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January 2021

Health Wearables Don’t Work

1. About ten years ago, when the first generation of wearable fitness trackers became
popular, they were heralded as the dawn of a revolution. Health experts and
businesspeople alike said that giving people access to real-time calorie-burning and step-
count data would inspire them to lose weight, eat better and–most important–exercise
more. But even as the U.S. market for wearable devices hits $7 billion this year, there’s
evidence that their promise isn’t quite paying off.
2. The U.S. has an exercise problem, with 28% of Americans ages 50 and over considered
wholly inactive. That means 31 million adults move no more than is necessary to perform
the most basic functions of daily life. Wearables, experts hoped, were going to change
that. Slap on a fitness tracker, the pitch went, and you’ll suddenly find yourself motivated
to move more. You’ll climb stairs without thinking and take the dog for an extra lap. You
may even start having your work meetings while ambulating.
3. But scant academic research has been done to figure out whether wearables change
people’s behavior in the long term. The little research that does exist isn’t encouraging. It
seems that it’s really hard to persuade people to exercise—even when they have access to
how many steps they’ve taken, and even when they get paid for it.
4. In the year long study, published in The Lancet Diabetes & Endocrinology, researchers
randomized 800 people in Singapore who had a full-time job into four groups. Some
wore a Fitbit Zip and were paid a small amount of money to get moving—which they
were instructed either to keep or to donate to charity—while others didn’t wear Fitbits.
Researchers measured their physical activity, weight, blood pressure, the body’s ability to
use oxygen (called cardiorespiratory fitness) and their self-reported quality of life.
5. For the last six months of the study, all incentives were dropped, and people could choose
whether or not to continue wearing their fitness trackers. About 40% of people had
stopped wearing it in the first six months anyway.
6. The cash seemed to work at first. Those who were rewarded with cash did an extra 13
minutes of moderate-to-vigorous physical activity each week and added 570 steps to their
daily counts. Raising money for charity had no effect. But once the monetary rewards
stopped, so did the improvements.
7. By the end of the study, just 10% of people were still wearing the trackers. And only the
Fitbit group had improved from where they started, getting 16 extra minutes of moderate-
to-vigorous physical activity per week. That small boost didn’t translate into any
differences in the health outcomes the researchers measured. In fact, no group improved
on those measures at either six or 12 months.
8. This isn’t the first scientific blow to wearables; in a study in the Journal of the American
Medical Association, researchers wanted to see whether activity trackers would help
overweight people lose more weight over two years than if they just did a weight-loss
intervention alone. They didn’t. “The whole hypothesis was that wearables would be
helpful, and they worked just the opposite,” says study author John Jakicic of the
University of Pittsburgh. “But that makes the study even more intriguing.”
9. Jakicic, who has ties to Weight Watchers International and has received funding from
wearable maker Jawbone Inc. for some of his past research, and his fellow researchers
assigned about 470 people who were overweight into a weight loss group for two years.
One was a standard weight-loss intervention group, in which people were assigned a low-
calorie diet, increased physical activity and group counseling; the other group did the
same thing, but adopted wearable technology six months in. The researchers included
people between ages 18 and 35, an age group that would be more likely to embrace
technology like wearable trackers, the researchers suspected.
10. About six months in, text message prompts and telephone counseling were added to both
groups. The people in the standard weight loss group started self-monitoring their diet
and exercise using a website. The people in the technology group were given a wearable
device to monitor their exercise and diet.
11. The results were surprising to Jakicic and his team. The people using wearables still lost
some weight, but significantly less than the people who weren’t using them. People in the
standard weight loss group lost 13 pounds on average, whereas the people in the
 wearables group lost 7.7 pounds on average. “We found that just giving people a device
doesn’t mean it’s going to result in something you think it’s going to result in,” says
Jakicic. “These activity trackers don’t engage people in strategies that make a difference
in terms of long-term change.”
12. Why the wearables didn’t help people lose more weight than the other group was
puzzling. Jakicic and his team don’t have a reason, but they have a few ideas. It’s
possible that when the people saw their physical activity throughout the day, they felt a
false sense of security that since they had walked so much, for example, they could eat
more. On the other hand, Jakicic suggests wearables may not be encouraging for the
people in the study. “These are people who are already struggling, and already don’t like
activity,” he says. “They look down and see, ‘I am so far away from my goal today, I
can’t do it.’ It could be working against them.”
13. The researchers used BodyMedia Fit activity trackers, which were a common brand when
they started the study years ago, but many more wearable tracking devices exist on the
market today. “We are going to get criticized for that, but at the end of the day, there are
studies that show that after a few months people get bored with them,” says Jakicic.
14. Jakicic says he hopes what people take away from the study is that there are other key
behaviors that are important for weight loss that people should continue to focus on for
long-term success, like eating well and exercising. “There’s probably a time and place for
wearables, and there’s so much more we need to learn about them,” he says. “For the
person who finds wearables engaging, absolutely use them.”
15. To be fair, some of the pricier and higher-tech wearables–not the ones typically used in
academic studies, because of their cost–have features baked into them that encourage
users to move more, says Shelten Yuen, Fitbit’s vice president of research. Among them:
vibrating sensors, movement reminders and social-media integration, all designed to
motivate users to make better health choices every day. But more research will be needed
to determine whether or not these features–or others like them–measurably improve
people’s health and fitness levels.
16. In the meantime, there are ways to get more out of most fitness trackers by using them
differently, says Catrine Tudor-Locke, a professor and the chair of the department of
 kinesiology at the University of Massachusetts Amherst, who’s been researching fitness
trackers for many years. For starters, she suggests, don’t change your behavior after
taking your wearable out of its box (or dusting off the one in a drawer) and putting it on
your body. “Live life as normal for at least three to seven days,” she says, “to get a
picture of where you’re at before you start to track where you’re going.”
17. Next, when you do look at your data, check for improvements. Then ask yourself how
you changed your routine to cause those improvements, so you can do it again in the
future. Once you have a realistic sense of your abilities, it will be easier to commit to a
long-term goal. “That dynamic process of monitoring your behavior and tracking it is
where we want to go and is the most important learning that comes from this,” says
Tudor-Locke. “Not the digits themselves.”