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Can Fitness Trackers Really Make You Healthier? - Terms of Service with Clare Duffy - Podcast on CNN Audio
Clare Duffy 00:00:02 'Okay, story time - A few years ago, I decided to get into running. As a lifelong swimmer who has historically not excelled at land sports, this was going to be a real challenge for me. So I decided download the exercise tracking app, Strava. Tracking my runs kept me motivated and allowed me to see my progress. And connecting with other friends on the app served as sort of an accountability check. As I got more into it, I set a goal to run 200 Strava tracked miles in one year. When I reached that, I went for 300 the next year, and then 400. But that year, as I found myself on New Year's Eve out running instead of spending time with my family, I realized I'd perhaps gone a bit far with the tracking. Running no longer felt good or fun. I was really just doing it to hit the number I wanted to see on the app. So I stopped the tracking and honestly fell off running for a while. I'm back at it now, but this question has remained in the back of my mind. How much tracking is too much? That question feels more pressing than ever now that the market for health trackers has exploded. There are apps to track your sleep, your exercise, your food intake, your heart rate, and more. And wearable health trackers, things like smartwatches and fitness rings, are more popular than ever. So I wanted to know, can these devices really lead us to make healthier choices? And how can we avoid going overboard with our health goals? To get some answers, I spoke with Dr. Leana Wen. She's an emergency physician and former Baltimore Health Commissioner, as well as CNN's health and wellness expert. I'm Clare Duffy, and this is Terms of Service. Clare Duffy 00:02:05 Hi, Dr. Wen. Dr. Leana Wen 00:02:06 Hi, great to join you, Clare. Clare Duffy 00:02:08 Thanks for being here. So to start, do you use any of these health tracking technologies? Dr. Leana Wen 00:02:14 I do, and I knew that we were going to have this conversation, but I actually just always have my watch on. So I am training for a triathlon. Clare Duffy 00:02:22 Nice. Dr. Leana Wen 00:02:24 'And I find that the fitness watch really helps with training purposes. I don't have a lot of time, I've got young kids and full-time work. And so I try to make the most use of my training. And so the wearable helps me with that. Clare Duffy 00:02:39 So I mentioned a few examples in the intro, but are there other examples of health tracking technologies that we're starting to see people really commonly use these days? Dr. Leana Wen 00:02:49 Yeah, so I think that fitness is one that we certainly see a lot of people track. They use the watch to track the length and intensity of the exercises. Perhaps they might use AI algorithms that help them to plan the next day's sessions based on how they've done before and all that data are captured by the wearable. Sleep is also very common, too. It's also factored into fitness and preparedness. And for other people who not necessarily athletes. It also helps them to understand sleep patterns and may be used for those purposes as well. Then you have people who are entering information in, but that's still part of tracking. For example, menstrual, fertility tracking, people use wearables for individuals who are tracking closely their food and nutrition. And then I would say too that there's a final category which is really emerging and that's if they have specific medical purposes. And they are working on tracking that in consultation with their healthcare providers. So for example, if they have a heart arrhythmia, an abnormal heart rhythm, and they're using a wearable to determine when they go into the abnormal heart rhythm, maybe they'll then take a pill to stop that abnormal heart rhythm. That is a possibility, it's certainly an emerging field, but I'd say that that's a lot more nascent than the more general fitness and wellness tracking. Clare Duffy 00:04:07 Why is it that you think we've seen such an explosion in this health tracking technology? Dr. Leana Wen 00:04:14 I think there are two main elements. First is that there is a growing interest in wellness and prevention. People are really trying to get a hold of what's good for them. They want to personalize their medical care, they want to focus on wellness and preventing diseases, and they also see a lot more data that's available. And they want to use that data and incorporate that into their decision making. So in general, I think that this is a really good thing. By the way, I have no vested interest in any of these health tracking technologies that I'm aware of. I am a fan of them because I think it does allow people to take charge of their health. And that is one big trend that we're seeing. The other major reason here is that the wearables have just gotten better. I mean, my garment that I wear all the time, I really never even noticed that it's there. The only time that I really take it off is maybe when I'm showering and when I am playing piano I feel like it's getting in the way. But otherwise I wear it to sleep, I wear to exercise, I wore it to swim, and so forth. And so I think there are lots of other wearables that look nice, they match different outfits, they are rings, they're just things that people want to wear. And I think the convenience factor is a part of it. And of course we cannot discount, so I don't use it for this purpose, but there are people who like their Apple watches or their devices that also allow them to receive messages and calls and calendar things. And so I think the always on thing may not necessarily be great for mental health in some ways, but it's important for some people. Clare Duffy 00:05:47 When it comes to wearables like the Apple Watch or the Oura Ring, you mentioned your Garmin, how do they actually work to track these health metrics? Dr. Leana Wen 00:05:57 'It depends on the metric. And so there are some things that we enter ourselves. So for example, people may enter when their menstrual period is. They may enter the food that they had. And there are often entries for how you're feeling, so you can be more aware of your own sensation along the way. So some of that is just self-entry. For the purposes of sleep, the trackers use something called the accelerometer, which are small motion detectors. And they're tracking how much movement you make while you're asleep. And then there's an algorithm that computes the estimated time that you're spending in different stages of sleep and then how that then correlates with the total quality of sleep. Other things are fairly straightforward. Pulse, for example, you use electro detection to track the heart rate. And so all of these are standard health metrics that have existed. Clare Duffy 00:06:48 So there are some straightforward health metrics that these wearable devices track, like telling you your heart rate. But wearables can also analyze various data to give users more comprehensive readiness or wellness scores. Dr. Leana Wen 00:07:04 Yeah. So a lot of those scores are determined by other algorithms. So for example, they might look at training readiness for various exercise and the types of things they'll input include how well did you sleep, what they call your stress level, but essentially they're measuring things like heart rate and respiration. And in a sense, this is not so different if you were tracking all this information yourself, as in imagine if you entered into an Excel spreadsheet, all the individual data of your heart rate over the course of many hours and your sleep stages, and there were an algorithm that you could input these into, that's what's happening behind the scenes for how they derive this information. Clare Duffy 00:07:44 Do we have any sense of how accurate these measurements are? Dr. Leana Wen 00:07:49 It's a great question, and I would say it depends on what we're tracking. For something like heart rate, there are a lot of data about accuracy. So for example, we know that some trackers are more accurate than others, like a chest strap is going to be more accurate than a watch that you wear. Also, people who have a lot of hair, for example, they might have more difficulty with that type of tracking, although the heart rate tracking and all these methods are certainly improving as technology improves as well. I'd say sleep trackers, again, it is a guesstimate. There is some variability between different trackers. Although the studies show that they're generally pretty accurate, although there are limitations. So, for example, if someone has obesity, if they have severe sleep apnea, or other significant underlying problems, it may interfere with the accuracy. And so again, for sleep purposes, it's generally not used as a medical diagnostic purpose. If you wanna find out if you have sleep apnea, for example, you're not gonna use your Fitbit or your Apple Watch, you're going to be seeking a specific diagnostic test. And I'd say that in general, the accuracy will depend on what it is that we're using the tracker for. And so to best understand the effectiveness or accuracy, it also helps to track how you're feeling and not solely rely on the data that you're seeing. Because if you see a big discrepancy, probably how you are feeling is going to be a better measure than whatever numbers were just captured. Clare Duffy 00:09:14 Yeah, such a good point. I feel like I've seen people on the internet do their own sort of individual tests of like, how many steps did this tracker say I did versus this other tracker? Are there ways to sort of evaluate these companies' claims? I think that piece about just sort of pay attention to how you actually feel is a good one. Are there other ways that people could think about doing that? Dr. Leana Wen 00:09:36 I think that people need to start with understanding why they're wearing a tracker. What is it that they're trying to accomplish? I think it's wonderful, by the way, if somebody says, I want to get more fit. I want it to get to 10,000 steps a day. People want to do that, and they're using the tracker for that purpose. But then maybe also take a look at what it is that you should not be using it for. As in, I think that there are certain claims that are for specific medical purposes. If you're using it for a specific medical purpose, make sure that that indication is FDA approved. And then ask yourself, do you really need it for that purpose? And if you do, maybe it's something that you should talk to your doctor. So for example, there are some medical devices that are approved for atrial fibrillation detection, detection of that irregular heart rhythm. But if you are really concerned that you have atrial fibulation, why, right? Is it because someone told you that you had it at some point? Are you feeling that your heart rate is jumping all over the place? If that's the case, maybe you need something that's an actual diagnostic tool, and your doctor should know about it. And at the same time, not everyone needs to detect atrial fibrillation. For most people, it's going to be a false positive. And so I think being careful about what you're trying to do is just as important as looking at what kind of information you're gleaning from the tracker. Clare Duffy 00:10:56 In some cases, devices that were once used for a specific medical purpose are now being marketed for more general wellness uses. Continuous glucose monitors, for example, are now been worn by many people who don't have diabetes. But are these devices really helping to make us more healthy? And how much tracking is too much? That's coming up after the break. Clare Duffy 00:11:30 Does health tracking generally lead to people making healthier decisions, sleeping more, exercising more, that sort of thing? Dr. Leana Wen 00:11:39 Look, I think that there are some data that are pointing in that direction. For example, there are data looking at step counts. And people being aware of their step counts could make them do more. As in you're saying, OK, my goal is 10,000. I meant 8,000, let me just get one more walk around the block and let me see if I can get to 10, 000 by the end of the day. I think that, in fact, just tracking, regardless of the wearable, can help people make healthier decisions. For example individuals who are trying to reduce their alcohol intake. There are trackers available where they can write down how much are they drinking. And some people will say, well, I was not aware that I was drinking this much. I need to cut down. And also tracking and correlation with the feedback is also useful. Again, using the drinking example, some people have said, well I'm trying dry January or dryish January. I'm reducing my alcohol intake and now look, I'm able to sleep better. And look at my sleep stages. And look, I'm also losing weight and I feel more energetic in the morning. So I think that feedback loop combined with tracking can help people make healthier decisions. Clare Duffy 00:12:42 What about in emergency situations, like you mentioned the atrial fibrillation example. Are we seeing these devices actually save lives in the way that, you know, I know we've heard some tech companies kind of advertise that as a possibility. Dr. Leana Wen 00:12:56 'I'm sure that there are one-off cases where this is the case, right? That there is somebody who was not aware that they had an irregular heart rhythm. This is now flagged. They then sought medical care. I think that that's certainly a very good thing for that individual. Of course, I'm also concerned about overdiagnosis. I remember being at this healthcare conference where a physician stood up in front of everyone and talked about his experience wearing this watch, and he was wearing some wearable that found that he had an irregular heart rhythm. And he said, after that, he got a whole bunch of tests done. He got some exercise stress tests. He looked at his cardiac function and the great news after six months of testing is that he is fine. He is healthy. And the entire audience got up and clapped. And I thought, wait, that was not exactly my take away from the story. I mean, I'm happy that he's fine. But I think the actual underlying lesson is that he was fine to begin with and maybe this just added concern and a lot of cost and overdiagnosis. And so I think that there will be a point where these devices can be used more in medical settings. And there are some very interesting use cases where that could be the case. For example, looking at wearables in detecting falls and alerting people of falls in elderly relatives. That could be very interesting, or using tracking as part of remote patient monitoring so that could spare the individual a trip to their doctor or a trip their emergency department. I think that there could be some of these areas that would be really helpful for saving lives, but I think we are a little bit off from prime time for those uses at the moment. Clare Duffy 00:14:39 Is there a line that can be crossed where there is too much tracking? And how do we kind of know where that line is? Dr. Leana Wen 00:14:47 Well, I think that for individuals, if you find that you are obsessing over data and that you're prioritizing the data that's showing up as opposed to how you're feeling, that's certainly a sign that perhaps you may want to dial back a little bit. I know that for some athletes, for example, they have said that it's helped them to not look at data all the time and to have some holidays away from having all the inputs of data and just really focus on how they're feeling and their perceived exertion and not just what it's showing on the screen. And so I think that that's really the question to ask yourself is, is this causing you more stress or is this actually helping you to have less stress because you have more control over your body? Clare Duffy 00:15:34 Do you think that the emergence of this kind of consumer health monitoring is going to fundamentally change how we think about health and wellness? Dr. Leana Wen 00:15:44 For some people, it already has. It's given people more control. It's helped them to take a more active role in prevention and in their medical care. I think that the next step needs to be to integrate these wearables and the data from these wearable into medical care, there are some very specific medical practices that have begun doing this. And again, for maybe for very specific indications like heart rhythm abnormalities. But I think given the ubiquity of these wearables primary care physicians, who I know have many things already on their plate, and so it's very difficult to integrate one more thing into their workflow. But ideally, this is something that could be incorporated into medical care. And for that to happen, we do need insurance reimbursement for the time it would take for the health care provider to consult with the patient. And then I would add one more factor here, which is, as with any new technology, we always want to make sure that it doesn't cause worsening of existing health care disparities. Because it would be very unfortunate if it's only the wealthy and the people who have access to many health services who are able to use these wearables and it just widens that gulf, as opposed to it could also help to bridge some of those disparities when it comes to access. Clare Duffy 00:17:01 Some doctors are already prescribing wearables to encourage their patients to be more active, even if the devices haven't been formally approved by regulators for that purpose. But not everyone has equal access to this technology. Research has found that age, education, and income may make people less likely to use wearables, although often those same people are at a higher risk of disease. And that could be a hurdle to this becoming a more widely adopted practice. Is there also a potential for this technology to be misused or for all of the health data that is collected to fall into the wrong hands? Dr. Leana Wen 00:17:44 That's always something that you have to worry about. And the issue is it's not enough if the company is assuring you that your data is currently safe, because what if that company is acquired by another? What if there is a cybersecurity issue? And so I think our data are out there. If you're using tracking apps in addition to your wearable, you're also giving your data to that particular app. And I think data security is certainly something that I worry about. Although, I'm not sure that I have a good answer for it. I would really just say when it comes to wearables to be very clear that it doesn't replace but rather augment how you're feeling. And you can talk to your doctor if you are thinking that it could help you with monitoring a specific medical condition, even if it's something as straightforward as your migraines. If there's something you can enter part of your tracking and integrate how you are feeling on a daily basis with your wearable, that could be a good thing as well. And overall, I think that this trend for better wellness prevention is a good thing, but of course, as with any technology, we have to be aware of the potential pitfalls and be true to ourselves about why we're doing this. Clare Duffy 00:18:54 You touched on this a little bit, but are there red flags that people should be on the lookout for that might suggest they're doing too much tracking or going overboard with it? Dr. Leana Wen 00:19:04 Ask yourself, is the tracker helping you or hurting you? As in, it may sound very straightforward, but are you getting increased stress because of all the data that you're having to process? Or is it actually helping you feel like you have more control over your life? Clare Duffy 00:19:20 Well, Dr. Leana Wen, thank you so much for doing this. Dr. Leana Wen 00:19:23 Thank you very much. Great to join you. Clare Duffy 00:19:27 'My conversation with Dr. Wen really opened my eyes to how many ways health tracking is being used to help people and how I can maybe avoid going overboard with it in the future. If you are thinking about getting into health or fitness tracking, think about what you actually want to track and how you hope to feel once you've brought it into your routine. It can be helpful to have a goal in mind so you don't get too overwhelmed by all the data. In some cases, wearable devices can help you discover if you have a medical issue, like an irregular heartbeat. And they have potentially life-saving features too, like fall detection. But remember that you can't rely on these devices alone to monitor your health. Always consult with a medical professional if you health concerns. Remember that when it comes to what you're learning from tracking apps and devices, the information they give you is generally an estimate. And it's only as good as the information you input. So make sure to give accurate information when setting them up. And finally, keep in mind that data isn't everything. If you wear a smartwatch or other health tracker, check in with yourself every once in a while to make sure you're not prioritizing numbers over how you actually feel. If you have a wearable tech story, we wanna hear about it. Send us an email or voicenote to CNNTermsOfService@ Thanks for listening to this week's episode of Terms of Service. I'm Clare Duffy. Talk to you next week. Clare Duffy 00:21:04 Terms of Service is a CNN Audio and Goat Rodeo production. This show is produced and hosted by me, Clare Duffy. At Goat Rodeo, the lead producer is Rebecca Seidel and the executive producers are Megan Nadolski and Ian Enright. The producer for this episode is Hazel Hoffman. At CNN, Matt Martinez is our senior producer and Dan Dzula is our technical director. Haley Thomas is senior producer of development. Steve Lickteig is the executive producer of CNN Audio. With support from Kyra Dahring, Emily Williams, Tayler Phillips, David Rind, Dan Bloom, Robert Mathers, Jamus Andrest, Nicole Pesaru, Alex Manasseri, Mark Duffy, Leni Steinhardt, Jon Dianora and Lisa Namerow. Special thanks to David Goldman and Wendy Brundage. Thank you for listening.
