By Vince Giuliano with inputs and assistance from Melody Winnig and James P Watson
The consumer electronics industry is giving a tremendous boost to public and individual health – perhaps the most important boost in the first half of this century. The digital health movement could result in a number of important but unforeseen consequences, such as the emergence of powerful personal electronic health biomarkers which were hitherto unavailable. The movement is already contributing significantly to changing our health paradigm by allowing individuals to document their day-to-day health-related behavior patterns.
2014 has been a huge year for health tech according to digital health incubator startup health, “Digital health funding in the first three quarters of 2014 has already surpassed $5 billion, close to double what was invested in all of 2013 ($2.8 billion). “Digital health funding for the year is on track to double last year’s total,” said Unity Stoakes, co-founder and president of startup health. “Some trends we’re watching include a growing corporate interest in digital health, more global cross-pollination of ideas, as well as increasing health consumerism as people move into the driver’s seat when it comes to their care. With this kind of capital pouring into the market, the health tech space should be exciting to watch in the coming years.” (from mashable.com 5 digital health trends you’ll see in 2015.
This Part 1 blog entry provides a panoramic snapshot view of one area of digital health: the rapidly changing landscape of consumer health and fitness smart wearables like smart watches, online and mobile health and wellness applications, and the associated emergence of online and mobile software platforms that can integrate such applications together. I also discuss a couple of devices I am personally familiar with.
Smart wearables include electronics-infused clothing and body devices that enhance our perceptions and allow us to do things we cannot normally do – such as know our actual heart rate at any time, or experience virtual reality. Consumer digital health and fitness is a central theme of smart wearables, The expectation has been that 90 million SMART wearables would be sold in 2014(ref), Accordingly, tremendous capital has been flowing into this area as can be seen from the amazing new array of health-measuring wearables now being sold by leading retailers.
Morgan Stanley has projected that the smart wearables market will soon be worth $1.6 trillion(ref). “Wearable devices will far surpass market expectations, and become the fastest ramping consumer technology device to date, in our view,” a group of Morgan Stanley analysts wrote in a note on Thursday. The analysts add that wearable devices will have “far-reaching” impacts by creating a new category and disrupting or even accelerating change within industries outside of technology.” (I think one of these industries will be medicine – VG) “The analysts project sales of wearable devices will grow at a 154-percent annual compound rate through 2017, where 248 million devices will be sold. The figure will grow even further where sales of wearable technologies will reach one billion in 2020.”
THE QUEST FOR SIMPLE, SENSITIVE AND EASILY-MEASURABLE GENERAL STRESS BIOMARKERS
Quest for the Holy Grail Image source
A key fantasy I and other longevity researchers have long had may soon start becoming reality – the ability for ordinary people to monitor readily accessible biomarkers that will allow us to evaluate the impacts of day-to-day health and longevity interventions and stress events. Such an intervention could be a simple change in diet, exercise or sleep patterns, or consuming a new supplement or drug. Stress events could be a disease, of an emotional or traumatic nature, or as simple as disruption of the normal sleep pattern. These biomarkers could conceivably provide easy and very accessible answers in a few days to very basic questions such as “is my new approach (to a new pattern of exercise/taking a new supplement or drug/sleeping longer or differently/etc.) really working?” “Comparatively speaking, how well am doing now compared to before?” “What price am I paying for staying up drinking and carousing until 4 AM last night?” “How long will it take for me after returning from China to re-establish my normal circadian rhythms?” “What has been the health impact of my partying for several nights in a row over Christmas, drinking more than usual and eating large late meals?” “I had to take a strong prescription antibiotic. How long will it take for my gut biome to recover?” Or “I have added a high intensity 8-minute segment to my daily exercise regimen, designed to send my heart rate above 125. What is this doing to me or for me?” I now believe the fantasy of ordinary people being able to answer such questions for themselves without professional help is rapidly becoming real. It will be realized through a powerful wave of developments in consumer electronics powered by billions of dollars in investment.
In fact, during the period of generating this blog entry I have been doing some initial personal research that leads me to think I may already have discovered reliable metrics of constitutional stress that can be easily computed from measurements made by an existing smartwatch device. I have initially reported on that personal research in a Part 2 blog entry. Wearables – measuring practical stress biomarkers.
I have helped Jim Watson prepare and publish a Part 3 in this wearables series. This is concerned with heart rate variability (HRV), a well-studied constitutional stress biomarker. That blog entry looks at both at the science of HRV and practical wearables technology to measure it.
Because new improved products are coming on the market at an incredible rate, it is likely that some devices described here will be becoming obsolete in six months or even less. That is why I expect to continue reporting on health and fitness wearables on an ongoing basis in this blog.
What is exciting from the viewpoint of this longevity science blog is not that the existing or even the latest generation of consumer devices and software can measure traditionally-identified biomarkers, such as those identified in the previous blog entry NAD+ an emerging framework for life health and life extension — part 2: deeper into the nad world, hopeful interventions. Rather what exciting to me is the extremely massive public scale and rapidity of adoption of consumer health wearables and apps, the deep pocket companies investing in them, the variety of physiologic biomarkers that are turning out to be electronically measurable by wearables, the possibilities inherent in 24-7 gathering of personal health data, and the extremely low cost to consumers of starting to participate in this movement.
THE SITUATION IS BIG, RAPIDLY DEVELOPING, ALREADY INVOLVING MORE THAT A HUNDRED MILLION PEOPLE, HIGHLY FACETED, AND CHAOTIC
The situation is one of chaos typical in the early stages of a rapidly developing new family of electronic gadgets aimed at almost everybody. There is an avalanche of new products together with much confusion about what they really do or whether they even really work. A wide variety of products with differing capabilities was already on the marketplace for Christmas 2014. I understand there were more than 300 booths at the 2015 Consumer Electronics Show in Las Vegas featuring new health and fitness product. It is impossible to know which product offerings are best and who the winners and losers will eventually be. The situation is like that we have seen repeatedly over the years for personal computers, digital cameras, personal PDA assistants, mobile music devices, digital pads and smart phones. Seemingly-sophisticated digital watches that can measure exercise and heart rates are now being sold for $5.99 and up. We seek here to provide a snapshot of the changing picture as we see it now.
SOME RECENT HISTORY
A variety of stand-alone health monitoring devices and kits have long been found on the shelves of drugstores. They measure a number of biomarkers that once required going into a doctor’s office or laboratory for testing. E.g. they measure blood pressure, blood glucose, pulse oximetry, heart rate, heart rate variability, cholesterol, and many are designed to detect presence of certain diseases. They are designed for personal use and are available to all without prescription. Likewise, some treadmills and other machines in sports facilities and homes have had built-in indicators of exercise heart rates and elaborate displays showing stress levels, heart rate and likely calories burned in the course of an exercise session.
What we are seeing today is the miniaturization and personalization of such devices – the continuing upward integration of historical lines of consumer electronic health and fitness devices and applications, including: a) functionalities of such stand-alone personal testing devices, b) fitness measuring devices that first appeared in sports facilities connected to machines, and c) consumer health and wellness computer applications, particularly mobile applications (over 100,000 of them),. Most current attention is on an almost-here generation of smart watches and wrist straps that monitor movement, exercise patterns, calories burned, heart rate, sleep parameters and other bio-indicators. However, I believe we are still in a very early stage of the wearables revolution, and new technologies and devices will continue to emerge that are not imagined now. This health-wearables revolution is being propelled by new technologies, by increasing consumer interest in health and well-being, and by a maturing baby boomer generation of mostly healthy people in the middle and late 60s who want to stay healthy, and by a consumer electronics industry that sees personal health as an ultimate Killer App.
Here, we look at some of what is going on with
- Fitness trackers
- Smart watches and bracelets
- Advanced body electronic sensor devices and smart clothing
- Health and fitness apps
- Integrated health and fitness display software platforms
- A couple of wearables that I have personal experience with
The consumer wearables area of digital health we discussed here is very large but the entire field of digital health is even larger. According to a recent report by Startup Health. “The top 10 most active subsectors include big data/analytics, navigating the care system, practice management, sensors/diagnostics and patient engagement.” We don’t touch the first three of these areas here and focus on consumer electronic monitoring. Also we touch only lightly on the tremendous area of associated software apps and online services. Perhaps in a subsequent blog entry we will try to make sense of the some 100,000 health and fitness apps currently available on iOS and Android.
A few years back, a first generation of personal health and fitness wearables appeared, like the first FitBit and Jawbone movement-tracking devices. They provided crude but effective constant real-time measurements of number of steps taken, intensity of exercise, flights of stairs climbed, calories burned, and different stages of sleep. They communicate by bluetooth with computers and smart phones and it is possible to see how these indicators change throughout the day and night, compare them from day-to-day, and even share them with other people in a personal network. I have been using a FitBit One for about a year now and have found it quite useful for telling me at the end of the day whether I have had sufficient exercise, and, when I wake in the morning a rough indicator of how well I have slept.
From Wikipedia: “The term “activity trackers” now primarily refers to wearable devices that monitor and record a person’s fitness activity. The concept grew out of written logs that led to spreadsheet-style computer logs in which entries were made manually, such as that provided in the us by the president’s council on physical fitness and sports as part of the president’s challenge. improvements in technology in the late 20th and early 21st century have made it possible to automate the monitoring and recording of fitness activities and to integrate them into more easily worn equipment. Early examples of this technology include wristwatch-sized bicycle computers that monitored speed, duration, distance, etc., available at least by the early 1990s. Wearable heart rate monitors for athletes were available in 1981. wearable fitness tracking devices, including wireless heart rate monitoring that integrated with commercial-grade fitness equipment found in gyms, were available in consumer-grade electronics by at least the early 2000s. Wearable fitness tracking computers with tightly integrated fitness training and planning software were available as consumer products by at least 2006.?\ — Electronic activity trackers are fundamentally upgraded versions of pedometers; in addition to counting steps, they use accelerometers and altimeters to calculate mileage, graph overall physical activity, calculate calorie expenditure, and in some cases also monitor and graph heart rate and quality of sleep. some also include a silent alarm. some newer models approach the us definition of a class ii medical monitor, and some manufacturers hope to eventually make them capable of alerting to a medical problem, although fda approval would be required. early versions such as the original FitBit (2009), were worn clipped to the waist; formats have since diversified to include wristbands, armbands, and smaller devices that can be clipped wherever preferred. Apple and nike together developed the nike+ipod, a sensor-equipped shoe that worked with an ipod nano. In addition, logging apps exist for smartphones and facebook; the nike+ system now works without the shoe sensor, through the gps unit in the phone. The forthcoming Apple watch and some other smart watches offer activity tracker functions.in the us, bodymedia has developed a disposable activity tracker to be worn for a week, which is aimed at medical and insurance providers and employers seeking to measure employees’ fitness. other activity trackers are intended to monitor vital signs in the elderly, epileptics, and people with sleep disorders and alert a caregiver to a problem. –
Earbuds and headphones are a better location for measuring some data, including core body temperature; valencell has developed sensor technology for new activity trackers that take their readings at the ear rather than the wrist, arm, or waist. — There are collar-mounted activity trackers for dogs. — Much of the appeal of activity trackers that makes them effective tools in increasing personal fitness comes from their making it into a game, and from the social dimension of sharing via social media and resulting rivalry. the device can serve as a means of identification with a community, which extends to broader participation.”
The December 2015 issue of PC magazine report The Best Activity Trackers for Fitness provides a lot of comparative data on some current trackers. This is what they look like. As you can see, the most popular ones are worn on the wrist
DEVICES FOR THE HIGH-END SPORTS AND FITNESS MARKET
One of the families of the new wave of wearables is devices designed to be worn in gyms and exercise clubs or by serious workout training addicts. While this category is quite important, it is not the central focus of this blog entry. The AMIGO is an example. It is a combination of a wristband and shoe lace device for measuring both upper and lower body movement. You train the Amigo to recognize patterns of movement that occur in specific exercises. This product, like many others reported here, is scheduled for delivery in 2015. Of many other devices in this category I mention the Polar H7 Bluetooth Smart Heart Rate Sensor, available as a bluetooth-enabled strap that measures heart rate quite accurately. This can be used as input for measuring Heart Rate Variability (HRV) on your smartphone, a potentially useful stress indicator. Much more on this in the Part2 blog entry.
MEDICAL ESTABLISHMENT WEARABLES
Another important category of wearables that we do not focus on here are high-end devices and systems designed to be worn in hospitals or healthcare institutions as well as by individuals at home under medical care. An example is the ZypherLIFE system. This system is designed to measure a significant portfolio of biomarkers and integrate them into medical systems as illustrated in the following diagram.
WHERE CONSUMER FITNESS ACTIVITY TRACKERS STAND NOW
We are currently seeing a transition from the first generation of consumer fitness trackers to a variety of second-generation devices with differing form factors and expanded functionalities.
The first generation are devices like the Fitbit One , the Nike+ Fuelband SE, and the Jawbone Up and many similar devices combine a sensitive electronic accelerometer-pedometer into a little bracelet or pendant which monitors movement. This movement can be interpreted by software to provide logging of: steps taken per day, total distance traveled, intensity of walking or running exercise during various times of the day, periods of sleep and rough indicators of depth of sleep, and calories burned per day. Other options, such as inclusion of an altimeter, allow logging of flights of stairs climbed. Following is one of several screenshot of a typical day of my FitBit results. I have been logging activity with this device for about a year. I have found it particularly useful for assessing periods of sleep and telling me at the end of the day whether I have exercised sufficiently.
Most of the shown boxes in the online or cell phone display are expandable to show more detail, and it is also possible to view weeky and monthly comparative data. The weight is from a FitBit wireless scale which also records computed BMI and lean-to-fat ratio
My FitBit 1 communicates with my Samsung S5 smart phone or my computer via bluetooth. Current and historical records are uploaded to the cloud and available on any Internet or mobile-connected platform. Further, my records can be shared with other FitBit users at my option. The software display platform is proprietary and cannot accept inputs from non-FitBit products. Other first-generation trackers generally provide similar capabilities and sharing of performance records with other users of the same device, a very useful feature for encouraging social support of exercise patterns.
Many smartphones came with built-in accelerometers and can do similar tracking. The Samsung S5 is an example and the phone comes with a similar activity tracking app, Samsung’s S Health. The phone itself contains a pedometer like the FitBit and can make other health measurements like instantaneous heart rate. Limits of the first-generation trackers and smart phones include:
- Measurements of movement depends on where the device is located on the body. If it is clipped to a belt or in a pants pocket, for example, the device may not provide a good indicator of my upper body exercise. If the device is a smartwatch on my wrist, it cannot detect the exercise movement when I am on a treadmill holding the rail. Or, while I am pushing a shopping cart. At best, it provides an approximation of whole body movement. You cannot rely on your smartphone for activity tracking if you don’t carry it all the time.
- The measurements do not include any that indicate how my body is responding to the exercise. They do not include anything we would normally regard to be a biomarker.
- Most basically, the devices are limited by the sensors they contain, in the case of a FitBit, an accelerometer/pedometer and an altimeter.
- The software platforms and display apps are highly specific to the manufacturer and are incompatible among each other. Users of one tracker cannot automatically share performance records with users of a different tracker. And if you carry two or more wearable trackers from different manufacturers, you can’t display the results together so you can compare them. Each of the three tracking apps now on my S5 smart phone only accepts device specific input and none can display an integrated picture.
- Although the market is crowded with new devices, hard technical and reliable performance specifications are generally unavailable. Information available from manufacturers is generally high-level hype, and it is quite impossible to tell which devices deliver on their promises and which deliver junk results. Reliable reviews are few and far between, and industry-level standards are missing. It is a general case of “buyer beware.” This situation appears to persist today for smartwatches and other new devices coming onto the market. Having said this, I can say that my limited personal experience with my FiytBit and Basis Peak devices up to this point has been generally positive.
CURRENT MARKET TRENDS
What we have seen in the market since before Christmas 2014 is a) strong price competition for activity trackers of the first generation described above – many new low-cost competitors, b) rapid emergence of second-generation and third-generation devices with much enhanced functionality and bio-measurement capabilities including smartwatches and smart wrist straps, c) a flood of new products being sold, and d) announcements of several new kinds of bio-measuring wearables that go far beyond traditional activity tracking. ..
There are some traditional products such as from FitBit, Misfit and Shine, selling in the $50 – $150price range. These are from FitBit:
Likewise, other reputable first-generation products like those from Jawbone are dropping their prices, but not by a lot.
Image Source: Amazon.Com
A recent review article is compare before you wear: the most popular fitness trackers.
THE NEW GENERATIONS OF WEARABLES – CHOICES GALORE
Smart wearables and wrist straps in the second generation include high-end devices costing $500 and more and low-end devices costing as little as $5.99. This link goes to the first of 13 pages listing smartwatches and tracker-related such devices for sale at Walmart, This link is to a Cruncheara site offering smart wearables ranging from eyeglasses, to polo shirts to insoles.
Who is in the game? Wearable health and fitness monitoring devices are available or announced from Polar, Garmin, Mio, Basis, Withings, FitBit, Timex, New Balance, Wahoo, Suunto, Jawbone, Pebble, Androset, Scosche. LL Bean, Radius, Jarv, Pyle, TomTom, New Arrival, Tune Belt, Luxsure, SNEER, New Arrival and several others, And, oh yes, also in this game are lurking giants like Microsoft, Intel, SONY, Motorola, Samsung and Apple. Browse for yourself! Here is a REI shopping site for watches and straps with heart rate monitors, Here is an Amazon.com shopping site for health and fitness monitors, Here is a listing of LL Bean offerings. Here is a different amazon.com catalog listing. Here is a listing of just SONY smart watches. This page from saleguru.net shows price comparisons for 49 different Apple-compatible models of smartwatches.
At the lower-end price points, such devices are highly likely to become must-have items for middle school and high school kids and young adults. Many cheaper ones were stocking stuffers for Christmas. For this reason alone, it is likely that tens of millions of people were introduced to health and fitness capable wearables just during the 2014 Christmas season, The images shows some of the cheaper devices.
Many smartphones have built-in sensors that allow them to function as first-generation trackers. Such as:
– accelerometer pedometer-type motion sensors which allow them to monitor movement and even sleep – if you are willing to sleep with your cell phones
– cameras which can double as optical heart rate monitors. They can also serve as bar code scanners for screening packaged foods at supermarkets or some restaurant menus that print barcodes. Software apps can then give you nutritional values and calorie counts.
HIGHER-END CONSUMER FITNESS TRACKERS AND SMART WATCHES
The higher-end devices are embodying the functionality of the first generation, in some cases doing a better job at that, plus additional functionality due to the incorporation of additional sensors. They are evolving from being basically movement trackers to more general health biotracking devices. Again, the first generation was based on pedometer/accelerometer and altitude sensors. The higher- end second-generation trackers variously embody additional other sensors such as for heart rate measurement, skin temperature, 02, skin galvanic resistance, and GPS capability. Some of these are sold in the form of wrist straps, and some in a new generation of smart watches, In general, these devices offer a higher level of integration with smart phones, and come with broader and more comprehensive but still proprietary health and wellness apps. Estimates of levels of exercise and associates stress can be based on combinations of the sensor outputs. The following as representative of the higher-end second generation trackers/smartwatches with heart rate measurement capabilities:
- The Jawbone UP3 $180
- The Microsoft Band $199
- The Fitbit Charge HR $150 or the FitBit Surge $250
- The Garmin Forerunner 310XT $299
- The Apple Watch (annouced but possibly not available until Spring 2015) Very exciting for Apple and iOS followers, with many health and wellness and advanced features. Probably starting at $350) See this review.
How can one make sense of this avalanche of offerings? I don’t know. My personal choice a few weeks ago was based on my health/longevity biomarker primary focus of interest – rather than a strongest interest in fitness/exercise, elegance, or general smartwatch capability. After limited research I ordered a Basis Peak. That and my trusty old FitBit One are the only devices I am personally familiar with and will discuss here in any detail.
THE BASIS PEAK
The Basis Peak arrived at my doorstep about three weeks ago, so I can tell you what motivated me to buy it but am not yet quite ready to report on my experience with it. The package claims “The ultimate fitness and sleep tracker.” Based on its published specifications and positive reviews, it indeed may be that right at the moment. However, there is no guarantee on how long it will remain that way. A November 2014 review in PC world This is the band to buy if you obsess over heart rate and sleep tracking reports: “this is a second generation device, an improvement in multiple dimensions over the first generation device which appeared about a year ago. Among the sensors it encompasses are a FitBit-type accelerometer, an optical sensor that measures heart rate through the skin 24-7, a galvanic skin resistance sensor and a skin temperature sensor. Basis was recently acquired by Intel and has a history of earlier devices basically marketed to the fitness community. As I write this, smart watches with heart rate measurement capabilities are announced and will be available in the coming months from Apple, FitBit, and Jawbone among others, but these will be first generation devices which will no-doubt need improvement. Now being an Intel company, I expect a continuing process of improvement in the Basis products.”
So far, I am very happy with the choice. Here is the Peak’s record of my sleep for a typical night..
I do not know how the Peak can distinguish REM sleep from light sleep and cannot vouch for the accuracy of its findings. The FitBit was on my wrist next to the Peak. It is interesting that the estimates of both devices for any period of sleeping are off by only a few minutes, although the details of the sleep is reported differently. The FitBit does not try to distinguish among depth or type of sleep. Here is A FitBit sleep record for me for a week:
Here is a day’s(24 hours) activity record from the Peak:
I have been logging these Basis Peak patterns every day on a spreadsheet since the watch arrived and studying them to see what their implications might be for my health. After just 24 days of doing this I can say the results so far are quite exciting. I am coming to believe these activity indicators can be combined with the sleep indicators to produce interesting new constitutional stress-state measures, I expect to report on my observations after a full month of data gathering and analysis in the Part 2 Blog Entry for the wearables topic.
A preliminary observation relating to the device is that the existing software could be more comprehensive in providing consumer advice, Also, I strongly suspect that the sensor data might be combined in different ways to provide measures of other physical conditions such as hydration and heat exhaustion stress. My sense is that the Basis Peak is probably a superior hardware platform but that its software and user-friendliness integration might be significantly enhanced. My hope is that the Basis company will move in this direction. Earlier, the company promised an API for Peak outputs that would allow new customized forms of use data analysis. And the company promised a software upgrade for December 2014 that would include smartwatch notifications on the Peak. But so far these have not been forthcoming.
A more basic downside of the Basis Peak or any other single smart wearable available today is that its measurements are limited by the sensors it contains. Ideally, my smartwatch would provide good measurements of heart rate variability, breathing regularity, blood pressure, body posture, glucose levels, blood oxygen, ECM, and embody a GPS capability. At present the Basis Peak does not measure any of these although other new-generation consumer wearables do. (None measures all or even most of these). Further, it is doubtful that third-party applications from either iOS or Android will be able to compute adequate heart rate variability (HRV) measurements from the physical sensor inputs the Peak watch provides.
NO SINGLE SMARTWATCHCAN PROVIDE THE BIOSENSING WE WILL WANT
Different smartwatches and other biosensing wearables typically embody different combinations of possible sensors and none have even most of them. This is understandable because the number of sensors that can be put in any single device is limited for reasons of size, power consumption and location of that device on the body. If you want to measure blood flow, near the ear may be a much better location than on the wrist. If you want to measure body movement during exercise, it is best to have multiple sensors on the arms, legs and torso. If you want to measure brain waves, it is best to have sensors on the head, etc.
For these reasons, I expect the long-term trend not to be cramming more and more sensors into a smartwatch, but rather the emergence of body networks of sensors all communicating with a central processing and data storage and external communications capability. Today, the smartphone is a far better candidate for that capability than any smartwatch.
This observation is also disappointing news for those expecting that the Apple Watch will be the ultimate sensing device with regard to health and fitness. It can’t possibly be that. However, it and watches like the Peak might provide a good start. What can be put in any smart watch is a matter of compromise. For example, the Apple Watch’s brilliant reconfigurable color display uses so much power that I suspect the watch must be taken off and recharged daily, while the black-and-white display trackers like the Peak can go for a few days between charges.
In the longer term I expect to see a wider variety of specialized and communicating wearables and direct-to skin-contact sensor devices, all kinds of smart clothing, and ultimately subcutaneous and possibly deeper body implants of many kinds. These sensors will measure a growing list of bio indicators, communicating locally to a central processor, probably in the smart cell phone, which in turn will communicate with database and processing resources on the web.
BEYOND SMARTWATCHES – THIS YEAR
The article 5 digital health trends you’ll see in 2015 list some interesting predictions of what is likely to come in 2015. I quote from this article here.
“Wearables for the ear”
Despite that current craze for wrist straps and smartwatches, the ear may be the next favorite place..
“Due to the proximity to the temporal artery, devices worn on the ear can conduct completely unobtrusive, passive monitoring and offer far more precise measurements,” says Dr. Vahram Mouradian, founder and CTO of Sensogram Technologies. “Moreover, they can deliver a wealth of wellness information, including real time blood pressure, respiration rate and oxygen saturation, in addition to the typical readings of heart rate or steps taken.” — We’ve already seen a few of companies introduce ear buds with basic health monitoring, such as Iriveron and Freewavz. Watch for increasing sophistication in ear-based devices over the coming year. For example, Sensogram’s Sensotrack — slated for general availability in March 2015 — is an elegantly designed device that fits snugly on your ear, where it measures heart rate, blood pressure, oxygen saturation and respiration rate. It also counts steps and calories burned, while sensing your speed, activity level, geolocation, altitude, body posture and pace.”
Notice that this device adds oxygen saturation, respiration rate and body posture to the measurements made by the latest smartwatches.
Continuing, “also keep an eye out for Bitbite, the first ear-based device that automatically tracks your eating habits and helps you improve them with real-time dietary advice. The Bitbite device fits comfortably in your ear and learns when, where and how you eat. It then analyzes this data and gently nudges you to make adjustments, such as slowing down your eating pace or drinking more water. Bitbite doles out its advice either by “whispering” in your ear or by alerting you through the bitbite smartphone app. Bitbite just launched its Indiegogo crowdfunding campaign on November 11, with general availability expected in Q2 of 2015.”
So, some of the devices are becoming more bossy and nanny-like. Some may end of virtually screaming at you if you start doing something healthwise foolish. For now, they’re mostly simply flashing reminders on your cell phone or smartwatch screens or giving you a gentle buzz. The Pavlok, a wrist wearable, is more aggressive and gives you electrical shocks.
“2. Sweat sensor strips”
“Want even more insight into what’s going on in your body? You’ll soon be able to track your internal biochemistry with a simple biosensor strip. Electrozyme is developing a printed, flexible strip sensor that inserts into the back of your wearable device and measures the metabolic substances secreted in your sweat, allowing you to track your electrolyte balance, hydration level, muscle exertion and physical performance. According to electrozyme, the chemical analysis enabled by its disposable biosensors can give people actual insights into their metabolism that go way beyond steps and heart rate.” Ok. Another bunch of indicators. “see also: Is that App FDA approved? Mobile health tech falls into gray area. “The advantage of tracking sweat using chemical sensors is that it gives insight into your body chemistry and how it is responding to your workout that is not available using traditional sensors,” says Jared Tangney, Ph.D., co-founder and COO of Electrozyme, llc. “Chemical sensors open up a whole new world of information that was previously never available in wearable devices.” “Tangney sees a range of different applications for this technology, including letting you know when it’s time to drink some water — something most of us probably need: according to some reports, up to 75% of americans may be chronically dehydrated.”
“3. Smartphone case devices”
“You’re already carrying around a smartphone with a protective case. Why shouldn’t it do double-duty as a medical device? “We’re starting to see some initial forays into using smartphones and their cases to measure medical conditions that previously required specialized equipment,” says Joanne Rohde, CEO and founder of Axial Exchange. “imagine an electrocardiogram anywhere — not just at your doctor’s office — or a dyi blood test to check your glucose right in your pocket. Some of these innovations are already available, but there are many more to come.” One of the first to hit the market was the Alivecor heart monitor, an FDA-approved iPhone case that allows you to record ECGS and heart rate on the go. You can rest it on your fingers or chest to record an ECG in 30 seconds, and know right away if atrial fibrillation is detected, which could be an early indicator of stroke.” This could be valuable because the pulse rate monitors currently being marketed fall far short of providing ECG levels of information.”
” in 2015, watch for more such devices to become available as they pass through the FDA approval process. — For example, Azoi’s Wello is a mobile health tracking device which doubles as an iphone case and is currently in the process of getting FDA approval. It can measure vitals such as ECG, heart rate, blood oxygen saturation levels, respiration and temperature.”
“4. Prescription-only apps”
“There are already thousands of health apps you can find on Google Play or iTunes. Soon, some of these apps may require a prescription. One early example is Welldoc’s Bluestar, the first “mobile prescription therapy” for people living with type 2 diabetes. The prescription-only app allows people to input data about their glucose levels, diet, exercise, well-being and other factors, which Bluestar automatically analyzes to give the patient immediate guidance and feedback. Bluestar also analyzes the data for the patient’s physician and allows the patient to provide a detailed summary of their progress to the physician for review prior to or during office visits. — While you might not see a flood of prescription-only apps hit the app store in January — launching one requires FDA approval, clinical trials, insurance reimbursement and more — Welldoc’s co-founder and chief medical officer Dr. Suzanne Sysko Clough says we should “expect to see more mobile prescription therapies for many major chronic diseases over the coming years.”
“5. Healthier lighting
“Finally, ever wonder why “you have trouble drifting off after staring at your iPAD in bed? The culprit may be the blue light emitted from your device — the part of the light spectrum that causes the biggest changes to your internal circadian rhythm, which can disrupt your sleep and impact your health.”
(Check out our blog entry Blue light, sleep, mental alertness and health)
“People who don’t get enough sleep have trouble being productive, controlling their emotions and coping with change. They’re also at greater risk of major health issues such as heart disease, diabetes and stroke,” says Cameron Postelwait of Sewell Development Corporation, developer of the low-blue-light Drift light bulb, which launched in May of this year. Postelwait believes that in 2015, we’ll see a much bigger focus on the effects that artificial light has on people’s health, as well as new product innovations to address the problem, particularly in clinical environments and hospitals. “A patient in unstable condition requires nurse visits all through the night. Every time the nurse enters the room, he activates some kind of lighting to help him check on the patient’s condition and to give medication. This throws off the patient’s natural circadian rhythm, which not only disturbs sleep, but may also impact immune response,” explains Postelwait. “There’s a huge need for lighting that either has an absence of blue light or a way to change the amount of blue light that the patient receives during the day or night.” But while too much bright light might be harmful at night, too little during the day can also bring you down. Luckily, there are folks hard at work to add some sunshine to your day. For example, Goodlux Technology recently launched Sunsprite, the first wearable device to track daily bright light intake. According to Goodlux, scientific studies have linked bright light exposure to health benefits such as better energy, mood and sleep.”
“There’s so much focus on nutrition and fitness that mental wellness is often overlooked. Bright light sets the body’s internal clock, which controls essential components of mental wellness: hormones, energy levels, mood, digestion and sleep,” says Goodlux CEO Ed Likovich. “Three out of four of our early adopters report improvements in these essential components to mental wellness.” “The solar-powered Sunsprite boasts dual sensors that measure visible and UV light and lets users know when they’ve absorbed just the right amount of bright light to maintain health, while also providing tracking for monitoring UV exposure.” (Quotes above are from ref)
HEALTH AND FITNESS MEASURING DEVICES VS. MEDICAL MEASURING DEVICES
As the consumer wearables move increasingly towards measuring traditional medical indicators like heart rate and blood pressure, the distinction between sports-and-fitness aids and medical devices becomes increasingly blurred. The former are not subjected to regulation but the later are regulated by the FDA, including being subject to approval. For now, manufacturers of most fitness-oriented devices and consumer smart wearables have not sought such approval. At the same time, a number of other manufacturers have sought and sometimes have received approval. See the December 2014 article Round-up: 31 FDA clearances for digital health in 2014 “In August, the FDA proposed to largely deregulate a sizable list of Class II and Class I medical devices and no longer require their makers to go through the 510(k) process. These devices included thermometers, smart body scales, stethoscopes, and some ophthalmic cameras. — Still, there were many devices that did get clearances this year — by MobiHealthNews’ count there were at least 31 new FDA 510(k) clearances for digital health. == Devices cleared this year include an app that uses the iPad’s camera to estimate the amount of blood lost during a surgery, a smartphone-connected thermometer, an iOS application that treats a medical condition called tinnitus, and a vitals sensing chair. There was even one mysterious clearance from South Korean technology company LG Electronics for something called “LG Smarthealth”.
The clearances are listed in the article. Most relate to applications in medical practice. Yet the distinction of what constitutes a medical device remains fuzzy. “Swiss remote cardiac monitoring company LifeWatch received FDA 510(k) clearance for LifeWatch VSP (Vital Signs Patch), the company’s adhesive patch for remote patient monitoring. The device is a disposable adhesive strip which contains sensors to monitor ECG, heart rate, respiration rate, temperature, saturation, and movement. It also contains a battery which allows the device to collect data continuously for five to seven days.” This description of functionality sounds identical to that for some sports-and-fitness wearables.
Building sensors into clothing and shoes seems to be a sensible approach and is already starting to happen. From the Gizmag article Top personal health and fitness gear of 2014: . “The Omsignal biometric smartwear is created from a stretchable, machine-washable fabric designed to compress the user’s torso in order to encourage blood flow both during exercise, and after, to expedite recovery. The shirts feature an inbuilt accelerometer and electrocardiogram sensors that monitor variations in the wearer’s heartbeat throughout the workout, while other sensors work together to calculate calories burnt. Data collected by the smart shirt is recorded by a detachable data module and relayed in real time via a bluetooth to the Omsignal companion app (currently only available for iOS) on the user’s smartphone. — The collection currently features only men’s smart shirts, which range from us$100 to $130 in price, with women’s shirts slated to become available in early 2015. — Not content with its own offerings, Omsignal also partnered with Ralph Lauren to design the Ralph Lauren Polo Tech Shirt. Complete with polo player logo, the shirt features an electrocardiogram, a breathing sensor, a gyroscope and an accelerometer that monitors and analyzes stress levels, energy output, heart rate, heart rate variability, breathing rate, breathing depth, activity intensity, steps and calories burned and provides real-time training feedback. For those looking to keep fit in colder climes, the Hexoskin Arctic Biometric Smartshirt (us$199) features sensors knitted into a new textile developed from research on polar bears. It tracks metrics like heart rate, steps and calories burned, as well as cadence, activity level, acceleration, breathing rate, sleep duration, heart rate recovery and variability, and more (in all, it tracks some 42,000 data points per minute). — from shirts to shoes – or at least, insoles. The moticon opengo sensor insoles (price on application) turn your footwear into a wireless performance-tracking system with 13 pressure sensors that monitor foot pressure, movement, acceleration patterns and gait, with the data stored on a usb stick for post-workout computer analysis, or transmitted wirelessly via ant+ for real-time feedback while working out.” I think it will only take a few years for costs of sensor-ladened clothing and shoes to come down to ordinary consumer price points. And the polo tech shirt already appears to have sensors beyond those available in any smartwatches
HEALTH AND FITNESS APPS
Starting perhaps four or five years ago, health and fitness applications began to appear for both the Apple iOS and the Android smartphone platforms. They are available in the Health and Fitness departments if the iTunes Store and of Google Play. These are variously devoted to activity and sleep tracking, management of diet, calorie counting, weight tracking, connecting you to fitness communities, personal training, customized workouts, specific athletic activities such as running, and countless specialized functions. Some make use of your phone camera and offer voice commands or virtual personal trainers, many allow you to compare week-by-week progress. Some are based on or can connect to motion trackers, or use your phone’s GPS, to determine where you have been, the distance covered and the level of exercise. Some are friendly companions, others are more like judgmental or bossy coaches. Some award you points for healthy behavior, some give you constant reminders, some network you with possibly supportive people. Some track your activity and tell you when you have fulfilled your daily quota. Some apps can be customized to personal activities like rock climbing or playing ping-pong. Some interface with pedometers, either in devices like a FitBit or built into your smartphone. Some perform highly specialized functions, like variable heart rate analysis when connected to a chest strap with sensors. Some have you play health and fitness games. The variety is almost endless. Zombie movement tracking, anybody? The more complex of these apps cover several approaches and increasingly offer integrated personal views of health from multiple viewpoints.
To get a more concrete sense of these apps, here are short reviews of the “best 64” such apps for 2014. Here is another list of the “best 100 android health and fitness apps” for 2014. One noticeable characteristic of these reviews is the general absence of hard technical or performance specifications that allow any real comparison. The reviews tell you what the apps look like and are generally supposed to do, but not how well they actually work and leave you little sense of what is best to buy.
Here is a news story from June 2014, and so already hopelessly obsolete. “health and fitness apps finally take off, fueled by fitness fanatics — “over the past six years, we have seen mobile and its apps disrupt and transform many industries. The healthcare industry, while named early on as an industry that would be totally transformed by smart devices, seemed to have lagged behind. In 2013 while the overall mobile app industry grew 115% in terms of average daily usage, the health and fitness category only grew 49%. This appears to be changing rapidly in 2014. We are not even halfway through the year (and usage normally accelerates in the summer and during the holidays) and the growth in health and fitness app usage has been stunning. We have studied the usage of over 6,800 iphone and iPAD apps listed in the health and fitness category on Flurry’s platform and we have seen a 62% increase in usage of health and fitness apps over the past six months. This compares to 33% increase in usage, measured in sessions, for the mobile app industry in general. Growth in health and fitness is 87% faster than the industry, which is itself growing at an astounding rate.” according to Nielsen: 46 million people used fitness apps in January 2014(ref). The current number is of health and fitness apps users is without doubt more than double that.
The good news is that these apps tend to be cheap – typically free or less than $5, and increasingly comprehensive and multi-platform accessible, working interchangeably on a smartphone, a PC or a pad. And they offer a multiplicity of displays of health data. The bad news is that the vast numbers of them make it very difficult for a novice to figure out which ones to download and use. Another piece of bad news is that those that connect to wearables tend to be very device specific. The information offered about them online tends to be very limited. And almost every app stands alone.
INTEGRATED CONSUMER HEALTH AND WELLNESS PLATFORMS
Given that there are many dozen kinds of of biometric sensors coming into use, be they in smart phones, wristbands, earbuds, clothing, shoes, or patches, question that arise include:
- What specific patterns of data among all those collectible by today’s and emerging wearables are useful either to individuals or health practitioners for determining states of health, possibly predicting diseases, and suggesting actions?
- As a prerequisite, how can this data be collected, viewed and analyzed together in ways that make sense for analyzing or predicting health and suggesting individual actions that will lead to longer healthier lives?
I do not know, nor do I think that anyone knows, the best answers to the first question. What I can say is that I have started to pay very careful attention to the personal data I am gathering now from my Basis Peak and am looking for patterns and correlations that I think may be meaningful. I believe I am finding interesting correlations between Peak data patterns and experienced stress events. I will also be conducting tiny personal experiments, such as determining how my nightly dose of melatonin or the time I have dinner or what I eat for dinner may affect my sleep patterns.
Integrated data analysis platforms
With regard to the second question, we already seeing the emergence of software platforms that will receive data from multiple sources and display them integrated together. As can be expected, the main competition now seems to be between Apple and Google and their respective operating systems iOS and Android.
In the Apple world, “Apple’s new mobile operating system, iOS8, released in September included a new feature in the Health app that displays various bits of health data collected by various apps in one place. In the same vein, the app’s Medical ID feature lets you input various pieces of health information that could be important for emergency services workers if you are involved in an accident. This includes such things as allergies, blood type, medical conditions and emergency contacts. Importantly, this data can be accessed even if your phone is locked.(ref)” The healthkit wellness app appears to be the main current Apple effort. “Healthkit will allow a user to view a personalized dashboard of health and fitness metrics, which conglomerates information from a myriad of different health and wellness apps, helping them “communicate” with one another. With this technology, it’s easy to envision hospitals, clinics, pharmacies, laboratories, and even insurers integrating bilaterally with any patient information housed on healthkit, at the discretion of the user. ” Mayo Clinic, Cleveland Clinic, Kaiser Permanente, Stanford, UCLA, And Mount Sinai Hospital are all rumored to be working with Apple to figure out how to exchange relevant patient information to enhance the continuity of a patient’s care. In addition to these potential collaborators, electronic health record providers epic systems and allscripts are rumored to be working with Apple in some sort of partnership.3,4” at least 56 apps to start with will connect to healthkit(ref). The consumer interface of healthkit, called Health is preloaded on all iphones running iOS
In the Android universe, it appears that Google Fit is the main competitor to Apple’s Healthkit. “Mobile fitness apps are a dime a dozen these days, but Google is trying to add value by letting fit act as a hub for third-party apps like those from Strava, Withings and Runkeeper. Fit users can access data gathered by those apps within the Fit app, instead of having to switch between them. That functionality makes Google Fit the prime competitor to Apple’s Healthkit, a software platform for iOS 8 that lets third-party apps share their data with Apple’s health app. Google Fit is available for devices running Android 4.0 (Ice Cream Sandwich) and above. Whether Google Fit catches on likely depends on the number of integrations it will support with other apps, and how well it presents the combined data. It’s unclear if other popular apps from device makers like FitBit or Jawbone will be integrated with Fit, and Google didn’t immediately comment. In addition to it being an app, Google Fit is a software development kit. Its apps aim to let developers access data from other sources to make their own apps more powerful. Fit, therefore, could be a win for Google by strengthening the broader ecosystem of health apps, and then weaving them into Fit. Fit API partners include Basis, Adidas And Motorola.” (As of the writing of this blog the Basis Peak data cannot be imported into Google Fit)
Both the Healthkit and Googlef Fit apps have had their own problems. See the October 2014 articles Apple’s health app is an embarrassment and Google Fit has its own ailments. I had no problem downloading the Google Fit app yesterday but found it quite useless in its present state for what I wanted it to accomplish, I wanted it to offer me an integrated view of data from my three current health and fitness devices. Those are my FitBit 1, my Basis Peak and my Samsung s5 smartphone which also has a pedometer and instantaneous heart rate measurement capabilities. As far as I can tell, there is no way right now to import data from the FitBit 1, or the Basis Peak into Google Fit. Apparently, neither the FitBit nor the Basis organization have released the necessary APIs (application program interfaces). So, a serious impediment to the emergence of software platforms that offer integrated data views from multiple devices could be the device manufacturers themselves who want to hold on to their own users via their own software. It could be that both Healthkit and Google Fit are actually on the right track but just not there yet. A Google fit webpage soliciting participation of sensor-makers lists 20 “partner” organizations including Intel, Basis and Withings. A list of apps that are presumably now compatible with Google Fit is here, as of this writing 13 in number.
MEDICAL AND RESEARCHER SKEPTICISM
The health and wellness consumer movement is seen by some members of the Health Care and Medical Establishment as possibly unsanitary trespassing on their pre-owned territory.
They rightly point out that the devices mentioned here are not regulated and who knows what these gizmos really can and cannot measure. And human behavior being as it is, information feedback may or may not be enough to influence personal health related behavior. Already we are seeing a few warning rockets being fired. For example, check out this research report: Wearable tracking devices alone won’t drive health behavior change, according to researchers. “New Year’s weight loss resolutions are in full swing, but despite all the hype about the latest wearable tracking devices, there’s little evidence that this technology alone can change behavior and improve health for those that need it most, according to a new online-first viewpoint piece in JAMA. The paper, written by researchers at the Perelman School of Medicine, the Penn Medicine Center for Health Care Innovation, and the LDI Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, points out that even though several large technology companies are entering this expanding market, there may be a disconnect between the assumed benefits and actual outcomes.” Personally, I think this kind of engagement of serious researchers and questioning in the Wild-West health-wearables market could be a very good thing and should be welcomed.
SOME QUESTIONS AND SPECULATIONS
Will the area of consumer health wearables continue to take off as seems to be happening now or will it turn out to be a current fad as people do not find the health-measuring facilities of their smart watches to be that useful?
I expect the wearables trend will continue to take off and become mainstream, although there are likely to be fits and starts and many products and concepts that go nowhere. The trend will be part of and empower a broader trend of consumer health consciousness and individuals increasingly taking responsibility for their own health and longevity
Where is body sensor tracking going? What, beyond smartwatches and straps will be the next big way of embodying consumer health- measuring sensors?
I do not see the present major trend continuing – that is integrating more and more sensors and measuring capability into a single device, be it wristband or smartwatch. Every added sensor, especially if it is constantly active in measures 24/7, takes space, has weight and consumes power. There are only so many sensor devices that can be compacted into the case of a smartwatch. Nobody wants a 2 pound smartwatch. That is why the different fitness band and smartwatch offerings available today are all compromises and none have all the functionality that is possible. Some leave out the altimeter, some leave out the pulse oximeter, some leave out the continuous pulse rate monitor, some cannot measure O2, etc. I see the emergence of numerous specialized measuring devices which may be associated with different parts of the body, which are integrated together by third-party multi-sensor tracking systems. The earbud sensors and leg motion sensors mentioned above are examples. Others might be in the form of patches, pills that are swallowed, shoelaces, pieces of clothing, shoe inserts, and subcutaneous implants.
Specifically, how popular can we expect clothing that embodies biosensors to become?
My guess is, in the longer run, very popular, along with smart shoes, hats, scarves, gloves, earrings, rings and pins. wallets, jewelry, skin patches and what-have you.
Where will the point of integration for all these sensors be on the body?
For now the best answer seems to be in the smart phone where there is plenty of processing power, memory, and external communications capability.
What about industry standards?
Standards will have to be developed, getting us beyond the current Wild West of proprietary software platforms associated with individual pieces of proprietary hardware and the over 100,000 health and wellness apps out there.
To what extent will there be a confluence of consumer health-and-fitness and medical sensing devices? Will the consumer health systems connect with or become integrated with or evolve into professional ones utilized by the medical profession? Or will they continue to evolve in their own trajectories and be regarded by medical professionals as “toy” systems. How and when will mainline medical practitioners tune into and adopt their practices to what health-conscious consumers are doing?
This is very hard to predict. I expect the consumer and medical devices and systems to remain in separate categories for some time. I foresee a slow and bumpy process of reconciliation of consumer-driven health initiatives and medical-establishment protocols and initiatives, one that may require 30, 50 or more years. In the shorter term, the consumer-related technologies and personal use patterns are likely to evolve very quickly in comparison to the hardened institutionalized patterns of the medical establishment, big pharma and the FDA. There will be controversy. There will be continuing efforts to regulate the consumer products as medical devices, but these will be mostly resisted. If history is any predictor, I expect soon to hear solemn warnings from medical device doctors in white coats not to trust health measurements made by consumer devices. A few forward-looking HMOs or medical insurance companies may move to accelerate a process of reconciliation, however. It will be fun to watch how this all unfolds.
ON TO PART 2
I will publish a Part 2 blog entry soon related to the likely emergence of practical health stress biomarkers, based on both theory and very recent personal experience. I acquired a Basis Peak smartwatch a little more than three weeks ago and have been building a log of daily and nightly experience with the parameters it can measure – continuous heart rate, movement, skin temperature, ambient temperature and perspiration. Based on these measurements I have been looking for overall health measurements – basically measures of overall constitutional condition of stress. I believe I have been successful at identifying such, but don’t want to publish my conjectures until I have at least a month of data and personal experience to report on. I am very excited by this effort. In addition, in a Part 3 blog entry Jim Watson will report on what is generally thought to be a good measure of constitutional health – HRV, Heart Rate Variability,
None of the authors has or has had a personal or commercial relationship with manufacturers or sellers of any of the devices mentioned here. In mentioning personal choices and experience, we acknowledge that our choices were necessarily relatively uninformed, given a general lack of reliable technical and performance specifications. More capable products might appear on the market at the same or lower price point within six months, and any existing device may be obsolete in a year. These are characteristics of a fast-paced consumer electronics market with multiple competitors at its current stage of development – like the situation was with consumer digital cameras about seven years ago.