Ali Edwards is a little obsessed with her Fitbit, a wearable device that tracks her steps, miles and floors. “I’ve been known to walk around the bedroom at night so that I reach my goal,” laughs the Edmonton-based 79-year-old. The Fitbit contains an accelerometer that measures movement and a tiny altimeter to measure barometric pressure and thus the floors one climbs.
When she hits 10,000 steps, Edwards feels a satisfying buzz. “I think, ‘Yippee, I’ve made it!’”
Edwards is part of a growing trend, one that came to the fore this past March with the much-hyped release of the Apple Watch. Embedded with a heart rate monitor and movement tracker, the watch comes on the heels of several health-related wearables that hit the market in the last few years. The Basis Peak wristband, for example, claims to “offer in-depth data on the quality of your night’s sleep.” And the HexoSkin shirt is equipped with sensors that allegedly “help you avoid hyperventilation and apnea.” Market analyst BCC Research estimated fitness-related consumer wearable technologies were worth $2.4 billion worldwide in 2014 and that by 2018, the market will hit $5.1 billion.
Many health experts think wearable technologies could help people improve their activity levels and thus prevent health issues, as well as alert wearers of warning signs like an elevated heart rate. But not everyone is convinced wearable technologies are the next big thing in health. Some argue they’re simply novel toys, most of which are expensive and offer a lot of information but little support.
Consumer wearable devices aren’t regulated as medical devices, and as such it’s buyer beware. The accuracy of technologies such as wearable electrocardiogram sensors have been called into question, but mass-market wearables don’t currently have to meet accuracy standards. That said, unregulated technologies aren’t allowed to claim to diagnose or treat health disorders, and those that do make false claims can be reported to the Healthy Environments and Consumer Safety Branch of Health Canada, explains Julie-Anne Lemire, a Health Canada spokesperson.
The health promoting potential of wearable technologies
The most common and researched wearable technology are activity trackers – wearables that measure movement. They’re also fairly accurate for recording steps, according to a study in the Journal of the American Medical Association. But do wearable activity trackers encourage healthy habits?
Kevin Imrie, physician-in-chief of Sunnybrook Health Sciences Centre as well as a self-described technology “geek,” says the wearable devices he’s used have encouraged him to exercise at times in the day he normally wouldn’t in order to increase his step count. For him, the social pressure is the biggest motivator. Fellow Fitbit wearers (who Imrie doesn’t know in person) can track his progress online and will send him messages on his smartphone like “Congratulations on reaching your goal!” or “Haha, passed you!” he explains. You don’t need a wearable device to tap into an online support network, of course. But wearable device programs make online peer coaching easier because they don’t require users to manually enter their activity. Because lifestyle change is notoriously difficult, any technology that supports that “has to be very easy to use,” explains Hadi Salah, senior health industry analyst at MaRS Discovery District.
By recording every little movement, wearable technology might also encourage users to spread their activity out over the day. That’s a good thing as “sedentary activity is a potential risk factor for a heart attack,” explains Jayson Parker, a biomedical engineer at the University of Toronto. And research shows that spreading 30 minutes of exercise throughout the day is better than working out for 30 minutes straight. Some trackers, like the Basis band, can even be set to remind users when they haven’t moved in the last one or two hours.
Indeed, wearable devices have high-tech fitness coaching potential. They automatically record progress and hold users to account via historical charts and reminders. “You’re able to track and see, I’ve hit my goal every day for a month,” says Chris Pryce, a business consultant who uses the Nike Fuel Band. “It’s human nature, you don’t want to fail.”
Activity trackers can also record how people sleep based on how little they’re moving at night. This can “give an idea” of how well one slept and might encourage wearers to get more shut eye or visit a sleep clinic if they suspect an issue, says Tammy Moroz, a sleep psychologist at the Foothills Medical Centre in Calgary. Devices have varying levels of accuracy, however, and individuals would need to visit a sleep clinic and have a polysomnogram to diagnose problems like sleep apnea.
The limitations of activity tracking wearables
While Imrie, Edwards and Pryce say their activity trackers at times spurred them to exercise when they wouldn’t have otherwise, all were already walking, running or cycling on a regular basis. “There is probably a mismatch in terms of who is using wearables and who might benefit the most from them,” says Anthony Levinson, a medical psychiatrist who researches wearables and behaviour change. “Those using them tend to be fairly self-motivated already, a little younger, a little healthier, a bit more affluent.”
And like new treadmills, the novelty factor can wear off. Research conducted in the U.S. found that more than half of those using activity trackers abandon them. Some may be abandoning wearables because they don’t work as well as they’d like. Dr. Mike Evans, a family physician at St. Michael’s Hospital and founder of the Evans Health Lab didn’t buy an activity tracker after his broke because the technology only logged his steps, not his cycling or tennis playing.
Another issue is that wearable programs tend to have “one size fits all” instructions, says Christy Lane, assistant professor in physical education and recreation studies at Mount Royal University in Calgary. Many activity trackers on the market have default goals of 10,000 steps “and that’s either too much or too little for a lot of people.” As the chief operating officer of Vivametrica, she’s currently working with other health researchers and doctors on a program that combine baseline activity data from an activity tracker with information on age, gender, weight and other information to provide people with “realistic goals.”
Of course, goals in themselves aren’t usually enough, argues Levinson; people need various supports to help them achieve those goals. “Most people know that it would be better for them to eat healthy and move more,” he says. But if you have a desk job and a car commute, fitting in exercise – especially without support from an employer – might not seem feasible. “There’s a complex series of work and life factors involved in the rise of a sedentary lifestyle, and it’s pretty challenging to break out of those habits,” Levinson says.
And in some cases, information alone can be unhelpful. Moroz says that she has encountered a handful of patients in her clinic who obsess too much over their activity trackers when it comes to sleep tracking. “Some insomnia patients who are very hyper-vigilant about their sleep almost over-monitor their sleep and that causes more anxiety, which, in turn, makes the insomnia worse,” says Moroz.
Should the health system embrace wearable technology?
Joseph Cafazzo, an engineer and director of the Centre for Global eHealth Innovation at Toronto’s University Health Network argues the real health-transforming potential lies not in the mass-market technologies but in wearables that are classified as medical devices and used in health care. Such devices are regulated and thus meet accuracy standards, and they can be targeted to people with specific conditions and needs. For example, two different Canadian companies are working on technologies that prevent bedsores. Other wearables that have been approved as medical devices include those that measure the wearer’s heart rate and respiratory rate and monitor heart arrhythmia.
Yet, the market for wearable technology that helps diagnose, monitor or treat conditions pales in comparison to the market for non-regulated health wearables. At $1.1 billion globally in 2014, according to BCC Research, medical wearable technologies have less than half the market share of fitness wearables. That’s because medical devices face a steeper regulatory barrier, Cafazzo argues.
Even the current activity monitors could have more potential if used in health care. The health system could fund them for those who would most benefit from them and provide additional coaching and motivational support, perhaps even coupling activity monitoring and incentives. Wearable activity monitors can also be used in a diagnostic way. For example, they can aid in the decision regarding hip replacement surgery should take place, Lane points out, as a decreasing step count over time could indicate that walking has become more difficult for a person.
Pilot projects incorporating activity trackers in health care have already begun. Levinson recently conducted a study on how activity trackers could help obese children alongside monitoring and coaching from health professionals. And Cafazzo is about to launch an experiment in which post-surgery patients will be asked to wear FitBits at home. Nurses will then be alerted to check in with patients who are moving much less than expected – an indication they’re not recovering well. His study follows Mayo Clinic research that found activity tracking could predict how long surgery patients would stay in the hospital.
Until enough trials show tracking patients via wearable devices costs the system less by avoiding hospital readmissions and reducing lengths of hospital stays, however, Parker doesn’t expect the financially stretched system to fund activity trackers on a wide scale.
One thing is for certain, however. Wearable technologies will make it easier than ever to study the intersection between health and everyday habits. No longer will study participants have to record activity. “They’re providing a way for [health researchers] to look at people’s lives in a way we haven’t done before,” says Parker.