Mumbai: Technological advancements are becoming exceedingly ingrained into everyday life. Advancing technology has given rise to the smart wearable market. The smart wearables market is gaining momentum as it helps to stay connected with the Internet and provides referential data concerning our health such as calories burnt, steps taken, sleep monitoring, heart rate, blood oxygen levels, blood glucose, electrocardiogram (ECG), stress etc.
Initially, when these wearables hit the markets they were more like gimmicks rather than being useful in monitoring the health of the wearer as the data was inaccurate. Original equipment manufacturers (OEMs) have started investing more capital and R&D into these smart wearables they started to become more accurate and currently the data can be referenced with approved medical devices in the market. The majority of the wearables available in the market still lack approval from agencies such as US FDA (Food and Drug Administration), CE and Central Drugs Standard Control Organisation (CDSCO).
The market is flooded with a plethora of these products that offer various features depending on the usage of the consumer. As these devices become more accurate, and precise with the advent of teleconsultation and telemedicine the data generated by these devices could become handy in monitoring health vitals in a precise personalised way. Currently, the market is dominated by fitness trackers and smartwatches to monitor health vitals and stay connected to the Internet but various organisations are working on various IoT (Internet of Things) devices, prototypes that individuals could use to monitor their vitals.
According to data from the International Data Corporation’s (IDC) India Monthly Wearable Device Tracker, the India wristwear market (inclusive of wrist band and watches) grew by a healthy 141.3 per cent year-over-year (YoY) in 2021, exiting the year with 14.4 million units shipments. Commenting on the growth of smart wearables in the Indian market, Anisha Dumbre, Market Analyst, Client Devices, IDC India, “The Indian watch market is thriving with a sharp increase in adoption due to increasing awareness around health and fitness. As consumers seek the best combination of features, price, and quality; most brands are trying to step up in meeting the changing consumer needs via product design and pricing strategies combined with partnerships and collaborations.”
OEMs changing how health is perceived
Health and fitness have become an integral part of the lifestyles of many as they have gone from being a basic function to an essential requirement. The pandemic further accelerated the adoption of a healthy lifestyle among people, triggering the growth of the smart wearables industry as more and more people have sought devices that helped them track their health and wellness in real time.
Commenting on how smart wearables are leading to behaviour change in individuals, Gaurav Khatri, Co-Founder, Noise, shared, “Monitoring our daily activities is a huge part of kickstarting a healthy lifestyle, this two-way process is only made possible with the right tools and devices such as smartwatches.”
Sharing his views on how smart wearables are helping to adapt to healthier lifestyles due to these devices becoming mainstream and accessible, Dr Marcus Ranney, Founder & CEO, Human Edge said, “We create close to two megabytes of data per second. Utilising this data for improving our health can have a multitude of benefits. For starters, data from smart wearables can allow medical professionals to assess a patient’s health state in real-time— be it by monitoring their continuous glucose readings, heart rate and rhythm, or exercise levels.”
“Moreover, you don’t need to be suffering from a chronic disease to reap the benefits of this health data that smart devices produce. HRV (heart rate variability), heart rate, energy burn, glucose, sleep, and other readings also create room for personalised lifestyle interventions—biohacks–that can help people optimise their energy to improve their quality of life and increase their healthspan, ie the number of healthy years a person has before the onset of disease,” added Dr Ranney.
Utilising recorded data in devising personalised therapies
While the majority of the population is aware of the basic habits one must inculcate for a healthy lifestyle, a lack of understanding of the impact often restricts them from practising it. For example, walking 10,000 steps in a day, however, most are unaware of the science behind it or its benefits. This is where data and insights come into play. While having a feature-packed smart wearable is vital, getting meaningful insights based on the collected data is equally essential as it helps one alter or make necessary changes to their workout regimen for an effective result. Keeping a track of heart rates while performing various activities throughout the day, has become essential. So, it is essential that the fitness trackers are able to track the pulse regularly irrespective of the time duration the tracker is used for the activity being performed.
“As Indians, research has indicated that we are four to five times more prone to heart diseases as compared to others rather due to our genetic composition. This makes it integral for us to include a healthy workout practice in our daily lifestyle, and also to do it the right way to ensure effective results. The need to maintain a healthy and fit regime is not a new concept, however, our dynamic and on-the-go lifestyles require us to keep a sharper focus on it. Smartwatches are no more just an accessory but have become a way of life, and will continue to play a more inclusive role in our lives,” stated Khatri.
Role of technology in better management of heart diseases
Wearables have also enabled a new wave of personalisation of therapies. For example, the dosage of medicines taken for blood pressure and heart conditions (such as beta blockers and blood thinners) can be personalised, enabling better treatment and reducing medicine-induced side effects. Wearables also enable early detection of cardiac conditions: today people go to cardiologists mostly when they have symptoms. By screening the heart early on, the conditions could be treated better using medicines instead of invasive surgeries. The newer artificial intelligence (AI) technologies also enable providing selective information to the doctor or the cardiologist on their patients’ health, without overloading them with information.
Smartwatches have become ubiquitous and are great for maintaining a healthy lifestyle. “Typically, a watch measures heart rate from wrist pulse, activity and sleep pattern. While they are beneficial for achieving a healthy lifestyle, in order to accurately monitor heart conditions, continuous ECG monitoring for the long term is needed. The ECG traces the electrical activity of the heart and is used by clinicians and cardiologists for accurate diagnosis of heart conditions,” shared Dr Srinivasan Murali, CEO and Co-founder, SmartCardia.
Diagnostics tools of the future
Smart wearables can act as the first alarm or a red flag which the body might be signalling such as low/ high heart rates, poor sleep score, low blood oxygen level, blood pressure, etc. By monitoring the impact/ signal, one can make an informed decision to stay healthy. It enables the user to not ignore the minor signals that the body sends which would have otherwise been ignored had it not been for the wearable.
Commenting on the role of smart wearables in monitoring health vitals, Sigal Atzmon, Founder and CEO, Medix Global, shared, “Wearables are still too often associated with fitness and active lifestyle gadgets – sometimes still overlooking the immense potential to drastically improve health and medical outcomes. With wearables, we are currently sitting on a mountain of insights and data from a global user pool, which should be analysed and applied in countless ways to positively impact not just well-being but actual medical health.”
“With the right ambition, wearables are primed to have a central role in changing the course of health. From predictive health to medical monitoring, population health, to disease case management and recovery efforts, wearables already play a central role and will ultimately be the conduit for health data moving forward, while keeping people in command of their unique health journeys,” added Atzmon.
Sharing his views on how trackers and smartwatches are proving to be beneficial to those who are using them, Dr Ranney added, “More than diagnostic, smart wearables are monitoring tools that can: a) enable consumers to seek medical help at the right time; and b) allow medical professionals to view data of how a patient’s body was functioning before they came in. A recent example of this is the Apple Watch with its ECG sensor that helped a British man detect an abnormal heart rhythm by sending alerts every time his heart rate was low. Many devices have published cohort-level studies, which have been peer-reviewed and published in journals.
Challenges and opportunities
Data acquisition from smart wearables are also prone to movement noise at the wrist. The majority of the devices available in the market provide measurements that are only indicative and not of diagnostic quality. The data could be inaccurate under movement, and the raw waveforms are not available to differentiate noise from the actual signal.
Sharing his scepticism on the widespread use of wearable devices- particularly the kind that monitor heart rate and respiratory rate. Dr Atul Limaye, Senior Interventional Cardiologist, Fortis Hospital, Mulund, opined, “These monitors are predominantly used by otherwise healthy people with little utility other than alert them of occasional skipped beats. The idea that somehow wearable devices can alert you to life-threatening heart problems is far-fetched. There certainly will be instances when malignant arrhythmias can be identified but such detections will be the exception and not the rule. It is akin to using a mouse trap to catch a tiger. Mice (benign skipped beats) are more common and will be caught most often by the trap (wearable) while an extremely rare tiger (heart attack, dangerous heart rhythm) may also trip the wire. The Apple Heart Study is one of the largest studies of a wearable to detect irregular pulse (atrial fibrillation) in a population. Of the close to four lakh subjects in the study, only 0.5 per cent received an irregular pulse notification. In younger subjects (<40 years old), this yield was 0.16 per cent, which supports my mouse trap theory.
Dr Murali further added, “Some smartwatches give a 30-second snapshot of ECG and are capable of capturing certain persistent heart conditions. Many cardiac arrhythmias are transient and may not produce symptoms, which cannot be captured by a 30-second ECG. A single-lead wrist ECG is insufficient for the clinician to make a diagnosis due to its unreliability in terms of accuracy.”
“In my cardiology practice, I do see a niche role for these wearable devices. I utilise them in prescribing heart rate targets for my patients with established coronary blockages who want to engage in strenuous activities such as long-distance running or high-intensity sports like tennis or badminton. In patients with episodic palpitations when more traditional tests such as a Holter test or an Event monitor fail to uncover an abnormal rhythm, a wearable device may be able to detect atrial fibrillation/ supraventricular tachycardia. Having said that, widespread uptake of these wearable devices risks ‘medicalising’ what are otherwise very benign skipped beats which can easily be skipped over,” concluded Dr Limaye.
Today smart wearables measure, monitor and report on many wellness parameters, there is increasing progress and use in certain medical fields such as wearable ECGs in cardiology (up to six leads ECG) for atrial fibrillation patients, HBP monitoring, oxygen levels measurements for chronic obstructive pulmonary disease (COPD) and Covid patients.
“Many biotech start-ups are already relentlessly working on the new breakthroughs we are all waiting for, specifically on wearables measuring and monitoring rapid eye movement sleep (REM), ascertaining the quality of sleep and not just efficiently measuring its timing and duration, Haemoglobin and HbH1C, without having to draw blood, alongside the improvement in data analytics capabilities, we are facing a real revolution in healthcare landscapes,” concluded Atzmon.
Wearable devices could help bridge the gaps in healthcare delivery by becoming reliable diagnostic tools but not replacing conventional diagnostics completely. As technology advances, better algorithms, machine learning and advanced sensors could help these tools provide more accurate diagnoses.