Wearable Trackers Step Up Activity in Patients with Cardiometabolic Conditions

Wearable activity trackers were associated with improved physical activity (PA) among patients with cardiometabolic conditions—and combining these activity trackers with health professional consultations led to even greater improvements, according to results from a systematic review and meta-analysis.

A low level of PA is a fundamental modifiable risk factor for individuals with cardiometabolic conditions, such as type 2 diabetes, obesity, and cardiovascular disease. However, prompting patients to actually engage in PA is often a challenge, Alexander Hodkinson, PhD, of the Manchester Academic Health Science Center in Manchester, U.K., and colleagues explained in JAMA Network Open. Previous research suggested that devices with simple activity trackers, such as pedometers and accelerometers or fitness trackers, may be associated with increased PA levels in patients with chronic conditions.

For this analysis, Hodkinson and colleagues examined whether interventions including activity trackers were associated with short- and long-term improvements in PA levels and health outcomes, including blood glucose levels, blood pressure, cholesterol levels, body weight, and body mass index (BMI), among people with cardiometabolic conditions compared with usual care.

“This systematic review and meta-analysis found that interventions using wearable activity trackers were associated with significant improvements in PA among people with cardiometabolic conditions compared with individuals who received usual care,” they found. “Interventions that combined the use of activity trackers with additional components, such as regular consultation sessions with a health care professional (face to face or remotely), had the strongest associations with PA improvement. The PA improvements were more pronounced among male participants.”

Interventions that used pedometers had the greatest association with increased PA levels, they added.

In an invited commentary accompanying the study, Paul Rivto, PhD, Megan Kirk, PhD, and Meysam Pirbaglou, PhD, of York University in Toronto, “commended Hodkinson et al for their review of the important literature on wearable physical activity (PA) tracker use in PA promotion. Despite the morbidity and mortality reductions associated with increased PA levels, approximately 80% of US adults and adolescents remain relatively inactive. This elevated inactivity level prevails despite robust associations between PA and multiple disease indexes. We may be able to rectify this situation by integrating wearable PA trackers and PA consultations into standard care. The systematic review and meta-analysis by Hodkinson et al points the way.”

In their own research group, Rivto, Kirk, and Pirbaglou have also touted the ability of combining wearable devices and consultation support to increase PA levels and improve patient outcomes—however, their primary focus has been on improving mental health outcomes.

For example, they noted that “a recent trial of youth diagnosed with major depressive disorder demonstrated that 60% of youth in the intervention group had experienced remission at follow-up (i.e., no residual depressive symptoms) and 83% of youth who had experienced remission had approximately more than 6,000 daily steps reported during the intervention.” Ritvo and Pirbaglou were both investigators on the trial.

They concluded that the question of how cost-effective wearable device-based PA monitoring is underlies the study by Hodkinson et al and findings from additional trials in mental health.

“Considering the potential health and disease reduction benefits, we have the technological resources for a more integrated campaign to increase PA levels for management of cardiometabolic disease and mental health,” they wrote. “Future cost-effectiveness analyses may be a practical step toward justifying the funding of larger, wearable device–based, PA promotion undertakings.”

For their systematic review and meta-analysis, Hodkinson and colleagues searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO from Jan. 1, 2000, through Dec. 31, 2020, for randomized or cluster randomized clinical trials that evaluated the use of wearable PA trackers, using the keywords “diabetes,” “obesity,” “cardiovascular disease,” “pedometers,” “accelerometers,” and “Fitbits.” The study population consisted of adults 18 years or older with or at risk for type 2 diabetes, obesity or overweight, and cardiovascular disease.

The primary outcome was mean difference in PA levels, the study authors explained. “When the scale was different across studies, standardized mean differences were calculated,” they wrote. “Heterogeneity was quantified using the I² statistic and explored using mixed-effects metaregression.”

A total of 38 randomized clinical trials with 4,203 participants were eligible for inclusion; of these, 29 evaluated the use of pedometers, and the other nine the use of accelerometers or fitness trackers. Four did not provide amenable outcomes data for this analysis, leaving 34 trials (3,793 participants) for the meta-analysis.

“Intervention versus comparator analysis showed a significant association of wearable tracker use with increased PA levels overall (standardized mean difference, 0.72; 95% CI, 0.46-0.97; I²=88%; 95% CI, 84.3%-90.8%; P<0.001) in studies with short to medium follow-up for median of 15 (range, 12-52) weeks,” they found. “Multivariable metaregression showed an association between increased PA levels and interventions that involved face-to-face consultations with facilitators (23 studies; β=−0.04; 95% CI, −0.11 to −0.01), included men (23 studies; β=0.48; 95% CI, 0.01-0.96), and assessed pedometer-based interventions (26 studies; β=0.20; 95% CI, 0.02-0.32).”

Hodkinson and colleagues noted that the comparison in this analysis involved only eight studies of accelerometers or fitness trackers versus 26 of pedometers, and “although the effect size was larger for accelerometer and fitness tracker interventions (0.92 vs 0.68 for the pedometer), the 95% CI was wider than that for pedometers. All these factors should be considered when interpreting the efficacy of the interventions.”

They also pointed out that, while use of wearable activity trackers were associated with greater PA levels per day among patients with cardiometabolic conditions, the improvements were “generally lower than those recommended in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report by the U.S. Department of Health and Human Services and in other recommendations from global governments and agencies.”

Study limitations included that the effects of changes at baseline could not be considered in the meta-analysis; the PA promotion technique was poorly reported across studies and therefore was not included in the regression analysis; it was not possible to assess for commercial bias because few studies declared their commercial interests; studies that did not explicitly report participant risk for a cardiometabolic condition may have been missed; and it was not possible to look at behavior change outcomes.

1. Interventions that used wearable activity trackers were associated with improved physical activity (PA) among patients with cardiometabolic conditions, and combining activity trackers with health professional consultations led to even greater improvements.

2. Future cost-effectiveness analyses may be a practical step toward justifying the funding of larger, wearable device–based, PA promotion undertakings to improve both physical and mental health outcomes.

John McKenna, Associate Editor, BreakingMED™

Cat ID: 305

Topic ID: 74,305,730,305,446,914,12,13,307,192,48,669,918,925