The purpose of this pilot study was to evaluate the feasibility, acceptability, and effectiveness of integrating a wearable Fitbit device into a high-touch, multicomponent weight loss intervention at a local community aging center.
Results of this pilot are the first to demonstrate the integration of a commercial wearable into a community-based weight loss program in older adults with obesity residing in rural areas. Despite misconceptions that this demographic is unable to use technology, these results not only showed effectiveness in the primary study outcomes but also showed ease of use, satisfaction, and engagement with the intervention and the technology itself. These findings suggest that wearable fitness devices have the potential to be acceptable and subsequently used in health promotion interventions in older adults.
John A. Batsis, Curtis L. Petersen, Matthew M. Clark, Summer B. Cook, Francisco Lopez-Jimenez, Rima I. Al-Nimr, Dawna Pidgeon, David Kotz, Todd A. Mackenzie, and Steven J. Bartels. A Weight-Loss Intervention Augmented by a Wearable Device in Rural Older Adults with Obesity: A Feasibility Study.Journals of Gerontology – Series A: Biological Sciences and Medical Sciences, volume 76, number 1, pages 95–100. Oxford Academic, January 2021. doi:10.1093/gerona/glaa115. First published 8 May 2020.
Although not specifically involving the Amulet device, John Batsis and members of the Amulet team published a recent feasibility study involving the use of wearables, like Amulet, in support of health monitoring for older adults.
John A. Batsis, Auden C. McClure, Aaron B. Weintraub, David F. Kotz, Sivan Rotenberg, Summer B. Cook, Diane Gilbert-Diamond, Kevin Curtis, Courtney J. Stevens, Diane Sette, and Richard I. Rothstein. Feasibility and acceptability of a rural, pragmatic, telemedicine-delivered healthy lifestyle programme. Obesity Science & Practice, 1-10, August 2019. DOI 10.1002/osp4.366.
Abstract: Background: The public health crisis of obesity leads to increasing morbidity that are even more profound in certain populations such as rural adults. Live, two-way video-conferencing is a modality that can potentially surmount geographic barriers and staffing shortages. Methods: Patients from the Dartmouth-Hitchcock Weight and Wellness Center were recruited into a pragmatic, single-arm, nonrandomized study of a remotely delivered 16-week evidence-based healthy lifestyle programme. Patients were provided hardware and appropriate software allowing for remote participation in all sessions, outside of the clinic setting. Our primary outcomes were feasibility and acceptability of the telemedicine intervention, as well as potential effectiveness on anthropometric and functional measures. Results: Of 62 participants approached, we enrolled 37, of which 27 completed at least 75% of the 16-week programme sessions (27% attrition). Mean age was 46.9 +/- 11.6 years (88.9% female), with a mean body mass index of 41.3 +/- 7.1 kg/m2 and mean waist circumference of 120.7 +/- 16.8 cm. Mean patient participant satisfaction regarding the telemedicine approach was favourable (4.48 +/- 0.58 on 1-5 Likert scale–low to high) and 67.6/75 on standardized questionnaire. Mean weight loss at 16 weeks was 2.22 +/- 3.18 kg representing a 2.1% change (P < .001), with a loss in waist circumference of 3.4% (P = .001). Fat mass and visceral fat were significantly lower at 16 weeks (2.9% and 12.5%; both P < .05), with marginal improvement in appendicular skeletal muscle mass (1.7%). In the 30-second sit-to-stand test, a mean improvement of 2.46 stands (P = .005) was observed. Conclusion: A telemedicine-delivered, intensive weight loss intervention is feasible, acceptable, and potentially effective in rural adults seeking weight loss.
A qualitative study to determine whether mHealth devices, like Amulet, could be useful in supporting rural-health interventions.
John Batsis, Stephen Bartels, Rachel Dokko, Alexandra Zagaria, John Naslund, Elizabeth Carpenter-Song, and David Kotz. Opportunities to Improve a Mobile Obesity Wellness Intervention for Rural Older Adults with Obesity. Journal of Community Health, September 2019. DOI 10.1007/s10900-019-00720-y.
Abstract: Older adults with obesity are at a high risk of decline, particularly in rural areas. Our study objective was to gain insights into how a potential Mobile Health Obesity Wellness Intervention (MOWI) in rural older adults with obesity, consisting of nutrition and exercise sessions, could be helpful to improve physical function. A qualitative methods study was conducted in a rural community, community-based aging center. Four community leaders, 7 clinicians and 29 patient participants underwent focus groups and semi-structured interviews. All participants had a favorable view of MOWI and saw its potential to improve health and create accountability. Participants noted that MOWI could overcome geographic barriers and provided feedback about components that could improve implementation. There was expressed enthusiasm over its potential to improve health. The use of technology in older adults with obesity in rural areas has considerable promise. There is potential that this intervention could potentially extend to distant areas in rural America that can surmount accessibility barriers. If successful, this intervention could potentially alter healthcare delivery by enhancing health promotion in a remote, geographically constrained communities. MOWI has the potential to reach older adults with obesity using novel methods in geographically isolated regions.
Another recent paper from John Batsis and the Amulet group, highlighting a custom sensor developed by our team and presented at the International Conference on Body Area Networks (ICBAN):
John A. Batsis, George G. Boateng, Lillian M. Seo, Curtis L. Petersen, Karen L. Fortuna, Emily V. Wechsler, Ronald J. Peterson, Summer B. Cook, Dawna Pidgeon, Rachel S. Dokko, Ryan J. Halter, and David F. Kotz. Development and Usability Assessment of a Connected Resistance Exercise Band Application for Strength-Monitoring. World Academy of Science, Engineering and Technology, 13(5):340-348, June 2019. DOI 10.5281/zenodo.
Abstract: Resistance exercise bands are a core component of any physical activity strengthening program. Strength training can mitigate the development of sarcopenia, the loss of muscle mass or strength and function with aging. Yet, the adherence of such behavioral exercise strategies in a home-based setting is fraught with issues of monitoring and compliance. Our group developed a Bluetooth-enabled resistance exercise band capable of transmitting data to an open-source platform. In this work, we developed an application to capture this information in real-time and conducted three usability studies in two mixed-aged groups of participants (n=6 each) and a group of older adults with obesity participating in a weight-loss intervention (n=20). The system was favorable, acceptable and provided iterative information that could assist in future deployment on ubiquitous platforms. Our formative work provides the foundation to deliver home-based monitoring interventions in a high-risk, older adult population.
John A. Batsis, John A. Naslund, Alexandra B. Zagaria, David Kotz, Rachel Dokko, Stephen J. Bartels & Elizabeth Carpenter-Song. Technology for Behavioral Change in Rural Older Adults with Obesity. Journal of Nutrition in Gerontology and Geriatrics, April 2019.DOI: 10.1080/21551197.2019.1600097