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How fitting that one of the kick-off sessions at EULAR 2017 focused on the use of wearable technologies in arthritis care. Even in 39-degree heat, the streets of Madrid are full of people walking, some even in full business suits!
The technological revolution over the past century has led to more sedentary lifestyles, which in turn are associated with negative health-related outcomes. We know that physical activity and exercise are important for overall health, including arthritis and chronic pain management. The difficulty is implementing and measuring activity.
The advent of new wearable technologies (such as Fitbit, Garmin, Apple watch, etc) are promising for measuring changes in physical activity and behavior. Although they are cheap and easy to use, there is poor data on their utility in research and clinical practice.
Work from Manchester, UK compared patient-reported activity to that measured by wearable technology. The Health Survey of England in 2008 found that 39% of men and 29% of women reported engaging in recommended levels of physical activity. However, when objective activity was measured using an accelerometer, only 6% of men and 4% of women met recommended targets. Initially, one might think that the difference is attributed to inaccurate patient reporting, which is likely a contributor. However, wearable technology use is not perfect.
Research grade wearables (accelerometers, etc) have poorly defined cut-points to define sedentary behavior. Consumer grade technologies (Fitbit, Garmin, Apple watch, etc) are less accurate for measuring steps and heart rate. Wearing these on non-dominant wrists seems to under-estimate steps, whereas wear on the dominant wrist often over-estimates steps. Furthermore, most wearable devices are unable to capture accurate measures of upper activity movement, such as cycling, swimming and weight-lifting.
Research is ongoing on the validity and reliability of data collected from wearable technologies for clinical trials. When doing research, you must consider your study population and what you are measuring, prior to choosing a wearable device.
From a clinical perspective, however, wearable devices are promising. They can be used to increase patient engagement, allow for real-time compliance monitoring, and goal setting. I often advise patients to set step targets daily, and have found it an easy and effective way to discuss their physical activity.
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About the Author
Dr. Shahin Jamal
Dr. Jamal is a Clinical Associate Professor at the University of British Columbia and an active staff physician at Vancouver Coastal Health. Her interests include diagnosis and prognosis of early inflammatory arthritis, and timely assessment and access to care for patients with rheumatoid arthritis.
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