Hello. I am Mike Painter, and I track. I don’t necessarily have a compelling reason to track health parameters such as exercise patterns, heart rate, weight, diet and the occasional blood pressure. Yet I do. I do most of my tracking with several small devices, simple sensors and software applications. My tracking is also pretty social—meaning I share much of my data widely and daily. You’re welcome to see it—most of it is on Strava. Admittedly, I still keep some data daily on a paper calendar, and I do monitor diet and sleep in my head—i.e., nobody needs to remind me about my food splurge days. The local bakery is intimately aware of that data point as the employees witness me charge in, wild-eyed and drooling for a giant cinnamon roll every Thursday morning—almost without fail.
It all feels pretty normal to me.
Here’s the rest of the story: I track to enhance athletic performance rather than monitor my health, per se, or even really my wellness. I am an avid cyclist and have tracked miles, location, accumulated elevation, heart rate and power readings and other data for years. I share that information with both cyclist colleagues I know and don’t know on Strava. That site eagerly ingests my data—and among other things, plops it into riding (and running) segment leader boards, riding heat maps—and, most importantly, in training, trend graphs like the attached. All that data is incredibly helpful to me—it empowers me by making me face the numbers—it makes my training data- and reality-based. I don’t have to guess to maximize my fitness and minimize my fatigue level in anticipation of a big event. I follow the numbers.
Is all that bad? To me, my obsession with tracking my athletic performance seems like an extension of observing data for health and wellness.
Last week I had the great fortune to participate in a breakout session at the very cool Stanford Medicine X conference in Palo Alto. I talked about RWJF’s pioneering work in patient engagement, including efforts like OpenNotes and Project HealthDesign. I also felt compelled to show my Garmin Edge 500, Garmin Forerunner 610 and heart rate monitor to the audience—mostly, to make the point that tracking is ubiquitous, helpful and powerful—and that it doesn’t require Google Glass-level technology.
Turns out, those of us tracking aren’t really odd-balls, after all. Last week I also had the opportunity to attend the annual Bay Area Heath 2.0 conference where the superb Susannah Fox gave a preview of new Pew research on the health information tracking behaviors of Americans. It’s pretty interesting stuff. Guess what? About 60% of us track some aspect of our health—weight, exercise, and diet. Like me with my diet, many of us (49%) track in our heads. And for many (34%), technology is not a big factor, at least not yet. Paper is still big with today’s trackers.
At both the Stanford and Health 2.0 conferences, I sensed a subtle snub against us athletic trackers in favor of real people and patients who use tracking tools for their health. I see it slightly differently. To me, it’s really a continuum from health and wellness to fitness and performance. Some of that leading-edge fitness and performance tracking shows us all the tremendous power of these tools. The thing that binds all this tracking behavior is the power of the data and self-awareness. Our own Project HeathDesign work, for instance, showed clearly that patients with Crohn’s had higher satisfaction, better communication, and a better understanding of their illness and symptoms when they collected observations of daily living data. Those findings overlap pretty consistently with my own tracking experience.
One major worry: the vulnerable. In my prior community health center clinical practice, many of my patients struggled simply to catch multiple buses to get to the clinic or faced basic needs obstacles like gunfire in their neighborhoods or food deserts. Fastidious data tracking for self-awareness in that context seems challenging if not absurd. Still I wouldn’t jump to conclusions. Even years ago, my patients surprised me with their enthusiastic embrace of technology—pushing to email or text me for instance. Many, if not most, of my patients with diabetes ended up tracking blood sugar by hand pretty consistently.
It will be interesting to see how our tracking evolves. I can imagine a world where we try hard to engineer health and wellness into everyone’s environment—everyone’s. But we’ll obviously never completely engineer out the badness. We should also be able to use technology and tools as a buffer against the bad—to help us gain awareness of how we interact with that world in both positive and negative ways—and then use that information to help us achieve health, wellness—and, yep, higher performance.
Michael W. Painter, JD, MD is a senior program officer at the Robert Wood Johnson Foundation.
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Shiv–another Strava-ite! Congratulations. And that’s a fantastic use of Fitbit tracking–it will be interesting to see your study results.
Michael–thanks for the note–agree with you that we have a long way to go before we get to the desired new normal–and that tracking some health parameters will be part of that–definitely.
Great article, Mike! I tried out Strava as a result of your recommendation and am becoming a performance tracker as well. Despite my longstanding interest in medical tech (writing about and reviewing many of the tracker devices), I have not been much of a Quantified Selfer. Maybe Strava will be a (tracked) step in the right direction.
I’m particularly interested in quantifying the baseline health status of people and using these tracker devices to monitor problems. For example, at Hopkins I performed research involving patients with normal pressure hydrocephalus who insidiously develop gait abnormalities (e.g. magnetic gait). The current screening protocol isn’t discerning enough to detect gradual changes despite patients often complaining that they don’t feel as fluid as they used to. Our project involved giving these patients Fitbits among other trackers and determining whether we could detect changes in gait, pre-lumbar puncture and post. While still ongoing we received some great initial results, and I see there being a whole slew of Quantified Self applications for patients with more serious conditions.
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Susannah’s right: there’s a continuum. Tracking everything you eat, every step you take, every move you make in the expectation that this will enable you to live longer than those who splurge on cinammon rolls is odd. Thinking that everyone will be/should be tracking on Fitbits is detached from reality. Tracking yourself for athletic performance? Just one step up from the data flashing from that odometer/speedometer on your handle bars. What you’ve done, Mike, is normalize this use of data. Good for you.
Now, if Project HealthDesign and OpenNotes can become the new normal for health care, we’ll really have achieved something!
MMM
Susannah-I totally agree. The tools for athletes are sort of showing some of the potential–but the big opportunity is with that broad swath of the population who already are tracking. Seems like there’s is enormous untapped potential there.
Mike,
Thank you for the kind words. We share the same interests and goals: to illuminate reality and help people focus on stuff that matters, all along the spectrum of health, wealth, etc.
My remarks were a sneak preview of the Pew Research Center’s upcoming report on people living with chronic conditions. If people want to check out what I said, here’s a link:
http://susannahfox.com/2013/10/07/data-collection-and-connection/
One of the posts that THCB suggests in the Related Posts section above was written by Leslie Schover, who is also on the conference circuit (or is it a bubble? That’s another post.)
She asks: Why aren’t we building the products patients really need?
https://thehealthcareblog.com/blog/2013/10/11/healthcares-tech-disconnect-why-arent-we-building-the-products-patients-really-need/
She goes on to call the connected patient movement “naive” but I think that’s too strong. There is a spectrum, as you point out: Athletes who track using Strava. Others who track using paper and pencil. Activists like Hugo Campos who want access to their device data. Others who would more appreciate some basic behavior change tips.
I think all the stuff that you’re using is incredibly cool — as was the stuff demo’d at Health 2.0. I hope companies continue to innovate for athletes, since we’ve seen it disperse throughout the population in later product releases.
But if people want to go after the big prize and really make a difference in a broad swath of the population, they are going to need to widen their lens. Paper and pencil, text messaging, mainstream media — these are the tools of the majority, not yet (and I dared say it on stage) any of the cool apps or gadgets being featured that day.
True. It is amusing to look at some of the old workout notebooks. And only a little dis-spiriting. As I am about to turn 56, I see incipient signs of decline.
But, I can still run a mile in 10 min, time trial on my bike at around 20 mph, bench 260 (down from 300 at my peak) and do at least 40 pushups nonstop. I also have zero cardiometabolic risk factors and a resting HR of 58. I am evidence of the fact that the right kind of compulsion is very, very good.
Jim–your work is very consistent with my experience even years ago in Seattle–and it’s pretty heartening that folks are so interested in the technology and willing to use it. It also makes complete sense, of course, that people would prefer smartphones over older cells. We’ll get there.
Vik–sounds like you’re a self-tracker too–and that we’re in good company with our fellow trackers. I also don’t think your story sounds compulsive in the least–there’s power in that information–it’s fantastic that you’ve collected it over the years.
Mike, your concerns regarding vulnerable populations resonate with me. As you note, most people figure that people from lower-income minority communities struggle so much “simply to catch multiple buses to get to the clinic or faced basic needs obstacles like gunfire in their neighborhoods or food deserts” that they will not be willing or interested in using diabetes apps and other mobile self monitoring tools. Our team recently surveyed diverse populations in the Mid-South to assess their interest in and use of smart phone technology for diabetes self-management. And our survey tells a different story than what most people might expect. Residents of lower income minority communities were actually more interested in smart phone apps than people from more affluent areas. The issue may just be that vulnerable populations can’t afford smart phones, just like they can’t afford laptops. We found that text message reminders were especially popular, and everybody has cell phones. Texts may be the most cost effective strategy for health reminders for low-income populations. But given a choice, our study suggests that most would like to have smart phones and many would like to use diabetes self-management apps.
Mike, I am totally with you on this. In the pre-smartphone era, I kept detailed notebooks of all my lifting, cycling, and running. Today, like you, I use Strava with a heart rate monitor for cycling and running. I take all that data and put into a spreadsheet, which is now going on 10 years old, that tells me the duration, RPE, and METs of every workout I’ve done in that time. I also do a field test of my HRmax each, year, 1-rep max test my bench press and squat, and see how many push ups and chin ups I can do. All dutifully recorded. A bit, compulsive, yes, but as you said, it is ALL about performance.