Motivating individuals to be physically active can be a challenge in all areas of rehabilitation practice, including the home healthcare (HHC) setting. Optimization of physical activity behaviors is more likely to be maintained long term when the individual is able to find internal motivation to participate in physical activity (Chia et al., 2019). Traditionally, interventions including motivational interviewing, health coaching, and written home exercise programs have been tools to guide and motivate individuals toward optimal physical activity behaviors. However, technology advancements and a vast array of consumer options provide additional means to promote positive active behaviors among product users.

Activity trackers have been identified as a way to promote self-efficacy and physical activity among older adults (Kononova et al., 2019). Older adults constitute the most sedentary age group with greater than 80% of those over 65 not meeting the recommended physical activity guidelines of 150 to 300 minutes of moderate physical activity per week (Kononova et al.). Activity monitors could be useful in addressing motivation-related barriers. Kononova et al. (2019) suggest activity trackers could bring about increased self-awareness and new insights related to current physical activity volumes to the end user. These benefits could be useful for therapists to set goals related to desired future activity levels, to design home exercise programs, and to establish measurable outcome metrics.

Activity trackers are commonly worn on the wrist, ankle, or clothing, and track movement volumes of activities such as walking and yard work. Activity trackers are capable of capturing the number of steps ambulated, calories burned and/or consumed, duration and quality of sleep, heart rate, and water consumed. These devices have had growing popularity over the last 5 years and have been found to promote physical activity through motivation, accountability, goal setting, and recording health habits (Link-Age Connect, 2019). However, only 20% of adults over the age of 55 reported using advanced fitness trackers (Link-Age Connect).

Boolani et al. (2019) evaluated the accuracy of heart rate, calorie expenditure, and steps and distance traveled in six commercially available activity monitors on adults 18 to 65 years of age. The Fitbit Zip(R) was found to provide the most accurate measure of steps and distance covered in most environments, and the Misfit Shine(R) recorded the most accurate steps during fast walking. However, none of the devices provided an accurate estimate of caloric expenditure during fast walking. Given these findings, the authors suggest activity trackers may be most beneficial as a motivator rather than a clinical measure of distance traveled or calories burned. Self-reported outcomes from older adults (age 65-94 years), who were enrolled in a home-based prevention-focused program led by a physical therapist, identified benefits of activity trackers (Wilson et al., in press). However, difficulty donning the wristband, using device features, and a lack of access to required web application were barriers to activity monitor use.

Although use of smart phones by individuals over the age of 65 has increased from 18% in 2013 to nearly 40% today, those who do not own a smartphone report no interest in getting one (Link-Age Connect, 2019). Furthermore, 40% of adults over 90 years of age do not have access to the internet and 15% to 20% of adults 60 to 85 years of age report not using the internet with common reasons being a lack of access and interest (Link-Age Connect). Access limitations to platforms for activity monitor device setup; syncing and using product features may pose additional barriers to user success.

Despite concerns of accuracy, accessibility, and usability, evidence suggests activity trackers may encourage physical activity among older adults. Therapists should consider activity trackers as a viable option to reduce sedentary activity volumes among older adults under their care (Chia et al., 2019). This may require HHC therapists to incorporate time into their visit encounters to include education on equipment use and to assist with device setup. Furthermore, the robust exercise dosing skill set of HHC therapists could optimize the efficacy of an activity tracker as a component of the individualized home exercise program.

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