Introduction

Wearable smart devices (WSD) are as ubiquitous as smart phones [1]. In 2016, 1 in 6 (15%) Americans owned some form of wearable smartwatch or fitness tracker [1]. These devices are capable of accurately measuring steps and heart rate [2]. Features such as ‘nudging’ (prompt to stand when you’ve been sedentary for too long) and ‘activity rings’ may have implications for facilitating positive physical activity (PA) behaviours [2]. Literature has demonstrated that WSD can facilitate positive PA behaviours in older adults and adults living with obesity, however, there is limited research investigating the effects of WSD in obese older adults.

Effectiveness of WSD in older adults

Research focused on WSD as an intervention for the general older population has shown promise (PA). McMahon et al[3] demonstrated through a 10-month observational study with 95 older adults (79.8 ± 6.8 years) that perceived ease-of-use, usefulness, and acceptance of WSD was highly positive in older adults. This suggests that older adults are willing to use WSD. Lee et al [4] recruited 16 active older adults (69.25 ± 2.45 years) with no experience with activity trackers for a 13-week study to determine if wearable devices facilitate higher step counts and more time in moderate-vigorous physical activity (MVPA). They observed increases in step counts and time spent performing MVPA [4], however the novelty effect and inherent motivation of the sample may reduce the generalizability of the findings. Nicklas et al [5] recruited 48 older (65-79 years) and sedentary (less than two days a week of structured exercise) for a 10-month study comparing a diet and exercise intervention to a diet, exercise and accelerometer intervention. For the first five months, researchers provided meals and supervised exercise for both groups. For the final five months, individuals independently choose their meals and exercise plans. Using weight as an outcome, the average weight gain was 1.3kg less in the accelerometer group compared to the group without the accelerometers [5], suggesting that self-monitoring with the use of a WSD can improve activity behaviours over a long period of time. O’Brien et al [6] recruited 35 older adults (73.5 ± 9.4 years) for a 12-week pilot study to determine if a Nike Fuel wristband could increase step count and improve overall health [BMI, blood pressure and Timed Up and Go (TUG) scores]. At the end of the 12-week period, researchers observed no statistically significant improvements in step count or health outcomes with the exception of TUG scores [6], which may suggest that there may be positive health trends associated with the intervention.

Effectiveness of WSD in obese older adults

Research investigating WSD for obese adults has shown promise as well, however, the evidence is conflicting and its applicability to older populations is questionable. Cadmus-Bertram et al [7] recruited 51 overweight women (60 ± 7 years) for a 16-week intervention comparing the effects of a FitbitTM device and a standard pedometer on MVPA time and steps taken per day. Researchers found that MVPA time and step count significantly increased in the Fitbit group compared to the pedometer group, however, improvements were observed in both groups [7]. The generalizability of these findings is questionable. In contrast, Jakicic et al [8] conducted a 24-month clinical trial comparing a text-prompt and behavioural management intervention to a WSD for weight loss in young adults (18-35 years) and found that WRS was ineffective over a 24-month period. In addition, Takahashi et al [9] conducted a 4-month clinical trial in multi-morbidity overweight adults (63.4 ± 15 years) to observe changes in step count, functional status, grip strength and gait speed and found no improvements with a WSD intervention with the exception of gait speed, a significant predictor of frailty.

Limitations of WSD in older adults

These studies share several limitations. A large percentage of the literature have female dominant samples, putting into question the generalizability of the findings [6-9]. Most literature have sample size listed as a limitation to their data [4,5,7]. Almost all research investigating wearable technology interventions has an accompanying behavioural management program or training session, making it difficult to determine if changes are attributed to the WSD [3-9]. Lastly, studies that have demonstrated statistically significant benefits have short intervention periods, putting into question the sustainability of the positive behavioural changes [4,7,9]. Research should focus solely on WSR as an intervention because in reality, individuals will not have an accompanying program or support from other external sources to improve health. A cohort study using WSD as an exposure is best. Jang et al [11] was able to demonstrate positive health outcomes later into a 13-month cohort WSD intervention trial with frail older adults. Outcome measures should focus on BMI, functional test performance, and perceived health. Step-count should be avoided as it has been shown to be limited indicator of positive health behaviour adherence [3,6,9,10].

Closing Remarks

The obesity epidemic is affecting the older population just as much as it effects other age groups [12]. With the growth of our older population accelerating as profound rates, finding a feasible intervention to prevent obesity associated with inactive aging is vital to preventing disease associated with obesity.

References

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