Since the first Ap­ple Watch release in 2015, wearable technology has be­come a lucrative and rapidly growing indus­try, worth over $34 billion dollars in 2020. These products soon included com­panies like Garmin and Fitbit offering “smart” wearables geared towards tracking fitness-related metrics, such as step count, calories burned and heart rate. Now, endless iterations of wearable technology exist, which claim to extract infor­mation about various biological behaviours, morphing into a scientific domain in and of itself. Current measurable biosig­nals include heart rate and heart rate variability, skin conduc­tance and temperature – generally pointing towards complete user-driven monitoring of 24/7 human performance. This offers an unprecedented window into human health.

Further, this technology is now branching out to the clini­cal field. Many physicians support devices to enhance patient care – user-directed devices that keep a watchful record of patient activity outside of strict clinical observations. Wheth­er you’re an endurance athlete training for an IRONMAN, a person looking to get text messages on their wrist along with a step count, or a physician, there’s a wearable product out there for you. The implications for wearable technology are monstrous, but the question remains – how reliable are these products, and should we be using them to guide our daily lives, or further, medical care?

A study conducted in 2018 by the Heart Rhythm Society of America tested the accuracy of wearables measuring base­line heart rate and rapid heart rate and found that the brands tested (Apple, Fitbit, and Samsung) were almost 100 percent accurate for these metrics. A professor from the University of Wisconsin cited that intended use for these wearables dictates the accuracy – most are accurate enough for most people and purposes. Still, it ultimately depends on the intended mea­surement. Most people have no reason, other than curiosity, to know their caloric burn or heart rate variability through­out the day and should not be using the information their watch gives them to adjust their diet or activity. For the most part, wearables can accurately measure step count, with few exceptions. At rest, the heart rate measured by these devices tends to be accurate but less so during the activity itself. These trackers cannot know certain things about one’s body, so the assumptions made on behalf of the wearable technology are often off when it comes to more vigorous activity. Caloric burn is hard to estimate out­side of wearable tech, never mind within, so this is considered an inaccurate metric when measured by such a device.

These devices generate monstrous amounts of low-cost data throughout the day. As the intended measures and us­age of the data become more complicated, the accuracy of said device decreases. Our biological systems’ unpredictable and interdependent nature across different states of “health” as humans presents a real challenge to measurement accura­cy. The popularity and advancement of artificial intelligence may help personalize these now standardized devices to indi­vidual systems to a certain extent. Still, there is a question as to whether it will ever be sufficient to guide clinical decisions.

As of now, there is little evidence to support the wide­spread use of wearables in clinical practice. However, nu­merous tech start-up companies around the globe are dedi­cated to developing technology to enhance wearable health device accuracy and integrate the data these devices collect into electronic health records. Various insurance companies are now encouraging the growth and uptake of wearables through health tracking and incentive programs for their customers. These companies claim to continue analyzing best practices and potential solutions to mitigate existing challenges to complete integration of these devices into the healthcare system. There is potential to integrate wearable technology with surgical operations, improve stroke rehabil­itation, sharpen clinical diagnoses and guide treatment. The emerging scientific domain of wearable technology has many exciting possibilities, but it isn’t significant without accuracy and proof! So, for now, your smartwatch is probably best used for checking time and texts on the go.


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Claudia Ritzker

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