PODCAST: Which Fitness Tracker Metrics Matter Most?

ZACH: Welcome to On Health with Houston Methodist. I'm Zach Moore. I'm a photographer and editor here, and I've worked in multimedia and television for over 15 years – and I'm also a longtime podcaster.

 

KATIE: I'm Katie McCallum. I'm a former researcher turned health writer, mostly writing for our blog.

 

ZACH: Katie, looks like you're wearing an activity tracker there.

 

KATIE: I am. I wear it pretty much 24/7. I take it off to charge it, that's about it. I don't see one on your wrist, I don't think.

 

ZACH: Well, this is actually a hybrid watch.

 

KATIE: Oh, a fancy one.

 

ZACH: I got a wedding present from my wife.

 

KATIE: Our listeners can't see, but Zach has a really fancy looking watch that, I guess is also an activity tracker.

 

ZACH: Yes. We have the technology these days for it to look both ways.

 

KATIE: Okay. Well, mine’s just -- definitely looks like an activity tracker.

 

ZACH: That, yeah, that looks like an activity tracker.

 

KATIE: Yeah. Everyone knows what this is.

 

ZACH: Yes. And I feel like the last 10 years or so, everybody has gotten an activity tracker.

 

KATIE: Yeah, I would agree. I started wearing one quite a while ago. I would say about 10 years ago or so. I started with the Fitbit that had just like the five dots. There was no interface or anything to it. You really would just look at it and see a dot or not, or two dots or none. And it was just tracking steps and I've kind of continuously worn one, and like upgraded along -- as things went. So, you know, like Fitbit got a little nicer and got a screen, so I got one of those. I've had an Apple Watch probably for the last three or four years. I love it.

 

ZACH: Yeah, I had a Fitbit a few years ago, and it was the one with the watch and the screen itself, so it kind of doubled as my watch. And yeah, it came a point where -- and this is the reason I wear this watch now. It's like, yeah, I wanted to have like a watch, watch. I felt like, you know, ‘cause when you're a kid you have these digital watches, it's like, “Oh, look at you in your little watch.” Right? But now I feel like a -- like an adult with this watch.

 

KATIE: It's a nice watch.

 

ZACH: Thank you.

 

KATIE: Yeah, it's a very nice watch.

 

ZACH: So, we're not talking about my watch on this podcast. We're talking about fitness trackers.

 

KATIE: It’s what the watches can do.

 

ZACH: Right. You know, we'll get into this conversation with our expert today, but I feel like as human beings we're goal oriented. And even before there were fitness trackers, there we're pedometers. And we'll get into all that too in our conversation. But there's something about, you know, you have these activity trackers, and you're going about your day, and you get an alert or a buzz that, “Oh hey, you’ve reached your goal.” And the dopamine drops and you feel like I accomplished something today. And I feel like that's a big reason why these have become so popular and prevalent.

 

KATIE: Yeah, I think people realize that maybe we've been sitting too much, as we've kind of evolved as a human species. I mean, I think I probably continue to wear one because I know that a lot of my day, I do end up sitting. So, I sit at a desk, I'm sitting right now while I'm talking to you on this podcast.

ZACH: I'm running a mile right now. I don't know…

 

KATIE: Hey, Zach's on a walking treadmill while we speak. We have expert audio people here. You can't even tell. No, I mean, I think we all sit a lot and for me it started from a place of like, “Okay, am I sitting too much? Am I stepping at all?” And then now they've gotten so fancy and have so many different metrics and I kind of -- I think I've said this before in the podcast, like, I love having data about myself.  And so, now I have all this data about myself. With that though, I don't know that I'm always using mine correctly. And that's who -- we're gonna talk today, not only just about whether activity trackers are a good idea to have, but also how to actually use the one that you wear on your wrist, or you've had sitting, you know, in your bathroom just because you don't know how to use it.

 

ZACH: Yeah, you might have gotten one over the holidays as a present.

KATIE: Exactly.

 

ZACH: You know, maybe you made a New Year's resolution. You're like, “I'm gonna get started on this.” And haven't quite figured out all the ins and outs of it, or what it means, or how you should be using it or accessing all of its options. So, who are we talking to today about this Katie?

 

KATIE: We're talking to JJ Rodriguez. He is an exercise physiologist here at Houston Methodist. I think he's gonna be the perfect person for us to talk to about activity trackers, just given his pretty unique role here at Houston Methodist, and his real extensive background. But I'm gonna let him describe all that and we can hop into the interview.

 

[Sound effect signals a brief interjection in the interview]

 

KATIE: So, you do a lot of interesting things here and I think you probably describe what it is that you do best. So, why don't you tell our listeners what it is you do at Houston Methodist.

 

JJ: At Houston Methodist, I am a program manager for the Center for Weight Loss and Bariatric surgery. And you can think of us as a prevention clinic or chronic disease state. We help and treat patients in many different aspects. Diabetes, nutritional consultations, weight loss, Bariatric surgery. But by training, I am an exercise professional. My undergraduate’s in Kinesiology, my master's is in Exercise Science and Performance Enhancement. And I'm certified through ACSM as a Clinical Exercise Physiologist, cancer exercise trainer, personal trainer, and have spent majority of my education in exercise, and still love it. I still stay connected, I still perform athletic events, endurance events, and stay in tune to the science of exercise science and performance. So, it's a passion of mine.

 

KATIE: That's awesome. Also, sounds like you're the perfect person for today's topic, which is fitness trackers. We're gonna get into a lot of parts of fitness trackers, but how to use 'em effectively is what we kinda wanna talk about. Before we get into that part, I wanna take a step back and maybe talk about activity generally, and how we define activity. Because I think it's a place where a lot of us get tripped up, and for instance, maybe we start with dispelling a common misconception that I think I've had in the past, and you can let me know how erroneous this thought is. If a person exercises often, frequently, every day even, is there such a thing as them still sitting too much and being too inactive?

 

JJ: Yes. So, and this is very recent, I would say in more in the past 10 years of literature, when we look at what's been coined “the sitting disease,” there are some interesting publications to show that if you get your -- the recommended 150 minutes a week, which is what, if you Google search how much exercise I should do.

 

KATIE: Right.

 

JJ: It's gonna give you 30 minutes, five days a week. You know, you'll see HIIT, do high intensity interval training, you'll see all these variations, but if you sum it up, it equals 150 of some variation. And that's what we see best return on your investments essentially for health. There's literature to support that, even if you get that. But 8, 10, 12 hours of your day is sedentary, the effects of chronic disease states, the effects of muscular skeletal conditions, the effects on mental conditions all are increased. Now, one of the things with literature and research, you can make a correlation, but you can't make -- say it's causing it. It's probably all the other factors that deal with being in a sedentary position, stress, and you know, not being able to move. Today, we are in a place where I talk about this with my wife a lot, but a lot of patients -- well, people will come in and it's their job is now on the computer all the time. They're on call all the time. So, they're stressed all the time. And all these factors play into sleep, they play into nutrition. And so, it's a big, big whole picture, but in summary, the less activity can outweigh even if you are active.

 

KATIE: And I think that it kind of brings us to this point of maybe defining physical activity versus exercise. And then once we do define those, how much do we quote unquote need of each? So, what is considered physical activity? And how much do we need to meet each kind of day or week when it -- in that regard?

 

JJ: Yeah. So, I teach a couple classes in our programs about this. And the simplest way I describe exercise is quantified movement.

 

KATIE: Okay.

 

JJ: And so, you take an activity, and you put a value to it and your intent is to progress that value over time, you now have an exercise plan. Physical activity, just general leisurely activity, that's every day. And so, when we think about like steps, gardening, moving more, getting up every now and then, that's physical activity that we should be doing regardless. And the human body and musculoskeletal system is meant and has to move. It's the concept they use a lot and say with patients is, “If you don't move it, you lose it.”

 

KATIE: Got it. Yeah.

 

JJ: Right? And that's like, the fundamental easiest principle for musculoskeletal features. How much do you need? When we look at actual physical activity bouts, this range is quite a bit because the beautiful part about physical activity and exercise, you can have a huge return with very, very little. So, the more you do, the better. So, this is kind of gets in the conversations of activity trackers and steps, but like hit your goal of 10,000, this is where these numbers begin to play. It's like, how much can you get throughout the day? And this may be a metric for like health and okay, I'm meeting my physical activity goal, but that does not replace your exercise goal, right? So, you receive some benefit from being physically active, getting steps, moving around, but there's still additional benefit to come from structured physical activity. And so, that's where the 150 minutes comes in, the recommendations of quote unquote “structured exercise,” right? 150 minutes of moderate exercise.

 

KATIE: You mentioned steps as a way of tracking physical activity. I don't -- you know, steps I think have become this like complex web that's been weaved. I know my first fitness tracker; I think the goal generally was to hit 10,000 steps. It was five lights, you hit the fifth light, that meant that was your 10,000 steps. There was no way to modify, you know, how many steps you were trying to get each day in those very early trackers. Now, you know, I think steps, you can modify your -- well, maybe you can't even modify your step goal, but steps seem less prioritized. Like, I have to actually spin the wheel on my fitness tracker to get down to steps sometimes. And I think even recently I've -- I read a study the other day that was like a new thought is 8,600 steps for weight maintenance and then 11,000 for weight loss. So, it seems like we're all over the place with the steps. So, if you had to distill us, bring us back down to like an actual actionable recommendation for steps per day to kind of meet some health benefits of being active, what would you say? What would you recommend?

 

JJ: So, for current review in like literature, there seems to be health benefit and steps at around 7,000 steps per day.

 

KATIE: Okay.

 

JJ: And this has kind of been looked at a few different ways. And so, not to say that there's not health benefits outside of that, but when we look at over long periods of time in like a longitudinal study type of look, we're monitoring patients over long periods of time. Those that have x amounts of steps have a reduced hazard ratio, or the risk that an event could occur, right? And that seems to have a inflection or a trend at around 7,000. But let me preface this, if a person's coming from 1,000, barely moving and progresses to 2,000. Guarantee, there are health benefits out of that. It's just not as broad in the literature to moni -- to understand that just yet, or what that could be. Though I would say 7,000 is where you can like, begin to say that's a goal we initially shoot for. And then 10,000 that that number came out of really nowhere. The pedometer started, and I say the pedometer, that's like the original word.

 

KATIE: Yes, yes, that's what it was. Yeah. It’s true we made a buzzword.

 

JJ: We made a buzzword.

 

KATIE: Yeah.

 

JJ: So, pedometer, it had even back earlier than the five dots, there was the clicker that you put  --wear it on your wrist and it clicked a lot. And so, it counted your steps essentially. And in that 10,000 was -- is not -- was not validated back in the day. That was just a random number that I -- that was chosen. And it ended up actually having some clinical validity. Like, it's a good number to shoot for.

KATIE: Right? Okay. Okay. Happy accident.

 

JJ: Happy accident. It's equivalent to around five miles. So, you -- everyone's gonna be different, but you can take like a rough estimate, 2,000 steps is a mile.

 

KATIE: Okay.

JJ: But this is varying amongst height and things like that, but so it's equivalent to like a five mile of activity per day is 10,000. So, the more the better. This all goes back into moving more per day, right? And we know that that's beneficial.

 

[Music plays to signal a brief interjection in the interview]

 

ZACH: 7,000 steps per day is a lot. And if you routinely fall short of this goal, you're not alone. Both Katie and I left our talk with JJ, realizing we were lacking in this department. So, we followed up with him afterwards about this. Asking him for some tips for getting more steps in each day. His first piece of advice was to choose an activity tracker that sends you periodic reminders to get up and move, and actually heed those reminders when they pop up. His other tips include drinking plenty of water, since this inherently means having to get up for bathroom breaks. Turning a call-in meeting you usually take from your work desk, into a walking meeting. Leaving time at the end of your lunch break for a walk, which comes with an added bonus of helping regulate your blood sugar levels after a meal. Getting up to move any time you feel tension or pain while sitting. And last but not least, and perhaps the most obvious yet least implemented tip. Carving out brakes in your day to actually get up to walk around for exercise.

 

KATIE: Up after the break, JJ helps us understand which metrics on your fitness tracker to hone in on based on your personal goals, as well as which metrics might not be totally reliable just yet.

 

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KATIE: We're back with JJ and it's time to talk about how to use your activity tracker effectively. The amount of data that's given to us, it's a lot. And I think it's to the extent now where it's unclear to me sometimes if I'm actually effectively using my fitness tracker. Am I looking at the right pieces of data? Which pieces of data can I rely on? Should I rely on? Maybe not rely on? If you had to pick, you know, the metric -- the universal metric on almost all fitness trackers that you would recommend. “Hey, keep your eye on this.” Or maybe it's a couple -- what are they? Whether that's for physical activity or for exercise.

 

JJ: Universal metric, that's gonna be -- that's cool. I like that phrase.

 

KATIE: Cool, nice. New buzzword maybe for us.

 

JJ: New buzzword. All activity trackers at this point have very similar metrics, which is I find interesting. And it's going to be steps, it's going to be sleep, it's going to be activity -- actually exercise minutes or exercise in general. And then it's going to be a newer one. I would say in the past five years, it's very trendy, is stress. And these are the big four that are gonna be, you can flip through, you can see, you can see metrics on. And so, you know, what's the one I should be looking at the most? My answer unfortunately is where your health goals are.

KATIE: Okay.

 

JJ: And that's the cool part about activity trackers. You have all this data and it's like, “Okay, my goal is to reduce my stress. I'm gonna start taking walks, I increase my step count. Let me see how it affects my stress score if I sleep better, eat better, and see if I can make improvements there. Well, let's say I'm just trying to be more fit, or I'm trying to meet my daily activity goals. Okay, let me see how I can get exercise minutes or close my ring, or get, you know, whatever the trend, whatever your device says you need to close or do. That's how I would advise patients. It's like, what's your goal? Overall health, hit these metrics. But if you're going beyond that, and you have to look at your personal goal and then see how you can improve it on the activity tracker.

 

KATIE: Yeah. Speaking of that, the goal setting maybe is some -- is an interesting thing to dig into here and pick your brain on. ‘Cause as you mentioned, everyone's gonna have different goals, and I know you and I have talked about this before and it was the first time I had heard it. But for a blog post recently we talked about how a health goal can be very different from a fitness goal. Do you wanna talk us through maybe what a health goal looks like? What a fitness goal looks like? And how you optimize your tracker towards one or the other?

 

JJ: That's a good question. So, let's define a health goal and a fitness goal. And when you look at health from an exercise perspective, and then from a fitness perspective, they're two separate things. And that's one piece that I think we get mixed up a lot. Health goal looks like this. I wanna reduce my diabetes, I want to improve my high blood pressure, I want to get off medication, I want to reduce my stress level, I want to reduce my anxiety, I want to have better control of depression. Everything I just listed exercise has a clinically proven effect on. And so, it's -- the question is, how can I add exercise to my routine at minimal level, and have a benefit from it for those health reasons, right? And so, then we're looking at how much do I need for that particular thing? Well, when you look at anxiety and depression, the main association dealing with depression, we have it in literature as reported as five minutes. Five minutes of walking can help improve hormonal regulation, and then make you feel better.

 

KATIE: Oh wow.

 

JJ: So, we're looking at very little.

 

KATIE: Yeah.

 

JJ: Right? We're looking at the very bare minimum for health for that particular aspect. Well, if you're looking at diabetes, we know in literature, very well published pre-post-meal. Post-Meal specifically you have a meal and you go on a walk, it helps in the spike of total blood sugar and insulin release. And so, now it's structuring your routine around what your health goal is. And so -- and then you improve that. We improve it to at least get to 150, maybe total minutes per week, because that's where the biggest bang for your buck. We see in literature as a whole, getting 150 minutes a week, regardless of how you get it. Seventy-five minutes, two days a week, 10 minutes, three times a day, five days. I mean, does it matter, the cumulative effect has a reduction in all-cause mortality, cardiovascular disease, diabetes, everything. And so, it's a really cool health measurement to hit for. Now, when you talk about fitness though, fitness is broken down by a lot of components. And this is what I think people just in social media, we get kind of bombarded with. What you see a lot of times on social and what's trendy, what's kind of sexy, that is fitness. Okay, the person doing a power clean, a deadlift, the person sprinting, the person sweating, drinking Gatorade. You know, the person jumping five boxes or -- you're looking at different aspects of fitness, speed, endurance, strength, muscular power, body composition is actually a fitness measurement. And so, the biggest thing about fitness that I tell individuals is that you can't hit 'em all.

 

KATIE: Okay?

 

JJ: You have to pick a few.

 

KATIE: Yeah.

 

JJ: And then go after those to improve, right? Because the endurance is different from strength. You train completely differently. And so, okay, let's say my fitness goal is cardiovascular endurance. I'm training for the Houston Marathon. Let's relate it to people that are in the area.

 

KATIE: Yeah definitely.

 

JJ: ‘Cause there’s a lot of people right now. Go to Memorial Park, it is packed.

 

KATIE: Right. Yeah, can confirm.

 

JJ: Yes. It is packed right now. And so, you know, everyone's in training season and so they have a fitness goal, right? They're looking to improve their time; they're looking to improve their speed and total cardiovascular capacity. Okay? So, what we should be looking at now is heart rates.

 

KATIE: Okay.

 

JJ: We should be looking at our zones and what areas are we performing in. And so, when you turn on your watch to go run, I'm doing a run at 70, 80% of my heart rate max. And your watch can tell you that. And now you're getting metrics specific to your training goal. And now I need to have a recovery day. I did a hard run today, tomorrow I'm gonna do a light day. Now, I'm gonna keep my heart rate in that 100, 120 range or the lower range for recovery. Now, we're getting performance specific, or fitness specific for an event. And so, that's kind of the difference between health and fitness. And the thing I always say is that if you're in the fitness bucket, you're encompassing your health bucket.

 

KATIE: Okay.

 

JJ: So, don't be like, I'm doing fitness and -- but I'm not getting my 150, you know, I'm not getting my cardio. I tell patients, don't worry about it. Keep shooting your fitness goal. You're getting and reaping the benefit of exercise by progressively increasing exercise, because that's typically what fitness looks like. You're progressing to a goal of some sort, get stronger, lean out, tone up, get more lean muscle mass, whatever the case is. But if you're in health, I meet with a lot of patients with, you know, we talk to our patients with chronic diseases. Their goal is not to run a marathon, it's just to lower the diabetes. All right, let's talk about the bare minimum of getting steps. You know, let's add steps to the routine very specific to diabetes. So that would be -- I hope that helps with a long explanation, but that's kind of the difference in how I would describe it

 

KATIE: Yeah, no, I think that explanation's great. There's a lot of nuance to it. So, I think it needs the -- that level of detail. A follow up question to that, and the heart rate tracking reminded me of it. Are there any metrics that you would say on these fitness trackers that are kind of out of their league, like maybe they're not that reliable, we're not quite there yet? It sounds like heart rate tracking is maybe reliable enough for at least telling you what zone you're in while figuring out if something's moderate intensity or not. Any other metrics that maybe aren't as reliable as we might want them to be?

 

JJ: For me.

 

KATIE: Is this a tricky question?

 

JJ: Well, it made me wanna answer a bigger question on reliability, I guess.

 

KATIE: Okay. Yeah, yeah, absolutely.

 

JJ: But I'll answer the first question. For me, sleep is not there yet.

 

KATIE: Okay.

 

JJ: So, right now, sleep is a very common metric on activity trackers. And currently in the literature when it's compared to sleep study and to see cycles of REM, your activity tracker a lot of times is gonna give you all the stages of your sleep. When you're light, when you're in rapid eye movement, when you're coming out of it. So, there's like four potential -- I think there's four main stages of sleep. And so, it typically breaks that down for you in minutes as you go through your cycle. Activity trackers today, track sleep through activity like movement, through the accelerometer, and heart rate. And so, heart rate variability. What has been shown in the literature is they are very accurate or fairly accurate, good enough at determining whether you're in an awake state or a sleep state. But outside of that, the ranges, there's a lot of variability in, I would say accuracy.

 

KATIE: Okay.

 

JJ: From that standpoint. Now, what's interesting about the accuracy piece, I wanna make a distinction with fitness trackers because this gets, I get that question. It's like, “Why do I wear it if it's not accurate?” So, I have to make an educational point on accuracy versus precision.

 

KATIE: Okay, yes.

 

JJ: So, at this date, I wouldn't say that activity trackers are the most accurate thing. And if I were to map this out, if I drew a bullseye and I took actually in truth, 10,000 steps today and the activity tracker says I took 12,000 steps per day, it's not hitting the exact 10,000. So, it's not hitting the bullseye, but what it does every day hit the 12,000. So, it hits precisely the same thing or relatively the same metrics in the same area, which is why I think they're still valid, because you can progress that still.

 

KATIE: Yeah.

 

JJ: Right, you can still progress that. And so, for things like energy expenditure, like how many calories I burned, for sleep, it could be a little bit of a problem ‘cause people are adjusting like food intake.

 

 

KATIE: Yeah, you're making decisions based off of it. Like, I think it's very realistic to say, “Oh, I burned way more calories that work out than I thought I did. I'm gonna splurge on dinner.” It's probably flawed logic and or maybe it's not. I don't know, you tell me.

 

JJ: Yeah, so you wanna be careful, specifically with energy expenditure. In January, 2022, the largest meta-analysis of accuracy and reliability in fitness trackers was published. And it was, I think it was 63 studies that were reviewed. And over -- I think it was over 20 different devices. The main thing that came out of that study is that the devices had different strong suits, which was interesting. Fitbit had very good reliability or very good accuracy for steps.

 

KATIE: Okay.

 

JJ: Apple Watches had very good reliability and accuracy on heart rate.

 

KATIE: Okay.

 

JJ: So, it was -- what they measured it by was what they called mean absolute percentage error. And so, the percentage in which their error was occurring, relative to what actually was occurring or what should have been. Anything under 10 is like very good and Apple Watches for heart rate was under 10%, which is…

 

KATIE: Oh nice. Okay.

 

JJ: Excellent when we're looking at heart rate.

 

KATIE: That’s what I use. So, I'm happy to hear this right now.

 

JJ: But one thing across all devices was energy expenditure was greater than 30%.

 

KATIE: Okay, we're entering the dangerous waters there of maybe not very accurate.

 

JJ: You're entering dangerous waters on maybe not very accurate for energy expenditure. So, you know, if your Fitbit device says I burned 500 calories, or a thousand calories in my, you know, class, I would be cautious to go have the burger or the thousand calorie meal, versus just what you actually need. Which is maybe a serving of carbohydrate and a protein shake, you know, or whatever the case may be.

 

KATIE: Yeah, okay. It's a really good point. My fitness tracker, definitely the first stat I think I see when I complete a workout is how many calories I burned. It kind of prioritizes that above everything else because let's face it, that's what we all wanna know is how much -- how worth it was this, and to us worth is measured in calories ‘cause that means, you know, in my mind that I can eat more. Probably flawed logic anyways, and then definitely flawed ‘cause maybe that's not even a reliable number that's being handed to me.

 

JJ: I would agree. I think for the majority of us, we correlate it with food. We correlate calories with food and that's where it gets dangerous.

 

KATIE: Yeah, I think we do.

 

JJ: From a progressive standpoint, it's like, “Oh, I burned 500 calories in this workout. Next time can I burn 600?” So that's another way I would phrase it.

 

KATIE: Okay.

 

JJ: It's like, how hard can I push to get a different amount? Because remember it's not accurate, but it is fairly precise.

 

KATIE: Right.

 

JJ: They'll replicate the same measurement.

 

KATIE: What about the technology of your phone just being in your pocket and acting as a pedometer? Is that something that's reliable and can replace a wearable?

 

JJ: Certain aspects. This is funny, I tell patients and educate patients this about all the time because your phone's already tracking you.

 

KATIE: Oh boy. Yeah, that's a --

 

JJ: You just have to allow it.

 

KATIE: Okay.

 

JJ: And so, it's funny when you do this and it's like if you have an iPhone or probably any phone. I have an iPhone, but for patients this is a fun one to get them to see. A lot of times they haven't set up their Health App. And so, you get 'em to log on and if you allow it, you'll see that there's prior information from other days in there.

 

KATIE: Okay. So, it's happening either way.

 

JJ: So, it's happening and it'll pull that data, and it's a good thing to track your steps on your phone. The only downsides with the phone, reliability for activity trackers is gonna be on your hip and your wrist. And that's typically why all the activity trackers that come out are hip or wrist related.

 

KATIE: Okay.

 

JJ: So, that's where you're gonna get the most accuracy from activity trackers. So, a phone being on you on your pocket is, ‘cause it's an -- it's a swinging movement, it's gonna track that. One thing it's not tracking is your heart rate. And in today's world of data that you have accessible via an activity tracker, heart rate is imperative for zones, understanding where your heart rate's at, your resting heart rate, but also stress scores and sleep. So, you won't be getting any information about stress or sleep if the heart rate is not being tracked. So, if you're gonna have an activity tracker, and you want to get the full gist of your health and your health scores, I would recommend to have some activity tracker with a heart rate monitor. But if you're just tracking steps, I think it's a good tool.

 

KATIE: So, activity tracker, I think in my mind, I think of mine on a day-to-day basis. “So, did I hit my goal today? Am I gonna hit it tomorrow?” I ask myself the same question again. So, in my mind it's very day-to-day, but as I'm listening to you talk, it does make me think, is there a way to take a step back with your tracker? Is there some metric you can look at? If you take a step back and say, “Over the last month, was I successful at completing my goal a certain percentage of time?” And that means yes, I'm making improvements or maintaining some kind of active goal towards my health. Do I need improvements? Is there a threshold there when you take a step back and look at trends or anything?

 

JJ: Yeah.

 

KATIE: Or you can get some insights?

 

JJ: Yeah. So, steps is one. So, I know steps is kind of like, I guess at this point over talked about like, it's like, but it -- to me it's not. It's fundamental to I would say, like the human movement experience.

 

KATIE: Okay.

 

JJ: It just means you're not moving, which means you're going to have issues.

 

KATIE: Okay.

 

JJ: And if you don't have 'em, you will have 'em. The most common musculoskeletal issues are due to inactivity. And so, for everyone it's like nail the seven to 10.

 

KATIE: Okay.

 

JJ: Every day. It's…

 

KATIE: More days than not. Is there a certain?

 

JJ: Every day.

 

KATIE: If, you know, if I'm only hitting it like right now, if I'm maybe 15 days outta the month, I'm hitting my step goal. Is that average? Bad?

 

JJ: No, every day.

 

KATIE: Okay, so it's, okay.

 

JJ: For me, and when I…

 

KATIE: I hear you.

 

JJ: What -- when you look at a -- from a muscular standpoint of how we're built, it is an everyday thing that we should be trying to achieve.

 

[Sound effect signals a brief interjection in the interview]

 

ZACH: Not everyone can rely on steps as a measure of how physically active they are, but almost anyone can still benefit from an activity tracker. For those who are immobile or have movement limitations, JJ emphasizes the importance of finding ways to get your upper body moving, whether that be through yoga, Tai Chi, strength training, or something else. He recommends measuring that activity through exercise minutes, which he explains next.

 

JJ: There is a second feature that now is heavily tracked. It's the green ring if you're an Apple user. It's active minutes, if you're a Fitbit user. Every brand has a different term for it. But usually, it's defined as exercise. And this is anytime your heart rate gets to a moderate level of activity, probably anywhere from 60 to 70% of your heart rate max. And that's based off, typically most of them are based off 220 minus your age, which is like the generic estimation of max heart rate. And then the watch, usually when you get a Fitbit, it asks about your weight and height and age.

 

KATIE: Yeah.

 

JJ: Does all those calculations.

 

KATIE: Yeah.

 

JJ: For you. And gets these ranges and it's getting the percentage. And any time you get to a moderate level, it's counting it as exercise. If you get to a vigorous exercise level, so you're huffing and puffing, it's counting two minutes for every minute you do.

 

KATIE: Oh, I didn't know that.

 

JJ: Yeah.

 

KATIE: That's nice.

 

JJ: It is nice.

 

KATIE: Okay.

 

JJ: And most of the trackers today will do that. You can do half the amount of work with higher intensity exercise.

 

KATIE: Yeah.

JJ: And reap the same health benefit.

 

KATIE: That's great.

 

JJ: And so, if you're doing a hard workout, you'll hit your ring quicker than if you do a slow, moderate workout. If you just take the stairs and you do it for a consistent minute, then you're gonna get moderate exercise, right? So, it can vary. People who have laborious jobs that are maybe roofing or slinging a hammer or whatever the case may be, they may get everything, they may get the minutes, they may get the steps. So, you know, that may be a, you know, they -- that's kinda nice for them where they get -- kill all two birds with one stone.

 

KATIE: Yeah. Seriously, yeah. Because I will say one of the hardest parts, at least for myself with the exercise ring is, you know, by the end of the day I usually work out after work and by the end of the day I'm exhausted. I look down, my green ring is empty and it's that moment I'm just like, “Oh my gosh, really? I have to somehow find 30 minutes of like energy right now.” But to your point, you mentioned earlier, I otherwise probably would just not even think about it, and not do it if I didn't have this wearable device sitting on my wrist. That for better or for worse, somewhat makes me feel a little bad if I don't. You know, engage with it and stuff like that.

 

JJ: The one area of improvement I think is for fitness trackers in the future is the emphasis on the day. And because there's a lot of people that resonate with what you just said, like, I didn't fill my green ring today.

 

KATIE: Yeah.

 

JJ: And my response to that is, it's okay.

 

KATIE: Okay.

 

JJ: It's…

 

KATIE: Thank you. Thank you, kinda like a therapy session with you right now. Thank you.

 

JJ: It's okay.

 

KATIE: I didn't hit mine yesterday. I'm okay.

 

JJ: It's okay, you're fine, right? So, it's like, remember when we talk about 150, and I said this early on, it's the cumulative effect of 150.

 

KATIE: Okay.

 

JJ: Okay. So, that means you didn't hit it today, can you hit it tomorrow? As a matter of fact, can you go to a spin class one day a week, two days a week, two spin classes that kick your butt a week. Now, you're getting into the higher range. Know that the benefit is half the amount of time, right? This is the piece that like, I don't think activity trackers show well enough. Fitbit has a little bit of a good diagram on their screen. If you go to your active minutes, it'll have a bar that shows minutes per week. And so, it's calculated all of it.

 

KATIE: Okay, yeah.

 

JJ: So, you'll see 0-0-0 and then you'll see like a 75 when you went to your class or you did something that was intense. And so again, remember you're looking for the total cumulative effect. But a lot of times I don't see that promoted on the front screen and you get so caught up in, “Ah, I didn't fill my rings today, you know?

 

KATIE: Yeah.

 

JJ: It's like, yeah, but the goal is not today, it's the week.

 

KATIE: The week, okay.

 

JJ: Like can we keep moving throughout the week? Can we keep moving every day?

 

KATIE: Right.

 

JJ: Right, 7,000 every day and then somewhere throughout the week get the 150.

 

KATIE: Okay. That's a great summary actually. I think that's perfect.

 

JJ: Yeah.

 

KATIE: Well, this was great. Do you have anything else you would add, as far as with fitness trackers, activity goals, things to keep in mind? I know I definitely learned a lot. I use my fitness tracker a ton as it is, and this was still very enlightening for me. I think you can't really know enough about this stuff, honestly.

 

JJ: I think it's only gonna get better, I really do. I think we're gonna get more accurate and that's gonna be fun once we get more accurate. I think the most recent stuff that's coming out that's fairly accurate is stress. The whole stress idea and stress is monitored through what they call HVR, or heart rate variability.

 

KATIE: Okay.

 

JJ: That's kind of the buzz right now. When you look at activity trackers, there's breathing apps and things like that. It's really cool. You typically have a stress score. It's like out of zero to a hundred or something like this, that they'll give you. And so, I think there's just a lot of opportunity to get more accurate with activity trackers, but also the interpreter -- again, like the education of what your goals are and the education for software to continue to educate people on how to interpret their trackers ‘cause we get caught up in the rings a lot.

 

KATIE: Yeah. I loved your idea of giving someone, maybe I take a quiz and I just get a score, and my watch automatically populates exactly how I need it to be with my goals. I would love that.

 

JJ: I truly believe that is coming in the very near future. And I -- there's probably already an app doing it. It's just not known yet. There's, I think there's so many factors that can be summarized by potentially one number that we can kind of hone in on, but it encompasses everything. Like, your sleep from the night before, the steps you did, the exercise you did or didn't do, your stress monitoring, the heart rate variability, understanding stress throughout the day, and then giving you a score right before you go to bed. And something to look forward to in goals to improve upon. Like I think we're gonna get to that point in healthcare technology that that's happening, and it's gonna be reliable. That's gonna be something to look forward to.

 

KATIE: I can't wait. Well, thank you so much JJ. This was great.

 

JJ: Thanks for having me.

 

ZACH: So, wow, the first thing I'm gonna do is dive deep into my activity tracker and make sure that I'm taking advantage of everything it offers.

 

KATIE: Yeah, I left my chat with JJ, I mean I do not take enough steps a day. I was…

 

ZACH: Yeah.

 

KATIE: I was kind of taken aback. I had stopped paying attention to steps because I think I had read somewhere, okay, 10,000 steps a day, doesn't matter anymore. Whether that's true or not, whatever. But I had deprioritized steps in my mind and then hearing JJ talk, you know, he's like, “No, there's still a priority.” I looked at how many steps I've been taking and like it's a sad number. I don't even wanna say how...

 

ZACH: We did compare steps a few days after we were…

 

KATIE: It's pretty bad, pretty bad. So, for me that was the first place to start, but it was interesting to hear him talk about all these other metrics like you mentioned that are there that we can be using to sort of fill in the gaps of our either exercise or physical activity. Which metric were you most surprised by Zach?

 

ZACH: So, I have an app that comes with my smartwatch and my hybrid smartwatch. And, you know, we get the steps, right? It also has like, you know, staircases and that kind of thing. But there's a lot else in there that I haven't really even barely bothered to look into, which I'm sure there's a lot of the stuff that you talked about with JJ that I could really like, the heart rate, that kind of stuff. Stuff I haven't really been paying much mind to at all, that I'm gonna open up my instruction manual or whatever and see what I can take advantage of that I really have been ignoring since I got this watch.

 

KATIE: Yeah, I think it seems like exercise minutes are pretty big to him over the course of the week. Hitting 150, whether that's, you know, in one day or throughout the course of the week. I kind of liked hearing that. So, if I am having a really productive work out and I get like 75 minutes, that's half of my minutes I need a week and that counts. I was, I think maybe surprise, but I shouldn't be, that I still need a certain daily number of steps a day, regardless of the exercise minutes. And I think that's where, kind of back to -- I think I went too far into looking at all these other metrics. “My -- what does my heart rate get to and how long am I in zone three?” Like, I've gone maybe too far in that direction and I need to get back to basics and say like, “Maybe I should be looking at my step count more often.” Because mine was pretty atrocious what I noticed after I left this interview.

 

ZACH: Yeah, with what I do, I have very active days and then very inactive days. Like, I'll be out on a shoot, thousands of steps, right? I'm like, “Wow, I just blew past my goal. I doubled my goal today, what a great day.” And then I'll go and, you know, edit and I'll be sitting at a desk at a computer for, I don't know, hours and hours and hours and I'll get up to refill my, you know, water. That is a trick though, talking about, you know, as y'all mentioned, like, you know, getting up, gotta refill my water, go sit down. Oh, drank a lot of water, gotta get up and go to the bathroom, come back and sit down. So, even that just little motion back and forth. ‘Cause I have found like, you know, as we're aging here, right? If I'm just like crouched down at a computer for hours and I get up like, “Man, ‘cause it's real easy today to just sit somewhere and not move at all.”

 

KATIE: Oh yeah, definitely. I, as a writer, am sitting most of the day. I cook dinner as I'm standing then, but then I sit on the couch to eat. I sit way too much. But something that was interesting to hear him talk about was this idea of how accurate are our trackers? It's a question I've had for a while, and he did a really good ex -- he gave us a really good explanation of the difference between accuracy and precision, and that they're not necessarily totally accurate in all these ways, but over time the trends are what are precise, and you can use to build on and things like that. So, it definitely made me feel a lot better about, you know, things like exercise minutes and stuff like that. Even if my watch is off by a couple minutes, it's off by the same amount every single day. And I can use that to kind of build, and build, and build.

 

ZACH: And another option in all this is, there are video games that encourage movement.

 

KATIE: Right.

 

ZACH: Right, you get your lightsaber sticks, or bowling, or whatever it is. You know, that you can really work up your heart rate, right? I mean the DDR, things like that, you're dancing around, you're moving your arms around.

 

KATIE: Yep. Yep.

 

ZACH: It's true though, anything to increase your heart rate, get the blood pumping, get your muscles moving, right? That is a very interactive video game. We're not just kind of laying back with a controller, so…

 

KATIE: That's a good point.

 

ZACH: There's a lot of better options these days for that than there were years ago.

 

KATIE: Yeah, absolutely. I'd be interested to know if our activity trackers give us credit for that. That could have been a question I asked JJ.

 

ZACH: Yeah.

 

KATIE: Missed opportunity.

 

ZACH: Just wear your activity tracker when you're, you know, fighting Darth Vader and you'll get some points.

 

KATIE: I love it.

 

ZACH: Ultimately, these aren't some kind of magic bullet that are gonna help you be like, “Oh, well I got my steps today, I am as healthy as I will ever be.” But if you're striving for that, and you're consistent with that, that's the goal. It's the lifestyle shift that it will help you make that's really gonna add up at the end as opposed to, “Well, did I get my right percentage of this and that? You know, it sounds like you got lost in analytics.

 

KATIE: Yes.

 

ZACH: Along the way there.

 

KATIE: Unsurprisingly, yes.

 

ZACH: But no, these are helpful tools and like any tool, you know, it's all about how you use it. Hopefully, we’re able to share some knowledge with everyone today, to help them better use their tools and I feel like it helped us.

 

[Music begins]

 

KATIE: Yeah, yeah, absolutely, I agree. I think he makes a good point about even passively wearing one has a benefit. So, what I would say to everyone is, if you have one, just wear it. The studies show that you're probably getting more steps a day than someone who doesn't wear one at all. So, slap the thing on your wrist, or put your ring on, whatever you're using and you know, try to hit your goals and things like that. But at least just being cognizant of all that is helpful too.

 

ZACH: Alright, this is gonna do it for us this time. And be sure to share, like and subscribe On Health with Houston Methodist wherever you get your podcasts. If you enjoyed this conversation, for more topics like this, visit our blog at HoustonMethodist.org/blog. Stay tuned and stay healthy.

[End of episode]