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      Using Fitness Trackers and Smartwatches to Measure Physical Activity in Research: Analysis of Consumer Wrist-Worn Wearables

      , MSc (Comp Sci), MBA , 1 , , BSc (Comp Sci) 2 , , MSc (Comp Eng), MSc (Telemed & e-Health) 2 , , MSc (Comp Sci) 3 , 4 , , MSc (Comp Sci), PhD 2 , , RN, CRNA, MSc (Nursing), PhD 5 , , MPH, MD, PhD 1

      (Reviewer), (Reviewer), (Reviewer), (Reviewer), (Reviewer)

      Journal of Medical Internet Research

      JMIR Publications

      motor activity, physical activity, fitness trackers, heart rate, photoplethysmography

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          Abstract

          Background

          New fitness trackers and smartwatches are released to the consumer market every year. These devices are equipped with different sensors, algorithms, and accompanying mobile apps. With recent advances in mobile sensor technology, privately collected physical activity data can be used as an addition to existing methods for health data collection in research. Furthermore, data collected from these devices have possible applications in patient diagnostics and treatment. With an increasing number of diverse brands, there is a need for an overview of device sensor support, as well as device applicability in research projects.

          Objective

          The objective of this study was to examine the availability of wrist-worn fitness wearables and analyze availability of relevant fitness sensors from 2011 to 2017. Furthermore, the study was designed to assess brand usage in research projects, compare common brands in terms of developer access to collected health data, and features to consider when deciding which brand to use in future research.

          Methods

          We searched for devices and brand names in six wearable device databases. For each brand, we identified additional devices on official brand websites. The search was limited to wrist-worn fitness wearables with accelerometers, for which we mapped brand, release year, and supported sensors relevant for fitness tracking. In addition, we conducted a Medical Literature Analysis and Retrieval System Online (MEDLINE) and ClinicalTrials search to determine brand usage in research projects. Finally, we investigated developer accessibility to the health data collected by identified brands.

          Results

          We identified 423 unique devices from 132 different brands. Forty-seven percent of brands released only one device. Introduction of new brands peaked in 2014, and the highest number of new devices was introduced in 2015. Sensor support increased every year, and in addition to the accelerometer, a photoplethysmograph, for estimating heart rate, was the most common sensor. Out of the brands currently available, the five most often used in research projects are Fitbit, Garmin, Misfit, Apple, and Polar. Fitbit is used in twice as many validation studies as any other brands and is registered in ClinicalTrials studies 10 times as often as other brands.

          Conclusions

          The wearable landscape is in constant change. New devices and brands are released every year, promising improved measurements and user experience. At the same time, other brands disappear from the consumer market for various reasons. Advances in device quality offer new opportunities for research. However, only a few well-established brands are frequently used in research projects, and even less are thoroughly validated.

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          Most cited references 82

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          The validity of consumer-level, activity monitors in healthy adults worn in free-living conditions: a cross-sectional study

          Background Technological advances have seen a burgeoning industry for accelerometer-based wearable activity monitors targeted at the consumer market. The purpose of this study was to determine the convergent validity of a selection of consumer-level accelerometer-based activity monitors. Methods 21 healthy adults wore seven consumer-level activity monitors (Fitbit One, Fitbit Zip, Jawbone UP, Misfit Shine, Nike Fuelband, Striiv Smart Pedometer and Withings Pulse) and two research-grade accelerometers/multi-sensor devices (BodyMedia SenseWear, and ActiGraph GT3X+) for 48-hours. Participants went about their daily life in free-living conditions during data collection. The validity of the consumer-level activity monitors relative to the research devices for step count, moderate to vigorous physical activity (MVPA), sleep and total daily energy expenditure (TDEE) was quantified using Bland-Altman analysis, median absolute difference and Pearson’s correlation. Results All consumer-level activity monitors correlated strongly (r > 0.8) with research-grade devices for step count and sleep time, but only moderately-to-strongly for TDEE (r = 0.74-0.81) and MVPA (r = 0.52-0.91). Median absolute differences were generally modest for sleep and steps (<10% of research device mean values for the majority of devices) moderate for TDEE (<30% of research device mean values), and large for MVPA (26-298%). Across the constructs examined, the Fitbit One, Fitbit Zip and Withings Pulse performed most strongly. Conclusions In free-living conditions, the consumer-level activity monitors showed strong validity for the measurement of steps and sleep duration, and moderate valid for measurement of TDEE and MVPA. Validity for each construct ranged widely between devices, with the Fitbit One, Fitbit Zip and Withings Pulse being the strongest performers.
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            Reliability and validity of ten consumer activity trackers

            Background Activity trackers can potentially stimulate users to increase their physical activity behavior. The aim of this study was to examine the reliability and validity of ten consumer activity trackers for measuring step count in both laboratory and free-living conditions. Method Healthy adult volunteers (n = 33) walked twice on a treadmill (4.8 km/h) for 30 min while wearing ten different activity trackers (i.e. Lumoback, Fitbit Flex, Jawbone Up, Nike+ Fuelband SE, Misfit Shine, Withings Pulse, Fitbit Zip, Omron HJ-203, Yamax Digiwalker SW-200 and Moves mobile application). In free-living conditions, 56 volunteers wore the same activity trackers for one working day. Test-retest reliability was analyzed with the Intraclass Correlation Coefficient (ICC). Validity was evaluated by comparing each tracker with the gold standard (Optogait system for laboratory and ActivPAL for free-living conditions), using paired samples t-tests, mean absolute percentage errors, correlations and Bland-Altman plots. Results Test-retest analysis revealed high reliability for most trackers except for the Omron (ICC .14), Moves app (ICC .37) and Nike+ Fuelband (ICC .53). The mean absolute percentage errors of the trackers in laboratory and free-living conditions respectively, were: Lumoback (−0.2, −0.4), Fibit Flex (−5.7, 3.7), Jawbone Up (−1.0, 1.4), Nike+ Fuelband (−18, −24), Misfit Shine (0.2, 1.1), Withings Pulse (−0.5, −7.9), Fitbit Zip (−0.3, 1.2), Omron (2.5, −0.4), Digiwalker (−1.2, −5.9), and Moves app (9.6, −37.6). Bland-Altman plots demonstrated that the limits of agreement varied from 46 steps (Fitbit Zip) to 2422 steps (Nike+ Fuelband) in the laboratory condition, and 866 steps (Fitbit Zip) to 5150 steps (Moves app) in the free-living condition. Conclusion The reliability and validity of most trackers for measuring step count is good. The Fitbit Zip is the most valid whereas the reliability and validity of the Nike+ Fuelband is low.
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              Effectiveness of activity trackers with and without incentives to increase physical activity (TRIPPA): a randomised controlled trial

              Despite the increasing popularity of activity trackers, little evidence exists that they can improve health outcomes. We aimed to investigate whether use of activity trackers, alone or in combination with cash incentives or charitable donations, lead to increases in physical activity and improvements in health outcomes.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                March 2018
                22 March 2018
                : 20
                : 3
                Affiliations
                1 Department of Community Medicine University of Tromsø – The Arctic University of Norway Tromsø Norway
                2 Department of Computer Science University of Tromsø – The Arctic University of Norway Tromsø Norway
                3 Norwegian Centre for E-health Research University Hospital of North Norway Tromsø Norway
                4 Spin-Off Company and Research Results Commercialization Center 1st Faculty of Medicine Charles University in Prague Prague Czech Republic
                5 Department of Health and Care Sciences University of Tromsø – The Arctic University of Norway Tromsø Norway
                Author notes
                Corresponding Author: André Henriksen andre.henriksen@ 123456uit.no
                Article
                v20i3e110
                10.2196/jmir.9157
                5887043
                29567635
                ©André Henriksen, Martin Haugen Mikalsen, Ashenafi Zebene Woldaregay, Miroslav Muzny, Gunnar Hartvigsen, Laila Arnesdatter Hopstock, Sameline Grimsgaard. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 22.03.2018.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                Categories
                Original Paper
                Original Paper

                Medicine

                motor activity, physical activity, fitness trackers, heart rate, photoplethysmography

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