Bored With Your Fitbit? These Cancer Researchers Aren't
If you’re trying to get in shape and you want a tiny, wrist-bound computer to help you do it, you have more options than ever before. Fitness trackers come in all shapes, colors, and price tags, with newfangled sensors and features to stand out to customers. But for doctors and scientists studying how exercise can help people deal with disease, the landscape is much simpler. There’s Fitbit, and then there’s everyone else.
Like most fitness trackers, Fitbit’s devices are far from perfect. They can count steps pretty well and give a good idea of activity levels day to day. But they haven’t yet cracked the code on caloric burn—which is kind of a big deal for understanding weight loss. And the ones equipped with Fitbit’s proprietary heart rate monitoring tech are on even shakier ground; the company is part of an ongoing class action lawsuit alleging dangerous inaccuracies. But that’s not stopping a growing number of medical researchers from flocking to Fitbit for use in clinical studies of everything from arthritis to sleep apnea to cancer.
Since 2012, scientists have published 457 studies using Fitbit device data, nearly half of them in 2017 alone. According to a recent analysis in the Journal of the Federation of American Societies for Experimental Biology, that puts the company well ahead of its competition. In clinical trials that used consumer activity monitors, a full 83 percent outfitted trial participants with a Fitbit. For NIH-funded research, that number rose to 95 percent.
Some researchers, like Sheri Hartman, a psychologist at the University of California San Diego, gravitate toward Fitbit devices because they deliver information without being burdensome for her patients—breast cancer survivors struggling with brain fogginess and other cognitive declines following treatment. They just have to keep it charged and wear it, that’s it. Fitbit, and its data-crunching research facilitation partner, Fitabase, do the rest.
Fitabase, if you haven’t heard of it, is like Fitbit’s personal digital plumber. The company has built a connection to Fitbit’s API that allows it to pipe out user data to scientists. Since it launched in 2012, Fitabase has collected over 3.5 billion minutes of Fitbit data on behalf of research customers at places like John Hopkins, MD Anderson Cancer Center, and the Dana Farber Cancer Institute.
For Hartman, Fitabase collected three months’ worth of data on a randomly-selected group of 43 women who had recently received chemotherapy or surgery for breast cancer. They, along with a control group which received health-related emails, were given the goal of exercising 150 minutes per week. Both groups were asked to wear a clinical-grade accelerometer for a week before and after the study to see how much their baseline activity had improved in three months' time. But only half of them received fitness trackers and access to a UCSD researcher to track their goals. Sticking with new lifestyle changes is hard, and Hartman’s team was testing how well the wearables helped keep subjects accountable to their plans.
By the end of the study, published Tuesday in Cancer, they found that women who wore Fitbits were exercising for about 14 more minutes per day than those in the control group. And importantly, the more-active Fitbitters scored higher on an objective measure of cognitive processing speed. While it was the only one of nine examined areas of brain function that showed significant improvement, Hartman says the results are promising. “Breast cancer survivors have the highest rate of cognitive decline after treatments than any other types of cancer patients,” she says. “We haven’t had a lot of good recommendations for them. But now we can say exercise looks like it works.” It was a small study, but Hartman has a larger one planned to see if the results hold up.
Others, like Carissa Low, a psychologist at the University of Pittsburgh Cancer Institute, landed on the Fitbit after testing it against other devices to see which ones synced most often and most reliably. Low studies how getting up and walking around can help cancer patients avoid readmission after surgery. In a small pilot she completed last year, daily step count predicted which patients wound up back in the hospital. She’s now working on an interventional study to see if prodding people to exercise increases the likelihood of a better outcome. “We’re not watching step counts in real time, but we do need to get the data without much of a lag,” she says. “If we’re trying to nudge somebody we don’t want to be wrong, especially if they’re sick.”
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Studies like these are helping to fill in some knowledge gaps about how motivating wearables are. There aren't many, if any, long-term studies of the devices, which most people stop wearing within the first six months. "If you just put a Fitbit on someone's wrist, that's not going to be enough to change behavior," says Mitesh Patel, an internist and digital health researcher at the University of Pennsylvania. "But if you combine it with incentives and other kinds of support, then there are a lot stronger effects. The question that remains, is if those effects remain over the long-term."
Steven Steinhubl, a cardiologist and the director of Digital Medicine at Scripps Translational Science Institute says wearable monitors shine most in research that compares you at one point in time to you at another. “If the goal is to specifically measure steps or calories with consumer technologies, it is difficult to compare different devices to each other,” he says. “On the other hand, if tracking the trajectory for an individual over time, they are ideal.”
While Fitbit says it’s still a consumer health and wellness company, it doesn’t deny it has eyes on one day getting a medical device designation. And with the company’s stock price down 60 percent compared with this time last year and Apple threatening its market leadership, the medical sector might be Fitbit’s best shot at a bright shiny tomorrow. So in the meantime, with the help of Fitabase, it’s quietly building up a scientific body of evidence that should certainly come in handy with the FDA, if and when the agency ever comes knocking.
“From a clinical research perspective, we’re really focused on engagement as well as longevity—keeping individuals on an activity protocol,” says Fitbit’s GM of Health Solutions Adam Pellegrini. He declined to say whether or not the company has immediate plans to move into the medical device market. “But as we start going deeper down the health road with more and more advanced sensors, I’d say, just stay tuned.”
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