The effectiveness of a wearable activity tracker (WAT)-based intervention to improve physical activity levels in sedentary older adults: A systematic review and meta-analysis

Highlights

• A WAT-based intervention grounded in BCTs improve PA levels in older adults.

• A traditional pedometer and WAT-based intervention seem to have similar improvements in older people’ PA levels.

• More clinical trials are still required to see the long term effects of WAT-based intervention.

Abstract

Background

The evidence shows that WAT-based interventions enhance the physical activity (PA) levels of young people by sustainably delivering behavior change techniques (BCTs). These results may not be replicable among older adults. This paper aims to evaluate the effectiveness of WAT-based interventions in improving PA levels in sedentary older adults.

Methods

Eight electronic databases were searched for randomized controlled trials published January 2008 to December 2018. BCTs delivered by WAT aimed at increasing PA levels using step counts or time spent on moderate-to-vigorous (MVPA) exercise as an outcome were eligible for inclusion.

Results

In nine out of the ten included studies, higher PA levels were seen in the intervention group than in the control group. One study where the participants’ mean age was 80+ showed no significant increase in PA levels. Significant effects were also demonstrated from the meta-analysis, which included four studies using a passive control (i.e., the usual care or health information) on step counts (n = 207, Hedges g = 1.27, 95 % CI = 0.51–2.04, p = 0.001) and two studies on MVPA (n = 83, Hedge’s g = 1.23, 95 % CI = 0.75–1.70, p < 0.001). A non-significant effect was found on step counts (n = 201, Hedge’s g = 0.22, 95 % CI = −0.62 to 1.06, p = 0.61) in three studies that used an active control comparison group (i.e., traditional pedometer).

Conclusions

A WAT-based intervention is effective at improving PA levels among older adults over the short term when compared with the usual care or health information. However, when compared with a traditional pedometer or when used among old-old adults, the results were inconclusive.

Introduction

Regular participation in physical activity (PA) confers a number of physical and psychological health benefits for older people. However, many older people are considered sedentary or physically inactive. Around 25%–60% of older adults failed to meet the recommended level of PA, which requires 150 min of moderate-intensity aerobic PA or 75 min of vigorous-intensity aerobic PA, or an equivalent combination of moderate to vigorous-intensity physical activity (MVPA) per week (Bauman, Merom, Bull, Buchner, & Fiatarone Singh, 2016). It was observed that older people often have high dropout and non-adherence rates to different exercise programs due to lower self-efficacy in overcoming barriers to maintaining a physically active lifestyle (Mullen et al., 2013). Adopting behavior change techniques (BCTs) including goal setting, feedback on performance, rewards contingent on successful behavior, and social support in the design of an exercise program is a common way to get old people to increase their self-efficacy to remain physically active (Olander et al., 2013). The traditional method of delivering BCTs by personal contact is costly, less flexible, and not sustainable due to limitations in time and venue (Lyons, Lewis, Mayrsohn, & Rowland, 2014). In addition, the effect is likely to stop once the program has been terminated and older people resume their sedentary lifestyle (Chase, 2015).

Nowadays, technology is becoming important in promoting a healthy lifestyle. A new trend in fitness technology, Wearable Activity Trackers (WATs) such as Apple Watch, FitBit, and UP® by JawBone are now easily available in the market (Mercer et al., 2016; Walker, Hickey, & Freedson, 2016). WAT is an electronic device that can be worn on the body as an accessory (Ruiz & Goransson, 2015), and integrated with a pedometer and accelerometer to measure physical movements such as step counts, energy expenditure, movements of different durations and intensities, and periods of inactivity (Mercer et al., 2016). WATs can record and provide users with feedback on their physical performance and activity levels.

When WATs collaborate with mobile devices to provide interactive BCTs, they allow users to do things such as self-monitor, set goals, and seek social support (Higgins, 2016; Shih, Han, Poole, Rosson, & Carroll, 2015), and also to record the data for regular reviews (Cadmus-Bertram, Marcus, Patterson, Parker, & Morey, 2015; Lyons & Lewis, 2014; Ruiz & Goransson, 2015). Therefore, BCTs can be continuously delivered to users by WATs, to increase the self-efficacy of the users and encourage them to improve and sustainably maintain their PA levels with less professional support (Lyons & Lewis, 2014; Sullivan & Lachman, 2017; Taylor, 2014).

A systematic review of 11 studies was conducted with the aim of synthesizing information on the efficacy of using WAT versus WAT-based interventions (Choi, Lee, Vittinghoff, & Fukuoka, 2016). Of the five studies in which a significant improvement was found in the participants’ physical activity levels, all went beyond simply giving WATs to the participants and involved interventions grounded in BCTs. The authors of that review argued that WATs might be more appropriately used as a medium for delivering BCTs (i.e., as a WAT-based intervention grounded in BCTs), rather than as an intervention in and of the device itself (Choi et al., 2016). Therefore, WAT-based interventions grounded in BCTs are the major focus in the current review.

A number of reviews have been conducted to examine the effectiveness of WAT-based interventions grounded in BCTs in promoting PA levels. Several reviews concluded that interventions applying computer, mobile, and wearable technologies are effective at increasing PA levels among younger adults (Goode et al., 2017; Lewis, Lyons, Jarvis, & Baillargeon, 2015; Stephenson, McDonough, Murphy, Nugent, & Mair, 2017). A recent systematic review of 28 papers with 3646 participants’ age ranged from 17.9 years to 79.5 years included 13 studies that targeted young adults (<39.9 years), 14 studies that targeted middle-aged adults (40–64.9 years), and only 1 study that target adults over the age of 65 (Brickwood, Watson, O’Brien, & Williams, 2019). This review included studies using WAT as either the basis of the intervention (11 studies) or as a component of a multifaceted intervention, such as one using established behavioral change techniques (17 studies). The result also showed that those interventions that adopted BCTs appeared to have a greater effect on PA levels when compared with control groups than those interventions that included just the use of WAT compared with control groups. However, no subgroup analysis has been conducted to determine if the age of the participants influenced the effectiveness of the intervention. Of all of the studies that were included in this review, 18 specified that the participants must have regular access to the Internet, a computer, and/or a smartphone. It is believed that the findings of this review tended to represent people who were more ready to use technology or more accepting of the use of technology in their daily life.

Whether or not similar results can be replicated in older adults, particularly those who are sedentary or physically inactive, is unclear. This is because all of the abovementioned reviews focused on exploring the effects on adults in general instead of older people in particular. Studies have shown an increased trend among people aged 55 or above to adopt technology (Lyons, Swartz, Lewis, Martinez, & Jennings, 2017; Mini & Janetius, 2012), although many older adults are also fearful of technology and of the associated cost of using a new technology (Deng, Mo, & Liu, 2014), leading to low levels of adoption or to non-adoption. Thus, the acceptability of technology in daily life varies among people aged > 55. It is interesting to explore the effects of using WAT, which is a kind of technology used in daily life by people aged 55 or above. Although some older adults were highly interested in using wearable technology (Kekade et al., 2018), the continual use of a WAT leading to an increase in PA levels depends on recognizing the long-term benefits of tracker use, social support, and internal motivation (Kononova et al., 2019). Thus, the objective of this review was to evaluate the effectiveness of WAT-based interventions aimed at improving PA levels in sedentary older people with aged > 55 and to describe the different BCTs that were adopted in different interventions.