Breaking down the Digital Fortress: The Unseen Challenges in Healthcare Technology—Lessons Learned from 10 Years of Research

Keogh, Alison; Argent, Rob; Doherty, Cailbhe; Duignan, Ciara; Fennelly, Orna; Purcell, Ciaran; Johnston, William; Caulfield, Brian

doi:10.3390/s24123780

Cited by 3 publications

(2 citation statements)

References 57 publications

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“…To effectively promote long-term engagement and healthier lifestyles, wearables must be designed to enhance motivation and adherence [48]. Personalized feedback and goal setting can help users achieve realistic health goals by providing tailored recommendations and progress tracking [49].…”

Section: User Engagement and Adherencementioning

confidence: 99%

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Bridging Gaps in Wearable Technology for Exercise and Health professionals: A brief review

Schumann,

Doherty

2024

Int J Sports Med

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The proliferation of wearable devices, especially over the past decade, has been remarkable. Wearable technology is used not only by competitive and recreational athletes but is also becoming an integral part of healthcare and public health settings. However, despite the technological advancements and improved algorithms offering rich opportunities, wearables also face several obstacles. This review aims to highlight these obstacles, including the prerequisites for harnessing wearables to improve performance and health, the need for data accuracy and reproducibility, user engagement and adherence, ethical considerations in data harvesting, and potential future research directions. Researchers, healthcare professionals, coaches, and users should be cognizant of these challenges to unlock the full potential of wearables for public health research, disease surveillance, outbreak prediction, and other important applications. By addressing these challenges, the impact of wearable technology can be significantly enhanced, leading to more precise and personalised health interventions, improved athletic performance, and more robust public health strategies. This paper underscores the transformative potential of wearables and their role in advancing the future of exercise prescription, sports medicine and health.

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Section: User Engagement and Adherencementioning

confidence: 99%

“…Integrating wearables with healthcare systems can enhance adherence by involving providers in monitoring and encouraging patient behaviors. User-centered design, involving patients in the development process, can help to ensure that wearables are user-friendly and meet the needs of the target population [48].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Bridging Gaps in Wearable Technology for Exercise and Health professionals: A brief review

Schumann,

Doherty

2024

Int J Sports Med

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Keeping Pace with Wearables: A Living Umbrella Review of Systematic Reviews Evaluating the Accuracy of Consumer Wearable Technologies in Health Measurement

Doherty,

Baldwin,

Keogh

et al. 2024

Sports Med

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Background Consumer wearable technologies have become ubiquitous, with clinical and non-clinical populations leveraging a variety of devices to quantify various aspects of health and wellness. However, the accuracy with which these devices measure biometric outcomes such as heart rate, sleep and physical activity remains unclear. Objective To conduct a ‘living’ (i.e. ongoing) evaluation of the accuracy of consumer wearable technologies in measuring various physiological outcomes. Methods A systematic search of the literature was conducted in the following scientific databases: MEDLINE via PubMed, Embase, Cinahl and SPORTDiscus via EBSCO. The inclusion criteria required systematic reviews or meta-analyses that evaluated the validation of consumer wearable devices against accepted reference standards. In addition to publication details, review protocol, device specifics and a summary of the authors’ results, we extracted data on mean absolute percentage error (MAPE), pooled absolute bias, intraclass correlation coefficients (ICCs) and mean absolute differences. Results Of 904 identified studies through the initial search, 24 systematic reviews met our inclusion criteria; these systematic reviews included 249 non-duplicate validation studies of consumer wearable devices involving 430,465 participants (43% female). Of the commercially available wearable devices released to date, approximately 11% have been validated for at least one biometric outcome. However, because a typical device can measure a multitude of biometric outcomes, the number of validation studies conducted represents just 3.5% of the total needed for a comprehensive evaluation of these devices. For heart rate, wearables showed a mean bias of ± 3%. In arrhythmia detection, wearables exhibited a pooled sensitivity and specificity of 100% and 95%, respectively. For aerobic capacity, wearables significantly overestimated VO2max by ± 15.24% during resting tests and ± 9.83% during exercise tests. Physical activity intensity measurements had a mean absolute error ranging from 29 to 80%, depending on the intensity of the activity being undertaken. Wearables mostly underestimated step counts (mean absolute percentage errors ranging from − 9 to 12%) and energy expenditure (mean bias = − 3 kcal per minute, or − 3%, with error ranging from − 21.27 to 14.76%). For blood oxygen saturation, wearables showed a mean absolute difference of up to 2.0%. Sleep measurement showed a tendency to overestimate total sleep time (mean absolute percentage error typically > 10%). Conclusions While consumer wearables show promise in health monitoring, a conclusive assessment of their accuracy is impeded by pervasive heterogeneity in research outcomes and methodologies. There is a need for standardised validation protocols and collaborative industry partnerships to enhance the reliability and practical applicability of wearable technology assessments. Prospero ID CRD42023402703.

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The Validity of Apple Watch Series 9 and Ultra 2 for Serial Measurements of Heart Rate Variability and Resting Heart Rate

O’Grady,

Lambe,

Baldwin

et al. 2024

Sensors

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The widespread use of wearable devices has enabled continuous monitoring of biometric data, including heart rate variability (HRV) and resting heart rate (RHR). However, the validity of these measurements, particularly from consumer devices like Apple Watch, remains underexplored. This study aimed to validate HRV measurements obtained from Apple Watch Series 9 and Ultra 2 against the Polar H10 chest strap paired with the Kubios HRV software, which together served as the reference standard. A prospective cohort of 39 healthy adults provided 316 HRV measurements over a 14-day period. Generalized Estimating Equations were used to assess the difference in HRV between devices, accounting for repeated measures. Apple Watch tended to underestimate HRV by an average of 8.31 ms compared to the Polar H10 (p = 0.025), with a mean absolute percentage error (MAPE) of 28.88% and a mean absolute error (MAE) of 20.46 ms. The study found no significant impact of RHR discrepancies on HRV differences (p = 0.156), with RHR showing a mean difference of −0.08 bpm, an MAPE of 5.91%, and an MAE of 3.73 bpm. Equivalence testing indicated that the HRV measurements from Apple Watch did not fall within the pre-specified equivalence margin of ±10 ms. Despite accurate RHR measurements, these findings underscore the need for improved HRV algorithms in consumer wearables and caution in interpreting HRV data for clinical or performance monitoring.

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Breaking down the Digital Fortress: The Unseen Challenges in Healthcare Technology—Lessons Learned from 10 Years of Research

Cited by 3 publications

References 57 publications

Bridging Gaps in Wearable Technology for Exercise and Health professionals: A brief review

Bridging Gaps in Wearable Technology for Exercise and Health professionals: A brief review

Keeping Pace with Wearables: A Living Umbrella Review of Systematic Reviews Evaluating the Accuracy of Consumer Wearable Technologies in Health Measurement

The Validity of Apple Watch Series 9 and Ultra 2 for Serial Measurements of Heart Rate Variability and Resting Heart Rate

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