Consumer Health Success – Fitness Apps 7/29/11

Continuing my series on Consumer Health Success, another group of apps getting good attention involves personal fitness and wellness. Wellness apps are great and I’ve seen some pretty cool ones recently for health challenges and diet tracking, but, for the purpose of this post, I want to focus on fitness apps specifically. They are already using social and gaming aspects tied to personal health that, in theory, create stickiness and can change behavior.

I realize that fitness apps really only appeal to the "Motivated Healthy", or the group that is probably in decent shape already and just wants to beat their last marathon time. Despite that, I really think there are some things that can be learned from them and potentially applied to more of a healthcare setting, or to more of a population that needs help getting healthier.

Specifically, I’m going to talk about RunKeeper. I’ll also talk about Nike+. I’m sure there are other similar offerings, but these two have the most uptake. I’ve only used RunKeeper myself.

(I was going to try Digifit, which I’ve heard a bit about, but the app store has a confusing number of Digifit apps. I decided it wasn’t worth the time to sort out which one I needed.)

It doesn’t really matter that I’m focusing on RunKeeper since I’m not comparing specific products or services, but rather exploring what is being offered to consumers to integrate personal data and encourage healthy behavior. If you were looking for a comparison of RunKeeper and Nike+, here is a good one.

What are RunKeeper, Nike+, and Digifit?

RunKeeper started in 2008 as an iPhone app that used the built-in GPS to track activity. It supports swimming, but I’ve only used it for running and biking. Nike was doing this first with its foot pod, but RunKeeper launched exclusively as an app to take advantage of the hardware and offer a very cheap alternative that worked with whatever shoe you were wearing.

Also, I didn’t know that the initial Nike foot pod was the inspiration for ANT, the wireless technology now used for most of the fitness monitors. RunKeeper has to use ANT with its integrated heart rate monitors on the iPhone because of the lack of control Apple gives to developers to access Bluetooth in iOS.

Over the last three years, RunKeeper has grown incredibly fast to over six million community members. It has gone beyond mobile fitness data collection to create an online fitness (I’m hesitant to call it health) community, with personal tracking and reporting tools.


The other thing that RunKeeper did, and I think this is probably a result of starting as an mobile app company as opposed to an athletic gear company (Nike), was really take advantage of the smart phone functionality and connectivity.

The first thing RunKeeper enabled was sharing your activities via Twitter and Facebook, though I think initially it was Twitter alone. It is motivating to know that people are going to see your results. With RunKeeper Elite ($4.99/month), you can even share your performance in real time to increase the pressure to keep going.

It would be nice if you could motivate certain populations to post about things like meals to create incentive to eat better, although I guess people could just fudge meal entries if they wanted to cheat on a diet and not hear about it. That is the nice thing about GPS — it’s harder to fudge. It’s also why a sensor system, like GlowCaps, is nice for tracking adherence.

In addition to your own activities on RunKeeper, you can also share and find routes based on your geography. This comes in handy if you travel or move, as I recently did.

The other thing that RunKeeper has added is the ability to enroll in a "Fitness Class" (additional/hefty fees required per class). The idea is that you get to register for a marathon or 5K or run-to-lose-weight training program that creates a schedule for you and then uses the app to track your performance on the schedule. Your performance, and that of the other people in the "Fitness Class," are shared with the group. You get motivation and are encouraged to motivate others. Nike+ does this in a slightly different way with fitness challenges.

These challenges and classes are one of the key things I can see being of value as tools for healthcare. I’ve participated in in-person group sessions with diabetic patients where group members share about diet, activity, recipes, meds, etc, and get support from other members of the group. The problem is that they only meet a few times a month, making too late to fully encourage and affect healthy behavior.

It’s all about that timely feedback loop everybody keeps talking about. Doing it virtually and over mobile might be a way to improve that, but you need to get the group engaged and also using mobile. Both of those might be a challenge unless you’ve got full buy-in from a provider.

The next step – RunKeeper’s HealthGraph

As the user base has grown, RunKeeper has integrated additional products that connect to its platform. It has heart rate monitors, pedometers, body weight scales, and even the Zeo sleep monitor to track and report on your sleep. What is RunKeeper hoping to do with all of this personal data it is collecting from motivated users?

Well, pretty close to the time Google Health was announcing its retirement, RunKeeper announced Health Graph, which, as the Twitter post above implies, is designed to replace the PHR or evolve the PHR concept.

What is Health Graph exactly? I’m not entirely sure myself beyond concept, but my understanding is that it correlates health and wellness data (eating, exercise, sleep) with social interactions to help users gain insight — and more actionable guidance, I hope — related to what works and what doesn’t work for their health.

The Health Graph is not confined to fitness data. It has defined data types for blood pressure, cholesterol, CRP (really?), TSH (really again?), glucose, insulin, vitamin D, and a few others. All are relevant data points for certain conditions, provided users with those conditions find their way to RunKeeper. I have to assume RunKeeper plans to integrate this data automatically from labs and providers.

RunKeeper is opening up the API to hopefully encourage developers to create tools based on RunKeeper’s growing volumes of data. Maybe developers will be creative enough to stretch this beyond what RunKeeper is currently doing — providing motivated fitness enthusiasts with reports on their performance — and make it into a tool that could help a diabetic patient better control their disease.

I’m really not sure, though. When I look at the example of an app on RunKeeper’s site that could be powered by Health Graph, I have to wonder what is so magical about the correlation engine RunKeeper has developed. The example plots weight, average calories, average sleep, average activity, and social network motivation (# of comments) per week for several weeks. Not surprisingly, weight is down when you eat less, sleep more, are more active, and have more social comments.

Do people really not know this? I think for the most part they do, even the sick ones do. You need to do more than show them the correlation between eating poorly and being overweight. RunKeeper probably had it right with the social connections and fitness classes alone, before all the Health Graph stuff. But maybe Health Graph will encourage other app developers to give RunKeeper more data, and over time, that data will become actionable in a way that encourages unhealthy people to be healthier.

I think RunKeeper will have to create some institutional partnerships to accomplish anything meaningful outside of the group of motivated users it is already targeting. Maybe if you’re RunKeeper you’re thinking, why bother, I’ve got six million motivated users over three years, why do I want to fight an uphill battle to attract unmotivated users? It sort of makes sense, and to that end, maybe RunKeeper should not lose focus on its user base by extending to things like TSH and insulin.

Travis Good is an MD/MBA and is involved with health IT startups.

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