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Move more, sit less, and be well

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Learning Objectives 1. Provide suggestions to help fitness professionals understand how wearable activity trackers (ATs) affect human movement patterns. 2. Describe the role of ATs in physical activity programming 3. Critique a programming case study using ATs in the workplace, including comments by participants.
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MOVE MORE, SIT LESS, AND BE WELL
Behavioral Aspects of Activity Trackers
by Brian Kiessling II,M.S.andCarol Kennedy-Armbruster,Ph.D.,FACSM
Learning Objectives
1. Provide suggestions to help
fitness professionals under-
stand how wearable activity
trackers (ATs) affect human
movement patterns.
2. Describe the role of ATs in
physical activity programming
3. Critique a programming case
study using ATs in the work-
place, including comments
by participants
Key words: Wearable Activity Trackers,
Physical Activity, Behavioral Outcomes,
Human Movement, Programming
INTRODUCTION
The American College of Sports Medicines(ACSMs) annual fitness trends
named wearable technology as the top trend for 2016 and 2017 (19). Recent
information from Endeavour Partners wearable research shows that sales of
activity trackers (ATs) have tripled (4), and, by 2019, the smart wearable
market is expected to generate $53 billion in sales (12). Although a recent
article by Hongu et al. (8) outlines how to select a mobile device for promoting health and
physical activity (PA), only a limited amount of research has been focused on how ATs af-
fect personal perception about movement and associated behavioral outcomes. Schulte et al.
(15) believe a broader perspective to workplace wellness includes a focus on well-being. ATs
are multidimensional and focus on many of the behavioral aspects that affect a personshealth
and well-being. ATs can track movement, sleep, and nutrition. They have the ability to
broaden an employees focus and consider his or her well-being at work. Many tools
designed to increase movement have come and gone in the industry, yet somehow, these
small yet significant devices have drawn attention to movement for millions of people.
This brings forth the question: Are wearable ATs reaching a population that has not
been reached by the fitness industry? Research by Mandic et al. (11) found that the greatest
health benefits are achieved for an entire population when the least fit individuals increase
their PA levels. Michelle SegarsbookNo Sweat: How the Simple Science of Motivation Can Bring
You a Lifetime of Fitness, describes numerous accounts of clients who did not know that mov-
ing throughout the day counted toward health and fitness (16). Many of her clients
thought the only way to get fit was to join a gym. With an estimated 33% of the U.S.
population predicted to own a wearable AT by 2017 (4), further research targeting the
usage and benefits of ATs is needed.
A FOCUS ON MOVEMENT NOT IN A GYM?
In the last 20 years, 14% to 17% of the U.S. population has joined a fitness center (18).
There are obvious barriers to joining and attending a fitness center such as cost, being
26 ACSMsHealth & Fitness Journal
®
November/December 2016
Copyright © 2016 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
comfortable using equipment, or attending classes at a specific
time or day. For the majority of people who do not use a fitness
center, the idea of wearing an AT may seem like an easier and
less threatening place to start. Could wearable ATs be a more
economical and effective way to attract participants who may
be part of the majority not currently participating in a fitness
facility-based program? Amanda Vogel asks a related question
in her article, Fitness Technology Conundrum(22): Fitness
technology is a new normal and the trend is poised for growth.
Will the fitness industry grow with it?Technology experts be-
lieve that getting wearable ATs into the hands of people who
are thinking about movement is important (7). Perhaps, more fit-
ness professionals and fitness centers should consider using ATs
because they present a tremendous opportunity to facilitate phys-
ical movement within the population of people who remain un-
reached by our traditional delivery of fitness.
Sforzo et al. (17), in their article on Health and Wellness
Coaching Competencies for Exercise Professionals,discuss
the potential benefits of integrating coaching skills with personal
training. Informatics researchers at the 2013 Consumer Health
Informatics show in Paris demonstrated that ATs are beneficial
when used in combination with coaching because they hold
users accountable for step goals and log the movement in an
easy and convenient manner (1). Could wearable ATs com-
bined with training or coaching help to change personal move-
ment patterns? ATs may serve as a reminder of the need for
behavior change by increasing awareness. The evaluation of
human movement patterns outlined as follows provides perspec-
tive on who may be helped by ATs.
HUMAN MOVEMENT PATTERNS
Exercise
ACSM regularly publishes and updates evidence-based recom-
mendations for exercise. The ACSM guidelines fall under the
exercise portion of human movement patterns and focus on car-
diorespiratory exercise as well as strength, flexibility, and neuro-
motor training. Ewing Garber et al. and ACSM recommend
that most adults engage in moderate-intensity cardiorespiratory
exercise training for 30 minutes or more per day on 5 days or
more per week for a total of 150 minutes or more per week,
vigorous-intensity cardiorespiratory exercise training for
20 minutes or more per day on 3 days or more per week (75
min/wk), or a combination of moderate- and vigorous-
intensity exercise to achieve a total energy expenditure of 500
to 1,000 MET minutes or more per week (5).
Physical Activity
In 2008, the Office of Disease Prevention and Health Promotion,
U.S. Department of Health and Human Services published
evidence-based PA guidelines that state the following: adults
should do at least 150 minutes (2 hours and 30 minutes) a week
of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a
week of vigorous-intensity aerobic PA, or an equivalent combi-
nation of moderate- and vigorous-intensity aerobic activity. It
is recommended that aerobic activity should be performed in
episodes of at least 10 minutes, and preferably spread through-
out the week(21).
Sedentary Living
Sitting-time evidence-based research is growing and no official
recommendations have been endorsed. Katzmarzyk et al. (9) re-
veal extended sitting results in metabolic alterations that cannot be
compensated for by an isolated exercise session. Levines (10)
work at Mayo Clinic found the negative effects of 6 hours of
sedentary time on fitness levels were similar in magnitude to
the benefit of 1 hour of exercise. Dwyer et al. (3) found a higher
daily step count at baseline was associated with lower all-cause
mortality rate. New studies reveal the importance of looking
at all movement through time in relation to mortality rate.
ATs can be an effective tool for increased awareness of human
movement patterns.
Wearable ATs could be useful for participants who are strug-
gling with PA challenges such as time limitations for those who
are forced to commute for work and then sit for extended periods
of time. Looking at the various movement patterns we do through-
out the day introduces the bigger picture of improving physical
activity levels for the masses.
As previously mentioned, the behavioral aspect of using
wearable ATs has largely been neglected in the current pub-
lished research. An iPod/iPad (Apple
®
Cupertino, CA) proof-
of-concept study found phone/tablet devices to be accurate with
tracking steps (14) via the accelerometer devices in them, but be-
haviorally, many people do not always carry phones or iPads to
track movement. Companies like Fitbit
®
, Jawbone
®
, Apple
®
,
Microsoft
®
,Garmin
®
, and others have produced wrist-worn wear-
able tracking devices as a solution for tracking movement through-
out the day. It seems that many of the major AT-producing
companies are moving toward a wrist-worn device for ease of
use. However, each company has introduced various ways of
motivating behavior change to encourage continued AT usage.
ACTIVITY TRACKERS AND PA PROGRAMMING
To experiment with ATs, a Ready to Move (RTM) program
was established by the authors of this article in collaboration
TABLE 1: Human Movement Patterns
Volume 20 | Number 6 www.acsm-healthfitness.org 27
Copyright © 2016 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
with the university employee wellness program. Student coaches
and clients met a minimum of 8 times during 10 weeks for
coaching sessions. Most sessions were in person, but because of
time constraints of both students and clients, online or tele-
phonic sessions were occasionally used. During the RTM pro-
gram, there were 100 student participants as well as 173 employee
participants (152 women and 21 men). The majority of employee
participants were staff or clerical rank.
As part of the program, students and employee participants
were given a Fitbit (San Francisco, CA) Flex® AT. The univer-
sity wellness directors chose the FitBit Flex® AT with cost con-
sideration, availability, and ease of use in mind. A focus on the
behavioral outcomes of wearable ATs in combination with stu-
dent coaching was emphasized. Coaching was administered by
students who shared a passion for helping others improve their
health and well-being through movement. The importance of
mutual respect, co-learning between partners, and individual
and community engagement within the workplace was stressed
(2). It should be noted that a coaching versus expert approach
was emphasized to facilitate client behavioral change. Sforzo
et al.s (17) expert versus coach approach encourages coaches
to facilitate participants driving the busversus leading with
expert advice. Student coaches were taught to facilitate
self-directed vision and goal setting throughout the RTM pro-
gram. Behavioral strategies, such as motivational interviewing
and coaching skills, as described in Niggs(13)ACSMsBehavioral
Aspects of Physical Activity and Exercise also were used.
The practical experience gained by students allowed for the
integration of movement and behavioral best practices. Stu-
dents analyzed their clientsgoals to monitor and evaluate PA
intervention strategies. Pre- and post-surveys measured behav-
ioral outcomes that were used to evaluate the impact of the
program on employees. At first, it was difficult for the Kinesiol-
ogystudentstoworkwithclientsoutside of a typical gym setting.
However, as the program progressed, both students and cli-
ents began to appreciate the importance of communication,
goal setting, AT logging/feedback, and how movement can
happen anywhere and at any time during the day.
PARTICIPANT COMMENTS REGARDING ATs
Responses recorded on the pre-RTM survey indicated that
83% of participants had previously used a movement tracking
device (including pedometers). Before receiving an AT, the ma-
jority of the participants envisioned the Fitbit Flex® acting as a
motivator and a reminder to move. Post-RTM program, partic-
ipants were asked what they liked the most about the ATs. Top
responses included being a reminder to move, a motivator, and
the ease and convenience of its use. Participants also reported
TABLE 2: AT Features (Wrist-Worn)
MOVE MORE, SIT LESS, & BE WELL
28 ACSMsHealth & Fitness Journal
®
November/December 2016
Copyright © 2016 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
enjoying sleep-tracking capabilities of the Fitbit even though
they did not envision using this feature pretracker use. Finally,
post-RTM program participants stated their day-to-day move-
ment was positively influenced by AT use. Users reported getting
more steps/activity and having increased awareness of sleep.
Other common responses included using the device as encour-
agement, a reminder, and a motivator to get moving. In addi-
tion, using the AT to set and meet goals was seen as beneficial
by users. Table 3 describes participantsactual comments re-
garding their ATs.
PROGRAMMING STRATEGIES FOR ATs
According to Green (6), 72% of ACE-certified fitness profes-
sionals reported clients/class participants asking about ATs, yet
only 51% of fitness professionals felt they were prepared to an-
swer questions on ATs. Education on AT usage is essential before
instructing others on AT use. The RTM program found coaches
had more success coaching clients after they were educated on
AT use and had acquired personal experience using the devices.
Coaches were educated on using the AT interfaces, including
lessons on movement, sleep, nutrition, and social capabilities
of the device. Employees enjoyed using such capabilities as sleep
and nutrition tracking and coaches appreciated social features
such as friendingand participating in movement challenges
with others.
The RTM program focused on the sedentary living and PA
portions of the human movement patterns. It also encouraged
SIDEBAR: AT FEATURES (WRIST-WORN)
TABLE 3: Participant Comments on ATs
To achieve the step goals, I set daily mini goals. The first was to
achieve 2,000 steps before work. When I achieve 2,000 before
work, it kick-starts the day with energy, motivation, and a sense of
accomplishment. Second, a time-management shift. Im happy
that the employee parking garage is 750 steps away from my
office and that my next meeting is 1,200 steps round trip.
The tracker helped me see that I could get in a lot of movement
during the workday, and that even the little things I did (walking
up the stairs, parking a little further away, moving for 20 seconds
every 20 minutes) really added up. This motivated me to find
even more ways to incorporate movement into my day. As a result,
I have a lot more energy and sleep better. The tracker helped
me see patterns of activity and inactivity.
Kept me honest and made me aware of my perceived exertion.
I often found the days that I was most exhausted by the end of the
day were days I had moved the least.
TABLE 4: Practical Programming Strategies
Strategy Ideas for Action
1Establish a
baseline
Establish a baseline for movement
based on average steps during
first week
Increase steps from individual
baseline number
2Increase steps
gradually from baseline
Encourage clients to increase
steps gradually to create lasting
behavior change
Weekly increase of 10% was
suggested
3Tudor-Locke et al.s
translation of moderate
to vigorous PA to steps
Start out with research-based
step goals rather than arbitrary
10,000-step rule
30 min/d of moderate to vigorous
PA translated to approximately
7,900 steps/d for men and
8,300 steps/d for women
150 min/wk of moderate to vigorous
PA translated to approximately
7,000 steps/d or 49,000 steps/wk
4Coaching strategies Apply behavioral aspects of
PA/exercise theories using ACSMs
Behavioral Aspects of Physical Activity
and Exercise by Claudio Nigg (13)
Motivational interviewing
Volume 20 | Number 6 www.acsm-healthfitness.org 29
Copyright © 2016 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
increasing PA based on steps achieved at baseline movement
levels. Most employees improved their confidence in their ability
to reach and sustain regular PA/movement when they focused
on moving more throughout the day. The RTM program used
Tudor-Locke et al.s (20) translation of accelerometer data to
daily movement. This study suggested that 30 min/d of moder-
ate to vigorous PA translated to approximately 7,900 steps/day
for men and 8,300 steps/day for women, whereas 150 min/wk
of moderate to vigorous PA translated to approximately
7,000 steps/day or 49,000 steps/week (20). To encourage
those with the lowest levels of PA at baseline, the program
reminded employees that starting at a low movement level pro-
vides the greatest initial improvement of health benefits (11).
Participating employees were coached on the benefits of in-
creasing movement gradually. Employees began walking to
restrooms or water fountains on different floors and found crea-
tive ways to take additional movement breaks throughout the
day. Being physically active was a milestone for numerous par-
ticipating employees, and by the end of the RTM program,
many began thinking more about the exercise portion of human
movement patterns.
SUMMARY
Overall, the RTM postsurvey results revealed that a combina-
tion of coaching and AT usage increased the importance of reg-
ular PA for employees as well as their confidence to sustain
PA and movement. Ninety-three percent of employees agreed
working with a student coach helped them develop effective
health and fitness goals. Ninety percent agreed that the combi-
nation of coaching and AT usage helped employees sustain
their health goals after their coaching ended. When asked
about their social connection with students, 92% of employees
agreed that engaging with students connected them better with
the university.
For the Kinesiology students, it was initially hard to focus
on PA and sedentary living rather than the exercise portion of
human movement patterns, but they eventually appreciated
the difference a small amount of movement throughout the day
can make in participantslives. Breaking the traditional focus
on what counted as movement was enlightening for both students
and employees. Could ATs better meet the needs of those who
have not joined a gym? Could this concept help account for the
mass popularity of these devices? ATs might be reaching a mar-
ket that is untapped by the fitness industry but also could appeal
to a much larger portion of the population. The fitness professions
perception of human movement patterns has traditionally been
focused on the exercise portion of human movement patterns.
ATs could help the fitness professional transition to include the
PA and sedentary living portions of human movement patterns.
There are many unanswered questions about AT usage and
for whom they are the most beneficial. Additional behavioral
research on ATs is needed. The popularity of wearable ATs
cannot be denied. Most likely, health and fitness professionals
will be using ATs at an accelerated rate in the near future. Becom-
ing familiar with ATs is encouraged for all fitness professionals
because their use could lead to a larger portion of the popula-
tion taking interest in and engaging with more opportunities
for physical movement. A focus that includes PA and sedentary
living could potentially broaden the reach of human movement
and help populations move more, sit less, and be well.
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TABLE 5: Participant Comments on Movement
Seeing how many steps Ive taken vs. how many I should be
taking has really motivated me to take breaks to walk
throughout the day. Having the activity tracker inspired me to
come up with a daily movement routine to help ensure Im
meeting my movement goals for the day.
It serves as a reminder that Imbehind for the day and thus
encourages me to get out for a walk. It makes me more
conscious about taking stairs, parking further away, and walking
instead of driving.
I sit at a desk or in meetings most of the workday. Tracking my
steps has made me 100% more aware of how much I sit
and has reminded me to get up at least 1per hour and move.
MOVE MORE, SIT LESS, & BE WELL
30 ACSMsHealth & Fitness Journal
®
November/December 2016
Copyright © 2016 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
12. Moar J. Smart wearable devices:fitness, glasses, watches, multimedia, clothing,
jewellery, healthcare & enterprise 20142019.Juniper Research [Internet]. 2015
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Suggested Reading:
Sun A, Dant A. What your activity tracker sees and doesntsee.NYTimes.com
[Internet]. 2014 [cited 2016 April 19]. Available from http://well.blogs.nytimes.
com/projects/2014/03/accelerometers.htm.
Disclosure: The authors declare no conflict of interest and do not have any
financial disclosures.
Brian Kiessling II, M.S., is an adjunct lecturer in
the Department of Kinesiologyat Indiana University
as well as a swim coach for the Councilman Center
Indiana Swim Team (CCiST) senior group. As a
recent graduate, his future plans are to continue his
education at the Ph.D. level.
Carol Kennedy-Armbruster, Ph.D., FACSM,isa
senior lecturer in the Department of Kinesiology at
Indiana University. As a prac-ademic,she has
worked in the academic and private setting as an ed-
ucator, program director, and practitioner of fitness
and wellness programs for more than 30 years.
Her research is centered on translational research
in a worksite setting. She has a special interest
in functional movement for health and evaluating physical activity/
exercise program outcomes. She also is on the editorial board for
ACSMs Health & Fitness Journal
®
and serves on ACSMs Exercise
is Medicine
®
Advisory Board.
BRIDGING THE GAP
The American College of Sports Medicine annual fitness
trends named wearable technology as the top trend for
2016 and 2017 (19). The popularity of wearable activity
trackers (ATs) is on the rise. Many worksite wellness
programs use ATs as incentives to help clients move
more and sit less. This article will enhance the readers
understanding of how wearable ATs may influence human
movement patterns and physical activity programming.
Published research has focused on wearable ATaccuracy.
This article focuses on the behavioral aspects of ATs and
presents a programming case study on how to integrate
ATs into a useable program for clients.
Volume 20 | Number 6 www.acsm-healthfitness.org 31
Copyright © 2016 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
... The university employees received a FitBit Flex activity tracker as well as individual health coaching from the students enrolled in the Department of Kinesiology's physical activity (PA) behavioral interventions class. The Fitbit Flex® was chosen by the university wellness program directors because of cost and ease of use (Kiessling & Kennedy-Armbruster, 2016). The university wellness program recruited the employees for this project through marketing and an organized sign up process. ...
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