In our digital health wearables research programme funded by Sir Halley Stewart Trust and the ESRC Impact Acceleration Award, we have been investigating the role of wearable activity monitoring technologies in the health and well-being of people - aged 55 years and over, carers, and the people being cared for.
Example technologies include activity trackers from Fitbit, Garmin and Samsung, and smart watches. Typically, these devices record steps walked, floors climbed, sleep patterns, calories expended and heart rate.
Research strand involving medical professionals
In this blog-post, we discuss the views of medical professionals on the role of activity monitors of medical professionals:
- for keeping fit and as a preventative measure towards medical conditions;
- for increasing physical activity during prehabilitation; the process of enhancing functional capacity of the individual before an operation to enable him or her to withstand the stress of surgery has been termed as prehabilitation;
- for monitoring of activity during rehabilitation; and
- for monitoring of mobility when suffering from a medical condition.
RESEARCH DATA SOURCES
- Survey with medical professionals where we received 84 responses.
- Interviews with 10 medical professionals including a physiotherapist, GPs, a geriatrician and A&E consultants. All the interviews were audio-recorded and the data was transcribed verbatim. The data was analysed inductively in NVivo, a qualitative data analysis software package, through thematic analysis and axial coding.
From the survey, we learned that the majority of medical professionals find activity monitors to be useful for people aged over 55. However, they have never recommended such devices to patients, due to ethical considerations related to costs and lack of available support with using this technology. The biggest concern of medical professionals is the accuracy of the data from these off-the-shelf activity monitors, their reliability, and the possible difficulty of interpreting the data from these devices by the users.
We have analysed the our interviews with medical professionals by applying the method of thematic analysis.
For each of the roles that the medical professionals have identified for activity monitors, we have included some example-quotes from our interview data to illustrate the theme. Although the context of the interviews was for people aged over 55 years, you will note that the comments of medical professionals are, in fact, applicable for people of all ages.
Medical professionals identified the role of activity monitors in supporting people to keep fit and in the prevention of various medical conditions that are normally associated with weight and lack of physical activity. They mentioned diabetes, obesity, and heart and circulatory diseases, and how the risks of suffering from these conditions increase as people age.
An A&E consultant said:
"Obesity and diabetes go together, so if you can keep the population more mobile, then you’d hope that their obesity levels would fall and that their diabetes would be less prevalent…then, on top of that, there would be all the secondary cardiovascular things like strokes, high blood pressure and other things." [A&E consultant]
The physiotherapist in our participant-set said:
“I think the older population in particular, we know everyone’s living longer, we know we’re getting more medical conditions and increased medical dependency. The evidence shows that the more active- the benefits of exercise in reducing the risk of diabetes, osteoporosis, and improving balance.” [Physiotherapist]
A General Practitioner [GP] said:
“That’s quite important because the point of the wearable is to have activity and to be more active than usual and to get healthy. That’s the point you wear a wearable.” [GP]
For an elective surgery, patients have to be optimised for the surgery – checking on nutrition levels and maintaining some physical activity. A physical activity programme aims to increase aerobic capacity, and muscle and core strength ahead of the surgery.
A surgeon mentioned about the role of activity monitors in this pre-surgery optimisation.
“about the optimisation of patients for surgery, so pre-optimisation is giving nutrition and doing many things including physical exercise. So, it has been shown that if you want to decrease, for example, the anastomatic leakage, if you make the patient have physical exercise two or three weeks before surgery, it is very effective as well as it’s effective to stop smoking or to take milkshakes for nutrition and so on. So, in elective surgery it will be very useful to say to other patients before surgery, “You are having an operation in three weeks, every day you have to do at least half an hour of activity.” It has been proved that it works.” [Surgeon]
For post-surgery rehabilitation or for maintaining some physical activity after a medical incident, the activity monitors could be useful for monitoring the necessary level of mobility that is required.
“Okay. Let’s say after a heart attack, so cardiac rehab. Again, there’s a very important part of recovery where they have exercise and have physio. That might be useful. Again, pneumonia rehab after a bad episode of COPD or something. Any sort of rehab programme where they are doing activities, this would be useful.” [GP]
“If you have the device, and you are able to walk, even inside your home, then, after being inside the home, I can see them going out in the garden. Then, aiming to the local shop and then, aiming to something more.” [Geriatrician]
For monitoring of medical condition
For patients, an activity monitor helps them to monitor their physical activity and to check whether they are keeping up with the level of activity that they have been advised. For medical professionals, these devices can give them an insight into their patients’ level of activity.
“In my Parkinson’s patients, … I would be using it [the activity tracker] for them to show me that they [patients] were gradually increasing their activity levels. I would be looking for trend[s]. Most of my Parkinson’s patients are very inactive and they shouldn’t be. I would be looking at using that during a six-week block of physiotherapy treatment to show an increase trend of how they’re moving. Also, an ideal situation, over six months I’d like them to maintain the levels I achieve after a six-week block.” [Physiotherapist]
All the medical professionals with whom we have interacted in this project have discussed the role of physical activity and especially walking in staying fit and healthy for people of all ages. As we have discussed in our previous blog-post, activity monitors enable people aged over 55 years :
- to raise awareness of their activity levels; and
- to improve and maintain their activity levels.
One of the GPs summarised the significance of walking for people of all ages by saying:
“Obviously we say to people that walking is free, doesn’t cost much and it’s very good exercise, because once you tell somebody how inactive [they] are, they say, “I can’t afford going to the gym,” or they say, “I just joined the gym.” As you know, joining a gym does not necessarily mean that they are active at all; they just pay the money and they don’t go, so we say, “Walking.” Walking is just simple and doesn’t cost money, and you can do it and so on.” [GP]
As we continue with our data analysis, we will share the results with you through this blog.
Academics: Dr. Duncan Banks (OU), Dr. Kate Hamblin (Oxford University) Dr. Caroline Holland (OU), Dr. George Leeson (Oxford University) Ms. Catherine McNulty (OU), Professor Shailey Minocha (OU) and Dr. Ana-Despina Tudor (OU)
Collaborators: Age UK MK (Jane Palmer), Carers MK (Sue Bowering and Robert Benn) and Samsung UK (Rohit Ail and Qian Shen)
Research Managers: Louise Thomas (OU) and Katia Padvalkava (Oxford University)