Beyond fitness trackers: Motivating the unmotivated to exercise more

(light piano music) – [Mark] This session will be given by Scott Delp, and Scott's been leading a program about motivating mobility, and what he means by this, he'll explain more, but we all know exercise is good for us, but we all don't do it as much as we should, and so his project is trying to deal with that conundrum Scott

(audience applauding) – [Scott] So our goal is to motivate physical activity on a global scale, and the team is producing tools and knowledge that can be deployed at a low cost on a planetary scale to improve both mental health and physical health of millions of individuals Like Mark said, we know that exercise is good for us, but in the US alone approximately 260,000,000 people do not get sufficient physical activity to maintain their bodies and their minds That's 78% of the population according to the Center for Disease Control

Now the cost of this inactivity is staggering In a recent article, Min Lee and her colleagues, reported that 53 million deaths per year can be attributed to physical inactivity 53 million deaths per year

So you can make a calculation like that because 18 major diseases and disorders are linked to physical activity There's strong correlation between physical activity and things we might consider, cardiovascular disease, diabetes, yes that's true, but also six types of cancer are related to physical activity as is anxiety, depression, and cognitive decline So that's the bad news The good news is that physical activity is potent medicine One of our team members, Abby King, chaired the national committee on physical activity that just produced this fantastic report that summarizes all of the evidence that's been gathered over the last 40 years, and it makes very clear the potent effect of physical activity, and what I wanted to do is just read you a single quote from this report

So here's the quote, "A single bout of moderate "to vigorous, physical activity will reduce blood pressure, "improve sleep, reduce anxiety, and improve cognition" So you can reduce your anxiety and improve your thought clarity with a single bout of physical activity Going for a bike ride, playing a game of tennis, that's awesome! That's incredibly motivating The other thing to know is that small doses have a big impact This doesn't mean that you need to be running six miles a day, six days a week

If you get up from your desk and you move about, there's very clear evidence that you begin to accrue benefit So, how are we doing? We recently conducted the largest worldwide assessment of physical activity that has been performed We worked with a local mobile app company, and what we gathered was minute-by-minute step counts for two million people in a hundred countries So this was the biggest survey of physical activity by a factor of a thousand We were able to characterize planetary scale trends in physical activity

One of the things that we found was that there's inequality in activity across a population So, just like there's income inequality, there's rich people and poor people, there's physical inactivity inequality, and when their inactivity inequality is high, women are differentially disadvantaged So there's more activity poor women, and if you relate that to lifespan when there are activity poor women, it costs women in terms of life years So, again, it's a big problem The other thing we discovered is that if you want to intervene, the place to have the biggest impact, is where there's activity poor individuals

Now there's no shortage of devices to measure your physical activity, but unfortunately, most if not all, activity interventions are failing and they fail in part because they provide lots of information, but simply providing the information doesn't help you move more If you survey people about, "Well, why can't you get more activity?" and people, no one ever responds, "Well, it's because I don't know exactly precisely "how many steps I take each day" And in fact, informing people of these quantitative metrics, for some people, can produce a mindset of inadequacy There'll frequently be nudges that might come during a meeting or an inopportune time, and so soon you begin to ignore them In most cases, people use physical activity monitors over the short term and then throw 'em in the drawer, and that's in part because it's a one size fits all

We're motivated by different things We respond to different things, and there hasn't been good personalization So, our team is developing scientific evidence and is based on evidence to replace information overloads with an understanding of mindsets that is how you think about the world influencing your behavior and your physiology To replace constant nudging with well-validated behavior change theory So, we know about behavior change

There's decades of research and almost none of that has been incorporated into current activity monitoring To achieve sustained engagement by storytelling People love stories, and engaging in a story as you move through the story by being active is one of the approaches we're taking, and also data-driven personalization So, we're bringing these approaches together in our catalyst project, and what I wanted to do is just give you a little bit of insight into the evidence that we've developed so far in the first year of the project So, first about mindsets

So, what are mindsets? They're lenses through which we see the world, and they influence your attention, your motivation, and amazingly, your physiology So, the placebo is a great example You can take a sugar pill and if you think it's gonna get you better, in many instances, there's profound healing effect from taking essentially nothing other than a placebo This is shown across almost all fields of medicine, the profound placebo effect So no particular medicine has a strong physiological response

So we wanted to investigate how getting genetic information influences your cardiovascular fitness So, Brad Turnwald, who was a student in Ali's lab worked with folks in my lab where we brought them in, we did a VO2 max test So, we have them run on a treadmill to exhaustion, and while they do that we measure their ventilatory gases How much oxygen they take, how much CO2 they put out They came back a week later, and we done a blood draw, and we randomized them into telling them whether they had excellent genes for exercise or not

We then ran the same test, and if we told them they were excellent, they didn't change If we told them they had the gene that was not excellent, their capacity was statistically significant and significantly reduced So, they were working just as hard, but things changed that you cannot control it Your changed voluntary oxygen to CO2 and things that you have no voluntary control over What this demonstrates is that the way you deliver information can have a powerful effect not just on people's behavior, but on how their body's respond to particular physical activity, and we're wanna use the information to design messaging that's personalized that affects mindset in a positive way

We also need to get lasting behavior change Getting behavior change for a week or a month, or even three months doesn't work, and Abby King has had good success with long-term behavior change with implementing theory This is not a fancy app This is kind of an old school, sit at a computer and have Carmen talk to you and she did an intervention, Abby did an intervention in a community center that served low-income, Latino, older adults, and the average session lasted six minutes They came back for four months, and this was the result they got

This is the change in minutes of physical activity per week So, there was a control group that didn't change from zero, and Carmen, this virtual advisor, was able to get 250 minutes of additional activity Four hours of additional activity per week That is a ton of additional, this is the biggest change I've ever seen! If you can get four more hours of physical activity per week, you know, half an hour a day, eight days a week, that's doing really well So, we really think that implementing this behavior change theory can have a big impact

James Landay is on the team and he's working with Paula Moya from the English department on developing narratives to promote long-term engagement What James has been able to show is that simply state-of-the-art detection and feedback is not enough, that simple stories are compelling, and that the multi-chapter narratives where you engage people over the long-term and the story advances by you engaging in physical activity can potentially change long-term behavior Jure Leskovec is an expert in artificial intelligence and personalization He developed the Friend Finder algorithm on Facebook This is Jure now

He must've developed that algorithm when he was about 12 (audience laughing) He also does personalization for Pinterest to get you to figure out how to click on various ads and engage over the long-term there Here he's applying his expertise to examine how to personalize feedback to users of health applications to engage them over long-term dynamics, and one of the things that we care about is whether you have a social network and you know your friends can help you exercise, but can virtual friends help you exercise The answer is yes What's plotted here is the average daily steps and you see when the experiment starts that they go up, and they go up in both the blue and the red

The blue is a group of individuals who were motivated, asked a friend to join them, the friend didn't join them, but they still improved The red is the additional boost that you get from a friend joining you This is a single friend and you see that you get a boost in activity for a period of three to four months That's pretty good When you add a second friend, they don't do quite as much and it dies off a little earlier and of course it varies from person to person

Interestingly, if you do competitions and you add friend groups, the groups that do best are mixed gender, 50/50 men and women, and also if the groups are matched If you get people who are all performing at a high level, they compete with each other, or groups that are really trying to build up, they compete, but if you have a mismatched group, it doesn't work very well So, these are powerful approaches that we're applying to a range of populations, older adults, people with pre-diabetes, individuals with arthritis, and also with cardiovascular disease So, because we can bring in people from English, Computer Science, Psychology, Bioengineering, like myself, together with people in the medical school, we can intervene on these populations So, our impact is to provide fundamental insights that we can disseminate and also the app developers out there in the world would make our information freely available and can be incorporated into commercial applications

Methods that are validated scientifically and really provide a new paradigm for low-cost medicine that can be disseminated worldwide to improve physical and mental health Thank you very much (audience applauding)