The quantified self and accuracy

Fitness tracking and accuracy

There has been a lot of discussion recently around the usefulness of activity trackers in enabling people to be more health. Some of these are less favourable incluing https://www.independent.co.uk/news/health/nhs-apple-watch-fitbits-ai-waiting-times-gp-misdiagnosis-a8749876.html.

I thought it is time for me to share my own personal views of using activity trackers for some time. My first activity trackers were cheap things bought from Amazon which gave a sort of measurement of steps which was useful but the dashboard was not really useful for me so I upgraded to a Fitbit Charge 2. I still wear this all the time and love the data it provides me. The key thing is the data is understandable and in a form I can digest, although there are parts of it I do not record as I am not interested in them.

Overall, throughout my time using a Fitbit, I have become fitter and more aware of my own levels of health. I like the sleep tracker and although I am aware of my sleep patterns it is great to be able to see how my sleep patterns change when I am under stress or doing a lot of exercise.

What I have learned is that data is useful to support what I already know. I don't think the data from the Fitbit has enabled me to find out anything new that I did not already have a good idea about, apart from the heart rate function.

The Heart Rate Monitor (HRM)

What I like about the Fitbit Charge 2 is the ability to see my heart rate at any time at a touch of a button and a screen touch.  I am really happy I am considered to be in excellent fitness with a cardio score of over 45. I have also found that my resting heart rate is around 60BPM. Again this is very encouraging as it means I am not necessarily the decaying person I sometimes feel I am.

Being a nerd, I have regularly counted my pulse at the same time as using the Fitbit and I have always found it really accurate. Accurate at low rates, but at higher rates it is a little less reliable.

I cycle, when I can,  on a push bike.  I also belong to a local cycle group which means that every week there are people going out for group rides.  These rides started at around 20 miles and have increased for me last year to 70 miles and hopefully in June I will ride my first 100 mile sportive since becoming an adult.

The Fitbit's accuracy on rides is very patchy.  I noticed more than a year ago that when I ride to the top of a hill, which I find very hard indeed as I hate hills, my pulse skyrockets. I recall counting my pulse for a short time when we stopped once and it was going at about 170bpm but the Fitbit was showing 85bpm.  Quite a disparity, wouldn't you agree?

In order to test this out in a more scientific setting I did a small test at home on my turbo Trainer, doing hill reps. The session was only 30 mins or so but it did show a huge difference in readouts between the two devices. I should point out that I use a Wahoo Heart Rate Monitor chest strap when I cycle.

Here are the readouts:

Firstly the Fitbit readout for the morning including the ride:

As you can see my pulse went up to 90bpm according to the Fitbit during this rather strenuous session.  This is not bourne out by my own observations of my pulse which I recorded as @176 at one point during the session using my watch and fingers.

Interestingly the Wahoo HRM gave a slightly different picture and one which seems to bare my own experiences out:

The Wahoo HRM puts my pulse/heart rate at averaging 166bpm for the session, which is almost twice what it recorded my peak rate on the Fitbit.  Moreover, the Wahoo has me doing upwards of 184bmp at a few points in the session.  Which explains the reasons why when I finished I was exhausted and felt like I had undertaken a good workout.

Is accuracy important?

The big question is whether accuracy is important?

My personal response is yes and no!

No it is not totally important to be totally accurate. I know when I wake up and look at my Fitbit and it says I have walked 160 steps this is not accurate.  For me the progress I make is more important.  By this I do not mean that I have to keep beating what I did before, rather that I am acknowledging to myself and affirming through Fitbit that I have not been a couch potato all day.

To me everything is a relational scale which I use to make judgements on how well I am doing.  in 2016 I had a year where I was really unwell for much of the time and if I had had this data then I might have gained some solace that I was improving, at times.  Even today when I have bouts where my condition resurfaces, I can use the data from the Fitbit to affirm I am still alive and continuing to move.

There is an issue though; How can a Fitbit be so wildly inaccurate during an exercise session.  I recall looking at the Fitbit on many occasions during the Turbo session and each time it recorded my pulse as below 90 where as the display from the Wahoo had me at at least 170 at the times I was looking. This could be a problem if I was not able to think for my self and relied totally on the output from the Fitbit.

If for example I had a heart condition, which hopefully I do not, then it is really important to keep you heart rate within clear parameters. As it is, I try to do this in any case which is why I purchased the Wahoo for cycling as when you are out and about, it is more difficult to tap a watch from the position of riding a bike.

Should data be God?

Poor heading, I know, but I could not think of anything better to explain the question. Data, via the quantified self, in which we are constantly measuring ourselves to determine who health we are, is the new fad.  It saves time at the doctors by allowing us as people to take control over our own health... or so the great plan in the sky suggests. But is is really possible to be accurate with health data. We constantly use short hand phrases which have no scientific backing as messages from on high. for example, 10,000 Steps,  five a day, or my BMI is too high. Although these well known quantifications are used readily and without doubt have been useful to allow people to change their behaviours, there is little scientific substance to either.

Using fitness tracking devices does mean that we are allowing ourselves to accept poor data. But this is not a problem unless the data is being used by people who do not understand it is poor or take the data as some form of Gospel truth.

Any data is flawed. The bigger the dataset the more accurate the results, does not always ring true.  I realise I am diverging into a mathematical discourse but what I hope any reader can take from this is that instead of letting the machine determine your health, you can determine it and use the machine to support you in your quest.

Personally I don't care whether I walked 3000 steps of 10000 steps or  two million steps, I am only interested in the fact that I am active every day as much as I can be.  Technology can support this but it does not control it.  I do as I hope you control your own.

Finally, No I have no intentions of ditching my Fitbit just yet and have not found any more accurate wrist health monitors around.  I am sticking with Fitbit and Wahoo.

Proactive telehealth apps

The use of mobile devices to encourage people to become fitter and healthier is nothing new.  The more recent development is the use of apps which connect to Smartwatches. As a Smartwatch wearer, I have found that there are some apps which have limited or no use to me, but I do like the apps that sit in the background and measure my inactivity. As an Independent research Consultant I spend  considerable hours every day sat in front of computer screens. As a single dad, I am also active as kids keep you active, well so I thought. The truth of my inactivity was brought home to me when I started wearing my Smartwatch and receiving daily updates on my activity.  When I receive the activity update such as the one in the picture above, I know that I need to be more a to bring the numbers up. 

This nudge is perfect for me. It does not imply that by not doing exercise something bad will happen to me, and on days when it is impossible to exercise at all I might feel bad but, over all, I feel in control of my own health.

The key design features I love about this is that it is non judgemental, it is up to me to exercise, it is my body and my life and I can decide I want to be a couch potato if I want to.  The is no one encouraging me to do anything, but at the end of the week I can see how little or how much I have exercised.

A current failure of this app, like many of its ilk, is its inability to actually detect exercise.  For example, I could do 154 sit ups,  squats  or push ups but the app would not see that as exercise as I am stationary and it requires movement to register activity.  This is a small issue and one that can be countered by manually adding any activity that I do which is not detected.

For people with long term health conditions and people who are couch potatoes this app and smartwatch could be a cost effective method of motivating people to take up activity.  If the NHS supplemented the purchase of Smartwatches of activity bands but also obtained the results from them, this would mean that people who do not exercise could be made to pay back the supplemented part.  For those that do use the watch I can see the benefits being  very high for the NHS in the long term.

Many Thanks

Many thanks to Telehealth and Telecare Aware (www.telecareaware.com) for their lovely write up on the DTA: the Dependability Telecare Assessment tool - The Person-centred Telecare Assessment manual which can be found here http://telecareaware.com/dependability-telecare-assessment-tool-released.

DTA: the Dependability Telecare Assessment tool manual is only available from the gdewsbury.com/dta website. It costs £19.99 which includes free first class UK postage and packaging.

DTA: The Dependability Telecare Assessment tool

New Book Press Release

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The Dependability Telecare Assessment tool (DTA) is a new independent assessment tool, which puts the person at the start, the middle and the finish of any assessment.  It considers the whole person, their needs, their activities and their wishes.  This assessment tool can be used in conjunction with existing care assessments.  As a result, a more transparent and accountable assessment is undertaken which clearly demonstrates the rationale for any equipment proposed.

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This manual represents a new technique for thinking about telecare assessments and demonstrates a qualitative way to consider telecare’s relationship with people in need of additional support. 

DTA is a culmination of many years of academic ethnographic research with older and disabled people in the design of telecare technology to support them. When gdewsbury (www.gdewsbury.com) formed in 2012, it proved to be the appropriate time to write and publish DTA as a manual for professionals. A key theme throughout DTA is “only install sufficient telecare to enable a person. Excessive use of telecare could disable a person.”

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gdewsbury are Dr Guy Dewsbury and Debbie Ballard

When technology turns to help people

For those who follow my twitter feed (@dewsbury) I mentioned how the Xbox’s always aware functionality caused Xboxes to switch on when Aaron Paul says in the advert says ‘Xbox on’ people report their Xboxes switching on (see http://www.bbc.co.uk/news/technology-27827545). This annoying functionality does have its upside as well as the downside.  

With the recent Google IO (https://www.google.com/events/io) it was mentioned that the new Android operating system will have a always aware functionality, so even in the closed state it will still listen for the command ‘OK Google’. This for some might be a little worrying, especially in the light of Facebook’s attempt to be constantly aware and record the sounds in your environment whilst you use its app (http://guardianlv.com/2014/05/facebook-has-new-microphone-application/).

 

Therefore, the benefits of always-aware applications might not appear to outweigh the security and privacy issues.  This was certainly my belief, until I was alerted, by my bother to an article in the ABC news (http://kstp.com/news/stories/S3484579.shtml?cat=127) in which a two year old uses Siri (the voice aware IOS platform) to call for emergency services as her mother suffered from “an autonomic nervous system disorder that causes her to faint”. The child was taught to press the button and say call emergency services, if her mother fell over, which was the case at the time.

As telecare and telehealth devices evolve the standard pendant, based technologies will be surpassed by smarter more common/mundane technologies such as the standard mobile phone.  Many smart phones have the ability to dial numbers through speech input and this will only increase over time as operating systems become smarter. The advent of smart watches will also add to this if they have accelerometers built into them and can determine if a person has fallen.

The rise in health apps (see http://phonesngagdets.blogspot.co.uk/2014/06/my-favourite-fitness-app-virtuagym-www.html) can only be a good thing as the poor ones will eventually be weeded out and the best ones will remain. Adding the ability to determine health characteristics is essential to make the move from a mobile phone being a standard communication tool to being a fully interactive useful piece of hardware. 

It is good news that technology is finally being used appropriately to help people in a number of ways. One such way that caught my eye was the Brianwriter (http://www.techrepublic.com/article/the-brainwriter-the-200-open-source-wearable-for-the-paralyzed-that-can-read-and-write-thoughts/#ftag=RSS56d97e7) which turns your thoughts into drawings and communications.  This was originally designed for people who were paralysed and in many ways is better or more promising than Oculus Rift (http://www.oculusvr.com/) or Google Glass (http://www.google.co.uk/glass/start/).

We are at the dawn of an incredible change in the way in which technology can be used to make people’s live better and facilitate their safety. I just hope that my idealistic dreams is not proved wrong. Technology developed for one thing can reused and re-purposed for something else. My fingers are crossed.