All winter, you vowed that as soon as the snow and ice melted, you’d make a point to get more exercise. Come the warm weather, you’d take long walks after dinner, jog on the weekends, and even ride your bike to work instead of driving on nice days. But now that it’s spring, you can’t seem to turn your good intentions into action. Want to get moving? An activity tracker may be just what the doctor ordered! That’s exactly why Rajani C. LaRocca, MD, an internist at the Massachusetts General Hospital Charlestown Healthcare Center, not only recommends activity trackers for her patients, but also wears one herself.
In 2013, Dr. LaRocca set out to teach patients with metabolic syndrome the importance of lifestyle change in controlling their condition and improving their health. Metabolic syndrome is a group of risk factors, including high blood pressure, high fasting blood sugar, bad blood fats and abdominal obesity, which increase your risk for diabetes and heart disease. About 34% of adults in the U.S. have this problem, making it a virtual epidemic. Studies show that exercise and a healthy diet can often reverse metabolic syndrome, but getting people to exercise regularly and make better food choices can be a challenge.
As part of her program, Dr. LaRocca gave Fitbit Zips to nine patients with metabolic syndrome — five men and four women, ages 59-74. The group met weekly for six weeks, during which time they received counseling from Dr. LaRocca on how to live a healthier lifestyle. Several kept food journals to stay on top of their eating.
Before starting the tracking program, about 78% of the patients had exercised for 60 minutes or less the previous week, way below the recommended guidelines of at least 30 minutes daily of doing something. While wearing their trackers, all nine patients increased their activity levels, as measured by a boost in their daily step count. Two of the patients lost a significant amount of weight and have kept it off. Eight months later, five of the nine are still wearing a tracker, which is remarkable.
Even though some of her patients may not be using their trackers anymore, it doesn’t mean that they’ve resumed their sedentary lifestyle. A few months after the program was completed, Dr. LaRocca ran into one of her patients who insisted that he no longer needed to wear a tracker. “My patient told me that he walks four miles a day without it,” she explained, “I asked him, ‘What are you going to do when the weather gets cold?’ He said, ‘I’m just going to put on a heavier coat because this is what I do now. I won’t let the weather interfere with me.’ In his case, I think the tracker served its purpose; walking several miles a day is just part of his routine.”
We asked Dr. LaRocca to share some of her insights on activity tracking from her perspective as both a physician and an avid tracker.
Wellocracy: Doctors frequently counsel patients to get more exercise, eat better, keep an eye on their blood pressure, etc., and are often frustrated that patients don’t follow their advice. How do you feel having your patients work with a tracker helped change the dynamic?
Dr. LaRocca: When we take blood pressure or other measurements in the office, no matter how many times we explain those numbers to our patients, it is hard for them to understand. Why should you care about your blood pressure numbers? What do your lab values mean in terms of your life? Measuring the number of steps you take every day is something people can relate to — it makes it more concrete. Second, it makes it fun because there are things that give you immediate feedback, “Oh really, I’ve only walked that much today? That’s not very much at all. I better get up and move around some more!” And then you can take action. My patients have told me that they are more likely to park far away from a building, take a walk during lunch, or take the stairs because they knew it would all add up and they wanted to get to a particular number by the end of the day.
As someone who wears a tracker, what’s your personal biggest insight on tracking?
Dr. LaRocca: What’s shocking to me is how easy it is to get to 10,000 steps a day and how hard it is to get to 10,000 steps. On days when you go to the gym, walk the dog and are running around, it’s not really much of a challenge. Then there are those days when you’re stuck at work and you’re literally stuck in a chair for eight hours. I sit there and think, “I’m not going to make it today, how am I going to do it?” I know unless I do something about it, it’s not going to happen. I think what surprised me the most is that if you don’t make a conscious effort to make exercise a part of what you’re doing, you’re not going to reach your goal.
Wellocracy: It’s very difficult to get people to change their behavior for the long run — about 30% of all trackers get abandoned within three months. What can be done to make lifestyle change more sustainable?
Dr. LaRocca: I think that the novelty can wear off with trackers, which is why people stop wearing them. There are two things that we have to think about: One is that we have to find ways to make things novel again. Fitbit and other trackers are linked to a website where you can be part of a community. It makes it more interesting, especially if you sign up with friends to take part in a challenge, like who can walk the most steps, or climb the most flights of stairs. If you’re in a group with friends who encourage each other to keep going, you’re more likely to stick with it. If you’re all by yourself, and not necessarily interacting with anyone else, it’s much more likely that you’re going to abandon your tracker.
Wellocracy: What did you like or didn’t like about your tracker.
Dr. LaRocca: I have used various iterations of Fitbit — right now I’m wearing a wristband, which I like because I don’t have to worry about it falling off me. It feels more secure than a tracker that I clip onto my clothes. Making it easy to wear is key to getting people to wear it. The wristband is loose enough to be comfortable, but tight enough that it’s not going to pop off. I also like wearing the wristband because it shows: People ask me about it, and then I can tell them about trackers, which I find interesting. I do think that feedback on the monitor itself is important. It’s not enough that a tracker just vibrates, as some of them do, I want to see the numbers on the screen. The Fitbit Flex didn’t give me the step count on the wristband, you had to get it off the website or the app, so I didn’t buy it.
The Fitbit Zip is great because it not only shows you the numbers; it also shows you a smiley face that grins more when you are more active! I thought the smiley face was the cutest thing. Every once in a while at night, a little icon would show up, it would be like a little alien or something. I thought it was the most entertaining thing and it made me like it even more. I think being able to surprise people with something like that keeps them more engaged. It certainly kept me entertained.
I think sometimes people want to be pushed and sometimes people don’t. Sometimes it’s good just to get the data for the day. I’ve got my Fitbit hooked up to my smartphone so it will give me push notifications, “ Hey, you’re only 104 steps from your daily goal.” I sometimes find it helpful, but on some days it’s not. If I’m having a really busy day, and it says, “You’re only at 2,400 steps away from your goal,” and I think, “That’s not going to happen!” Having interactions like that is okay if you can turn it off when it becomes too annoying, which I do.
Wellocracy: What’s the best way to work with a tracker?
Dr. LaRocca: The patients who did well learned that they had to plan to do something every day to meet their goals. Whether it’s, “I’m going to take two 10-minute walks today,” or “I’m going to walk 45 minutes at lunch,” or “I’m going to go to the gym and do XYZ,” they planned to do that. After they did that, they would check their tracker to see how many steps they got, and then try to figure out how much more they needed to do. If their regular activity wasn’t going to bring them to their goal, then they had to plan an extra trip later on in the day.
Interestingly, some of the most successful people in changing their habits have been those who built it into their commute. They said, “I don’t have time to go to the gym, so I’m going to take public transportation and I’m going to walk.” So they would walk 45 minutes to the train, 45 minutes back at night. It seemed to work well for them because it was already built into their day.