Can Tech Motivate Long-Term Healthy Behavior?

Anthony Lamarca once told me about a theory he had that people who do applications-based research tend to focus on areas where they see themselves as having a weakness. He claims that he got into location sensing because he has a terrible sense of direction, and he knows of people who do decision-support systems because they themselves are terribly indecisive. I suppose that is why I got in interested in designing technology in the health and behavior change space. I have historically been pretty bad about taking care of my health, despite knowing that I should and that it’s important for my overall happiness and wellbeing. Thus, I find it very satisfying to help people with their health-related issues such as tracking a child’s developmental progress or promoting healthy sleep behaviors.

That said, despite being professionally and personally interested in this area, based on my own experiences I am somewhat skeptical about technology’s ability to have long-term effects in this space. In the past year or so, I’ve finally made some changes in my life that are for the better. The changes were prompted by one, my doctor telling me I had high cholesterol, which was kind of a wakeup call, and two, I was getting married, and well, losing weight seemed to be the thing to do before you got married. Thus, over the last 14 months, I worked hard at making some positive lifestyle changes with regard to my health. While I still have more to go to reach my long-term fitness goals, I managed to lose 30 pounds, work up to running 3 miles, do strength training 3 times per week, lower my cholesterol, and develop a habit of eating mostly whole, unprocessed foods (though I still haven’t quite kicked my love of chocolate and cheese). I also feel like something inside of me has changed and that this is not just a temporary blip. I’ve already stuck it out four times as long as any other previous attempts, with no desire at all to quit.

Despite being a total technology enthusiast and someone with a vested interest in health and technology, I used very little technology to get where I am, and I definitely cannot credit it for my success so far. I have tried different technologies, but none of them really stuck. I tried tracking my food and activities with the Lose It app on my iPhone, but it was way too tedious and time consuming. Same deal with the Weight Watcher’s online tool, though I did find that easier than the Lose It app and only gave up after a few weeks rather than a few days. I tried WiiFit, EA Active, and My Fitness Coach, and despite my love of video games, they got old after awhile and did not really result in any success. I started using a FitBit last August, and this has had more success than other applications. I’m still using it and wear it every day because it’s so easy to just clip it on and not worry about it, I think it’s more of a curiosity thing than it is an actual motivator. However, there have been days when I’ve jogged laps around my house to get my step count up to 10,000, so I suppose it has some effect. I actually have to say the best piece of technology I used was my iPhone’s iPod with a good mix of tunes, because upbeat music is very motivating to me when I run. A similar useful technology was setting up my laptop in front of my bike trainer in the garage and streaming movies from Netflix while I biked. However, I’m not even sure if they count as persuasive technology.

What do I credit my success to? I knew that if I was going to try to make changes over the long term, then what I would need to do are things that I could live with forever. The first thing I did was sign up for weekly personal training at the UW’s recreation center, the IMA, last January. I tend to feel guilty when I let others down, and I figured that having someone who would be disappointed if I didn’t work out would be helpful. I did the calculations, and weekly personal training cost about the same as my monthly cable television bill. When you put it in that perspective, it seemed like a much better investment in my future to work out every week than to rot my brain. I definitely credit this most with keeping me on track. There were certainly weeks where I fell back to my old habits, but knowing I had to meet with my trainer and how much she would make me work and how much it would hurt always made me dust myself off and keep going. I feel like having a real person on my side makes a huge difference, and she definitely is more effective than the virtual trainer on the Wii Fit or My Fitness Coach games. My husband can’t play that role, because he is too forgiving of me and doesn’t want to hurt my feelings, so he doesn’t get on my case if I don’t work out.

The second thing is that the trainer helped me select the types of activities I could do to maintain variety and interest over time. This involved helping me set and commit to goals that kept things interesting, such as running races, and helping me choose things that I actually like and can live with every day. Working out can be pretty boring and research has shown that not varying your routine enough can lead to plateaus. She adapts my training plan to meet my diverse needs. For example, I travel a lot for conferences, program committee meetings, etc., and that has been my breaking point in the past. I’d do well while at home, but then be gone for a week, break my rhythm, and never get back into it. My trainer helped me plan around that and gave me suggestions for things I could do while on the road. She’s able to assess my current fitness level and strength and select things for me that will work, based on a lot of experience.

The third thing I credit, and probably the most important, was that I felt a change in myself—that I had to make being healthy a priority above nearly everything except for my family. This meant I probably worked a little bit less than average for tenure-track faculty at first, but I found that as I got fitter, my energy levels went up and thus my productivity went up and I end up getting more done with less time. Also, taking the time to exercise is a good stress reliever and gives you time to think, which is a rare thing these days.

Thus, I have to wonder whether technology can be successful for long-term behavior change. Technology is ephemeral, and I feel that the changes we make need to be permanent for lasting effects and lifestyle changes. People tire of technology too quickly (we may love our iPhones now, but we’re quick to discard them when the next shiny model comes out), and technology becomes outdated quickly, whereas fitness and healthy behaviors are for life. Perhaps we need to focus more on designing technologies that will help us realize what our priorities are and let us think through the things we can do to make sure we are meeting those priorities, and how we can do that permanently. Or, perhaps we need to design technologies that will evolve as our interests evolve and are truly adaptable based on our personal lives and can account for life’s nuances. We need a way to still tap into that human element. It’s easy for me to ignore a fake avatar on the screen, since I know she’s fake. It’s much harder to ignore a woman who can bench press over 200 lbs and run up 60 flights of stairs with 50 lb weights strapped to her back. I respect her a lot, and thus it’s very motivating. Perhaps technology that uses our social networks to help us identify these real world role models can make the difference.

What are your thoughts on technology for promoting healthy behaviors? Have people used technologies successfully to change aspects of their health for the long term, or is it mostly for short term gains? Is it possible, but we just haven’t found the right technologies yet? Or do we need machine learning techniques that are good enough to mimic the flexibility of a human trainer? Or does it really just depend on the person using it, and I’m not someone for whom technology can be successful? Or is it that short-term gains are fine, as long as they lead toward a positive, long-term outcome? I do not think that all hope is lost, as there are things technology can do that can help us make small changes that can make a big difference in the long run. We just have to accept that no single technology will make us healthy, but it will have to be a number of things that work in together with our non-technological lives that will make the difference in the long run.