What Apple, Google smartwatches are learning about our health

Customers try Apple Watch devices in the Apple Marunouchi store on September 07, 2019 in Tokyo, Japan.

Tomohiro Ohsumi | Getty Images

Fitness trackers from companies like Apple, Amazon, and Google are making a significant shift from being low-tech devices that counted steps to now becoming what’s fashionable in personal health.

Tracking fitness and workout data for personal use or sharing with friends can be useful and fun. But there’s an increasing interest in incorporating a wider range of medical data into the digital health ecosystem — piggybacking on the dramatic rise in remote telehealth services necessitated during the Covid-19 pandemic — making individuals’ information accessible to physicians and hospitals as part of electronic medical health records.

The wearables market got moving more than a decade ago with basic fitness, workout, and sports-activity tracking devices. Now, nearly 30{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} of Americans now use a wearable health care device, many of which now have the capabilities to track, monitor and transmit data on heart rate and rhythm, blood pressure, body temperature, blood sugar levels, quality of sleep and even early warning signs of Covid-19 infection.

Fitbit helped launch the trend in 2009 with a clip-on gizmo that recorded the wearer’s movements, sleep and calories. That model morphed into a wrist band, which over the years added more biosensors and Bluetooth connectivity for downloading data to smartphones. Google parent Alphabet acquired Fitbit for $2.1 billion in January.

Apple entered the space in 2015 with the debut of its Watch, since adding a bevy of health-related functions and apps and spawning a platform for third-party developers to create tools utilized not only by consumers but also health care organizations and researchers for accessing and analyzing data captured on their smartwatches. It has also aligned with fitness companies like Nike, Strava and Adidas to allow them to synchronize their activity apps to the watch. In 2020, the Apple Watch generated nearly $13 billion in sales, capturing 65{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} of the global smartwatch market by revenue, research firm Strategy Analytics estimates.

This burgeoning market has attracted other Big Tech players, including Amazon, maker of the Halo smart band, and Huawei, which unveiled its Watch 3 this year. There also are a variety of other smartwatch entrants from the consumer electronics realm, among them Samsung, Garmin and Withings.

In the pure-play category, Finnish startup Oura designed a ring embedded with biosensors for monitoring sleep, heart rate and body temperature. In May, the company announced a $100 million Series C investment round, bringing its total funding to more than $148 million. And Peloton is reportedly planning a digital heart rate armband. 

The global market for wearable health and fitness devices — including sensor-laden watches, wrist bands, rings, skin patches, eyeglasses and clothing — reached more than $36 billion in 2020, according to Fortune Business Insights, and is projected to top $114 billion by 2028 at a CAGR of 15.4{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33}. Deloitte Global predicts that the market segment just for smartwatches and smart patches will ship 320 million units worldwide in 2022, a figure likely to reach 440 million by 2024.

“There is significant money in this area from venture capital and private investment sources,” said Deloitte’s Paul Silverglate, vice chair and U.S. technology sector leader.

Several medtech companies have introduced smart patches, penny-sized swaths that adhere to the skin and use microscopic needles that act as biosensors and deliver medications. BioIntelliSense, based in Redwood City, Calif., created the BioSticker, worn on the upper left chest for continuous monitoring and data capture of respiratory rate, heart rate at rest and skin temperature. Publicly owned Insulet, based in Acton, Massachusetts, has developed OmniPod, a patch that serves as an insulin pump.

Sensorized clothing has emerged, too. Montreal-based Hexoskin developed a line of smart shirts that collect cardiac, respiratory and activity data, and transmits it to an iOS or Android compatible device. The company partnered with the Canadian Space Agency on an extraterrestrial version, Astroskin, to track astronauts’ vitals while rocketing out of this world.

Providing accurate data and information

Beyond the technological capabilities, there is now the critical issue of efficacy — of the devices, the apps that link to them and the petabytes of data generated — which is leading wearables makers to coordinate with independent researchers to see if they deliver as advertised.

Joshua Hagen, a research associate professor at The Ohio State University’s Department of Integrated Systems Engineering, was studying biosensors more than a decade ago at the Air Force Research Labs “before wearables really exploded on the scene,” he said. Hagen then started testing devices on elite athletes, monitoring their performance data. “There’s a ton of devices out there, but we have to first and foremost trust the data that’s coming off of them,” he said.

Hagen has discovered that the part of the body where a device is worn matters. The Polar heart monitor chest strap, for instance, around since the early 1980s, “has been validated a thousand different ways.” And the wrist is good for measuring resting heart rate. “But fingers are a very interesting place,” he said, referring to his studies on the Oura ring. In one, it had the second-highest accuracy among the devices, with chest straps ranking first.

Another study, launched after Covid hit, found that by applying an algorithm to Oura user data, Hagen’s team could identify early warning signs three days in advance of coronavirus infection. A separate proof-of-concept study, examining the efficacy of various wearables, showed they could detect the onset of fever, a pervasive symptom of Covid and other infections.

In November 2019, Apple partnered with research groups to launch three health studies using the Apple Watch. A women’s health project, in conjunction with the Harvard School of Public Health and the National Institutes of Health, aims to advance the understanding of menstrual cycles and their relationship to various health conditions, including infertility, osteoporosis and menopausal transition. Apple’s heart and movement study, with Brigham and Women’s Hospital and the American Heart Association, is exploring how certain mobility signals and details about heart rate and rhythm could serve as potential early warning signs of atrial fibrillation, or Afib, heart disease or declining mobility.

How physicians might use the data

The ultimate scenario for health wearables envisions the general public donning smart devices, proven to be efficacious, that continuously download vital data to primary care providers who track patients in real-time, monitor their overall health and respond to any emergencies. To make that leap, however, physicians must be convinced that the devices work, patients use them properly and the data is reliable.

Toward that goal, the American Medical Association (AMA) conducted a survey of physicians to gauge their opinions on a variety of digital health tools, including wearables. More than 87{44affb6c5789133b77de981cb308c1480316fee51f5fd5f1575b130f48379a33} of respondents see at least some advantage in their usage overall, especially wearables and telehealth devices. Yet physicians also said there are “must-haves” that digital tools need in order to turn their enthusiasm into adoption, including improved efficiency and increased protection of patients’ data privacy and security. “Physician enthusiasm for technology is directly tied to a solution’s ability to help them take better care of patients,” said Meg Barron, AMA digital health strategy vice president.

For marketers, the most critical factor will be whether people actually buy and use wearables. “Health is a killer app category for consumers,” especially as the internet of things emerges, said Lauren Martin, senior internet and media analyst at Needham & Company. It will be increasingly helpful if users can be monitored when they’re out of the house, she said, and then have their data uploaded to their electronic medical record.

And while it remains too early to pick winners and losers, Martin said, “Apple has a play because they’ve got this great distribution network through its physical stores. So they can push the Watch when you walk into the store to buy an iPhone. Amazon can tie their health devices into Alexa [smart speakers].”

Martin is not counting out standalone players, though, and is anxious to see what emerges at January’s Consumer Electronics Show in Las Vegas (Covid variants permitting). “It will be interesting to figure out what new companies are doing, compared to what’s already in the marketplace,” she said.

Indeed, “Who are you wearing?” may become the next fashion axiom applied to health care.  

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Fitbit Sense smart watch on arm of a man, showing ECG heart health function, San Ramon, California, October 8, 2020. (Photo by Smith Collection/Gado/Getty Images)

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