It took a while to improve upon the humble pedometer. This tiny wearable device, typically attached on or near one’s waist, has been tracking how many steps and how much distance we travel each day ever since its invention by Abraham-Louis Perrelet back in 1780.
But with the relatively recent explosion of wearable digital activity trackers on the market, I’m now waiting for the randomized control trial that compares Fitbit or any other similar device head to head with that simple old-fashioned pedometer. In other words:
Q: Just because you make it digital, does it make it better?
Consider the inexpensive little pedometer I’ve been using since Mayo Clinic cardiologists gave one to me in 2008 following my heart attack. My low-tech pedometer works just fine for my daily walks, and believe it or not, without even so much as a battery change since 2008.
Fast forward six years from the day I received that pedometer at Mayo: Vancouver physicians give me a Fitbit a few months ago as part of a lovely gift bag following my presentation at a medical conference there. But that little Fitbit sits unopened on my kitchen counter, month after month, until a few weeks ago when I finally unpack it and try it out. Might as well give this thing a chance, I decide, even though I am perfectly happy with my combination of pedometer-measured walks and the sparkly stickers I award myself on a small bathroom calendar for each one hour period of exercise activity.
So here’s what I learn from test-driving my new Fitbit – but first let me paint you this simple picture of one fairly typical part of my week.
Every Saturday morning, I walk downtown (about a 45-minute brisk walk from home). After visiting with friends, I walk home again, stopping at a weekly farmers’ market en route to stock up on fruit/veggies. We browse the vendor tables, chat with the farmers, enjoy the live music, and then, if I’m feeling up to it and my ongoing cardiac symptoms are not flaring, I’ll have a coffee while watching the local guest chef’s weekly live-cooking demo. After a pleasant morning like this, I hug my friends goodbye and continue walking home (albeit a wee bit slower by now because I’m feeling more tired and am also loaded down with shopping bags of produce).
So here’s what my new Fitbit tells me about my Saturday morning adventure (high intensity activity in green, moderate intensity in brown, light intensity in yellow; total steps tracked that day: 13,484):
- high intensity exercise activity from about 8:45 to 9:30 a.m. while walking downtown
- no activity while sitting with friends
- a brief moderate activity blip as we walk to the farmers’ market
- very light intensity activity while browsing the market
- another blip of moderate-to-high intensity activity while I walk home for lunch (slower, tired and now carrying two heavy shopping bags)
- several no-activity chunks of time while I’m resting/napping to recuperate from my morning’s outing
- crash into bed by 8 p.m.
But what good, I ask you, is this information to me?
Will knowing what my Saturday morning looks like on a Fitbit graph change at all what I do or how I do it on Saturdays? Will I now start jogging through the farmers’ market to try to boost that moderate intensity walk up to high intensity? Will I stop buying all those heavy veggies that seem to slow me down on the walk home?
No. No. And no.
The question is not so much about Fitbit data. It’s about whether – despite the hype – the Fitbit or any other activity tracker is any better than my good ol’ inexpensive little pedometer I’ve used almost every single day since May 2008 to track my daily walks – or my shiny sparkly reward stickers on my little bathroom calendar?
What is the purpose of obsessively tracking such information unless one intends to actually do something with that information?
I don’t walk because my Fitbit screen calls me a “Champ!” for my progress. Nor because I need to know how many miles I’ve walked or how many calories I’ve burned. I already know the difference between a slow stroll around the grocery store aisles (Fitbit includes that useless info in my step total, too) and a good sweat-producing walk up the steep Quadra Street hill. Fitbit does not record any of my bike rides or weight training classes – those activities I have to input manually – and really, what’s the point of any digital device if I have to do that? My shiny sparkly calendar reward stickers are faster – and better!
Yet the happily-tracking hypemeisters of the Quantified Self movement (motto: “Self Knowledge Through Numbers”) will tell you that self-tracking using technology like that of my Fitbit can and will change health care as we know it.
In fact, they predict that one day even our physicians will be able to keep informed in real time about our physical activity, our blood pressure, our blood glucose readings, our mood, or any other trackable health indicator. One fine day, we are told, our doctors will be able to track a digital pill signal via mobile phone to inform them that we’ve just taken the medication they prescribed for us. Instant solution to the nasty problem of non-compliance.
Unless, of course, you believe the recent flurry of realists who remind us that more data is not in fact the answer to better health care.
As Mark Sullivan wrote in his VentureBeat column called “Guess What? Doctors Don’t Care About Your Fitbit Data”:
“Most doctors have little time for, or interest in, using wellness data collected by wearable devices. They don’t want to spend money on additional (and unproven clinical systems), and most of all, they don’t want to worry about keeping the data private.”
Dr. Aaron Carroll is the director of the Center for Health Policy and Professionalism Research at Indiana University School of Medicine. He observes in this brilliant little 7-minute Healthcare Triage video:
“No endocrinologist, no matter how dedicated they are, wants to know every glucose value of every patient every day. No primary care physician wants to know every patient’s daily weight.”
Speaking of weight, let me break the news to those of you who own a digital scale like Withings (able to not only weigh you, but automatically tweet your precise weight to your Twitter followers every morning):
If your own overworked and exhausted doctor doesn’t have time or interest or energy to cope with the minutiae of your endlessly fascinating self-tracking numbers, why would you believe that casual acquaintances give a flying fig about such self-centred navel-gazing?
Or, as Telecare Aware’s Donna Cusano more bluntly concludes:
“The self-absorption of some Quantified Self adherents has a whiff of stark raving narcissism about it all.“
Want a good example of a no-tech self-tracking tool that really works? The delightful Susannah Fox famously points out her own favourite – the pair of skinny jeans in her closet. Every woman alive knows the precise personal feedback value that such a tool provides to its owner.
From no-tech to multi-tech, consider also the cautionary tale provided by Alexandra Carmichael, one of the founders of the self-tracking/sharing site, CureTogether. In 2010, she explained why she decided she had to stop self-tracking (up to 40 different health indicators about herself each day via devices or mobile phone apps):
“Each day my self-worth was tied to the data. One pound heavier this morning? You’re fat. Skipped a day of running? You’re lazy. It felt like being back in school. Less than 100 percent on an exam? You’re dumb.
“I won’t let it be an instrument of self-torture. Any. More.”
This view may help explain what many tech hypemeisters haven’t picked up on yet. We know that only 5% of smartphone apps (including health-tracking apps) are still in use within 30 days of initial download. Approximately 26% of apps are used only once, and 74% are ditched by the tenth use. And according to ComScore, just the top 7 percent of app users are responsible for around half of an average month’s total downloads.
It hasn’t even been 30 days for me so far, and I’m already ready to ditch this device.
As a former distance runner, I’m already well aware of the importance of daily exercise. But as a current heart patient with ongoing debilitating cardiac issues, I also know it’s often easier said than done compared to my old life of healthy privilege – before being diagnosed with a chronic and progressive illness.
I don’t need motivating. I need to not feel sick.
Here’s how health tracking technology can play out for somebody who isn’t a member of the worried well:
One evening while getting ready for bed, I noted that I’d walked only 795 steps all day long. To most digital self-trackers, results like that would seem like a massive fail. Hardly even deserves a shiny sparkly sticker on my bathroom calendar, right?
But I knew that this daily total was approximately 794 more steps than I’d actually believed I was capable of walking on that day. It was a bad day. I’d already had several bouts of debilitating chest pain, back-to-back bouts of crushing fatigue, shortness of breath, and two doses of my nitroglycerine, the vasodilating drug that often helps when I’m experiencing the daily cardiac symptoms of Inoperable Coronary Microvascular Disease. Heart patients know that needing a third dose of nitro means we’re calling 911 at the same time. Again, a bad day.
So those 795 puny steps – basically down to the corner mailbox and back – were at least SOMETHING on a day of distressing cardiac symptoms, a day when I really felt like I could accomplish NOTHING.
Unlike the worried well who embrace their blow-by-blow results on their digital devices like Fitbit, those numbers themselves meant little to me, all things considered. See also: “Fewer Numbers, More Life Experiences”
As Stanford’s Dr. BJ Fogg reminds us about what motivates human behaviour:
“If it’s hard to do, don’t boost motivation! Instead, make it easier to do!”
In other words, I and other people living with chronic and progressive illness simply do not care how many badges, rewards, bells and whistles a Fitbit or other digital device offers when I’m too ill to do more than I am able to do. The digital tracking devices/apps that are much loved by the worried well of the Quantified Self movement may have just the opposite effects on others by making us feel bad about what we’re not able to do.
That’s why I’ve decided that on the days I manage to actually put one foot in front of the other when I’m feeling too ill to do so is a day that definitely qualifies for a shiny sparkly sticker – no matter what my Fitbit tells me.
NEWS UPDATE, September 23, 2014: My Fitbit battery died just seven weeks after I started using it (despite the 4-6 month battery life its corporate website promises). Other users on the company’s online support community report similar battery issues – one, in fact, reporting going through one battery per week.
- On Being a (Former) Runner (my essay in Runner’s World magazine)*
- Healthy Privilege: When You Just Can’t Imagine Being Sick*
- When the Elephant in the Room Has No Smartphone*
- “Us” vs “Them: The Underserved Patient Speaks Up*
- The Quantified Self meets The Urban Datasexual
- Can Self-Tracking Drive You Crazy?
- Self-Tracking Tech Revolution? Not So Fast…
- “Fewer Numbers, More Life Experiences”
- Digital Temptations: “Quantifying, Tracking or Gamifying Everything”
* originally published on my other site, Heart Sisters