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The Motivational Impact of Wearable Healthy Lifestyle Technologies: A Self-determination Perspective on Fitbits With Adolescents

Studies show that considerable proportions of young people do not meet the national guidelines for daily physical activity. Approximately 50% of young people engage in sufficient physical activity to achieve positive health benefits. Echoing calls of international health and physical activity organizations the United Nations Educational, Scientific, and Cultural Organization recently stressed that substantial action was required to address rising levels of youth physical inactivity and the substantial increase in associated noncommunicable diseases. Health interventions are particularly important because they provide the foundation for an active lifestyle. Schools are suitably positioned as a site to promote physical activity, given the staff, equipment, facilities, and duration of time that young people spend there. Yet, over a number of decades, physical activity interventions targeting young people in schools have only produced modest effects.8 Finding new ways to motivate young people to be active is therefore vital.

Although technology has been associated with physical inactivity, healthy lifestyle technologies, such as wearable fitness devices (eg, Fitbits) and mobile health applications (apps; eg, Fitbit app or MyFitnessPal), are suggested to provide new and exciting opportunities for physical activity promotion. It is suggested that access to personalized data on physical activity behaviors and the ability to track, compare, and monitor behavior has huge potential for impacting cognitions and emotions and, in turn, increasing levels of physical activity.Given that young people are becoming increasingly tethered to their mobile devices, alongside reports that they are increasingly turning to technology for health information, healthy lifestyle technologies should be considered as tools to address physical inactivity in young people.

Though most empirical evidence on healthy lifestyle technologies is based on assessing quality and validity, an emerging evidence base in young adults demonstrates that commercial wearable fitness trackers and their associated apps increase physical activity levels and impact motivational constructs of enjoyment, challenge, affiliation, and positive health motivation. Young people (age 11–12) have also reported finding features of real-time feedback and competition from the commercial Fitbit motivating, suggesting that promotion of self-monitoring and goal-setting behaviors can increase physical activity levels. Yet the evidence base on the health-related impact of young people’s (age 13–14) use of healthy lifestyle technologies is limited. A recent systematic literature review on adolescents and young adults (age 12–25 years) identified only 2 empirical studies that measured the health-related effects of using nutritional or physical activity apps. Further, the limited evidence base is inconclusive. For example, though a noncommercial app used with obese patients (age 11–15) resulted in weight reduction and improvements to intrinsic and extrinsic motivation, other nonrandomized interventions (age 12–25) report no significant differences in diet/nutrition or physical activity behaviors. In an account of young girls’ (age 11–15) experiences of commercial health apps and wearable devices (eg, Popsugar Active or Strava), heightened levels of body dissatisfaction were reported—a known variable evidenced to impact negatively on physical activity behaviors. Research that determines the healthrelated impacts of wearable devices and apps would contribute to an emerging evidence base on the role of digital technologies in the health of young people.

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