Fitbit-Based Interventions for Healthy Lifestyle Outcomes: Systematic Review and Meta-Analysis

Abstract

Background Unhealthy behaviors, such as physical inactivity, sedentary lifestyle, and unhealthful eating, remain highly prevalent, posing formidable challenges in efforts to improve cardiovascular health. While traditional interventions to promote healthy lifestyles are both costly and effective, wearable trackers, especially Fitbit devices, can provide a low-cost alternative that may effectively help large numbers of individuals become more physically fit and thereby maintain a good health status. Objective The objectives of this meta-analysis are (1) to assess the effectiveness of interventions that incorporate a Fitbit device for healthy lifestyle outcomes (eg, steps, moderate-to-vigorous physical activity, and weight) and (2) to identify which additional intervention components or study characteristics are the most effective at improving healthy lifestyle outcomes. Methods A systematic review was conducted, searching the following databases from 2007 to 2019: MEDLINE, EMBASE, CINAHL, and CENTRAL (Cochrane). Studies were included if (1) they were randomized controlled trials, (2) the intervention involved the use of a Fitbit device, and (3) the reported outcomes were related to healthy lifestyles. The main outcome measures were related to physical activity, sedentary behavior, and weight. All the studies were assessed for risk of bias using Cochrane criteria. A random-effects meta-analysis was conducted to estimate the treatment effect of interventions that included a Fitbit device compared with a control group. We also conducted subgroup analysis and fuzzy-set qualitative comparative analysis (fsQCA) to further disentangle the effects of intervention components. Results Our final sample comprised 41 articles reporting the results of 37 studies. For Fitbit-based interventions, we found a statistically significant increase in daily step count (mean difference [MD] 950.54, 95% CI 475.89-1425.18; P<.001) and moderate-to-vigorous physical activity (MD 6.16, 95% CI 2.80-9.51; P<.001), a significant decrease in weight (MD −1.48, 95% CI −2.81 to −0.14; P=.03), and a nonsignificant decrease in objectively assessed and self-reported sedentary behavior (MD −10.62, 95% CI −35.50 to 14.27; P=.40 and standardized MD −0.11, 95% CI −0.48 to 0.26; P=.56, respectively). In general, the included studies were at low risk for bias, except for performance bias. Subgroup analysis and fsQCA demonstrated that, in addition to the effects of the Fitbit devices, setting activity goals was the most important intervention component. Conclusions The use of Fitbit devices in interventions has the potential to promote healthy lifestyles in terms of physical activity and weight. Fitbit devices may be useful to health professionals for patient monitoring and support. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42019145450; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019145450

Using Fitbit as an mHealth Intervention Tool to Promote Physical Activity: Potential Challenges and Solutions

“…According to a recent International Data Corporation report on wearable devices, Fitbit is one of the leading companies in the wearable PA tracker space and has a large user base with more than 28 million active users [ 9 ]. A similar dominant trend is also observed in research, where Fitbits are the most frequently used devices, particularly in interventional studies that focus on promoting PA and other healthy lifestyle behaviors [ 10 ]. A search on the Fitabase library [ 11 ], which maintains a list of published research studies that have used Fitbit PA trackers, yielded over 200 validity studies and 172 interventional studies (this list is not exhaustive).…”

“…In our experience, the use of research platforms (eg, iCardia) that remotely collect Fitbit data from participants’ accounts proved to be an effective, reliable, and cost-effective method. The iCardia platform was successfully implemented in 3 of the 4 studies [ 9 , 10 , 25 ], allowing our research team to view and export Fitbit data from multiple participants and also to deliver personalized text messages based on the incoming data (for more details about the platform, please see Kitsiou et al [ 24 ]). iCardia is a secure, password-protected system that is hosted in a Health Insurance Portability and Accountability Act (HIPAA)-compliant server at the University of Illinois at Chicago.…”

“…Regardless of the type of issue faced during the intervention period, we learned a single strategy that helped to address most of the challenges during the intervention delivery: devoting time to in-person intervention meetings or placing telephone calls when necessary to discuss potential challenges or issues associated with the use of Fitbit. Across the studies we conducted, we dedicated a portion of the in-person meeting to Fitbit-related content [ 9 , 10 , 20 , 35 ]. During this time, participants were free to externalize any concerns or issues related to Fitbit use, and research staff were ready to assist with possible problems or questions.…”

Exploring Beliefs and Preferences for Reducing Sedentary Behavior Among Adults With Symptomatic Knee Osteoarthritis or Knee Replacement

“…Additionally, considering the high penetration of smartphones across all age groups and demographics (25), with over 50% of every demographic group, including older adults, owning a smartphone in 2019 (25), these results provide insight into favorable intervention components that may be useful for the design and implementation of a sedentary behavior reduction program. Many participants also mentioned that they would be willing to receive a notification to sit less on a wearable physical activity tracker; however, current evidence suggests that these devices may not be effective in reducing sedentary behavior (29,30). More research is needed to examine the effect of prompting on changes in sedentary time as well as to determine the optimal method to deliver these prompts.…”

Comparison of Mobile Health Technology Use for Self-Tracking Between Older Adults and the General Adult Population in Canada: Cross-Sectional Survey

“…Prior research has examined the potential role of mHealth technologies in providing long-term support for older adults [ 16 - 18 ] and in monitoring chronic conditions often associated with older age [ 19 - 26 ]. Self-tracking devices in particular (eg, smart devices with mobile apps, fitness trackers, blood pressure monitors) have gained interest in recent years in light of their potential for monitoring and motivating individuals to remain healthy [ 27 - 31 ]. However, their use remains variable and less widespread among older adults [ 32 ], and prior research has reported risks associated with health information tracking, which may trigger negative emotions among patients with multiple chronic conditions and potential emotional draining in this group [ 33 ].…”