Wearables have the potential to improve our health. They can be reminders that we’re not moving enough throughout the day, and they can be useful tools for doctors to monitor the fitness progress of their patients. However, in the Journal of the American Medical Association, McDermott and her colleagues recently reported that their trial of prescribing a home-based exercise program using a wearable activity monitor (FitBit Zip) plus telephone coaching over nine months, did not improve patients’ lower extremity peripheral arterial disease (PAD), when compared to typical care that had no onsite sessions, active exercise, nor coaching.
Many studies have already shown that supervised treadmill exercise as a treatment for patients with peripheral arterial disease significantly improves symptoms. Furthermore, combining supervised exercises with home exercises gives patients even bigger improvements. However, these supervised programs require patients to visit an exercise center three times a week. This can be difficult for patients and so many choose to not participate.
Therefore, the goal of this study was to assess the feasibility of a home-based exercise program to achieve fitness improvements, by supervising patients using wearable activity trackers, and coaching them through weekly or monthly telephone calls. The researchers studied a total of 200 PAD patients who were 70.2±10.4 years old on average. 99 were randomized to the exercise intervention group, and 101 were randomized to the usual care group.
McDermott and colleagues found that at the end of the nine month study, there was no difference in the six minute walk distance between the patients that had exercise intervention and the patients that had usual care. (The six minute walk distance is a standardized test that measures the severity of a patient’s PAD; longer walk distances indicate less disease.) Patients with the intervention had a non-significant increase in their walk distance from 330.5±100.2m to 333.4±115.1m, and the patients with usual care saw a non-significant increase in their walk distance from 336.2±96.6m to 348.2±98.1m; essentially, the intervention did nothing. The study’s secondary subjective measures of PAD also showed no differences between the groups. Curiously, one of the questionnaires that allowed patients to report their pain during activity showed that patients with usual care actually improved more and had less pain than patients with exercise intervention.
The study had several limitations. Perhaps most significant were the weekly or monthly coaching sessions that took out immediate feedback, and that only 79% of scheduled telephone coaching sessions were actually made, which could be insufficient for significant results. Regardless, the study presented strong evidence for a lack of efficacy of applying wearables and technology to improve fitness to reduce disease.
As we move towards tele-health, more technologies will attempt to solve health problems from the comfort of a patient’s home. We can imagine a world where we Skype a doctor and they order a few blood tests to be processed by a home Theranos-like unit, and then they prescribe medications and exercise routines and track healing progress using wearables and more blood tests. One day, it’ll probably be that way. For now, however, it’s still worth it to visit the doctor and follow their guidance and care plans in person.
Journal article in JAMA: Effect of a Home-Based Exercise Intervention of Wearable Technology and Telephone Coaching on Walking Performance in Peripheral Artery Disease The HONOR Randomized Clinical Trial