Millions of people use wearables, but the field is still something of a Wild West. 

Here’s what the current landscape of wearables looks like.

Dialing in athletic training

Some of the first people to use activity trackers and wearables were athletes. 

Using a wearable to track workouts and progress, particularly workouts that include distances, has been a huge training breakthrough for many athletes, says Seth Max, an International Sports Sciences Association certified personal trainer whose clients use wearables to train.

“To track a run before wearables and location services on smartphones, we would have to get in the car, reset the odometer, drive to measure, and then use a stopwatch to record time," he recalls.

With a wearable that has GPS capabilities, this elaborate process is completely eliminated.

Sports teams are now using wearables to give moment-to-moment feedback on players’ performance.

Professional soccer league D.C. United uses the Catapult GPS system to collect data about their performance on the field during training, says Derek Landry, the team’s assistant fitness coach.

Catapult offers palm-sized devices that players can wear on their back, inserted into a special fitted vest.

Player load, or the work they’re doing on the field, is among thousands of metrics the Catapult GPS system can analyze. Others include distance, distance per minute, and changes in direction.

This technology has improved training by helping the team figure out "when… to try to push the needle on performance or pull back to avoid overly fatiguing the athlete,” Landry explains.

More wearables for tracking sports performance are already on the field or in the works, including soft, fabric-based sensors incorporated into clothing, small wearable patches for injury rehab, wearables that detect impact, and apps that analyze athlete workload and hydration status to reduce the risk of injury and improve performance.

Helping people reach their personal health goals

Many experts say that having measurable goals give you a higher chance of success. But wearables take that a step further, making measuring your progress easy and precise.

Keren Reiser, a registered dietitian, says that some of her clients have used wearables to help them lower their heart rate and improve blood sugar control through regular exercise. 

Sarah Grajeda, a NASM-certified personal trainer and fitness nutrition specialist uses a platform called Apotheo for her clients. The app syncs tracked nutrition info, steps, sleep, weigh-ins, and heart rate from various apps, including MyFitnessPal, Cronometer, MyMacros+, Macros First, Apple Health, and FitBit.

Through Apotheo, Grajeda can monitor her clients remotely in real time and provide responsive support.

Of course, you don’t need a personal trainer to get all those metrics. Consumer health trackers have user-friendly apps that give you the tools to become your own trainer.

And they’re powerful motivators, according to research. One observational study from 2020 looked at motivation in people who used wearables, with 42.6 percent wearing a Fitbit and 25.5 percent wearing an Apple Watch.

The study found that 83 percent of people said that cues from wearables helped motivate them. These included app rewards, badges, notifications, prompts, and social features such as likes and comments.

Much more than a pedometer

Today, wearables go way beyond athletic performance, offering insights into many other aspects of wellness, like menstrual cycle trends, sleep habits, and stress levels. 

The Ava bracelet is a fertility tracking wearable, and the Oura Ring is a multipurpose health sensor. Both predict ovulation by analyzing real time data on the wearer’s skin temperature, heart rate, respiratory rate, and heart rate variability.

In other words, if you want to track an aspect of your physiology, there’s probably a device out there to monitor it — or one in development.

Wearables are already starting to change the discussion of wellness from primarily diet and exercise to whole-body health.

One research team is using data from people using the Oura Ring, a wearable that fits like a ring on your finger, to help predict symptoms of anxiety and depression. The idea is to potentially help people identify mental health conditions sooner — and encourage them to seek treatment earlier than they may otherwise.

This potential for early detection and proactive healthcare is a big deal.

Other researchers are interested in how wearables might help motivate people with serious mental illnesses, like schizophrenia or mood disorders, to be more physically active. These individuals tend to have low fitness levels and higher rates of obesity.

And fertility is another burgeoning area in the wearables space. Wearables can help predict ovulation in women, according to research.

Oura, maker of the Oura Ring, is currently working with the University of California, San Diego to assess the ring's ability to help detect early pregnancy and potentially even predict certain pregnancy outcomes, like preterm births and pregnancy loss.

Personalized health recommendations are the next frontier of wearables, says Caroline Kryder of Oura.

“During the earlier days of the wearable industry, devices would use population-level recommendations like, 'Get 10,000 steps' or, 'Get 8 hours of sleep' to advise people on how to live a healthier life," says Kryder. "Now, devices like Oura get to know your personal baseline and make recommendations that are tailored to you.”

The Apple Watch has a feature called Fall Detection that detects falls. And the Apple iPhone has a related feature called Walking Steadiness, which identifies users who are at high risk for falls and provides them with proactive fall prevention strategies.

While these developments are still in their infancy, wearables are already starting to change the discussion of wellness from primarily diet and exercise to whole-body health.

Investments in digital health reached an incredible $15 billion in the first half of 2021 — the majority toward telemedicine, followed by wellness, mobile health apps, and data analytics.

More potential uses for wearable technology in health and wellness are popping up in labs around the world.

When it comes to acute and chronic health conditions, there’s no shortage of studies underway to investigate how wearables might improve detection and treatment. 

Research is underway on how wearables can help monitor stress patterns in children and care for people with chronic conditions.

For example, recent research used breathing data from wrist-worn WHOOP health monitors to detect COVID-19 sooner in some wearers. The research suggests that the potential of wearables to help people self-isolate sooner and help stop the spread of infectious diseases.

Researchers at the Neuromotor Recovery Laboratory at Boston University are finding that wearables could potentially collect enough movement data to help identify signs of neurological health and disease. 

In an intervention for childhood obesity, researchers are pairing wearable sensors with a specialized smartphone app for children and their parents. The app works in real time to monitor behavior and actively encourage kids’ healthy habits.

And even more research is currently underway on how wearables can help:

• Monitor stress patterns in children
• Care for people with chronic conditions, including cancer, lung diseases, and heart conditions  

These technologies are still under development, and it will likely be several years before the general population can use them.

Still, the health applications of wearable technology are increasing.

Access to wearable data could drastically change the healthcare landscape in at least two major ways.

For one, wearables provide powerful, personalized, moment-to-moment health analysis that could allow people to detect health issues early and improve outcomes.

And secondly, wearables allow apps and doctors to monitor their patients remotely, meaning fewer in-person and potentially costly visits to doctors’ offices and hospitals.

These could result in major downstream benefits for public health.

Wearables as tools for telehealth

Consumer wearables are becoming capable of collecting health data they couldn’t before, like blood pressure and blood glucose, says Richard Milani, MD, Chief clinical transformation officer at Ochsner Health and medical director of innovationOchsner (iO).

Until recently, patients have only been able to find out these and other more obscure personal health measurements at the doctor’s office or at home with specialized equipment.

“More and more health data that previously required collection in the doctor’s office can now be reliably collected at home,” says Milani.‍

Of course, it’s important to note that these devices can’t replace a primary care physician.

Freeing up healthcare capacity

Wearables have the potential to drastically reduce the amount of time healthcare professionals need to spend with patients one-on-one while still providing high quality care.

A 2021 study looked at how two private healthcare systems used wearables and found that digital care programs outperformed usual care in a few important ways.

Doctors could monitor their patients more closely because they received real time data relayed directly from patients’ wearable monitors. This allowed for better care and health outcomes while reducing the time everyone spent on in-person appointments.

People with diabetes used continuous glucose monitors to measure their blood sugar levels in one of the healthcare systems. Clinician time devoted to telephone visits decreased by 50 percent. This freed up valuable time for doctors and gave patients more control over their diabetes management.

The other healthcare system used a digital health program in people with high blood pressure. Seventy-one percent of people in the digital health program reached their target blood pressure, compared with 31 percent of those under usual care.

People with diabetes are already using continuous glucose monitors to get more control over their blood sugar levels at home.

And several products, including the Apple Watch, offer ECG monitoring and alert patients to potential irregularities in their heart rate.

The potential for wearables is there, but they have some significant hurdles to overcome before they can become the powerful healthcare tools many envision.

"Technology has always moved faster than our ability to safeguard ourselves from its consequences, and connected health products are no exception,” says Andrea Coravos, co-founder and CEO of HumanFirst. Her company offers software solutions for decentralized clinical trials and distributed healthcare, which includes the use of wearables.

Healthcare has been very slow to warm to consumer-friendly technologies that replace in-clinic measurements. But we might eventually see a pharmacy-style delivery system for wearables.

Andrea Coravos
HumanFirst

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Her company offers software solutions for decentralized clinical trials and distributed healthcare, which includes the use of wearables.

When we asked experts about the current or potential limitations of wearable technology, a few trends emerged.

Healthcare will need time to catch up

The reality is, we still have a long way to go before wearables are incorporated into healthcare settings on a large scale. Healthcare systems are often notoriously bureaucratic and slow at making large-scale changes.

"Healthcare has been very slow to warm to consumer-friendly technologies that replace in-clinic measurements,” says Coravos.

She suggests that healthcare systems might eventually use a pharmacy-style delivery system for wearables.

The next steps are to bring wearables to market such that their metrics are accurate, reliable, and consistent, which will take some time.

Richard Milani, MD

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For a wearables program to be successful in a healthcare setting, they need to be integrated into healthcare delivery, have tech support available, and be easily reimbursable through insurance or other means, among other challenges, according to a 2021 study.

The study authors, who interviewed experts from various healthcare backgrounds, pointed out that data from wearables would also need to be standardized across devices and sensor locations. This currently isn’t the case, since every wearables company has its own standards and technology.

Healthcare systems would also need a way of adding the data to electronic health records and clinicians’ workflows.

One of the biggest bottlenecks to the use of wearables in healthcare in the United States is figuring out who’s going to pay for them and how. Many people can afford only what their insurance company will cover.

“Reimbursement still drives so much of the industry that without clear guidelines from insurance companies it forces doctors and researchers to be very slow and deliberate about which technologies they adopt, or else they risk not getting paid,” says Coravos.

“The next steps are to bring these to market such that these metrics are accurate, reliable, and consistent, which will take some time,” says Milani.

However, once wearables become a regular part of healthcare, research suggests that they could help provide better care and save time and money.

Equity concerns

A socioeconomic gap currently limits the use of smartphones and wearables mainly to people with higher incomes.

According to the Pew Research Center, in 2021, 24 percent of adults with incomes below $30,000 per year didn’t own smartphones. 

Lower income individuals may be less likely to use wearables, too.

Paradoxically, this group of people may stand to benefit greatly from using wearables. People from lower income households tend to have poorer health outcomes than those from higher income households, according to research. 

Yet they’re among the least likely to use them.

"There have been consistent concerns about inequities and bias in connected sensor technologies,” says Coravos.

Skin color is one clear area of bias the wearables sector needs to tackle head-on. Research has shown that some wearables provide more accurate results for people with lighter skin than for those with darker skin.

One 2017 study found that fitness trackers made the most errors when the participants had darker skin, among other factors. In this study, the Apple Watch measured participants’ health data most accurately, and the Samsung Gear S2 data was off by the most.

Clearly, researchers, companies, and policymakers have a lot of work to do to make wearables more inclusive.

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Eating disorders

It’s also important to note that using wearables may actually be harmful for some people. For example, people with eating disorders may find that having access to real time body metrics may increase stress and motivate disordered eating behavior.

Some people may find that using wearables intensifies feelings of body dissatisfaction and inadequacy or encourages unrealistic body or health ideals.

Research involving college women has shown that using wearables is associated with increases in disordered eating and exercise behaviors in people who were susceptible to these behaviors.

If you’re using wearable devices and you think that they might be encouraging disordered behaviors, make sure to speak with your doctor.

Who has access to the data?

Fitness tracking bracelets, continuous blood glucose monitors, multisport GPS watches, and stylish smartwatches — these devices collect vast amounts of data on your health, athletic performance, and lifestyle behaviors.

So, what happens to all that data?

It’s complicated. Many researchers and healthcare professionals want to use it to improve public health. But with consumer wearables in particular, tech companies hold the keys to the data vault, and they don’t want to share with their competitors.

As it stands, data scientists from each wearables company are siloed, each spending years simply collecting data from their proprietary wearables before they’re able to develop accurate models to predict health outcomes or make reliable recommendations.

Many wearable products rely on machine learning — a type of artificial intelligence in which scientists use data to teach computers to find patterns and predict outcomes. And the more data from the more people the machine learning takes into account, the better it gets at making accurate predictions and personalized health recommendations.

But machine learning is only as good its algorithms, and to make these algorithms you need data — lots of data.

Thus, to create great wearables that make meaningful interpretations and recommendations for your health, the makers need access to the data from many, many people. Data can be anonymized, meaning that it’s no longer attached to your identity when it’s sent to the big data pool.

Nevertheless, many people don’t like the potential for privacy breaches.

Some companies, like Apple, have tight privacy controls for users. However, one 2021 review article found that virtually no research had been done into the security, data rights, and ethics of digital health technologies, including wearables. 

It’s clear that several important issues need to be addressed as people adopt wearable technologies more widely.

Chronic diseases account for 90 percent of the $3.8 trillion annual healthcare expenditure in the United States, according to the Centers for Disease Control and Prevention (CDC).

Yet we can prevent many of these chronic diseases by making healthy lifestyle changes.

On the population level, researchers will use wearables to find out more about diseases, resulting in early detection and more effective, personalized treatments.

On the personal level, consumer wearables can help us become more educated about what’s going on in our own bodies, and motivate us to take action to improve our health.

In the years to come, wearable health technology will inevitably become woven seamlessly into the fabric of our lives.

Here’s how to take advantage of the data on your wrist. 

• Step 1: Know what you need (and what you can live without). Shopping for a wearable can quickly go from exciting to overwhelming. To help narrow down your search, figure out what features and sensors you need.
• Step 2: Choose wisely. Some wearables are more user-friendly than others. The Oura Ring and Fitbit Sense, for example, make it easier to understand your data by offering overall health scores. 
• Step 3: Read the manual. Sure, it’s not the most exciting literature, but reading the manual is the best way to take full advantage of all that your product has to offer.
• Step 4: Set yourself up for success. It’s important to set specific and realistic goals with an actionable plan for achieving them. Also, make sure to keep your device charged so you don’t lose out on any data.
• Step 5: Focus on trends. Wearables provide a lot of data, making it easy to go down a rabbit hole of numbers. Instead, take a step back and see if you can identify any patterns. For example, you may notice that your stress and sleep scores are generally better on days you exercise.
• Step 6: Ask an expert. You don’t have to make sense of the data by yourself. Experts, such as registered dietitians, certified physical trainers, and other health professionals, can help make the data meaningful for your personal needs and goals.‍
• Step 7: Connect with a community. When you’re looking to make lifestyle changes, try asking others what’s worked for them. “We’re all better off if we share our knowledge. It just might turn out that the key to deep sleep is wearing wet socks to bed or listening to a particular Adele song,” says Kryder of Oura. “We won’t know until we try and share!”