How Self-monitoring is Transforming Health

The self-monitoring trend has exploded into a plethora of shiny new gadgets and toys - but what are the health benefits, and will the appeal last or will we sink under mountains of data?

Judging from the abundance of news stories, it seems we are getting serious about self-monitoring, and tracking everything from what we eat, to how active and happy we are. The quiet revolution in self-tracking has turned into an explosion, mirroring the large-scale liberation of data being promoted by organizations like the Health Data Consortium who wish to increase the pace and volume of data available to innovators so they can devise products and services to improve health and health care. Self-monitoring or self-tracking is where individuals use intelligent tools like wearable sensors and mobile apps to collect, process and display a wealth of personal data to help them monitor and manage all aspects of their personal health.

More self-monitoring devices, more people using them. Spurred by movements such as the Quantified Self, an increasing number of people are using personal gadgets to monitor their own fitness and health indicators, plus how they use their time, in order to improve wellbeing and personal efficiency. Consumer technology has now advanced to the point of being small and cheap enough that today we have apps and devices that tell us things almost instantly that before you could only discover from a doctor in a hospital running lengthy tests. According to Pew Internet Research, who last year carried out the first US national survey on self-tracking, seven in ten US adults say they track at least one health indicator, with: 1. 60% tracking weight, diet or exercise and 2. 33% tracking health symptoms (blood pressure, blood sugar, headaches, sleep patterns, and so on). 3. The array of tools is now so vast you could keep track of every waking (and sleeping) moment, from counting steps, miles cycled, floors climbed, and calories consumed, to measuring all kinds of bodily functions like urine colour, blood pressure, insulin, blood sugar, heart rate and sleep patterns. Earlier this year we reviewed three popular self-tracking tools. It is estimated that in a few years, there will be around 170 million wireless devices tracking personal health around the world.

Instant feedback is a great motivator. There is an old saying in management, if you want to improve something, start by measuring it, or you won't see how to make a difference. The added appeal of today's self-tracking tools is that seeing the numbers so soon can be motivational: they reward you when you do well and they spur you to do something when you feel lazy. If you want to lose weight for example, it can be hard to stay motivated. You may decide part of the strategy is to do more walking. But you won't lose weight overnight. What helps you stay motivated is seeing the instant feedback that something like a pedometer or activity monitor gives you. It keeps you going long enough to see the hard results when you step on those scales. The other way self-tracking works is by creating a common language so you can share results with others, either to receive encouragement as in a support group or to take part in competitions. Big shake-up in medicine. The trend in self-tracking being brought about by what is possible with today's technology, heralds "the biggest shake-up in the history of medicine," according to Eric Topol, a leading American physician. Topol believes the growth of self-tracking devices is bringing us to a turning point in medicine.

He doesn't prescribe drugs for his patients, he told the BBC, instead he prescribes apps. "You name the condition, we get the apps to match up with your phone," he says. However, while the growing trend in self-tracking is being embraced with enthusiasm by users and doctors alike, there is also concern that focusing on the wrong data, or using a poorly designed monitoring tool, can cause people to make their health worse or get into problems that then have to be picked up by health professionals. Another area of concern is regulation. Some apps and devices should be classed as medical devices. The US Food and Drug Administration recently told a company they should seek regulatory approval of their mobile app that analyzes urine from photographs. Lionel Tarassenko, professor at the University of Oxford and director at Oxehealth, a spin-off from the university's Institute of Biomedical Engineering, is one of the UK's pioneers in biomedical engineering. He has been collecting clinically based evidence on self-monitoring. The technology Prof Tarassenko has developed "will allow early signs of deterioration to be detected and addressed in a timely and efficient manner," he says, so that:

"The worried-well would stop bothering busy clinicians; the ill would access a clinician when there was still time to treat the condition." What happens when the novelty wears off? The play value of shiny new gadgets appeals to the child within us. But what happens when the novelty wears off and you are left with the stark realization that to achieve your goal of improved health you have to keep doing something that might now feel rather boring? In a recent informal experiment reported by the BBC, scientist and presenter Dr Kevin Fong joined three women to see how three weeks of measuring sleep and activity levels would affect them. One of the effects he noticed was the feeling of competition, not only with other participants but also within himself. All participants increased their activity levels, to the point where, as one woman explained, she ended up running on the spot while watching TV just to get her activity numbers up. But a question that arises is how long does this effect last? According to the Pew Internet Research report, only 46% of people who tracked at least one measure said it changed their overall approach to maintaining their health. This is a surprisingly low figure. Will the woman in the BBC-reported experiment still be running on the spot while watching TV when the media spotlight is turned off? Or is the value of the self-tracking tool more one of raising awareness - in that it highlights the types of changes needed to make a significant difference to your life?

How to make self-tracking work for you: If you're not careful, you could end up spending a lot of money on a lot of gadgets that after the novelty wears off end up as a pile of expensive hardly-used equipment. So here is a list of tips for getting on the right track with self-monitoring: 1. Get used to the idea of self-monitoring. Pick something that is not difficult to track, that is fun, easy to interpret, and doesn't require you take out a bank loan. Many people start with a pedometer. 2. Set realistic, achievable goals. Better to have a series of small steps than one huge one. If you keep your goal-setting realistic, with regular reviews and small increments, the changes you make to your lifestyle to achieve the goals will be gradual and more long-lasting. 3. Celebrate your achievements and don't beat yourself up when you don't reach your goal. Throw a party or treat yourself when you manage to sustain your new level. If you fail, review the reasons, be honest and compassionate with yourself, reset the target to a lower level, and try again. 4. Ask yourself, every now and again, what the benefits have been for you personally achieving the goals. Review how you feel, how your life has changed, and whether the change is for the better. Have others noticed the changes?

5. Focus on the measures that will make the biggest difference to your life. When you feel ready to move onto another challenge, be guided by your health priorities rather the seductive marketing of new gadgets. 6. Also be prepared to experiment. By trying new things you discover what you can change and gain insights about what is possible and works for you. 7. Pick the right device. There are lots of devices out there, and it is not easy to tell the good ones from the bad ones. Read user reviews and consult an expert to help you choose a quality device and how to use the data meaningfully. 8. Hold strong. Before you move onto the next thing to monitor, or buy a new gadget, think about how you are going to hold onto the gains you have made so far. 9. Identify patterns. As you gain more experience with self-monitoring, try looking at correlations between measures. For example, is there a pattern between activity level and sleep quality? Applications like Tictrac are now emerging to help in this area.