The Evolution of the Wearable Fitness Device

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Hi and thank you for taking the time to review our presentation on the evolution of the wearable fitness device. My name is Dani Hill and I am one of the health educators with Optima Health. Today, what we're going to do is take a look at a brief history of the use of fitness devices in society. We're also going to review some of the benefits and drawbacks of their use. And finally we're going to talk about how we can use fitness devices to enhance our overall physical activity goals.

So, again, to get started, we are going to talk a little bit about the history of fitness devices. And really in order to understand how fitness devices have become ingrained into exercise as we know it today, we have to start all the way back at the beginning of physical activity when it served a purpose outside of mere survival. The earliest records of humans using intentional exercise for a purpose beyond necessity shows up in the form of dance. It served as a means of communication, of courtship, and/or social connection. All of these were just as critical to survival as the ability to hunt, for example. Dance was also a means to train the body to meet the demands of daily life at that time. So, hunting as we just mentioned, but also traveling long distances or building shelters. Those would be ways that the body would benefit from movement outside of just those activities when it was needed.

Around 6000 BC we start to see exercise equipment (and I'm saying that in air quotes) in Chinese, Egyptian and ancient Greek, Indian murals and writings. At this time, physical activity was used as a means to display male strength, to prepare for warfare. And the equipment that they were using at this time is very rudimentary compared to what we used today. So basically anything that was in their surrounding environment, something like stones or bags of sand, for example. A lot of time passes before we see a return to physical activity in the way of text and not really much changes again until the 18th century and this is gymnastics and its earliest form is introduced. It becomes popularized with the intention to help men become stronger but they're doing it through a more recreational and social setting. So they're leaving the environment in which they live and then traveling to a different environment for that sole purpose.

It's not really again until the late 1800sthat commercial fitness becomes an industry and this starts in 1885 with the opening of the first fitness center. The individual that opened the first fitness center (his name was Professor Edmund Desbonnet), he also introduced the first rules to the sport of weightlifting and this was the gateway for what we consider exercise today. Desbonnet eventually built a fitness club empire. He had over 200 clubs. He wrote a lot in exercise-related journals and books and he really set the tone for what the fitness industry was at that time. Barbells, dumbbells, gymnastics-style equipment all continue to serve in fitness centers throughout Europe and the United States until the mid-1900s. And then by 1960, we start to see the invention of more cardio based exercise equipment - things like treadmills, stationary bikes and also the true commercialization of exercise as we know it today. So we start to see the fad dieting, the workout at home tapes, the different classes, the different use of different types of equipment for different purposes and this is from this time moving forward, the fitness industry is kind of in a constant state of change. Everyone in that industry is trying to chase the next big thing. What you'll notice from this timeline is that I omitted sports. And that's because what I'm trying to do is point out that we've used equipment, and again, I'm staying in the air quotes, as a tool toward our overall fitness goals for a relatively short period of time. Fitness devices, though they are probably the most technologically savvy version of fitness equipment, it is certainly an equipment. It's providing you another tool in your fitness goals.

What we see by the early 1970s, 1980s are all of these equipment manufacturers popping up and eventually consolidating. Smaller companies are eventually becoming acquired by more established companies. And now, equipment manufacturers are providing very extensive lines of equipment. Think about the gym scene that you're seeing on your screen right now. Just there's so many options if you, if it's been a long time since you've been in the gym, you almost don't know where to start. So, as the fitness industry starts to consolidate into these fewer large manufacturers, a new trend starts to emerge around functional fitness. And the intention of functional fitness was to answer the question of how well your exercise is preparing you for real world tasks. So think about our previous slides, we've come full circle. Right? Historically, of course, all training was functional. So this quote-unquote “new trend” was really just revisiting something that was hundreds and thousands of years old. This brought the return of using body weight training which has literally been around forever. So - pushups, pull ups, squats. You know you've heard of all of these different boutique type of gyms that you can go to - Crossfit or Orangetheory or Regymen. All of these different types of really movement based programs that are focused around using simple equipment and using a lot of body weight exercises that starts to show back up. Young and old - everyone is doing this kind of stuff. It's being done in gyms, but also in city parks, and it's being done all around the world. And the low cost of these body weight exercises is certainly one appeal, but also, just the ease of use. It can be modified to meet anybody's physical activity, where they are in that realm and also it's available any time. Right? You can do this whenever it's convenient to you. You don't have to have a gym membership to do this kind of stuff. So, at the same time, the fitness industry sees a perfect opportunity to introduce technology into the daily work out. Why and how?

So, who remembers the Wii? I'm sure we all do. So, back in the early 2000s, fitness technology is really used for the committed athlete at this point. It's not really for the average exerciser. Well, the, Wii stations like this, bring about the popularity of what's called “exergaming”. And it was a short fad, it definitely was probably the most popular with kids, but the overall commercial success of exergaming really spawned the idea of combining gaming with activity tracking and that started with the use of a basic pedometer. But what we start to see is that folks are using now this more functional fitness type of activity. But they're getting a gaming aspect of it as gaining some instant feedback on how they're performing. What really turns the tide from pedometers being used for exergaming into the wearables as we know them today was the adoption of this mantra that 10000 steps per day was the magic number for you to become healthier. The idea of taking 10000 steps for optimal health actually came from Japan back in the 1960s. It was a group of researchers that was studying how Olympic athletes (right before the Tokyo Olympics in 1964); how were the Japanese olympians’ movement different from those of other Japanese citizens? How is their movement different? Were they walking more? And it was intended to be more of a study base to understand how, how their movement was differing from the rest of the Japanese society. So, a pedometer was introduced. It was called the manpo kei, which literally translated to “10000 steps meter” and it was really more of a business slogan than anything else. But it resonated with the Japanese people at that time. It turned out that they were onto something. Researchers started looking into how useful the 10000 steps per day rule was and since then, hundreds of studies have started linking higher step counts to better health outcomes.

The first wearables were mostly wrist more bands or watches as we all know the original Fitbit are pretty much everything that we see. Nowadays that's on our on our wrist. If it's not an old school watch. We know it's probably a fitness device. And so we went from being able to track steps to very quickly, being able to track calorie expenditure, sleep quality, heart rate, body temperature, all these other key data points. At the same time, smartphone developers recognize that there's an opportunity to integrate this activity tracking application into the phone itself. And this was really the spawning of everybody having their own proprietary health app. Right? So pretty much any smart phone you have today, there's a health or activity tracking mechanism in it and it's inside that smartphone developer’s own app. So, we really are at the cusp of the next wave of technology, in terms of how fitness devices are going to continue to be utilized. If you were to search this topic online, you'll find lots of different ways you can now use technology toward use fitness goals. But I think when we talk about the future of digital health, the sky is really the limit.

Digital health, the whole purpose of digital health is to converge technology with connectivity and software and the whole outcome of those three meeting is to bring you the most information and more analytics about your health. And now, what we're noticing or seeing in society is that that's not now just being consumed by us but we're also providing it to those that are assisting us in our health goals. So, whether that might be a personal trainer, our registered dietitian, a healthcare provider, we’re now using this more in a medical setting in addition to in a fitness setting. I think there's 2 takeaways that we can sum up from how we live our lives today: 1 - digital devices aren't going to go anywhere, right? They’re going to continue to grow and popularity and in use and 2 - there's some real benefit to having technology and getting this instant feedback. Just consider some of the things that you encounter when you're working with your healthcare provider right now. During the pandemic if you had a telemedicine appointment with a doctor, you were using digital health. If you went onto your Sentara MyChart, or any other electronic medical records, you’re using digital health. If you confirmed an appointment, or got a reminder about an appointment through a text message, you were using digital health.

So we are now going to see this use of technology in terms of our health, not just in the space of fitness, but also in the space of our health as we know it in the medical community. So, now that we've talked through where we have been, let's talk about some of the benefits of using these types of devices. I think one thing that's safe to assume is that society as a whole is probably the most technology savvy than any society in modern history. One reason that, that we like technology so much is the instant feedback that we get. Okay. Let me give you some examples. One would be posting a picture on social media. How many of us go back to see how many people maybe liked that photo? How about been binge watching a show? You love an episode? We go right into the next one. Or how about having a smart device in our home (an Alexa), you can pretty much ask it a question on any topic. You get an instant answer. We truly have information on the click of a button. And this is absolutely a benefit to us in terms of not just wearable fitness devices but also, wearable health devices at large.

Before we discuss the benefits and the considerations of fitness devices, I wanted to highlight this term for you and that's behavior change. Behavior change is exactly what it sounds like. It's modifying a habit or a way of thinking. And there is a vast list of theories and models out there that can kind of explain how an individual can be successful in changing their behavior. That's beyond the scope of our presentation today but I wanted to highlight this term because the majority of research done around fitness devices focuses on these two questions. One is: How are fitness devices impacting our overall physical activity? And if they are impacting our physical activity, are they doing so in a good way or a bad way? So, what I thought we would do for this section is to review 2 large scale research reviews. These 2 reviews examined research from over about a course of 10 years and included about 50 studies and all of these studies were really looking at the use of fitness devices in terms of them being beneficial to our overall physical activity. And this is going to give us a good idea of what researchers have been looking at for over the past decade. Before we get into the research reviews what I'd like to do is just ask you a question and that is, do you think wearable fitness devices help increase physical activity? What is your innate response to that question? Is it a yes or no? And as we consume the results of these research reviews, think back to this question and see if it changes your opinion.

All right, so, let's first talk about what we know. We know that there is extensive evidence out there that engaging in regular physical activity is beneficial to our overall health. We know that. We also know that only about 1 and 4 adults in America are engaging in a recommended amount of moderate physical activity every week. The recommendation is at least 150 minutes or 30 minutes a day, 5 days a week. We only know about 25% of American adults are doing that. We also know that wearable fitness devices are convenient. They're small. They're relatively low cost and they’re user friendly and a lot of them allow physical activity to be individualized. So, things like reducing or increasing your daily step count, for example. We know that behavior change is best achieved when we apply several different tools or resources in order to change that behavior. So an example might be, I am going to stop drinking soda. That's going to be my behavior change. Well, what kind of tools would be beneficial? Well, one might be looking up good alternatives to soda by using our computer to search for that. One might be avoiding the soda aisle at the grocery store. Another might be getting a friend or family member to make that commitment as well so we have some motivation and accountability. So we know that when we have several different tools and our tool kit, we're probably going to do better with our behavior change. We also know that receiving immediate feedback on our progress towards goals usually helps us feel like we're going to be doing better at it and certainly fitness devices give us immediate feedback. And the last is, if we have the ability to self-monitor, that typically enhances our confidence in achieving the goals that we set out for ourselves. So, these are all things that we know. Here’s what the research has shown us.

First, the validity of step counts within several of these fitness devices has been tested and shown to be pretty accurate. There's been less testing done on some of the other data points that some of these devices will collect data on. So things like calorie expenditure or sleep quality, for example, but we know that the step counts is usually pretty accurate. We also know that people that have friends or family members who are using fitness devices as well tend to feel a stronger sense of support for their Physical activity goals. They're usually a little bit more confident in our ability to achieve their goals and certainly, because they're getting that instant feedback, like we've talked about, but also, because they have a stronger sense of community. So, they have a little bit of innate accountability. They've got some gratification from using those fitness devices, and that's because they've created a community within themselves that they're able to talk about how their goals are going. Knowing that, the opposite can also be true. Many participants within these studies reported a negative impact if they couldn't reach that 10000 steps per day count. So, this is again focused around that 10000 steps a day. Remember that this is the, the aspect of fitness devices that's probably been studied the most was around step count. And what this is showing is that sometimes if we are not able to obtain that 10000 steps, so we're not able to get close to it, sometimes it can have an adverse impact on our desire to continue. So, that is something that we should consider. These studies also show that using fitness devices had a little bit of mixed results on whether or not they really benefited our overall physical activity. There are certain groups within the population that seem to respond to them better. Adolescents, for example, they tend to show more physical activity when they wear fitness devices. Adults that are defined as sedentary (so folks that really aren't getting up and moving on any kind of regular basis), they tend to see the most benefit from using fitness devices. However, college-age adults and older, if they’re somewhat active already, the use of a fitness device doesn't really help them to increase their physical activity over long periods of time.

Our next finding is that studies that were reviewed showed to have devices that had applications that had a way to motivate the user were very beneficial. So if there were cues in there to tell you to get up and get moving, that seemed to be very beneficial. Also, fitness devices that allow you to tailor the device to meet your specific goal showed to have an incredibly strong benefit as well. So, if you, let's say, were or are a sedentary individual and 10000 steps day is just way far out of range for you from the get go, having a device that maybe allows you to drop down your daily step count to 4000 and slowly work up from there -those devices seem to give you the best sense of motivation and self- efficacy as you're moving forward. Next, we know that fitness devices and physical activity interventions is still a relatively new area of study in the physical activity research field. So, as more research and evidence emerges, there will probably be a continuous evaluation of what’s been done and what's out there and that will help to guide and inform future research. So this necessarily isn't check it off, we know how fitness devices are used. There's still not a ton out there for us to look at. So, I know that these recommendations could change as research continues. And the last bullet I wanted to show you is that while a lot of the research out there around fitness devices has focused on having more daily steps, the Physical Activity Guidelines for Americans has actually shifted their recommendation away from step count and actually towards minutes of daily activity. And that's because a lot of what we are finding is that health benefits from movement are coming from an increase in our heart rate. Not just from steps. I'm sure we all know we can walk around a lot and not see any increase in our heart rate. So while we have the research has been done on steps, minutes of activity is where we shifted our focus.

Here is a little bit of information about those Physical Activity Guidelines for Americans. What we know is that some physical activity is certainly better than none. Adults who sit less and do any form of moderate to vigorous physical activity are going to gain some health benefit. For you to get some substantial health benefits, we should be moving at least 150 minutes a week. So, again, 5 days a week, 30 minutes per session and that would be moderate intensity activity. If you prefer to engage in vigorous intensity activity, the recommendation is 75 minutes per week. Or you can mix the 2 together however you prefer to do it is fine. We also know that there is more benefit, another increase in benefit from engaging in more physical activity. So, the more you're adding on, probably the more benefit you're going to see as long as you're not exceeding a large amount of physical activity every day that can obviously start to have the opposite effect that you would want it to have. But engaging in regular physical activity most days of the week, you're going to see the most health benefit from doing that. And then the other aspect of the recommendations is around strength training. Here the recommendation is to strengthening activity, strengthen your major muscle groups, 2 days a week or more and that is going to be through moderate intensity activity as well. Whether you have 2 minutes of time or 15 minutes of time, physical activity for any length is going to give you health benefits. Even an episode just climbing up a few flights of stairs, for example, can count for you. And that's what we're trying to show on this graphic. So, you don't necessarily have to dedicate 30 minutes that onetime during the day to get the benefit. You certainly can break it up into different segments as it fits best for your schedule and for your current level of fitness.

If you're curious if you're doing a moderate intensity activity, or a vigorous intensity activity, there is something that you can do called the talk test. And what you'll notice with moderate intensity activity is an increase in your heart rate. You’re able to talk, but you can't sing. That's kind of the guideline there and then in vigorous intensity exercise, you'll see a significant increase in your heart rate and that’ll be make it difficult for you to carry on a conversation without pausing to take a breath. Moderate intensity activity would be things like walking briskly, playing doubles tennis, line dancing or doing yard work, maybe doing recreational swimming. Vigorous intensity activity is going to be things like jogging or running, playing singles tennis, doing hip hop dancing or shoveling snow, or maybe swimming laps. So you can see we're doing similar types of activity, but the intensity of those is a little bit different.

So knowing all of this information, what's the summary of the research? What can we do with all this information? Well, there's a couple of bullet points here that I want you to take away from what we've discussed. 1: we feel more confident in our ability to achieve our physical activity goals when we have a fitness device. We have another tool in our tool kit. Like we said before, we have instant feedback that gives us objective information about our progress and that gives us a sense of accountability. Next, just because we have them doesn't mean that we're moving as much as we should. So, like we discussed before, it's important to move throughout the day. It's important to break up long bouts of sitting, but if we're not elevating our heart rate to at least moderate intensity, we're probably not experiencing the most benefit from our movement. Additionally, as we discussed, some fitness devices can de- motivate us. So, if we have a few days of not hitting that 10000 steps per day, for example, we might give up. So that's something for you to consider with the device that you're using.

Next, the most significant increases in physical activity we see are when groups are using them together. So friends, family in person or online, it doesn't matter. Even if our physical activity goals aren't the same. If we're using them together, it makes us have accountability. It gives us a little bit more of a motivation to keep going and we have that sense of community. And last summary is that our fitness devices should have features on them that best equip us to achieve our physical activity goals as we've defined them for ourselves. That might not mean just counting steps, but it might mean measuring your heart rate or counting your minutes of physical activity or giving you cues to get up and move or to keep going. So you have to think about what is within that, your fitness device, and if it's matching what your goals are.

So, now that we have a better understanding of fitness devices, let's talk about how to most effectively use them when we set goals. First, I wanted to highlight another word for you that you may have seen in previous slides and that’s self-efficacy. Self-efficacy is our perception of how well we can do something. The tool that we're going to talk about in order for us to set good goals for ourselves is intended to help bolster self-efficacy, and we can use a fitness device to, again, help bolster that sense of competence in our goal setting. So here's our goal, let's say we want to exercise more. It's a new year. I'm ready to give it another try. Let's say, historically, I have not been very dedicated to any kind of consistent physical activity as an adult. So, you know, exercising 4 hours a week is pretty lofty. I've given myself good amount of room to fail, but if I build in some detail to this goal, I'm probably going to set myself up a little bit better. There's an acronym that I want you to remember and that is SMART. We’re going to walk through this acronym to help build a better plan for ourselves.

So, as you'll see as we're going through this, we're going to move from goal to a SMART goal. So when we look at our S in our acronym for smart that is to be: SPECIFIC. We want to clearly define the outcome. So rather than just saying, I'm going to exercise more, maybe we say I'm going to exercise for 2 hours every week. So, we've given ourselves a specific number to work for.

Our letter M is for MEASURABLE. We want to indicate objective ways to track our progress and hey, guess what, that's what a fitness device can do for us. So, for our SMART goal, we're going to say we're going to track our progress by checking our minutes of activity on our fitness device.

The next is A, we've got 3 A’s to be ATTAINABLE, ACTION-ORIENTED, and ASSIGNABLE. Our A for ATTAINABLE is to think about adjusting our goal so it's just out of reach. So we don't want it to be so hard that we're not able to obtain it in the timeframe that we want to obtain it in, so in this example, if we look back to our original goal, we said we want to start exercising 4 hours a week. We noticed that we adjusted it down to 2 hours a week. That might be a good place for us to start. The next A is ACTION-ORIENTED. We want to answer the questions of when, where, and how we are going to achieve this goal. And then, in some instances, our A might be ASSIGNABLE, and that's going to be in the case of a goal that you might be working on with a group. Maybe it's a family goal to get healthier. In that case, you want to make sure everybody understands what their role is and helping the group achieve their goal. So are A for this one is answering those when and how questions, and we are going to join our friends in a group challenge. We're going to see who can reach at least 2 hours of physical activity a week.

R is to be RELEVANT. How much is our activity matching our goal? Are we doing what we need to do to get there? Do we need to break up our goal that's a long term goal into shorter term goals? So, maybe what you're seeing here is that we did do that. We took our 4 hour a week goal originally, and we broke it up into a 2 hour a week goal. So what we can do here is say, okay, so to get to that 4 hours a week, what I'm going to do is I'm going to add an extra 30 minutes on every 2 weeks. So I can eventually build up the time. I need to get to my total 4 hour a week goal.

And then the T is TIME BOUND. We want to set dates and so, in order to set dates in our SMART goal, we're going to add those 30 minute increments every 2 weeks. And our goal is after 8 weeks, we should be up to 4 hours a week. So, look at the difference in the goal that we set for ourselves. You'll notice how we were able to incorporate our fitness device in a meaningful way. And we were able to use that acronym to really define out what we needed to do, how and when we were going to do it in order to give ourselves a chance to continue to be motivated, but also to have the accountability that we need.

I recognize that not everyone that's watching this presentation has Optima Health insurance, but I wanted to draw your attention to a tool that is available to you if you are Optima insured. If you're not, your insurance provider probably has something similar so I would recommend you take a look into it. Optima refers to this as the personal health assessment, or PHA for short. The PHA is a questionnaire you can answer online through your Optima Health account. And it gives you input or output on your overall health, wellness and lifestyle habit so you get an idea of where you stand based off of the answers to the questions within the questionnaire. What you'll see at the top where that 42 is that your health score. And that's the score that's based off the information that's collected during the assessment questions. You also will get a summary of your current risks, and you'll get a chance to compare your score to those that are within the same age range and gender as you. It's a great tool to get started with developing health goals; gives you some tools right there to help set up goals on the spot. You have the ability to sync several brands of fitness devices to this WebMD portal, which is where the PHA is located and is again within the WebMD portal that's available to all Optima Health members. All you'll need to do is log into your Optima Health account and then look for wellness tools within your account and you can find the portal, which is robust. It's personalized and it's free of charge.

Whether or not, you are Optima insured, we do have some good resources that are helpful in increasing your physical activity. I used some of our own resources in developing this PowerPoint. One of those is the Move About booklet. Um, that booklet will give you a deeper dive into this topic for those that are interested in learning more. We also have on demand yoga classes, on demand tai chi videos. Those are great resources and there's also tons of information about healthy eating on here as well. So, you'd want to visit optimahealth.com/mylifemyplan and you can access this information as well as the list of our pre-recorded webinars.

I’d like to thank you so much for your time. We hope to see you next month.