Fitbit Use and Activity Levels From Intervention to 2 Years After: Secondary Analysis of a Randomized Controlled Trial

Sheri J Hartman, Ruohui Chen, Rowena M Tam, Hari K Narayan, Loki Natarajan, Lin Liu, Sheri J Hartman, Ruohui Chen, Rowena M Tam, Hari K Narayan, Loki Natarajan, Lin Liu

Abstract

Background: There has been a rapid increase in the use of commercially available activity trackers, such as Fitbit, in physical activity intervention research. However, little is known about the long-term sustained use of trackers and behavior change after short-term interventions.

Objective: This study aims to use minute-level data collected from a Fitbit tracker for up to 2 years after the end of a randomized controlled trial to examine patterns of Fitbit use and activity over time.

Methods: Participants in this secondary data analysis were 75 female breast cancer survivors who had been enrolled in a 12-week physical activity randomized controlled trial. Participants randomized to the exercise intervention (full intervention arm) received a Fitbit One, which was worn daily throughout the 12-week intervention, and then were followed for 2 years after the intervention. Participants randomized to the waitlist arm, after completing the randomized controlled trial, received a Fitbit One and a minimal version of the exercise intervention (light intervention arm), and then were followed for 2 years after the intervention. Average and daily adherence and MVPA were compared between the 2 groups in the interventional and postinterventional periods using both linear and generalized additive mixed effects models.

Results: Adherence to wearing the Fitbit during the 12-week intervention period was significantly higher in the full intervention arm than in the light intervention arm (85% vs 60%; P<.001). Average adherence was significantly lower for both study arms during the follow-up period than in the intervention period; however, there were statistically different patterns of adherence during the follow-up period, with the light intervention arm having steeper declines than the full intervention arm over time (P<.001). Similar to the adherence results, mean minutes of Fitbit-measured MVPA was higher for the full intervention arm than for the light intervention arm during the 12-week intervention period (mean MVPA 27.89 minutes/day, SD 16.38 minutes/day vs 18.35 minutes/day, SD 12.64 minutes/day; P<.001). During the follow-up period, average MVPA was significantly lower than the 12-week intervention period for both the full intervention arm (21.74 minutes/day, SD 24.65 minutes/day; P=.002) and the light intervention arm (15.03 minutes/day, SD 13.27 minutes/day; P=.004). Although the mean MVPA in each arm was similar across the follow-up period (P=.33), the pattern of daily MVPA was significantly different between the 2 groups (P<.001).

Conclusions: While adherence to wearing activity trackers and maintaining physical activities declined after completion of a 12-week exercise intervention, a more active interventional strategy resulted in greater wear time and activity levels during the intervention and more stable patterns of adherence and activity in the long term. An improved understanding of long-term maintenance patterns may inform improved exercise interventions that result in sustained increases in physical activity.

Trial registration: ClinicalTrials.gov NCT02332876; https://ichgcp.net/clinical-trials-registry/NCT02332876.

Keywords: Fitbit; activity level; activity tracker; adherence; behavior change; breast; cancer; digital health; exercise; fitness; health technology; long-term use; mHealth; maintenance; physical activity; survivor; sustained use; tracker; use pattern; wearable.

Conflict of interest statement

Conflicts of Interest: None declared.

©Sheri J Hartman, Ruohui Chen, Rowena M Tam, Hari K Narayan, Loki Natarajan, Lin Liu. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 30.06.2022.

Figures

Figure 1
Figure 1
Box-plots of median and interquartile range of adherence to wearing the Fitbit during the 12-week exercise intervention or “light” intervention period for each study group, and during the post-intervention to 2-year follow-up period for each study group.
Figure 2
Figure 2
Weekly rolling average adherence to wearing the Fitbit during the 12-week intervention period for the Full Intervention arm and the 12-week “light” intervention period for the Light Intervention arm, by group.
Figure 3
Figure 3
Weekly rolling average adherence to wearing the Fitbit after completion of the 12-week intervention period, by group.
Figure 4
Figure 4
Daily Fitbit measured MVPA during the 12-week intervention period for the Full Intervention arm and the 12-week “light” intervention period for the Light Intervention arm, by group.
Figure 5
Figure 5
Daily Fitbit measured MVPA after completion of the 12-week intervention period, by group.

References

    1. American Cancer Society . American Cancer Society. Atlanta, GA: American Cancer Society; 2019. [2022-06-06]. .
    1. Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity, risk of death and recurrence in breast cancer survivors: A systematic review and meta-analysis of epidemiological studies. Acta Oncol. 2015 May;54(5):635–54. doi: 10.3109/0284186X.2014.998275.
    1. Spei M, Samoli E, Bravi F, La Vecchia C, Bamia C, Benetou V. Physical activity in breast cancer survivors: A systematic review and meta-analysis on overall and breast cancer survival. The Breast. 2019 Apr;44:144–152. doi: 10.1016/j.breast.2019.02.001.
    1. Schmitz KH, Campbell AM, Stuiver MM, Pinto BM, Schwartz AL, Morris GS, Ligibel JA, Cheville A, Galvão Daniel A, Alfano CM, Patel AV, Hue T, Gerber LH, Sallis R, Gusani NJ, Stout NL, Chan L, Flowers F, Doyle C, Helmrich S, Bain W, Sokolof J, Winters-Stone Kerri M, Campbell KL, Matthews CE. Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA Cancer J Clin. 2019 Nov 16;69(6):468–484. doi: 10.3322/caac.21579. doi: 10.3322/caac.21579.
    1. Patel A, Friedenreich C, Moore S, Hayes S, Silver J, Campbell K, Winters-Stone Kerri, Gerber Lynn H, George Stephanie M, Fulton Janet E, Denlinger Crystal, Morris G Stephen, Hue Trisha, Schmitz Kathryn H, Matthews Charles E. American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control. Med Sci Sports Exerc. 2019 Nov;51(11):2391–2402. doi: 10.1249/MSS.0000000000002117. 00005768-201911000-00024
    1. Campbell Kristin L, Winters-Stone Kerri M, Wiskemann Joachim, May Anne M, Schwartz Anna L, Courneya Kerry S, Zucker David S, Matthews Charles E, Ligibel Jennifer A, Gerber Lynn H, Morris G Stephen, Patel Alpa V, Hue Trisha F, Perna Frank M, Schmitz Kathryn H. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019 Nov;51(11):2375–2390. doi: 10.1249/MSS.0000000000002116. 00005768-201911000-00023
    1. Cancer Survivors and Physical Activity. National Cancer Institute. [2022-06-06]. .
    1. Lucas AR, Levine BJ, Avis NE. Posttreatment trajectories of physical activity in breast cancer survivors. Cancer. 2017 Jul 15;123(14):2773–2780. doi: 10.1002/cncr.30641. doi: 10.1002/cncr.30641.
    1. Grimmett C, Corbett T, Brunet J, Shepherd J, Pinto BM, May CR, Foster C. Systematic review and meta-analysis of maintenance of physical activity behaviour change in cancer survivors. Int J Behav Nutr Phys Act. 2019 Apr 27;16(1):37. doi: 10.1186/s12966-019-0787-4. 10.1186/s12966-019-0787-4
    1. Haas BK, Kimmel G, Hermanns M, Deal B. Community-Based FitSTEPS for Life Exercise Program for Persons With Cancer: 5-Year Evaluation. JOP. 2012 Nov;8(6):320–324. doi: 10.1200/jop.2012.000555.
    1. Cheifetz O, Dorsay JP, MacDermid JC. Exercise facilitators and barriers following participation in a community-based exercise and education program for cancer survivors. J Exerc Rehabil. 2015 Feb 28;11(1):20–9. doi: 10.12965/jer.150183. jer-11-1-20
    1. Courneya KS, Vardy JL, O'Callaghan CJ, Friedenreich CM, Campbell KL, Prapavessis H, Crawford JJ, O'Brien P, Dhillon HM, Jonker DJ, Chua NS, Lupichuk S, Sanatani MS, Gill S, Meyer RM, Begbie S, Bonaventura T, Burge ME, Turner J, Tu D, Booth CM. Effects of a Structured Exercise Program on Physical Activity and Fitness in Colon Cancer Survivors: One Year Feasibility Results from the CHALLENGE Trial. Cancer Epidemiol Biomarkers Prev. 2016 Jun;25(6):969–77. doi: 10.1158/1055-9965.EPI-15-1267.1055-9965.EPI-15-1267
    1. Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009 Nov;28(6):690–701. doi: 10.1037/a0016136.2009-20990-006
    1. Michie S, Ashford S, Sniehotta FF, Dombrowski SU, Bishop A, French DP. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health. 2011 Nov;26(11):1479–98. doi: 10.1080/08870446.2010.540664.938640058
    1. Carver CS, Scheier MF. Control theory: a useful conceptual framework for personality-social, clinical, and health psychology. Psychol Bull. 1982 Jul;92(1):111–35.
    1. Sullivan AN, Lachman ME. Behavior Change with Fitness Technology in Sedentary Adults: A Review of the Evidence for Increasing Physical Activity. Front Public Health. 2016;4:289. doi: 10.3389/fpubh.2016.00289. doi: 10.3389/fpubh.2016.00289.
    1. Gell NM, Grover KW, Humble M, Sexton M, Dittus K. Efficacy, feasibility, and acceptability of a novel technology-based intervention to support physical activity in cancer survivors. Support Care Cancer. 2017 Apr;25(4):1291–1300. doi: 10.1007/s00520-016-3523-5.10.1007/s00520-016-3523-5
    1. Lewis ZH, Lyons EJ, Jarvis JM, Baillargeon J. Using an electronic activity monitor system as an intervention modality: A systematic review. BMC Public Health. 2015 Jun 24;15:585. doi: 10.1186/s12889-015-1947-3. 10.1186/s12889-015-1947-3
    1. Coughlin SS, Stewart J. Use of Consumer Wearable Devices to Promote Physical Activity: A Review of Health Intervention Studies. J Environ Health Sci. 2016 Nov;2(6):10.15436/2378-6841.16.1123. doi: 10.15436/2378-6841.16.1123.
    1. Hardcastle SJ, Jiménez-Castuera Ruth, Maxwell-Smith C, Bulsara MK, Hince D. Fitbit wear-time and patterns of activity in cancer survivors throughout a physical activity intervention and follow-up: Exploratory analysis from a randomised controlled trial. PLoS One. 2020 Oct 19;15(10):e0240967. doi: 10.1371/journal.pone.0240967. PONE-D-20-16675
    1. Ringeval M, Wagner G, Denford J, Paré Guy, Kitsiou S. Fitbit-Based Interventions for Healthy Lifestyle Outcomes: Systematic Review and Meta-Analysis. J Med Internet Res. 2020 Oct 12;22(10):e23954. doi: 10.2196/23954. v22i10e23954
    1. Gell NM, Grover KW, Savard L, Dittus K. Outcomes of a text message, Fitbit, and coaching intervention on physical activity maintenance among cancer survivors: a randomized control pilot trial. J Cancer Surviv. 2020 Feb;14(1):80–88. doi: 10.1007/s11764-019-00831-4.10.1007/s11764-019-00831-4
    1. Howlett Neil, Trivedi Daksha, Troop Nicholas A, Chater Angel Marie. Are physical activity interventions for healthy inactive adults effective in promoting behavior change and maintenance, and which behavior change techniques are effective? A systematic review and meta-analysis. Transl Behav Med. 2019 Jan 01;9(1):147–157. doi: 10.1093/tbm/iby010. 4913688
    1. Hartman SJ, Nelson SH, Weiner LS. Patterns of Fitbit Use and Activity Levels Throughout a Physical Activity Intervention: Exploratory Analysis from a Randomized Controlled Trial. JMIR Mhealth Uhealth. 2018 Feb 05;6(2):e29. doi: 10.2196/mhealth.8503. v6i2e29
    1. Van Blarigan EL, Chan H, Van Loon K, Kenfield SA, Chan JM, Mitchell E, Zhang L, Paciorek A, Joseph G, Laffan A, Atreya CE, Fukuoka Y, Miaskowski C, Meyerhardt JA, Venook AP. Self-monitoring and reminder text messages to increase physical activity in colorectal cancer survivors (Smart Pace): a pilot randomized controlled trial. BMC Cancer. 2019 Mar 11;19(1):218. doi: 10.1186/s12885-019-5427-5. 10.1186/s12885-019-5427-5
    1. Farnell G, Barkley J. The effect of a wearable physical activity monitor (Fitbit One) on physical activity behaviour in women: A pilot study. jhse. 2017;12(4):1230–1237. doi: 10.14198/jhse.2017.124.09.
    1. DiFrancisco-Donoghue J, Jung M, Stangle A, Werner WG, Zwibel H, Happel P, Balentine J. Utilizing wearable technology to increase physical activity in future physicians: A randomized trial. Prev Med Rep. 2018 Dec;12:122–127. doi: 10.1016/j.pmedr.2018.09.004. S2211-3355(18)30187-6
    1. Shin G, Jarrahi MH, Fei Y, Karami A, Gafinowitz N, Byun A, Lu X. Wearable activity trackers, accuracy, adoption, acceptance and health impact: A systematic literature review. J Biomed Inform. 2019 May;93:103153. doi: 10.1016/j.jbi.2019.103153. S1532-0464(19)30071-1
    1. Shin Grace, Feng Yuanyuan, Jarrahi Mohammad Hossein, Gafinowitz Nicci. Beyond novelty effect: a mixed-methods exploration into the motivation for long-term activity tracker use. JAMIA Open. 2019 Apr;2(1):62–72. doi: 10.1093/jamiaopen/ooy048. ooy048
    1. Lindgren T, Hooper J, Fukuoka Y. Perceptions and Experiences of Women Participating in a Digital Technology-Based Physical Activity Intervention (the mPED Trial): Qualitative Study. JMIR Public Health Surveill. 2019 Dec 20;5(4):e13570. doi: 10.2196/13570. v5i4e13570
    1. Wu HS, Gal R, van Sleeuwen NC, Brombacher AC, IJsselsteijn WA, May AM, Monninkhof EM. Breast Cancer Survivors' Experiences With an Activity Tracker Integrated Into a Supervised Exercise Program: Qualitative Study. JMIR Mhealth Uhealth. 2019 Feb 21;7(2):e10820. doi: 10.2196/10820. v7i2e10820
    1. Thomas S, Reading J, Shephard RJ. Revision of the Physical Activity Readiness Questionnaire (PAR-Q) Can J Sport Sci. 1992 Dec;17(4):338–45.
    1. Hartman SJ, Natarajan L, Palmer BW, Parker B, Patterson RE, Sears DD. Contemp Clin Trials. 2015 Nov;45(Pt B):371–376. doi: 10.1016/j.cct.2015.09.021. S1551-7144(15)30096-3
    1. Van Domelen DR. accelerometry: Functions for Processing Minute-to-Minute Accelerometer Data. . [2022-06-06]. .
    1. Choi L, Liu Z, Matthews CE, Buchowski MS. Validation of accelerometer wear and nonwear time classification algorithm. Med Sci Sports Exerc. 2011 Feb;43(2):357–64. doi: 10.1249/MSS.0b013e3181ed61a3.
    1. Kelly LA, McMillan DG, Anderson A, Fippinger M, Fillerup G, Rider J. Validity of actigraphs uniaxial and triaxial accelerometers for assessment of physical activity in adults in laboratory conditions. BMC Med Phys. 2013 Nov 26;13(1):5. doi: 10.1186/1756-6649-13-5. 1756-6649-13-5
    1. Freedson P S, Melanson E, Sirard J. Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc. 1998 May;30(5):777–81. doi: 10.1097/00005768-199805000-00021.

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