Regular physical activity is associated with numerous health benefits, including reduced risk of cardiovascular disease. Simply increasing step count is thought to lower the 10-year risk of death [1]. However, fewer than half of all veterans achieve the recommended physical activity levels to improve their health [2]. Many stakeholders, including the Veterans Health Administration (VHA), are interested in the potential of using mobile technologies such as smartphones and wearable devices to change health behaviors [3]. In particular, there is growing interest in the potential of wearable activity tracking devices to facilitate increased physical activity. These wearable devices provide feedback about physical activity levels in the form of step counts and may encourage people to monitor and change their daily activities. They also offer a reward for positive behavior changes by indicating that the day’s step goals have been achieved. Both techniques can be motivating for people attempting to make behavioral changes [4,5]. Wearable devices often differ from traditional pedometers in both their technology and ability to wirelessly transmit activity data. In 2015, the VHA commissioned a systematic review of the published literature on the use of wearable devices in veteran populations [6]. The review found that 12 of 14 trials focused on using wearables for physical activity but that more evidence was needed on how these technologies impact veterans. The objective of this exploratory study was to evaluate veterans’ perceptions of and experiences with wearable activity trackers to identify barriers and opportunities for their use in a future clinical trial using social interventions to increase physical activity among veterans.

The sample comprised 16 veterans with a mean age of 60.6 (SD 12.5) years; 88% (14/16) veterans were males (Table 1). All participants reported having regular access to the internet and a smartphone. In the past week, 12 participants had access to a tablet, but only 3 had access to a connected health device (1 had a smartwatch, 1 had a Bluetooth-connected hearing aid, and 1 had a smart pill bottle). The mean physical activity level was 59.1 (SD 57.6) MET-minutes per week. All 16 veterans agreed to take home and use a wearable device to track their activity. At follow-up, 91% (10/11) veterans were still using it daily, but 1 participant had misplaced it after 6 weeks of daily use.

Overall, participants felt positively about wearable activity tracking devices. Several participants mentioned feeling confident that most veterans they know would benefit greatly from owning a wearable device and cited financial restraints as the primary reason why they had not previously owned one themselves. When asked about potential barriers to using these devices in larger interventions for veterans, one participant stated: “people might not be comfortable with the idea of someone else tracking their behavior” (Table 2).

Many participants reported that the device motivated them to make incremental adjustments to their behavior by providing feedback on their daily activity. One veteran explained, “When I’m out, I tend to look and see if I got a star. If it doesn’t hit the star, I know I didn’t get out much that day […] I might take some more steps if I don’t hit the star.” This activity change was not limited to physical activity. Several participants commented on the utility of the sleep tracking ability. For example, one veteran noted, “it made me set my alarm so I don’t sleep too long. I was sleeping too long.”

When asked about how this feedback translated to behavioral change, however, participants had variable experiences and identified both opportunities and barriers to incorporating wearable activity monitors into interventions to increase physical activity (Table 2). One veteran stated, “this increased my activity 100 percent,” and he credited the device with helping him lose 9 pounds and improve control of his diabetes. However, most of the participants noted that rather than motivating them to meet a minimum level of daily physical activity, the device kept them moving on days spent out of the house. For example, one veteran said, “sometimes I set goals, sometimes I just go with it,” indicating that the device helped him more so when he was already motivated.

Lastly, veterans also expressed contrasting opinions about the potential utility of combining this device with a social incentive to increase physical activity. Several felt that it would be beneficial, and one stated that it “would be motivating and could build on the MOVE! program.” However, 2 veterans noted that a disability might prevent them from participating in such a program. For these participants, the device allowed them to set their own physical activity goals based on their physical abilities.