Digital Medicine

REVIEW ARTICLE
Year
: 2017  |  Volume : 3  |  Issue : 1  |  Page : 11--17

Wearable technologies, health and well-being: A case review


David Wortley1, Ji-Young An2, Claudio R Nigg2,  
1 President of European Chapter of the International Society of Digital Medicine, The Old Barn, Alderton, Northants, United Kingdom
2 Office of Public Health Studies, University of Hawaii, Honolulu, USA

Correspondence Address:
David Wortley
President of European Chapter of the International Society of Digital Medicine, The Old Barn, Pury Road, Alderton, NN12  7LN
United Kingdom

Abstract

Wearable technologies designed to deliver benefits to health and well-being through the use of digital applications are becoming increasingly ubiquitous. This article focuses on the use of wearable technologies which track user lifestyle behaviors and seek to provide tools for better personal health management. It provides an evidence of general positive health outcomes from previous research and provides a detailed analysis of the functionalities and strategic approaches of three different wearable devices which have been used continuously and simultaneously by the lead author for over 18 months. Based on the experience of long-term use of these devices, the article draws some conclusions about their usage and future development strategies.



How to cite this article:
Wortley D, An JY, Nigg CR. Wearable technologies, health and well-being: A case review.Digit Med 2017;3:11-17


How to cite this URL:
Wortley D, An JY, Nigg CR. Wearable technologies, health and well-being: A case review. Digit Med [serial online] 2017 [cited 2020 Jan 24 ];3:11-17
Available from: http://www.digitmedicine.com/text.asp?2017/3/1/11/208446


Full Text

 Introduction



Over the last decade, wearable technology has increasingly captured the attention of researchers, practitioners, vendors, and consumers. Technological innovations foster consumer empowerment and personalized healthy lifestyle and well-being.[1] Earlier, Microsoft's Health Vault and Apple's HealthKit and Google Fit were introduced as mobile-based health data storage and health tracking platforms with a focus on fitness, medical conditions, and well-being. However, studies have shown that wearable technology has more benefits compared to mobile applications.[2] Recently, large technology companies including Apple, Google, and Samsung are entering this growing market of wearable technology.

Wearable technology has shown positive impact in promoting healthy behavior changes [3],[4],[5],[6],[7],[8] as well as increasing health outcomes in the following areas such as cardiovascular disease,[9],[10] weight loss,[11],[12],[13] physical activity,[5],[8],[14] stroke,[15] and well-being and health-related quality of life.[8],[16]

With health promoting wearable technology, data obtained from wearers' behavior can be easily tracked, collected, and analyzed. This approach makes data meaningful in psychological, motivational, behavioral, and environmental aspects. For long-term effects of wearable technology on health and well-being, it is critical to motivate wearers' intention for continued use of technology. In literature, the technology acceptance model [17] and its extensions [18],[19],[20] have been introduced and utilized, which incorporate theoretical constructs originally from the theory of planned behavior [21],[22] and theory of reasoned action.[23] The design of individualized continuous tracking and technically assisted self-care can guide consumers' everyday life and eventually will promote their health and well-being.

The purpose of this article is to explore the role and likely future development of wearable technology for body monitoring and its impact on personal health and well-being through a review of three different wearable body monitoring devices.

In this article, wearable technology is defined as:

”Those technologies which are designed to be worn, attached to the body, and/or integrated into textiles and garments for the purpose of monitoring and/or influencing the health and well-being of the wearer.”

According to Paciorkowski and Marzantowicz,[24] one of the ways of categorizing wearable technologies in the consumer market is to consider their purpose, resulting in the following three fairly distinct types.

Body monitoring wearables whose purpose is to track various parameters of our bodies or physical activities. They are generally passive devices which collect data for use in digital applicationsSense enhancement wearables whose purpose is amplify or extend the range of our human senses by their ability to digitally detect environmental data and use that data to enhance our own human capabilities. These devices can be considered as active rather than passiveBody enhancement wearables whose purpose is to enhance or replace the functions normally carried out by our body parts. These are also active devices, often referred to collectively as “bionic” technologies.

This article primarily focuses on body monitoring wearables and considers how disruptive digital technologies are likely to impact their development and the implications for medicine, health, and well-being.

 Passive Body Monitoring Wearables and Applications



The global wearable's marketplace is primarily dominated by devices which monitor physical activity, sleep, and other behaviors. The global wearable's marketplace was valued at US $9.2 billion in 2014 and experts estimate that this could reach US $30.2 billion by 2018.[25] Approximately 3.3 million consumer wearable fitness bands and activity trackers were sold between April 2013 and March 2014 in the US, and 96% were made by Fitbit (67%), Jawbone (18%), and Nike (11%).[26] There are many different devices in this marketplace offering very similar functionality and products such that Fitbit has almost become synonymous with the technology type in the same way that Hoover became synonymous and interchangeable with vacuum cleaners when they came onto the market as consumer items.

The primary aim of many of these devices has been to track physical activity, enabling the wearer to track how many steps and how many hours of physical activity were done each day. [Figure 1] shows some examples of these consumer items, all of which have been tested and compared by the author over the last 3 or 4 years. The most common “healthy activity target” is to walk 10,000 steps each day [27] which equates to about 5 miles distance. Most, if not all, of this category of device collect data and synchronize with a mobile device such as a smartphone. This synchronization process uses a Bluetooth connection between the wearable and the mobile device and applications on the mobile device then display the data in the form of a “dashboard” that allows the wearer to track progress.{Figure 1}

This article compares the functionality of the three devices shown in [Figure 1] and provides a subjective view of the effectiveness of each of the approaches.

 The Jawbone up Wearable



The Jawbone UP wearable takes the form of a bracelet with sensors around the inside to measure heart rate. There is no display, only a series of flashing lights to indicate status. The design of the bracelet is intended to be waterproof to a limited extent with a rechargeable battery life of around 7 days and a USB connector cable with magnetic connection to the wearable.

The Jawbone UP device has been used for testing by the primary author since June 2013. These tests began as an exploration of the potential of wearable devices to influence personal health management through a combination of wearable technologies, mobile applications, and “Gamification strategies.” The author began by testing the hypothesis of “10,000 steps” as a daily target to see if applying a daily discipline of this amount of physical activity would have a significant impact on health and well-being. At the time of starting the routine in June 2017, the author weighed 106.7 kg and had a body mass index (BMI) in the “obese” range with blood sugar levels in the “prediabetic category” and blood pressure reading typically around 140/95. At this time, the primary author had no other significant medical symptoms or indications of ill-health. [Figure 2] shows examples of how the data collected is presented to the wearer on the Jawbone UP in the current version (March 2017) of the mobile application.{Figure 2}

By setting and adhering to a daily step target of 10,000, the author was able to lose around 21 kg in a period of 4 months with simultaneous improvements in BMI, blood sugar levels, and blood pressure [Figure 3]. During this 4-month period, the author also tracked the nutritional value of his diet, with a focus on ensuring that the calories daily consumed figure was consistently less than calories burned. The JawboneUP mobile application referred to a food database with nutritional values, supplemented by the author's web-based research into the nutritional values of meals not included on this database. The only negative aspect to this trial period was a loss of muscle tone, probably due to insufficient attention to protein levels in the diet.{Figure 3}

The author also began to understand that, while overall physical activity is important for both weight loss and well-being, it is the food consumption and diet which has the greatest impact on weight and BMI. It should also be noted that the author was single and living alone during this period, providing greater levels of control over lifestyle than would be the case in a relationship.

Coincidentally, in September 2013, the primary author was invited by his local doctor to volunteer for a clinical trial called “PROPELS” which was being offered to all prediabetics over a certain age in the city of Leicester in the UK. On joining this scheme in September 2013, the author's baseline health readings for blood sugar, BMI, and blood pressure were already significantly improved since starting the tests of the Jawbone UP and the baseline blood pressure when taken at the Leicester Diabetes Centre in September 2013 was 120/80.

Since beginning the tests of the Jawbone UP bracelets in 2013, the mobile applications have been regularly updated and highlights of the Jawbone solution include:

Nutritional database and “food scores”Comparative trend graphs by day, month, and year to identify relationships between data types, for example, steps taken versus weightSmart coach capabilities with personalized advice based on data collected, for example, drink more water for better sleep patternsMonitoring of resting heart rates.

The most recent announcements by Jawbone indicate that they intend to withdraw from the consumer wearables market to focus more on medically accredited devices.

During the time I have been wearing the Jawbone UP, I also investigated a number of other devices from different manufacturers, including a mechanical pedometer provided as part of the PROPELS project and wrist devices from iHealth and Neurosky. By wearing these devices at the same time as the Jawbone UP bracelet and also comparing the design of the associated mobile applications, I aimed to compare the data collected and the effectiveness of the applications and processes in shaping my lifestyle behavior. Some of the devices I used (including the pedometer) suffered reliability problems after relatively short periods and eventually I came to use two other devices which have been worn and compared for over 18 months on a daily basis. The background to the selection of the two devices (Buddy Band 2 and Withings Activite) is described in the following sections.

The Buddy Band 2 Activity Tracker

The principal author first became aware of the Buddy Band device at a digital health seminar in the UK when he watched a presentation from a UK design company commissioned to design a new product called “Buddy Wotch” for a company called Activ8rlives specializing in personal health management solutions. On investigation of Activ8rlives, the principal author discovered that they had a wide portfolio of complementary medical grade products, primarily supporting chronic obstructive pulmonary disease (COPD) patients. The Buddy Band 2 device was the equivalent of the Jawbone UP, so he decided to road test this alongside the Jawbone.

The Buddy Band 2 wearable, unlike the Jawbone, has a display which can be activated by pressing on a touch-sensitive metallic square on the bracelet. This provides for a series of status displays of time, physical activity, calories burned, distance walked, and activity time without the need to synchronize with the mobile device or refer to it. The Buddy Band has been developed and marketed in the UK by a company called Activ8rlives who are based in Huntingdon, Cambridgeshire. This company was founded by an individual with a medical and life-sciences background and consequently has a slightly different approach to personal health management, with a special focus on providing personal health management tools for patients with chronic conditions such as COPD.

The most immediate difference in approach between this wearable and the Jawbone UP is the way the data are presented and also the health parameters included on the opening screen. [Figure 4] shows a summary screen which not only includes step count and sleep performance but also a range of other parameters which includes weight, blood pressure, heart rate, and peak flow. The data for these parameters are collected by other devices supplied by the company. This opening dashboard uses a “traffic light” technique to show at a glance which health indicators are good and which merit special attention.{Figure 4}

Other noticeable differences between Jawbone and the Buddy Band include a greater emphasis on social media and the development of user communities who can provide support and sharing of information. Activ8rlives also have developed “Gamification” initiatives such as a project involving team of young scouts whose steps are aggregated and represented on a virtual map with a challenge to see how long it takes to walk from their base in the UK to Baden Powell's former home in Africa.

Activ8rlives formed a recent partnership with another UK company called Spirit Healthcare, further strengthening their portfolio of user technologies designed to assist patients with chronic conditions to manage personal health and avoid hospitalization. Both companies are also committed to developing collaborative partnerships with doctors and health trusts so that an ecosystem of “win-win” relationships can be enabled by these technologies to the benefit of all health stakeholders.

Like the Jawbone UP, the Buddy Band2 has a similar battery life of around 7 days and a recharging mechanism using a USB cable with magnetic connectors.

 The Withings Activite Pop



Withings is a French company which, like Activ8rlives, has a portfolio of personal health management products and applications targeted at the consumer market. These include devices for measuring BMI and blood pressure. The principal author started using the Withings Activite Pop on the advice of a friend who had been following his progress with the Jawbone UP and had purchased the Activite Pop because of its long battery life, waterproof capabilities, and its form factor. The principal author, therefore, acquired the Activite Pop and has worn all three devices and used their associated mobile applications for at least 18 months.

The Withings Activite Pop, whose dashboard is shown in [Figure 5], adopts a slightly different approach using a form factor and display in the shape of an analog watch so that it can be regarded almost as a fashion accessory which has an additional functionality on the display of showing an additional small dial to represent the number of steps taken against the target of 10,000. The Withings wearable uses a more traditional long-life watch battery sealed in a waterproof case with a life of about 6 months before replacement is needed. The battery replacement is a more specialized operation if the waterproof seal is to be protected.{Figure 5}

The Withings wearable and portfolio of products sit between Jawbone and Activ8rlives by offering a complementary set of devices which can track blood pressure and other parameters although these are not integrated into a single mobile application in the same way as the Activ8lives products.

 Apple Health and Apple Watch



A review of wearable activity trackers would not be complete without reference to Apple who has invested substantial sums of money into mobile health applications not only to market wearable devices such as the Apple Watch but also to collaborate with the developers of other wearable devices to collect and share health data.

The Apple watch wearable device targets the higher end of the market in both functionalities (with additional smartwatch features) and visual appeal [Figure 6]. What is possibly more significant, however, is Apple's strategy of collaboration with developers of other wearable devices to consolidate a very broad spectrum of health data which can be collected by and shared with several different manufacturers of wearable devices. In addition, the Apple Health app which comes free of charge with all IOS smartphones has a very comprehensive set of medical data, which potentially either challenges or enhances (depending on your point of view) national and international health records, providing, potentially, one of the most comprehensive sets of health big data in the world.{Figure 6}

 The Future of Passive Body Monitoring Wearables and Applications



While this article is not intended to be a comprehensive and comparative review of these types of activity trackers, the capabilities, functionality, and development patterns give an indication of how these types of wearable devices and associated applications are evolving. From the experience of using the three wearable devices included in this article (and others which are not mentioned for a variety of reliability and usability reasons), the following conclusions might reasonably be drawn.

Accuracy

By wearing all three devices over several months, the following observations were made:

The Jawbone UP and Buddy Band step counts were almost identical – the Withings step count was consistently less by up to 10%Certain activities distorted the data – steps could be counted by moving the arms but wheeling a suitcase recorded zero steps on all devices.

Thus, focusing only on step counts may not be as useful, especially if paired with clinical programs. Accelerometer technology is becoming more affordable and some wearables are now including them.

Measurement of health data

The devices appear to be all moving toward ability to measure health data as well as physical activity and sleep, with a focus on multiple indicators including heart rate data.

Gamification strategies

All of the applications associated with these wearables are beginning to develop gamification strategies as a way of influencing personal lifestyles and health management, recognizing the importance of human psychology in turning data visualization into forms of action.

Medical accreditation

This appears to be an extremely sensitive area because of potential litigation issues around any advice or recommendation given by the applications based on the data collected. Some manufacturers are taking positive steps to get the accuracy and reliability of the data collected accepted by the medical profession, but the interpretation of the data is not used to provide specific medical advice within the application. Instead, a typical approach would be to direct the user to a relevant medical website for more information or to suggest seeking professional advice from a human doctor.

Collaborative ecosystems

The ongoing development of these wearable devices is likely to see the convergence between consumer wearable devices and “clinically approved” specialized monitoring equipment, meaning that consumers will increasingly have access to these devices in their own homes. This phenomenon not only provides the potential for citizens to manage their personal health better but also opens up the possibility of misinterpretation of data. Clearly, preventative healthcare which both better manages chronic conditions such as COPD and reduces hospital admissions as well as tackling lifestyle-related issues such as obesity is to be welcomed. The likely direction to achieve these goals is a focus on building collaborative ecosystems between wearable device developers, consumers, and clinical stakeholders.

 Implications for the Future of Health and Well-Being



Passive body measurement wearables currently only collect, analyze, and visualize data in ways which provide advice and guidance to individuals who have complete freedom of choice on the interpretation of that data and any resulting actions.

The principal author's experience of daily use of three different wearable devices has provided a better understanding of his personal health factors as they relate to measurable parameters such as weight, BMI, and blood pressure giving a reasonable degree of confidence in his ability to better manage these parameters by adjusting diet and physical activity.

A majority who use wearable technology and interventions for physical activity are using activity trackers for self-monitoring, reinforcement, goal-setting, and measurement.[28],[29] Therefore, it is important to establish validity and reliability of wearable technology.[28]

Although the validity of the daily target of 10,000 steps is now being called into question,[27] the subjective experience of hitting this daily target 99.5% of the time over a 4-year period has resulted in higher perceived levels of physical and mental well-being.

Today, the use of these devices and consequent actions of users remain within the control of the individual's freedom of choice, consumer empowerment.[1] Developments in the sophistication of these devices, the reliability of the interpretation of the data at a personal level and artificial intelligence is likely to mean that there could be a shift from wearables being purely passive devices into “smart devices” which make interventions on behalf of and “for the benefit of” the user. These portable “expert systems”[30] (like the computer/laptops systems of the 1990s) have the potential to individualize the messages based on the behavior, psychological aspects, and now the environment to maximize tailoring of the motivational messages. The implications of a loss of freedom of choice in lifestyle behaviors in such a scenario are potentially very profound.

A recent systematic review summarizes the evidence for validity and reliability of the most popular wearable trackers and indicates higher validity of steps, lower validity for energy expenditure and sleep, high interdevice reliability for steps, energy expenditure, and sleep.[28]

Lack of randomized clinical trials has been reported in the literature.[11] Therefore, research based on sustainable use of wearable technology should be designed and implemented for establishing scientific and clinical evidence.

Further works are necessary to develop more adaptable devices to different settings and individualized lifestyles. Various types of groups such as elders, children, and people with disabilities also should be considered. Short-term adherence to wearing the wearables has been documented.[31] However, long-term retention of wearable technology has yet to be ensured. For this, multilevel and grounded in theory and driven by health consumers' needs, transdisciplinary work, between psychologists, behavior change experts, designers, data scientists, and engineers is recommended.

A key component of self-care and management is self-monitoring,[29] which is one of the most prevalent theoretical constructs of health intervention. Wearable technology enables consumers to monitor their behaviors and track their health data in an easy and convenient way. No entry barrier such as health literacy or computer literacy is necessary;[32] therefore, it is a mode for people across their lifespan.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (NRF-2014S1A5B8044097).

Conflicts of interest

There are no conflicts of interest.

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