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Behavioral Science, Health and Fitness, Medical Apps, Public Health, Technology

What needs to happen for wearable devices to improve people’s health?

What needs to happen for wearable devices to improve people's health?

15353072639_f3a79557df_z“Wearable devices” are pieces of technology that are worn in clothes or accessories, and they often have biometric functionality – they can measure and record heart rates, steps taken, temperature, or sleep habits. Numerous tech companies have begun manufacturing and marketing such devices, which are part of a larger movement often referred to as the “quantified self” – where data about one’s life is meticulously gathered and recorded. Only 1% to 2% of Americans have used a wearable device, but annual sales are projected to increase to more than $50 billion by 2018.

Health and fitness apps are also proliferating, from software that maps where you run or provides a digital workout community, to programs that count calories or suggest how to improve your sleep. But what’s the real impact for people’s health?

Earlier this month, a report from the Journal of the American Medical Association called into question the idea that wearable devices will effect population-scale changes in health. There is a big gap, the authors claim, between recording health information and changing health behavior, and little evidence suggests that this gap is being bridged. Wearable devices might be seen as facilitating change, but not driving it. Mitesh Patel, MD, MBA, from University of Pennsylvania, and colleagues wrote:

Ultimately, it is the engagement strategies—the combinations of individual encouragement, social competition and collaboration, and effective feedback loops—that connect with human behavior.

The difficulty of population health is that changes have to be sustained to have meaningful effects, and that is quite difficult. The authors identify four steps that must be taken to bridge this gap towards sustained change.

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Health and Fitness, Patient Care, SMS Unplugged, Technology

“Nudges” in health: Lessons from a fitness tracker on how to motivate patients

“Nudges” in health: Lessons from a fitness tracker on how to motivate patients

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

fitness trackerIt was 11:47 PM. That meant that I had 13 minutes to reach my pre-set goal of  “activity” that the fitness tracker on my wrist had been registering throughout the day. If I met the goal I would get a “trophy” on the accompanying app. I probably looked pretty funny bouncing around my living room doing a squat here and a sit-up there, punching a pretend opponent, and running in place. But I made it minutes before midnight. If I hadn’t – well, then I would have just blamed the piece of technology on my arm for not working.

The tracker was a gift from my cousin Steve. Steve is impressively fit; he runs marathons, tackles obstacle courses, and races road bikes. A few years back at Christmas dinner, Steve challenged me to a pull-up contest – I was super hyped and ready for it until, well, I lost. Every holiday season since then, I’ve spent the weeks prior to heading home logging extra push-ups, pull-ups, and bicep curls just in case a re-match comes up. Without knowing it, Steve inspired me to get active. Now, with blinking lights and status reminders, the fitness tracker he gave me does so more frequently, more annoyingly, but in a way, more enjoyably and effectively.

The fitness band on my wrist doesn’t tell me to go to the gym or go for a run. The periodic updates on how far I am from my pre-set goal, however, “nudge” me to get up during a commercial and do a set of push-ups, to get out for a walk, or to take the stairs. I’ve even turned to running in place or a set of body squats whenever I find myself yawning to make sure I get enough points.

In the past, I’ve been good about working out, even doing stretches of two-a-day gym trips. But this doesn’t last very long as I use the busy “medical school” schedule as an excuse. After getting the fitness tracker, it’s been a string of random, spontaneous, and unstructured “work outs” throughout the day. While I may not have achieved Mr. America status, I’ve felt good about meeting my daily goal and racking up “trophies.” It’s even become a bit of a game to see how high I can actually make my numbers go. I’m competing against myself. This may sound weird, but at least I know my opponent and understand what I’m up against, right?

Wearing the fitness band reminded me of the concept of nudges. Nudges, as discussed by Richard Thaler, PhD, and Cass Sunstein, JD, describe how a person can be steered toward making a particular decision without hard instruction. An individual encounters small pushes towards doing something that is desired of them, unaware that they’re being led in that direction. Commercial companies have mastered this in form of advertising, making us feel as if we “need” their product. This fitness band has me thinking that I’m playing a game; the soreness in my legs and looser fitting clothes would indicate that I’m working out.

My experience with the fitness tracker has reminded me of the importance in framing conversations with patients. We often resort to telling patients, “You should work out and eat healthy – if you don’t you’ll get this or that disease.” It’s easy to frame things in the negative and use scare tactics. But rather than give constant reminders of what they aren’t doing, conversations with patients should contain nudges of encouragement. Nudges such as aligning goals with patient priorities, setting check-in time-points, and incorporating social networks for accountability. If we could do for chronic-disease management what the fitness band tries to do for working out, our patients might have an easier time.

Moises Gallegos is a fourth-year medical student. He’ll be going into emergency medicine, and he’s interested in public-health topics such as health education, health promotion and global health.

Photo by Vernon Chan

Health and Fitness, Parenting, Pediatrics, Pregnancy, Public Health

Exercising during pregnancy may reduce children’s risk of hypertension

Exercising during pregnancy may reduce children's risk of hypertension

7619293834_c18e2bee15_zRegular physical activity during pregnancy has been shown to benefit both mom and baby: Past studies found that exercise can help expectant mothers manage weight gain, sleep better, improve circulation and reduce swelling or leg cramps and increase their endurance in preparation for childbirth. A growing body of evidence also suggests that maternal exercise can boost babies’ brain development and influence a child’s health into adulthood.

Now findings (subscription required) published in the Journal of Sports Medicine and Physical Fitness show that by exercising, moms may reduce their children’s risk of developing high blood pressure, or hypertension. The Michigan State University researchers say their findings are significant because earlier studies have shown babies with low birth weight are more likely to have poor cardiovascular health and an increased risk of hypertension. PsychCentral reports:

[Researchers] initially evaluated 51 women over a five-year period based on physical activity such as running or walking throughout pregnancy and post-pregnancy.

In a follow up to the study, they found that regular exercise in a subset of these women, particularly during the third trimester, was associated with lower blood pressure in their children.

“This told us that exercise during critical developmental periods may have more of a direct effect on the baby,” [said lead author James Pivarnik, PhD].

The finding was evident when his research team also discovered that the children whose mothers exercised at recommended or higher levels of activity displayed significantly lower systolic blood pressures at eight to 10 years old.

“This is a good thing as it suggests that the regular exercise habits of the mother are good for heart health later in a child’s life,” Pivarnik said.

Previously: Extreme pregnancy: A look at exercise and expectant moms, Could exercise before and during early pregnancy lower risk of pre-eclampsia?, Are women getting the message about the benefits of exercising during pregnancy? and Pregnant and on the move: The importance of exercise for moms-to-be
Photo by Nathan Rupert

Ask Stanford Med, Health and Fitness, Nutrition, Obesity

How to keep New Year’s resolutions to eat healthy

How to keep New Year's resolutions to eat healthy

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New Year’s Day always offers the opportunity to hit pause, reflect on our lives and set goals to improve our health and well-being. For many of us, this year also involved making promises to eat healthier and lose weight. To help you achieve your nutrition goals, I reached out to Stanford health educator Jae Berman. Below she shares how to select New Year’s resolutions that you’ll actually keep (perhaps you’ll have to tweak the ones you made last week!), offers strategies for eating healthy even when you’re pressed for time, and explains why cooking for yourself is a key factor in changing nutritional habits.

What are some examples of smaller, more manageable, goals that could help someone make better food choices?

People often jump in too hard, too fast when creating New Year’s resolutions. This perfectionist and “all or nothing” attitude tends to result in grand, lofty goals that we quit if we have a setback or don’t see immediate results. When considering health and weight loss-related goals make sure they are realistic and sustainable.

Instead, closely examine your routine and note one thing you can improve. This behavior may be something obvious, such as you drinking soda every day and wanting to stop. Or, it could be an aspiration to make healthy habits more sustainable, for example, bringing your lunch to work so you can lose weight and save money. Those who already eat well and exercise regularly may want to adopt a goal on a larger scope and learn to cook or try a new form of exercise.

Pick one thing (just one!) and make sure it is SMART – specific, measurable, achievable, results-focused and time-bound. Pick a resolution that is within reach, yet a bit of a stretch so that it’s a challenge. Additionally, goals should lead towards creating a sustainable habit. Some ideas include: Bring your lunch to work Monday-Thursday for the entire month of January; eat five fist-sized servings of vegetables every day; drink coffee only at breakfast; go to sleep at at the same time every night and wake up at the same time every morning for the month of January; or do 30 minutes of weight training three times a week.

In an effort to slim down in the New Year, some individuals may go on the Atkins diet and other popular weight-loss plans, or decide to do a juice fast, like the Master Cleanse. What’s your advice for those considering these approaches?

It’s very difficult to change someone’s mind when they decide to try these types of weight loss plans. So I usually say, “Go for it!” After a few days, the person often feels miserable and wants to create a long-term plan for managing their weight. I will say the one benefit of these quick fixes and fad diets, which I do not endorse, is that they teach a person what it feels like to be hungry. This may sound strange, but this awareness is an important lesson.

Many people overeat and are used to eating to avoid being hungry. We also tend to mindlessly eat out of boredom, or simply because food is in front of us. Going on a restrictive diet results in some feeling hungry for the first time in long time and, as a result they learn their hunger cues. When you experience a hunger cue, which is right when you think “I could eat,” then you should eat just enough food to get through the next three to four hours. You don’t need a huge meal to feel stuffed and small; unsatisfying snacks aren’t helpful either. Understanding what it feels like to be satiated is very important for long-term success.

Ongoing research at the Stanford Prevention Research Center shows that “one diet really does not fit all.”  So I can’t tell you exactly what to eat, but I can tell you that creating a long-term sustainable plan is key.

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Health and Fitness, Orthopedics, Videos

Director of Stanford Runner’s Injury Clinic discusses advances in treating six common running injuries

Director of Stanford Runner's Injury Clinic discusses advances in treating six common running injuries

Running, as many athletes and fitness fanatics are well aware of, can often lead to foot, knee and hip injuries as a result of repetitive overload. But many of the aches and pains that nag runners can be easily avoided and remedied.

In the above Stanford Health Care video, Michael Fredericson, MD, director of the Stanford Runner’s Injury Clinic and head team physician with the Stanford Sports Medicine Program since 1992, provides an overview of prevention and treatment strategies for six of the most common running injuries. He also describes advancements in non-surgical treatment options for patients who don’t respond to standard therapies.

Previously: Director of Stanford Runner’s Injury Clinic discusses treating and preventing common injuries, Watching your phone or tablet while working out may diminish form, Stanford physician discusses prevalence of overuse injuries among college athletes and A closer look at how stretching may benefit the body

Chronic Disease, Health and Fitness, Videos

The importance of regular exercise in delaying and treating diabetes

The importance of regular exercise in delaying and treating diabetes

Looking for motivation to exercise regularly? Consider this statistic: People who engage in physical activity for seven hours a week have a 40 percent lower risk of dying early than those who are active for 30 minutes or less a week. Among the many health benefits bestowed is helping prevent and manage diabetes.

In this Stanford Health Care video, Baldeep Singh, MD, a clinical professor at Stanford who focuses on chronic disease management, explains how exercise can lower blood sugar during your workout and afterwards and help insulin work better. He says in the talk:

[Exercise] is one of the most important things that you can do as you get older because it really has all plus and no minuses … One of the keys is consistency. You want to be consistent in your regiment – even the same time of day … It’s much better to make small incremental changes and be consistent with them, than to make a huge change and than do nothing the rest of the year.

This video is the second lecture in a three-part series addressing important questions related to diabetes and lifestyle choices.

Previously: Examining the role of exercise in managing and preventing diabetesWithout exercise, Americans are growing more obese, according to Stanford researchers, Preventing pre-diabetes from turning into diabetes and Fighting a fatalistic attitude toward diabetes 

Chronic Disease, Health and Fitness, Nutrition

How to make it through holiday dinners without putting on the pounds

How to make it through holiday dinners without putting on the pounds

640px-Christmas_sugar_cookies,_January_2010A lot of people are worrying about overeating over the holidays, especially if they’re on a diet. We’ve offered advice in the past on how to avoid gaining weight over the holidays, and the  blog Obesity Panacea yesterday listed a few tips for eating healthy. My favorite:

Serve healthy snacks in large bowls and the unhealthy ones in small bowls

This little trick should result in a greater consumption of healthy snacks and a limited consumption of unhealthy ones, not only helping you, but those you have over to your place during the holidays.

A wonderfully simple study found that when snacks are offered in a large bowl, people take 53% more food (146 extra calories) and eat 56% (142 calories) more than when offered the same amount of food but in a smaller bowl (roughly half the size of large bowl).

It’s an easy change to make, but not one I never would have thought about. Other tips include drinking a glass or two of water 30 minutes before a meal and making sure you eat breakfast. Both tips ensure you won’t overeat when you get to the Christmas dinner table.

Previously: “Less is more”: More holiday eating tips from a Stanford nutrition lecturerEasy-to-follow tips to avoid overeating this holiday, “Less is more”: Eating wisely, with delight, during the holidays and Enjoying the turkey while watching your waistline
Photo by sweetfixNYC

Behavioral Science, Health and Fitness, Nutrition, Obesity, Public Health, Research

Perceptions about progress and setbacks may compromise success of New Year’s resolutions

3336185391_60148a87fa_zMy physical therapist is constantly telling me to pause during the workday and take stretch breaks to counter act the damage of being hunched over a computer for hours on end. After every visit to his office, I vow to follow his advice, but then life gets busy and before I know it I’ve forgotten to keep my promise.

So I decided that one of my New Year’s resolutions will be to set an alarm on my phone to serve as a reminder to perform simple stretches throughout the day. Keeping in mind that a mere eight percent of people who make resolutions are successful, I began looking for strategies help me accomplish my goal. My search turned up new research about how the perception of setbacks and progress influence achievement of behavior change. According to a University of Colorado, Boulder release:

New Year’s resolution-makers should beware of skewed perceptions. People tend to believe good behaviors are more beneficial in reaching goals than bad behaviors are in obstructing goals, according to a University of Colorado Boulder-led study.

A dieter, for instance, might think refraining from eating ice cream helps his weight-management goal more than eating ice cream hurts it, overestimating movement toward versus away from his target.

“Basically what our research shows is that people tend to accentuate the positive and downplay the negative when considering how they’re doing in terms of goal pursuit,” said Margaret C. Campbell, lead author of the paper — published online in the Journal of Consumer Research — and professor of marketing at CU-Boulder’s Leeds School of Business.

Given these findings, researchers suggest you develop an objective method for measuring your progress and monitor it regularly.

Previously: Resolutions for the New Year and beyond, How learning weight-maintenance skills first can help you achieve New Year’s weight-loss goals, To be healthier in the new year, resolve to be more social and Helping make New Year’s resolutions stick
Photo by Laura Taylor

Behavioral Science, Health and Fitness, Nutrition, Parenting

"Less is more”: Eating wisely, with delight, during the holidays

"Less is more": Eating wisely, with delight, during the holidays

309295507_10531bb128_zSome multi-culture families celebrate their heritage by adding more holidays, writes Maya Adam, MD, a Stanford lecturer who operates the nonprofit Just Cook for Kids. “For our family, with its unusual set of Indian, German and Jewish South African roots, this season seems particularly out of control because we celebrate all of these holidays, one after another. And if we’re not careful, we can easily end up suffering from a severe case of sugar shock.”

Sugar shock, or rather, avoiding sugar shock is the topic of Adam’s blog post on the Healthier, Happy Lives Blog, published by Stanford Children’s Health.

For me, the whole moderation thing is a particularly daunting challenge. Either yes or no seems much simpler. Eat lots or say “no thanks” — none of this healthy balance baloney for me.

But with three simple guidelines, Adam makes moderation seem possible, even doable. Numero uno: Offer healthy alternatives. If potato chips are accompanied by fresh veggies and hummus, it’s much easier to go for the veggies. Dos: Model good behavior for your kiddos. As Adam writes: “When kids see that their parents are able to enjoy a small treat on occasion — and then stop — they learn a great lesson: Less is more.”

And for the third tasty pointer, I’ll let you check that out for yourself. Mmmm, mmmm, it’s a good one.

As Adam writes: “Holidays should be happy times — and sharing food with the people we love is a big part of that happiness.” Bon appetit!

Previously: A physician realizes that she had “officially joined our nation of fellow sugar addicts”, Eat well, be well and enjoy (a little) candy and Pediatrics group issues new recommendations for building strong bones in kids
Photo by Laura

Aging, Health and Fitness, Neuroscience, Public Health, Research

Neighborhood’s “walkability” helps older adults maintain physical and cognitive health

Neighborhood’s “walkability” helps older adults maintain physical and cognitive health

3275748024_c4914d4ae0_zLiving in a walkable neighborhood could be an important factor in helping older adults maintain their physical and cognitive health, according to new research from the University of Kansas.

In the small study, researchers monitored a group of adults diagnosed with mild Alzheimer’s disease and compared them to those without any cognitive impairment. Over a two-year period, individuals completed cognitive tests designed to measure attention, verbal memory and mental status. The “walkability” of participants’ neighborhoods was determined using geographic information systems (GIS). Medical News Today reports:

Results from the study suggest that communities that are easier to walk in are linked to better physical health outcomes – such as lower body mass and blood pressure – and cognition – including better memory.

[Researchers] believe their findings could benefit older adults, health care professionals, caregivers and even architects and urban planners.

Finding also showed that environments with more complex layouts appeared to aid residents in staying mentally sharp, rather than confusing them. Researchers presented their findings over the weekend at the Gerontological Society of America’s annual meeting in Washington, DC.

Previously: Walking and aging: A historical perspective, Even old brains can stay healthy, says Stanford neurologist,  Exercise and your brain: Stanford research highlighted on NIH Director’s blog , Moderate exercise program for older adults reduces mobility disability, study shows and Creating safer neighborhoods for healthier lifestyles
Photo by Ed Yourdon

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