As a hospital medicine doctor I use apps everyday to analyze drug interactions, remember complex clinical formulas to predict risk and outcomes, and to stay on top of current research. I see the greatest value for patients in apps that help them set and track goals, keep a symptom journal, and by joining communities engaged in similar health challenges. Despite all this, I still have no idea what to do with data from fitness trackers if a rare patient does bring it to my attention.
Let me be clear- I am not talking about game changing medical devices that let providers know when you have an irregular heart rhythm, those that collect blood sugar for diabetics or similarly allow hypertensive patients to measure blood pressure and feed the data back to providers. I am talking about bracelets and clip-ons that simply collect pulse, sleep time (and supposedly 'sleep quality' - whatever that means), and function as pedometers. If you're a die hard fan of the quantified self movement and find such devices helpful - congratulations. For the majority of people though, the proliferation of such devices seems more like marketing madness than medical miracle.
Problematic Pulse
Yes, heart rate is one of the five vital signs that is measured when you are first examined in a medical setting. However, values collected in asymptomatic individuals reveal very little information (since every 'normal value' in medicine is based on a bell shaped curve derived from averages in large population sets). We've been told that athletes generally have lower resting pulses than people that do not run marathons, and pregnant women have resting pulses that are higher than their non-pregnant counterparts. Beyond numbers, there are cardiovascular questions I actually care about as your physician if you are having symptoms. Do you have palpitations? Do you have chest pain? Do you have shortness of breath at rest or with activity? Have you noticed any swelling (edema)? Has your weight increased? I hardly ever care whether a person has an asymptomatic high or low pulse. Incidentally- blood pressure and high cholesterol are the main contributors to mortality worldwide.
Stalking Sleep
Yawn (literally). We already know many Americans get much less sleep than they should. It's naïve to assume a fitness tracker will provide useful information on what is wrong and what interventions could be made. We should all start by getting rid of our smart devices from our bedroom- the constant beeping, pinging, vibrations probably contribute more to sleep disturbance than any wrist fitness tracker could elucidate. Since poor sleep is linked to everything from hypertension, weight gain to dementia, if you have real concerns after sincerely trying to get more sleep (going to bed earlier, decreasing caffeine intake, and cutting out the beeping from your bedroom), you need specialist doctors not consumer devices. The simple information in graphical form these devices display on the hours slept and number of 'awakenings' in the middle of the night is meaningless.
Estimating Exercise
A simple checklist, calendar, or to-do app will suffice to tell me I have not exercised. Silicon valley types believe that by gamifying everything we automatically have greater engagement (akin to Yelp Elite Badge and Four Square Check-ins). That reality is simply not true. The type-A personalities that run marathons, complete in Tough Mudders and are conscientious calorie counters probably don't need these devices in the first place. The rest of us need multidisciplinary intervention; in our diet, behaviors and exercise routine, rather than simply digitizing data. Graphs themselves provide little-to-no impetus to change (likely similar to why showing people pictures of amputated limbs or blackened lungs does not make them quit smoking).
Rather than buying a toy, there may be more health benefit from buying a gym membership and actually using it for cardiovascular exercise (and tracking progress on a calendar/checklist), cooking at home, consuming less sugar and salt, and joining a community to motivate you and attempt to attain the holy grail of behavioral change. If you have cardiovascular or sleep symptoms you need a consultation with a doctor, not a fitness tracker. If you're asymptomatic and haven't seen a doctor lately, go and see one. Preventative medicine (unlike unicorns) actually does exist and there are screening tests we should all undergo periodically. Some practices have even teamed up with nutritionists and personal trainers to help. Human interaction still matters in a world of digital dominance.
Varun Verma, M.D. is a board-certified Internal Medicine physician who splits his time as a Hospitalist at Brigham and Women’s Hospital (Boston) and as a Senior Clinical Advisor to Possible (Nepal)
@VarunVermaMD
* Note, I have absolutely no relationship with the apps/websites/devices in the above post.
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