There has been no shortage of recent news about health systems and technology developers exploiting the surge in consumer fitness technology.
In just the past several weeks, for example, Boston-based Partners HealthCare announced it had received a $468,000 grant from the Robert Wood Johnson Foundation to develop an "engagement engine" that will use analytics and big data parsing to help patients sustain use of wearable fitness devices. Electronic health records vendor eClinicalWorks also announced it was enabling integration of data from wearable devices into its online healow platform and into its EHR.
There has been a shortage, however, of clinically valid quantification of activity data. There has been cohort-level data for decades on the benefits of exercise, and wellness programs recommending people take 10,000 steps a day abound. But exactly how important fitness has been in relation to other elements of health, such as whether one has hypertension or hyperlipidemia or diabetes has been lacking, and the message around the real clinical potential of wearables the "metrics of movement," if you will has been very sketchy, until now.
Researchers at the Johns Hopkins Ciccarone Centerfor the Prevention of Heart Disease have published a study in Mayo Clinic Proceedings that definitively showed fitness level is the single most powerful predictor of 10-year survival. The researchers analyzed data from 58,020 people, ages 18 to 96, from Detroit, Mich., who underwent standard exercise stress tests between 1991 and 2009 for evaluation of chest pain, shortness of breath, fainting, or dizziness. What they found is good news for those who are already fit.
"We looked at hypertension, we looked at hyperlipidemia, we looked at the effect of cholesterol medicines, and we looked at diabetes," says Haitham Ahmed, M.D., a cardiology fellow at the Ciccarone Center and the study's lead investigator. "And with any or all of those things, after adjusting for your age, gender, and fitness, nothing else mattered. It didn't matter whether you were taking a statin or not. It didn't matter whether you were hypertensive or not in terms of predicting your 10-year survival."
Ahmed says the team's eventual goal is to indeed find a way to transfer the algorithm that calculates the survival odds, based on treadmill stress testing data, to fitness devices or smartphone-based apps ideally, that data may then be able to become a vetted part of a patient's medical record. One of the great inhibitors of incorporating fitness data into medical records has been the expense of stress tests and the prevailing practice of not using them for any cohort other than those who already exhibit some sort of symptom of cardiovascular distress.
"Physicians and insurance companies in general have thought of stress tests as something you pass or fail," he said. "But coronary disease is not binary. It's a continuum. You start developing plaque at a young age, and it keeps developing over decades. So to ignore millions of people earlier in the spectrum of their disease and only care about them once they've had a heart attack or have blockages severe enough to cause symptoms is a mistake. We're moving very fast. We've already started looking at validating it in different cohorts. We already have an app that's in development and will be launched using our treadmill score. We'll use some preliminary data with a soft launch there and then see how we can convert it to a wearable eventually."
If the algorithm, dubbed the FIT Treadmill Score, is adopted widely enough, Ahmed says insurers and purchasers of big group health plans could have substantially more survival-enriched prediction data, but more importantly, it could also be a very helpful tool to help motivate individuals. Quantifiable performance thresholds from a person's age- and gender-based peers could be a much better motivator than the usual "eat less and exercise more" advice, he said. In the era of "consumer-driven" healthcare, too, in which more of the cost of care is assumed by the consumer, knowing and improving one's fitness level could save money for everyone involved.
"Research institutions spend billions of dollars developing new drugs that improve your risk of survival by 0.1 percent, and they market them, and you go to your doctor's office and talk about them," he said, "but not enough people talk about fitness and how to improve your well being naturally that way. And that costs you nothing, actually, and probably reduces your costs downstream if you're not going to have heart attacks and strokes."
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