The Association Between Logging Steps Using a Website, App, or Fitbit and Engaging With the 10,000 Steps Physical Activity Program: Observational Study

Background: Engagement is positively associated with the effectiveness of digital health interventions. It is unclear whether tracking devices that automatically synchronize data (eg, Fitbit) produce different engagement levels compared with manually entering data. Objective: This study examines how different step logging methods in the freely available 10,000 Steps physical activity program differ according to age and gender and are associated with program engagement. Methods: A subsample of users (n=22,142) of the free 10,000 Steps physical activity program were classified into one of the following user groups based on the step-logging method: Website Only (14,617/22,142, 66.01%), App Only (2100/22,142, 9.48%), Fitbit Only (1705/22,142, 7.7%), Web and App (2057/22,142, 9.29%), and Fitbit Combination (combination of web, app, and Fitbit; 1663/22,142, 7.51%). Generalized linear regression and binary logistic regression were used to examine differences between user groups' engagement and participation parameters. The time to nonusage attrition was assessed using Cox proportional hazards regression. Results: App Only users were significantly younger and Fitbit user groups had higher proportions of women compared with other groups. The following outcomes were significant and relative to the Website Only group. The App Only group had fewer website sessions (odds ratio [OR] -6.9, 95% CI -7.6 to -6.2), whereas the Fitbit Only (OR 10.6, 95% CI 8.8-12.3), Web and App (OR 1.5, 95% CI 0.4-2.6), and Fitbit Combination (OR 8.0; 95% CI 6.2-9.7) groups had more sessions. The App Only (OR - 0.7, 95% CI -0.9 to -0.4) and Fitbit Only (OR -0.5, 95% CI -0.7 to -0.2) groups spent fewer minutes on the website per session, whereas the Fitbit Combination group (OR 0.2, 95% CI 0.0-0.5) spent more minutes. All groups, except the Fitbit Combination group, viewed fewer website pages per session. The mean daily step count was lower for the App Only (OR -201.9, 95% CI - 387.7 to -116.0) and Fitbit Only (OR -492.9, 95% CI -679.9 to -305.8) groups but higher for the Web and App group (OR 258.0, 95% CI 76.9-439.2). The Fitbit Only (OR 5.0, 95% CI 3.4-6.6), Web and App (OR 7.2, 95% CI 5.9-8.6), and Fitbit Combination (OR 15.6, 95% CI 13.7-17.5) groups logged a greater number of step entries. The App Only group was less likely (OR 0.65, 95% CI 0.46-0.94) and other groups were more likely to participate in Challenges. The mean time to nonusage attrition was 35 (SD 26) days and was lower than average in the Website Only and App Only groups and higher than average in the Web and App and Fitbit Combination groups. Conclusions: Using a Fitbit in combination with the 10,000 Steps app or website enhanced engagement with a real-world physical activity program. Integrating tracking devices that synchronize data automatically into real-world physical activity interventions is one strategy for improving engagement.