September 1, 2023 – The way forward for public health may very well be in your hands – or more specifically, in your wrist.
Researchers are using smartwatches and fitness trackers to conduct large-scale studies that might have been unimaginable before. It's a growing trend that might significantly expand our knowledge of a spread of diseases.
“There really is no disease that is untouched by this type of research,” said Calum MacRae, MD, PhD, vice chair for scientific innovation within the Department of Medicine at Brigham and Women's Hospital.
Wearables are already getting used to research heart, respiratory, nerve and liver diseases in addition to gynecological diseases, certain kinds of cancer, diabetes, sleep quality, autism and mental illnesses.
In one recent example, as much as 1 million iPhone and smartwatch users can enroll to share data about their menstrual cycle and other health and lifestyle aspects reminiscent of sleep and stress. 100,000 have already signed up for this program. Apple study on women’s healtha 10-year project unprecedented in size and scope by Harvard, Apple and the National Institute of Environmental Health Sciences (NIEHS).
Doctors know that an irregular menstrual cycle is usually a sign of many things, from infertility to heart disease, diabetes and even cancer. Many doctors imagine that menstrual history ought to be considered a significant sign, like pulse or blood pressure, but they are saying menstrual and reproductive health is woefully underfunded and under-researched.
By studying a bigger and more diverse sample of individuals, researchers hope to advance the diagnosis and treatment of health conditions related to menstrual cycle disorders.
“We can ask questions we couldn’t ask before,” said Dr. Shruthi Mahalingaiah, considered one of the study’s lead researchers and an assistant professor of environmental, reproductive and ladies’s health on the Harvard TH Chan School of Public Health.
Rise of wearables
Nearly half of Americans wear smartwatches or fitness trackers, in response to a Survey 2022In addition to calorie consumption and steps, the technology also can provide information on respiratory rate, heart rate, blood oxygen levels and sleep duration via smartphone apps.
University hospitals are partnering with digital giants like Apple, Google, Samsung, Alphabet and Amazon, in addition to tech startups and nonprofits. The coronavirus pandemic accelerated this trend as medical facilities tested wearable devices to watch patients from home. Symptom checkers and outbreak apps helped monitor infection risk and discover hotspots, and demonstrated how large data sets could be collected in a consistent way.
Trials that use wearable devices to gather data represent lower than 1% of all trials worldwide, but that number is growing, having increased by several hundred in recent times, in response to clinicaltrials.gov (the National Library of Medicine's clinical trials registry).
This trend has expanded beyond the wrist and now includes “smart” glasses, rings, necklaces, “hearables” and even clothing. And the growing variety of medical wearables are also helping: smart patches that monitor vital signs, blood pressure monitors and continuous glucose monitors, often prescribed by doctors but additionally increasingly available in shops.
“You can live anywhere in the country and participate in research using wearables,” says Ray Dorsey, MD, professor of neurology on the Center for Health Technology on the University of Rochester Medical Center in New York. Previously, volunteers needed to travel to medical centers for testing and updates, often limiting the scope of studies.
Big Tech, big studies
In recent years, technology firms reminiscent of Apple, Samsung and Google have introduced and developed open-source platforms that enable researchers to create apps and tools that may securely collect people's health information using wearable devices.
In 2015, a smartphone app developed by Dorsey's URMC team and partners used Apple's ResearchKit in a Parkinson's study. Researchers enrolled over 2,000 volunteers in in the future, an unheard of number on the time. Ultimately, over 9,000 people participated within the study, performing tasks reminiscent of walking to measure gait changes. The published results helped researchers higher understand how Parkinson's symptoms varied from each day, Dorsey said.
In 2017, in collaboration with Stanford University School of Medicine, greater than 400,000 Apple Watch users from all 50 states were enrolled within the Apple Heart Study in only 8 months. The study showed that smartwatches can detect irregular heart rhythms reminiscent of atrial fibrillation. Along with a second study, it also paved the best way for the FDA to categorise the watch as dangerous.Electrocardiogram (ECG) app as a medical device. Since then, ECG apps for smartwatches from Fitbit, Samsung and Garmin have received similar approvals.
The Apple Women's Health Study was launched in 2019 together with two other ambitious projects: the Apple Heart and Movement Study, led by MacRae at Brigham and Women's Hospital with the American Heart Association, and the Apple Hearing Study on the University of Michigan.
The Apple Women's Health Study tracks a greater mix of individuals by race, ethnicity, age, socioeconomic status and place of residence, compared with the much smaller reach of previous studies. Data collected covers exercise, sleep, and environmental and behavioral aspects, and monthly surveys capture personal details that the sensors can't pick up.
“This gives us the opportunity to consider very detailed information in our analyses,” said Huichu Li, PhD, study co-author and research associate on the Harvard School of Public Health.
Among the initial findings: The barely longer menstrual cycles that could be brought on by the COVID vaccines turned out to be temporary. In general, irregular and infrequent periods were found to be more common among the many black and Asian women studied, while menstrual cycles were longer amongst Asian, Hispanic and obese people.
An evaluation of over 50,000 people provided insights into links between abnormal periods and health conditions reminiscent of polycystic ovary syndrome, endometrial hyperplasia and cancer.
“Future studies will delve deeper into the data and examine the effects of environmental, behavioral and stress on the menstrual cycle,” Mahalingaiah said.
Challenges and future
But the promise of wearables comes with challenges. Much more testing is required to make sure the devices deliver clinical-quality data. Concerns about privacy and cybersecurity threats remain within the healthcare sector, in response to a study by consulting firm Deloitte.
These recent kinds of studies have limitations. People have to own smartwatches and smartphones—technologies which are less common amongst underrepresented and rural populations—and so they have to have reliable web access.
However, with increasing acceptance of those devices – each amongst consumers and healthcare providers – this trend is anticipated to accentuate.
“I can’t imagine a world where this kind of research declines,” says Urvi Shah, senior manager in life sciences and health care at Deloitte Consulting.