization, 44 are mid-intervention, and 9 have completed the intervention and posttest.\n\nConclusions: This study addresses the critical need for feasible, acceptable mind-body-activity interventions for chronic pain that follow evidence-based guidelines and improve all aspects of physical function across diverse populations. Results will inform a future fully-powered multisite efficacy trial.", "links": [] }, { "title": "Evaluating Accuracy in Five Commercial Sleep-Tracking Devices Compared to Research-Grade Actigraphy and Polysomnography", "author": "Kainec, Kyle A.; Caccavaro, Jamie; Barnes, Morgan; Hoff, Chloe; Berlin, Annika; Spencer, Rebecca M. C.", "year": "2024", "journalProceedings": "Sensors (Basel, Switzerland)", "category": "Validation,Systematic Review", "devices": "Versa,Inspire,Garmin Vivosmart", "population": "Adults", "dataUsed": "Sleep", "abstract": "The development of consumer sleep-tracking technologies has outpaced the scientific evaluation of their accuracy. In this study, five consumer sleep-tracking devices, research-grade actigraphy, and polysomnography were used simultaneously to monitor the overnight sleep of fifty-three young adults in the lab for one night. Biases and limits of agreement were assessed to determine how sleep stage estimates for each device and research-grade actigraphy differed from polysomnography-derived measures. Every device, except the Garmin Vivosmart, was able to estimate total sleep time comparably to research-grade actigraphy. All devices overestimated nights with shorter wake times and underestimated nights with longer wake times. For light sleep, absolute bias was low for the Fitbit Inspire and Fitbit Versa. The Withings Mat and Garmin Vivosmart overestimated shorter light sleep and underestimated longer light sleep. The Oura Ring underestimated light sleep of any duration. For deep sleep, bias was low for the Withings Mat and Garmin Vivosmart while other devices overestimated shorter and underestimated longer times. For REM sleep, bias was low for all devices. Taken together, these results suggest that proportional bias patterns in consumer sleep-tracking technologies are prevalent and could have important implications for their overall accuracy.", "links": [] }, { "title": "Family-Focused Facilitated Fitness: Feasibility and Acceptability of a Couple-Based Physical Activity Intervention for Hematopoietic Cell Transplant Recipients and their Caregiving Partners", "author": "Langer, Shelby L.; Joseph, Rodney P.; Mistretta, Erin; Tao, Chun; Porter, Laura; Spain, Allison; Khera, Nandita", "year": "2024", "journalProceedings": "Transplantation and Cellular Therapy", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Reductions in physical activity (PA) are common among patients following hematopoietic cell transplantation, and a risk factor for poor physical functioning. PA among spouses/cohabiting partners, who frequently serve as the patient's primary caregiver, may also be reduced due to caregiving demands and limited bandwidth for self-care. In addition, the patient-caregiver relationship can be compromised, and communication patterns disrupted. All PA interventions in the hematopoietic cell transplantation setting have focused entirely on patients, ignoring an opportunity to synergistically engage and benefit the caregiver as well.\n\nObjective: To establish the feasibility and acceptability of a couple-based intervention entitled Family-Focused Facilitated Fitness (FFFF), designed to improve PA as assessed by daily step counts among both patients undergoing hematopoietic cell transplantation and their caregivers. Guided by interdependence and communal coping perspectives, FFFF is an 8-week, remotely-delivered intervention that provides training in communication skills and joint problem-solving to help patients and caregivers support one another in PA. Participants are also given a Fitbit to track their steps and weekly individualized step prescription based on the 75th percentile ranked value of their last 7 recorded daily step counts. A priori benchmarks for feasibility and acceptability were as follows: 50% of eligible couples would agree to participate, 70% of couples would attend all 8 sessions, 80% of participants would provide valid Fitbit wear data 4/7 days/ week, and among sessions reviewed for treatment fidelity, 85% of treatment protocol elements would be covered.\n\nStudy design: Single-arm pilot intervention.\n\nResults: Couples were recruited prior to transplant. Among 26 couples approached and deemed eligible, 17 enrolled (65% agreement) and completed baseline assessment. Three couples later withdrew after transplantation but prior to receiving the intervention, resulting in 14 couples commencing the intervention, on average 21 days post-transplant. Four couples subsequently discontinued due to medical complications (n=3) or caregiver schedule (n=1). Among the 10 couples who completed the intervention, the percentage of participants meeting our benchmark of valid Fitbit wear at least 4 days per week was 85% in week 1, 90% in weeks 2-7, and 80% in week 8. Treatment fidelity was 95% on average across 24 sessions reviewed (3 cases). Treatment satisfaction scores were uniformly high across multiple dimensions, with all means above 4 on the 1-5 scale. Daily step counts among those attending all 8 intervention sessions increased from 2249 ± 302 steps/day in week 1 to 4975 ± 1377 steps/day in week 8 among patients, and from 8676 ± 3760 steps/day in week 1 to 9838 ± 3723 steps/day in week 8 among caregivers. Qualitative feedback indicated perceived mental and physical health benefits of the program. Participants also offered suggestions for adaptations to accommodate medical setbacks and constraints.\n\nConclusion: All a priori feasibility benchmarks were met or exceeded. Results offer promise for utility of the program to engage and leverage patient-caregiver dyads to increase PA following transplant. An investigation using a randomized controlled design will be necessary to adequately examine change over time relative to control and its possible impact on clinical and patient-reported outcomes.\n\nKeywords: caregiver; couples; hematopoietic cell transplantation; physical activity.", "links": [] }, { "title": "Menstruation-related symptoms are associated with physical activity and midpoint of sleep: a pilot study", "author": "Masuda, Hazuki; Okada, Shima", "year": "2023", "journalProceedings": "Frontiers in Global Women's Health", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Energy Expenditure,Sleep", "abstract": "Introduction: Menstruation-related symptoms (MRSs) significantly impact women's health and contribute to economic burdens worldwide. Current interventions, primarily pharmacological ones, have limitations and side effects that underscore the need for alternative management strategies. This study explores the association between MRSs and lifestyle factors, specifically physical activity and sleep timing across menstrual cycle phases, to inform non-pharmacological intervention development.\n\nMethods: Fourteen female students from Ritsumeikan University, Japan, with regular menstrual cycles (25-38 days), not on hormonal treatment or engaged in shift work, participated in this observational study. Using a Fitbit Inspire 2, total daily energy expenditure (TDEE) and sleep timing were monitored over a complete cycle. Menstrual cycle phases were defined based on ovulation day, predicted using home luteinizing hormone tests. Participants completed daily electronic questionnaires rating MRSs using a modified menstrual distress questionnaire. Data were analyzed using a generalized linear mixed model with a gamma distribution and logarithmic link function, examining the relationship of TDEE and the midpoint of sleep time (MS time) with MRS severity.\n\nResults and discussion: The following observations were noted: first, MRS severity, except for behavioral change symptoms, significantly increased during the menstrual and luteal phases compared to the follicular phase. Second, delayed MS time was associated with reduced pain, concentration symptoms, water retention, and negative affect during the menstrual phase and reduced negative affect during the luteal phase. Finally, an increase in TDEE was associated with reduced concentration symptoms, autonomic reaction symptoms, and negative affect during the menstrual and luteal phases and reduced water retention only during the luteal phase. This study provides insights into the relationship between MRSs and TDEE/MS time, suggesting potential non-therapeutic approaches for symptom management, though further research is needed to substantiate these findings for practical applications.\n\nKeywords: generalized linear mixed model; menstrual cycle; menstrual cycle phase; menstruation-related symptoms; physical activity; sleep; wearable device.", "links": [] }, { "title": "Data-efficient machine learning methods in the ME-TIME study: Rationale and design of a longitudinal study to detect atrial fibrillation and heart failure from wearables", "author": "Naseri, Arman; Tax, David; van der Harst, Pim; Reinders, Marcel; van der Bilt, Ivo", "year": "2023", "journalProceedings": "Cardiovascular Digital Health Journal", "category": "Intervention", "devices": "Inspire 2,Charge 5", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Background: Smartwatches enable continuous and noninvasive time series monitoring of cardiovascular biomarkers like heart rate (from photoplethysmograms), step counter, skin temperature, et cetera; as such, they have promise in assisting in early detection and prevention of cardiovascular disease. Although these biomarkers may not be directly useful to physicians, a machine learning (ML) model could find clinically relevant patterns. Unfortunately, ML models typically need supervised (ie, annotated) data, and labeling of large amounts of continuous data is very labor intensive. Therefore, ML methods that are data efficient, ie, needing a low number of labels, are required to detect potential clinical value in patterns found in wearable data.\n\nObjective: The primary study objective of the ME-TIME (Machine Learning Enabled Time Series Analysis in Medicine) study is to design an ML model that can detect atrial fibrillation (AF) and heart failure (HF) from wearable data in a data-efficient manner. To achieve this, self-supervised and weakly supervised learning techniques are used.\n\nMethods: Two hundred subjects (100 reference, 50 AF, and 50 HF) are being invited to participate in wearing a Fitbit fitness tracker for 3 months. Interested volunteers are sent a questionnaire to determine their health, in particular cardiovascular health. Volunteers without any (history of) serious illness are assigned to the reference group. Participants with AF and HF are recruited in the Haga teaching hospital in The Hague, The Netherlands.\n\nResults: Enrollment commenced on May 1, 2022, and as of the time of this report, 62 subjects have been included in the study. Preliminary analysis of the data reveals significant inter-subject variability. Notably, we identified heart rate recovery curves and time-delayed correlations between heart rate and step count as potential strong indicators for heart disease.\n\nConclusion: Using self-supervised and multiple-instance learning techniques, we hypothesize that patterns specific to AF and HF can be found in continuous data obtained from smartwatches.\n\nKeywords: Artificial intelligence; Atrial fibrillation; Heart failure; Machine learning; Multiple-instance learning; Self-supervised learning; Smartwatch; Wearables; mHealth.", "links": [] }, { "title": "Validation of ActiGraph and Fitbit in the assessment of energy expenditure in Huntington's disease", "author": "Simón-Vicente, Lucía; Rodríguez-Fernández, Alejandro; Rivadeneyra-Posadas, Jéssica; Soto-Célix, María; Raya-González, Javier; Castillo-Alvira, Daniel; Calvo, Sara; Mariscal, Natividad; García-Bustillo, Álvaro; Aguado, Laura; Cubo, Esther", "year": "2024", "journalProceedings": "Gait \\& Posture", "category": "Validation", "devices": "Charge 4", "population": "Adults", "dataUsed": "Energy Expenditure", "abstract": "Background: Consumer and research activity monitors have become popular because of their ability to quantify energy expenditure (EE) in free-living conditions. However, the accuracy of activity trackers in determining EE in people with Huntington's Disease (HD) is unknown.\n\nResearch question: Can the ActiGraph wGT3X-B or the Fitbit Charge 4 accurately measure energy expenditure during physical activity, in people with HD compared to Indirect Calorimetry (IC) (Medisoft Ergo Card)?\n\nMethods: We conducted a cross-sectional, observational study with fourteen participants with mild-moderate HD (mean age 55.7 ± 11.4 years). All participants wore an ActiGraph and Fitbit during an incremental test, running on a treadmill at 3.2 km/h and 5.2 km/h for three minutes at each speed. We analysed and compared the accuracy of EE estimates obtained by Fitbit and ActiGraph against the EE estimates obtained by a metabolic cart, using with Intra-class correlation (ICC), Bland-Altman analysis and correlation tests.\n\nResults: A significant correlation and a moderate reliability was found between ActiGraph and IC for the incremental test (r = 0.667)(ICC=0.633). There was a significant correlation between Fitbit and IC during the incremental test (r = 0.701), but the reliability was poor at all tested speeds in the treadmill walk. Fitbit significantly overestimated EE, and ActiGraph underestimated EE compared to IC, but ActiGraph estimates were more accurate than Fitbit in all tests.\n\nSignificance: Compared to IC, Fitbit Charge 4 and ActiGraph wGT3X-BT have reduced accuracy in estimating EE at slower walking speeds. These findings highlight the need for population-specific algorithms and validation of activity trackers.\n\nKeywords: Activity monitor; Exercise; Health promotion; Physical activity; Rehabilitation; Validation.", "links": [] }, { "title": "Engagement With a Remote Symptom-Tracking Platform Among Participants With Major Depressive Disorder: Randomized Controlled Trial", "author": "White, Katie M.; Carr, Ewan; Leightley, Daniel; Matcham, Faith; Conde, Pauline; Ranjan, Yatharth; Simblett, Sara; Dawe-Lane, Erin; Williams, Laura; Henderson, Claire; Hotopf, Matthew", "year": "2024", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "Charge", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Background: Multiparametric remote measurement technologies (RMTs), which comprise smartphones and wearable devices, have the potential to revolutionize understanding of the etiology and trajectory of major depressive disorder (MDD). Engagement with RMTs in MDD research is of the utmost importance for the validity of predictive analytical methods and long-term use and can be conceptualized as both objective engagement (data availability) and subjective engagement (system usability and experiential factors). Positioning the design of user interfaces within the theoretical framework of the Behavior Change Wheel can help maximize effectiveness. In-app components containing information from credible sources, visual feedback, and access to support provide an opportunity to promote engagement with RMTs while minimizing team resources. Randomized controlled trials are the gold standard in quantifying the effects of in-app components on engagement with RMTs in patients with MDD.\n\nObjective: This study aims to evaluate whether a multiparametric RMT system with theoretically informed notifications, visual progress tracking, and access to research team contact details could promote engagement with remote symptom tracking over and above the system as usual. We hypothesized that participants using the adapted app (intervention group) would have higher engagement in symptom monitoring, as measured by objective and subjective engagement.\n\nMethods: A 2-arm, parallel-group randomized controlled trial (participant-blinded) with 1:1 randomization was conducted with 100 participants with MDD over 12 weeks. Participants in both arms used the RADAR-base system, comprising a smartphone app for weekly symptom assessments and a wearable Fitbit device for continuous passive tracking. Participants in the intervention arm (n=50, 50%) also had access to additional in-app components. The primary outcome was objective engagement, measured as the percentage of weekly questionnaires completed during follow-up. The secondary outcomes measured subjective engagement (system engagement, system usability, and emotional self-awareness).\n\nResults: The levels of completion of the Patient Health Questionnaire-8 (PHQ-8) were similar between the control (67/97, 69%) and intervention (66/97, 68%) arms (P value for the difference between the arms=.83, 95% CI -9.32 to 11.65). The intervention group participants reported slightly higher user engagement (1.93, 95% CI -1.91 to 5.78), emotional self-awareness (1.13, 95% CI -2.93 to 5.19), and system usability (2.29, 95% CI -5.93 to 10.52) scores than the control group participants at follow-up; however, all CIs were wide and included 0. Process evaluation suggested that participants saw the in-app components as helpful in increasing task completion.\n\nConclusions: The adapted system did not increase objective or subjective engagement in remote symptom tracking in our research cohort. This study provides an important foundation for understanding engagement with RMTs for research and the methodologies by which this work can be replicated in both community and clinical settings.\n\nTrial registration: ClinicalTrials.gov NCT04972474; https://clinicaltrials.gov/ct2/show/NCT04972474.\n\nInternational registered report identifier (irrid): RR2-10.2196/32653.\n\nKeywords: app; community; depression; engagement; mobile phone; remote measurement; self-awareness; smartphones; symptom tracking; technology; wearable devices.", "links": [] }, { "title": "The experiences of people with chronic obstructive pulmonary disease (COPD) using activity monitors in everyday life: an interpretative phenomenological study", "author": "Wilde, Laura J.; Percy, Carol; Ward, Gillian; Clark, Cain; Wark, Petra A.; Sewell, Louise", "year": "2024", "journalProceedings": "Disability and Rehabilitation", "category": "Usability", "devices": "Device unspecified", "population": "Adults", "dataUsed": "User Friendliness", "abstract": "Purpose: Understanding the experiences of people with Chronic Obstructive Pulmonary Disease (COPD) using activity monitors in daily life could support the utilisation of technology within healthcare to increase physical activity and support self-management. This qualitative study aimed to explore the experiences of people with COPD using activity monitors at home in everyday life.\n\nMethods: Semi-structured face-to-face or telephone interviews were conducted with seven people with COPD between August 2018 and June 2020. Participants had all used an activity monitor within the last year (Fitbit, Garmin, or Apple Watch). Interviews were analysed in-depth using Interpretative Phenomenological Analysis (IPA).\n\nResults: Four themes, developed using IPA, highlight participants' engagement with activity monitors and integrating them into their lives: (1) Motivational features to monitor activity, (2) Importance of setting achievable goals, (3) Developing knowledge and awareness, and (4) Integration into everyday life for self-management.\n\nConclusion: Activity monitors were perceived to be beneficial and useful to people with COPD, not just for monitoring their activity, but also helping to self-manage their condition. Activity monitors may be a useful tool within rehabilitation and healthcare services for COPD.\n\nKeywords: Activity tracker; exercise; physical activity; pulmonary rehabilitation; respiratory care; respiratory disease; self-management; wearable technology.", "links": [] }, { "title": "The Use of Wearable Devices in Oncology Patients: A Systematic Review", "author": "Chow, Ronald; Drkulec, Hannah; Im, James H. B.; Tsai, Jane; Nafees, Abdulwadud; Kumar, Swetlana; Hou, Tristan; Fazelzad, Rouhi; Leighl, Natasha B.; Krzyzanowska, Monika; Wong, Philip; Raman, Srinivas", "year": "2023", "journalProceedings": "The Oncologist", "category": "Systematic Review", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps,User Friendliness", "abstract": "Introduction: The aim of this systematic review was to summarize the current literature on wearable technologies in oncology patients for the purpose of prognostication, treatment monitoring, and rehabilitation planning.\n\nMethods: A search was conducted in Medline ALL, Cochrane Central Register of Controlled Trials, Embase, Emcare, CINAHL, Scopus, and Web of Science, up until February 2022. Articles were included if they reported on consumer grade and/or non-commercial wearable devices in the setting of either prognostication, treatment monitoring or rehabilitation.\n\nResults: We found 199 studies reporting on 18 513 patients suitable for inclusion. One hundred and eleven studies used wearable device data primarily for the purposes of rehabilitation, 68 for treatment monitoring, and 20 for prognostication. The most commonly-reported brands of wearable devices were ActiGraph (71 studies; 36%), Fitbit (37 studies; 19%), Garmin (13 studies; 7%), and ActivPAL (11 studies; 6%). Daily minutes of physical activity were measured in 121 studies (61%), and daily step counts were measured in 93 studies (47%). Adherence was reported in 86 studies, and ranged from 40% to 100%; of these, 63 (74%) reported adherence in excess of 80%.\n\nConclusion: Wearable devices may provide valuable data for the purposes of treatment monitoring, prognostication, and rehabilitation. Future studies should investigate live-time monitoring of collected data, which may facilitate directed interventions.\n\nKeywords: oncology; prognostication; treatment monitoring; wearable devices.", "links": [] }, { "title": "Links Between Objectively-Measured Hourly Smartphone Use and Adolescent Wake Events Across Two Weeks", "author": "Garrett, Shedrick L.; Burnell, Kaitlyn; Armstrong-Carter, Emma L.; Nelson, Benjamin W.; Prinstein, Mitchell J.; Telzer, Eva H.", "year": "2023", "journalProceedings": "Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53", "category": "Case Study", "devices": "Inspire 2", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "Purpose: Psychosocial and bioregulatory pressures threaten sleep during adolescence. Although recent work suggests that the ubiquity of smartphone use throughout adolescence may also relate to poorer sleep outcomes, most existing research relies upon self-report and retrospective measures. This study drew upon objective measures of smartphone use and sleep at the hourly level to understand how smartphone use was associated with the duration of wake events during sleeping hours.\n\nMethods: Across a 14-day daily study, 59 racially and ethnically diverse adolescents ages 15 to 18 had their sleep assessed via Fitbit Inspire 2 devices and uploaded screenshots of their screen time, pickups, and notifications as logged by their iPhone's iOS. Multi-level modeling was performed to assess hourly level associations between adolescent smartphone use and wake-events during their sleep sessions (N = 4,287 hourly cases).\n\nResults: In hours during adolescents' sleep session with more screen time or pickups, adolescents had longer wake event duration. More notifications in a given hour were not associated with wake event duration in the same hour.\n\nConclusions: Using objectively measured smartphone and sleep data collected at the hourly level, we found that during sleeping hours, when adolescents are actively engaging with their smartphones, their sleep is disrupted, such that their wake events are longer in that hour.", "links": [] }, { "title": "Tailor Made: A Pilot Virtual Weight Loss Intervention Individually Tailored for African American Men", "author": "Griffith, Derek M.; Jaeger, Emily C.; Pennings, Jacquelyn S.; Semlow, Andrea R.; Ellison, Jennifer M.; Alexander, Leah R.", "year": "2023", "journalProceedings": "Health Promotion Practice", "category": "Intervention", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps,User Friendliness", "abstract": "This study tests the acceptability and feasibility of the first virtual weight loss study individually tailored for middle-aged African American men. Tailor Made is a 3-month randomized controlled pilot of a weight loss intervention that included 58 overweight or obese African American men (mean age of 50.4; SD = 7.9). Control group participants received a Fitbit activity tracker and Bluetooth-enabled scale and copies of the self-led Tailor Made curriculum. Intervention group participants received the same Fitbit, Bluetooth-enabled scale, and curriculum and also participated in weekly, 45-minute virtual small group, professional-led education sessions using the Tailor Made curriculum and received three SMS text messages weekly: (a) a message individually tailored on African American Manhood that links men's values, goals, and motivation to health-promoting behavior; (b) a goal-tracking message to monitor physical activity, healthier eating, and lifestyle changes; and (c) a reminder 24 hours before their session. Participation rates in weekly small group sessions, randomization, and attendance at the assessments suggest that Tailor Made was feasible and acceptable. Only among intervention group participants, we found a small and significant decrease in BMI between baseline and final. In addition, active minutes of physical activity decreased for the control group while active minutes for the intervention group remained steady throughout the intervention. In sum, we demonstrated that a virtual, individually tailored weight loss intervention is feasible and acceptable to African American men. Participants valued the convenience of a virtual intervention, but there were a number of ways we may be able to enhance the potential benefits of this approach.\n\nKeywords: African American men; men’s health equity; nutrition; obesity; physical activity; weight loss.", "links": [] }, { "title": "Exploring Variations in Sleep Perception: Comparative Study of Chatbot Sleep Logs and Fitbit Sleep Data", "author": "Jang, Hyunchul; Lee, Siwoo; Son, Yunhee; Seo, Sumin; Baek, Younghwa; Mun, Sujeong; Kim, Hoseok; Kim, Icktae; Kim, Junho", "year": "2023", "journalProceedings": "JMIR mHealth and uHealth", "category": "Case Study", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background: Patient-generated health data are important in the management of several diseases. Although there are limitations, information can be obtained using a wearable device and time-related information such as exercise time or sleep time can also be obtained. Fitbits can be used to acquire sleep onset, sleep offset, total sleep time (TST), and wakefulness after sleep onset (WASO) data, although there are limitations regarding the depth of sleep and satisfaction; therefore, the patient's subjective response is still important information that cannot be replaced by wearable devices.\n\nObjective: To effectively use patient-generated health data related to time such as sleep, it is first necessary to understand the characteristics of the time response recorded by the user. Therefore, the aim of this study was to analyze the characteristics of individuals' time perception in comparison with wearable data.\n\nMethods: Sleep data were acquired for 2 weeks using a Fitbit. Participants' sleep records were collected daily through chatbot conversations while wearing the Fitbit, and the two sets of data were statistically compared.\n\nResults: In total, 736 people aged 30-59 years were recruited for this study, and the sleep data of 543 people who wore a Fitbit and responded to the chatbot for more than 7 days on the same day were analyzed. Research participants tended to respond to sleep-related times on the hour or in 30-minute increments, and each participant responded within the range of 60-90 minutes from the value measured by the Fitbit. On average for all participants, the chat responses and the Fitbit data were similar within a difference of approximately 15 minutes. Regarding sleep onset, the participant response was 8 minutes and 39 seconds (SD 58 minutes) later than that of the Fitbit data, whereas with respect to sleep offset, the response was 5 minutes and 38 seconds (SD 57 minutes) earlier. The participants' actual sleep time (AST) indicated in the chat was similar to that obtained by subtracting the WASO from the TST measured by the Fitbit. The AST was 13 minutes and 39 seconds (SD 87 minutes) longer than the time WASO was subtracted from the Fitbit TST. On days when the participants reported good sleep, they responded 19 (SD 90) minutes longer on the AST than the Fitbit data. However, for each sleep event, the probability that the participant's AST was within ±30 and ±60 minutes of the Fitbit TST-WASO was 50.7% and 74.3%, respectively.\n\nConclusions: The chatbot sleep response and Fitbit measured time were similar on average and the study participants had a slight tendency to perceive a relatively long sleep time if the quality of sleep was self-reported as good. However, on a participant-by-participant basis, it was difficult to predict participants' sleep duration responses with Fitbit data. Individual variations in sleep time perception significantly affect patient responses related to sleep, revealing the limitations of objective measures obtained through wearable devices.\n\nKeywords: Fitbit; PGHD; chat; patient-generated health data; self-report; sleep; sleep diary; sleep log; sleep time; wearables.", "links": [] }, { "title": "From intention to behavior: Within- and between-person moderators of the relationship between intention and physical activity", "author": "Knapova, Lenka; Cho, Young Won; Chow, Sy-Miin; Kuhnova, Jitka; Elavsky, Steriani", "year": "2024", "journalProceedings": "Psychology of Sport and Exercise", "category": "Case Study", "devices": "Charge 3,Charge 4", "population": "Adults", "dataUsed": "Steps", "abstract": "Intention is a proximal predictor of behavior in many theories of behavior change, but intentions to be physically active do not always translate to actual physical activity. Little research has examined intensive longitudinal changes in physical activity and corresponding within-person moderators needed to elucidate the mechanisms, hurdles, and facilitators of individuals' everyday physical activity behaviors. The present study set out to evaluate the possible moderators of the intention-physical activity relationship across within-person and between-person levels, including cross-level interactions. Data comprise the first intensive measurement burst (14 days) of the longitudinal prospective Healthy Aging in Industrial Environment (HAIE) study, with N = 1135 participants (N = 10,030 person-days), aged 18-65. Physical activity was operationalized as step counts measured objectively using Fitbit Charge 3/4 fitness monitor. Intention, barriers to physical activity, and social support for physical activity were measured daily via smartphone surveys. Stable characteristics, i.e., physical activity habit and exercise identity, were measured using an online questionnaire. A multilevel moderation regression model with Bayesian estimator was fitted. At the within-person level, the relation between intention and steps was weaker on days when barriers were more severe than usual for a given person (Estimate = -0.267; CI95 = [-0.340, -0.196]) and social support was below average for a given person (Est = 0.143; CI95 = [0.023, 0.262]). Additionally, the daily intention-behavior relationship was stronger for people with lower average severity of barriers (Est = -0.153; CI95 = [-0.268, -0.052]), higher exercise identity (Est = 0.300; CI95 = [0.047, 0.546]), men (Est = -1.294, CI95 = [-1.854, -0.707]), and older individuals (Est = 0.042, CI95 = [0.017, 0.064]). At the between-person level, only physical activity habit strengthened the intention-behavior link (Est = 0.794; CI95 = [0.090, 1.486]). Our results underscore the need to separate the between-person differences from the within-person fluctuations to better understand the individual dynamics in physical activity behaviors. Personalized interventions aimed at helping individuals translate intentions to actual physical activity could be tailored and become more intensive when there is a higher risk of intention-behavior gap on a given day for a specific individual (i.e., a day with more severe barriers and less social support), by increasing the dosage or deploying more precisely targeted intervention strategies and components. In addition, interventionists should take gender and age into account when tailoring everyday strategies to help individuals act on their intentions.\n\nKeywords: Barriers; Intention; Intention-behavior gap; Physical activity; Social support.", "links": [] }, { "title": "Comparing self-reported energy intake using an online dietary tool with energy expenditure by an activity tracker", "author": "Vasileiou, Aikaterina; Searle, Dominique; Larsen, Sofus C.; Magkos, Faidon; Horgan, Graham; Stubbs, R. James; Santos, Inês; Palmeira, António L.; Heitmann, Berit L.", "year": "2024", "journalProceedings": "Nutrition (Burbank, Los Angeles County, Calif.)", "category": "Validation", "devices": "Charge 2", "population": "Adults", "dataUsed": "Energy Expenditure,Heart Rate", "abstract": "Objective: The aim of this study was to compare self-reported total energy intake (TEI) collected using an online multiple-pass 24-h dietary recall tool (Intake24) with total energy expenditure (TEE) estimated from Fitbit Charge 2-improved algorithms in adults from the NoHoW trial (12-mo weight maintenance after free-living weight loss).\n\nMethods: Bland-Altman plots were used to assess the level of agreement between TEI and TEE at baseline and after 12 mo. The ratio of TEI to TEE was also calculated.\n\nResults: Data from 1323 participants (71% female) was included in the analysis (mean ± SD: age 45 ± 12 y, body mass index 29.7 ± 5.4 kg/m2, initial weight loss 11.5 ± 6.5 kg). The TEI was lower than TEE on average by 33%, with limits of agreement ranging from -91% to +25%. Men, younger individuals, those with higher body mass index, those with the greater weight loss before enrollment, and those who gained weight during the study underestimated to a greater extent.\n\nConclusions: These findings contribute to the ongoing research examining the validity of technology-based dietary assessment tools.\n\nKeywords: 24-h dietary recall tool; Digital dietary assessment tools; Fitbit; Intake24; Wearable technology; Weight loss maintenance.", "links": [] }, { "title": "Patient Engagement and Provider Effectiveness of a Novel Sleep Telehealth Platform and Remote Monitoring Assessment in the US Military: Pilot Study Providing Evidence-Based Sleep Treatment Recommendations", "author": "Wickwire, Emerson M.; Collen, Jacob; Capaldi, Vincent F.; Williams, Scott G.; Assefa, Samson Z.; Adornetti, Julianna P.; Huang, Kathleen; Venezia, Janet M.; Jones, Rachell L.; Johnston, Christine W.; Thomas, Connie; Thomas, Mary Ann; Mounts, Charles; Drake, Christopher L.; Businelle, Michael S.; Grandner, Michael A.; Manber, Rachel; Albrecht, Jennifer S.", "year": "2023", "journalProceedings": "JMIR formative research", "category": "Medical", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Sleep", "abstract": "Background: Sleep problems are common and costly in the US military. Yet, within the military health system, there is a gross shortage of trained specialist providers to address sleep problems. As a result, demand for sleep medicine care far exceeds the available supply. Telehealth including telemedicine, mobile health, and wearables represents promising approaches to increase access to high-quality and cost-effective care.\n\nObjective: The purpose of this study was to evaluate patient engagement and provider perceived effectiveness of a novel sleep telehealth platform and remote monitoring assessment in the US military. The platform includes a desktop web portal, native mobile app, and integrated wearable sensors (ie, a commercial off-the-shelf sleep tracker [Fitbit]). The goal of the remote monitoring assessment was to provide evidence-based sleep treatment recommendations to patients and providers.\n\nMethods: Patients with sleep problems were recruited from the Internal Medicine clinic at Walter Reed National Military Medical Center. Patients completed intensive remote monitoring assessments over 10 days (including a baseline intake questionnaire, daily sleep diaries, and 2 daily symptom surveys), and wore a Fitbit sleep tracker. Following the remote monitoring period, patients received assessment results and personalized sleep education in the mobile app. In parallel, providers received a provisional patient assessment report in an editable electronic document format. Patient engagement was assessed via behavioral adherence metrics that were determined a priori. Patients also completed a brief survey regarding ease of completion. Provider effectiveness was assessed via an anonymous survey.\n\nResults: In total, 35 patients with sleep problems participated in the study. There were no dropouts. Results indicated a high level of engagement with the sleep telehealth platform, with all participants having completed the baseline remote assessment, reviewed their personalized sleep assessment report, and completed the satisfaction survey. Patients completed 95.1% of sleep diaries and 95.3% of symptom surveys over 10 days. Patients reported high levels of satisfaction with most aspects of the remote monitoring assessment. In total, 24 primary care providers also participated and completed the anonymous survey. The results indicate high levels of perceived effectiveness and identified important potential benefits from adopting a sleep telehealth approach throughout the US military health care system.\n\nConclusions: Military patients with sleep problems and military primary care providers demonstrated high levels of engagement and satisfaction with a novel sleep telehealth platform and remote monitoring assessment. Sleep telehealth approaches represent a potential pathway to increase access to evidence-based sleep medicine care in the US military. Further evaluation is warranted.\n\nKeywords: application; behavioral; care; effective care; effectiveness; insomnia; monitoring; obstructive sleep apnea; patient engagement; remote monitoring; sleep; sleep disorders; telehealth; wearables.", "links": [] }, { "title": "Using Wearable Devices to Profile Demographic-Specific Recovery After Pediatric Appendectomy", "author": "Zeineddin, Suhail; Figueroa, Angie; Pitt, J. Benjamin; Carter, Michela; DeTella, Mia; Perez, Amparo; Park, Erica; Kwon, Soyang; Ghomrawi, Hassan; Abdullah, Fizan", "year": "2023", "journalProceedings": "The Journal of Surgical Research", "category": "Case Study", "devices": "Inspire HR,Inspire 2", "population": "Patients,Children", "dataUsed": "Steps", "abstract": "Introduction: Counseling patients and parents about the postoperative recovery expectations for physical activity after pediatric appendectomy varies significantly and is not specific to patients' demographic characteristics. Consumer wearable devices (CWD) can be used to objectively assess patients' normative postoperative recovery of physical activity. This study aimed to develop demographic-specific normative physical activity recovery trajectories using CWD in pediatric patients undergoing appendectomy.\n\nMethods: Children ages 3-18 y old undergoing laparoscopic appendectomy for acute appendicitis were recruited. Patients wore a Fitbit device for 21 d postoperatively and daily step counts were measured. Patients with postoperative complications were excluded. Segmented regression models were fitted and time-to-plateau was estimated for patients with simple and complicated appendicitis separately for each age group, sex, race/ethnicity, and body mass index category.\n\nResults: Among 147 eligible patients; 76 (51.7%) were female, 86 (58.5%) were in the younger group, and 79 (53.7%) had complicated appendicitis. Patients 3-11 y old demonstrated a faster trajectory to a physical activity plateau compared to those 12-18 in both simple (postoperative day [POD] 9 versus POD 17) and complicated appendicitis (POD 17 versus POD 21). Males and females had a similar postoperative recovery trajectory in simple and complicated appendicitis. There was no clear pattern differentiating trajectories based on race/ethnicity. Overweight/obese patients demonstrated a slower recovery trajectory in simple appendicitis.\n\nConclusions: This study demonstrates that factors other than the disease itself, such as age, may affect recovery, suggesting the need for more tailored discharge instructions. CWDs can improve our understanding of recovery and allow for better data-driven counseling perioperatively.\n\nKeywords: Appendectomy; Appendicitis; BMI; Demographics; Fitbit; Recovery; Wearable devices.", "links": [] }, { "title": "Association between sleep quality and nocturnal erection monitor by RigiScan in erectile dysfunction patients: a prospective study using fitbit charge 2", "author": "Zhang, Yuyang; Zhang, Wei; Feng, Xingliang; Liu, Guodong; Wu, Xu; Jiang, Hui; Zhang, Xiansheng", "year": "2023", "journalProceedings": "Basic and Clinical Andrology", "category": "Case Study", "devices": "Charge 2", "population": "Patients", "dataUsed": "Sleep", "abstract": "Background: Few studies were conducted to explore the association between sleep quality and nocturnal erection. Here, we intended to explore the association between sleep quality and nocturnal erection monitor when conducting nocturnal erection monitor. All erectile dysfunction (ED) patients underwent sleep monitors using Fitbit Charge 2™ (Fitbit Inc.) and nocturnal penile tumescence and rigidity (NPTR) monitors using RigiScan® (GOTOP medical, Inc., USA) for two nights. Subsequently, the patients were divided into two groups: Group A included patients who experienced effective erections only on the second night, while Group B included patients who had effective erections on both nights. To explore the associations between NPTR parameters and sleep parameters, a comparative analysis was performed between Group A and Group B for both nights.\n\nResults: Finally, our study included 103 participants, with 47 patients in Group A and 56 patients in Group B. Notably, the Group A patients showed significant improvements in NPTR parameters on the second night compared to the first night. Conversely, the NPTR parameters on Group B of the second night did not demonstrate a superior outcome when compared to the second night of Group A. Interestingly, it was found that only the disparities in sleep parameters accounted for the variation in NPTR parameters between the two groups on the first night. After correlation and ROC analysis, we identified the rapid eye movement (REM) sleep time and wake after sleep onset (WASO) time monitoring by the Fitbit Charge 2 as the primary parameters for predicting abnormal NPTR results in the first night.\n\nConclusions: Therefore, our study strongly suggests a close association between sleep parameters and NPTR parameters. It emphasizes the importance of incorporating sleep monitoring alongside nocturnal erection monitoring to enhance the reliability of the NPTR results.\n\nKeywords: Erectile dysfunction; Fitbit Charge 2™; Nocturnal erection monitor; RigiScan; Sleep quality.", "links": [] }, { "title": "Physical activity and menopausal symptoms: evaluating the contribution of obesity, fitness, and ambient air pollution status", "author": "Elavsky, Steriani; Burda, Michal; Cipryan, Lukáš; Kutáč, Petr; Bužga, Marek; Jandačková, Vera; Chow, Sy-Miin; Jandačka, Daniel", "year": "2024", "journalProceedings": "Menopause (New York, N.Y.)", "category": "Case Study", "devices": "Charge 3", "population": "Older Adults,Adults", "dataUsed": "Intensity", "abstract": "OBJECTIVE: The menopausal transition is accompanied by transient symptoms that have been linked to subclinical cardiovascular disease (CVD); CVD has also been linked to air pollution. Physical activity (PA) reduces CVD, improves body composition, and can reduce menopausal symptoms. The purpose of this study was to assess the links between PA and menopausal symptoms and whether obesity, fitness, and air pollution status play a role in this relationship. METHODS: Women (40-60 y; N = 243; mean [SD] age, 47.8 [5.6] y) from areas with high versus low air pollution enrolled in the Healthy Aging in Industrial Environment Program 4 prospective cohort study completed psychological, cardiorespiratory fitness, body composition, and menopausal status screening followed by a 14-day prospective assessment of menopausal symptoms (Menopause Rating Scale) using a mobile application. Daily PA was assessed objectively across 14 days via Fitbit Charge 3 monitor. General linear mixed models were conducted and controlled for age, menopausal status, day in the study, wear time, and neuroticism. RESULTS: Peri/postmenopausal women (β = 0.43, P {\\textless} 0.001) and those residing in a high-air-pollution environment (β = 0.45, P {\\textless} 0.05) reported more somatovegetative symptoms. Hot flashes alone were associated with peri/postmenopausal status (β = 0.45, P {\\textless} 0.001), and for women residing in a high-air-pollution environment, lower reporting of hot flashes was observed on days when a woman was more physically active than usual (β = -0.15, P {\\textless} 0.001). No associations were found for cardiorespiratory fitness and visceral fat with any of the symptoms. CONCLUSIONS: PA may enhance resilience to hot flashes, especially when residing in high-air-pollution environments where we also observed higher reporting of somatovegetative menopausal symptoms.", "links": [] }, { "title": "The Annual Rhythms in Sleep, Sedentary Behavior, and Physical Activity of Australian Adults: A Prospective Cohort Study", "author": "Ferguson, Ty; Curtis, Rachel; Fraysse, François; Olds, Timothy; Dumuid, Dorothea; Brown, Wendy; Esterman, Adrian; Maher, Carol", "year": "2024", "journalProceedings": "Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine", "category": "Case Study", "devices": "Charge 3", "population": "Adults", "dataUsed": "Intensity,Sleep", "abstract": "BACKGROUND: Sleep, sedentary behavior, and physical activity have fundamental impacts on health and well-being. Little is known about how these behaviors vary across the year. PURPOSE: To investigate how movement-related behaviors change across days of the week and seasons, and describe movement patterns across a full year and around specific temporal events. METHODS: This cohort study included 368 adults (mean age = 40.2 years [SD = 5.9]) who wore Fitbit activity trackers for 12 months to collect minute-by-minute data on sleep, sedentary behavior, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Data were analyzed descriptively, as well as through multilevel mixed-effects linear regression to explore associations with specific temporal cycles (day-of-the-week, season) and events. RESULTS: Movement patterns varied significantly by day-of-the-week and season, as well as during annual events like Christmas-New Year and daylight saving time (DST) transitions. For example, sleep was longer on weekends (+32 min/day), during autumn and winter relative to summer (+4 and +11 min/day), and over Christmas-New Year (+24 min/day). Sedentary behavior was longer on weekdays, during winter, after Christmas-New Year, and after DST ended (+45, +7, +12, and +8 min/day, respectively). LPA was shorter in autumn, winter, and during and after Christmas-New Year (-6, -15, -17, and -31 min/day, respectively). Finally, there was less MVPA on weekdays and during winter (-5 min/day and -2 min/day, respectively). CONCLUSIONS: Across the year, there were notable variations in movement behaviors. Identifying high-risk periods for unfavorable behavior changes may inform time-targeted interventions and health messaging.", "links": [] }, { "title": "Psychological and behavioral responses to daily weight gain during behavioral weight loss treatment", "author": "Hagerman, Charlotte J.; Onu, Michael C.; Crane, Nicole T.; Butryn, Meghan L.; Forman, Evan M.", "year": "2024", "journalProceedings": "Journal of Behavioral Medicine", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Energy Expenditure", "abstract": "Self-weighing is consistently associated with more effective weight control. However, patterns show that participants disengage from their weight control behaviors following weight gain. Women with BMIs in the overweight/obese range (N = 50) enrolled in a long-term behavioral weight loss program completed ecological momentary assessment (EMA) surveys immediately after their daily weigh-ins. Nightly EMA surveys and self-monitoring data through Fitbit measured their weight control behavior that day. On days when participants gained weight (vs. lost or maintained), they reported more negative mood, more guilt/shame, and lower confidence in weight control. Motivation following daily weight gain depended on participants' overall satisfaction with their weight loss so far: more satisfied participants had marginally higher, but less satisfied participants had marginally lower motivation in response to daily weight gain. Greater guilt/shame and lower motivation after the weigh-in predicted less effective weight control behavior that day (e.g., lower likelihood of calorie tracking, fewer minutes of physical activity). Results demonstrate that even small weight gain is distressing and demoralizing for women in BWL programs, which can lead to goal disengagement. These findings have implications for future BWL interventions, including the potential utility of just-in-time adaptive interventions to promote more adaptive responses in the moments after weigh-ins.", "links": [] }, { "title": "Comparison of daily step count between the Fitbit Inspire 3 and the activPAL 3 in adults with transtibial amputation", "author": "Leister, Kyle R.; Burke, Sara E.; Kim, Joon Young; Duenas, Victor H.; Barreira, Tiago V.", "year": "2024", "journalProceedings": "Frontiers in Rehabilitation Sciences", "category": "Validation", "devices": "Inspire 3", "population": "Adults", "dataUsed": "Steps", "abstract": "INTRODUCTION: Physical activity has significant positive effects on health. Accelerometers can be used to track daily physical activity. The Fitbit Inspire 3 is a commercially available health and fitness tracker, but its validity for tracking steps among individuals with transtibial amputation has not been examined. Therefore, the purpose of this study was to evaluate the concurrent validity of the Fitbit Inspire 3 for assessing free-living daily steps in adults with transtibial amputation. METHODS: Participants (n = 79) completed a general health survey and were provided with a Fitbit Inspire 3 and activPAL 3 accelerometer to wear concurrently for seven days in their home environment. Relationships between the activPAL and Fitbit Inspire 3 were examined using Pearson's Correlation. Paired samples t-tests, mean difference, mean absolute difference, and equivalence testing were used to compared daily step counts between Fitbit Inspire 3 and activPAL 3. RESULTS: Average step counts were 5,768 ± 3,750 (mean ± SD) and 4,674 ± 3,081 by the Fitbit Inspire 3 and activPAL, respectively. A high correlation (r = 0.93) but significant mean difference was found between the activPAL 3 and Fitbit Inspire 3 (p {\\textless} 0.001). The mean absolute difference between the devices was 1,347 ± 1,184 steps. On average, the Fitbit Inspire 3 counted 1,094 ± 1,423 more daily steps than the activPAL 3. Equivalency could not be claimed between the devices. DISCUSSION: The Fitbit Inspire 3 counted more steps compared to the activPAL. Because of the significant mean differences and the large mean absolute difference between the devices, the activPAL 3 and Fitbit Inspire 3 are not interchangeable for estimating physical activity in individuals with transtibial amputation. However, due to the high correlation, the devices will produce similar classification rankings based on step counts.", "links": [] }, { "title": "A comparison of the rates of clock-based nocturnal hypoglycemia and hypoglycemia whilst asleep among people living with diabetes: findings from the Hypo-METRICS study", "author": "Martine-Edith, Gilberte; Divilly, Patrick; Zaremba, Natalie; Søholm, Uffe; Broadley, Melanie; Baumann, Petra Martina; Mahmoudi, Zeinab; Gomes, Mikel; Ali, Namam; Abbink, Evertine J.; de Galan, Bastiaan E.; Brøsen, Julie Maria Bøggild; Pedersen-Bjergaard, Ulrik; Vaag, Allan A.; McCrimmon, Rory; Renard, Eric; Heller, Simon; Evans, Mark; Cigler, Monika; Mader, Julia K.; Speight, Jane; Pouwer, Frans; Amiel, Stephanie; Choudhary, Pratik", "year": "2024", "journalProceedings": "Diabetes Technology \\& Therapeutics", "category": "Case Study", "devices": "Charge 4", "population": "Adults", "dataUsed": "Sleep", "abstract": "Introduction Nocturnal hypoglycemia is generally calculated between 00:00 and 06:00. However, those hours may not accurately reflect sleeping patterns and it is unknown whether this leads to bias. We therefore compared hypoglycemia rates whilst asleep to those of clock-based nocturnal hypoglycemia in adults with type 1 (T1D) or insulin-treated type 2 diabetes (T2D). Methods Participants from the Hypo-METRICS study wore a blinded continuous glucose monitor and a Fitbit Charge 4 activity monitor for 10 weeks. They recorded details of episodes of hypoglycemia using a smartphone app. Sensor-detected hypoglycemia (SDH) and person-reported hypoglycemia (PRH) were categorized as nocturnal (00:00-06:00hrs) vs diurnal and whilst asleep vs awake defined by Fitbit sleeping intervals. Paired sample Wilcoxon tests were used to examine the differences in hypoglycemia rates. Results 574 participants (47\\% T1D, 45\\% women, 89\\% White, median (IQR) age 56 (45-66) years and HbA1c 7.3\\% (6.8-8.0)) were included. Median sleep duration was 6.1h (5.2-6.8), bedtime and waking time approximately 23:30 and 07:30 respectively. There were higher median weekly rates of SDH and PRH whilst asleep than clock-based nocturnal SDH and PRH among people with T1D, especially for SDH{\\textless}70 mg/dL (1.7 vs 1.4, p{\\textless}0.001). Higher weekly rates of SDH whilst asleep than nocturnal SDH were found among people with T2D, especially for SDH{\\textless}70 mg/dL (0.8 vs 0.7, p{\\textless}0.001). Conclusion Using 00:00 to 06:00 as a proxy for sleeping hours may underestimate hypoglycemia whilst asleep. Future hypoglycemia research should consider the use of sleep trackers to record sleep and reflect hypoglycemia whilst asleep more accurately.", "links": [] }, { "title": "Effects of a mobile health intervention on health-related outcomes in Japanese office workers: a pilot study", "author": "Meguro, Takumi; Takayama, Fuminori; Hammarlund, Hampus; Honjo, Masaru", "year": "2024", "journalProceedings": "International Journal of Occupational Medicine and Environmental Health", "category": "Intervention", "devices": "Fitbit Luxe", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "OBJECTIVES: The purpose of the current study was to explore the effects of a mobile health (mHealth) intervention based on the Persuasive System Design (PSD) model on health-related outcomes among office workers. MATERIAL AND METHODS: The authors conducted a trial that consisted of a 4-week baseline and an 8-week intervention period by reference to 23 office workers in a private research company. The mHealth application was developed to improve these workers' daily step count, decrease their sedentary time, and increase their sleep duration in accordance with the PSD model. The app features included at least 1 principal factor from each of the 4 main categories of the PSD model (primary task support, dialogue support, system credibility support, and social support). The objective health-related variables were measured using a smartwatch (Fitbit Luxe) that was synchronized with the application using the Fitbit Web Application Programming Interface. Subjects used the app, which included self-monitoring, personalized messages, education, and a competition system for users, during the intervention period. RESULTS: Sedentary time exhibited a significant decrease (a median reduction of 14 min/day, p {\\textless} 0.05) during the intervention period. No significant differences in daily step count and sleep duration were observed between the baseline and intervention periods. CONCLUSIONS: This study suggests that the mHealth intervention based on the PSD model was useful for reducing sedentary time among office workers. Given that many previous studies on this topic have not been based on any theories, future studies should investigate the impact of structured selection behavior change theories on health-related outcomes among office workers. Int J Occup Med Environ Health. 2024;37(2).", "links": [] }, { "title": "Reducing the burden of inconclusive smart device single-lead ECG tracings via a novel artificial intelligence algorithm", "author": "Weidlich, Simon; Mannhart, Diego; Kennedy, Alan; Doggart, Peter; Serban, Teodor; Knecht, Sven; Du Fay de Lavallaz, Jeanne; Kühne, Michael; Sticherling, Christian; Badertscher, Patrick", "year": "2024", "journalProceedings": "Cardiovascular Digital Health Journal", "category": "Case Study", "devices": "Sense", "population": "Patients,Adults", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Multiple smart devices capable of automatically detecting atrial fibrillation (AF) based on single-lead electrocardiograms (SL-ECG) are presently available. The rate of inconclusive tracings by manufacturers' algorithms is currently too high to be clinically useful. METHOD: This is a prospective, observational study enrolling patients presenting to a cardiology service at a tertiary referral center. We assessed the clinical value of applying a smart device artificial intelligence (AI)-based algorithm for detecting AF from 4 commercially available smart devices (AliveCor KardiaMobile, Apple Watch 6, Fitbit Sense, and Samsung Galaxy Watch3). Patients underwent a nearly simultaneous 12-lead ECG and 4 smart device SL-ECGs. The novel AI algorithm (PulseAI, Belfast, United Kingdom) was compared with each manufacturer's algorithm. RESULTS: We enrolled 206 patients (31\\% female, median age 64 years). AF was present in 60 patients (29\\%). Sensitivity and specificity for the detection of AF by the novel AI algorithm vs manufacturer algorithm were 88\\% vs 81\\% (P = .34) and 97\\% vs 77\\% (P {\\textless} .001) for the AliveCor KardiaMobile, 86\\% vs 81\\% (P = .45) and 95\\% vs 83\\% (P {\\textless} .001) for the Apple Watch 6, 91\\% vs 67\\% (P {\\textless} .01) and 94\\% vs 82\\% (P {\\textless} .001) for the Fitbit Sense, and 86\\% vs 82\\% (P = .63) and 94\\% vs 80\\% (P {\\textless} .001) for the Samsung Galaxy Watch3, respectively. In addition, the proportion of SL-ECGs with an inconclusive diagnosis (1.2\\%) was significantly lower for all smart devices using the AI-based algorithm compared to manufacturer's algorithms (14\\%-17\\%), P {\\textless} .001. CONCLUSION: A novel AI algorithm reduced the rate of inconclusive SL-ECG diagnosis massively while maintaining sensitivity and improving the specificity compared to the manufacturers' algorithms.", "links": [] }, { "title": "Missing Data Statistics Provide Causal Insights into Data Loss in Diabetes Health Monitoring by Wearable Sensors", "author": "Braem, Carlijn I. R.; Yavuz, Utku S.; Hermens, Hermie J.; Veltink, Peter H.", "year": "2024", "journalProceedings": "Sensors (Basel, Switzerland)", "category": "Systematic Review", "devices": "Charge HR,Charge 2", "population": "Patients", "dataUsed": "Steps,Heart Rate", "abstract": "Background: Data loss in wearable sensors is an inevitable problem that leads to misrepresentation during diabetes health monitoring. We systematically investigated missing wearable sensors data to get causal insight into the mechanisms leading to missing data.\n\nMethods: Two-week-long data from a continuous glucose monitor and a Fitbit activity tracker recording heart rate (HR) and step count in free-living patients with type 2 diabetes mellitus were used. The gap size distribution was fitted with a Planck distribution to test for missing not at random (MNAR) and a difference between distributions was tested with a Chi-squared test. Significant missing data dispersion over time was tested with the Kruskal-Wallis test and Dunn post hoc analysis.\n\nResults: Data from 77 subjects resulted in 73 cleaned glucose, 70 HR and 68 step count recordings. The glucose gap sizes followed a Planck distribution. HR and step count gap frequency differed significantly (p < 0.001), and the missing data were therefore MNAR. In glucose, more missing data were found in the night (23:00-01:00), and in step count, more at measurement days 6 and 7 (p < 0.001). In both cases, missing data were caused by insufficient frequency of data synchronization.\n\nConclusions: Our novel approach of investigating missing data statistics revealed the mechanisms for missing data in Fitbit and CGM data.\n\nKeywords: activity trackers; biomedical sensors; continuous glucose monitoring; health monitoring; heart rate; missing data; signal processing; vital signs; wearable sensors.", "links": [] }, { "title": "Assessment of Fitbit Charge 4 for sleep stage and heart rate monitoring against polysomnography and during home monitoring in Huntington's disease", "author": "Doheny, Emer P.; Renerts, Klavs; Braun, Andreas; Werth, Esther; Baumann, Christian; Baumgartner, Philipp; Morgan-Jones, Philippa; Busse, Monica; Lowery, Madeleine M.; Jung, Hans H.", "year": "2024", "journalProceedings": "Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine", "category": "Validation", "devices": "Charge 4", "population": "Adults", "dataUsed": "Sleep,Heart Rate", "abstract": "Study objectives: Wearable devices, monitoring sleep stages and heart rate (HR), bring the potential for longitudinal sleep monitoring in patients with neurodegenerative diseases. Sleep quality reduces with disease progression in Huntington's disease (HD). However, the involuntary movements characteristic of HD may affect the accuracy of wrist-worn devices. This study compares sleep stage and heart rate data from the Fitbit Charge 4 (FB) against polysomnography (PSG) in participants with HD.\n\nMethods: Ten participants with manifest HD wore a FB during overnight hospital-based PSG, and for nine of these participants continued to wear the FB for seven nights at home. Sleep stages (30s epochs) and minute-by-minute HR were extracted and compared against PSG data.\n\nResults: FB-estimated total sleep and wake times, and sleep stage times were in good agreement with PSG, with intra-class correlations 0.79-0.96. However, poor agreement was observed for Wake After Sleep Onset, and the number of awakenings. FB detected wake with 68.6±15.5% sensitivity and 93.7±2.5% specificity, rapid eye movement (REM) sleep with high sensitivity and specificity (78.7±31.9%, 95.6±2.3%), and deep sleep with lower sensitivity but high specificity (56.4±28.8%, 95.0±4.8%). FB HR was strongly correlated with PSG, and the mean absolute error between FB and PSG HR data was 1.16 ± 0.42 bpm. At home, longer sleep and shorter wake times were observed compared to hospital data, while percentage sleep stage times were consistent with hospital data.\n\nConclusions: Results suggest the potential for long-term monitoring of sleep patterns using wrist-worn wearable devices as part of symptom management in HD.\n\nKeywords: PPG; PSG; home monitoring; neurodegeneration; wearable sensor.", "links": [] }, { "title": "Imagery rescripting and cognitive restructuring for inpatients with moderate and severe depression - a controlled pilot study", "author": "Kanczok, Jabin; Jauch-Chara, Kamila; Müller, Franz-Josef", "year": "2024", "journalProceedings": "BMC psychiatry", "category": "Intervention", "devices": "Charge 3", "population": "Patients", "dataUsed": "Steps", "abstract": "Background: This controlled pilot study investigates the effect of the combined use of cognitive restructuring (CR) and imagery rescripting (IR) compared to treatment as usual among inpatients with moderate and severe depression. Alongside expert ratings and self-report tools, fitness wristbands were used as an assessment tool.\n\nMethods: In addition to the standard inpatient care (SIC) program, 33 inpatients with moderate and severe depression were randomly assigned to an intervention group (two sessions of IR and CR) or an active treatment-as-usual (TAU) control group (two sessions of problem-solving and build-up of positive activity). Depression severity was assessed by the Hamilton Depression Rating Scale-21 (HDRS-21), the Beck Depression Inventory-II (BDI-II), and as a diagnostic adjunct daily step count via the Fitbit Charge 3™. We applied for analyses of HDRS-21 and BDI-II, 2 × 2 repeated-measures analysis of variance (ANOVA), and an asymptotic Wilcoxon test for step count.\n\nResults: The main effect of time on both treatments was η2 = .402. Based on the data from the HDRS-21, patients in the intervention group achieved significantly greater improvements over time than the TAU group (η2 = .34). The BDI-II data did not demonstrate a significant interaction effect by group (η2 = .067). The daily hourly step count for participants of the intervention group was significantly higher (r = .67) than the step count for the control group.\n\nConclusions: The findings support the utilization of imagery-based interventions for treating depression. They also provide insights into using fitness trackers as psychopathological assessment tools for depressed patients.\n\nTrial registration: The trial is registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien) under the registration number: DRKS00030809.\n\nKeywords: Cognitive restructuring; Depression; Fitness wristband; Imagery rescripting.", "links": [] }, { "title": "Feasibility Study on Menstrual Cycles With Fitbit Device (FEMFIT): Prospective Observational Cohort Study", "author": "Lang, Anna-Lena; Bruhn, Rosa-Lotta; Fehling, Maya; Heidenreich, Anouk; Reisdorf, Jonathan; Khanyaree, Ifrah; Henningsen, Maike; Remschmidt, Cornelius", "year": "2024", "journalProceedings": "JMIR mHealth and uHealth", "category": "Case Study", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Background: Despite its importance to women's reproductive health and its impact on women's daily lives, the menstrual cycle, its regulation, and its impact on health remain poorly understood. As conventional clinical trials rely on infrequent in-person assessments, digital studies with wearable devices enable the collection of longitudinal subjective and objective measures.\n\nObjective: The study aims to explore the technical feasibility of collecting combined wearable and digital questionnaire data and its potential for gaining biological insights into the menstrual cycle.\n\nMethods: This prospective observational cohort study was conducted online over 12 weeks. A total of 42 cisgender women were recruited by their local gynecologist in Berlin, Germany, and given a Fitbit Inspire 2 device and access to a study app with digital questionnaires. Statistical analysis included descriptive statistics on user behavior and retention, as well as a comparative analysis of symptoms from the digital questionnaires with metrics from the sensor devices at different phases of the menstrual cycle.\n\nResults: The average time spent in the study was 63.3 (SD 33.0) days with 9 of the 42 individuals dropping out within 2 weeks of the start of the study. We collected partial data from 114 ovulatory cycles, encompassing 33 participants, and obtained complete data from a total of 50 cycles. Participants reported a total of 2468 symptoms in the daily questionnaires administered during the luteal phase and menses. Despite difficulties with data completeness, the combined questionnaire and sensor data collection was technically feasible and provided interesting biological insights. We observed an increased heart rate in the mid and end luteal phase compared with menses and participants with severe premenstrual syndrome walked substantially fewer steps (average daily steps 10,283, SD 6277) during the luteal phase and menses compared with participants with no or low premenstrual syndrome (mean 11,694, SD 6458).\n\nConclusions: We demonstrate the feasibility of using an app-based approach to collect combined wearable device and questionnaire data on menstrual cycles. Dropouts in the early weeks of the study indicated that engagement efforts would need to be improved for larger studies. Despite the challenges of collecting wearable data on consecutive days, the data collected provided valuable biological insights, suggesting that the use of questionnaires in conjunction with wearable data may provide a more complete understanding of the menstrual cycle and its impact on daily life. The biological findings should motivate further research into understanding the relationship between the menstrual cycle and objective physiological measurements from sensor devices.\n\nKeywords: PMS; digital health; menstrual cycle; mobile app; premenstrual syndrome; sensor data; wearable device; women’s health.", "links": [] }, { "title": "Optimization of mHealth behavioral interventions for patients with chronic lymphocytic leukemia: the HEALTH4CLL study", "author": "Lee, Che Young; Gordon, Max J.; Markofski, Melissa M.; LaVoy, Emily C.; Peterson, Susan K.; Li, Liang; Fares, Sara; Baum, Miranda; Pace, Margaret; Walsh, Danielle; Ferrajoli, Alessandra; Basen-Engquist, Karen", "year": "2024", "journalProceedings": "Journal of Cancer Survivorship: Research and Practice", "category": "Intervention", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps,Energy Expenditure,Goals,Food,Active Minutes/Active Zone Minutes", "abstract": "Purpose: This pilot study of a diet and physical activity intervention (HEALTH4CLL) was conducted to reduce fatigue and improve physical function (PF) in patients with chronic lymphocytic leukemia (CLL).\n\nMethods: The HEALTH4CLL study used a randomized factorial design based on the multiphase optimization strategy (MOST). Patients received diet, exercise, and body weight management instructional materials plus a Fitbit and were randomized to undergo one of 16 combinations of 4 evidence-based mHealth intervention strategies over 16 weeks. Patients' fatigue, PF, health-related quality of life, behavior changes, and program satisfaction and retention were assessed. Paired t-tests were used to examine changes in outcomes from baseline to follow-up among patients. Factorial analysis of variance examined effective intervention components and their combinations regarding improvement in fatigue and PF scores.\n\nResults: Among 31 patients, we observed significant improvements in fatigue (+ 11.8; t = 4.08, p = 0.001) and PF (+ 2.6; t = 2.75, p = 0.01) scores. The combination of resistance and aerobic exercise with daily self-monitoring was associated with improved fatigue scores (β = 3.857, SE = 1.617, p = 0.027). Analysis of the individual components of the MOST design demonstrated greater improvement in the PF score with resistance plus aerobic exercise than with aerobic exercise alone (β = 2.257, SE = 1.071, p = 0.048).\n\nConclusions: Combined aerobic and resistance exercise and daily self-monitoring improved PF and reduced fatigue in patients with CLL.\n\nImplications for cancer survivors: This pilot study supported the feasibility of a low-touch mHealth intervention for survivors of CLL and provided preliminary evidence that exercising, particularly resistance exercise, can improve their symptoms and quality of life.\n\nKeywords: Cancer; Exercise; Non-Hodgkin lymphoma; Nutrition; Physical activity; Skeletal muscle function.", "links": [] }, { "title": "Criterion-Related Validity of Consumer-Wearable Activity Trackers for Estimating Steps in Primary Schoolchildren under Controlled Conditions: Fit-Person Study", "author": "Mayorga-Vega, Daniel; Casado-Robles, Carolina; Guijarro-Romero, Santiago; Viciana, Jesús", "year": "2024", "journalProceedings": "Journal of Sports Science \\& Medicine", "category": "Validation", "devices": "Ace 2", "population": "Children", "dataUsed": "Steps", "abstract": "The purposes were to examine the criterion-related validity of the steps estimated by consumer-wearable activity trackers (wrist-worn activity trackers: Fitbit Ace 2, Garmin Vivofit Jr, and Xiomi Mi Band 5; smartphone applications: Pedometer, Pedometer Pacer Health, and Google Fit/Apple Health) and their comparability in primary schoolchildren under controlled conditions. An initial sample of 66 primary schoolchildren (final sample = 56; 46.4% females), aged 9-12 years old (mean = 10.4 ± 1.0 years), wore three wrist-worn activity trackers (Fitbit Ace 2, Garmin Vivofit Jr 2, and Xiaomi Mi Band 5) on their non-dominant wrist and had three applications in two smartphones (Pedometer, Pedometer Pacer Health, and Google Fit/Apple Health for Android/iOS installed in Samsung Galaxy S20+/iPhone 11 Pro Max) in simulated front trouser pockets. Primary schoolchildren's steps estimated by the consumer-wearable activity trackers and the video-based counting independently by two researchers (gold standard) were recorded while they performed a 200-meter course in slow, normal and brisk pace walking, and running conditions. Results showed that the criterion-related validity of the step scores estimated by the three Samsung applications and the Garmin Vivofit Jr 2 were good-excellent in the four walking/running conditions (e.g., MAPE = 0.6-2.3%; lower 95% CI of the ICC = 0.81-0.99), as well as being comparable. However, the Apple applications, Fitbit Ace 2, and Xiaomi Mi Band 5 showed poor criterion-related validity and comparability on some walking/running conditions (e.g., lower 95% CI of the ICC < 0.70). Although, as in real life primary schoolchildren also place their smartphones in other parts (e.g., schoolbags, hands or even somewhere away from the body), the criterion-related validity of the Garmin Vivofit Jr 2 potentially would be considerably higher than that of the Samsung applications. The findings of the present study highlight the potential of the Garmin Vivofit Jr 2 for monitoring primary schoolchildren's steps under controlled conditions.", "links": [] }, { "title": "Assessing the current utilization status of wearable devices in clinical research", "author": "Miyakoshi, Takashi; Ito, Yoichi M.", "year": "2024", "journalProceedings": "Clinical Trials (London, England)", "category": "Usability,Review", "devices": "Device unspecified", "population": "NA", "dataUsed": "NA", "abstract": "Background/aims: Information regarding the use of wearable devices in clinical research, including disease areas, intervention techniques, trends in device types, and sample size targets, remains elusive. Therefore, we conducted a comprehensive review of clinical research trends related to wristband wearable devices in research planning and examined their applications in clinical investigations.\n\nMethods: As this study identified trends in the adoption of wearable devices during the planning phase of clinical research, including specific disease areas and targeted number of intervention cases, we searched ClinicalTrials.gov-a prominent platform for registering and disseminating clinical research. Since wrist-worn devices represent a large share of the market, we focused on wrist-worn devices and selected the most representative models among them. The main analysis focused on major wearable devices to facilitate data analysis and interpretation, but other wearables were also surveyed for reference. We searched ClinicalTrials.gov with the keywords \"ActiGraph,\"\"Apple Watch,\"\"Empatica,\"\"Fitbit,\"\"Garmin,\" and \"wearable devices\" to obtain studies published up to 21 August 2022. This initial search yielded 3214 studies. After excluding duplicate National Clinical Trial studies (the overlap was permissible among different device types except for wearable devices), our analysis focused on 2930 studies, including simple, time-series, and type-specific assessments of various variables.\n\nResults: Overall, an increasing number of clinical studies have incorporated wearable devices since 2012. While ActiGraph and Fitbit initially dominated this landscape, the use of other devices has steadily increased, constituting approximately 10% of the total after 2015. Observational studies outnumbered intervention studies, with behavioral and device-based interventions being particularly prevalent. Regarding disease types, cancer and cardiovascular diseases accounted for approximately 20% of the total. Notably, 114 studies adopted multiple devices simultaneously within the context of their clinical investigations.\n\nConclusions: Our findings revealed that the utilization of wearable devices for data collection and behavioral interventions in various disease areas has been increasing over time since 2012. The increase in the number of studies over the past 3 years has been particularly significant, suggesting that this trend will continue to accelerate in the future. Devices and their evaluation methods that have undergone thorough validation, confirmed their accuracy, and adhered to established legal regulations will likely assume a pivotal role in evaluations, allowing for remote clinical trials. Moreover, behavioral intervention therapy utilizing apps is becoming more extensive, and we expect to see more examples that will lead to their approval as programmed medical devices in the future.\n\nKeywords: ActiGraph; Apple Watch; Empatica; Fitbit; Garmin; clinical trial; disease area; intervention; observational study; wearable device.", "links": [] }, { "title": "Benefits of physical activity self-monitoring in patients with haemophilia: a prospective study with one-year follow-up", "author": "Pérez-Alenda, Sofía; Carrasco, Juan J.; Querol-Fuentes, Felipe; Megías-Vericat, Juan Eduardo; Querol-Giner, Felipe; Luz Sánchez-Sánchez, María; Bonanad, Santiago; Núñez-Cortés, Rodrigo", "year": "2024", "journalProceedings": "Haemophilia: The Official Journal of the World Federation of Hemophilia", "category": "Case Study", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Introduction: Activity wristbands have been shown to be effective in relation to self-monitoring activity levels and increasing exercise adherence. However, previous reports have been based on short-term follow-ups in people with haemophilia (PWH).\n\nAim: (1) To evaluate compliance with physical activity (PA) recommendations in PWH during a 1-year follow-up period using activity wristbands to record daily steps and intensity; (2) To determine the effect of PA self-monitoring on clinical outcomes.\n\nMethods: A prospective observational study was conducted in 27 adults with severe haemophilia undergoing prophylactic treatment. The Fitbit Charge HR was used to track daily PA for an entire year. The participants were encouraged to try to reach a goal of 10,000 steps/day and to track their progress. The pre- and post-evaluation included quality of life (A36 Hemophilia-QoL Questionnaire), joint health (Haemophilia Joint Health Score), functionality (Timed Up and Go test), and muscle strength.\n\nResults: A total of 323.63 (95%CI: 194-364) valid days (i.e., > 2000 steps) were recorded. The annual average number of steps per day taken by participants was 10,379. Sixteen (59%) PWH reached 10,000 steps/day at baseline and 17 (63%) at 1 year follow-up, with no significant differences (x2 = .33; p = .56). A statistically significant improvement was observed in daily moderate activity time (p = .012) and in the 'physical health' quality of life subscale (mean difference: 2.15 points; 95%CI: .64-3.65; p = .007).\n\nConclusion: Our results suggest that patients with severe haemophilia who self-managed their PA can improve their long-term quality of life in the domain of physical health and also the daily time spent in moderate-intensity PA.\n\nKeywords: blood coagulation disorders; exercise; fitness tracker; haemophilic arthropathy; walking.", "links": [] }, { "title": "The moderating effect of social support on the effectiveness of a web-based, computer-tailored physical activity intervention for older adults", "author": "Alley, Stephanie J.; Schoeppe, Stephanie; Moore, Hayley; To, Quyen G.; van Uffelen, Jannique; Parker, Felix; Duncan, Mitch J.; Schneiders, Anthony; Vandelanotte, Corneel", "year": "2024", "journalProceedings": "Journal of Health Psychology", "category": "Intervention", "devices": "Device unspecified", "population": "Older Adults", "dataUsed": "Intensity", "abstract": "This study aimed to assess the moderating effect of social support on the effectiveness of a web-based, computer-tailored physical activity intervention for older adults. In the Active for Life trial, 243 inactive adults aged 65+ years were randomised into: (1) tailoring + Fitbit (n = 78), (2) tailoring-only (n = 96) or (3) control (n = 69). For the current study, participants were categorised as having higher (n = 146) or lower (n = 97) social support based on the Duke Social Support Index (DSSI\\_10). Moderate-to-vigorous physical activity (MVPA) was measured through accelerometers at baseline and post-intervention. A linear mixed model analysis demonstrated that among participants with lower social support, the tailoring + Fitbit participants, but not the tailoring only participants increased their MVPA more than the control. Among participants with higher social support, no differences in MVPA changes were observed between groups. Web-based computer-tailored interventions with Fitbit integration may be more effective in older adults with lower levels of social support.", "links": [] }, { "title": "Actívatexto: Feasibility and Acceptability of a Mobile Intervention That Promotes Smoking Cessation and Physical Activity among Latinos", "author": "Lara, Daimarelys; Alaniz-Cantú, Edgar I.; Siddalingaiaha, Simran; Oliveira, Igor; Chávez-Iñiguez, Arlette; DeJesus, Elisa; Fuller, Daniel; Marquez, David X.; Vásquez, Elizabeth; Li, Dongmei; McIntosh, Scott; Ossip, Deborah J.; Cupertino, Ana Paula; Cartujano-Barrera, Francisco", "year": "2024", "journalProceedings": "Cancer Research Communications", "category": "Intervention", "devices": "Versa 4", "population": "Adults", "dataUsed": "Intensity,Device Weartime,Active Minutes/Active Zone Minutes", "abstract": "The purpose of this study was to assess the feasibility and acceptability of a mobile intervention that promotes smoking cessation and physical activity among Latinos living in the United States. Twenty Latino adults who smoked and did not meet recommended levels of physical activity were recruited using community-based recruitment strategies. Participants received Actívatexto, a theory-based, culturally accommodated, 12-week text messaging intervention (available in English and Spanish) that promotes smoking cessation and physical activity. Actívatexto integrates four components: (i) a text messaging program, (ii) a wearable device, (iii) an online dashboard where the research team manages participants' incoming and outgoing data from both the text messaging program and wearable device, and (iv) nicotine replacement therapies (NRT). We assessed self-reported 7-day point prevalence smoking abstinence at month 3, weekly minutes of moderate to vigorous physical activity (MVPA), pharmacotherapy adherence, and satisfaction. At baseline, participants' mean age was 47.3 years old (SD 16.0), 55\\% of participants were female, and 60\\% indicated that Spanish was their language of preference. Seventy-five percent of participants smoked 1-10 cigarettes daily and 35\\% smoked their first cigarette within 5 minutes after waking up. At month 3, 14 participants (70\\%) self-reported 7-day point prevalence smoking abstinence (90\\% follow-up rate). Fitbit-assessed mean minutes of MVPA per week increased from 113 (SD 127; range: 0-399) at week 1 to 177 (SD 163; range: 0-513) at month 3 (P = 0.15). Sixteen participants (88.9\\%, 16/18) reported NRT use in the past 90 days. Most participants reported being extremely satisfied or satisfied with the intervention (88.9\\%, 16/18). SIGNIFICANCE: Actívatexto resulted in a noteworthy cessation rate at month 3 (70\\%), increased mean weekly minutes of MVPA, produced high use of NRT, and was well received by participants. Additional testing in a randomized clinical trial is warranted to assess the efficacy of the intervention.", "links": [] }, { "title": "Physical activity decreases in patients on the liver transplant waiting list and influences postoperative outcome-a prospective cohort study", "author": "Magyar, Christian T. J.; Bühlmann, Lea; Becchetti, Chiara; Beekman, Lara; Candinas, Daniel; Beldi, Guido; Kim-Fuchs, Corina; Berzigotti, Annalisa; Banz, Vanessa", "year": "2024", "journalProceedings": "Hepatobiliary Surgery and Nutrition", "category": "Case Study", "devices": "Charge 2", "population": "Patients", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance", "abstract": "BACKGROUND: Physical deconditioning affects patients suffering from end-stage liver disease (ESLD). Liver transplantation (LT) is the only curative option for ESLD. Growing evidence suggests that pre-habilitation is beneficial in reducing post-surgical morbidity and mortality. We investigated physical activity (PA) in patients awaiting LT in a country with long waiting times. METHODS: Prospective, single center, longitudinal study in Bern, Switzerland between June 2019 and February 2020 (halted due to SARS-CoV-2 pandemic), with follow-up data up to six months post-transplant. Patients were instructed to use a wrist tracker (FitBit) to monitor PA, which was assessed using mixed-effects generalized linear models. The study was approved by the local ethics committee (BASEC ID 2019-00606). RESULTS: Thirty-five patients were included [71\\% male, median 59 years, body mass index (BMI) 28 kg/m2, lab Model End-Stage Liver Disease (MELD) 11], 17 (49\\%) pre-frail and 5 (14\\%) frail according to the Liver Frailty Index (LFI). Twenty-eight patients underwent transplantation with 0 ninety-day mortality and 15 (53.6\\%) composite adverse clinical outcome. Median daily steps were 4,661 [interquartile range (IQR), 1,685-8,609] and weekly moderate PA (MPA) was 41 min (IQR, 0-127 min). Longitudinal analysis showed that female patients and patients on nutritional support had an increase in MPA between weeks 20 and 40. A significant decrease was seen in MPA after week 40, whilst no significant association was seen with age, Child-Pugh Score, LFI or quality of life at time of inclusion. MPA was significantly associated with the occurrence of the composite clinical endpoint after week 30 of waiting time (odds ratio 0.882, P=0.026). World Health Organization (WHO)-recommended MPA was significantly associated with less adverse composite clinical outcomes (P{\\textless}0.001). CONCLUSIONS: In patients listed for LT, MPA decreased over time, showing a significant association with adverse outcome, specifically after week 30 on the waiting list. Our data support the implementation of routine pre-habilitation in patients awaiting LT.", "links": [] }, { "title": "Participatory development of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED)", "author": "Novak, Jan; Jurkova, Katerina; Lojkaskova, Anna; Jaklova, Andrea; Kuhnova, Jitka; Pfeiferova, Marketa; Kral, Norbert; Janek, Michael; Omcirk, Dan; Malisova, Katerina; Maes, Iris; Dyck, Delfien Van; Wahlich, Charlotte; Ussher, Michael; Elavsky, Steriani; Cimler, Richard; Pelclova, Jana; Tufano, James J.; Steffl, Michal; Seifert, Bohumil; Yates, Tom; Harris, Tess; Vetrovsky, Tomas", "year": "2024", "journalProceedings": "BMC public health", "category": "Intervention", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Steps", "abstract": "BACKGROUND: The escalating global prevalence of type 2 diabetes and prediabetes presents a major public health challenge. Physical activity plays a critical role in managing (pre)diabetes; however, adherence to physical activity recommendations remains low. The ENERGISED trial was designed to address these challenges by integrating mHealth tools into the routine practice of general practitioners, aiming for a significant, scalable impact in (pre)diabetes patient care through increased physical activity and reduced sedentary behaviour. METHODS: The mHealth intervention for the ENERGISED trial was developed according to the mHealth development and evaluation framework, which includes the active participation of (pre)diabetes patients. This iterative process encompasses four sequential phases: (a) conceptualisation to identify key aspects of the intervention; (b) formative research including two focus groups with (pre)diabetes patients (n = 14) to tailor the intervention to the needs and preferences of the target population; (c) pre-testing using think-aloud patient interviews (n = 7) to optimise the intervention components; and (d) piloting (n = 10) to refine the intervention to its final form. RESULTS: The final intervention comprises six types of text messages, each embodying different behaviour change techniques. Some of the messages, such as those providing interim reviews of the patients' weekly step goal or feedback on their weekly performance, are delivered at fixed times of the week. Others are triggered just in time by specific physical behaviour events as detected by the Fitbit activity tracker: for example, prompts to increase walking pace are triggered after 5 min of continuous walking; and prompts to interrupt sitting following 30 min of uninterrupted sitting. For patients without a smartphone or reliable internet connection, the intervention is adapted to ensure inclusivity. Patients receive on average three to six messages per week for 12 months. During the first six months, the text messaging is supplemented with monthly phone counselling to enable personalisation of the intervention, assistance with technical issues, and enhancement of adherence. CONCLUSIONS: The participatory development of the ENERGISED mHealth intervention, incorporating just-in-time prompts, has the potential to significantly enhance the capacity of general practitioners for personalised behavioural counselling on physical activity in (pre)diabetes patients, with implications for broader applications in primary care.", "links": [] }, { "title": "Association between changes in habitual stepping activity and cognition in older adults", "author": "O’Brien, Myles W.; Bray, Nick W.; Quirion, Isadora; Ahmadi, Shirko; Faivre, Pierre; Gallant, Francois; Gagnon, Caroline; Sénéchal, Martin; Dupuy, Olivier; Bélanger, Mathieu; Mekari, Said", "year": "2024", "journalProceedings": "Scientific Reports", "category": "Intervention", "devices": "Inspire 2 HR", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Advancing age is associated with declines in cognitive function. Although physical activity is thought to protect against this decline, it is unclear how a short-term uptake in daily steps or a decline in day-to-day step variability may contribute to cognition among older adults. We tested associations between changes in step counts, day-to-day step variability and executive cognitive functions among older adults taking part in a physical activity intervention. Thirty-seven older adults (33 females; 71.4 ± 6.3 years) completed a 10-week personalized physical activity intervention. Participants wore a Fitbit to measure daily step counts throughout the study. They also completed a computerized Stroop task before and after the intervention. Average step counts and step count variability via average-real-variability (ARV) were determined. Compared to pre-intervention, step counts increased (p {\\textless} 0.001) and step variability decreased post-intervention (p = 0.04). Models describing the changes in step counts and ARV over the 10-weeks were cubic (both, p {\\textless} 0.04). Reaction times during the simple (p = 0.002) and switching (p = 0.04) conditions were faster post-intervention. Change in step variability was positively associated with the change in reaction time for the switching condition (β = 0.029, p = 0.002). On average, a reduction in day-to-day step variability was associated with improvements in cognitive flexibility.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10997579/", "newWindow": true } ] }, { "title": "Accuracy of Fitbit Charge 4, Garmin Vivosmart 4, and WHOOP Versus Polysomnography: Systematic Review", "author": "Schyvens, An-Marie; Van Oost, Nina Catharina; Aerts, Jean-Marie; Masci, Federica; Peters, Brent; Neven, An; Dirix, Hélène; Wets, Geert; Ross, Veerle; Verbraecken, Johan", "year": "2024", "journalProceedings": "JMIR mHealth and uHealth", "category": "Systematic Review", "devices": "Charge 4,Garmin Vivosmart 4", "population": "NA", "dataUsed": "Sleep", "abstract": "BACKGROUND: Despite being the gold-standard method for objectively assessing sleep, polysomnography (PSG) faces several limitations as it is expensive, time-consuming, and labor-intensive; requires various equipment and technical expertise; and is impractical for long-term or in-home use. Consumer wrist-worn wearables are able to monitor sleep parameters and thus could be used as an alternative for PSG. Consequently, wearables gained immense popularity over the past few years, but their accuracy has been a major concern. OBJECTIVE: A systematic review of the literature was conducted to appraise the performance of 3 recent-generation wearable devices (Fitbit Charge 4, Garmin Vivosmart 4, and WHOOP) in determining sleep parameters and sleep stages. METHODS: Per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, a comprehensive search was conducted using the PubMed, Web of Science, Google Scholar, Scopus, and Embase databases. Eligible publications were those that (1) involved the validity of sleep data of any marketed model of the candidate wearables and (2) used PSG or an ambulatory electroencephalogram monitor as a reference sleep monitoring device. Exclusion criteria were as follows: (1) incorporated a sleep diary or survey method as a reference, (2) review paper, (3) children as participants, and (4) duplicate publication of the same data and findings. RESULTS: The search yielded 504 candidate articles. After eliminating duplicates and applying the eligibility criteria, 8 articles were included. WHOOP showed the least disagreement relative to PSG and Sleep Profiler for total sleep time (-1.4 min), light sleep (-9.6 min), and deep sleep (-9.3 min) but showed the largest disagreement for rapid eye movement (REM) sleep (21.0 min). Fitbit Charge 4 and Garmin Vivosmart 4 both showed moderate accuracy in assessing sleep stages and total sleep time compared to PSG. Fitbit Charge 4 showed the least disagreement for REM sleep (4.0 min) relative to PSG. Additionally, Fitbit Charge 4 showed higher sensitivities to deep sleep (75\\%) and REM sleep (86.5\\%) compared to Garmin Vivosmart 4 and WHOOP. CONCLUSIONS: The findings of this systematic literature review indicate that the devices with higher relative agreement and sensitivities to multistate sleep (ie, Fitbit Charge 4 and WHOOP) seem appropriate for deriving suitable estimates of sleep parameters. However, analyses regarding the multistate categorization of sleep indicate that all devices can benefit from further improvement in the assessment of specific sleep stages. Although providers are continuously developing new versions and variants of wearables, the scientific research on these wearables remains considerably limited. This scarcity in literature not only reduces our ability to draw definitive conclusions but also highlights the need for more targeted research in this domain. Additionally, future research endeavors should strive for standardized protocols including larger sample sizes to enhance the comparability and power of the results across studies.", "links": [] }, { "title": "Exploring the effects of fitbit incentive on treatment outcomes in veterans undergoing intensive pain rehabilitation program", "author": "Toor, Tiffany; Palyo, Sarah; Schopmeyer, Kathryn; Simmons, Alan N.; Strigo, Irina A.", "year": "2024", "journalProceedings": "Journal of Patient-Reported Outcomes", "category": "Intervention", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps,Energy Expenditure,Distance,Goals", "abstract": "OBJECTIVE: This study compares clinical pain outcomes between patients in a pain treatment program that received a Fitbit, to patients that did not. We also explored: (1) cognitive, emotional, and psychological factors that may have impacted the decision to opt in to receiving a Fitbit; and (2) whether the choice to receive a Fitbit impacted changes in cognitive, emotional, and psychological factors following treatment. METHODS: Among 58 patients in a multidisciplinary pain treatment program at a Veterans Affairs Healthcare System hospital, 31 patients opted to receive a Fitbit as adjunct treatment, while 27 did not. This study utilized patient-reported and practitioner-collected data from the pain treatment program. RESULTS: Compared to the non-Fitbit group, the Fitbit group displayed a significant decrease in average pain intensity, however showed no correlation between Fitbit activity and average pain intensity. Additionally, treatment satisfaction was the only predictor of treatment group, when modeling pre- and post-treatment outcomes changes. CONCLUSION: The implementation of a Fitbit may lead to improved pain intensity. Initial evidence suggests that opting to receive a Fitbit during a pain treatment program indicates treatment engagement leading to greater treatment satisfaction. Future work is needed to verify and expand upon this potential mechanism.", "links": [] }, { "title": "Home-based circuit training and community walking for intermittent claudication", "author": "Waddell, Alexander; Denton, Francesca; Powell, Richard; Broom, David R.; Birkett, Stefan T.; McGregor, Gordon; Harwood, Amy E.", "year": "2024", "journalProceedings": "Annals of Vascular Surgery", "category": "Intervention", "devices": "Charge 4", "population": "Patients", "dataUsed": "Steps", "abstract": "OBJECTIVE: Supervised exercise training is recommended for people with peripheral artery disease (PAD), yet it remains underutilised. Home-based exercise programmes are a potential alternative. The aim of this study was to assess the feasibility of conducting a full scale trial of a 12-week home-based exercise programme (HBEP) for people living with symptomatic PAD. METHODS: In a randomised feasibility trial, patients with intermittent claudication (IC) were allocated to either a HBEP or a non-exercise control. The HBEP group were given a Fitbit to use during a 12-week exercise programme comprising of personalised step goals and a resistance-based circuit to be undertaken at home twice weekly. The primary outcome was feasibility, assessed via eligibility, recruitment, attrition, tolerability, and adherence. Acceptability was assessed via semi-structured interviews. Secondary analysis was undertaken to determine the feasibility of collecting clinical outcome data. RESULTS: 188 people were screened, 133 were eligible (70.7\\%), 30 were recruited (22.6\\%) and one withdrew (3.33\\%). Mean adherence to the daily step goal was 53.5\\% (range=29.8-90.5\\%), and 58.6\\% of prescribed circuits were completed of which 56.4\\% were at the desired intensity. Six adverse events were recorded, three of which were related to study involvement. No significant differences were observed in exploratory outcomes. Small clinically important differences were seen in walking speed and pain-free treadmill walking distance which should be confirmed or refuted in a larger trial. CONCLUSION: The HBEP was feasible and well tolerated, with successful recruitment and minimal attrition. The intervention was acceptable, with walking seen as more enjoyable than circuit exercise. The WALKSTRONG programme may be suitable for those who will not, or cannot, take part in supervised exercise outside of the home.", "links": [] }, { "title": "Performance of wearable sleep trackers during nocturnal sleep and periods of simulated real-world smartphone use", "author": "Willoughby, Adrian R.; Golkashani, Hosein Aghayan; Ghorbani, Shohreh; Wong, Kian F.; Chee, Nicholas I. Y. N.; Ong, Ju Lynn; Chee, Michael W. L.", "year": "2024", "journalProceedings": "Sleep Health", "category": "Validation", "devices": "Sense", "population": "Adults", "dataUsed": "Sleep", "abstract": "GOAL AND AIMS: To test sleep/wake transition detection of consumer sleep trackers and research-grade actigraphy during nocturnal sleep and simulated peri-sleep behavior involving minimal movement. FOCUS TECHNOLOGY: Oura Ring Gen 3, Fitbit Sense, AXTRO Fit 3, Xiaomi Mi Band 7, and ActiGraph GT9X. REFERENCE TECHNOLOGY: Polysomnography. SAMPLE: Sixty-three participants (36 female) aged 20-68. DESIGN: Participants engaged in common peri-sleep behavior (reading news articles, watching videos, and exchanging texts) on a smartphone before and after the sleep period. They were woken up during the night to complete a short questionnaire to simulate responding to an incoming message. CORE ANALYTICS: Detection and timing accuracy for the sleep onset times and wake times. ADDITIONAL ANALYTICS AND EXPLORATORY ANALYSES: Discrepancy analysis both including and excluding the peri-sleep activity periods. Epoch-by-epoch analysis of rate and extent of wake misclassification during peri-sleep activity periods. CORE OUTCOMES: Oura and Fitbit were more accurate at detecting sleep/wake transitions than the actigraph and the lower-priced consumer sleep tracker devices. Detection accuracy was less reliable in participants with lower sleep efficiency. IMPORTANT ADDITIONAL OUTCOMES: With inclusion of peri-sleep periods, specificity and Kappa improved significantly for Oura and Fitbit, but not ActiGraph. All devices misclassified motionless wake as sleep to some extent, but this was less prevalent for Oura and Fitbit. CORE CONCLUSIONS: Performance of Oura and Fitbit is robust on nights with suboptimal bedtime routines or minor sleep disturbances. Reduced performance on nights with low sleep efficiency bolsters concerns that these devices are less accurate for fragmented or disturbed sleep.", "links": [] }, { "title": "Changes in rest-activity rhythms in adolescents as they age: associations with brain changes and behavior in the ABCD study", "author": "Zhang, Rui; Schwandt, Melanie; Vines, Leah; Volkow, Nora D.", "year": "2024", "journalProceedings": "medRxiv: The Preprint Server for Health Sciences", "category": "Case Study", "devices": "Charge", "population": "Adolescents", "dataUsed": "Steps,Sleep", "abstract": "BACKGROUND: Adolescents with disrupted rest-activity rhythms (RAR) including shorter sleep duration, later sleep timing and low physical activity levels have higher risk for mental and behavioral problems. However, it remains unclear whether the same associations can be observed for within-subject changes in RAR. METHODS: Our longitudinal investigation on RAR used Fitbit data from the Adolescent Brain Cognitive Development (ABCD) Study at the 2-year (FL2: aged 10-13 years) and 4-year follow-up (FL4: aged 13-16 years). 963 youths had good-quality Fitbit data at both time points. In this study we examined changes in RAR from FL2 to FL4, their environmental and demographic contributors as well as brain and behavioral correlates. RESULTS: From FL2 to FL4, adolescents showed decreases in sleep duration and physical activity as well as delayed sleep timing (Cohen's d .44-.75). The contributions of environmental and demographic factors to RAR changes were greatest to sleep timing (explained 10\\% variance) and least to sleep duration (explained 1\\% variance). Delays in sleep timing had stronger correlations with behavioral problems including greater impulsivity and poor academic performance than reductions in sleep duration or physical activity. Additionally, the various brain measures differed in their sensitivity to RAR changes. Reductions in sleep duration were associated with decreased brain functional connectivity between subcortical regions and sensorimotor and cingulo-opercular networks and with enhanced functional connectivity between sensorimotor, visual and auditory networks. Delays in sleep timing were mainly associated with grey matter changes in subcortical regions. CONCLUSIONS: The current findings corroborate the role of sleep and physical activity in adolescent's brain neurodevelopment and behavior problems. RAR might serve as biomarkers for monitoring behavioral problems in adolescents and to serve as potential therapeutic targets for mental disorders.", "links": [] }, { "title": "Using Positive Psychology to Address Emotional Barriers to Physical Activity After Bariatric Surgery: Proof-of-Concept Trial of the Gaining Optimism After Weight Loss Surgery (GOALS) Project", "author": "Feig, Emily H.; Szapary, Claire; Harnedy, Lauren E.; Castillo, Crystal; Thorndike, Anne N.; Psaros, Christina; Millstein, Rachel A.; Huffman, Jeff C.", "year": "2024", "journalProceedings": "Cognitive and Behavioral Practice", "category": "Intervention", "devices": "Device unspecified", "population": "Patients,Adults", "dataUsed": "NA", "abstract": "Physical activity promotes health and longevity after metabolic/bariatric surgery (MBS), but most patients do not meet recommended levels. The Gaining Optimism After weight Loss Surgery (GOALS) Project was a positive psychological intervention designed to address common emotional barriers to physical activity in patients who have recently undergone MBS (e.g., low confidence around exercise, internalized weight bias, fear of injury) and use motivational interviewing and standard behavior change techniques (e.g., self-monitoring) to increase physical activity. This single-arm proof-of-concept trial was designed to refine the intervention, test feasibility and acceptability, and explore pre-post changes in behavioral and psychological outcomes. Participants were 12 adults 6-12 months post-MBS (M age of 46, 58\\% female, 67\\% non-Hispanic white). GOALS was a 10-week telephone counseling program that introduced new positive psychological skills and physical activity topics each week. Participants tracked physical activity with a Fitbit and set weekly goals. Results showed that the intervention was feasible (85\\% of sessions completed) and acceptable (average participant ratings of session ease and utility above 8.0 on a 0-10 scale). There were medium-to-large effect size improvements in physical activity and psychological well-being (e.g., depressive symptoms). The GOALS intervention will next be tested in a pilot randomized controlled trial with longer-term follow-up to assess its effect more robustly.", "links": [] }, { "title": "Testing the Reliability and Validity of the Korean Version of the Pittsburgh Sleep Quality Index Using Fitbit Devices: A Cross-Sectional Analysis", "author": "Lee, Si-Yeon; Choi, Ja-Eun; Lee, Ji-Won; Lee, Yaeji; Park, Jae-Min; Hong, Kyung-Won", "year": "2024", "journalProceedings": "Korean Journal of Family Medicine", "category": "Validation", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Sleep", "abstract": "BACKGROUND: Sleep disorders and insomnia are prevalent worldwide, with negative health outcomes. The Pittsburgh Sleep Quality Index (PSQI) is a widely used self-report assessment tool for evaluating sleep quality, comprising seven subdomains. The Korean version of the PSQI (PSQI-K) has been tested for reliability and validity in small sample sizes but lacks large-scale validation using objective measures. METHODS: This study was conducted with 268 Korean adults attending health check programs. Participants completed the PSQI-K questionnaire and wore Fitbit devices (Fitbit Inc., USA) to ascertain sleep parameters. Reliability was analyzed using the Cronbach's α coefficient, and construct validity was determined through factor analysis. Criteria validity was assessed by correlating their index scores with Fitbit sleep parameters. We identified the optimal cutoff for detecting sleep disorders. RESULTS: The Cronbach's α coefficient was 0.61, indicating adequate internal consistency. Factor analysis revealed three factors, explaining 48.2\\% of sleep quality variance. The index scores were negatively correlated with Fitbit sleep efficiency, total sleep time, and number of awakenings (P{\\textless}0.05). The optimal cutoff point for identifying sleep disorder groups was ≥6. CONCLUSION: The PSQI-K demonstrated good reliability and validity when correlated with Fitbit sleep parameters, offering a practical screening tool for identifying sleep disorders among Korean adults. Cutoff scores can help identify patients for sleep interventions. However, further large-scale studies are required to validate these findings.", "links": [] }, { "title": "A pilot randomised controlled trial exploring the feasibility and efficacy of a human-AI sleep coaching model for improving sleep among university students", "author": "Liu, Jintana; Ito, Sakura; Ngo, Tra My; Lawate, Ashwini; Ong, Qi Chwen; Fox, Tatiana Erlikh; Chang, Si Yuan; Phung, Duy; Nair, Elizabeth; Palaiyan, Malar; Joty, Shafiq; Abisheganaden, John; Lee, Chuen Peng; Lwin, May Oo; Theng, Yin Leng; Ho, Moon-Ho Ringo; Chia, Michael; Bojic, Iva; Car, Josip", "year": "2024", "journalProceedings": "Digital Health", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "OBJECTIVE: Sleep quality is a crucial concern, particularly among youth. The integration of health coaching with question-answering (QA) systems presents the potential to foster behavioural changes and enhance health outcomes. This study proposes a novel human-AI sleep coaching model, combining health coaching by peers and a QA system, and assesses its feasibility and efficacy in improving university students' sleep quality. METHODS: In a four-week unblinded pilot randomised controlled trial, 59 university students (mean age: 21.9; 64\\% males) were randomly assigned to the intervention (health coaching and QA system; n = 30) or the control conditions (QA system; n = 29). Outcomes included efficacy of the intervention on sleep quality (Pittsburgh Sleep Quality Index; PSQI), objective and self-reported sleep measures (obtained from Fitbit and sleep diaries) and feasibility of the study procedures and the intervention. RESULTS: Analysis revealed no significant differences in sleep quality (PSQI) between intervention and control groups (adjusted mean difference = -0.51, 95\\% CI: [-1.55-0.77], p = 0.40). The intervention group demonstrated significant improvements in Fitbit measures of total sleep time (adjusted mean difference = 32.5, 95\\% CI: [5.9-59.1], p = 0.02) and time in bed (adjusted mean difference = 32.3, 95\\% CI: [2.7-61.9], p = 0.03) compared to the control group, although other sleep measures were insignificant. Adherence was high, with the majority of the intervention group attending all health coaching sessions. Most participants completed baseline and post-intervention self-report measures, all diary entries, and consistently wore Fitbits during sleep. CONCLUSIONS: The proposed model showed improvements in specific sleep measures for university students and the feasibility of the study procedures and intervention. Future research may extend the intervention period to see substantive sleep quality improvements.", "links": [] }, { "title": "Associations between sleep health, negative reinforcement learning, and alcohol use among South Florida college students with elevated internalizing symptoms", "author": "Sollenberger, Nathan A.; Cummings, Logan R.; Freitag, Josefina; Trucco, Elisa M.; Gomez, Sthefany; Giraldo, Melanie; Muse, Gabriela; Mattfeld, Aaron T.; McMakin, Dana L.", "year": "2024", "journalProceedings": "Alcohol (Fayetteville, N.Y.)", "category": "Case Study", "devices": "Charge 4", "population": "Adults", "dataUsed": "Sleep", "abstract": "Negative reinforcement is proposed to mediate associations between sleep and alcohol use, especially among people with depression and/or anxiety symptoms. Worse sleep (e.g., shorter duration, less efficiency, more irregular timing) exacerbates negative emotions, which alcohol may temporarily relieve. Not yet examined, we propose sleep indirectly impacts early stages of alcohol use via differences in negative reinforcement learning (NRL), since sleep impacts emotion, reward response, and learning. The current study aimed to replicate associations between sleep and alcohol use, test associations with NRL, and examine indirect associations between sleep health and alcohol use via NRL among 60 underage college students (ages 18-20 years, 77\\% female) varying in depression and anxiety symptoms. Participants wore Fitbit smartwatches and completed daily diaries measuring sleep and substance use for ∼14 days before completing two computer tasks assessing social (SNRL) and monetary (MNRL) negative reinforcement learning. Robust generalized linear models tested direct associations within the proposed model. SNRL performance was positively associated with alcohol use, but no other associations were observed. Statistical mediation models failed to indicate indirect effects of sleep on alcohol use via SNRL or MNRL performance. Post-hoc exploratory models examining depression and anxiety symptoms as moderators of direct associations indicated several interactions. Positive associations between sleep timing variability and alcohol use were weakened at higher anxiety symptom severity and stronger at higher depression symptom severity. The positive association between SNRL performance and alcohol use was also stronger at higher depression symptom severity. Among students with elevated depression symptoms, variable sleep timing and stronger SNRL performance were independently associated with more alcohol use, but indirect effects were not supported. Future research should replicate findings, confirm causality of interactions, and examine sleep timing and behavioral responses to negative social stimuli as targets for improving alcohol-related outcomes among underage college students with elevated depressive symptoms.", "links": [] }, { "title": "Effectiveness of a Lifestyle Improvement Support App in Combination with a Wearable Device in Japanese People with Type 2 Diabetes Mellitus: STEP-DM Study", "author": "Takahashi, Akiko; Ishii, Manabu; Kino, Yurika; Sasaki, Kazuyo; Matsui, Takahiro; Arakawa, Kenji; Kunisaki, Makoto", "year": "2024", "journalProceedings": "Diabetes Therapy: Research, Treatment and Education of Diabetes and Related Disorders", "category": "Case Study", "devices": "Charge 5", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "INTRODUCTION: Although the use of application (app)s and wearable devices supporting diabetes treatment has spread rapidly in recent years, evidence of their impact, especially in combination of them, is limited. TOMOCO™ is a lifestyle improvement support app that features interactive virtual conversations according to the programmed algorithm guiding users toward their goals of lifestyle improvement. We hypothesized that TOMOCO™ in combination with Fitbit, which accurately tracks users' activity level, would encourage people with type 2 diabetes mellitus (T2DM) to change their lifestyles and improve their glycated hemoglobin (HbA1c) levels without changes in conventional therapy. Thus, we performed the present study to explore the effectiveness of this combination in Japanese participants with T2DM who had not achieved their glycemic targets. METHODS: In this single-arm exploratory study, participants with T2DM used the TOMOCO™ and Fitbit in addition to the conventional diet/exercise therapy and anti-diabetic drug for 12 weeks. They were provided with feedback/advice by health care providers based on the TOMOCO™ and Fitbit records. The primary endpoint was the change in HbA1c from baseline to the end of the observation period. Data were expressed as mean ± standard deviation. RESULTS: Fifty-nine (96.7\\%) of the 61 participants (male, 42 [71.2\\%]; age, 60.1 ± 8.7 years; HbA1c level, 7.48 ± 0.37\\% at screening) completed the study. At the end of the observation period, the HbA1c was significantly reduced (- 0.41 ± 0.41\\%, p {\\textless} 0.001). This trend was consistent across the preselected patient characteristics, including sex, age, and body mass index. However, it was more pronounced in the participants with earlier stages of behavioral changes defined by the transtheoretical model at baseline. CONCLUSIONS: The unique features of TOMOCO™ in combination with Fitbit, together with conventional therapy, may promote a healthy lifestyle and thus contribute to improving HbA1c in people with T2DM. CLINICAL TRIAL REGISTRATION: jRCT1070220007.", "links": [] }, { "title": "Implementation of a randomized mobile-technology lifestyle program in individuals with nonalcoholic fatty liver disease", "author": "Tincopa, Monica A.; Patel, Nik; Shahab, Areesha; Asefa, Haila; Lok, Anna S.", "year": "2024", "journalProceedings": "Scientific Reports", "category": "Intervention", "devices": "Zip", "population": "Patients", "dataUsed": "Steps", "abstract": "Identifying effective, feasible, low-cost interventions that promote sustainable lifestyle changes in nonalcoholic fatty liver disease (NAFLD) is a key unmet need. The aim of this study was to assess predictors of lifestyle practice patterns of NAFLD patients and evaluate the implementation of a mobile technology-based intervention. We prospectively enrolled adults with NAFLD (diagnosed by imaging or biopsy). Individuals with additional liver diseases or decompensated cirrhosis were excluded. Patient were randomized to usual care or a FitBit based program for 6-months. We obtained anthropometrics, labs, vibration controlled transient elastography (VCTE), health-related quality of life (HRQOL), physical activity, diet and motivation to change data. 70 patients were enrolled, 33\\% with cirrhosis. Median age was 52.1 years, 47\\% males, 83\\% white, body mass index 32.3, liver stiffness 7.6 kPa, controlled attenuation parameter 319 db/m, and 50\\% had diabetes. Baseline HRQOL was 5.4/7 and independently negatively correlated with level of concern about their disease and positively with physical function. Younger age was independently associated with unhealthy diets whereas diabetes was independently associated with unhealthy diets and higher VCTE kPa. 6-month follow-up data available on 31 patients showed trends in improvement in weight. In a cohort of NAFLD patients, we identified independent correlates of lifestyle behaviors and HRQOL. Implementation of interventions that improve physical function may improve HRQOL in NAFLD. Younger patients and those with diabetes appeared to have the greatest need for dietary interventions. Structured mobile technology lifestyle interventions using Fitbit and personalized coaching showed promise but require further validation with a focus on sustainability of intervention and improvement in outcomes.", "links": [] }, { "title": "Feasibility of application-based psychomotor vigilance testing to assess fatigue in doctors working night shifts and correlation with smartwatch assessed shift intensity", "author": "Weetman, Stefan; Roche, Matthew; Leckie, Todd; Samuels, Theophilus; Hodgson, Luke", "year": "2024", "journalProceedings": "Occupational and Environmental Medicine", "category": "Usability,Case Study", "devices": "Versa 2", "population": "Adults", "dataUsed": "Steps,Active Minutes/Active Zone Minutes", "abstract": "OBJECTIVES: To assess: (1) the feasibility of novel data collection methods (wearable technology and an application-based psychomotor vigilance test (PVT)), (2) the impact of night shift working on fatigue, both objective and perceived, for doctors working night shifts in acute hospital specialties and (3) the effects of shift intensity and naps obtained on participant fatigue. METHODS: We adopted an innovative, multimodal approach to data collection allowing assessment of objective and perceived measures of fatigue, in addition to markers of shift intensity. This comprised 5 min PVT for objective quantification of fatigue (via the validated, smartphone-based NASA PVT+ application), wearable electronic devices (Fitbit Versa2) for assessment of shift intensity (step counts and active minutes) and questionnaires to elicit perceptions of fatigue and shift intensity. RESULTS: Data was collected from 25 participants for a total of 145 night shifts. Objective fatigue (assessed by PVT performance) was significantly increased post night shift, with a PVT mean reaction time 257 ms pre shift versus 283 ms post shift (p{\\textless}0.0001). However, differences in PVT pre and post shift were not affected by night shift intensity, nor breaks or naps taken on shift. Differences in psychomotor performance between doctors working in different specialties were also observed. CONCLUSIONS: The data collection methods used were found to be feasible with good participant engagement. Findings support existing evidence that night shift working in healthcare workers is associated with fatigue, with psychomotor impairment observed post shift. Lower shift intensity and napping did not appear to mitigate this effect.", "links": [] }, { "title": "Comparison of raw accelerometry data from ActiGraph, Apple Watch, Garmin, and Fitbit using a mechanical shaker table", "author": "White, James W.; Finnegan, Olivia L.; Tindall, Nick; Nelakuditi, Srihari; Brown, David E.; Pate, Russell R.; Welk, Gregory J.; de Zambotti, Massimiliano; Ghosal, Rahul; Wang, Yuan; Burkart, Sarah; Adams, Elizabeth L.; Chandrashekhar, Mvs; Armstrong, Bridget; Beets, Michael W.; Weaver, R. Glenn", "year": "2024", "journalProceedings": "PloS One", "category": "Validation", "devices": "Sense", "population": "NA", "dataUsed": "Heart Rate", "abstract": "The purpose of this study was to evaluate the reliability and validity of the raw accelerometry output from research-grade and consumer wearable devices compared to accelerations produced by a mechanical shaker table. Raw accelerometry data from a total of 40 devices (i.e., n = 10 ActiGraph wGT3X-BT, n = 10 Apple Watch Series 7, n = 10 Garmin Vivoactive 4S, and n = 10 Fitbit Sense) were compared to reference accelerations produced by an orbital shaker table at speeds ranging from 0.6 Hz (4.4 milligravity-mg) to 3.2 Hz (124.7mg). Two-way random effects absolute intraclass correlation coefficients (ICC) tested inter-device reliability. Pearson product moment, Lin's concordance correlation coefficient (CCC), absolute error, mean bias, and equivalence testing were calculated to assess the validity between the raw estimates from the devices and the reference metric. Estimates from Apple, ActiGraph, Garmin, and Fitbit were reliable, with ICCs = 0.99, 0.97, 0.88, and 0.88, respectively. Estimates from ActiGraph, Apple, and Fitbit devices exhibited excellent concordance with the reference CCCs = 0.88, 0.83, and 0.85, respectively, while estimates from Garmin exhibited moderate concordance CCC = 0.59 based on the mean aggregation method. ActiGraph, Apple, and Fitbit produced similar absolute errors = 16.9mg, 21.6mg, and 22.0mg, respectively, while Garmin produced higher absolute error = 32.5mg compared to the reference. ActiGraph produced the lowest mean bias 0.0mg (95\\%CI = -40.0, 41.0). Equivalence testing revealed raw accelerometry data from all devices were not statistically significantly within the equivalence bounds of the shaker speed. Findings from this study provide evidence that raw accelerometry data from Apple, Garmin, and Fitbit devices can be used to reliably estimate movement; however, no estimates were statistically significantly equivalent to the reference. Future studies could explore device-agnostic and harmonization methods for estimating physical activity using the raw accelerometry signals from the consumer wearables studied herein.", "links": [] }, { "title": "A lifestyle physical activity intervention for women in alcohol treatment: A pilot randomized controlled trial", "author": "Abrantes, Ana M.; Browne, Julia; Stein, Michael D.; Anderson, Bradley; Iacoi, Sydney; Barter, Sarah; Shah, Zainab; Read, Jennifer; Battle, Cynthia", "year": "2024", "journalProceedings": "Journal of Substance Use and Addiction Treatment", "category": "Intervention", "devices": "Alta", "population": "Adults", "dataUsed": "Steps", "abstract": "Introduction: Compared to men, women with alcohol use disorder (AUD) are more likely to drink to manage stress and negative affect. Given women's risk for poor drinking outcomes, it is critical to develop and test interventions that target these affective factors. Physical activity improves negative affect and has emerged as a promising adjunct to AUD treatment and, thus, may be especially valuable for women.\n\nMethods: Fifty women with AUD (49.9 ± 12.0 years of age) participated in either a 12-week telephone-delivered lifestyle physical activity plus Fitbit (LPA + Fitbit) or a health education contact (HEC) control intervention following a partial hospital addictions treatment program. The study examined changes in drinking behaviors, mental health outcomes, and physical activity engagement post-intervention using both conventional test statistics and standard effect sizes.\n\nResults: Higher rates of continuous abstinence during the 12-week period were observed in the LPA + Fitbit condition (55.6 %) than in the HEC condition (33.6 %); odds ratio = 2.97. However, among women who drank any alcohol during the 12-weeks, slightly higher rates of heavy drinking and drinks/day were observed among women in the LPA + Fitbit condition. Significant differences for improved mental health outcomes (including depression, anxiety, negative affect, positive affect, perceived stress, and behavioral activation) and increased self-reported physical activity were consistently observed among participants in the LPA + Fitbit condition, relative to HEC.\n\nConclusions: The LPA + Fitbit program had a positive impact on alcohol abstinence, mental health, and physical activity in adult women receiving treatment for AUD. Future research should continue to investigate the optimal implementation strategies, duration, and intensity of LPA interventions in the context of a fully-powered RCT.\n\nKeywords: Alcohol craving; Depression; Drinking outcomes; Physical activity; Women.", "links": [] }, { "title": "Detection of Arrhythmias Using Smartwatches-A Systematic Literature Review", "author": "Bogár, Bence; Pető, Dániel; Sipos, Dávid; Füredi, Gábor; Keszthelyi, Antónia; Betlehem, József; Pandur, Attila András", "year": "2024", "journalProceedings": "Healthcare (Basel, Switzerland)", "category": "Systematic Review", "devices": "Charge,Charge HR,Charge 2,Blaze,Sense", "population": "Adults", "dataUsed": "Sleep,Heart Rate", "abstract": "Smartwatches represent one of the most widely adopted technological innovations among wearable devices. Their evolution has equipped them with an increasing array of features, including the capability to record an electrocardiogram. This functionality allows users to detect potential arrhythmias, enabling prompt intervention or monitoring of existing arrhythmias, such as atrial fibrillation. In our research, we aimed to compile case reports, case series, and cohort studies from the Web of Science, PubMed, Scopus, and Embase databases published until 1 August 2023. The search employed keywords such as \"Smart Watch\", \"Apple Watch\", \"Samsung Gear\", \"Samsung Galaxy Watch\", \"Google Pixel Watch\", \"Fitbit\", \"Huawei Watch\", \"Withings\", \"Garmin\", \"Atrial Fibrillation\", \"Supraventricular Tachycardia\", \"Cardiac Arrhythmia\", \"Ventricular Tachycardia\", \"Atrioventricular Nodal Reentrant Tachycardia\", \"Atrioventricular Reentrant Tachycardia\", \"Heart Block\", \"Atrial Flutter\", \"Ectopic Atrial Tachycardia\", and \"Bradyarrhythmia.\" We obtained a total of 758 results, from which we selected 57 articles, including 33 case reports and case series, as well as 24 cohort studies. Most of the scientific works focused on atrial fibrillation, which is often detected using Apple Watches. Nevertheless, we also included articles investigating arrhythmias with the potential for circulatory collapse without immediate intervention. This systematic literature review provides a comprehensive overview of the current state of research on arrhythmia detection using smartwatches. Through further research, it may be possible to develop a care protocol that integrates arrhythmias recorded by smartwatches, allowing for timely access to appropriate medical care for patients. Additionally, continuous monitoring of existing arrhythmias using smartwatches could facilitate the assessment of the effectiveness of prescribed therapies.\n\nKeywords: arrhythmia; atrial fibrillation; smartwatch.", "links": [] }, { "title": "Association of Remote Patient-Reported Outcomes and Step Counts With Hospitalization or Death Among Patients With Advanced Cancer Undergoing Chemotherapy: Secondary Analysis of the PROStep Randomized Trial", "author": "Manz, Christopher R.; Schriver, Emily; Ferrell, William J.; Williamson, Joelle; Wakim, Jonathan; Khan, Neda; Kopinsky, Michael; Balachandran, Mohan; Chen, Jinbo; Patel, Mitesh S.; Takvorian, Samuel U.; Shulman, Lawrence N.; Bekelman, Justin E.; Barnett, Ian J.; Parikh, Ravi B.", "year": "2024", "journalProceedings": "Journal of Medical Internet Research", "category": "Case Study", "devices": "Inspire HR", "population": "Patients", "dataUsed": "Steps", "abstract": "Background: Patients with advanced cancer undergoing chemotherapy experience significant symptoms and declines in functional status, which are associated with poor outcomes. Remote monitoring of patient-reported outcomes (PROs; symptoms) and step counts (functional status) may proactively identify patients at risk of hospitalization or death.\n\nObjective: The aim of this study is to evaluate the association of (1) longitudinal PROs with step counts and (2) PROs and step counts with hospitalization or death.\n\nMethods: The PROStep randomized trial enrolled 108 patients with advanced gastrointestinal or lung cancers undergoing cytotoxic chemotherapy at a large academic cancer center. Patients were randomized to weekly text-based monitoring of 8 PROs plus continuous step count monitoring via Fitbit (Google) versus usual care. This preplanned secondary analysis included 57 of 75 patients randomized to the intervention who had PRO and step count data. We analyzed the associations between PROs and mean daily step counts and the associations of PROs and step counts with the composite outcome of hospitalization or death using bootstrapped generalized linear models to account for longitudinal data.\n\nResults: Among 57 patients, the mean age was 57 (SD 10.9) years, 24 (42%) were female, 43 (75%) had advanced gastrointestinal cancer, 14 (25%) had advanced lung cancer, and 25 (44%) were hospitalized or died during follow-up. A 1-point weekly increase (on a 32-point scale) in aggregate PRO score was associated with 247 fewer mean daily steps (95% CI -277 to -213; P<.001). PROs most strongly associated with step count decline were patient-reported activity (daily step change -892), nausea score (-677), and constipation score (524). A 1-point weekly increase in aggregate PRO score was associated with 20% greater odds of hospitalization or death (adjusted odds ratio [aOR] 1.2, 95% CI 1.1-1.4; P=.01). PROs most strongly associated with hospitalization or death were pain (aOR 3.2, 95% CI 1.6-6.5; P<.001), decreased activity (aOR 3.2, 95% CI 1.4-7.1; P=.01), dyspnea (aOR 2.6, 95% CI 1.2-5.5; P=.02), and sadness (aOR 2.1, 95% CI 1.1-4.3; P=.03). A decrease in 1000 steps was associated with 16% greater odds of hospitalization or death (aOR 1.2, 95% CI 1.0-1.3; P=.03). Compared with baseline, mean daily step count decreased 7% (n=274 steps), 9% (n=351 steps), and 16% (n=667 steps) in the 3, 2, and 1 weeks before hospitalization or death, respectively.\n\nConclusions: In this secondary analysis of a randomized trial among patients with advanced cancer, higher symptom burden and decreased step count were independently associated with and predictably worsened close to hospitalization or death. Future interventions should leverage longitudinal PRO and step count data to target interventions toward patients at risk for poor outcomes.\n\nTrial registration: ClinicalTrials.gov NCT04616768; https://clinicaltrials.gov/study/NCT04616768.\n\nInternational registered report identifier (irrid): RR2-10.1136/bmjopen-2021-054675.\n\nKeywords: accelerometer; accelerometers; cancer; chemotherapy; death; gastrointestinal cancer; hospitalization; lung cancer; mobile phone; monitoring; oncology; patient-generated health data; patient-reported outcomes; risk; step counts; symptom burden; symptoms; wearables.", "links": [] }, { "title": "Association of physical activity and screen time with cardiovascular disease risk in the Adolescent Brain Cognitive Development Study", "author": "Nagata, Jason M.; Weinstein, Shayna; Alsamman, Sana; Lee, Christopher M.; Dooley, Erin E.; Ganson, Kyle T.; Testa, Alexander; Gooding, Holly C.; Kiss, Orsolya; Baker, Fiona C.; Pettee Gabriel, Kelley", "year": "2024", "journalProceedings": "BMC public health", "category": "Case Study", "devices": "Charge", "population": "Adolescents", "dataUsed": "Steps", "abstract": "Background: According to the Physical Activity Guidelines Advisory Committee Scientific Report, limited evidence is available on sedentary behaviors (screen time) and their joint associations with physical activity (steps) for cardiovascular health in adolescence. The objective of this study was to identify joint associations of screen time and physical activity categories with cardiovascular disease (CVD) risk factors (blood pressure, hemoglobin A1c, cholesterol) in adolescence.\n\nMethods: This study analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, comprising a diverse sample of 4,718 U.S. adolescents aged 10-15 years between 2018 and 2021. Steps were measured by a Fitbit wearable device and levels were categorized as low (1,000-6,000), medium (> 6,000-12,000), and high (> 12,000) averaged daily step counts. Self-reported recreational screen time hours per day were classified as low (0-4), medium (> 4-8), and high (> 8) hours per day. CVD risk factors including blood pressure, hemoglobin A1c, and cholesterol (total and HDL) were measured.\n\nResults: The analytical sample averaged 6.6 h of screen time per day and 9,722 steps per day. In models including both screen time and steps, the high screen time category was associated with a 4.27 higher diastolic blood pressure percentile (95% CI 1.83-6.73) and lower HDL cholesterol (B= -2.85, 95% CI -4.77 to -0.94 mg/dL) compared to the low screen time category. Medium (B = 3.68, 95% CI 1.24-6.11) and low (B = 7.64, 95% CI 4.07-11.20) step categories were associated with higher diastolic blood pressure percentile compared to the high step category. The medium step category was associated with lower HDL cholesterol (B= -1.99, 95% CI -3.80 to -0.19 mg/dL) compared to the high step category. Findings were similar when screen time and step counts were analyzed as continuous variables; higher continuous step count was additionally associated with lower total cholesterol (mg/dL).\n\nConclusions: Combinations of low screen time and high steps were generally associated with favorable cardiovascular health markers including lower diastolic blood pressure and higher HDL cholesterol, which can inform future adolescent health guidelines.\n\nKeywords: Adolescent; Blood pressure; Cardiovascular disease; Cholesterol; Diabetes; Digital media; Dyslipidemia; Hemoglobin A1c; Hypertension; Physical activity; Screen use.", "links": [] }, { "title": "Patterns of virtual reality and Fitbit wearable activity device use after skull base surgery", "author": "Pandrangi, Vivek C.; Araujo, Ana; Buncke, Michelle; Olson, Brennan; Jorizzo, Matthew; Said-Al-Naief, Nasser; Sanusi, Olabisi; Ciporen, Jeremy; Shindo, Maisie; Schindler, Joshua; Colaianni, C. Alessandra; Clayburgh, Daniel; Andersen, Peter; Flint, Paul; Wax, Mark K.; Geltzeiler, Mathew; Li, Ryan J.", "year": "2024", "journalProceedings": "International Forum of Allergy \\& Rhinology", "category": "Intervention", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps", "abstract": "Virtual reality (VR) and Fitbit devices are well tolerated by patients after skull base surgery. Postoperative recovery protocols may benefit from incorporation of these devices. However, challenges including patient compliance may impact optimal device utilization.\n\nKeywords: Fitbit; opioid; pain; skull base; surgery; virtual reality; wearable activity device.", "links": [] }, { "title": "A multiple technology-based and individually-tailored Sit Less program for people with cardiovascular disease: A randomized controlled trial study protocol", "author": "Park, Chorong; Larsen, Britta; Mogos, Mulubrhan; Muchira, James; Dietrich, Mary; LaNoue, Marianna; Jean, Jason; Norfleet, John; Doyle, Abigail; Ahn, Soojung; Mulvaney, Shelagh", "year": "2024", "journalProceedings": "PloS One", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Intensity,Active Minutes/Active Zone Minutes", "abstract": "Sedentary behavior, a key modifiable risk factor for cardiovascular disease, is prevalent among cardiovascular disease patients. However, few interventions target sedentary behavior in this group. This paper describes the protocol of a parallel two-group randomized controlled trial for a novel multi-technology sedentary behavior reduction intervention for cardiovascular disease patients (registered at Clinicaltrial.gov, NCT05534256). The pilot trial (n = 70) will test a 12-week \"Sit Less\" program, based on Habit Formation theory. The 35 participants in the intervention group will receive an instructional goal-setting session, a Fitbit for movement prompts, a smart water bottle (HidrateSpark) to promote hydration and encourage restroom breaks, and weekly personalized text messages. A control group of 35 will receive the American Heart Association's \"Answers by Heart\" fact sheets. This trial will assess the feasibility and acceptability of implementing the \"Sit Less\" program with cardiovascular disease patients and the program's primary efficacy in changing sedentary behavior, measured by the activPAL activity tracker. Secondary outcomes include physical activity levels, cardiometabolic biomarkers, and patient-centered outcomes (i.e. sedentary behavior self-efficacy, habit strength, and fear of movement). This study leverages commonly used mobile and wearable technologies to address sedentary behavior in cardiovascular disease patients, a high-risk group. Its findings on the feasibility, acceptability and primary efficacy of the intervention hold promise for broad dissemination.", "links": [] }, { "title": "Physical activity and sedentary behaviour of Bahraini people with type 2 diabetes: A cross-sectional study", "author": "Rajab, Ebrahim; Wasif, Pearl; Doherty, Sally; Gaynor, Declan; Malik, Hani; Fredericks, Salim; Al-Qallaf, Amal; Almuqahwi, Rabab; Alsharbati, Wafa; Rashid-Doubell, Fiza", "year": "2024", "journalProceedings": "Digital Health", "category": "Case Study", "devices": "Flex 2", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Objective: Study patterns of physical activity and sedentary behaviour and the influence of demographics and body mass index (BMI) on these behaviours amongst Bahraini adults with type 2 diabetes over 10 weeks using an activity tracker.\n\nMethod: This cross-sectional observational study was conducted at a Bahrain government health centre. Thirty-three Bahraini Arab adults, 30-60 years old, with controlled type 2 diabetes, wore a Fitbit Flex 2TM activity tracker for 10 weeks. Data on age, sex, marital and employment status, education and BMI were collected at the start of the study.\n\nResults: A total of N = 32 participants completed the study. The average steps per day were 7859 ± 4131, and there were no differences between baseline, week 5 and 10. A third of participants were sedentary, based on a threshold of 5000 steps/day. Females accumulated fewer average daily steps than males (6728 ± 2936 vs. 10,281 ± 4623, p = 0.018). Daily averages for physical activity intensity were as follows: sedentary (786 ± 109 min), light (250 ± 76 min), moderate (9 ± 10 min) and vigorous (12 ± 18 min). Males had higher daily averages versus females for moderate (13 ± 9 vs. 5 ± 9 min, p = 0.018) and vigorous physical activity (21 ± 23 vs. 5 ± 7 min, p = 0.034). 91% of participants wore the device ≥10 h/day. The adherence rate was 79% based on percentage of days the device was worn continuously over 10 weeks.\n\nConclusion: Future physical activity interventions should target sedentary and female participants with type 2 diabetes. In addition, we need to understand the facilitators and barriers to physical activity and the physical activity preferences of these two subgroups.\n\nKeywords: Exercise; behaviour; mHealth; physical activity; type 2 diabetes mellitus.", "links": [] }, { "title": "Feasibility of Fit24, a Digital Diabetes Prevention Program for Hispanic Adolescents: Qualitative Evaluation Study", "author": "Soltero, Erica G.; Musaad, Salma M.; O'Connor, Teresia M.; Thompson, Debbe; Norris, Keith; Beech, Bettina M.", "year": "2024", "journalProceedings": "JMIR formative research", "category": "Intervention", "devices": "Charge 5", "population": "Children", "dataUsed": "Steps,User Friendliness", "abstract": "Background: Digital health interventions are promising for reaching and engaging high-risk youth in disease prevention opportunities; however, few digital prevention interventions have been developed for Hispanic youth, limiting our knowledge of these strategies among this population.\n\nObjective: This study qualitatively assessed the feasibility and acceptability of Fit24, a 12-week goal-setting intervention that uses a Fitbit watch (Fitbit Inc) and theoretically grounded SMS text messages to promote physical activity and sleep among Hispanic adolescents (aged between 14 and 16 years) with obesity.\n\nMethods: After completing the intervention, a subsample of youth (N=15) participated in an in-depth interview. We categorized the themes into dimensions based on participant perspectives using the Practical, Robust Implementation, and Sustainability Model (PRISM) framework.\n\nResults: Participants shared positive perceptions of wearing the Fitbit and receiving SMS text messages. Youth were highly engaged in monitoring their behaviors and perceived increased activity and sleep. Almost all youth organically received social support from a peer or family member and suggested the use of a group chat or team challenge for integrating peers into future interventions. However, most youth also expressed the need to take personal responsibility for the change in their behavior. Barriers that impacted the feasibility of the study included the skin-irritating material on the Fitbit watch band and environmental barriers (eg, lack of resources and school schedules), that limited participation in activity suggestions. Additionally, sync issues with the Fitbit limited the transmission of data, leading to inaccurate feedback.\n\nConclusions: Fit24 is a promising approach for engaging Hispanic youth in a diabetes prevention program. Strategies are needed to address technical issues with the Fitbit and environmental issues such as message timing. While integrating peer social support may be desired by some, peer support strategies should be mindful of youth's desire to foster personal motivation for behavior change. Findings from this study will inform future diabetes prevention trials of Fit24 and other digital health interventions for high-risk pediatric populations.", "links": [] }, { "title": "Assessing the impact of message relevance and frequency on physical activity change: A secondary data analysis from the random AIM trial", "author": "Wu, Jingchuan; Brunke-Reese, Deborah; Lagoa, Constantino M.; Conroy, David E.", "year": "2024", "journalProceedings": "Digital Health", "category": "Intervention", "devices": "Versa", "population": "Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Text messages are widely used to deliver intervention content; however, sending more intensive messages may not always improve behavioral outcomes. This study investigated whether message frequency was associated with daily physical activity, either by itself or in interaction with message content relevance. Healthy but insufficiently active young adults (aged 18-29 years) wore Fitbit activity trackers and received text messages for 180 days. Message frequencies varied daily at random, and messages were sent from three content libraries (40% Move More, 40% Sit Less, 20% Inspirational Quotes). Contrary to expectations, the results revealed a null association between total daily text message frequency and physical activity, both for daily step counts and moderate-to-vigorous physical activity (MVPA) duration. Additional analyses revealed that the daily frequency of messages with relevant content (i.e. Move More, Sit Less) was not associated with physical activity, but the daily frequency of messages with irrelevant content (i.e. Inspirational Quotes) was negatively associated with physical activity. We concluded that the effectiveness of text messages in promoting physical activity is impacted by the combination of content relevance and frequency, with frequent irrelevant messages potentially decreasing activity levels. This study suggests that irrelevant message frequency can negatively impact physical activity, highlighting the risks of delivering irrelevant content in digital health interventions.", "links": [] }, { "title": "Fitbit's accuracy to measure short bouts of stepping and sedentary behaviour: validation, sensitivity and specificity study", "author": "Delobelle, Julie; Lebuf, Elien; Dyck, Delfien Van; Compernolle, Sofie; Janek, Michael; Backere, Femke De; Vetrovsky, Tomas", "year": "2024", "journalProceedings": "Digital Health", "category": "Validation,Intervention", "devices": "Ionic,Inspire 2", "population": "Adults", "dataUsed": "Steps", "abstract": "OBJECTIVE: This study aims to assess the suitability of Fitbit devices for real-time physical activity (PA) and sedentary behaviour (SB) monitoring in the context of just-in-time adaptive interventions (JITAIs) and event-based ecological momentary assessment (EMA) studies. METHODS: Thirty-seven adults (18-65 years) and 32 older adults (65+) from Belgium and the Czech Republic wore four devices simultaneously for 3 days: two Fitbit models on the wrist, an ActiGraph GT3X+ at the hip and an ActivPAL at the thigh. Accuracy measures included mean (absolute) error and mean (absolute) percentage error. Concurrent validity was assessed using Lin's concordance correlation coefficient and Bland-Altman analyses. Fitbit's sensitivity and specificity for detecting stepping events across different thresholds and durations were calculated compared to ActiGraph, while ROC curve analyses identified optimal Fitbit thresholds for detecting sedentary events according to ActivPAL. RESULTS: Fitbits demonstrated validity in measuring steps on a short time scale compared to ActiGraph. Except for stepping above 120 steps/min in older adults, both Fitbit models detected stepping bouts in adults and older adults with sensitivities and specificities exceeding 87\\% and 97\\%, respectively. Optimal cut-off values for identifying prolonged sitting bouts achieved sensitivities and specificities greater than 93\\% and 89\\%, respectively. CONCLUSIONS: This study provides practical insights into using Fitbit devices in JITAIs and event-based EMA studies among adults and older adults. Fitbits' reasonable accuracy in detecting short bouts of stepping and SB makes them suitable for triggering JITAI prompts or EMA questionnaires following a PA or SB event of interest.", "links": [] }, { "title": "Text Messages to Promote Physical Activity in Patients With Cardiovascular Disease: A Micro-Randomized Trial of a Just-In-Time Adaptive Intervention", "author": "Golbus, Jessica R.; Shi, Jieru; Gupta, Kashvi; Stevens, Rachel; Jeganathan, V. Swetha E.; Luff, Evan; Boyden, Thomas; Mukherjee, Bhramar; Kohnstamm, Sarah; Taralunga, Vlad; Kheterpal, Vik; Kheterpal, Sachin; Resnicow, Kenneth; Murphy, Susan; Dempsey, Walter; Klasnja, Predrag; Nallamothu, Brahmajee K.", "year": "2024", "journalProceedings": "Circulation. Cardiovascular Quality and Outcomes", "category": "Intervention", "devices": "Versa", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Text messages may enhance physical activity levels in patients with cardiovascular disease, including those enrolled in cardiac rehabilitation. However, the independent and long-term effects of text messages remain uncertain. METHODS: The VALENTINE study (Virtual Application-supported Environment to Increase Exercise) was a micro-randomized trial that delivered text messages through a smartwatch (Apple Watch or Fitbit Versa) to participants initiating cardiac rehabilitation. Participants were randomized 4× per day over 6-months to receive no text message or a message encouraging low-level physical activity. Text messages were tailored on contextual factors (eg, weather). Our primary outcome was step count 60 minutes following a text message, and we used a centered and weighted least squares mean method to estimate causal effects. Given potential measurement differences between devices determined a priori, data were assessed separately for Apple Watch and Fitbit Versa users over 3 time periods corresponding to the initiation (0-30 days), maintenance (31-120 days), and completion (121-182 days) of cardiac rehabilitation. RESULTS: One hundred eight participants were included with 70 552 randomizations over 6 months; mean age was 59.5 (SD, 10.7) years with 36 (32.4\\%) female and 68 (63.0\\%) Apple Watch participants. For Apple Watch participants, text messages led to a trend in increased step count by 10\\% in the 60-minutes following a message during days 1 to 30 (95\\% CI, -1\\% to +20\\%), with no effect from days 31 to 120 (+1\\% [95\\% CI, -4\\% to +5\\%]), and a significant 6\\% increase during days 121 to 182 (95\\% CI, +0\\% to +11\\%). For Fitbit users, text messages significantly increased step count by 17\\% (95\\% CI, +7\\% to +28\\%) in the 60-minutes following a message in the first 30 days of the study with no effect subsequently. CONCLUSIONS: In patients undergoing cardiac rehabilitation, contextually tailored text messages may increase physical activity, but this effect varies over time and by device. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04587882.", "links": [] }, { "title": "Perceived and physiological strains of societal participation in people with multiple sclerosis: a real-time assessment study", "author": "Gravesteijn, Arianne S.; Ouwerkerk, Maaike; Eijssen, Isaline C. J. M.; Beckerman, Heleen; De Groot, Vincent", "year": "2024", "journalProceedings": "Journal of Rehabilitation Medicine", "category": "Case Study", "devices": "Charge 2,Charge 3", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "OBJECTIVE: To examine the relationship between perceived and physiological strains of real-time societal participation in people with multiple sclerosis. DESIGN: Observational study. SUBJECTS/PATIENTS: 70 people with multiple sclerosis. METHODS: Perceived and physiological strain of societal participation (10 participation-at-location and 9 transport domains) were measured in real time using the Whereabouts smartphone app and Fitbit over 7 consecutive days. Longitudinal relationships between perceived (1 not strenuous to 10 most strenuous) and physiological strains (heart rate reserve) were examined using mixed-model analyses. Type of event (participation-at-location or transport) was added as covariate, with further adjustments for fatigue and walking ability. RESULTS: Median perceived strain, summarized for all societal participation domains, varied between 3 and 6 (range: 1-10), whereas physiological strain varied between 18.5\\% and 33.2\\% heart rate reserve. Perceived strain (outcome) and physiological strain were not associated (β -0.001, 95\\%CI -0.008; 0.005, with a 7-day longitudinal correlation coefficient of -0.001). Transport domains were perceived as less strenuous (β -0.80, 95\\%CI -0.92; -0.68). Higher fatigue levels resulted in higher perceived strain (all societal participation domains) (β 0.05, 95\\%CI 0.02; 0.08). CONCLUSION: Societal participation resulted in low-to-moderate perceived and physiological strain. Perceived and physiological strain of societal participation were unrelated and should be considered different constructs in multiple sclerosis.", "links": [] }, { "title": "Evaluating the technical use of a Fitbit during an intervention for patients with pulmonary arterial hypertension with quality of life as primary endpoint: Lessons learned from the UPHILL study", "author": "Kwant, Chermaine T.; de Man, Frances S.; Bogaard, Harm J.; Noordegraaf, Anton Vonk", "year": "2024", "journalProceedings": "Pulmonary Circulation", "category": "Intervention", "devices": "Charge 3", "population": "Patients", "dataUsed": "Steps", "abstract": "This article examines technical use of Fitbit during an intervention for pulmonary hypertension (PAH)-patients. Technical issues with the device led to data being unavailable(37.5\\%). During intervention objective daily physical activity (DPA) decreased and subjective DPA increased. This emphasizes that an assessment of DPA in PAH requires incorporating both objective and subjective measurements.", "links": [] }, { "title": "Heart Rate Monitoring Among Breast Cancer Survivors: Quantitative Study of Device Agreement in a Community-Based Exercise Program", "author": "Page, Lindsey L.; Fanning, Jason; Phipps, Connor; Berger, Ann; Reed, Elizabeth; Ehlers, Diane", "year": "2024", "journalProceedings": "JMIR cancer", "category": "Intervention", "devices": "Inspire HR", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Exercise intensity (eg, target heart rate [HR]) is a fundamental component of exercise prescription to elicit health benefits in cancer survivors. Despite the validity of chest-worn monitors, their feasibility in community and unsupervised exercise settings may be challenging. As wearable technology continues to improve, consumer-based wearable sensors may represent an accessible alternative to traditional monitoring, offering additional advantages. OBJECTIVE: The purpose of this study was to examine the agreement between the Polar H10 chest monitor and Fitbit Inspire HR for HR measurement in breast cancer survivors enrolled in the intervention arm of a randomized, pilot exercise trial. METHODS: Participants included breast cancer survivors (N=14; aged 38-72 years) randomized to a 12-week aerobic exercise program. This program consisted of three 60-minute, moderate-intensity walking sessions per week, either in small groups or one-on-one, facilitated by a certified exercise physiologist and held at local community fitness centers. As originally designed, the exercise prescription included 36 supervised sessions at a fitness center. However, due to the COVID-19 pandemic, the number of supervised sessions varied depending on whether participants enrolled before or after March 2020. During each exercise session, HR (in beats per minute) was concurrently measured via a Polar H10 chest monitor and a wrist-worn Fitbit Inspire HR at 5 stages: pre-exercise rest; midpoint of warm-up; midpoint of exercise session; midpoint of cool-down; and postexercise recovery. The exercise physiologist recorded the participant's HR from each device at the midpoint of each stage. HR agreement between the Polar H10 and Fitbit Inspire HR was assessed using Lin concordance correlation coefficient (rc) with a 95\\% CI. Lin rc ranges from 0 to 1.00, with 0 indicating no concordance and 1.00 indicating perfect concordance. Relative error rates were calculated to examine differences across exercise session stages. RESULTS: Data were available for 200 supervised sessions across the sample (session per participant: mean 13.33, SD 13.7). By exercise session stage, agreement between the Polar H10 monitor and the Fitbit was highest during pre-exercise seated rest (rc=0.76, 95\\% CI 0.70-0.81) and postexercise seated recovery (rc=0.89, 95\\% CI 0.86-0.92), followed by the midpoint of exercise (rc=0.63, 95\\% CI 0.55-0.70) and cool-down (rc=0.68, 95\\% CI 0.60-0.74). The agreement was lowest during warm-up (rc=0.39, 95\\% CI 0.27-0.49). Relative error rates ranged from -3.91\\% to 3.09\\% and were greatest during warm-up (relative error rate: mean -3.91, SD 11.92\\%). CONCLUSIONS: The Fitbit overestimated HR during peak exercise intensity, posing risks for overexercising, which may not be safe for breast cancer survivors' fitness levels. While the Fitbit Inspire HR may be used to estimate exercise HR, precautions are needed when considering participant safety and data interpretation. TRIAL REGISTRATION: Clinicaltrials.gov NCT03980626; https://clinicaltrials.gov/study/NCT03980626?term=NCT03980626\\&rank=1.", "links": [] }, { "title": "Digital Phenotyping of Geriatric Depression Using a Community-Based Digital Mental Health Monitoring Platform for Socially Vulnerable Older Adults and Their Community Caregivers: 6-Week Living Lab Single-Arm Pilot Study", "author": "Song, Sunmi; Seo, YoungBin; Hwang, SeoYeon; Kim, Hae-Young; Kim, Junesun", "year": "2024", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "Sense", "population": "Older Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "BACKGROUND: Despite the increasing need for digital services to support geriatric mental health, the development and implementation of digital mental health care systems for older adults have been hindered by a lack of studies involving socially vulnerable older adult users and their caregivers in natural living environments. OBJECTIVE: This study aims to determine whether digital sensing data on heart rate variability, sleep quality, and physical activity can predict same-day or next-day depressive symptoms among socially vulnerable older adults in their everyday living environments. In addition, this study tested the feasibility of a digital mental health monitoring platform designed to inform older adult users and their community caregivers about day-to-day changes in the health status of older adults. METHODS: A single-arm, nonrandomized living lab pilot study was conducted with socially vulnerable older adults (n=25), their community caregivers (n=16), and a managerial social worker over a 6-week period during and after the COVID-19 pandemic. Depressive symptoms were assessed daily using the 9-item Patient Health Questionnaire via scripted verbal conversations with a mobile chatbot. Digital biomarkers for depression, including heart rate variability, sleep, and physical activity, were measured using a wearable sensor (Fitbit Sense) that was worn continuously, except during charging times. Daily individualized feedback, using traffic signal signs, on the health status of older adult users regarding stress, sleep, physical activity, and health emergency status was displayed on a mobile app for the users and on a web application for their community caregivers. Multilevel modeling was used to examine whether the digital biomarkers predicted same-day or next-day depressive symptoms. Study staff conducted pre- and postsurveys in person at the homes of older adult users to monitor changes in depressive symptoms, sleep quality, and system usability. RESULTS: Among the 31 older adult participants, 25 provided data for the living lab and 24 provided data for the pre-post test analysis. The multilevel modeling results showed that increases in daily sleep fragmentation (P=.003) and sleep efficiency (P=.001) compared with one's average were associated with an increased risk of daily depressive symptoms in older adults. The pre-post test results indicated improvements in depressive symptoms (P=.048) and sleep quality (P=.02), but not in the system usability (P=.18). CONCLUSIONS: The findings suggest that wearable sensors assessing sleep quality may be utilized to predict daily fluctuations in depressive symptoms among socially vulnerable older adults. The results also imply that receiving individualized health feedback and sharing it with community caregivers may help improve the mental health of older adults. However, additional in-person training may be necessary to enhance usability. TRIAL REGISTRATION: ClinicalTrials.gov NCT06270121; https://clinicaltrials.gov/study/NCT06270121.", "links": [] }, { "title": "A tree-based explainable AI model for early detection of Covid-19 using physiological data", "author": "Talib, Manar Abu; Afadar, Yaman; Nasir, Qassim; Nassif, Ali Bou; Hijazi, Haytham; Hasasneh, Ahmad", "year": "2024", "journalProceedings": "BMC medical informatics and decision making", "category": "Case Study", "devices": "Versa 2", "population": "NA", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "With the outbreak of COVID-19 in 2020, countries worldwide faced significant concerns and challenges. Various studies have emerged utilizing Artificial Intelligence (AI) and Data Science techniques for disease detection. Although COVID-19 cases have declined, there are still cases and deaths around the world. Therefore, early detection of COVID-19 before the onset of symptoms has become crucial in reducing its extensive impact. Fortunately, wearable devices such as smartwatches have proven to be valuable sources of physiological data, including Heart Rate (HR) and sleep quality, enabling the detection of inflammatory diseases. In this study, we utilize an already-existing dataset that includes individual step counts and heart rate data to predict the probability of COVID-19 infection before the onset of symptoms. We train three main model architectures: the Gradient Boosting classifier (GB), CatBoost trees, and TabNet classifier to analyze the physiological data and compare their respective performances. We also add an interpretability layer to our best-performing model, which clarifies prediction results and allows a detailed assessment of effectiveness. Moreover, we created a private dataset by gathering physiological data from Fitbit devices to guarantee reliability and avoid bias.The identical set of models was then applied to this private dataset using the same pre-trained models, and the results were documented. Using the CatBoost tree-based method, our best-performing model outperformed previous studies with an accuracy rate of 85\\% on the publicly available dataset. Furthermore, this identical pre-trained CatBoost model produced an accuracy of 81\\% when applied to the private dataset. You will find the source code in the link: https://github.com/OpenUAE-LAB/Covid-19-detection-using-Wearable-data.git .", "links": [] }, { "title": "Pilot Randomized Controlled Trial of Lymfit: A Theory-Guided Exercise Intervention for Young Adults with Lymphoma", "author": "Tock, Wing Lam; Johnson, Nathalie A.; Andersen, Ross E.; Salaciak, Matthew; Angelillo, Christopher; Loiselle, Carmen G.; Hébert, Maude; Maheu, Christine", "year": "2024", "journalProceedings": "Healthcare (Basel, Switzerland)", "category": "Intervention", "devices": "Charge 5", "population": "Adults", "dataUsed": "Steps,Device Weartime", "abstract": "Despite the rapidly emerging evidence on the contributions of physical activity to improving cancer-related health outcomes, adherence to physical activity among young adults with lymphoma remains suboptimal. Guided by self-determination theory (SDT), the Lymfit intervention (a 12-week individualized exercise program with bi-weekly kinesiologist support and an activity tracker) aimed to foster autonomous motivation toward physical activity. This pilot randomized controlled trial aimed to evaluate the feasibility, acceptability, and preliminary effects of Lymfit. Young adults (N = 26; mean age of 32.1 years) with lymphoma who were newly diagnosed and those up to six months after completing treatment were recruited and randomly assigned one-to-one to either the intervention group (n = 13) or a wait-list control group (n = 13). All a priori feasibility benchmarks were met, confirming the feasibility of the study in terms of recruitment uptake, retention, questionnaire completion, intervention fidelity, missing data, Fitbit wear adherence, and control group design. The intervention acceptability assessment showed high ratings, with eight out of ten items receiving {\\textgreater}80\\% high ratings. At post-intervention, an analysis of covariance models showed a clinically significant increase in self-reported physical activity levels, psychological need satisfaction, and exercise motivation in the intervention group compared to controls. Lymfit also led to meaningful changes in six quality-of-life domains in the intervention group, including anxiety, depression, fatigue, sleep disturbance, social roles and activities, and pain interference. The findings support Lymfit as a promising means to meet psychological needs and increase the autonomous motivation for physical activity in this group. A fully powered efficacy trial is warranted to assess the validity of these findings.", "links": [] }, { "title": "Exploring Health-Related Quality of Life in Children With Hypertrophic Cardiomyopathy and Relationship to Physical Activity", "author": "Wagner, Mitchell J.; Jeewa, Aamir; Pidborochynski, Tara; Lemaire-Paquette, Samuel; Khoury, Michael; Cunningham, Chentel; Dhillon, Santokh; Laroussi, Nassiba Alami; Vaujois, Laurence; Dallaire, Frederic; Schantz, Daryl; Armstrong, Kathryn; Mawad, Wadi; Bradley, Timothy J.; Conway, Jennifer", "year": "2024", "journalProceedings": "Journal of the American Heart Association", "category": "Case Study", "devices": "Charge,Charge HR", "population": "Children", "dataUsed": "Steps,Intensity,Distance,Active Minutes/Active Zone Minutes", "abstract": "BACKGROUND: Hypertrophic cardiomyopathy is a burdensome condition that inflicts both physical and psychological impairment on those with the disease, negatively impacting health-related quality of life (HRQoL). Given the abundance of evidence suggesting a role of physical activity (PA) in modulating HRQoL in healthy populations of children, we sought to determine the relationship between HRQoL and PA in children diagnosed with hypertrophic cardiomyopathy. METHODS AND RESULTS: A multicenter prospective observational cohort study was conducted, with patients with hypertrophic cardiomyopathy aged 10 to 19 years being provided a wrist-worn activity tracker (Fitbit Charge HR) to wear for 14 days. Patients self-reported on Pediatric Quality of Life 4.0 quality of life inventory items, which were associated with PA metrics following covariate adjustment using linear regression. A total of 56 participants were recruited to the study. The median age at enrollment was 15.5 years (interquartile range, 13.8-16.8), and 16 out of 56 (29\\%) of the cohort were girls. The cohort reported decreased metrics of physical, psychosocial, and total summary scores compared with health reference populations, with scores comparable with that of published populations with chronic disease. Increased physical HRQoL scores were significantly associated with increased daily steps taken, distance traveled, and flights of stairs climbed. CONCLUSIONS: These results show that impaired PA correlates with reduced HRQoL in children with hypertrophic cardiomyopathy, suggesting PA may partially mediate HRQoL in this population.", "links": [] }, { "title": "Longitudinal Assessment of Seasonal Impacts and Depression Associations on Circadian Rhythm Using Multimodal Wearable Sensing: Retrospective Analysis", "author": "Zhang, Yuezhou; Folarin, Amos A.; Sun, Shaoxiong; Cummins, Nicholas; Ranjan, Yatharth; Rashid, Zulqarnain; Stewart, Callum; Conde, Pauline; Sankesara, Heet; Laiou, Petroula; Matcham, Faith; White, Katie M.; Oetzmann, Carolin; Lamers, Femke; Siddi, Sara; Simblett, Sara; Vairavan, Srinivasan; Myin-Germeys, Inez; Mohr, David C.; Wykes, Til; Haro, Josep Maria; Annas, Peter; Penninx, Brenda Wjh; Narayan, Vaibhav A.; Hotopf, Matthew; Dobson, Richard Jb; RADAR-CNS consortium", "year": "2024", "journalProceedings": "Journal of Medical Internet Research", "category": "Case Study", "devices": "Charge 2,Charge 3", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "BACKGROUND: Previous mobile health (mHealth) studies have revealed significant links between depression and circadian rhythm features measured via wearables. However, the comprehensive impact of seasonal variations was not fully considered in these studies, potentially biasing interpretations in real-world settings. OBJECTIVE: This study aims to explore the associations between depression severity and wearable-measured circadian rhythms while accounting for seasonal impacts. METHODS: Data were sourced from a large longitudinal mHealth study, wherein participants' depression severity was assessed biweekly using the 8-item Patient Health Questionnaire (PHQ-8), and participants' behaviors, including sleep, step count, and heart rate (HR), were tracked via Fitbit devices for up to 2 years. We extracted 12 circadian rhythm features from the 14-day Fitbit data preceding each PHQ-8 assessment, including cosinor variables, such as HR peak timing (HR acrophase), and nonparametric features, such as the onset of the most active continuous 10-hour period (M10 onset). To investigate the association between depression severity and circadian rhythms while also assessing the seasonal impacts, we used three nested linear mixed-effects models for each circadian rhythm feature: (1) incorporating the PHQ-8 score as an independent variable, (2) adding seasonality, and (3) adding an interaction term between season and the PHQ-8 score. RESULTS: Analyzing 10,018 PHQ-8 records alongside Fitbit data from 543 participants (n=414, 76.2\\% female; median age 48, IQR 32-58 years), we found that after adjusting for seasonal effects, higher PHQ-8 scores were associated with reduced daily steps (β=-93.61, P{\\textless}.001), increased sleep variability (β=0.96, P{\\textless}.001), and delayed circadian rhythms (ie, sleep onset: β=0.55, P=.001; sleep offset: β=1.12, P{\\textless}.001; M10 onset: β=0.73, P=.003; HR acrophase: β=0.71, P=.001). Notably, the negative association with daily steps was more pronounced in spring (β of PHQ-8 × spring = -31.51, P=.002) and summer (β of PHQ-8 × summer = -42.61, P{\\textless}.001) compared with winter. Additionally, the significant correlation with delayed M10 onset was observed solely in summer (β of PHQ-8 × summer = 1.06, P=.008). Moreover, compared with winter, participants experienced a shorter sleep duration by 16.6 minutes, an increase in daily steps by 394.5, a delay in M10 onset by 20.5 minutes, and a delay in HR peak time by 67.9 minutes during summer. CONCLUSIONS: Our findings highlight significant seasonal influences on human circadian rhythms and their associations with depression, underscoring the importance of considering seasonal variations in mHealth research for real-world applications. This study also indicates the potential of wearable-measured circadian rhythms as digital biomarkers for depression.", "links": [] }, { "title": "Design and rationale for a randomized clinical trial testing the efficacy of a lifestyle physical activity intervention for people with HIV and engaged in unhealthy drinking", "author": "Abrantes, Ana M.; Ferguson, Erin; Stein, Michael D.; Magane, Kara M.; Fielman, Sarah; Karzhevsky, Skylar; Flanagan, Amanda; Siebers, Robert; Quintiliani, Lisa M.", "year": "2024", "journalProceedings": "Contemporary Clinical Trials", "category": "Intervention", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Device Weartime", "abstract": "BACKGROUND: Among people living with HIV (PLWH), unhealthy drinking presents an increased risk for negative outcomes. Physical inactivity and sedentariness raise additional health risks. Despite evidence that physical activity (PA) is associated with improved physical and mental functioning and reduced alcohol cravings, there have been no PA studies conducted with PLWH engaged in unhealthy drinking. We describe a study protocol of a remote lifestyle physical activity (LPA) intervention to increase PA and reduce alcohol consumption among PLWH. METHODS: Using online advertisements, 220 low-active PLWH engaged in unhealthy drinking will be recruited and randomized nationwide. After providing informed consent and completing a baseline interview, participants will receive a Fitbit. Participants will complete 15 days of ecologic momentary assessment through a phone application and up to 15 days of Fitbit wear time. Following this period, participants will be randomly assigned to a Fitbit-only control condition or a LPA and Fitbit intervention condition. Health counselors meet with control participants once (and have 6 subsequent brief check ins on Fibit use) and with intervention participants 7 times for PA counseling over a 12-week period. Follow-up assessments will be conducted at 3- and 6-months post-randomization. We hypothesize that individuals in the LPA and Fitbit condition will have lower rates of alcohol consumption and higher rates of PA at 6-month follow-up. CONCLUSION: The randomized controlled trial described in this paper investigates remote methods to influence multimorbidity among PLWH using a LPA approach for increasing PA and reducing alcohol consumption.", "links": [] }, { "title": "Accuracy of consumer-based activity trackers to measure and coach patients with lower limb lymphoedema", "author": "Blondeel, Astrid; Devoogdt, Nele; Asnong, Anne; Geraerts, Inge; De Groef, An; Heroes, An-Kathleen; Van Calster, Charlotte; Troosters, Thierry; Demeyer, Heleen; Ginis, Pieter; De Vrieze, Tessa", "year": "2024", "journalProceedings": "PloS One", "category": "Validation", "devices": "Zip,Alta,Inspire", "population": "Patients,Adults", "dataUsed": "Steps", "abstract": "PURPOSE: This study investigated the accuracy of activity trackers in chronic lower limb lymphoedema (LLL) patients and in comparison to matched controls. MATERIALS AND METHODS: Seventeen LLL patients and 35 healthy subjects wore an activity tracker at the hip (Fitbit Zip/Inspire; hip-AT) and one at the wrist (Fitbit Alta/Inspire; wrist-AT) combined with a reference activity monitor (Dynaport Movemonitor; DAM), for 14 consecutive days. To analyze accuracy and agreement, mean daily step count from both AT's were compared to DAM. To evaluate the accuracy as coaching tool, day-by-day differences were calculated. The Kendall correlation coefficient was used to test consistency of ranking daily steps between the AT's and the DAM. RESULTS: The wrist-AT significantly overestimated daily step count compared to DAM in the LLL group (+1221 ± 1754 steps per day, p = 0.011) while the hip-AT underestimated the step count, although not significantly. Similar results were found in the healthy control group. As a coaching tool, both wrist-AT and hip-AT showed a moderate correlation with the DAM (r = 0.507 and 0.622, respectively) in the LLL group regarding consistency of ranking from most to least active days. CONCLUSION: Wrist-AT's significantly overestimate daily step count in a LLL population. As a coaching tool, both trackers show moderate validity, indicating applicability to improve physical activity.", "links": [] }, { "title": "Effects of night-float shifts on cognitive function among radiology residents", "author": "Flink, Carl C.; Hobohm, Robert E.; Zhang, Bin; Jacobson, Deborah L.; England, Eric B.", "year": "2024", "journalProceedings": "Emergency Radiology", "category": "Case Study", "devices": "Charge 3", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Distance,Sleep", "abstract": "BACKGROUND: Many radiology programs utilize a night-float system to mitigate the effects of fatigue, improve patient care, and provide faster report turnaround times. Prior studies have demonstrated an increase in discrepancy rates during night-float shifts. OBJECTIVES: This study was performed to examine the effects of night-float shift work on radiology resident cognition. We hypothesized that there would be diminished cognitive function on testing following night-float shifts when compared to testing following day shifts. METHODS: Diagnostic radiology residents in their second to fifth years of residency at a single institution were recruited to participate in this pilot study. Cognitive function was evaluated using the Lumosity Neurocognitive Performance Tests (NCPT), standardized performance tests that provide real-time, objective measurements of cognitive function. Study participants completed the NCPT in 5 sessions following 5 consecutive day shifts to evaluate their baseline cognitive function. The tests were re-administered at the end of consecutive night-float shifts to assess for any changes. Sleep was objectively monitored using actigraphy devices worn around the wrist during all study weeks. Descriptive and summary statistics were performed. RESULTS: 23 prospectively recruited diagnostic radiology residents working night-float shifts took a mean 13.6 (± 5.1) neurocognitive performance tests during the study period. There was a statistically significant decline in 2 of the 6 cognitive tests administered, signifying a decrease in attention, speed, and complex reasoning ability. Night-float shifts were significantly longer than the day shifts and associated with a significantly higher study volume and cross-sectional study volume. Fitbit data demonstrated that there were no significant differences in level of activity while awake. However, participants slept significantly longer during day shifts. CONCLUSIONS: A sample of 23 radiology residents working night-float shifts demonstrated declines in attention, speed, and complex reasoning ability following sequential administration of standardized neurocognitive performance tests. While the sample size is small, these findings demonstrate the potential deleterious effects of night-float shift work and provide evidence to support further inquiry into this phenomenon.", "links": [] }, { "title": "Impact of Outdoor Play Structures on Moderate to Vigorous Physical Activity in Children during Recess: A Comparative Study", "author": "Fuentes Diaz, Maria Fernanda; Sénéchal, Martin; Bouchard, Danielle R.", "year": "2024", "journalProceedings": "Children (Basel, Switzerland)", "category": "Case Study", "devices": "Inspire 2", "population": "Children", "dataUsed": "Intensity,Heart Rate", "abstract": "BACKGROUND/OBJECTIVES: It is believed that outdoor play structures lead to more physical activity for kids during school recess. However, the intensity of this activity remains unknown. This study explored whether access to outdoor play structures during recess interferes with children's physical activity levels. METHODS: Forty-one children (8-10 years old) accessed play structures during the afternoon recess but not in the morning for one entire week. To control for temperature differences, the same number of participants from another school who did not access playground structures were invited to participate. Moderate to Vigorous Physical Activity (MVPA) was determined using heart rate reserve. Heart rate was recorded using the Fitbit Inspire 2 (San Francisco, CA, USA) for at least three full school days. Wilcoxon signed-rank and Mann-Whitney U tests analyzed within- and between-group differences. RESULTS: The findings show no difference in MVPA when accessing or not accessing outdoor play structures, both within groups [(n = 37) median (25th-75th) 16 min (7-30) vs. 14 min (5-22)] and between groups [(n = 22) 16 min (7-26)]. The weekly MVPA for all participants (n = 59) [172 min (117-282)] was the strongest variable associated with MVPA during recess [t(df) = 5.40 (38), 95\\% CI 0.04-0.09, p {\\textless} 0.001]. CONCLUSION: accessibility to outdoor play structures does not increase MVPA during recess in children aged 8 to 10. Therefore, schools may need various options for children to play during recess, allowing them to accumulate MVPA.", "links": [] }, { "title": "Cook and Move for Your Life, an eHealth intervention for women with breast cancer", "author": "Greenlee, Heather; Rillamas-Sun, Eileen; Yung, Rachel L.; Cobos, Sofia; Donzella, Sidney M.; Huang, Yuhan; Schattenkerk, Liza; Ueland, Katherine; VanDoren, Matthew; Myers, Samantha A.; Garcia, Gino; King, Theresa; Santiago-Torres, Margarita; Di, Chongzhi; Dey, Neelendu; Guthrie, Katherine A.; Davidson, Nancy E.", "year": "2024", "journalProceedings": "NPJ breast cancer", "category": "Intervention", "devices": "Aria", "population": "Adults", "dataUsed": "Weight", "abstract": "We tested the feasibility and preliminary efficacy of an online diet and physical activity program for women with early-stage breast cancer who had completed surgery, chemotherapy, and radiation therapy (ongoing endocrine therapy allowed). Participants with low fruit and vegetable (F/V) consumption and/or low moderate-to-vigorous physical activity (MVPA) levels were randomized to one of two doses - low (one Zoom group session) or high (12 Zoom group sessions) - of an online lifestyle program with the goal of improving F/V intake and MVPA. All participants received eHealth communications (text messages, study website access), a Fitbit, and a WiFi-enabled scale. Primary objectives evaluated feasibility. Secondary objectives compared the 6-month change in F/V intake and MVPA between the two dose groups. Seventy-four women (mean age = 58.4 years; 87\\% non-Hispanic White; mean time since diagnosis = 4.6 years) were accrued. Among women in the low dose group, 94\\% attended the single session; among women in the high dose group, 84\\% attended at least 8 of the 12 sessions. Retention at 6 months was 93\\%. High relative to low dose participants consumed 1.5 more servings/day of F/V at 6 months (P = 0.007) but MVPA levels did not differ between groups. We successfully implemented an online lifestyle program for early-stage breast cancer survivors. The high dose intervention demonstrated preliminary efficacy in improving F/V consumption in early-stage breast cancer survivors. Future trials can test the intervention in a larger and more diverse population of breast cancer survivors.", "links": [] }, { "title": "Pilot study comparing sleep logs to a commercial wearable device in describing the sleep patterns of physicians-in-training", "author": "Hassinger, Amanda B.; Kwon, Misol; Wang, Jia; Mishra, Archana; Wilding, Gregory E.", "year": "2024", "journalProceedings": "PloS One", "category": "Usability", "devices": "Inspire", "population": "Adults", "dataUsed": "Sleep", "abstract": "With the increasing burden of professional burnout in physicians, attention is being paid to optimizing sleep health, starting in training. The multiple dimensions of physicians' sleep are not well described due to obstacles to easily and reliably measuring sleep. This pilot study tested the feasibility of using commercial wearable devices and completing manual sleep logs to describe sleep patterns of medical students and residents. Prospective pilot study of 50 resident physicians and medical students during a single year of training. Participants completed a manual sleep log while concurrently wearing the Fitbit Inspire device for 14-consecutive days over three clinical rotations of varying work schedules: light, medium, and heavy clinical rotations. Study completion was achieved in 24/50 (48\\%) participants. Overall correlation coefficients between the sleep log and Fitbit were statistically low; however, the discrepancies were acceptable, i.e., Fitbit underestimated time in bed and total sleep time by 4.3 and 2.7 minutes, respectively. Sleep onset time and waketime were within 8 minutes, with good agreement. Treatment of sleep episodes during the day led to variance in the data. Average missingness of collected data did not vary between medical students or residents or by rotation type. When comparing the light to heavy rotations, hours slept went from 7.7 (±0.64) to 6.7 (±0.88), quality-of-life and sleep health decreased and stress, burnout, and medical errors increased. Burnout was significantly associated with worse sleep health, hours worked, and quality-of-life. Prospective data collection of sleep patterns using both sleep logs and commercial wearable devices is burdensome for physicians-in-training. Using commercial wearable devices may increase study success as long as attention is paid to daytime sleep. In future studies investigating the sleep of physicians, the timing of data collection should account for rotation type.", "links": [] }, { "title": "The relationship between wearable-derived sleep features and relapse in Major Depressive Disorder", "author": "Matcham, F.; Carr, E.; Meyer, N.; White, K. M.; Oetzmann, C.; Leightley, D.; Lamers, F.; Siddi, S.; Cummins, N.; Annas, P.; de Girolamo, G.; Haro, J. M.; Lavelle, G.; Li, Q.; Lombardini, F.; Mohr, D. C.; Narayan, V. A.; Penninx, B. W. H. J.; Coromina, M.; Riquelme Alacid, G.; Simblett, S. K.; Nica, R.; Wykes, T.; Brasen, J. C.; Myin-Germeys, I.; Dobson, R. J. B.; Folarin, A. A.; Ranjan, Y.; Rashid, Z.; Dineley, J.; Vairavan, S.; Hotopf, M.; RADAR-CNS consortium", "year": "2024", "journalProceedings": "Journal of Affective Disorders", "category": "Case Study", "devices": "Charge", "population": "Adults", "dataUsed": "Sleep", "abstract": "BACKGROUND: Changes in sleep and circadian function are leading candidate markers for the detection of relapse in Major Depressive Disorder (MDD). Consumer-grade wearable devices may enable remote and real-time examination of dynamic changes in sleep. Fitbit data from individuals with recurrent MDD were used to describe the longitudinal effects of sleep duration, quality, and regularity on subsequent depression relapse and severity. METHODS: Data were collected as part of a longitudinal observational mobile Health (mHealth) cohort study in people with recurrent MDD. Participants wore a Fitbit device and completed regular outcome assessments via email for a median follow-up of 541 days. We used multivariable regression models to test the effects of sleep features on depression outcomes. We considered respondents with at least one assessment of relapse (n = 218) or at least one assessment of depression severity (n = 393). RESULTS: Increased intra-individual variability in total sleep time, greater sleep fragmentation, lower sleep efficiency, and more variable sleep midpoints were associated with worse depression outcomes. Adjusted Population Attributable Fractions suggested that an intervention to increase sleep consistency in adults with MDD could reduce the population risk for depression relapse by up to 22 \\%. LIMITATIONS: Limitations include a potentially underpowered primary outcome due to the smaller number of relapses identified than expected. CONCLUSION: Our study demonstrates a role for consumer-grade activity trackers in estimating relapse risk and depression severity in people with recurrent MDD. Variability in sleep duration and midpoint may be useful targets for stratified interventions.", "links": [] }, { "title": "Feasibility of wearable sensor signals and self-reported symptoms to prompt at-home testing for acute respiratory viruses in the USA (DETECT-AHEAD): a decentralised, randomised controlled trial", "author": "Quer, Giorgio; Coughlin, Erin; Villacian, Jorge; Delgado, Felipe; Harris, Katherine; Verrant, John; Gadaleta, Matteo; Hung, Ting-Yang; Ter Meer, Janna; Radin, Jennifer M.; Ramos, Edward; Adams, Monique; Kim, Lomi; Chien, Jason W.; Baca-Motes, Katie; Pandit, Jay A.; Talantov, Dmitri; Steinhubl, Steven R.", "year": "2024", "journalProceedings": "The Lancet. Digital Health", "category": "Intervention", "devices": "Sense", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "BACKGROUND: Early identification of an acute respiratory infection is important for reducing transmission and enabling earlier therapeutic intervention. We aimed to prospectively evaluate the feasibility of home-based diagnostic self-testing of viral pathogens in individuals prompted to do so on the basis of self-reported symptoms or individual changes in physiological parameters detected via a wearable sensor. METHODS: DETECT-AHEAD was a prospective, decentralised, randomised controlled trial carried out in a subpopulation of an existing cohort (DETECT) of individuals enrolled in a digital-only observational study in the USA. Participants aged 18 years or older were randomly assigned (1:1:1) with a block randomisation scheme stratified by under-represented in biomedical research status. All participants were offered a wearable sensor (Fitbit Sense smartwatch). Participants in groups 1 and 2 received an at-home self-test kit (Alveo be.well) for two acute respiratory viral pathogens: SARS-CoV-2 and respiratory syncytial virus. Participants in group 1 could be alerted through the DETECT study app to take the at-home test on the basis of changes in their physiological data (as detected by our algorithm) or due to self-reported symptoms; those in group 2 were prompted via the app to self-test only due to symptoms. Group 3 served as the control group, without alerts or home testing capability. The primary endpoints, assessed on an intention-to-treat basis, were the number of acute respiratory infections presented (self-reported) and diagnosed (electronic health record), and the number of participants using at-home testing in groups 1 and 2. This trial is registered with ClinicalTrials.gov, NCT04336020. FINDINGS: Between Sept 28 and Dec 30, 2021, 450 participants were recruited and randomly assigned to group 1 (n=149), group 2 (n=151), or group 3 (n=150). 179 (40\\%) participants were male, 264 (59\\%) were female, and seven (2\\%) identified as other. 232 (52\\%) were from populations historically under-represented in biomedical research. 118 (39\\%) of the 300 participants in groups 1 and 2 were prompted to self-test, with 61 (52\\%) successfully completing self-testing. Participants were prompted to home-test more frequently due to symptoms (41 [28\\%] in group 1 and 51 [34\\%] in group 2) than due to detected physiological changes (26 [17\\%] in group 1). Significantly more participants in group 1 received alerts to test than did those in group 2 (67 [45\\%] vs 51 [34\\%]; p=0·047). Of the 61 individuals who were prompted to test and successfully did so, 19 (31\\%) tested positive for a viral pathogen-all for SARS-CoV-2. The individuals diagnosed as positive for SARS-CoV-2 in the electronic health record were eight (5\\%) in group 1, four (3\\%) in group 2, and two (1\\%) in group 3, but it was difficult to confirm if they were tied to symptomatic episodes documented in the trial. There were no adverse events. INTERPRETATION: In this direct-to-participant trial, we showed early feasibility of a decentralised programme to prompt individuals to use a viral pathogen diagnostic test based on symptoms tracked in the study app or physiological changes detected using a wearable sensor. Barriers to adequate participation and performance were also identified, which would need to be addressed before large-scale implementation. FUNDING: Janssen Pharmaceuticals.", "links": [] }, { "title": "Effect of desflurane maintenance on postoperative sleep quality in patients undergoing elective breast surgery: A non-inferiority randomized controlled trail", "author": "Wang, Xiaohua; Xiong, Bingrui; Wu, Tangjing; Liu, Xin; Li, Ke; Wang, Shan; Deng, Ming-Gang; Peng, Mian", "year": "2024", "journalProceedings": "Sleep Medicine", "category": "Case Study", "devices": "Charge 2", "population": "Patients", "dataUsed": "Sleep", "abstract": "BACKGROUND: Postoperative sleep disturbance (PSD) is prevalent in perioperative patients，and has significant impact on postoperative recovery and prognosis. The aim of this study was to investigate the effect of desflurane maintenance on postoperative sleep quality, in order to optimize patients' perioperative sleep management. METHOD: A total of 118 patients undergoing elective breast surgery were randomized to receive either desflurane-based volatile anesthesia (desflurane group) or propofol-based total intravenous anesthesia (propofol group) for anesthesia maintenance. The primary outcome was the quality of sleep, which was assessed by the Pittsburgh Sleep Quality Index (PSQI) on 3 days after operation (POD3). Secondary outcomes were PSQI on postoperative day 7 (POD7) and 30 (POD30), and postoperative anxiety, depression, and pain score, as well as objective sleep parameters including total sleep time (TST), WASO (Wakefulness after sleep onset), REM (Rapid eye movement) and NREM (Non-rapid Eye Movement) measured by Fitbit Charge 2TM during the initial 3 postoperative days. RESULTS: The global PSQI scores on POD3 in the desflurane group was non-inferior to that in the propofol group [mean (SD) 8.47 (3.46) vs. 7.65 (3.16); mean difference (95 \\% CI) 0.82 (-0.43, 2.07); p {\\textless} 0.001 for non-inferiority]. There were no significant differences in PSQI scores on POD3 and POD7. In addition, the score of anxiety, depression, and pain on the 3rd, 7th, and 30th day after surgery have no significant differences between the propofol and the desflurane group, respectively. The postoperative NREM was higher in the desflurane group than that in the propofol group. CONCLUSION: The effects of desflurane-based volatile anesthesia maintenance on postoperative sleep quality is not inferior to that of propofol-based total intravenous anesthesia, and these two drugs may have different effects on the sleep structure. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04805775.", "links": [] }, { "title": "Prediction of Mild Cognitive Impairment Status: Pilot Study of Machine Learning Models Based on Longitudinal Data From Fitness Trackers", "author": "Xu, Qidi; Kim, Yejin; Chung, Karen; Schulz, Paul; Gottlieb, Assaf", "year": "2024", "journalProceedings": "JMIR formative research", "category": "Case Study", "devices": "Charge 4", "population": "Patients", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "BACKGROUND: Early signs of Alzheimer disease (AD) are difficult to detect, causing diagnoses to be significantly delayed to time points when brain damage has already occurred and current experimental treatments have little effect on slowing disease progression. Tracking cognitive decline at early stages is critical for patients to make lifestyle changes and consider new and experimental therapies. Frequently studied biomarkers are invasive and costly and are limited for predicting conversion from normal to mild cognitive impairment (MCI). OBJECTIVE: This study aimed to use data collected from fitness trackers to predict MCI status. METHODS: In this pilot study, fitness trackers were worn by 20 participants: 12 patients with MCI and 8 age-matched controls. We collected physical activity, heart rate, and sleep data from each participant for up to 1 month and further developed a machine learning model to predict MCI status. RESULTS: Our machine learning model was able to perfectly separate between MCI and controls (area under the curve=1.0). The top predictive features from the model included peak, cardio, and fat burn heart rate zones; resting heart rate; average deep sleep time; and total light activity time. CONCLUSIONS: Our results suggest that a longitudinal digital biomarker differentiates between controls and patients with MCI in a very cost-effective and noninvasive way and hence may be very useful for identifying patients with very early AD who can benefit from clinical trials and new, disease-modifying therapies.", "links": [] }, { "title": "Rationale, Design, and Baseline Characteristics of Participants in the Health@NUS mHealth Augmented Cohort Study Examining Student-to-Work Life Transition: Protocol for a Prospective Cohort Study", "author": "Chua, Xin Hui; Edney, Sarah Martine; Müller, Andre Matthias; Petrunoff, Nicholas A.; Whitton, Clare; Tay, Zoey; Goh, Claire Marie Jie Lin; Chen, Bozhi; Park, Su Hyun; Rebello, Salome A.; Low, Alicia; Chia, Janelle; Koek, Daphne; Cheong, Karen; van Dam, Rob M.; Müller-Riemenschneider, Falk", "year": "2024", "journalProceedings": "JMIR research protocols", "category": "Case Study", "devices": "Versa Lite", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Heart Rate,Active Minutes/Active Zone Minutes", "abstract": "BACKGROUND: Integration of mobile health data collection methods into cohort studies enables the collection of intensive longitudinal information, which gives deeper insights into individuals' health and lifestyle behavioral patterns over time, as compared to traditional cohort methods with less frequent data collection. These findings can then fill the gaps that remain in understanding how various lifestyle behaviors interact as students graduate from university and seek employment (student-to-work life transition), where the inability to adapt quickly to a changing environment greatly affects the mental well-being of young adults. OBJECTIVE: This paper aims to provide an overview of the study methodology and baseline characteristics of participants in Health@NUS, a longitudinal study leveraging mobile health to examine the trajectories of health behaviors, physical health, and well-being, and their diverse determinants, for young adults during the student-to-work life transition. METHODS: University students were recruited between August 2020 and June 2022 in Singapore. Participants would complete biometric assessments and questionnaires at 3 time points (baseline, 12-, and 24-month follow-up visits) and use a Fitbit smartwatch and smartphone app to continuously collect physical activity, sedentary behavior, sleep, and dietary data over the 2 years. Additionally, up to 12 two-week-long bursts of app-based ecological momentary surveys capturing lifestyle behaviors and well-being would be sent out among the 3 time points. RESULTS: Interested participants (n=1556) were screened for eligibility, and 776 participants were enrolled in the study between August 2020 and June 2022. Participants were mostly female (441/776, 56.8\\%), of Chinese ethnicity (741/776, 92\\%), undergraduate students (759/776, 97.8\\%), and had a mean BMI of 21.9 (SD 3.3) kg/m2, and a mean age of 22.7 (SD 1.7) years. A substantial proportion were overweight (202/776, 26.1\\%) or obese (42/776, 5.4\\%), had indicated poor mental well-being (World Health Organization-5 Well-Being Index ≤50; 291/776, 37.7\\%), or were at higher risk for psychological distress (Kessler Psychological Distress Scale ≥13; 109/776, 14.1\\%). CONCLUSIONS: The findings from this study will provide detailed insights into the determinants and trajectories of health behaviors, health, and well-being during the student-to-work life transition experienced by young adults. TRIAL REGISTRATION: ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/study/NCT05154227. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56749.", "links": [] }, { "title": "Detection of Common Respiratory Infections, Including COVID-19, Using Consumer Wearable Devices in Health Care Workers: Prospective Model Validation Study", "author": "Esmaeilpour, Zeinab; Natarajan, Aravind; Su, Hao-Wei; Faranesh, Anthony; Friel, Ciaran; Zanos, Theodoros P.; D'Angelo, Stefani; Heneghan, Conor", "year": "2024", "journalProceedings": "JMIR formative research", "category": "Validation", "devices": "Versa 3,Sense", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: The early detection of respiratory infections could improve responses against outbreaks. Wearable devices can provide insights into health and well-being using longitudinal physiological signals. OBJECTIVE: The purpose of this study was to prospectively evaluate the performance of a consumer wearable physiology-based respiratory infection detection algorithm in health care workers. METHODS: In this study, we evaluated the performance of a previously developed system to predict the presence of COVID-19 or other upper respiratory infections. The system generates real-time alerts using physiological signals recorded from a smartwatch. Resting heart rate, respiratory rate, and heart rate variability measured during the sleeping period were used for prediction. After baseline recordings, when participants received a notification from the system, they were required to undergo testing at a Northwell Health System site. Participants were asked to self-report any positive tests during the study. The accuracy of model prediction was evaluated using respiratory infection results (laboratory results or self-reports), and postnotification surveys were used to evaluate potential confounding factors. RESULTS: A total of 577 participants from Northwell Health in New York were enrolled in the study between January 6, 2022, and July 20, 2022. Of these, 470 successfully completed the study, 89 did not provide sufficient physiological data to receive any prediction from the model, and 18 dropped out. Out of the 470 participants who completed the study and wore the smartwatch as required for the 16-week study duration, the algorithm generated 665 positive alerts, of which 153 (23.0\\%) were not acted upon to undergo testing for respiratory viruses. Across the 512 instances of positive alerts that involved a respiratory viral panel test, 63 had confirmed respiratory infection results (ie, COVID-19 or other respiratory infections detected using a polymerase chain reaction or home test) and the remaining 449 had negative upper respiratory infection test results. Across all cases, the estimated false-positive rate based on predictions per day was 2\\%, and the positive-predictive value ranged from 4\\% to 10\\% in this specific population, with an observed incidence rate of 198 cases per week per 100,000. Detailed examination of questionnaires filled out after receiving a positive alert revealed that physical or emotional stress events, such as intense exercise, poor sleep, stress, and excessive alcohol consumption, could cause a false-positive result. CONCLUSIONS: The real-time alerting system provides advance warning on respiratory viral infections as well as other physical or emotional stress events that could lead to physiological signal changes. This study showed the potential of wearables with embedded alerting systems to provide information on wellness measures.", "links": [] }, { "title": "Individual-Level Experiences of Structural Inequity and Their Association with Subjective and Objective Sleep Outcomes in the Adolescent Brain Cognitive Development Study", "author": "Harriman, Nigel Walsh; Chen, Jarvis T.; Lee, Sunmin; Slopen, Natalie", "year": "2024", "journalProceedings": "The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine", "category": "Case Study", "devices": "Charge HR", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "PURPOSE: Research has documented that adolescent sleep is impacted by various stressors, including interpersonal experiences and structural disadvantage. This study extends existing knowledge by empirically examining interconnected individual experiences of structural inequity and assessing its association with subjective and objective sleep outcomes. METHODS: We utilized data from the Adolescent Brain and Cognitive Development Study to identify seven conceptual domains of structural inequity: perceived discrimination, low school inclusivity, neighborhood safety, unmet medical needs, legal problems, material hardship, and housing insecurity. We operationalized experiences of structural inequity as latent classes, a cumulative exposure, and each domain separately. Sleep disturbances were measured using the Sleep Disturbance Scale, and sleep duration was assessed using Fitbits. Mixed effects linear regression estimated the association between our measures of structural inequity, longitudinal sleep disturbances, and cross-sectional sleep duration. RESULTS: Latent class analysis revealed common exposure profiles (low risk, interpersonal, and systemic) of experiences of structural inequity across our sample. In longitudinal models, structural inequity was associated with higher Sleep Disturbance Scale scores, whether measured as latent classes, a cumulative exposure, or individual domains. Individuals with interpersonal exposures, those with at least one exposure, and those with legal problems, material hardship, and housing insecurity had lower mean sleep duration. DISCUSSION: Results are consistent with literature that frames structural inequity as a lifelong determinant of sleep disturbance and duration. Adolescence represents a crucial time for interventions aimed at improving sleep and redressing inequities throughout the life course; our work can inform the development of policies and interventions toward this end.", "links": [] }, { "title": "An adapted transdiagnostic sleep and circadian intervention for adults with excess weight and suboptimal sleep health: pilot study results", "author": "Imes, Christopher C.; Kline, Christopher E.; Patel, Sanjay R.; Sereika, Susan M.; Buysse, Daniel J.; Harvey, Allison G.; Burke, Lora E.", "year": "2024", "journalProceedings": "Sleep Advances: A Journal of the Sleep Research Society", "category": "Intervention", "devices": "Charge 4", "population": "Adults", "dataUsed": "Sleep", "abstract": "STUDY OBJECTIVES: This single-arm, mixed-methods, pilot study examined the feasibility and preliminary efficacy of an adapted version of the transdiagnostic intervention for sleep and circadian dysfunction (TranS-C) on multidimensional sleep health (MDSH) in a sample of adults with excess weight and suboptimal sleep health. METHODS: Participants received up to eight, weekly, remotely delivered, tailored TranS-C sessions. At pre- and post-intervention, the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and 7 days of Fitbit data were used to evaluate changes in sleep dimensions (regularity, alertness, timing, satisfaction, duration, and efficiency) and the composite MDSH score. Study feasibility examined recruitment, data collection, and intervention engagement (completion of core TranS-C sessions). Acceptability of the intervention was assessed with semi-structured interviews, which were analyzed using thematic analysis. RESULTS: From 85 referrals, 11 individuals were eligible, and 10 completed the study. All intervention participants completed the measures needed to calculate their composite MDSH score and completed the core intervention sessions. Themes from interviews support the intervention's remote delivery approach, applicability of the information provided, and impact on self-reported health. The intervention resulted in a large improvement in the mean composite MDSH score (Cohen's d = 1.17). Small-to-large effects were also observed for individual sleep health dimensions except for timing. CONCLUSIONS: Adapted TranS-C is acceptable for adults with excess weight and suboptimal sleep health and may be effective at improving short-term MDSH. With changes to recruitment methods, a larger study is feasible. Limitations include the small sample size and the lack of a control condition.", "links": [] }, { "title": "Commercially available activity monitors such as the fitbit charge and apple watch show poor validity in patients with gait aids after total knee arthroplasty", "author": "Kooner, Paul; Baskaran, Sandhya; Gibbs, Vanessa; Wein, Sam; Dimentberg, Ronald; Albers, Anthony", "year": "2024", "journalProceedings": "Journal of Orthopaedic Surgery and Research", "category": "Validation", "devices": "Charge", "population": "Adults", "dataUsed": "Steps", "abstract": "PURPOSE: The aim of this study is to determine the validity of consumer grade step counter devices during the early recovery period after knee replacement surgery. METHODS: Twenty-three participants wore a Fitbit Charge or Apple Watch Series 4 smart watch and performed a walking test along a 50-metre hallway. There were 9 males and 14 females included in the study with an average age of 68.5 years and BMI of 32. Each patient wore both the Fitbit Charge and Apple Watch while completing the walking test and an observer counted the ground truth value using a thumb-push tally counter. This test was repeated pre-operatively with no gait aid, immediately post operatively with a walker, at 6 weeks follow up with a cane and at 6 months with no gait aid. Bland-Altman plots were performed for all walking tests to compare the agreement between measurement techniques. RESULTS: Mean overall agreement of step count for pre-operative and at 6 months for subjects walking without gait aids was excellent for both the Apple Watch vs. actual and Fitbit vs. actual with bias values ranging from - 0.87 to 1.36 with limits of agreement (LOA) ranging between - 10.82 and 15.91. While using a walker both devices showed extremely little agreement with the actual step count with bias values between 22.5 and 24.37 with LOA between 11.7 and 33.3. At 6 weeks post-op while using a cane, both the Apple Watch and Fitbit devices had a range of bias values between - 2.8 and 5.73 with LOA between - 13.51 and 24.97. CONCLUSIONS: These devices show poor validity in the early post operative setting, especially with the use of gait aids, and therefore results should be interpreted with caution.", "links": [] }, { "title": "Evaluating the impact of individuals' morningness-eveningness on the effectiveness of a habit-formation intervention for a simple and a complex behavior", "author": "Phillips, L. Alison; More, Kimberly R.; Russell, Daniel; Kim, Hyun Seon", "year": "2024", "journalProceedings": "Journal of Behavioral Medicine", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Planning-based interventions are often used to help individuals form habits. Existing literature suggests a one-size-fits all approach to habit formation, but planning interventions may be optimized if tailored to individual differences and/or behavioral complexity. We test the hypothesis that planning to do a relatively complex behaviour (exercise) at a time that matches an individuals' diurnal preference will facilitate behavioral engagement; whereas for a simpler behaviour (calcium supplementation), the optimal time-of-day for a new behavior will occur in the morning. Young, women volunteers (N = 317) were randomly assigned to take calcium supplements or to exercise for 4 weeks and to control (no planning) or to one of three planning interventions (morning plan; evening plan; unassigned-time plan). Participants reported diurnal preference at baseline and habit strength and behavioral frequency weekly. Fitbit Zips and Medication Event Monitoring System Caps (MEMS) were used to objectively assess behavioral engagement. Multilevel modelling found that calcium-supplementation was greatest for morning-types in the morning-cue condition, whereas exercise was greatest for morning-types with morning cues and evening-types with evening cues. Habit-formation strategies may depend on diurnal preference and behavioral complexity. Future research can evaluate the role of other individual differences.", "links": [] }, { "title": "Feasibility and preliminary effects of the Fit2ThriveMB pilot physical activity promotion intervention on physical activity and patient reported outcomes in individuals with metastatic breast cancer", "author": "Phillips, Siobhan M.; Starikovsky, Julia; Solk, Payton; Desai, Ria; Reading, Jean M.; Hasanaj, Kristina; Wang, Shirlene D.; Cullather, Erin; Lee, Jungwha; Song, Jing; Spring, Bonnie; Gradishar, William", "year": "2024", "journalProceedings": "Breast Cancer Research and Treatment", "category": "Intervention", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps,Goals,Device Weartime", "abstract": "PURPOSE: Physical activity research among patients with metastatic breast cancer (MBC) is limited. This study examined the feasibility and potential benefits of Fit2ThriveMB, a tailored mHealth intervention. METHODS: Insufficiently active individuals with MBC (n = 49) were randomized 1:1 to Fit2ThriveMB (Fit2ThriveMB app, Fitbit, and weekly coaching calls) or Healthy Lifestyle attention control (Cancer.Net app and weekly calls) for 12 weeks. Fit2ThriveMB aimed to increase daily steps via an algorithm tailored to daily symptom rating and step goal attainment. The primary outcome was feasibility defined as ≥ 80\\% completion rate. Secondary feasibility metrics included meeting daily step goal and wearing the Fitbit ≥ 70\\% of study days, fidelity, adherence to intervention features and safety. Secondary outcomes included physical activity, sedentary time, patient reported outcomes (PROs), health-related quality of life (QOL) and social cognitive theory constructs. A subsample (n = 25) completed functional performance tests via video conferencing. RESULTS: The completion rate was 98\\% (n = 1 died). No related adverse events were reported. Fit2ThriveMB participants (n = 24) wore the Fitbit 92.7\\%, met their step goal 53.1\\%, set a step goal 84.6\\% and used the app 94.1\\% of 84 study days. Intent-to-treat analyses indicated trends toward improvements in activity, QOL, and some PROs, social cognitive theory constructs, and functional performance tests favoring the Fit2ThriveMB group. Significant effects favoring Fit2ThriveMB were observed for self-efficacy and goal-setting. However, some PROs and functional performance improvements favored the control group (p-values {\\textgreater} 0.05). CONCLUSIONS: Fit2ThriveMB is feasible and safe for patients with MBC and warrants further evaluation in randomized controlled trials with larger sample sizes. Registration Clinicaltrials.gov NCT04129346, https://clinicaltrials.gov/ct2/show/NCT04129346.", "links": [] }, { "title": "Deconstructing Fitbit to Specify the Effective Features in Promoting Physical Activity Among Inactive Adults: Pilot Randomized Controlled Trial", "author": "Takano, Keisuke; Oba, Takeyuki; Katahira, Kentaro; Kimura, Kenta", "year": "2024", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention,Case Study", "devices": "Sense", "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "BACKGROUND: Wearable activity trackers have become key players in mobile health practice as they offer various behavior change techniques (BCTs) to help improve physical activity (PA). Typically, multiple BCTs are implemented simultaneously in a device, making it difficult to identify which BCTs specifically improve PA. OBJECTIVE: We investigated the effects of BCTs implemented on a smartwatch, the Fitbit, to determine how each technique promoted PA. METHODS: This study was a single-blind, pilot randomized controlled trial, in which 70 adults (n=44, 63\\% women; mean age 40.5, SD 12.56 years; closed user group) were allocated to 1 of 3 BCT conditions: self-monitoring (feedback on participants' own steps), goal setting (providing daily step goals), and social comparison (displaying daily steps achieved by peers). Each intervention lasted for 4 weeks (fully automated), during which participants wore a Fitbit and responded to day-to-day questionnaires regarding motivation. At pre- and postintervention time points (in-person sessions), levels and readiness for PA as well as different aspects of motivation were assessed. RESULTS: Participants showed excellent adherence (mean valid-wear time of Fitbit=26.43/28 days, 94\\%), and no dropout was recorded. No significant changes were found in self-reported total PA (dz{\\textless}0.28, P=.40 for the self-monitoring group, P=.58 for the goal setting group, and P=.19 for the social comparison group). Fitbit-assessed step count during the intervention period was slightly higher in the goal setting and social comparison groups than in the self-monitoring group, although the effects did not reach statistical significance (P=.052 and P=.06). However, more than half (27/46, 59\\%) of the participants in the precontemplation stage reported progress to a higher stage across the 3 conditions. Additionally, significant increases were detected for several aspects of motivation (ie, integrated and external regulation), and significant group differences were identified for the day-to-day changes in external regulation; that is, the self-monitoring group showed a significantly larger increase in the sense of pressure and tension (as part of external regulation) than the goal setting group (P=.04). CONCLUSIONS: Fitbit-implemented BCTs promote readiness and motivation for PA, although their effects on PA levels are marginal. The BCT-specific effects were unclear, but preliminary evidence showed that self-monitoring alone may be perceived demanding. Combining self-monitoring with another BCT (or goal setting, at least) may be important for enhancing continuous engagement in PA. TRIAL REGISTRATION: Open Science Framework; https://osf.io/87qnb/?view\\_only=f7b72d48bb5044eca4b8ce729f6b403b.", "links": [] }, { "title": "Predicting long-term sleep deprivation using wearable sensors and health surveys", "author": "Trujillo, Rafael; Zhang, Enshi; Templeton, John Michael; Poellabauer, Christian", "year": "2024", "journalProceedings": "Computers in Biology and Medicine", "category": "Measurement", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Active Minutes/Active Zone Minutes", "abstract": "Sufficient sleep is essential for individual well-being. Inadequate sleep has been shown to have significant negative impacts on our attention, cognition, and mood. The measurement of sleep from in-bed physiological signals has progressed to where commercial devices already incorporate this functionality. However, the prediction of sleep duration from previous awake activity is less studied. Previous studies have used daily exercise summaries, actigraph data, and pedometer data to predict sleep during individual nights. Building upon these, this article demonstrates how to predict a person's long-term average sleep length over the course of 30 days from Fitbit-recorded physical activity data alongside self-report surveys. Recursive Feature Elimination with Random Forest (RFE-RF) is used to extract the feature sets used by the machine learning models, and sex differences in the feature sets and performances of different machine learning models are then examined. The feature selection process demonstrates that previous sleep patterns and physical exercise are the most relevant kind of features for predicting sleep. Personality and depression metrics were also found to be relevant. When attempting to classify individuals as being long-term sleep-deprived, good performance was achieved across both the male, female, and combined data sets, with the highest-performing model achieving an AUC of 0.9762. The best-performing regression model for predicting the average nightly sleep time achieved an R-squared of 0.6861, with other models achieving similar results. When attempting to predict if a person who previously was obtaining sufficient sleep would become sleep-deprived, the best-performing model obtained an AUC of 0.9448.", "links": [] }, { "title": "Accuracy of parent-reported sleep duration among adolescents assessed using accelerometry", "author": "Turan, Ozerk; Garner, Jonathan; Chang, Linda; Isaiah, Amal", "year": "2024", "journalProceedings": "Pediatric Research", "category": "Case Study", "devices": "Charge 2,Charge 4", "population": "Children", "dataUsed": "Sleep", "abstract": "Parent-reported children's sleep duration is a primary outcome measure in population-level studies, and is the primary driver of pharmacotherapy such as melatonin. Accelerometry using the Fitbit suggests that few adolescents sleep for the optimal 9-12 h as recommended by the American Academy of Sleep Medicine, and most parent reports grossly overestimate average nightly sleep duration. Parent reports of adolescent sleep duration are unreliable, and quantitative assessment of children's sleep duration should be considered when a significant step such as pharmacotherapy is undertaken for sleep.", "links": [] }, { "title": "Feeling Younger on Active Summer Days? On the Interplay of Behavioral and Environmental Factors With Day-to-Day Variability in Subjective Age", "author": "Schmidt, Laura I.; Rupprecht, Fiona S.; Gabrian, Martina; Jansen, Carl-Philipp; Sieverding, Monika; Wahl, Hans-Werner", "year": "2024", "journalProceedings": "Innovation in Aging", "category": "Case Study", "devices": "Charge HR", "population": "Older Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND AND OBJECTIVES: Subjective age, that is, how old people feel in relation to their chronological age, has mostly been investigated from a macro-longitudinal, lifespan point of view and in relation to major developmental outcomes. Recent evidence also shows considerable intraindividual variations in micro-longitudinal studies as well as relations to everyday psychological correlates such as stress or affect, but findings on the interplay with physical activity or sleep as behavioral factors and environmental factors such as weather conditions are scarce. RESEARCH DESIGN AND METHODS: We examined data from 80 recently retired individuals aged 59-76 years (M = 67.03 years, 59\\% women) observed across 21 days. Daily diary-based assessments of subjective age, stress, affect, and sleep quality alongside physical activity measurement via Fitbit (steps, moderate-to-vigorous physical activity) and daily hours of sunshine were collected and analyzed using multilevel modeling. RESULTS: Forty-four percent of the overall variance in subjective age was due to intraindividual variation, demonstrating considerable fluctuation. Affect explained the largest share in day-to-day fluctuations of subjective age, followed by stress and steps, whereas sunshine duration explained the largest share of variance in interindividual differences. DISCUSSION AND IMPLICATIONS: In our daily diary design, subjective age was most strongly related to self-reported affect as a psychological correlate. We, however, also found clear associations with objective data on daily steps and weather. Hence, our study contributes to contextualizing and understanding variations in subjective age in everyday life.", "links": [] }, { "title": "Using formative process evaluation to improve program implementation and accessibility of competitive group-based physical activity in the TEAM-PA trial", "author": "Sweeney, Allison M.; Wilson, Dawn K.; Zarrett, Nicole; Simmons, Timothy; Mansfield, Makayla; Decker, Lindsay", "year": "2024", "journalProceedings": "The International Journal of Behavioral Nutrition and Physical Activity", "category": "Intervention", "devices": "Inspire", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: This study demonstrates how formative process evaluation was used to assess implementation and improve dose and fidelity in the Together Everyone Achieves More Physical Activity (TEAM-PA) randomized controlled trial. TEAM-PA uses a randomized group cohort design to evaluate the efficacy of a group-based intervention for increasing physical activity among African American women. METHODS: Intervention groups met for 10 weeks and were co-led by female African American facilitators, with intervention sessions consisting of group feedback, a health curriculum, group-based physical activity games, and group-based goal-setting. Drawing from a multi-theoretical framework, the intervention targeted social affiliation using collaborative and competitive group strategies, including essential elements focused on group-based behavioral skills, peer-to-peer positive communication, collectivism, optimal challenge, social facilitation, and peer to peer challenges. Formative process evaluation was used to monitor reach, dose, and fidelity, and implement feedback and solutions. RESULTS: Across two cohorts, four groups (n = 54) were randomized to the TEAM-PA intervention. On average 84.8\\% of participants attended each week, which exceeded the a priori criteria. Results from the systematic observations indicated that on average 93\\% of the dose items were completed in each session and adequate levels of fidelity were achieved at both the facilitator and group-levels. Participants were compliant with wearing the FitBits (6.73 ± 0.42 days/week) and most participants successfully contributed to meeting the group-based goals. The use of open-ended items also revealed the need for additional modifications to the group-based PA games, including allowing for individuals to take breaks, incorporating a broader range of exercises, minimizing activities that required bending/reaching down without assistance, and providing facilitators with additional training for implementing the games. Initial evidence suggests that these changes were successful in increasing participants' comprehension of the games from Cohort 1 (M = 1.83, SD = 0.71) to Cohort 2 (M = 3.33, SD = 0.69). CONCLUSION: Findings from this study demonstrated high levels of reach, dose, and fidelity, while also highlighting strategies for implementing competitive group-based PA games that are accessible across physical fitness levels. Formative process evaluation, including open-ended items and collaborative brainstorming, holds tremendous potential for improving future interventions. TRIAL REGISTRATION: This study was registered on Clinicaltrials.gov (\\# NCT05519696) on August 22, 2022 prior to the enrollment of the first participant on September 12, 2022 ( https://clinicaltrials.gov/study/NCT05519696?term=NCT05519696\\&rank=1 ).", "links": [] }, { "title": "Sleep Behavior in Royal Australian Navy Shift Workers by Shift and Exposure to the SleepTank App", "author": "Devine, Jaime K.; Cooper, Nadine; Choynowski, Jake; Hursh, Steven R.", "year": "2024", "journalProceedings": "Military Medicine", "category": "Measurement", "devices": "Versa 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "Introduction: Rotating shiftwork schedules are known to disrupt sleep in a manner that can negatively impact safety. Consumer sleep technologies (CSTs) may be a useful tool for sleep tracking, but the standard feedback provided by CSTs may not be salient to shift-working populations. SleepTank is an app that uses the total sleep time data scored by a CST to compute a percentage that equates hours of sleep to the fuel in a car and warns the user to sleep when the \"tank\" is low. Royal Australian Navy aircraft maintenance workers operating on a novel rotational shift schedule were given Fitbit Versa 2s to assess sleep timing, duration, and efficiency across a 10-week period. Half of the participants had access to just the Fitbit app while the other half had access to Fitbit and the SleepTank app. The goal of this study was to evaluate differences in sleep behavior between shifts using an off-the-shelf CST and to investigate the potential of the SleepTank app to increase sleep duration during the 10-week rotational shift work schedule.\n\nMaterials and methods: Royal Australian Navy volunteers agreed to wear a Fitbit Versa 2 with the SleepTank app (SleepTank condition), or without the SleepTank app (Controls), for up to 10 weeks from May to July 2023 during the trial of a novel shift rotation schedule. Participants from across 6 units worked a combination of early (6:00 AM to 2:00 PM), day (7:30 AM to 4:30 PM), late (4:00 PM to 12:00 AM), and night shifts (12:00 AM to 6:00 AM) or stable day shifts (6:00 AM to 4:00 PM). Differences in sleep behavior (time in bed, total sleep time, bedtime, wake time, sleep efficiency [SE]) between conditions and shift types were tested using Analysis of Variance. This study was approved by the Australian Departments of Defence and Veterans' Affairs Human Research Ethics Committee.\n\nResults: Thirty-four participants completed the full study (n = 17 Controls; n = 17 SleepTank). There was a significant effect of shift type on 24-hour time in bed (TIB24; F(4,9) = 8.15, P < .001, η2 = 0.15) and total sleep time (TST24; F(4,9) = 8.54, P < .001, η2 = 0.18); both were shorter in early shifts and night shifts compared to other shift types. TIB24 and TST24 were not significantly different between conditions, but there was a trend for greater SE in the SleepTank condition relative to Controls (F(1,9) = 2.99, P = .08, η2 = 0.11).\n\nConclusions: Sleep data collected by Fitbit Versa 2s indicated shorter sleep duration (TIB24, TST24) for Royal Australian Navy workers during early and late shifts relative to stable day shifts. Access to the SleepTank app did not greatly influence measures of sleep duration but may be protective against fatigue by affecting SE. Further research is needed to evaluate the utility of the SleepTank app as a means of improving sleep hygiene in real-world, shift-working environments.", "links": [] }, { "title": "Physical Activity and Sedentary Time Among U.S. Adolescents Before and During COVID-19: Findings From a Large Cohort Study", "author": "Hunt, Ethan T.; Brazendale, Keith; De Moraes, Augusto C. F.; Malkani, Raja; Heredia, Natalia I.; Pfledderer, Christopher D.; Brown, Denver M.; Hoelscher, Deanna M.; Beets, Michael W.; Weaver, Robert G.", "year": "2024", "journalProceedings": "AJPM focus", "category": "Case Study", "devices": "Charge 2", "population": "Adolescents", "dataUsed": "Steps,Intensity", "abstract": "Introduction: Evidence suggests that adolescents engage in less physical activity during the summer break. Less is known regarding physical activity during the summer months of the COVID-19 pandemic.\n\nMethods: Utilizing data from the Adolescent Brain Cognitive Development study, the authors examined daily activity measured by Fitbit Charge 2 devices before and after the onset of the COVID-19 pandemic during school and summer months. Linear models estimated activity during pre-COVID-19 school, pre-COVID-19 summer, COVID-19 school, and COVID-19 summer.\n\nResults: Participants (N=7,179, aged 11.96 years, 51% female, 51% White) accumulated 8,671.0 (95% CI=8,544.7; 8,797.3) steps, 32.5 (95% CI=30.8, 32.3) minutes of moderate-to-vigorous physical activity, and 507.2 (95% CI=504.2, 510.2) minutes of sedentary time. During COVID-19 school, adolescents accumulated fewer daily steps and minutes of moderate-to-vigorous physical activity (-1,782.3 steps [95% CI= -2,052.7; -1,511.8] and -6.2 minutes [95% CI= -8.4, -4.0], respectively). Adolescents accumulated more minutes of daily sedentary time (29.6 minutes [95% CI=18.9, 40.3]) during COVID-19 school months than during the pre-COVID-19 school months. During pre-COVID-19 summer months, adolescents accumulated 1,255.1 (95% CI=745.3; 1,765.0) more daily steps than during COVID-19 months. Boys accumulated more daily steps and moderate-to-vigorous physical activity (2,011.5 steps [95% CI=1,271.9; 2,751.0] and 7.9 minutes [95% CI=1.4, 14.4], respectively) during the summer before COVID-19 than in summer during COVID-19. Both girls and boys accumulated more minutes of sedentary time during COVID-19 school months (47.4 [95% CI=27.5, 67.3] and 51.2 [95% CI=22.8, 79.7], respectively) than during COVID-19 summer months.\n\nConclusions: Societal restrictions during COVID-19 negatively impacted activity levels in the U.S., particularly during the summer months during COVID-19.\n\nKeywords: COVID-19; adolescents; physical activity; summer.", "links": [] }, { "title": "Effect of kaempferol ingestion on physical activity and sleep quality: a double-blind, placebo-controlled, randomized, crossover trial", "author": "Ikeda, Yasutaka; Gotoh-Katoh, Aina; Okada, Shinpei; Handa, Shuichi; Sato, Teruyuki; Mizokami, Tsubasa; Saito, Bungo", "year": "2024", "journalProceedings": "Frontiers in Nutrition", "category": "Case Study", "devices": "Charge 4", "population": "Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Background: Kaempferol (KMP), a flavonoid in edible plants, exhibits diverse pharmacological effects. Growing body of evidence associates extended lifespan with physical activity (PA) and sleep, but KMP's impact on these behaviors is unclear. This double-blind, placebo-controlled, crossover trial assessed KMP's effects on PA and sleep.\n\nMethods: A total of 33 city workers (17 males and 16 females) participated in this study. They were randomly assigned to take either 10 mg of KMP or placebo for 2 weeks in the order allocated, with a 7-day washout period in between. All participants wore an accelerometer-based wearable device (Fitbit Charge 4), which monitored daily PA, heart rate (HR), and HR variability during sleep.\n\nResults: The duration of wearing the device was 23.73 ± 0.04 h/day. HR decreased in each PA level, and the mean daily step count and distance covered increased significantly during KMP intake compared to placebo. The outing rate, number of trips, number of recreational activities, and time spent in recreation on weekends increased. Sleep quality improved following KMP intake. The decrease in HR and increase in RMSSD may be important in mediating the effects of these KMPs.\n\nConclusion: KMP leads to behavioral changes that subsequently improve sleep quality and potentially improve long-term quality of life.\n\nClinical trial registration: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048447, UMIN000042438.\n\nKeywords: Fitbit; behavioral change; daily step count; kaempferol; sleep quality.", "links": [] }, { "title": "Exploring Pain Reduction through Physical Activity: A Case Study of Seven Fibromyalgia Patients", "author": "Jenssen, Marit Dagny Kristine; Salvi, Elisa; Fors, Egil Andreas; Nilsen, Ole Andreas; Ngo, Phuong Dinh; Tejedor, Miguel; Bellika, Johan Gustav; Godtliebsen, Fred", "year": "2024", "journalProceedings": "Bioengineering (Basel, Switzerland)", "category": "Case Study", "devices": "Charge 3,Charge 4,Versa 3", "population": "Patients", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Fibromyalgia is a chronic disease that affects a considerable fraction of the global population, primarily women. Physical activity is often recommended as a tool to manage the symptoms. In this study, we tried to replicate a positive result of pain reduction through physical activity. After collecting pain and physical activity data from seven women with fibromyalgia, one patient experienced a considerable reduction in pain intensity. According to the patient, the improvement was related to physical activity. Our study was conducted to investigate the replicability of this result through personalized activity recommendations. Out of the other six patients, three experienced a reduction in pain. The remaining three patients did not experience any pain relief. Our results show that two of these were not able to follow the activity recommendations. These results indicate that physical activity may have a positive effect on chronic pain patients. To estimate how effective physical activity can be for this patient group, an intervention with longer follow-ups and larger sample sizes needs to be performed in the future.", "links": [] }, { "title": "Efficacy of Activity Trackers in Patients With Heart Failure With Preserved Ejection Fraction", "author": "Kogelschatz, Benjamin; Penn, Brittany A.; Leavitt, Ashlynn J.; Dranow, Elizabeth; Ma, Christy L.; Ryan, John J.", "year": "2024", "journalProceedings": "Cureus", "category": "Medical", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps", "abstract": "Background: Heart failure with preserved ejection fraction (HFpEF) is a common, complex syndrome associated with elevated morbidity and mortality. Patients with HFpEF have a high prevalence of comorbidities, including hypertension, diabetes mellitus, and obesity, which are closely related to the underlying mechanisms of the disease. Lifestyle modification with weight loss and physical activity can improve risk factors and functional outcomes in HFpEF. We sought to observe daily physical activity and determine whether utilizing an activity tracker can enhance functional status in HFpEF patients.\n\nMethods: We performed a prospective analysis of 57 patients with HFpEF from 2021 to 2023 at a single academic medical center who utilized a Fitbit to record one year of daily step activity. The patients were evaluated in the ambulatory setting for an initial visit and subsequently at intervals of 3, 6, and 12 months to gather vitals, labs, physical exam, and functional measurements, including the Six-Minute Walk Test (6MWT) and Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12). Associations between variables were assessed using Pearson's r correlation using Stata 18.0.\n\nResults: Of the 49 patients who completed the study, the mean age was 68.1 ± 10.2 years, with 67% of patients identifying as female. The average BMI was 36.4 ± 8.6 kg/m2. Across each time interval, the median numbers of steps per day were 4,113 (2,517-6,520) (1-3 months), 4,583 (2,532-6,326) (4-6 months), and 3,957 (2,942-5,982) (7-12 months). There was no statistically significant variation in daily step count (p=0.06). We observed a statistically significant increase of 66 (6-200) feet in the 6MWT (p= 0.002) from baseline (1,175 (910-1,400)) to 12 months (1,321 (1,000-1,550)). The daily step count was highly correlated with the 6MWT across all time points (1-3 months: r= .70, p< .001; 4-6 months: r= .61, p< .001; 7-12 months: r= .69, p< .001). The total KCCQ-12 scores increased by 6.8 (-4.2-19.8) points (p=0.005) from baseline (60.1 (41.7-73.4)) to 12 months (69.8 (50-84.4)). Among the sub-categories of the questionnaire, we observed a positive correlation between physical limitation scores and daily step count (1-3 months: r= .47, p=.001; 4-6 months: r= .63, p< .001; 7-12 months: r= .56, p= .001). Of interest, one patient who was taking over 15,000 daily steps scored their physical limitation 10-20 points lower than those taking less than half the steps and had one of the lowest quality of life scores in the cohort, reflecting the subjective nature of heart failure (HF) symptoms.\n\nConclusion: Fitbit technology offers a convenient means to monitor real-time physical activity in patients with HFpEF. Utilizing a Fitbit to record daily step activity enhances health-related quality of life in this population. In contrast to the improved average total KCCQ-12 score, we did not observe a clinically significant increase in the 6MWT over the course of the year. Our findings establish the utility of daily step count as a valuable surrogate for six-minute walk distance.", "links": [] }, { "title": "Supervised machine learning to predict smoking lapses from Ecological Momentary Assessments and sensor data: Implications for just-in-time adaptive intervention development", "author": "Perski, Olga; Kale, Dimitra; Leppin, Corinna; Okpako, Tosan; Simons, David; Goldstein, Stephanie P.; Hekler, Eric; Brown, Jamie", "year": "2024", "journalProceedings": "PLOS digital health", "category": "Case Study", "devices": "Charge 4", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Specific moments of lapse among smokers attempting to quit often lead to full relapse, which highlights a need for interventions that target lapses before they might occur, such as just-in-time adaptive interventions (JITAIs). To inform the decision points and tailoring variables of a lapse prevention JITAI, we trained and tested supervised machine learning algorithms that use Ecological Momentary Assessments (EMAs) and wearable sensor data of potential lapse triggers and lapse incidence. We aimed to identify a best-performing and feasible algorithm to take forwards in a JITAI. For 10 days, adult smokers attempting to quit were asked to complete 16 hourly EMAs/day assessing cravings, mood, activity, social context, physical context, and lapse incidence, and to wear a Fitbit Charge 4 during waking hours to passively collect data on steps and heart rate. A series of group-level supervised machine learning algorithms (e.g., Random Forest, XGBoost) were trained and tested, without and with the sensor data. Their ability to predict lapses for out-of-sample (i) observations and (ii) individuals were evaluated. Next, a series of individual-level and hybrid (i.e., group- and individual-level) algorithms were trained and tested. Participants (N = 38) responded to 6,124 EMAs (with 6.9% of responses reporting a lapse). Without sensor data, the best-performing group-level algorithm had an area under the receiver operating characteristic curve (AUC) of 0.899 (95% CI = 0.871-0.928). Its ability to classify lapses for out-of-sample individuals ranged from poor to excellent (AUCper person = 0.524-0.994; median AUC = 0.639). 15/38 participants had adequate data for individual-level algorithms to be constructed, with a median AUC of 0.855 (range: 0.451-1.000). Hybrid algorithms could be constructed for 25/38 participants, with a median AUC of 0.692 (range: 0.523 to 0.998). With sensor data, the best-performing group-level algorithm had an AUC of 0.952 (95% CI = 0.933-0.970). Its ability to classify lapses for out-of-sample individuals ranged from poor to excellent (AUCper person = 0.494-0.979; median AUC = 0.745). 11/30 participants had adequate data for individual-level algorithms to be constructed, with a median AUC of 0.983 (range: 0.549-1.000). Hybrid algorithms could be constructed for 20/30 participants, with a median AUC of 0.772 (range: 0.444 to 0.968). In conclusion, high-performing group-level lapse prediction algorithms without and with sensor data had variable performance when applied to out-of-sample individuals. Individual-level and hybrid algorithms could be constructed for a limited number of individuals but had improved performance, particularly when incorporating sensor data for participants with sufficient wear time. Feasibility constraints and the need to balance multiple success criteria in the JITAI development and implementation process are discussed.", "links": [] }, { "title": "Validation of activity trackers to estimate energy expenditure in older adults with cardiovascular risk factors", "author": "Rieckmann, Alina; Jordan, Bas; Burczik, Friederike; Meixner, Jacqueline; Thiel, Christian", "year": "2024", "journalProceedings": "PloS One", "category": "Validation", "devices": "Charge 3", "population": "Older Adults", "dataUsed": "Heart Rate", "abstract": "Objectives: To compare different types of activity trackers recording physical activity energy expenditure (PAEE) and examine their criterion validity against indirect calorimetry (IC) as the gold standard in adults over 60 years of age with a special focus on women with cardiovascular risk.\n\nDesign: Synchronous registrations of PAEE were performed with up to four different devices to determine criterion validity against IC while participants performed a protocol of simulated activities in a laboratory setting.\n\nMethod: Thirty-four participants (25 women, 9 men) with at least a light cardiac risk performed a protocol of simulated activities in a laboratory setting (daily living activities, cycle ergometer test). PAEE was simultaneously assessed by IC, two research-grade activity trackers (ActiGraph-wGT3X-BT and Actiheart-4) and two consumer-level activity trackers (OMRON pedometer and Fitbit Charge-3). Tracker-derived PAEE was compared with PAEE calculated from IC descriptively and by Bland-Altman plots.\n\nResults: The ActiGraph (0.7 ± 0.4 kcal/min), the Actiheart (1.1 ± 0.6 kcal/min) and the OMRON (0.8 ± 0.6 kcal/min) underestimated, while the Fitbit (3.4 ± 1.2 kcal/min) overestimated PAEE compared to IC-PAEE (2.0 ± 0.5 kcal/min). The Bland-Altman limits of agreement (LoA) against IC were +0.5/+2.2 kcal/min for the ActiGraph, -0.3/+2.1 kcal/min for the Actiheart, -3.7/+1.0 kcal/min for the Fitbit, and -0.5/+2.9 kcal/min for the OMRON. The magnitude of the deviation varied considerably depending on the activity (e.g. walking, cleaning, cycle ergometer test).\n\nConclusions: The research-grade activity trackers estimated PAEE with higher validity than the commercially available activity trackers. The partly very wide LoA have to be critically considered when assessing PAEE in the context of health service research, as individual Physical Activity behaviour may be under- or overestimated.", "links": [] }, { "title": "Real-World Accuracy of Wearable Activity Trackers for Detecting Medical Conditions: Systematic Review and Meta-Analysis", "author": "Singh, Ben; Chastin, Sebastien; Miatke, Aaron; Curtis, Rachel; Dumuid, Dorothea; Brinsley, Jacinta; Ferguson, Ty; Szeto, Kimberley; Simpson, Catherine; Eglitis, Emily; Willems, Iris; Maher, Carol", "year": "2024", "journalProceedings": "JMIR mHealth and uHealth", "category": "Systematic Review", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Background: Wearable activity trackers, including fitness bands and smartwatches, offer the potential for disease detection by monitoring physiological parameters. However, their accuracy as specific disease diagnostic tools remains uncertain.\n\nObjective: This systematic review and meta-analysis aims to evaluate whether wearable activity trackers can be used to detect disease and medical events.\n\nMethods: Ten electronic databases were searched for studies published from inception to April 1, 2023. Studies were eligible if they used a wearable activity tracker to diagnose or detect a medical condition or event (eg, falls) in free-living conditions in adults. Meta-analyses were performed to assess the overall area under the curve (%), accuracy (%), sensitivity (%), specificity (%), and positive predictive value (%). Subgroup analyses were performed to assess device type (Fitbit, Oura ring, and mixed). The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Diagnostic Test Accuracy Studies.\n\nResults: A total of 28 studies were included, involving a total of 1,226,801 participants (age range 28.6-78.3). In total, 16 (57%) studies used wearables for diagnosis of COVID-19, 5 (18%) studies for atrial fibrillation, 3 (11%) studies for arrhythmia or abnormal pulse, 3 (11%) studies for falls, and 1 (4%) study for viral symptoms. The devices used were Fitbit (n=6), Apple watch (n=6), Oura ring (n=3), a combination of devices (n=7), Empatica E4 (n=1), Dynaport MoveMonitor (n=2), Samsung Galaxy Watch (n=1), and other or not specified (n=2). For COVID-19 detection, meta-analyses showed a pooled area under the curve of 80.2% (95% CI 71.0%-89.3%), an accuracy of 87.5% (95% CI 81.6%-93.5%), a sensitivity of 79.5% (95% CI 67.7%-91.3%), and specificity of 76.8% (95% CI 69.4%-84.1%). For atrial fibrillation detection, pooled positive predictive value was 87.4% (95% CI 75.7%-99.1%), sensitivity was 94.2% (95% CI 88.7%-99.7%), and specificity was 95.3% (95% CI 91.8%-98.8%). For fall detection, pooled sensitivity was 81.9% (95% CI 75.1%-88.1%) and specificity was 62.5% (95% CI 14.4%-100%).\n\nConclusions: Wearable activity trackers show promise in disease detection, with notable accuracy in identifying atrial fibrillation and COVID-19. While these findings are encouraging, further research and improvements are required to enhance their diagnostic precision and applicability.", "links": [] }, { "title": "Feasibility characteristics of wrist-worn fitness trackers in health status monitoring for post-COVID patients in remote and rural areas", "author": "Wiebe, Madeleine; Mackay, Marnie; Krishnan, Ragur; Tian, Julie; Larsson, Jakob; Modanloo, Setayesh; Job McIntosh, Christiane; Sztym, Melissa; Elton-Smith, Gail; Rose, Alyssa; Ho, Chester; Greenshaw, Andrew; Cao, Bo; Chan, Andrew; Hayward, Jake", "year": "2024", "journalProceedings": "PLOS digital health", "category": "Usability", "devices": "Charge 2", "population": "Patients", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Introduction: Common, consumer-grade biosensors mounted on fitness trackers and smartwatches can measure an array of biometrics that have potential utility in post-discharge medical monitoring, especially in remote/rural communities. The feasibility characteristics for wrist-worn biosensors are poorly described for post-COVID conditions and rural populations.\n\nMethods: We prospectively recruited patients in rural communities who were enrolled in an at-home rehabilitation program for post-COVID conditions. They were asked to wear a FitBit Charge 2 device and biosensor parameters were analyzed [e.g. heart rate, sleep, and activity]. Electronic patient reported outcome measures [E-PROMS] for mental [bi-weekly] and physical [daily] symptoms were collected using SMS text or email [per patient preference]. Exit surveys and interviews evaluated the patient experience.\n\nResults: Ten patients were observed for an average of 58 days and half [N = 5] were monitored for 8 weeks or more. Five patients [50%] had been hospitalized with COVID [mean stay = 41 days] and 4 [36%] had required mechanical ventilation. As baseline, patients had moderate to severe levels of anxiety, depression, and stress; fatigue and shortness of breath were the most prevalent physical symptoms. Four patients [40%] already owned a smartwatch. In total, 575 patient days of patient monitoring occurred across 10 patients. Biosensor data was usable for 91.3% of study hours and surveys were completed 82.1% and 78.7% of the time for physical and mental symptoms, respectively. Positive correlations were observed between stress and resting heart rate [r = 0.360, p<0.01], stress and daily steps [r = 0.335, p<0.01], and anxiety and daily steps [r = 0.289, p<0.01]. There was a trend toward negative correlation between sleep time and physical symptom burden [r = -0.211, p = 0.05]. Patients reported an overall positive experience and identified the potential for wearable devices to improve medical safety and access to care. Concerns around data privacy/security were infrequent.\n\nConclusions: We report excellent feasibility characteristics for wrist-worn biosensors and e-PROMS as a possible substrate for multi-modal disease tracking in post-COVID conditions. Adapting consumer-grade wearables for medical use and scalable remote patient monitoring holds great potential.", "links": [] }, { "title": "Ecological Momentary Intervention to Replace Sedentary Time With Physical Activity to Improve Executive Function in Midlife and Older Latino Adults: Pilot Randomized Controlled Trial", "author": "Bronas, Ulf G.; Marquez, David X.; Fritschi, Cynthia; Petrarca, Katherine; Kitsiou, Spyros; Ajilore, Olu; Tintle, Nathan", "year": "2024", "journalProceedings": "Journal of Medical Internet Research", "category": "Intervention", "devices": "Charge 4", "population": "Adults", "dataUsed": "Steps,User Friendliness,Active Minutes/Active Zone Minutes", "abstract": "BACKGROUND: Exercise interventions often improve moderate to vigorous physical activity, but simultaneously increase sedentary time due to a compensatory resting response. A higher level of sedentary time is associated with a lower level of executive function, while increased moderate to vigorous physical activity is associated with improved global cognition and working memory among Latino adults. Latino adults are the fastest-growing minority group in the United States and are at high risk for cognitive decline, spend more time sedentary compared to non-Hispanic populations, and engage in low levels of physical activity. Interventions that are culturally appropriate for Latino adults to replace sedentary time with physical activity are critically needed. OBJECTIVE: This study aims to develop and test the feasibility and acceptability of an ecological momentary intervention (EMI; delivered in real time) that is individually designed to replace sedentary time with physical activity in Latino adults. METHODS: This pilot study randomized 39 (n=26, 67\\% female; mean age 61, SD 5.8 years) community-dwelling, Spanish-speaking Latino adults (1:1 allocation) to either a 6-week EMI program designed to replace sitting time with physical activity (20/39, 51\\%) or physical activity guidelines education (19/39, 49\\%). The program was conducted on the web and in Spanish. The intervention was individualized based on individual interview responses. The intervention included the use of a Fitbit activity monitor, weekly didactic phone meetings, interactive tools (SMS text messages), and coach-delivered feedback. Feasibility and acceptability were assessed via study satisfaction (Likert scales), motivation (ecological momentary assessment), retention, and compliance. Sedentary time and physical activity were assessed via 7-day actigraphy. Cognitive performance was assessed via the trail making test part A and B (part B=executive function) and via the National Institutes of Health Toolbox remote cognitive assessment. Statistical analysis included a linear model on change score from baseline, adjusting for age, sex, and education, emphasizing effect size. RESULTS: Participant satisfaction with EMI was high (9.4/10), with a high degree of motivation to replace sitting time with physical activity (9.8/10). The intervention compliance rate was 79\\% with low difficulty using the Fitbit (1.7/10). Weekly step count increased in the intervention group by 5543 steps (group difference: d=0.54; P=.05) and sedentary time decreased by a mean 348 (SD 485) minutes (group difference: d=0.47; P=.24) compared to controls, with moderately strong effect sizes. The trail making test part B improved in the intervention group (mean -35.26, SD 60.35 seconds), compared to the control group (mean 7.19, SD 46 seconds; group difference: d=0.74; P=.01). No group differences were observed in other cognitive measures. CONCLUSIONS: An individualized EMI designed for midlife and older Latino adults has the potential to replace sitting time with physical activity and improve executive functioning. The intervention was feasible and well received with a high degree of satisfaction. TRIAL REGISTRATION: ClinicalTrials.gov NCT04507464; https://tinyurl.com/44c4thk5.", "links": [] }, { "title": "The acceptability of using wearable electronic devices to monitor physical activity of patients with Multiple Myeloma undergoing treatment: a systematic review", "author": "Brown, Tommy; Muls, Ann; Pawlyn, Charlotte; Boyd, Kevin; Cruickshank, Susanne", "year": "2024", "journalProceedings": "Clinical Hematology International", "category": "Systematic Review", "devices": "Flex,Alta,Inspire 2", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "INTRODUCTION: Multiple myeloma (MM) is diagnosed in 6,000 people in the UK yearly. A performance status measure, based on the patients' reported level of physical activity, is used to assess patients' fitness for treatment. This systematic review aims to explore the current evidence for the acceptability of using wearable devices in patients treated for MM to measure physical activity directly. METHODS: Three databases were searched (MEDLINE, EMBASE and CINAHL) up until 7th September 2023. Prospective studies using wearable devices to monitor physical activity in patients on treatment for MM were included. Bias across the studies was assessed using the CASP tool. RESULTS: Nine studies, with 220 patients on treatment for MM, were included. Only two studies had a low risk of bias. Different wearable device brands were used for varying lengths of time and were worn on either the wrist, upper arm, or chest. Adherence, reported in seven studies, ranged from 50\\% to 90\\%. Six studies reported an adherence greater than 75\\%. Although physical activity was also measured in a heterogenous manner, most studies reported reduced physical activity during treatment, associated with a higher symptom burden. CONCLUSION: Monitoring patients receiving treatment for MM with a wearable device appears acceptable as an objective measure to evaluate physical activity. Due to the heterogeneity of the methods used, the generalisability of the results is limited. Future studies should explore the data collected prospectively and their ability to predict relevant clinical outcomes.", "links": [] }, { "title": "Digitizing Survivorship Care Plans Through the POST-Treatment Health Outcomes of Cancer Survivors (POSTHOC) Mobile App: Protocol for a Phase II Randomized Controlled Trial", "author": "Chung, Kaitlin H.; Youngblood, Shari M.; Clingan, Carin L.; Deighton, Dana C.; Jump, Virginia A.; Manuweera, Thushini; McGeorge, Nicolette M.; Renn, Cynthia L.; Rosenblatt, Paula Y.; Winder, Aaron T.; Zhu, Shijun; Kleckner, Ian R.; Kleckner, Amber S.", "year": "2024", "journalProceedings": "JMIR research protocols", "category": "Intervention", "devices": null, "population": "Patients", "dataUsed": "Steps,Intensity,Sleep", "abstract": "BACKGROUND: Survivorship care plans (SCPs) are provided at the completion of cancer treatment to aid in the transition from active treatment to long-term survivorship. They describe the details of a patient's diagnosis and treatment and offer recommendations for follow-up appointments, referrals, and healthy behaviors. The plans are currently paper-based and become outdated as soon as a patient's health status changes. There is a need to digitize these plans to improve their accessibility, modifiability, and longevity. With current technology, SCPs can be linked to mobile devices and activity trackers so that patients can track health behaviors and compare them to their clinical goals, taking charge of their own health. OBJECTIVE: A mobile app, POSTHOC (POST-Treatment Health Outcomes of Cancer Survivors), that digitizes the SCP was developed, with goals of integrating it with wearable technologies and electronic medical records. Herein, we are conducting a randomized controlled trial that evaluates the POSTHOC app versus the traditional SCP on total symptom burden in the early posttreatment period. METHODS: We will recruit 54 patients who have recently completed curative therapy for cancer (any type) in person and remotely. They will be randomized 2:1, POSTHOC:usual care (unblinded). Those randomized to the POSTHOC group will receive their SCP via the app and will choose to focus on nutrition or exercise for the duration of the study based on their individual plan and personal preferences. Those randomized to the control group will get a paper-based plan. At baseline, 6 weeks, and 12 weeks, we will evaluate patient-reported outcomes, including total symptom burden (web-based questionnaire), diet (24-hour Automated Self-Administered [ASA24]), and physical activity (Fitbit Charge 6 [Google LLC]). We will also collect quantitative and qualitative feedback on the usability of the app from those in the POSTHOC arm to improve the app for future implementation studies, with a specific focus on patient-provider communication. For feasibility, we will calculate the percentage of patients who used the POSTHOC app at least 3 times per week. We will use linear mixed models to evaluate the effects of the POSTHOC app versus those of usual care on other outcomes at weeks 6 and 12. RESULTS: This trial is open to accrual in the University of Maryland Medical System as of March 2024, and as of July 3, 2024, a total of 20 participants have consented. CONCLUSIONS: This study is among the first to digitize the SCP in a mobile app and test the effects of a mobile health-delivered behavioral health intervention on symptom burden in cancer survivors. Our results will provide evidence about the effects of health self-management on symptoms. This knowledge will be integral to larger randomized controlled studies, integration with the electronic medical record, and nationwide implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT05499663; https://clinicaltrials.gov/ct2/show/NCT05499663. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/59222.", "links": [] }, { "title": "Modeling engagement with a digital behavior change intervention (HeartSteps II): An exploratory system identification approach", "author": "De La Torre, Steven A.; El Mistiri, Mohamed; Hekler, Eric; Klasnja, Predrag; Marlin, Benjamin; Pavel, Misha; Spruijt-Metz, Donna; Rivera, Daniel E.", "year": "2024", "journalProceedings": "Journal of Biomedical Informatics", "category": "Intervention", "devices": "Versa", "population": "Adults", "dataUsed": "Steps", "abstract": "OBJECTIVE: Digital behavior change interventions (DBCIs) are feasibly effective tools for addressing physical activity. However, in-depth understanding of participants' long-term engagement with DBCIs remains sparse. Since the effectiveness of DBCIs to impact behavior change depends, in part, upon participant engagement, there is a need to better understand engagement as a dynamic process in response to an individual's ever-changing biological, psychological, social, and environmental context. METHODS: The year-long micro-randomized trial (MRT) HeartSteps II provides an unprecedented opportunity to investigate DBCI engagement among ethnically diverse participants. We combined data streams from wearable sensors (Fitbit Versa, i.e., walking behavior), the HeartSteps II app (i.e. page views), and ecological momentary assessments (EMAs, i.e. perceived intrinsic and extrinsic motivation) to build the idiographic models. A system identification approach and a fluid analogy model were used to conduct autoregressive with exogenous input (ARX) analyses that tested hypothesized relationships between these variables inspired by Self-Determination Theory (SDT) with DBCI engagement through time. RESULTS: Data from 11 HeartSteps II participants was used to test aspects of the hypothesized SDT dynamic model. The average age was 46.33 (SD=7.4) years, and the average steps per day at baseline was 5,507 steps (SD=6,239). The hypothesized 5-input SDT-inspired ARX model for app engagement resulted in a 31.75 \\% weighted RMSEA (31.50 \\% on validation and 31.91 \\% on estimation), indicating that the model predicted app page views almost 32 \\% better relative to the mean of the data. Among Hispanic/Latino participants, the average overall model fit across inventories of the SDT fluid analogy was 34.22 \\% (SD=10.53) compared to 22.39 \\% (SD=6.36) among non-Hispanic/Latino Whites, a difference of 11.83 \\%. Across individuals, the number of daily notification prompts received by the participant was positively associated with increased app page views. The weekend/weekday indicator and perceived daily busyness were also found to be key predictors of the number of daily application page views. CONCLUSIONS: This novel approach has significant implications for both personalized and adaptive DBCIs by identifying factors that foster or undermine engagement in an individual's respective context. Once identified, these factors can be tailored to promote engagement and support sustained behavior change over time.", "links": [] }, { "title": "Leveraging mHealth Technologies for Public Health", "author": "Velmovitsky, Pedro Elkind; Kirolos, Merna; Alencar, Paulo; Leatherdale, Scott; Cowan, Donald; Morita, Plinio Pelegrini", "year": "2024", "journalProceedings": "JMIR public health and surveillance", "category": "Review", "devices": "Device unspecified", "population": "Older Adults", "dataUsed": "User Friendliness", "abstract": "Traditional public health surveillance efforts are generally based on self-reported data. Although well validated, these methods may nevertheless be subjected to limitations such as biases, delays, and costs or logistical challenges. An alternative is the use of smart technologies (eg, smartphones and smartwatches) to complement self-report indicators. Having embedded sensors that provide zero-effort, passive, and continuous monitoring of health variables, these devices generate data that could be leveraged for cases in which the data are related to the same self-report metric of interest. However, some challenges must be considered when discussing the use of mobile health technologies for public health to ensure digital health equity, privacy, and best practices. This paper provides, through a review of major Canadian surveys and mobile health studies, an overview of research involving mobile data for public health, including a mapping of variables currently collected by public health surveys that could be complemented with self-report, challenges to technology adoption, and considerations on digital health equity, with a specific focus on the Canadian context. Population characteristics from major smart technology brands-Apple, Fitbit, and Samsung-and demographic barriers to the use of technology are provided. We conclude with public health implications and present our view that public health agencies and researchers should leverage mobile health data while being mindful of the current barriers and limitations to device use and access. In this manner, data ecosystems that leverage personal smart devices for public health can be put in place as appropriate, as we move toward a future in which barriers to technology adoption are decreasing.", "links": [] }, { "title": "Variations in objectively measured sleep parameters in patients with different premature ejaculation syndromes", "author": "Wu, Xu; Zhang, Yuyang; Jiang, Hui; Zhang, Xiansheng", "year": "2024", "journalProceedings": "The Journal of Sexual Medicine", "category": "Case Study", "devices": "Charge 2", "population": "Patients", "dataUsed": "Sleep", "abstract": "BACKGROUND: Poor sleep quality is now a cause of sexual dysfunction. AIM: To investigate variations in sleep quality among patients with different types of premature ejaculation (PE) and a control group. METHODS: Patients with PE were categorized into groups according to 4 types: lifelong (LPE), acquired (APE), variable (VPE), and subjective (SPE). Basic demographic information about the participants was first collected, and then clinical data were obtained. OUTCOMES: Outcomes included the 5-item International Index of Erectile Function, Premature Ejaculation Diagnostic Tool, 7-item Generalized Anxiety Disorder, 9-item Patient Health Questionnaire, Pittsburgh Sleep Quality Index, self-estimated intravaginal ejaculation latency time (minutes), and sleep monitoring parameters obtained from a wearable device (Fitbit Charge 2). RESULTS: A total of 215 participants were enrolled in the study, of which 136 patients with PE were distributed as follows: LPE (31.62\\%), APE (42.65\\%), VPE (10.29\\%), and SPE (15.44\\%). Subjective scales showed that patients with APE were accompanied by a higher prevalence of erectile dysfunction, anxiety, and depression, as well as poorer sleep quality (assessed by the Pittsburgh Sleep Quality Index). The results of objective sleep parameters revealed that average durations of sleep onset latency (minutes) and wake after sleep onset (minutes) in patients with APE (mean ± SD; 20.03 ± 9.14, 55 ± 23.15) were significantly higher than those with LPE (15.07 ± 5.19, 45.09 ± 20.14), VPE (13.64 ± 3.73, 38.14 ± 11.53), and SPE (14.81 ± 4.33, 42.86 ± 13.14) and the control group (12.48 ± 3.45, 37.14 ± 15.01; P {\\textless} .05). The average duration of rapid eye movement (REM; minutes) in patients with APE (71.34 ± 23.18) was significantly lower than that in patients with LPE (79.67 ± 21.53), VPE (85.93 ± 6.93), and SPE (80.86 ± 13.04) and the control group (86.56 ± 11.93; P {\\textless} .05). Similarly, when compared with the control group, patients with LPE had significantly longer durations of sleep onset latency and wake after sleep onset and a significantly shorter duration of REM sleep. CLINICAL IMPLICATIONS: Our study suggests that clinicians should pay attention not only to male physical assessment but also to mental health and sleep quality. STRENGTHS AND LIMITATIONS: This study suggests that changes in sleep structure occur in patients with PE, which may provide some direction for future research. However, the cross-sectional study design does not allow us to conclude that sleep is a risk factor for PE. CONCLUSION: After controlling for traditional parameters such as age, erectile dysfunction, anxiety, and depression, sleep parameters are independently associated with PE. Patients with APE and LPE show significant alterations in sleep parameters, with patients with APE having notably poorer sleep quality, whereas patients with VPE and SPE have sleep parameters similar to controls.", "links": [] }, { "title": "The Association Between Direct Health Costs Related to Non-communicable Diseases and Physical Activity in Elderly People", "author": "Zhang, Junlong; Li, Bo", "year": "2024", "journalProceedings": "Journal of Prevention (2022)", "category": "Case Study", "devices": "Flex 2", "population": "Older Adults", "dataUsed": "Steps,Energy Expenditure", "abstract": "The aim of this study was to evaluate the association between direct health costs related to non-communicable diseases (NCDs) and the level of physical activity in Chinese elderly people. In this longitudinal study, 410 people over 64 years old were selected from health centers. The direct health costs caused by NCDs were recorded on a weekly basis for a period of six months. Also, physical activity was measured using FitBit Flex2™ and as the number of daily steps as well as calories burned during this six month. The multiple linear regression analysis was used to identify the predictors of direct health costs caused by NCDs as the dependent variable. Age, gender, marital status, education level, currently working, Fitbit steps and calories, and BMI were entered into the model as predictor variables to perform a stepwise regression analysis. Four variables of age, BMI, Fitbit steps and Fitbit calories were able to enter the regression model. The model explained 24.8\\% of the variability of direct health costs due to NCDs. The strongest predictor of health costs was Fitbit calories (B = - 2.113, t =  - 4.807, p {\\textless} 0.001), followed by BMI (B = 1.267, t = 3.482, p {\\textless} 0.001), Fitbit steps (B =  - 1.157, t =  - 3.118, p {\\textless} 0.001), and age (B = 1.115, t = 2.599, p {\\textless} 0.001). It can be said that having regular physical activity can reduce health costs due to NCDs in Chinese older people.", "links": [] }, { "title": "Autocorrelation of daily resting heart rate: A novel metric of postoperative recovery", "author": "Carter, Michela; Hua, Rui; O'Brien, Megan K.; Benjamin Pitt, J.; Kwon, Soyang; Jayaraman, Arun; Mk Ghomrawi, Hassan; Abdullah, Fizan", "year": "2024", "journalProceedings": "International Journal of Medical Informatics", "category": "Case Study", "devices": "Device unspecified", "population": "Children", "dataUsed": "Heart Rate", "abstract": "Purpose: Resting heart rate (RHR) is a sensitive indicator of an individual's physiologic condition. However, its use in clinical practice has been limited due to the wide variation in baseline RHR based on multiple factors, including age, sex, cardiovascular fitness, and comorbidities. The study aims to develop a novel, clinically meaningful metric that is applicable across these conditions, based on day-by-day changes in RHR-the difference in autocorrelation of daily RHR (ACΔ-RHR). We present ACΔ-RHR in the context of monitoring post-discharge recovery for pediatric appendectomy patients.\n\nMethods: Children 3-17 years old who underwent laparoscopic appendectomy for complicated appendicitis from 2019 to 2022 at a tertiary children's hospital wore a Fitbit for twenty-one postoperative days (POD). Patients without complications were included to describe normative recovery. Using RHR on POD 1-3 as the baseline, autocorrelation of daily RHR was calculated (fixed lag = 1) for POD 3-21. Then, daily ACΔ-RHR was determined by subtracting autocorrelation values between the current and previous day. Means and standard deviations were calculated for daily RHR to estimate on which POD ACΔ-RHR stabilized at 0, representing general RHR stability and recovery from surgery for all patients. Subgroup analyses were performed by age (3-10 years old vs 11-17 years old) and sex.\n\nResults: Thirty-one patients were included (58.1 % 3-10 years old, 41.9 % female, 67.7 % Hispanic). Whereas the mean daily RHR did not demonstrate clear trends, the mean ACΔ-RHR for the cohort first reached 0 on POD 12 and stabilized on POD 14 (95 % confidence interval: POD [11,17]). Subgroup analysis showed that ACΔ-RHR stabilized on POD 9 for age of 3-10 years, POD 12 for age of 11-17 years, POD 12 for females and POD 10 for males.\n\nConclusions: The ACΔ-RHR is a promising clinical metric that could enhance post-surgical patient monitoring, such as for children following laparoscopic appendectomy for complicated appendicitis.\n\nKeywords: Appendectomy; Autocorrelation; Consumer wearable devices; Fitbit; Pediatrics; Postoperative care; Remote sensing technology; Resting heart rate.", "links": [] }, { "title": "Scrolling Your Sleep Away: The Effects of Bedtime Device Use on Sleep Among Young Adults with Poor Sleep", "author": "Chkhaidze, Ana; Millar, Brett M.; Revenson, Tracey A.; Mindlis, Irina", "year": "2024", "journalProceedings": "International Journal of Behavioral Medicine", "category": "Intervention", "devices": "Charge 3", "population": "Adults", "dataUsed": "Sleep", "abstract": "BACKGROUND: Many young adults report sleep problems, including insufficient sleep and poor sleep quality. Young adults are heavily reliant on electronic devices, even using them during bedtime with adverse effects on sleep. Given the importance of adequate sleep, the present study examined the daily association between using electronic devices during bedtime and sleep in a diverse sample of young adults with poor sleep. METHOD: We analyzed data from a pilot randomized controlled trial in which young adults with poor sleep [n = 46; 84\\% female; mean age 19.3 (SD = 2.9); 30\\% Asian, 19\\% Black/African American, 9\\% multiracial; 34\\% Hispanic/Latino] wore an electronic sleep tracking device (Fitbit Charge 3) and completed daily sleep diaries including questions about sleep and bedtime routine for 4 weeks following a behavioral sleep intervention. The effect of bedtime device use on sleep latency-time needed to fall asleep-and sleep duration was estimated by generalized linear mixed models (GLMM), adjusting for weeknights/weekend nights. RESULTS: Bedtime device use on a given night was significantly associated with shorter self-reported sleep duration (b =  - 19.80, p = .011), but not with sleep latency. Concordance between the self-reported and Fitbit-measured sleep variables was low, and bedtime device use was not associated and Fitbit-measured sleep variables. CONCLUSION: Using electronic devices before bed negatively affected self-reported sleep duration the following night. This finding highlights the importance of minimizing nightly device use among young adults with poor sleep and suggests that the inconsistency between self-reported sleep and device use warrants further investigation.", "links": [] }, { "title": "Mental and Physical Readiness for Weight Loss After Abdominal Organ Transplant", "author": "Cote, Maria P.; Atthota, Srilakshmi; MacDonald, Anne; Cataldo, Jennie; Shah, Anushi; Flores, Flor; Singh, Ruby; Elias, Nahel; Dageforde, Leigh Anne", "year": "2024", "journalProceedings": "The Journal of Surgical Research", "category": "Intervention", "devices": "Charge 4", "population": "Patients", "dataUsed": "Steps", "abstract": "INTRODUCTION: Readiness to incorporate healthy lifestyle practices is not studied in posttransplant patients. We evaluate physical and mental readiness for a weight-loss guided lifestyle intervention. METHODS: 12 kidney and 12 liver transplant patients were given a Fitbit and weighing scale for 12 mo. Twelve patients received group sessions on lifestyle modifications. Mental readiness was assessed using Patient Activation Measurement-13, Physical Activity, Process of Change, and Weight Stages of Change. Physical readiness was assessed using Fatigue, Resistance, Ambulation, Illness, and Loss of Weight, and Short Physical Performance Battery questionnaires. Weight change, group session attendance, device usage, and readiness were analyzed. RESULTS: 23 patients (12 kidney, 11 liver), 57 y (46.2-67.5), 75\\% male, 24.9 (15.7-43.2) months posttransplant) completed the study. Twenty-two patients had robust physical readiness, and high Fitbit usage ({\\textgreater}80\\%). Ten patients (43\\%) lost ≥2.5\\% (moderate) of body weight, including 4 (17.3\\%) losing {\\textgreater}5\\% total weight (high). 13 patients lost ≤2.5\\% or gained weight (maintenance). High loss and target group session attendance groups had the highest use of Processes of Change. CONCLUSIONS: Posttransplant patients are physically ready for a weight-loss guided lifestyle intervention and show high usage of the Fitbit device. Higher mental readiness associates with higher weight loss.", "links": [] }, { "title": "Validity and stability of the international physical activity questionnaire short-form for stroke survivors with preserved walking ability", "author": "de Diego-Alonso, Cristina; Blasco-Abadía, Julia; Doménech-García, Víctor; Bellosta-López, Pablo", "year": "2024", "journalProceedings": "Topics in Stroke Rehabilitation", "category": "Validation", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Background: Stroke survivors usually present sedentary lifestyles and fail to comply with the World Health Organization physical activity recommendations. Reliable, low-cost, and fast tools are needed to monitor physical activity levels in this population.\n\nObjectives: This study aimed to evaluate the content and face validity, construct validity, and test-retest stability of the International Physical Activity Questionnaire Short-Form (IPAQ-SF) in stroke survivors.\n\nMethods: One hundred and twenty stroke survivors able to walk independently and preserved comprehension and communication abilities (61 ± 12 years, 35% female) were involved in this psychometric study. Participants completed the interview form of the IPAQ-SF via standardized videoconference twice, one week apart, under identical conditions, to evaluate test-retest stability. Correlations between IPAQ-SF and the caloric expenditure during the minutes of activity registered with the Fitbit Inspire 2 activity tracker wristband and 6-Metre Timed Walk (6MTW) were explored to assess construct validity.\n\nResults: The IPAQ-SF showed good content and face validity. \"Moderate\" to \"strong\" correlations were found with the Fitbit Inspire 2 (rho: 0.40 to 0.63), while \"weak\" to \"moderate\" correlations were found with the 6MTW (rho: 0.35 to 0.50). Test-retest stability was \"moderate\" to \"excellent\" (κ: 0.844 to 0.881; ICC: 0.533 to 0.917).\n\nConclusions: The IPAQ-SF demonstrated satisfactory content and construct validity, and stability in stroke survivors, supporting its clinical and research utility when the data collection is conducted by trained evaluators using a standardized interview protocol in large samples.\n\nKeywords: Stroke; physical activity; psychometric properties; questionnaire; reliability; sedentary behavior; validity.", "links": [] }, { "title": "Unlocking the potential of wearable device wear time to enhance postpartum depression screening and detection", "author": "Hurwitz, Eric; Meltzer-Brody, Samantha; Butzin-Dozier, Zachary; Patel, Rena C.; Elhadad, Noémie; Haendel, Melissa A.", "year": "2024", "journalProceedings": "medRxiv: The Preprint Server for Health Sciences", "category": "Case Study", "devices": "Device unspecified", "population": "Pregnant Women", "dataUsed": "Steps,Energy Expenditure,Heart Rate,Device Weartime", "abstract": "Postpartum depression (PPD) is a mood disorder affecting one in seven women after childbirth that is often under-screened and under-detected. If not diagnosed and treated, PPD is associated with long-term developmental challenges in the child and maternal morbidity. Wearable technologies, such as smartwatches and fitness trackers (e.g., Fitbit), offer continuous and longitudinal digital phenotyping for mood disorder diagnosis and monitoring, with device wear time being an important yet understudied aspect. Using the All of Us Research Program (AoURP) dataset, we assessed the percentage of days women with PPD wore Fitbit devices across pre-pregnancy, pregnancy, postpartum, and PPD periods, as determined by electronic health records. Wear time was compared in women with and without PPD using linear regression models. Results showed a strong trend that women in the PPD cohort wore their Fitbits more those without PPD during the postpartum (PPD: mean=72.9\\%, SE=13.8\\%; non-PPD: mean=58.9\\%, SE=12.2\\%, P-value=0.09) and PPD time periods (PPD: mean=70.7\\%, SE=14.5\\%; non-PPD: mean=55.6\\%, SE=12.9\\%, P-value=0.08). We hypothesize this may be attributed to hypervigilance, given the common co-occurrence of anxiety symptoms among women with PPD. Future studies should assess the link between PPD, hypervigilance, and wear time patterns. We envision that device wear patterns with digital biomarkers like sleep and physical activity could enhance early PPD detection using machine learning by alerting clinicians to potential concerns facilitating timely screenings, which may have implications for other mental health disorders.", "links": [] }, { "title": "A Pregnancy and Postnatal RCT Among Women With Gestational Diabetes Mellitus and Overweight/Obesity: The PAIGE2 Study", "author": "Kemp, Bridie J.; Kelly, Bronagh; Cupples, Georgina; Fleck, Olwen; McAuley, Emma; Creighton, Rachel M.; Wallace, Helen; Graham, Una; Mulligan, Ciara; Kennedy, Adele; Patterson, Chris C.; McCance, David R.", "year": "2024", "journalProceedings": "Journal of the Endocrine Society", "category": "Intervention", "devices": "Device unspecified", "population": "Pregnant Women", "dataUsed": "Steps", "abstract": "PURPOSE: Resting heart rate (RHR) is a sensitive indicator of an individual's physiologic condition. However, its use in clinical practice has been limited due to the wide variation in baseline RHR based on multiple factors, including age, sex, cardiovascular fitness, and comorbidities. The study aims to develop a novel, clinically meaningful metric that is applicable across these conditions, based on day-by-day changes in RHR-the difference in autocorrelation of daily RHR (ACΔ-RHR). We present ACΔ-RHR in the context of monitoring post-discharge recovery for pediatric appendectomy patients. METHODS: Children 3-17 years old who underwent laparoscopic appendectomy for complicated appendicitis from 2019 to 2022 at a tertiary children's hospital wore a Fitbit for twenty-one postoperative days (POD). Patients without complications were included to describe normative recovery. Using RHR on POD 1-3 as the baseline, autocorrelation of daily RHR was calculated (fixed lag = 1) for POD 3-21. Then, daily ACΔ-RHR was determined by subtracting autocorrelation values between the current and previous day. Means and standard deviations were calculated for daily RHR to estimate on which POD ACΔ-RHR stabilized at 0, representing general RHR stability and recovery from surgery for all patients. Subgroup analyses were performed by age (3-10 years old vs 11-17 years old) and sex. RESULTS: Thirty-one patients were included (58.1 \\% 3-10 years old, 41.9 \\% female, 67.7 \\% Hispanic). Whereas the mean daily RHR did not demonstrate clear trends, the mean ACΔ-RHR for the cohort first reached 0 on POD 12 and stabilized on POD 14 (95 \\% confidence interval: POD [11,17]). Subgroup analysis showed that ACΔ-RHR stabilized on POD 9 for age of 3-10 years, POD 12 for age of 11-17 years, POD 12 for females and POD 10 for males. CONCLUSIONS: The ACΔ-RHR is a promising clinical metric that could enhance post-surgical patient monitoring, such as for children following laparoscopic appendectomy for complicated appendicitis.", "links": [] }, { "title": "Validity of Wrist-Worn Activity Tracker Heart Rate Detection in Fontan Patients During Exercise", "author": "Pierick, Alyson R.; Burke, Kelly J.; Prusi, Megan; Largent, Bethany; Yu, Sunkyung; Lowery, Ray E.; Duimstra, Ashley; Hansen, Jesse E.", "year": "2024", "journalProceedings": "Medicine and Science in Sports and Exercise", "category": "Validation", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Heart Rate", "abstract": "PURPOSE: Physical activity and a healthy lifestyle play an essential role in optimizing long-term health in patients with Fontan physiology. Wrist-worn activity trackers may be useful in medically directed exercise programs for patients with Fontan physiology. The objective of this study was to measure the validity of Garmin and Fitbit activity tracker heart rate detection in patients with Fontan circulation when compared to electrocardiogram (ECG) during cardiopulmonary exercise testing (CPET). METHODS: 47 Fontan patients undergoing CPET for clinical indications were included and wore activity trackers during CPET. Heart rate via the activity tracker was collected at baseline, maximal exercise, and recovery. Patient heart rates, peak VO2, and peak respiratory exchange ratio (RER) were collected using standard CPET protocols and equipment. Heart rate at each time point was compared between the activity trackers and CPET ECG. RESULTS: Median age of participants was 17.1 years, 15.1 years since Fontan completion. Mean percent of predicted peak VO2 was 56.8\\%, z-score -3.2 with 61.7\\% of participants completing a maximal CPET (RER ≥ 1.09). Baseline oxygen saturation mean was 92.9\\%, 90.0\\% at maximal exercise. Activity trackers demonstrated mean absolute percentage error {\\textless} 10\\% at most time points, comparable with other studies. Demographics, Fontan-associated comorbidities, and echocardiogram findings did not impact the accuracy. CONCLUSIONS: Consumer-oriented wrist-worn activity trackers show promising accuracy for heart rate monitoring in medically directed exercise programs for adolescents and young adults with Fontan physiology. Further validation across different exercise modalities is needed.", "links": [] }, { "title": "Association of Wearable Derived Pulse Rate Variability With Pediatric Appendectomy Complications", "author": "Pitt, J. Benjamin; Carter, Michela; Zeineddin, Suhail; Bai, Iris; Hua, Rui; Kwon, Soyang; Ghomrawi, Hassan; Abdullah, Fizan", "year": "2024", "journalProceedings": "Journal of Pediatric Surgery", "category": "Case Study", "devices": "Inspire HR,Inspire 2", "population": "Children", "dataUsed": "Heart Rate", "abstract": "INTRODUCTION: Postoperative recovery of children is difficult to gauge by parents after hospital discharge. Consumer wearable devices (CWD) generate valid and near real-time pulse rate data, integer pulse rate variability (PRVi), that can serve as digital biomarkers for the onset of complications during post-discharge recovery. This study sought to explore whether pediatric patients with surgical complications after appendectomy exhibited a CWD-derived PRVi trajectory that differs from the normative PRVi recovery trajectory. METHODS: In this retrospective analysis, children aged 3-17 undergoing appendectomy for complicated appendicitis was invited to participate. Participants wore a Fitbit device for 21 days postoperatively. PRVi was calculated as the variance, defined as the sum of the squared differences of each value from the mean, of the heart rate in beats per minute measured over 5 consecutive minutes. The mean daily PRVi was calculated for patients recovering with and without complications. RESULTS: Ninety-eight patients were enrolled in the study; 60 (61 \\%) were ages 3-11, 54 (55 \\%) were female, and 57 (58 \\%) were Caucasian. Eleven (11 \\%) developed surgical complications. Those with complications experienced a slower increase in the mean PRVi over the 21-day period. CONCLUSIONS: In this prospective observational study, it was demonstrated that PRVi derived from CWD data can be used as an objective digital biomarker to profile surgical complications. This finding provides clinicians with an additional tool for monitoring children during the postoperative period, enhancing their ability to proactively detect and address complications. LEVEL OF EVIDENCE: IV.", "links": [] }, { "title": "Accuracy of Three Commercial Wearable Devices for Sleep Tracking in Healthy Adults", "author": "Robbins, Rebecca; Weaver, Matthew D.; Sullivan, Jason P.; Quan, Stuart F.; Gilmore, Katherine; Shaw, Samantha; Benz, Abigail; Qadri, Salim; Barger, Laura K.; Czeisler, Charles A.; Duffy, Jeanne F.", "year": "2024", "journalProceedings": "Sensors (Basel, Switzerland)", "category": "Case Study", "devices": "Sense 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "Sleep tracking by consumers is becoming increasingly prevalent; yet, few studies have evaluated the accuracy of such devices. We sought to evaluate the accuracy of three devices (Oura Ring Gen3, Fitbit Sense 2, and Apple Watch Series 8) compared to the gold standard sleep assessment (polysomnography (PSG)). Thirty-five participants (aged 20-50 years) without a sleep disorder were enrolled in a single-night inpatient study, during which they wore the Oura Ring, Fitbit, and Apple Watch, and were monitored with PSG. For detecting sleep vs. wake, the sensitivity was ≥95\\% for all devices. For discriminating between sleep stages, the sensitivity ranged from 50 to 86\\%, as follows: Oura ring sensitivity 76.0-79.5\\% and precision 77.0-79.5\\%; Fitbit sensitivity 61.7-78.0\\% and precision 72.8-73.2\\%; and Apple sensitivity 50.5-86.1\\% and precision 72.7-87.8\\%. The Oura ring was not different from PSG in terms of wake, light sleep, deep sleep, or REM sleep estimation. The Fitbit overestimated light (18 min; p {\\textless} 0.001) sleep and underestimated deep (15 min; p {\\textless} 0.001) sleep. The Apple underestimated the duration of wake (7 min; p {\\textless} 0.01) and deep (43 min; p {\\textless} 0.001) sleep and overestimated light (45 min; p {\\textless} 0.001) sleep. In adults with healthy sleep, all the devices were similar to PSG in the estimation of sleep duration, with the devices also showing moderate to substantial agreement with PSG-derived sleep stages.", "links": [] }, { "title": "A pilot randomized controlled trial of a virtual peer-support exercise intervention for female older adults with cancer", "author": "Smith-Turchyn, Jenna; Sinclair, Susanne; O'Loughlin, Erin K.; Innes, Anthea; Vani, Madison F.; Beauchamp, Marla; Phillips, Stuart M.; Richardson, Julie; Thabane, Lehana; Sabiston, Catherine M.", "year": "2024", "journalProceedings": "BMC geriatrics", "category": "Intervention", "devices": "Inspire 2", "population": "Older Adults", "dataUsed": "Steps,Intensity,Active Minutes/Active Zone Minutes", "abstract": "BACKGROUND: Regular exercise can mitigate side effects of cancer treatment. However, only a small proportion of adults with cancer meet exercise guidelines, and older adults ({\\textgreater} 65 years) are underrepresented in cancer rehabilitation research. Peer support facilitates health-promoting behaviours in general populations, but interventions merging exercise and peer support for older adults with cancer are not examined. The purpose of this study was to determine the feasibility and preliminary effectiveness of a virtual partner-based peer support exercise intervention for older adult female cancer survivors. METHODS: Older adult female cancer survivors with internet access and currently participating in {\\textless} 150 min of moderate-vigorous physical activity per week were included in this study. Participants were matched with a partner and given a peer support guide, exercise guidelines, and a Fitbit Inspire©. In addition, intervention group dyads (AgeMatchPLUS) had weekly 1-h virtual sessions with a qualified exercise professional for 10 weeks. Dyads randomized to the control group (AgeMatch) independently supported their partner around exercise for 10 weeks. The primary outcome was feasibility, measured using retention and adherence rates. Secondary outcomes included exercise volume, social support, quality of life, physical function, and physical activity enjoyment. Descriptive statistics were used to report feasibility and an ANCOVA was used to explore between group differences on secondary outcomes at post-intervention (10 weeks post baseline) and post-tapering timepoints (14 weeks post baseline). RESULTS: Eighteen participants (9 dyads; mean age 72 years (SD: 5.7 years)) were included in the pilot trial. Retention and adherence rates to the AgeMatchPLUS intervention were 100\\% and 95\\% respectively. All but one participant was satisfied with the quality of their peer match. Preliminary effects were seen between group, favouring AgeMatchPLUS for exercise-related social support post-intervention (effect size (d) = 0.27, 95\\% CI = 0,0.54) and physical activity enjoyment at post-tapering (d = 0.25, 95\\% CI = 0,0.52) and favouring the AgeMatch group for 30 s sit-to-stand repetitions at post-tapering (d = 0.31, 95\\% CI = 0.004, 0.57). No other effects were found. CONCLUSIONS: A virtual partner-based exercise intervention for older adults with cancer is feasible and shows preliminary effect benefits. Findings inform future trials aimed at increasing exercise in older adults with cancer. TRIAL REGISTRATION: Clinicaltrials.gov (ID: NCT05549479, date: 22/09/22).", "links": [] }, { "title": "Evaluation of Machine Learning to Detect Influenza Using Wearable Sensor Data and Patient-Reported Symptoms: Cohort Study", "author": "Farooq, Kamran; Lim, Melody; Dennison-Hall, Lawrence; Janson, Finn; Olszewska, Aspen Hazel; Ahmad Zabidi, Muhammad Mamduh; Haratym-Rojek, Anna; Narowski, Karol; Clinch, Barry; Prunotto, Marco; Chawla, Devika; Hunter, Victoria; Ukachukwu, Vincent", "year": "2024", "journalProceedings": "Journal of Medical Internet Research", "category": "Case Study", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "BACKGROUND: Machine learning offers quantitative pattern recognition analysis of wearable device data and has the potential to detect illness onset and monitor influenza-like illness (ILI) in patients who are infected. OBJECTIVE: This study aims to evaluate the ability of machine-learning algorithms to distinguish between participants who are influenza positive and influenza negative in a cohort of symptomatic patients with ILI using wearable sensor (activity) data and self-reported symptom data during the latent and early symptomatic periods of ILI. METHODS: This prospective observational cohort study used the extreme gradient boosting (XGBoost) classifier to determine whether a participant was influenza positive or negative based on 3 models using symptom-only data, activity-only data, and combined symptom and activity data. Data were collected from the Home Testing of Respiratory Illness (HTRI) study and FluStudy2020, both conducted between December 2019 and October 2020. The model was developed using the FluStudy2020 data and tested on the HTRI data. Analyses included participants in these studies with an at-home influenza diagnostic test result. Fitbit (Google LLC) devices were used to measure participants' steps, heart rate, and sleep parameters. Participants detailed their ILI symptoms, health care-seeking behaviors, and quality of life. Model performance was assessed by area under the curve (AUC), balanced accuracy, recall (sensitivity), specificity, precision (positive predictive value), negative predictive value, and weighted harmonic mean of precision and recall (F2) score. RESULTS: An influenza diagnostic test result was available for 953 and 925 participants in HTRI and FluStudy2020, respectively, of whom 848 (89\\%) and 840 (90.8\\%) had activity data. For the training and validation sets, the highest performing model was trained on the combined symptom and activity data (training AUC=0.77; validation AUC=0.74) versus symptom-only (training AUC=0.73; validation AUC=0.72) and activity-only (training AUC=0.68; validation AUC=0.65) data. For the FluStudy2020 test set, the performance of the model trained on combined symptom and activity data was closely aligned with that of the symptom-only model (combined symptom and activity test AUC=0.74; symptom-only test AUC=0.74). These results were validated using independent HTRI data (combined symptom and activity evaluation AUC=0.75; symptom-only evaluation AUC=0.74). The top features guiding influenza detection were cough; mean resting heart rate during main sleep; fever; total minutes in bed for the combined model; and fever, cough, and sore throat for the symptom-only model. CONCLUSIONS: Machine-learning algorithms had moderate accuracy in detecting influenza, suggesting that previous findings from research-grade sensors tested in highly controlled experimental settings may not easily translate to scalable commercial-grade sensors. In the future, more advanced wearable sensors may improve their performance in the early detection and discrimination of viral respiratory infections.", "links": [] }, { "title": "Associations of seasonally available global positioning systems-derived walkability and objectively measured sleep in the Nurses' Health Study 3 Mobile Health Substudy", "author": "Hu, Cindy R.; Wilt, Grete E.; Roscoe, Charlotte; Iyer, Hari S.; Kessler, William H.; Laden, Francine; Chavarro, Jorge E.; Coull, Brent; Redline, Susan; James, Peter; Hart, Jaime E.", "year": "2024", "journalProceedings": "Environmental Epidemiology (Philadelphia, Pa.)", "category": "Intervention", "devices": "Charge HR,Charge 2,Charge 3", "population": "Adults", "dataUsed": "Sleep", "abstract": "BACKGROUND: Sleep is influenced by the environments that we experience while awake and while asleep. Neighborhood walkability has been linked with chronic disease and lifestyle factors, such as physical activity; however, evidence for the association between walkability and sleep is mixed. Extant studies assign walkability based on residential addresses, which does not account for mobility. We examined the association between walkability and sleep in the Nurses' Health Study 3 (NHS3) Mobile Health Substudy (MHS). METHODS: From 2018 to 2020, individuals in the United States-based NHS3 prospective cohort participated in the MHS, in which minute-level global positioning systems (GPS) data and objective sleep duration and efficiency measures were collected via a custom smartphone application and Fitbit, respectively, for four 7-day periods across a year to capture seasonal variability. Census tract walkability was calculated by summing z-scores of population density (2015-2019 American Community Survey), business density (2018 Infogroup), and intersection density (2018 TIGER/Line road shapefiles). We ran generalized additive mixed models with penalized splines to estimate the association between walkability and sleep, adjusting for individual-level covariates as well as GPS-based exposure to environmental and contextual factors. RESULTS: The average main sleep period duration was 7.9 hours and the mean sleep efficiency was 93\\%. For both sleep duration and sleep efficiency, we did not observe an association with daily average walkability exposure. CONCLUSION: In this study of women across the United States, we found that daily GPS-based neighborhood walkability exposure during wake time was not associated with objective wearable-derived sleep duration or sleep efficiency.", "links": [] }, { "title": "Assessment of sleep characteristics using Fitbit Charge 4 in head and neck cancer patients undergoing palliative chemotherapy and radiotherapy: a prospective observational study", "author": "Jain, Anuj; Suryavanshi, Jha; Waindeskar, Vaishali; Gupta, Manish; Kaushal, Ashutosh; Kumar, Harish", "year": "2024", "journalProceedings": "Palliative Care and Social Practice", "category": "Case Study", "devices": "Charge 4", "population": "Patients", "dataUsed": "Sleep", "abstract": "BACKGROUND: Sleep disturbance is prevalent among cancer patients. The quantification of this sleep disturbance is missing, especially in palliative care settings. AIM: The aim of this study was to study the sleep patterns of the patients undergoing palliative chemotherapy and radiotherapy for head and neck cancer (HNC) using a Fitbit Charge 4 sleep-tracking device. DESIGN: Prospective observational study. SETTING: A total of 110 HNC patients undergoing palliative chemotherapy and radiotherapy at a tertiary care teaching hospital in Central India. RESULTS: Forty-four percent of patients had a poor sleep score (less than 60). Average sleep duration was 218.66 ± 139.05 min; non-rapid eye movement (NREM) sleep duration 197.7 ± 115.91 (light NREM 171.36 ± 104 and deep NREM 23.36 ± 16.73); REM sleep duration was 30.44 ± 34.14 min. The Pittsburgh Sleep Quality Index was 10.23 ± 3.45, which indicated sleep deprivation over the past 1 month. Moderate levels of anxiety, depression, confusion, and distress existed in the cohort. Statistically significant but weak correlation existed between sleep score, anxiety, and depression. Strong correlation existed between distress score and sleep score. Confusion score did not have a significant correlation with sleep score. CONCLUSION: HNC patients in palliative care settings were chronically sleep deprived. Sleep architecture was also disturbed. Moderate levels of anxiety, depression, confusion, and distress existed in the studied cohort; these psychosocial disturbances had a weak correlation with the sleep score and are likely to be multifactorial. TRIAL REGISTRATION: Institutional Ethics Committee number: IHEC-LOP/2020/IM0349. The study has been registered with clinical trial registry of India with registration number CTRI/2021/03/032400 (http://www.ctri.in).", "links": [] }, { "title": "Accuracy of smartwatches for the remote assessment of exercise capacity", "author": "Jamieson, Alexandra; Jones, Siana; Chaturvedi, Nishi; Hughes, Alun D.; Orini, Michele", "year": "2024", "journalProceedings": "Scientific Reports", "category": "Usability", "devices": "Sense,Garmin Vivoactive 4", "population": "Adults", "dataUsed": "Steps,Distance,Heart Rate", "abstract": "Exercise capacity is a strong independent predictor of cardiovascular and all-cause mortality. The utilization of well-established submaximal tests of exercise capacity such as the 6-min walk test (6MWT), 3-min step test (3MST) and 10-chair rise test (10CRT) in the community would improve patient care but requires remote monitoring technology. Consumer grade smartwatches provide such an opportunity, however, their accuracy in measuring physiological responses to these tests is unclear. The aim of this study was to determine the accuracy of consumer grade smartwatches in assessing exercise capacity to develop a framework for remote, unsupervised testing. 16 healthy adults (7 male (44\\%), age median 27 [interquartile range (IQR) 26,29] years) performed 6MWTs using two protocols: (1) standard-straight 30 m laps (6MWT-standard) and 2) continuous lap-circular 240 m laps around a park (6MWT-continuous lap), 3MSTs and 10CRTs. Each one of these four tests was performed three times across two clinic visits. Each participant was fitted with a Garmin Vivoactive4 and Fitbit Sense smartwatch to measure three parameters: distance, step counts and heart rate (HR) response. Reference measures were a meter-wheel, hand tally counter and ECG, respectively. Mean HR was measured at rest, peak exercise and recovery. Agreement was measured using Bland-Altman analysis for repeated measures and summarized as median absolute percentage errors (MAPE). Distance during 6MWT-continuous lap had better agreement than during 6MWT-standard for both Garmin (MAPE: 6.4\\% [3.0, 10.4\\%] versus 20.1\\% [13.9, 28.4\\%], p {\\textless} 0.001) and Fitbit (8.0\\% [2.9, 10.1\\% versus 18.8\\% [15.2, 28.1\\%], p {\\textless} 0.001). Garmin measured step count more accurately than Fitbit (MAPE: 1.8\\% [0.9, 2.9\\%] versus 8.0\\% [2.6, 12.3\\%], p {\\textless} 0.001). Irrespective of test, both devices showed excellent accuracy in measuring HR at rest and recovery (≤ 3\\%), while accuracy decreased during peak exercise (Fitbit: {\\textasciitilde} 12\\% and Garmin: {\\textasciitilde} 7\\%). In young adults without mobility difficulties, exercise capacity can be measured remotely using standardized tests and consumer grade smartwatches.", "links": [] }, { "title": "The Utility and Limitations of Remotely Delivered Feedback Messages Regarding Physical Activity in a 12-Month Weight Loss Intervention: Insights From the SMARTER Trial Focus Groups", "author": "Kariuki, Jacob Kigo; Burke, Lora E.; Zickmund, Susan; Beatrice, Britney; Kimball, Elisabeth R.; Galyean, Patrick; Cheng, Jessica; Sereika, Susan M.; Bizhanova, Zhadyra; Cedillo, Maribel; Wells, Jessica; Conroy, Molly B.", "year": "2024", "journalProceedings": "The Journal of Cardiovascular Nursing", "category": "Intervention", "devices": "Charge 2,Aria 2", "population": "Adults", "dataUsed": "Steps,Weight,User Friendliness", "abstract": "BACKGROUND: The increasing prevalence of obesity necessitates innovative interventions to address this grave public health concern. Standard behavioral therapy has been the mainstay for promoting weight loss, but its access and uptake are limited. The SMARTER randomized controlled trial aimed to explore the effects of self-monitoring with real-time, remotely delivered tailored feedback to recorded physical activity (PA) on weight loss. OBJECTIVE: This qualitative study examined the perceived utility and limitations of key intervention components in promoting PA and weight loss in the SMARTER trial. METHODS: Twenty-three participants who received feedback engaged in Zoom-based focus groups, providing insights into their interactions with the SMARTER app, Fitbit Charge 2 tracker, Aria II scale, and daily weighing. Participants' perspectives on feedback messages, personalized app experiences, and the impact of daily weighing on mental health emerged, providing nuanced insights into the multifaceted nature of success. RESULTS: Themes from the focus group emphasized the importance of tailoring feedback to individual preferences related to message timing, content, and engagement. The challenges that made the participants stop using the program as instructed included disappointment with not losing weight after several weeks of engagement, inability to open feedback messages within the 60-minute window, and environmental situations that prevented them from acting on the feedback received. CONCLUSION: These findings contribute to ongoing efforts geared toward refining interventions targeting PA and weight loss among individuals with obesity and provide important insights for future studies seeking to optimize the design and delivery of remotely delivered feedback messages.", "links": [] }, { "title": "Digital phenotyping in bipolar disorder: Using longitudinal Fitbit data and personalized machine learning to predict mood symptomatology", "author": "Lipschitz, Jessica M.; Lin, Sidian; Saghafian, Soroush; Pike, Chelsea K.; Burdick, Katherine E.", "year": "2024", "journalProceedings": "Acta Psychiatrica Scandinavica", "category": "Case Study", "devices": "Inspire", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "BACKGROUND: Effective treatment of bipolar disorder (BD) requires prompt response to mood episodes. Preliminary studies suggest that predictions based on passive sensor data from personal digital devices can accurately detect mood episodes (e.g., between routine care appointments), but studies to date do not use methods designed for broad application. This study evaluated whether a novel, personalized machine learning approach, trained entirely on passive Fitbit data, with limited data filtering could accurately detect mood symptomatology in BD patients. METHODS: We analyzed data from 54 adults with BD, who wore Fitbits and completed bi-weekly self-report measures for 9 months. We applied machine learning (ML) models to Fitbit data aggregated over two-week observation windows to detect occurrences of depressive and (hypo)manic symptomatology, which were defined as two-week windows with scores above established clinical cutoffs for the Patient Health Questionnaire-8 (PHQ-8) and Altman Self-Rating Mania Scale (ASRM) respectively. RESULTS: As hypothesized, among several ML algorithms, Binary Mixed Model (BiMM) forest achieved the highest area under the receiver operating curve (ROC-AUC) in the validation process. In the testing set, the ROC-AUC was 86.0\\% for depression and 85.2\\% for (hypo)mania. Using optimized thresholds calculated with Youden's J statistic, predictive accuracy was 80.1\\% for depression (sensitivity of 71.2\\% and specificity of 85.6\\%) and 89.1\\% for (hypo)mania (sensitivity of 80.0\\% and specificity of 90.1\\%). CONCLUSION: We achieved sound performance in detecting mood symptomatology in BD patients using methods designed for broad application. Findings expand upon evidence that Fitbit data can produce accurate mood symptomatology predictions. Additionally, to the best of our knowledge, this represents the first application of BiMM forest for mood symptomatology prediction. Overall, results move the field a step toward personalized algorithms suitable for the full population of patients, rather than only those with high compliance, access to specialized devices, or willingness to share invasive data.", "links": [] }, { "title": "Randomized controlled trial of a multiple technology-based physical activity intervention for Latina adolescents: Recruitment strategies and baseline data from the Chicas Fuertes trial", "author": "Naqvi, Jeanean B.; Olesen, Brittany; Greenstadt, Emily; Carson, Jacob; Marcus, Bess; Godino, Job; Zive, Michelle; Meyer, Dawn; Higgins, Michael; Osuna, Lilliana; Gomez, Rubi; Dunsiger, Shira; Larsen, Britta", "year": "2024", "journalProceedings": "Contemporary Clinical Trials", "category": "Intervention", "devices": "Inspire HR", "population": "Adolescents", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND: Latina adolescents report low levels of physical activity (PA) and high lifetime risk of lifestyle-related diseases. They also have high rates of using technology, suggesting interventions delivered through mobile devices may be effective for this population. The current paper describes recruitment methods and baseline study characteristics for Chicas Fuertes, a fully powered randomized trial of a mobile technology PA intervention. METHODS: Underactive Latina adolescents (aged 13-18) were recruited using social media and presentations at local schools and community organizations in San Diego, California. Participants were randomly assigned 1:1 to either the intervention (Fitbit, tailored texting, social media, and website) or control group. Baseline measures included demographics, psychosocial variables, and PA measured by the 7-Day Physical Activity Recall (PAR), ActiGraph GT3X+ accelerometers, and Fitbits. Baseline data were collected from 2020 to 2023. RESULTS: Social media yielded the most contacts (465), but had the lowest chance of enrollment (14 \\%, vs. 52 \\% from school presentations). Participants (N = 160) were mostly second generation (68.8 \\%), and low income (61.8 \\%), but technology access was high ({\\textgreater}99 \\%). Median self-reported moderate-to-vigorous PA (MVPA) using the 7-Day PAR was 120 min/week (range 0-720), and median daily steps were 5222 (IQR 359). Median MVPA measured by ActiGraphs, however, was 0 min per week. There was no correlation between the 7-day PAR and ActiGraphs (ρ=.13,p=.12). However, ActiGraph MVPA was correlated with total steps recorded by the Fitbit (ρ=.38,p{\\textless}.001). CONCLUSIONS: Both remote and in-person approaches were successful in recruiting a sample that was underactive and low income, but had high technology use.", "links": [] }, { "title": "Biometrically measured sleep in medical students as a predictor of psychological health and academic experiences in the preclinical years", "author": "Oberleitner, Lindsay M.; Baxa, Dwayne M.; Pickett, Scott M.; Sawarynski, Kara E.", "year": "2024", "journalProceedings": "Medical Education Online", "category": "Survey Research", "devices": "Charge HR", "population": "Adults", "dataUsed": "Sleep", "abstract": "BACKGROUND: Student wellness is of increasing concern in medical education. Increased rates of burnout, sleep disturbances, and psychological concerns in medical students are well documented. These concerns lead to impacts on current educational goals and may set students on a path for long-term health consequences. METHODS: Undergraduate medical students were recruited to participate in a novel longitudinal wellness tracking project. This project utilized validated wellness surveys to assess emotional health, sleep health, and burnout at multiple timepoints. Biometric information was collected from participant Fitbit devices that tracked longitudinal sleep patterns. RESULTS: Eighty-one students from three cohorts were assessed during the first semester of their M1 preclinical curriculum. Biometric data showed that nearly 30\\% of the students had frequent short sleep episodes ({\\textless}6 hours of sleep for at least 30\\% of recorded days), and nearly 68\\% of students had at least one episode of three or more consecutive days of short sleep. Students that had consecutive short sleep episodes had higher rates of stress (8.3\\%) and depression (5.4\\%) symptoms and decreased academic efficiency (1.72\\%). CONCLUSIONS: Biometric data were shown to significantly predict psychological health and academic experiences in medical students. Biometrically assessed sleep is poor in medical students, and consecutive days of short sleep duration are particularly impactful as it relates to other measures of wellness. Longitudinal, biometric data tracking is feasible and can provide students the ability to self-monitor health behaviors and allow for low-intensity health interventions.", "links": [] }, { "title": "Physical activity patterns of children and adolescents with Down syndrome: Using the Fitbit and parental proxy questionnaire", "author": "Yang, Seung Hyeon; Kim, Hwa In; Van Riper, Marcia; Choi, Eun Kyoung", "year": "2024", "journalProceedings": "Journal of Pediatric Nursing", "category": "Case Study", "devices": "Charge 5", "population": "Children,Adolescents", "dataUsed": "Steps,Energy Expenditure,Intensity", "abstract": "PURPOSE: The purpose of this study was to assess physical activity (PA) levels in children and adolescents with Down syndrome (DS) using a commercially available activity tracker (Fitbit) and a parental proxy questionnaire. DESIGN AND METHODS: This cross-sectional study included two groups of individuals with DS (school-age children and adolescents) and one parent per child/adolescent. The school-age children and adolescents with DS wore the Fitbit for seven consecutive days. Parents completed the parental proxy questionnaire on the seventh day. Weekday and weekend PA levels for the two groups of individuals with DS were compared. In addition, PA levels obtained with the Fitbit were compared to parental responses. RESULTS: Complete data sets were available for 32 child-parent dyads. Sedentary time was higher for the adolescent group (p = .022), while light PA time was lower (p = .020). All measured PA patterns, excluding sedentary behavior, decreased on weekends in both groups: steps (p = .002), light PA time (p = .028), and moderate-to-vigorous PA time (p = .004). Parental proxy questionnaires underestimated actual PA levels. CONCLUSIONS: PA was lower in the adolescent group and during the weekend for both groups. PRACTICE IMPLICATIONS: Findings from this study suggest a need for tailored programs designed to increase weekend PA levels in school-age children and adolescents with DS in pediatric nursing research. The use of commercial activity trackers, such as the Fitbit, which are user-friendly and relatively affordable, is effective for pediatric nurses to monitor PA levels of children and adolescents with DS in clinical settings.", "links": [] }, { "title": "Prospective associations between Sleep, Sensation-Seeking and Mature Screen Usage in Early Adolescents: Findings from the Adolescent Brain Cognitive Development (ABCD) Study", "author": "Zhang, Linhao; Oshri, Assaf; Carvalho, Cory; Uddin, Lucina Q.; Geier, Charles; Nagata, Jason M.; Cummins, Kevin; Hoffman, Elizabeth A.; Tomko, Rachel L.; Chaarani, Bader; Squeglia, Lindsay M.; Wing, David; Mason, Michael J.; Fuemmeler, Bernard; Lisdahl, Krista; Tapert, Susan F.; Baker, Fiona C.; Kiss, Orsolya", "year": "2024", "journalProceedings": "Sleep", "category": "Case Study", "devices": "Charge HR", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "STUDY OBJECTIVES: Early exposure to mature content is linked to high-risk behaviors. This study aims to prospectively investigate how sleep and sensation-seeking behaviors influence the consumption of mature video games and R-rated movies in early adolescents. A secondary analysis examines the bidirectional relationships between sleep patterns and mature screen usage. METHODS: Data were obtained from a subsample of 3,687 early adolescents (49.2\\% female; mean age: 11.96 years) participating in the Adolescent Brain and Cognitive Development study. At Year 2 follow-up, participants wore Fitbit wearables for up to 21 nights to assess objective sleep measures and completed a scale about sensation-seeking traits. At Year 3 follow-up, they answered questions about mature screen usage. RESULTS: Of the sample, 41.8\\% of the sample reported playing mature-rated video games and 49\\% reported watching R-rated movies. Sensation-seeking traits were associated with R-rated movie watching one year later. Shorter sleep duration, later bedtime, more bedtime variability, and more social jetlag (discrepancy between the mid-sleep on weekdays and weekends) were associated with mature-rated video gaming and R-rated movie watching one year later. Sleep duration variability was associated with mature-rated video gaming. There was also an interaction effect: those with higher sensation-seeking scores and shorter sleep duration reported more frequent R-rated movie usage than those with longer sleep duration. Secondary analyses showed bidirectional associations between later bedtimes, more variability in bedtimes, and more social jetlag with mature screen usage. CONCLUSION: Early adolescents with sensation-seeking traits and poorer sleep health were more likely to engage in mature screen usage.", "links": [] }, { "title": "A Novel Scale of Lifestyle Physical Activity: Measure Description and Intervention Responsiveness", "author": "Browne, Julia; Halverson, Tate F.; Battle, Cynthia L.; Stein, Michael D.; Bergeron, Alicia; Abrantes, Ana M.", "year": "2024", "journalProceedings": "American Journal of Lifestyle Medicine", "category": "Intervention", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps", "abstract": "Lifestyle physical activity (LPA) interventions emphasize small bouts of movement that can be flexibly integrated into one's everyday routine. Despite research illustrating benefits for LPA on health outcomes, few LPA interventions and measurement tools have been developed and tested. The purpose of this study was to present a novel LPA self-report scale, including its content, scoring, and internal consistency reliability, and summarize its intervention responsiveness. The LPA scale was administered in a pilot randomized controlled trial that tested a 12-week LPA + Fitbit intervention against a health education (HE) control (matched to LPA + Fitbit on contact time) in a sample of 50 women with depression in alcohol treatment. The LPA scale includes 22 items covering five domains relevant to LPA. Results demonstrated good internal consistency reliability for the total score (ω = 0.84) but poor-to-acceptable internal consistency reliability for the domain scores (ω range: 0.43-0.80). Participants randomized to the LPA + Fitbit intervention had significantly greater improvements in the LPA total score and two domain scores compared to HE participants. Overall, results demonstrate good internal consistency reliability and intervention responsiveness of the LPA scale total score. A larger, more comprehensive psychometric evaluation is needed for validation of this scale.", "links": [] }, { "title": "Preoperative determinants of normative postoperative recovery rate following minimally invasive repair of pectus excavatum", "author": "Carter, Michela; Chen, Austin R.; Pitt, J. Benjamin; Hua, Rui; Edobor, Arianna; Kwon, Soyang; Goldstein, Seth D.; Ghomrawi, Hassan M. K.; Abdullah, Fizan", "year": "2024", "journalProceedings": "Pediatric Surgery International", "category": "Case Study", "devices": "Inspire 2", "population": "Patients,Children", "dataUsed": "Steps,Heart Rate,Device Weartime", "abstract": "PURPOSE: Recovery after minimally invasive repair of pectus excavatum (MIRPE) is prolonged. The purpose of this prospective study was to enhance our understanding of post-MIRPE recovery by following patients' recovery through postoperative day (POD) 60 using wearable devices and determine if recovery rate is impacted by PE severity and preoperative physical activity (PA) level. METHODS: Children ≤ 18 years who underwent MIRPE with cryoablation between 8/2023 and 1/2024 wore a Fitbit™ for ≥ 3 days preoperatively to determine preoperative PA and through POD 60. The recovery trajectory, defined by postoperative daily step count divided by mean preoperative daily step count, was fit by power function through POD 60 among patients with uncomplicated recovery. Subgroup analyses were performed to compare recovery by PE severity and preoperative PA level. RESULTS: Sixteen patients met criteria (68.8\\% male, mean [SD] age 15.4 [1.6] years). Recovery trajectory analysis demonstrated recovery on POD 60 was 84.8\\% (95CI 79.0-90.6\\%). On subgroup analysis, patients with Correction Index {\\textgreater} 40\\% and preoperative mean steps/day ≥ 10,000 had faster recovery. CONCLUSIONS: Patients undergoing MIRPE with cryotherapy who are more active preoperatively or have higher Correction Indices were found to have accelerated recovery trajectories. These results may provide insight for preoperative counselling and interventions to optimize post-MIRPE recovery.", "links": [] }, { "title": "The Comprehensive Resilience-building psychosocial Intervention (CREST) for people with dementia in the community: a feasibility and acceptability study", "author": "Casey, Dympna; Doyle, Priscilla; Gallagher, Niamh; O'Sullivan, Grace; Smyth, Siobhán; Devane, Declan; Murphy, Kathy; Clarke, Charlotte; Woods, Bob; Dröes, Rose-Marie; Windle, Gill; Murphy, Andrew W.; Foley, Tony; Timmons, Fergus; Gillespie, Paddy; Hobbins, Anna; Newell, John; Abedin, Jaynal; Domegan, Christine; Irving, Kate; Whelan, Barbara", "year": "2024", "journalProceedings": "Pilot and Feasibility Studies", "category": "Intervention", "devices": "Device unspecified", "population": "Older Adults", "dataUsed": "User Friendliness", "abstract": "BACKGROUND: A dementia diagnosis can lead to a decline in cognitive, social, and physical health, but people with dementia can live meaningful lives and participate actively in society with psychosocial support. This single-arm, non-randomised feasibility study explored the feasibility and acceptability of a Comprehensive REsilience-building psychoSocial intervenTion (CREST) for people with dementia, their caregivers, General Practitioners (GPs), and the public. METHODS: Nine people with dementia and their primary caregivers living in the community (n = 9 dyads) completed the CREST intervention which had three components (cognitive stimulation therapy [CST], physical exercise, and dementia education). Quantitative secondary outcomes were assessed at baseline and following the 15-week intervention; qualitative interviews were conducted during and post-intervention. All study components were assessed against pre-defined criteria, to determine the feasibility of conducting a future definitive trial. RESULTS: Recruitment of people with dementia and their caregiver was a significant challenge and led to considerable delays to the onset and conduct of the intervention. Only 13\\% of eligible GP practices agreed to assist in recruitment and achieved a 6\\% enrolment rate; a community-based recruitment strategy proved more effective, yielding a 29\\% enrolment rate. However, once recruited, participants maintained high attendance and adherence to the content of each component with average adherence rates of 98\\% for CST, exercise sessions and caregiver education. Adherence to secondary exercise measures was lower, with home exercise diary completion at 37\\% and Fitbit wear adherence at 80\\% during the day and 67\\% at night. The people with dementia felt their concentration and fitness had improved over the 15-week intervention and particularly enjoyed the social aspects (e.g. group classes, exercising with partners from the community). Caregivers felt they had better knowledge and understanding following their education component and reported that the social aspects (interacting and sharing experiences with each other) were important. Overall, participants reported that the three components of the intervention were feasible and acceptable. In addition, the quantitative measures and health economic tools employed were feasible. However, the secondary elements of the exercise component (recording home exercise diaries and Fitbit use) were not considered feasible. Overall, pre-defined criteria for progression to a definitive intervention were fulfilled in terms of acceptability, retention and fidelity but not recruitment. CONCLUSION: While overall, the CREST intervention was feasible and acceptable to participants, significant difficulties with recruitment of people with dementia and their caregiver through GP practices impacted the viability of delivering the intervention. Recruitment through community-based groups proved a more feasible option and further work is needed to overcome barriers to recruiting this cohort before a larger-scale trial can be conducted. TRIAL REGISTRATION: ISRCTN25294519.", "links": [] }, { "title": "Impact of Environmental Noise and Sleep Health on Pediatric Hypertension Incidence: ABCD Study", "author": "De Moraes, Augusto César F.; Ma, Martin Y.; Nascimento-Ferreira, Marcus V.; Hunt, Ethan H.; Hoelscher, Deanna M.", "year": "2024", "journalProceedings": "Journal of the American Heart Association", "category": "Case Study", "devices": "Charge HR 2", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "BACKGROUND: Pediatric hypertension is linked to environmental factors like neighborhood noise disrupting sleep, which is crucial for health. The specific interaction between noise and sleep health in causing hypertension still needs to be explored. METHODS AND RESULTS: We analyzed data from 3320 participants of the ABCD (Adolescent Brain Cognitive Development) study, recruited across 21 US cities and monitored from 2018 to 2020 through 2020 to 2022. Participants with complete data on Fitbit-tracked sleep, blood pressure, height, neighborhood noise, and covariates (biological sex, race and ethnicity, pubertal stage, waist circumference) were included. Hypertension was defined as average blood pressure ≥95th percentile for age, sex, and height. Sleep health was categorized on the basis of daily duration: healthy (9-12 hours), moderately healthy (±1 hour from optimal), and low (≥1 hour deviation). Noise exposure was measured as median nighttime anthropogenic noise levels by zip code. The incidence of hypertension increased from 1.7\\% (95\\% CI, 1.4-2.1) in 2018 to 2020 to 2.9\\% (95\\% CI, 2.4-3.6) in 2020 to 2022. Adolescents with healthier sleep had a lower risk of developing hypertension (relative risk, 0.63 [95\\% CI, 0.25-0.82]), while no significant effects were found for neighborhood noise alone or in combination with sleep health. CONCLUSIONS: Adequate sleep significantly reduces the risk of hypertension in adolescents, independent of environmental noise exposure. These findings underscore the importance of promoting good sleep hygiene among youth to mitigate hypertension risk.", "links": [] }, { "title": "Integrating genome-wide information and wearable device data to explore the link of anxiety and antidepressants with pulse rate variability", "author": "Friligkou, Eleni; Koller, Dora; Pathak, Gita A.; Miller, Edward J.; Lampert, Rachel; Stein, Murray B.; Polimanti, Renato", "year": "2024", "journalProceedings": "Molecular Psychiatry", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "This study explores the genetic and epidemiologic correlates of long-term photoplethysmography-derived pulse rate variability (PRV) measurements with anxiety disorders. Individuals with whole-genome sequencing, Fitbit, and electronic health record data (N = 920; 61,333 data points) were selected from the All of Us Research Program. Anxiety polygenic risk scores (PRS) were derived with PRS-CS after meta-analyzing anxiety genome-wide association studies from three major cohorts- UK Biobank, FinnGen, and the Million Veterans Program (NTotal =364,550). PRV was estimated as the standard deviation of average five-minute pulse wave intervals over full 24-hour pulse rate measurements (SDANN). Antidepressant exposure was defined as an active antidepressant prescription at the time of the PRV measurement in the EHR. Anxiety PRS and antidepressant use were tested for association with daily SDANN. The potential causal effect of anxiety on PRV was assessed with one-sample Mendelian randomization (MR). Anxiety PRS was independently associated with reduced SDANN (beta = -0.08; p = 0.003). Of the eight antidepressant medications and four classes tested, venlafaxine (beta = -0.12, p = 0.002) and bupropion (beta = -0.071, p = 0.01), tricyclic antidepressants (beta = -0.177, p = 0.0008), selective serotonin reuptake inhibitors (beta = -0.069; p = 0.0008) and serotonin and norepinephrine reuptake inhibitors (beta = -0.16; p = 2×10-6) were associated with decreased SDANN. One-sample MR indicated an inverse effect of anxiety on SDANN (beta = -2.22, p = 0.03). Anxiety and antidepressants are independently associated with decreased PRV, and anxiety appears to exert a causal effect on reduced PRV. Those observational findings provide insights into the impact of anxiety on PRV.", "links": [] }, { "title": "Increased Steps in Japanese Older Adults Associated with Improved Winter Sleep Quality", "author": "Harai, Nozomi; Okuma, Hideyuki; Tsuchiya, Kyoichiro; Matsuoka, Satoshi; Kashiwagi, Kenji", "year": "2024", "journalProceedings": "Gerontology \\& Geriatric Medicine", "category": "Case Study", "devices": "Charge 5", "population": "Older Adults", "dataUsed": "Sleep", "abstract": "Objective: We aimed to assess seasonal and age-related variations in sleep quality using Fitbit data and offer lifestyle recommendations for enhancing winter sleep quality. Methods: Fitbit sleep and activity data of 51 participants randomly recruited from members of the Association for Research in Supporting System of Chronic Disease, a nonprofit organization in the Yamanashi Prefecture of Japan, were collected and retrospectively analyzed from July to December 2022. Sleep stage targets were set at 10\\% to 25\\% for deep sleep, 50\\% to 60\\% for shallow sleep, and 20\\% to 25\\% for REM sleep. Participants were categorized into improved, unchanged, and worsened groups based on sleep stage unit changes between August and December. Results: The median (interquartile range) age was 71 (68-74) years old. There were eight participants in the improved group, 23 in the unchanged group, and nine in the worsened group. The improved group showed significantly more steps (990 ± 1,102 steps/day, p = .039) in December than in August, while the worsened group showed fewer steps (-507 ± 1,638 steps/day, p = .38). Conclusion: Increasing step count in winter may improve sleep quality, as assessed by sleep stage. Further research considering potential confounders and factors affecting winter sleep is needed to support and extend these findings.", "links": [] }, { "title": "Validity of a Consumer-Based Wearable to Measure Clinical Parameters in Patients With Chronic Obstructive Pulmonary Disease and Healthy Controls: Observational Study", "author": "Hermans, Fien; Arents, Eva; Blondeel, Astrid; Janssens, Wim; Cardinaels, Nina; Calders, Patrick; Troosters, Thierry; Derom, Eric; Demeyer, Heleen", "year": "2024", "journalProceedings": "JMIR mHealth and uHealth", "category": "Validation", "devices": "Charge 4", "population": "Patients", "dataUsed": "Steps,Heart Rate", "abstract": "BACKGROUND: Consumer-based wearables are becoming more popular and provide opportunities to track individual's clinical parameters remotely. However, literature about their criterion and known-groups validity is scarce. OBJECTIVE: This study aimed to assess the validity of the Fitbit Charge 4, a wrist-worn consumer-based wearable, to measure clinical parameters (ie, daily step count, resting heart rate [RHR], heart rate variability [HRV], respiratory rate [RR], and oxygen saturation) in patients with chronic obstructive pulmonary disease (COPD) and healthy controls in free-living conditions in Belgium by comparing it with medical-grade devices. METHODS: Participants wore the Fitbit Charge 4 along with three medical-grade devices: (1) Dynaport MoveMonitor for 7 days, retrieving daily step count; (2) Polar H10 for 5 days, retrieving RHR, HRV, and RR; and (3) Nonin WristOX2 3150 for 4 nights, retrieving oxygen saturation. Criterion validity was assessed by investigating the agreement between day-by-day measures of the Fitbit Charge 4 and the corresponding reference devices. Known-groups validity was assessed by comparing patients with COPD and healthy controls. RESULTS: Data of 30 patients with COPD and 25 age- and gender-matched healthy controls resulted in good agreement between the Fitbit Charge 4 and the corresponding reference device for measuring daily step count (intraclass correlation coefficient [ICC2,1]=0.79 and ICC2,1=0.85, respectively), RHR (ICC2,1=0.80 and ICC2,1=0.79, respectively), and RR (ICC2,1=0.84 and ICC2,1=0.77, respectively). The agreement for HRV was moderate (healthy controls: ICC2,1=0.69) to strong (COPD: ICC2,1=0.87). The agreement in measuring oxygen saturation in patients with COPD was poor (ICC2,1=0.32). The Fitbit device overestimated the daily step count and underestimated HRV in both groups. While RHR and RR were overestimated in healthy controls, no difference was observed in patients with COPD. Oxygen saturation was overestimated in patients with COPD. The Fitbit Charge 4 detected significant differences in daily step count, RHR, and RR between patients with COPD and healthy controls, similar to those identified by the reference devices, supporting known-groups validity. CONCLUSIONS: Although the Fitbit Charge 4 shows mainly moderate to good agreement, measures of clinical parameters deviated from the reference devices, indicating that monitoring patients remotely and interpreting parameters requires caution. Differences in clinical parameters between patients with COPD and healthy controls that were measured by the reference devices were all detected by the Fitbit Charge 4.", "links": [] }, { "title": "Accuracy of wrist-worn activity trackers for measuring steps in patients after major abdominal surgery: A validation study", "author": "Li, Zhi; Feng, Weiyan; Zhou, Lili; Gong, Shu", "year": "2024", "journalProceedings": "Digital Health", "category": "Validation", "devices": "Inspire HR", "population": "Patients", "dataUsed": "Steps", "abstract": "BACKGROUND: Wearable activity trackers provide a simple and objective measurement of postoperative mobilization. However, few have validated the accuracy of trackers in patients after major abdominal surgery. OBJECTIVE: To examine the accuracy of wrist-worn activity trackers to measure steps of patients in early mobilization after major abdominal surgery, and to explore the influence of clinical variables and gait parameters on the accuracy of trackers. METHODS: Forty-five patients after major abdominal surgery were recruited to participate in modified six-minute walk tests wearing three trackers simultaneously, the Fitbit Inspire HR, Xiaomi MI 4, and HONOR 5. The differences in displayed steps before and after the walking test were considered as the step counts measured by the trackers; the actual steps taken were determined as the average of the values manually counted by two researchers. The intraclass correlation coefficient, Bland-Altman method, mean percentage error, and mean absolute percentage error were used to assess the accuracy of trackers with reference to manual step counts. RESULTS: The three trackers undercounted postoperative steps by -65.5\\% to -23.5\\%. Analysis showed low-to-good agreement between step counts recorded by trackers and actual steps (ICC = 0.35-0.75); the mean absolute percentage errors ranged from 24.5\\% to 65.7\\%. For all trackers, mean absolute percentage errors correlated negatively with postoperative days (r = -0.626 to -0.744), walking speed (r = -0.714 to -0.854), step length (r = -0.466 to -0.615), and cadence (r = -0.681 to -0.790), while there were positive correlations between mean absolute percentage errors and the number of abdominal drains (r = 0.450-0.514). CONCLUSIONS: The specific activity trackers used in this study might not be reliable tools for measuring steps counts during the walking test in the early postoperative period for patients undergoing major abdominal surgery.", "links": [] }, { "title": "Real-time biopsychosocial antecedents and correlates of functional neurological symptoms in daily life: A pilot remote monitoring technology study", "author": "Pick, Susannah; Millman, L. S. Merritt; Davies, Jessica; Hodsoll, John; Stanton, Biba; David, Anthony S.; Edwards, Mark J.; Goldstein, Laura H.; Mehta, Mitul A.; Nicholson, Timothy R.; Reinders, A. a. T. S.; Winston, Joel S.; Chalder, Trudie; Hotopf, Matthew", "year": "2024", "journalProceedings": "Psychiatry Research", "category": "Case Study", "devices": "Charge 5", "population": "Adults", "dataUsed": "Sleep,Heart Rate,Device Weartime", "abstract": "Functional neurological symptom disorder (FNSD) is a neuropsychiatric diagnosis referring to symptoms resembling those of neurological disorders, occurring without causal neuropathology. FNSD has a complex biopsychosocial aetiology but its mechanisms are poorly understood. Remote monitoring technologies (RMT) could provide critical insights into functional neurological symptoms (FNS) in real-world contexts. We examined the feasibility and acceptability of a novel RMT protocol, to identify psychobiological correlates and antecedents of FNS in everyday life. Seventeen individuals with FNS (seizures/motor) and 17 healthy controls (HC) completed ecological momentary assessments (EMA) eight times daily for 1-week, reporting FNS severity, associated physical and psychological symptoms, and subjectively significant events. Sleep quality was reported daily. Physiological variables were measured using wearable Fitbit 5 devices. Multilevel modelling examined variables associated with FNS variability. Average EMA completion rates were good in both groups (≥80\\%). At week-level, the FNS group reported significantly greater subjective arousal, pain, fatigue, dissociation, negative affect, daily events, stressful events, and sleep duration, compared to HC. Objective sleep disturbance and duration, and resting heartrate, were also significantly greater in the FNS sample. FNS severity correlated significantly with daily events, affect, subjective arousal, pain, fatigue and sleep disturbance, at day- or within-day levels. Daily events and negative affect were the most prominent time-lagged predictors of within-day moment-to-moment FNS severity. RMTs are feasible and acceptable tools for investigation of FNS in real-world settings, revealing daily events and negative affect as possible triggers of FNS. Interventions targeting affective reactivity and regulation might be beneficial in this group. Larger-scale, longer-term RMT studies are needed in this population.", "links": [] }, { "title": "Pilot evaluation on an adapted tele-behavioral activation to increase physical activity in persons with depression: a single-arm pilot study", "author": "Rethorst, Chad D.; Trombello, Joseph M.; Chen, Patricia M.; Carmody, Thomas J.; Goodman, Lynnel C.; Lazalde, Alejandra; Trivedi, Madhukar H.", "year": "2024", "journalProceedings": "BMC psychology", "category": "Intervention", "devices": "Inspire HR", "population": "Adults", "dataUsed": "Steps,Intensity,Active Minutes/Active Zone Minutes", "abstract": "BACKGROUND: Physical activity has the potential to improve physical and mental health outcomes of persons with depression. However, feasible and acceptable strategies to integrate physical activity interventions into real-world settings are needed. OBJECTIVE: To assess the feasibility and acceptability of a manualized Behavioral Activation intervention aimed to increase physical activity in persons with depression (defined as a PHQ-9 score ≥ 10). METHODS: A single-arm pilot study was conducted. The intervention consisted of 8 tele-therapy sessions delivered over a 10-week period. Measures of feasibility included screening, enrollment, intervention adherence, outcome data availability, and intervention fidelity. Acceptability was assessed with a post-intervention survey and qualitatively through focus groups and interviews. Preliminary efficacy of the intervention was assessed by evaluating pre-to-post changes in physical activity and depressive symptoms. RESULTS: All feasibility metrics exceeded predetermined feasibility goal metrics with the exception of Fitbit wear and screening rate, which was due to a greater than anticipated enrollment rate. Participants (n = 15) reported perceived benefits from the intervention and convenience in attending tele-therapy sessions. Depressive symptoms, as measured by the PHQ-9 improved (16.8 at enrollment to 10.1 post intervention, Cohen's d = 1.13). Self-reported moderate-to-vigorous physical activity (MVPA) increased from 22.0 min/week at baseline to 36.67 min/week post-intervention (d = 0.58). Physical activity as measured by the Fitbit showed little change (daily step 5543.29 during Week 1 to 6177.48 during Week 10, (d = 0.14); MVPA 21.23 min/week during Week 1 to 19.22 at Week 10 (d = 0.0.06). CONCLUSIONS: Results of the pilot study suggest the intervention is feasible to deliver and acceptable to participants. Preliminary results suggest the intervention may be effective in improving depressive symptoms and increasing self-reported physical activity. TRIAL REGISTRATION: ClinicalTrials.gov NCT04990401, Registered July 21, 2021.", "links": [] }, { "title": "Effectiveness of a digital health and financial incentive intervention to promote physical activity in patients with type 2 diabetes: study protocol for a randomised controlled trial with a nested qualitative study-ACTIVATE trial", "author": "Sanders, James P.; Daley, Amanda J.; Esliger, Dale W.; Roalfe, Andrea K.; Colda, Antoanela; Turner, Joanne; Hajdu, Soma; Potter, Andrew; Humayun, Asif M.; Spiliotis, Ioannis; Reckless, Ian; Mytton, Oliver", "year": "2024", "journalProceedings": "Trials", "category": "Intervention", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Intensity,Heart Rate", "abstract": "BACKGROUND: The prevention of type 2 diabetes (T2DM) is recognised as a health care priority in the UK. In people living with T2DM, lifestyle changes (e.g. increasing physical activity) have been shown to slow disease progression and protect from the development of associated comorbidities. The use of digital health technologies provides a strategy to increase physical activity in patients with chronic disease. Furthermore, behaviour economics suggests that financial incentives may be a useful strategy for increasing the maintenance and effectiveness of behaviour change intervention, including physical activity intervention using digital health technologies. The Milton Keynes Activity Rewards Programme (MKARP) is a 24-month intervention which combines the use of a mobile health app, smartwatch (Fitbit or Apple watch) and financial incentives to encourage people living with T2DM to increase physical activity to improve health. Therefore, this randomised controlled trial aims to examine the long-term acceptability, health effects and cost-effectiveness of the MKARP on HbA1c in patients living with T2DM versus a waitlist usual care comparator. METHODS: A two-arm, single-centre, randomised controlled trial aiming to recruit 1018 participants with follow-up at 12 and 24 months. The primary outcome is the change in HbA1c at 12 months. Secondary outcomes included changes in markers of metabolic, cardiovascular, anthropometric, and psychological health along with cost-effectiveness. Recruitment will be via annual diabetes review in general practices, retinal screening services and social media. Participants aged 18 or over, with a diagnosis of type 2 diabetes and a valid HbA1c measurement in the last 2 months are invited to take part in the trial. Participants will be individually randomised (1:1 ratio) to receive either the Milton Keynes Activity Rewards Programme or usual care. The intervention will last for 24 months with assessment for outcomes at baseline, 12 and 24 months. DISCUSSION: This study will provide new evidence of the long-term effectiveness of an activity rewards scheme focused on increasing physical activity conducted within routine care in patients living with type 2 diabetes in Milton Keynes, UK. It will also investigate the cost-effectiveness of the intervention. TRIAL REGISTRATION: ISRCTN 14925701. Registered on 30 October 2023.", "links": [] }, { "title": "Actigraphy Study Endpoints to Reduce Sample Size and Facilitate Drug Development for Pediatric Pulmonary Arterial Hypertension", "author": "Sun, Haihao; Stockbridge, Norman; Ivy, D. Dunbar; Clark, Jennifer; Bates, Angela; Handler, Stephanie S.; Krishnan, Usha S.; Mullen, Mary P.; Yung, Delphine; Hopper, Rachel K.; Varghese, Nidhy P.; Avitabile, Catherine M.; Fineman, Jeff; Austin, Eric D.; Freire, Grace", "year": "2024", "journalProceedings": "The Journal of Pediatrics", "category": "Intervention", "devices": "Charge 2", "population": "Children", "dataUsed": "Steps,Heart Rate", "abstract": "OBJECTIVE: To investigate the feasibility of using actigraphy to measure physical activity (pA) and heart rate variability (HRV) as study endpoints in pediatric pulmonary arterial hypertension (PAH) and to compare their performance to 6-minute-walk distance (6MWD), a common primary endpoint used in PAH clinical trials in adults and children who can walk and understand the test process. STUDY DESIGN: We conducted a prospective, multicenter, noninterventional study in pediatric PAH patients and healthy children. Actiheart and Fitbit Charge 2 recorded pA and heart rate data. HRV was defined as SD of daily heart rate. Actigraphy pA and HRV and 6MWD from the same subjects were analyzed to compare children with PAH with controls, and Panama functional classification (FC) III vs II. Power/sample size simulations were conducted to detect hypothetical treatment effect equivalent to differences seen between FC III and FC II. RESULTS: We enrolled 116 children: 90 and 98 adhered with Actiheart and Fitbit, respectively. Actigraphy daily pA was ∼36\\% lower (P {\\textless} .05) and daily HRV was ∼18\\% lower (P {\\textless} .05) in children with PAH (n = 62) than healthy controls (n = 54). Daily pA and daily HRV trended ∼17\\% lower in FC III than FC II, whereas 6MWD showed little difference. Simulation at 80\\% power showed that pA required 175 subjects per group and HRV required 40 per group to detect the difference/effect, whereas 6MWD required over our maximum sample size of 200. CONCLUSIONS: Actigraphy is a feasible measure in pediatric PAH. Compared with 6MWD, pA and HRV may be more sensitive in differentiating Panama FC III from II. HRV may improve actigraphy's utility in pediatric PAH.", "links": [] }, { "title": "Changes in Rest-Activity Rhythms in Adolescents as They Age: Associations With Brain and Behavioral Changes in the ABCD Study", "author": "Zhang, Rui; Schwandt, Melanie L.; Vines, Leah; Volkow, Nora D.", "year": "2024", "journalProceedings": "Journal of the American Academy of Child and Adolescent Psychiatry", "category": "Case Study", "devices": "Charge", "population": "Adolescents", "dataUsed": "Steps,Sleep", "abstract": "OBJECTIVE: Adolescents with disrupted rest-activity rhythms (RARs), including shorter sleep duration, later sleep timing, and low physical activity levels, are at greater risk for mental health and behavioral problems. It remains unclear whether the same associations can be observed for within-subject changes in RARs. METHOD: This longitudinal investigation on RARs used Fitbit data from the Adolescent Brain Cognitive Development (ABCD) Study at the 2-year follow-up (FL2) (ages 10-13 years) and 4-year follow-up (FL4) (ages 13-16 years). Good-quality Fitbit data were available for 963 youths at both time points. Changes in RARs from FL2 to FL4, their environmental and demographic contributors, and brain and behavioral correlates were examined. RESULTS: From FL2 to FL4, adolescents showed decreases in sleep duration and physical activity as well as delayed sleep timing (Cohen d = 0.44-0.75). Contributions of environmental and demographic factors to RAR changes were greatest for sleep timing (explained 10\\% variance) and least for sleep duration (explained 1\\% variance). Delays in sleep timing had stronger correlations with behavioral problems including impulsivity and poor academic performance than reductions in sleep duration or physical activity. Additionally, the various brain measures differed in their sensitivity to RAR changes. Reductions in sleep duration were associated with decreased functional connectivity between subcortical regions and sensorimotor and cingulo-opercular networks and with enhanced functional connectivity between sensorimotor, visual, and auditory networks. Delays in sleep timing were mainly associated with gray matter changes in subcortical regions. CONCLUSION: The current findings corroborate the importance of sleep and physical activity in brain neurodevelopment and behavioral problems in adolescents. RARs might serve as biomarkers for monitoring behavioral problems and be potential therapeutic targets for mental disorders in adolescents.", "links": [] }, { "title": "Adolescents' Daily Lives (ADL) project: an intensive longitudinal design study protocol examining the associations between physical literacy, movement behaviours, emotion regulation and mental health", "author": "Ames, Megan; Srinivasa Gopalan, Sharan; Sihoe, C. Emmett; Craig, Stephanie G.; Garcia-Barrera, Mauricio; Liu, Sam; Rhodes, Ryan; Rush, Jonathan; Buckler, E. Jean", "year": "2024", "journalProceedings": "BMJ open", "category": "Intervention", "devices": "Inspire 3", "population": "Adolescents", "dataUsed": "Steps,Intensity,Sleep,Heart Rate", "abstract": "Introduction: Adolescence represents a critical developmental period, with changes in emotional regulation capacities influencing physical and mental health. With less than 6% of Canadian youth currently meeting the 24-hour movement guidelines for physical activity, sleep and sedentary behaviour, there is an urgent need to understand the potential association between movement behaviours, physical literacy, emotional regulation and mental health during adolescence. Additionally, there is a need to better understand these associations among equity-deserving groups. We developed the Adolescents' Daily Lives (ADL) project to identify how, when, under what contexts and to whom to promote healthy engagement in movement behaviours to optimise youth mental health.\n\nMethods and analysis: For the ADL project, we will employ a 14-day intensive longitudinal design to investigate the associations between physical literacy, movement behaviours, emotion regulation and mental health among a diverse sample of 120 adolescents (ages 13-17 years) living in the Greater Victoria Area, British Columbia, Canada. A comprehensive baseline survey and movement competence test, assessing physical and mental well-being, 24-hour movement behaviours (ie, physical activity, sleep and sedentary behaviours) and physical literacy, will be accompanied by daily diary surveys and accelerometer-based movement tracking (ie, Fitbit Inspire 3) to assess daily fluctuations in movement behaviour, emotional regulation and mood. Multivariate analyses, including multilevel modelling, multilevel structural equation modelling and Bayesian hierarchical continuous-time SEM, will be used to model the repeated measures data and understand the simultaneous variations in daily movement behaviours, emotion regulation and mental health.\n\nEthics and dissemination: The ADL project received ethical approval from the University of Victoria Behavioural Research Ethics Board (protocol #22-0262). Study participation is voluntary, and data collection will be anonymised to protect participant privacy and confidentiality. Research findings will be shared through academic publications and conference proceedings. Through knowledge mobilisation resources, cocreated with the youth community advisory board, relevant findings will be shared directly with the wider community of adolescents.\n\nKeywords: Adolescents; Child; Exercise; MENTAL HEALTH.", "links": [] }, { "title": "Use of commercial WAMs for monitoring individual with lung cancer. A systematic review", "author": "Bahadori, Shayan; Hosseini, Mozhdeh", "year": "2024", "journalProceedings": "Lung Cancer (Amsterdam, Netherlands)", "category": "Systematic Review", "devices": "Device unspecified", "population": "Patients", "dataUsed": "NA", "abstract": "This systematic review explored the feasibility and impact of interventions using commercial activity monitors to track physical activity and health-related outcomes during lung cancer treatment. Inclusion criteria focused on studies involving commercially available activity trackers that provided monitoring feedback to lung cancer patients. The devices selected were popular models, including Fitbit, Garmin, Apple, Samsung, and Polar. Studies assessing the reliability or validity of these trackers, as well as qualitative studies, protocols, non-English publications, and those featuring non-commercial devices, were excluded. Additionally, studies incorporating physical activity with other interventions (e.g., robotic surgery) were excluded if exercise outcomes could not be analysed independently. Searches were conducted across various electronic databases, including the Cochrane Database of Systematic Reviews, CINAHL Complete®, Science Citation Index, Google Scholar, Scopus, IEEE Xplore, and PubMed, covering the period from January 2000 to November 2023. The quality of the studies was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) and the Risk of Bias in Randomised Trials (RoB 2.0) tools. Twelve studies met the inclusion criteria, utilising commercial wearable technology for monitoring lung cancer patients over an average of 6.3 ± 4.7 weeks. A key limitation of this review was the wide variation in how interventions were implemented across studies. Yet, the interventions significantly improved daily activity levels and intensity, quality of life, psychological impact, and physical function compared to usual care. These monitors show promise in predicting, monitoring, and detecting physical activity, motivating patients, and aiding in recovery. However, limitations exist, and further evidence is needed to confirm their efficacy as primary monitoring tools in lung cancer treatment.", "links": [] }, { "title": "Neuroplastic Responses to Chiropractic Care: Broad Impacts on Pain, Mood, Sleep, and Quality of Life", "author": "Haavik, Heidi; Niazi, Imran Khan; Amjad, Imran; Kumari, Nitika; Ghani, Usman; Ashfaque, Moeez; Rashid, Usman; Navid, Muhammad Samran; Kamavuako, Ernest Nlandu; Pujari, Amit N.; Holt, Kelly", "year": "2024", "journalProceedings": "Brain Sciences", "category": "Intervention", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate,Active Minutes/Active Zone Minutes", "abstract": "Objectives: This study aimed to elucidate the mechanisms of chiropractic care using resting electroencephalography (EEG), somatosensory evoked potentials (SEPs), clinical health assessments (Fitbit), and Patient-reported Outcomes Measurement Information System (PROMIS-29).\n\nMethods: Seventy-six people with chronic low back pain (mean age ± SD: 45 ± 11 years, 33 female) were randomised into control (n = 38) and chiropractic (n = 38) groups. EEG and SEPs were collected pre and post the first intervention and post 4 weeks of intervention. PROMIS-29 was measured pre and post 4 weeks. Fitbit data were recorded continuously.\n\nResults: Spectral analysis of resting EEG showed a significant increase in Theta, Alpha and Beta, and a significant decrease in Delta power in the chiropractic group post intervention. Source localisation revealed a significant increase in Alpha activity within the Default Mode Network (DMN) post intervention and post 4 weeks. A significant decrease in N30 SEP peak amplitude post intervention and post 4 weeks was found in the chiropractic group. Source localisation demonstrated significant changes in Alpha and Beta power within the DMN post-intervention and post 4 weeks. Significant improvements in light sleep stage were observed in the chiropractic group along with enhanced overall quality of life post 4 weeks, including significant reductions in anxiety, depression, fatigue, and pain.\n\nConclusions: These findings indicate that many health benefits of chiropractic care are due to altered brain activity.\n\nKeywords: PROMIS-29; chiropractic; default mode network (DMN); electroencephalogram (EEG); somatosensory evoked potentials (SEPs).", "links": [] }, { "title": "Association of Physical Activity from Wearable Devices and Chronic Disease Risk: Insights from the All of Us Research Program", "author": "Hou, Yu; Cui, Erjia; Ikramuddin, Sayeed; Zhang, Rui", "year": "2024", "journalProceedings": "medRxiv: The Preprint Server for Health Sciences", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity", "abstract": "Background: Physical activity is widely recognized as a key modifiable factor for reducing the risk of chronic diseases. Wearable devices such as Fitbit offer a unique opportunity to objectively measure physical activity metrics, providing insights into the association between different types of physical activity and chronic disease risk.\n\nObjective: This study aims to examine the association between physical activity metrics derived from Fitbit devices and the incidence of various chronic diseases among participants from the All of Us Research Program.\n\nMethods: Physical activity metrics included daily steps, elevation gain, and activity durations at different intensities (e.g., very active, lightly active, and sedentary). Cox proportional hazards models and multiple regression models were used to assess the relationship between these metrics and the incidence of chronic diseases represented by Phecodes. Age, sex, and body mass index (BMI) were included as covariates.\n\nResults: A total of 15,538 participants provided Fitbit activity data, of which 9,320 also had electronic health records (EHR). Increased daily step count, elevation gain, and very active minutes were significantly associated with a reduced risk of several chronic conditions, including obesity, Type 2 diabetes, and major depressive disorder. Conversely, increased sedentary time was linked to higher risks for conditions such as obesity, Type 2 diabetes, and essential hypertension. Multiple regression analyses confirmed these associations.\n\nConclusion: Our findings highlight the beneficial effects of increased physical activity, particularly daily steps and elevation gain, on reducing the risk of chronic diseases. Conversely, sedentary behavior remains a significant risk factor for the development of several conditions. These insights may inform personalized activity recommendations aimed at reducing disease burden and improving population health outcomes.", "links": [] }, { "title": "Augmenting Prognostication: Utilizing Activity Trackers to Enhance Survival Prediction in Metastatic Non-Small Cell Lung Cancer", "author": "Jo, Yeonjung; Puri, Sonam; Haaland, Benjamin; Coletta, Adriana M.; Chipman, Jonathan J.; Embrey, Kelsey; Kerrigan, Kathleen C.; Patel, Shiven B.; Moynahan, Kelly; Gumbleton, Matthew; Akerley, Wallace L.", "year": "2024", "journalProceedings": "Clinical Lung Cancer", "category": "Usability", "devices": "Alta HR,Inspire HR,Inspire 2", "population": "Patients", "dataUsed": "Steps,Intensity,Distance,Heart Rate", "abstract": "Introduction/background: Prognostication by performance status (PS) assessment is a fundamental element of treatment decisions and clinical trial design in oncology, but it is limited by subjectivity and potential miscommunication between patient, physician, and family. Activity tracker offers the potential to collect a broad range of patient-generated data to supplement the assessment of PS.\n\nPatients and methods: Patients with metastatic NSCLC (mNSCLC) participated in a single institute, prospective, observational feasibility study conducted at Huntsman Cancer Institute. Patients were given a Fitbit® activity tracker, which collects their steps taken, distance moved, heart rate, and activity intensity. At baseline, PS was assessed by physicians and patients, and demographics and clinical data were collected. We defined novel indices of health: Heart rate Activity zone Mismatch (HAM) and excessive Sedentary Heart Rate (eSHR). We used multivariable Cox proportional hazards models adjusted for age, sex, and treatment line to estimate and test the prognostic ability of clinical and fitness metrics on overall survival (OS). Each prognostic model was evaluated using Harrell's concordance index (C-index).\n\nResults: Fifty-five patients with mNSCLC were enrolled. The median OS was 10.4 months (95% CI: 7.2, 15.2). PS-physician (HR = 2.0; P < .001) and Fitbit metrics were associated with OS, including daily total steps (1,000-steps) (HR = 0.8; P = .004), HAM (HR = 2; P = .02), eSHR (HR = 0.3; P = .001). The prognostic model that includes PS-physician was associated with the best concordance (C-index = 0.75), followed by daily total distance (C-index = 0.74) and steps (C-index = 0.73) CONCLUSIONS: Tracker-based measures were prognostic of survival in mNSCLC and may be useful as a supplement or alternative to PS in practice and clinical trials.", "links": [] }, { "title": "Adherence to the Mediterranean diet and sleep quality are inter-correlated with flash glucose monitoring (FGM)-measured glycemia among children with type 1 diabetes", "author": "Muayyad, Mariam; Abusnana, Salah; Mussa, Bashair M.; Helal, Radwa; Abdelrahim, Dana N.; Abdelreheim, Naguib Hassan; Al Amiri, Elham; Daboul, Mays; Al-Abadla, Zainab; Lessan, Nader; Faris, MoezAlIslam E.", "year": "2024", "journalProceedings": "Journal of Education and Health Promotion", "category": "Case Study", "devices": "Ace 3,Ace 2", "population": "Patients", "dataUsed": "Sleep", "abstract": "Background: We examined the inter-correlation between diet quality, objectively measured sleep duration, and subjectively measured sleep quality with flash glucose monitoring (FGM)-measured glycemia among young patients with type 1 diabetes (T1D).\n\nMaterials and methods: Following cross-sectional design, Fitbit® accelerometers were used to objectively assess sleep duration, while the validated questionnaires Pittsburgh sleep quality index and Mediterranean diet (MD) adherence were used to subjectively assess sleep quality and diet quality, respectively. Glycated hemoglobin (HbA1c) and FGM-reported glycemia components among children with T1D were assessed as well.\n\nResults: Of the 47 participants surveyed (25 boys, 22 girls, 9.31 ± 2.88 years), the majority reported high HbA1c, good sleep quality, and high adherence to the MD. However, only one-third of the participants reported a healthy sleep duration. Only the sleep latency was significantly (P < 0.05) associated with the time above range level 2 and time below range level 2 (P = 0.048) components of the FGM. A positive correlation (r = 0.309, P = 0.035) was reported between adherence to MD and time in range of the FGM.\n\nConclusions: Diet quality and sleep quality are variably inter-correlated with FGM-measured glycemia among young patients with T1D and are suggested to be considered influential factors in FGM-monitored diabetes research on this age group.", "links": [] }, { "title": "The effects of COVID-19 lockdown and reopening on rest-activity rhythms in Singaporean working adults: A longitudinal age group comparison study", "author": "Qin, Shuo; Ong, Ju Lynn; Chia, Janelle; Low, Alicia; Lee, Charmaine; Koek, Daphne; Cheong, Karen; Chee, Michael Wei Liang", "year": "2024", "journalProceedings": "Sleep Health", "category": "Case Study", "devices": "Versa", "population": "Older Adults,Adults", "dataUsed": "Steps,Sleep", "abstract": "Study objectives: COVID-19 mobility restrictions disrupted daily rhythms worldwide, but how this rhythm disruption differs across age groups is unclear. We examined the course of age-related differences in trajectories of rest-activity rhythm during the COVID-19 pandemic lockdown and reopening in Singapore. We also evaluated the association of these patterns with mental well-being.\n\nMethods: 24-hour step count data (Fitbit) were obtained from 617 younger (age range: 21-40) and 602 older adults (age range: 55-70) from January 2020 (baseline) through lockdown (April 2020) and reopening periods until August 2021. Nonparametric rest-activity rhythm metrics: interdaily stability, intradaily variability and most active 10-hour period (M10) were computed. Longitudinal changes in rest-activity rhythm, age-related differences in changes, and the associations between mental well-being and these changes were assessed using nonlinear latent-growth models.\n\nResults: In younger adults, mobility restrictions during lockdown caused significant decline in interdaily stability and M10, alongside significant increase in intradaily variability. However, in older adults, changes were confined to increased intradaily variability and decreased M10. Older adults also showed less change in intradaily variability and M10 compared to younger adults. Gradual recovery of rest-activity rhythm metrics during reopening was observed, with interdaily stability and M10 remaining lower after 15months post-lockdown. In younger but not older adults, a larger decline in interdaily stability was associated with poorer mental well-being 15months post-lockdown.\n\nConclusion: Younger adults appear more vulnerable than older adults to mobility restrictions as reflected in their rest-activity rhythm metrics. A significant disruption of daily routine may have long-lasting effects on younger adults' mental well-being.\n\nStatement of significance: Although stringent mobility restrictions imposed to curb the spread of COVID-19 were imposed primarily to protect older adults, we found that younger adults were more vulnerable to rhythm disruption arising from mobility restrictions. Disrupted rhythm stability was associated with poorer mental well-being 15months after the lockdown ended in younger but not older adults. These asymmetric long-term effects on mental health on younger relative to older adults should be kept in mind when planning for large-scale catastrophes linked to mobility restrictions.", "links": [] }, { "title": "Detection of sedentary time and bouts using consumer-grade wrist-worn devices: a hidden semi-Markov model", "author": "Salim, Agus; Brakenridge, Christian J.; Lekamlage, Dulari Hakamuwa; Howden, Erin; Grigg, Ruth; Dillon, Hayley T.; Bondell, Howard D.; Simpson, Julie A.; Healy, Genevieve N.; Owen, Neville; Dunstan, David W.; Winkler, Elisabeth A. H.", "year": "2024", "journalProceedings": "BMC medical research methodology", "category": "Intervention", "devices": "Ionic,Versa 2,Inspire HR", "population": "Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Background: Wrist-worn data from commercially available devices has potential to characterize sedentary time for research and for clinical and public health applications. We propose a model that utilizes heart rate in addition to step count data to estimate the proportion of time spent being sedentary and the usual length of sedentary bouts.\n\nMethods: We developed and trained two Hidden semi-Markov models, STEPHEN (STEP and Heart ENcoder) and STEPCODE (STEP enCODEr; a steps-only based model) using consumer-grade Fitbit device data from participants under free living conditions, and validated model performance using two external datasets. We used the median absolute percentage error (MDAPE) to measure the accuracy of the proposed models against research-grade activPAL device data as the referent. Bland-Altman plots summarized the individual-level agreement with activPAL.\n\nResults: In OPTIMISE cohort, STEPHEN's estimates of the proportion of time spent sedentary had significantly (p < 0.001) better accuracy (MDAPE [IQR] = 0.15 [0.06-0.25] vs. 0.23 [0.13-0.53)]) and agreement (Bias Mean [SD]=-0.03[0.11] vs. 0.14 [0.11]) than the proprietary software, estimated the usual sedentary bout duration more accurately (MDAPE[IQR] = 0.11[0.06-0.26] vs. 0.42[0.32-0.48]), and had better agreement (Bias Mean [SD] = 3.91[5.67] minutes vs. -11.93[5.07] minutes). With the ALLO-Active dataset, STEPHEN and STEPCODE did not improve the estimation of proportion of time spent sedentary, but STEPHEN estimated usual sedentary bout duration more accurately than the proprietary software (MDAPE[IQR] = 0.19[0.03-0.25] vs. 0.36[0.15-0.48]) and had smaller bias (Bias Mean[SD] = 0.70[8.89] minutes vs. -11.35[9.17] minutes).\n\nConclusions: STEPHEN can characterize the proportion of time spent being sedentary and usual sedentary bout length. The methodology is available as an open access R package available from https://github.com/limfuxing/stephen/ . The package includes trained models, but users have the flexibility to train their own models.", "links": [] }, { "title": "MHealth devices demonstrate validity and reliability in detecting steps in chronic stroke survivors who rely on assistive devices", "author": "Vieira Costa, Pollyana Helena; Thome Teixeira da Silva, Leonardo Vinicius; Dias de Jesus, Thainá Paula; Dario, Daniella Moura; Torriani-Pasin, Camila; Polese, Janaine Cunha", "year": "2024", "journalProceedings": "Journal of Bodywork and Movement Therapies", "category": "Validation", "devices": "Ultra", "population": "Adults", "dataUsed": "Steps", "abstract": "Purpose: To assess the concurrent validity and reliability of five mHealth devices (STEPZ, Health, Pacer, Google Fit, and Fitbit Inc.®) in counting steps among individuals with chronic stroke using assistive devices (AD). Our primary objective was to identify significant variations in step counts between AD users and non-users.\n\nMethods: In a cross-sectional study, individuals performed a 2-min walking test while carrying two smartphones (Android OS and iOS) equipped with four different applications (STEPZ, Health, Pacer, and Google Fit), alongside a Fitbit Inc.® device. A visual video recording served as criterion-standard measure for step counting. Each participant completed four walking trials. Two proficient researchers conducted data collection in a controlled environment at a single day.\n\nResults: Twenty-four individuals were included. The devices were valid for individuals in individuals with chronic stroke who used AD (0.52 ≤ r ≥ 0.89), except for Health (iOS). There is no agreement between the criterion-standard and Health (iOS), and all other devices showed adequate reliability (0.107 ≤ CCI [2, 1] ≥ 0.701). There was no difference in stepping counting when the individuals used or not the AD.\n\nConclusions: Health for iOS is neither valid nor reliable for individuals with chronic stroke who are AD users. There is no difference in step counting were when the individuals with chronic stroke are users or non-users of AD.", "links": [] }, { "title": "Relationship Between Heart Rate and Perceived Stress in Intensive Care Unit Residents: Exploratory Analysis Using Fitbit Data", "author": "Wang, Ruijing; Rezaeian, Olya; Asan, Onur; Zhang, Linghan; Liao, Ting", "year": "2024", "journalProceedings": "JMIR formative research", "category": "Case Study", "devices": "Charge 3", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Background: Intensive care unit (ICU) residents are exposed to high stress levels due to the intense nature of their work, which can impact their mental health and job performance. Heart rate measured through wearable devices has the potential to provide insights into residents' self-reported stress and aid in developing targeted interventions.\n\nObjective: This exploratory study aims to analyze continuous heart rate data and self-reported stress levels and stressors in ICU residents to examine correlations between physiological responses, stress levels, and daily stressors reported.\n\nMethods: A secondary data analysis was conducted on heart rate measurements and stress assessments collected from 57 ICU residents over a 3-week period using Fitbit Charge 3 devices. These devices captured continuous physiological data alongside daily surveys that assessed stress levels and identified stressors. The study used Spearman rank correlation, point-biserial correlation analysis, 2-tailed paired t tests, and mixed-effect models to analyze the relationship between heart rate features and stress indicators.\n\nResults: The findings reveal complex interactions between stress levels and heart rate patterns. The correlation analysis between stress levels and median heart rate values across different percentile ranges showed that lower percentile heart rates (bottom 5%, 10%, 25%, and 50%) had modest correlations with stress, whereas higher percentiles (top 50%, 25%, 10%, and 5%) did not correlate significantly (all P>.05). The 2-tailed paired t test indicated significant differences in stress levels reported in midday versus end-of-day surveys (P<.001), although these changes in stress levels were not consistently reflected in heart rate patterns. Additionally, we explored and found that stressors related to \"other health\" issues had the highest positive correlation with stress level changes from midday to end-of-day surveys. However, the weak effect of these stressors on peak heart rate suggests that their impact on physiological measures like heart rate is not yet clear. According to our mixed-effects model, stress levels significantly influenced heart rate variations when hierarchical data were taken into account (P=.03), meaning that as the stress level increased, there was a significant increase in mean heart rate.\n\nConclusions: This study highlights the complexity of using heart rate as an indicator of stress, particularly in high-stress environments like the ICU. Our findings suggest that while heart rate is found to correlate with self-reported stress in the mixed-effect model, its impact is modest, and it should be combined with other physiological and psychological measures to obtain a more accurate and comprehensive assessment of residents' stress levels.\n\nKeywords: Fitbit; health care worker; heart rate; intensive care unit; mental health; occupational health; perceived stress; physician; provider; resident; secondary data analysis; self-reported; stress; trainee; wearable.", "links": [] }, { "title": "Efficacy of Auricular Acupressure Combined With Positive Psychological Techniques on Sleep Quality in Cancer Patients Undergoing Radiotherapy: A Randomized Controlled Trial", "author": "Bi, Liuna; Gao, Wenjuan; Zhang, Qian; Li, Na; Zhang, Xian; Han, Jing", "year": "2024", "journalProceedings": "Cancer Nursing", "category": "Intervention", "devices": "Charge 3", "population": "Patients", "dataUsed": "Sleep", "abstract": "BACKGROUND: Auricular acupressure (AA) and positive psychological intervention (PPI) are promising sleep improvement methods. OBJECTIVE: To assess and compare the efficacies of combined intervention (CI [AA + PPI]), AA, and PPI in sleep quality enhancement and their potential effects in alleviating negative psychological states in radiotherapy-treated patients with cancer. METHODS: This study was a 4-arm, placebo-controlled randomized trial. We randomly assigned 120 eligible patients into 4 groups (30 patients per group). The main outcomes included subjective sleep quality, psychological distress, and fear of cancer recurrence, which were measured at baseline, immediate postintervention, and 4 weeks postintervention. Objective sleep quality was measured using Fitbit Charge 3 at baseline and immediate postintervention. The intervention effects were estimated using the linear mixed model. RESULTS: The 4 groups demonstrated significant differences in subjective sleep quality (P {\\textless} .001), psychological distress (P = .004), and fear of cancer recurrence (P {\\textless} .001). CI, AA, and PPI had different degrees of positive effects on subjective sleep quality compared with sham control; CI was more effective than AA and PPI, whereas AA was more effective than PPI. CI and PPI showed significant and comparable effects on psychological distress and fear of cancer recurrence reduction. Only CI and AA significantly improved the objective sleep quality. CONCLUSIONS: CI, AA, and PPI are recommended as complementary therapies to improve the sleep quality of patients with cancer. IMPLICATIONS FOR PRACTICE: In future clinical practice, healthcare workers should assess patients' sleep quality and psychological status and select appropriate interventions.", "links": [] }, { "title": "A Digital Biomarker Dataset in Hematopoietic Cell Transplantation: A Longitudinal Study of Caregiver-Patient Dyads (dHCT)", "author": "Jalin, Aditya; Swatthong, Nawat; Rozwadowski, Michelle; Kumar, Rajnish; Barton, Deb; Braun, Tom; Carlozzi, Noelle; Hanauer, David A.; Hassett, Afton; Choi, Sung Won", "year": "2024", "journalProceedings": "medRxiv: The Preprint Server for Health Sciences", "category": "Case Study", "devices": "Charge 3", "population": "Patients", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "BACKGROUND: Hematopoietic stem cell transplantation (HCT) is a potentially life-saving therapy for individuals with blood diseases, but involves a challenging recovery process that requires dedicated caregivers. The complex interplay between emotional distress, care partner (or unpaid caregiver) burden, and treatment outcomes necessitates comprehensive physiological and psychological measurements to fully understand these dynamics. FINDINGS: We collected longitudinal data from 166 HCT caregiver-patient dyads over 120 days post-transplant as part of a randomized controlled trial ( NCT04094844 ). Data were gathered using the Fitbit® Charge 3 device, a custom mood-reporting app with positive psychology-based activities (Roadmap), PROMIS® health measures, and clinical events. The dataset includes minute-level heart rate, daily sleep metrics, step counts, self-reported mood scores, app usage metrics, PROMIS® T-scores (i.e. global health, depression), infection and readmission records, and clinical outcomes (e.g., acute and chronic graft-versus-host disease, relapse, mortality). Physiological data were available for both caregivers and patients. Data validation confirmed high compliance with mood reporting and the presence of physiological patterns between caregivers and patients that differed (i.e., lower activity in patients compared with caregivers across time). CONCLUSIONS: This dataset offered an unprecedented view into the daily fluctuations of caregiver and patient well-being throughout the critical post-HCT period. It provided a valuable resource for researchers investigating the impact of mHealth app interventions, including emotional distress and physiological markers on treatment course and clinical outcomes. Our unique dataset informs interventions that may address caregiver support, patient care, or dyadic-focused strategies and enable novel analyses of single member or dyadic dynamics in HCT treatment.", "links": [] }, { "title": "The Effect of Inhaled Beta-2 Agonists on Heart Rate in Patients With Asthma: Sensor-Based Observational Study", "author": "Khusial, Rishi Jayant; Sont, Jacob K.; Usmani, Omar S.; Bonini, Matteo; Chung, Kian Fan; Fowler, Stephen James; Honkoop, Persijn J.", "year": "2024", "journalProceedings": "JMIR cardio", "category": "Case Study", "devices": "Charge HR", "population": "Patients", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Beta-2 agonists play an important role in the management of asthma. Inhaled long-acting beta-2 agonists (LABAs) and short-acting beta-2 agonists (SABAs) cause bronchodilation by stimulating adrenoceptors. These receptors are also present in cardiac cells and, as a side effect, could also be stimulated by inhaled beta-2 agonists. OBJECTIVE: This study aims to assess the effect of beta-2 agonists on heart rate (HR). METHODS: The data were retrieved from an observational study, the myAirCoach Quantification Campaign. Beta-2 agonist use was registered by self-reported monthly questionnaires and by smart inhalers. HR was monitored continuously with the Fitbit Charge HR tracker (Fitbit Inc). Patients (aged 18 years and older) were recruited if they had uncontrolled asthma and used inhalation medication. Our primary outcome was the difference in HR between LABA and non-LABA users. Secondary outcomes were the difference in HR on days SABAs were used compared to days SABAs were not used and an assessment of the timing of inhaler use during the day. RESULTS: Patients using LABA did not have a clinically relevant higher HR (average 0.8 beats per minute difference) during the day. Around the moment of SABA inhalation itself, the HR does increase steeply, and it takes 138 minutes before it returns to the normal range. CONCLUSIONS: This study indicates that LABAs do not have a clinically relevant effect on HR. SABAs are instead associated with a short-term HR increase. TRIAL REGISTRATION: ClinicalTrials.gov NCT02774772; https://clinicaltrials.gov/study/NCT02774772.", "links": [] }, { "title": "Effect of communicating genetic risk of type 2 diabetes and wearable technologies on wearable device-measured behavioural outcomes in East Asians: protocol of a randomised controlled trial", "author": "Kim, Youngwon; Godino, Job G.; Cheung, Flora Lai Tung; Multhaup, Michael; Chan, Derwin King Chung K. C.; Chen, Ziyuan; Ho, Harrison Hin Sheung; Tse, Tsz Him Timothy; Au Yeung, Shiu Lun Ryan; Lou, Shan; Zhang, Joni H.; Wang, Mengyao; Chung, Brian; Griffin, Simon", "year": "2024", "journalProceedings": "BMJ open", "category": "Intervention", "devices": "Inspire", "population": "Adults", "dataUsed": "Steps,Intensity,Goals", "abstract": "INTRODUCTION: The communication of information about the risk of type 2 diabetes (T2D) alone has not been associated with changes in habitual behaviours among individuals of European ancestry. In contrast, the use of wearable devices that monitor physical activity (PA) has been associated with behavioural changes in some studies. It is uncertain whether risk communication might enhance the effects of wearable devices. We aim to assess the effects of communicating genetic risk for T2D alone or in combination with wearable device functions on wearable device-measured PA among overweight or obese East Asians. METHODS AND ANALYSIS: In a parallel group, randomised controlled trial, 355 overweight or obese East Asian individuals aged 40-60 years are allocated into one of three groups: one control and two intervention groups. Blood samples will be used for estimation of T2D genetic risk and analysis of metabolic risk markers. Genetic risk of T2D will be estimated based on 113 single-nucleotide polymorphisms associated with T2D among East Asians. All three groups receive a Fitbit device. Both intervention groups will receive T2D genetic risk estimates along with lifestyle advice, but one of the intervention groups additionally uses Fitbit's step goal setting and prompt functions. Questionnaires and physical measurements are administered at baseline, immediately after intervention delivery, and 6 and 12 months post intervention. The primary outcome is time spent in moderate-to-vigorous PA from the Fitbit, which will be assessed at baseline, immediately post intervention, 12 months post intervention and at 6-month follow-up. Secondary outcomes include other wearable device-measured parameters, sedentary time, and sleep, blood pressure, metabolic risk markers, hand grip strength, self-reported PA, fruit and vegetable consumption, smoking, and psychological variables. Between-group differences in the continuous and categorical variables collected at baseline will be examined using Analysis of Variance (ANOVA) and χ2 tests, respectively. A series of linear mixed effects models with fixed effects of time, group and interaction between time and group will be performed, with adjustment for potential confounders. ETHICS AND DISSEMINATION: The study protocol has undergone review and received approval from the ethics committee of the University of Hong Kong. Findings from our trial will be disseminated through publication in peer-reviewed research journals and presented at international academic conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, NCT05524909. https://register. CLINICALTRIALS: gov/ (11 November 2024).", "links": [] }, { "title": "Engagement With Daily Symptom Reporting, Passive Smartphone Sensing, and Wearable Device Data Collection During Chemotherapy: Longitudinal Observational Study", "author": "McClaine, Sean; Fedor, Jennifer; Bartel, Christianna; Chen, Leeann; Durica, Krina C.; Low, Carissa A.", "year": "2024", "journalProceedings": "JMIR cancer", "category": "Case Study", "devices": "Inspire", "population": "Patients", "dataUsed": "User Friendliness,Device Weartime", "abstract": "BACKGROUND: Chemotherapy can cause symptoms that impair quality of life and functioning. Remote monitoring of daily symptoms and activity during outpatient treatment may enable earlier detection and management of emerging toxicities but requires patients, including older and acutely ill patients, to engage with technology to report symptoms through smartphones and to charge and wear mobile devices. OBJECTIVE: This study aimed to identify factors associated with participant engagement with collecting 3 data streams (ie, daily patient-reported symptom surveys, passive smartphone sensing, and a wearable Fitbit device [Google]) during chemotherapy. METHODS: We enrolled 162 patients receiving outpatient chemotherapy into a 90-day prospective study. Patients were asked to install apps on their smartphones to rate daily symptoms and to collect passive sensor data and to wear a Fitbit device for the duration of the study. Participants completed baseline demographic and quality of life questionnaires, and clinical information was extracted from the electronic medical record. We fit a series of logistic generalized estimating equations to evaluate the association between demographic and clinical factors and daily engagement with each data stream. RESULTS: Participants completed daily surveys on 61\\% (SD 27\\%) of days and collected sufficient smartphone data and wearable sensor data on 73\\% (SD 35\\%) and 70\\% (SD 33\\%) of enrolled days, respectively, on average. Relative to White participants, non-White patients demonstrated lower odds of engagement with both symptom surveys (odds ratio [OR] 0.49, 95\\% CI 0.29-0.81; P=.006) and wearable data collection (OR 0.35, 95\\% CI 0.17-0.73; P=.005). Patients with stage 4 cancer also exhibited lower odds of engagement with symptom reporting than those with earlier stage disease (OR 0.69, 95\\% CI 0.48-1.00; P=.048), and patients were less likely to complete symptom ratings on the weekend (OR 0.90, 95\\% CI 0.83-0.97; P=.008). Older patients (OR 1.03, 95\\% CI 1.01-1.06; P=.01) and those who reported better cognitive functioning at study entry (OR 1.18, 95\\% CI 1.03-1.34; P=.02) were more likely to engage with Fitbit data collection, and patients who reported higher levels of depressive symptoms were less likely to engage with smartphone data collection (OR 1.18, 95\\% CI 1.03-1.36; P=.02). CONCLUSIONS: Remote patient monitoring during chemotherapy has the potential to improve clinical management, but only if patients engage with these systems. Our results suggest significant associations between demographic and clinical factors and long-term engagement with smartphone and wearable device assessments during chemotherapy. Non-White participants, those with metastatic cancer, or those with existing cognitive impairment may benefit from additional resources to optimize engagement. Contrary to hypotheses, older adults were more likely than younger adults to engage consistently with wearable device assessments.", "links": [] }, { "title": "Gender diversity and daily steps: Findings from the Adolescent Brain Cognitive Development Study", "author": "Nagata, Jason M.; Sui, Shirley; Kim, Angela E.; Shao, Iris Yuefan; Otmar, Christopher D.; Ganson, Kyle T.; Testa, Alexander; Dooley, Erin E.; Gooding, Holly C.; Baker, Fiona C.; Pettee Gabriel, Kelley", "year": "2025", "journalProceedings": "Annals of Epidemiology", "category": "Case Study", "devices": "Charge 2", "population": "Adolescents", "dataUsed": "Steps", "abstract": "PURPOSE: To examine the association between multiple dimensions of gender diversity and physical activity (daily steps) in a diverse national sample of early adolescents in the United States. METHODS: This study analyzed Year 2 data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 6038, Mage=12.0 years). Linear regression models were used to estimate the associations of gender diversity across multiple measures (transgender identity, felt gender, gender expression, gender non-contentedness) with daily step count measured by wrist-worn Fitbit devices. RESULTS: In this sample of early adolescents, 49.7 \\% were assigned female at birth, 39.4 \\% were from racial/ethnic minority groups, and 1 \\% to 16.9 \\% identified as gender diverse, depending on the measure used. Transgender identity was associated with 1394 (95 \\% confidence interval 284-2504) fewer steps per day compared to cisgender identity after adjusting for all covariates. Greater gender diversity, as measured by felt gender and gender non-contentedness, was also associated with lower daily steps. CONCLUSIONS: Transgender and gender-diverse adolescents engage in less physical activity than their cisgender peers. This research has important implications for public health and policies focused on supporting physical activity among transgender and gender-diverse early adolescents.", "links": [] }, { "title": "Healthy at Home for COPD: An Integrated Digital Monitoring, Treatment, and Pulmonary Rehabilitation Intervention", "author": "O'Connor, Laurel; Behar, Stephanie; Tarrant, Seanan; Stamegna, Pamela; Pretz, Caitlin; Shirshac, Jeanne; Scornavacca, Thomas; Wilkie, Tracey; Fisher, Kimberly; Tigas, Emil; Mullen, Marie; Hyder, Michael; Wong, Steven; Savage, Brendon; Toomey, Shaun; Wang, Biqi; Zai, Adrian; Alper, Eric; Lindenauer, Peter; Dickson, Eric; Broach, John; McManus, David; Kheterpal, Vik; Soni, Apurv", "year": "2024", "journalProceedings": "Research Square", "category": "Intervention", "devices": "Charge 5", "population": "Patients", "dataUsed": "Heart Rate,Device Weartime", "abstract": "BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality in the United States. Frequent exacerbations result in higher use of emergency services and hospitalizations, leading to poor patient outcomes and high costs. OBJECTIVE: Demonstrate the feasibility of a multimodal, digitally enhanced remote monitoring, treatment, and tele-pulmonary rehabilitation intervention among patients with COPD. METHODS: In this pilot clinical trial, community-dwelling adults with moderate-severe COPD were enrolled in a multimodal digital monitoring and treatment program including a Fitbit wearable device, study app that tracked COPD-related symptoms, on-demand mobile integrated health (MIH) services for acute home-based treatment, and tele-pulmonary-rehabilitation. Participants were enrolled in the program for six months. COPD severity and health-related quality of life assessments were performed at baseline, 3 months, and 6 months. Primary feasibility outcomes include recruitment and retention rate, and participant protocol fidelity, which were reported descriptively. Exploratory clinical outcomes included patient-reported quality of life, activation, and intervention satisfaction. RESULTS: Over 18 months, 1,333 patients were approached and 100 (7.5\\%) were enrolled (mean age 66, 52\\% female). Ninety-six participants (96\\%) remained in the study for the full enrollment period. Fifty-five (55\\%) participated in tele-pulmonary-rehabilitation. Participants wore the Fitbit for a median of 114 days (IQR 183.6) and 16.85 hours/day (4.05), resulting in a median of 1133 minutes (243) per day. Completion rates for scheduled instruments ranged from 78-93\\%. Nearly all participants (85\\%) performed COPD ecological momentary assessment at least once with a median of 4.85 recordings. On average, a 2.48-point improvement (p=0.03) in COPD Assessment Test Score was observed from baseline to study completion. The adherence and symptom improvement metrics were not associated with baseline patient activation measures. CONCLUSIONS: A multimodal intervention combining preventative care, symptom and biometric monitoring, and home treatment was feasible in adults living with COPD. Participants demonstrated high protocol fidelity and engagement and reported improved quality of life.", "links": [] }, { "title": "An Outdoor Walking Program for Immigrant Muslim Older Adults: A Community-Based Participatory Intervention", "author": "Salma, Jordana; Yamamoto, Shelby; Salbach, Nancy M.; Barclay, Ruth; Jones, Allyson", "year": "2024", "journalProceedings": "Nursing Open", "category": "Intervention", "devices": "Alta", "population": "Older Adults", "dataUsed": "Steps", "abstract": "AIM: To explore Muslim immigrant older adults' experiences of a modified community-based outdoor walking program and identify factors that facilitate or hinder program acceptance and participation. DESIGN: An exploratory qualitative description single-group pilot study was designed and implemented in three phases: (1) pre-intervention focus group interviews; (2) intervention implementation with tracking of physical activity levels using personal activity monitors; and (3) postintervention individual interviews. METHODS: Participants were recruited using a convenience sampling strategy in a mosque in Edmonton, Canada, in June 2019. After focus group discussions with participants, walking sessions were conducted for 10 weeks in a local accessible park with required amenities such as benches and restrooms. A fitness instructor delivered the weekly program that was followed by individual semistructured interviews to explore participants' satisfaction and program acceptance. Content analysis was used for qualitative data and sociodemographic, health and physical activity level (via step counts) data was documented for all participants. RESULTS: Thirteen participants with a mean age of 66.9 years completed the program. The majority of participants led a sedentary lifestyle. Participants identified three motivators that increased program satisfaction, which were socialising with peers, having a fitness instructor, and using Fitbit activity trackers. Difficulties with transportation and lack of appropriate educational components were areas for improvement that could enhance acceptability of the program. CONCLUSIONS: This study suggests that early incorporation of older immigrants' preferences increases acceptance of physical activity programs. IMPLICATIONS: Nurses' engaging in healthy lifestyle support for older immigrants can identify the influences on positive uptake of physical activity programs in this population. IMPACT: Immigrant Muslim older adults lack access to evidence-based physical activity programming that meets their cultural and religious preferences. This study provides some insights into ways to engage this population in similar programs. PATIENT OR PUBLIC CONTRIBUTION: Community-dwelling older adults who participated in this study completed focus groups and interviews and engaged in the 10-week pilot intervention. Their input informed the modifications to the intervention.", "links": [] }, { "title": "Technological monitoring of motor parameters to assess multidimensional frailty of older people in the PRO-HOME project", "author": "Seminerio, Emanuele; Morganti, Wanda; Barbagelata, Marina; Sabharwal, Sanket Rajeev; Ghisio, Simone; Prete, Camilla; Senesi, Barbara; Dini, Simone; Custureri, Romina; Galliani, Simonetta; Morelli, Simona; Puleo, Gianluca; Berutti-Bergotto, Carlo; Camurri, Antonio; Pilotto, Alberto; PRO-HOME Project Investigators Group", "year": "2024", "journalProceedings": "Scientific Reports", "category": "Intervention", "devices": "Sense", "population": "Patients", "dataUsed": "Steps,Distance", "abstract": "An interconnected system employing Kinect Azure and Fitbit Sense for continuous and non-intrusive data collection was used in the PRO-HOME protected discharge program, aiming at monitoring functional and clinical parameters in hospitalized older patients at different risks of frailty. The present study shows the findings on 30 older patients included in the PRO-HOME project. The Fitbit Sense recorded the mean daily and hourly number of steps, mean daily walked distance, and time spent inactive. Moreover, Kinect infrared camera captured gait speed and daily mean latero-lateral (body sway) and antero-posterior oscillations (lean-in). Patients underwent a standard Comprehensive Geriatric Assessment (CGA) to compute the Multidimensional Prognostic Index (MPI), including basic and instrumental activities of daily living (ADL, IADL), cognition (Short Portable Mental Status Questionnaire, SPMSQ) and nutrition, risk of pressure sores (Exton-Smith Scale, ESS), comorbidity, number of drugs and cohabitation status. Significant correlations between the mean hourly number of steps and MPI (p = 0.022), IADL (p = 0.013), SPMSQ (p = 0.006), ESS (p = 0.009), and both mean and maximum automated gait speed (p = 0.046 and p = 0.048) were found. Automated gait speed was also correlated with mean walked distance per day (p = 0.007) and lean-in (p = 0.047). Domotic technological monitoring through Fitbit Sense and Kinect Azure provides information on multidimensional frailty, including mobility and cognitive and functional status, in older people.", "links": [] }, { "title": "Analysis of Physical Activity Using Wearable Health Technology in US Adults Enrolled in the All of Us Research Program: Multiyear Observational Study", "author": "Singh, Rujul; Tetrick, Macy K.; Fisher, James L.; Washington, Peter; Yu, Jane; Paskett, Electra D.; Penedo, Frank J.; Clinton, Steven K.; Benzo, Roberto M.", "year": "2024", "journalProceedings": "Journal of Medical Internet Research", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "BACKGROUND: To date, no studies have examined adherence to the 2018 Physical Activity Guidelines for Americans (PAGA) in real-world longitudinal settings using objectively measured activity monitoring data. This study addresses this gap by using commercial activity monitoring (Fitbit) data from the All of Us dataset. OBJECTIVE: The primary objectives were to describe the prevalence of adherence to the 2018 PAGA and identify associated sociodemographic determinants. Additionally, we compared 3 distinct methods of processing physical activity (PA) data to estimate adherence to the 2008 PAGA. METHODS: We used the National Institutes of Health's All of Us dataset, which contains minute-level Fitbit data for 13,947 US adults over a 7-year time span (2015-2022), to estimate adherence to PAGA. A published step-based method was used to estimate metabolic equivalents and assess adherence to the 2018 PAGA (ie, ≥150 minutes of moderate- to vigorous-intensity PA per week). We compared the step-based method, the heart rate-based method, and the proprietary Fitbit-developed algorithm to estimate adherence to the 2008 PAGA. RESULTS: The average overall adherence to the 2018 PAGA was 21.6\\% (3006/13,947; SE 0.4\\%). Factors associated with lower adherence in multivariate logistic regression analysis included female sex (relative to male sex; adjusted odds ratio [AOR] 0.66, 95\\% CI 0.60-0.72; P{\\textless}.001); BMI of 25.0-29.9 kg/m2 (AOR 0.53, 95\\% CI 0.46-0.60; P{\\textless}.001), 30-34.9 kg/m2 (AOR 0.30, 95\\% CI 0.25-0.36; P{\\textless}.001), or ≥35 kg/m2 (AOR 0.13, 95\\% CI 0.10-0.16; P{\\textless}.001; relative to a BMI of 18.5-24.9 kg/m2); being aged 30-39 years (AOR 0.66, 95\\% CI 0.56-0.77; P{\\textless}.001), 40-49 years (AOR 0.79, 95\\% CI 0.68-0.93; P=.005), or ≥70 years (AOR 0.74, 95\\% CI 0.62-0.87; P{\\textless}.001; relative to being 18-29 years); and non-Hispanic Black race or ethnicity (AOR 0.63, 95\\% CI 0.50-0.79; P{\\textless}.001; relative to non-Hispanic White race or ethnicity). The Fitbit algorithm estimated that a larger percentage of the sample (10,307/13,947, 73.9\\%; 95\\% CI 71.2-76.6) adhered to the 2008 PAGA compared to the heart rate method estimate (4740/13,947, 34\\%; 95\\% CI 32.8-35.2) and the step-based method (1401/13,947, 10\\%; 95\\% CI 9.4-10.6). CONCLUSIONS: Our results show significant sociodemographic differences in PAGA adherence and notably different estimates of adherence depending on the algorithm used. These findings warrant the need to account for these disparities when implementing PA interventions and the need to establish an accurate and reliable method of using commercial accelerometers to examine PA, particularly as health care systems begin integrating wearable device data into patient health records.", "links": [] }, { "title": "Exploring the Applications of Explainability in Wearable Data Analytics: Systematic Literature Review", "author": "Abdelaal, Yasmin; Aupetit, Michaël; Baggag, Abdelkader; Al-Thani, Dena", "year": "2024", "journalProceedings": "Journal of Medical Internet Research", "category": "Review", "devices": "Device unspecified", "population": "NA", "dataUsed": "NA", "abstract": "Background: Wearable technologies have become increasingly prominent in health care. However, intricate machine learning and deep learning algorithms often lead to the development of \"black box\" models, which lack transparency and comprehensibility for medical professionals and end users. In this context, the integration of explainable artificial intelligence (XAI) has emerged as a crucial solution. By providing insights into the inner workings of complex algorithms, XAI aims to foster trust and empower stakeholders to use wearable technologies responsibly.\n\nObjective: This paper aims to review the recent literature and explore the application of explainability in wearables. By examining how XAI can enhance the interpretability of generated data and models, this review sought to shed light on the possibilities that arise at the intersection of wearable technologies and XAI.\n\nMethods: We collected publications from ACM Digital Library, IEEE Xplore, PubMed, SpringerLink, JMIR, Nature, and Scopus. The eligible studies included technology-based research involving wearable devices, sensors, or mobile phones focused on explainability, machine learning, or deep learning and that used quantified self data in medical contexts. Only peer-reviewed articles, proceedings, or book chapters published in English between 2018 and 2022 were considered. We excluded duplicates, reviews, books, workshops, courses, tutorials, and talks. We analyzed 25 research papers to gain insights into the current state of explainability in wearables in the health care context.\n\nResults: Our findings revealed that wrist-worn wearables such as Fitbit and Empatica E4 are prevalent in health care applications. However, more emphasis must be placed on making the data generated by these devices explainable. Among various explainability methods, post hoc approaches stand out, with Shapley Additive Explanations as a prominent choice due to its adaptability. The outputs of explainability methods are commonly presented visually, often in the form of graphs or user-friendly reports. Nevertheless, our review highlights a limitation in user evaluation and underscores the importance of involving users in the development process.\n\nConclusions: The integration of XAI into wearable health care technologies is crucial to address the issue of black box models. While wrist-worn wearables are widespread, there is a notable gap in making the data they generate explainable. Post hoc methods such as Shapley Additive Explanations have gained traction for their adaptability in explaining complex algorithms visually. However, user evaluation remains an area in which improvement is needed, and involving users in the development process can contribute to more transparent and reliable artificial intelligence models in health care applications. Further research in this area is essential to enhance the transparency and trustworthiness of artificial intelligence models used in wearable health care technology.\n\nKeywords: XAI; analytics; deep learning; explainable artificial intelligence; health informatics; interpretation; machine learning; user experience; wearable; wearable data; wearable sensors.", "links": [] }, { "title": "The Physical Activity at Work (PAW) Program in Thai Office Workers: Mixed Methods Process Evaluation Study", "author": "Akksilp, Katika; Rouyard, Thomas; Isaranuwatchai, Wanrudee; Nakamura, Ryota; Müller-Riemenschneider, Falk; Teerawattananon, Yot; Chen, Cynthia", "year": "2025", "journalProceedings": "JMIR formative research", "category": "Intervention", "devices": "Inspire HR", "population": "Adults", "dataUsed": "Steps,Device Weartime", "abstract": "Background: An increasing number of multicomponent workplace interventions are being developed to reduce sedentary time and promote physical activity among office workers. The Physical Activity at Work (PAW) trial was one of these interventions, but it yielded an inconclusive effect on sedentary time after 6 months, with a low uptake of movement breaks, the main intervention component.\n\nObjective: This study investigates the factors contributing to the outcomes of the PAW cluster randomized trial.\n\nMethods: Following the Medical Research Council's guidance for process evaluation of complex interventions, we used a mixed methods study design to evaluate the PAW study's recruitment and context (how job nature and cluster recruitment affected movement break participation), implementation (dose and fidelity), and mechanisms of impact (assessing how intervention components affected movement break participation and identifying the facilitators and barriers to participation in the movement breaks). Data from accelerometers, pedometers, questionnaires, on-site monitoring, and focus group discussions were used for the evaluation. Linear mixed effects models were used to analyze the effects of different intervention components on the movement breaks. Subsequently, qualitative analysis of the focus group discussions provided additional insights into the relationship between the intervention components.\n\nResults: The participation in movement breaks declined after the third week, averaging 12.7 sessions (SD 4.94) per participant per week for the first 3 weeks, and continuing to decrease throughout the intervention. On-site monitoring confirmed high implementation fidelity. Analysis of Fitbit data revealed that each additional movement break was associated with a reduction of 6.20 (95% CI 6.99-5.41) minutes in sedentary time and an increase of 245 (95% CI 222-267) steps. Regarding the mechanisms of impact, clusters with higher baseline sedentary time demonstrated greater participation in movement breaks, while those with frequent out-of-office duties showed minimal engagement. Moreover, clusters with enthusiastic and encouraging movement break leaders were associated with a 24.1% (95% CI 8.88%-39.4%) increase in participation. Environmental and organizational support components using posters and leaders' messages were ineffective, showing no significant change in percentage participation in movement breaks (4.49%, 95% CI -0.49% to 9.47% and 1.82%, 95% CI -2.25% to 5.9%, respectively). Barriers such as high workloads and meetings further hindered participation, while the facilitators included participants' motivation to feel active and the perceived health benefits from movement breaks.\n\nConclusions: Despite high fidelity, the PAW trial did not significantly reduce sedentary time, with limited uptake of movement breaks due to context-related challenges, ineffective environmental support, and high workloads during the COVID-19 pandemic.\n\nKeywords: movement breaks; physical activity; process evaluation; sedentary behavior; workplace.", "links": [] }, { "title": "Enhancing Interpretable, Transparent, and Unobtrusive Detection of Acute Marijuana Intoxication in Natural Environments: Harnessing Smart Devices and Explainable AI to Empower Just-In-Time Adaptive Interventions: Longitudinal Observational Study", "author": "Bae, Sang Won; Chung, Tammy; Zhang, Tongze; Dey, Anind K.; Islam, Rahul", "year": "2025", "journalProceedings": "Jmir Ai", "category": "Case Study", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Background: Acute marijuana intoxication can impair motor skills and cognitive functions such as attention and information processing. However, traditional tests, like blood, urine, and saliva, fail to accurately detect acute marijuana intoxication in real time.\n\nObjective: This study aims to explore whether integrating smartphone-based sensors with readily accessible wearable activity trackers, like Fitbit, can enhance the detection of acute marijuana intoxication in naturalistic settings. No previous research has investigated the effectiveness of passive sensing technologies for enhancing algorithm accuracy or enhancing the interpretability of digital phenotyping through explainable artificial intelligence in real-life scenarios. This approach aims to provide insights into how individuals interact with digital devices during algorithmic decision-making, particularly for detecting moderate to intensive marijuana intoxication in real-world contexts.\n\nMethods: Sensor data from smartphones and Fitbits, along with self-reported marijuana use, were collected from 33 young adults over a 30-day period using the experience sampling method. Participants rated their level of intoxication on a scale from 1 to 10 within 15 minutes of consuming marijuana and during 3 daily semirandom prompts. The ratings were categorized as not intoxicated (0), low (1-3), and moderate to intense intoxication (4-10). The study analyzed the performance of models using mobile phone data only, Fitbit data only, and a combination of both (MobiFit) in detecting acute marijuana intoxication.\n\nResults: The eXtreme Gradient Boosting Machine classifier showed that the MobiFit model, which combines mobile phone and wearable device data, achieved 99% accuracy (area under the curve=0.99; F1-score=0.85) in detecting acute marijuana intoxication in natural environments. The F1-score indicated significant improvements in sensitivity and specificity for the combined MobiFit model compared to using mobile or Fitbit data alone. Explainable artificial intelligence revealed that moderate to intense self-reported marijuana intoxication was associated with specific smartphone and Fitbit metrics, including elevated minimum heart rate, reduced macromovement, and increased noise energy around participants.\n\nConclusions: This study demonstrates the potential of using smartphone sensors and wearable devices for interpretable, transparent, and unobtrusive monitoring of acute marijuana intoxication in daily life. Advanced algorithmic decision-making provides valuable insight into behavioral, physiological, and environmental factors that could support timely interventions to reduce marijuana-related harm. Future real-world applications of these algorithms should be evaluated in collaboration with clinical experts to enhance their practicality and effectiveness.\n\nKeywords: Fitbit; JITAI; XAI; XGBoost; algorithmic decision-making process; artificial intelligence; cannabis; data collection; decision support; digital phenotyping; eXtreme Gradient Boosting Machine classifier; experience sampling; explainable artificial intelligence; intoxication; just-in-time adaptive interventions; mHealth; machine learning; marijuana; passive sensing; smart devices; smartphone-based sensors; wearables.", "links": [] }, { "title": "A Remotely Delivered Light-Intensity Physical Activity Intervention for Older Cancer Survivors: Protocol for a Feasibility Randomized Controlled Trial", "author": "Blair, Cindy K.; Brown-Glaberman, Ursa; Walters, Scott T.; Pestak, Claire; Boyce, Tawny; Barriga, Laura; Burgess, Ellen; Tawfik, Bernard; Killough, Cynthia; Kinney, Anita Y.; Demark-Wahnefried, Wendy; Meisner, Angela L.; Wiggins, Charles L.; Pankratz, V. Shane; Davis, Sally", "year": "2024", "journalProceedings": "JMIR research protocols", "category": "Intervention", "devices": "Inspire 3", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Background: Older cancer survivors face age- and treatment-related comorbidities, including physical functional impairment, which are exacerbated by physical inactivity and sedentary behavior. Regular physical activity can reduce this risk, yet less than 30% of older cancer survivors meet the recommended guidelines for physical activity.\n\nObjective: This study aims to describe the design, methods, and rationale for a remotely delivered intervention that uses a whole-of-day approach to physical activity in older cancer survivors. This approach focuses on the accumulation of intermittent bouts of light-intensity activity throughout the entire day by disrupting and reducing sedentary activity. The intervention was guided by social cognitive and self-determination theories and incorporated motivational interviewing.\n\nMethods: The 12-week Move for Your Health trial randomly assigned 64 older cancer survivors to a theory-based physical activity intervention or a waitlist control. A Fitbit (Google) activity tracker and smartphone app were used to promote awareness of activity levels and enable self-monitoring of both activity and inactivity in tandem with health coaching phone calls. Motivational interviewing was used to engage participants and tailor strategies to achieve goals during the 12-week intervention. Data were collected at baseline, immediately after the intervention, and at longer-term follow-up (3 months thereafter). Feasibility outcomes included recruitment, retention, adherence, adverse events, and acceptability. Other outcomes included obtaining the parameter estimates for changes in physical function, physical performance, physical activity, sedentary behavior, and quality of life.\n\nResults: Recruitment for the Move for Your Health randomized controlled trial was completed in June 2023. Data collection was completed in March 2024. Data analyses are ongoing.\n\nConclusions: The results of this trial will provide information on the feasibility of implementing this intervention in the target patient population, as well as data that will provide information about the potential impact of the intervention on the outcomes. Both of these outcomes will inform the design of a larger randomized controlled trial to more fully test a physical activity intervention in an older cancer survivor population.\n\nTrial registration: ClinicalTrials.gov NCT05582889; https://clinicaltrials.gov/study/NCT05582889.\n\nInternational registered report identifier (irrid): DERR1-10.2196/59504.\n\nKeywords: activity tracker; cancer survivor; mobile phone; older adults; physical activity; physical function; physical performance.", "links": [] }, { "title": "Digital Rehabilitation Program for Breast Cancer Survivors on Adjuvant Hormonal Therapy: A Feasibility Study", "author": "Chan, Wing-Lok; Wong, Yat-Lam; Tai, Yin-Ling; Liu, Michelle; Yun, Bryan; Zhang, Yuning; Hou, Holly Li-Yu; Kwong, Dora; Lee, Victor Ho-Fun; Lam, Wendy Wing-Tak", "year": "2024", "journalProceedings": "Cancers", "category": "Intervention", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Intensity,Active Minutes/Active Zone Minutes", "abstract": "Background: Breast cancer survivors often face physical and psychological challenges, including weight gain, metabolic syndrome, and reduced quality of life. To address these concerns, a mobile app-based rehabilitation program called \"THRIVE\" was developed to improve physical activity, medication adherence, and health-related quality of life (HRQoL) in this population. Methods: This prospective, single-arm study assessed the feasibility and effectiveness of the \"THRIVE\" app among breast cancer survivors undergoing hormonal therapy. Participants were recruited from Queen Mary Hospital in Hong Kong between December 2022 and June 2023. Eligible survivors had completed treatment within the last five years or had stable advanced disease on hormonal therapy. Participants monitored their exercise, medication adherence, and self-care via the app and a Fitbit activity tracker for 16 weeks. Primary outcomes included recruitment, dropout, adherence rates, and safety. Secondary outcomes, measured at baseline and week 16, included physical activity intensity, HRQoL, psychological stress, body composition, and app satisfaction. Results: A total of 50 participants, with a median age of 53 years, completed the study. The recruitment rate was 70.4% with no dropouts. The adherence rate, measured by completing exercises recommended in the mobile app at least three times per week, was 74%. No severe adverse events were reported. While physical activity intensity showed no significant changes from baseline to week 16 (p = 0.24), cognitive function (p = 0.021), future perspective (p = 0.044), arm symptoms (p = 0.042), depression (p = 0.01), and anxiety (p = 0.004) improved. All participants reported perfect medication compliance (100%). Satisfaction with the app was high. Conclusions: This mobile app-based rehabilitation program demonstrated good feasibility, with satisfactory recruitment, adherence, and safety, providing valuable insights into future definitive studies.\n\nKeywords: breast cancer; cognition; depression; digital rehabilitation; hormonal therapy; mobile app-based intervention; survivor.", "links": [] }, { "title": "Feasibility of at-Home Sleep Monitoring in Adolescents with and without Concussion", "author": "Donahue, Catherine C.; Smulligan, Katherine L.; Wingerson, Mathew J.; Kniss, Joshua R.; Simon, Stacey L.; Wilson, Julie C.; Howell, David R.", "year": "2024", "journalProceedings": "Nature and Science of Sleep", "category": "Usability", "devices": "Charge 2", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "Background: Poor sleep is associated with longer recovery following adolescent concussion, making the longitudinal assessment of sleep important for monitoring recovery and identifying sleep disruptions. An important consideration for successful monitoring of sleep following concussion is the feasibility and adherence of a given sleep monitoring tool when used in an at-home environment. Understanding the usability of different sleep monitoring tools is essential for determining their applicability for longitudinal assessment in an ecologically valid environment.\n\nPurpose: The purpose of this study was to: (1) report on the adherence and feasibility of at-home sleep monitoring in adolescents following concussion, and (2) compare outcomes of subjective and wearable measures of sleep between adolescents with and without a concussion.\n\nPatients and methods: Participants included adolescents within 21 days of a concussion and uninjured controls that participated in four separate, prospective and longitudinal investigations of sleep following concussion. Sleep data was measured with: (1) Dreem Headband; (2) Philips Actiwatch; (3) Fitbit; and (4) subjective sleep diary. Sleep data was collected nightly, and adherence was defined as percentage of nights the participant used the sleep-monitoring tool over the study duration. Independent t-tests and effect sizes were calculated for the following sleep data outcomes as measured by each of the monitoring tools: duration, efficiency, latency, wake after sleep onset.\n\nResults: Sleep data for a total of 183 adolescents (104 with concussion, 79 uninjured controls) was assessed. Adherence rates across all devices ranged from 53% to 98%, with the subjective sleep diary showing the highest adherence rate for both groups (concussion: 91%, control: 94%). Across the four different monitoring tools, adolescents with a concussion demonstrated longer duration, latency, wake after sleep onset, and lower (worse) efficiency, with medium to large effect sizes.\n\nConclusion: The results indicate that at-home sleep monitoring is a feasible approach for tracking sleep in adolescents following concussion.", "links": [] }, { "title": "Relationship between physical activity and biomarkers of pathology and neuroinflammation in preclinical autosomal-dominant Alzheimer's disease", "author": "Guzmán-Vélez, Edmarie; Rivera-Hernández, Angelys; Fabrega, Sofia; Oliveira, Gabriel; Martínez, Jairo E.; Baena, Ana; Picard, Glen; Lopera, Francisco; Arnold, Steven E.; Taylor, J. Andrew; Quiroz, Yakeel T.", "year": "2024", "journalProceedings": "Alzheimer's \\& Dementia (New York, N. Y.)", "category": "Case Study", "devices": "Charge 4", "population": "Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Objective: Physical activity (PA) has been linked to reduced Alzheimer's disease (AD) risk. However, less is known about its effects in the AD preclinical stage. We aimed to investigate whether greater PA was associated with lower plasma biomarkers of AD pathology, neural injury, reactive astrocytes, and better cognition in individuals with autosomal-dominant AD due to the presenilin-1 E280A mutation who are virtually guaranteed to develop dementia.\n\nMethods: Twenty-eight cognitively unimpaired mutation carriers (ages x̄ = 29.28) wore a FitBit Charge-4 for 14 days. We calculated their average steps to measure locomotion, and Training Impulse (TRIMP) to quantify the intensity and duration of PAs using heart rate. Plasma amyloid beta 42/40 ratio, phosphorylated tau 181, neurofilament light chain, and glial fibrillary acidic protein (GFAP) were measured. Cognition was assessed with the Consortium to Establish a Registry for Alzheimer's Disease word list learning and delayed recall, Trail Making Test Part A, and Wechsler Adult Intelligence Scale-version IV Digit Span Backward. We conducted multiple linear regressions controlling for age, sex, body mass index, and education.\n\nResults: There were no associations among steps or TRIMP with plasma biomarkers or cognition. Greater TRIMP was related to higher GFAP levels.\n\nConclusions: PA was not associated with cognition or plasma biomarkers. However, greater intensity and duration of PAs were related to higher GFAP. Participants engaged very little in moderate to vigorous PA. Therefore, light PA may not exert a significant protective effect in preclinical AD. Future work with larger samples and longitudinal data is needed to elucidate further the potential impact of PA on AD progression in the preclinical stages.\n\nHighlights: Locomotion (average steps) was not associated with plasma biomarkers or cognition.Greater training load (training impulse) was related to higher glial fibrillary acidic protein levels in mutation carriers.Light physical activity may not suffice to exert a protective effect on Alzheimer's disease.\n\nKeywords: early onset Alzheimer's disease; exercise; glial fibrillary acidic protein; neurofilament light chain; phosphorylated tau 181; presenilin‐1 E280A.", "links": [] }, { "title": "Sensor-Based Frailty Assessment Using Fitbit", "author": "Hosseinalizadeh, Mohammad; Asghari, Mehran; Toosizadeh, Nima", "year": "2024", "journalProceedings": "Sensors (Basel, Switzerland)", "category": "Usability", "devices": "Sense 2", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "This study evaluated the reliability of Fitbit in assessing frailty based on motor and heart rate (HR) parameters through a validated upper extremity function (UEF) test, which involves 20 s of rapid elbow flexion. For motor performance, participants completed six trials of full elbow flexion using their right arm, with and without weight. Fitbit and a commercial motion sensor were worn on the right arm. For HR measurements, an ECG system was placed on the left chest alongside the Fitbit on the left wrist. Motor parameters assessing speed, flexibility, weakness, exhaustion, and HR before, during, and after UEF were measured. A total of 42 participants (age = 22 ± 3) were recruited. For motor parameters, excellent agreement was observed between the wearable sensor and Fitbit, except for flexibility (ICC = 0.87 ± 0.09). For HR parameters, ICC values showed weak agreement between ECG and Fitbit for HR increase and recovery (ICC = 0.24 ± 0.11), while moderate to stronger agreement was seen for mean HR during baseline, task, and post-task (ICC = 0.81 ± 0.13). Fitbit is a reliable tool for assessing frailty through motor parameters and provides reasonably accurate HR estimates during baseline, task, and recovery periods. However, Fitbit's ability to track rapid HR changes during activity is limited.\n\nKeywords: Fitbit smartwatch; frailty assessment; heart rate (HR) monitoring; motor performance; wearable sensor.", "links": [] }, { "title": "Can Wearable Technology Help Guide Dieting Safety?", "author": "Tang, Maya; Powell, Joseph; Li, Xiao", "year": "2024", "journalProceedings": "Research Square", "category": "Intervention", "devices": "Versa", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Background: The safety of dietary interventions is often unmonitored. Wearable technology can track elevations in resting heart rate (RHR), a marker of physiologic stress, which may provide safety information that is incremental to self-reported data.\n\nMethods: A single subject was placed on an isocaloric diet for four weeks. In weeks # 1 and 4, timing of food consumption was unregulated. In week #2, food was consumed during a three-hour feeding window (one-meal-a-day, OMAD). During week #3, food was consumed at six intervals, spaced three hours apart (6-meal diet). A Fitbit Versa™ was worn continuously, and questionnaires were administered twice daily.\n\nResults: Meal frequency did not affect the subject's weight. Hunger scores from morning and night were widely split on OMAD and relatively constant on the 6-meal diet. Energy, happiness, irritability, and sleep scores were more favorable on the 6-meal diet than on OMAD. RHR extracted from the wearable device was lower during the 6-meal diet than during OMAD, especially in the late afternoon, evening, and nighttime (p<0.05). Lower RHR during the 6-meal diet corresponded to more favorable questionnaire scores.\n\nConclusions: Changes in RHR patterns acquired by wearable technology are promising indicators of physiologic stress during dietary interventions. Wearable technology can provide physiologic data that are complementary to questionnaire scores or timed manual measurements.\n\nKeywords: dieting; resting heart rate; wearable technology.", "links": [] }, { "title": "Commonly Used Dose of Montmorency Tart Cherry Powder Does Not Improve Sleep or Inflammation Outcomes in Individuals with Overweight or Obesity", "author": "Tucker, Robin M.; Kim, Nahyun; Gurzell, Eric; Mathi, Sruti; Chavva, Shreya; Senthilkumar, Dharshini; Bartunek, Olivia; Fenton, Kayla C.; Herndon-Fenton, Sidney J.; Cardino, Vanessa N.; Cooney, Gabrielle M.; Young, Sam; Fenton, Jenifer I.", "year": "2024", "journalProceedings": "Nutrients", "category": "Case Study", "devices": "Inspire 3", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background/objectives: Sleep problems are frequently experienced and play an important role in inflammation and disease risk. US Montmorency tart cherries (MTC) improve sleep outcomes in previous studies, but studies in individuals with overweight and obesity are lacking.\n\nMethods: A total of 34 individuals with sleep issues and overweight or obesity (BMI: 32.1 ± 7.0 kg/m2) were recruited to this randomized controlled, crossover study. MTC capsules (500 mg) or a placebo were taken one hour before bed for 14 days. Sleep outcomes including total sleep time, deep and REM sleep duration, nap duration, and nocturnal sleep duration were assessed using the Zmachine and/or Fitbit Inspire 3. Subjective sleep information on quality and insomnia symptoms was collected using the Pittsburgh Sleep Quality Index, the Sleep Quality Scale, and the Insomnia Severity Index. Markers of inflammation included C-reactive protein, TNF-α, and IL-6, IL-8, IL-10, and IL-17A.\n\nResults: No significant effects of MTC supplementation were observed for any of the measures of interest (p > 0.05 for all).\n\nConclusions: These results suggest studies of individuals with overweight and obesity should test higher doses of MTC than those currently recommended.", "links": [] }, { "title": "An approach to boost adherence to self-data reporting in mHealth applications for users without specific health conditions", "author": "Aguiar, Maria; Cejudo, Ander; Epelde, Gorka; Chaves, Deisy; Trujillo, Maria; Artola, Garazi; Ayala, Unai; Bilbao, Roberto; Tueros, Itziar", "year": "2025", "journalProceedings": "BMC medical informatics and decision making", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Energy Expenditure", "abstract": "Background: The popularization of mobile health (mHealth) apps for public health or medical care purposes has transformed human life substantially, improving lifestyle behaviors and chronic condition management. The objective of this study is to evaluate the effect of gamification features in a mHealth app that includes the most common categories of behavior change techniques for the self-report of lifestyle data. The data reported by the user can be manual (i.e., diet, activity, and weight) and automatic (Fitbit wearable devices). As a secondary objective, this work aims to explore the differences in the adherence when considering a longer study duration and make a comparative analysis of the gamification effect.\n\nMethods: In this study, the effectiveness of various behavior change techniques strategies is evaluated through the analysis of two user groups. With a first group of users, we perform a comparative analysis in terms of adherence and system usability scale of two versions of the app, both including the most common categories of behavior change techniques but the second version having added gamification features. Then, with a second group of participants and the best mHealth app version, a longer study is carried out and user adherence, the system usability scale and user feedback are analyzed.\n\nResults: In the first stage study, results have shown that the app version with gamification features has achieved a higher adherence, as the percentage of days active was higher for most of the users and the system usability scale score is 80.67, which is categorized as rank A. The app also exceeded the expectations of the users by about 70% for the app version with gamification functionalities. In the second stage of the study, an adherence of 76.25% is reported after 8 weeks and 58% at the end of the pilot for the mHealth app. Similarly, for the wearable device, an adherence of 74.32% is achieved after 8 weeks and 81.08% is obtained at the end of the pilot. We hypothesize that these specific wearable devices have contributed to a decreased system usability scale score, reaching 62.89 which is ranked as C.\n\nConclusion: This study evidences the effectiveness of the gamification category of behavior change techniques in increasing the overall user adherence, expectations, and perceived usability. In addition, the results provide quantitative results on the effect of the most common categories of behavior change techniques for the self-report of lifestyle data. Therefore, a higher duration in the study has shown several limitations when capturing lifestyle data, especially when including wearable devices such as Fitbit.", "links": [] }, { "title": "Improving Outcomes for Care Partners of Individuals With Traumatic Brain Injury: Results for a mHealth Randomized Control Trial of the CareQOL App", "author": "Carlozzi, Noelle E.; Troost, Jonathan P.; Sen, Srijan; Choi, Sung Won; Wu, Zhenke; Miner, Jennifer A.; Lombard, Wendy L.; Graves, Christopher; Sander, Angelle M.", "year": "2025", "journalProceedings": "Archives of Physical Medicine and Rehabilitation", "category": "Intervention", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Sleep,User Friendliness", "abstract": "Objective: To test the efficacy of a randomized control trial low-touch mobile health intervention designed to promote care partner self-awareness and self-care.\n\nDesign: This randomized controlled trial included a baseline assessment of self-report surveys of health-related quality of life (HRQOL), care partner-specific outcomes, and the functional/mental status of the person with traumatic brain injury (TBI), as well as a 6-month home monitoring period that included 3 daily questions about HRQOL, monthly assessments of 12 HRQOL domains, and the use of a Fitbit to continuously monitor physical activity and sleep. HRQOL surveys were repeated at 3 and 6 months post-home monitoring.\n\nSetting: Two academic medical centers.\n\nParticipants: A total of 254 TBI care partners.\n\nInterventions: The CareQOL app, a mobile health app designed to promote care partner self-awareness (through self-monitoring) and self-care (through personalized self-care push notifications).\n\nResults: Care partners were randomly assigned to self-monitoring alone (n=128) or self-monitoring plus self-care push notifications (n=126). Although we neither saw improvements in HRQOL outcomes, nor in physical activity or sleep, we found that across all the different measures, approximately 1/3 of the participants showed clinically meaningful improvements, 1/3 stayed the same, and 1/3 got worse; care partners who reported engagement in the intervention were more likely to show improvements than those who were not engaged. There was preliminary support for factors that being male, caring for a person with posttraumatic stress symptoms, living in the same household as the person with TBI, being a spousal care partner, working, and being diagnosed with COVID-19 during the study were associated with increased risk for negative outcomes.\n\nConclusions: Findings suggest that engagement with the app, even when it is confined to self-monitoring alone, is associated with small improvements in HRQOL.\n\nKeywords: Brain injuries; Caregivers; Health care; Mobile applications; Outcome assessment; Quality of life; Rehabilitation; Self-monitoring; Traumatic.", "links": [] }, { "title": "Reliability and Accuracy of the Fitbit Charge 4 Photoplethysmography Heart Rate Sensor in Ecological Conditions: Validation Study", "author": "Ceugniez, Maxime; Devanne, Hervé; Hermand, Eric", "year": "2025", "journalProceedings": "JMIR mHealth and uHealth", "category": "Validation", "devices": "Charge 4", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Background: Wrist-worn photoplethysmography (PPG) sensors allow for continuous heart rate (HR) measurement without the inconveniences of wearing a chest belt. Although green light PPG technology reduces HR measurement motion artifacts, only a limited number of studies have investigated the reliability and accuracy of wearables in non-laboratory-controlled conditions with actual specific and various physical activity movements.\n\nObjective: The purpose of this study was to (1) assess the reliability and accuracy of the PPG-based HR sensor of the Fitbit Charge 4 (FC4) in ecological conditions and (2) quantify the potential variability caused by the nature of activities.\n\nMethods: We collected HR data from participants who performed badminton, tennis, orienteering running, running, cycling, and soccer while simultaneously wearing the FC4 and the Polar H10 chest belt (criterion sensor). Skin tone was assessed with the Fitzpatrick Skin Scale. Once data from the FC4 and criterion data were synchronized, accuracy and reliability analyses were performed, using intraclass correlation coefficients (ICCs), Lin concordance correlation coefficients (CCCs), mean absolute percentage errors (MAPEs), and Bland-Altman tests. A linear univariate model was also used to evaluate the effect of skin tone on bias. All analyses were stratified by activity and pooled activity types (racket sports and running sports).\n\nResults: A total of 77.5 hours of HR recordings from 26 participants (age: mean 21.1, SD 5.8 years) were analyzed. The highest reliability was found for running sports, with ICCs and CCCs of 0.90 and 0.99 for running and 0.80 and 0.93 for orienteering running, respectively, whereas the ICCs and CCCs were 0.37 and 0.78, 0.42 and 0.88, 0.65 and 0.97, and 0.49 and 0.81 for badminton, tennis, cycling, and soccer, respectively. We found the highest accuracy for running (bias: 0.1 beats per minute [bpm]; MAPE 1.2%, SD 4.6%) and the lowest for badminton (bias: -16.5 bpm; MAPE 16.2%, SD 14.4%) and soccer (bias: -16.5 bpm; MAPE 17.5%, SD 20.8%). Limit of agreement (LOA) width and artifact rate followed the same trend. No effect of skin tone was observed on bias.\n\nConclusions: LOA width, bias, and MAPE results found for racket sports and soccer suggest a high sensitivity to motion artifacts for activities that involve \"sharp\" and random arm movements. In this study, we did not measure arm motion, which limits our results. However, whereas individuals might benefit from using the FC4 for casual training in aerobic sports, we cannot recommend the use of the FC4 for specific purposes requiring high reliability and accuracy, such as research purposes.\n\nKeywords: Fitbit; Fitbit Charge 4; accuracy; device; ecological; ecological conditions; exercise; heart rate; heart rate sensor; photoplethysmography; physical activity; reliability; sensitivity; sensor; usefulness; variability; wearables; wrist-worn device.", "links": [] }, { "title": "Use of mHealth Technology for Improving Exercise Adherence in Patients With Heart Failure: Systematic Review", "author": "Deka, Pallav; Salahshurian, Erin; Ng, Teresa; Buchholz, Susan W.; Klompstra, Leonie; Alonso, Windy", "year": "2025", "journalProceedings": "Journal of Medical Internet Research", "category": "Systematic Review", "devices": "Charge HR,Inspire HR", "population": "NA", "dataUsed": "Steps,Heart Rate", "abstract": "Background: The known and established benefits of exercise in patients with heart failure (HF) are often hampered by low exercise adherence. Mobile health (mHealth) technology provides opportunities to overcome barriers to exercise adherence in this population.\n\nObjective: This systematic review builds on prior research to (1) describe study characteristics of mHealth interventions for exercise adherence in HF including details of sample demographics, sample sizes, exercise programs, and theoretical frameworks; (2) summarize types of mHealth technology used to improve exercise adherence in patients with HF; (3) highlight how the term \"adherence\" was defined and how it was measured across mHealth studies and adherence achieved; and (4) highlight the effect of age, sex, race, New York Heart Association (NYHA) functional classification, and HF etiology (systolic vs diastolic) on exercise adherence.\n\nMethods: We searched for papers in PubMed, MEDLINE, and CINAHL databases and included studies published between January 1, 2015, and June 30, 2022. The risk of bias was analyzed.\n\nResults: In total, 8 studies (4 randomized controlled trials and 4 quasi-experimental trials) met our inclusion and exclusion criteria. A moderate to high risk of bias was noted in the studies. All studies included patients with HF in NYHA classification I-III, with sample sizes ranging from 12 to 81 and study durations lasting 4 to 26 weeks. Six studies had an equal distribution of male and female participants whose ages ranged between 53 and 73 years. Videoconferencing was used in 4 studies, while 4 studies used smartphone apps. Three studies using videoconferencing included an intervention that engaged participants in a group setting. A total of 1 study used a yoga program, 1 study used a walking program, 1 study combined jogging with walking, 1 study used a cycle ergometer, 2 studies combined walking with cycle ergometry, and 1 study used a stepper. Two studies incorporated resistance exercises in their program. Exercise programs varied, ranging between 3 and 5 days of exercise per week, with exercise sessions ranging from 30 to 60 minutes. The Borg rating of perceived exertion scale was mostly used to regulate exercise intensity, with 3 studies using heart rate monitoring using a Fitbit. Only 1 study implicitly mentions developing their intervention using a theoretical framework. Adherence was reported to the investigator-developed exercise programs. All studies were mostly feasibility or pilot studies, and the effect of age, sex, race, and NYHA classification on exercise adherence with the use of mHealth was not reported.\n\nConclusions: The results show some preliminary evidence of the feasibility of using mHealth technology for building exercise adherence in patients with HF; however, theoretically sound and fully powered studies, including studies on minoritized communities, are lacking. In addition, the sustainability of adherence beyond the intervention period is unknown.\n\nKeywords: activity monitors; adherence; age; exercise; exercise programs; feasibility; heart; heart failure; mHealth; mHealth technology; mobile health; mobile phone; race; sex; smartphone; software apps; telehealth technology; videoconferencing.", "links": [] }, { "title": "Promoting Healthy Aging for Older People Living with Chronic Disease by Implementing Community Health Programs: A Randomized Controlled Feasibility Study", "author": "Hill, Anne-Marie; Starling, Trish; Xin, Wei; Naseri, Chiara; Xu, Dan; O'Brien, Geraldine; Etherton-Beer, Christopher; Flicker, Leon; Bulsara, Max; Morris, Meg E.; Vaz, Sharmila", "year": "2024", "journalProceedings": "International Journal of Environmental Research and Public Health", "category": "Intervention", "devices": "Inspire 2", "population": "Older Adults", "dataUsed": "Steps", "abstract": "The rising prevalence of chronic diseases could be mitigated by expanding community programs. This study aimed to evaluate the feasibility of delivering a community wellness program for older adults living with chronic disease. A two-group randomized controlled study, with blinded assessments, enrolling adults (≥50 years) with chronic disease, was conducted at a Western Australian community hub. Participants randomly allocated to the intervention participated in exercise groups and a wellness activity twice a week. Both the intervention and control groups received a Fitbit™ and workbook. The primary outcomes were recruitment, retention, acceptability, and suitability. The secondary outcomes measured at baseline and 12 weeks included physical function and physical activity (step count). There were 126 older adults approached, of whom 22 (17.5%) were recruited. Eighteen participants (mean age = 70.8 ± 8.1, n = 8 intervention, n = 10 control) completed 12 weeks. Two intervention participants (25% adherence) completed over 70% of sessions and eight participants (44.4% retention) accepted an ongoing 3-month program. Health problems (30.2%) were barriers to both recruitment and adherence. There were no significant between-group differences in physical function. Physical activity was significantly higher in the intervention group compared to the control group (p = 0.01). Tailored programs with ongoing support may be required to improve the health of older adults living with chronic disease.", "links": [] }, { "title": "Exploring the Use of Activity Trackers to Support Physical Activity and Reduce Sedentary Behavior in Adults Diagnosed With Type 2 Diabetes: Qualitative Interview Study Using the RE-AIM Framework", "author": "Hodgson, William; Kirk, Alison; Lennon, Marilyn; Janssen, Xanne", "year": "2024", "journalProceedings": "JMIR diabetes", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Distance,Sleep,User Friendliness", "abstract": "Background: The prevalence of type 2 diabetes in adults worldwide is increasing. Low levels of physical activity and sedentary behavior are major risk factors for developing the disease. Physical activity interventions incorporating activity trackers can reduce blood glucose levels in adults diagnosed with type 2 diabetes. The My Diabetes My Way website is a support and educational platform for people diagnosed with diabetes and health care professionals. Users of the My Diabetes My Way website can upload their Fitbit (Google Inc) activity data into the system but this is not presently being analyzed and used routinely within clinical care. Developers of the My Diabetes My Way system are planning to allow different makes of activity trackers to be integrated with the platform.\n\nObjective: This qualitative study aimed to explore (through the RE-AIM [reach, effectiveness, adoption, implementation, and maintenance] framework) views from adults diagnosed with type 2 diabetes and health care professionals on the integration of activity trackers into type 2 diabetes care.\n\nMethods: Overall, 12 adults diagnosed with type 2 diabetes and 9 health care professionals (4 general practitioners, 1 consultant, 2 diabetes nurses, 1 practice nurse, and 1 physical activity advisor) were recruited through social media and professional contacts. Semistructured one-to-one interviews were conducted. Abductive thematic analysis was undertaken, and main themes and subthemes were identified. The RE-AIM framework was used to evaluate the themes with respect to the wider use of activity trackers and the My Diabetes My Way platform within type 2 diabetes clinical care.\n\nResults: Overall, 6 main themes (awareness, access, cost, promotion, support, and technology and data) and 20 subthemes were identified. Evaluation using the 5 RE-AIM dimensions found that reach could be improved by raising awareness of the My Diabetes My Way platform and the ability to upload activity tracker data into the system. Effectiveness could be improved by implementing appropriate personalized measures of health benefits and providing appropriate support for patients and health care staff. Adoption could be improved by better promotion of the intervention among stakeholders and the development of joint procedures. Implementation could be improved through the development of an agreed protocol, staff training, and introducing measurements of costs. Maintenance could be improved by supporting all patients for long-term engagement and measuring improvements to patients' health.\n\nConclusions: Through this study, we identified how the reach, effectiveness, adoption, implementation, and maintenance of integrating activity trackers into adult type 2 diabetes care could be improved.\n\nKeywords: thematic analysis; Fitbit; My Diabetes My Way; RE-AIM framework; activity tracker; clinical care; diabetes care; health promotion; physical activity; sedentary behavior; type 2 diabetes.", "links": [] }, { "title": "Data from the All of Us research program reinforces existence of activity inequality", "author": "Jeong, Hayoung; Roghanizad, Ali R.; Master, Hiral; Kim, Juseong; Kouame, Aymone; Harris, Paul A.; Basford, Melissa; Marginean, Kayla; Dunn, Jessilyn", "year": "2025", "journalProceedings": "NPJ digital medicine", "category": "Case Study", "devices": "Charge 4,Versa 3", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Large-scale and detailed analyses of activity in the United States (US) remain limited. In this work, we leveraged the comprehensive wearable, demographic, and survey data from the All of Us Research Program, the largest and most diverse population health study in the US to date, to apply and extend the previous global findings on activity inequality within the context of the US. We found that daily steps differed by sex at birth, age, body characteristics, geography, and built environment. Quantifying activity inequality using the modified Gini index, we found a strong correlation with obesity prevalence (R2 = 0.804) and a moderate correlation with perceived walkability (R2 = 0.426) and the activity gender gap (R2 = 0.385). This study demonstrates the value of digital health technologies in exploring and understanding public health practices while highlighting the need to examine complexities, including biopsychosocial factors that may contribute to activity inequality.", "links": [] }, { "title": "Acceptability of the Fit2ThriveMB mHealth physical activity promotion intervention in women with metastatic breast cancer", "author": "Starikovsky, Julia; Solk, Payton; Desai, Ria; Reading, Jean M.; Hasanaj, Kristina; Wang, Shirlene D.; Carden, Lillian B.; Wolter, Melanie; Hickey, Brendan; Lee, Jungwha; Song, Jing; Freeman, Hannah; Alexander, Jacqueline; Spring, Bonnie; Gradishar, William; Phillips, Siobhan M.", "year": "2025", "journalProceedings": "Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer", "category": "Intervention", "devices": "Inspire HR", "population": "Patients", "dataUsed": "Steps", "abstract": "Purpose: Increasing physical activity (PA) is safe and associated with improved health outcomes in patients with metastatic breast cancer (MBC). Mobile health (mHealth) PA interventions that allow for remote monitoring and tailoring to abilities may be particularly useful for MBC patients. However, limited data exist on the acceptability of these interventions for MBC patients. This study examined the acceptability of Fit2ThriveMB, a highly tailored mHealth intervention targeting increased daily steps in MBC patients.\n\nMethods: Insufficiently active women with MBC ((N = 25) Mage = 57.2, SD = 11.9) received the Fit2ThriveMB intervention (Fit2ThrviveMB app, Fitbit, weekly coaching calls) for 12 weeks. Participants completed an online questionnaire (n = 22) and semi-structured interview (n = 23) at 12 weeks to assess intervention acceptability. Quantitative data were analyzed using descriptive statistics. Interviews were analyzed and coded using thematic content analysis and consensus review.\n\nResults: All (n = 23) participants indicated they were satisfied with the intervention, Fit2ThriveMB app design, and Fitbit usability via questionnaire. Four themes emerged from qualitative interview data: (1) Overall satisfaction with implementation, (2) Social interaction is important, but within-app social features need improvement, (3) Fit2ThriveMB was encouraging and enhanced accountability, (4) Fit2ThriveMB helped form sustainable habits. Participants were generally satisfied with the intervention. However, areas for improvement were identified for some study features.\n\nConclusions: Findings indicate Fit2ThriveMB was acceptable among people with MBC. Further refinement of Fit2ThriveMB social feed features and step count goals is warranted for future testing in fully powered trials with a larger sample size.\n\nKeywords: Acceptability; Behavioral medicine; Exercise; MHealth; Metastatic breast cancer.", "links": [] }, { "title": "Accelerometers can correctly count orthopaedic patients' early post-operative steps while using walking aids", "author": "Tsamassiotis, Spiros; Schwarze, Michael; Gehring, Philipp; Karkosch, Roman F.; Tücking, Lars-René; Einfeldt, Ann-Kathrin; Jakubowitz, Eike", "year": "2025", "journalProceedings": "Journal of Experimental Orthopaedics", "category": "Case Study", "devices": "Charge 3,Garmin Vivofit 4", "population": "Adults", "dataUsed": "Steps", "abstract": "Purpose: Effective rehabilitation after orthopaedic surgery is critical. The early post-operative phase is increasingly managed in outpatient settings, necessitating objective measures such as step counts to monitor rehabilitation progress. However, it remains unclear if commercially available wearables or accelerometers using simple algorithms can accurately count steps in early post-operative conditions. We hypothesised that only accelerometers could accurately determine the number of steps under these conditions.\n\nMethods: This case series involved 20 healthy subjects, 7 female and 13 males, walking in a circle at varying speeds under partial loading with three different walking aids (forearm crutches, walking frame and rolling walker) and four wearables (Vivofit 4, Fenix 3HR, Fitbit Charge 3 and Omron HJ-325) and one accelerometer (AX6) worn on the wrist, hip and ankle. The two-point and modified three-point gait patterns commonly used post-operatively were simulated. The primary end point was the relative error (RE), defined as RE = (manual count - automated count)/manual count, of each wearable measurement compared to visual and video step counting, the gold standard.\n\nResults: The RE of AX6 and Fitbit was less than 0.1 for all walking aids except the rolling walker, with AX6 showing the lowest standard deviation (SD) compared to other wearables. Other wearables had significantly higher RE. Increased gait speed generally improved accuracy, reducing RE in most devices, except for the AX6, which showed the opposite trend. At 0.6 m/s, only AX6 achieved an RE below 0.1. The ankle was identified as the best measuring location.\n\nConclusion: During the early post-operative period, commercial wearables can only accurately count steps under specific conditions and should be used cautiously for monitoring steps in the early post-operative phase. However, accelerometers with appropriate coding appear suitable for this purpose.\n\nLevel of evidence: Level III diagnostic study.\n\nKeywords: accelerometer; accuracy; assistive device; early post‐operative period; orthopaedic rehabilitation; speed; step count; walking aid; wearable; weight‐bearing.", "links": [] }, { "title": "The effects of weather on physical activity and sedentary behaviour in older adults", "author": "Crosby, Kathryn M.; Adams, Brittany; Zambrano Garza, Elizabeth; Bourbonnais, Mathieu L.; Fenton, Melanie; Hoppmann, Christiane; Jakobi, Jennifer M.", "year": "2024", "journalProceedings": "Frontiers in Sports and Active Living", "category": "Usability", "devices": "Charge 4", "population": "Older Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND: Many older adults do not meet current physical activity (PA) guidelines, and this might be influenced by environmental factors (e.g., temperature). The purpose of this study was to determine how various weather variables influence light PA (LPA), moderate-vigorous PA (MVPA), and sedentary behaviour (SB), steps, and time spent walking outdoors. METHODS: Fifty community-dwelling older adults completed the 10-day assessment period, using a Fitbit fitness tracker, Global Position System (GPS), and completing self-report questionnaires. Forty participants were included in the analysis. LPA, MVPA, and SB were calculated using heart rate and multilevel models were used to assess their association with weather variables. RESULTS: Number of steps was positively associated with self-reported health status (0.18, p {\\textless} 0.01). Increased age was associated with less time spent engaging in LPA (total and outdoors), reduced steps, increased time spent sedentary, and less time spent walking outdoors. LPA outdoors was positively associated with mean temperature. Freeze thaw cycles were associated with time spent walking outdoors. Females spent more time in total LPA and LPA indoors, and as age increased total LPA and LPA outdoors decreased. CONCLUSIONS: Older adults located in a dry (∼690 mm precipitation annually) region with warm winters and hot summers (-5°C-30°C) seemingly choose indoor activities. Females tend to participate in indoor LPA, and as age increases the time spent in outdoor LPA decreases. IMPLICATIONS: Consideration needs to be given to designing indoor PA interventions, with a focus on increasing MVPA for older adults.", "links": [] }, { "title": "Pain detection using biometric information acquired by a wristwatch wearable device: a pilot study of spontaneous menstrual pain in healthy females", "author": "Hirayama, Hideyuki; Yoshida, Shiori; Sasaki, Konosuke; Yuda, Emi; Yoshida, Yutaka; Miyashita, Mitsunori", "year": "2025", "journalProceedings": "BMC research notes", "category": "Case Study", "devices": "Sense 2", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "OBJECTIVE: Pain is subjective, and self-reporting pain might be challenging. Studies conducted to detect pain using biological signals and real-time self-reports pain are limited. We evaluated the feasibility of collecting pain data on healthy females' menstrual pain and conducted preliminary analysis. RESULTS: Five healthy adult females participated. They wore two wristwatch devices (Silmee and Fitbit) and a Holter ECG (electrocardiogram) during menstruation to record the pain intensity and timing. Subsequently, we analyzed the correlation between heart and pulse rates and assessed pre- and post-pain biometric differences. We collected sixty pain records from five participants. The correlation coefficients between heart rate and pulse rate ranged from 0.79 to 0.95 with Holter ECG vs. Fitbit and 0.32 to 0.74 with Holter ECG vs. Silmee. Analysis revealed significant changes in motion frequency post-pain (p = 0.04). For abdominal pain with a numerical rating scale score of ≥ 4 (n = 13), motion frequency (p {\\textless} 0.001) and pulse rate (p = 0.02) showed significant differences post-pain compared to baseline values. Healthy females could wear the wristwatch device in daily life and report pain in real time. Wristwatch devices can effectively collect biological data to detect moderate pain by focusing on acceleration and pulse rate.", "links": [] }, { "title": "Physiological Data Collected From Wearable Devices Identify and Predict Inflammatory Bowel Disease Flares", "author": "Hirten, Robert P.; Danieletto, Matteo; Sanchez-Mayor, Milagros; Whang, Jessica K.; Lee, Kyung Won; Landell, Kyle; Zweig, Micol; Helmus, Drew; Fuchs, Thomas J.; Fayad, Zahi A.; Nadkarni, Girish N.; Keefer, Laurie; Suarez-Farinas, Mayte; Sands, Bruce E.", "year": "2025", "journalProceedings": "Gastroenterology", "category": "Survey Research", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "BACKGROUND \\& AIMS: Wearable devices capture physiological signals noninvasively and passively. Many of these parameters have been linked to inflammatory bowel disease (IBD) activity. We evaluated the associative ability of several physiological metrics with IBD flares and how they change before the development of flare. METHODS: Participants throughout the United States answered daily disease activity surveys and wore an Apple Watch (Apple), Fitbit (Google), or Oura Ring (Oura Health). These devices collected longitudinal heart rate (HR), resting heart rate (RHR), heart rate variability (HRV), steps, and oxygenation. C-reactive protein, erythrocyte sedimentation rate, and fecal calprotectin were collected as standard of care. Linear mixed-effect models were implemented to analyze HR, RHR, steps, and oxygenation, and cosinor mixed-effect models were applied to HRV circadian features. Mixed-effect logistic regression was used to determine the predictive ability of physiological metrics. RESULTS: Three hundred and nine participants were enrolled across 36 states. Circadian patterns of HRV differed significantly between periods of inflammatory flare and remission and symptomatic flare and remission. Marginal means for HR and RHR were higher during periods of inflammatory flare and symptomatic flare. There were fewer daily steps during inflammatory flares. HRV, HR, and RHR differentiated whether participants with symptoms had inflammation. HRV, HR, RHR, steps, and oxygenation were significantly altered up to 7 weeks before inflammatory and symptomatic flares. CONCLUSIONS: Longitudinally collected physiological metrics from wearable devices can identify and change before IBD flares, suggesting their feasibility to monitor and predict IBD activity.", "links": [] }, { "title": "mHealth-Based Diabetes Prevention Program for Chinese Mothers With Abdominal Obesity: Randomized Controlled Trial", "author": "Huang, Qinyuan; Zhong, Qinyi; Zeng, Yanjing; Li, Yimeng; Wiley, James; Wang, Man Ping; Chen, Jyu-Lin; Guo, Jia", "year": "2025", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "Alta HR", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Sleep,Food", "abstract": "BACKGROUND: Among people with abdominal obesity, women are more likely to develop diabetes than men. Mobile health (mHealth)-based technologies provide the flexibility and resource-saving opportunities to improve lifestyles in an individualized way. However, mHealth-based diabetes prevention programs tailored for busy mothers with abdominal obesity have not been reported yet. OBJECTIVE: The aim of this study is to evaluate the feasibility and acceptability of an mHealth-based diabetes prevention program and its preliminary efficacy in reducing weight-related variables, behavioral variables, psychological variables, and diabetes risk among Chinese mothers with abdominal obesity over 6 months. METHODS: A randomized controlled trial was conducted at health management centers in 2 tertiary hospitals in Changsha, China. The mHealth group (n=40) received 12 weekly web-based lifestyle modification modules for diabetes prevention, 6 biweekly individualized health education messages based on their goal settings, and a Fitbit tracker. The control group (n=40) received 12 weekly web-based general health education modules, 6 biweekly general health education messages, and a Fitbit tracker. Data were collected at baseline, 3 months, and 6 months on the feasibility and acceptability outcomes, weight-related variables (waist circumference and BMI), diabetes risk scores, glycemic levels, behavioral variables (daily step count, active minutes, fruit and vegetable intake, calorie consumption, and sleep duration), and psychological variables (self-efficacy and social support for physical activity and diet, perceived stress, and quality of life). Generalized estimating equations were used for data analysis. RESULTS: Approximately 85\\% (68/80) of the participants completed 6 months of follow-up assessments. Regarding the feasibility and acceptance of the program in the mHealth group, the average number of modules reviewed was 7.9 out of 12, and the satisfaction score was 4.37 out of 5. Significant improvements at 6 months between the intervention and control groups were found in waist circumference (β=-2.24, 95\\% CI -4.12 to -0.36; P=.02), modifiable diabetes risk scores (β=-2.5, 95\\% CI -4.57 to -0.44; P=.02), daily steps (β=1.67, 95\\% CI 0.06-3.29; P=.04), self-efficacy for physical activity (β=1.93, 95\\% CI 0.44-3.43; P=.01), social support for physical activity (β=2.27, 95\\% CI 0.80-3.74; P=.002), and physical health satisfaction (β=0.82, 95\\% CI 0.08-1.55; P=.03). No differences were found in BMI, total diabetes risk score, daily active minutes, daily intake of fruits and vegetables, sleep duration, daily calorie consumption, self-efficacy, and social support for diet (P{\\textgreater}.05). CONCLUSIONS: This study addresses the potential role of tailored lifestyle interventions based on mHealth technology by offering tailored web-based health modules and health information in managing diabetes risk among mothers with abdominal obesity. The mHealth diabetes prevention program provides a flexible, customized, and resource-saving model for busy mothers. Future research could further explore the efficacy improvement on dietary behaviors to better serve the health care needs of this population. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2400090554; https://www.chictr.org.cn/showproj.html?proj=226411.", "links": [] }, { "title": "Utility of a Wearable Tracker to Assess Sleep Quality in Nurses and Their Spouses: A Prospective Cohort Study", "author": "Ishinuki, Tomohiro; Goda, Erika; Tatsumi, Hiroomi; Kutomi, Goro; Ohyanagi, Toshio; Ohnishi, Hirofumi; Masuda, Yoshiki; Hui, Thomas T.; Mizuguchi, Toru", "year": "2025", "journalProceedings": "SAGE open nursing", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "INTRODUCTION: Sleep disturbances among nurses engaged in night duty and their spouses need to be improved to ensure their ability to provide care and perform daily tasks. Therefore, an objective investigation is needed to establish a sleep improvement strategy. OBJECTIVE: To investigate the utility of a sleep tracker to assess sleep quality in nurses and spouses. METHOD: Nurses (n = 30) and spouses (n = 30) wore a sleep tracker for 14 days to investigate sleep scores. Sleep quality and number of steps were evaluated by Fitbit. They responded to the Richards-Campbell Sleep Questionnaire and Pittsburgh Sleep Quality Index. A multiple regression analysis was performed to identify the factors affecting sleep quality. RESULTS: Factors affecting sleep scores in nurses were hypnotic medication, night duty, and steps, while those in spouses were mental instability, hypnotic medication, alcohol, night duty, and steps. Factors affecting the Richards-Campbell Sleep Questionnaire in nurses were household chores, night duty, and steps, while those in spouses were hypnotic medication and steps. CONCLUSION: The sleep quality of nurses was affected by household chores, hypnotic medication, night duty, and steps. Besides the factors of nurses, spouses were affected by mental instability and alcohol. Night duty affected negativity in both nurses and spouses. Steps exerted positive effects in both the sleep tracker and the Richards-Campbell Sleep Questionnaire. The sleep tracker may be useful for identifying factors that improve sleep quality.", "links": [] }, { "title": "Patient-Centered mHealth Intervention to Improve Self-Care in Patients With Chronic Heart Failure: Phase 1 Randomized Controlled Trial", "author": "Kitsiou, Spyros; Gerber, Ben S.; Buchholz, Susan W.; Kansal, Mayank M.; Sun, Jiehuan; Pressler, Susan J.", "year": "2025", "journalProceedings": "Journal of Medical Internet Research", "category": "Intervention", "devices": "Charge 2", "population": "Patients", "dataUsed": "Steps,Intensity,Sleep,Heart Rate", "abstract": "BACKGROUND: Heart failure (HF) is one of the most common causes of hospital readmission in the United States. These hospitalizations are often driven by insufficient self-care. Commercial mobile health (mHealth) technologies, such as consumer-grade apps and wearable devices, offer opportunities for improving HF self-care, but their efficacy remains largely underexplored. OBJECTIVE: The objective of this study was to examine the feasibility, acceptability, safety, and preliminary efficacy of a patient-centered mHealth intervention (iCardia4HF) that integrates 3 consumer mHealth apps and devices (Heart Failure Health Storylines, Fitbit, and Withings) with a program of individually tailored SMS text messages to improve HF self-care. METHODS: We conducted a phase 1 randomized controlled trial. Eligible patients had stage C HF, were aged ≥40 years, and had New York Heart Association (NYHA) class I, II, or III HF. Patients were randomly assigned to either iCardia4HF plus usual care or to usual care only and were observed for 8 weeks. Key feasibility measures were recruitment and retention rates. The primary efficacy outcome was change in HF self-care subscale scores (maintenance, symptom perception, and self-care management) at 8 weeks, assessed with the Self-Care Heart Failure Index (SCHFI; version 7.2). Key secondary outcomes were modifiable behaviors targeted by the intervention (health beliefs, self-efficacy, and HF knowledge), health status, and adherence to daily self-monitoring of 2 core vital signs (body weight and blood pressure). RESULTS: A total of 27 patients were enrolled in the study and randomly assigned to iCardia4HF (n=13, 48\\%) or usual care (n=14, 52\\%). Of these 27 patients, 11 (41\\%) in the intervention group (iCardia4HF) and 14 (52\\%) in the usual care group started their assigned care and were included in the full analysis. Patients' mean age was 56 (SD 8.3) years, 44\\% (11/25) were female, 92\\% (23/25) self-reported race as Black, 76\\% (19/25) had NYHA class II or III HF, and 60\\% (15/25) had HF with reduced left ventricular ejection fraction. Participant retention, completion of study visits, and adherence to using the mHealth apps and devices for daily self-monitoring were high ({\\textgreater}80\\%). At 8 weeks, the mean group differences in changes in the SCHFI subscale scores favored the intervention over the control group: maintenance (Cohen d=0.19, 95\\% CI -0.65 to 1.02), symptom perception (Cohen d=0.33, 95\\% CI -0.51 to 1.17), and self-care management (Cohen d=0.25, 95\\% CI -0.55 to 1.04). The greatest improvements in terms of effect size were observed in self-efficacy (Cohen d=0.68) and health beliefs about medication adherence (Cohen d=0.63) and self-monitoring adherence (Cohen d=0.94). There were no adverse events due to the intervention. CONCLUSIONS: iCardia4HF was found to be feasible, acceptable, and safe. A larger trial with a longer follow-up duration is warranted to examine its efficacy among patients with HF. TRIAL REGISTRATION: ClinicalTrials.gov NCT03642275; https://clinicaltrials.gov/study/NCT03642275.", "links": [] }, { "title": "Feasibility trial of STRONG: A digital intervention to improve nutritional management for individuals with esophageal and gastroesophageal junction cancer", "author": "Lin, Yu Chen; Pimiento, Jose M.; Milano, Jeanine; Riccardi, Diane; Mckinnie, Nakesha; Hume, Emma; Sprow, Olivia; Diaz-Carraway, Sophia; Budnetz, Mara; Hagen, Ryan; Al-Jumayli, Mohammed; Pereira, Allan Lima; Sinnamon, Andrew J.; Somasundaram, Ashwin; Permuth, Jennifer B.; Tabriz, Amir Alishahi; Turner, Kea", "year": "2025", "journalProceedings": "Contemporary Clinical Trials Communications", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Food", "abstract": "INTRODUCTION: Individuals with esophageal and gastroesophageal junction (GEJ) cancers are at especially high risk of malnutrition. However, most patients with malnutrition do not receive adequate nutritional support. We conducted a single-arm trial to test the implementation of Support Through Remote Observation and Nutrition Guidance (STRONG), a multilevel digital intervention to improve nutritional outcomes for patients with locally advanced esophageal and gastroesophageal junction cancer. METHODS: Participants received five nutritional counseling sessions with a dietitian, logged daily food intake through the Fitbit app, and completed five study assessments related to patient malnutrition, nutrition-related symptoms, and quality-of-life outcomes. We assessed the feasibility, acceptability, and usability of STRONG against a priori benchmarks. RESULTS: Participants (N = 17) had a median age of 68 years, and 71 \\% were male. Feasibility benchmarks were met for participants completing the baseline assessment (94 \\%), completing four out of five assessments (82 \\%), and participant retention (85 \\%). Among participants who only received an oral diet during the study period, adherence to dietetic appointments (89 \\%) and food intake tracking (78 \\%) were high. Participant recruitment rate (47 \\%) was slightly below the benchmark (50 \\%). All participants found the intervention to be acceptable. Usability of the intervention was high, with 69 \\% and 92 \\% of participants reporting high satisfaction with tracking food intake through the Fitbit and the dietitian-led nutrition counseling sessions, respectively. CONCLUSION: Our study demonstrated that STRONG could be implemented with high feasibility, acceptability, and usability for esophageal and GEJ cancer patients. Findings from this study can guide a future efficacy study to assess the impact of STRONG on patient outcomes. CLINICAL TRIAL REGISTRATION: The Support Through Remote Observation and Nutrition Guidance Program for Gastroesophageal Cancer Patients (STRONG-GEC) study was registered on clinicaltrials.gov (NCT05438940) in June 2022 prior to participant enrollment.", "links": [] }, { "title": "Circadian rhythm of heart rate and activity: A cross-sectional study", "author": "Natarajan, Aravind; Gleichauf, Karla; Khalid, Maryam; Heneghan, Conor; Schneider, Logan Douglas", "year": "2025", "journalProceedings": "Chronobiology International", "category": "Case Study", "devices": "Versa 2,Versa 3,Sense,Inspire 2,Charge 5,Inspire 3,Sense 2,Fitbit Luxe,Versa 4", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Circadian rhythms are governed by a biological clock, and are known to occur in a variety of physiological processes. We report results on the circadian rhythm of heart rate observed using a wrist-worn wearable device (Fitbit), consisting of over 17,000 individuals over the course of 30 days. We obtain an underlying heart rate circadian rhythm from the time series heart rate by modeling the circadian rhythm as a sum over the first two Fourier harmonics. The first Fourier harmonic accounts for the approximate 24-hour rhythmicity of the body clock, while the second harmonic accounts for non-sinusoidal perturbations. From the diurnal modulation of heart rate, we obtain the following circadian parameters: (i) amplitude of modulation, (ii) bathyphase, and (iii) acrophase. We also consider the circadian rhythm of activity and show that in most individuals, the circadian rhythm of heart rate lags the circadian rhythm of activity. The widespread availability of smartwatches and trackers may enable individuals who are interested in observing their circadian rhythms of numerous physiological parameters, and to measure longitudinal changes in circadian parameters in response to various changes in health-related variables such as diet, sleep, exercise, or illness.", "links": [] }, { "title": "Exploring the Psychological and Physiological Insights Through Digital Phenotyping by Analyzing the Discrepancies Between Subjective Insomnia Severity and Activity-Based Objective Sleep Measures: Observational Cohort Study", "author": "Yeom, Ji Won; Kim, Hyungju; Pack, Seung Pil; Lee, Heon-Jeong; Cheong, Taesu; Cho, Chul-Hyun", "year": "2025", "journalProceedings": "JMIR mental health", "category": "Case Study", "devices": "Inspire 3", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "BACKGROUND: Insomnia is a prevalent sleep disorder affecting millions worldwide, with significant impacts on daily functioning and quality of life. While traditionally assessed through subjective measures such as the Insomnia Severity Index (ISI), the advent of wearable technology has enabled continuous, objective sleep monitoring in natural environments. However, the relationship between subjective insomnia severity and objective sleep parameters remains unclear. OBJECTIVE: This study aims to (1) explore the relationship between subjective insomnia severity, as measured by ISI scores, and activity-based objective sleep parameters obtained through wearable devices; (2) determine whether subjective perceptions of insomnia align with objective measures of sleep; and (3) identify key psychological and physiological factors contributing to the severity of subjective insomnia complaints. METHODS: A total of 250 participants, including both individuals with and without insomnia aged 19-70 years, were recruited from March 2023 to November 2023. Participants were grouped based on ISI scores: no insomnia, mild, moderate, and severe insomnia. Data collection involved subjective assessments through self-reported questionnaires and objective measurements using wearable devices (Fitbit Inspire 3) that monitored sleep parameters, physical activity, and heart rate. The participants also used a smartphone app for ecological momentary assessment, recording daily alcohol consumption, caffeine intake, exercise, and stress. Statistical analyses were used to compare groups on subjective and objective measures. RESULTS: Results indicated no significant differences in general sleep structure (eg, total sleep time, rapid eye movement sleep time, and light sleep time) among the insomnia groups (mild, moderate, and severe) as classified by ISI scores (all P{\\textgreater}.05). Interestingly, the no insomnia group had longer total awake times and lower sleep quality compared with the insomnia groups. Among the insomnia groups, no significant differences were observed regarding sleep structure (all P{\\textgreater}.05), suggesting similar sleep patterns regardless of subjective insomnia severity. There were significant differences among the insomnia groups in stress levels, dysfunctional beliefs about sleep, and symptoms of restless leg syndrome (all P≤.001), with higher severity associated with higher scores in these factors. Contrary to expectations, no significant differences were observed in caffeine intake (P=.42) and alcohol consumption (P=.07) between the groups. CONCLUSIONS: The findings demonstrate a discrepancy between subjective perceptions of insomnia severity and activity-based objective sleep parameters, suggesting that factors beyond sleep duration and quality may contribute to subjective sleep complaints. Psychological factors, such as stress, dysfunctional sleep beliefs, and symptoms of restless legs syndrome, appear to play significant roles in the perception of insomnia severity. These results highlight the importance of considering both subjective and objective assessments in the evaluation and treatment of insomnia and suggest potential avenues for personalized treatment strategies that address both psychological and physiological aspects of sleep disturbances. TRIAL REGISTRATION: Clinical Research Information Service KCT0009175; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26133.", "links": [] }, { "title": "Large-scale digital phenotyping: Identifying depression and anxiety indicators in a general UK population with over 10,000 participants", "author": "Zhang, Yuezhou; Stewart, Callum; Ranjan, Yatharth; Conde, Pauline; Sankesara, Heet; Rashid, Zulqarnain; Sun, Shaoxiong; Dobson, Richard J. B.; Folarin, Amos A.", "year": "2025", "journalProceedings": "Journal of Affective Disorders", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Sleep,Heart Rate", "abstract": "BACKGROUND: Digital phenotyping offers a novel and cost-efficient approach for managing depression and anxiety. Previous studies, often limited to small-to-medium or specific populations, may lack generalizability. METHODS: We conducted a cross-sectional analysis of data from 10,129 participants recruited from a UK-based general population between June 2020 and August 2022. Participants shared wearable (Fitbit) data and self-reported questionnaires on depression, anxiety, and mood via a study app. We examined correlations between mental health scores and wearable-derived features, demographics, health variables, and mood assessments. Unsupervised clustering was used to identify behavioural patterns associated with depression and anxiety. Furthermore, we employed XGBoost machine learning models to predict depression and anxiety severity and compared the performance using different subsets of features. RESULTS: We observed significant associations between the severity of depression and anxiety with several factors, including mood, age, gender, BMI, sleep patterns, physical activity, and heart rate. Clustering analysis revealed that participants simultaneously exhibiting lower physical activity levels and higher heart rates reported more severe symptoms. Prediction models incorporating all types of variables achieved the best performance (R2 = 0.41, MAE = 3.42 for depression; R2 = 0.31, MAE = 3.50 for anxiety) compared to those using subsets of variables. Several wearable-derived features were observed to have non-linear relationships with depression and anxiety in the prediction models. LIMITATIONS: Data collection during the COVID-19 pandemic may introduce biases. CONCLUSION: This study identified several indicators for depression and anxiety and highlighted the potential of digital phenotyping and machine learning technologies for rapid screening of mental disorders in general populations.", "links": [] }, { "title": "Contexts, affective and physical states and their variations during physical activity in older adults: an intensive longitudinal study with sensor-triggered event-based ecological momentary assessments", "author": "Delobelle, Julie; Compernolle, Sofie; Vetrovsky, Tomas; Van Cauwenberg, Jelle; Van Dyck, Delfien", "year": "2025", "journalProceedings": "The International Journal of Behavioral Nutrition and Physical Activity", "category": "Intervention", "devices": "Ionic,Inspire 2", "population": "Older Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: To design effective tailored interventions to promote physical activity (PA) among older adults, insights are needed into the contexts in which older adults engage in PA and their affective and physical experiences. Sensor-triggered event-based ecological momentary assessment (EMA) is an innovative method for capturing real-life contexts, as well as affective and physical states, during or immediately after specific events, such as PA. This study aimed to (1) describe the physical and social contexts, and the affective and physical states during PA among older adults, (2) evaluate how these constructs fluctuate during PA episodes, and (3) describe affective states during PA according to the context. METHODS: An intensive longitudinal sensor-triggered event-based EMA study was conducted with 92 Belgian older adults (65 + years). During seven days, participants were monitored using a Fitbit, which triggered a smartphone-based questionnaire on the event-based EMA platform 'HealthReact' after a five-minute walk. Participants reported on contexts and affective (positive/negative valence) and physical states (pain and fatigue) during the PA event. Descriptive statistics and generalized mixed models were used for data analysis. RESULTS: Older adults predominantly engaged in daily physical activities, such as walking for transport, leisure walking, and gardening, rather than structured exercise. They consistently reported high positive affect, low negative affect, and minimal physical complaints during PA. Furthermore, older adults mainly engage in physical activities alone, particularly in outdoor settings. Variations in contexts, affect, and fatigue were mostly driven by within-subject differences. The model showed significant differences across times of day, with negative affect being highest in the evening and fatigue lowest in the morning. Additionally, the physical and social context influenced negative affect (but not positive affect), with outdoor activities performed alone and indoor activities performed with others being associated with lower negative affect. CONCLUSIONS: While these findings could enhance the effectiveness of tailored PA interventions, it remains unclear whether the observed affective and physical states are causes or effects of PA, and whether the contexts in which the activities were performed align with older adults' preferences. Further research is needed to explore these relationships and to better understand older adults' preferred PA contexts.", "links": [] }, { "title": "Improved glycemic outcomes in people with type 2 diabetes using smart blood glucose monitoring integrated with popular digital health therapeutics", "author": "Grady, Mike; Holt, Elizabeth; Cameron, Hilary; Edelman, Steven", "year": "2025", "journalProceedings": "Scientific Reports", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps", "abstract": "The increasing prevalence of metabolic syndrome and type 2 diabetes places a burden on healthcare systems, necessitating cost-effective, engaging and accessible interventions to address the underlying behavioral and lifestyle drivers. Our study evaluated combining Bluetooth connected OneTouch blood glucose meters (BGM) and the OneTouch Reveal mobile app with one of four digital therapeutic apps. Each group was independent, with people with type 2 diabetes (PwT2D) themselves choosing their therapeutic intervention, to better reflect real-world use. Our 3-month decentralized study screened 912 subjects, with 612 returning mail-in A1cs, providing 191 subjects (Noom = 68, Fitbit = 31, Cecelia Health = 47, Welldoc = 45) who met all inclusion criteria, including entry A1c 7.5 to 12.0\\%. The primary endpoint of A1c change showed improvement in the overall group by - 0.77\\% (95\\% CI - 0.98 to - 0.56, n = 141) after 3-months, Noom - 1.03\\% (CI - 1.4 to - 0.61, n = 49), Fitbit - 0.56\\% (CI - 1.0 to - 0.11, n = 24), Cecelia Health - 0.76\\% (CI - 1.2 to - 0.36, n = 36), Welldoc - 0.55\\% (CI - 0.94 to - 0.17, n = 32). In terms of secondary endpoints, more than half (56\\%) of these PwT2D lowered A1c by ≥ 0.5\\% and more than a third (36\\%) lowered A1c by ≥ 1.0\\%, with similar improvements across each of the four independent groups. Our real-world approach shows the potential for connected BGMs and widely accessible digital therapeutics to contribute to improvements in glycemic outcomes.", "links": [] }, { "title": "Dialysis-Imposed Patterns of Nocturnal Sleep Duration: A Multi-Center Prospective Study in Patients Using a Wearable Activity Tracker", "author": "Han, Maggie; van der Sande, Frank M.; Kooman, Jeroen P.; Tao, Xia; Preciado, Priscila; Tisdale, Lela; Thwin, Ohnmar; Kotanko, Peter", "year": "2025", "journalProceedings": "Kidney360", "category": "Case Study", "devices": "Charge 2", "population": "Patients", "dataUsed": "Sleep", "abstract": "BACKGROUND: In patients on hemodialysis, the effects of determinants of sleep duration are not widely studied. Using wearable activity trackers, we aimed to characterize natural and hemodialysis-imposed temporal patterns of nocturnal sleep. METHODS: In this yearlong prospective observational study, patients on in-center hemodialysis were equipped with activity trackers (Fitbit® Charge 2™). Nocturnal sleep duration was assessed according to dialysis start time (early starters: before 8 a.m., late starters: others), dialysis versus interdialytic days (post-dialysis day and 2nd interdialytic day), weekdays, and seasons. Clinical, laboratory, and hemodialysis treatment data were extracted from electronic medical records. Linear mixed-effects models were constructed to determine the effect of various time patterns and predictors of nocturnal sleep duration. RESULTS: 109 patients contributed data (age 54±12 years, 73\\% males, 23\\% diabetic). Sleep duration was 276±91 minutes; 102 (94\\%) patients slept on average less than the recommended 420 minutes per night. On dialysis days, participants slept 55 (95\\% CI [51,59]) and 48 (95\\% CI [43,54]) minutes less compared to post-dialysis and 2nd interdialytic days, respectively. Early starters slept on average 40 (95\\% CI [6,74]) minutes less compared to late starters. On dialysis days, early starters slept 86 (95\\% CI [55,118]) minutes less compared to late starters. We observed greater sleep-wake disturbance in early starters. Irrespective of dialysis schedule, patients slept on average 26 (95\\% CI [19,33]) to 32 (95\\% CI [24,40]) minutes longer on Sunday. In winter, sleep was 7 (95\\% CI [1,13]) to 10 (95\\% CI [5,16]) minutes shorter. In multivariate analysis, higher blood pressure and higher serum creatinine were significantly associated with shorter sleep duration. CONCLUSIONS: On average, patients on hemodialysis slept less than the recommended amount of time. The timing of hemodialysis treatment has pronounced effects on sleep duration and could be considered in patient care.", "links": [] }, { "title": "Validation of the Caen Chronotype Questionnaire: Exploring the added value of amplitude and correlations with actigraphy", "author": "Hickman, Robert; Lai Jie, Daniel; Shergill, Sukhi; Laborde, Sylvain; D'Oliveira, Teresa C.", "year": "2025", "journalProceedings": "Chronobiology International", "category": "Case Study", "devices": "Charge 4", "population": "Adults", "dataUsed": "Sleep", "abstract": "Chronotype self-report instruments are time and cost-efficient measures to profile diurnal or time-of-day preferences. The Caen Chronotype Questionnaire (CCQ) captures morningness and eveningness (CCQ-ME) and a circadian amplitude dimension for diurnal variation (distinctiveness; CCQ-DI). This study extends prior multilanguage validations for the English version of the CCQ. In total, 628 participants enrolled from a UK working population (mean age 30.34 ± 8.36 years, 61.3\\% female) including a subset of shift workers (n = 179; mean age 27.62 ± 5.95 years, 49.2\\% female). A subsample of participants also wore a consumer-grade actigraph device (Fitbit Charge 4) for seven days to compare chronotype estimates with objective sleep-wake parameters (n = 22; mean age 27.05 ± 3.99 years, 81.8\\% female, 90.9\\% worked standard daytime schedules, and 9.1\\% worked rotating shifts). All participants completed online chronotype measures, including the CCQ and Morningness-Eveningness Questionnaire (MEQ), depressive symptoms (Patient Health Questionnaire; PHQ-9), sleep quality (Pittsburgh Sleep Quality Index; PSQI), and other outcome measures. Results from the Confirmatory Factor Analysis (CFA) offer support for a two-factor structure of the CCQ in an English-speaking sample, highlighting how individual preferences for the timing of activities is associated with chronotype (morningness-eveningness; ME) and a second subjective amplitude dimension (DI). However, in contrast with the original CCQ structure, a more parsimonious solution and best overall fit involved the reduction of the original 16-item questionnaire (8 items per factor) to 4 ME items and 5 DI items. Convergent validity with the reduced CCQ scale (rME) and the MEQ was also established. The CCQ was sensitive in discriminating differences in actigraphic sleep-wake timings between morning-and evening-oriented individuals. Regression models demonstrated that amplitude (CCQ-DI) was a significant predictor explaining most of the variance in depressive symptoms (PHQ-9) compared to other variables. Overall, the English version of the CCQ was shown to be a robust tool in estimating chronotype in a sample of adults based in the UK.", "links": [] }, { "title": "Improving Early Prediction of Abnormal Recovery after Appendectomy in Children using Real-world Data from Wearables", "author": "Hua, Rui; O'Brien, Megan K.; Carter, Michela; Pitt, J. Benjamin; Kwon, Soyang; Ghomrawi, Hassan M. K.; Jayaraman, Arun; Abdullah, Fizan", "year": "2024", "journalProceedings": "Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference", "category": "Case Study", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Postoperative complications are primary concerns during early recovery from pediatric appendectomy. Identifying complications or symptoms of abnormal recovery typically relies on intermittent and subjective assessments from children and their caregivers, which may result in delayed diagnosis. Wearable devices can capture continuous and objective health measurements, which can be mined for early biomarkers of complications or symptoms using machine learning models. However, real-world datasets from wearables often have missing and imbalanced data, which can affect model performance and utility. We have recorded real-world Fitbit data from 93 children during the first 21 days following appendectomy for complicated appendicitis. This dataset included missing data (37.0\\% across all participants) and imbalanced data (2.7\\% of total days recorded from children exhibiting abnormal recovery). Aiming to improve early prediction of abnormal recovery, we extracted 143 daily features from the data, including Fitbit metrics of activity, heart rate, and sleep, as well as metrics derived from clinical knowledge. We trained a Balanced Random Forest classifier and tested different early prediction strategies for identifying abnormal recovery (complications or abnormal symptoms) 1-3 days before they were clinically diagnosed. The best-performing model predicted abnormal recovery three days before diagnosis at an accuracy of 87.5\\%, two days before at 76.4\\%, one day before at 85.7\\%, and on the day of diagnosis at 78.8\\%. The overall prediction accuracy was improved 10.1\\% compared to a previous study. With further development, this approach could be used to generate near real-time alerts of abnormal postoperative recovery to enhance pediatric care and clinical decision making.", "links": [] }, { "title": "Wearable technology for mobility measurement in orthopedics and traumatology: a comparison of commercially available systems", "author": "Keppler, A. M.; Zaccaria, R.; Weigert, M.; Keppler, L.; Böcker, W.; Neuerburg, C.; Schniepp, R.; Fürmetz, J.", "year": "2025", "journalProceedings": "Archives of Orthopaedic and Trauma Surgery", "category": "Validation", "devices": "Charge 3", "population": "Older Adults,Children", "dataUsed": "Steps", "abstract": "BACKGROUND: Wearable activity sensors offer valuable insights into physical activity and are increasingly used in clinical and rehabilitation settings. However, most are designed for healthy individuals, necessitating a thorough evaluation of their applicability for pathological gait patterns. This study aims to assess the accuracy of commercially available wearables in measuring gait patterns among patients with lower limb injuries compared to healthy individuals. METHODS: A prospective cohort study enrolled 40 participants divided into four groups: Group A (younger patients with lower limb injuries with age {\\textless} 75y), Group B (younger healthy individuals with age 75y), Group C (elderly patients with lower limb injuries and age 75y), and Group D (elderly healthy individuals with age {\\textgreater} 75y). Mobility was assessed in real-world scenarios using four wearable devices (Apple Watch Series 4, Fitbit Charge 3, ActivPal 4, and StappOne Insoles V1.0) across three gait speeds in a gait laboratory, with GAITrite mats and video as gold standards. RESULTS: Accuracy varied significantly between devices. The accelerometer-based wearables (Apple Watch Series 4, Fitbit Charge 3 and ActivPal 4™) underestimated cumulative step count compared to pressure-based Stappone v1. 0, especially for slow and restricted gait patterns (Groups C and D). Relative Difference of Wearables Measurements to the true numbers of steps (Group C: AW -21.83\\%, FB -28.99\\%, AP -20.00\\% versus SO 0.00\\% - Group D: AW -8.51\\%, FB -14.29\\%, AP -20.00\\% versus SO 4.55\\%). Zero measurements occurred frequently with wrist-worn devices, highlighting their limitations in detecting slow or restricted movements. In contrast, pressure-based StappOne Insoles demonstrated superior accuracy, with minimal deviations across all groups and gait speeds. The inaccuracy was exacerbated by factors such as the use of mobility aids, partial weight-bearing, and postoperative restrictions, which altered arm and leg movements. CONCLUSIONS: Accelerometer-based wearables require algorithmic improvements to address the challenges of slow and pathological gait patterns. The frequent occurrence of zero measurements with wrist-worn devices underscores their limited utility in clinical populations. Practical challenges, such as altered movement patterns due to mobility aids and partial weight-bearing, further limit their accuracy. Pressure-based systems, while accurate, face practicality issues for daily use. These findings emphasize the need for tailored wearable technologies for orthopedic and trauma patients. LEVEL OF EVIDENCE: Prospective cohort study, Level of Evidence 2.", "links": [] }, { "title": "Assessment of Sleep Measures and their agreement: Youth-Reported, Caregiver-Reported, and Fitbit-Derived Data in a Large Early Adolescent Cohort", "author": "Kiss, Orsolya; Shaska, Adrianna; Müller-Oehring, Eva M.; Hasler, Brant P.; Franzen, Peter L.; Fitzgerald, Douglas H.; Clark, Duncan B.; Baker, Fiona C.", "year": "2025", "journalProceedings": "Sleep", "category": "Case Study", "devices": "Charge 2", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "STUDY OBJECTIVES: Adequate sleep is essential for adolescents' physical, emotional, and cognitive well-being. However, accurately capturing the complex components of sleep in this demographic is challenging, especially with retrospective self-report measures. This study aims to compare sleep data obtained from youth reports, caregiver reports, and Fitbit devices among early adolescents. METHODS: Data from 11,879 adolescents (11-14 years, 47.83\\% female), in Year 2 of the Adolescent Brain Cognitive Development (ABCD) Study, were analyzed. Adolescents self-reported their sleep characteristics using the Munich Chronotype Questionnaire, and caregivers provided data through the Children's Sleep Disturbance Scale. Additionally, a subset of participants (N = 3,803) wore Fitbit Charge 2 devices for 21 days. We assessed the questionnaires' internal consistency and utilized Bland-Altman and interclass correlation analyses for comparing self-reported sleep characteristics with Fitbit measures. RESULTS: Youth-reported and caregiver-reported sleep questionnaires demonstrated acceptable internal consistency. Discrepancies between caregiver and adolescent reports were more pronounced when adolescents reported sleep periods of less than 7 hours. Compared to Fitbit measurements, adolescents' self-reports showed a reasonably high agreement on sleep period and bedtime, while agreement on duration of wakefulness after sleep onset and sleep onset latency was poor. CONCLUSIONS: Results show reasonable agreement between adolescent self-reports and Fitbit measurements of sleep period and indicate their usefulness in assessing sleep behavior in adolescents. Caregivers provided valuable perspectives of the youth's sleep disturbances, however, they tended to overestimate sleep duration. These findings offer important methodological insights and highlight the necessity of adopting multi-dimensional approaches to assess sleep in adolescents.", "links": [] }, { "title": "A randomized comparative effectiveness trial to evaluate two programs for promotion of physical activity after spinal cord injury in manual wheelchair users", "author": "Martinez, Jenna M.; Haubert, Lisa L.; Eberly, Valerie J.; Weiss, Walter B.; Rankin, Jeffery W.", "year": "2025", "journalProceedings": "Frontiers in Sports and Active Living", "category": "Intervention", "devices": "Blaze,Versa", "population": "Adults", "dataUsed": "Steps,Heart Rate,Active Minutes/Active Zone Minutes", "abstract": "OBJECTIVE: The goal of this study was to determine the effectiveness of a novel whole of day activity accumulation (WODAA) physical exercise program. WODAA physical activity and physiological outcomes were compared to outcomes from individuals using a traditional planned arm crank exercise (PACE) program. Both programs included progressive exercise instruction and goal setting over a 4-month period, and utilization of a wrist-worn activity monitor (Fitbit Blaze/Versa, Fitbit Inc., San Francisco, CA). DESIGN: Longitudinal, randomized, comparative effectiveness trial with collaborative goal setting. SETTING: Research laboratory at a rehabilitation hospital and in participants' homes and communities. PARTICIPANTS: Forty-nine manual wheelchair users with paraplegia. OUTCOME MEASURES: Physical activity measurements and cardiometabolic data were collected before, during, and after the program. The primary measures were amount of daily arm activity (Steps) and time spent in different activity and heart rate zones. RESULTS: Relative to baseline measures, participants in the WODAA group had significantly more daily arm movement/propulsion activity (Steps) and time spent in the Fairly and Very Active Zones and the Cardio Heart Rate Zone compared to those in the PACE group over the final month of the intervention (p {\\textless} 0.05). Minutes spent in other Activity and Heart Rate Zones were similar between groups. At final evaluation, diastolic blood pressure after a 6-Minute Push Test was significantly lower in the WODAA group, while no differences were found in distance traveled, systolic, or pre-test diastolic blood pressures. Metabolic bloodwork and shoulder pain scores did not change and were similar between groups. CONCLUSION: Depending on the measure used, these findings suggest that a WODAA approach to PA is comparable or more effective than a traditional PACE program in promoting physical activity in low-active manual wheelchair users with paraplegia.", "links": [] }, { "title": "Concurrent Validity of a Physical Activity Vital Sign Used in an Adult Preventive Cardiology Clinic", "author": "McCarthy, Margaret; Fletcher, Jason; Melkus, Gail; Vorderstrasse, Allison; Chehade, Mireille; Katz, Stuart", "year": "2025", "journalProceedings": "Nursing Research", "category": "Validation", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps,Distance", "abstract": "BACKGROUND: In clinical settings, counseling patients on physical activity starts by assessing patients' current physical activity levels. Self-report measures of PA are generally easy to administer; however, they may be too long to be convenient and are known to correlate poorly with objective measures of physical activity. OBJECTIVE: To assess the concurrent validity of a self-report three-question physical activity vital sign with objective Fitbit step counts and the distance walked during a 6-min walk test. METHODS: This pilot study tested a best practice advisory embedded in the Epic electronic health record, which was designed to prompt providers in a preventive cardiology clinic to counsel patients reporting low levels of physical activity . Patients were invited to participate in the remote patient monitoring phase to assess the change in their physical activity by wearing a Fitbit for 12 weeks and completing a 6-min walk test at baseline and 12 weeks. This analysis used the cross-sectional data collected in this phase. Pearson correlations were conducted between self-reported physical activity, Fitbit step counts, and the distance walked during the 6-min walk-a measure associated with current physical activity levels. Kappa coefficients were calculated to assess agreement between the self-reported physical activity and step counts. RESULTS: Participants who enrolled in the Fitbit monitoring were approximately 50\\% female, with the majority identified as White non-Hispanic adults. Their most common cardiovascular risk factor was hypertension. The self-reported physical activity vital signs were significantly associated with step counts at baseline and 12 weeks but were not associated with the distance during the 6-min walk test. However, the distance walked was significantly associated with step counts at baseline and 12 weeks. The Kappa results demonstrate a poor level of agreement between two categories (meeting or not meeting current physical activity guidelines) of self-report physical activity vitals and the objective Fitbit step counts. DISCUSSION: There were moderate correlations between the self-reported physical activity vital signs and the Fitbit step counts, but there was lack of agreement when they were categorized. Further validation of this physical activity vital sign is warranted.", "links": [] }, { "title": "Tension and Trauma Releasing Exercises for People with Multiple Sclerosis: A Randomized Controlled Trial", "author": "Skovgaard, Lasse; Trénel, Philipp; Hanehøj, Kirsten; Lynning, Marie", "year": "2025", "journalProceedings": "Advances in Mind-Body Medicine", "category": "Intervention,Measurement", "devices": "Charge 3", "population": "Patients", "dataUsed": "Sleep", "abstract": "CONTEXT: Some studies suggests that mind-body therapies may be helpful for people with multiple sclerosis (PwMS) for symptom management. PwMS have reported benefits from Tension and Trauma Releasing Exercises (TRE); however, only limited research exists on the potential benefits of TRE. OBJECTIVE: The study intended to determine whether an eight-week intervention of Tension and Trauma Releasing Exercises (TRE), a mind-body therapy, could primarily reduce fatigue and secondarily decrease other MS-related symptoms and to explore new, experimental outcome measures-sleep, hand motor function, gait function, cognitive function, or mood-for use in future research on TRE for PwMS. DESIGN: The research team performed a randomized controlled trial (RCT). SETTING: The study took place at the Danish MS Society in Valby, Denmark. PARTICIPANTS: Participants were 28 members of the society who had an MS diagnosis and lived in the Copenhagen area. INTERVENTION: The research team performed simple randomization to allocate participants to the intervention and control groups. The intervention group received eight sessions of TRE and performed TRE daily at home, while the control group continued their usual care only. OUTCOME MEASURES: The primary outcome measure was self-reported fatigue measured via the Modified Fatigue Impact Scale (MFIS) at baseline and postintervention. Daily self-reported levels of nine MS-related symptoms as well as stress levels were obtained as secondary endpoints, using a digital tool, the MS PRO. For explorative purposes, daily measures of sleep duration and quality were obtained, via the Fitbit Charge 3 activity tracker. Finally, smartphone-based measurements of hand motor function, gait, cognition, and mood were obtained via the Floodlight Open (FLO) app. RESULTS: On primary outcomes, no significant differences between the TRE intervention group and the control group were detected at follow-up in the unadjusted analyses. However, when adjusted for imbalance in covariates, significant group differences were obtained in the MFIS total score (P = .03) as well as marginal significance in the MFISphys score (P = .06). The TRE intervention significantly reduced reported levels of spasticity and pain across the whole intervention period, and it showed a significant effect of gradual improvement in the 5 U-turn test over the study period. CONCLUSIONS: Positive effects on both primary and secondary outcomes from the TRE intervention were seen when adjusting for covariate imbalance. Therefore, it cannot be ruled out that TRE significantly improves fatigue in people with MS. Furthermore, the current study underlines the potential effect of bias-adjustment, when covariate imbalance is present. However, further research is needed to confirm the positive effects.", "links": [] }, { "title": "Changing User Experience of Wearable Activity Monitors Over 7 Years: Repeat Cross-Sectional Survey Study", "author": "Beckett, Darcy; Curtis, Rachel; Szeto, Kimberley; Maher, Carol", "year": "2025", "journalProceedings": "Journal of Medical Internet Research", "category": "Usability,Survey Research", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Device Weartime", "abstract": "Background: Lifestyle behaviors, including physical inactivity, sedentary behavior, poor sleep, and unhealthy diet, significantly impact global population health. Wearable activity trackers (WATs) have emerged as tools to enhance health behaviors; however, their effectiveness and continued use depend on their user experience.\n\nObjective: This study aims to explore changes in user experiences, preferences, and perceived impacts of WATs from 2016 to 2023.\n\nMethods: We conducted a cross-sectional online survey among an international cohort of adults (n=475, comprising 387 current and 88 former WAT users). Results were compared with a 2016 cross-sectional online survey (n=237, comprising 200 current and 37 former WAT users) using descriptive statistics and chi-square tests. The survey examined brand preference, feature usefulness, motivations, perceived health behavior change, social sharing behaviors, and technical issues.\n\nResults: In 2023, Apple (210/475, 44%) and Fitbit (101/475, 21%) were the most commonly used devices, compared with the 2016 survey where Fitbit (160/237, 68%) and Garmin devices (39/237, 17%) were most common. The median usage duration in 2023 was 18 months, significantly longer than the 7 months reported in 2016, with most users planning ongoing use. Users in both survey years reported greater improvements in physical activity than diet or sleep, despite lower improvement in physical activity in 2023 compared with 2016, contrasted with greater perceived improvements in diet and sleep. Social media sharing of WAT data notably rose to 73% (283/387) in 2023 from 35% (70/200) in 2016. However, reports of technical issues and discomfort increased, alongside a decrease in overall positive experiences. There was also a noticeable shift in discontinuation reasons, from having learned everything possible in 2016 to dissatisfaction in 2023.\n\nConclusions: The study highlights significant shifts in WAT usage, including extended use and evolving preferences for brands and features. The rise in social media sharing indicates a deeper integration of WATs into everyday life. However, user feedback points to a need for enhanced design and functionality despite technological progress. These findings illustrate WAT's potential in health promotion, emphasizing the need for user-focused design in diverse populations to fully realize their benefits in enhancing health behaviors.\n\nKeywords: Apple; Fitbit; accessibility; activity tracker; cohort; cross-sectional survey; diet; health behaviour; lifestyle; mobile phone; physical activity; preferences; reliability; sleep; user experience; wearable activity trackers.", "links": [] }, { "title": "Sleep duration and efficiency moderate the effects of prenatal and childhood ambient pollutant exposure on global white matter microstructural integrity in adolescence", "author": "Cotter, Devyn L.; Kiss, Orsolya; Ahmadi, Hedyeh; de Jesus, Alethea; Schwartz, Joel; Baker, Fiona C.; Hackman, Daniel A.; Herting, Megan M.", "year": "2025", "journalProceedings": "bioRxiv: The Preprint Server for Biology", "category": "Case Study", "devices": "Charge 2", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "Background: Air pollution is a ubiquitous neurotoxicant associated with alterations in structural connectivity. Good habitual sleep may be an important protective lifestyle factor due to its involvement in the brain waste clearance and its bidirectional relationship with immune function. Wearable multisensory devices may provide more objective measures of sleep quantity and quality. We investigated whether sleep duration and efficiency moderated the relationship between prenatal and childhood pollutant exposure and whole-brain white matter microstructural integrity at ages 10-13 years.\n\nMethods: We used multi-shell diffusion-weighted imaging data collected on 3T MRI scanners and objective sleep data collected with Fitbit Charge 2 from the 2-year follow-up visit for 2178 subjects in the Adolescent Brain Cognitive Development Study®. White matter tracts were identified using a probabilistic atlas. Restriction spectrum imaging was performed to extract restricted normalized isotropic (RNI) and directional (RND) signal fraction parameters for all white matter tracts, then averaged to calculate global measures. Sleep duration was calculated by summing the time spent in each sleep stage; sleep efficiency was calculated by dividing sleep duration by time spent in bed. Using an ensemble-based modeling approach, air pollution concentrations of PM2.5, NO2, and O3 were assigned to each child's residential addresses during the prenatal period (9-month average before birthdate) as well as at ages 9-10 years. Multi-pollutant linear mixed effects models assessed the associations between global RNI and RND and sleep-by-pollutant interactions, adjusting for appropriate covariates.\n\nResults: Sleep duration interacted with childhood NO2 exposure and sleep efficiency interacted with prenatal O3 exposure to affect RND at ages 10-13 years. Longer sleep duration and higher sleep efficiency in the context of higher pollutant exposure was associated with lower RND compared to those with similar pollutant exposure but shorter sleep duration and lower sleep efficiency.\n\nConclusions: Low-level air pollution poses a risk to brain health in youth, and healthy sleep duration and efficiency may increase resilience to its harmful effects on white matter microstructural integrity. Future studies should evaluate the generalizability of these results in more diverse cohorts as well as utilize longitudinal data to understand how sleep may impact brain health trajectories in the context of pollution over time.\n\nKeywords: adolescence; air pollution; ground-level ozone; objective sleep measures; prenatal exposure; white matter microstructural integrity.", "links": [] }, { "title": "Usability and Implementation Considerations of Fitbit and App Intervention for Diverse Cancer Survivors: Mixed Methods Study", "author": "Dabbagh, Zakery; Najjar, Reem; Kamberi, Ariana; Gerber, Ben S.; Singh, Aditi; Soni, Apurv; Cutrona, Sarah L.; McManus, David D.; Faro, Jamie M.", "year": "2025", "journalProceedings": "JMIR cancer", "category": "Intervention", "devices": "Charge 2,Charge 5", "population": "Patients", "dataUsed": "Steps,Goals", "abstract": "Background: Despite the known benefits of physical activity, cancer survivors remain insufficiently active. Prior trials have adopted digital health methods, although several have been pedometer-based and enrolled mainly female, non-Hispanic White, and more highly educated survivors of breast cancer.\n\nObjective: The objective of this study was to test a previously developed mobile health system consisting of a Fitbit activity tracker and the MyDataHelps smartphone app for feasibility in a diverse group of cancer survivors, with the goal of refining the program and setting the stage for a larger future trial.\n\nMethods: Participants were identified from one academic medical center's electronic health records, referred by a clinician, or self-referred to participate in the study. Participants were screened for eligibility, enrolled, provided a Fitbit activity tracker, and instructed to download the Fitbit: Health & Wellness and MyDataHelps apps. They completed usability surveys at 1 and 3 months. Interviews were conducted at the end of the 3-month intervention with participants and cancer care clinicians to assess the acceptability of the intervention and the implementation of the intervention into clinical practice, respectively. Descriptive statistics were calculated for demographics, usability surveys, and Fitbit adherence and step counts. Rapid qualitative analysis was used to identify key findings from interview transcriptions.\n\nResults: Of the 100 patients screened for eligibility, 31 were enrolled in the trial (mean age 64.8, SD 11.1 years; female patients=17/31, 55%; Hispanic or Latino=7/31, 23%; non-White=11/31, 35%; less than a bachelor's degree=14/31, 45%; and household income 0.05). Shifting 10 min from ST to active time is associated with a theoretical decrease of -0.76 (95% CI, -1.49 to -0.04) units in BMI. Similarly, reallocating 10 min from active time to ST is associated with a theoretical increase of 1.17 (95% CI, 0.03 to 2.3) units in BMI. Reallocating 10 min between other movement behaviors yielded no statistical significance. Conclusions: Our study highlights the importance of promoting active time to improve BMI in this population. Encouraging 10 min bouts of PA among older adults, in place of ST, is vital for improving national PA guideline adherence.\n\nKeywords: cognition; movement behavior; physical activity; sedentary time; sleep.", "links": [] }, { "title": "Cross-evaluation of wearable data for use in Parkinson's disease research: a free-living observational study on Empatica E4, Fitbit Sense, and Oura", "author": "Reithe, Haakon; Marty, Brice; Torrado, Juan C.; Førsund, Elise; Husebo, Bettina S.; Erdal, Ane; Kverneng, Simon U.; Sheard, Erika; Tzoulis, Charalampos; Patrascu, Monica", "year": "2025", "journalProceedings": "Biomedical Engineering Online", "category": "Usability", "devices": "Sense", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Heart Rate", "abstract": "Background: Established assessment scales used for Parkinson's disease (PD) have several limitations in tracking symptom progression and fluctuation. Both research and commercial-grade wearables show potential in improving these assessments. However, it is not known whether pervasive and affordable devices can deliver reliable data, suitable for designing open-source unobtrusive around-the-clock assessments. Our aim is to investigate the usefulness of the research-grade wristband Empatica E4, commercial-grade smartwatch Fitbit Sense, and the Oura ring, for PD research.\n\nMethod: The study included participants with PD (N = 15) and neurologically healthy controls (N = 16). Data were collected using established assessment scales (Movement Disorders Society Unified Parkinson's Disease Rating Scale, Montreal Cognitive Assessment, REM Sleep Behavior Disorder Screening Questionnaire, Hoehn and Yahr Stage), self-reported diary (activities, symptoms, sleep, medication times), and 2-week digital data from the three devices collected simultaneously. The analyses comprised three steps: preparation (device characteristics assessment, data extraction and preprocessing), processing (data structuring and visualization, cross-correlation analysis, diary comparison, uptime calculation), and evaluation (usability, availability, statistical analyses).\n\nResults: We found large variation in data characteristics and unsatisfactory cross-correlation. Due to output incongruences, only heart rate and movement could be assessed across devices. Empatica E4 and Fitbit Sense outperformed Oura in reflecting self-reported activities. Results show a weak output correlation and significant differences. The uptime was good, but Oura did not record heart rate and movement concomitantly. We also found variation in terms of access to raw data, sampling rate and level of device-native processing, ease of use, retrieval of data, and design. We graded the system usability of Fitbit Sense as good, Empatica E4 as poor, with Oura in the middle.\n\nConclusions: In this study we identified a set of characteristics necessary for PD research: ease of handling, cleaning, data retrieval, access to raw data, score calculation transparency, long battery life, sufficient storage, higher sampling frequencies, software and hardware reliability, transparency. The three analyzed devices are not interchangeable and, based on data features, none were deemed optimal for PD research, but they all have the potential to provide suitable specifications in future iterations.\n\nKeywords: Cross-evaluation; Multi-modal sensing; Parkinson’s disease; Smart wearables; System usability; Wearable devices.", "links": [] }, { "title": "Pilot Study on the Effect of Cannabidiol-Coated Fabric for Pillow Covers Improves the Sleep Quality of Shift Nurses", "author": "Afzal, Mashita; Huang, Chieh-Liang; Huang, Shih-Hao; Li, Chia-Ing; Liao, Wen-Chun; Yang, Juan-Cheng; Ma, Wen-Lung", "year": "2025", "journalProceedings": "Healthcare (Basel, Switzerland)", "category": "Intervention", "devices": "Charge 3", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background: Sleep difficulty is common in the current society. Poor sleep has a significant influence on health, social interactions and even mortality; therefore, maintaining good sleep is of prime importance. Cannabidiol (CBD), a cannabis-derived compound, is known for its medical significance with many positive effects in humans, including decreasing anxiety and improving sleep for those with sleep disorders. Objective: However, whether CBD skin absorption results in similar effects is unknown. Therefore, examining CBD-coated fabric as a pillow cover to improve sleep quality in duty shift nurses is the purpose of this paper. Methods: This study recruited 55 duty shift nurses as participants to evaluate sleep patterns and quality using the Pittsburgh Sleep Quality Index (PSQI) and a consumer-grade tracker (Fitbit Charge 3). Data were collected over three phases: a one-week baseline period, a two-week intervention period using a CBD-coated pillow cover and a one-week follow-up period, referred to as the post-intervention phase, during which the use of CBD-coated pillow cover was continued. Results: Of the 55 participants, 10 were men (18.2%) and 45 were women (81.8%). At baseline, all participants exhibited poor sleep quality (PSQI ≥ 5). However, after three weeks of using CBD-coated pillow covers, subjective sleep quality significantly improved, with 7.3% of participants achieving PSQI scores <5. Additionally, slight changes in sleep patterns were observed, with increases in both light sleep and deep sleep durations. Light sleep duration increased from a baseline of 196.21 ± 65.28 to 206.57 ± 59.15 min two weeks after intervention (p = 0.337). Similarly, deep sleep duration showed a modest increase from 61.97 ± 21.01 min to 64.35 ± 22.19 min (p = 0.288). Furthermore, a significant reduction in anxiety levels was reported (p < 0.005). Conclusions: Using a CBD-coated pillow cover was found to enhance sleep duration in healthy individuals experiencing poor sleep. Consequently, for adults struggling with sleep difficulties, incorporating a CBD-coated pillow cover may serve as an effective aid in improving sleep quality.\n\nKeywords: cannabidiol (CBD); non-rapid eye movement (NREM); nurses; pillowcase; sleep quality.", "links": [] }, { "title": "Using Wear Time for the Analysis of Consumer-Grade Wearables' Data: Case Study Using Fitbit Data", "author": "Baroudi, Loubna; Zernicke, Ronald Fredrick; Tewari, Muneesh; Carlozzi, Noelle E.; Choi, Sung Won; Cain, Stephen M.", "year": "2025", "journalProceedings": "JMIR mHealth and uHealth", "category": "Usability", "devices": "Charge,Inspire 2", "population": "Adults", "dataUsed": "Steps,Device Weartime", "abstract": "Background: Consumer-grade wearables allow researchers to capture a representative picture of human behavior in the real world over extended periods. However, maintaining users' engagement remains a challenge and can lead to a decrease in compliance (eg, wear time in the context of wearable sensors) over time (eg, \"wearables' abandonment\").\n\nObjective: In this work, we analyzed datasets from diverse populations (eg, caregivers for various health issues, college students, and pediatric oncology patients) to quantify the impact that wear time requirements can have on study results. We found evidence that emphasizes the need to account for participants' wear time in the analysis of consumer-grade wearables data. In Aim 1, we demonstrate the sensitivity of parameter estimates to different data processing methods with respect to wear time. In Aim 2, we demonstrate that not all research questions necessitate the same wear time requirements; some parameter estimates are not sensitive to wear time.\n\nMethods: We analyzed 3 Fitbit datasets comprising 6 different clinical and healthy population samples. For Aim 1, we analyzed the sensitivity of average daily step count and average daily heart rate at the population sample and individual levels to different methods of defining \"valid\" days using wear time. For Aim 2, we evaluated whether some research questions can be answered with data from lower compliance population samples. We explored (1) the estimation of the average daily step count and (2) the estimation of the average heart rate while walking.\n\nResults: For Aim 1, we found that the changes in the population sample average daily step count could reach 2000 steps for different methods of analysis and were dependent on the wear time compliance of the sample. As expected, population samples with a low daily wear time (less than 15 hours of wear time per day) showed the most sensitivity to changes in methods of analysis. On the individual level, we observed that around 15% of individuals had a difference in step count higher than 1000 steps for 4 of the 6 population samples analyzed when using different data processing methods. Those individual differences were higher than 3000 steps for close to 5% of individuals across all population samples. Average daily heart rate appeared to be robust to changes in wear time. For Aim 2, we found that, for 5 population samples out of 6, around 11% of individuals had enough data for the estimation of average heart rate while walking but not for the estimation of their average daily step count.\n\nConclusions: We leveraged datasets from diverse populations to demonstrate the direct relationship between parameter estimates from consumer-grade wearable devices and participants' wear time. Our findings highlighted the importance of a thorough analysis of wear time when processing data from consumer-grade wearables to ensure the relevance and reliability of the associated findings.\n\nKeywords: Fitbit; behavior; caregiver; dataset; engagement; mobile health; physical activity; reliability; smartwatch; students; users; walking; wear time; wearable devices; wearables.", "links": [] }, { "title": "No evidence of fluctuations in daily step count between infusions in people with multiple sclerosis treated with anti-CD20 monoclonal antibodies", "author": "Block, Valerie J.; Henderson, Kyra; Poole, Shane; Joseph, Gabby B.; Gelfand, Jeffrey M.; Cree, Bruce Ac; Bove, Riley", "year": "2025", "journalProceedings": "Multiple Sclerosis Journal - Experimental, Translational and Clinical", "category": "Case Study", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps", "abstract": "Background: Patients with multiple sclerosis (MS) on some disease-modifying therapies (i.e., natalizumab), report a \"wearing-off\" effect characterized by increased symptoms directly before infusions. Prior research suggests this may reflect natural MS fluctuations rather than true treatment waning; however, this has not been confirmed for anti-CD20 agents (e.g., ocrelizumab). Daily step count (STEPS) can reflect overall function. This study examined temporal associations between anti-CD20 therapy infusions and STEPS.\n\nMethods: Retrospective analysis evaluated data from two Fitbit-monitored cohorts (N = 145 total, 32 anti-CD20-treated participants) across 60 treatment cycles. Monthly STEPS were recorded directly pre- and three-month post-infusion over the six-month treatment intervals. Mixed-effects models evaluated the relationship between infusion timing, STEPS, and participant demographics, controlling for confounding variables.\n\nResults: No significant difference in STEPS was observed pre- versus post-infusion (p = 0.32). An average decrease of 3.3% was noted post-infusion but was not statistically significant. No associations between STEPS and participant characteristics (e.g., age, disability level) were identified. Individual variability existed, but no clear group-level trends emerged.\n\nConclusions: This study found no evidence of an association between timing of anti-CD20 infusion and changes in STEPS. Findings highlight the need for integrating objective measures with patient-reported outcomes and biomarkers in future research to better understand potential treatment fluctuations.\n\nKeywords: Multiple sclerosis; activity monitoring; anti-CD20 monoclonal antibodies; physical activity; self-reported wearing off; step count.", "links": [] }, { "title": "Daily Heart Rate per Step: A Wearables Metric Associated With Cardiovascular Disease in a Cross-Sectional Study of the All of Us Research Program", "author": "Chen, Zhanlin; Wang, Charles T.; Hu, Carolyn J.; Ward, Kendra; Kho, Abel; Webster, Gregory", "year": "2025", "journalProceedings": "Journal of the American Heart Association", "category": "Intervention", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Background: Simple biometrics such as peak heart rate and exercise duration remain core predictors of cardiovascular disease (CVD). Commercial wearable devices track physical and cardiac electrical activity. Detailed, longitudinal data collection from wearables presents a valuable opportunity to identify new factors associated with CVD.\n\nMethods and results: This cross-sectional study analyzed 6947 participants in the Fitbit Bring-Your-Own-Device Project, a subset of the All of Us Research Program. The primary exposure daily heart rate per step (DHRPS) was defined as the average daily heart rate divided by steps per day. Our analysis correlated DHRPS with established CVD factors (type 2 diabetes, hypertension, stroke, heart failure, coronary atherosclerosis, myocardial infarction) as primary outcomes. We also performed a DHRPS-based phenome-wide association study on the spectrum of human disease traits for all 1789 disease codes across 17 disease categories. Secondary outcomes included maximum metabolic equivalents achieved on cardiovascular treadmill exercise stress testing. We examined 5.8 million person-days and 51 billion total steps of individual-level Fitbit data paired with electronic health record data. Elevated DHRPS was associated with type 2 diabetes (odds ratio [OR], 2.03 [95% CI, 1.70-2.42]), hypertension (OR, 1.63 [95% CI, 1.32-2.02]), heart failure (OR, 1.77 [95% CI, 1.00-3.14]), and coronary atherosclerosis (OR, 1.44 [95% CI, 1.14-1.82]), even after adjusting for daily heart rate (DHR) and step count. DHRPS also had stronger correlations with maximum metabolic equivalents achieved on exercise stress testing compared with steps per day (∆ρ=0.04, P<0.001) and heart rate (∆ρ=0.31, P<0.001). Lastly, DHRPS-based phenome-wide association study demonstrated stronger associations with CVD factors (P<1×10-55) compared with daily heart rate or step count.\n\nConclusions: In the All of Us Research Program Fitbit Bring-Your-Own-Device Project, DHRPS was an easy-to-calculate wearables metric and was more strongly associated with cardiovascular fitness and CVD outcomes than DHR and step count.\n\nKeywords: biomarkers; cardiovascular disease; heart rate; physical activity; step count; wearables.", "links": [] }, { "title": "A 10-week remote monitoring study of sleep features and their variability in individuals with and without ADHD", "author": "Denyer, Hayley; Carr, Ewan; Deng, Qigang; Asherson, Philip; Bilbow, Andrea; Folarin, Amos; Groom, Madeleine J.; Hollis, Chris; Sankesara, Heet; Dobson, Richard Jb; Kuntsi, Jonna", "year": "2025", "journalProceedings": "BMC psychiatry", "category": "Case Study", "devices": "Charge 3", "population": "Children,Adults", "dataUsed": "Sleep", "abstract": "Background: People with attention deficit hyperactivity disorder (ADHD) often report disturbed sleep, as well as co-occurring symptoms of anxiety and depression. Yet studies employing objective assessments often do not show as many sleep disturbances compared to subjective measures. These discrepancies may relate to subjective reports capturing problematic nights, which may not be captured in a single night's sleep or by averaging objective measurements over several nights. Given that variability in behaviours is in general strongly linked to ADHD, individuals with ADHD could have greater sleep variability than individuals without ADHD. Using active and passive remote monitoring, we investigate differences in the level and variability of daily sleep behaviours between individuals with and without ADHD and explore if sleep is associated with changes in anxiety and depressive symptoms across a 10-week remote monitoring period.\n\nMethods: Forty individuals (20 with ADHD, 20 without) took part in a 10-week remote monitoring study. Active monitoring involved participants completing questionnaires on ADHD and co-occurring psychiatric symptoms at weeks 2, 6 and 10. Passive monitoring involved participants wearing a wearable device (Fitbit) that measured sleep each night.\n\nResults: Individuals with and without ADHD were similar in the levels of sleep recorded each night. However, compared to those without ADHD, participants with ADHD had more variable sleep duration, sleep onset and offset, and sleep efficiency over 10 weeks. Within-individual associations of co-occurring anxiety and depressive symptoms with the sleep features were non-significant.\n\nConclusions: In a 10-week remote monitoring study of sleep using a wearable device, we show that what distinguishes individuals with ADHD from those without is their greater variability in sleep features: participants with ADHD had a more variable sleep duration, sleep onset and offset, and sleep efficiency. Inconsistency and high variability are hallmarks of ADHD, and we show that this characteristic extends also to sleep among adolescents and adults with ADHD.\n\nTrial registration: Clinical trial number: not applicable.\n\nKeywords: ADHD; Attention deficit hyperactivity disorder; Remote measurement technology; Sleep variability; Wearable devices; mHealth.", "links": [] }, { "title": "Acceptability and Preliminary Efficacy of a Novel Web-Based Physical Activity for the Heart (PATH) Intervention Designed to Promote Physical Activity in Adults With Obesity: Protocol for a Pilot Randomized Controlled Trial", "author": "Kariuki, Jacob; Burke, Lora; Erickson, Kirk; Sereika, Susan; Paul, Sudeshna; Cheng, Jessica; Biza, Heran; Abdirahman, Amjad; Wilbraham, Katherine; Milton, Heather; Brown, Cornelius; Sells, Matthew; Osei Baah, Foster; Wells, Jessica; Chandler, Rasheeta; Barone Gibbs, Bethany", "year": "2025", "journalProceedings": "JMIR research protocols", "category": "Intervention", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps", "abstract": "Background: Even in the absence of weight loss, any level of physical activity (PA) can reduce the risk of cardiovascular disease among individuals with obesity. However, these individuals face multifaceted barriers that reduce their motivation and engagement in PA. They prefer programs that are convenient, fun to engage in, and feature people who they can relate to. Yet, there is a paucity of PA interventions that are designed to incorporate these preferences. We designed the web-based PA for The Heart (PATH) intervention to address this gap.\n\nObjective: This study aimed to describe the protocol of a study that aims to examine the acceptability and preliminary efficacy of PATH intervention among insufficiently active adults with obesity aged at least 18 years.\n\nMethods: This is a 6-month pilot randomized controlled trial (RCT), using a parallel design with 1:1 allocation to intervention or control group. The PATH intervention group is given access to the PATH platform, but the resources each participant can access are tailored according to their baseline fitness level. Control group receives a self-help PA handout. Both groups self-monitor their PA using Fitbit (Google) and have Zoom (Zoom Video Communications) meetings twice a month with either the health coach (intervention) or study coordinator (control). The outcomes at 6-months include acceptability, changes in PA, and cardiometabolic risk from baseline to 6-months.\n\nResults: We screened 763 individuals for eligibility and 89 participants were enrolled and randomized to the intervention (45/504, 50.6%) and control arms (44/504, 49.4%). The average age was 48.7 (SD 12.17) years, and most participants were female (81/504, 90.1%), Black (45/504, 50.6%), and non-Hispanic (83/504, 93.3%). No systematic differences in baseline characteristics were observed between the study arms. The 6-month intervention is currently underway, and the completion of follow-up data collection is expected in February 2025, with results to be published soon after.\n\nConclusions: The PATH intervention offers a promising, evidence-based approach to overcoming the barriers that have hindered previous PA programs for adults with obesity. It can support new and existing programs to foster long-term maintenance of health-enhancing PA.", "links": [] }, { "title": "Modulating Brain Activity to Improve Goal-directed Physical Activity in Older Adults: A Pilot Randomized Controlled Trial", "author": "Lo, On-Yee; Ask, Levi; Kahya, Melike; Travison, Thomas; Lipsitz, Lewis A.; Manor, Brad", "year": "2025", "journalProceedings": "The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences", "category": "Intervention", "devices": "Device unspecified", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Background: Insufficient physical activity in older adults remains a global health issue. Several interrelated factors contributing to inactivity are linked to the prefrontal cortex. We conducted a pilot study to assess the feasibility, acceptability, and effects of combining transcranial direct current stimulation (tDCS) and behavior counseling to improve physical activity in older adults.\n\nMethods: Inactive older adults living in subsidized housing participated in this randomized controlled trial. Baseline physical activity (daily steps) was measured with a Fitbit for 2 weeks. Participants then received an 8-week intervention, including 10 daily sessions of tDCS or Sham stimulation during the first 2 weeks, along with 4 biweekly behavior sessions. Functional outcomes were assessed at baseline, poststimulation, and after the entire intervention. Step counts were measured throughout the intervention and a 12-week retention period.\n\nResults: Twenty-eight participants completed the study. Compliance was 97%, 93%, and 92% for brain stimulation, behavior sessions, and follow-up assessments, respectively. Fitbit adherence was 96% and 71% during the intervention and retention periods. The tDCS arm, compared to Sham, exhibited greater increase in average daily steps (p .001). Participants increased 1 179 (+ 22%) and 550 (+ 15%) steps/day from baseline in the tDCS and Sham arms, respectively. Motivation (p .03) and self-reported walking performance (p .02) were also improved in the tDCS arm compared to Sham.\n\nConclusions: Combining tDCS and personalized behavior counseling to improve physical activity was feasible, acceptable, and appeared to be effective in a cohort of inactive older adults living within subsidized housing. Larger and more definitive studies are warranted.\n\nKeywords: Behavior; Motivation; Multimodal intervention; Step counts; tDCS.", "links": [] }, { "title": "Fitbit-Measured Sleep Duration in Young Adolescents is Associated with Functional Connectivity in Attentional, Executive Control, Memory, and Sensory Networks", "author": "Turan, Ozerk; Garner, Jonathan; Isaiah, Amal; Palatino, Maylin; Ernst, Thomas; Wang, Ze; Chang, Linda", "year": "2025", "journalProceedings": "Sleep", "category": "Case Study", "devices": "Device unspecified", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "Study objectives: Adolescents often do not sleep as much as recommended by most national guidelines, which may impact their brain development. The current study aims to evaluate the relationship between objective assessment of sleep duration measured with actigraphy, and brain network connectivity on functional magnetic resonance imaging (fMRI).\n\nMethods: We used data from the two-year follow-up of the Adolescent Brain Cognitive Development (ABCD) study comprising 3,799 adolescents, ages 10 to 13 years old, to assess the relationship between sleep duration, measured by two weeks of Fitbit-derived actigraphy, and brain network connectivity derived from resting-state fMRI, using linear regression models. Linear regression analysis was also used to investigate the interaction between participant sex and sleep duration on brain network connectivity.\n\nResults: We identified both positive and negative correlations between mean sleep duration and 6 within brain network and 30 between-network pairs. These included networks involved in attention (Dorsal and Ventral Attention networks), executive control (Cingulo-Opercular and Default Mode networks), memory (Retrosplenial Temporal network), and sensory function (Auditory and Sensorimotor networks). We also identified sex-specific effects in three network pairs (Auditory - Retrosplenial Temporal, Retrosplenial Temporal - Sensorimotor, and Visual - Visual) and sex differences in functional connectivity across 23 distinct within- and between-network connections.\n\nConclusions: Sleep duration is associated with the functional network connectivity in attentional, executive control, memory, and sensory networks during early adolescence. The identification of sex-specific effects in select network pairs underscores the importance of sex as a biological variable in studies of adolescent sleep and brain development.\n\nKeywords: actigraphy; functional connectivity; resting-state fMRI; sex-specific effects; sleep duration.", "links": [] }, { "title": "Validity of the Fitbit wearable activity monitor to estimate step counts in free-living conditions in ambulatory children and youth living with disability", "author": "Voss, Christine; Bremer, Emily; Sharma, Ritu; Martin Ginis, Kathleen A.; Arbour-Nicitopoulos, Kelly P.", "year": "2025", "journalProceedings": "Disability and Rehabilitation", "category": "Validation", "devices": "Charge HR", "population": "Children", "dataUsed": "Steps", "abstract": "Purpose: To assess the validity of the Fitbit ChargeHR versus a research-grade accelerometer (ActiGraph GT3X) for estimating daily step counts in free-living conditions in ambulatory children and youth living with physical and non-physical disabilities.\n\nMaterials and methods: Children and youth living with disability (n = 29; median age 10 years (IQR: 8-13), 55% boys; n = 2 with mobility aid) wore the GT3X ActiGraph accelerometer (hip) and the Fitbit ChargeHR (wrist) for seven days. Inter-device agreement in steps/day was assessed by intraclass correlation coefficients (ICCs) and Bland-Altman plots. A receiver operating curve (ROC) was used to determine a Fitbit step-count cut-point that corresponds to meeting physical activity guidelines (defined as ≥60 min of moderate-to-vigorous physical activity per day).\n\nResults: Overall, we found an ICC = 0.861 (p < 0.001) between daily step counts measured by the two devices. Bland-Altman analyses revealed a mean difference (\"bias\") between the devices with the Fitbit recording, on average, 1,388 more steps/day than the accelerometer (Limits of Agreement (LoA) 1,741 to -4,518 steps per day). The ROC revealed a Fitbit cut-point of 12,272 steps/day corresponding to meeting guidelines.\n\nConclusions: Fitbit ChargeHR devices tend to overestimate daily step counts, but may still provide useful estimates of step counts and patterns in children and youth living with disability.\n\nKeywords: Childhood disability; activity monitors; free-living; measurement; physical activity; wearable technology.", "links": [] }, { "title": "Insights into maternal sleep: a large-scale longitudinal analysis of real-world wearable device data before, during, and after pregnancy", "author": "Young-Lin, Nichole; Heneghan, Conor; Liu, Yun; Schneider, Logan; Niehaus, Logan; Haney, Ariel; Asiedu, Mercy; Gleichauf, Karla; Shreibati, Jacqueline Baras; Lafon, Belen", "year": "2025", "journalProceedings": "EBioMedicine", "category": "Case Study", "devices": "Device unspecified", "population": "Pregnant Women", "dataUsed": "Sleep,Heart Rate", "abstract": "Background: Current understanding of pregnancy and postpartum sleep is driven by limited lab or self-reported data. Our goal is to use consumer wearable devices through an observational study to reveal longitudinal, real-world sleep patterns in this population.\n\nMethods: We analysed retrospective, de-identified Fitbit device data from 2540 users in the United States and Canada who met strict wear-time requirements (≥80% daily usage for ≥80% of the time periods of interest [12 weeks prepregnancy, throughout pregnancy, and 20 weeks immediately postpartum]). We tracked sleep time and stages using Fitbit devices.\n\nFindings: Pregnant participants experienced a peak in total sleep time (TST) at 10 weeks (447.6 ± 47.6 min), exceeding their prepregnancy average (425.3 ± 43.5 min) before declining throughout pregnancy. This initial TST increase, mirrored by time in bed (TIB), was driven by more light sleep. Deep and rapid-eye movement sleep decreased significantly throughout pregnancy, with maximum reductions of 19.2 ± 13.8 min and 9.0 ± 19.2 min respectively by pregnancy end (two-sided t-test, p < 0.001 for both). Sleep efficiency also slightly declined during pregnancy (median drop: 88.3%-86.8%). Postpartum, TIB remained below prepregnancy levels by 14.7 ± 45.7 min one year after birth and 15.2 ± 47.7 min at 1.5 years after birth.\n\nInterpretation: This study revealed a previously unquantified initial increase in sleep followed by decreases in both quantity and quality as pregnancy progresses. Sleep deficits persist for at least 1.5 years postpartum. These quantified trends can assist clinicians and patients in understanding what to expect through their pregnancy and postpartum journey.\n\nFunding: Google, LLC.\n\nKeywords: Postpartum-related sleep; Pregnancy-related sleep; Sleep architecture; Wearables.", "links": [] }, { "title": "Digital, Personalized Clinical Trials Among Older Adults, Lessons Learned From the COVID-19 Pandemic, and Directions for the Future: Aggregated Feasibility Data From Three Trials Among Older Adults", "author": "Arader, Lindsay; Miller, Danielle; Perrin, Alexandra; Vicari, Frank; Friel, Ciaran P.; Vrany, Elizabeth A.; Goodwin, Ashley M.; Butler, Mark", "year": "2025", "journalProceedings": "Journal of Medical Internet Research", "category": "Systematic Review", "devices": "Device unspecified", "population": "Older Adults,Adults", "dataUsed": "Steps,User Friendliness,Device Weartime", "abstract": "BACKGROUND: The COVID-19 pandemic was extremely disruptive to clinical practice and research. Given older adults' increased likelihood of chronic health concerns, limited resources, and greater risk for adverse outcomes of COVID-19, access to research participation during this time was critical, particularly to interventions that may impact health conditions or behaviors. Fortunately, the implementation of personalized, digital research trials during the pandemic allowed for research and intervention delivery for older adults to continue remotely, resulting in feasibility findings that can benefit researchers, practitioners, and the broader older adult population. OBJECTIVE: This study discusses 3 digital, remote, and personalized intervention trials implemented during the pandemic to increase physical activity (2 trials) or to reduce back pain (1 trial). METHODS: We identified measures used for all 3 trials including Fitbit activity monitor use and self-reported participant satisfaction. Participant levels of Fitbit activity monitor use and satisfaction ratings of the digital trials were compared between younger (younger than 55 years) and older adults (older than 55 years). Differences between these cohorts were analyzed using chi-square tests for categorical outcomes and 2-tailed independent-sample t tests for continuous outcomes. RESULTS: Across the 3 trials, the majority of participants reported high satisfaction with the usability of the trials' digital systems including SMS text message interventions and surveys (≥62\\% satisfied) and the use of wearable devices such as Fitbits (≥81\\% satisfied). In addition, the use of the Fitbit device was shown to be feasible, as older adults across all trials wore their Fitbits for the majority of the day (mean 20.3, SD 3.6 hours). Furthermore, consistent Fitbit wear was common; 100\\% of participants older than 55 years wore their Fitbit an average of 10 or more hours per day. These trials highlight that digital, remote intervention delivery may be successfully implemented among older adults by way of personalized trials. Across the 3 digital interventions, feasibility and acceptability were high among older adults, and comparable to younger adults. CONCLUSIONS: Given the success of the current trials amid pandemic restrictions, we argue that these trials serve as a useful framework to aid in designing personalized, digital, remote interventions in other areas of clinical care among older adults and in planning for future disruptions including new pandemics.", "links": [] }, { "title": "Associations between objective and self-perceived physical activity and participation in everyday activities in mild stroke survivors", "author": "de Diego-Alonso, Cristina; Alegre-Ayala, Jorge; Blasco-Abadía, Julia; Doménech-García, Víctor; Part\\&Sed-Stroke collaborators’; Bellosta-López, Pablo", "year": "2025", "journalProceedings": "PloS One", "category": "Case Study", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Energy Expenditure", "abstract": "BACKGROUND AND PURPOSE: Stroke survivors present limited levels of physical activity (PA) and participation in everyday activities although the specific interaction between PA and participation in these individuals is still uncertain. This study aimed to analyse the relationship between PA and participation in everyday activities among Spanish mild stroke survivors. METHODS: A total of 130 mild stroke survivors (61.3 ± 12.4 years, 35\\% female) with preserved walking ability and without cognitive and communication impairments participated in this cross-sectional study involving several rehabilitation centres from Spain. Self-reported levels of PA were reported by the International Physical Activity Questionnaire - short form (IPAQ-SF). Objective PA measures were monitored with the wristband Fitbit Inspire 2, recording the average steps/day and kilocalories/day. Participation and activity satisfaction levels were measured with the Satisfaction with Daily Occupations-Occupational Balance (SDO-OB) and participation retention through Activity Card Sort (ACS). RESULTS: ACS total score showed a weak correlation with self-reported PA (rho = 0.324) and moderate correlations with kilocalories/day and average steps/day (rho ≥ 0.581), while stronger correlations were found for the ACS subdomain of instrumental activities (rho ≥ 0.640) compared to the subdomains of leisure activities and social participation (rho ≤ 0.454). SDO-OB participation showed moderate correlations with kilocalories/day, and average steps/day (rho ≥ 0.647), and a weak correlation with self-reported PA (rho = 0.303). Weaker correlations were found for SDO-OB satisfaction with objective PA measures (rho = 0.407) and self-reported PA (rho = 0.254). Relationships between variables were explored by calculating Spearman correlation coefficients. DISCUSSION AND CONCLUSIONS: The objective and self-reported measures of PA in mild stroke survivors have a bilateral relationship with their current participation levels and the retained instrumental activities of daily living. However, the weaker correlations with leisure and social participation may suggest that promoting PA alone without integrating it into daily activities relevant to the stroke survivor may be insufficient to achieve comprehensive goals during rehabilitation programs.", "links": [] }, { "title": "Sensor-triggered ecological momentary assessment in physical activity and sedentary behaviour research among Belgian community-dwelling elderly: lessons learnt from intensive longitudinal studies", "author": "Delobelle, Julie; Lebuf, Elien; Compernolle, Sofie; Vetrovsky, Tomas; Van Cauwenberg, Jelle; Cimler, Richard; Kuhnova, Jitka; Van Dyck, Delfien", "year": "2025", "journalProceedings": "BMJ open", "category": "Case Study", "devices": "Ionic,Inspire 2", "population": "Older Adults", "dataUsed": "Steps", "abstract": "OBJECTIVES: Regular physical activity (PA) and reduced sedentary behaviour (SB) have been associated with positive health outcomes, but many older adults do not comply with the current recommendations. Sensor-triggered ecological momentary assessment (EMA) studies allow capturing real-time data during or immediately after PA or SB, which can yield important insights into these behaviours. Despite the promising potential of sensor-triggered EMA, this methodology is still in its infancy. Addressing methodological challenges in sensor-triggered EMA studies is essential for improving protocol adherence and enhancing validity. Therefore, this study aimed to examine (1) the patterns in sensor-triggered EMA protocol adherence (eg, compliance rates), (2) the impact of specific settings (eg, event duration) on the number of prompted surveys, and (3) participants' experiences with engaging in a sensor-triggered EMA study. DESIGN: Two longitudinal, sensor-triggered EMA studies-one focused on PA and the other on SB-were conducted using similar methodologies from February to October 2022. Participants' steps were monitored for seven days using a Fitbit activity tracker, which automatically prompted an EMA survey through the HealthReact smartphone application when specified (in)activity thresholds were reached. After the monitoring period, qualitative interviews were conducted. Data from both studies were merged. SETTING: The studies were conducted among community-dwelling Belgian older adults. PARTICIPANTS: The participants had a median age of 72 years, with 54.17\\% being females. The PA study included 88 participants (four dropped out), while the SB study included 76 participants (seven dropped out). PRIMARY AND SECONDARY OUTCOME MEASURES: Descriptive methods and generalised logistic mixed models were employed to analyse EMA adherence patterns. Simulations were conducted to assess the impact of particular settings on the number of prompted EMA surveys. Additionally, qualitative interview data were transcribed verbatim and thematically analysed using NVivo. RESULTS: Participants responded to 81.22\\% and 79.10\\% of the EMA surveys in the PA and SB study, respectively. The confirmation rate, defined as the percentage of EMA surveys in which participants confirmed the detected behaviour, was 94.16\\% for PA and 72.40\\% for SB. Logistic mixed models revealed that with each additional day in the study, the odds of responding to the EMA survey increased significantly by 1.59 times (OR=1.59, 95\\% CI: 1.36 to 1.86, p{\\textless}0.01) in the SB study. This effect was not observed in the PA study. Furthermore, time in the study did not significantly impact the odds of participants confirming to be sedentary (OR=0.97, 95\\% CI: 0.92 to 1.02, p=0.28). However, it significantly influenced the odds of confirming PA (OR: 0.81, 95\\% CI: 0.68 to 0.97, p=0.02), with the likelihood of confirming decreasing by 19\\% with each additional day in the study. Furthermore, a one-minute increase in latency (ie, time between last syncing and starting the EMA survey) in the PA study decreased the odds of the participant confirming to be physically active by 20\\% (OR: 0.80, 95\\% CI: 0.72 to 0.89, p{\\textless}0.01). Simulations of the specific EMA settings revealed that reducing the event duration and shorter minimum time intervals between prompts increased the number of EMA surveys. Overall, most participants found smartphone usage to be feasible and rated the HealthReact app as user-friendly. However, some reported issues, such as not hearing the notification, receiving prompts at an inappropriate time and encountering technical issues. While the majority reported that their behaviour remained unchanged due to study participation, some noted an increased awareness of their habits and felt more motivated to engage in PA. CONCLUSIONS: This study demonstrates the potential of sensor-triggered EMA to capture real-time data on PA and SB among older adults, showing strong adherence potential with compliance rates of approximately 80\\%. The SB study had lower confirmation rates than the PA study, due to technical issues and discrepancies between self-perception and device-based measurements. Practical recommendations were provided for future studies, including improvements in survey timing, technical reliability and strategies to reduce latency.", "links": [] }, { "title": "Leveraging Accelerometry and Heartrate Data from Consumer Wearables to Predict Physical Activity in Children: A Device Agnostic Approach", "author": "Ghosal, Rahul; White, James W.; Finnegan, Olivia; Nelakuditi, Srihari; Brown, Trey; Pate, Russ; Welk, Greg; de Zambotti, Massimiliano; Wang, Yuan; Burkart, Sarah; Adams, Elizabeth L.; Armstrong, Bridget; Beets, Michael W.; Weaver, R. Glenn", "year": "2025", "journalProceedings": "Medicine and Science in Sports and Exercise", "category": "Validation", "devices": "Sense", "population": "Children", "dataUsed": "Steps,Heart Rate", "abstract": "INTRODUCTION: This study examined the potential of a device agnostic approach for predicting physical activity energy expenditure (PAEE) from research grade and consumer wearable accelerometry and heartrate (HR) raw data compared to indirect calorimetry in children. METHODS: Two-hundred and thirty-one 5-12-year-olds (52.4\\% male) of diverse skin tone and body weights participated in a 60-minute protocol with multiple activities at varying intensities. Children wore two of three consumer wearables (Apple Watch Series 7, Garmin Vivoactive 4S, Fitbit Sense) and a research grade accelerometer (ActiGraph GT9X) on their non-dominant wrist, and a chest-placed, research grade HR monitor (Actiheart 5, ECG), concurrently. Children also wore a K5 criterion measure of PAEE (i.e., COSMED K5). Cross-sectional time series (CSTS), generalized additive mixed effects model (GAMM) and random forest (RF) were used to estimate minute-by-minute PAEE from features extracted from raw accelerometry and HR data. Variance explained (R2), in addition to other metrics, evaluated agreement between estimated and criterion measurements. RESULTS: For the research grade devices (i.e., ActiGraph accelerometry and Actiheart HR) R2 was 0.74, 0.74, and 0.76 for CSTS, GAMM, and RF, respectively. For Apple R2 was 0.77, 0.76, and 0.78, Garmin's was 0.73, 0.73, and 0.75, and Fitbit's was 0.63, 0.65, and 0.67 for CSTS, GAMM, and RF, respectively. Across all other evaluation metrics, a similar pattern was observed with Fitbit performing the worst but with little variability between the modeling approaches or the other devices. CONCLUSIONS: Except for Fitbit, accelerometry and HR data from consumer wearables predicted PAEE comparably to research grade devices and there was little variability across modeling approach. These outcomes support deploying a consumer wearable device-agnostic approach for PAEE estimation in children.", "links": [] }, { "title": "Effects of Virtual Reality Meditation on Sleep and Delirium in ICU Patients: A Randomized Controlled Trial", "author": "Kim, Soogyeong; Kang, Jiyeon", "year": "2025", "journalProceedings": "Computers, informatics, nursing: CIN", "category": "Intervention", "devices": "Charge 3", "population": "Patients", "dataUsed": "Sleep", "abstract": "The purpose of this study was to evaluate the effectiveness of virtual reality meditation compared with standard care on sleep quality and delirium incidence in patients admitted to the ICU. We conducted a randomized controlled trial with 96 patients in an 11-bed surgical ICU at a South Korean university hospital. The control group received usual sleep care, whereas the intervention group received an additional 20-minute virtual reality-based mindfulness and relaxation meditation before bedtime. Using the Verran and Snyder-Halpern Sleep Scale, we found significantly improved subjective sleep quality in the intervention group compared with controls during both the first (47.82 vs 39.75, P = .015) and second nights (50.26 vs 43.65, P = .025) of ICU admission. However, objective sleep measurements using Fitbit devices showed no significant differences in total sleep time between groups for either the first (384.59 vs 358.19 minutes, P = .450) or second night (319.94 vs 310.77 minutes, P = .807). Delirium incidence was similar between groups (12.2\\% vs 12.8\\%, P = .938). These findings suggest the need for larger-scale studies with robust experimental designs to definitively establish the impact of virtual reality meditation on sleep quality and delirium in ICU patients.", "links": [] }, { "title": "Digital Health Intervention to Reduce Malnutrition Among Individuals With Gastrointestinal Cancer Receiving Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Chemotherapy: Feasibility, Acceptability, and Usability Trial", "author": "Lin, Yu Chen; Hagen, Ryan; Powers, Benjamin D.; Dineen, Sean P.; Milano, Jeanine; Hume, Emma; Sprow, Olivia; Diaz-Carraway, Sophia; Permuth, Jennifer B.; Deneve, Jeremiah; Alishahi Tabriz, Amir; Turner, Kea", "year": "2025", "journalProceedings": "JMIR cancer", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Food", "abstract": "BACKGROUND: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can improve survival outcomes for individuals with gastrointestinal (GI) cancer and peritoneal disease (PD). Individuals with GI cancer and PD receiving CRS-HIPEC are at increased risk for malnutrition. Despite the increased risk for malnutrition, there has been limited study of nutritional interventions for individuals receiving CRS-HIPEC. OBJECTIVE: We aimed to test the feasibility, acceptability, and usability of Support Through Remote Observation and Nutrition Guidance (STRONG), a multilevel digital health intervention to improve nutritional management among individuals with GI cancer and PD receiving CRS-HIPEC. We also assessed patient-reported outcomes, including malnutrition risk, health-related quality of life, and weight-related measures. METHODS: STRONG is a 12-week digital intervention in which participants received biweekly nutritional counseling with a dietitian, logged food intake using a Fitbit tracker, and reported nutrition-related outcomes. Dietitians received access to a web-based dashboard and remotely monitored patients' reported food intake and nutrition-impact symptoms. Implementation outcomes were assessed against prespecified benchmarks consistent with benchmarks used in prior studies. Changes in patient-reported outcomes at baseline and follow-up were assessed using linear and ordered logistic regressions. RESULTS: Participants (N=10) had a median age of 57.5 (IQR 54-69) years. Feasibility benchmarks were achieved for recruitment (10/17, 59\\% vs benchmark: 50\\%), study assessment completion (9/10, 90\\% vs benchmark: 60\\%), dietitian appointment attendance (7/10, 70\\% vs benchmark: 60\\%), daily food intake logging adherence (6/10, 60\\% vs benchmark: 60\\%), and participant retention (10/10, 100\\% vs benchmark: 60\\%). Most participants rated the intervention as acceptable (8/10, 80\\% vs benchmark: 70\\%) and reported a high level of usability for dietitian services (10/10, 100\\%). The benchmark usability for the Fitbit tracker to log food intake was not met. Compared to baseline, participants saw on average a 6.0 point reduction in malnutrition risk score (P=.01), a 20.5 point improvement in general health-related quality of life score (P=.002), and a 5.6 percentage point increase in 1-month weight change (P=.04) at the end of the study. CONCLUSIONS: The STRONG intervention demonstrated to be feasible, acceptable, and usable among individuals with GI cancer and PD receiving CRS-HIPEC. A fully powered randomized controlled trial is needed to test the effectiveness of STRONG for reducing malnutrition and improving patient outcomes.", "links": [] }, { "title": "The feasibility and acceptability of delivering and evaluating a physical activity intervention (ACCEPTANCE) for cervical cancer survivors", "author": "Millet, Nessa; McDermott, Hilary J.; Munir, Fehmidah; Edwardson, Charlotte L.; Plekhanova, Tatiana; Moss, Esther L.", "year": "2025", "journalProceedings": "Pilot and Feasibility Studies", "category": "Intervention", "devices": "Inspire", "population": "Adults", "dataUsed": "User Friendliness", "abstract": "BACKGROUND: Cervical cancer treatment can be associated with long-term physical, psychological and emotional issues leading to compromised quality of life (QOL). Physical activity (PA) may improve QOL in cervical cancer survivors. METHODS: A one-arm pre/post-feasibility study with parallel process evaluation was conducted to test the feasibility and acceptability of a 12-week PA intervention (ACCEPTANCE). Feasibility was determined by using pre-established criteria relating to inclusion criteria, recruitment and retention, compliance with intervention components and compliance with evaluation measures. The 12-week intervention consisted of (1) an online education session on the benefits of PA and a barrier identification and problem-solving session; (2) a Fitbit monitor; (3) daily and weekly diary entries; (4) brief fortnightly online health coaching sessions; and (5) organising and participating in group walks; (6) online social interaction via a messaging group. Measures included accelerometer assessed PA and sleep, quality-of-life and PA behaviour change questionnaires distributed at 4-time points (baseline, week 6, week 12, and week 24). Process evaluation measures were questionnaires on the acceptance of intervention components and semi-structured interviews with participants after completion. RESULTS: Thirty participants were recruited with a retention rate of 77\\% at week 24. The education session, health coaching and Fitbit PA monitor were deemed to be feasible based on compliance rates whilst the online messaging group, diary and group walking compliance suggested that modifications would be needed for these components. Accelerometer and questionnaires were deemed to be feasible evaluation measures based on compliance rates. Process evaluation results suggest that the Fitbit and health coaching sessions were perceived to be the most beneficial aspects of the programme as they enabled self-monitoring of behaviour and goal setting. Unexpected mechanisms of behaviour change were the integration of a small change approach and formation of habits to facilitate PA, whilst barriers to behaviour change included the online, virtual nature of the programme, poor mental health, and environmental challenges. PA levels were higher after the intervention, whilst global QOL was seen to worsen throughout the study, and depression and anxiety symptoms improved. CONCLUSIONS: The ACCEPTANCE study is deemed to be feasible based on criteria established a priori, and only minor modifications would needed to implement in a definitive randomised control trial. The intervention showed potential to increase PA, through hypothesised mechanisms of self-monitoring behaviour and problem solving and unexpected mechanisms such as habit formation. TRIAL REGISTRATION: ISRCTN16349793, Registered 30 September 2020.", "links": [] }, { "title": "Examining the Agreement Between Subjective and Objective Measures of Sleep: A Comparison of Munich Chronotype Questionnaire and Fitbit-Derived Sleep Metrics", "author": "Rohr, Kayla E.; Thomas, Michael L.; McCarthy, Michael J.; Meruelo, Alejandro D.", "year": "2025", "journalProceedings": "Journal of Sleep Research", "category": "Usability", "devices": "Device unspecified", "population": "Adolescents", "dataUsed": "Sleep,Heart Rate", "abstract": "Understanding the relationship between subjective and objective sleep measures is essential for evaluating their agreement and utility. This study compared Munich Chronotype Questionnaire (MCTQ) and Fitbit metrics for sleep duration, sleep midpoint and social jetlag in 5252 participants from the Adolescent Brain Cognitive Development (ABCD) study. Linear and nonlinear models assessed relationships between Fitbit-derived and MCTQ-reported metrics, whilst moderation analyses examined the influence of age, sex, household income and BMI. A sensitivity analysis compared results pre- and post-COVID-19 to assess pandemic-related effects (pre-COVID n = 4451). Correlations were weak to moderate: r = 0.15-0.21 for sleep duration, r = 0.37-0.42 for sleep midpoint, and r = 0.12-0.16 for social jetlag. Quadratic and LOESS models confirmed nonlinear trends for sleep midpoint, with greater Fitbit-MCTQ divergence at extreme morningness or eveningness. Fitbit classified 63.2\\% of participants as having insufficient sleep, compared to 39.45\\% with MCTQ, suggesting Fitbit underestimates sleep duration. Bland-Altman plots confirmed MCTQ overestimation, especially for shorter sleepers. BMI was significantly associated with sleep duration and social jetlag, with higher BMI linked to shorter sleep and greater variability. Household income and BMI moderated specific sleep metrics, whilst age and sex did not significantly moderate any metric. Sensitivity analyses showed consistent results across pre- and post-COVID periods. Findings highlight stronger agreement for sleep midpoint than for sleep duration or social jetlag, with methodological differences driving discrepancies. The consistency across demographics and time periods supports the complementary use of Fitbit and MCTQ for adolescent sleep assessment.", "links": [] }, { "title": "Design and baseline characteristics of an implementation study to increase activity with social incentives: The STEP together trial", "author": "Scheffey, Krista; Aronson, Joshua; Goncalves, Yolande; Greysen, S. Ryan; Iwu, Ashley; Kwong, Pui L.; Nezir, Freya; Small, Dylan; Glanz, Karen", "year": "2025", "journalProceedings": "Contemporary Clinical Trials", "category": "Intervention", "devices": "Inspire 2,Inspire 3", "population": "Older Adults,Adults", "dataUsed": "Steps,Intensity,Goals", "abstract": "BACKGROUND: The majority of people in the United States do not achieve recommended levels of physical activity. Even small, daily increases can have health benefits. Wearable devices paired with social incentives increased daily steps in pilot studies but have not been tested for long-term effectiveness in community settings. This paper describes the study design and baseline participant characteristics of a trial testing these approaches to increase physical activity among families in the Philadelphia area. METHODS: The trial, called STEP Together, is a Hybrid Type 1 effectiveness-implementation study. Participants enroll on family teams of 2-10 people, including at least one person 60 years old or older. Each participant receives a Fitbit device, establishes a baseline daily step count, and selects a daily step goal 1500 to 3000 steps greater than their baseline. Family teams are stratified based on family size and randomized to Control, Social Incentive Gamification, or Social Goals through Incentives to Charity. Participation is 18-months: a 12-month intervention and 6-month follow up. RESULTS: 779 participants on 285 family teams were randomized. Recruitment was more difficult than anticipated due to the COVID-19 pandemic and higher-than expected numbers of participants who were already physically active and therefore ineligible. Changes to the eligibility criteria that did not impact the underlying intent or conceptual basis for the trial improved recruitment feasibility. CONCLUSION: The results from this study will contribute to the growing body of evidence about scalable, effective strategies to motivate individuals and families to increase their daily physical activity. CLINICAL TRIAL REGISTRATION NUMBER: NCT04942535.", "links": [] }, { "title": "Personalized Physician-Assisted Sleep Advice for Shift Workers: Algorithm Development and Validation Study", "author": "Shen, Yufei; Choto Olivier, Alicia; Yu, Han; Ito-Masui, Asami; Sakamoto, Ryota; Shimaoka, Motomu; Sano, Akane", "year": "2025", "journalProceedings": "JMIR formative research", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "BACKGROUND: In the modern economy, shift work is prevalent in numerous occupations. However, it often disrupts workers' circadian rhythms and can result in shift work sleep disorder. Proper management of shift work sleep disorder involves comprehensive and patient-specific strategies, some of which are similar to cognitive behavioral therapy for insomnia. OBJECTIVE: Our goal was to develop and evaluate machine learning algorithms that predict physicians' sleep advice using wearable and survey data. We developed a web- and app-based system to provide individualized sleep and behavior advice based on cognitive behavioral therapy for insomnia for shift workers. METHODS: Data were collected for 5 weeks from shift workers (N=61) in the intensive care unit at 2 hospitals in Japan. The data comprised 3 modalities: Fitbit data, survey data, and sleep advice. After the first week of enrollment, physicians reviewed Fitbit and survey data to provide sleep advice and selected 1 to 5 messages from a list of 23 options. We handcrafted physiological and behavioral features from the raw data and identified clusters of participants with similar characteristics using hierarchical clustering. We explored 3 models (random forest, light gradient-boosting machine, and CatBoost) and 3 data-balancing approaches (no balancing, random oversampling, and synthetic minority oversampling technique) to predict selections for the 7 most frequent advice messages related to bedroom brightness, smartphone use, and nap and sleep duration. We tested our predictions under participant-dependent and participant-independent settings and analyzed the most important features for prediction using permutation importance and Shapley additive explanations. RESULTS: We found that the clusters were distinguished by work shifts and behavioral patterns. For example, one cluster had days with low sleep duration and the lowest sleep quality when there was a day shift on the day before and a midnight shift on the current day. Our advice prediction models achieved a higher area under the precision-recall curve than the baseline in all settings. The performance differences were statistically significant (P{\\textless}.001 for 13 tests and P=.003 for 1 test). Sensitivity ranged from 0.50 to 1.00, and specificity varied between 0.44 and 0.93 across all advice messages and dataset split settings. Feature importance analysis of our models found several important features that matched the corresponding advice messages sent. For instance, for message 7 (darken the bedroom when you go to bed), the models primarily examined the average brightness of the sleep environment to make predictions. CONCLUSIONS: Although our current system requires physician input, an accurate machine learning algorithm shows promise for automatic advice without compromising the trustworthiness of the selected recommendations. Despite its decent performance, the algorithm is currently limited to the 7 most popular messages. Further studies are needed to enable predictions for less frequent advice labels.", "links": [] }, { "title": "A remotely delivered exercise-based rehabilitation program for patients with persistent chemotherapy-induced peripheral neuropathy (EX-CIPN): Protocol for a phase I feasibility trial", "author": "Antonen, Eric M.; Nadler, Michelle B.; Langelier, David M.; Campbell, Kristin L.; Flamer, David; Cho, Jang Hyuk; Capozza, Scott; Avery, Lisa; Bland, Kelcey A.; Leatherdale, Scott; Manthorne, Jackie; Jones, Jennifer M.", "year": "2025", "journalProceedings": "PloS One", "category": "Intervention", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps,User Friendliness", "abstract": "Background: Chemotherapy-induced peripheral neurotoxicity (CIPN) is a prevalent adverse effect of chemotherapy agents that is estimated to be present in 2/3 of patients who receive neurotoxic chemotherapy. In 30-40% of these patients, CIPN signs and symptoms can persist for months or years post-treatment. Recent studies have supported exercise as a feasible and possibly effective intervention for CIPN; however, more rigorous studies are needed to confirm feasibility, estimate efficacy, and clarify risk. In response, we developed an innovative virtual exercise-based rehabilitation program (EX-CIPN) for cancer survivors with persistent CIPN.\n\nMethods: This study is a phase I study conducted at the Princess Margaret Cancer Centre in cancer survivors with persistent CIPN, with a focus on feasibility, acceptability, and safety. A total of 40 patients aged 18 or older, with persistent CIPN at least 6 months after chemotherapy completion will be recruited and receive the EX-CIPN program. The EX-CIPN program is a 10-week virtual home-based intervention that includes an individualized exercise program supported with a mobile application (Physitrack), wearable technology (FitBit), and weekly virtual check-ins with an oncology exercise specialist. The primary outcome of feasibility will be assessed by examining accrual, retention, and adherence rates. Acceptability will be assessed through qualitative interviews. Safety events will be monitored and reported based on CTCAE v5. Secondary outcomes will be collected using questionnaires and physiological assessments at baseline (T1), after the intervention (T2), and 3-months after intervention (T3).\n\nConclusion: This phase I study will determine intervention feasibility, acceptability, and safety and will inform the planning for a future Phase II RCT with the EX-CIPN intervention.", "links": [] }, { "title": "Association between working conditions during the COVID-19 pandemic and sleep and stress among Colombian healthcare workers", "author": "Carrillo-González, Andrés; Cantor-Cutiva, Lady Catherine", "year": "2025", "journalProceedings": "Archives of Environmental \\& Occupational Health", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Sleep", "abstract": "Introduction: Although COVID-19 is no longer a public health emergency, its mental health effects on healthcare workers persist.\n\nAim: This study investigated the relationship between working conditions, sleep, and stress among Colombian hospital healthcare personnel during the pandemic.\n\nMethods: In this cross-sectional study, 79 healthcare workers completed questionnaires on working conditions, stress, and sleep. Sleep duration was measured with Fitbit Armbands. Associations were analyzed using Generalized Linear Models with Gamma and ordinal distributions.\n\nResults: Approximately 79% of participants reported high to very high stress levels (61% \"very high,\" 18% \"high\"). Sleep complications were minimal, averaging 6.2 hours. Nurses showed significantly higher stress and longer sleep duration than administrative workers. Overtime correlated with less sleep, while workers who had COVID-19 reported lower stress.\n\nConclusion: The study highlights connections between stress, sleep, and working conditions, suggesting targeted health promotion programs could enhance work-life balance.", "links": [] }, { "title": "Physical Activity, Sleep, and Quality of Life in Pulmonary Arterial Hypertension: Novel Insights From Wearable Devices", "author": "Hughes, Andrew M.; Lindsey, Alisha; Annis, Jeffrey; Burke, Kelly; Master, Hiral; Silverman-Lloyd, Luke G.; Garry, Jonah D.; Blaha, Michael J.; Berman Rosenzweig, Erika S.; Frantz, Robert P.; Hassoun, Paul M.; Horn, Evelyn M.; Leopold, Jane A.; Rischard, Franz P.; Larive, Brett; Hill, Nicholas S.; Erzurum, Serpil C.; Beck, Gerald J.; Hemnes, Anna R.; Brittain, Evan L.", "year": "2025", "journalProceedings": "Pulmonary Circulation", "category": "Usability", "devices": "Versa,Charge 3,Charge 5", "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Reduced functional capacity and poor sleep quality are common in pulmonary arterial hypertension (PAH). Wearable devices are an emerging, user-friendly tool to capture activity and sleep information. We aimed to determine whether Fitbit-derived activity and sleep trends provide clinically meaningful information in patients with PAH. Our prospective observational study recruited patients with PAH from across the United States using remote enrollment strategies and in-person efforts. Participants wore a Fitbit device for 12 weeks at baseline and a subgroup with 1-year follow-up. A matched control cohort was generated from the All of Us Research Program and we evaluated changes in patients with PAH compared to matched controls. Among 110 patients with baseline monitoring, average daily steps correlated with 6MWD (r = 0.61, p < 0.001) and percent rapid eye movement (REM) sleep (r = 0.28, p = 0.008). In 44 PAH participants who completed baseline and 1-year monitoring, there was a group-time interaction for percent light sleep (p = 0.024) and percent REM sleep (p = 0.034), which demonstrated that sleep quality worsened in patients with PAH over 1 year compared to matched controls. Average daily steps decreased in patients with PAH from 5200 [IQR 3212-7458] at baseline to 4651 [IQR 2912-6827] at 1 year (p = 0.008). In conclusion, our study demonstrated the potential clinical value of wearable devices by showing that activity and sleep quality are reduced in PAH compared to matched controls and these measures decline over time. Future studies should investigate if monitoring these health behaviors detects early functional decline and whether targeted interventions may improve outcomes.", "links": [] }, { "title": "The Impact of Macronutrient Intake on Sleep Quality in Female Endurance Athletes: A Pilot Observational Cross-Sectional Study", "author": "Koikawa, Natsue; Minamino, Yume; Kawasaki, Yu; Kasai, Takatoshi; Suzuki, Yoshio", "year": "2025", "journalProceedings": "Nutrients", "category": "Case Study", "devices": "Charge 3", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background/Objectives: Sleep is essential for athletes. However, the impact of dietary habits on sleep quality in female endurance athletes at risk for low energy availability (LEA) is underexplored. This was a pilot study to examine the correlation between dietary patterns and sleep quality in healthy female endurance athletes. Methods: Twenty-four female endurance athletes recorded their dietary intake and sleeping habits for 6 days. Dietary intake data were collected via meal logs and photos. Sleep parameters were tracked using the Fitbit Charge 3 device. Correlation analyses were performed to explore the associations between macronutrient intake and sleep. Results: The athletes' mean consumption was 2049.3 ± 396.9 kcal/day (52.9% carbohydrates, 28.2% fat, and 17.2% protein). One-third of the athletes had poor sleep quality, and thirty-eight percent experienced high daytime sleepiness. A higher protein intake was correlated with a lower awake time (R = -0.491; p = 0.015), and fat intake was related to a lower duration of deep sleep (R = -0.477; p = 0.019). Deep sleep was negatively correlated with fat intake during dinner (R = -0.417; p = 0.042) and was positively correlated with carbohydrate intake (R = 0.417; p = 0.042). Conclusions: In healthy female endurance athletes without LEA, dietary fat intake, especially at dinner, negatively affects deep sleep. Meanwhile, carbohydrates promote deep sleep. Therefore, optimizing macronutrient balance during evening meals may enhance sleep quality and, consequently, athletic performance.", "links": [] }, { "title": "Relationship Between Step Count and the Timed Up and Go and L Test of Functional Mobility Among Adults With Transtibial Amputation", "author": "Leister, Kyle R.; Barreira, Tiago V.", "year": "2025", "journalProceedings": "Archives of Physical Medicine and Rehabilitation", "category": "Case Study", "devices": "Inspire 3", "population": "Adults", "dataUsed": "Steps", "abstract": "Objective: To explore the relationship between daily steps measured by the activPAL 3 and Fitbit Inspire 3 accelerometers and performance on the Timed Up and Go test (TUG) and L Test of Functional Mobility (L test) in adults with transtibial amputation.\n\nDesign: Observational design.\n\nSetting: Six outpatient prosthetic clinics located in the United States and the participant's home environment.\n\nParticipants: Adults (n=96) with unilateral transtibial amputation.\n\nInterventions: Not applicable.\n\nMain outcome measures: Each participant wore the activPAL and Fitbit concurrently for 7 days. Pearson correlation was used to assess the relationship between daily steps from each device and TUG and L test completion times. Regression was employed to control for sex, body mass index, age, and type 2 diabetes status.\n\nResults: Moderate negative correlations were observed between daily steps recorded by the activPAL and TUG (r=-.52) and L test (r=-.51) times. Moderate negative correlations were also found between daily steps from the Fitbit Inspire 3 and TUG (r=-.55) and L test (r=-.56) times. These relationships remained statistically significant with minimal influence by the included covariates.\n\nConclusions: Participants who performed well on the TUG and L test tend to have higher daily step counts, highlighting a meaningful association between clinical mobility performance and free-living physical activity. This finding provides evidence that TUG and L test completion times may reflect both functional capacity in a clinical setting and real-world ambulatory behavior. Although step counts and clinical performance measures are not interchangeable, together they offer complementary insights that can enhance the evaluation and monitoring of mobility in individuals with transtibial amputation.", "links": [] }, { "title": "Effectiveness of PEER Intervention on Older Adults' Physical Activity Time Series Using Smoothing Spline ANOVA", "author": "Liu, Yi; Liu, Chang; Ni, Liqiang; Zhang, Wei; Chen, Chen; Lopez, Janet; Zheng, Hao; Thiamwong, Ladda; Xie, Rui", "year": "2025", "journalProceedings": "Mathematics (Basel, Switzerland)", "category": "Intervention", "devices": "Charge 5", "population": "Older Adults", "dataUsed": "Intensity,Active Minutes/Active Zone Minutes", "abstract": "Falls are a major cause of injury among older adults. The Physio-fEedback Exercise pRogram (PEER) combines physio-feedback, cognitive reframing, and guided exercises to reduce fall risk. However, its impact on physical activity (PA) over time is underexplored. Functional time-series analysis offers insight into behavior patterns and sustainability. This preliminary study assessed PEER's effectiveness in improving PA levels immediately and over time. A total of 64 community-dwelling older adults were cluster-randomized into PEER \n(\nN\n=\n33\n)\n or control groups \n(\nN\n=\n31\n)\n . Participants wore Fitbit trackers, generating time-series data on activity. The PEER group completed an 8-week program, while the control group received CDC fall prevention pamphlets. PA data were analyzed using smoothing spline analysis of variance (SSANOVA), chosen for its flexibility in modeling complex, non-linear relationships in time-series data and its ability to handle skewed distributions and repeated measures. Unlike traditional parametric models, SSANOVA decomposes temporal trends into interpretable components, capturing both smooth trends and abrupt changes, such as those occurring on group workout days. This capability ensures robust and nuanced analysis of intervention effects. Results showed PEER participants significantly increased evenly and had very active minutes and reduced sedentary behavior during the intervention. No significant effect was found for light active minutes. Specifically, during the intervention period, PEER participants engaged in an average of 6.7% fewer sedentary minutes per day, 13.8% additional fairly active minutes per day, and 2.8% additional very active minutes per day compared to the control group. While the reduction in sedentary minutes and increase in fairly active minutes were not statistically significant, the increase in very active minutes was significant. However, our functional time-series analysis revealed these improvements diminished over the 15-week follow-up, indicating challenges in maintaining PA. In conclusion, PEER boosts PA and reduces sedentary behavior short-term, but strategies are needed to sustain these benefits. In conclusion, PEER boosts PA and reduces sedentary behavior short-term, but strategies are needed to sustain these benefits. Public health policies should emphasize technology-driven fall risk assessments, community-based prevention programs, and initiatives that promote physical activity, home safety, and chronic condition management.", "links": [] }, { "title": "KArAT (Knee Arthroplasty Activity Trial): Rationale and design features of a multicenter randomized controlled trial", "author": "Losina, Elena; Collins, Jamie E.; Kumara, Mahima; Ehrlich-Jones, Linda; Opare-Addo, Maame; Safran-Norton, Clare; Segal, Neil A.; Mitchell, Lauren M.; Kopp, Paul T.; Selzer, Faith; Mass, Hanna; Paskewicz, Michael; Chang, Rowland W.; Dunlop, Dorothy; Chen, Antonia F.; Lerner, Samuel; Chin, Samantha; Pellegrini, Christine; Katz, Jeffrey N.", "year": "2025", "journalProceedings": "Osteoarthritis and Cartilage Open", "category": "Intervention", "devices": "Inspire 3", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: Total knee arthroplasty (TKA) is commonly performed to relieve pain in persons with severe knee osteoarthritis. Despite substantial pain reduction and functional improvements, physical activity (PA) does not necessarily increase post TKA. The premise for this randomized trial is that a behavioral intervention invoking internal and external motivators could lead to improvement in PA uptake post TKA.\n\nMethods: KArAT (the Knee Arthroplasty Activity Trial) is a three-arm multi-center randomized controlled trial designed to establish the efficacy and sustainability of a personalized behavioral intervention in improving PA among TKA recipients with a primary diagnosis of knee osteoarthritis. The three arms include: 1) usual care, 2) attention control with Fitbit activity trackers, and 3) health coaching and financial incentives for reaching personalized PA goals. The primary outcome is defined as the proportion of participants engaged in at least 150 ​min of moderate-to-vigorous physical activity over a given week after the 6-month intervention. We also plan to conduct a cost-effectiveness analysis to establish the value and affordability of the KArAT interventions.\n\nDiscussion: This paper aims to outline the rationale, study design, and implementation of KArAT.", "links": [] }, { "title": "Predicting Real-World Physical Activity in Multiple Sclerosis: An Integrated Approach Using Clinical, Sensor-Based, and Self-Reported Measures", "author": "Monaghan, Patrick G.; VanNostrand, Michael; Takla, Taylor N.; Fritz, Nora E.", "year": "2025", "journalProceedings": "Sensors (Basel, Switzerland)", "category": "Case Study", "devices": "Versa 2", "population": "Adults", "dataUsed": "Steps,Intensity,Active Minutes/Active Zone Minutes", "abstract": "Multiple sclerosis (MS) is a chronic neurodegenerative disease characterized by mobility impairments that limit physical activity and reduce quality of life. While traditional clinical measures and participant-reported outcomes provide valuable insights, they often fall short of fully capturing the complexities of real-world mobility. This study evaluates the predictive value of combining sensor-derived clinical measures and participant-reported outcomes to better forecast prospective physical activity levels in individuals with MS. Forty-six participants with MS completed surveys assessing fatigue, concern about falling, and perceived walking ability (MSWS-12), alongside sensor-based assessments of gait and balance. Over three months, participants wore Fitbit devices to monitor physical activity, including step counts and total activity levels. Forward stepwise regression revealed that a combined model of participant-reported outcomes and sensor-derived measures explained the most variance in future physical activity, with MSWS-12 and backward walking velocity emerging as key predictors. These findings highlight the importance of integrating subjective and objective measures to provide a more comprehensive understanding of physical activity patterns in MS. This approach supports the development of personalized interventions aimed at improving mobility, increasing physical activity, and enhancing overall quality of life for individuals with MS.", "links": [] }, { "title": "More variable circadian rhythms in epilepsy captured by long-term heart rate recordings from wearable sensors", "author": "Smith, Billy C.; Thornton, Christopher; Stirling, Rachel E.; Besné, Guillermo M.; Gascoigne, Sarah J.; Evans, Nathan; Taylor, Peter N.; Leiberg, Karoline; Karoly, Philippa J.; Wang, Yujiang", "year": "2025", "journalProceedings": "Epilepsia", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "Objective: The circadian rhythm synchronizes physiological and behavioral patterns with the 24-h light-dark cycle. Disruption to the circadian rhythm is linked to various health conditions, although optimal methods to describe these disruptions remain unclear. An emerging approach is to examine the intraindividual variability in measurable properties of the circadian rhythm over extended periods. Epileptic seizures are modulated by circadian rhythms, but the relevance of circadian rhythm disruption in epilepsy remains unexplored. Our study investigates intraindividual circadian variability in epilepsy and its relationship with seizures.\n\nMethods: We retrospectively analyzed >70 000 h of wearable smartwatch data (Fitbit) from 143 people with epilepsy (PWE) and 31 healthy controls. Circadian oscillations in heart rate time series were extracted, daily estimates of circadian period, acrophase, and amplitude properties were produced, and estimates of the intraindividual variability of these properties over an entire recording were calculated.\n\nResults: PWE exhibited greater intraindividual variability in period (76 vs. 57 min, d = .66, p < .001) and acrophase (64 vs. 48 min, d = .49, p = .004) compared to controls, but not in amplitude (2 beats per minute, d = -.15, p = .49). Variability in circadian properties showed no correlation with seizure frequency nor any differences between weeks with and without seizures.\n\nSignificance: For the first time, we show that heart rate circadian rhythms are more variable in PWE, detectable via consumer wearable devices. However, no association with seizure frequency or occurrence was found, suggesting that this variability might be underpinned by the epilepsy etiology rather than being a seizure-driven effect.", "links": [] }, { "title": "Feasibility of an Individualized Exercise Training Program for Children with Hypertrophic Cardiomyopathy", "author": "Wanner, Julianne; Burstein, Danielle; Paridon, Stephen; Shah, Maully; O'Malley, Shannon; Lin, Kimberly Y.; Edelson, Jonathan B.", "year": "2025", "journalProceedings": "Pediatric Cardiology", "category": "Intervention", "devices": "Device unspecified", "population": "Children", "dataUsed": "Heart Rate", "abstract": "Limited data exist to guide exercise participation in pediatric hypertrophic cardiomyopathy (HCM) patients. Exercise is traditionally restricted in this population, despite research in adults with HCM demonstrating exercise-associated cardiovascular and psychological benefit. This pilot study seeks to assesses the safety and feasibility of a moderate-intensity exercise program in children with HCM to guide future study design. Eight subjects ages 8-18 with HCM were recruited from the outpatient cardiology clinic at a large tertiary care referral center. All subjects were NYHA Class I (n = 4) or II (n = 4) and median septal wall thickness was 2.3 cm [IQR 1.4, 2.5]. The intervention included a 16-week exercise program, consisting of three 30-min aerobic and two strength sessions per week. A target heart rate zone was established using a baseline cardiopulmonary exercise test (CPET). A FitBit device was used to titrate activity to this zone during sessions. Self-reported adherence ranged from 1.25 to 96.25%. At baseline, cardiorespiratory fitness, assessed by CPET, and Health Related Quality of Life (HRQoL), assessed using two validated instruments, were reduced compared to peers. All subjects (n = 4) who completed the intervention improved in exercise performance and HRQoL measures. Ambulatory rhythm monitoring did not reveal any intervention-related arrhythmias, and there were no cardiac adverse events. This pilot study shows the promise of a potential benefit of an interventional exercise program in children with HCM. Future work should aim to improve retention, and more fully assess the safety and impact of exercise in pediatric HCM.", "links": [] }, { "title": "Adolescent smartphone use, sleep, and physical activity: daily associations between sensor-based measures in the adolescent brain cognitive development (ABCD) study", "author": "Alexander, Jordan D.; Nguyen-Louie, Tam T.; Gupta, Suhaani; Cummins, Kevin M.; Wade, Natasha E.", "year": "2025", "journalProceedings": "Psychiatry Research", "category": "Case Study", "devices": "Charge", "population": "Adolescents", "dataUsed": "Steps,Sleep,Device Weartime", "abstract": "PURPOSE: Potential health consequences of adolescent smartphone use are a growing public concern. Improving upon existing, largely self-report-based research, this study investigated relationships between adolescent smartphone use, sleep, and physical activity using passive sensor measures. METHODS: Over three weeks, 791 Adolescent Brain Cognitive Development (ABCD) Study participants (Mage=14.12, 53 \\% female) provided smartphone application and keyboard use data via the Effortless Assessment Research System (EARS) application, and sleep and physical activity data via Fitbit device. RESULTS: Mixed-effects models found that daytime/evening application use (6:00AM-7:59PM) predicted reduced exercise, more time sedentary, and fewer daily steps (Standardized β=-0.21-0.07, P{\\textless}.001). Late-evening use (8:00PM-9:59PM) modestly predicted increased sedentary time and reduced steps (Standardized β=-0.05-0.02, P{\\textless}.001). Late-night use (10:00PM-5:59AM) predicted reduced sleep, delayed sleep onset, delayed waking, increased sedentary time, and fewer daily steps (Standardized β=-0.16-0.27, P{\\textless}.001). After disaggregating within and between-person smartphone use, within-person relationships remained significant, with associations of similar magnitude to the initial analyses (daytime/evening use: standardized ꞵ=-0.22-0.07, P{\\textless}.001; late-evening use: standardized ꞵ=-0.05-0.02, P{\\textless}.001; late-night use: standardized ꞵ=-0.16-0.24, P≤.002), indicating daily-level relationships unattributable to between-subject differences. Examining smartphone use effects by hour relative to sleep onset indicated that only use recorded after initial sleep onset significantly predicted sleep, while use recorded 3-12 hours before sleep onset significantly predicted step counts. CONCLUSIONS: Using passive sensor data, we found significant associations between adolescent smartphone use, physical activity, and sleep which differed by time of day and remained significant within subjects. Experimental replication is recommended to strengthen tentative causal claims.", "links": [] }, { "title": "Temporal relationships between depression, self-efficacy, and physical activity in individuals with stroke", "author": "Bellinger, Grace C.; Roemmich, Ryan T.; Psoter, Kevin J.; Wegener, Stephen T.; Keatley, Eva; French, Margaret A.", "year": "2025", "journalProceedings": "medRxiv", "category": "Case Study", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps", "abstract": "Objective To investigate the temporal relationships between depressive symptoms, physical activity, and self-efficacy in individuals with stroke Design Six-month prospective observational cohort study Setting General community Participants Seventy-three individuals with stroke (42 male; 61.9±12.3 years old) Interventions Not applicable Main Outcome Measures Three functional domains were the primary outcomes: physical activity was defined by average steps per day as measured by a Fitbit device; depressive symptoms and self-efficacy were measured by Patient-Reported Outcomes Measurement Information System (PROMIS) short forms. These outcome measures were collected at study enrollment and monthly thereafter for six months, resulting in a maximum of seven timepoints. Results Three separate lagged linear mixed effects models were constructed (one with each functional domain as the dependent variable). Each model included the measure of the targeted functional domain as the dependent variable, measurements from the previous month of the two other functional domains and their interaction as fixed effects, participant as a random effect, and demographics and stroke characteristics as covariates. The depressive symptoms by self-efficacy interaction was associated with future physical activity, suggesting that higher self-efficacy positively impacts the following month’s physical activity only when depressive symptoms are low. Depressive symptoms were not associated with self-efficacy, steps per day, or their interaction in the prior month, indicating that the relationship between depressive symptoms and physical activity is unidirectional. Finally, depressive symptoms were associated with self-efficacy in the subsequent month. Conclusions The longitudinal study provides evidence that 1) mitigating depressive symptoms and promoting self-efficacy may improve future physical activity; 2) addressing depressive symptoms first may lead to more effective treatment of depression, low self-efficacy, and low physical activity; and 3) treating depression may improve future self-efficacy. Together the results provide additional knowledge about the complex relationships between mobility, mood, and self-efficacy that must be carefully managed during post-stroke rehabilitation.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12047946/", "newWindow": true } ] }, { "title": "Working Women Walking Program: A Sequential Multiple Assignment Randomized Trial", "author": "Buchholz, Susan W.; Daniel, Manju; Kitsiou, Spyros; Schoeny, Michael E.; Halloway, Shannon; Johnson, Tricia J.; Vispute, Sachin; Wilbur, JoEllen", "year": "2025", "journalProceedings": "Journal of Physical Activity \\& Health", "category": "Intervention", "devices": "Charge 2,Charge 3", "population": "Adults", "dataUsed": "Steps,Goals", "abstract": "BACKGROUND: Different interventions have shown efficacy in improving physical activity in women. This study aimed to determine the most effective adaptive intervention combining 4 efficacious treatments (Fitbit, text messages, personal calls, and group meetings) for improving physical activity. METHODS: The Working Women Walking program used a Sequential Multiple Assignment Randomized Trial (SMART) design with 3 phases: initial (weeks 1-8), augmented (weeks 9-34), and maintenance (weeks 35-50). Low-active women aged 18-70 working at an academic medical center were recruited. In the initial phase, participants were randomized to Fitbit or Fitbit + text messages. After 8 weeks, nonresponders were rerandomized to an augmented treatment (personal calls or group meetings). The primary outcomes (steps/day and minutes of moderate/vigorous physical activity [MVPA]/day via ActiGraph) were assessed at baseline and 8, 34, and 50 weeks. RESULTS: The study had 301 women (age: 45.1 [11.6] y). During the initial phase, there were no differences by initial treatment for change in steps (P = .78) or MVPA (P = .60). During the augmented phase, there were no differences by augmented treatment among nonresponders for change in steps (P = .95) or MVPA (P = .78). A significant overall increase was seen in steps (752/d; P {\\textless} .001, d = 0.56) and MVPA at 8 weeks (4.1 min/d; P {\\textless} .001, d = 0.48), and this was sustained at 34 and 50 weeks. CONCLUSIONS: Text messages, personal calls, and group meetings did not lead to increased physical activity. Using Fitbit and goal setting (a constant) appeared to have some benefit for many of the women in improving physical activity.", "links": [] }, { "title": "Exploring the usefulness of real-time digitally supported fatigue monitoring in fatigue management: Perspectives from occupational therapists and brain injury survivors", "author": "Ezekiel, Leisle; Wilding, Harriet; Dearling, Jeremy; Collett, Johnny; Dawes, Helen", "year": "2024", "journalProceedings": "The British Journal of Occupational Therapy", "category": "Case Study", "devices": "Charge 4", "population": "Adults", "dataUsed": "Intensity,User Friendliness,Active Minutes/Active Zone Minutes", "abstract": "INTRODUCTION: Persistent fatigue after acquired brain injury (ABI) needs long-term self-management. Self-monitoring supports self-management and informs the use of fatigue management strategies. Using ecological momentary assessment to monitor fatigue offers a data-driven approach to managing fatigue. AIMS: To explore the usefulness of self-monitoring fatigue in real-time, using ecological momentary assessment to support self-management, from the perspective of people with ABI and occupational therapists. METHODS: People with ABI monitoried their fatigue by wearing a Fitbit and completing six surveys a day on their phone for 6 days. Think aloud and semi-structured interviews elicited views on self-monitoring and the data generated. Transcripts were analysed using reflexive thematic analysis. RESULTS: Four themes were developed from people with ABI (n = 9): (1) Attending to experience, (2) making sense of data, (3) the relationship between fatigue and activity, (4) implications for daily life. Three themes from occupational therapists (n = 5): (1) Challenges of using of data, (2) perceived benefits of self-monitoring, (3) viewing data in relation to their understanding of fatigue. CONCLUSION: Data generated in real-time challenged perspectives on fatigue and fatigue management. These insights may help people with ABI and their clinicians to plan personalised strategies for fatigue management and evaluate its impact on daily living.", "links": [] }, { "title": "What is the effect of postpartum hemorrhage on physical activity after cesarean?", "author": "Felfeli, Mina; Lehn, Samuel; Tveit, Meghan; Hill, Devin; Ahmadzia, Homa K.", "year": "2025", "journalProceedings": "International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics", "category": "Case Study", "devices": "Inspire", "population": "Patients,Pregnant Women", "dataUsed": "Steps,Device Weartime", "abstract": "OBJECTIVES: This study introduces a novel approach, utilizing activity tracking devices (ATDs), such as Fitbit, to monitor mobility during cesarean recovery and investigate the relationship between physical activity (PA) and postpartum hemorrhage (PPH). METHODS: We conducted a prospective cohort study involving postpartum patients aged 18-50 years who delivered at George Washington University and underwent a scheduled or emergent cesarean from December 2022 to September 2023. The primary outcome was assessing the relationship between PPH and PA for 2 weeks postpartum using the Fitbit. Data from all patients were extracted from the electronic medical records. The Fitbit Model of Inspire was used to monitor patients' PA. RESULTS: Statistical analyses of the relationship between quantitative blood loss (QBL) during cesarean delivery and average steps per day postpartum found statistically non-significant results (Δ1.16 [1.16\\%], P = 0.817) for the collective cohort. Excluding one outlier from the patient cohort, analysis of the relationship between the same two variables found statistically significant results (Δ1.83 [1.83\\%], P = 0.023). A coefficient of 1.83 (1.83\\%) on the QBL variable was found, signifying that an increase of 1 mL in QBL corresponds to an average decrease of 1.83 (1.83\\%) in average steps per day postpartum. CONCLUSION: This study's findings underscore the potential clinical relevance of monitoring PA to identify and address postpartum complications. Further research could explore interventions to mitigate the observed decline in mobility associated with PPH, ultimately enhancing maternal healthcare outcomes.", "links": [] }, { "title": "Monitoring Substance Use with Fitbit Biosignals: A Case Study on Training Deep Learning Models Using Ecological Momentary Assessments and Passive Sensing", "author": "Li, Shizhe; Fan, Chunzhi; Kargarandehkordi, Ali; Sun, Yinan; Slade, Christopher; Jaiswal, Aditi; Benzo, Roberto M.; Phillips, Kristina T.; Washington, Peter", "year": "2024", "journalProceedings": "AI (Basel, Switzerland)", "category": "Case Study", "devices": "Charge 5", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Substance use disorders affect 17.3\\% of Americans. Digital health solutions that use machine learning to detect substance use from wearable biosignal data can eventually pave the way for real-time digital interventions. However, difficulties in addressing severe between-subject data heterogeneity have hampered the adaptation of machine learning approaches for substance use detection, necessitating more robust technological solutions. We tested the utility of personalized machine learning using participant-specific convolutional neural networks (CNNs) enhanced with self-supervised learning (SSL) to detect drug use. In a pilot feasibility study, we collected data from 9 participants using Fitbit Charge 5 devices, supplemented by ecological momentary assessments to collect real-time labels of substance use. We implemented a baseline 1D-CNN model with traditional supervised learning and an experimental SSL-enhanced model to improve individualized feature extraction under limited label conditions. Results: Among the 9 participants, we achieved an average area under the receiver operating characteristic curve score across participants of 0.695 for the supervised CNNs and 0.729 for the SSL models. Strategic selection of an optimal threshold enabled us to optimize either sensitivity or specificity while maintaining reasonable performance for the other metric. Conclusion: These findings suggest that Fitbit data have the potential to enhance substance use monitoring systems. However, the small sample size in this study limits its generalizability to diverse populations, so we call for future research that explores SSL-powered personalization at a larger scale.", "links": [] }, { "title": "At-home Breast Oncology care Delivered with EHealth solutions (ABODE) study protocol: a randomised controlled trial", "author": "Mac, Amanda; Kalia, Mohini; Reel, Emma; Amir, Eitan; Isenberg, Adina; Kim, Raymond H.; Kennedy, Erin; Koch, C. Anne; Li, Madeline; McCready, David; Metcalfe, Kelly; Okrainec, Allan; Papadakos, Janet; Rotstein, Sarah; Rodin, Gary; Xu, Wei; Zhong, Toni; ABODE Study Group; Cil, Tulin D.", "year": "2025", "journalProceedings": "BMJ open", "category": "Intervention", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps,Heart Rate", "abstract": "INTRODUCTION: The COVID-19 pandemic disrupted healthcare delivery for patients with breast cancer. eHealth solutions enable remote care and may improve patient activation, which is defined as having the knowledge, skills and confidence to manage one's health. Thus, we developed the Breast Cancer Treatment Application (app) for patients and practitioners to use throughout the cancer care continuum. The app facilitates virtual assistance, delivers educational resources, collects patient-reported outcome measures and provides individualised support via volunteer e-coaches. Among newly diagnosed patients with breast cancer, we will compare changes in patient activation, other patient-reported outcomes and health service outcomes over 1 year between those using the app and Fitbit, and those receiving standard care and Fitbit only. METHODS AND ANALYSIS: This randomised controlled trial will include 200 patients with breast cancer seen at a tertiary care cancer centre in Ontario, Canada. The intervention group (n=100) will use the app in addition to standard care and Fitbit for 13 months following diagnosis. The control group (n=100) will receive standard care and Fitbit only. Patients will complete questionnaires at enrolment, 6 and 12 months post-diagnosis to measure patient activation (Patient Activation Measure-13 score), distress, anxiety, quality of life and experiences with their care and information received. All patients will also receive Fitbits to measure activity and heart rate. We will also measure wait times and number of visits to ambulatory care services to understand the impact of the app on the use of in-person services. ETHICS AND DISSEMINATION: Ethics approval was obtained on 6 January 2023. Protocol version 2.0 was approved on 6 January 2023. The trial is registered with ClinicalTrials.gov. Study findings will be disseminated via publication in a peer-reviewed journal and shared with participants, patient programmes and cancer awareness groups. The app has also been approved as a secure communication method at our trial institution, thus we are well-positioned to support future integration of the app into standard care through collaboration with our hospital network. TRIAL REGISTRATION NUMBER: NCT05989477.", "links": [] }, { "title": "Innovative health monitoring for wheelchair users: A scoping review of smartwatch applications", "author": "Oliveira, José Igor V.; Almeida, Rízia; de Lucena, Erick Guilherme Peixoto; Tessutti, Vitor; Silva, Emely Pujólli; Uchida, Marco Carlos", "year": "2025", "journalProceedings": "Assistive technology: the official journal of RESNA", "category": "Validation,Systematic Review", "devices": "Flex 2,Charge 2,Versa", "population": "Adults", "dataUsed": "Energy Expenditure,Heart Rate", "abstract": "This study aimed to review the application of commercial smartwatches as a tool for monitoring health and exercise variables and the accuracy of their measurements, with users being people with physical disabilities who use manual wheelchairs. The searches were conducted in PubMed, Scopus, Web of Science, and IEEEXplore. Studies were included regardless of experimental design as long as they involved people with physical disability or without any physical disabilities who used manual wheelchairs in evaluations with commercial smartwatches. Thirteen studies were included in the review. Overall, there was no consensus on the accuracy of wheelchair-related measurements, such as physical tests and daily activities, with only the Apple Watch® Series 1 and 4 and the Fitbit Charge 2® providing acceptable information. Regarding the physiological measurements offered by smartwatches during physical evaluations, only the Xiaomi Mi Band 5® provided reliable heart rate readings. Additionally, the Apple Watch® Series 5 did not demonstrate sufficient sensitivity to detect falls from the wheelchair. Finally, despite these limitations, commercial smartwatches are seen as a promising tool for self-care and increased autonomy. However, restrictions must be considered, especially in contexts where movements are subtle or gradual, and they should not be used for clinical purposes or disease diagnosis.", "links": [] }, { "title": "A performance validation of six commercial wrist-worn wearable sleep-tracking devices for sleep stage scoring compared to polysomnography", "author": "Schyvens, An-Marie; Peters, Brent; Van Oost, Nina Catharina; Aerts, Jean-Marie; Masci, Federica; Neven, An; Dirix, Hélène; Wets, Geert; Ross, Veerle; Verbraecken, Johan", "year": "2025", "journalProceedings": "Sleep Advances: A Journal of the Sleep Research Society", "category": "Usability", "devices": "Charge 5", "population": "Adults", "dataUsed": "Sleep", "abstract": "Study Objectives The aim of this study is to assess the performance of six different consumer wearable sleep-tracking devices, namely the Fitbit Charge 5, Fitbit Sense, Withings Scanwatch, Garmin Vivosmart 4, Whoop 4.0, and the Apple Watch Series 8, for detecting sleep parameters compared to the gold standard, polysomnography (PSG). Methods Sixty-two adults (52 males and 10 females, mean age ± SD = 46.0 ± 12.6 years) spent a single night in the sleep laboratory with PSG while simultaneously using two to four wearable devices. Results The results indicate that most wearables displayed significant differences with PSG for total sleep time, sleep efficiency, wake after sleep onset, and light sleep (LS). Nevertheless, all wearables demonstrated a higher percentage of correctly identified epochs for deep sleep and rapid eye movement sleep compared to wake (W) and LS. All devices detected {\\textgreater}90\\% of sleep epochs (ie, sensitivity), but showed lower specificity (29.39\\%–52.15\\%). The Cohen’s kappa coefficients of the wearable devices ranged from 0.21 to 0.53, indicating fair to moderate agreement with PSG. Conclusions Our results indicate that all devices can benefit from further improvement for multistate categorization. However, the devices with higher Cohen’s kappa coefficients, such as the Fitbit Sense (κ = 0.42), Fitbit Charge 5 (κ = 0.41), and Apple Watch Series 8 (κ = 0.53), could be effectively used to track prolonged and significant changes in sleep architecture.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038347/", "newWindow": true } ] }, { "title": "Multidomain postoperative recovery trajectories after lumbar and thoracolumbar spine surgery", "author": "Yakdan, Salim; Zhang, Jingwen; Benedict, Braeden; Xu, Ziqi; Javeed, Saad; Zhang, Justin K.; Steel, Benjamin A.; Gupta, Vivek P.; Botterbush, Kathleen; Piccirillo, Jay F.; Rodebaugh, Thomas L.; Goodin, Burel R.; Buchowski, Jacob M.; Neuman, Brian; Hafez, Daniel; Kelly, Michael; Ray, Wilson Z.; Lu, Chenyang; Frumkin, Madelyn; Greenberg, Jacob K.", "year": "2025", "journalProceedings": "The Spine Journal: Official Journal of the North American Spine Society", "category": "Case Study", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND CONTEXT: Understanding early postoperative recovery is crucial for improving perioperative care and long-term outcomes. Traditional recovery assessments relying primarily on cross-sectional patient-reported measures may not fully capture the complexity of the recovery process. PURPOSE: Our study evaluates early postoperative recovery using mobile health assessment and explores the relationship between early recovery patterns, multidomain recovery, and long-term outcomes. STUDY DESIGN/SETTING: A prospective observational study. PATIENT SAMPLE: A total of 129 patients were included in the analysis. OUTCOME MEASURES: Patient-reported outcome measures (PROMs) of pain, physical function, and disability at 1, 6 and 12 months postoperatively. METHODS: This study recruited patients aged 21 to 85 undergoing lumbar/thoracolumbar surgery for degenerative diseases. During the first month postoperatively, patients completed daily Ecological Momentary Assessment (EMA) surveys assessing pain, depression, and physical function and were passively monitored with Fitbit. EMA and Fitbit data (steps per minute, Maximum 30-minute cadence, and activity bout number) were clustered using functional principal component analysis. RESULTS: 129 patients were included (median age: 62; 56\\% female). Two dominant recovery patterns were identified across all domains. At 12 months, patients with more favorable recovery across all domains except for activity bout number and depression, showed better outcomes. Favorable recovery in pain intensity and steps per minute was associated with greater improvements in all outcomes, while favorable recovery in maximum 30-minute cadence was associated with greater improvement in disability and physical function. Patients with less favorable pain recovery had a significantly higher complication rate (23\\% vs. 7\\%). A greater number of favorable recovery domains was associated with better 12-month outcomes improvement and demonstrated superior prognostic value compared to traditional patient assessment methods. CONCLUSION: Early postoperative recovery patterns and multidomain recovery, captured using mHealth tools, provide valuable insights into long-term outcomes. With further validation, these findings highlight the potential of integrating mHealth into clinical practice to personalize rehabilitation strategies, improve resource allocation, and enhance patient care.", "links": [] }, { "title": "Fitbit-measured physical activity is inversely associated with incident atrial fibrillation among All of Us participants", "author": "Barua, Souptik; Upadhyay, Dhairya; Surapaneni, Aditya; Grams, Morgan; Jankelson, Lior; Heffron, Sean", "year": "2025", "journalProceedings": "American Heart Journal", "category": "Survey Research", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Intensity", "abstract": "Background Individuals who report meeting weekly moderate to vigorous physical activity (MVPA) guidelines have lower risk of atrial fibrillation (AF). However existing studies have relied on subjective questionnaires or short-duration ({\\textless}1 week) objective assessments using accelerometry. The objective of this research was to investigate an association between MVPA levels and the incidence of AF, utilizing long-term, free-living accelerometry data. Methods 1-year Fitbit data, in addition to survey and electronic health record (EHR) data, were extracted from the NIH All of Us (AoU) research database. Cox proportional hazards regression was used to model the association of average MVPA and incident AF over a five-year follow-up period. Results 15570 AoU participants were included (52 ± 16 years, 71\\% female, 79\\% White, BMI 28.9 ± 5.0 kg/m2, 41±12 complete weeks of Fitbit wear). 97 individuals (0.6\\%) experienced incident AF in the five-year follow-up period. Every additional hour of MVPA was associated with 8\\% lower AF risk (HR = 0.92 [0.86,0.99], P = .02). In a subset of 10533 participants with genomic data, this association persisted after adjustment for AF genetic risk score. Conclusions Higher amounts of objectively measured MVPA, measured using free-living, long-term accelerometry data, were inversely associated with risk of incident AF, independent of clinical and genetic risk factors.", "links": [ { "caption": "URL", "url": "https://www.sciencedirect.com/science/article/pii/S0002870325001607", "newWindow": true } ] }, { "title": "Do Patients Sleep Better at Home or in the Hospital Following Primary Total Joint Arthroplasty?", "author": "Liao, Gerald Y.; Chansky, Howard; Manner, Paul A.; Brinkmann, Elyse; Fernando, Navin D.; Hernandez, Nicholas M.", "year": "2025", "journalProceedings": "The Journal of Arthroplasty", "category": "Case Study", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Sleep", "abstract": "BACKGROUND: Despite increasing primary total joint arthroplasty (total knee arthroplasty [TKA] and total hip arthroplasty [THA]) rates in the United States, research on its impact on sleep quality is limited. The potential benefits of same-day discharge (SDD) post-total joint arthroplasty on sleep quality remain unexplored. This study examined whether patients undergoing SDD or overnight hospitalization experienced better sleep on the first night after surgery. METHODS: In this prospective cohort study, patients undergoing THA or TKA were stratified by discharge status: SDD or overnight. The first postoperative night's sleep was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ), the Insomnia Severity Index (ISI), and Fitbit-derived total sleep time (TST). Group differences were evaluated using analyses of covariance adjusted for age, sex, body mass index, Charlson Comorbidity Index, anesthesia type, and baseline ISI. RESULTS: For THA, SDD was associated with higher RCSQ scores across several domains, including Total Score (d = 0.84, P = 0.0058), Sleep Depth (d = 0.82, P = 0.005), and Noise Disturbance (d = 1.22, P {\\textless} 0.0001). Postoperative ISI was lower in SDD patients (d = 0.62, P = 0.010), and TST was longer (d = 1.03, P = 0.010). Higher postoperative ISI scores were strongly correlated with lower RCSQ and TST values. For TKA, SDD patients reported modest improvements in sleep depth (d = 0.59, P = 0.04) and noise disturbance (d = 0.97, P = 0.012), but no differences were found in total RCSQ, ISI, or TST (all P-values {\\textgreater}0.05). Associations between ISI, RCSQ, and TST were weak. CONCLUSIONS: An SDD was associated with better early postoperative sleep after THA, including higher perceived quality and longer duration. While sleep benefits after TKA were more domain-specific, reductions in environmental disturbances suggest meaningful improvements in select aspects of rest. These findings support sleep as a modifiable perioperative outcome and support incorporating sleep quality into discharge planning.", "links": [] }, { "title": "Identifying Optimal Wearable Devices for Monitoring Mobility in Hospitalized Older Adults: Feasibility, Acceptability, and Validity Study", "author": "Nascimento, Paulo; Kirkwood, Renata; Griffith, Lauren E.; Duong, Mylinh; Cooper, Cody; Hao, Yujiao; Zheng, Rong; Raza, Samir; Beauchamp, Marla", "year": "2025", "journalProceedings": "JMIR Aging", "category": "Usability,Validation", "devices": "Versa", "population": "Older Adults", "dataUsed": "Steps,User Friendliness", "abstract": "Background Hospitalized, frail older adults have an increased risk of developing hospital-acquired disability associated with hospital practices of restricted physical activity and immobilization. The use of activity tracking wearable devices may allow identification and prevention of mobility decline, reducing hospital-acquired disability. Objective This study aimed to identify the optimal wearable device and wear location for monitoring mobility in older hospitalized patients. Specific objectives included (1) comparison of the feasibility and acceptability of ActiGraph wGT3X-BT (ActiGraph LLC), MOX1 (Maastricht Instruments), MetaMotionC (mBientLab), and Fitbit Versa (Google) for continuous mobility monitoring and (2) determination of the concurrent validity of the selected device for detecting body posture and step count. Methods Participants were recruited for this observational study in the acute medical care unit of an academic hospital in Hamilton, Ontario, Canada. Eligible patients were aged 60 years and older, able to undertake the mobility protocol, and had an anticipated length of stay greater than 4 days. The study was divided into 2 experiments. Experiment 1 evaluated the feasibility of 4 wearable devices and validated the derived data for body posture and step count. Experiment 2 involved a mobility assessment session and a 24-hour monitoring and feasibility period with the selected device from experiment 1. Results The ActiGraph wGT3X-BT emerged as the most feasible device, demonstrating superior usability, data acquisition, and management. The thigh-worn ActiGraph accurately detected sedentary behavior, while the ankle-worn device provided detailed information on step counts and body postures. Bland-Altman plots and intraclass correlation coefficients indicated that the ankle-worn ActiGraph showed excellent reliability for step counting, with minimal bias and narrow limits of agreement. Patients expressed a high willingness to wear a continuous mobility tracking device at the hospital and at home. Conclusions Thigh- and ankle-worn ActiGraph are optimal for assessing and monitoring mobility in older hospitalized patients. Challenges such as discomfort and device removal observed during the 24-hour monitoring period highlight areas for future studies. Overall, our findings support the integration of wearable technology in hospital settings to enhance mobility monitoring and early intervention strategies. Further research is warranted to evaluate the long-term use of wearable data for predicting health outcomes post hospitalization and informing clinical decision-making to promote early mobility.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088621/", "newWindow": true } ] }, { "title": "Wearable Devices in Remote Cardiac Rehabilitation With and Without Weekly Online Coaching for Patients With Coronary Artery Disease: Randomized Controlled Trial", "author": "Nishio, Ryota; Dohi, Tomotaka; Yokoyama, Miho; Nakade, Taisuke; Takahashi, Norihito; Chikata, Yuichi; Endo, Hirohisa; Nishiyama, Hiroki; Okai, Iwao; Iwata, Hiroshi; Okazaki, Shinya; Miyauchi, Katsumi; Daida, Hiroyuki; Minamino, Tohru", "year": "2025", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "Sense", "population": "Patients", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Background Cardiac rehabilitation (CR) is effective in preventing cardiovascular diseases; however, participation in CR programs remains limited due to the associated challenges. The integration of wearable devices and real-time monitoring offers a potential solution to enhance adherence to remote CR programs and their outcomes. Objective This study aimed to evaluate the efficacy of a remote CR program using wearable devices and real-time monitoring with or without online coaching (OLC) in improving exercise capacity in patients with coronary artery disease (CAD). Methods We enrolled 50 patients with CAD in a remote CR program in this randomized, open-label, single-center pilot trial (phase III). After baseline cardiopulmonary exercise tests (CPETs), all patients were assigned a CPET-based home exercise program and were provided with a wearable device (Fitbit Sense; Fitbit, Inc) with a real-time monitoring system (Recoval; SapplyM, Inc). The patients were randomly assigned to an intervention group with OLC (n=25) or a control wearable device (CON; n=25) group. The primary outcomes were changes in peak oxygen consumption (peak VO2) and anaerobic threshold VO2 (oxygen consumption) at 12 weeks. The secondary outcomes were changes in CPET parameters, daily activity, anxiety levels, and health-related quality of life. Results Peak VO2 and anaerobic threshold VO2 increased significantly from baseline to 12 weeks in the OLC (+1.6 mL/kg/min, P{\\textless}.001; +1.0 mL/kg/min, P=.001) and CON (+0.6 mL/kg/min, P=.008; +1.3 mL/kg/min, P=.002) groups with no significant between-group differences (P=.65 and P=.90). In the latter half of the intervention, the daily distance and highly active time in the OLC group were significantly increased compared with those in the CON group (all P{\\textless}.05). Mental status and health-related quality of life scores showed no significant differences between the groups. No major adverse cardiac events were reported. One patient in the OLC group dropped out due to lower limb muscle strain. Conclusions Remote CR using wearable devices and a real-time monitoring system significantly improved exercise capacity in patients with CAD over a 12-week intervention program. The addition of regular OLC to the intervention program further enhanced the physical activity levels, particularly in high-intensity activities. Future studies are warranted to validate these findings in more diverse populations and over longer intervention periods to optimize the benefits and safety of remote CR programs.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088619/", "newWindow": true } ] }, { "title": "Validation of an Open-Source Smartwatch for Continuous Monitoring of Physical Activity and Heart Rate in Adults", "author": "Ravanelli, Nicholas; Lefebvre, KarLee; Brough, Amy; Paquette, Simon; Lin, Wei", "year": "2025", "journalProceedings": "Sensors (Basel, Switzerland)", "category": "Validation", "devices": "Charge 5", "population": "Adults", "dataUsed": "Steps", "abstract": "Consumer-grade wrist-based wearable devices have grown in popularity among researchers to continuously collect metrics such as physical activity and heart rate. However, manufacturers rarely disclose the preprocessing sensor data algorithms, and user-generated data are typically shared leading to data governance issues. Open-source technology may address these limitations. This study evaluates the validity of the Bangle.js2 for step counting and heart rate during lab-based validation and agreement with other wearable devices (steps: Fitbit Charge 5; heart rate: Polar H10) in free-living conditions. A custom open-source application was developed to capture the sensor data from the Bangle.js2. Participants (n = 47; 25 males; 27 ± 11 years) were asked to complete a lab-based treadmill validation (3 min stages at 2, 3, 4, and 5 mph) and stair climbing procedure followed by a 24 h free-living period. The Bangle.js2 demonstrated systematic undercounting of steps at slower walking speeds with acceptable error achieved at 5 km/h. During free-living conditions, the Bangle.js2 demonstrated strong agreement with the Fitbit Charge 5 for per-minute step counting (CCC = 0.90) and total steps over 24 h (CCC = 0.96). Additionally, the Bangle.js2 demonstrated strong agreement with the Polar H10 for minute-averaged heart rate (CCC = 0.78). In conclusion, the Bangle.js2 is a valid open-source hardware and software solution for researchers interested in step counting and heart rate monitoring in free-living conditions.", "links": [] }, { "title": "Impact of Usual-Care Physiotherapy on Physical Activity and Self-Efficacy in People With Multiple Sclerosis: An Observational Longitudinal Study", "author": "Torchio, Alessandro; Fusari, Giulia; Cattaneo, Davide; Grosso, Cristina; Pagliari, Chiara; Crispiatico, Valeria; Perini, Gloria; Jonsdottir, Johanna", "year": "2025", "journalProceedings": "International journal of MS care", "category": "Case Study", "devices": "Versa", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND: People with multiple sclerosis (MS) experience motor and nonmotor symptoms that affect daily life. Although regular physical activity (PA) may enhance the overall well-being of people with MS, they tend to have lower activity levels than healthy individuals. This study aims to investigate the impact of usual-care physiotherapy on PA and self-efficacy in people with MS and identify prerehabilitation factors that influence positive changes in PA with physiotherapy. METHODS: Forty-one people with MS undergoing physiotherapy with a median (IQR) age of 54.00 (17.00) years and an Expanded Disability Status Scale score of 6.00 (2.00) points were assessed on the first days (T0) and last days of their rehabilitation period (T1), and 6 weeks after it ended (T2). Instrumental assessment utilized Fitbit Versa trackers, measuring daily steps and moderate/vigorous PA engagement (MVPA). Self-efficacy, perceived fatigue, walking ability, and quality of life were measured using the Self-Efficacy in Multiple Sclerosis scale (SEMS), the Fatigue Severity Scale, the 10-Meter Walk Test, and the Short Form-12 Health Survey. RESULTS: Usual-care physiotherapy did not improve (P {\\textgreater} .05) daily steps (T0: 4139 [3333]; T1: 4438 [2505] steps per day), MVPA (T0: 6.00 [15.6]; T1: 10.52 [16.30] minutes per day), or self-efficacy (SEMS: T0: 42.0 [10.8]; T1: 40.5 [8.7] points). Low perceived fatigue, better overall PA, and good physical health perception were identified as predictors of positive changes in PA after physiotherapy. CONCLUSIONS: Usual-care physiotherapy focusing on mobility did not result in significant improvements in PA or self-efficacy for people with MS. Perceived fatigue and overall PA before physiotherapy impacted PA levels after rehabilitation. Future interventions may benefit from integrating motivational strategies into the rehabilitation protocol to increase PA levels.", "links": [] }, { "title": "mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED): statistical analysis plan", "author": "Vetrovsky, Tomas; Kral, Norbert; Pfeiferova, Marketa; Seifert, Bohumil; Capek, Vaclav; Jurkova, Katerina; Steffl, Michal; Cimler, Richard; Kuhnova, Jitka; Harris, Tess; Ussher, Michael; Wahlich, Charlotte; Malisova, Katerina; Pelclova, Jana; Dygryn, Jan; Elavsky, Steriani; Maes, Iris; Van Dyck, Delfien; Rowlands, Alex; Yates, Tom", "year": "2025", "journalProceedings": "Trials", "category": "Intervention", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Steps,Goals", "abstract": "Background Type 2 diabetes and prediabetes represent significant global health challenges, with physical activity (PA) being essential for disease management and prevention. Despite the well-documented benefits, many individuals with (pre)diabetes remain insufficiently active. General practitioners (GP) provide an accessible platform for delivering interventions; however, integrating PA interventions into routine care is hindered by resource constraints. Objectives The ENERGISED trial aims to address these barriers through an innovative GP-initiated mHealth intervention combining wearable technology and just-in-time adaptive interventions. Methods The ENERGISED trial is a pragmatic, 12-month, multicentre, randomised controlled trial, assessing a GP-initiated mHealth intervention to increase PA and reduce sedentary behaviour in patients with type 2 diabetes and prediabetes. The primary outcome is daily step count, assessed via wrist-worn accelerometry. The primary analysis follows the intention-to-treat principle, using mixed models for repeated measures. Missing data will be handled under the missing-at-random assumption, with sensitivity analyses exploring robustness through reference-based multiple imputation. The trial incorporates the estimand framework to provide transparent and structured treatment effect estimation. Discussion This statistical analysis plan outlines a robust approach to addressing participant non-adherence, protocol violations, and missing data. By adopting the estimand framework and pre-specified sensitivity analyses, the plan ensures methodological rigour while enhancing the interpretability and applicability of results. Conclusions The ENERGISED trial leverages innovative mHealth strategies within primary care to promote PA in individuals with (pre)diabetes. The pre-specified statistical framework provides a comprehensive guide for analysing trial data and contributes to advancing best practices in behavioural intervention trials for public health. Trial registration ClinicalTrials.gov NCT05351359. Registered on April 28, 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-025-08865-z.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093599/", "newWindow": true } ] }, { "title": "Transcutaneous auricular vagus nerve stimulation (taVNS) improves sleep quality in chronic insomnia disorder: A double-blind, randomized, sham-controlled trial", "author": "Yeom, Ji Won; Kim, Hyojin; Park, Soohyun; Yoon, Yeaseul; Seo, Ju Yeon; Cho, Chul-Hyun; Lee, Heon-Jeong", "year": "2025", "journalProceedings": "Sleep Medicine", "category": "Case Study", "devices": "Charge 4", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background Insomnia is a common sleep disorder that significantly impacts quality of life and health. Conventional treatments such as cognitive-behavioral therapy and pharmacological interventions have limitations, underscoring the need for non-invasive alternatives. Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising therapy to enhance sleep quality by modulating the autonomic nervous system. Objective This study aimed to evaluate the efficacy and safety of taVNS compared to sham in managing chronic insomnia disorder. Methods A randomized, double-blind, sham-controlled trial was conducted with 40 participants diagnosed with chronic insomnia disorder. Participants were randomly assigned to receive taVNS or sham for 30 min daily over six weeks. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) as the primary outcome. Secondary outcomes included the Insomnia Severity Index (ISI), World Health Organization Quality of Life Brief Version (WHOQOL-BREF), and total sleep time. Adverse events were recorded, and objective sleep measures were obtained using Fitbit wearable devices. Results In the modified intention-to-treat analysis at 6 weeks, the taVNS group exhibited significantly greater reductions in PSQI scores compared to the sham group (mean change: 4.5 ± 3.55 vs. −1.9 ± 2.15; Cohen's d = −1.21; p = .009). ISI scores also improved more in the taVNS group (−7.6 ± 5.23 vs. −4.25 ± 3.48; Cohen's d = −.75; p = .023). Total sleep time increased significantly in the taVNS group (584 ± 1015 min, vs. −10.8 ± 579 min; Cohen's d = .69; p = .019) and improved quality of life (WHOQOL-BREF: 32.2 ± 40.9 vs. 7.95 ± 33.5; Cohen's d = .65, p = .047). No significant adverse events were reported. Conclusions taVNS significantly improved sleep quality, insomnia severity, and overall quality of life compared to sham. These findings establish taVNS as a safe and effective non-invasive therapy for managing insomnia, with potential for broader clinical applications.", "links": [ { "caption": "URL", "url": "https://www.sciencedirect.com/science/article/pii/S1389945725002540", "newWindow": true } ] }, { "title": "Latent Default Mode Network Connectivity Patterns: Associations With Sleep Health and Adolescent Psychopathology", "author": "Zhang, Linhao; Geier, Charles; House, Ellen; Oshri, Assaf", "year": "2025", "journalProceedings": "Brain and Behavior", "category": "Case Study", "devices": "Charge HR", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "Background: The present study examined default mode network (DMN) neural connectivity patterns among adolescents. Next, we tested two critical markers of sleep health-duration and efficiency, in predicting neural connectivity patterns. Last, we investigated the latent DMN profiles' predictive utility of internalizing and externalizing symptoms in youth.\n\nMethods: The study included 2811 youth (47.8% female; mean age = 11.94) enrolled in the Adolescent Brain Cognitive Development study. Sleep duration and efficiency were objectively measured via Fitbit wearable's (mean number of nights = 14.13). Latent profile analysis identified neural connectivity profiles within the DMN and between other networks (fronto-parietal, salience, ventral attention, and dorsal attention). Parents reported the youth's psychopathology symptoms.\n\nResults: Four DMN profiles were empirically identified: (1) moderate; (2) low within and high between; (3) high within and low between; and (4) high within and high between. Youth with shorter sleep duration were more likely to be classified as low within and high between subgroup. Youth with lower sleep efficiency were more likely to be classified as the high within and low between subgroup. There were between-group differences in externalizing problems one year later.\n\nConclusion: Our findings highlight unique neural patterns in youth and their associations with sleep and psychopathology. The results will inform clinical practice and preventive programming that attempts to address the crisis in youth mental health through a focus on mitigating sleep problems in youth.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086304/", "newWindow": true } ] }, { "title": "Effect of Intraoperative Intravenous Infusion of Esketamine Combined with Dexmedetomidine on Postoperative Sleep Disturbance in Patients Undergoing Radical Mastectomy", "author": "Geng, Xingyu; Pu, Yutian; Hu, Ziwei; Zhang, Heling; Wang, Maosan; Fang, Can; Lv, Gaochao; Li, Wanting; Zhang, Xinyue; Fan, Xiaoxuan; Liu, Su; Chen, Xiuxia; Wu, Jingru", "year": "2025", "journalProceedings": "Drug Design, Development and Therapy", "category": "Case Study", "devices": "Charge 2", "population": "Patients", "dataUsed": "Sleep", "abstract": "Objective Postoperative sleep disturbance(POSD) is a problem in breast cancer patients after surgery. Little is known about the differences in the treatment of POSD with esketamine combined with dexmedetomidine under the same circumstances. We investigated the effects of intraoperative esketamine combined with intravenous dexmedetomidine on the incidence of POSD and postoperative sleep architecture. Methods A single-center, randomized, double-blind controlled trial was conducted. A total of 100 participants were randomly assigned to four groups: the esketamine group (Group E), the dexmedetomidine group (Group D), the esketamine combined with dexmedetomidine group (Group ED), and the control group (Group S) (n=25 each). The intervention drugs were continuously infused until the placement of the drainage tube. The primary outcome measure was the incidence of POSD, defined as an Athens Insomnia Scale (AIS) score {\\textgreater}6 on at least one of the first three postoperative days. The secondary outcome measure was the duration of sleep structure, which was collected using the Fitbit Charge 2® smartwatch (Fitbit, Inc. San Francisco, California, USA). Results In the first three postoperative days, the incidence of POSD was similar across the four groups (P=0.947). However, on postoperative day 3 (POD3), there was a significant interaction between esketamine and dexmedetomidine (P=0.004). Further simple effect analysis revealed that, in the absence of esketamine, dexmedetomidine had a significant effect on POSD on POD3 (OR=0.196, [0.056–0.691]; P=0.019). In the absence of dexmedetomidine, esketamine had a significant effect on POSD on POD3 (OR=0.248, [0.074–0.833]; P=0.042). Dexmedetomidine reduced rapid eye movement (REM) sleep on postoperative day 1 (P=0.042). Esketamine reduced nighttime awakening time on POD1 (P=0.036) and POD3 (P=0.020). Conclusion Intraoperative infusion of esketamine combined with dexmedetomidine had no significant effect on POSD, but dexmedetomidine reduced REM sleep, and esketamine reduced the nocturnal awakening time.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135961/", "newWindow": true } ] }, { "title": "The relationship between sleep and problem behaviors in children with attention-deficit/hyperactivity disorder", "author": "Ghanim, Fanar; Harkness, Kelsey; Wiley, Bevin; Guadagni, Veronica; Murias, Kara", "year": "2025", "journalProceedings": "European Journal of Pediatrics", "category": "Case Study", "devices": "Charge 2", "population": "Children", "dataUsed": "Sleep", "abstract": "Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is commonly associated with sleep disturbances. Sleep disruption can contribute to difficulties in a child’s life and, therefore, can be an important determinant of their quality of life. This study uses data from the large multisite Adolescent Brain Cognitive Development (ABCD) database to examine the relationship between sleep and behavior in children with ADHD. We hypothesized that shorter and more interrupted sleep would relate to increased problem behaviors such as inattention and social difficulties. Sleep data was obtained using commercially available actigraphy (Fitbit) measures, and the Sleep Disturbance Scale for Children (SDSC) for 212 children ages 10 to 13 years, with ADHD and an age and sex matched control group (n = 212). Behavioral and emotional subscores were obtained from the Child Behavior Checklist (CBCL). SDSC sleep data was significantly different between ADHD and control groups, while wearable actigraphy data was not. ADHD diagnosis, family income, sleep latency (measured by wearable device), and 3 out of 6 of the SDSC subscores were significantly related to problem behavior scores measured by the CBCL.", "links": [ { "caption": "URL", "url": "https://doi.org/10.1007/s00431-025-06209-2", "newWindow": true } ] }, { "title": "Unlocking the Potential of Wear Time of a Wearable Device to Enhance Postpartum Depression Screening and Detection: Cross-Sectional Study", "author": "Hurwitz, Eric; Meltzer-Brody, Samantha; Butzin-Dozier, Zachary; Patel, Rena C.; Elhadad, Noémie; Haendel, Melissa A.", "year": "2025", "journalProceedings": "JMIR Formative Research", "category": "Case Study", "devices": "Device unspecified", "population": "Pregnant Women", "dataUsed": "Device Weartime", "abstract": "Background Postpartum depression (PPD) is a mood disorder affecting 1 in 7 women after childbirth that is often underscreened and underdetected. If not diagnosed and treated, PPD is associated with long-term developmental challenges in the child and maternal morbidity. Wearable technologies, such as smartwatches and fitness trackers (eg, Fitbit), offer continuous and longitudinal digital phenotyping for mood disorder diagnosis and monitoring, with device wear time being an important yet understudied aspect. Objective We aimed to suggest that wear time of a wearable device may provide additional information about perinatal mental health to facilitate screening and early detection of PPD. We proposed that wear time of a wearable device may also be valuable for managing other mental health disorders. Methods Using the All of Us Research Program dataset, we identified females who experienced childbirth with and without PPD using computational phenotyping. We compared the percentage of days and number of hours per day females with and without PPD wore Fitbit devices during prepregnancy, pregnancy, postpartum, and PPD periods, determined by electronic health records. Comparisons between females with and without PPD were conducted using linear regression models. We also assessed the correlation between Fitbit wear time consistency (measured as the maximum number of consecutive days the Fitbit was worn) during prepregnancy and PPD periods in females with and without PPD using the Pearson correlation. All analyses were run with Bonferroni correction. Results Our findings showed a strong trend, although nonsignificant after multiple testing correction, that females in the PPD cohort wore their Fitbits more than those in non-PPD cohort during the postpartum (PPD cohort: mean 69.9\\%, 95\\% CI 42.7\\%-97\\%; non-PPD cohort: mean 50\\%, 95\\% CI 25.5\\%-74.4\\%; P=.02) and PPD periods (PPD cohort: mean 66.6\\%, 95\\% CI 37.9\\%-95.3\\%; non-PPD cohort: mean 46.4\\%, 95\\% CI 20.5\\%-72.2\\%; P=.02). We found no difference in the number of hours per day females in the PPD and non-PPD cohorts wore their Fitbit during any period of pregnancy. Finally, there was no relationship between the consistency of Fitbit wear time during prepregnancy and PPD periods (r=–0.05, 95\\% CI –0.46 to 0.38; P=.84); however, there was a trend, though nonsignificant, in Fitbit wear time consistency among females without PPD (r=0.25, 95\\% CI –0.02 to 0.49; P=.07). Conclusions We hypothesize that increased Fitbit wear time among females with PPD may be attributed to hypervigilance, given the common co-occurrence of anxiety symptoms. Future studies should assess the link between PPD, hypervigilance, and wear time patterns. We envision that wear time patterns of a wearable device combined with digital biomarkers such as sleep and physical activity could enhance early PPD detection using machine learning by alerting clinicians to potential concerns and facilitating timely screenings, which may have implications for other mental health disorders.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144471/", "newWindow": true } ] }, { "title": "Machine learning applied to wearable fitness tracker data and the risk of hospitalizations and cardiovascular events", "author": "Kundrick, John; Naniwadekar, Aditi; Singla, Virginia; Kancharla, Krishna; Bhonsale, Aditya; Voigt, Andrew; Shalaby, Alaa; Estes, N. A. Mark; Jain, Sandeep K.; Saba, Samir", "year": "2025", "journalProceedings": "American Journal of Preventive Cardiology", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Background: Wearable fitness trackers generate extensive physiological and activity data, offering potential to monitor health and predict outcomes. Machine learning (ML) techniques applied to these data may enable early identification of adverse health conditions, such as hospitalizations and development of cardiovascular diseases (CVD). This study aimed to evaluate ML models' ability to forecast the incidence of (1) hospitalizations from any cause and (2) of new diagnosis of CVD, including a composite of heart failure (HF), coronary artery disease or myocardial infarction (CAD-MI), cardiomyopathy (CMP), and atrial fibrillation (AF). Method and Results: Data from 14,157 participants in the All of Us study that included both Fitbit and electronic health record (EHR) information were censored on the date preceding events and analyzed using various ML classifiers for extracted feature data. Performance metrics included accuracy, area under the receiver operating characteristic (AUROC) curve, and F1 scores. Our overall study population was young (median age 54 years), with good representation of women (67\\%). For hospitalizations, a Random Forest classifier achieved the best performance (AUROC=0.95, accuracy=0.99, F1 score=0.92). For the CVD events, the best prediction model was gradient boosting (AUROC=0.80, accuracy=0.71, F1 score=0.15)., Conclusion: ML models applied to Fitbit data demonstrate promise in predicting clinical outcomes with strong performance for predicting all-cause hospitalizations and modest performance for predicting incident CVD. Wearable technology could play a role in risk assessment and patient management.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149649/", "newWindow": true } ] }, { "title": "The effect of sleep quality on glucose variability among adolescents with type 1 diabetes in China: A multi-central temporal longitudinal association analysis", "author": "Li, Qingting; Lv, Wencong; Yuwen, Weichao; Jia, Zhumin; Li, Xia; Guo, Jia", "year": "2025", "journalProceedings": "Sleep Medicine", "category": "Case Study", "devices": "Inspire HR", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "Study objectives High glucose variability is common among adolescents with type 1 diabetes mellitus (T1DM). On person level, poor sleep quality has been reported to be an important factor associated with high glucose variability among adolescents with T1DM. However, on day level, the effect of sleep quality on glucose variability remains unclear, limiting temporal adjustment of treatment regimens. This study aimed to concurrently explore associations between sleep quality and glucose variability at both day and person levels among Chinese adolescents with T1DM based on the 24-h Recursive Cycle model. Methods A multi-center, seven-day, temporal longitudinal study was conducted among Chinese adolescents with T1DM. Glucose variability measures were calculated by fingertip blood glucose level at least seven times a day. Subjective sleep quality was measured by total sleep time, wake after sleep onset, number of awakenings, a score of sleep quality, sleep time, and wake time using a sleep diary. Objective sleep quality was assessed by Fitbit Inspire HR and included total sleep time, wake after sleep onset, and number of awakenings, rapid eye movement, light sleep time, deep sleep time, sleep time, wake time, sleep midpoint, and sleep efficiency. A multilevel linear regression model was performed to examine the associations between objective and subjective sleep quality and glucose variability at day and person levels. Gender, age, diabetes duration, complications documented within the preceding 6 months, HbA1c, and insulin pump therapy were controlled at person-level model. Results A total of 51 adolescents with T1DM participated in this study, which included 357 records of data. Only 21.57 \\% (N = 12) of adolescents met the recommended sleep time of 480 min per night measured by Fitbit. About a quarter (N = 11) of adolescents had a coefficient of variation of blood glucose {\\textgreater}36 \\%. At person level, there was no significant association between sleep quality and glucose variability (p {\\textgreater} 0.05). Multilevel models found significant associations between sleep quality and glucose variability at day level. Lower score of subjective sleep quality was significantly associated with higher standard deviation of blood glucose (p {\\textless} 0.05) in the next day. Less Fitbit-measured light sleep time was significantly associated with higher standard deviation of blood glucose, and postprandial of glycemic excursions in the next day (p {\\textless} 0.05). More Fitbit-measured awakenings and less rapid eye movement were associated with higher postprandial glycemic excursions in the next day (p {\\textless} 0.05). Conclusion Nearly 80 \\% of Chinese adolescents with T1DM did not meet the recommended amount of sleep for their age group. They experienced more wakes after sleep onset at night and poorer sleep quality than their subjective experience. According to the findings on temporal relationships, intervention components targeting reducing wakes after sleep onset and improving subjective sleep quality would reduce glucose variability over time among Chinese adolescents with T1DM.", "links": [ { "caption": "URL", "url": "https://www.sciencedirect.com/science/article/pii/S1389945725002722", "newWindow": true } ] }, { "title": "Consumer-facing and professional medical devices in cardiology: monitoring and evaluation of big data and the implications for the practice of cardiology", "author": "Nuvvula, Sri; Makaryus, Amgad N.", "year": "2025", "journalProceedings": "Expert Review of Medical Devices", "category": "Review", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Heart Rate", "abstract": "With the ever-expanding increase in the availability of electronic devices that can monitor everything from a patient’s daily step count to more detailed devices that can measure or estimate pulmonary artery pressures in patients with heart failure, the amount of data measured by these devices produces mountains of information. Our review will examine the various options and developments of both consumer-facing and professional medical devices. We discuss provider-facing cardiac devices including pacemakers, implantable cardioverter-defibrillators, Holter monitors, implantable loop recorders, left ventricular assist devices, patch monitors, and pulmonary artery pressure sensors, as well as consumer-facing cardiac medical devices including the Apple Watch and the Fitbit wearable device. We searched through the available studies on the PubMed, Cochrane Library, and Embase databases for information on these devices. The role of artificial intelligence in the analysis and interpretation of data currently and in the future is also discussed. We expect future consumer-facing cardiac medical devices to focus on ventricular arrhythmias especially given their clinical impact. We also expect clinical data and patient-specific information to play a larger role as artificial intelligence advances, and it becomes more capable of drawing conclusions using multiple variables from a single patient.", "links": [ { "caption": "URL", "url": "https://doi.org/10.1080/17434440.2025.2514005", "newWindow": true } ] }, { "title": "Effects of web platform delivery of a physical activity program for breast cancer survivors: a randomized controlled trial", "author": "Pinto, Bernardine M.; Kindred, Madison; Dunsiger, Shira; Mitchell, Sheryl; Patel, Ashwin; Ostendorf, Danielle; Huebschmann, Amy G.", "year": "2025", "journalProceedings": "Journal of Cancer Survivorship", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Intensity,Active Minutes/Active Zone Minutes", "abstract": "We previously demonstrated that a 3-month peer-delivered program (Moving Forward Together, MFT) significantly increased breast cancer survivors’ moderate-to-vigorous PA (MVPA). To enhance MFT’s scalability and reach, we adapted it to an existing web platform and developed webMFT. Our goal was to test the efficacy of webMFT on survivors’ MVPA.", "links": [ { "caption": "URL", "url": "https://doi.org/10.1007/s11764-025-01811-7", "newWindow": true } ] }, { "title": "Unlocking the potential of wearable technology: Fitbit-derived measures for predicting ADHD in adolescents", "author": "Rahman, Muhammad Mahbubur", "year": "2025", "journalProceedings": "Frontiers in Child and Adolescent Psychiatry", "category": "Case Study", "devices": "Charge 2", "population": "Adolescents", "dataUsed": "Energy Expenditure,Heart Rate", "abstract": "Background Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with a complex etiology. The current diagnostic process for ADHD is often time-intensive and subjective. Recent advancements in machine learning offer new opportunities to improve ADHD diagnosis using diverse data sources. This study explores the potential of Fitbit-derived physical activity data to enhance ADHD diagnosis. Method We analyzed a sample of 450 participants from the Adolescent Brain Cognitive Development (ABCD) study (data release 5.0). Correlation analyses were conducted to examine associations between ADHD diagnosis and Fitbit-derived measurements, including sedentary time, resting heart rate, and energy expenditure. We then used multivariable logistic regression models to evaluate the predictive power of these measurements for ADHD diagnosis. Additionally, machine learning classifiers were trained to automatically classify individuals into ADHD+ and ADHD− groups. Results Our correlation analyses revealed statistically significant associations between ADHD diagnosis and Fitbit-derived physical activity data. The multivariable logistic regression models identified specific Fitbit measurements that significantly predicted ADHD diagnosis. Among the machine learning classifiers, the Random Forest outperformed others with cross-validation accuracy of 0.89, AUC of 0.95, precision of 0.88, recall of 0.90, F1-score of 0.89, and test accuracy of 0.88. Conclusion Fitbit-derived measurements show promise for predicting ADHD diagnosis, with machine learning classifiers, particularly Random Forest, demonstrating high predictive accuracy. These findings suggest that wearable data may contribute to more objective and efficient methods for ADHD identification, potentially enhancing clinical practices for diagnosis and management.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142065/", "newWindow": true } ] }, { "title": "Effects of a Valerian‐Hops Extract Combination (Ze 91019) on Sleep Duration and Daytime Cognitive and Psychological Parameters in Occasional Insomnia: A Randomized Controlled Feasibility Trial", "author": "Schicktanz, Nathalie; Gerhards, Christiane; Schlitt, Thomas; Aerni, Amanda; Müggler, Elia; de Quervain, Dominique; Papassotiropoulos, Andreas; Boonen, Georg; Drewe, Juergen; Butterweck, Veronika", "year": "2025", "journalProceedings": "Brain and Behavior", "category": "Case Study", "devices": "Charge 5", "population": "Adults", "dataUsed": "Sleep", "abstract": "Valerian‐hops extract combination (Ze 91019) significantly increased sleep duration in individuals with occasional sleep problems by 21.7 minutes per night and 48.7 minutes on the shortest night, compared to placebo, without impairing daytime cognitive or psychological functioning. This randomized controlled trial demonstrated high adherence and proved feasibility.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134488/", "newWindow": true } ] }, { "title": "Integration of Wearables Into a Cardiac Rehabilitation Program and Its Impact on Physical Activity and Exercise Capacity in Older Patients With Cardiovascular Disease", "author": "Yagi, Eijiro; Matsumura, Koichiro; Uchigashima, Yuki; Shiroyama, Jun; Hase, Mitsuki; Nanba, Tomoya; Yamada, Nobuhiro; Funauchi, Yohei; Ueno, Masafumi; Togi, Kiyonori; Shirotani, Manabu; Nakazawa, Gaku", "year": "2025", "journalProceedings": "Advances in Rehabilitation Science and Practice", "category": "Case Study", "devices": "Versa 3", "population": "Older Adults,Patients", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Cardiac rehabilitation using mobile health is increasingly being described as effective in improving exercise habits and physical function. However, the effectiveness of combined mobile health and hospital-based cardiac rehabilitation in older patients with cardiovascular disease is unknown. OBJECTIVE: To investigate the effect of a wearable watch device combined with hospital-based cardiac rehabilitation in older patients with cardiovascular disease compared with those with usual care. METHODS: A randomized, controlled trial was conducted in patients with cardiovascular disease aged ⩾60 years who underwent hospital-based cardiac rehabilitation. The patients were randomized 1:1 in those with a wearable watch (Fitbit Versa 3) or usual care. During out-of-hospital cardiac rehabilitation, patients with a wearable watch were advised to check their heart rate with a wearable watch and to target their physical activity at the heart rate determined by cardiopulmonary exercise testing. The primary endpoint was a change in physical activity obtained from the International Physical Activity Questionnaire (metabolic equivalents [METs]-minute/week) between the 2 groups during 12 weeks. RESULTS: Among 39 patients (median age = 73 years, 82\\% men), the change in physical activity was significantly greater in patients with a wearable watch than in those with usual care (median: 2073 [1155-4400] vs 148 [-1261-899] METs-minute/week; analysis of covariance; P {\\textless} .001). In patients with a wearable watch, 6-minute walk distance, the peak oxygen uptake, peak METs, and anaerobic threshold were significantly improved, whereas no significant increase was observed in patients with usual care from baseline to 12 weeks. CONCLUSIONS: In older patients with cardiovascular disease, a wearable watch device combined with hospital-based cardiac rehabilitation increases physical activity and improves exercise capacity outside of hospital.", "links": [] }, { "title": "Feasibility and Cultural Adaptation of a Community-Engaged Physical Activity Intervention for Hispanic Older Adults: Pilot Study", "author": "Zlatar, Zvinka Z.; Greenwood-Hickman, Mikael Anne; Lujan, Lazaro N. Martinez; Cooper, Julie; Florez-Acevedo, Stefani; Marquez, David X.; Aceves, Rosa Gutierrez; Vargas, Andrea Paula; Rosenberg, Dori E.", "year": "2025", "journalProceedings": "JMIR Formative Research", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Goals,Active Minutes/Active Zone Minutes", "abstract": "Background The adult Hispanic population of the United States faces an increased risk of dementia compared to non-Hispanic White adults. Physical activity (PA) can help reduce dementia risk, but culturally adapted interventions for Hispanic populations are lacking. Culturally adapted interventions are needed to increase uptake and adherence to brain health promotion strategies in the Hispanic community. Objective The De Pie y a Movernos intervention aims to reduce barriers to participation in clinical research by culturally adapting a remotely based PA intervention for middle-aged and older Hispanic adults and establish its feasibility and acceptability through a pre-post pilot study. Findings from the cultural adaptation process will inform a stage II PA randomized controlled trial. Methods The adaptation process followed Barrera and Castro’s 2006 cultural adaptation framework and included a literature review, translation of intervention materials, review by a Hispanic-comprised community advisory board and bilingual staff, and a pre-post pilot study (N=10) with subsequent focus groups to refine the intervention. The pilot intervention included the use of Fitbit activity trackers and 2 individualized goal-setting calls with a health coach over a period of 3 weeks. Feasibility and acceptability were assessed using both quantitative methods and qualitative focus groups. Primary quantitative outcomes included enrollment, recruitment, and completion rates, as well as acceptability (predetermined satisfaction survey scores ≥3). Focus groups were thematically coded to identify themes for participants’ opinions about several aspects of the intervention and explore key barriers and facilitators to PA engagement to improve the planned stage II trial. Results Ten Hispanic adults (age: mean 62.7, SD 5.3 years; education: mean 11.8, SD 3.8 years; n=9, 90\\% female; n=9, 90\\% Spanish-speaking) participated in the pre-post pilot, with a 100\\% completion rate, 50\\% enrollment rate, and a recruitment rate of 5 participants per month. Acceptability was high (mean score 4.6, SD 0.3; range 1‐5). Qualitative analyses indicated that participants had high satisfaction with the intervention. They expressed a preference for adding group-based activities and increased interaction with study staff. Key barriers to PA included lack of awareness about the benefits of PA, low self-efficacy, time constraints, health conditions, and weather, while facilitators included awareness of PA’s cognitive benefits, social support from family or friends, accountability, enjoyable activities, self-efficacy, and Fitbit use. Insights from participants and community advisory board recommendations led to modifications for the larger trial, such as incorporating group-based elements for those who want them and adding an option for teleconference coaching calls. Conclusions The cultural adaptation process was essential in refining the intervention to align with the preferences of older Hispanic adults, which resulted in a feasible and acceptable intervention. Findings will inform a planned stage II randomized controlled trial aimed at promoting PA and reducing dementia risk in older Hispanic adults.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12154937/", "newWindow": true } ] }, { "title": "AirPredict: an eHealth platform for asthma management leveraging wearable sensors, digital diaries, and air quality monitoring to optimize patient outcomes", "author": "Atzeni, Michele; Cossu, Luca; Gaiotti, Sergio; Cappon, Giacomo; Tinè, Mariaenrica; Previtero, Daniele; Padrin, Ylenia; Baraldo, Simonetta; Semenzato, Umberto; Vettoretti, Martina", "year": "2025", "journalProceedings": "Frontiers in Digital Health", "category": "Intervention", "devices": "Charge 6", "population": "Patients", "dataUsed": "Heart Rate", "abstract": "INTRODUCTION: Asthma management is complex, and while it is known that many environmental factors play a critical role in exacerbations, there is increasing interest on the role of air pollution. Yet, the precise relations by which these factors affect exacerbation risk are not fully understood. There is a need for innovative solutions to monitor and assess personal exposure to air pollutants in both outdoor and indoor environments to better understand their impact on respiratory outcomes, particularly asthma exacerbations. This paper introduces AirPredict, an innovative eHealth platform designed to enhance asthma management through the integration of wearable sensors, digital diaries, and ambient air quality monitoring. METHODS: AirPredict comprises a mobile application for patients, a web interface for clinicians, and a robust cloud-based infrastructure. The platform utilizes devices such as the Fitbit Charge 6 for heart rate monitoring, the Atmotube PRO for air quality assessment, and the MIR SmartOne for spirometry, providing precise, real-time data on individual exposures and health outcomes. A feasibility study involving 16 participants, including asthma patients and specialized clinicians in Padova, Italy, was conducted to evaluate the usability of platform's components. RESULTS: The results indicated high usability and user satisfaction, with average Single Ease Question (SEQ) scores ranging from of 6.8 to 5.5 out of 7 for patients and from 6.8 to 6.6 for clinicians, reflecting ease of use and functionality. DISCUSSION: The findings support the platform's broader adoption and further development, highlighting its role in advancing eHealth solutions for chronic disease management.", "links": [] }, { "title": "Fitbit Physical Activity and Sleep Data in the All of Us Research Program: Data Exploration and Processing Considerations for Research", "author": "Bailey, Caitlin P.; Dodd, Kevin W.; McClain, James J.; Seo, Isabell; Wheeler, William; Wolff-Hughes, Dana L.", "year": "2025", "journalProceedings": "Medicine and Science in Sports and Exercise", "category": "Survey Research", "devices": "One,Zip,Flex,Charge,Surge,Blaze,Alta,Ionic,Versa,Sense,Inspire,Fitbit Luxe", "population": "Adults", "dataUsed": "Steps,Intensity,Sleep,Heart Rate", "abstract": "PURPOSE: The All of Us Research Program is a national effort to enroll ≥1 million participants for health research. The program enables participants to donate Fitbit data, providing a unique dataset for physical activity (PA) and sleep research. This study characterizes Fitbit device data in the All of Us cohort version 8 (v8) data release to facilitate use by researchers. METHODS: Data were inspected and quality control guardrails were implemented. Days 15-21 (inclusive) post consent date were selected for analysis of demographic characteristics, wear days, and wear time proxy variables. RESULTS: On days 15-21 post consent, the v8 All of Us Fitbit cohort consisted of n = 30,445 participants with PA and/or sleep summary data from 160,487 person-days. Almost all participants (99\\%) provided both PA and sleep data. The sample consisted of 57\\% Bring-Your-Own-Device [BYOD] participants and 43\\% Wearables Enhancing All of Us Research [WEAR] participants provided with a device. Participants were majority Non-Hispanic White (66\\%) and female (68\\%). 70\\% of the sample had ≥5 days of summary data available. Using heart rate data as a proxy for wear, participants averaged 1310 ± 170 min/day of wear time on wear days, or roughly 21 hours and 50 minutes. The Fitbit Charge series were the most common devices worn in the cohort. CONCLUSIONS: Considerations for working with All of Us Fitbit data (v8) are discussed and include rolling dates of primary consent, date shift implementation, proprietary Fitbit algorithm, valid day methodology, missing data assumptions, photoplethysmography (PPG) technology, device version data, and population representation.", "links": [] }, { "title": "Comparing the Accuracy of Different Wearable Activity Monitors in Patients With Lung Cancer and Providing Initial Recommendations: Protocol for a Pilot Validation Study", "author": "Benzo, Roberto M.; Singh, Rujul; Presley, Carolyn J.; Tetrick, Macy K.; Chaplow, Zachary L.; Hery, Chloe M.; Yu, Jane; Washington, Peter; Penedo, Frank J.; Paskett, Electra D.; Lugade, Vipul; Fortune, Emma", "year": "2025", "journalProceedings": "JMIR research protocols", "category": "Validation", "devices": "Charge 6", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND: Wearable activity monitors (WAMs) provide insights into physical activity (PA) and are widely used in behavioral interventions and cancer survivorship research. However, validation studies of wearable devices in populations with cancer are scarce, and existing studies using activity monitors in patients with cancer lack standardization. This gap is particularly significant in patients with lung cancer (LC), who often experience unique mobility challenges and gait impairments that may affect device accuracy. This study addresses this gap by validating the Fitbit Charge 6, ActiGraph LEAP, and activPAL3 micro in patients with LC in both laboratory and free-living conditions and developing a standardized framework for assessing wearable devices in populations with cancer and impaired mobility. OBJECTIVE: This study aims to validate and compare the accuracy of consumer-grade (Fitbit Charge 6) and research-grade (activPAL3 micro and ActiGraph LEAP) WAMs in patients with LC under both laboratory and free-living conditions. Moreover, this protocol aims to establish standardized procedures that can be adapted for validating current and future generations of wearable devices while accounting for disease-specific factors that may impact measurement accuracy. METHODS: In total, 15 adults diagnosed with LC (stages 1-4) will participate in laboratory and free-living protocols, wearing Fitbit Charge 6, activPAL3 micro, and ActiGraph LEAP devices simultaneously. The laboratory protocol will consist of a series of structured activities, including variable-time walking trials, sitting and standing tests, posture changes, and gait speed assessments. Activities will be video recorded for validation. In the free-living protocol, participants will wear the devices continuously for 7 days except during water-based activities. WAM-based outcome measures will include step count; time spent at light, moderate, and vigorous PA intensity levels; posture; and posture changes (only the activPAL3 micro measured posture). Validated survey instruments will be administered both before and after WAM data collection to control for potential confounding factors that may influence movement patterns and device accuracy. Laboratory-based validity measures will compare WAM data to video-recorded observations. Sensitivity, specificity, positive predictive value, and agreement will also be determined. Free-living agreement between devices will be assessed using Bland-Altman plots, intraclass correlation analysis, and 95\\% limits of agreement. RESULTS: Data collection is ongoing, with 11 participants enrolled and 7 (64\\%) having completed both in-laboratory and free-living protocols. On average, enrolled participants are aged 63.0 (SD 7.8; range 50.0-73.0) years, with 8 (73\\%) participants being women. Participant enrollment is expected to conclude in mid-2025, and initial findings are expected to be disseminated by the end of 2025. CONCLUSIONS: This is the first study that validates WAM accuracy for populations with LC while providing comprehensive recommendations for future validation studies. This study will provide critical insights into the accuracy and reliability of WAMs for assessing PA in LC survivors, which are essential for interpreting clinical research and informing future interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/70472.", "links": [] }, { "title": "Inconclusive Single-Lead ECGs From Smart-Devices: Impact of Baseline ECG Anomalies", "author": "Isenegger, Corinne; Mannhart, Diego; Weidlich, Simon; Brügger, Jonas; Serban, Teodor; Jordan, Fabian; Krisai, Philipp; Knecht, Sven; Schaerli, Nicolas; Subin, Behnam; Mosher, Luke; du Fay de Lavallaz, Jeanne; Schaer, Beat; Mahfoud, Felix; Kühne, Michael; Sticherling, Christian; Badertscher, Patrick", "year": "2025", "journalProceedings": "JACC. Clinical electrophysiology", "category": "Case Study", "devices": "Sense", "population": "Patients", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Multiple smart devices can record single-lead electrocardiograms (SL-ECGs) with automated rhythm classification. The impact of pre-existing baseline ECG anomalies on the accuracy of automated rhythm classification remains largely unknown. OBJECTIVES: This study sought to compare the presence of predefined ECG anomalies and their impact on rhythm classification ability of 5 commercially available FDA and CE-marked wearable smart-devices. METHODS: This prospective study included consecutive patients undergoing electrophysiological procedures at a tertiary referral center. Each participant obtained a 12-lead ECG followed by SL-ECGs with 5 different smart devices (AliveCor KardiaMobile, Apple Watch 6, Fitbit Sense, Samsung Galaxy Watch 3, and Withings ScanWatch). Two independent cardiologists performed manual rhythm classification and assessed the following ECG anomalies: ventricular pacing, conduction delay, low voltage, artifacts, and premature atrial or ventricular complexes. RESULTS: A total of 256 participants were included (29\\% female, mean age 66 years) generating 1,280 recorded SL-ECGs. Of these, 242 SL-ECGs (19\\%) were classified as inconclusive by at least 1 smart device. The presence of any ECG anomaly was significantly higher in inconclusive vs conclusive SL-ECGs, with 74\\% vs 42\\%; P {\\textless} 0.001. ORs with 95\\% CIs for inconclusive classification by ECG anomaly were ventricular pacing 6.35 [3.84-10.61], conduction delay 2.42 [1.82-3.22], low voltage 2.37 [1.75-3.21], minor artifact 1.72 [1.17-2.51], major artifact 10.62 [6.78-16.99], premature atrial complex 2.23 [1.29-3.74], and premature ventricular complex 1.94 [1.29-2.89]. Notable differences were found between the assessed smart devices. CONCLUSIONS: Automated rhythm classification is highly susceptible to baseline ECG anomalies. This study provides insights into the most appropriate patient population for smart device-based arrhythmia monitoring and offers guidance for selecting the optimal smart device tailored to individual patient characteristics.", "links": [] }, { "title": "Sleep duration and timing are associated with next-day physical activity: Insights from two large-scale wearable sensor studies", "author": "Leota, Josh; Czeisler, Mark É.; Le, Flora; Presby, David M.; Capodilupo, Emily R.; Scott, Hannah; Wiley, Joshua F.; Drummond, Sean P. A.; Rajaratnam, Shantha M. W.; Facer-Childs, Elise R.", "year": "2025", "journalProceedings": "Proceedings of the National Academy of Sciences", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "Sleep and physical activity (PA) are pillars of health. However, the temporal dynamics between these two behaviors remain poorly understood. This research aims to examine the independent and interactive between- and within-person associations of sleep duration and sleep onset timing on next-day PA duration in two large, longitudinal samples of adults under free-living conditions. In the primary study, participants (N = 19,963; 5,995,080 person-nights) wore a validated biometric device (WHOOP) for 1 y (01/09/2021 to 31/08/2022). Objective sleep and PA metrics were derived from the wrist-worn device. Generalized additive mixed models assessed between- and within-person associations between sleep and PA variables, adjusted for age, sex, Body Mass Index, weekday/weekend, seasonal effects, biometric feedback, and autocorrelated errors. Between participants, longer sleep duration and later sleep onset timing were associated with decreased moderate-to-vigorous PA (MVPA) and overall PA duration (ps {\\textless} 0.001). Within participants, sleeping shorter-than-usual and falling asleep earlier-than-usual were associated with increased next-day MVPA and overall PA, whereas sleeping longer-than-usual, or falling asleep later-than-usual, showed the opposite relationship (ps {\\textless} 0.001). Next-day MVPA duration was highest following earlier-than-usual sleep onset timing combined with one’s typical sleep duration. Results were consistent but smaller in magnitude in the external validation study (N = 5,898; 635,477 person-nights) using Fitbit data from the All of Us Research Program. Individuals may sacrifice time in one health behavior for time in the other. Interventions promoting exercise and holistic public health messaging should consider the temporal dynamics between sleep and next-day PA outcomes.", "links": [ { "caption": "URL", "url": "https://www.pnas.org/doi/full/10.1073/pnas.2420846122", "newWindow": true } ] }, { "title": "Selecting Wearable Devices to Measure Cardiovascular Functions in Community-Dwelling Adults: Application of a Practical Guide for Device Selection", "author": "Lu, Jessica K.; Wang, Weilan; Goh, Jorming; Maier, Andrea B.", "year": "2025", "journalProceedings": "Mayo Clinic Proceedings. Digital Health", "category": "Systematic Review", "devices": "Charge 6", "population": "Adults", "dataUsed": "User Friendliness", "abstract": "Continuous monitoring of cardiovascular functions can provide crucial insights into the health status and lifestyle behaviors of an individual. Wearable devices offer a convenient and cost-effective solution for collecting cardiovascular measurements outside clinical settings. However, the abundance of available devices poses challenges for researchers, health care professionals, and device users in selecting the most suitable one. This article illustrates the application of a practical guide for selecting wearable devices for the continuous monitoring of cardiovascular functions in community-dwelling adults who are generally healthy or have minimal, well-managed chronic conditions. An initial systematic review of the literature revealed 216 devices, each of which were assessed on the basis of 5 core criteria from the guide: (1) continuous monitoring capability, (2) device availability and suitability, (3) technical performance (accuracy and precision), (4) feasibility of use, and (5) cost evaluation. From the 216 devices, there were 136 devices capable of continuous monitoring. After the exclusion of unavailable and unsuitable devices, 53 devices underwent validation assessment of accuracy and precision. Although COSMIN criteria were applied to evaluate technical performance, a lack of validation for certain devices limits a comprehensive evaluation. After selection of valid devices, the feasibility and cost of 20 devices were examined. Wearable devices, such as the Apple Watch Series 9, Fitbit Charge 6, Garmin vívosmart 5, and Oura Ring Gen3, emerged as suitable devices to measure cardiovascular function in community-dwelling adults. The systematic process for device selection could also be applied to select wearable devices for the measurement of other physiologic variables and lifestyle behaviors.", "links": [] }, { "title": "Somatomotor Disconnection Links Sleep Duration With Socioeconomic Context, Screen Time, Cognition, and Psychopathology", "author": "Michael, Cleanthis; Taxali, Aman; Angstadt, Mike; McCurry, Katherine L.; Weigard, Alexander; Kardan, Omid; Molloy, M. Fiona; Toda-Thorne, Katherine; Burchell, Lily; Dziubinski, Maria; Choi, Jason; Vandersluis, Melanie; Hyde, Luke W.; Heitzeg, Mary M.; Sripada, Chandra", "year": "2025", "journalProceedings": "Biological Psychiatry Global Open Science", "category": "Review", "devices": "Charge 2", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "BACKGROUND: Sleep is critical for healthy brain development and emotional well-being, especially during adolescence, when sleep, behavior, and neurobiology are rapidly evolving. Theoretical reviews and empirical research have historically focused on how sleep influences mental health through its impact on higher-order brain systems. No studies have leveraged data-driven network neuroscience methods to uncover interpretable, brainwide signatures of sleep duration in adolescence, their socioenvironmental origins, and their consequences for cognition and psychopathology. METHODS: We implemented graph theory and component-based predictive modeling to examine how a multimodal index of sleep duration (parent-report, youth-report, Fitbit) is associated with intrinsic brain architecture in 3037 youths (ages 11-12 years) from the ABCD (Adolescent Brain Cognitive Development) Study. RESULTS: We demonstrated that network integration/segregation exhibited a strong, generalizable multivariate association with sleep duration (r = 0.23, p {\\textless} .001). The multivariate signature of shorter sleep predominantly involved increasing disconnection of a lower-order system, the somatomotor network, from other systems. Next, we identified a single component of brain architecture as the dominant contributor of this relationship (r = 0.15), which again exhibited this somatomotor disconnection motif. Finally, greater somatomotor disconnection was associated with lower socioeconomic resources, longer screen times, reduced cognitive/academic performance, and elevated externalizing problems (βs {\\textgreater} 0.03, ps ≤ .007). CONCLUSIONS: These findings reveal a novel neural signature of shorter sleep in adolescence that is intertwined with environmental risk, cognition, and psychopathology. By robustly elucidating the key involvement of an understudied brain system in sleep, this study can inform theoretical and translational research directions on sleep to promote neurobehavioral development and mental health during the adolescent transition.", "links": [] }, { "title": "Feasibility of Data Collection Via Consumer-Grade Wearable Devices in Adolescent Student Athletes: Prospective Longitudinal Cohort Study", "author": "Ransom, Danielle; Tudor, Brant; Irani, Sarah; Rehman, Mohamed; Suskauer, Stacy; Mularoni, P. Patrick; Ahumada, Luis", "year": "2025", "journalProceedings": "JMIR Formative Research", "category": "Usability", "devices": "Sense", "population": "Adolescents", "dataUsed": "Steps,Sleep,Heart Rate,Active Minutes/Active Zone Minutes", "abstract": "Background Recent advancements in sports medicine have been fueled by innovative technologies, particularly consumer-grade wearable devices like Fitbit, Apple Watch, and Garmin. These devices offer physiological and biomechanical data and hold promise for personalized, real-time, and remote assessment of athlete recovery. However, few studies have been conducted with these devices in adolescent student athletes. Objective The primary objective of this study was to assess the feasibility of integrating consumer-grade wearable technology into injury recovery monitoring of adolescent student athletes. Methods The study included 34 high school student athletes aged 14‐18 diagnosed with either concussion or orthopedic injury, enrolled within 10 days of injury. Participants were equipped with a Fitbit Sense for continuous monitoring of physiological markers, including cardiovascular metrics, physical activity levels, and sleep patterns. Data collection extended 4‐6 weeks beyond injury clearance, during which adherence rates were assessed at both hourly and daily intervals. Hourly adherence was defined as the proportion of participants with at least 1 recorded heart rate data point per hour, while daily adherence was defined as the proportion of participants with at least 1 recorded heart rate data point per 24-hour period. Results The study demonstrated high participant adherence to wearing the device. The orthopedic injury cohort exhibited a median adherence rate of 95\\%, with individual rates ranging from 82\\% to 100\\%. Similarly, the concussion cohort demonstrated a median adherence rate of 93\\%, with adherence rates spanning from 37\\% to 100\\%. Notably, the study encountered minimal issues related to device functionality, with only 1 participant necessitating a device replacement. Conclusions These findings demonstrate successful integration of wearable technology in data collection for adolescent student athletes recovering from sports-related injuries. However, it is important to consider current limitations, including factors that may influence data accuracy and precision. In conclusion, this feasibility study demonstrates the practicality of using consumer-grade wearable technology for the collection of physiological and biomechanical parameters in adolescent student athletes recovering from sport-related injuries. The high level of adherence highlights the potential applicability of consumer-grade wearable devices in this population. Study findings lay the foundation for future investigations with larger and more diverse cohorts to identify the utility of device metrics in identifying unique patterns of injury-specific recovery (ie, sport-related concussion). Consumer-grade wearable devices offer promise for optimizing assessment and management of injured athletes through wearable technology integration into standard clinical protocols.", "links": [ { "caption": "URL", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180680/", "newWindow": true } ] }, { "title": "Continuous heart rate measurements in patients with cardiac disease: Device comparison and development of a novel artefact removal procedure", "author": "Vermunicht, Paulien; Makayed, Katsiaryna; Buyck, Christophe; Knaepen, Lieselotte; Piedrahita Giraldo, Juan Sebastian; Naessens, Sebastiaan; Hens, Wendy; Craenenbroeck, Emeline Van; Laukens, Kris; Desteghe, Lien; Heidbuchel, Hein", "year": "2025", "journalProceedings": "Digital Health", "category": "Validation", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Intensity,Heart Rate", "abstract": "INTRODUCTION: Heart rate (HR) monitors could objectively measure physical activity intensity in patients with cardiac disease. However, thorough validation of HR monitors in cardiac populations during daily life, compared to gold-standard Holter monitoring, remains limited. Photoplethysmography (PPG)-based HR data provides near-continuous data, spanning longer periods, but improved algorithms to filter unreliable data are needed. METHODS: This observational, prospective pilot study compared the accuracy of two wearables for HR monitoring (electrocardiogram [ECG]-based Polar H10 chest strap and PPG-based Fitbit Inspire 2 wrist tracker) against Holter monitoring in 15 patients with atrial fibrillation (AF), heart failure (HF) and coronary artery disease referred for cardiac rehabilitation (CR). All devices were worn simultaneously for 24 h. We developed and assessed an artefact removal procedure (ARP) using logistic regression machine learning models to detect unreliable PPG data. RESULTS: The ECG-based chest strap showed a strong correlation (r = 0.94) and clinically acceptable errors (mean absolute error, MAE = 3.4 bpm; mean absolute percentage error, MAPE = 4.9\\%). Photoplethysmography data exhibited weaker correlation (r = 0.69) and higher errors (MAE = 8.3 bpm, MAPE = 14.3\\%), with highest accuracies in CR and lowest in HF and especially AF. After implementing the ARP, PPG-based HR data improved to a correlation of 0.75, with MAE of 7.2 bpm and MAPE of 12.4\\%. The procedure removed nearly one-third of unreliable data, achieving an 81\\% accuracy. CONCLUSIONS: While ECG-based monitors provide HR data with clinical acceptable accuracy, PPG-based monitors present accuracy challenges. Our machine learning procedure showed potential to filter unreliable PPG-based HR data, which could help measure physical activity intensity in cardiac disease continuously.", "links": [] }, { "title": "Psychometric evaluation of the exercise self-regulatory efficacy scale using objective measures of physical functioning in persons with chronic obstructive pulmonary disease", "author": "Bamonti, Patricia M.; Wingood, Mariana; Robinson, Stephanie A.; Rose, Grace A.; Moy, Marilyn L.", "year": "2025", "journalProceedings": "Respiratory Medicine", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Introduction: Physical activity (PA) promotion is an essential component of managing chronic obstructive pulmonary disease (COPD). Exercise self-efficacy is a primary indicator of exercise engagement. The Exercise Self-Regulatory Efficacy scale (Ex-SRES) was developed and validated in persons with COPD recruited at pulmonary rehabilitation programs who self-reported exercise behaviors. Our study evaluates its psychometric properties using objective assessments of PA and exercise capacity.\n\nMethods: Secondary analyses were performed on baseline assessments of U.S. Veterans with COPD who participated in two PA intervention studies (N = 210; age M = 69 ± 8; 97 % male; 91.9 % White). The Ex-SRES asked how confident participants felt they could exercise 3X/week for 20 min given 16 barriers. The Omron HJ-720 or Fitbit Zip pedometer assessed daily step counts for 7-10 days and the 6-min walk test (6 MWT) assessed exercise capacity. Breathlessness was assessed with the Modified Medical Research Council Dyspnea Scale (mMRC). The St. George Respiratory Questionnaire (SGRQ) assessed health-related quality of life; participants self-reported confidence and motivation for exercising regularly. Exploratory factor analysis (EFA) assessed the underlying factor structure of the Ex-SRES and internal consistency reliability. Convergent validity was evaluated through correlations with objective and subjective measures.\n\nResults: EFA resulted in a one-factor structure accounting for 58.28 % of the common variance. The Ex-SRES demonstrated convergent-type validity: daily step counts (ρ = .17), 6 MWT distance (ρ = .22), mMRC (ρ = -.15), SGRQ (ρ = -.24), motivation (ρ = .42), and confidence (ρ = .58) (p's < .05) and internal consistency reliability (Cronbach's α = .95) CONCLUSION: Objective measures of PA and exercise capacity confirm the psychometric properties of the Ex-SRES.", "links": [] }, { "title": "Wearable Technology in Cardiology: Advancements, Applications, and Future Prospects", "author": "Jena, Nihar; Singh, Prabhat; Chandramohan, Deepak; Garapati, Hari N.; Gummadi, Jyotsna; Mylavarapu, Maneeth; Shaik, Bushra Firdous; Nanjundappa, Athmananda; Apala, Dinesh Reddy; Toquica, Christian; Lapsiwala, Boney; Simhadri, Prathap Kumar", "year": "2025", "journalProceedings": "Reviews in Cardiovascular Medicine", "category": "Validation,Review", "devices": "One,Flex,Charge,Versa,Charge 4,Sense,Inspire,Fitbit Luxe", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "As the use of wearable devices continues to expand, their integration into various aspects of healthcare becomes increasingly prevalent. Indeed, significant advancements have been made in the field of cardiology through the application of wearable technology to monitor heart rate, rhythm, and other biological signals. This review examines the various applications of wearable technology in cardiology, with the goal of improving patient care. We evaluate the accuracy and functionality of existing wearable electrocardiograms, defibrillators, blood pressure monitors, fitness trackers, activity trackers, and sleep trackers, including their roles in cardiac rehabilitation. Furthermore, we highlight the significant advancements in wearable electrocardiograms, demonstrating their accuracy comparable to that of traditional monitoring devices, as shown by studies such as the Apple Heart Study and the Fitbit Heart Study. Recent research suggests that wearable electrocardiograms are comparable to conventional monitoring devices in terms of performance and can help reduce healthcare costs. However, as technological improvements continue to evolve, challenges related to accessibility, patient privacy, and the need for improved accuracy are also emerging. This review highlights recent advancements that aim to address these challenges. Nonetheless, further research is crucial to critically assess and identify shortcomings, as wearable devices possess significant potential to enhance cardiovascular and overall health.", "links": [] }, { "title": "Characterization and clustering of intra-day physical activity patterns using accelerometry among sexual and gender minority adults", "author": "Lopez-Veneros, David; Caceres, Billy A.; Jackman, Kasey; Belloir, Joseph A.; Sharma, Yashika; Bakken, Suzanne; Ensari, Ipek", "year": "2025", "journalProceedings": "BMC public health", "category": "Case Study", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: Sexual and gender minority (SGM) adults experience significant health disparities linked to chronic exposure to minority stressors (e.g., discrimination), and could be reciprocally associated with physical activity (PA) behavior. While PA is a health-protective factor, research on PA patterns in SGM adults is limited. Identifying potential latent PA profiles can inform tailored behavior change approaches.\n\nObjective: To investigate latent profiles (i.e., clusters) of daily PA trajectories among sexual and gender minority (SGM; lesbian, gay, bisexual, transgender, queer) adults using functional latent block models (FLBMs), a co-clustering technique that simultaneously accounts for variation at the individual- and day-level.\n\nStudy sample: The study included 42 Black and Latinx SGM adults who wore Fitbit trackers for up to 30 days of PA data collection as a part of a sleep health study, yielding 1,209 person-level days of step count data.\n\nMethods: Each 24-h period of step counts was smoothed using Fourier-transform to create the functional data matrix and fit the FLBMs. The optimal number of clusters was determined using the integrated completed likelihood (ICL) criterion.\n\nResults: The best-fitting model identified 3 individual-level clusters (K) based on the daily step count patterns (ICL = -88,495.88). Low activity cluster (n = 11) was characterized with the lowest overall PA, slightly later bedtimes, and the least intra-day and hourly variability. Steady moderate activity cluster (n = 23) was characterized by a gradual increase in step counts that spread over the course of the day, with a small peak in the afternoon. Fluctuating high activity cluster was characterized by a peak in activity earlier in the day, compared to other clusters. Cluster 3 membership was also associated with the highest volume of PA overall, along with hourly and daily variability in step counts and higher intensities of PA. The model secondarily identified 2 day-level clusters (L), representing weekday and weekend PA patterns.\n\nConclusions: We identified distinct habitual daily PA trajectories among SGM adults based on daily volume and variability. Analyzing individual PA variances can help identify inactive periods and individuals at higher risk, which can inform the design of tailored interventions and self-management strategies to promote PA.", "links": [] }, { "title": "A Culturally Tailored mHealth Intervention (MobileMen App) to Promote Physical Activity in African American Men: Protocol for a Comparative Effectiveness Trial", "author": "Nuss, Kayla; Brice, Amanda; Hebert, Callie; Nauta, Phillip; Stull, April J.; Swift, Damon L.; Griffith, Derek M.; Buller, David B.; Newton, Robert L.", "year": "2025", "journalProceedings": "JMIR research protocols", "category": "Intervention", "devices": "Charge 6", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "Background: African American men are at a higher risk for serious health conditions such as cardiovascular disease, diabetes, and stroke compared to non-Hispanic White men. Physical activity (PA) is a modifiable health behavior that has been shown to decrease chronic disease risk; yet, PA engagement is alarmingly low in African American men. Interventions to improve PA engagement are effective in a number of populations; however, very few have been tailored to the unique needs of African American men. Even fewer have leveraged mobile health apps, despite African American men's interest in and willingness to use such technologies for health improvement.\n\nObjective: This comparative effectiveness trial aims to evaluate MobileMen, a PA promotion app tailored to the needs and preferences of African American men. This trial will compare the MobileMen app to a commercially available PA promotion app with similar features but lacks culturally tailored components.\n\nMethods: We will recruit a sample of \"low active\" (accumulating <7500 steps per day) African American men (n=100) aged >30 years from Baton Rouge, Louisiana, and the surrounding communities. All participants are given a Fitbit Charge 6 wearable activity tracker to assess daily PA and steps and are randomized to either the MobileMen intervention app or the comparator app, which is a commercially available PA tracking app called Stridekick. The Stridekick app has features similar to those in the MobileMen app but was not intentionally designed for African American men. The intervention period is 6 months during which participants will interact with their assigned mobile app. MobileMen includes features such as digital badges earned for PA; tangible prizes like exercise equipment; challenges among participants; goal setting; nutrition; PA; and behavior change educational information in text, audio, and video formats. Participants will complete assessments at baseline and at 6 months post randomization. Assessments include objective measurements of daily steps and minutes of moderate to vigorous PA, quality of life, dietary measures, self-efficacy for fruit and vegetable consumption and PA, and autonomous motivation for PA.\n\nResults: This trial is in the start-up phase. The MobileMen app development and usability testing was completed in August 2024. Participant recruitment efforts began in October 2024. The trial and associated data analyses and interpretation are planned to be completed by fall 2025.\n\nConclusions: Mobile apps are a widely accessible means to disseminate culturally tailored PA promotion interventions to various populations, including African American men. MobileMen has the potential to impact PA engagement in African American men, which would dramatically improve the overall health and chronic disease risk in this underrepresented group.", "links": [] }, { "title": "Activity tracking devices in pregnancy: Understanding the participant experience in a longitudinal birth cohort", "author": "Redding, Ashley; Coates, Dionne; Cassidy-Bushrow, Andrea E.; Straughen, Jennifer K.; Santarossa, Sara", "year": "2025", "journalProceedings": "Women's Health (London, England)", "category": "Intervention", "devices": "Charge 4,Charge 5", "population": "Pregnant Women", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Background: Improving understanding of physical activity (PA) during pregnancy can inform future interventions and support the delivery of high-quality prenatal care.\n\nObjectives: Within the longitudinal birth cohort Research Enterprise to Advance Children's Health (REACH), the sub-study REACH-Fitbit sought to understand the prenatal experiences of utilizing an activity monitoring device and best practices for receiving PA information.\n\nDesign: REACH recruits gravid patients ⩾18 years old receiving prenatal care and planning to deliver at predefined hospitals. REACH-Fitbit participants had to be <20 weeks gestation with access to a Bluetooth-enabled device. Recruitment (self-selection) for focus groups occurred from completed REACH-Fitbit participants (e.g., delivered their baby).\n\nMethods: A semi-structured moderator guide was utilized to capture feedback on experiences, adherence to protocols, resources, and best practices for measuring PA during pregnancy. Two groups of six participants participated virtually, which included conversations about the overall participant experience, compliance with protocols, and opportunities for knowledge dissemination about PA.\n\nResults: The majority of focus group participants identified as Black, were between 20 and 29 years of age, and had positive feelings about the Fitbit, finding it usable and functional. Participants felt protocol compliance was facilitated by text message reminders and research team support, while barriers included Fitbit application problems, busy schedules, and forgetting. Participants preferred to receive PA information from a trusted healthcare source (e.g., doctor, nurse, or other healthcare provider), though most participants (57%) did not receive PA information during prenatal care. Participants were interested in learning about the safety, type, and amount of prenatal PA in which to engage.\n\nConclusion: Findings presented here can support compliance in future studies or PA interventions utilizing similar technology. Incentives for compliance with study protocols and enhanced communication with the research team can improve participant engagement. Future work will address the need to communicate the interests of pregnant persons to clinical care teams, specifically, improvements to how providers share information on PA.", "links": [] }, { "title": "Effectiveness of an mHealth-based impact exercise program for bone health in postmenopausal women: a randomised controlled trial protocol", "author": "Sañudo, Borja; Reverte-Pagola, Gonzalo; Maher, Carol; Godino, Job; Carrasco, Luis; Oviedo, Miguel Ángel; Feria, Adrián; Sánchez-Trigo, Horacio; Gamboa, Hugo; Domingo-Molina, Raquel; Sánchez-Arteaga, Alejandro; Giráldez, Miguel Ángel; Martínez-Maestre, Mª Ángeles; Cepeda, Elena; Ladrón-de-Guevara, Carmen; Rangel, Carlos; Pecci, Javier; Farrahi, Vahid; Tejero, Sergio", "year": "2025", "journalProceedings": "BMC public health", "category": "Intervention", "devices": "Versa 3", "population": "Pregnant Women", "dataUsed": "Steps,Intensity", "abstract": "Background: Osteoporosis, a major global health concern, increases fracture risk due to reduced bone mineral density (BMD), particularly in postmenopausal women. Weight-bearing and high-impact exercises are recommended for bone health, yet accurately quantifying mechanical loading outside the laboratory remains a challenge. Without precise tools, it is difficult to assess whether individuals engage in sufficient osteogenic activity. Moreover, poor adherence to structured exercise programs limits their effectiveness. Mobile health (mHealth) technologies offer a promising solution by enabling real-time mechanical loading monitoring in free-living conditions and providing personalized feedback to improve adherence. This study evaluates the effectiveness of an individualized mHealth-based intervention in optimizing exercise adherence and promoting bone health in postmenopausal women through real-time quantification of mechanical loading.\n\nMethods: A single-blind randomized controlled trial (RCT) will include 120 postmenopausal women (≤ 10 years since menopause, < 150 min/week of moderate-to-vigorous physical activity). Participants will be randomly assigned (1:1) to an intervention group (mHealth-based impact exercise program) or a control group (usual care). The 9-month intervention will use wearable activity monitors (Fitbit Versa 3) to track step cadence, impact frequency, and intensity. Exercise targets include fast walking (≥ 100 steps/min), progressive jump training (≥ 3.9 G impact forces), and wrist wall strikes for radius bone adaptation. Primary outcomes include changes in BMD (DXA) at the lumbar spine, proximal femur, and distal radius. Secondary outcomes include bone geometry, and bone turnover markers (β-CTX, P1 NP). Functional mobility, muscle strength, physical activity levels, quality of life and adherence will also be assessed.\n\nDiscussion: This study will provide insights into optimal mechanical loading for osteoporosis prevention and assess the feasibility of mHealth solutions for improving adherence to osteogenic exercise programs. Findings may inform future guidelines on digital health applications for musculoskeletal health.", "links": [] }, { "title": "Impact of Frailty on Physical Activity in the Postoperative Period After Liver Transplant Surgery: Pilot Study Using Fitbit Watch", "author": "Shamaa, Tayseer M.; Allenspach, Lisa; Shamaa, Omar; Hage-Hassan, Omar; Kitajima, Toshihiro; Shimada, Shingo; Bajjoka-Francis, Iman; Abouljoud, Marwan S.; Nagai, Shunji", "year": "2025", "journalProceedings": "Clinical Transplantation", "category": "Usability", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Steps", "abstract": "Introduction: Robust physical activity after liver transplant (LT) is an important determinant of long-term health. This pilot study aimed to evaluate whether a physical activity monitor (PAM) can be employed to monitor postoperative physical activity levels after LT.\n\nMethods: Adult patients undergoing LT were screened for inclusion. Several frailty tests, including the liver frailty index, were performed in the preoperative and postoperative periods. All patients were provided with Fitbit Inspire 2 watches to measure biophysical data and were instructed to wear them continuously for 30-60 postoperative days (POD).\n\nResults: Thirty-five patients were enrolled in the study. There was a negative linear correlation between age and the average daily steps during POD 1-30 and POD 31-60 after LT (r = -0.52, P = 0.001; r = -0.36, P = 0.044, respectively). In addition, longer hospital length of stay was negatively associated with daily steps during POD 1-30 and POD 31-60 (r = -0.43, P = 0.01; r = -0.50, P = 0.002, respectively). The majority of patients (89%) reported a medical benefit from using the PAM in the postoperative period.\n\nConclusion: This is the first study to demonstrate the feasibility and utility of providing wearable devices to measure patient physical activity after LT.\n\nKeywords: Fitbit and physical activity; frailty; liver transplantation; patient outcomes; physical activity monitory; sarcopenia; technology.", "links": [] }, { "title": "Fit4Surgery: A pilot randomized controlled trial to assess the feasibility of prehabilitation prior to debulking surgery for ovarian cancer", "author": "Silberman, Jason N.; Benjamin, Annella; Solk, Payton; Matei, Daniela; Alter, Raanan; Hinchcliff, Emily; Roque, Dario; Marcus, Jenna; Tanner, Edward; McKoy, June M.; Flores, Ann Marie; Kocherginsky, Masha; Phillips, Siobhan; Barber, Emma", "year": "2025", "journalProceedings": "Gynecologic Oncology", "category": "Usability,Case Study", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps", "abstract": "Objectives: To assess the feasibility of enrolling women with ovarian cancer in a randomized controlled trial (RCT) of a home-based, patient-tailored physical activity prehabilitation program (Fit4Surgery, F4S) and assess adherence while estimating effects on patient-reported outcomes (PROs), frailty, and physical function.\n\nMethods: Thirty patients aged ≥60 with ovarian cancer, scheduled for neoadjuvant chemotherapy and surgery, were randomized 2:1 to Fit4Surgery or educational control. The intervention group received a Fitbit, access to the F4S app, and weekly coaching calls. Controls received educational calls and access to the Cancer.Net app. The primary outcome was feasibility, defined as >80 % evaluability and adherence. Daily steps and PROs were compared using paired t-tests or Wilcoxon rank sum tests.\n\nResults: Of 74 patients approached, 32 consented and 30 were randomized. Average age was 69.7 years (range 60-81). Ninety percent of patients completed both baseline and pre-surgical assessments. Patients wore their FitBit on 94 % of days, attended 97 % of coaching calls, and engaged with the F4S app on 80 % of days. Patients reached personal step goals on 49 % of days, while 77.8 % of patients increased their daily steps over the intervention, with an average increase of 1804 steps per day (37 % increase, p = 0.01). Patient-reported physical function (p = 0.09) and frailty-related metrics, including energy levels (p = 0.01) and weekly walks (p = 0.02) improved in the F4S group, while no differences were detected in surgical outcomes.\n\nConclusions: Fit4Surgery was feasible with high engagement and adherence. Patients demonstrated increased daily step count and positive trends in PROs, frailty, and physical function.", "links": [] }, { "title": "The mLIFE randomized trial examining the impact of gamifying social support provision for weight loss", "author": "Turner-McGrievy, Gabrielle M.; Delgado-Díaz, Diana Carolina; DuBois, Kelli E.; Aydin, Halide Zeynep; Monroe, Courtney M.; Kim, Yesil; Hardin, James; Wilcox, Sara; Valafar, Homayoun", "year": "2025", "journalProceedings": "Obesity (Silver Spring, Md.)", "category": "Intervention", "devices": null, "population": "Adults", "dataUsed": "Weight", "abstract": "Objective: The Mobile Lifestyle Intervention for Food and Exercise (mLIFE) study was a 12-month mobile weight loss intervention examining social gaming to promote social support.\n\nMethods: Adults with overweight or obesity (n = 243) were randomized to the mLIFE + points (received points for social support activities) or mLIFE group (blinded to points). Weight was measured via Fitbit scales. Repeated-measures mixed models were used to conduct both an intent-to-treat analysis and an analysis among adherent participants (logged on to the mLIFE app ≥25% of study days).\n\nResults: Attrition was lower in the mLIFE + points group (22% vs. 41% in mLIFE; χ2 = 9.8, p < 0.01), and adherence was higher (61% vs. 42% in mLIFE; χ2 = 7.6, p < 0.01). None of the group × time interactions was significant for the intent-to-treat analysis except for total number of points earned at 12 months (mLIFE + points mean 605.9 [SE 203.2] vs. mLIFE mean 350.0 [SE 200.0]; p < 0.01). The mLIFE + points participants lost a mean of 5.3 [SE 0.6] kg at 12 months (vs. mean 3.5 [SE 0.7] kg in mLIFE; p = 0.09). Among adherent participants (n = 127), mLIFE + points participants lost more weight (mean 7.3 [SE 0.8] kg) than mLIFE (mean 3.8 [SE 0.9] kg; p < 0.01).\n\nConclusions: The use of points led to greater weight loss at 12 months, but only among adherent participants. Providing points for completing social support activities is a way to retain participants and increase engagement in a mobile intervention.", "links": [] }, { "title": "GPS-based street-view greenspace exposure and wearable assessed physical activity in a prospective cohort of US women", "author": "Yi, Li; Hart, Jaime E.; Wilt, Grete; Hu, Cindy R.; Jimenez, Marcia Pescador; Lin, Pi-I. Debby; Suel, Esra; Hystad, Perry; Hankey, Steve; Zhang, Wenwen; Chavarro, Jorge E.; Laden, Francine; James, Peter", "year": "2025", "journalProceedings": "The International Journal of Behavioral Nutrition and Physical Activity", "category": "Case Study", "devices": "Charge HR,Charge 2,Charge 3", "population": "Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "Background: Increasing evidence positively links greenspace and physical activity (PA). However, most studies use measures of greenspace, such as satellite-based vegetation indices around the residence, which fail to capture ground-level views and day-to-day dynamic exposures, potentially misclassifying greenspace and limiting policy relevance.\n\nMethods: We analyzed data from the US-based Nurses' Health Study 3 Mobile Health Substudy (2018-2020). Participants wore Fitbits™ and provided smartphone global positioning system (GPS) for four 7-day periods throughout the year. Street-view greenspace (%trees, %grass, %other greenspace [flowers/plants/fields]) were derived from 2019 street-view imagery using deep-learning algorithms at a 100-meter resolution and linked to 10-minute GPS observations. Average steps-per-minute for were calculated for each 10-minute period following each GPS observation. Generalized Additive Mixed Models examined associations of street-view greenspace exposure with PA, adjusting for individual and area-level covariates. We considered effect modification by region, season, neighborhood walkability and socioeconomic status (SES), temperature, and precipitation.\n\nResults: Our sample included 335 participants (meanage= 39.4 years, n = 304,394 observations). Mean steps-per-minute per 10-minutes were 6.9 (SD = 14.6). An IQR increase (18.7%) in street-view trees was associated with a 0.36 steps-per-minute decrease (95%CI: -0.71, -0.01). In addition, an IQR increase (10.6%) in grass exposure was associated with a 0.59 steps-per-minute decrease (95% CI: -0.79, -0.40); however, the association was non-linear and flattened out after the 75th percentile of street-view grass. Conversely, an IQR increase (1.2%) in other greenspace was associated with a 1.99 steps-per-minute increase (95%CI: 0.01, 3.97). Associations were stronger in the spring and in higher SES neighborhoods, and among residents of the Northeast.\n\nConclusions: In this prospective cohort, momentary street-view exposure to trees and grass was inversely associated with PA, while exposure to other greenspace was positively associated. Future research should confirm these results in other populations and explore the mechanisms through which specific greenspace components influence PA.\n\nKeywords: Deep learning; Global positioning system; Greenspace; Machine learning; Mobile health; Nature; Physical activity; Street view image; Wearables.", "links": [] }, { "title": "Virtual Group-based Walking Intervention for Adults with Schizophrenia-Spectrum Disorders: Psychosocial Outcome Results from a Pilot Randomized Controlled Trial", "author": "Browne, Julia; Kunicki, Zachary; Jarskog, L. Fredrik; Sheeran, Paschal; Abrantes, Ana M.; Elliott, Tonya; Gonzalez, Oscar; Penn, David L.; Battaglini, Claudio", "year": "2025", "journalProceedings": "Community Mental Health Journal", "category": "Intervention", "devices": "Charge", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Physical activity improves mental health in individuals with schizophrenia. Yet, limited access, low motivation, and social isolation make participation in face-to-face programs challenging. This 16-week pilot randomized controlled trial examined differences in symptoms and loneliness between adults with schizophrenia that were randomized to a virtual group-based walking program (\"Virtual PACE-Life\", n = 17) or Fitbit Alone (n = 20). The Positive and Negative Syndrome Scale and UCLA Loneliness scale were administered at baseline, 8 weeks, 16 weeks, and one-month follow-up. Standardized effects (SE) and confidence intervals from mixed effects models were used to evaluate group differences. Results demonstrated small-to-moderate effects (SE: 0.1-0.3) on total, negative, disorganization, excitement, and emotional distress symptoms favoring Virtual PACE-Life; however, negligible effects were observed for positive symptoms or loneliness. Despite the small sample size, these findings may suggest symptom but not loneliness benefits of a virtual group-based physical activity program for people with schizophrenia.\n\nKeywords: Exercise; Loneliness; Serious Mental Illness; Symptoms; Videoconferencing.", "links": [] }, { "title": "Effects of pre- and post-surgery physical activity interventions on physical activity and sedentary behaviour levels following knee and hip arthroplasty: A systematic review and meta-analysis of randomised controlled trials", "author": "d'Unienville , Noah; Singh, Ben; Gower, Bethany; Szeto, Kimberley; Badger, Heather; Krywanio, Matilda; Maher, Carol; Thewlis, Dominic", "year": "2025", "journalProceedings": "Osteoarthritis and Cartilage", "category": "Systematic Review", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps,Energy Expenditure,Intensity", "abstract": "Objective: To evaluate general exercise and behavioural interventions designed to improve physical activity (PA) or reduce sedentary behaviour in total knee or hip arthroplasty (TKA/THA) patients.\n\nDesign: A systematic review and meta-analysis were conducted on randomised controlled trials reporting PA or sedentary behaviour changes in TKA/THA patients, with effects calculated using standardised mean differences (SMD). Subgroup analyses assessed whether effects differed based on intervention characteristics, arthroplasty timing, outcome type, and follow-up duration. Risk of bias and certainty of evidence were assessed using the PEDro scale and GRADE, respectively.\n\nResults: Twenty-three trials were included, with meta-analyses including 1265 and 270 participants for PA and sedentary behaviour outcomes, respectively. PA interventions did not decrease sedentary behaviour (SMD=-0.19; 95% CI: -0.66 to 0.29; very low certainty of evidence), but did improve PA (SMD=0.16; 95% CI: 0.01 to 0.30; high certainty of evidence). This included improvements in step count (SMD=0.22; 95% CI: 0.05 to 0.40), but not moderate-to-vigorous PA (SMD=-0.01, 95% CI: -0.33 to 0.30). Interventions were most effective when they integrated wearable activity trackers (e.g., Fitbits; SMD=0.38; 95% CI: 0.18 to 0.57), behaviour change techniques (SMD=0.20, 95% CI: 0.01 to 0.39), and began less than two weeks after surgery (SMD=0.32, 95% CI: 0.14 to 0.50).\n\nConclusion: PA interventions, particularly those integrating behavioural strategies and wearable technology, promote PA in arthroplasty patients, but their effects on sedentary behaviour are unclear. These findings suggest that implementing evidence-based PA interventions be considered an essential component of acute arthroplasty care to enhance overall patient health.\n\nKeywords: Activity trackers; Arthroplasty; Behaviour change; Physical activity; Sedentary behavior; Step count.", "links": [] }, { "title": "Detection and Analysis of Circadian Biomarkers for Metabolic Syndrome Using Wearable Data: Cross-Sectional Study", "author": "Kim, Jeong-Kyun; Mun, Sujeong; Lee, Siwoo", "year": "2025", "journalProceedings": "JMIR medical informatics", "category": "Case Study", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Background: Wearable devices are increasingly used for monitoring health and detecting digital biomarkers related to chronic diseases such as metabolic syndrome (MetS). Although circadian rhythm disturbances are known to contribute to MetS, few studies have explored wearable-derived circadian biomarkers for MetS identification.\n\nObjective: This study aimed to detect and analyze sleep and circadian rhythm biomarkers associated with MetS using step count and heart rate data from wearable devices and to identify the key biomarkers using explainable artificial intelligence (XAI).\n\nMethods: Data were analyzed from 272 participants in the Korean Medicine Daejeon Citizen Cohort, collected between 2020 and 2023, including 88 participants with MetS and 184 without any MetS diagnostic criteria. Participants wore Fitbit Versa or Inspire 2 devices for at least 5 weekdays, providing minute-level heart rate, step count, and sleep data. A total of 26 indicators were derived, including sleep markers (midsleep time and total sleep time) and circadian rhythm markers (midline estimating statistic of rhythm, amplitude, interdaily stability, and relative amplitude). In addition, a novel circadian rhythm marker, continuous wavelet circadian rhythm energy (CCE), was proposed using continuous wavelet transform of heart rate signals. Statistical tests (t test and the Wilcoxon rank sum test) and machine learning models-Shapley Additive Explanations, explainable boosting machine, and tabular neural network-were applied to evaluate marker significance and importance.\n\nResults: Circadian rhythm markers, especially heart rate-based indicators, showed stronger associations with MetS than sleep markers. The newly proposed CCE demonstrated the highest importance for MetS identification across all XAI models, with significantly lower values observed in the MetS group (P<.001). Other heart rate-based markers, including relative amplitude and low activity period, were also identified as important contributors. Although sleep markers did not reach statistical significance, some were recognized as secondary predictors in XAI-based analyses. The CCE marker maintained a high predictive value even when adjusting for age, sex, and BMI.\n\nConclusions: This study identified CCE and relative amplitude of heart rate as key circadian rhythm biomarkers for MetS monitoring, demonstrating their high importance across multiple XAI models. In contrast, traditional sleep markers showed limited significance, suggesting that circadian rhythm analysis may offer additional insights into MetS beyond sleep-related indicators. These findings highlight the potential of wearable-based circadian biomarkers for improving MetS assessment and management.\n\nKeywords: circadian rhythm; digital biomarker; explainable artificial intelligence; metabolic syndrome; wearable device.", "links": [] }, { "title": "Effect of arthroscopic repair on sleep disturbances in rotator cuff tear patients: A prospective cohort study analyzing short-term postoperative pain correlations", "author": "Kim, Hyojune; Lee, Jangwon; Koh, Kyoung Hwan", "year": "2025", "journalProceedings": "Journal of Orthopaedic Surgery (Hong Kong)", "category": "Case Study", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Sleep", "abstract": "PurposeThe aim is to explore the impact of rotator cuff repair on sleep quality and its correlation with postoperative pain and recovery.MethodsA prospective cohort study from December 2022 to May 2023 was conducted on 28 patients undergoing arthroscopic rotator cuff repair. Pre- and postoperative sleep quality was assessed using the Korean version of the Pittsburgh Sleep Quality Index (K-PSQI), and pain was measured using the pain visual analog scale (pVAS). Sleep duration was monitored using Fitbit Inspire 2 trackers post-surgery. Statistical analyses were conducted to evaluate the relationship between sleep quality, pain, and postoperative recovery.ResultsThe mean preoperative PSQI score (9.5 ± 6.0) indicated sleep disturbances, with elevations in sleep latency and disturbances. Six weeks post-surgery, PSQI decreased significantly to 6.4 ± 3.3 (p = .03), with marked improvements in sleep quality and efficiency. Mean pVAS scores consistently declined post-operation, while sleep duration increased. A statistically significant correlation (p < .05) existed between pVAS score reduction and sleep duration increment. Additionally, preoperative PSQI scores significantly correlated with 'Daily pVAS decrease' and 'Daily sleep duration increase'.ConclusionsWe demonstrate that rotator cuff repair leads to improvements in sleep quality and reductions in pain. However, the persistently high postoperative PSQI scores suggest that sleep disturbances may not be entirely resolved by surgery alone. These findings highlight the need for comprehensive perioperative care in rotator cuff tear patients, incorporating both surgical and non-surgical strategies to manage sleep disturbances and enhance overall patient outcomes.Level of evidenceLevel III, Prospective cohort study.", "links": [] }, { "title": "Using Continuous Glucose Monitoring as a Biological Feedback Strategy to Motivate Physical Activity in Cancer Survivors: A Mixed-Methods Pilot Study", "author": "Liao, Yue; Brannon, Grace E.; Rethorst, Chad D.; Baum, Miranda; Bevers, Therese B.; Schembre, Susan M.; Basen-Engquist, Karen M.", "year": "2025", "journalProceedings": "Cancer Control: Journal of the Moffitt Cancer Center", "category": "Intervention", "devices": "Inspire", "population": "Adults", "dataUsed": "Steps,Intensity,Heart Rate,User Friendliness", "abstract": "IntroductionIdentifying novel strategies to motivate regular physical activity in cancer survivors continues to be a critical mission, as the majority of cancer survivors are not sufficiently active to achieve the many health benefits of being regularly physically active. Providing biological feedback is one of the behavioral change techniques that shows promising effects in physical activity interventions. This study used a mixed-methods approach to test the acceptability and changes in physical activity motivation of a pilot intervention that provided personalized feedback via text messaging based on data from an activity tracker (Fitbit) and continuous glucose monitor (CGM) over a 4-week period.MethodsTwelve breast and colorectal cancer survivors completed this pilot intervention, which involved a one-on-one educational session followed by a 4-week intervention period with a Fitbit wristband and CGM. They received 2-3 weekly text messages based on their Fitbit and CGM data that aimed to increase their motivation to engage in physical activity. Participants completed surveys assessing motivational readiness before and after the intervention, and a post-intervention survey that assessed acceptability of the intervention. Exit interview was also conducted to collect their feedback and opinions toward the intervention.ResultsBoth quantitative and qualitative results suggest a high acceptability of the study devices (ie, Fitbit and CGM) as well as the intervention components (e.g., the glucose-based biological feedback). Participants reported a significant decrease in the preparation stage and an increase in the action and maintenance stages (ps < 0.05). Results from qualitative analysis further indicate participants' positive changes in physical activity motivations.ConclusionThe use of CGM along with an activity tracker is a viable method to provide personally relevant and motivating biological feedback messages to motivate physical activity in cancer survivors. Future studies can incorporate this behavior change technique into their intervention and further evaluate its impact on behavior change and related health outcomes.Clinical trial number: NCT05124405.", "links": [] }, { "title": "Longitudinal trends in physical activity and sleep before, during, and after pregnancy using Fitbit and EHR data from the All of Us research program", "author": "Lo, Claire; Annis, Jeffrey; Master, Hiral; Cakar, Adnan; Osmundson, Sarah; Ruderfer, Douglas; Brittain, Evan", "year": "2025", "journalProceedings": "American journal of obstetrics \\& gynecology MFM", "category": "Case Study", "devices": "Device unspecified", "population": "Pregnant Women", "dataUsed": "Steps,Sleep", "abstract": "None", "links": [] }, { "title": "Predicting Social Frailty in Older Adults Using Fitbit-Derived Circadian and Heart Rate Biomarkers: Cross-Sectional Study", "author": "Maekawa, Hiroki; Kume, Yu", "year": "2025", "journalProceedings": "JMIR formative research", "category": "Case Study", "devices": "Inspire", "population": "Older Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Background: Social frailty poses a potential risk even for relatively healthy older adults, necessitating development of early detection and prevention strategies. Recently, consumer-grade wearable devices have attracted attention due to their ability to continuously collect physiological and activity-related data. These data can potentially be used to calculate digital biomarkers for screening social frailty in older adults.\n\nObjective: The objective of this study was to explore digital biomarkers associated with social frailty using sensor data recorded via Fitbit devices and evaluate their relationship with health outcomes in older adults.\n\nMethods: This cross-sectional study was conducted in 102 community-dwelling older adults. Participants attending frailty prevention programs wore devices from the Fitbit Inspire series on their nondominant wrist for at least 7 consecutive days, during which step count and heart rate data were collected. Standardized questionnaires were used to assess physical functions, cognitive functions, and social frailty, and based on the scores, the participants were categorized into 3 groups: robust, social prefrailty, and social frailty. The sensor data were analyzed to calculate nonparametric and extended cosinor rhythm metrics, along with heart rate-related metrics.\n\nResults: The final sample included 86 participants who were categorized as robust (n=28, 33%), social prefrailty (n=39, 45%), and social frailty (n=19, 22%). The mean age of the participants was 77.14 (SD 5.70) years, and 91% (78/86) were women. Multinomial logistic regression analysis revealed that a step-based rhythm metric (intradaily coefficient of variation) was significantly associated with social frailty (odds ratio 1.05, 95% CI 1.01-1.11; P=.01). The heart rate metrics, including the delta resting heart rate and time of transition from rest to activity, showed significant associations with both social prefrailty (odds ratio 0.82, 95% CI 0.68-0.99; P=.04) and social frailty (odds ratio 0.69, 95% CI 0.50-0.95; P=.01). Specifically, delta resting heart rate, defined as the difference between the overall average heart rate and resting heart rate, exhibited significant negative associations with social prefrailty (odds ratio 0.82, 95% CI 0.68-0.97; P=.02) and social frailty (odds ratio 0.74, 95% CI 0.58-0.94; P=.02). Furthermore, analysis using a linear regression model revealed a significant association between the intradaily coefficient of variation and the word list memory score, a measure of cognitive decline (β=-0.04; P=.02).\n\nConclusions: This study identified associations between novel rhythm and heart rate metrics calculated from the step count and heart rate recorded by Fitbit devices and social frailty. These findings suggest that consumer-grade wearable devices, which are low cost and accessible, hold promise as tools for evaluating social frailty and its risk factors through enabling the calculation of digital biomarkers. Future research should include larger sample sizes and focus on the clinical applications of these findings.", "links": [] }, { "title": "Evaluation of an integrated digital and mobile intervention to improve outcomes for patients with moderate to severe COPD", "author": "O'Connor, Laurel; Wang, Biqi; Ye, Zehao; Behar, Stephanie; Tarrant, Seanan; Stamegna, Pamela; Pretz, Caitlin; Dunkel, Leah; Savage, Brandon; Scornavacca, Thomas; Shirshac, Jeanne; Wilkie, Tracey; Toomey, Shaun; Mullen, Marie; Fisher, Kimberly; Tigas, Emil; Wong, Steven; McManus, David D.; Alper, Eric; Martinez, Fernando; Walkey, Allan; Lindenauer, Peter K.; Dickson, Eric; Broach, John P.; Kheterpal, Vik; Soni, Apurv", "year": "2025", "journalProceedings": "NPJ digital medicine", "category": "Intervention", "devices": "Charge 5", "population": "Patients", "dataUsed": "NA", "abstract": "Chronic obstructive pulmonary disease (COPD) leads to high rates of emergency department (ED) visits and hospitalizations. This study evaluated a community-based digital health intervention's association with acute care utilization among patients with moderate to severe COPD. In a decentralized, nonrandomized trial, participants received biometric monitoring, symptom tracking, on-demand paramedic services, and digital pulmonary rehabilitation for 6 months. Outcomes were compared to a synthetic control group using weighted optimal matching and multivariable-adjusted regression. The primary outcome was hospitalization; secondary outcomes included readmission rates, ED visits, length of stay, and mortality. Eighty-eight intervention participants (mean age 67 (SD 10)) were compared to a weighted control group of 14,492 (mean age 69 (SD 11)). Intervention participants had lower odds of hospitalization (OR 0.67, 95% CI: 0.46-0.98) and 30-day readmission (OR 0.38, 95% CI: 0.17-0.84). This digital and mobile intervention was associated with reduced acute care use and supports further evaluation of hybrid care models for COPD.", "links": [] }, { "title": "A Personalized, Texting-Based Conversational Agent to Address Sleep Disturbance in Individuals Who Have Survived Breast Cancer: Protocol for a Pilot Waitlist Randomized Controlled Trial", "author": "Tsai, Chi-Shan; Szewczyk, Warren; Drerup, Michelle; Liao, Jason; Vasbinder, Alexi; Greenlee, Heather; Heffner, Jaimee L.; Yung, Rachel; Reding, Kerryn W.", "year": "2025", "journalProceedings": "JMIR research protocols", "category": "Intervention", "devices": "Charge 4", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background: Sleep disturbance is one of the most common health concerns reported by individuals who have survived breast cancer (BC) and is associated with poor quality of life (QoL) and greater mortality after treatment. Cognitive behavioral therapy for insomnia (CBTi) has shown efficacy for improving sleep and QoL for this population. Considered the gold standard for insomnia treatment, CBTi can be delivered remotely, including via digital intervention. Despite the potential for wider dissemination of CBTi via digital means, these modalities have unique challenges, including technology barriers and poor adherence. We developed a conversational agent (CA) to deliver CBTi via a SMS text messaging intervention, supported by mobile-ready web content. Named \"Cecebot,\" this CA delivers sleep education, implements sleep compression, provides just-in-time interventions for sleep-disrupting behaviors, and includes enhanced support for physical activity (PA) beyond what is typically included in CBTi. This represents a novel modality for a CBTi and PA intervention among individuals who have survived BC.\n\nObjective: We aim to examine the safety and acceptability of the Cecebot intervention, developed by an academic partnership between Dr Reding's research team and Moby Inc, for individuals who have survived BC and experience symptoms of insomnia, and to explore its efficacy.\n\nMethods: This trial will recruit 60 individuals who have survived BC and are experiencing moderate to severe sleep disturbance. Participants will be assigned to the Cecebot intervention or waitlist control group at a 1:1 ratio. The treatment group will receive the Cecebot intervention during weeks 1-6 of the study, while the waitlist control condition will receive the Cecebot intervention during weeks 6-12. The Cecebot intervention uses SMS text messaging technology paired with a Fitbit. Participants will be assessed at baseline, week 6, and week 12. Measurements will include feasibility and acceptability and will explore the effect of the Cecebot intervention. Feasibility will be assessed through recruitment, enrollment, and retention rates. Acceptability will be evaluated using a satisfaction survey and open-ended responses. Quantitative analysis, such as t test, Fisher exact tests, and generalized linear models, will be used to assess feasibility, baseline group differences, and the outcomes of the intervention.\n\nResults: Recruitment of participants began in Fall 2024. The completion of data collection is anticipated to be by Fall 2025.\n\nConclusions: The study results will give insight into the potential for an SMS text messaging-based CA to improve sleep in individuals who have survived BC and experience sleep disturbances.", "links": [] }, { "title": "Predicting Sleep and Sleep Stage in Children Using Actigraphy and Heartrate via a Long Short-Term Memory Deep Learning Algorithm: A Performance Evaluation", "author": "Weaver, R. Glenn; White, James W.; Finnegan, Olivia; Yang, Hongpeng; Zhong, Zifei; Kiely, Keagan; Jones, Catherine; Tong, Yan; Nelakuditi, Srihari; Ghosal, Rahul; Brown, David E.; Pate, Russ; Welk, Gregory J.; de Zambotti, Massimiliano; Wang, Yuan; Burkart, Sarah; Adams, Elizabeth L.; Armstrong, Bridget; Beets, Michael W.", "year": "2025", "journalProceedings": "Journal of Sleep Research", "category": "Case Study", "devices": "Sense", "population": "Children", "dataUsed": "Sleep,Heart Rate", "abstract": "hildren's ambulatory sleep is commonly measured via actigraphy. However, traditional actigraphy measured sleep (e.g., Sadeh algorithm) struggles to predict wake (i.e., specificity, values typically < 70) and cannot predict sleep stages. Long short-term memory (LSTM) is a machine learning algorithm that may address these deficiencies. This study evaluated the agreement of LSTM sleep estimates from actigraphy and heartrate (HR) data with polysomnography (PSG). Children (N = 238, 5-12 years, 52.8% male, 50% Black 31.9% White) participated in an overnight laboratory polysomnography. Participants were referred because of suspected sleep disruptions. Children wore an ActiGraph GT9X accelerometer and two of three consumer wearables (i.e., Apple Watch Series 7, Fitbit Sense, Garmin Vivoactive 4) on their non-dominant wrist during the polysomnogram. LSTM estimated sleep versus wake and sleep stage (wake, not-REM, REM) using raw actigraphy and HR data for each 30-s epoch. Logistic regression and random forest were also estimated as a benchmark for performance with which to compare the LSTM results. A 10-fold cross-validation technique was employed, and confusion matrices were constructed. Sensitivity and specificity were calculated to assess the agreement between research-grade and consumer wearables with the criterion polysomnography. For sleep versus wake classification, LSTM outperformed logistic regression and random forest with accuracy ranging from 94.1 to 95.1, sensitivity ranging from 94.9 to 95.9 across different devices, and specificity ranging from 84.5 to 89.6. The addition of HR improved the prediction of sleep stages but not binary sleep versus wake. LSTM is promising for predicting sleep and sleep staging from actigraphy data, and HR may improve sleep stage prediction.", "links": [] }, { "title": "Considerations in using heart rate-based physical activity estimates from consumer wearables in individuals with varying weight status", "author": "Brown, Denver M. Y.; Wing, David; Pfledderer, Christopher D.; Stoepker, Peter; Fairclough, Stuart J.; Carlson, Jordan A.", "year": "2025", "journalProceedings": "The International Journal of Behavioral Nutrition and Physical Activity", "category": "Case Study", "devices": "Device unspecified", "population": "Adolescents", "dataUsed": "Intensity,Heart Rate", "abstract": "Although moderate-to-vigorous physical activity (MVPA) is a widely used construct in physical activity (PA) research, the lack of standardized assessment methods- particularly with the growing use of consumer-grade wearable activity trackers- poses challenges for comparability. Consumer-grade devices tend to rely on heart rate (HR)-based estimation methods to classify PA intensity, which contrasts with traditional research-grade accelerometers that use count- or raw-acceleration metrics. Comparability issues are particularly salient across individuals with varying weight status. In this commentary, we discuss systematic discrepancies between HR-based (relative intensity) and acceleration-based (absolute intensity) classifications of MVPA among individuals with differing weight statuses. Using Fitbit data from the Adolescent Brain Cognitive Development Study, we illustrate how HR-based PA intensity classification may indicate higher MVPA in youth with greater adiposity despite lower step counts and light PA levels. We highlight implications for research design, public health surveillance, messaging, policy, and interventions. We also call for greater transparency, standardized methodologies, and integrative measurement approaches to ensure more accurate assessment of PA behavior.\n\nKeywords: Absolute intensity; Accelerometry; Adiposity; Fitness; Relative intensity; Wearable devices.", "links": [] }, { "title": "Scoping review of the utilization of wearable devices in pediatric and young adult oncology", "author": "Collier, Lane; Grimshaw, Sarah L.; Stolper, Julian; Passmore, Elyse; Ball, Gareth; Elliott, David A.; Conyers, Rachel", "year": "2025", "journalProceedings": "NPJ digital medicine", "category": "Review", "devices": "Device unspecified", "population": "Children,Adults,Adolescents", "dataUsed": "Steps,Heart Rate", "abstract": "This review summarizes the current literature on the use of wearable devices for collecting physiological data in pediatric and young adult (0-25 years) oncology. Searches were conducted in MEDLINE, PubMed and Embase, focusing on pediatric and young adult patients with a cancer diagnosis, and utilizing a wearable device during and/or after treatment. Of the 77 articles that met the inclusion criteria, 61 studies primarily used wearable devices as a tool to monitor physiological changes in an interventional or observational setting. Only 16 studies integrated wearable devices as an active component of the intervention. The most reported wearable device brands were ActiGraph (19, 24.7%), FitBit (14, 18.2%), Ambulatory Monitoring Inc. (11, 14.3%) and Philips Respironics (10, 13%). This scoping review offers valuable insights into the current use of wearable devices in pediatric and young adult (0-25 years) oncology but also reveals notable gaps in the literature.", "links": [] }, { "title": "Interpretable framework for predicting preoperative cardiorespiratory fitness using wearable data", "author": "Hussain, Iqram; Zeepvat, Julianna; Reid, M. Cary; Czaja, Sara; Pryor, Kane O.; Boyer, Richard", "year": "2025", "journalProceedings": "Computer Methods and Programs in Biomedicine", "category": "Case Study", "devices": "Charge 3", "population": "Older Adults", "dataUsed": "Heart Rate", "abstract": "Objectives: Predicting preoperative cardiorespiratory fitness (CRF) is crucial for assessing the risk of complications and adverse outcomes in patients undergoing surgery. CRF is formally evaluated through submaximal exercise testing with cardiopulmonary exercise testing (CPET) or the 6-minute walk test (6MWT). However, formal CRF testing is impractical as a preoperative screening tool. Wrist-worn devices with actigraphy and heart rate monitoring have become increasingly capable of predicting physiological measurements. Our aim was to develop a clinically interpretable machine learning (ML) model using wearable-derived physiological data to predict CRF for older adults, and to access whether this model can accurately estimate the 6MWT distances for preoperative risk evaluation.\n\nMethods: We examined heart rate and activity data collected from Fitbit devices worn by older adults (N = 65) who were scheduled to undergo major noncardiac surgery. Data collection took place over a 1-week period prior to surgery while participants engaged in their typical daily activities. Our primary aim was to leverage this wearable technology to forecast CRF among this group. We employed a machine-learning ensemble regression model to predict CRF, using 6MWT outcomes as an index. Further, we applied the shapley feature attribution approach to gain insights into how specific features derived from wearable data contribute to CRF prediction within the model, aiding in personalized fitness prediction.\n\nResults: Adults with higher CRF exhibited elevated levels of moderate-to-vigorous physical activity (MVPA), maximal activity energy expenditure (aEEmax), heart rate recovery (HRR), and non-linear heart rate variability (HRV). These measures increased concurrently with improvements in 6MWT outcomes. Our regression models, employing random forest and linear regression techniques, demonstrated strong predictive capabilities, with coefficient of determination values of 0.91 and 0.81, respectively, for estimating CRF. The shapley feature attribution approach elucidated those greater levels of MVPA, aEEmax, HRR, and nonlinear dynamics of HRV serve as reliable indicators of enhanced CRF test performance.\n\nConclusion: The integration of wearable data-driven activity and heart rate metrics forms the basis for utilizing wearables to provide preoperative cardiorespiratory fitness assessments, supporting surgical risk stratification, personalized prehabilitation, and improved patient outcomes.\n\nKeywords: Cardiorespiratory fitness; Interpretability; Machine-learning; Personalized medicine; Preoperative assessment; Wearables.", "links": [] }, { "title": "The Effect of Assistive Devices on the Accuracy of Fitbits in Healthy Individuals: A Brief Report", "author": "Jaworski, John; Makowski, Brian; Weaver, Michael; Seils, Michael; Scheid, Jennifer L.", "year": "2025", "journalProceedings": "International Journal of Environmental Research and Public Health", "category": "Validation", "devices": "Inspire 3", "population": "Adults", "dataUsed": "Steps", "abstract": "Our study explored the accuracy of Fitbit recorded step count during the use of an assistive device (two-wheeled walker and standard cane) at various body positions (wrists, hips, and ankles). Participants (n = 11) ambulated an obstacle course (50 m total, including turns and a step up/down) a total of three times (two-wheeled walker, standard cane, and a deviceless control trial). Fitbit generated step counts (at the wrists, hips, and ankles) were then compared to the individual's \"actual\" step count captured through video analysis. During the cane trial and the deviceless trial, all positions were significantly correlated (r = 0.764 to 0.984; p < 0.006) with the actual step count. However, increased variability (demonstrated by increased limits of agreement) was observed when the Fitbit was worn on the wrist (compared to the hips or ankles). During the walker trial, the step count was significantly correlated to the actual step count at the ankle and hip positions (r = 0.669 to 0.888; p < 0.017) with an average error of 1.5%, while it was not statistically correlated at the wrist with a 31.2% average error. Our study suggests that Fitbits are a good predictor of actual step count, with the caveat that the location of the Fitbit should be considered if an assistive device (e.g., two-wheeled rolling walker and single-point cane) is being used.\n\nKeywords: Fitbits; assistive devices; cane; physical activity; rehabilitation; walker; wearable technology.", "links": [] }, { "title": "Validation of the Fitbit Charge 5 for the Detection of Heart Rate and Electrodermal Activity", "author": "Ko, Katherine; McArthur, Genevieve; Johnco, Carly", "year": "2025", "journalProceedings": "Psychophysiology", "category": "Validation", "devices": "Charge 5", "population": "Adults", "dataUsed": "Intensity,Heart Rate", "abstract": "Wearable devices are increasingly used to evaluate psychophysiological markers of anxiety for continuous health monitoring. Consumer-grade wearable devices, such as Fitbits, have the potential for widespread use and dissemination given their affordability and accessibility for both research and clinical settings. However, the validation of consumer-grade devices against research-grade devices is required. This study aimed to evaluate and compare the accuracy of the Fitbit Charge 5 against a research-grade wearable device, the Equivital EQ02, in measuring psychophysiological parameters of anxiety, specifically heart rate (HR) and electrodermal activity (EDA). Fifty-five undergraduate students (Mage = 19.4, SDage = 1.6, 46% female) wore both Fitbit and Equivital devices whilst completing social stressor and reading tasks. Statistical analyses demonstrated significant moderate correlations between the two devices for heart rate (HR) estimates (rs = 0.45-0.58) and low to moderate correlations for electrodermal activity (EDA) estimates (rs = 0.42-0.50). Intraclass correlations were moderate for both HR (ICCs = 0.53-0.72) and EDA (ICCs = 0.46-0.64) across conditions (ps < 0.05). Furthermore, Bland-Altman analyses revealed that the Fitbit showed a pattern of underestimation of HR (ranging from 24 to 32 bpm) and overestimation of EDA (ranging from -12.92 to 10.29 μS) compared to the Equivital. These findings highlight potential reliability concerns with the Fitbit Charge 5 in measuring physiological data. While the device may have some utility in assessing HR and EDA, it is crucial to approach the interpretation of data from consumer-grade wearable devices with caution due to potential accuracy limitations.", "links": [] }, { "title": "Capturing Real-World Habitual Sleep Patterns With a Novel User-Centric Algorithm to Preprocess Fitbit Data in the All of Us Research Program: Retrospective Observational Longitudinal Study", "author": "Master, Hiral; Annis, Jeffrey; Ching, Jack H.; Gleichauf, Karla; Han, Lide; Coleman, Peyton; Full, Kelsie M.; Zheng, Neil; Ruderfer, Douglas; Hernandez, John; Schneider, Logan D.; Brittain, Evan L.", "year": "2025", "journalProceedings": "Journal of Medical Internet Research", "category": "Validation", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background: Commercial wearables such as Fitbit quantify sleep metrics using fixed calendar times as default measurement periods, which may not adequately account for individual variations in sleep patterns. To address this limitation, experts in sleep medicine and wearable technology developed a user-centric algorithm designed to more accurately reflect actual sleep behaviors and improve the validity of wearable-derived sleep metrics.\n\nObjective: This study aims to describe the development of a new user-centric algorithm, compare its performance with the default calendar-relative algorithm, and provide a practical guide for analyzing All of Us Fitbit sleep data on a cloud-based platform.\n\nMethods: The default and user-centric algorithms were implemented to preprocess and compute sleep metrics related to schedule, duration, and disturbances using high-resolution Fitbit sleep data from 8563 participants (median age 58.1 years, 6002/8341, 71.96%, female) in the All of Us Research Program (version 7 Controlled Tier). Variations in typical sleep patterns were calculated by examining the differences in the mean number of primary sleep logs classified by each algorithm. Linear mixed-effects models were used to compare differences in sleep metrics across quartiles of variation in typical sleep patterns.\n\nResults: Out of 8,452,630 total sleep logs collected over a median of 4.2 years of Fitbit monitoring, 401,777 (4.75%) nonprimary sleep logs identified by the default algorithm were reclassified as primary sleep by the user-centric algorithm. Variation in typical sleep patterns ranged from -0.08 to 1. Among participants with the greatest variation in typical sleep patterns, the user-centric algorithm identified significantly more total sleep time (by 17.6 minutes; P<.001), more wake after sleep onset (by 13.9 minutes; P<.001), and lower sleep efficiency (by 2.0%; P<.001), on average. Differences in sleep stage metrics between the 2 algorithms were modest.\n\nConclusions: The user-centric algorithm captures the natural variability in sleep schedules, providing an alternative approach to preprocess and evaluate sleep metrics related to schedule, duration, and disturbances. A publicly available R package facilitates the implementation of this algorithm for clinical and translational research.\n\nKeywords: All of Us Research Program; Fitbit; R package; algorithms; metrics; sleep.", "links": [] }, { "title": "Evaluating Fitbits for Assessment of Physical Activity and Sleep in Pediatric Pain: Feasibility and Acceptability Pilot Study", "author": "Nestor, Bridget A.; Baumer, Andreas M.; Chimoff, Justin; Delecourt, Benoit; Koike, Camila; Tacugue, Nicole; Brusseau, Roland; Roy, Nathalie; Gaytan-Fuentes, Israel A.; Sethna, Navil; Wallace, Danielle; Kossowsky, Joe", "year": "2025", "journalProceedings": "JMIR formative research", "category": "Usability", "devices": "Charge 3,Inspire 2", "population": "Children,Adolescents", "dataUsed": "Steps,Sleep,Heart Rate,Device Weartime", "abstract": "Background: Consumer-grade wearables, such as Fitbits, are a promising, cost-effective methodology for objectively assessing sleep and physical activity in youth with pain.\n\nObjective: This study investigated the acceptability and feasibility of implementing Fitbits for youth with acute and chronic pain in and out of hospital settings while maintaining data security and patient confidentiality.\n\nMethods: We investigated participant experience of Fitbit use over 3 to 4 weeks for a sample of youth with acute pain undergoing either orthopedic or cardiac surgical procedures (N=34, mean age 14.46, SD 3.70 years, 47.06% [n=36] female) and a sample of youth with chronic pain enrolled in an intensive interdisciplinary pain treatment program (N=28, mean age 15.00, SD 2.33 years, 82.14% [n=23] female). We assessed the acceptability of Fitbit use through survey items probing comfort (0=extremely uncomfortable to 10=extremely comfortable), perceived burdensomeness (0=not burdensome at all to 10=extremely burdensome), and open-ended issues or concerns. Feasibility was assessed by tracking the daily compliant wear of the Fitbit device, which was operationalized as more than 600 minutes of daily wear time. We tested for group differences in acceptability and feasibility between orthopedic and cardiac patients within the acute pain sample and between the acute pain and chronic pain samples. We created an automated data pipeline to ensure data security, patient confidentiality, and quality.\n\nResults: Acceptability findings revealed high levels of reported comfort (acute pain: mean 8.56, SD 1.43; chronic pain: mean 8.27, SD 1.69) and low levels of perceived burdensomeness (acute: mean 0.68, SD 1.17; chronic: mean 1.15, SD 1.38) related to Fitbit wearing in both samples. No significant differences in these acceptability outcomes emerged between orthopedic and cardiac patients or between the acute pain and chronic pain groups (P values>.10). Transient concerns of mild wrist irritation and sleep discomfort were occasionally reported across both samples (15.79% [n=9] of participants). Feasibility findings indicated high feasibility (acute: median compliance rate of 86.67%; chronic: median compliance rate of 96.65%) for the study duration in both samples. Mann-Whitney U tests indicated significantly higher median compliance rates per participant among orthopedic as compared with cardiac patients (U=146.5, P=.04) and significantly higher median compliance rates per participant among the chronic pain group as compared with the acute pain group (U=186, P<.001), including significantly higher median compliant days (U=162, P<.001) and study days (U=234.5, P<.001) per participant.\n\nConclusions: These findings support the use of Fitbits as an acceptable and feasible method for collecting objective data on sleep and physical activity for youth experiencing pain. Findings also highlight the logistics of implementing consumer-grade wearable devices throughout all stages of the clinical research process.\n\nKeywords: Fitbit; acceptability; feasibility; pediatric; pediatric pain; physical activity; sleep; wearable devices; youth.", "links": [] }, { "title": "Wearable sensor data visualization for patient monitoring and management: a Cancer Wellness application in Vietnam", "author": "Nguyen, Huyen Thi Hoa; Tran, Tran Ngoc; Nguyen, Giang Huong; Nguyen, Tung Truong; Nguyen, Ngan Thi Thuy; Pham, Hieu Huy; Bui, Linh Khanh; Nguyen, Anh Chau; Anderson, Debra J.", "year": "2025", "journalProceedings": "Future science OA", "category": "Case Study", "devices": "Charge 5", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Background: This study incorporates Fitbit wearable sensor technology into a mobile application named Cancer Wellness Program (CWP) for patient monitoring. The objective of this study is to explore the experiences of healthcare providers in using the CWP application for managing symptoms of people with cancer and in delivering health education programs. Methods: A qualitative study design with a purposive sampling approach was employed, using a structured, in-depth interview method to involve 15 healthcare workers. Results: Key features of the CWP application include a patient education platform, a dashboard to monitor patient health data and learning progress, and interactive communication between the two parties. Multiple advantages of this application were identified by healthcare providers, namely user-friendliness, data aggregation and personalization. Conclusion: Despite minor technical drawbacks, the CWP application proves to be a powerful assistant for healthcare providers to optimize patient care.\n\nKeywords: Smart app; cancer management; health education; healthcare providers; wearable fitness sensors.", "links": [] }, { "title": "Optimizing a mHealth physical activity intervention with mindful awareness lessons in breast cancer survivors: Fit2ThriveMIND protocol", "author": "Wolter, Melanie; Reading, Jean M.; Solk, Payton; Starikovsky, Julia; Hasanaj, Kristina; Wang, Shirlene D.; Siddique, Juned; Horowitz, Bruriah; Spring, Bonnie; Carden, Lillian B.; Fox, Rina; Sauer, Christina; Freeman, Hannah; Frey, Julia; Victorson, David; Phillips, Siobhan M.", "year": "2025", "journalProceedings": "Contemporary Clinical Trials", "category": "Intervention,Systematic Review", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Intensity,Device Weartime", "abstract": "Fit2ThriveMIND is a theory-guided moderate to vigorous physical activity (MVPA) promotion trial guided by the Multiphase Optimization Strategy (MOST) framework to evaluate the efficacy of four intervention components for increasing MVPA among inactive, post-treatment breast cancer survivors (BCS; n = 304). All participants receive a core mHealth intervention, including a Fitbit and custom-built self-monitoring Fit2ThriveMIND smartphone application. Participants are randomized to one of 16 intervention conditions, reflecting every possible combination of the four intervention components, each of which has two levels (Yes v. No): 1) Buddy, 2) E-Coach, 3) General Mindfulness (MIND), 4) MVPA-guided mindfulness (PAMIND). The primary aim is to determine the individual and combined effects of the intervention components on accelerometer-assessed MVPA at 24-weeks (post-intervention) and 48-weeks follow-up. The secondary aim is to examine how changes in MVPA influence patient-reported outcomes, other intensity activities (light and sedentary), and sleep duration and quality. All components have a 24-week duration, except E-coaching, which includes \"boosters\" personalized to an individual's MVPA goal attainment during weeks 25-48. Fit2ThriveMIND represents the first systematic effort to use MOST to design an optimized mHealth MVPA intervention for BCS that incorporates mindfulness and tests a maintenance strategy. This trial will improve understanding of how to effectively and efficiently change and maintain MVPA among BCS to inform more effective and scalable interventions to improve health and disease outcomes. Clinical Trials Registration #NCT05931874.", "links": [] }, { "title": "The Association Between Quality of Recovery, Objective and Subjective Sleep Quality, and Pain After Abdominal Surgery: A Cross-Sectional Study", "author": "Wozniak, Anita Bilde; Knudstrup, Katja Tenna; Bilberg, Randi Marie; Konradsen, Hanne", "year": "2025", "journalProceedings": "Gastroenterology Nursing: The Official Journal of the Society of Gastroenterology Nurses and Associates", "category": "Case Study", "devices": "Charge 4", "population": "Patients", "dataUsed": "Sleep,Heart Rate", "abstract": "Major surgery often leads to a decrease in sleep quality on the first postoperative night. This study aims to investigate the associations between quality of recovery, subjective and objective measured sleep quality, depth of sleep, and pain among patients who have undergone abdominal surgery. This study was designed as a cross-sectional study using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist for observational studies to strengthen the reporting of results. For 100 patients admitted to the department of gastroenterology at a medium-sized hospital in Denmark between February and June 2021, we collected data on the quality of recovery after surgery, as well as subjective and objective sleep quality measured using Fitbit smartwatch data. Data were analyzed using descriptive analysis and multiple line regression. We found a significant association between the quality of recovery and subjective sleep parameters. Objective sleep measures showed a tendency toward an association between the total score of the Fitbit ActiGraph and the quality of recovery, although not significant. It is concluded that sleep quality is important for patient recovery. The increasing number of patients using wearables during hospitalization calls for further exploration of the reliability of such devices.", "links": [] }, { "title": "Optimization and pre-use suitability selection for wrist photoplethysmography-based heart rate monitoring in patients with cardiac disease", "author": "Vermunicht, Paulien; Buyck, Christophe; Naessens, Sebastiaan; Hens, Wendy; Verberckt, Caro; Van Craenenbroeck, Emeline; Laukens, Kris; Desteghe, Lien; Heidbuchel, Hein", "year": "2025", "journalProceedings": "European Heart Journal. Digital Health", "category": "Intervention", "devices": "Inspire 2", "population": "Patients", "dataUsed": "Heart Rate", "abstract": "Introduction: Sensor placement, activity type influencing wrist movements, and individual characteristics impact accuracy of wrist-worn photoplethysmography (PPG)-based heart rate (HR) monitors. This study investigated technical interventions to optimize PPG accuracy in patients with cardiac disease.\n\nMethods and results: The Fitbit Inspire 2 PPG monitor was evaluated across three cohorts, using a Polar H10 chest strap as reference: (ⅰ) 10 healthy volunteers performed wrist movements with the monitor placed one or three fingers above the wrist to identify optimal placement; (ⅱ) 10 volunteers engaged in sport activities (walking, running, cycling, rowing); (ⅲ) 30 cardiac rehabilitation patients were monitored during exercise to assess baseline accuracy. Patients with low accuracy [mean absolute percentage error (MAPE) < 10% for <70% of training time] underwent technical interventions (sensor cleaning, forearm shaving, position fixation, and/or relocation to the volar wrist). Placement three vs. one fingers above the wrist was significantly more accurate (mean difference in MAPE: -11.4%, P < 0.001). Walking showed the highest accuracy (MAPE = 3.8%), followed by cycling (MAPE = 6.9%) and running (MAPE = 8.5%), while rowing had the lowest accuracy (MAPE = 13.4%, P < 0.001). Among CR patients, 66.7% achieved high baseline accuracy. Technical interventions improved accuracy in 50.0% of those with low baseline accuracy, but no significant predictors of optimization success were identified.\n\nConclusion: Accurate PPG-based monitoring requires a sensor placed higher on the wrist. Nevertheless, only two-thirds of patients are suitable for such monitoring, with improvement by technical adaptations possible (but impractical) in the others. Therefore, assessing baseline accuracy is a prerequisite before relying on these devices for activity guidance.", "links": [ { "caption": "URL", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12450509/", "newWindow": true } ] }, { "title": "A culturally tailored community gardening approach to improving physical activity, fruit and vegetable consumption, and psychological health among African American women: A pre-post feasibility study", "author": "Canton, Imani; Jakachira, Vanesu; Blackman, Dawn; Rose, Heather; Aguiñaga, Susan", "year": "2025", "journalProceedings": "Health Promotion Perspectives", "category": "Intervention", "devices": "Charge 3", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Background: African American (AA) women participate in low levels of physical activity (PA), under consume fruits and vegetables (FV), and experience poor psychological health. Increasing evidence suggests community gardening as an approach to positively affect health. The purpose of this study was to examine the feasibility of an 8-week culturally tailored community gardening intervention among middle-aged AA women. Methods: Eleven AA women (45-64 years) participated in a single group pre-posttest feasibility study during the summer of 2023 in Champaign, Illinois. The intervention included a novel approach to cultural tailoring by embedding Black History Knowledge (BHK) within the context of community gardening. Feasibility was assessed through a postintervention survey. Device-assessed PA (Fitbit Charge 3), FV consumption (Veggie Meter®), self-report PA, food frequency questionnaire, and psychological health were assessed at baseline and postintervention. Wilcoxon signed rank tests examined changes in pre-post measures. Effect size estimates were calculated using r. Results: Participants increased device-assessed daily step count (median 880 steps per day increase; r=0.53; P=0.028) and FV consumption (median 82-unit increase; r=0.51; P=0.016). There was a moderate effect on device-assessed light PA (r=0.45) and a small effect on device-assessed total PA (r=0.29), and perceived stress (r=-0.25). Sixty-seven percent (6/9) of women indicated that they would recommend this program to others. Conclusion: A culturally tailored, community-gardening intervention may be a feasible approach to increase device-assessed PA and FV consumption and improve psychological health among AA women, but future studies should be adequately powered.", "links": [ { "caption": "URL", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12450582/", "newWindow": true } ] }, { "title": "Relationship Between Activity Tracker Metrics and the Physical Activity Index and Their Association With Cardiometabolic Phenotypes, Subclinical Atherosclerosis, and Cardiac Remodeling: Cross-Sectional Study", "author": "Huang, Weiting; Wong, Mark Kei Fong; Loh, Enver De Wei; Koh, Tracy; Tan, Alex Weixian; Shen, Xiayan; Varli, Onur; Kong, Siew Ching; Chin, Calvin Woon Loong; Tan, Swee Yaw; Yap, Jonathan Jiunn Liang; Ng, Eddie Yin Kwee; Yeo, Khung Keong", "year": "2025", "journalProceedings": "JMIR mHealth and uHealth", "category": "Case Study", "devices": "Charge HR", "population": "Adults", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "Background Consumer wearable technology quantifies physical activity; however, the association between these metrics and cardiometabolic health requires further elucidation. Objective This study identified latent factors derived from Fitbit heart rate metrics and their relationship with cross-sectional cardiovascular phenotypes. Methods This cross-sectional analysis included 457 participants from the SingHEART study, a multiethnic, population-based study of Asian individuals aged 21 to 69 years recruited in Singapore. Participants wore the Fitbit Charge HR for 7 days, and data on physical activity metrics, self-reported physical activity index (PAI), blood tests, coronary artery calcium scores, and cardiac magnetic resonance imaging were collected. Exploratory factor analysis identified latent factors from Fitbit metrics, and multivariate regression analysis assessed associations with blood and cardiovascular imaging phenotypes. Results Higher levels of self-reported PAI were significantly associated with a higher number of calories burned (P=.008), number of steps and floors climbed, distance, number of activity calories, and number of very active minutes (P{\\textless}.001). However, there was no association between PAI and other Fitbit metrics. Using exploratory factor analysis, we identified three latent factors measured by Fitbit metrics: (1) elevated metabolic equivalents of task (METs; calories burned per day, minutes per day spent fairly active in 3-6 METs and very active in ≥6 METs, and activity calories), (2) total activity (steps per day, distance in kilometers per day, and number of floors per day), and (3) others, all with a Cronbach α of {\\textgreater}0.7. Higher total activity was associated with increased high-density lipoprotein levels (β=0.06; P{\\textless}.001), decreased triglyceride levels (β=−0.10; P=.006), and lower BMI (β=−0.63; P{\\textless}.001) after adjustment for age, gender, systolic blood pressure, total cholesterol, and family history of heart disease. The interaction between total activity and elevated METs was associated with lower fasting glucose (β=−0.07; P=.004). Elevated METs were associated with higher log(coronary artery calcium+1) and higher BMI (P{\\textless}.001). Total activity was significantly associated with higher indexed biventricular systolic (P=.01 for left and P=.006 for right) and diastolic volumes (P{\\textless}.001) and higher indexed left ventricular mass (P=.005). Conclusions We identified 3 groups of wearable metrics with distinct characteristics. While total activity had a significant relationship with self-reported PAI, most metrics of elevated METs did not. Total activity had a consistent and favorable association with lipid and glucose profiles and a dose-dependent association with cardiac remodeling. Elevated METs alone did not appear to have a significant association with favorable cardiovascular profiles. This study suggests that the total activity metrics are robust and dependable when interpreting an individual’s activity levels, with construct validity according to self-reported PAI and a positive association with lipid and glucose profiles, and demonstrate dose-dependent associations with cardiac remodeling after adjustment for demographics and risk factors. Findings related to elevated METs may be due to the Hawthorne effect and require further studies.", "links": [ { "caption": "URL", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12508664/", "newWindow": true } ] }, { "title": "A Series of Personalized Melatonin Supplement Interventions for Poor Sleep: Feasibility Randomized Crossover Trial for Personalized N-of-1 Treatment", "author": "Butler, Mark J.; Chandereng, Thevaa; Ahn, Heejoon; Slotnick, Stefani; Miller, Danielle; Perrin, Alexandra; Rodillas, Jordyn; Friel, Ciaran P.; Goodwin, Ashley M.; Cheung, Ying Kuen; Davidson, Karina W.", "year": "2025", "journalProceedings": "JMIR Formative Research", "category": "Intervention", "devices": "Charge 5", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background Poor sleep (defined by short sleep duration or poor quality) is a common condition with potential serious health consequences. Exogenous melatonin supplements have been found to effectively improve poor sleep but have also been shown to have heterogeneity of treatment effects (HTEs) between individuals. Personalized N-of-1 trials, in which each participant is the unit of analysis, are ideal for identifying whether a treatment with high HTE is beneficial for each individual patient. Objective This study aimed to identify the feasibility, acceptability, and effectiveness of a series of personalized N-of-1 trials of melatonin for poor sleep. Methods This study consisted of 60 digital, personalized N-of-1 crossover trials comparing the effects of 3.0 mg and 0.5 mg of melatonin versus placebo for poor sleep with randomization to 1 of 2 orders. The trial comprised a 2-week baseline period and a 12-week intervention period. The primary outcomes were usability of the personalized trial system (measured using the System Usability Scale [SUS]) and participant satisfaction with the trial. Effectiveness outcomes included sleep duration (measured using a Fitbit activity tracker [Google]) and sleep quality (measured using the consensus sleep diary). Results Participants rated the usability of the personalized trial as acceptable (average SUS score 76.3, SD 17.1), and 96\\% (55/57) of those who completed satisfaction surveys stated that they would recommend the trial to others. Importantly, indices of HTE were low for 3.0 mg and 0.5 mg doses of melatonin, indicating that the effect of these treatments on sleep duration and sleep quality did not substantially vary between participants and that averaged treatment responses are appropriate. Averaged participant sleep duration did not significantly differ between the 3.0 mg (P=.70) and 0.5 mg (P=.90) melatonin intervention periods and the baseline period. In addition, regression models did not show differences between different levels of melatonin and placebo periods for sleep duration or quality. Conclusions Participant ratings of the usability of and satisfaction with this series of personalized N-of-1 trials of melatonin for sleep suggest these trials are both feasible and acceptable. However, our results show that melatonin supplements did not significantly improve sleep duration or sleep quality. Furthermore, the treatment effects’ lack of heterogeneity among participants suggests that future use of N-of-1 trials of melatonin for poor sleep is not needed.", "links": [ { "caption": "URL", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12468169/", "newWindow": true } ] }, { "title": "Enhancing Physical Activity in Older Adults More Than 6 Months Post Total Hip or Knee Replacement Through Telerehabilitation: A Pilot Randomized Controlled Trial", "author": "Takenaka, Hiroto; Ida, Kunio; Goto, Shin; Suzuki, Junya", "year": "2025", "journalProceedings": "Journal of Aging and Physical Activity", "category": "Intervention", "devices": "Sense", "population": "Older Adults", "dataUsed": "Steps,Intensity,Active Minutes/Active Zone Minutes", "abstract": "Background: Physical activity levels often remain suboptimal in older adults undergoing total hip replacement or total knee replacement after surgery, which can affect functional independence and quality of life. Purpose: To explore the feasibility and potential effects of a telerehabilitation delivery mode that combines activity tracking with remote physical therapist counseling on physical activity levels in older adults post total hip replacement or total knee replacement. Methods: The participants were randomly allocated to receive either a 12-week telerehabilitation program involving brief weekly telephone counseling from a physical therapist (n = 19) or a control group (n = 18). Activity trackers (Fitbit Sense) were used in both groups to objectively measure daily step counts, sedentary time (in minutes per day), low-intensity physical activity (in minutes per day), and moderate to vigorous physical activity (in minutes per day). These measures, along with physical function tests, were assessed at baseline and Weeks 12 and 24. The primary outcome was the change in physical activity levels across these parameters. Results: No adverse events were reported among the 37 participants. The telerehabilitation group demonstrated a significant increase in low-intensity physical activity at Weeks 12 and 24 compared with the control group (mean between-group difference: +30.9 min/day at 12 week and +29.0 min/day at 24 week; p = .04, effect size r = .33 at 12 week, r = .34 at 24 weeks). No significant differences emerged in step count, sedentary time, or moderate to vigorous physical activity. Conclusions: This pilot study showed telerehabilitation’s potential to promote active lifestyles in post total hip replacement or total knee replacement older adults, particularly for increasing low-intensity physical activity. Future research should develop more intensive programs to improve moderate to vigorous physical activity and physical functions.", "links": [ { "caption": "URL", "url": "https://journals.humankinetics.com/view/journals/japa/aop/article-10.1123-japa.2024-0347/article-10.1123-japa.2024-0347.xml", "newWindow": true } ] }, { "title": "Perioperative Wearable Device Features are associated with Moderate-to-Severe Chronic Pain after Surgery in the “All of Us” Research Program", "author": "Zhang, Wenyu; Ross, Mindy K.; Frumkin, Madelyn R.", "year": "2025", "journalProceedings": "medRxiv", "category": "Case Study", "devices": null, "population": "Adults", "dataUsed": "Steps,Sleep", "abstract": "Chronic pain is a common and disabling condition affective over 50 million adults in the United States. Surgery may offer a critical opportunity to prevent chronic pain, as 10–35\\% of surgical patients develop new or worsening pain. However, prevention and treatment of chronic pain among surgical patients is hindered by a lack of reliable and clinically actionable biomarkers. Digital health technologies offer novel opportunities to develop and validate digital biomarkers of chronic pain among surgical patients. In this study, we leveraged data from the “All of Us” Research Program, which linked Electronic Health Record (EHR) data with participant’s own Fitbit data. We identified participants who: 1) had a surgical procedure as indicated in the EHR; 2) had Fitbit data available 30 days before and/or after surgery; and 3) completed the Overall Health Questionnaire assessing pain intensity 3 months to 5 years after surgery. Our final cohort included 302 surgical patients, 29\\% of whom reported moderate-to-severe pain approximately 1.5 years after surgery. Among the domain-specific models, sleep features provided the best predictive performance, achieving an AUC of .722 in a held-out test set. The lowest AIC was observed in the stepwise model based on the subset of participants whose Fitbits provided sleep stage data (n = 244, AIC = 178.75, AUC = .649, sensitivity = 0.37, specificity = 0.87). Younger age (OR = 0.97; p = 0.048), lower preoperative step variability (OR = 0.56; p = 0.009), and higher preoperative variability in REM sleep proportion (OR = 1.62; p = 0.023) were associated with greater risk of moderate-to-severe pain approximately 1.5 years after surgery. Digital biomarkers derived from consumer wearable device data appear highly promising for improving prediction and understand of chronic postoperative pain.", "links": [ { "caption": "URL", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12485980/", "newWindow": true } ] }, { "title": "Wearable Devices Detect Physiological Changes that Precede and Are Associated with Symptomatic and Inflammatory Rheumatoid Arthritis Flares", "author": "Sharma, Pragya; Danieletto, Matteo; Whang, Jessica K.; Landell, Kyle; Helmus, Drew; Sands, Bruce E.; Suarez-Farinas, Mayte; Gulko, Percio S.; Hirten, Robert P.", "year": "2025", "journalProceedings": "medRxiv", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Physiological parameters are altered in rheumatoid arthritis (RA). We evaluated whether changes in physiological metrics, collected from wearable devices, identify and precede the development of both symptomatic and inflammatory RA flares. Participants with RA answered daily disease activity surveys and provided laboratory assessments of inflammatory activity. They wore an Apple Watch (n=35), Fitbit (n=17), or Oura Ring (n=3) collecting heart rate (HR), resting heart rate (RHR), heart rate variability (HRV), and steps. Linear mixed effect models were used to associate HR, RHR and steps with flare and remission periods. Cosinor mixed effect models assessed circadian features of HRV. Mixed effect logistic regression models evaluated changes in physiological metrics prior to the onset of flares. The study enrolled 53 participants (88.7\\% female) with a mean age of 51.1 (SD 15.2) years. Each contributed a mean of 105 (SD 97) days of data. Mean steps were lower, while mean nighttime HR was higher during symptomatic periods, compared to periods of symptomatic remission. Means daily HR, daytime HR, nighttime HR, and RHR were higher during periods of inflammatory flares, compared to inflammatory remission. Circadian features of HRV differentiated inflammatory and symptomatic flares from remission. All metrics were altered up to 4 weeks prior to inflammatory and symptomatic flare development. This suggests the potential use of wearable devices for disease monitoring and flare prediction.", "links": [ { "caption": "URL", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12486041/", "newWindow": true } ] }, { "title": "A Dual In-Person and Remote Assessment Approach to Developing Digital End Points Relevant to Autism and Co-Occurring Conditions: Protocol for a Multisite Observational Study", "author": "Yorke, Isabel; Boatman, Charlotte A.; Roy Choudhury, Akash; Oakley, Bethany; Conde, Pauline; Sankesara, Heet; Ranjan, Yatharth; Rashid, Zulqarnain; Dineley, Judith; Downs, Johnny; Chatham, Christopher H.; Cummins, Nicholas; Folarin, Amos; Loth, Eva; Buitelaar, Jan; Murphy, Declan; Dobson, Richard; Simonoff, Emily", "year": "2025", "journalProceedings": "JMIR Research Protocols", "category": "Intervention", "devices": "Inspire 2", "population": "Children,Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Background Research priorities for autistic people include developing effective interventions for the numerous challenges affecting their daily living, for example, mental health problems, sleep difficulties, and social well-being. However, clinical research progress is limited by a lack of validated objective measures that represent target outcomes for improvement. Digital technologies, including wearable devices and smartphone apps, provide opportunities to develop novel measures that may reflect everyday experience and complement key clinical assessments. However, little is known about the acceptability and feasibility of implementing digital data collection in this population. Objective The primary objective of this study is to evaluate the usability, acceptability, adherence, and feasibility of a dual in-person and remote (ie, at-home) protocol. Secondarily, we aim to explore the properties of certain resulting data with a view to developing novel digital end points for key target outcomes, including social communication, sleep, and mental health. Methods Eligible autistic and nonautistic in the AIMS Longitudinal European Autism Project were invited to participate in a digitally augmented in-person Autism Diagnostic Observation Schedule-2 (ADOS-2) and a 28-day remote measurement (RM) protocol involving wearing a Fitbit device, downloading a passive smartphone data collection app, and using 2 active reporting apps. Results The first AIMS Longitudinal European Autism Project study participants were enrolled in September 2021 (in-person component) and March 2022 (RM component). To date, 190 participants have taken part in the digitally augmented ADOS-2 component, and 86 participants have been enrolled for the RM protocol. Recruitment is now complete with some RM data collection ongoing until August 2025. Data analysis has commenced, including qualitative framework analysis of feedback interview data coproduced with autism community members, exploration of acceptability and feasibility metrics, pipeline development for ADOS-2 speech analysis, and RM sleep measures. Conclusions This study lays important groundwork in understanding the acceptability and feasibility of in-person and remotely implemented digital measurement procedures to capture meaningful outcomes in domains important to improving everyday life for autistic people. International Registered Report Identifier (IRRID) DERR1-10.2196/71145", "links": [ { "caption": "URL", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12534762/", "newWindow": true } ] }, { "title": "Validity of Heart Rate Measurement Using Wearable Devices During Cardiopulmonary Exercise Testing in Patients With Cardiovascular Disease: Prospective Pilot Validation Study", "author": "Kitagaki, Kazufumi; Hongo, Yuji; Futai, Rie; Hasegawa, Takeshi; Morikawa, Hiroshi; Shimoyama, Hisashi", "year": "2025", "journalProceedings": "JMIR cardio", "category": "Validation", "devices": "Inspire 3", "population": "Patients", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Wearable devices offer a promising solution for remotely monitoring heart rate (HR) during home-based cardiac rehabilitation. However, evidence regarding their accuracy across varying exercise intensities and patient profiles remains limited, particularly in populations with cardiovascular disease (CVD) such as those with heart failure (HF). OBJECTIVE: The objective of this study was to evaluate the accuracy of HR measurements obtained using the Fitbit Inspire 3 during cardiopulmonary exercise testing (CPX) in patients with CVD, including those with HF. METHODS: In this single-center, prospective pilot study, we enrolled 30 patients with CVD undergoing CPX. HR was simultaneously recorded using electrocardiography and the Fitbit Inspire 3 at 1-minute intervals across various CPX phases: rest, exercise below and above the anaerobic threshold (AT), and recovery. The correlation between the two methods was assessed using the Pearson correlation coefficient. Measurement error was quantified by mean absolute error and mean absolute percentage error (MAPE), with a MAPE of ≤10\\% defined as the threshold for acceptable agreement. RESULTS: All data points were 630 points per minute. The Fitbit Inspire 3 device demonstrated a strong overall correlation with electrocardiography-derived HR (r=0.90; IQR 0.88-0.91) and an acceptable MAPE of 5.40\\% (SD 8.33\\%). The total error was 14.9\\% (94/630), with overestimation and underestimation of 37 (5.8\\%) points and 57 (9\\%) points, respectively. The rate of HR underestimation reached 19 (16\\%) points during exercise above the AT, compared to 1 (3\\%) point at rest. When stratified by HF stage (B vs C), underestimation was more pronounced in patients with HF (14/275, 5\\% points vs 40/355, 11.2\\% points). CONCLUSIONS: The Fitbit Inspire 3 provides acceptable validity for HR monitoring during CPX in patients with CVD. However, clinicians should interpret HR data with caution during high-intensity exercise, especially in patients with HF.", "links": [] }, { "title": "Evaluating the role of interpersonal support on daily physical activity across systems, contexts, and time among African American women: an ecological momentary assessment study", "author": "Sweeney, Allison M.; Prine, Halle; Yang, Chih-Hsiang; Wilson, Dawn K.; Forthofer, Melinda; Martin, Pamela", "year": "2025", "journalProceedings": "Annals of Behavioral Medicine", "category": "Intervention", "devices": "Inspire", "population": "Adults", "dataUsed": "Steps,Goals,Active Minutes/Active Zone Minutes", "abstract": "Many studies have found that various aspects of the social environment, such as social support, promote greater physical activity among African American women. However, few studies have evaluated how these social factors vary across time, contexts, and relationships. This study examined the associations between various social factors and physical activity across an ongoing 10-week group-based physical activity program for African American women. We found that social support from both participants’ family and friends and their treatment groups varied and positively impacted their daily physical activity.Extensive research demonstrates the importance of the social environment for physical activity (PA) among African American (AA) women. Such studies rarely evaluate the simultaneous impact of interpersonal factors across multiple systems or fluctuations across time.This study used Ecological Momentary Assessment (EMA) within a group-based PA intervention to evaluate how interpersonal factors impacted daily PA.Data were collected from 45 AA women (Mage = 52.7 ± 14) in the Together Everyone Achieves More Physical Activity randomized controlled trial. Participants used a smartphone-based EMA application and received two daily prompts across three 7-day phases of the intervention period while simultaneously wearing a Fitbit. Participants answered questions about interpersonal factors within their intervention group (social support given and received, relatedness, collective efficacy, and group cohesion) and external social support.Participants engaged in greater steps on days with higher than usual external social support (relative to one’s usual level) (B = 535.25, P \\<.001) and higher than usual social support given to others in the intervention group (B = 673.10, P = .003). Participants were more likely to engage in any moderate to vigorous PA (MVPA) on days with higher than usual social support received from the intervention group (OR = 1.59, P = .014) and engaged in greater overall MVPA on days with higher than usual external social support (B = 0.18, p \\<.001).By evaluating within-person changes over time and with a systems-level focus, this study provides novel insights into the role of interpersonal support for promoting PA among AA women.", "links": [ { "caption": "URL", "url": "https://doi.org/10.1093/abm/kaaf076", "newWindow": true } ] }, { "title": "Smartphone Application With Health Coaching Facilitates Multi‐Symptom Improvement in IBS Patients: A Pilot Feasibility Trial", "author": "Eisele, Max; Yousuf, Munazza; Haskey, Natasha; D'Silva, Adrijana; Nasser, Yasmin; Franco, Laura; Raman, Maitreyi", "year": "2025", "journalProceedings": "Neurogastroenterology and Motility", "category": "Intervention", "devices": "Inspire 3", "population": "Adults", "dataUsed": "Steps,Intensity,Sleep", "abstract": "Background: Irritable bowel syndrome (IBS), a disorder of the gut-brain interaction, is associated with significant symptom burden and impaired psychosocial functioning. Evidence-based behavioral therapies are effective, but often underutilized due to accessibility barriers. Mobile health is an emerging field with the potential to bridge the gap between the needs of individuals with IBS and the limitations of the healthcare system. This study evaluated the feasibility and effectiveness of the LyfeMD app plus health coaching (HC) in improving IBS symptom severity and psychosocial wellbeing.\n\nMethods: This 12-week interventional pilot study evaluated the effectiveness of a mobile application combined with HC in adults diagnosed with IBS. Participants were assessed at baseline, 6 weeks, and 12 weeks using validated surveys to assess symptom severity, psychosocial wellbeing, diet, physical activity, and sleep. A Fitbit was also used to track physical activity and sleep.\n\nResults: Thirty-nine participants completed the 12-week intervention. IBS symptom severity improved significantly (p < 0.001) over the 12-week period, with 63.2% of the participants having a clinically meaningful improvement in their symptoms. In addition to symptom severity, participants improved in all measured psychosocial domains and their subjective sleep quality at 12 weeks.\n\nConclusion: In summary, the LyfeMD platform, in combination with HC, shows potential in improving IBS symptom severity, psychosocial well-being, and sleep quality in individuals diagnosed with IBS. These findings highlight the potential of mobile health as a complement to traditional medical care. Further research, including randomized controlled trials with extended follow-up, is needed to confirm findings and the sustainability of these outcomes.", "links": [ { "caption": "URL", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12623270/", "newWindow": true } ] }, { "title": "American Life in Realtime: Benchmark, publicly available person-generated health data for equity in precision health", "author": "Chaturvedi, Ritika R.; Angrisani, Marco; Troxel, Wendy M.; Jain, Monika; Gutsche, Tania; Ortega, Eva; Boch, Adrien; Liang, Citina; Sima, Shiyang; Mezlini, Aziz; Daza, Eric J.; Boodaghidizaji, Miad; Suen, Sze-chuan; Chaturvedi, Alok R.; Ghasemkhani, Hossein; Ardekani, Arezoo M.; Kapteyn, Arie", "year": "2025", "journalProceedings": "PNAS Nexus", "category": "Case Study", "devices": "Inspire 2", "population": "Older Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "Person-generated health data (PGHD) from smartphones/wearables are invaluable for precision health, a field promoting health equity through tailored disease prevention, detection, and intervention strategies. However, pervasive convenience sampling in extant PGHD research introduces selection biases that systematically underrepresent disadvantaged groups, limit model generalizability, and risk exacerbating health disparities. Benchmark PGHD (representative, validated, longitudinal, and frequently repeated) are urgently needed to support model equity. To address this fieldwide limitation, we established American Life in Realtime (ALiR), a longitudinal population health study involving PGHD collected from a probability-based, nationally representative cohort using study-provided Fitbits and (as needed) 4G tablets. As a result, ALiR's 1,038 participants are broadly representative across comprehensive sociodemographic, behavioral, and health-related US population norms, overcoming disparities in established convenience samples (e.g. NIH's All of Us; AoU). Only two sources of differential enrollment remained: older age (odds ratio [OR]: 1.27, 99\\% CI: 1.12–1.45) during consent, lower education (OR: 0.86, 99\\% CI: 0.79–0.94) during enrollment, though oversampling individuals without bachelor's degrees sufficiently counterbalanced the latter. An illustrative coronavirus disease 2019 classification model—chosen for global significance, known disparities in experience and outcomes, and methodological relevance—trained using ALiR performed equivalently when tested in sample (area under the curve [AUC] = 0.84, 95\\% CI: 0.79–0.89) and out of sample on AoU (AUC = 0.83, 95\\% CI: 0.78–0.89) overall, and in historically underserved subgroups (AUC = 0.82–1.0). Conversely, an identically trained classification model using AoU underperformed by 35\\% out of sample on ALiR (overall AUC = 0.68, 95\\% CI: 0.61–0.75 vs. AUC = 0.93, 95\\% CI: 0.91–0.96 in sample), with worse performance in older female and non-White subgroups (by 22–40\\%). Our results suggest that probability sampling and hardware provisioning enabled cohort inclusivity and generalizable model performance, supporting ALiR's benchmarking potential for equitable recruitment, PGHD collection, and precision health application.", "links": [ { "caption": "URL", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12501968/", "newWindow": true } ] }, { "title": "A pilot exercise intervention to evaluate the role of cardiorespiratory fitness in modulating cardiotoxicity among childhood cancer survivors exposed to anthracycline therapy", "author": "Toro-Salazar, Olga H.; Pescatello, Linda S.; Mah, May Ling; Wilhelm, Carolyn; Orsey, Andrea D.; Berthod, Tiffany; Mosha, Maua H.; Brimacombe, Michael; Fan, Tongyao; Wanner, Corbinian; Slawinski, Michelle; Hor, Kan N.", "year": "2025", "journalProceedings": "Cardio-Oncology (London, England)", "category": "Intervention", "devices": "Alta HR", "population": "Children,Adults", "dataUsed": "Steps,Intensity,Heart Rate,Active Minutes/Active Zone Minutes", "abstract": "BACKGROUND: Childhood cancer survivors (CCS) often experience cancer treatment-related cardiotoxicity, leading to reduced cardiorespiratory fitness (CRF), an integrated marker of cardiovascular, respiratory, and musculoskeletal function. Furthermore, low CRF is a strong predictor of mortality. OBJECTIVE: This study investigates the effects of a 16-week aerobic exercise intervention on CRF changes, as measured by peak oxygen consumption (VO2peak) and parameters of cardiac structure and function by cardiac magnetic resonance imaging (CMR). METHODS: Anthracycline-treated CCS were enrolled {\\textgreater} 2 years post-treatment and underwent cardiotoxicity risk stratification, cardiopulmonary stress test (CPET) to determine CRF, and CMR before and after a 16-week aerobic exercise intervention. The intervention consisted of individualized sessions performed 3–5 days per week, with duration progressively increasing from 15 to 45 min at 50–80\\% of age-predicted maximal heart rate. Exercise adherence and intensity were objectively measured throughout the intervention using a Fitbit tracker. Subclinical myocardial dysfunction was assessed by segmental strain abnormality, with specific focus on the number of segments showing peak circumferential strain magnitude (εcc) ≤ 10\\% and εcc ≤ 17\\%. Descriptive and comparative statistics, including Pearson’s correlation and chi-square/Fisher’s exact and Mann-Whitney tests, were performed using SAS 9.4, with significance set at p {\\textless} 0.05. RESULTS: Forty-seven subjects (median age 22.0 years [IQR 8.5], 10–25 years), 57.4\\% male, and 75\\% white were enrolled. Thirty patients (63.8\\%) completed the exercise intervention, 56.7\\% male, and 83.3\\% white, with a median age of 24.0 years (IQR 9.8 years). Twenty participants (42.6\\%) met the predefined adherence criterion of achieving ≥ 100\\% of the prescribed fairly active plus very active minutes. There was no statistically significant change in VO₂peak (mL/kg/min) for the study cohort (median [IQR]: 34.0 [13.7] vs. 34.4 [13.3]; p = 0.76). Total active minutes were positively correlated with change in VO2peak (mL/kg/min) (r = 0.71, p {\\textless} 0.005), and VO2peak (L/min) (r = 0.64, p = 0.03). VO2peak increased ≥ 1 mL/kg/min in 16/30 (53.3\\%) of subjects. These subjects labeled “responders”, demonstrated a median increase in VO2peak of 3.6 mL/kg/min and significant increase in right ventricular end diastolic volume index (p = 0.035), left ventricular stroke volume index (p = 0.014) and ejection fraction (EF) (p = 0.045). At baseline, 12 subjects met high-risk definition based on segmental strain abnormalities (i.e., ≥ 2 segments with εcc ≤ 10\\% or ≥ 9 segments ≤ 17\\%). High risk subjects showed significant improvement in εcc with a post-intervention reduction in number of segments ≤ 10\\% from 2.0 to 0.0 (p = 0.017). CONCLUSIONS: Overall CCS did not show a significant change in VO₂peak in response to a 16-week exercise intervention. Those with higher adherence to the exercise prescription were more likely to experience meaningful improvements in post-intervention VO2peak and improvement in CMR parameters of structure and function. Participants classified as high-risk, based on εcc abnormalities, derived the greatest benefit. TRIAL REGISTRATION: Retrospectively registered: https://classic.clinicaltrials.gov/ct2/show/NCT04036032, Registration date: July 25, 2019. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40959-025-00388-5.", "links": [] }, { "title": "The role of health monitoring technologies in optimising athletes' self-regulation", "author": "Gakh, Roman V.; Fedoniuk, Larisa Ya; Furman, Oksana Ye; Kramchenkova, Vira O.; Kuznetsov, Oleksiy I.", "year": "2025", "journalProceedings": "Wiadomosci Lekarskie (Warsaw, Poland: 1960)", "category": "Systematic Review", "devices": "Charge 5", "population": "NA", "dataUsed": "Sleep,Heart Rate", "abstract": "OBJECTIVE: Aim: To analyse current approaches to monitoring sports performance and health of athletes by developing an intelligent system that combines wearable devices, cloud computing and deep learning methods. PATIENTS AND METHODS: Materials and Methods: The paper analyses related literature in sports medicine, informatics and artificial intelligence. The work is based on studying the effectiveness of devices such as Fitbit Charge 5, Garmin Venu 2, Samsung Galaxy Watch 4, and Oura Ring Gen 3. RESULTS: Results: Showed that such systems provide high accuracy in predicting athletes' health status. The presented models allow real-time tracking of physiological parameters, analysing the data and generating health reports for prompt adjustment of the training process. These devices enable systematic monitoring of various indicators, such as heart rate, stress level, sleep quality and overall physical activity. Reading these indicators allows athletes to receive objective information about their condition. This, in turn, contributes to more effective training planning, recovery and injury prevention. CONCLUSION: Conclusions: Integrating wearables, cloud computing, and deep learning methods presented on the latest devices is a promising approach to sports health monitoring. The analysed devices can improve athletes' performance, prevent injuries and optimise training programmes.", "links": [] }, { "title": "An Example Analysis for a Gender-inclusive Approach in Sport and Exercise Science Research using Fitbit Outcomes from the All of Us Research Program Dataset", "author": "Navalta, James W.; Davis, Dustin W.; Thomas, Jafra D.; Stone, Whitley J.", "year": "2025", "journalProceedings": "International Journal of Exercise Science", "category": "Survey Research", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Heart Rate,Active Minutes/Active Zone Minutes", "abstract": "Prevalence studies with wearable devices are used to understand disparities in health-related physical activity behaviors and whether interventions are efficacious. However, studies have been limited to a binary definition of sex. This example analysis aimed to demonstrate how researchers can investigate differences in data beyond the sex-gender binary. Using a cross-sectional analysis of the All of Us Research Program dataset, participants' self-identified gender was categorized into Cisgender Female (n = 10,401), Additional Options (n = 27), Non-binary (n = 84), Transgender (n = 17), and Cisgender Male (n = 4,470). Fitbit data on active calories, steps, sedentary minutes, and very active minutes were analyzed following a valid statistical decision framework found in the companion editorial to this paper. Data were checked for normality using the Shapiro-Wilk test, and because data were not normally distributed, homogeneity was evaluated using the Brown-Forsyth test. The omnibus test for significant group differences was determined using the Kruskal-Wallis test, with significance accepted at p {\\textless} 0.05. Effect sizes (ES) for omnibus test results were calculated using Epsilon squared. Results provide evidence for differences in physical activity metrics among gender groups (p {\\textless} 0.001; active calories ES = 0.069, steps ES = 0.005, and very active minutes ES = 0.026). Cisgender males had higher active calories, steps, and very active minutes than cisgender females (40\\% more) and non-binary individuals (45\\% more). No differences were observed among other gender groups studied. These findings highlight that activity patterns vary beyond traditional binary classifications, emphasizing the need for gender-inclusive research in sport and exercise science. Specifically, the disparities observed underscore the importance of nuanced interpretations and tailored recommendations for diverse populations, addressing systemic gaps in supporting gender-diverse individuals in health and exercise behaviors.", "links": [] }, { "title": "Exploring the relative importance of the factors associated with menopausal symptoms using a random forest model: a cross-sectional study", "author": "Chin, Meejung; Hahn, Sowon; Kim, Yeon Soo; Kwon, Young Hye; Park, Yeon-Hwan; Choi, Younghwan; Kim, Gahye; Kim, Youjin; Lee, Inju; Yoon, Hyun Jeong; Bae, Hanjin", "year": "2025", "journalProceedings": "Women's Health Nursing (Seoul, Korea)", "category": "Case Study", "devices": "Charge 5", "population": "Adults", "dataUsed": "Steps", "abstract": "PURPOSE: This study aimed to identify key factors associated with menopausal symptoms among middle-aged women by examining a comprehensive set of physical, psychological, and lifestyle variables. METHODS: A cross-sectional study was conducted with 94 women aged 45 to 55 years in Seoul, South Korea. Data were collected through physical assessments, self-reported questionnaires, and monitoring using a wearable device (Fitbit Charge 5, Fitbit Inc.). The Menopause Rating Scale was used to assess symptom severity, with scores dichotomized into no/mild symptoms (0-8) and moderate/severe symptoms (9-44). Random forest analysis was applied to evaluate the relative importance of various factors in relation to menopausal symptoms. RESULTS: Fourteen significant predictors were identified from an initial set of 57 variables using recursive feature elimination with cross-validation. The final random forest model achieved balanced predictive performance, with an accuracy of 74.1\\%, an area under the curve of 75.7\\%, sensitivity of 78.9\\%, and specificity of 62.5\\%. Age emerged as the most influential predictor, followed by psychological well-being and loneliness as the second and third most important factors. Among physical characteristics, relative grip strength (fourth) and body fat percentage (fifth) were significant predictors. Lifestyle factors, including moderate physical activity (sixth) and health-conscious dietary behaviors (seventh), showed moderate importance, while socioeconomic factors demonstrated lower importance. CONCLUSION: The findings highlight the multifaceted nature of menopausal symptoms and suggest that effective management strategies should incorporate physical, psychological, and lifestyle interventions. These results provide evidence for developing comprehensive digital healthcare applications that incorporate monitoring and intervention features across multiple domains for effective menopausal symptom management.", "links": [] }, { "title": "Objective vs perceived sleep in Belgian occupational drivers: A field study", "author": "Schyvens, An-Marie; Van Oost, Nina Catharina; Peters, Brent; Veys, Frederik; Aerts, Jean-Marie; Masci, Federica; Neven, An; Dirix, Hélène; Wets, Geert; Ross, Veerle; Verbraecken, Johan", "year": "2025", "journalProceedings": "Sleep Medicine", "category": "Case Study", "devices": "Charge 5", "population": "Adults", "dataUsed": "Sleep", "abstract": "STUDY OBJECTIVE: This prospective, descriptive observational study aimed to investigate objective and subjective sleep among Belgian occupational drivers, focusing on short haul (SHD), long haul (LHD), and local delivery drivers (LDD). METHODS: A total of 31 drivers wore a Fitbit Charge 5 for one month to capture total sleep time (TST), time in bed (TIB), sleep efficiency (SE), wakefulness and sleep stage distribution. Subjective sleep was assessed daily using a 5-point scale. Data were analyzed using descriptive statistics, one-way ANOVAs and Pearson correlations. RESULTS: Drivers averaged 6.2 ± 0.7 h of TST and 7.1 ± 0.7 h of TIB, with a mean SE of 87.3 ± 2.1 \\%. Sleep stages were distributed as follows: 60.1 ± 5.2 \\% light sleep (LS), 18.0 ± 3.3 \\% deep sleep (DS), 21.2 ± 4.2 \\% REM sleep and 12.8 ± 1.8 \\% of awake. 12.9 \\% of participants had low DS ({\\textless}15 \\%) and 25.8 \\% had low REM ({\\textless}20 \\%). 29.0 \\% of participants experienced elevated nocturnal wakefulness. One-way ANOVA revealed no significant group differences in most sleep parameters, except for DS (F = 3.47, p = 0.05), with LHD showing the lowest proportion. Subjectively, most drivers rated their sleep from good to neutral. However, one-third reported poor sleep. Modest correlations were found between better subjective sleep and higher DS, TST, and SE. CONCLUSION: Although SE was adequate, chronic sleep restriction was common. Group differences were minimal, suggesting that individual and environmental factors may outweigh driver type in influencing sleep. Subjective assessments only partially aligned with objective measures, reflecting a discrepancy between perceived and objective sleep.", "links": [] }, { "title": "The effects of diaphragm release on sleep quality: a pilot feasibility study", "author": "Erol, Erkan; Kurtboğan, Muhammed", "year": "2025", "journalProceedings": "BMC pulmonary medicine", "category": "Intervention", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Sleep,Heart Rate", "abstract": "BACKGROUND: Poor sleep quality is a common health concern with wide-ranging consequences. Manual diaphragm release, by improving diaphragmatic function and autonomic balance, may help enhance sleep quality. This pilot feasibility study aimed to explore the preliminary effects of diaphragm release on sleep quality in healthy individuals. METHODS: 35 participants were included in the study. The Pittsburgh Sleep Quality Index (PSQI) and Fitbit smartband were utilized to evaluate individuals' sleep quality. The diaphragm release technique was administered over three sessions, with two days of rest in between each session. RESULTS: Following the intervention, increases in sleep duration and sleep score were observed as per Fitbit measurements (p {\\textless} 0.05). Post-intervention, statistically significant changes were found in sleep latency, sleep duration, sleep disturbance subscales, and the total score of the PSQI (p {\\textless} 0.05). CONCLUSIONS: As a preliminary investigation, this pilot study suggests that diaphragm release may be a feasible and safe intervention to enhance sleep quality. Further randomized controlled trials using gold-standard sleep assessments are needed to confirm these findings. GOV ID: NCT05762913 (Date: 10/03/2023).", "links": [] }, { "title": "Daily Step Count 2 Years After Anterior Cruciate Ligament Reconstruction and Associations With Cartilage Health and Knee Symptoms and Function", "author": "Øiestad, Britt Elin; Williams, Ashley A.; Titchenal, Matthew R.; Lutz, Amelie M.; Chu, Constance R.", "year": "2026", "journalProceedings": "Sports Health", "category": "Case Study", "devices": "Charge HR", "population": "Patients", "dataUsed": "Steps", "abstract": "BACKGROUND: People suffering anterior cruciate ligament (ACL) injuries are at increased risk for development of osteoarthritis (OA). This study investigated associations between daily step count, cartilage degeneration and patient-reported outcomes 2 years after ACL reconstruction (ACLR). HYPOTHESIS: Daily step count is associated with cartilage health and patient-reported knee symptoms and function 2 years after ACLR. STUDY DESIGN: Cross-sectional. LEVEL OF EVIDENCE: Level 4. METHODS: We analyzed data from 34 patients (18 female), aged 33.4 ± 10.8 years with stable knees recruited from the community 2 years after primary ACLR. Mean daily step count was measured using an activity tracker (FitBit) over a 7-day collection period. Cartilage morphology on magnetic resonance imaging (MRI) was graded across multiple joint areas. Knee symptoms and function were assessed by the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales pain, symptoms, activity of daily living (ADL), sport/recreation (sport/rec), and knee-related quality of life (QoL) using published thresholds for patient acceptable symptom state (PASS). Analyses were adjusted for age, sex, and body mass index. RESULTS: The mean (SD) daily step count was 9276 (3199). At least 1 cartilage abnormality was present on morphological MRI in 20\\% of ACLR knees. The mean (SD) KOOS values were: pain 94 (7), symptoms 92 (8), ADL 91 (10), function in sport/rec 85 (14), and knee-related QoL 56 (22). Failure to achieve PASS rates were 76\\% for ADL; 59\\% for QoL, 18\\% for pain, 35\\% for sport/rec, and 0\\% for symptoms. CONCLUSION: Daily step count was not associated with cartilage health or knee symptoms and function 2 years after ACLR. However, a high proportion of participants with reported unacceptable ADL and QoL 2 years after ACLR. CLINICAL RELEVANCE: The proportion with unacceptable PASS for ADL and QoL in participants with stable knees after ACLR indicates a need to optimize rehabilitation and improve post-ACLR recovery.", "links": [] }, { "title": "Engagement in a digital health physical activity program, TPA4You, among older family care partners of persons with heart failure: A Scenario-based design", "author": "Baik, Dawon; Allen, Larry A.; Coats, Heather; Matlock, Daniel D.; Jankowski, Catherine", "year": "2025", "journalProceedings": "Geriatric Nursing (New York, N.Y.)", "category": "Intervention", "devices": "Device unspecified", "population": "Older Adults", "dataUsed": "User Friendliness", "abstract": "This study examined the perceptions of older family care partners of persons with heart failure (HF-FCPs) about a tailored digital physical activity program, TPA4You, consisting of Zoom sessions with a health coach, Fitbit, and motivational text messages. A scenario-based design was used to identify determinants of engagement. Semi-structured interviews were conducted with 15 older HF-FCPs from September 2022 to January 2023. Thematic analysis guided by the Theory of Planned Behavior was used. Participants reported that TPA4You would be acceptable and useful for managing their health in the caregiving context. TPA4You was perceived as convenient and potentially effective, but challenges such as limited time for use and age-related technical difficulties were reported. Support from health coaches and encouragement from other FCPs were highlighted as helpful. The findings underscore the importance of technology-supported health strategies tailored to caregiving burden, age-related health challenges, and digital literacy limitations to enhance engagement among older HF-FCPs.", "links": [] }, { "title": "Older Latino adults' facilitators and barriers to reducing sedentary behavior following an individualized intervention", "author": "Gaedecke, Tyler; Zahlan, Jana; Redondo-Sáenz, Diego; Marquez, David X.; Tintle, Nathan; Bronas, Ulf G.", "year": "2026", "journalProceedings": "Ethnicity \\& Health", "category": "Intervention", "devices": "Device unspecified", "population": "Older Adults", "dataUsed": "NA", "abstract": "OBJECTIVES: To identify facilitators, barriers, and perceptions of older Latino adults regarding sedentary behaviors (SB) and physical activity (PA) SB and PA following a randomized controlled trial designed to replace SB with PA; we investigate how these factors differed between study groups. DESIGN: Qualitative descriptive study. Semi-structured post-intervention interviews were conducted in Spanish with 38 Latino mid-life and older adults from Chicago in the Physical Activity Program to Disrupt Sedentary Time in Older Latinos study. After translation, two independent coders coded transcripts deductively and inductively to identify categories and themes. RESULTS: Compared to factors identified prior to the intervention, new barriers emerged around age, finances, and technology. Adapting exercise to one's needs, Fitbits, and PA feasibility were new facilitators. Two new categories characterized participants' underlying needs for engaging in PA (e.g. accessible facilities and education) and their knowledge and attitudes regarding SB and PA. Participants began to connect both SB and PA to cognitive function, discussed behavior changes related to the intervention, and often shared the intervention's information about both SB and PA with their community. CONCLUSION: Feasibility, accessibility, and awareness play an important role in reducing SB for mid-life and older Latino adults. This intervention shows promise for decreasing barriers in these areas and positively impacting knowledge, attitudes, and behaviors towards both PA and SB.", "links": [] }, { "title": "Characterization of Post-Viral Infection Behaviors Among Patients With Long COVID: Prospective, Observational, Longitudinal Cohort Analyses of Fitbit Data and Patient-Reported Outcomes", "author": "Zhang, Tianmai M.; Sharp, Sydney P.; Scott, John D.; Taren, Douglas; Samaniego, Jane C.; Unger, Elizabeth R.; Bertolli, Jeanne; Lin, Jin-Mann S.; Ramers, Christian B.; Godino, Job G.", "year": "2025", "journalProceedings": "JMIR formative research", "category": "Case Study", "devices": "Charge 5", "population": "Patients,Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "BACKGROUND: Long COVID encompasses a range of health problems that can be highly debilitating. While some research has relied on self-reported measures of symptoms and functioning, few studies have characterized symptoms in relation to behaviors and physiology measured objectively through wearable devices. OBJECTIVE: The primary aim of this study was to identify longitudinal patterns in physical activity, physiology, and patient-reported outcomes (PROs) among patients with long COVID at a Federally Qualified Health Center in the United States. The secondary aim was to identify meaningful subgroups or phenotypes within this cohort and examine how PROs and symptoms overlay with physical activity characteristics. METHODS: This was a prospective, observational, longitudinal cohort study recruiting a subset of low-income patients enrolled in the Long COVID and Fatiguing Illness Recovery Program. From March 2022 to May 2023, a total of 172 patients with long COVID or myalgic encephalomyelitis/chronic fatigue syndrome were given Fitbit Charge 5 (Fitbit Inc) devices and instructed to wear them continuously for up to a year. Patients completed PRO questionnaires (PROMIS-29 [Patient-Reported Outcomes Measurement Information System-29] and symptom questionnaires, etc) at baseline, 3, and 6 months. Inclusion in longitudinal analysis required at least 20 hours of valid wear data per day for a minimum of 7 days. The World Health Organization guideline on moderate to vigorous physical activity (MVPA) was used to differentiate MPVA-active and MVPA-inactive patients. Linear mixed effects regression was performed to assess longitudinal associations between physical activity levels and PROs. RESULTS: Among 172 patients, 80.2\\% (n=138) were female, 75.6\\% (n=130) were White, 45.3\\% (n=78) were unemployed, and 94.8\\% (n=163) had estimated annual income below US \\$50,000. Of these patients, 82 (47.7\\%) met valid wear criteria, providing 50.5 days of Fitbit data on average. At baseline, MVPA-inactive patients (n=41) reported statistically more severe problems regarding physical function, fatigue, and dyspnea than MVPA-active patients (n=41) on both continuous and categorical scales, with P{\\textless}.05 from both Student t tests (2-tailed) and chi-squared tests. Longitudinal analysis found that MVPA-inactive patients showed a decreased ability to participate in social roles (estimated group difference=-4.21 T-score points over 3 months, 95\\% CI -6.64 to -1.78, P{\\textless}.001) and a higher intensity of sleep symptoms (estimated group difference=2.06 severity score points over 3 months, 95\\% CI 0.40 to 3.71, P=.02) over time. CONCLUSIONS: This study showed that patients with long COVID could remain MVPA-active despite experiencing symptoms. These findings provide insights into the relationship between PROs, physical activity, and long COVID, which suggests the importance of considering individual activity profiles when tailoring treatment plans, especially in a low-income population. The findings of this study should be interpreted as hypothesis-generating, considering its exploratory nature and limitations, including high attrition rates and missing data.", "links": [] }, { "title": "Trajectories of Adherence to Study-Prescribed Physical Activity Goals in a mHealth Weight Loss Intervention", "author": "Bizhanova, Zhadyra; Burke, Lora E.; Brooks, Maria M.; Rockette-Wagner, Bonny; Kariuki, Jacob K.; Sereika, Susan M.", "year": "2025", "journalProceedings": "Sensors (Basel, Switzerland)", "category": "Intervention,Case Study", "devices": "Charge 2", "population": "Adults", "dataUsed": "Steps,Intensity,Food", "abstract": "Introduction: Engaging in ≥300 min/week of moderate-to-vigorous physical activity (MVPA) is recommended for weight management. This study identified MVPA goal-adherence trajectories and associated predictors and weight outcomes in a 12-month mHealth weight-loss trial. Materials and Methods: This was a secondary analysis of valid PA data (≥4 days/week with ≥500 steps/day) from participants (age ≥ 18 years, BMI 27-43 kg/m2) randomized 1:1 to self-monitoring with tailored feedback or self-monitoring only. Both groups received Fitbit trackers. Group-based trajectory modeling identified adherence trajectories and baseline predictors. Analysis of variance was used to estimate associations between trajectory group membership and 12-month weight change. Results: Among 502 participants (79\\% female, 82\\% White, mean age of 45.0 ±14.4 years), four MVPA goal-adherence trajectories were identified: lower stable (34.5\\%), moderate (39.8\\%), increasing (19.3\\%), and high (6.4\\%). A graded association was observed with better adherence trajectories being associated with greater 12-month weight loss (p {\\textless} 0.0001). Older age, male sex, being unpartnered, and higher first-week MVPA predicted membership in higher adherence trajectory groups (p {\\textless} 0.05). Conclusions: Higher MVPA goal-adherence was related to greater weight loss. Early MVPA levels predicted long-term adherence, supporting the importance of personalized, technology-supported strategies to promote long-term PA adherence and inform targeted interventions to prevent chronic diseases.", "links": [] }, { "title": "Engagement of African American Women With Fitness Trackers and Mobile Technology for Shared Physical Activity Goals: Mixed Methods Study", "author": "Sweeney, Allison; Simmons, Timothy; Nair, Anika; Decker, Lindsay", "year": "2025", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "Inspire", "population": "Adults", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND: While there is growing evidence demonstrating the usefulness of integrating social features within mobile health approaches, little research has explored how African American women use mobile platforms to facilitate physical activity within the context of a group-based physical activity intervention. OBJECTIVE: The primary aim of this study was to qualitatively describe how African American women used private group messaging boards on the Fitbit mobile app (eg, the type of social and motivational strategies) during a 10-week group-based physical activity intervention. The secondary aim of this study was to quantitatively test whether greater engagement on the Fitbit mobile app (number of posts per week) was associated with greater daily physical activity (ie, steps and total minutes of physical activity) across 10 weeks. METHODS: Data were collected from 54 African American women who participated in the Together Everyone Achieves More Physical Activity trial (mean age 51.57, SD 13.89 y). Participants completed weekly in-person group sessions, set group-based weekly physical activity goals, and used the Fitbit mobile app for ongoing group communication and support, including posting in a private group. This study used a QUAN-qual mixed methods design to describe how participants used the private group messaging boards on the Fitbit mobile app and to evaluate whether engagement on the Fitbit app was associated with greater physical activity (ie, steps and total minutes of physical activity) across the 10-week intervention. RESULTS: The mean number of posts per week ranged from 1.79 (SD 2.95) in week 1 to 1.11 (SD 2.49) in week 10, with a maximum of 5.06 (SD 7.62) posts in week 5. A thematic content analysis revealed that the private groups reflected numerous topics, including motivational strategies, cognitive strategies, group strategies, informal positive communication, and sharing pictures. The quantitative analyses revealed that participants who posted at least once per week engaged in more steps (P=.006) and total minutes of physical activity (P=.02). CONCLUSIONS: Participants engaged in ongoing social support, positive communication, and vicarious learning through the Fitbit app, suggesting several important directions for future research, including potential interpersonal mechanisms and best practices for enhancing social support and physical activity among African American women.", "links": [] }, { "title": "The effectiveness and cost effectiveness of Snacktivity™ as an intervention to promote physical activity and health outcomes: a study protocol for a multi-centre randomised controlled trial", "author": "Daley, Amanda J.; Griffin, Ryan A.; Sanders, James P.; Edwardson, Charlotte L.; Neal, Liam; Lee, Sam; Skrybant, Magdalena; Moakes, Catherine A.; Gkini, Eleni; Frew, Emma; Greaves, Colin J.; Dobell, Alexandra; Gokal, Kajal; Tearne, Sarah; Parretti, Helen M.; Biddle, Stuart J. H.; Jolly, Kate; Greenfield, Sheila M.; Maddison, Ralph; Esliger, Dale W.; Sherar, Lauren B.; Mutrie, Nanette; Yates, Tom; Ives, Natalie", "year": "2025", "journalProceedings": "Trials", "category": "Intervention", "devices": "Versa 4", "population": "Adults", "dataUsed": "Intensity,Active Minutes/Active Zone Minutes", "abstract": "BACKGROUND: A novel 'whole day' approach that could motivate the public to be more physically active is termed Snacktivity™. Consistent with guidance, the Snacktivity™ approach encourages the public to accumulate ≥ 150 min of physical activity in short 2-5-min 'activity snacks' of moderate-vigorous intensity physical activity throughout the day/week. Snacktivity™ also promotes muscle-strengthening activity twice per week. Following completion of research to co-design and develop the Snacktivity™ approach, the aim of this trial is to assess the effectiveness and cost-effectiveness of a Snacktivity™ intervention to increase physical activity and reduce future risk of disease in the population, compared with usual care. METHODS: A multi-centre, two-arm, individually randomised, parallel group, superiority trial, with an economic evaluation, will be conducted in 966 physically inactive adults. Participants will be recruited from National Health Service Trusts and organisations and non-National Health Service settings (e.g. community groups and social media). Participants will be individually randomized (1:1) to the Snacktivity™ intervention group or a usual care comparator group. The Snacktivity intervention involves two main components; a brief 5-min consultation about the principles and purpose of Snacktivity™; and access to technology support (mobile phone app called the SnackApp, linked to a Fitbit activity device (Versa 4)) that through behavioural change techniques promote self-monitoring of physical activity, habit formation, action planning and feedback on the number of activity snacks completed each day. The primary outcome is the difference in average minutes of moderate-vigorous physical activity between the groups at 12-months follow up, measured using a wrist worn accelerometer. Secondary outcomes include accelerometer-assessed average minutes per day of light, moderate, and vigorous intensity physical activity, time sedentary, weight and psychological health outcomes, at 12 month follow-up. DISCUSSION: Innovative interventions such as Snacktivity™, that aim to support the public to increase their physical activity each day are required. Findings could inform future public health guidance and public health messaging that seeks to raise awareness in the population of the potential benefits of Snacktivity™ for health. TRIAL REGISTRATION: ISRCTN: 12390945 . Registered on 22 March, 2024.", "links": [] }, { "title": "Monitoring Adolescent Sport-Related Concussion Recovery Using Consumer-Grade Wearables: A Pilot Study", "author": "Ransom, Danielle M.; Tudor, Brant H.; Irani, Sarah A.; Rehman, Mohamed A.; Suskauer, Stacy J.; Svingos, Adrian M.; Ahumada, Luis M.; Mularoni, P. Patrick", "year": "2025", "journalProceedings": "The Journal of Head Trauma Rehabilitation", "category": "Case Study", "devices": "Sense", "population": "Adolescents", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "OBJECTIVE: To evaluate whether consumer-grade wearable devices (CGWDs) can detect physiological differences between adolescent athletes recovering from sport-related concussion (SRC) versus musculoskeletal (MSK) injury, and to examine whether wearable-derived physiological markers are associated with symptom burden during the acute post-injury phase. SETTING: Outpatient sports medicine clinic at a pediatric academic medical center. PARTICIPANTS: High school student-athletes aged 14-18 years were eligible if they presented within 10 days of SRC or acute, nonsurgical MSK injury and had internet access and willingness to comply with study procedures. Thirty-eight participants were enrolled; four were excluded due to protocol deviations. The final analytic sample included 34 participants (SRC: n = 17; MSK: n = 17). DESIGN: Prospective observational cohort study conducted from September 2021 to April 2022. All participants were issued a Fitbit Sense to passively monitor sleep, activity, and heart rate for up to 6 weeks post-injury. No randomization or blinding occurred, as this was an observational study. MAIN MEASURES: The primary outcome was group differences in CGWD-derived physiological metrics (sleep patterns and architecture, physical activity, heart rate) across 3 post-enrollment time intervals (Days 1-14, 15-28, 29-42). Secondary outcomes included correlations between physiological data and symptom burden based on the Post-Concussion Symptom Inventory, Second Edition (PCSI-2). RESULTS: Compared to MSK peers, participants with SRC showed significantly more light sleep, more nocturnal wake time, and lower daily step counts during the first 4 weeks post-injury (P {\\textless}.0038). No significant differences were observed in REM sleep, deep sleep, or heart rate. In SRC participants, greater nocturnal wake time and lower resting heart rate were modestly associated with higher cognitive symptom ratings; emotional symptoms were modestly associated with step counts. No adverse events occurred. CONCLUSIONS: CGWDs may capture recovery-specific physiological disruptions in adolescent SRC, particularly in sleep and physical activity. These findings support the potential for wearable technology to inform individualized, objective approaches to concussion monitoring in clinical practice.", "links": [] }, { "title": "Neighborhood disadvantage and adolescent sleep health: a longitudinal population-based study", "author": "Niu, Li; Tan, Luyao; Diaz, Angela; Xiao, Yunyu; Li, Yan; Wang, Yijie", "year": "2026", "journalProceedings": "Lancet Regional Health. Americas", "category": "Case Study", "devices": "Charge 2", "population": "Adolescents", "dataUsed": "Sleep", "abstract": "BACKGROUND: Neighborhood disadvantage may adversely affect adolescent sleep health, yet causal evidence is limited and whether these effects differ by sex and pubertal development remain unclear. This study examined the potential causal effect of neighborhood disadvantage on adolescent sleep duration and variability over a two-year period. METHODS: This cohort study analyzed data from 5045 adolescents (mean age 9.96 years at baseline) in the Adolescent Brain Cognitive Development (ABCD) Study, a longitudinal, population-based sample in the United States. Three indicators of neighborhood disadvantage were assessed: Area Deprivation Index (ADI), air pollution, and nighttime noise, each dichotomized at the 80th percentile to indicate high exposure. Sleep outcomes were derived from Fitbit devices worn continuously for 21 days two years after baseline, including sleep duration and night-to-night variability (defined as the standard deviation of sleep duration across nights). Bayesian causal forests were used to estimate average treatment effects (ATEs) and subgroup-specific effects by sex and pubertal status. Analyses adjusted for the propensity to reside in a high-advantage neighborhood, accounting for individual and household factors including income-to-needs ratio, parental education, and race/ethnicity. FINDINGS: Adolescents living in neighborhoods with high ADI (ATE -0.11, 10th percentile: -0.18, 90th percentile: -0.05), high air pollution (ATE -0.08, -0.14 to -0.02), and high nighttime noise (ATE -0.07, -0.13 to -0.01) had shorter sleep duration two years after baseline. High ADI was also associated with greater night-to-night sleep variability (ATE 0.17, 0.10-0.23). Stratified analyses revealed that boys were more susceptible to reduced sleep duration, girls to greater sleep variability, and adolescents with more advanced pubertal status were more affected across both outcomes. INTERPRETATION: Neighborhood disadvantage has lasting adverse effects on adolescent sleep health, with differential vulnerability by sex and pubertal stage. These findings underscore the need for developmentally tailored policies and interventions that address neighborhood environments to promote healthy sleep during adolescence. FUNDING: This study was supported by the National Natural Science Foundation of China, the Fundamental Research Funds for the Central Universities, the National Institute of Mental Health, and the American Foundation for Suicide Prevention.", "links": [] }, { "title": "Frailty is associated with low physical activity and poor sleep quality in patients undergoing myeloablative allogeneic hematopoietic cell transplantation: a Fitbit® pilot study", "author": "Libbert, Caryn R.; He, Fiona; El Jurdi, Najla; Fagrelius, Helen; Juckett, Mark; Maakaron, Joseph; Juckett, William; Evanoff, Nicholas; Dengel, Donald R.; Holtan, Shernan G.", "year": "2025", "journalProceedings": "Frontiers in Medical Technology", "category": "Case Study", "devices": "Sense", "population": "Patients,Adults", "dataUsed": "Steps,Sleep", "abstract": "INTRODUCTION: Frailty, a multidimensional syndrome of reduced physiologic reserve, is associated with poorer outcomes following allogeneic hematopoietic cell transplantation (alloHCT), even among younger adults. This pilot study explores whether wearable sensor data reflecting physical activity and sleep are associated with pre-transplant frailty status in patients undergoing myeloablative alloHCT. METHODS: Adults undergoing first myeloablative alloHCT at the University of Minnesota from June 2022 to January 2023 were enrolled and given Fitbit® Sense devices. Frailty was assessed pre-transplant using Fried Phenotype criteria. Activity and sleep data were collected from hospital admission to day +30 post-transplant. Descriptive and inferential statistics assessed differences across frailty phenotypes. RESULTS: Nine patients were included: 2 not frail, 5 pre-frail, and 2 frail. Not frail patients demonstrated significantly higher daily steps and active minutes, and lower sedentary time compared to pre-frail and frail groups (all p {\\textless} 0.01). Frail individuals had significantly reduced deep and REM sleep. The nadir for sleep and peak in sedentary behavior occurred around day +15 post-transplant. CONCLUSION: Pre-transplant frailty was associated with decreased physical activity and less restorative sleep during the peri-transplant period. These findings support further study of wearable data to guide personalized supportive care strategies in alloHCT recipients.", "links": [] }, { "title": "Self-Reported Acceptance of a Wearable Activity Monitor in Persons With Stroke: Usability Study", "author": "Nam, Jamie; Bellinger, Grace C.; Li, Junyao; French, Margaret A.; T Roemmich, Ryan", "year": "2025", "journalProceedings": "JMIR cardio", "category": "Case Study", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Heart Rate,Device Weartime", "abstract": "BACKGROUND: Wearable activity monitors offer clinicians and researchers accessible, scalable, and cost-effective tools for continuous remote monitoring of functional status. These technologies can complement traditional clinical outcome measures by providing detailed, minute-by-minute, remotely collected data on a wide array of biometrics, including physical activity and heart rate. There is significant potential for the use of these devices in rehabilitation after stroke if individuals will wear and use the devices; however, the acceptance of these devices by persons with stroke is not well understood. OBJECTIVE: This study investigated the self-reported acceptance of a commercially available, wrist-worn wearable activity monitor (the Fitbit Inspire 2; Fitbit Inc) for remote monitoring of physical activity and heart rate in persons with stroke. We also assessed relationships between reported acceptance and adherence to wearing the device. METHODS: Sixty-five participants with stroke wore a Fitbit Inspire 2 for 3 months, at which point we assessed acceptance using the Technology Acceptance Questionnaire (TAQ), which includes 7 dimensions: perceived usefulness, perceived ease of use, equipment characteristics, privacy concerns, perceived risks, facilitating conditions, and subjective norm. We then performed Spearman correlations to assess relationships between acceptance and adherence to device wear, calculated as both the percentage of daily wear time and the percentage of valid days the device was worn during the 3 weeks preceding TAQ administration. RESULTS: Most participants reported generally agreeable responses, with high overall total TAQ scores across all 7 dimensions, indicating strong acceptance of the device; \"Agree\" was the median response to 29 of the 31 TAQ statements. Participants generally found the device beneficial for their health, efficient for monitoring, easy to use and to don and doff, and unintrusive to daily life. However, participant responses on the TAQ did not show significant positive correlations with measures of actual device wear time (all P{\\textgreater}.05). CONCLUSIONS: This study demonstrates generally high self-reported acceptance of the Fitbit Inspire 2 among persons with stroke. Participants reported general agreement across all 7 TAQ dimensions, with minimal concerns interpreted as being directly relatable to poststroke motor impairment (eg, donning and doffing the device, using it independently). However, the high self-reported acceptance scores did not correlate positively with measures of real-world device wear. Accordingly, it should not be assumed that persons with stroke will adhere to wearing these devices simply because they report high acceptability.", "links": [] }, { "title": "Adherence to Accelerometer Use in Older Adults Undergoing mHealth Cardiac Rehabilitation: Secondary Analysis of a Randomized Clinical Trial", "author": "Barua, Souptik; Upadhyay, Dhairya; Pena, Stephanie; McConnell, Riley; Varghese, Ashwini; Adhikari, Samrachana; LeRoy, Erik; Schoenthaler, Antoinette; Dodson, John A.", "year": "2025", "journalProceedings": "Journal of Medical Internet Research", "category": "Intervention", "devices": "Inspire,Inspire 2", "population": "Older Adults", "dataUsed": "Steps,Intensity,Distance,Device Weartime", "abstract": "BACKGROUND: Wearable accelerometers, which continuously record physical activity metrics, are commonly used in mobile health-enabled cardiac rehabilitation (mHealth-CR). The association between adherence to accelerometer use during mHealth-CR and improvement in clinical outcomes, such as functional capacity, is understudied. The emergence of artificial intelligence (AI) technology provides novel opportunities to investigate accelerometry use patterns in relation to mHealth-CR outcomes. OBJECTIVE: In this study, we sought to use an AI clustering framework to identify distinct behavioral phenotypes of adherence to accelerometer use. We then aimed to quantify the association of these adherence phenotypes with functional capacity improvements in older adults undergoing mHealth-CR. METHODS: We analyzed data from the RESILIENT (Rehabilitation at Home Using Mobile Health in Older Adults After Hospitalization for Ischemic Heart Disease) trial, the largest randomized clinical study to date comparing mHealth-CR versus usual care in older adults (aged ≥65 years). Intervention arm participants were instructed to wear a Fitbit accelerometer for the 3-month study duration. Adherence to accelerometer use was quantified as overall adherence (percentage of days worn) via k-means clustering AI-derived measures and compared with changes in 6-minute walk distance (6-MWD), adjusted for demographic and clinical covariates. RESULTS: Among 271 participants with a mean age of 71 years (SD 8), of whom 198 (73\\%) were male, accelerometers were worn for an average of 76 days (95\\% confidence limits 73,78) over 3 months. Adjusted analyses showed a weak association between days of wear and improvement in 6-MWD, with every 30 additional days associated with an 11-meter improvement (P=.08). Our k-means clustering framework identified adherence phenotypes at two resolutions: low resolution (k=2 clusters) and high resolution (k=8 clusters). The consistently high adherence cluster trended toward a 24.6-meter improvement in 6-MWD compared to the low and declining adherence clusters (n=39; 95\\% CI 0.7-49.9; P=.06). The 8-cluster phenotyping revealed a richer set of adherence patterns, with the consistently high adherence cluster in this analysis having a 38.5-meter (95\\% CI 2.2-74.7; P=.04) improvement in 6-MWD than the low adherence cluster, as well as greater average daily steps over the 3-month intervention (mean 7518, SD 3415 vs mean 4800, SD 2920 steps; P=.008). CONCLUSIONS: A time-series AI clustering framework identified a range of behavioral phenotypes representing different degrees of adherence to accelerometer use. Regression analysis identified a weak association between the higher adherence phenotype and functional capacity improvement in older adults undergoing mHealth-CR. Our AI-derived accelerometry adherence phenotypes may offer a new approach to tailor mHealth-CR regimens to individual patients, potentially leading to better outcomes in this high-risk population. TRIAL REGISTRATION: ClinicalTrials.gov NCT03978130; https://clinicaltrials.gov/study/NCT03978130. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/32163.", "links": [] }, { "title": "Health outcomes after national acute sleep deprivation events among the American public", "author": "Kelly, Neil J.; Chaudhary, Rahul; El Khoury, Wadih; Kalepalli, Nishita; Wang, Jesse; Patel, Priya; Chan, Irene N.; Rahman, Haris; Saiyed, Aisha; Shah, Anisha N.; McClung, Colleen A.; Okawa, Satoshi; Nouraie, Seyed Mehdi; Chan, Stephen Y.", "year": "2026", "journalProceedings": "JCI insight", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Sleep", "abstract": "BACKGROUNDSleep is increasingly recognized as essential to human health, yet the adverse health consequences of acute sleep deprivation are unknown. We hypothesized that acute sleep deprivation is associated with health outcomes and modulated by sleep-associated genotypes.METHODSLocally estimated scatterplot smoothing (LOESS) was performed on sleep estimates from Fitbit users (n = 14,681) between June 1, 2016, and July 1, 2022. Dates when population minutes slept were less than the 90\\% confidence interval of the LOESS regression were named acute sleep deprivation events (ASDEs). Phenome-wide disease incidence among the All of Us Research Program population (n = 287,012) in the 10 days after ASDE was compared with a preceding reference period by McNemar's test. Circadian rhythm-associated and sleep duration-associated SNPs were screened to identify genotypes associated with shorter ASDE sleep duration. Influences of sleep and circadian genotype on post-ASDE influenza risk were modeled using binomial family generalized estimating equations.RESULTSWe identified 32 ASDEs spanning major national events. A phenome-wide screen found increased risk of influenza (odds ratio = 1.54 [1.40, 1.70], P = 1.00 × 10-18) following ASDEs. Fifty-six SNPs were associated with decreased sleep duration on ASDEs. Higher quantiles of ASDE-related SNP genotype burden were associated with less ASDE sleep duration and a greater risk of influenza-associated health care visits.CONCLUSIONMajor national events are associated with acute sleep deprivation and greater influenza risk, which is amplified by sleep genotypes. These findings should inform public health vigilance surrounding major national events.FUNDINGWoodNext Foundation; NIH grants T32HL129964, K08ES037420, R01HL124021, R01HL122596, and R01HL151228; American Heart Association grants 24SFRNCCN1276089 and 24SFRNPCN1280228; and the United Therapeutics Jenesis Innovative Research Awards, the Pulmonary Hypertension Association, the McKamish Family Foundation, the Hemophilia Center of Western Pennsylvania, and the Institute for Transfusion Medicine.", "links": [] }, { "title": "Sleep Compensation on Work-Free days Is Associated with Better Sleep Quality", "author": "Aslamyar, Diana; von Gall, Charlotte", "year": "2025", "journalProceedings": "Nature and Science of Sleep", "category": "Case Study", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "PURPOSE: Sleep of sufficient duration and quality is crucial for physical and mental health and performance. In modern urban society, work-related factors such as perceived workload and limited sleep duration on workdays appear to have a significant impact on sleep and well-being. Our current study examines both subjective and objective measures of sleep on workdays and work-free, as well as their associations. METHODS: The study combines questionnaires and longitudinal wearable (Fitbit Inspire 2) sleep data from young, healthy adults (aged 18-48 years) in a German metropolitan region (n = 67). Associations were investigated by Spearman correlation analyses with a 95\\% confidence interval. RESULTS: Perceived workload was associated with symptoms of depression/anxiety, daytime dysfunction, as well as subjective sleep quality, in particular on workdays. Sleep and sleep stages were objectively longer and later on work-free days than on work-days. Likewise, objective sleep efficiency and subjective sleep quality were higher on work-free days. Longer sleep duration, thus sleep compensation, on work-free days was associated with subjectively more restful and better sleep, and objectively with later phase and a higher proportion of REM sleep. CONCLUSION: These data suggest that work-related sleep loss should be avoided whenever possible or at least compensated for on work-free days in order to achieve not only sufficient sleep duration but also good sleep quality, which is pivotal for mental health and performance.", "links": [] }, { "title": "Rethinking measurement of movement-evoked pain with digital technology", "author": "Frumkin, Madelyn R.; Zhang, Jingwen; Xu, Ziqi; Yakdan, Salim; Benedict, Braeden; Javeed, Saad; Zhang, Justin; Botterbush, Kathleen; Goodin, Burel R.; Lu, Chenyang; Ray, Wilson Z.; Greenberg, Jacob K.", "year": "2025", "journalProceedings": "The Journal of Pain", "category": "Case Study", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps,Heart Rate", "abstract": "Movement-evoked pain (MEP) may be a useful metric for phenotyping musculoskeletal pain conditions. However, there is significant disagreement over operationalization, and no studies have assessed stability of MEP over time. Fitbit and Ecological Momentary Assessment (EMA) data were collected from adults with moderate-to-severe chronic pain schedule to receive lumbar/thoracolumbar fusion surgery (N=114). On average, participants provided 323 h of Fitbit data and 74 EMA surveys (84\\% completion rate). To mimic task-based assessment of MEP using the 6-minute walk test, EMA pain ratings completed within 3 h of walking at a speed ≥70spm for at least 6 min were extracted. Of the full sample, 91 individuals (80\\%) had any instances of pain ratings following 6-minute activity bouts (Median=6, SD=11). Post-activity pain scores exhibited good within-person consistency (ICC=.76). However, between-person differences in average pain accounted for {\\textgreater}70\\% of the variance in post-activity pain. MEP change scores defined as the difference between post-activity and pre-activity pain scores had poor reliability (ICC =.08). MEP change scores were not associated with average pain or factors related to the uncontrolled nature of digital assessment (e.g., activity amount, time from activity to pain report). However, MEP change scores tended to be lower when the preceding pain rating was elevated (β = -7.96, 95\\% Credible Interval: -9.28, -6.66), suggesting ceiling effects. Small effects of time of day and prior activity were also observed, which could contaminate MEP assessed in the lab or clinic. Continued development of digital methodologies for assessing MEP is recommended. PERSPECTIVE: Existing movement-evoked pain assessments have limitations. Post-activity pain ratings capture overall disability and day-to-day fluctuations in pain, rather than the relationship between movement and pain. Pre-to-post activity change scores had poor reliability when assessed naturalistically and over time. Digital methodologies capture movement-evoked pain continuously across time, contexts, and real-world environments.", "links": [] }, { "title": "Relationship between social determinants of health, health-related quality of life, health perceptions, and physical activity during pregnancy", "author": "Nowell, Kallie; Dlugonski, Deirdre; DeFranco, Emily; May, Linda; Hawk, Gregory S.; Hoch, Johanna M.", "year": "2025", "journalProceedings": "Women's Health (London, England)", "category": "Case Study", "devices": "Device unspecified", "population": "Pregnant Women", "dataUsed": "Steps,Heart Rate", "abstract": "BACKGROUND: Physical activity is essential to maintain the health of the mother and fetus during pregnancy; however, most pregnant women do not achieve the recommended amount. Studies have identified that social determinants of health (SDOH) may play a role in a woman's ability to participate in physical activity throughout pregnancy; however, there is little exploration of pregnant women from diverse backgrounds. Differences across SDOH influence health-related quality of life (HRQOL) and health perception, and each variable's relationship to physical activity during pregnancy requires further investigation. OBJECTIVES: Our first objective was to examine the relationship between SDOH and HRQOL variables in pregnant women. Our second objective was to compare participant physical activity levels by HRQOL, health perception, and SDOH categories in pregnant women. DESIGN: Secondary analysis. METHODS: Survey data from the National Institute of Health All of Us Research Program were utilized for this study. Demographics, SDOH, and HRQOL variables were extracted for analyses along with digital Fitbit data. HRQOL variables were analyzed for association with SDOH and demographic variables using separate one-way ANOVA. SDOH, demographic variables, and HRQOL variables were then analyzed for association with participant Fitbit data using separate one-way ANOVA. For significant associations, Tukey pairwise comparisons were performed. RESULTS: We found significant differences in health perception and quality of life across groups of SDOH and demographic variables including supportive relationships, income level, education level, and marital status. Women who reported higher HRQOL perceptions had significantly higher step counts and more very active minutes than those who reported lower HRQOL perceptions. CONCLUSIONS: SDOH are related to how pregnant women perceive their health and quality of life. Pregnant women with better health and quality-of-life perceptions are more likely to participate in more very active physical activity.", "links": [] }, { "title": "Mental Stress Assessment and Clinical Application of Wearable Devices as Evaluable Outcomes in Robotic Prostatectomy", "author": "Naiki, Taku; Mimura, Yoshihisa; Sugiyama, Yosuke; Etani, Toshiki; Nakane, Akihiro; Nagai, Takashi; Tasaki, Yoshihiko; Shimizu, Nobuhikio; Gonda, Masakazu; Aoki, Maria; Morikawa, Toshiharu; Iwatsuki, Shoichiro; Hamamoto, Shuzo; Umemoto, Yukihiro; Yasui, Takahiro", "year": "2025", "journalProceedings": "Annals of Surgical Oncology", "category": "Case Study", "devices": "Charge 2", "population": "Adults", "dataUsed": "Heart Rate", "abstract": "BACKGROUND: Because of the rapid uptake of robot-assisted radical prostatectomy (RARP), educational programs or established methods based on the skill level and mental stress of surgeons have yet to be established. This study aimed to measure physiologic stress as heart rate (HR) changes and heart rate variations (HRVs) in surgeons wearing a device during RARP. PATIENTS AND METHODS: We collected device data for 30 consecutive cases from surgeon A, relatively inexperienced in RARP, and surgeon B, experienced in over 200 cases. As a wearable device, we used Fitbit Charge 2 (Fitbit Inc., San Francisco, CA, USA). Surgical outcomes included estimated blood loss volume and robotic console time; HR changes and HRVs in each surgeon were measured. The standard deviation of NN intervals (SDNN) for HRV was calculated and cumulative sum (CUSUM) control charts used to quantitatively evaluate surgeons' learning curves. RESULTS: For surgeon A, as case numbers increased, console time was significantly reduced; maximum and average HRs were also significantly decreased. However, a trend was not observed for surgeon B. The SDNN, as a biomarker of mental stress in surgeon B, was significantly better compared with surgeon A. For surgeon A, according to an analysis using CUSUM methods, and average and maximum HRs, learning curves with regard to console time and estimated blood loss volume were similar. CONCLUSIONS: By using a wearable device, mental stress, as represented by the HRV, could be easily estimated and visualized as a surgical outcome. This affected surgeons' learning curves, including for console time and estimated blood loss volumes.", "links": [] }, { "title": "Multimodal Sensing and Modeling of Endocrine Therapy Adherence in Breast Cancer Survivors", "author": "Yuan, Fangxu; Kaur, Navreet; Wang, Zhiyuan; Gonzales, Manuel; Alcaraz, Cristian Garcia; Estrella, Gabriel; Wells, Kristen J.; Barnes, Laura E.", "year": "2025", "journalProceedings": "Proceedings of the ACM on interactive, mobile, wearable and ubiquitous technologies", "category": "Intervention", "devices": "Sense", "population": "Adults", "dataUsed": "Steps,Sleep,Heart Rate,Active Minutes/Active Zone Minutes", "abstract": "Many breast cancer survivors are prescribed daily oral medications called endocrine therapy that prevent cancer recurrence. Despite its clinical importance, maintaining consistent daily adherence remains challenging due to the dynamic and interrelated influences of behavioral, physiological, and psychological factors. While prior studies have explored adherence prediction using mobile sensing, they often rely on single-modality data, limited temporal granularity, or aggregate-level modeling-limiting their ability to capture short and long-term behavioral variability and to facilitate deeper understanding of non-adherence and tailored interventions. To address these gaps, we propose a multimodal sensing framework that explicitly models daily adherence dynamics using temporally adaptive inputs. We recruited a sample of breast cancer survivors (N = 20) and collected longitudinal data streams including wearable-derived physiological features (Fitbit), medication event monitoring system (MEMS) data, and ecological momentary assessments (EMAs). Using multimodal data across varying time windows, we examined whether recent patterns in behavioral, physiological, psychological, and environmental factors improve the prediction of next-day endocrine therapy adherence. Our results demonstrate the feasibility of using multimodal sensing data to predict daily adherence with moderate accuracy. Moreover, models integrating multimodal data consistently outperformed those relying on a single modality. Importantly, we observed that the predictive value of each modality varied depending on the temporal proximity of the input signals, underscoring the importance of modeling immediate and longer-term behavioral patterns. The findings offer valuable insights for advancing adherence monitoring systems, suggesting that incorporating personalized and temporally adaptive data fusion strategies may significantly enhance the effectiveness of intervention design and delivery.", "links": [] }, { "title": "Evening preference with evening-type rest-activity rhythm: a risk for poor quality of life", "author": "Mun, Sujeong; Kim, Jeong-Kyun; Baek, Younghwa; Park, Kihyun; Lee, Siwoo", "year": "2025", "journalProceedings": "Health and Quality of Life Outcomes", "category": "Case Study", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Chronotype reflects an individual’s intrinsic preference for the timing of activity and rest; however, perceived circadian preference may differ from actual behavioral rhythms due to external demands. Both chronotype and rest–activity rhythm have been linked to adverse health outcomes, but their combined association with health-related quality of life (HRQoL) has been less explored. This study investigated how combinations of circadian preference and objectively measured rest–activity timing relate to HRQoL. METHODS: We analyzed data from the Korean Medicine Daejeon Citizen Cohort, including participants who wore a Fitbit for ≥ 7 consecutive days. Chronotype was determined from the Morningness–Eveningness Questionnaire score quintiles, and rest–activity rhythm type from quintiles of the 5-h lowest activity period (L5 start time). Participants in intermediate quintiles were excluded. Four chronotype–rhythm groups were defined: MM (morning preference/morning rhythm), ME (morning preference/evening rhythm), EM (evening preference/morning rhythm), and EE (evening preference/evening rhythm). HRQoL was assessed using the SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS), the EQ-5D index, and the EQ Visual Analog Scale (VAS). Multiple linear and logistic regression analyses were conducted, adjusting for sociodemographic, lifestyle, and circadian rhythm variables. RESULTS: In total, 458 adults were included in the analysis. Compared with the MM group, the EE group had significantly lower scores for PCS, MCS, EQ-5D index, and EQ VAS (all P {\\textless} 0.05), which persisted after full adjustment. The EM group had lower MCS but no significant differences in other HRQoL measures. In SF-12 subscales, both EM and EE groups reported lower general health and vitality, while only the EE group had lower role-physical and role-emotional scores. In EQ-5D dimensions, the EE group was more likely to report moderate to extreme pain/discomfort. CONCLUSIONS: Evening preference combined with an evening-type rhythm was associated with consistently poor HRQoL across physical, mental, and health utility domains, independent of confounders including activity levels, circadian robustness, social jetlag, and variability in sleep onset timing. Alignment between preference and rhythm did not confer benefit in the context of eveningness and may be disadvantageous in morning-oriented societies. Future longitudinal studies should examine underlying mechanisms and potential intervention strategies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12955-025-02463-y.", "links": [] }, { "title": "Characterizing proximal risk for depressive symptoms and suicidal ideation with acute cannabis use and withdrawal among adolescents using ecological momentary assessment: Study protocol", "author": "Feibus, Isabella; Mahiques, Marta Borrego; Costello, Meghan; Potter, Kevin; Bentley, Kate H.; Hoeppner, Bettina B.; Liu, Luwei; Evohr, Bryn; Yan, Lynn; Gilman, Jodi; Evins, A. Eden; Kossowsky, Joe; Schuster, Randi M.", "year": "2025", "journalProceedings": "PloS One", "category": "Case Study", "devices": "Inspire 3", "population": "Adolescents", "dataUsed": "Steps,Sleep", "abstract": "BACKGROUND: Heavy cannabis use often co-occurs with symptoms of depression in adolescents. Adolescents with past-year cannabis use are at increased risk of major depressive episodes and cannabis use is more than twice as common in adolescents with depression compared to those without. This study seeks to disentangle relationships between acute cannabis use, withdrawal, and abstinence on proximal depression and suicide risk using ecological momentary assessment (EMA) within the context of a randomized controlled trial comparing the effects of cannabis abstinence to cannabis use as usual. METHODS: This study will enroll 200 adolescents aged 12-18 who have daily or near-daily cannabis use and current depressive symptoms. Participants will complete 12 study visits over a 10-week period. At visit 2, participants will be randomized (1:1) to either 8 weeks of sustained cannabis abstinence encouraged through contingency management (CB-Abst) or a monitoring control group (CB-Mon). All participants will complete self-report and interview-based measures of substance use and symptom severity, along with 3 phases of EMA data collection (4 total weeks), involving 8 daily surveys that inquire about past-hour substance use, mood, and situational context. Phases will take place during baseline cannabis use, immediately after randomized abstinence, and following 8 weeks of sustained abstinence. The primary outcomes will be EMA-measured depressive symptoms and suicidal ideation across the 3 EMA phases, by randomized group. Exploratory outcomes will include Fitbit-derived measures of sleep, circadian rhythms, and step count. DISCUSSION: This is the first study, to our knowledge, to evaluate the acute effects of cannabis use, withdrawal, and sustained abstinence on mood among adolescents with heavy cannabis use and co-morbid symptoms of depression. Results will characterize periods of risk for fluctuations in mood and suicidal ideation across the withdrawal period and aim to guide intervention development to reduce depression and suicide risk among adolescents. TRIAL REGISTRATION: ClinicalTrials.gov NCT06576076.", "links": [] }, { "title": "A Multiple Technology-Based Physical Activity Intervention for Latina Adolescents: Results From the Chicas Fuertes Randomized Controlled Trial", "author": "Carson, Jacob R.; Greenstadt, Emily; Olivera, Brittany; Dunsiger, Shira; Zive, Michelle; Higgins, Michael; Godino, Job; Marcus, Bess; Meyer, Dawn; Larsen, Britta", "year": "2025", "journalProceedings": "JMIR mHealth and uHealth", "category": "Intervention", "devices": "Inspire HR", "population": "Adolescents", "dataUsed": "Steps,Intensity,Heart Rate", "abstract": "BACKGROUND: Latina adolescents report low levels of moderate-vigorous physical activity (MVPA) and high lifetime risk of lifestyle-related diseases. There is a lack of MVPA interventions targeted at this demographic despite documented health disparities. Given their high rates of mobile technology use, interventions delivered through mobile devices may be effective for this population. OBJECTIVE: This paper examines the efficacy of the Chicas Fuertes intervention in increasing MVPA across 6 months in Latina adolescents. METHODS: Participants were Latina adolescents (aged 13-18 years) in San Diego County who reported being underactive ({\\textless}150 min/wk of MVPA). All participants received a wearable fitness tracker (Fitbit Inspire HR); half were randomly assigned to also receive the multimedia intervention. Intervention components included a personally tailored website, personalized texting based on Fitbit data, and social media. The primary outcome was change in minutes of weekly MVPA from baseline to 6 months, measured by ActiGraph accelerometers and the 7-Day Physical Activity Recall Interview. Changes in daily steps using Fitbit devices were also examined to test intervention efficacy. RESULTS: Participants (N=160) were 15.85 (SD 1.71) years old on average, and mostly second generation in the United States. For ActiGraph-measured MVPA, participants in the intervention group (n=83) increased from a median of 0 (IQR 0-24) minutes/week at baseline to 64 (IQR 19-72) minutes/week at 6 months compared to control participants, who showed increases from a median of 0 (IQR 0-26) at baseline to 41 (IQR 7-76) minutes/week at 6 months (P=.04). Self-reported MVPA increased in the intervention group from a median of 119 (IQR 62.5-185) minutes/week at baseline to 147 (IQR 96-181) minutes/week at 6 months compared to control participants, who showed increases from a median of 120 (IQR 48.8-235) at baseline to 124 (IQR 100-169) minutes/week at 6 months (P=.03). Steps also increased in both groups, with the intervention group showing significantly greater increases (P=.03). CONCLUSIONS: This intervention was successful in using a tailored technology-based strategy to increase MVPA in Latina adolescents and provides a promising approach for addressing a key health behavior. Given the scalable technology used, future studies should focus on broad-scale dissemination to address health disparities.", "links": [] }, { "title": "Real-Time and Long-Term Effects of Medical Marijuana on Older Adults: Protocol for the Study on Medical Marijuana and its Long-Term Effects (the SMILE study) Prospective Cohort", "author": "Robinson, Kendall R.; Seeger, Stella D.; Nave, Lauren; Mejia, Marlin; Vander Meulen, Maria; Rashid, Ahmed; Mickle, Angela M.; Sibille, Kimberly; Li, Zhigang; Przkora, Rene; Schmidt, Siegfried; Lo, Margaret C.; Cook, Robert L.; Wang, Yan", "year": "2025", "journalProceedings": "JMIR research protocols", "category": "Case Study", "devices": "Charge 5,Charge 6", "population": "Older Adults", "dataUsed": "Steps,Sleep,Heart Rate", "abstract": "BACKGROUND: Older adults represent the fastest-growing group of medical marijuana (MM) users in the United States, with chronic pain being the most common reason for use. Despite this trend, scientific evidence remains limited regarding the short- and long-term effects of MM on critical health outcomes, including cognitive function, physical and mental health, and overall quality of life in this population. To better inform clinical practice and public policy, there is a clear need for more rigorous, longitudinal studies that examine the impact of real-world MM products over time. OBJECTIVE: The Study on Medical Marijuana and Its Long-Term Effects on Older Adults (SMILE) is a prospective cohort study that aims to 1) determine MM's short- and long-term effects on pain, physical, emotional, and cognitive functioning, and quality of life in older adults; and 2) identify MM product characteristics and patient subgroups associated with improved outcomes and side effects. METHODS: This study will recruit and follow 440 older adults (50 years or older, {\\textasciitilde}50\\% {\\textgreater}65, {\\textasciitilde}50\\% male) with chronic pain for 12 months, as some initiate MM (MM group, n=330) and others do not (comparison group, n=110). Data collection included quarterly survey questionnaires (focusing longitudinal changes in cannabis use, pain, physical and emotional functioning, side effects, and quality of life); baseline and 12-month cognitive assessments, pain sensory tests, and blood/urine samples for cannabis use; and periodic smartphone- and Fitbit sensor-based measurements to capture detailed MM use patterns, real-time pain, mental health, and objective data on physical activity and sleep. Data will be analyzed using descriptive analyses, generalized linear mixed effects models, and generalized estimating equations models to assess differences in short- and long-term effects between the MM and comparison groups, and subgroups among those initiating MM treatment. RESULTS: Recruitment for the SMILE study began in July 2022 and all data collection is expected to be completed by 2026. As of October 2025, we enrolled 399 participants, with 277 in the MM group and 122 in the comparison group. Data analysis is currently underway, and results are expected to be published starting in 2027. CONCLUSIONS: With multisource data collected in real-time and over 12 months, our study will provide much-needed scientific evidence addressing: 1) whether MM can reduce pain and improve physical and emotional functioning in the short term among older adults; 2) whether effects of MM last for 12 months and demonstrate changes in quality of life or cognition; and 3) whether health benefits and consequences differ by MM product type and whether individual differences (e.g. sex, baseline pain phenotyping) moderate the relationship. Our findings will offer valuable insights for physicians and patients when considering MM as a treatment option, and will help guide more informed, individualized care decisions.", "links": [] }, { "title": "Older breast cancer survivors' exercise and support group program experiences and recommendations from the IMPROVE trial: a qualitative study", "author": "Hundal, Jasmin; Williams, Dionne; Nock, Nora L.; Austin, Kristina; Bennet, Elizabeth; Cerne, Stephen; Moore, Halle C. F.; Petkac, Jean; Schmitz, Kathryn H.; Berger, Nathan A.; Owusu, Cynthia", "year": "2026", "journalProceedings": "BMC cancer", "category": "Intervention", "devices": "Blaze", "population": "Older Adults", "dataUsed": "User Friendliness", "abstract": "BACKGROUND: Physical activity is critical for older breast cancer survivors. We explored the experiences and recommendations of older breast cancer survivors from the IMPROVE trial, including a sizable number of older African American and socioeconomically disadvantaged survivors, to inform future implementation and dissemination of sustainable programs. METHODS: Participants included women, ≥ 65 years, within five years of treatment completion for stage I-III breast cancer who were enrolled into a randomized controlled trial of supervised group moderate-intensity exercise for 20-weeks followed by 32 weeks of unsupervised exercise versus support group (SG) plus Fitbit intervention. Semi-structured exit interviews were conducted at study completion. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis with constant comparison. Two researchers independently coded transcripts, discussing discrepancies to enrich interpretation. The Social Cognitive Theory and the Transtheoretical Model guided interpretation of results. RESULTS: Between 2016 and 2020, 213 older breast cancer survivors were randomized into the exercise arm, (n = 108) or a SG + Fitbit arm, (n = 105). At study completion, 145 (68\\%) opted to participate in exit interviews. This included 75 Exercise and 70 Support Group participants. Participants described a range of experiences and recommendations that clustered into five broad themes: program experiences, transition challenges, Fitbit experiences, program impact, and recommendations. Survivors consistently highlighted camaraderie, peer bonding, and accountability as central benefits of participation, with enjoyment of activities and staff support further enriching their experience. Many described difficulties sustaining activity after program completion, underscoring the need for ongoing group-based support. Experiences with Fitbit were mixed: some found it motivating, while others reported technical barriers. Survivors also noted increased energy, health awareness, and reduced isolation. Recommendations included extending program duration, adding nutrition content, reducing survey burden, and addressing transportation challenges. CONCLUSION: Older breast cancer survivors, including those underrepresented in survivorship research, emphasized the importance of social support, structured exercise, and wearable technology in sustaining physical activity. Their recommendations highlight strategies for tailoring future interventions to enhance accessibility, sustainability, and long-term impact. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02763228.", "links": [] }, { "title": "Heat-Treated Limosilactobacillus fermentum PS150 Improves Sleep Quality with Severity-Dependent Benefits: A Randomized, Placebo-Controlled Trial", "author": "Lee, Mon-Chien; Chen, Chao-Yuan; Chen, Ching-Yun; Huang, Chi-Chang", "year": "2025", "journalProceedings": "Nutrients", "category": "Case Study", "devices": "Inspire 3", "population": "Adults", "dataUsed": "Sleep", "abstract": "Background: Insomnia is prevalent and difficult to treat safely over the long term. Given the role of the microbiota-gut-brain axis in melatonin and hypothalamic-pituitary-adrenal (HPA) regulation, and preclinical evidence for Limosilactobacillus fermentum PS150, we evaluated whether a heat-treated formulation (HT-PS150) could improve sleep and modulate endocrine/circadian markers in adults with poor sleep. Methods: In a randomized, double-blind, placebo-controlled trial, 84 adults aged 20-60 years with PSQI ≥ 5 and ISI {\\textless} 22 were assigned to receive either placebo or HT-PS150 for eight weeks. Outcomes included patient-reported sleep (PSQI, ISI), anxiety/depression (GAD-7, PHQ-9), quality of life (QLESQ-SF), gastrointestinal symptoms (VAS-GI), wrist actigraphy (Fitbit Inspire 3), and sleep-relevant biomarkers measured from urine, saliva, and/or blood samples (melatonin, cortisol, orexin, serotonin, GABA, and/or norepinephrine). Repeated measures were analyzed using generalized estimating equations. An exploratory proportional regulation analysis classified individual biomarker changes as up- or down-regulated and compared proportions between study arms. Per-protocol analyses required ≥80\\% compliance. Results: Improvements in the primary outcomes, PSQI and ISI, were observed over time in both groups, while no significant group × time interactions were detected. In exploratory proportional analyses, a higher proportion of participants in the HT-PS150 group exhibited up-regulated nocturnal melatonin secretion and improved daytime plasma orexin levels, as well as a tendency toward greater reductions in nocturnal salivary cortisol compared with placebo. In subgroup analyses with higher baseline insomnia severity (ISI ≥ 8), HT-PS150 was associated with greater improvements in PSQI (notably sleep duration and efficiency) and reduction in anxiety (GAD-7) upon post hoc testing. Conclusions: Although group mean scores on sleep symptom scales did not differ significantly in the full cohort, HT-PS150 appeared to modulate sleep-wake regulation by enhancing nocturnal melatonin secretion, attenuating HPA-axis activity, and stabilizing wakefulness. Clinical benefits were most evident among participants with greater baseline symptom burden, suggesting potential utility in more symptomatic populations.", "links": [] }, { "title": "Using Step Trackers Among Older People Receiving Aged Care Services Is Feasible and Acceptable: A Mixed-Methods Study", "author": "Dawson, Rik; Kay, Judy; Cameron, Lauren; Bucalon, Bernard; Sherrington, Catherine; Haynes, Abby", "year": "2025", "journalProceedings": "Healthcare", "category": "Usability", "devices": "Inspire 3", "population": "Older Adults", "dataUsed": "Steps,User Friendliness", "abstract": "Background: Maintaining physical activity (PA) is vital for older people, particularly those with frailty and mobility limitations. Wearable activity trackers and digital feedback tools show promise for encouraging PA, but their feasibility and acceptability in aged care remain underexplored. This study evaluated the feasibility and acceptability of using wearable and mobile devices for step tracking and examined the usability of three interfaces (Fitbit, mobile app, and website) for reviewing PA progress in aged care. Methods: This is a user experience and feasibility study that does not involve objective physical activity quantification or device performance analysis. It is a mixed-methods feasibility study conducted with 14 participants aged ≥65 years from residential and community aged care services in metropolitan and regional New South Wales, Australia. Participants used a Fitbit Inspire 3 linked to a study website and a mobile phone step-counting app to monitor their steps across the three interfaces for four weeks. Feasibility was evaluated through enrolment and retention, and acceptability through a facilitator-led survey. Quantitative items on usability, comfort, motivation and device preference were summarised descriptively; open-ended responses were analysed thematically to identify user experiences, benefits, and barriers. Results: Step tracking was feasible, with 82\\% enrolment and 93\\% retention. Participants preferred the Fitbit over the mobile phone or website due to its ease of use, visibility and more enjoyable experience. Step tracking increased awareness of PA and supported confidence to move more. Participants valued reminders, rewards and opportunities for social sharing. Reported barriers included illness, usability challenges and occasional technical issues. Conclusions: Wearable step trackers show promise for supporting PA among older people receiving aged care. Despite the small sample and short follow-up, strong acceptability signals suggest that simple digital tools could enhance the reach and sustainability of mobility-promoting interventions into aged care systems. Future studies should examine long-term adherence, usability across diverse mobility and cognitive needs, and conditions for successful scale-up.", "links": [] }, { "title": "Dog Owners Exhibit Better Diet Quality but Similar Physical Activity Compared to Non-Owners: A Case-Control Study", "author": "Margaritis, Konstantinos Lazaridis; Perantonaki, Marilena; Pyrga, Katerina; Pardali, Eleni C.; Poulimeneas, Dimitrios; Goulis, Dimitrios G.; Tsigga, Maria; Grammatikopoulou, Maria G.", "year": "2025", "journalProceedings": "Nutrients", "category": "Case Study", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "Introduction: \"The dog is a man's best friend\" and research has showed that this idea is extended beyond the degree of loyalty. Dog ownership has been linked to several positive health outcomes for the owner. The aim of the present cross-sectional case-control study was to assess differences in the physical activity level (PAL), body composition, quality of life (QoL), and diet quality and dietary knowledge between dog owners and non-owners. Methods: A total of 55 dog owners and an equal amount of non-dog owners (all aged between 18 and 60 years old) formed the case and control groups, respectively. Basic anthropometric measurements were performed, including body fat (BF) and diet, assessed with the Mediterranean Diet Score (MedDietScore) and the Eating Assessment Table (EAT). Physical activity was recorded for 3 consecutive days using activity monitors. QoL was evaluated using the brief version of the World Health Organization QoL (WHOQOL-BREF) tool. Results: The two groups demonstrated a similar PAL, but lower BF\\% (p = 0.009), hip circumference (p {\\textless} 0.001), triceps (p = 0.012), and subscapular skinfolds (p = 0.003) were recorded among dog owners. The EAT score was greater among dog owners (p = 0.0023), indicating improved dietary intake and knowledge, even after adjustment for education attained and BMI (p = 0.026). On the other hand, greater adherence to the Mediterranean diet was exhibited among those not having dogs (p = 0.018). Regarding dog measurements and their owners' anthropometry, dog neck circumference was negatively correlated to the owners' biceps and triceps skinfolds (r = -0.327, p = 0.016; r = -0.320, p = 0.018, respectively). Additionally, dog breed size was negatively correlated to the owners' triceps skinfold (r = -0.325, p = 0.015), sum of skinfolds (r = -0.311, p = 0.021), hip circumference (r = -0.341, p = 0.011), body fat (r = -0.357, p = 0.007), and fat mass index (r = -0.307, p = 0.023). Conclusions: Dog ownership is associated with improved body composition and smaller skinfold thickness at specific body sites, as well as with a more health-conscious lifestyle, including better diet quality and knowledge.", "links": [] }, { "title": "Effects of a 90-Min Nap on Time-Motion Metrics and Psychophysiological Responses During Small-Sided Games in Professional Soccer Players", "author": "Kerkeni, Mohamed; Boukhris, Omar; Kerkeni, Manel; Ammar, Achraf; Husain, Waqar; Zmijewski, Piotr; Jahrami, Haitham; Chtourou, Hamdi; Trabelsi, Khaled", "year": "2026", "journalProceedings": "Scandinavian Journal of Medicine \\& Science in Sports", "category": "Case Study", "devices": "Charge 6", "population": "Adults", "dataUsed": "Sleep", "abstract": "This study investigated the impact of a 90-min nap (N90) on time-motion metrics and psychophysiological responses during small-sided games (SSGs) in soccer players. In a within-subjects counterbalanced design, 15 professional male soccer players (mean ± SD; age: 22.4 ± 1.2 years; stature: 178 ± 9 cm; body mass: 70.1 ± 4.0 kg; estimated VO2max: 55.9 ± 2.8 mL·min-1·kg-1) completed two SSGs sessions under N90 and no-nap (N0) conditions. N90 was monitored using a Fitbit Charge 6 wristband. Daytime sleepiness was assessed pre- and post-nap. Mood states, the wellness status (Hooper index), and cognitive performance (Go/NoGo task) were evaluated before each SSGs session. Time-motion metrics, obtained via the FieldWiz GPS system, along with exercise heart rate (HR), were continuously monitored throughout the SSGs. Blood lactate concentration ([La]) and ratings of perceived exertion (RPE) were assessed post-SSGs. Compared to N0, the N90 condition resulted in a significantly greater total distance covered during SSGs (p = 0.002, Cohen's {\\textbar}d{\\textbar} = 0.96), lower presession resting HR (p {\\textless} 0.001, {\\textbar}d{\\textbar} = 1.33), and reduced relative exercise HR (p = 0.03, {\\textbar}d{\\textbar} = 0.33). Additionally, post-SSGs [La] and RPE were lower following N90 (p = 0.015, {\\textbar}d{\\textbar} = 0.71 and p = 0.001, {\\textbar}d{\\textbar} = 1.03 respectively). The N90 also led to higher vigor scores (p = 0.003, {\\textbar}d{\\textbar} = 1.01), lower Hooper index values (p = 0.02, {\\textbar}d{\\textbar} = 0.59), and faster reaction time (p = 0.02, {\\textbar}r{\\textbar} = 0.60) than N0. A 90-min nap before SSGs training increased total distance covered, reduced perceived fatigue, and enhanced mood, wellness, and cognitive alertness. These findings support implementing a 90-min nap as a practical ergogenic aid to optimize recovery status, performance, cognitive alertness and overall well-being in professional soccer players.", "links": [] }, { "title": "Addressing Low Physical Activity in COPD: The Importance of Patients' Symptom Perception", "author": "Zo, Sungmin; Kang, Danbee; Kong, Sung A.; Shin, Sun Hye; Lee, Jiseon; Do, Jong Geol; Park, Hye Yun", "year": "2025", "journalProceedings": "Tuberculosis and Respiratory Diseases", "category": "Case Study", "devices": "Charge 4", "population": "Patients", "dataUsed": "Steps,Intensity", "abstract": "The importance of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) is well established, but improving adherence remains a challenge, particularly among patients with low physical activity (PA) despite adequate physical capacity (PC). This prospective study categorized COPD patients into 'Do do' (≥30 min/day moderate-to-vigorous PA [MVPA]) and 'Don't do' ({\\textless}30 min/day MVPA) groups using Fitbit data. Baseline characteristics, pulmonary function, exercise capacity, and patient-reported outcomes (PROs)-including the mMRC, COPD Assessment Test (CAT) and Patient Health Questionnaire-9 (PHQ-9)-were assessed. Factors associated with low PA were identified by logistic regression analysis. Among the 96 patients, 44 were in the 'Do do' group and 52 in the 'Don't do' group. 'Don't do' group exhibited significantly lower 6-minute walk distance (6MWD, 424m vs. 488m, p = 0.005) and reduced pulmonary function (FEV1: 46.73\\% vs. 54.48\\%, p = 0.005), as expected. However, PRO analysis revealed that the 'Don't do' group had higher dyspnea scores (mMRC: 1.77 vs. 1.30, p = 0.019) and greater breathlessness on the CAT (OR 1.31, 95\\% CI 1.06-1.62), even after adjusting for 6MWD and pulmonary function. This trend persisted in the 'Can do' subgroup with high PC, indicating that dyspnea remains a major barrier to PA despite preserved PC. Low PA in COPD patients is influenced not only by PC but also by subjective symptoms such as breathlessness and fatigue. These findings highlight the importance of integrating PROs into PR assessments to identify barriers and enhance adherence. Addressing symptom burden through targeted interventions may improve PA engagement and optimize PR outcomes.", "links": [] }, { "title": "Predicting Incident Type 2 Diabetes Using Wearable Activity and Polygenic Risk: A Survival-Modeling Study in All of Us", "author": "Rahman, Md Hafizur; Arian, Ash; Konda, Sreenivas; McGuinn, Laura A.; Islam, Humayera; Chowdhury, Muhammad Ashique Haider; Shahriar, Mohammad Hasan; Rayna, Shahrin Emdad; Farzana, Shahla; Tasmin, Saira; Manna, Ridwana Maher; Haider, Mohammad Rifat; Ahsan, Habibul", "year": "2025", "journalProceedings": "The Journal of Clinical Endocrinology and Metabolism", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Evidence is limited on whether daily step counts are uniform across individuals or whether combining them with genetic risk improves prediction of type 2 diabetes (T2D), both essential for precision prevention. We aimed to assess whether objectively measured daily step count and Polygenic Risk Score (PRS) predict the incidence of T2D, and to evaluate the predictive performance of machine-learning models. METHODS: We conducted a prospective cohort study of 4,589 adults in the NIH All of Us Research Program with valid Fitbit step data and whole-genome-derived PRS, excluding individuals with T2D before or within a 180-day lead-in period. Incident T2D was defined by HbA1c ≥6.5\\%, plasma glucose ≥126 mg/dL, or an All of Us T2D condition record. We evaluated Cox and machine-learning survival models. FINDINGS: Over a median of 2.92 years (15,340 person-years), 265 participants developed T2D (5.77\\% cumulative incidence; 17.27 per 1,000 person-years). Risk-reducing thresholds were ∼7,000 steps/day (p{\\textless}0.001) but differed by PRS group (∼7,800 high vs ∼5,800 low; p{\\textless}0.001). Each additional 1,000 steps/day was associated with lower T2D risk (aHR 0.83, 95\\% CI 0.79-0.88; p{\\textless}0.005), whereas each 1-SD higher PRS was associated with higher T2D risk (aHR 2.62, 2.32-2.96; p{\\textless}0.005). Adding steps to a clinical model increased the C-index from 0.748 to 0.774; adding PRS increased it to 0.867. Penalized Cox achieved the highest discrimination (C-index 0.859), followed by survival SVM (0.85) and classical Cox (0.846). Calibration was best with Random Survival Forests. INTERPRETATION: Step-count thresholds for reducing T2D risk varied across genetic risk groups, indicating that step counts do not confer uniform protection. Step counts and PRS provided independent, complementary predictive information, and their combination improved prediction of incident T2D.", "links": [] }, { "title": "¡Mi Vida Saludable!: Results of a Randomized, Controlled, 2x2 Factorial Trial of an In-Person and eHealth Diet and Physical Activity Intervention in Latina Breast Cancer Survivors", "author": "Greenlee, Heather; Santiago-Torres, Margarita; Contento, Isobel; Koch, Pamela A.; Rillamas-Sun, Eileen; Gray, Heewon L.; Brickman, Adam M.; Ogden Gaffney, Ann; Thomson, Cynthia A.; Crane, Tracy E.; Dominguez, Naxielly; Sepulveda, Jhack; Marín-Chollom, Amanda M.; Paul, Rachel; Shi, Zaixing; Ulanday, Kathleene T.; Accordino, Melissa; Camacho, Fernando J.; Crew, Katherine D.; Kalinsky, Kevin; Taback, Brett; Trivedi, Meghna S.; Hale, Christiane; Reaves, Brieyona; Beauchemin, Melissa P.; Castellano, Marisol; Fuentes, Yanette; Eddy, Martha; Bella, Ana Leon; Meisner, Allison; Hershman, Dawn L.", "year": "2025", "journalProceedings": "Journal of the Academy of Nutrition and Dietetics", "category": "Intervention", "devices": "Zip", "population": "Adults", "dataUsed": "Steps", "abstract": "BACKGROUND: Latina breast cancer (BC) survivors experience health disparities. Effective lifestyle interventions are sparse. OBJECTIVE: This trial tested the effectiveness of a culturally-tailored diet and physical activity (PA) intervention in Latina BC survivors. DESIGN: Using a 2x2 factorial design, women were randomized to receive: 1) 4 weekly in-person group sessions, 2) 11 months of eHealth communications, 3) in-person sessions and eHealth, or 4) control. Follow-up data were collected at months 6 and 12. PARTICIPANTS/SETTING: Eligibility criteria were self-identification as Latina, post-treatment for early-stage BC, and consuming {\\textless}5 daily servings of fruits and vegetables (F/V) and/or engaging in {\\textless}150 minutes/week of moderate-to-vigorous PA (MVPA). A total 167 women from New York City were enrolled from July 2016 to October 2018 with 93.4\\% retention at 12-month follow-up (n=156). INTERVENTION: All participants received a Fitbit and one 1:1 health coaching session. In-person group sessions included nutrition and PA education, cooking classes, fitness classes or grocery store visit, and social activities. The eHealth communications included motivational text messaging, emailed newsletters, and study website access. Activities were conducted in Spanish and English. MAIN OUTCOME MEASURES: Primary outcomes were 12-month change in F/V servings/day and energy density of food. Secondary outcomes were 12-month change in MVPA and anthropometry. STATISTICAL ANALYSIS: Outcomes comparing intervention arms with the control were examined using generalized estimating equations. RESULTS: At baseline (n=167), mean age was 56.7 years; 82.3\\% had overweight/obesity. At month 12, daily F/V intake for women in the in-person sessions increased by 10\\% and decreased by 44\\% for women in the control, a +96\\% group difference (p=0.01); no other between-group differences were observed. At month 12, women in the control had a 53\\% increase in minutes/week of MVPA while women in the in-person plus eHealth group had a 34\\% decrease, a -57\\% group difference (p=0.01); no other between-group differences were noted. No changes in energy density or weight between groups were observed. CONCLUSION: Women randomized to the in-person ¡Mi Vida Saludable! classes modestly increased F/V intake at 12 months relative to control. Those receiving eHealth communication did not have diet, MVPA, or weight change. More research is needed to understand how to support Latina BC survivors make sustained diet and PA changes.", "links": [] }, { "title": "Association of chronic disease risk and physical activity measured by wearable devices in the All of Us program", "author": "Hou, Yu; Cui, Erjia; Lim, Kelvin; Chow, Lisa S.; Howell, Michael; Ikramuddin, Sayeed; Zhang, Rui", "year": "2026", "journalProceedings": "Communications Medicine", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Intensity,Heart Rate", "abstract": "BACKGROUND: Physical activity plays an important role in preventing chronic diseases, but most studies rely on self-reported or short-term data that fail to capture habitual behavior. This study utilizes Fitbit data to investigate the relationship between physical activity and various chronic diseases. METHODS: We analyzed data from 22,019 participants in the All of Us Research Program who shared at least six months of Fitbit activity data linked with electronic health records. Various physical activity patterns were evaluated using Cox proportional hazards and logistic regression models, adjusting for age, sex, and body mass index (BMI). To test robustness, sensitivity analyses were conducted using obesity defined by BMI, applying a two-year exclusion window for outcome diagnoses to mitigate potential reverse causation, and incorporating lifestyle covariates (smoking and alcohol use) under a simplified directed acyclic graph (DAG) framework to address residual confounding. RESULTS: Here, we show that higher physical activity levels are associated with lower risks of multiple chronic conditions. Higher daily step counts were negatively associated with obesity and type 2 diabetes, while greater elevation gains and longer vigorous activity are associated with lower risks of conditions such as morbid obesity, obstructive sleep apnea, and major depressive disorder. All sensitivity analyses yield consistent results, supporting the robustness of findings against reverse causation and lifestyle confounding. CONCLUSIONS: Higher physical activity and lower sedentary time may help prevent diverse chronic diseases. These findings demonstrate the potential of large-scale wearable data to inform personalized prevention and population health strategies.", "links": [] }, { "title": "Concurrent associations between visit-to-visit changes in actigraphy-based physical activity and cognitive aging in older adults", "author": "Shankar, Ranjani P.; Saloner, Rowan; Chen, Coty; Cadwallader, Claire; VandeBunte, Anna M.; Diaz, Valentina; Callies, Lana; Lo, Carina; Licata, Sophia; Buxton, Jessica; Pham, Albert; Olzinski, Molly; Cobigo, Yann; Staffaroni, Adam M.; Rabinovici, Gil D.; Kramer, Joel H.; Casaletto, Kaitlin B.; Paolillo, Emily W.", "year": "2026", "journalProceedings": "Neurobiology of Aging", "category": "Case Study", "devices": "Flex 2,Inspire 2", "population": "Older Adults", "dataUsed": "Steps", "abstract": "Physical activity (PA) is associated with lower dementia risk, yet few studies examine objectively measured PA with concurrently measured brain and cognitive aging outcomes longitudinally, leaving a gap in knowledge regarding temporality of these brain-behavior associations. We examined how longitudinal within-person changes in average daily step count track with changes in memory, executive function, hippocampal volumes, white matter hyperintensities (WMH), and depressive symptoms over time. 107 older adults completed neuropsychological testing and brain magnetic resonance imaging, followed by 30-day Fitbit monitoring at two or more annual study visits at the UCSF Memory and Aging Center. Linear mixed-effects models examined each brain health outcome as a function of visit-to-visit PA, time (years since baseline), baseline age, sex, education, and total intracranial volume (neuroimaging models only). Within-person increases in daily step count were most strongly associated with within-person increases in executive functioning (Std. β = 0.128, 95 \\%CI [0.056, 0.200], p ≤ 0.001) and decreases in depressive symptoms (Std. β = -0.201, 95 \\%CI [-0.284, -0.119], p ≤ 0.001). Longitudinal PA associations with memory, hippocampal volumes, and WMH did not reach statistical significance. Findings suggest that within-person changes in PA may reduce real-time risk of cognitive decline; additionally, real-world monitoring of movement via actigraphy may be sensitive to early and subtle aspects of neurobehavioral declines with aging.", "links": [] }, { "title": "Analysis of influencing factors of sleep quality in severe trauma patients without continuous sedation", "author": "Jin, Yue; Wang, Shuya", "year": "2025", "journalProceedings": "Frontiers in Medicine", "category": "Case Study", "devices": "Charge 2", "population": "Patients", "dataUsed": "Sleep,Heart Rate", "abstract": "AIM: Sleep disorders are very common and serious among trauma patients, particularly in those with severe trauma, and have a negative impact on patients' physiological functioning. This study aimed to explore the status and influencing factors of sleep quality in severe trauma patients receiving non-continuous sedation. METHODS: The prospective observational study was conducted in our hospital. A total of 139 patients receiving non-continuous sedation for severe trauma were selected as the research objectives. Objective: Sleep quality was continuously monitored for seven consecutive nights using the Fitbit Charge 2 to measure total sleep time (TST), while subjective sleep quality was assessed each morning using the Richards-Campbell Sleep Questionnaire (RCSQ). Demographical, clinical, environmental, and psychosocial variables were collected concurrently. Univariate and multiple linear regression analyses were performed to identify the predictors of sleep quality at different time points. RESULTS: The average nighttime TST among the participants was 299.76 ± 85.22 min, and the mean RCSQ score was 51.38 ± 13.67, indicating generally poor sleep quality. Both objective and subjective sleep measures were poorest on day 1 and showed gradual improvement through day 7. Multivariate regression analyses identified several major predictors of reduced sleep quality, including pain intensity, thirst severity, environmental noise and light levels, ward temperature, pre-admission sleep status, trauma site (limbs), anxiety level, duration of visits, use of sleep aids, and the frequency of night-time non-invasive procedures. CONCLUSION: Severe trauma patients without continuous sedation experience markedly impaired sleep during the early post-injury period, with gradual improvement over time but persistent effects from multiple clinical, environmental, and psychological factors. The findings highlight several modifiable determinants-such as pain control, environmental management, and reduced nighttime procedures-that may serve as key targets for clinical sleep-promoting interventions in trauma care.", "links": [] }, { "title": "Screens, Teens, and Sleep: Is the Impact of Nighttime Screen Use on Sleep Driven by Physiological Arousal?", "author": "Meredith-Jones, Kim A.; Haszard, Jillian J.; Galland, Barbara C.; Wickham, Shay-Ruby; Brosnan, Bradley J.; Russell-Camp, Takiwai; Taylor, Rachael W.", "year": "2026", "journalProceedings": "Journal of Sleep Research", "category": "Case Study", "devices": "Inspire 2", "population": "Adolescents", "dataUsed": "Heart Rate", "abstract": "Few studies have objectively measured both screens and sleep in real-world settings. This study uses repeated measures to assess heart rate during evening screen use, providing new insights into how these behaviours relate to adolescent sleep. Screen use was recorded using wearable cameras over four nights in 70 youth (37\\% indigenous Māori, 42\\% female) aged 11-14.9 years. Heart rate was measured via a Fitbit Inspire 2. Mixed effects regression models were used to estimate within-person differences in heart rate across screen behaviours and time periods, as well as associations with sleep outcomes. Median heart rate was lower during screen use than during non-screen activities (83 BPM, [IQR: 77-91] vs. 93 [IQR: 87-100]). Social media use most proximal to bedtime was associated with slightly lower heart rate compared to other screen activities (-3 BPM, 95\\% CI: -5, -1), while communication was associated with slightly higher heart rate (3 BPM, 95\\% CI: 1, 5). Heart rate in the 2 h before bed was not associated with sleep outcomes except for sleep latency; which increased by 9 min (95\\% CI: 3, 14) for every 10 BPM increase in heart rate. Evening screen use may be a relaxation tool for youth, with social media, gaming and multitasking having minimal physiological impact. In contrast, communication activities were less conducive to relaxation, though differences were small and effects on sleep only modest. Thus, relationships between screen use and sleep are more likely driven by changes in sleep timing rather than physiological arousal from screen exposure. Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12621000193875.", "links": [] }, { "title": "Hierarchical heated markov modeling for synthesizing activity data from wearable devices", "author": "Fang, Darren; Ruan, Dan", "year": "2026", "journalProceedings": "Computational and Structural Biotechnology Journal", "category": "Methods", "devices": "Inspire HR", "population": "NA", "dataUsed": "Steps,Heart Rate", "abstract": "BACKGROUND: Wearable devices enable continuous acquisition of physiological and behavioral signals with broad utility in precision and population health. However, real-world datasets often have privacy constraints, irregular sampling, and activity-dependent recording, complicating data sharing and modeling. We present a synthesis framework that preserves statistical realism by matching marginal distributions and inter-record distances. METHOD: We propose a hierarchical heated Markov model (HHMM) that captures conditional dependencies and time-varying behavioral patterns. Tier 1 generates minute-level activity types using hour-specific priors and a heating mechanism to achieve a target ergodic distribution. Tier 2 samples heart rate (via Metropolis-Hastings conditioned on activity) and activity duration from empirical conditional distributions. Tier 3 synthesizes additional variables (e.g., sleep duration, calories) conditioned on Tiers 1-2, with deterministic rules for activity codes and floors climbed. Activity-conditioned Poisson subsampling emulates device-driven irregular timestamps. We benchmark HHMM against CTGAN and TVAE using a synthetic IEEE BHI dataset and validate on a real Fitbit dataset. Fidelity is assessed by comparing distributions of pairwise inter-record distances-within synthetic vs. within reference cohorts-via Wasserstein distances for Kolmogorov-Smirnov (KS), Jensen-Shannon (JSD), and distance-correlation (DC) metrics. RESULTS: On the BHI dataset, mean WD(KS)/WD(JSD)/WD(DC) were 0.125/0.242/0.327 for HHMM, 0.130/0.245/0.257 for CTGAN, and 0.129/0.246/0.249 for TVAE. On the Fitbit dataset, values were 0.295/0.489/0.233 (HHMM), 0.293/0.488/0.209 (CTGAN), and 0.293/0.588/0.160 (TVAE). DISCUSSION: HHMM offers task-specific gains on synthetic benchmarks. Real-world results highlight a need for domain adaptation. The method is computationally efficient and privacy-preserving, supporting scalable synthetic data generation for wearable health research.", "links": [] }, { "title": "Efficacy of Telehealth-Based Coaching to Improve Physical Activity and Overall Experience for Cancer Survivors: Secondary, Mixed Methods Analysis of a Randomized Controlled Trial", "author": "Khairat, Saif; Kent, Erin E.; Geracitano, John; Mendis, Kaushalya; Zhou, Zhaoqiang; Bailey, Carly; Wood, William A.", "year": "2026", "journalProceedings": "JMIR cancer", "category": "Intervention", "devices": "Device unspecified", "population": "Patients", "dataUsed": "Steps,Energy Expenditure,Heart Rate,Active Minutes/Active Zone Minutes", "abstract": "BACKGROUND: Cancer survivors face significant challenges in maintaining adequate physical activity levels, which are essential for overall health and quality of life. Telehealth-based interventions offer promising opportunities to provide accessible support and promote healthier lifestyles throughout the cancer survivorship continuum. HealthScore is a telehealth coaching program designed to optimize the health of cancer survivors. OBJECTIVE: This study assessed the effectiveness of HealthScore in improving physical activity metrics among cancer survivors compared to controls. We also evaluated participants' qualitative experiences with the program to understand its impact on motivation, accountability, and overall health-related quality of life. METHODS: We performed a secondary analysis of a randomized controlled study of cancer survivors who participated in a comprehensive health coaching intervention called HealthScore. Participants in control and intervention groups received a Fitbit activity tracker that collected heart rate, step counts, active minutes, and calories burned. These metrics were analyzed using statistical methods to compare overall averages and temporal trends between intervention and control groups. Eleven exit interviews were conducted with intervention arm participants to ascertain their experiences with HealthScore. Inductive thematic analysis was performed to identify emerging themes. Data were collected between May 2020 and March 2022. RESULTS: Of the 32 participants enrolled, 20 (62\\%) were in the intervention group. Compared to the control group, intervention participants had significantly higher average daily steps (mean 3660, SD 3344; 95\\% CI 3557-3764 vs mean 3408, SD 3288; 95\\% CI 3299-3518; P=.001) and more moving average daily steps (mean 4813, SD 1723; 95\\% CI 4680-4946 vs mean 4581, SD 1224; 95\\% CI 4494-4669; P=.003). Moving average daily step counts in the intervention arm showed an increasing trend, which was significantly higher than that of the control group (regression slope=5.89 vs 2.80; P{\\textless}.001). Compared to the control group, the intervention participants had significantly higher average daily walking distance (mean 2.6, SD 2.5; 95\\% CI 2.5-2.7 vs mean 2.4, SD 2.3; 95\\% CI 2.3-2.5; P{\\textless}.001) and more moving average daily walking distance (mean 3.5, SD 1.3; 95\\% CI 3.4-3.6 vs mean 3.2, SD 0.8; 95\\% CI 3.1-3.3; P{\\textless}.001). Moving average daily walking distances among intervention participants increased, which was also significantly higher than that of the control group (regression slope=0.0046 vs 0.0017; P{\\textless}.001). Participants in the intervention group reported a growing sense of accountability and motivation. One barrier was completing weekly monitoring of patient-reported outcome surveys, which focused on symptoms and physical function and did not always align with participants' goals. CONCLUSIONS: The HealthScore telehealth coaching program improved physical activity levels among cancer survivors and enhanced motivation and accountability. These findings support the integration of telehealth-based health coaching into posttreatment care, promoting healthier lifestyles and improved quality of life for cancer survivors. TRIAL REGISTRATION: ClinicalTrials.gov NCT04923997; https://clinicaltrials.gov/study/NCT04923997.", "links": [] }, { "title": "Effect of Cannabigerol on Sleep and Quality of Life in Veterans: A Decentralized, Randomized, Placebo-Controlled Trial", "author": "Emerson, Chris R.; Webster, Courtney E.; Daza, Eric J.; Klamer, Brett G.; Tummalacherla, Meghasyam", "year": "2025", "journalProceedings": "Medical Cannabis and Cannabinoids", "category": "Case Study", "devices": "Inspire 2", "population": "Adults", "dataUsed": "Sleep", "abstract": "Introduction This decentralized, randomized, triple-blind, placebo-controlled study evaluated efficacy and safety of oral cannabigerol (CBG) in Veterans with sleep issues. Methods After a 2-week run-in phase, participants received CBG (25 mg daily for 2 weeks, then 50 mg daily for a further 2 weeks) or placebo. The primary endpoint was change in sleep quality via the Medical Outcomes Study Sleep Problems Index II questionnaire (MOS-SS SPI-II). Additional endpoints included change in quality of life measured via the World Health Organization Disability Assessment Schedule, version 2.0 instrument (WHODAS-2.0–12), post-traumatic stress disorder (PTSD) symptoms evaluated via the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5 (PCL-5), and sleep actigraphy data via Fitbit. Results A total of 63 participants were randomized to receive CBG (n = 33) or placebo (n = 30). A total of 35 participants completed the study without major protocol deviations (CBG [n = 18]; placebo [n = 17]). MOS-SS SPI-II scores indicated improved sleep with no statistically significant difference between the CBG and placebo groups. Similar patterns were observed for WHODAS-2.0–12 and PCL-5 scores. CBG was well tolerated. Conclusion While no firm conclusion on the efficacy of CBG in improving sleep can be made, the favorable safety profile supports future studies with CBG. ClinicalTrials.gov ID: NCT05088018.", "links": [ { "caption": "URL", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12823110/", "newWindow": true } ] }, { "title": "Steps to Health: Backward Walking Predicts Physical Activity Levels in Multiple Sclerosis", "author": "VanNostrand, Michael; Monaghan, Patrick G.; Takla, Taylor N.; Fritz, Nora E.", "year": "2026", "journalProceedings": "Neurorehabilitation and Neural Repair", "category": "Case Study", "devices": "Versa", "population": "Adults", "dataUsed": "Steps", "abstract": "BackgroundPhysical activity (PA) supports physical, cognitive, and mental health, yet is often limited in persons with multiple sclerosis (PwMS) due to mobility, cognitive, and psychological factors. Practical methods to identify those meeting PA recommendations are needed. This study aimed to develop a clinically useful approach combining patient-reported outcomes and objective measures to determine whether PwMS meet step count goals.MethodsParticipants completed mobility assessments (static balance, reactive balance, forward walking [FW], and backward walking [BW]), cognitive testing, and self-report measures. Fitbit tracked PA for 3 months, categorizing participants based on whether they met the MS daily step goal (7500 steps).ResultsForty-five PwMS (age: 51.16 ± 11.12 years; median Patient Determined Disease Steps: 1; 84\\% female) participated, with 15 meeting the daily step goal. Participants who met the step count goal reported significantly lower mobility limitations (MS Walking Scale-12, P = .01) and concern about falling (Falls Efficacy Scale-International, P {\\textless} .01) compared to those who did not. Significant differences were also observed for BW at both comfortable and fast speeds (P {\\textless} .01), FW at both speeds (P = .01), and reactive balance (P = .04). No differences were observed for cognition. Logistic regression identified BW at both comfortable (0.89 m/s) and fast speeds (1.25 m/s) as the strongest predictors of achieving the daily step goal, with predictive accuracies of 80\\% and 82.2\\%, respectively.ConclusionBW is a clinically relevant predictor of achieving daily step goals in PwMS. Established cut-off values-0.89 m/s for comfortable and 1.25 m/s for fast BW-demonstrated strong predictive accuracy. These findings highlight the utility of BW as a mobility measure to inform interventions and promote PA in clinical practice.", "links": [] }, { "title": "Comparing methods to measure wearable device adherence for physical activity monitoring for persons with autism: A prospective observational cohort study", "author": "Tovin, Melissa M.; Madden, Sheila B.; Wu, Kaiwen; Nunez-Gaunaurd, Annabel", "year": "2026", "journalProceedings": "Physiotherapy Theory and Practice", "category": "Intervention", "devices": "Inspire 3", "population": "Adults,Adolescents", "dataUsed": "Steps,Heart Rate", "abstract": "INTRODUCTION: Individuals with autism spectrum disorder (ASD) have higher rates of obesity and exhibit more sedentary behaviors than neurotypical peers. Use of wearable devices (WD) to target insufficient physical activity (PA) in this population has increased over the past decade. However, standardized methods for assessing WD adherence remain limited among this understudied population. PURPOSE: A prospective observational cohort design was used to compare two methods for determining WD adherence for monitoring PA in adolescents and adults with ASD. METHODS: Subjects were enrolled in an 8-week telehealth program aimed at improving PA among adolescents and adults with ASD. The Fitbit Inspire 3 WD was utilized for PA tracking and self-monitoring. Subject step activity and heart rate (HR) data were collected for an 8-week period via FITABASE management platform. Adherence was calculated using two methods. Method-A was defined as ≥10-hr daily wear-time based on HR monitoring; Method-B was defined as ≥ 500 steps/day. Observational data collected via researcher field notes documented participant-reported factors and/or behaviors that influenced WD adherence. RESULTS: Data from twenty-seven subjects (21 males, 6 females) ages 14 to 28 years (mean: 18.85 years) were analyzed. Adherence was significantly higher when calculated using Method B (mean = 40 days, 5.4 weeks) compared to Method A (mean = 24 days, 2.8 weeks; p  {\\textless} .001). Observational data identified disability-related behaviors that negatively impacted Method A derived adherence. CONCLUSIONS: Using HR-based measures of adherence may underestimate device use in individuals with ASD, potentially setting unrealistic expectations for continuous wear. Step-based metrics provides a more inclusive and pragmatic approach for assessing WD adherence in this population, with implications for future intervention design and evaluation. This study highlights the need to tailor WD adherence definitions to the behavioral and sensory profiles of neurodiverse populations. Further study is warranted.", "links": [] }, { "title": "Implementation of wearable activity trackers in hospital rehabilitation: a feasibility study tailored to local settings", "author": "Szeto, Kimberley; Arnold, John; Singh, Ben; Diestel-Feddersen, Peter; Edwards, Dominique; Cheary, Shannon; Lo Basso, Matthew; Maher, Carol", "year": "2026", "journalProceedings": "BMC health services research", "category": "Intervention", "devices": "Inspire 3", "population": "Patients", "dataUsed": "Steps,Intensity", "abstract": "BACKGROUND: Physical inactivity during and after hospitalisation is associated with poorer outcomes. Wearable activity trackers (WATs) are effective in promoting physical activity in healthcare settings, however, their successful implementation remains a challenge, and evidence for how this can be achieved is so far limited. OBJECTIVE: This feasibility study evaluated WAT implementation in inpatient and outpatient rehabilitation by assessing: (1) feasibility metrics including uptake and retention rates; (2) patient and clinician perceptions; (3) challenges and factors contributing to success; and (4) changes in PA. METHODS: A single-arm, feasibility study was conducted in two rehabilitation settings at a major teaching hospital. Patients were provided with a WAT (Fitbit Inspire 3) to wear throughout their admission, which was used to set step goals with clinicians, monitor daily step counts and support efforts and encouragement to meet step goals. Feasibility was assessed based on recruitment, retention, and data completeness rates. Patient and clinician experiences, satisfaction and perceptions were evaluated through surveys. Effect sizes for change in physical activity from baseline to follow-up were assessed for daily step counts, light physical activity, moderate-vigorous physical activity, and sedentary behaviour, were calculated using Cohen’s d and matched-pairs rank-biserial correlation (r). RESULTS: Of 36 invited patients, 26 participated, (mean age 72 years; SD: 13; range 33–93; 72\\% uptake rate). Data completeness was high (92\\%), with no devices lost or broken. Most patients perceived WATs helped increase walking (68\\%) and achieve rehabilitation goals (64\\%), with 84\\% willing to use WATs again in rehabilitation. All clinicians (n = 6) found WATs easy to use, though perspectives on therapy enhancement varied. Large effect sizes were observed for increased daily steps in both the inpatient (1050 to 1366 steps/day, (r) = 0.595) and outpatient (4749 to 5986 steps/day, (r) = 0.532) rehabilitation settings. The simplicity of the approach and patient and clinician resources were identified as factors contributing to the success of implementation, though the recruitment approach revealed challenges related to inviting individual patients to participate. CONCLUSION: WAT implementation was feasible in both rehabilitation settings. Future research should evaluate larger scale implementation and effectiveness of such approaches through service-level enrolment and larger controlled trials, and exploring applications across diverse clinical settings. TRIAL REGISTRATION: This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (Trial ID: ACTRN12624000447550; registration date: 11 April 2024). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-026-14066-4.", "links": [] }, { "title": "Amblyopia and adult health: a comprehensive analysis of long-term systemic, sensory and mental health comorbidities in a national cohort", "author": "Lee, Kyoung A. Viola; Langholm, Carsten; Lin, Trevor; Jin, Kimberly; Aboobakar, Inas F.; Oke, Isdin; Whitman, Mary C.", "year": "2026", "journalProceedings": "The British Journal of Ophthalmology", "category": "Case Study", "devices": "Device unspecified", "population": "Adults", "dataUsed": "Steps,Energy Expenditure,Active Minutes/Active Zone Minutes", "abstract": "AIMS: To evaluate the adult health consequences of amblyopia, including sensory deficits, mental health, physical activity and cardiovascular health. METHODS: A cross-sectional study using data from the National Institutes of Health's All of Us Research Program, including 1998 adults with amblyopia (1335 non-strabismic, 663 strabismic) identified by International Classification of Diseases (ICD)-9/ICD-10/Systemized Nomenclature of Medicine (SNOMED) codes, including 187 with Fitbit data. Controls (10:1 ratio) were propensity-score-matched on age, sex, self-reported race, income and healthcare visits. Separate matched control groups were used for Fitbit and subgroup analyses. Data from electronic health records, surveys and Fitbit were used to assess sensory impairments, cardiometabolic conditions, physical activity and neuropsychiatric disorders. Prevalence and ORs with 95\\% CIs were calculated to assess associations between amblyopia (total, strabismic and non-strabismic) and health outcomes. RESULTS: Amblyopia was associated with increased odds of bilateral blindness (OR=2.96, 95\\% CI 2.54 to 3.44), obesity (OR=1.27, 95\\% CI 1.16 to 1.39), type 2 diabetes (OR=1.39, 95\\% CI 1.26 to 1.53) and cardiovascular disease (OR=1.92, 95\\% CI 1.69 to 2.19). Amblyopic individuals took fewer daily steps (5859 vs 6229; p=0.044), indicating decreased physical activity. Neuropsychiatric disorders were more common, including generalised anxiety (OR=1.57, 95\\% CI 1.43 to 1.72), substance use disorder (OR=1.40, 95\\% CI 1.25 to 1.55), bipolar disorder (OR=1.35, 95\\% CI 1.13 to 1.61), attention-deficit/hyperactivity disorder (OR=1.54, 95\\% CI 1.28 to 1.86), obsessive compulsive disorder (OR=1.82, 95\\% CI 1.31 to 2.54) and autism (OR=3.27, 95\\% CI 1.79 to 5.99). Schizophrenia was not associated (OR=1.00, 95\\% CI 0.70 to 1.42). CONCLUSIONS: Amblyopia is associated with long-term systemic health conditions, suggesting either long-term effects of visual impairment or shared underlying risk factors. These findings underscore the need for early detection and intervention. Further research is needed to explore the neurodevelopmental pathways linking amblyopia and its comorbidities.", "links": [] } ] }