1. Fitbit Activity Monitors and Resident Wellness Heather Paladine MD hlp222@gmail.com Seth Mathern Allison Lynch MD Pooja Shah MD David Rosenthal PhD

2. Disclosures Nothing to disclose

3. Introduction Residency is associated with long work hours, decreased exercise and decreased sleep Previous studies have looked at burnout during residency, but less attention has been paid to wellness

4. Introduction Pedometer use has been associated with increased activity, but data on workplace interventions is insufficient Wearable activity monitors (such as Fitbit, Jawbone, Garmin, Misfit) can give individual data on activity and sleep, and also encourage friendly competition

5. Introduction This was a pilot study to examine the feasibility of using wearable activity monitors to measure and promote health behaviors among Family Medicine residents

6. Methods Residents in our Family Medicine program were eligible to participate A baseline survey was done using questions from the Gallup-Healthways Well-Being Life Evaluation Index and the Perceived Stress Scale (PSS-10)

7. Methods Participants were then allowed to choose Fitbit activity montiors (either Fitbit Flex or Fitbit One) Repeat survey was done after two months with the addition of questions about Fitbit use Participants were given a gift card to a local coffee shop on completion of each survey

8. Results All 18 residents chose to participate and gave informed consent 16 participants completed the first survey (88.9%) and 15 completed the second survey (83.3%) 16 residents chose Fitbit Flex (wrist monitor); 2 chose Fitbit One (belt clip)

9. Results Wellness and perceived stress scores were similar at baseline and two months Reported days of exercise did increase in the second survey, but numbers are too small for statistical analysis

10. Initial surveyFollow up survey Felt well-rested8/16 (50%)8/15 (53%) Had flu, cold, headache, allergies 4/16 (25%)3/15 (20%) No exercise in the past week 9/16 (56.3%)6/15 (40%) Less than 5 fruits and vegetables per day 14/16 (87.5%)13/15 (86.7%) Thriving11/16 (68.8%)9/15 (60%) Struggling5/16 (31.3%)6/15 (40%) Gallup-Healthways Well-Being Index

11. Perceived Stress Scale (PSS-10) Initial surveyFollow up survey Overall17.417.6 PGY1-22 PGY2-16.6 PGY3-15.5

12. Fitbit Use and Satisfaction Number of participants (%) Somewhat or very satisfied9/15 (60%) Would recommend Fitbit11/14 (78.6%) Wore Fitbit daily9/14 (64.3%) Wore Fitbit 2-3 days/week4/14 (28.6%)

13. List three things you liked about using Fitbit CodesExamples of comments Competition“The competition with peers motivates me to work harder” “Brought some friendly competition to exercise” Data collection“Getting a realistic picture of walking patterns” “Seeing how many steps just walking to work can give me” Positive reinforcement “I feel a sense of satisfaction after reaching 10,000 steps” “Positive re-enforcement for things well done and weekly summary was helpful” Design“Small and easy to place on clothes” “Nice color made me happy” None“None”

14. List three things you disliked about using Fitbit CodesExamples of comments Lifestyle compatibility Battery life“Sometimes I don’t have time to charge it” “The battery ran out, then I gave up” Sleep function“You have to wear it all the time if u want to track sleep” “Doesn’t track quality of sleep in a useful manner” Usefulness with non-step-based activities “I feel more satisfaction with running but less satisfaction with stationary bike or swimming because it doesn’t log steps” Additional features“I wish it had a HR (heart rate) monitor” Comfort and fit“Uncomfortable, bulky to wear on wrist” “Irritating to have something on my arm all day and night, which actually made me stop using it for the most part” Additional stress“Annoying to remember to wear” “Another thing I have to think about

15. Impact on activity and sleep CodesExamples of comments No impact“None” “I have not been using it for sleep” Little impact Novelty“Some while I was wearing it but the excitement was short lived” Fit/comfort“Not much b/c stopped wearing about 1 week 2/2 found too uncomfortable” Stress“I’ve definitely TRIED to walk a lot more. I’m worried that it’s added an additional stress though, by taking more time each day to get more steps” Moderate“It was a fun way to connect with other residents/attendings which improved relationships” Substantial“Increased the amount I chose to walk instead of taking a taxi or subway”

16. Conclusions Resident wellness behaviors are lower than the general population Positive factors included friendly competition and positive reinforcement for increased activity Barriers included device fit, battery life, and increased stress, resulting in some residents who decreased or discontinued use

17. Future directions Plan is for the study to continue for three years with surveys every six months Strategies to increase use may include team-based competition or rewards for all users that reach a minimum activity level

18. Please evaluate this session at: stfm.org/sessionevaluation