Making Healthcare Technologies Accessible to All - Part 3: Widening the Scope of Wearables and their Sensors (a PharMedTech curtain-raiser)

It is fair to say that the desire to lead a better and healthy lifestyle has driven a good degree of technological evolution whilst other divers have been as a result of improvement delivery of medical, health and social care and their complementary?systems. The technological evolution include the digitalisation of healthcare delivery, electronic health records and others with efficiency and accessibility in mind.

Digital Health incorporating Connected Intelligent Health and Medical Devices with mHealth apps aims to create a long-lasting positive impact of general public health and the way healthcare services are delivered as well, In some cases via life-saving mobile solutions have been reported. The medical sector is one of most under-served industries in terms of mobile device technology, despite the countless use cases to aid in the diagnosis, treatment, recovery, and monitoring of health and wellness. The collaborations between technology giants and healthcare leaders working with service providers aim to improve the quality of delivered and patient outcomes through mHealth development.

Areas Connected Intelligent Health and Medical Devices that have seen growth are the increased use of smartwatches, sports watches, fitness trackers and healthcare wristbands that can be comfortably and discreetly worn on the body for today’s connected generation for medical and health reasons. In addition, they support a growing number of use cases, including payment, access, health-related keep fit and activity tracking, education, and gaming. Wearable technology delivers a curated flow of information in an easy-to-understand format and can trigger customised notifications or send alerts to connected services.

Smartwatch Features and Functions: A List on What They Can Do

Many smartwatches are capable of doing almost everything a smartphone can, as well as using sensors, they are able to detect, count or/ and measure a number of wearer’s activities such as steps taken, distance covered, heart rate and many more. They are able to collect data that smartphones are not capable of collecting. Smartwatches can also provide quick and easy access to app notifications on your phone.

The following is a compiled a list of all the smartwatch features identified with those reviewed. Please be kindly advised that not every smartwatch has every single one of these features top end models of well-known brands have most of these features listed:

Clock Features

• Time/date
• GPS Time Syncing (or Cell Tower)
• Automatic daylight-saving time
• Alarm clock
• Timer
• Stopwatch
• Sunrise/sunset times

Standard Smart Features (Things you would expect from a smart phone)

• App store compatibility (downloadable watch faces, data fields, widgets and apps)
• App Notifications
• Text response
• Phone response: answer or reject phone call with text (Android? only)
• Calendar
• Weather
• Music Control
• Music Storage
• Find Your Phone (and vice versa with finding your watch )
• Camera Remote Control
• Smartphone pairing compatibility (iPhone, Android, etc)
• NFC Payments (Hold your phone/watch to payment terminal to complete payment)
• Wireless charging
• Solar Charging (Just extends battery life, but does not keep up with full battery consumption)

Heart & Health Monitoring

• Heart Rate (constant monitoring by wrist)
• Daily Resting Heart Rate
• Abnormal Heart Rate Detection Alerts
• Respiration rate (Know your breathing rate 24×7)
• Blood Oxygen Saturation - SpO2 (Usually measured by a Pulse Oximeter)
• Stress Tracking
• Relaxation reminders and breathing strategies
• Sleep Monitoring (Advanced sleep metrics & suggestions)
• Hydration (keep track of how much water you drink)
• Menstrual Cycle

Heart & Health Monitoring When Exercising

• Heart rate zones
• Heart rate alerts
• Maximum heart rate
• Heart Rate Reserve (HRR) (the difference between your Maximum Heart Rate and Resting Heart Rate)
• Recovery time
• HR Sharing (Share your heart rate with paired devices)
• Respiration rate (during exercise)

Location & Activity Tracking Features

• Step counter
• Movement reminders
• Daily Activity Goals
• Calories burned
• Elevation changes (counts steps/floors climbed, hills hiked)
• Distance travelled
• Intensity minutes (measure high intensity workouts vs low intensity such as walking)
• Activity Identification (identify periods of movement that match familiar exercising patterns such as biking, running, swimming, walking)
• Sync with activity trackers (such as Fitbit)
• Activity profiles (Sets your smartwatch up for a specific activity. Changes screens, etc.)

Activity Specific Features

In addition to the basic activity tracking we have all become used to, smartwatches have to ability to help us track and manage specific activities, such as going to the gym, or even golfing.

General Activity

• GPS speed and distance
• Customizable activity profiles
• Automatic Pause (Stops tracking automatically if you take a break.)
• Interval training
• Downloadable training plans
• Lap Counting (Automatically count laps for certain activities.)
• Heat and altitude performance adjustments
• V?O? max (also maximal oxygen consumption, maximal oxygen uptake or maximal aerobic capacity)
• Training Status (lets you see if you’re training effectively by tracking your training history and fitness level trend.)
• Training Load (your total training load for the last 7 days calculated from estimated EPOC)
• Training load focus
• Training Effect (measures the impact of an activity on your aerobic and anaerobic fitness)
• Audio prompts
• Start & Finish times
• Virtual Partner
• Course guidance
• Round-trip course creator (running/cycling)
• Activity history

Gym

• Workout routines
• Workout animations (show the specific exercise to perform)
• Counts Reps & Sets Automatically

Running Features

• Adjustable based on run type (Outdoor Running, Treadmill Running, Indoor Track Running, Trail Running)
• GPS-based distance, time and pace
• Vertical oscillation and ratio (the degree of ‘bounce’ in your running motion and the cost-benefit ratio with stride length) (with compatible accessory)
• Ground contact time and balance (shows how much time, in the running motion, your foot is on the ground rather than in flight and lets you check your running symmetry) (with compatible accessory)
• Stride length (real time) yes (with compatible accessory)
• Cadence (number of steps per minute)
• Performance condition (after running 6–20 minutes, compares your real-time condition to your average fitness level)
• Lactate threshold (through analysis of your pace and heart rate, estimates the point where your muscles start to rapidly fatigue) (with compatible accessory)
• Run workouts
• Race predictor
• Foot pod capable

Cycling Features

• Alerts (triggers alarm when you reach goals including time, distance, heart rate or calories)
• Courses
• Cycle Map (routable cycling-specific street map)
• Adjustable based on cycling type (Biking, Indoor Biking, Mountain Biking, Triathlon)
• Bike lap and lap maximum power (with sensor)
• Race an activity
• Other Speed and cadence sensor support (various Bluetooth Smart sensors)

Swimming Features

• Adjustable based on swim type (Pool Swimming, Open Water Swimming, Swimming/Running)
• Open-water swim metrics (distance, pace, stroke count/rate, stroke distance, calories)
• Pool swim metrics (lengths, distance, pace, stroke count, calories)
• Stroke type detection (freestyle, backstroke, breaststroke, butterfly)
• Time and distance alerts
• Pacing alerts (pool swim only)
• Countdown start (pool swim only)
• Pool swim workouts
• Critical swim speed
• Underwater wrist-based heart rate
• Heart rate from external HRM (real-time during rests, interval and session stats during rests, and automatic heart rate download post-swim)

Golfing Features

• Preloaded courses from around the worldwide
• Yardage (front, middle and back of green)
• Yardage to layups/doglegs
• Automatic Measures shot distance (calculates exact yardage for shots from anywhere on course)
• Digital scorecard
• Game stat tracking (strokes, putts per round, greens and fairways hit)
• Green View with manual pin position
• Hazards and course targets
• Handicap scoring
• Golf club swing sensor (e.g. TruSwing)
• Round timer/odometer
• Club tracking compatible (requires accessory tracker placed on club)

Other Outdoor Recreation

Available outdoor recreation includes: Hiking, Indoor Climbing, Bouldering, Climbing, Mountain Biking, Skiing, Snowboarding, XC Skiing, Stand Up Paddle boarding, Rowing, Kayaking, Surfing, etc.

• Point-to-point navigation
• Bread crumb trail in real time (Know how to get back home)
• Back to start navigation
• Elevation tracking
• Distance to destination
• Barometric trend indicator (Know if a storm is coming in)
• Vertical speed
• Total ascent/descent
• Preloaded topographical maps
• Preloaded ski resort maps
• GPS coordinates
• Seasonal Hunting & Fishing calendars
• Projected waypoint estimates
• Sun and moon information
• Tidal information

Sensors

Here are the sensors and sensing techniques used to record data and conduct the calculations to provide the information in this list:

Ambient light sensor to tweak display brightness

• Most fitness trackers and smartwatches come with an ambient light sensor. It’s primary job is to tweak the brightness of the display as per surrounding light. This also helps in saving battery life.

3 axis accelerometer detects movement and tracks direction

• 3 axis accelerometer is the most common sensor that you will find inside a wearable. This sensor can track forward and backward movements, sense gravity and determine body’s orientation, position and also rate of speed change.

Barometric Altimeter detects how much you are climbing

• Altimeter simply detects changes in height. It helps detect whether you are climbing stairs or going down a slope and accordingly helps in measuring calorie count.

Optical heart rate sensor detects heart beats per minute

• Almost every fitness tracker comes with an optical heart rate sensor. It’s job is to calculate your heart beats per minute. The sensor uses light to check the speed of blood flow on the wrist. When the heart beats, blood moves quickly inside the artery thus less light is reflected back to the sensor and is detected as a heartbeat.

Heart Rate Monitor (utilising ECG and PPG sensors)

• ECG sensor is a new addition to wearables to detect the electrical impulse that your heart sends out with every heartbeat. This sensor detects this minute heart signal through the electrodes on the wearable.
• Electrocardiography is the process of recording the electrical activity of the heart over a period of time using electrodes placed over the skin. These electrodes detect the tiny electrical changes on the skin that arise from the heart muscle's electrophysiologic pattern of depolarizing and repolarizing during each heartbeat. It is very commonly performed to detect any cardiac problems.
• A photoplethysmogram ( PPG) is an optically obtained plethysmogram, a volumetric measurement of an organ. A PPG is often obtained by using a pulse oximeter which illuminates the skin and measures changes in light absorption. A conventional pulse oximeter monitors the perfusion of blood to the dermis and subcutaneous tissue of the skin.

Pulse Oximeter Blood Oxygen Saturation Monitor (SpO2 monitor to measure blood oxygen levels)

• The colour of blood is examined by the sensor to understand the oxygen levels present in it. As Fitbit explains, “Deoxygenated blood, which is returned to your lungs via your veins, is a slightly darker red colour than the fully oxygenated blood in your arteries. The sensors measure the relative reflection of red and infrared light from your blood via your wrist, and seeing how it varies as your heart beats, the device estimates your SpO2 value.”

Bioimpedance sensor to measure respiratory rate, sleep, etc

• A bioimpedance sensor measures the resistance that your skin is offering to a small amount of electricity. The battery charger electrodes in the fitness tracker deliver a very small amount of current to measure sleep, heart rate, respiration rate, water level and more.

Proximity sensor (saves battery and wakes the display when needed)

• Proximity sensor simply lets the device know that you are near the device and wants to use it. If you are not wearing the fitness tracker, this sensor enables the device to sleep and save battery when not in use. It is mostly used to turn on or off the display screen.

Compass helps is direction and Maps

• A compass helps Map applications to run on a smartwatch and also gives the device a sense of direction.

GPS (for location tracking)

• GPS simply helps in detecting how much you are running, the location of the wearable and track your activity. It also helps in guiding Map applications.

Gyroscope

• Technically gyroscopes measure angular velocity which is used to detect motion, track them accurately when you are on the go. For example, data from gyroscopes along with other sensors can determine whether you are actually running or simply jogging at one place. Also, it helps eliminate motion from violent shake of the wrist and mistake it for an intense running session.

Gesture sensors detect wrist motion

• Gesture sensors can instruct the smartwatch to do certain activity when the hand is moved in a certain way. For example, if a wrist is flicked twice, the call will be disconnected or when the hand is moved in circles the stopwatch will start. Detecting these pre-fed motion is the job of gesture sensors.

UV sensor measure exposure to harmful sunlight

• Some smartwatches also offer whether the sunlight outdoors is harmful or not. This is detected by the UV sensor which detects the UV radiation when you step outside.

Magnetometer

• A magnetometer works along with the GPS and compass to determine the exact coordinates of your location.

Electrodermal activity sensor

• Electrodermal activity or EDA sensor is a new addition to wearables. It measure stress along with a heart rate tracker, ECG and skin temperature sensor. It detects small electrical changes in the sweat level of your skin and helps you manage your stress.

Skin temperature sensor (Thermometer)

• Skin temperature sensor detects slight changes in temperature to understand whether you are going to fall sick like fever or detect a start of menstrual phase.

Additional Information

This list was compiled using information from the following smartwatch manufacturers:

• Garmin
• Fitbit
• Apple
• Polar Electro,
• Suunto
• Huawei
• Samsung
• Other branded and non-branded devices

Significant progress has been seen with ECG, a pulse oximeter and skin temperature sensors employed within the design of smartwatches. There are also devices dedicated to glucose monitoring that can be connected to smartwatches and smartphones to provide that data.

Further developments are required for types of sensors and biomarkers for non-invasive continuous monitoring, e.g. blood glucose level monitoring to incorporate the sensor in a smartwatch like those that track heart rate and other parameters.

An on-going study aims to compile a comprehensive feature-function matrix of smartwatches and the sensing techniques used. Please with focus on health and medical applications kindly provide any information of smartwatches (brand name and model) on the features and functions as well as the sensors employed that have not been listed. You may provide any information via the "Comment" button/icon. Thank you.

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