Wearable Fitness and Health Tech Tools Offer Promise
A look at what research says about wearable AI-powered tracking devices, including their accuracy, usage precautions, and role on the path to developing more equitable and personalized health treatments.
Increasingly prevalent rates of chronic diseases like diabetes, heart disease, and cancer have driven the need for more accessible and personalized health monitoring.
From clinical research and development to energy and fitness tracking to remote heart monitoring, mobile health tools are used for a variety of purposes by both recipients of health services and by clinicians. And for good reason: customized tech-driven health tracking can be highly beneficial for those who are lacking access to health care resources or who just want to take charge of their own health. These tools are also critical when it comes to more equitable and accessible drug development and disease management.
Wearable electronic health devices fall into two categories: personal use and clinical use, with the lines becoming increasingly blurred between the two.
Clinical use devices like remote arrhythmia monitors and continuous blood glucose monitoring tools are FDA approved. Comparatively, personal wearable health devices are often (but not always) “cleared” for use by the FDA. When considering wearable health devices, it is important to understand the type of FDA approvals a device has, as well as its benefits and limitations.
Personal-use health tools like fitness trackers (i.e. FitBit, Garmin, and Apple watches) and health and wellness apps have exploded in popularity in recent years. In 2023, the global wearable healthcare devices market was worth over $25 billion. According to a March 2024 survey, over one-third of U.S. smartphone users reported tracking their exercise or weight-related parameters. And in 2024 alone, health and wellness apps saw their downloads increase to 3.6 billion worldwide, an increase of six percent compared to the previous year.
But the people who need to monitor their health the most are the least likely to wear a tracking device.
Per the National Institutes of Health and a study published in JAMA, one in three Americans use a wearable device, like a smart watch or band, to track their health and fitness, and less than one in four adults with or at risk for cardiovascular disease use a wearable device.
Only 12% of people with cardiovascular disease older than 65 years of age use wearable devices, even though it is estimated half of all people with cardiovascular disease are older than age 65. The study found that adults between the ages of 18-49, with higher household incomes, and who attended college were also more likely to report using wearable devices. The authors concluded that as wearable devices become more popular and paired with medical data, strategies to support more equitable access should be considered.
How Accurate Is Wearable Health Technology?
A 2024 research study in Sports Medicine found a high margin of error, or range of uncertainty or variability, in health, fitness, and sleep tracking results from wearables due to a lack of standardized validation protocols. Investigators uncovered accuracy issues, including “varying sample sizes, participant demographics, and experimental conditions – all of which add layers of complexity to the interpretation of findings,” the study stated. Researchers examined more than 400,000 participants and found a varying margin of error in measuring physical activities. They determined that wearable devices can measure heart rate with an error rate of about 3%, depending on factors like skin tone, exercise intensity, and activity type, and that step counts are typically underestimated by nearly 10%.
The study found that total energy expenditures (calories burned) and sleep measurements have the highest margin of errors, with calories burned having a margin of error of −21.27% to 14.76%, depending on the device used and the activity, and sleep time and efficiency typically being overestimated by about 10%. Researchers urge users to be cautious about the results they receive from wearable health devices and are calling for standardized validation protocols and collaborative industry partnerships to enhance the reliability of wearable technology data.
Artificial intelligence, or AI, refers to the science and engineering of making intelligent machines, through algorithms or a set of rules, which the machine follows to mimic human cognitive functions, such as learning and problem solving. And health tech trends today are reliant on advanced data processes and AI; in particular, cloud computing is enabling the transition of effective and safe AI systems into mainstream healthcare delivery.
A 2021 study in Future Healthcare highlights how advancements in AI have the potential to fundamentally transform the practice of medicine and the delivery of healthcare, clinical trial design, and drug manufacturing processes through increased accessibility and automation.
But researchers acknowledge that there are still limitations and drawbacks when it comes to AI-powered health, particularly when it comes to data safety, privacy, and accuracy.
In The Emergence of AI-Based Wearable Sensors for Digital Health Technology: A Review, scientists examined wearable sensors that can track various health parameters, such as heart rate, blood pressure, oxygen saturation, skin temperature, physical activity levels, sleep patterns, and biochemical markers, such as glucose, cortisol, lactates, electrolytes, and pH and environmental parameters.
The study concluded that, despite the progress being made in remote health monitoring, “it is imperative to implement robust encryption, data anonymization, and strict access controls to safeguard users’ personal information from potential threats from hackers and malicious actors. Another critical challenge is ensuring the accuracy and reliability of the AI algorithms that drive these wearable health technologies.”
Still, despite the lack of consistency reported amongst these devices, there is reason to be hopeful about the promise of health tech and its ability to create more equitable and advanced healthcare solutions.
Seth Creasy, PhD, associate professor in the Division of Endocrinology, Metabolism, and Diabetes at the University of Colorado Anschuz Medical Campus, explained in an article that: “This field is ever evolving. The devices keep getting better, and the analysis side keeps improving as well. It will continue evolving over time, and we’ll keep getting to learn more about ourselves, our bodies, what works, and what doesn’t.”
Are Wearable Health Devices for Everyone? Experts Offer Precautions
Wearable health devices have numerous advantages and can be a useful way to initiate positive changes for many in the pursuit of improved health. But for some, there can be a tendency to become more anxious, obsessed, and overly focused on numbers as a measure of self-worth, according to experts.
Deborah Glasofer, assistant professor of clinical psychiatry at Columbia University in New York, explains in an article: “People can become overly focused on numbers, which may exacerbate unhealthy behaviors like food restriction or compulsively exercising.”
One study of college students found a connection between the use of health trackers and disordered eating behaviors. A study published in the Journal of the American Heart Association notes that wearing fitness trackers to monitor heart conditions like AFib—a condition that causes an irregular heartbeat—could actually worsen health anxiety.
And a 2021 article in the Cardiovascular Digital Health Journal cautions: “Although unlimited access to digital health information can motivate some individuals to engage in healthy behaviors, the data may inadvertently contribute to pathologic symptom monitoring and impaired function in others.”
“These trackers can be dangerous for people with eating disorders. They can also be problematic for people who are not getting guidance on diet and exercise. Keeping track of calories expended, calories consumed, steps and physical activity can easily become obsessive for some,” said Emily Hemendinger, MPH, LCSW, clinical director of the OCD Program and assistant professor in the Department of Psychiatry at the University of Colorado School of Medicine, in an article.
Focusing on Self-Empowerment and Future Health Advancements
For those who are comfortable wearing a health monitor and who are aware of their limitations and drawbacks, wearables can be highly empowering and beneficial.
While these smart devices cannot replace doctors, they can fuel an active, healthier lifestyle, and provide enough information for people to talk to their doctor about potential problems or medical issues through increased self-awareness.
And advanced technology will continue to pave the way for broader access to more equitable health solutions and personalized medical treatments.
Jamie Robertson, PhD, MPH, Director of Innovation in Surgical Education at Brigham and Women’s Hospital and Program Co-Director of Harvard Medical School’s Post-Graduate Medical Education program, Foundations of Clinical Research, said in an article, that: “For clinical research purposes, this opens up a door for researchers to collect data from people they didn’t have access to in the past. This provides them with a more representative sample size and hopefully allows them to get a wider range of people from broader geographical regions they couldn’t attract before.”
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Additional References:
Doherty, C., Baldwin, M., Keogh, A. et al. Keeping Pace with Wearables: A Living Umbrella Review of Systematic Reviews Evaluating the Accuracy of Consumer Wearable Technologies in Health Measurement. Sports Med 54, 2907–2926 (2024).
McCarthy J. What is artificial intelligence? John McCarthy, 1998. [Google Scholar]
Shajari S, Kuruvinashetti K, Komeili A, Sundararaj U. The Emergence of AI-Based Wearable Sensors for Digital Health Technology: A Review. Sensors (Basel). 2023 Nov 29;23(23):9498. doi: 10.3390/s23239498. PMID: 38067871; PMCID: PMC10708748.
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